Indications for operation and results from surgical treatment of vesicoureteral reflux

The main objective of this retrospective study was to evaluate the value of surgical approach in the treatment of children with vesicoureteral reflux (VUR). Material and method: The study was conducted in the period from January 2006 to December 2014, and included children with symptomatic VUR, who were surgically treated. A total of 72 children were treated, of whom 56 were females and 16 were males, aged between 2 and 16 years. They were treated with IV and V grade reflux ureters. Thirty-two of the unilateral refluxes were left-sided, 18 right-sided and 22 both-sided. VUR was diagnosed with Voiding cystourethrography (VCUG). Cohen technique was performed in 64 (90%) patients, Politano-Lead better technique in 4 (5%) patients and Lich-Gregoir technique in 4 (5%) patients. Results: Out of the 72 treated patients, 69 had a postoperative negative finding of VUR on the performed VCUG, indicating a high 95% success rate. In three girls, persistent postoperative reflux was found in postoperative VCUG. In the first patient persistent VUR was unilateral, of V grade. In the second patient, a third-degree VUR was found and the third patient was diagnosed with II grade VUR. Postoperatively, non-febrile UTIs (urinary tract infections) were diagnosed in 23 patients (20 female children and 3 male children) out of 72 patients in total. One female child was hospitalized with febrile UTI and 8 patients or 10% developed febrile UTI within one year of the operative treatment. Conclusion: Open surgery, despite excellent results, is used for more complicated cases, VUR grade IV – V or in previously failed cases, and it does not appear to provide definitive correction of VUR in all patients and does not prevent certain low incidence of UTI postoperatively. Non-febrile UTIs can occur several years after a surgical correction. Endoscopic treatment is an alternative treatment for VUR

SYNCHRONOUS COLON CANCER PRESENTED AS ADULT ILEO-CAECAL INTUSSUSCEPTION, A RARE CASE REPORT

Colorectal cancer (CRC) is the third most common tumor type worldwide with approximately 1.8 million new cases diagnosed per year. Despite the high incidence of newly diagnosed cases, the majority (70%- 80%) of these tumors are respectable. These tumors can present as an incidental ndings on screening colonoscopy, with anemia symptoms such as general weakness and fatigue ( for right sided- tumors) or changes in bowel habits ( for left sided tumors). In advanced cases, loss of weight and loss of appetite are also common presenting symptoms. Less common, yet emergent presentations include large bowel obstruction, severe gastrointestinal hemorrhage and free intra-abdominal perforation. Synchronous CRC (SCRC) tumors, dened as two or more primary tumors existing independently of one another, have an incidence rate of 2.3% - 12.4% of overall CRC with male predominance. Presentation of these tumors is usually identical to presentation of solitary CRC. Emergency surgical presentation, with two different surgical indications for operation is very rare. Herein, we present a case of SCRC tumor in a 32-year-old man, with indication for emergent surgery being ileo-caecal intussusceptions but incidentally was diagnosed to have sigmoid colon growth .

Fluorescent Cholangiography in Laparoscopic Cholecystectomy: An Updated Canadian Experience

Background. Laparoscopic cholecystectomy (LC) is one of the most common general surgery procedures in Canada with approximately 100 000 cases performed per year. Bile duct injury remains a morbid complication with an incidence rate of 0.3% to 0.5%. Indocyanine green (ICG) fluorescent cholangiography is a noninvasive technology aiding in real-time identification of biliary structures for safe dissection within Calot’s triangle. The objectives were to provide an update to our initial experience with ICG aiding in the identification of biliary structures and ensuring that no adverse patient reactions occurred with ICG administration. Methods. Prospective case series from 2016 to 2018 for elective LC with ICG technology performed at a single academic teaching institution. Patient demographics, indications for operation, biliary structures visualized, amount of ICG used, operative times, and complications were recorded. Results. One hundred eight cases were included for review. The cystic duct, common hepatic duct, and common bile duct were identified with ICG in 90%, 48%, and 84% of cases, respectively. ICG simultaneously visualized at least 2 of 3 biliary structures 83.4% of the time. Only 1 biliary structure was identified in 10% of cases. No biliary structures were identified in 6% of cases. Mean initial ICG dose given was 1.65 mL. No adverse patient reactions to ICG were noted. Conclusions. This updated series illustrates that administration of ICG enhances visualization of the biliary system during outpatient LC. ICG is safe and its application should be further studied in early LC for acute cholecystitis.

Modifications and Further Development of the Original Nuss Procedure: Blessing or Curse?

The procedure introduced by Donald Nuss in 1997 for the treatment of pectus excavatum at the American Pediatric Surgical Association meeting has now been adopted by pediatric, thoracic, and plastic surgeons around the world. Rather than resection of the costal cartilages and sternal fracture, which had been standard practice for decades, he advocated using a metal bar to push the sternum into position. Reasoning that the chest wall of children is very flexible, he felt that resection was unnecessary. Since that time, medical centers from around the world have reported their experience with the procedure. There is now robust evidence of its safety and efficacy. As the Nuss procedure has become a standard treatment, indications for operation have expanded, and numerous modifications have been introduced. Some of these were intended to improve upon the original procedure, and others to adapt it to new circumstances, such as use in adults whose chest is not as flexible. This report reviews those modifications.

The early and late results of distal pacreatic resection

Objective. To study up the early and late results of distal pancreatic resection with the aim to improve diagnosis and surgical treatment of the distal pancreatic segment disease. Маterials and methods. Resectional interventions on distal pancreatic segment were performed in 19 patients in Department of General Surgery of Ivano-Frankivsk Regional Clinical Hospital in 2013 - 2017 yrs. In 12 (63.2%) patients the complicated forms of chronic pancreatitis (CHP) were diagnosed, and in 7 (36.8%) – pancreatic neoplasia. For diagnosis of pathological changes in corpora-caudal pancreatic segment there were applied laboratory investigations, ultrasound investigation, computed tomography, magnet-resonance tomography, pathohistological investigation of operational material. Results. In CHP a DR, using anterior operative access, was performed in 7 patients, and using a posterior one - in 5. For pancreatic neoplasia a standard DR was done in 3 patients, a radical one – in 1, radical antegrade module (RAMPS) - 2, and applying a laparoscopic operative access – in 1 woman-patient. Postoperative complications have occurred in 6 (31.6%) patients. Late results were followed-up in 13 (68.4%) patients in 6 mo – 5 yrs terms: after DR for CHP – in 9, after DR for tumors – in 4. Good late results were obtained in 7 (77.7%) patients after DR for CHP and in 2 (50.0%) – for tumors, satisfactory results – in 2 (22.3%) and in 1 (25.0%) patients, accordingly, and poor result - in 1 (25.0%) after pancreatic DR, performed for malignant tumor. Conclusion. Complex diagnosis of the distal pancreatic segment diseases with obligatory application of computed tomography gives possibility to establish strict indications for operation and to select a mostly adequate method of surgical intervention individually. Laparoscopic pancreatic DR constitutes a perspective method of surgical treatment in patients with CHP and locally-spread pancreatic neoplasia, it has good and fair early and late results. Resectional interventions on distal pancreatic segment leads to the diabetes mellitus occurrence in 16.6% of the patients.

Comparative Analysis of Laparoscopic and Open Approaches in Emergency Abdominal Surgery

The objective of this study was to evaluate usage and outcomes of emergency laparoscopic versus open surgery at a single tertiary academic center. Over a three-year period 165 patients were identified retrospectively using National Surgical Quality Improvement Program results. Appendectomies and cholecystectomies were excluded. Open and laparoscopic approaches were compared regarding preoperative and operative characteristics, the development of postoperative complications, 30-day mortality, and length of hospital stay. Indications for operation were similar between groups. Patients who underwent open surgery had more severe comorbidities and higher ASA class. Laparoscopy was associated with reduced complication rates, operative time, length of stay, and discharges to skilled nursing facilities on univariate analysis. In a multivariate model, surgical approach was not associated with the development of complications. Older age, dependent status, and dyspnea were predictors of conversion from attempted laparoscopic to open approaches.

A comparative study of total laparoscopic hysterectomy and non-descent vaginal hysterectomy for treatment of benign diseases of uterus

Background: Hysterectomy is the most common performed major gynaecological surgery and the decision depends on indications for operation, surgeon’s training and preference, uterine size, adnexal pathologies and patient choice. To avoid laparotomy either total laparoscopic hysterectomy (TLH) or non-descent vaginal hysterectomy (NDVH) is the recently practised option. Objectives of the present study are to compare duration of operation, blood loss, ambulation time, post-operative pain and complications between TLH and NDVH.Methods: Patients undergoing above operation during January 2014 to December 2014 at N.R.S. Medical College, Kolkata, were included under the study. All patients were thoroughly examined and investigated and malignancies were excluded by Pap smear and or D&C. All patients were observed minutely during pre-operative, intra operative and post-operative period for any complications.Results: NDVH requires less operative time than TLH but intra operative blood loss, post-operative pain and ambulation time are slightly more.Conclusions: TLH requires infrastructural set up, greater surgical expertise, longer operative time and major intraopertive complications as compared to NDVH. In our low resource government hospital NDVH is better choice for removal of uterus in uncomplicated benign conditions.

Laparoscopic transhiatal esophagectomy with neoadjuvant chemotherapy to treat carcinoma of the upper esophagus.

e15181 Background: Esophagectomy for Carcinoma of the upper esophagus has traditionally been performed by open methods. Results from most series include mortality rates in excess of 5% and hospital stays frequently greater than 14 days. Laparoscopic transhiatal esophagectomy (LTHE) with neoadjuvant chemotherapy has the potential to improve these results and may lead to a sound outcome, but only a few articles have reported it. The objective of this study is to investigate the method of LTHE with neoadjuvant chemotherapy treating cervical esophageal cancer. Methods: From 2011 to 2012, LTHE was performed in 15 patients with carcinoma of the upper esophagus. There were 11 men and 4 women. Median age was 64 years (range, 44–79). Indications for operation included high-grade dysplasia (n = 4) and cancer (n = 11). Neoadjuvant chemotherapy was used in 15 patients. Results: There was no conversion to open procedure. LTHE was successfully completed in 15 patients. The median intensive care unit stay was 1.5 days (range, 1–8); hospital stay was 10.5 days (range, 8–23). Anastomotic leak rate was 6.7% (n=1). At a mean follow-up of 13 months (range, 1–24), quality of life scores were similar to preoperative values and population norms. Conclusions: LTHE with neoadjuvant chemotherapy is a safe and relatively advanced, complex procedure with little blood loss and less-invasion. Its long-term outcome needs to be investigated with large-volume cases.