Thyroidectomy without Ligatures in Differentiated Thyroid Cancer

Technical improvements in thyroid surgery are nearly close with the progress of the vessels sealing systems. In all cases, we need to obtain a radical and safe thyroid excision. This chapter is conducted to evaluate the technical key point and the postoperative benefits of our procedure using vessels sealing devices in differentiated thyroid cancers. A prospective study, carried out in First Surgical Clinic, Emergency County Clinical Hospital Tirgu Mureș, Romania from January 01, 2013 to March 01, 2018, based on 100 consecutive patients, divided into two groups: first group without ligatures, using Small Jaw LigaSure™, and the second group operated by conventional procedure. Statistical analysis of some parameters (the thyroid pathology, operative time, hospitalization days, analgesic drugs, immediate postoperative complications and histopathological findings) shows that this procedure provides a total and “complete” removal of the thyroid specimen, with a decreased operative time and fewer hospitalization days

Quality of Life Following Intersphincteric Resections for Low Rectal Cancer: Early Results

Intersphincteric resections are part of the therapeutic arsenal that preserves the sphincterian apparatus. This chapter analyzes the evolution of rectal surgery leading up to intersphincteric resections, deals with anatomical and oncological aspects in rectal cancer, and finally shows our own personal experience with ISR in a series of 40 cases focusing on oncological outcomes, continence, and defecation. As a conclusion, intersphincteric resection represents a feasible therapeutic option in highly selected cases that exempts the patient from the need of a permanent colostomy bag without compromising oncological principles. The Wexner score system is simple and effective in objectifying continence in patients that undergo this type of surgery

Epehólyag-agenesia. Epekövességet utánzó ritka rendellenesség egy felnőtt nőben = Gallbladder agenesis – A rare congenital anomaly mimicking cholelithiasis in an adult woman

Absztrakt: Az epehólyag-agenesia ritka, a biliaris rendszer embriológiai hibája miatt kialakult veleszületett elváltozás. Az esetek többségében tünetmentes, más esetekben az epekólika tüneteit utánozza. Betegünk 72 éves kaukázusi nő. Anamnézisében magasvérnyomás-betegség, illetve magas koleszterinszint szerepelt, melyekre vérnyomáscsökkentő, illetve koleszterinszint-csökkentő kezelést kapott. Felvételére az epekólika tüneteinek megjelenése miatt került sor. Laparoszkópos műtéten esett át, mely alátámasztotta a végleges diagnózist. E ritka eset kapcsán bemutatjuk megközelítésünket, valamint az orvosi szakirodalom rövid áttekintését. A sebésznek intraoperatívan el kell döntenie, hogy egy lehetséges ectopiás epehólyagot keres, vagy tovább vizsgálja az esetet képalkotó eljárások segítségével. Az epehólyag-agenesia ritka állapot, mellyel a sebésznek számolnia kell. Azokban az esetekben, amikor az epekövesség tünetei nem meggyőzőek, a műtét elkerülése végett a legjobb kiegészítő képalkotó eljárás a mágnesesrezonancia-kolangiopankreatográfia. Orv Hetil. 2019; 160(38): 1510–1513. | Abstract: Gallbladder agenesis is a rare congenital malformation due to an embryological defect of the biliary system. In most cases it is asymptomatic, but it can also mimic biliary colic. We report the case of a 72-year-old Caucasian woman with a medical history of cardiovascular disease and hypercholesterolemia, under cholesterol-lowering and hypotensive treatment, who presented symptoms suggesting biliary colic. She underwent laparoscopic surgery that confirmed the final diagnosis. We present our approach in this rare case as well as a brief review of medical literature. The surgeon should decide intraoperatively whether to continue and search for a possible ectopic gallbladder or investigate further with imaging studies. Gallbladder agenesis is a rare condition that the surgeon must be aware of. In the cases of inconclusive or indirect signs of cholelithiasis, the best approach is complementary imaging investigations such as magnetic resonance cholangiopancreatography in order to avoid surgery. Orv Hetil. 2019; 160(38): 1510–1513

Emergency Treatment of Transverse Colon Cancer

This chapter deals with the emergency treatment of transverse colon cancer. The main complications that classify transverse colon cancer in an emergency setting are obstruction, perforation accompanied by localized or generalized peritonitis, and hemorrhage which may be occult or cataclysmic with hemorrhagic shock. We present the technical principles of radical surgical resection using embryological, anatomical, and oncological concepts. In this chapter we also discuss the principles of lymphadenectomy associated with complete excision of the mesocolon with high vascular ligation, in particular with T3 or T4 cancers requiring D2/D3 lymphadenectomy. The use of infrapyloric, gastro-epiploic, and prepancreatic lymphadenectomy is recommended due to the frequent metastases in these regional lymph nodes

Supralevator Total Pelvic Exenteration Without Colostomy — Case Report

Background: Pelvic exenteration is an ultra-radical surgical procedure described by Brunschwig in 1948, which attempts to surgically cure patients with recurrent pelvic cancer after radiotherapy. Several variants of pelvic exenteration are described that allow a more limited or extensive resection, depending on the stage of the disease

Postoperative Lymphorrhagia- a Possible Complication Following Cephalic Duodenopancreatectomy

Surgery associated with lymphadenectomy may sometimes result in a lymphorrhagia, which usually resolves spontaneously within a few days, sometimes becoming a refractory complication to the treatment. In the case of large flows, particular attention should be paid to hydro-electrolytic and protein losses. We present the case of a patient with persistent lymphorrhagia after a cephalic duodenopancreatectomy for a pancreatic head tumor. From the 5th postoperative day, the patient had a milky-like secretion on the subhepatic drainage tube. The discharge rate was variable, between 500 and 1500 ml per day, requiring parenteral administration of amino acids, plasma and electrolyte solutions. The postoperative progression was slowly favorable, with the patient discharge on the 25th day following surgery. There are several treatment options for a lymphorrhagia following an extended lymphadenectomy, from intensive parenteral therapy to peritoneal-venous shunt or ligation of the lymphatic vessel responsible for the production of lymphorrhagia. In this case the conservative treatment had a favorable result

Long Term Results of Modified Intersphincteric Resections for Low Rectal Cancer: A Single Center Experience

Background and Objectives: The objective of this article is to evaluate the long-term oncological and functional outcomes following modified intersphincteric resections (ISR) for low rectal cancer. The modified technique consisted of the abandonment of colonic J-pouches, transverse coloplasty, or defunctioning temporary stoma in favor of a direct handsewn coloanal anastomosis (CAA). Material and Methods: Sixty consecutive patients with type II and III (juxta-anal or intra-anal) low rectal tumors underwent modified ISR by the same surgical team and were followed for a period of five years. Functional outcomes using the Wexner Score, postoperative complications, recurrence rates, morbidity, and mortality rates were assessed. Results: The five-year survival rate was 93.3% with a disease-free interval at three years of 98%. Morbidity was 15% (n = 9) consisting of intestinal wall necrosis (n = 6), stenosis (n = 2), and sacral metastasis (n = 1). The Wexner score values were, at 1 year, 8.5 (range, 4–13); at three years 7.2 (range, 2–11); and at 5 years 6.7 (range, 2–12). A second surgery was needed in only one case that showed postoperative transmural necrosis of the colonic wall. Conclusions: In highly selected patients with type II or III low rectal tumors and proper preoperative imaging staging, ISR might be a viable alternative to other techniques such as abdominoperineal resection and low anterior resection, both from a functional and an oncological perspective

The predictive role of platelet to lymphocyte ratio in the occurrence of anastomotic complications following gastric resections for neoplasia – single centre experience

Introduction: Our study investigated the importance of inflammation markers – ratio of platelets and lymphocytes (PLR), ratio of neutrophils and lymphocytes (NLR) and ratio of lymphocytes and monocytes (LMR) – as predictive markers in the occurrence of fistula or stenosis in patients diagnosed with gastric adenocarcinoma who underwent gastric resections