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

The Vascularization Pattern of the Colon and Surgical Decision in Esophageal Reconstruction with Colon. A Selective SMA and IMA Arteriographic Study

Rezumat Pattern-ul de vascularizaåie al colonului aei decizia chirurgicalã în reconstrucåia esofagianã cu colon -studiu arteriografic selectiv al AMS aei AMI Introducere: Indiferent de tehnica reconstructivã, conceptele de fundamentare din reconstrucåia visceralã au ca baza principalã suportul vascular necesar pentru grefonul de substituåie. Particularitãåile vasculare individuale pot înclina sau chiar obliga chirurgul la o anumitã opåiune cãtre unul sau altul dintre procedee. De aceea, vascularizaåia este, fãrã îndoialã, factorul care dominã mobilizarea colonului pentru reconstrucåia esofagianã. Material aei metodã: Studiul nostru arteriografic aei-a propus o investigaåie asupra tiparului vascular al celor douã surse principale ce participã prin vasele emergente la irigarea arterialã a colonului: a. mezentericã superioarã (AMS) respectiv a. mezentericã inferioarã (AMI). Nu am avut în vedere selectarea pacienåilor dupã un anumit criteriu dupã cum nu am realizat nici o excludere dintr-un anumit considerent. Lotul de studiu a constat din 49 de pacienåi care s-au prezentat în clinicã pentru o tehnicã reconstructivã, toåi aparåinând perioadei 2000-2010. În intervalul 1981-2012, au fost efectuate 187 de tehnici reconstructive pentru o indicaåie postcausticã. Din totalul de 49 de pacienåi, 11 bolnavi suferiserã intervenåii chirurgicale abdominale majore iar dintre aceaetia, 5 cu tentative nereuaeite de reconstrucåie. Rezultate: Din cei 49 de pacienåi la care s-a efectuat explorarea, arteriografia a evidenåiat o situaåie favorabilã reconstrucåiei la 31 dintre aceştia. La ceilalåi 18 pacienåi au fost identificate anomalii ori distribuåii atipice, 5 ale AMS respectiv 13 ale AMI. Decizia operatorie a fost ajustatã la 22 de bolnavi. Un lucru important de semnalat dpdv predictiv asupra viscerul de mobilizat: nu am avut necroze de grefon la pacienåii cu examinare arteriograficã preoperatorie. Concluzii: Dictate de necesitatea unei bune mobilizãri, ligaturile arteriale trebuie adaptate şi modificate în funcåie de particularitãåile de distribuåie vascularã, astfel încât sã se menåinã un flux sangvin suficient în arcada marginalã pânã la nivelul secåiunilor colice şi, implicit, în arterele drepte din vecinãtatea acestora. main grounds the mandatory vascular support for the graft replacement. Individual vascular particularities can influence or even oblige the surgeon to choose a certain procedure. This is why the vascularization is beyond doubt the dominant factor in mobilizing the colon for reconstruction. Material and method: Our arteriographic study entails an investigation upon the vascularization pattern of the two main sources that participate in the arterial irrigation of the colon via the emerging vessels: superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). We did not consider certain patients upon a specific criterion; also, we did not exclude any patients due to various reasons. We took into account 49 patients as study group, all of them having registered into the clinic for a reconstructive technique, throughout the years from 2000 to 2010. From 1981 to 2012 there have been 187 reconstructive techniques performed due to post caustic pathology. From a total of 49 patients, 11 had suffered major abdominal surgeries, 5 of which had had unsuccessful reconstructive attempts. Results: Out of the 49 patients on whom we have performed the exploration, arteriography showed a favorable situation for reconstruction in 31 of them. In the other 18 patients anomalies or atypical distributions were identified, in 5 of the SMA and in 13 of the IMA, respectively. Operative decision was modified in 22 patients. One important thing to note from the point of view of the segment to be moved: we had no graft necrosis in patients with preoperative arteriographic examination. Conclusions: Due to the need for good mobilization, arterial ligations should be adjusted and modified depending on the particular vascular distribution, to maintain a sufficient blood flow in the marginal artery, in order to reach the colic sections and the straight arteries near them. Abbreviations: SMA -superior mesenteric artery; IMAinferior mesenteric artery; ICa -ileocolic artery; RCa -right colic artery; MCa -middle colic artery; LCa -left colic artery; LC acc.a -left accessory colic artery (or middle left colic artery); ILCa -inferior left colic artery; S trunk -sigmoidian trunk; Sa -sigmoidian artery; SRa -superior rectal arter

Transferência de massa e secagem em leitos vibrofluidizados: uma revisão Mass transfer and drying in vibro-fluidized beds: a review

O desenvolvimento de tecnologias de processamento e equipamentos requer a utilização de novos métodos e melhor qualidade do produto processado. Dentro do processo de secagem contínua, a utilização de equipamentos que promovem incremento nos coeficientes de transferência, é a de maior interesse. O uso de energia vibracional tem sido recomendado para materiais dispersos. Assim, uma revisão da literatura sobre a transferência de massa e a secagem em leitos vibrofluidizados foi realizada, envolvendo resultados experimentais e modelagem matemática.<br>Development of processing technology and equipments requires new methods and better quality of the processed product. In the continuous drying process, utilization of equipments that promotes an increment in the transfer coefficients becomes of the major interest. The use of vibrational energy has been recommended to the dispersed materials. Such method is based on the use of vibrational energy applied to disperse media. Thus, a literature review on the mass transfer and drying in vibro-fluidized beds was carried out, showing experimental results and mathematical modeling