Operative Removal of 154 Objects in Chronic Compulsive Foreign Body Ingestion

Intentional foreign body ingestion presents as a chronic surgical challenge. We encountered a severe case of ingestion that had failed endoscopic retrieval secondary to the size, shape, and quantity of structures encountered. Open gastrostomy with removal of objects with care to prevent future hostile abdomen was performed with 154 total objects removed at completion. We report a lesson in approaching a clinical problem with thought to approach for the preservation of anatomical structures in potential future interventions.

TO CASUISTICS OF TOTAL REMOVAL OF THE UTERUS THROUGH VAGINA

One of the most interesting and important questions of operative gynecology was and is the question of surgical methods of treatment of uterine cancer. The task and purpose of each operative removal of a malignant neoplasm should be expressed, on the one hand, in its technical simplicity, and, on the other, in achieving the desired and final result, i.e., in the radical healing of the body, since the operation is undertaken under conditions with a predicted quo ad valetudinem, and not quo ad vitam. A whole galaxy of scientists, converging more or less in this complex and main goal of surgical intervention for uterine cancer, begins to break up into groups, as soon as it comes to the nature and extent of the spread of neoplasm in connection with the operative method, with indications and contraindications to it. These disagreements, depending both on the difficulty of determining in each given case microscopically the extent of cancer prevalence, and on the complexity of some of the problems, are the reason that the main surgical methods, such as: Amputatio infravaginalis colli uteri, supravaginalis, colpohysteroectomoectomia and laparohyster serve as controversial points in gynecology.

Recurent Ectopic Pregnancy Score As Predictor To Fertility Outcome Following Tubal Ectopic Pregnancy

Introduction: Ectopic pregnancy may occur in fallopian tube, ovary or abdominal cavity. This study focused on tubal pregnancy outcome. The return of fertility after operative removal of tubal ectopic pregnancy was examined in 237 women who were admitted to Hospital Sultanah Nur Zahirah (HSNZ) for ectopic pregnancy between 2012 and 2016. The follow-up period averaged six months to four years. Materials and Methods: This was a case control, retrospective non-comparative study. Data collected from HSNZ Human Resources Management Information System (HRMIS). Patient who has no pregnancy or delivery record after six months of ectopic event were contacted via phone. Multivariate analysis was done to identify score for patients who were at risk of recurrence, and who require fertility help. Results: One hundred forty eight women (64%) aged 20-35 years old able to conceive spontaneously after ectopic pregnancy, with the mean-time of 8 months if one tube is patent. Ninety three percents of those who conceived had intrauterine pregnancy, 5% had recurrent ectopic pregnancy. Conclusion: From a multivariate analysis, a scoring system, Recurrent Ectopic Pregnancy (REP) score was made to choose most suitable patient for laparoscopic intervention, preserve fertility or facilitate fertility. Significant REP score of 4/5 suggest laparoscopic salpingectomy with contralateral sterilization to prevent recurrence of ectopic. Patient with REP score 2-3 may have spontaneous conception and REP score less than 1/5 will require further fertility treatment.

Unique complication of laparoscopic adjustable gastric band? A misplaced band encircling the abdominal aorta

In the recent past, laparoscopic adjustable gastric bands (LAGBs) have been used extensively in bariatric surgery. Despite questionable long-term efficacy, they are generally safe and reversible. We report a possibly unique presentation of a potential hazard of the insertion technique; a misplaced LAGB encircling the abdominal aorta, which was confirmed radiologically and on operative removal of the gastric band. This is a dramatic complication of LAGB, representing an important anatomical hazard for gastric band insertion.

Comparative characteristics of the efficiency of different methods of operational treatment for pectus excavatum in children: a multicenter study

Background. Congenital malformations of the chest are observed in 1%–4% of the population, and the most common among these is pectus excavatum (90%). Aim. We aimed to conduct a retrospective multicenter study to compare the effectiveness of various methods of operative removal of pectus excavatum in children. Material and methods. We retrospectively analyzed the results of the surgical treatment of funnel-like deformity of the thorax in children conducted in clinics of pediatric surgery in seven regions of Russia (1,226 patients). The ratio of boys to girls in the study population was 2.2:1. The study population was divided as per their age into the following groups: 4–7 years (n = 180, 14.7%), 8–14 years (n = 731, 59.6%), and > 14 years (n = 315, 25.7%). The average age at which most children were operated was 11.83 ± 1.24 years. All children underwent a standard preoperative laboratory examination, including a general blood test, urine tests, a biochemical blood test, a hemostasiogram; radiographic diagnostic methods were used with the calculation of the Gizycka index; functional methods of investigation, such as electrocardiography, spirography, and radioisotope scintigraphy of the lungs were also used. Children with second- or third-degree pectus excavatum underwent surgical treatment almost exclusively. The symmetrical forms of the pectus excavatum were more prevalent. In most cases, the main pathological course was complicated. Results and discussion. The operated patients were divided into the following 3 groups: the first (n = 62): operations with the resection of the curved cartilages and external fixation of the sternum-rib complex (Bairov’s operation), the second (n = 374): thoracoplasty with the resection of warped cartilages using internal metal fixators by Timoshchenko, Ravitch, Paltia, Kondrashin), and the third (n = 790): minimally invasive operations without resection with internal fixation (Nuss operations: original and modified). In the first group, favorable results of surgical treatment were noted in 80.6% of the patients, satisfactory results were observed in 6.5%, unsatisfactory results were seen in 12.9%, and the overall effectiveness of operative correction was 87.1%. In the second group, good results of surgical treatment were recorded in 88% of the patients, satisfactory in 6.4%, and unsatisfactory in 5.6%; the overall efficiency of operative correction was 94.4%. In the third group, good results of surgical treatment were recorded in 95.3%, satisfactory in 3.8%, and unsatisfactory in 0.9%; the efficiency of operative correction was 99.1%. Conclusion. Today, the authors consider acceptable the operations by Timoshchenko and Paltia for complex of indicators, the optimal operation is Nuss.

Septic abdominal gossypiboma: A life threatening surgical site infection

Gossypiboma is an uncommon surgical iatrogenic complication due to the retention of textile material inside natural cavities, especially in abdomen. An important aspect of gossypiboma is linked to the kind of inflammatory-triggered reaction: aseptic or pyogenic. In pyogenic reactions, granulomas and pus appear as a response to contaminated material left in the abdomen. Most patients are symptomatic, and clinical history and physical examination combined with computed tomography are essential to establish the diagnosis. The complication has similar pathophysiology from intra-abdominal abscess, however, has worse clinical course, poor prognosis and needs operative removal. Therefore, the gossypiboma deserves special attention and should be considered as a severe surgical site infection involving organs and/or spaces. Prevention is the key point to control the complication and is based on a systematic and systematized conference of such materials at the end of an operation. The purpose of this paper is to show for the first time all pathophysiologic steps of pyogenic gossypiboma. Moreover, to remind the risk factors associated to fungal infection (female, age, acute care unit stay, upper intestinal tract perforation, prolonged broad spectrum antibacterial therapy, parenteral nutrition and central venous catheter placement). At the same time, highlight that early antifungal therapy (Candida glabrata), should be kept in mind and should not be neglected as these was the agent involved in this patient’s death. Finally, alert the surgeons about this severe surgical site infection, which may lead to litigation.