Conduct of duodenal traumatic lesions in toraco-abdominal traumatism

Catedra de chirurgie nr. 1 “Nicolae Anestiadi”, Universitatea de Stat de Medicină și Farmacie “Nicolae Testemitanu”, Chișinău, Republica Moldova, Spitalul Clinic de Urgență “Floreasca”, București, România, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Traumatismul toraco-abdominal se caracterizează prin gravitate aparte și politraumatism de organe a toracelui și abdomenului, urmată de greșeli de diagnostic 25-65% și letalitate înaltă, 20% se datorează leziunilor toracelui. Toracele cu organele adăpostite de importanță vitală pun în valoare gravitatea acestor leziuni în asociere cu abdomenul. Nu este precizat un algoritm diagnostico-curativ datorită polimorfismului, stării grave și caracterului lezional. Scopul: Analiza rezultatelor tratamentului leziunilor traumatice duodenale în cadrul traumatismului toraco-abdominal. Material și metode: Studiul include 21(100%) pacienți cu traumatism toraco-abdominal închis(TTAÎ) 13(62%), deschis(TTAD) 8(38%) cu implicarea duodenului. Bolnavii cu implicarea toracelui n=63 pacienți, restul cazuri implică alte sisteme. Bărbați-16(76,19%), femei-5(23,8%), vârsta 26-72ani. Mecanismul traumei: accident rutier-1(4,76%), catatrauma-3(14,28%), agresiune fizică-8(38,09%), sport-2(9,52%), armă albă-4(19,04%), armă de foc, explozie-3(14.28%); spitalizați<12ore 16(76,19%); ebrietate 8(38,09%), șoc 17(80,95%); examinați 15(71,42%): Rx.abdominală 7(38.33%). Rx.torace 10(47,61%), USG 9(42,85%), CT 1(4,76%), laparocenteză 3(14,28%), laparoscopie 3(14,28%), FEGDS 1(4,76%); operați<12ore15(71,42%); intraoperator: peritonită 6(28,57%), hemoperitoneum14(66.6%), hematom retroperitoneal12(57,14%), flegmon retroperitoneal 2(9,52%); D1-7(33.33%),D2- 15(71,42%),D3-6(25,57%),D4-0, leziuni asociate-4cazuri. Peretele: anterior-5(23,8%), posterior-6(25,57%), asociat-10(47,61%). Gr.I-8(38.9%), gr.II-7(33,33%), gr.III-0, gr.IV-3(14,28%), gr.V-3(14,28%). Torace: fracturi costale-11, unilateral-11, bilateral-1, hemotorace+pneumotorace-9, diafragm-4. Rezultate: Intraoperator s-a stabilit metoda, volumul și succesivitatea rezolvării prin raportul complexității și severității lezionale la starea pacientului și timpul scurs. Conduita a inclus succesivitatea măsurilor de rezolvare urgentă: toracocenteză(n=9), laparotomie(n=21) în ansamblu cu măsurile anti-șoc și restituire volemică. Complicații: 8-abdominale,4-pulmonare. În 9 cazuri (4-cazuri de fistule duodenale,5-fistule externe pancreatice) s-a recurs la operații repetate. Letalitatea generală-12(57,14%), legată de corecțiile duodenale-3(14,28%). Concluzii: Conduita pacienților cu traumatism toraco-abdominal este strict legată de gravitatea și complexitatea lezională și constă în utilizarea de urgență succesiv a măsurilor complexe anti-șoc, prioritar hemostază, toracocenteză, laparotomie.Background: Toraco-abdominal trauma is characterized by particular gravity and organ pluritraumatism of the thorax and abdomen, followed by 25-65% and high lethality rate, 20% due to thoracic lesions. Chest with organs housed with vital importance highlight the severity of these lesions in association with the abdomen. There is no cure diagnostic algorithm due to polymorphism, serious condition and lesional character. Aim of the study: Analysis of the results of the treatment of traumatic duodenal injuries in the thoraco-abdominal trauma. Methods and materials: The study includes 21(100%) patients with closed, 13(62%) open thoraco-abdominal trauma, 8(38%) with duodenal involvement. Patients with chest involvement n = 63, the remaining cases involve other systems. Men16(76.19%), women-5(23.8%), age 26-72 years. Trauma mechanism: Road accident 1(4.76%), catatrauma-3(14.28%), physical aggression-8(38.09%), sport-2(9.52%), knife injury 4(19.04%), firearm, explosion-3 (14.28%); hospitalized <12h 16(76.19%); inebriety 8(38.09%), shock 17(80.95%); examined 15(71.42%): abdominal Rx 7(38.33%), chest Rx 10(47.61%),USG 9(42.85%), CT1(4.76%), laparocentesis3(14.28%), laparoscopy 3(14.28%),gastroscopy 1 (4.76%); operated <12 h 15(71.42%), intraoperative: peritonitis 6(28.57%), hemo-peritoneum 14(66.6%), retroperitoneal hematoma12(57.14%), retroperitoneal-phlegmon 2(9.52%), D1- 7(33.33%),D2-15(71.42%),D3-6(25.57%),D4-0, associated lesions-4 cases. The wall: Previously 5(23.8%), Posterior 6(25.57%), Associate 10(47.61%). First degree 8(38.9%), II dg-7(33.33%), third degree-0 IV dg-3(14.28%),V dg-3(14.28% ). Chest: costal fractures 11, unilateral11, bilateral1, hemopneumothorax 9, diaphragm-4. Results: The method was established intraoperative, which depends on the volume, the complexity and severity of the lesion to the patient's condition and the elapsed time. Conduct included the succession of urgent resolving measures: thoracentesis 9, laparotomy 21 as a whole with anti-shock and volumetric rescue measures.8-abdominal complications,4-lung. In 9 cases (4 duodenal fistulas, 5 external pancreatic fistulas) repeated procedures were performed. Overall lethality 12(57.14%), correlated with duodenal corrections 3(14.28%). Conclusion: The algorithm of patients with thoraco-abdominal trauma is strictly related to lesion seriousness and complexity and consists in the successive use of complex anti-shock measures, in particular haemostasis, thoraco-concentration, laparotomy

Survival trends and complications in surgical interventions for colorectal cancer: an overview of patients hospitalized in Clinical Emergency Hospital Bucharect

The preoperative imaging diagnosis of rectal cancer lies at the heart of oncological staging and has a crucial influence on patient management and therapy planning. Rectal cancer is common, and accurate preoperative staging of tumors using high-resolution magnetic resonance imaging (MRI) is a crucial part of modern multidisciplinary team management (MDT). Indeed, rectal MRI has the ability to accurately evaluate a number of important findings that maBay impact patient management, including distance of the tumor to the mesorectal fascia, presence of lymph nodes, presence of extramural vascular invasion (EMVI), and involvement of the anterior peritoneal reflection/peritoneum and the sphincter complex. Many of these findings are difficult to assess in nonexpert hands. In this lecture, we present currently used staging modalities with focus on MRI, including optimization of imaging techniques, tumor staging, interpretation help as well as essentials for reporting

The laparoscopic treatment of perforated duodenal ulcer in Romania – a multicentric study

Clinica Chirurgie 2, Timișoara, România, Clinica Chirurgie, Spitalul de Urgență, București, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Aims. This retrospective study was evaluated the results of laparoscopic treatment of the perforated duodenal ulcer (PDU) in 6 Romanian centres with an important experience in laparoscopic surgery.Methods. Between 2000 and 2010, 221 patients (38 females and 183 men) aged from 18 to 78 years, were operated laparoscopicaly for PDU, by using 3 (66.0%), 4 (27%) or 5 (7.0%) trocars. Forty six (20.8%) of them had a weak, 143(64.7%) an important and 32(14.5%) a grave peritonitis. Procedures performed were: simple suture 84(38.1%) patients, suture with epiplonoplasty 135(61.1%) patients, only epiplonoplasty 1(0.4%) patients, excision with suture 1(0.4%) patients. All patients had abundant peritoneal cavity washing and tub drainage (1-3 tubs).Results. The interventions lasted between 30 and 120 min, with an average of 63 min. No mortality was reported. Postoperative oral nutrition began after 24 hours for 114(51.6%) patients and after intestinal transit has restarted for 107(48.4%) patients. The intestinal transit has restarted after 1-6 days (average 3.5 days), depending of the gravity of peritonitis. Complications were: parietal infections 3 (1.3%), duodenal fistula 1 (0.4%), abdominal abcesses 1(0.4%), digestive haemorrhage 1(0.4%) and duodenal stenosis 1 (0.4%). Hospitalization lasted between 2 and 13 days (average 5.5 days). In comparison with open techniques, patients had the same intravenous perfusions, less pain, less antibiotics, less dressings, less complications during postoperative evolution. Conclusion. Laparoscopic treatment of PDU is safe even in case of severe peritonitis, with faster patient’s recovery. with less complications and with less postoperative medical care than open procedures. Aims. This retrospective study was evaluated the results of laparoscopic treatment of the perforated duodenal ulcer (PDU) in 6 Romanian centres with an important experience in laparoscopic surgery.Methods. Between 2000 and 2010, 221 patients (38 females and 183 men) aged from 18 to 78 years, were operated laparoscopicaly for PDU, by using 3 (66.0%), 4 (27%) or 5 (7.0%) trocars. Forty six (20.8%) of them had a weak, 143(64.7%) an important and 32(14.5%) a grave peritonitis. Procedures performed were: simple suture 84(38.1%) patients, suture with epiplonoplasty 135(61.1%) patients, only epiplonoplasty 1(0.4%) patients, excision with suture 1(0.4%) patients. All patients had abundant peritoneal cavity washing and tub drainage (1-3 tubs). Results. The interventions lasted between 30 and 120 min, with an average of 63 min. No mortality was reported. Postoperative oral nutrition began after 24 hours for 114(51.6%) patients and after intestinal transit has restarted for 107(48.4%) patients. The intestinal transit has restarted after 1-6 days (average 3.5 days), depending of the gravity of peritonitis. Complications were: parietal infections 3 (1.3%), duodenal fistula 1 (0.4%), abdominal abcesses 1(0.4%), digestive haemorrhage 1(0.4%) and duodenal stenosis 1 (0.4%). Hospitalization lasted between 2 and 13 days (average 5.5 days). In comparison with open techniques, patients had the same intravenous perfusions, less pain, less antibiotics, less dressings, less complications during postoperative evolution. Conclusion. Laparoscopic treatment of PDU is safe even in case of severe peritonitis, with faster patient’s recovery. with less complications and with less postoperative medical care than open procedures

Spontaneous splenic rupture due to Plasmodium Falciparum-nonoperative management

Universitatea de Medicină și Farmacie “Carol Davila”, București, Clinica Chirurgie, Spitalul de Urgență, București, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Introducere. Ruptura spontană a splinei malarice (Plasmodium Falciparum) este o complicație rară fiind frecvent asociată cu malaria cauzată de Plasmodium Vivax. Material și metode. Lucrarea prezintă cazul unui pacient de 30 de ani internat de urgență prin transfer de la Spitalul Clinic de Boli Infecțioase cu diagnosticul ruptura spontană de splină patologică (malarică), hemoperitoneu mare tratat nonoperator (angioembolizare splenică proximală).Rezultate. Evoluție favorabilaă cu recuperare compleăa.Concluzii. Ruptura splinei malarice poate fi tratată nonoperator cu succes iar prezervarea acesteia trebuie sa fie obiectivul tratamentului. Pentru stabilirea precoce a diagnosticului este necesar un indice ridicat de suspiciune pentru evitarea unor consecințe catastrofale.Introduction Spontaneous rupture of malarial spleen due to Plasmodium Falciparum is uncommon. It is most frequently associated with Plasmodium Vivax malaria. Material and methodsWe report the case of a 30-years old male transferred to our hospital from Clinical Hospital of Infectious and Tropical Diseases. He was admitted with the diagnosis of spontaneous splenic rupture and large haemoperitoneum. Because the hemodynamic stability we decided a nonoperative management and performed a proximal splenic angioembolization.ResultsThe evolution was uneventful and the patient was discharged on day 14th.ConcluziiRupture of the pathologic spleen do heal and attempt at splenic salvage should be the aim in management. A high index of suspicion of splenic rupture is imperative because delay in diagnosis may lead to catastrophic consequences

Duodenal contusions: management and evolution

Catedra Chirurgie nr.1 “N.Anestiadi”, USMF „Nicolae Testemiţanu”, Chişinău, Republica Moldova, Clinica Chirurgie Generală, UMF “Carol Davila”, Bucureşti, România, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Leziunile duodenale prin contuzie în cadrul traumatismelor abdominale, asociate cu schimbări organice fac diagnosticul şi intervenţiile dificile, cu o morbiditate şi mortalitate marcată. Incidenţa perforaţiilor duodenale în urma contuziilor este 1:1000, fiind urmată de o mortalitate de 2-16%. Scopul: Analiza letalităţii în lotul bolnavilor cu contuzii duodenale. Material si metode: Din lotul de 108 politraumatizaţi, trataţi în Spitalul Clinic de Urgenţă (Chişinău) şi Spitalul Clinic de Urgenţă (Bucureşti) în aa.1990–2015, cei cu contuzie duodenală au constituit – 26 (24,07%); B:F – 4:1; vârsta variind între 19 şi 80 ani. Mecanismul traumei: accident rutier – 15 (57,69%), catatraumatism – 6 (23,07%), agresiune fizică – 5 (19,23%). Toţi pacienţii au fost supuşi intervenţiei chirurgicale după indicaţii vitale pentru hemoperitoneum sau peritonită. După soluţionarea altor leziuni viscerale a fost determinată macroscopic contuzia duodenală, care nu a necesitat soluţionare chirurgicală. Rezultate: Letalitatea a constituit 46,15%. Nici un caz de contuzie duodenală nu a evoluat cu fistulă duodenală. Concluzii: Analizând rezultatele tratamentului pacienţilor cu contuzii duodenale în politraumatisme s-a constatat că contuzia duodenală nu a necesitat intervenţie pe duoden şi nu a influenţat mortalitatea în cazuistica prezentată. Cauza letalităţii a fost politraumatismul sever ce a provocat insuficienţă poliorganică, fapt confirmat la necropsie.Introduction: Duodenal contusion associated with organic changes makes the diagnosis and interventions difficult with a significant morbidity and mortality. Incidence of duodenal perforations after contusion is 1:1000, with a mortality rate of 2-16%. The aim: To analyze mortality of the patients with duodenal contusions. Material and methods: From a total of 108 patients with polytrauma treated between years 1990-2015 within the Emergency Hospitals from Chisinau and Bucharest, those with duodenal contusion accounted 26 (24.07%); M:F – 4:1; age – between 19 and 80 years. Trauma mechanism: vehicle accidents – 15 (57.69%), falls from heights – 6 (23.07%), violence attack – 5 (19.23%). All patients underwent surgery for vital indications for hemoperitoneum or peritonitis. After treating other visceral injuries, macroscopically duodenal contusion was determined, that not required surgical treatment. Results: Mortality rate was 46.15%. None of the duodenal contusion cases evolved to duodenal fistula. Conclusions: Analysis of treatment results of the polytrauma patients with duodenal contusion showed that duodenal contusion did not require interventions on duodenum, and did not have an impact on the mortality rate in presented series. Mortality was caused by severe polytrauma which induced multiple organ failure confirmed after necropsy

Gallstone ileus- 20 years of interclinical experience

Universitatea de Medicină și Farmacie “Carol Davila”, Bucureşti, Clinica Chirurgie, Spitalul Clinic de Urgentă Bucureşti, Universitatea de Medicina si Farmacie “Carol Davila”, Facultatea de Farmacie, Catedra Matematici Aplicate şi Biostatistică, Bucureşti, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Introducere: Ileusul biliar reprezintă o complicaţie rară a litiazei veziculare (0.3-0.5 %), a cărui incidenţă a rămas practic neschimbată în decursul timpului. Actual diagnosticul şi tratamentul acestei boli au suferit schimbări majore dar , cu toate acestea, mortalitatea a rămas crescută fapt explicabil prin patologia asociată şi prezentarea tardivă la medic.Material şi metodă. Studiul retrospectiv al cazurilor de ileus biliar internate în perioada mai 1991-mai 2011 în SCUB şi Centrul Naţional Stiinţifico-Practic al Medicinei de Urgenţă Chişinău.Au fost înregistrate un număr de 40 de cazuri (34-SCUB, 6 cazuri CNSPMUC). 3 cazuri au reprezentat sindrom Bouveret, 4 cazuri de obstrucţie colonică restul de 33 de cazuri au fost ileusuri biliare clasice. Incidenţa globală a ileusului biliar în studiul nostru a fost 0.15 % (din numărul total de cazuri de litiază biliară internate în perioada menţionată). Vârsta medie a fost 71,62 ani cu predominenţa sexului feminin (37 cazuri, 92,5 %). Diagnosticul preoperator a fost stabilit in 17,5 % din cazuri. Terapeutic, lotul a fost împărţit în 2 grupe de pacienţi : enterolitotomie (grup I, 28 pacienţi) şi enterolitotomie cu desfiinţarea traiectului fistulos (grup II , 12 pacienţi). Nu s-au constatat diferenţe statistice semnificative între cele 2 grupuri referitor la vârsta durata simtomatologiei şi scorul ASA. Timpul operator a fost semnificativ crescut la pacienţii din grupul II . S-a inregistrat un număr total de 14 complicaţii chirurgicale, 9 complicaţii (33,33 %) în grupul I, şi 5 complicaţii ( 41,66 %) în grupul II . Mortalitatea globală a fost de 25 %, 8 cazuri în grupul I (28,57 %) şi 2 cazuri în grupul II (16,66 %). CONCLUZII : Ileusul biliar , ramâne o provocare pentru chirurg. Dificultatea diagnosticului preoperator, starea generală alterată şi vârsta avansată a pacienţilor impun o decizie chirurgicală realistă şi adaptată situaţiei intraoperatorii. În situaţiile dificile enterolitotomia rămâne soluţia terapeutică optimă, în absenţa endoscopiei intervenţionale.Background. Gallstone ileus represents a rare (0.3-0.5%), but serious complication of a common illness – the gallbladder lithiasis and the incidence of this fascinating disease has remained the same over the years. Actually, the diagnosis and management of gallstone ileus had suffered major changes, but despite these diagnostic and therapeutic possibilities, the mortality remains high and the common causes are associated comorbidities and late presentation to the physician.Materials and Methods.A retrospective and descriptive study of patients with diagnosis of gallstone ileus admitted to the Clinical Emergency Hospital Bucharest and National Scientific and Practical Center of Emergency Medicine Chisinau, between May 1991-May 2011. 40 consecutive patients with gallstone ileus (34 cases- ECHB; 6 cases- NSPCEMC) were included. Bouveret’s syndrome was diagnosticated in 3 cases, gallstone colonic obstruction in 4 cases and “classical” gallstone ileus in 33 cases. The overall incidence in our study was 0.15 % (from the total number of gallbladder lithiasis admitted in the mentioned period). Results.The mean age was 71,62 years with the female gender prevalence (92.5 %, 37 cases). In 17.5 % cases the diagnosis was made before the operation. Enterolithotomy was performed in 28 patients (group 1) and cholecystectomy and fistula closure (one-stage procedure) were added in 12 patients (group 2).We found no statistically significant differences between group 1 and group 2 on age, duration of symptoms and ASA score.Operating time was significantly longer for the one-stage procedure. The morbidity and mortality rate still have a high percentage. Complications occurred in 9 of 28 patients (33.33%) from group 1 and in 5 of 12 patients (41.66 %) from group 2. The overall mortality was 25 %, 8 cases in group 1 (28.57 %) and 2 cases (16.66 %) in group 2.ConclusionThe gallstone ileus remains a challenge for the general surgeon. The difficulty of preoperative diagnosis, general malaise and the advanced age of patients require a realistic and appropriate surgical decision adapted to the intraoperative situation. In difficult situations enterolithotomy remains the optimal solution in the absence of interventional endoscopy

Laparoscopic treatment for perforated duodenal ulcer

Clinica de Chirurgie 2, UMF “Victor Babeș” Timișoara, Clinica de Chirurgie, UMF ”Carol Davila”, București, Clinica de Chirurgie 2, UMF ”Grigore T Popa”, Iași, Clinica de Chirurgie 2, Facultatea de Medicină, Universitatea ”Ovidius”, Constanța, Clinica de Chirurgie 2, Facultatea de Medicina, Sibiu, Clinica de Chirurgie 1, UMF ”Iuliu Hațieganu”, Cluj- Napoca, Departamentul de Chirurgie I, Facultatea de Medicină, UMF Craiova, România, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Acest studiu retrospectiv evaluează rezultatele tratamentului laparoscopic în ulcerul duodenal perforat și este realizat în 7 spitale cu experiență în chirurgia laparoscopica din România. Material și metode: Între anii 2006 și 2013, 297 pacienți (48 femei, 249 bărbați) cu vârste cuprinse între 18 și 77 ani au fost supuși intervenției chirurgicale laparoscopice pentru ulcer duodenal perforat, cu utilizarea a 3 (61%), 4 (29%) sau 5 (10%) trocare. Șaizeci și doi (21%) dintre pacienți au prezentat o formă ușoară, 190 (64,1%) au prezentat o formă moderată și 45 (14,9%) o formă severă de peritonită. Procedurile utilizate au fost: sutura simplă – 118 (39,8%) pacienți, sutura cu epiplonoplastie – 176 (59,5%), doar epiplonoplastie – 1 (0,3%) pacient, excizie și sutură – 1 (0,3%) pacient. Rezultate: Durata intervențiilor a fost între 30 și 120 minute, cu o medie de 65 minute. Mortalitatea a fost nulă. Complicații: infecții parietale – 3 (1%), fistule duodenale – 3 (1%), abcese abdominale – 2 (0,6%), hemoragii digestive – 1 (0,3%) și stenoza duodenală – 1 (0,3%). Durata medie de spitalizare – 5,5 zile. În comparație cu tehnica clasica, pacienții au necesitat mai puține analgetice și antibiotice, cu 80% mai puține pansamente și au avut cu 70% mai puține infecții parietale în evoluția postoperatorie. Concluzii: Tratamentul laparoscopic pentru ulcerul duodenal perforat, este recomandat chiar și în cazurile cu peritonită severă, evoluția postoperatorie fiind cu mai puține complicații și cu o recuperare mai rapidă fața de procedura clasică. Aceast abord poate fi considerat “standard de aur” în tratamentul ulcerului duodenal perforat.Introduction: This retrospective study evaluates results of the laparoscopic treatment of perforated duodenal ulcer obtained in 7 centers with experience in laparoscopic surgery from Romania. Material and methods: A total of 297 (48 women and 249 men) patients with perforated duodenal ulcer underwent laparoscopic intervention between 2006 and 2013, with ages 18 to 77 years. Three (61%), 4 (29%) or 5 (10%) trocars were used. In 62 patients (21%) was diagnosed mild form of peritonitis, in 190 (64.1%) – moderate and in 45 (14.9%) – severe peritonitis. Types of repair used in this study: simple suture – 118 (39.8%) patients, suture with omental patch – 176 (59.5%), only sutured omental patch – 1 (0.3%), excision and suture – 1 (0.3%) patient. Results: Operation time was between 30 and 120 min, with average of 65 min. Mortality rate was zero. Complications: parietal infections – 3 (1%), duodenal fistula – 3 (1%), intraabdominal abscesses – 2 (0.6%), digestive bleeding – 1 (0.3%) and duodenal stenosis – 1 (0.3%). Average length of hospital stay – 5.5 days. Patients treated using laparoscopic technique needed less analgesics, antibiotics, 80% less dressing procedures and had 70% less surgical site infections in comparison to traditional operation. Conclusions: Laparoscopic treatment of perforated duodenal ulcer can be recommended even for patients with severe peritonitis. This treatment is associated with fewer complications and more rapid recovery than traditional intervention. Laparoscopic repair can be considered “gold standard” in the treatment of perforated duodenal ulcer

Global and regional burden of disease and injury in 2016 arising from occupational exposures : a systematic analysis for the Global Burden of Disease Study 2016

Objectives This study provides an overview of the influence of occupational risk factors on the global burden of disease as estimated by the occupational component of the Global Burden of Disease (GBD) 2016 study. Methods The GBD 2016 study estimated the burden in terms of deaths and disability-adjusted life years (DALYs) arising from the effects of occupational risk factors (carcinogens; asthmagens; particulate matter, gases and fumes (PMGF); secondhand smoke (SHS); noise; ergonomic risk factors for low back pain; risk factors for injury). A population attributable fraction (PAF) approach was used for most risk factors. Results In 2016, globally, an estimated 1.53 (95% uncertainty interval 1.39-1.68) million deaths and 76.1 (66.3-86.3) million DALYs were attributable to the included occupational risk factors, accounting for 2.8% of deaths and 3.2% of DALYs from all causes. Most deaths were attributable to PMGF, carcinogens (particularly asbestos), injury risk factors and SHS. Most DALYs were attributable to injury risk factors and ergonomic exposures. Men and persons 55 years or older were most affected. PAFs ranged from 26.8% for low back pain from ergonomic risk factors and 19.6% for hearing loss from noise to 3.4% for carcinogens. DALYs per capita were highest in Oceania, Southeast Asia and Central sub-Saharan Africa. On a per capita basis, between 1990 and 2016 there was an overall decrease of about 31% in deaths and 25% in DALYs. Conclusions Occupational exposures continue to cause an important health burden worldwide, justifying the need for ongoing prevention and control initiatives