Therapeutico-surgical options in hydatid cyst of the left hepatic lobe

Catedra 2 Chirurgie, Clinica Chirurgie 2 USMF „Nicolae Testemițanu”Se prezintă cazul clinic de chist hidatic hepatic gigant depășit și neglijat de către pacientă, pentru mai mult de 15 ani. Acesta a fost depistat la timp, în anul 2000, însă, din cauza neglijenței pacientei, a fost operat tardiv.There is presented a clinical case of giant hepatic hydatid cyst outdated and neglected by the patient, for over 15 years. It was detected on time, in 2000, but due to patient’s negligence, the operation was delayed

Insuficiența hepatică postoperatorie - cauză semnificativă a mortalității la pacienți cu chisturi hidatice gigante complicate

Background. Giant hydatid cysts usually lead to diffuse irreversible damage to the liver, aggravating the results of surgical treatment and their presence is accompanied by high mortality. Objective of the study. Analysis of factors that predispose to the development of liver failure in patients with complicated echinococcosis Material and Methods. 347 patients with hepatic hedadidosis were operated on in the clinic between 2000 and 2020. The diagnostic algorithm included: USG, Doppler, EFGDS, CT, MRI in cholangiography regime, serological and biochemical analyzes. Results. In 33 (9.5%) cases, giant hydatid cysts located in more than 4 segments of the liver were detected. Of which, in the preoperative period, liver cirrhosis was detected in 4 (12.1%) patients, the early stage of portal hypertension was detected in 7 (21.2%), mechanical jaundice in 9 (27.3%), reactive hepatitis in 10 ( 30.3%) patients, hydatid cachexia in 3 (9.09%). Postoperative liver failure developed in 9 (27.3%) patients who underwent urgent surgery. Mortality rate - 7 (18.1%). Conclusion. Predisposing factors for the development of postoperative liver failure are as follows - large destructive lesions of the liver parenchyma, small volume of the remaining parenchyma, decreased blood supply, cachexia, old age, the presence of concomitant pathologies. Introducere. Chisturile hidatice hepatice gigante, de regulă, determină leziuni difuze ireversibile ale ficatului, agravând astfel rezultatele tratamentului chirurgical și sunt insoțite de o mortalitate înaltă. Scopul lucrării. Analiza factorilor predisponibili evoluției insuficienței hepatice la pacienții cu chisturi hidatice gigantice complicate. Material și Metode. Studiul este axat asupra 347 pacienți cu hidadidoză hepatică operați în perioada aa.2000 – 2020. Algoritmul diagnostic a inclus: USG, dopplerografie, FEGDS, CT, IMRCP în regim colangiografic, analize serologice și biochimice. Rezultate. În 33 (9.5%) cazuri au fost depistate chisturi hidatice hepatice gigante, ce au inclus mai mult de 4 segmente ale ficatului. În acest grup, preoperator s-a atestat ciroză hepatică la 4 (12.1%) pacienți, manifestări clinice ale hipertensiunii portale - la 7 (21.2%) pacienți, icter mecanic- în 9 (27.3%) cazuri, hepatită reactivă la 10 (30.3%) pacienți, cașexie hidatică la 3 (9.09%) bolnavi. Insuficiența hepatică postoperatorie a evoluat la 9 (27.3%) pacienți operați după indicații vitale. Mortalitatea generală în acest lot a constituit 7(18.1%) cazuri. Concluzii. Factorii predisponibili ai insuficienței hepatice postoperatorii în chisturile hepatice gigante sunt polimorfi, primordial fiind reprezentați de leziunile destructive voluminoase ale parenchimului hepatic cu funcționalitate redusă a parenchimului hepatic restant, hipoperfuzie arterială și portală

Risk factors in the development of acute appendicitis complications

Department of Surgery No 2, Laboratory of Liver Surgery, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: To study the risk factors of the development of acute appendicitis (AA) complications in adults in order to improve the results of surgical treatment. Material and methods: The research included 449 patients with AA treated surgically during the years 2015-2017 divided into 2 groups: 117 patients who were admitted with complicated appendicitis (intra- and extraabdominal complications) and 332 patients with non-complicated AA were randomly selected from the same period. The rate and characteristic of the complications evolved during the pre- and postoperative period in these two groups were specified and analyzed. Results: In the acute complicated appendicitis group (CAA), there was a predominance of women with a ratio of 1.60 versus 1.26 in the uncomplicated acute appendicitis group (NAA). The proportion of people aged> 60 years was significantly higher in the case of CAA-23.1% (n=27), while in uncomplicated AA it was only 3.9% (n=13). In the case of AA complications, there was an emphasis on late addressing, the debut-addressing term being higher compared to uncomplicated AA. The low socio-economic status has a significant negative impact on the evolution of AA and its complications, as well as on the results of appendectomy. Thus, uninsured patients (n=59, 49.6%) formed almost half of CAA group. Associated comorbidities were established in 76 or 16.9% of cases, respectively in CAA-21.4% vs 15.4% in NAA group. In summary we note that the presence of associated uncorrected comorbidities has an obvious negative impact on the development of AA. Conclusions: Our findings suggest that clinical assessment is most important for identifying individuals at risk of developing complications of AA and the above-mentioned risk factors are useful for emergency surgical decisions

The reevaluation of the role of duodenal dysmotility in the etiopathogenesis of vesicular cholelithiasis

Department of Surgery No 2, Laboratory of Liver Surgery, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: Gallstone disease and chronic calculous cholecystitis are the most prevalent gastro-enterological diseases requiring a surgical treatment. This disease occupies a special place in the pathology of the hepato-bilio-pancreatic area, which is important for the etiological diagnosis as well as for the resonance and the complex impact on the function of the adjacent organs. Besides, gallstone disease can result in serious outcomes, such as acute gallstone pancreatitis and gallbladder cancer. This article analyzes the clinico- morphological characteristics of gallbladder stones. At the same time, the role of duodenal dysmotility in the ethiopathogenesis of cholestasis was reevaluated through the contemplation of the contemporary concepts of lithogenesis. Conclusions: The pathogenesis of gallstone disease is suggested to be multifactorial and probably develops from complex interactions between many genetic and environmental factors and the state of adjacent organs. Based on its anatomical and physiological features, the duodenum is a completely unique crossroads where the digestive pathways of the stomach, liver and pancreas meet. The sealing functionality of these organs allows them to be cataloged as an integral system, and the duodenum due to its specific role exerts ”the pituitary function” of the gastrointestinal tract. Therefore, any disruption of the duodenum activity may not be etiopathogenetically reflected on the hepatobiliary-pancreatic disease, and biliary cholelithiasis is no exception in this regard. The achievement in the study of the pathophysiology of bile stones formation and the pathogenesis of gallstone disease can help to improve the complex medico-surgical treatment of this category of patients

Etiopathogeny of acute acalculous cholecystitis: a myth change?

Department of surgery Nr. 2, State Medical and Pharmaceutical University “Nicolae Testemitanu”, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction. Usual predisposing factors of acute acalculous cholecystitis (AAC) are critical conditions, prolonged fasting, parenteral nutrition, sepsis. However, we notice an incidence of AAC in several of our patients in the absence of these factors. This fact determined us to initiate this study. Purpose. To estimate the rate, clinical and evolutive characteristics of AAC in order to identify the risk factors. Material and methods. 142 cholecystectomized pts for acute cholecystitis were analyzed. AAC was defined by: 1) absence of gallstones/biliary sludge at US; 2) intraoperative confirmation of AAC; 3) diagnosis morphological certification. Demographic, clinical and intraoperative parameters of the patients divided into 2 groups: I-AAC; II-acute calculous cholecystitis were analyzed. Results. 14 (9.9%) cases met the AAC criteria. The M/F ratio in AAC was 11/3 compared to 49/79 in the group II (p<0.01). The mean age in the groups was 48±2.3 and 57±1.2 years(p<0.05). Concomitant pathologies were more frequent in AAC- 78.6% compared to 32% into group II (p<0.001). Preoperative EGD showed evident duodenogastric reflux in almost all ACC pts (71.4%), which indicates the role of intraduodenal pressure growth in the ACC etiopathogeny. In 6 (42.9%) pts with AAC, destructive forms with a fulminant course of inflammation were established during 72 hours. It was attested a direct correlation between the development of destructive forms and the age of the pts in the AAC group. Conclusions. We can assume that the disruptions of the gastro-duodenal motility with elements of duodenostasis play a certain role in the development of non-calculous inflammation of the gallbladder. The rapid evolution of the inflammatory process in AAC requires early surgical treatment

Postoperative hepatic insufficiency as a cause of mortality in patients with giant complicated hydatic cysts

Department of Surgery no. 2, State University of Medicine and Pharmacy „Nicolae Testemitanu”, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction Giant hydatid cysts usually lead to diffuse irreversible damage to the liver, aggravating the results of surgical treatment and their presence is accompanied by high mortality. Purpose analysis of factors that predispose to the development of liver failure in patients with complicated echinococcosis Material and methods 347 patients with hepatic hedadidosis were operated on in the clinic between 2000 and 2020. The diagnostic algorithm included: USG, Doppler, EFGDS, CT, MRT in cholangiography, serological and biochemical analyzes. Results In 33 (9.5%) cases, giant hydatid cysts located in more than 4 segments of the liver were detected. Of which, in the preoperative period, liver cirrhosis was detected in 4 (12.1%) patients, the early stage of portal hypertension was detected in 7 (21.2%), mechanical jaundice in 9 (27.3%), reactive hepatitis in 10 ( 30.3%) patients, hydatid cachexia in 4 (12.1%). Postoperative liver failure developed in 9 (27.3%) patients who underwent urgent surgery. Mortality rate - 7 (18.1%). Conclusions Predisposing factors for the development of postoperative liver failure are as follows - large destructive lesions of the liver parenchyma, small volume of the remaining parenchyma, decreased blood supply, cachexia, old age, the presence of concomitant pathologies

Острый бескаменный холецистит (ОБХ): заболеваемость, клинические и эволюционные особенности течения

USMF Nicolae Testemițanu, Spitalul Clinic Municipal Sfânta Treime, USMF Nicolae Testemiţanu, IMSP SCM Sfânta Treime, Conferinţa consacrată aniversării celor 40 de ani de la fondarea SCM Sfânta Treime 17 iunie 2016 Chișinău, Republica MoldovaThe predisposing factors of AAC include critically illness, total parenteral nutrition, sepsis. AAC frequently shows a fulminant course with gangrene, perforation, empyema. The aim was to evolve the incidence of AAC and to specify its clinico- evolutional features. The study includes a prospective analysis of 121 patients traditional or laparoscopic operated for acute cholecystitis. Demographic and clinical indicators were estimated into 2 groups: I – AAC; II – acute calculous cholecystitis. From a total of 121 patients, 12 (9,9%) fulfi lled the criteria for AAC. Male / female ratio into group I and II was 10/2 and 48/61 (p <0.01); mean age 47 ± 1.3 and 58 ± 1.5 (p <0.05). In AAC group 83.3% patients had comorbid associations (diabetes – 3; hypertension – 5; hemiplegia – 1, asthma – 1) and 33.9% in group II (p <0.001). At the AAC group in 41.7% cases destructive forms predominated, evolving thundering up to 72 hours of the onset of the disease. AAC mostly develops in male with associated comorbidities, quick clinical picture with predominance of destructive forms. The arterial hypertension, diabetes and gastro-duodenal dysmotility can play the role of the pathogenic factors in the AAС Предрасполагающими факторами ОБХ являются критические состояния, пролонгированное парентеральное питание, сепсис. ОБХ зачастую характеризуется молниеносным течением с развитием гангрены, перфорацией, эмпиемы. Целью исследования явилось выявление частоты ОБХ с установлением клиническоэволюционных особенностей течения. Исследование включает проспективный анализ 121 пациентов, оперированных традиционно или лапароскопически по поводу острого холецистита. Демографические и клинические показатели были оценены в 2-х группах: I – ОБХ; II – острый калькулезный холецистит. Из общего числа 121 больных, 12 (9,9%) соответсвовали критериям ОБХ. Соотношение мужчин / женщин в I и II группах составило 10/2 и 48/61 (р <0,01); средний возраст 47 ± 1,3 и 58 ± 1,5 (р <0,05). В группе ОБХ 83,3% пациентов имели сопутствующие заболевания (диабет – 3, гипертония – 5; гемиплегия – 1, астма – 1) в сравнении с 33,9% во II группе (р <0,001). При ОБХ в 41,7% случаях отмечены деструктивные формы, развившиеся в течении до 72 часов с начала заболевания. ОБХ чаще развивается у мужчин с сопутствующими заболеваниями, быстрым клиническим течением и преобладанием деструктивных форм. Артериальная гипертензия, сахарный диабет и нарушения гастро-дуоденальной моторики могут играть роль патогенетических факторов ОБХ

Дифференцированное хирургическое лечение перфоративной язвы двенадцатиперстной кишки

USMF Nicolae Testemiţanu, IMSP SCM Sfânta Treime, Conferinţa consacrată aniversării celor 40 de ani de la fondarea SCM Sfânta Treime 17 iunie 2016 Chișinău, Republica MoldovaWe studied 374 clinical observations of patients admitted urgently with perforated duodenal ulcer, for the period 1994-2015 and operated in the Surgical Clinic of the Municipal Hospital “Holy Trinity”. The frequency of perforated duodenal ulcers during this period was 3.8%. We studied the etiopathogenetical factors, which affect the clinical picture and surgical treatment, such as age, time from onset of the disease to entering the clinic, the symptoms on admission, as well as the type of surgical intervention. Surgery was performed according to the general condition of the patients at admission and status of each patient individually during the operation. The mortality was 3.2% in the studied lot Было изучено 374 клинических наблюдения пациентов, госпитализированных в срочном порядке с перфоративной язвой двенадцатиперстной кишки, за период 1994–2015 годов, и оперированных в хирургической клинике Муниципальной клинической больницы «Святой Троицы». Частота перфоративной дуоденальной язвы в этот период составляла 3,8%. Были изучены этиопатогенетические факторы, которые влияли на клиническую картину и хирургическое лечение, такие как возраст, время от начала заболевания до поступления в клинику, симптомы при поступлении, а также вид хирургического вмешательства. Хирургические вмешательства производились в зависимости от общего состояния пациентов при поступлении и состояние каждого больного в частности во время операции. В изученном материале смертность составляет 3.2%.

Etiopatogenia colecistitei acute acalculoase: schimbare de mit?

Background. Usual predisposing factors of acute acalculous cholecystitis (AAC) are critical conditions, prolonged fasting, parenteral nutrition, sepsis. However, we notice an incidence of AAC in several of our patients in the absence of these factors. This fact determined us to initiate this study. Objective of the study. To estimate the rate, clinical and evolutive characteristics of AAC in order to identify the risk factors. Material and Methods. 142 cholecystectomized pts for acute cholecystitis were analyzed. AAC was defined by: 1) absence of gallstones/biliary sludge at US; 2)intraoperative confirmation of AAC; 3)diagnosis morphological certification. Demographic, clinical and intraoperative parameters of the patients divided into 2 groups: I -AAC; II -acute calculous cholecystitis were analyzed. Results. 14 (9.9%) cases met the AAC criteria. The M/F ratio in AAC was 11/3 compared to 49/79 in the group II (p<0.01). The mean age in the groups was 48±2.3 and 57±1.2 years(p<0.05). Concomitant pathologies were more frequent in AAC - 78.6% compared to 32% in group II (p<0.001). Preoperative EGD showed evident duodenogastric reflux in almost all ACC pts (71.4%), which indicates the role of intraduodenal pressure growth in the ACC etiopathogeny. In 6 (42.9%) pts with AAC, destructive forms with a fulminant course of inflammation were established during 72 hours. It was attested a direct correlation between the development of destructive forms and the age of the pts in the AAC group. Conclusion. We can assume that the disruptions of the gastro-duodenal motility with elements of duodenostasis play a certain role in the development of non-calculous inflammation of the gallbladder. The rapid evolution of the inflammatory process in AAC requires early surgical treatment. Introducere. Factorii predispozanți tradiționali ai colecistitei acute acalculoase (CAA) sunt consideraţi: stările critice, repaosul alimentar, nutriţia parenterală, sepsisul. Remarcăm o incidenţă a CAA la mai mulţi dintre pacienţii noştri în absenţa acestor factori, fapt ce a determinat efectuarea acestui studiu. Scopul lucrării. A estima rata şi caracteristicile clinico-evolutive ale CAA în scopul identificării factorilor de risc. Material și Metode. S-au analizat 142 bolnavi colecistectomizați cu colecistită acută. CAA a fost definită prin: 1) absenţa calculilor/ sladjului biliar la USG; 2) confirmare intraoperatorie a colecistitei acute fără calculi; 3) certificarea morfologică a diagnosticului. S-au analizat indicii demografici, clinici, parametrii intraoperatori ai bolnavilor divizaţi în 2 loturi: I-CAA; II-colecistită acută calculoasă. Rezultate. 14 (9,9%) cazuri au corespuns criteriilor CAA. Raportul B/F în CAA a fost 11/3 și 49/79 în lotul II (p <0,01). Vârsta medie în I și II loturi a fost de 48±2,3 și 57±1,2 ani (p <0,05). În CAA, patologii concomitente au fost urmărite mai frecvent – 78,6% comparativ cu 32% în lotul II (p <0,001). FEGDS a evidențiat reflux duodenogastral pronunțat la majoritatea pacienților cu CAA (71,4%), ce indică rolul creșterii presiunii intraduodenale în etiopatogenia CAA. La 6 (42,9%) bolnavi cu CAA s-au stabilit forme distructive cu un curs fulminant al inflamației în decurs de 72 ore. S-a atestat o corelație directă între dezvoltarea formelor distructive și vârsta pacienților în lotul CAA. Concluzii. Putem presupune că perturbările motilității gastro-duodenale cu elemente de duodenostază posedă un rol în dezvoltarea inflamației non-calculoase a vezicii biliare. Evoluţia rapidă a procesului inflamator în CAA necesită tratament chirurgical precoce

Causal factors and surgical treatment in ventral postoperative hernias

Catedra Chirurgie 2, clinica 2, SCM „Sfânta Treime”Here are presented the results of operations on 154 patients with postoperative ventral hernia after conventional cholecystectomy, appendectomy, as well as gynecological operations on which was performed the plastic of hernia gates with own tissue – 91 cases, with synthetic mesh – 56 cases, and combined techniques – 7 patients. The results were good, except in five cases, two patients with postoperative lethality due to concomitant diseases. Sunt prezentate rezultatele operaţiilor la 154 bolnavi cu hernii ventrale postoperatorii după colecistectomia clasică, apendicectomie, cât şi operaţii ginecologice la care s-a efectuat plastia porţilor herniare cu ţesuturi proprii – 91 cazuri, cu plasă sintetică – 56 cazuri, şi combinată la 7 bolnavi. Rezultatele au fost bune, cu excepţia în 5 cazuri, cu letalitatea postoperatorie la 2 bolnavi din cauza maladiilor concomitente