Complicated giant duodenal ulcer in the HIV-infected patient

This article presented the clinical observation of the giant duodenal ulcer complicated by bleeding in the HIV-infected patient. The original method of forming the duodenal stump was used during the resection of the stomach by Billroth-2. The method was characterized by using the post-ulcer stenotic ring as a skeleton of the formed duodenal stump and the double-row continuous suture that allowed to avoid the suture insufficiency in the patient.

Laparoscopic surgery for malignancies of the colon, rectum, and anus in Lithuania in 2008

The objective of this study was to analyze data on laparoscopic surgery for malignant diseases of the colon, rectum, and anus in Lithuania during the period of January 1, 2005, to February 15, 2008. Material and methods. During the above-mentioned period in Lithuania, 130 laparoscopic surgeries for malignancies of colon, rectum, and anus were performed in seven different hospitals. There were 73 males and 57 females with a mean age of 68 years (range, 35–85 years). Laparoscopic procedures were attempted in 140 cases. Out of them, 130 were completed laparoscopically; 10 operations were converted to open, and conversion rate was 7.1%. Twenty-seven (20.8%) patients had stage I, 45 (34.6%) stage II, 45 (34.6%) stage III, and 13 (10%) stage IV disease. Ninety-two (70.8%) patients underwent straight laparoscopic surgery and 38 (29.2%) – hand-assisted laparoscopic surgery. Time in surgery was from 50 to 365 min, with a mean of 183 min. During 130 operations, in 11 (8.5%) cases, blood vessels were ligated through specimen retrieval site. Out of 104 operations, where anastomosis was performed (23 abdominoperineal resections and 3 Hartmann’s procedures), in 68 (65.4%) cases it was done laparoscopically and in 36 (34.6%) cases using conventional extracorporal suturing. Results. Hospital stay ranged from 7 to 59 days, with a mean of 12 days. One (0.8%) patient died. Postoperative complications occurred in 27 (20.8%) cases. Reoperation rate was 4.6% (6 cases). Complications were as follows: suture insufficiency (3 cases), eventration (3 cases), wound infection (7 cases), intraperitoneal abscess (1 case), abdominal wall phlegmon (1 case), intra-abdominal infiltrate (1 case), perineal hematoma (1 case), proctovaginal fistula (2 case), intraoperative bleeding from uterus (1 case), urinary retention (4 cases), cystitis (1 case), pneumonia (1 case), acute cardiovascular insufficiently (1 case). In histological specimens, 10 lymph nodes were found on the average (range, 2 to 27). Conclusions. Laparoscopic surgery for malignant diseases of the colon, rectum, and anus is dominating among laparoscopic surgeries for colorectum. Complication rate is similar to other authors. To evaluate disease relapse and outcomes, observation time is not sufficient yet.

Use Of Mechanical Sutures In Pulmonary Surgery

In a ten years period, Six hundred and twenty patients under surgical treatment for different kinds of pulmonary diseases. Pulmonary tuberculosis was the indication for 395 thoracotomies and 115 patients were operated for lung cancer. Ninetyone thoracotomies were performed chronic non-specific diseases of the lung and in 19 cases indications for pulmonary resection were other diseases. In all cases various types of mechanical staplers were used for individual suturing of the culmonary vessels and bronchus. Operations performed included 207 pneumonectomies, 341 lob and bilobectomies, 49 segementectomics and 23 combined resections. Chronometry was done in seventyone thoracotomitromies with average time spent for each operation being one hour and fortyseven minutes only. Out of this time, only four minutes and thirtyfour seconds (4.2%) were spent for individual suturing of the pulmonary vessels and bronchus. During the operation insufficiency of mechanical sutures were seen in few cases and dealt with accordingly. Arterial and bronchial stump insufficiency were noted in the percent cases each, whereas venous suture insufficiency was seen only in 1.3 percent cases. Five huudred and fortysix patients (88.1%) had a benign course, whereas fortythree patients (6.9%) experienced postoperative complications. But only in sixteen cases (2.6%) could the mechanical sutures be related theoretically for those complications. There were thirtyone hospital deaths (5%). Our results show that the use of mechanical sutures is safe, considerably reduces the time for pulmonary resection and is associated with relatively very few intraoperative and postoperative complications.