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Nechita VI, Al-Hajjar N, Leucuța DC, Moiş E, Fetti A, Nechita MA, Graur F. Inflammatory Ratios as Survival Prognostic Factors in Resectable Gastric Adenocarcinoma. Diagnostics (Basel) 2023; 13:diagnostics13111910. [PMID: 37296762 DOI: 10.3390/diagnostics13111910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The purpose of the study was to assess the relationship between inflammatory biomarkers (NLR-neutrophil-to-lymphocyte ratio, PLR-platelet-to-lymphocyte ratio, LMR-lymphocyte-to-monocyte ratio, SII-systemic immune-inflammation index) and overall survival in gastric cancer patients. METHODS Over a six-year period (2016-2021), we conducted a longitudinal retrospective cohort research on 549 patients with resectable stomach adenocarcinoma. The overall survival was determined using the univariate and multivariate COX proportional hazards models. RESULTS The age of the cohort varied between 30 and 89 years old, with an average age of 64.85 ± 10.51 years. Four hundred seventy-six patients (86.7%) had R0 resection margins. Eighty-nine (16.21%) subjects received neoadjuvant chemotherapy. Two hundred sixty-two (47.72%) patients died during the follow-up period. The median survival time in the cohort was 390 days. A significantly lower (p = 0.029-Logrank test) median survival was observed for R1 resections (355 days) in comparison with R0 resections (395 days). Significant differences in survival were observed regarding tumor differentiation, tumoral (T), and node (N) stage. No differences in survival were observed between the low or high value of inflammatory biomarkers (dichotomized by median value in the sample). In the COX univariate and multivariate regression models, elevated NLR proved an independent prognostic factor for lower overall survival [HR = 1.068, (95% CI 1.011-1.12)]. In this study, the other inflammatory ratios (PLR, LMR, and SII) did not prove as prognostic factors for gastric adenocarcinoma. CONCLUSIONS In resectable gastric adenocarcinoma, elevated NLR before surgery was associated with lower overall survival. PLR, LMR, and SII had no prognostic value for the patient's survival.
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Affiliation(s)
- Vlad-Ionuţ Nechita
- Department of Medical Informatics and Biostatistics, "Iuliu Hațieganu" University of Medicine and Pharmacy, Louis Pasteur Street, No. 6, 400349 Cluj-Napoca, Romania
- Octavian Fodor Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Nadim Al-Hajjar
- Octavian Fodor Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
- 3rd Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Daniel-Corneliu Leucuța
- Department of Medical Informatics and Biostatistics, "Iuliu Hațieganu" University of Medicine and Pharmacy, Louis Pasteur Street, No. 6, 400349 Cluj-Napoca, Romania
| | - Emil Moiş
- Octavian Fodor Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
- 3rd Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Alin Fetti
- Octavian Fodor Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
- 3rd Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Mihaela-Ancuţa Nechita
- Ion Chiricuță Oncology Institute, Republicii Street, No. 34-36, 400015 Cluj-Napoca, Romania
| | - Florin Graur
- Octavian Fodor Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
- 3rd Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
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Zaharie F, Valean D, Zaharie R, Popa C, Mois E, Schlanger D, Fetti A, Zdrehus C, Ciocan A, Al-Hajjar N. Surgical management of hydatid cyst disease of the liver: An improvement from our previous experience? World J Gastrointest Surg 2023; 15:847-858. [PMID: 37342852 PMCID: PMC10277938 DOI: 10.4240/wjgs.v15.i5.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/12/2023] [Accepted: 03/24/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Hydatid liver disease remains an important issue in endemic areas, which may require immediate surgery. Although laparoscopic surgery is on the rise, the presence of certain complications may require conversion to the open approach.
AIM To compare the results of laparoscopic treatment and the open approach in the context of a 12-year single institution experience, and to perform a further comparison between results from the current study and those from a previous study.
METHODS Between January 2009 and December 2020, 247 patients underwent surgery for hydatic disease of the liver in our department. Of the 247 patients, 70 underwent laparoscopic treatment. A retrospective analysis between the two groups was performed, as well as a comparison between current and previous laparoscopic experience (1999-2008).
RESULTS There were statistically significant differences between the laparoscopic and open approaches regarding the cyst dimension, location, and presence of cystobiliary fistula. There were no intraoperative complications in the laparoscopic group. The cutoff value for the cyst size regarding the presence of cystobiliary fistula was 6.85 cm (P = 0.001).
CONCLUSION Laparoscopic surgery still plays an important role in the treatment of hydatid disease of the liver, with an increase in its usage over the course of years that has shown benefits regarding the postoperative recovery with a decreased rate of intraoperative complications. Although experienced surgeons can perform laparoscopic surgery in the most difficult conditions, there are some selection criteria that need to be maintained for higher quality results.
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Affiliation(s)
- Florin Zaharie
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Dan Valean
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Roxana Zaharie
- Department of Gastroenterology, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
- Department of Gastroenterology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400012, Cluj, Romania
| | - Calin Popa
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Emil Mois
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Diana Schlanger
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Alin Fetti
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Claudiu Zdrehus
- Department of Anaesthesiology, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Andra Ciocan
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Nadim Al-Hajjar
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
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Zaharie F, Valean D, Al-Hajjar N. Surgical technique in the laparoscopic repair of Morgagni hernia in adults. How do we do it? Authors’ reply. Hernia 2022; 26:1711-1712. [DOI: 10.1007/s10029-022-02700-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/06/2022] [Indexed: 11/30/2022]
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Puia VR, Puia A, Fetti AC, Stefan PA, Valean D, Herdean A, Rusu I, Vasile T, Lebovici A, Al-Hajjar N. Computed Tomography for the Diagnosis of Intraperitoneal Infected Fluid Collections after Surgery for Gastric Cancer. Role of Texture Analysis. J Gastrointestin Liver Dis 2022; 31:184-190. [PMID: 35574623 DOI: 10.15403/jgld-4219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIMS Several computed tomographic (CT) imaging features have been proposed to describe the infection of postoperative abdominal fluid collections; however, these features are vague, and there is a significant overlap between infected and non-infected collections. We assessed the role of textural parameters as additional diagnostic tools for distinguishing between infected and non-infected peritoneal collections in patients operated for gastric cancer. METHODS From 527 patients operated for gastric cancer, we retrospectively selected 82 cases with intraperitoneal collections who underwent CT exams. The fluid component was analyzed through a novel method (texture analysis); different patterns of pixel intensity and distribution were extracted and processed through a dedicated software (MaZda). A univariate analysis comparing the parameters of texture analysis between the two groups was performed. Afterwards, a multivariate analysis was performed for the univariate statistically significant parameters. RESULTS The study included 82 patients with bacteriologically verified infected (n=40) and noninfected (n=42) intraperitoneal effusions. The univariate analysis evidenced statistically significant differences between all the parameters involved. The multivariate analysis highlighted 10 parameters as being statistically significant, adjusted to Bonferroni correction. CONCLUSIONS Our evidence supports the fact that textural analysis can be used as a complementary diagnostic tool for the detection of infected fluid collections after gastric cancer surgery. Further studies are required to validate the accuracy of this method.
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Affiliation(s)
- Vlad Radu Puia
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca; Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania. .
| | - Aida Puia
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. .
| | - Alin Cornel Fetti
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca; Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Paul Andrei Stefan
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca; Radiology and Imaging Department, County Emergency Hospital, Cluj- Napoca, Romania.
| | - Dan Valean
- Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Andrei Herdean
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Ioana Rusu
- Pathology Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Tudor Vasile
- Radiology and Imaging Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Andrei Lebovici
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca; Radiology and Imaging Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Nadim Al-Hajjar
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca; Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
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Popa C, Voicescu GT, Pestean C, Graur F, Momani TA, Al-Hajjar N, Liviu I. An innovative approach for laparoscopic liver resections. Training protocol. Ann Ital Chir 2020; 91:105-111. [PMID: 32180581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM To evaluate the benefits of systematical use of ex vivo liver model and CT imaging in the planning process for swine laparoscopic liver resections done by residents during a dedicated training program. MATERIAL AND METHODS Thirty general surgery residents, part of a dedicated and continuous training program, were equally divided into two groups: first one which performed laparoscopic liver resections without planning stage and the second one which systematically used an interactive tutorial for establishing the strategy for the resection followed by performing open liver dissection and the same resection on an ex vivo swine model. Afterwards, laparoscopic procedures were performed on twenty anesthetized domestic pigs. RESULTS All teams successfully completed the procedure, with no conversions to open approach and without trainers' intervention. The second group was faster than the first group on both minor and major resections (p=0.0001). The blood loss was significantly lower on the second group (p=0.005). DISCUSSION The residents surpassed our expectations regarding the operation time, blood loss and conversions, validating our training program. The step-by-step program was developed using the IDEAL paradigm, being now at the end of the 2b phase (exploration), when the residents realize the benefits of this model. The reduction in blood loss and loss of functional parenchyma demonstrates the utility of a warming-up phase. CONCLUSIONS The "warming up" by adding the imagistic and anatomical data to the core protocol offer more clarity before laparoscopic liver resections and makes an upgrade for our "step by step" protocol. KEY WORDS Experimental model, Laparoscopic liver resections, Residents.
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Pop MG, Fit AM, Vesa SC, Bartos A, Bartos DM, Corpadean AG, Puia C, Al-Hajjar N, Cornel I. Predictors of 1-year postoperative mortality in radical colon cancer surgery. Ann Ital Chir 2018; 89:507-512. [PMID: 30665223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM The aim of this study was to determine the impact of patient, tumor and surgery-related parameters on 1-year postoperative mortality in a cohort of patients operated in a single tertiary center. MATERIALS AND METHODS The study included 605 patients diagnosed with colon cancer between January 2013 and December 2015 that underwent radical surgery in a tertiary center. Patient demographics, comorbidities, preoperative biological parameters alongside with tumor and surgery-related factors were prospectively recorded and then analyzed in relation 1-year postoperative mortality. RESULTS One-year mortality rate in the study group was 10.9%. Independent risk factors in relation to 1-year mortality were advanced TNM stage (OR 3.10, 1.10 - 8.75 95% CI ), emergency surgery (OR 1.91, 1.11 - 3.74 95% CI ), location of the tumor in the ascending colon (OR 2.17, 1.32 - 3.57 95% CI ), multiorgan resections (OR 2.07, 1.15 - 3.74 95% CI), age over 63 years (OR 2.05, 1.16 - 3.62 95% CI) and the history of alcohol consumption (OR 2.058, 1.17 - 3.61 95% CI ). DISCUSSION Postoperative complications are still being reported in colon cancer surgery, despite technological progress and constant research in the field. So far, factors that influence postoperative mortality have been mostly studied up to 30 days postoperatively. According to some recent papers, reporting 30-day mortality data can underestimate accurate communication of postoperative adverse events. Thus, 1-year mortality in colon cancer surgery could be a better indicator of the impact on surgery on postoperative period of this patients and factors that influence it should be well known. KEY WORDS Surveillance, Colon cancer, 1-year mortality.
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Mois E, Graur F, Al-Hajjar N, Zaharie F, Bartos A, Bodea R, Zaharie T, Rusu I, Iancu C. Microscopically positive (R1) resections do not affect survival in pancreatic head cancer. Ann Ital Chir 2017; 88:491-496. [PMID: 29339587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Obtaining negative microscopic resection margins (R0) in cephalic duodenopancreatectomy (CDP) is the gold standard. Resection line involvement at microscopic histopathological examination (R1) could change prognostic unfavorable. Regarding R1 resections in CDP (data from the literature show rates between 20-80%), we considered it necessary to perform a study in Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor'' Cluj-Napoca. METHODS Here we present the results of a retrospective study carried out between January 2012 - December 2013 in our Institute. This study includes 63 patients with pancreatic head resections for pancreatic cancer. The circumferential soft tissue margin, the pancreatic transection margin, the bile duct and duodenum/stomach margins were analyzed. We investigated the incidence of R1 and its impact on the survival rates after oncologic pancreatic resections using a nonstandardized pathologic routine protocol. R1 status was defined as the distance of the tumor from the resection margin of ≤ 1 mm. RESULTS Pancreatic ductal adenocarcinoma (PDAC) was diagnosed in 93.65 %. The R1 rate was 36.5 % (23 cases). The circumferential margins were most commonly involved as R1 (91,3%). No statistically significant differences were found between patients with R1 to those with R0 (p ≥ 0.1) regarding 3-year survival. CONCLUSIONS Survival for pancreatic head cancer at 3 years is not influenced by the margins of resection (R1/R0). Microscopic resection margin involvement is not an independent marker of survival. KEY WORDS Circumferential margins, Nonstandardized pathologic protocol, Pancreatic ductal adenocarcinoma, Positive margins R1 Survival.
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Mois EI, Graur F, Sechel R, Al-Hajjar N. McKittrick-Wheelock syndrome: a rare case report of acute renal failure. ACTA ACUST UNITED AC 2016; 89:301-3. [PMID: 27152085 PMCID: PMC4849392 DOI: 10.15386/cjmed-536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/21/2015] [Accepted: 09/24/2015] [Indexed: 11/28/2022]
Abstract
Giant tubular-villous adenoma of the rectum can determine secretory diarrhea, associated with a depleting syndrome of prerenal acute renal failure, hyponatremia, hypokalemia and hypoproteinemia. These symptoms are known as the McKittrick-Wheelock syndrome, and there are about 50 cases reported in literature. We present the case of a 59-year-old woman presented to our emergency department with abdominal pain, prerenal azotemia, and electrolyte disturbances with a background of chronic diarrhea, caused by a giant rectal tumor. Conservative therapy initially improved and normalized renal function, and made surgical resection of the tumor possible.
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Affiliation(s)
- Emil Ioan Mois
- Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Department of Surgery, Regional Institute of Gastroenterology and Hepatology Prof. O. Fodor, Cluj-Napoca, Romania
| | - Florin Graur
- Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Department of Surgery, Regional Institute of Gastroenterology and Hepatology Prof. O. Fodor, Cluj-Napoca, Romania
| | - Roxana Sechel
- Department of Pathology, Regional Institute of Gastroenterology and Hepatology Prof. O. Fodor, Cluj-Napoca, Romania
| | - Nadim Al-Hajjar
- Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Department of Surgery, Regional Institute of Gastroenterology and Hepatology Prof. O. Fodor, Cluj-Napoca, Romania
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Negrean V, Graur F, Moiş E, Al-Hajjar N. Ileocecal Obstruction Due to B-cell Non-Hodgkin Lymphoma. Chirurgia (Bucur) 2016; 111:71-73. [PMID: 26988544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 06/05/2023]
Abstract
We report a rare case of non-Hodgkin lymphoma presented as an ileocecal mass. The patient was a 77-year-old man with history of symptoms of partial bowel obstruction, intermittent right iliac fossa pain, loss of weight, vomiting and fatigue. Clinical signs included moderate abdominal tenderness with a palpable mass in the right iliac fossa at the physical examination. Colonoscopy revealed an intussusception of the right colon causing a complete stenosis. The patient developed complete bowel obstruction during hospitalization that required emergent surgical intervention. Intraoperatively an ileocecal mass was found measuring 10-12 cm in diameter, causing complete stenosis at its level and bowel dilatation proximally. Multiple nodules were found in the liver and the parietal peritoneum as well. An ileotransverso-anastomosis was performed and biopsies of the nodules were taken. Pathological evaluation revealed a diffuse large B cell non-Hodgkin's lymphoma of the ileocecum and the parietal peritoneum.
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Cioca A, Cimpean A, Ceausu R, Fit AM, Zaharie T, Al-Hajjar N, Puia V, Raica M. Crosstalk between EGFR and p53 in hepatocellular carcinoma. Asian Pac J Cancer Prev 2015; 15:8069-73. [PMID: 25338986 DOI: 10.7314/apjcp.2014.15.19.8069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the most frequent cancers worldwide, with a high mortality. Most patients present with late stage disease, when the treatment options are limited to systemic chemotherapy. The purpose of our study was to evaluate the significance of p53 and EGFR expression in HCC, and to determine whether these two markers correlate with conventional parameters of prognosis. MATERIALS AND METHODS Our study included a total of 45 patients, diagnosed histopathologically with HCC. Clinicopathological data including sex, age, tumor necrosis, tumor size, histologic grading, tumor stage, the presence of cirrhosis and chronic hepatitis, were recorded from the Institute database. Three independent microscopic fields were selected for each sample and all the tumor cells within each microscopic field were counted, and then the positive percent of p53 cells were calculated. Three staining patterns were recognized: diffuse, heterogenous and focal. The intensity of EGFR staining was scored on a scale of 0-3+: 0 no staining; 1+ when a weak membrane staining was observed; 2+ when membrane staining is more intense than in 1+, but less than 3+, and 3+ when intense dark brown staining delineated the membrane. To determine the relationship between EGFR expression and p53, we performed double staining in the same HCC specimens. RESULTS By immunohistochemical staining, p53 protein was detected in tumor cell nuclei in 20 HCCs (44%). We found a significant correlation between the intensity of p53 expression and the histological grade (p=0.008). EGFR expression was detected in 17 (38%) cases, linked to histological grade (p=0.039). Moreover, the intensity of p53 expression was significantly correlated with EGFR intensity (p=0.014). CONCLUSIONS Our results suggest that overexpression of p53 and EGFR plays an important role in hepatocarcinogenesis and contributes to more advanced disease. These markers are not only valuable predictors of prognosis in HCC, but they are also rational targets for new anti-tumor strategies.
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Affiliation(s)
- Andreea Cioca
- Department of Pathology "Iuliu Hatieganu", Cluj-Napoca, 2Angiogenesis Research Center, "Victor Babes" University of Medicine and Pharmacy, Timisoara, 3Department of Pathology, 4Department of Surgical, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania E-mail :
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Bartoş A, Bartoş D, Al-Hajjar N, Puia C, Munteanu D, Bodea R, Mocan L, Zaharie F, Iancu C. Risk factors for complications after duodenopancreatectomy. Initial results after implementing a standardized perioperative protocol. Chirurgia (Bucur) 2014; 109:318-324. [PMID: 24956335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION During 1993-2008 period, in the Surgical Clinic III were conducted several retrospective studies, in order to identify risk factors for complications after cephalic duodenopancreatectomy(DP). As a result of these studies, a preoperative protocol was developed for preparation of patients proposed for DPC, as well as a number of intraoperative technical changes in order to improve postoperative morbidity and mortality. Implementation of the protocol was gradually and inomogenic done in our service. METHODS The study is prospective, conducted in 2009-2012, ina group of 180 patients and aims to evaluate immediate results after DPC for periampular malignancy, looking to analyze the effects of implementation of the protocol mentioned above.We analyzed the rates of complications (pancreatic fistula,blunt pancreatitis, bleeding from the pancreatic blunt, delayed gastric emptiness), and the factors that might influence their occurrence. RESULTS AND CONCLUSIONS of the 180 patients, 10 (5.5%) developed pancreatic fistula and 24 (13.3%) had delayed gastric emptiness. Among the factors that have been significant associated with these complications we mention: the pancreatico-jejunalanastomosis and gastro-jejunal transmesocolic assembly. With the implementation of the protocol, the risk factors previously identified in retrospective studies performed in our service(elevated transaminases, experienced surgical team, etc.) have lost significance, but they have not disappeared entirely, due to fact that the conduit proposed was not entirely followed. We believe that the homogeneous application of a perioperative guide, together with a standardized surgical technique, will lead to improve immediate results after DP.
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Graur F, Elisei R, Al-Hajjar N. E-NOTES transumbilical laparoscopic appendectomy. Chirurgia (Bucur) 2013; 108:571-575. [PMID: 23958105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2013] [Indexed: 06/02/2023]
Abstract
We present a case of laparoscopic transumbilical single incision appendectomy. A 17-year-old patient with an insidious onset of symptoms 4 months ago by diffuse abdominal pain that later was localized in the right iliac fossa accompanied by loss of appetite, nausea and vomiting. Following clinical examination and abdominal ultrasound, she was diagnosed with chronic appendicitis and surgical treatment was recommended. Pneumoperitoneum was performed under general anesthesia. Three trocars of 5 mm diameter were inserted through a single umbilical incision of 10 mm length into the peritoneal cavity. The exploration has revealed a swollen appendix. After transsection of the mesoappendix with LigaSure forceps, two Roeder knots were placed at on the base of the appendix. Intervention duration was 60 minutes. Postoperative course was favorable. Patient assessment within 2 months after discharge showed disappearance of symptoms and the postoperative scar hidden in the umbilical scar.
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Affiliation(s)
- F Graur
- University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Puia IC, Iancu C, Bălă O, Munteanu D, Al-Hajjar N, Cristea PG. Gastrojejunocolic fistula: report of six cases and review of the literature. Chirurgia (Bucur) 2012; 107:52-54. [PMID: 22480116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
UNLABELLED Six gastrojejunocolic fistulae were recorded at our service between 1995-2005. All the fistulae occurred in men who had gastric resection performed for duodenal ulcer. METHOD Diarrhea, weight loss, postprandial pain and fecal breath were the clinical findings present in descending frequency. Preoperative diagnosis was possible in 5 patients by endoscopy and barium contrast studies. In five patients the option was a one-stage procedure with revision gastrectomy and segmental resection of the transverse colon. In one case simple dismantling of the fistula was performed. RESULTS Although in two patients anastomotic leakage developed no mortality was recorded.
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Affiliation(s)
- I C Puia
- Surgical Clinic III, University of Medicine and Pharmacy "Iuliu Haţieganu", Cluj-Napoca, Romania.
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Al-Hajjar N, Piţu F, Piţu F, Fărcaş F, Zdrehuş C, Serban A. [Intestinal stromal tumor with large unique hepatic metastasis--diagnostic difficulties]. Chirurgia (Bucur) 2010; 105:849-853. [PMID: 21355183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The digestive tract mesenchymal neoplasms were viewed modified radically once it was discovered that gastrointestinal stromal tumors (GIST), the most frequent non-epithelial digestive tumors, constitute a distinctive group of tumors originating in the interstitial cells of Cajal, cells which normally express the CD117 antigen. The discovery of GIST's origin and understanding of the molecular mechanisms underlying the development of such tumors have led to important progress concerning their diagnosis and treatment. Thus, tumoral expression of c-KIT (CD117) is presently considered to be the most specific criterion for the diagnosis of GIST, and targeted molecular therapy using thyrosin-kinase inhibitors (imatinib) has encouraging results even in the case of locally advanced or metastatic tumors. This is the case of a 47 year old man who accused nonspecific abdominal symptomatology due to a large epigastric tumor which, postoperatively, proved to be the metastasis of a stromal enteral tumor.
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Affiliation(s)
- N Al-Hajjar
- UMF Iuliu Haţieganu, Clinica Chirurgie III, Cluj-Napoca, România.
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Matei D, Dadu R, Prundus R, Danci I, Ciobanu L, Mocan T, Bocsan C, Zaharie R, Serban A, Tantau M, Iancu C, Alexandru I, Al-Hajjar N, Andreica V. Alkaline reflux esophagitis in patients with total gastrectomy and Roux en Y esojejunostomy. J Gastrointestin Liver Dis 2010; 19:247-252. [PMID: 20922186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND AND AIMS Alkaline reflux esophagitis is a complication that might develop in patients with total gastrectomy. The aim of the study was to analyze the prevalence and severity of reflux esophagitis and the occurence of complications (Barrett's esophagus and esophageal stenosis) in patients with total gastrectomy and Roux en Y esojejunostomy. METHODS 92 patients with total gastrectomy performed for gastric cancer were included in the study. None of the patients had esophagitis prior to gastrectomy. The patients were assessed clinically and endoscopically after a certain interval from surgery. RESULTS An important number of patients (14 out of 92, 15.22%) had reflux esophagitis; 5.43% of the patients had also complications of reflux esophagitis (Barrett's esophagus and benign esophageal stenosis) and 6.52% had local tumor recurrence. Of the 14 patients with reflux esophagitis, the majority (9/14) had Los Angeles (LA) grade C esophagitis. The mean interval between surgery and the endoscopic evaluation was 4.43 years. Barrett's esophagus and benign stenosis were diagnosed after a longer period of time (10.33 and 8 years, respectively) as compared to reflux esophagitis (5.29 years). More than half of the esophagitis patients had reflux symptoms. CONCLUSIONS Although Roux en Y esojejunostomy is a reconstructive technique which prevents the reflux, an important percentage of our patients developed alkaline reflux esophagitis. In most cases, the esophagitis was moderate or severe. Complications of alkaline reflux, i.e. benign stenosis and Barrett's esophagus, also occurred after longer periods of time (8 to 10 years) in a small percentage of patients.
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Affiliation(s)
- Daniela Matei
- 3rd Medical Clinic, University of Medicine and Pharmacy Iuliu Haţieganu, Cluj Napoca, Romania
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Duca S, Bãlã O, Al-Hajjar N, Lancu C, Puia IC, Munteanu D, Graur F. Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations. HPB (Oxford) 2008. [PMID: 18332976 DOI: 10.1080/13651820304298] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Even though laparoscopic cholecystectomy (LC) has become the customary method for treating gallstones, some incidents and complications appear rather more frequently than with the open technique. Several aspects of these complications and their treatment possibilities are analysed. MATERIALS AND METHODS Over the last 9 years 9542 LCs have been performed at this centre, of which 13.9% were carried out for acute cholecystitis, 38.4% in obese patients and 7.6% in patients aged >65 years. RESULTS The main operative incidents encountered were haemorrhage (224 cases, 2.3%), iatrogenic perforation of the gallbladder (1517 cases, 15.9%) and common bile duct (CBD) injuries (17 cases, 0.1%). Conversion to open operation was necessary in 184 patients (1.9%), usually due to obscure anatomy as a result of acute inflammation. The main postoperative complications were bile leakage (54 cases), haemorrhage (15 cases), sub-hepatic abscess (10 cases) and retained bile duct stones (11 cases). Ten deaths were recorded (0.1%). DISCUSSION Most of the postoperative incidents (except bile duct injuries) were solved by laparoscopic means. Among patients with postoperative complications 28.9% required revisional surgery. In 42.2% of cases minimally invasive procedures were used successfully: 15 laparoscopic re-operations (for choleperitoneum, haemoperitoneum and subhepatic abscess) and 22 endoscopic sphincterotomies (for bile leakage from the subhepatic drain and for retained CBD stones soon after operation). The good results obtained allow us to recommend these minimally invasive procedures in appropriate patients.
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Affiliation(s)
- S Duca
- Training Center in Laparoscopic Surgery, Romanian Society of Laparoscopic Surgery, Cluj, Romania
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Puia IC, Vlad L, Iancu C, Munteanu D, Bălă O, Pop F, Al-Hajjar N, Radu H, Osian G, Necula A, Molnar G, Graur F, Furcea L, Zdrehuş R. [Laparoscopic antireflux surgery--long-term results]. Chirurgia (Bucur) 2008; 103:171-174. [PMID: 18457094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
METHOD AND MATERIAL Between 1995 and 2005 a number of 98 antireflux laparoscopic procedures have been performed. The patients have answered to a 7 point questionnaire regarding the disappearance of specific gastro-esophageal symptoms, the necessity of medical adjuvant treatment as well as regarding the measure in which surgery brought a real subjective improvement. The average follow-up was 57 months (4.7 years). RESULTS 43 laparoscopic patients have answered the questions. 10 patients had dysphagia, most of which had a spontaneous remission. Only 3 of those patients needed an endoscopic dilatation. Bloating was still possible for 33 of the patients. Retrosternal pain remained present for 14 patients. Intestinal transit disorders have showed up in 11 cases. Reflux persisted at a variable degree in 12 patients. Only 7 patients continue to follow a systematic drug treatment. 35 patients consider that the surgery has brought an improvement of their disease.
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Affiliation(s)
- I C Puia
- Clinica Chirurgie III, UMF Iuliu Haţieganu Cluj-Napoca, Romania.
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18
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Iancu C, Osian G, Mocan L, Mocan T, Zaharie F, Todea-Iancu D, Bălă O, Bodea R, Al-Hajjar N, Pop F, Puia IC, Graur F, Munteanu D, Vlad L. [Management of colorectal resections for treatment of neoplastic intestinal occlusions. Experience of surgery clinic No III, Cluj-Napoca]. Chirurgia (Bucur) 2008; 103:45-51. [PMID: 18459496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE We analyzed the clinical results of different techniques of resection for malignant colorectal (primary or staged) obstruction. METHODS The subjects of this retrospective nonrandomized clinical study were 165 patients with malignant colorectal occlusion who underwent surgery treatment in our Department between 2002-2006. Patients with peritonitis or treated by means of permanent colostomy, palliative anastomosis, primary Hartman resection and rectal excision were excluded. RESULTS Patients with large bowel obstruction caused by obstructive malignant colorectal lesions underwent either one-stage primary resection with anastomosis (77 patients) or staged interventions (88 patients). There were no differences in age, sex, comorbidities, tumor staging, serum preoperative levels of hemoglobin and proteins between the two groups of patients defined by the different surgical techniques. Regarding mortality and morbidity following surgical treatment for large bowel obstruction no significant difference among the two groups (p > 0.05) or the fistula rate (p = 0.435) was obtained. Moreover, results showed a higher incidence of mortality (11.8% vs 7.8%), morbidity (13.6 vs 10.4) and increased hospitalization period (p = 0.03) among the patients that undergone series resections. CONCLUSIONS One stage primary resections with anastomosis of the large bowel can be performed safely in case of emergency whenever patient comorbidities and local conditions do not stand as major restrictions.
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Affiliation(s)
- C Iancu
- Clinica Chirurgie 3, Spital Clinic de Adulţi, Cluj-Napoca
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Puia IC, Vlad L, Iancu C, Al-Hajjar N, Pop F, Bălă O, Munteanu D. [Laparoscopic cholecystectomy for porcelain gallbladder]. Chirurgia (Bucur) 2005; 100:187-9. [PMID: 15957463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The porcelain gallbladder is uncommon type of chronically inflamed gallbladder wall considered to be associated with a high frequency of adenocarcinoma and subsequently not suitable for a laparoscopic approach. In 12,000 patients chosen for a laparoscopic cholecystectomy 4 porcelain gallbladders were diagnosed. In 2 cases the laparoscopic approach was successful. One conversion was due to an unconfirmed suspicion of gallbladder cancer and the other one to a fistula between the gallbladder and the common bile duct. Patients with a preoperative diagnosis of porcelain gallbladder must not be excluded from the laparoscopic approach yet a low threshold for conversion must be maintained in those with a cancer suspicion.
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Affiliation(s)
- I C Puia
- Universitatea de Medicină şi Farmacie Iuliu Haţieganu, Cluj-Napoca, România
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Puia IC, Vlad L, lancu C, Al-Hajjar N, Pop F, Bălă O, Munteanu D. [Hepatic hydatid cyst ruptured in the peritoneum]. Chirurgia (Bucur) 2004; 99:541-4. [PMID: 15739672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Romania is an endemic region for hydatid cyst and has a high incidence of hepatic hydatid cysts. If the intrabiliary rupture is the most frequent complication encountered, rupture in the peritoneum is rare, with exact data not available. Between 1993-2002 160 patients with hepatic hydatid cysts were operated. Six of them had an intraperitoneal ruptured cyst. Ultrasound raised the suspicion of hepatic hydatid cyst ruptured in the peritoneum in 4 cases, in one case the intact cyst migrated in the lower abdomen were it was mistaken for an ovarian cyst. After a thorough lavage with hypertonic serum, the parasite was evacuated, the pericyst partially removed and the cavity collapsed with non-absorbable sutures. The postoperative course was uneventful. Prophylaxis with benzimidazolic drugs started days 2-3 PO. At a follow-up between 1-4 years no peritoneal hydatidosis was detected. In the intraperitoneal ruptured hydatid cyst the hypertonic serum and benzimidazolic drugs can be useful in preventing peritoneal seedings.
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Affiliation(s)
- I C Puia
- Clinica Chirurgie III, U.M.F Iuliu Hatieganu, Cluj-Napoca
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Duca S, Al-Hajjar N, Graur F, Bâlă O, Indoitu G. [Laparoscopic management of Meckel's diverticulum]. Chirurgia (Bucur) 2004; 99:233-6. [PMID: 15560559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
We present our observations on two young patients with repeated digestive bleeding from hemorrhagic Meckel's diverticulum. In one patient examined by Tc99 scintigraphy, the hemorrhagic area was shown in the lower abdomen. The laparoscopic exploration showed the Meckel's diverticulum at 1 m distance from ileocecal angle. Both cases were treated by resection with a vascular stapler postoperative evolution was favorable.
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Affiliation(s)
- S Duca
- Centrul de Instruire Laparoscopică A SRCL Cluj-Napoca
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Abstract
BACKGROUND Even though laparoscopic cholecystectomy (LC) has become the customary method for treating gallstones, some incidents and complications appear rather more frequently than with the open technique. Several aspects of these complications and their treatment possibilities are analysed. MATERIALS AND METHODS Over the last 9 years 9542 laparoscopic cholecystectomies have been performed, of which 13.9% were carried out for acute cholecystitis, 38.4% in obese patients and 7.6% in patients aged > 65 years. RESULTS The main postoperative complications were bile leakage and choleperitoneum (54 cases), haemorrhage (15 cases), subhepatic abscess (10 cases) and retained bile duct stones (11 cases). Classic re-interventions were practiced in 28.8% of cases with complications. Mini-invasive techniques were used in 42.2% of cases with complications: laparoscopic re-interventions (15 cases) for choleperitoneum, haemoperitoneum and subhepatic abscess and endoscopic sphincterotomy (22 cases) for prolonged bile leak on subhepatic drain and for early diagnosed remnant lithiasis of the common bile duct. All cases healed. Another 26 patients were treated conservatively. DISCUSSION With a precise diagnosis and a good indication, the mini-invasive treatment of complications was completed with good results. 16 laparoscopic re-operations and 22 endoscopic sphyncterotomies were performed (for the treatment of bile leakage and remnant gallbladder stones).
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Affiliation(s)
- S Duca
- The Training Center in Laparoscopic Surgery of the Romanian Society of Laparoscopic Surgery, Cluj, Romania
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Duca S, Bãlã O, Al-Hajjar N, Lancu C, Puia IC, Munteanu D, Graur F. Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations. HPB (Oxford) 2003; 5:152-8. [PMID: 18332976 PMCID: PMC2020579 DOI: 10.1080/13651820310015293] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Even though laparoscopic cholecystectomy (LC) has become the customary method for treating gallstones, some incidents and complications appear rather more frequently than with the open technique. Several aspects of these complications and their treatment possibilities are analysed. MATERIALS AND METHODS Over the last 9 years 9542 LCs have been performed at this centre, of which 13.9% were carried out for acute cholecystitis, 38.4% in obese patients and 7.6% in patients aged >65 years. RESULTS The main operative incidents encountered were haemorrhage (224 cases, 2.3%), iatrogenic perforation of the gallbladder (1517 cases, 15.9%) and common bile duct (CBD) injuries (17 cases, 0.1%). Conversion to open operation was necessary in 184 patients (1.9%), usually due to obscure anatomy as a result of acute inflammation. The main postoperative complications were bile leakage (54 cases), haemorrhage (15 cases), sub-hepatic abscess (10 cases) and retained bile duct stones (11 cases). Ten deaths were recorded (0.1%). DISCUSSION Most of the postoperative incidents (except bile duct injuries) were solved by laparoscopic means. Among patients with postoperative complications 28.9% required revisional surgery. In 42.2% of cases minimally invasive procedures were used successfully: 15 laparoscopic re-operations (for choleperitoneum, haemoperitoneum and subhepatic abscess) and 22 endoscopic sphincterotomies (for bile leakage from the subhepatic drain and for retained CBD stones soon after operation). The good results obtained allow us to recommend these minimally invasive procedures in appropriate patients.
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Affiliation(s)
- S Duca
- Training Center in Laparoscopic Surgery, Romanian Society of Laparoscopic Surgery, Cluj, Romania
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Al-Hajjar N, Graur F, Hassan AB, Molnár G. Splenic abscesses. Rom J Gastroenterol 2002; 11:57-9. [PMID: 12096316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Splenic abscesses are rare entities (autopsy incidence between 0.14-0.7%). The most frequent etiology is the septic emboli seeding from bacterial endocarditis (about 20% of cases) or other septic foci (typhoid fever, malaria, urinary tract infections, osteomielitis, otitis). The treatment of splenic abscesses was until recently splenectomy with antibiotherapy. The actual trends are more conservative (mini invasive or non-invasive) because the immunologic role of the spleen has been better understood over the last year
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Affiliation(s)
- Nadim Al-Hajjar
- 3rd Surgical Clinic, University of Medicine and Pharmacy, Cluj-Napoca, Romania
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