STRATEGY OF DIAGNOSIS, PROGNOSIS AND MANAGEMENT OF ACUTE DESTRUCTIVE PANCREATITIS

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LIVER INJURY

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Laparoscopic Appendectomy - Advantages and Indications

Introduction: The first laparoscopic appendectomy was performed by Kurt Semm in 1980. Thirty-six years later, the issue of the choice between laparoscopic and open surgery approach as a standard remains controversial.Materials and Methods: Forty-three laparoscopic appendectomies have been performed at our surgery department by one operative team. We had to convert to open surgery in 3(6.98%) cases. Meckel`s diverticulum was found in 1(2.33%) case. Results: The average hospital stay was 4.14 days. We had no lethal outcomes. In two (4.88%) of the cases the patients developed a paralytic ileus as a complication, but no reoperation was necessary. We observed no wound complications. No complications have been observed in the clinical one-month follow-up of the patients after discharge.Conclusions: The laparoscopic appendectomy should be the first choice of surgery in patients with uncomplicated appendicitis or appendicitis with local peritonitis. The laparoscopic method leads to an earlier postoperative patient activity restoration, shorter hospital stay, better pain control, far fewer wound complications and an earlier return to normal life activity. When there is a dissociation between the preoperative data and the laparoscopic findings, the conversion to open surgery is absolutely acceptable. In cases with generalized peritonitis, the open approach is the first method of choice

A Gastrointestinal Stromal Tumour (GIST) - a Case Report

Introduction: Gastrointestinal stromal tumours are the most common mesenchymal neoplasms of the GI tract with the following abdominal distribution: stomach - 40-60%, small intestine - 30%, extraintestinal localisation - below 9%. The usual symptoms are: GI bleeding, fever, night sweats, weight loss, palpable mass, symptoms of compression. Materials and Methods: The case refers to a 34-year-old male patient (2013). Results and Discussion: Radical tumour resection along with small intestine resection was performed. One year later multiple resections of recurrent pelvic, mesocolic, omental and peritoneal tumours were performed. After immunohistochemical re-examination, the primary diagnosis - leiomyosarcoma, was replaced by a poorly differentiated GIST. Imatinib treatment course was conducted. Due to a second recurrence, en bloc resection of a large pelvic mass infiltrating the urinary bladder and the rectum was performed. Macroscopically clear resection lines were achieved. Conclusions: Surgery is the only curative treatment of GIST. If R0 resection lines are impossible to achieve and highly aggressive malignancies are present, adjuvant tyrosine-kinase inhibitors therapy is recommended. The 5-year survival rate after radical surgery is 48 to 64%. The recurrence risk is increased by: large tumour mass, high mitotic index, extraintestinal localisation

Laparoscopic Lortat-Jacob Procedure for Hiatal Hernia Repair

Introduction: Hiatal hernia, together with its related complications (GERD, Barett`s esophagus, malignant dysplasia, anemia, upper GI bleeding, perforation, etc.), is one of the most common diseases of the upper GI tract. Despite the rich pharmacological variety of PPI, prokinetic agents, etc., the operative treatment proves to be the only reliable method of treatment. Numerous and controversial statistics and recommendations for the choice of an operative technique are found in the related medical literature.Materials and Methods: From November, 2014 until June, 2016, 32 hiatal hernia repairs have been performed at our surgery department. Twenty patients underwent the laparoscopic Lortat-Jacob procedure. Fourteen patients underwent an open hernia repair. All the patients have been followed up clinically and by means of radiological contrast upper GI imaging at the end of the second month after the surgery. Emergency (present or absent), patients` general condition, concomitant diseases, perioperative risk and the surgeon`s experience were the determining criteria for the choice of the procedure. Results: No clinical or radiological data of recurrent hiatal hernia or GER have been found at the patient`s follow-up. The anemia was resolved completely without the need of oral administration of iron salts. Conclusions: The laparoscopic Lortat-Jacob procedure is a reliable method of hiatal hernia elective surgery. It has been proved effective and with a low complication rate. In case of emergency and severe heart diseases, the open approach is preferred

Laparoscopic Management of Acute Necrotising Pancreatitis - a Case Report

Introduction: Most cases of acute pancreatitis (80%) are self-limiting and susceptible to medication. The rest develop a severe form of the disease with the formation of pancreatic necrosis. Materials and Methods: A 74-year-old female was admitted to our clinic with complaints of abdominal bloating and impossible food and fluid intake. She had undergone a previous conservative treatment for acute pancreatitis in a therapeutic ward. The onset of the disease had been dated back to about 50 days prior to the surgery clinic admission.Results and Discussion: The CT revealed a lesser-sac abscess and necrosis of the head and body of the pancreas. Due to age and comorbidity issues a laparoscopic approach was chosen. A lesser-sac abscess, total necrosis of the head and body and partial necrosis of the tail of the pancreas were found. A laparoscopic evacuation of the abscess, followed by a subtotal proximal pancreatonecrectomy, was performed. The six-month follow-up evaluation showed good general health and no evidence of complications.Conclusion: The severe form of acute pancreatitis remains one of the most difficult to manage benign diseases of the GI tract, requiring multidiscipline approach with controversial treatment results. Ðœinimally invasive operative techniques contribute to a shortened hospital stay, surgical trauma reduction and a better treatment outcome