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Augustin G, Bruketa T, Kunjko K, Romić I, Mikuš M, Vrbanić A, Tropea A. Colonic gallstone ileus: a systematic literature review with a diagnostic-therapeutic algorithm. Updates Surg 2023:10.1007/s13304-023-01537-0. [PMID: 37209317 DOI: 10.1007/s13304-023-01537-0] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 05/10/2023] [Indexed: 05/22/2023]
Abstract
Rare complication of gallstone disease is gallstone ileus. The common location is the small intestine, followed by the stomach. The rarest location is colonic gallstone ileus (CGI). To summarize and define the most appropriate diagnostic methods and therapeutic options for CGI based on the paucity of published data. Literature searches of English-, German-, Spanish-, Italian-, Japanese-, Dutch- and Portuguese language articles included and Italian-language articles using PubMed, EMBASE, Web of Science, The Cochrane Library, and Google Scholar. Additional studies were identified from the references of retrieved studies. 113 cases of CGI were recorded with a male to female patient ratio of 1:2.9. The average patient age was 77.7 years (range 45-95 years). The usual location of stone impaction was the sigmoid colon (85.8%), followed by a descending colon (6.6%), transverse colon (4.7%), rectum (1.9%), and lastly, ascending colon (0.9%). Gallstones ranged from 2 to 10 cm. The duration of symptoms was variable (1 day to 2 months), with commonly reported abdominal distension, obstipation, and vomiting; 85.2% of patients had previous biliary symptoms. Diverticular disease was present in 81.8% of patients. During the last 23 years, CT scan was the most common imaging method (91.5%), confirming the ectopic gallstone in 86.7% of cases, pneumobilia in 65.3%, and cholecytocolonic fistula in 68%. The treatment option included laparotomy with cololithotomy and primary closure (24.7%), laparotomy and cololithotomy with diverting stoma (14.2%), colonic resection with anastomosis (7.9%), colonic resection with a colostomy (12.4%), laparoscopy with cololithotomy with primary closure (2.6%), laparoscopy with cololithotomy with a colostomy (0.9%), colostomy without gallstone extraction (5.3%), endoscopic mechanical lithotripsy (success rate 41.1%), extracorporeal shock wave lithotripsy (1.8%). The cholecystectomy rate was 46.7%; during the initial procedure 25%, and as a separate procedure, 21.7%; 53.3% of patients had no cholecystectomy. The survival rate was 87%. CGI is the rarest presentation of gallstone ileus, mainly in women over 70 years of age, with gallstones over 2 cm, and predominantly in the sigmoid colon. Abdominal CT is diagnostic. Nonoperative treatment, particularly in subacute presentations, should be the first-line treatment. Laparotomy with cololithotomy or colonic resection is a standard procedure with favorable outcomes. There are no robust data on whether primary or delayed cholecystectomy is mandatory as a part of CGI management.
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Affiliation(s)
- Goran Augustin
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tomislav Bruketa
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Kristian Kunjko
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ivan Romić
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mislav Mikuš
- Department of Gynecology and Obstetrics, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
| | - Adam Vrbanić
- Department of Gynecology and Obstetrics, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Alessandro Tropea
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT, University of Pittsburgh Medical Center, Palermo, Italy
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Bruketa T, Augustin G, Staroveški T, Klaić M, Brezak D, Capak H, Dobrić I. Distribution of coolant during drilling with open type internally cooled medical steel drill. Injury 2021; 52 Suppl 5:S32-S37. [PMID: 32958340 DOI: 10.1016/j.injury.2020.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/16/2020] [Accepted: 09/15/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Internally cooled bone drills with an open system, conduct coolant directly to the point of contact of cutting surface of the drill and the bone and lower the temperature at the drilling site. During bone drilling with internally cooled drills of open type, there is a possibility that coolant enters the intramedullary canal and has an adverse effect on intramedullary pressure. In this research, the intramedullary distribution of the coolant during and after drilling was analyzed. MATERIALS AND METHODS Specially constructed open type internally cooled medical steel drills were used. Experimental studies were conducted on the porcine femoral bone diaphysis. Coolant (saline) was mixed with water-soluble contrast agent and x-ray images of the distribution of coolant during and after drilling were taken with different regimes of drilling (drill rotational speed from 1300 rpm to 5000 rpm, and coolant flow rate from 0,6 l/min to 1,35 l/min). RESULTS An x-ray images showed that coolant did not spread from the borehole and has not spread intramedullary with any combination of coolant flow and drill rotation regimes. CONCLUSION Coolant does not disperse into the intramedullary canal outside of the borehole in given flow ranges (0,6-1,35 l/min) and drill rotational speed regimes (1300-5000 rpm). Open type internally cooled can safely be used for bone drilling.
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Affiliation(s)
- Tomislav Bruketa
- Department of Surgery, University Hospital Centre Zagreb and School of Medicine University of Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia.
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb and School of Medicine University of Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia.
| | - Tomislav Staroveški
- Department of Technology, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, 10000, Zagreb.
| | - Miho Klaić
- Department of Technology, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, 10000, Zagreb.
| | - Danko Brezak
- Department of Technology, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, 10000, Zagreb.
| | - Hrvoje Capak
- Department of Radiology, Ultrasound Diagnostic and Physical Therapy, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova 55, 10000 Zagreb, Croatia.
| | - Ivan Dobrić
- Department of Surgery, University Hospital Centre Zagreb and School of Medicine University of Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia.
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Romic I, Augustin G, Bogdanic B, Bruketa T, Moric T. Laser treatment of pilonidal disease: a systematic review. Lasers Med Sci 2021; 37:723-732. [PMID: 34291332 DOI: 10.1007/s10103-021-03379-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/13/2021] [Indexed: 12/14/2022]
Abstract
Pilonidal disease (PD) is a common condition, and there is still an ongoing debate on ideal management that should be minimally invasive, safe, and efficient. The use of radially emitting laser in the treatment of chronic PD is a novel minimally invasive technique, and initial studies with a small number of patients showed promising results. This study aimed to assess the efficacy and safety of chronic PD treatment with a laser using a systematic review of the published literature. A systematic review was conducted after PubMed, Scopus, Embase, Web of Science, and the Cochrane database search for studies reporting laser treatment of chronic PD. Also, our unpublished prospective single-center study was included in this review. Ten of 87 studies were eligible for the review, including 971 patients. The median age of the patients was 26 (range 13-68), and the median operative time was 26 (range 6-65) min. With a median follow-up of 12 (range 7-25) months, 917 (94.4%) patients achieved primary healing with a weighted mean recurrence rate of 3.8%. The weighted mean complication rate was 10% (95% CI 5.7-14.3%, I2 = 82.28, p < 0.001), and all were minor. The published literature demonstrates that laser treatment is a promising procedure in the management of chronic PD. Furthermore, the review showed that standardized operative techniques and perioperative steps were used. The results were limited to the mild chronic PD. Classification of PD severity and standardized outcome reporting is required to define indications and contraindications for laser PD treatment. Randomized controlled trials are needed to determine the long-term effectiveness and superiority of laser treatment over other methods.
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Affiliation(s)
- Ivan Romic
- Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10 000, Zagreb, Croatia.
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10 000, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Branko Bogdanic
- Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10 000, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tomislav Bruketa
- Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10 000, Zagreb, Croatia
| | - Trpimir Moric
- Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10 000, Zagreb, Croatia
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Bruketa T, Augustin G, Pintarić S, Šeol-Martinec B, Dobrić I, Bakota B. Pilot study: Internally cooled orthopedic drills - standard sterilization is not enough? Acta Clin Croat 2019; 58:379-385. [PMID: 31819337 PMCID: PMC6884392 DOI: 10.20471/acc.2019.58.02.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/02/2018] [Indexed: 11/24/2022] Open
Abstract
Bone drilling causes focal temperature rise due to metal-to-bone contact, which may result in thermal osteonecrosis. Newly constructed internally cooled medical drill of an open type decreases temperature rise at a point of metal-to-bone contact although standard sterilization of such a drill could be inadequate due to bacteria retention within the drill lumen. The aim of this pilot study was to examine the effectiveness of sterilization and to propose sterilization recommendations for internally cooled open type bone drills. Unused internally cooled medical steel bone drills were tested. Drills were contaminated with Pseudomonas aeruginosa, Bacillus sp., beta-hemolytic Streptococcus sp., Enterobacter sp. and methicillin-resistant Staphylococcus pseudintermedius and then incubated for 24 hours at 37 °C. Afterwards, drills were autoclaved for 15, 20 and 30 minutes at 132 °C and 2.6 bar. When 15-minute sterilization was used, one out of 16 drills was contaminated with Pseudomonas aeruginosa, while the other 15 drills were sterile. Extended cycle sterilization in autoclave lasting for 20 and 30 minutes resulted in 100% sterility of all drills tested. In conclusion, lumened drills should be exposed to extended sterilization times in autoclave. Minimal recommended time for sterilization of lumened drills is 20 minutes.
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Domitran Z, Brezak D, Staroveski T, Klaic M, Bruketa T. Experimental and finite element analysis of surgical drill bits with and without irrigation channel - A case study approach. Med Eng Phys 2018; 62:29-35. [PMID: 30337053 DOI: 10.1016/j.medengphy.2018.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 09/24/2018] [Accepted: 10/07/2018] [Indexed: 10/28/2022]
Abstract
The aim of this study was to perform a finite element and experimental comparative analysis of the mechanical characteristics of surgical drill bits used in bone and joint surgery applications with and without an irrigation channel. Internally cooled drills are very efficient in maintaining the drilling temperature below the critical level. However, a cooling channel could potentially have a negative influence on the drill structure, particularly in the flutes zone. A commercially available type of surgical drill bit without irrigation channel and a modified variant with the built-in channel were simultaneously loaded with torque, axial and bending forces with magnitudes similar to and higher than those utilized in clinical practice. When loaded under the same conditions, both types of drills showed very similar mechanical properties in the sense of the average von Mises stress in chosen sections and the deflections after plastic deformation. The highest stress was observed in the bending zone which was located at the beginning of the flutes section of the drill. All analysed drills suffered only from plastic deformation without any breakage despite the fact that they were loaded with forces higher than those expected in normal operational conditions.
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Affiliation(s)
- Zoran Domitran
- Department of Design, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, I. Lucica 5, HR-10000 Zagreb, Croatia
| | - Danko Brezak
- Department of Robotics and Production Systems Automation, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lucica 5, HR-10000 Zagreb, Croatia.
| | - Tomislav Staroveski
- Department of Technology, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, I. Lucica 5, HR-10000 Zagreb, Croatia
| | - Miho Klaic
- Department of Technology, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, I. Lucica 5, HR-10000 Zagreb, Croatia
| | - Tomislav Bruketa
- University Hospital Centre Zagreb, Kispaticeva 12, HR-10000 Zagreb, Croatia
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Bruketa T, Majerovic M, Augustin G. Rectal cancer and Fournier’s gangrene - current knowledge and therapeutic options. World J Gastroenterol 2015; 21:9002-9020. [PMID: 26290629 PMCID: PMC4533034 DOI: 10.3748/wjg.v21.i30.9002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/08/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023] Open
Abstract
Fournier’s gangrene (FG) is a rapid progressive bacterial infection that involves the subcutaneous fascia and part of the deep fascia but spares the muscle in the scrotal, perianal and perineal region. The incidence has increased dramatically, while the reported incidence of rectal cancer-induced FG is unknown but is extremely low. Pathophysiology and clinical presentation of rectal cancer-induced FG per se does not differ from the other causes. Only rectal cancer-specific symptoms before presentation can lead to the diagnosis. The diagnosis of rectal cancer-induced FG should be excluded in every patient with blood on digital rectal examination, when urogenital and dermatological causes are excluded and when fever or sepsis of unknown origin is present with perianal symptomatology. Therapeutic options are more complex than for other forms of FG. First, the causative rectal tumor should be removed. The survival of patients with rectal cancer resection is reported as 100%, while with colostomy it is 80%. The preferred method of rectal resection has not been defined. Second, oncological treatment should be administered but the timing should be adjusted to the resolution of the FG and sometimes for the healing of plastic reconstructive procedures that are commonly needed for the reconstruction of large perineal, scrotal and lower abdominal wall defects.
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Budak AM, Škegro M, Majerović M, Smud D, Jelinčić Ž, Kinda E, Kekez T, Augustin G, Silovski H, Matošević P, Bruketa T. [First synchronous liver resection as a part of cytoreductive surgery, peritonectomy and HIPEC in Croatia--case report]. Lijec Vjesn 2015; 137:87-90. [PMID: 26065285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We present a case of a 37-year-old female, with large adenocarcinoma of transverse colon, and metastases in spleen, liver, peritoneum, greater omentum, gall bladder and right adnexa. She was transferred to our Hospital, and extensive elective cytoreductive surgery with intraabdominal hyperthermal chemotherapy (HIPEC) was performed. Couple of months later, she was operated on for a newly evidenced secondary nodus in liver segment VII, and metastasectomy was performed. Throughout entire postoperative period she was receiving cyclic chemotherapy. At this point, 2 years from the first operation, she was without evidenced recurrence of the disease. Aggressive cytoreductive surgery with multiorgan resection, peritonectomy, HIPEC and adjuvant chemotherapy which was proved to be a feasible option in some patients, with synchronous liver resection (LR) proved to be feasible and beneficial for patients with three or fewer liver metastases. This is the first liver resection included in usually performed cytoreductive surgery and HIPEC in Croatia.
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Augustin G, Bruketa T, Korolija D, Milosevic M. Lower incidence of hepatic metastases of colorectal cancer in patients with chronic liver diseases: meta-analysis. Hepatogastroenterology 2014; 60:1164-8. [PMID: 23803379 DOI: 10.5754/hge11561] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIMS The rarity of metastatic malignancy in injured liver has been noticed. This meta-analysis evaluates the difference in occurrence of metastatic colorectal cancer in healthy and chronically injured liver. METHODOLOGY Literature search of occurrence of metastatic colorectal cancer in chronically injured liver opposed to healthy liver was conducted. Chronically injured/damaged liver included cirrhosis, steatosis or fatty liver and infection with Hepatitis virus B or C. RESULTS A total of 7 retrospective studies between 1992 and 2010 matched the selection criteria with total of 4049 patients. Results suggest significantly lower incidence of colorectal metastasis in chronically injured liver (Pooled odds ratio = 0.260 (95% CI = 0.18 to 0.38); χ² (test odds ratio differs from 1) = 45.90 (df = 1); p <0.0001). CONCLUSIONS Patients with chronic liver injury have significantly lower occurrence of hepatic metastasis of primary colorectal cancer than the patients with healthy liver.
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