Current Issue : July - September Volume : 2017 Issue Number : 3 Articles : 6 Articles
Background/Aim. Hirschsprung�s disease (HD) has a skewed gender distribution, with a female to male ratio of 1 : 4. This study\naims to examine differences between boys and girls with HD regarding preoperative features and postoperative treatment and\noutcome. Method.The first part of the study was conducted as a retrospective review of all HD patients who underwent transanal\nendorectal pull-through (TERPT). Pre-, peri-, immediate post-, and first-year postoperative data were collected. The second part\nwas conducted as an observational cross-sectional study by comparing bowel function scores (BFS) determined by structured\ninterviews of patients 4 years old and older. Results. Included were 39 boys and 12 girls. Of these, 25 boys and 9 girls were older than\n4 years and participated in the BFS interview. Boys had a higher frequency of hospitalizations during the first postoperative year\ncompared to girls (...
The laser speckle contrast imaging (LSCI) is proved to be a reliable tool in flap monitoring in general surgery; however, it has not\nbeen evaluated in oral surgery yet.We applied the LSCI to compare the effect of a xenogeneic collagen matrix (GeistlichMucograft)\nto connective tissue grafts (CTG) on the microcirculation of themodified coronally advanced tunnel technique (MCAT) for gingival\nrecession coverage. Gingival microcirculation and wound fluid were measured before and after surgery for six months at twentyseven\ntreated teeth. In males, the flap microcirculation was restored within 3 days for both grafts followed by a hyperemic response.\nDuring the first 8 days the blood flow was higher at xenogeneic graft comparing to the CTG. In females, the ischemic period lasted\nfor 7ââ?¬â??12 days depending on the graft and no hyperemic response was observed. Females had more intense and prolonged wound\nfluid production. The LSCI method is suitable to capture the microcirculatory effect of the surgical intervention in human oral\nmucosa. The application of xenogeneic collagen matrices as a CTG substitute does not seem to restrain the recovery of graft bed\ncirculation. Gender may have an effect on postoperative circulation and inflammation....
Background: Endoscopic axillary lymphadenectomy (EALND) was introduced to clinical work to reduce side effects\nof conventional axillary lymphadenectomy, while the lipolysis and liposuction of EALND made the process consume\nmore time. The aim of the study was to determine whether immediate liposuction after tumescent solution\ninjection to the axilla could shorten the total time of EALND.\nMethods: Fifty-nine patients were enrolled in the study, 30 of them received EALND with traditional liposuction\nmethod (TLM), and the rest 29 patients received EALND with immediate liposuction method (ILM). The operation\ntime, cosmetic result, drainage amount, and hospitalization time of the two groups were compared.\nResults: The median EALND operation time of TLM group and ILM group were 68 and 46 min, respectively, the\ndifference was significant (P < 0.05); the median cosmetic results of the two groups were 6.6 and 6.4, respectively;\nthe median drainage amount of the two groups were 366 and 385 ml, respectively; the hospitalization time of\nthe two groups were 15 and 16 days, respectively. For the last three measures, no significant difference was\nconfirmed (P > 0.05).\nConclusions: Our work suggests immediate liposuction could shorten the endoscopic axillary lymphadenectomy\nprocess, and this method would not compromise the operation results. However, due to the limitations of the\nresearch, more work needs to be done to prove the availability and feasibility of immediate liposuction....
Background: Laparoscopic surgery has been performed less frequently in the era of pancreatic cancer due to\ntechnical difficulties and concerns about oncological safety. Radical antegrade modular pancreatosplenectomy\n(RAMPS) is expected to be helpful to obtain a negative margin during radical lymph node dissection. We\nhypothesized that it would also be favorable as a laparoscopic application due to unique features.\nMethods: Fifteen laparoscopic RAMPS for well-selected patients with left-sided pancreatic cancer were performed\nfrom July 2011 to April 2016. Five trocars were usually used, and the operative procedures and range of dissection\nwere similar to or the same as those of open RAMPS described by Strasberg. All medical records and follow-up data\nwere reviewed and analyzed.\nResults: All patients had pancreatic ductal adenocarcinoma. Mean operative time was 219.3 �± 53.8 min, and\nestimated blood loss was 250 �± 70 ml. The length of postoperative hospital stay was 6.1 �± 1.2 days, and\npostoperative morbidities developed in two patients (13.3%) with urinary retention. The median number of\nretrieved lymph nodes was 18.1 �± 6.2 and all had negative margins. Median follow-up time was 46.0 months, and\nthe 3-year disease free survival and overall survival rates were 56.3% and 74.1%, respectively.\nConclusion: Our early experience with laparoscopic RAMPS achieved feasible perioperative results accompanied by\nacceptable survival outcomes. Laparoscopic RAMPS could be a safe and oncologically feasible procedure in wellselected\npatients with left-sided pancreatic cancer....
Background: Spinal canal tumors are difficult to diagnose and treat. The traditional\nsurgical approaches for attempting a complete excision of these lesions\nfrequently involve big incisions and tissue dissection with high risk of\npostop instability and cerebrospinal fluid leakage. Also, there is a risk of neurological\nworsening, sometimes irreversible. Methods: We present our experience\nin a patient series with spinal canal tumors and describe the surgical approach\nwith minimally invasive techniques (MIS). All of them were performed by the\nNeurosurgery team of the Hospital Universitario San Ignacio during the period\nof 2011-2016. Results: We reviewed forty patients with spinal canal tumors\nsurgically treated with MIS techniques. 15 patients (37.5%) had Meningioma\ndiagnosis (complete resection in 11 (73.3%), subtotal in 3 (20%) and biopsy in\none patient), 10 patients (25%) with Schwannomas reached complete resection\nin 70% and subtotal in 30%. 5 patients had spinal cord metastasis, with complete\nresection in 4 patients (80%) and subtotal in 1 (20%). Other included\nependymoma, astrocytoma, and miscellaneous. No patient has had cerebrospinal\nfluid leakage and no postoperative fusion has been required. Conclusions:\nThe minimally invasive approach allowed complete tumors removal in a high\nnumber of patients and good postoperative results. These findings are similar\nand in some cases, better than the reported with traditional techniques. This\nMIS technique provides encouraging results. It requires a wide learning curve\nand a high degree of surgical experience....
Background: Restrictive intraoperative fluid management is increasingly recommended for patients undergoing\nesophagectomy. Controversy still exists about the impact of postoperative fluid management on perioperative outcome.\nMethods: We retrospectively examined 335 patients who had undergone esophagectomy for esophageal cancer at the\nUniversity Hospital Freiburg between 1996 and 2014 to investigate the relation between intra- and postoperative fluid\nmanagement and postoperative morbidity after esophagectomy.\nResults: Perioperative morbidity was 75%, the in-hospital mortality 8%. A fluid balance above average on the operation\nday was strongly associated with a higher rate of postoperative mortality (21% vs 3%, p < 0.001) and morbidity (83% vs\n66%, p = 0.001). Univariate analysis for risk factors for adverse surgical outcome (Clavien � III) identified ASA-score\n(p = 0.002), smoking (p = 0.036), reconstruction by colonic interposition (p = 0.036), cervical anastomosis (p = 0.017),\nblood transfusion (p = 0.038) and total fluid balance on the operation day and on POD 4 (p = 0.001) as risk factors.\nMultivariate analysis confirmed only ASA-score (p = 0.001) and total fluid balance (p = 0.001) as independent predictors of\nadverse surgical outcome.\nConclusion: Intra- and postoperative fluid overload is strongly associated with increased postoperative morbidity. Our\nresults suggest restrictive intra- and especially postoperative fluid management to optimize the outcome after\nesophagectomy....
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