Impact on Quality of Life of Laparoscopic Nerve-sparing Radical Treatment of Parametrial Deep Infiltrating Endometriosis (Postoperative Pain Assessment and Functional Outcomes)

Objective: Complete eradication of parametrial nodules of Deep Infiltrating Endometriosis (DIE) is associated with a high risk of iatrogenic nerves damage and pelvic organs dysfunction. The aim of this study is to evaluate via validated questionnaires the effect of laparoscopic excision of parametrial DIE on quality of life as first outcome and on pain symptoms and post- operative voiding function (bladder and rectal) as secondary outcome.Study design: All patients undergoing laparoscopic excision of posterior or lateral parametrial DIE by a single expert surgeon between January 2013 and March 2017 were included in the study. A nerve-sparing approach was adopted in all patients. Quality of life (QoL) and Functional outcomes were evaluated using validated questionnaires (EHP-30 for the health profile, NBD score for intestinal function, ICIQ-FLUTS for urinary function), administered preoperatively and after surgery. Pain scores were collected before and after surgery using Visual Analogue Scale (VAS).Results: During the study period a total of fifty-nine patients met the inclusion criteria. Fifty-one patients agreed to fill out questionnaires for post-operative outcomes. EHP-30 scores had a significant improvement in all the domains analyzed even in the relationship with children and fertility module despite to the small number of patients answering those questions. No differences were found in terms of urinary function between pre and post-operative questionnaires (ICIQ-FLUTS). Bowel function improved in patients’ subjective perception. The NBD score showed that intestinal dysfunction related only to constipation and was reported as very minor by 76.4% of patients, minor by 11.8%, moderate by 5.9% by and severe by 5.95% of patients. Pain symptoms (VAS score) decreased significantly after surgery with the exception of chronic pelvic pain. (p value < 0,05). Conclusions: Laparoscopic nerve-sparing radical excision of parametrial DIE is safe and effective when performed by an expert surgical equipe. This approach can favorably impact on patients QoL. Moreover, it has proved to result in pain score and voiding function improvements.

Inflammatory Myofibroblastic Tumor in Adult: A Rare Case

Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm of intermediate biologic potential. Inflammatory myofibroblastic tumor (IMT) of the alimentary tract often occurs in children or young adults, but may occur at any age. The lung is the most commonly affected location. However, it may appear in small bowel mesentery especially the distal ileum, mesotransverse colon, or greater omentum. A 35 years old female presented to out-patient department with complaint of mass in right abdomen since 1 month associated with loss of weight. Computed tomography of abdomen revealed a solid intraperitoneal mass arising from bowel mesentery. Laparoscopic excision of the tumor was performed and the histopathological examination of the mass revealed it to be an inflammatory myofibroblastic tumor arising from the omentum and large bowel mesentery. The post- operative period was uneventful with no evidence of tumor recurrence at follow up at 2 years. Inflammatory myofibroblastic tumor is a rare soft tissue tumor usually arising from lungs but tumor arising from the omental-mesenteric origin has also been documented. The precise diagnosis is made only by the histopathological evidence. Surgical resection is the treatment of choice.

Surgical Management of Benign Gastric Tumors: A Review

Benign stomach and duodenal tumors are uncommon. Any component of the stomach epithelium, whether glandular, endocrine, or mesenchymal, can develop benign neoplastic tumors. The majority of people with benign stomach and duodenal tumors are asymptomatic for a long time. When symptoms do appear, they are determined by the tumor's size, location, and comorbidities. Endoscopy, computed tomography, and especially endoscopic ultrasonography results are used diagnose. Clinically, it's difficult to tell the difference between benign and malignant stomach tumors. Even benign tumors can undergo malignant transformation, severe obstructive problems, and bleeding. As a result, aggressive surgical resection of the tumors should be undertaken. Laparoscopic resection has become the first option of many surgeons since the development of minimally invasive surgery. According to previous literature, laparoscopic excision of GIST is safe and effective. In this review we’ll be looking at benign gastric tumors, gastrointestinal stromal tumors (GISTs) and their diagnosis.

Treatment of children with incomplete duodenal membrane

BACKGRAUND: An incomplete or perforated duodenal membrane is a rare developmental pathology of the gastrointestinal tract. AIM: This study aimed to analyze the diagnostic and treatment results of children with an incomplete duodenal membrane in the Republican Childrens Clinical Hospital in Ufa. MATERIALS AND METHODS: This study retrospectively analyzed case histories of 34 children who underwent surgery for incomplete duodenal membrane from 2005 to 2020. Features of the life history of the children, clinical picture of the disease, presence of concomitant developmental anomalies, laboratory and instrumental examination data, surgical correction methods, and postoperative period were analyzed. All children underwent ultrasound examination of the abdominal organs and contrast-enhanced radiography of the upper gastrointestinal tract with barium sulfate. Esophagogastroduodenoscopy was performed in 17 cases. RESULTS: Antenatally, the diagnosis was made in 21 cases. Patients age at the time of hospitalization was 9.7 2.7 days. Children were presented with symptoms such as persistent regurgitation or vomiting of curdled milk, which was sometimes mixed with bile (22 cases). Bloating in the epigastric region, retraction of the lower abdomen, and low weight gain after birth were found in nine children, and in five children, no weight changes were observed. Moreover, 13 (38.2%) children had concomitant developmental anomalies; 4 (11.7%) children had Down syndrome. Surgical treatment of 10 children was performed laparoscopically. Of the 24 children, three received laparotomic access, including conversion. The procedures included duodenotomy, partial excision of the membrane, and suturing of the duodenum. Enteral feeding was started 4.9 0.6 days after surgery. The average duration of hospitalization was 27 1.4 days. CONCLUSION: Vomiting or frequent regurgitation in infants and low-weight gain should alert pediatricians and pediatric surgeons. Malformation of the duodenal membrane in combination with other malformations necessitates a comprehensive examination. Laparoscopic excision of the duodenal membrane is the preferred treatment.