16 research outputs found

    Surgical treatment of duodenal ulcer

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    The Role of Preoperative Computer Simulation in Prediction of Dehiscence after Gastric Resection

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    UVOD: Popuštanje šava na duodenalnom patrljku nakon Billroth II želudačne resekcije je oduvek smatrano teškom postoperativnom komplikacijom pa ipak do danas ne postoji kompletna studija koja bi precizno kvantifikovala uticaj svakog od faktora koji mogu dovesti do ove komplikacije. METODE: Rad predstavlja kombinaciju eksperimentalne studije na materijalu animalnog porekla in vitro i matematičkog modeliranja na osnovu podataka dobijenih merenjima. Originalna hardverska i softverska oprema je korišćena za merenje intraluminalnog pritiska u duodenalnom patrljku nakon Billroth II resekcije želuca. Laboratorijska ispitivanja su vršena na materijalima animalnog porekla. Interaktivan, trodimenzionalni kompjuterski model, zasnovan na DICOM MSCT podacima je korišćen za simulaciju mehaničkog odgovora dvanaestopalačnog creva pod dejstvom pritiska i omogućavanje uvida u deformaciono-naponsko stanje tkiva, korišćenjem metode konačnih elemenata. REZULTATI: Eksperimentalni rezultati dobijeni laboratorijskim merenjima na materijalu životinjskog porekla kao i rezultati kompjuterske simulacije ukazuju da je povećan pritisak u aferentnoj vijuzi dominantan, ali ne i jedini faktor koji vodi popuštanju šava. Geometrija rekonstruisanog gastrointestinalnog trakta nakon želudačne resekcije je presudna za raspodelu pritiska. Analiza distribucije pritisaka kao i transfera fluida je pokazala da je pritisak najveći upravo u regiji šavne linije. Cilj jebio precizno kvantifikovati nivo intraluminalnog pritiska u duodenumu u stanjima nakon resekcije želuca, koji kao dominantni etiološki činilac vodi popuštanju šava duodenalnog patrljka. ZAKLjUČAK: - Metodologija predstavljena u ovoj studiji je pacijent-specifična, personalizovana i predstavlja vid individualizacije hirurške terapije, analogno onome što se primenjuje u drugim granama medicine, ponajviše u onkologiji. - Individualizovana preoperativna kompjuterska simulacija može dati hirurgu korisne smernice prilikom planiranja hirurške intervencije prilagođene svakom pacijentu ponaosob - Može biti korišćena za teoretska razmatranja u smislu da da hirurgu uopštene sugestije u cilju bezbednijeg izvođenja hirurške intervencije. - Može biti korišćena za edukaciju - Billroth II želudačna resekcija korišćenjem omega vijuge jeunuma ima nedostatak kada se uzme u obzir povišen intraluminalni pritisak u dovodnoj vijuzi, koji u korelaciji sa ostalim faktorima rizika može dovesti do sindroma aferentne vijuge i sledstvenog popuštanja šava na duodenalnom patrljku, te su u tom smislu neke druge vrste rekonstrukcije, tipa Roux en Y, bezbednije - Ukoliko se hirurg odluči za izvođenje ovog tipa rekonstrukcije opisana metodologija i preoperativna kompjuterska simulacija mogu minimizirati rizik od nastanka dehiscencije, kao i od hroničnih komplikacija uzrokovanih duodenalnom hipertenzijomINTRODUCTION: Duodenal stump dehiscence after Billroth II gastric resection has always been considered as a serious postoperative complication and yet to date there is no complete study to accurately quantify the impact of each of the factors that can lead to this complication. METHODS: This paper presents a combination of experimental study on materials of animal origin in vitro and mathematical modeling based on measurement data. The original hardware and software equipment were used for measuring the intraluminal pressure in the duodenal stump after Billroth II gastrectomy. Laboratory tests were carried out on materials of animal origin. Interactive, three-dimensional computer model, based on DICOM data MSCT was used to simulate the mechanical response of the duodenal wall under the influence of pressure and allowedinsightinto strain-stress state of tissue, using the finite element method. RESULTS: The experimental results obtained by laboratory measurements on materials of animal origin and the results of computer simulations indicated that the increased pressure in afferent limb was dominant, but not the only factor leading to suture disruption. The geometry of the reconstructed gastrointestinal tract after gastric resection is crucial for the distribution of pressure. Analysis of the pressure distribution as well as the transfer of fluids showed that the pressure is greatest in the region of suture. The goal was to precisely quantify the level of intraluminal pressure in the duodenum in conditions after resection of the stomach, which as the dominant etiological factor leadedto duodenal stump dehiscence. CONCLUSION: - The methodology presented in this study is a patient-specific, personalized and represents a form of individualization surgical treatment, analogous to that which applies in other branches of medicine, primarily in oncology. - Individualized preoperative computer simulation can provide useful guidance for the surgeon when planning surgical interventions tailored to each patient individually - It can be used for theoretical considerations in order to give surgeon general suggestionshow to perform a safer surgery. - It can be used for education. - Billroth II gastric resection using omega loop of jejunum has the disadvantage when taking into account the increased intraluminal pressure in the afferent limb, which in correlation with other risk factors can lead to a afferent limb syndrome and the consequent suture dehiscence of the duodenal stump, and in this sense some other types of reconstruction, as Roux en Y type, is safer. - If the surgeon decides to perform this type of reconstruction described methodology and preoperative computer simulation can minimize the risk of dehiscence and/or chronic complications of duodenal hypertension

    Examination the role of C reactive protein as an early predictor of the wound line dehiscence in various types of reconstruction in elective abdominal surgery

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    abdominalnoj hirurgiji, najvažniji i najčešći operativni zahvat predstavlja resekcija obolelog segmenta sa istovremenom anastomozom presečenih krajeva u svrhu uspostavljanja intestinalnog kontinuiteta. Najvažnije za uspeh operativnog lečenja je uspešno zarastanje intestinalne anastomoze. U pokušaju ranog otkrivanja njenog neuspešnog zarastanja ispitivani su različiti biomarkeri među kojima i C reaktivni protein (CRP). CILJ: Ispitivanje uloge CRP-a u predikciji problematičnog zarastanja šavne linije na digestivnim anastomozama u prvoj nedelji posle operacije. METOD: Istraživanje je obuhvatilo 100 pacijenata obolelih od benigne i maligne bolesti digestivnog trakta, koji su hirurški lečeni na Klinici za hirurgiju Kliničko Bolničkog Centra Zvezdara, u Beogradu, u periodu od 2014. do 2015.godine. U postoperativnom toku merene su vrednosti CRP-a, leukocita i telesne temperature i njihove vrednosti praćenje u odnosu na razvoj svih postoperativnih komplikacija. REZULTATI: Pacijenti sa komplikacijama u postoperativnom toku imali su više vrednosti leukocita svakoga dana počevši od trećeg postoperativnog dana u odnosu na pacijente koji nisu imali komplikacije, iako njihova vrednost nije značajno prelazila referentne vrednosti. Beležeći postoperativnu visinu telesne temperature, značajno više prosečne vrednosti imali su pacijenti sa dehiscencijom anastomoze III, V i VI postoperativnog dana u odnosu na pacijente koji nisu imali komplikacije iako srednja vrednost nije nije značajno prelazila 37C. Vrednosti CRP-a II PO dana skoro 9 puta su veće od preoperativnih kod pacijenata koji nemaju postoperativne komplikacije, a 14 puta veće kod pacijenata koji su ih imali. ZAKLJUČAK: Određivanje postoperativnih vrednosti CRP-a može da ukaže na problematično zarastanje anastomoze na digestivnom traktu pre pojave kliničkih znakova.In abdominal surgery, the most important and most common surgical procedure is the resection of the diseased segment with simultaneous anastomosis of the cut ends for the purpose of establishing intestinal continuity. The most important for the success of operative treatment is successful healing of intestinal anastomosis. In the attempt of early detection of its unsuccessful healing, various biomarkers were studied, among them C reactive protein (CRP). OBJECTIVE: Testing the role of CRP in the prediction of problematic healing of the wound line on digestive anastomosis in the first week after surgery. METHOD: The study included 100 patients with benign and malignant digestive tract diseases, who were surgically treated at the Clinic for Surgery at the Clinical Hospital Center Zvezdara in Belgrade in the period from 2014. to 2015. In the postoperative course, the values of CRP, leukocyte and body temperature and their values were measured in relation to the development of all postoperative complications. RESULTS: Patients with complications in the postoperative course had more leukocyte values every day starting from the third postoperative day compared to patients who did not have complications, although their value did not significantly exceed the reference values. By recording the postoperative height of body temperature, significantly more average values had patients with dehiscence of anastomosis III, V, and VI postoperative days compared to patients who did not have complications, although the mean did not significantly exceed 37C. The values of CRP on the second postoperative day are almost 9 times greater than preoperative in patients who have no postoperative complications and 14 times greater in patients who had them. CONCLUSION: Determination of postoperative values of CRP can indicate a problematic healing of digestive tract anastomosis before the appearance of clinical signs

    Volume 21, issue 1

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    The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research. Visit the journal website at http://canjsurg.ca/ for more.https://ir.lib.uwo.ca/cjs/1152/thumbnail.jp

    Recent Advances in Laparoscopic Surgery

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    The implementation of laparoscopy has revolutionized surgery over the past few years, incorporating significant benefits for the patient. However, this evolution has also entailed many technical obstacles for surgeons. This book is for readers wanting to learn more about recent surgical techniques and technologies. Topics cover novel sophisticated approaches for single-site surgery, natural orifice transluminal endoscopic surgery, and transanal surgery, among others. Also included are reviews of new innovative surgical devices, robotic platforms, and methodological guidelines for improving surgical performance and surgeon ergonomics

    Volume 09, issue 1

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    The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research. Visit the journal website at http://canjsurg.ca/ for more.https://ir.lib.uwo.ca/cjs/1078/thumbnail.jp

    Volume 29, issue 6

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    The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research. Visit the journal website at http://canjsurg.ca/ for more.https://ir.lib.uwo.ca/cjs/1213/thumbnail.jp

    Hepatic Surgery

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    Longmire, called it a "hostile" organ because it welcomes malignant cells and sepsis so warmly, bleeds so copiously, and is often the ?rst organ to be injured in blunt abdominal trauma. To balance these negative factors, the liver has two great attributes: its ability to regenerate after massive loss of substance, and its ability, in many cases, to forgive insult. This book covers a wide spectrum of topics including, history of liver surgery, surgical anatomy of the liver, techniques of liver resection, benign and malignant liver tumors, portal hypertension, and liver trauma. Some important topics were covered in more than one chapter like liver trauma, portal hypertension and pediatric liver tumors
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