Single Incision Laparoscopic Cholecystectomy – A New Advantage of Gallbladder Surgery

In this study is demonstrated our experience in single incision laparoscopic cholecystectomy (SILS), compared to standard laparoscopic cholecystectomy. There were 48 single incision laparoscopic cholecystectomies (SILS) performed during one-year period (A group) and results have been compared with a group of 50 patients who underwent standard laparoscopic cholecystectomy (B group). Outcome measures included operative time, need for conversion, complications, additional analgesia for pain control after procedure, hospital stay and cosmetic outcome. The mean operative time was 46+/–3.5 min in A group, and 43+/–4 min in B patients group. Early postoperative complications were not detected. The mean hospitalization period was 2 days in both groups. Our experience suggests that SILS cholecystectomy can be performed with outcome similar to standard laparoscopic surgery while affording better cosmesis

Spontaneous Isolated Dissection of the Abdominal Aorta

Isolated spontaneous dissection of the abdominal aorta is such a rare entity and there are only a few cases reported in literature up to date. A 42-year old male was admitted to the hospital with mild pain in the lower abdomen and back that had began seven days prior to admission together with the sudden onset of the ischemic symptoms of the left leg (ischemic ulcers of the calf, gangrenous toe and pallor foot). Patient denied any trauma, hypertension history was negative, while he was active cigarette smoker. MSCT and digital subtracted angiography have shown a dissection of the abdominal aorta approximately two centimeters below the origin of the inferior mesenteric artery extending in the left common iliac artery, with no sign of the aneurysmatic dilatation of the abdominal aorta. Emergent surgery was performed with aorto- biiliacal bypass graft interposition, amputation of the left toe and necrectomy of the left calf. Postoperative follow up and local vascular condition were satisfied. Even though is rare entity, isolated abdominal aorta dissection accounts for ap proximately 2–4% of all aortic dissection. Nowadays therapeutic regimen includes endovascular, open surgery or conser vative treatment

EARLY CAROTID ENDARTERECTOMY IN SYMPTOMATIC PATIENTS – OUR EXPERIENCE

U ovoj je studiji analiziran učinak endarterektomije unutarnje karotidne arterije (ACI) u bolesnika unutar tri tjedna od razvoja neurološke simptomatologije s obzirom na učestalost i vrstu neželjenih događaja u poslijeoperacijskom tijeku. U studiju su uključeni bolesnici sa simptomatskom stenozom visokog stupnja ACI, koji su preboljeli ishemijski moždani udar (IMU) ili tranzitornu ishemijsku ataku (TIA). Kod svih je bolesnika učinjena uzdužna karotidna endarterektomija u općoj anesteziji s uporabom intraluminalnog shunt-a. Praćenje bolesnika se odnosi na razdoblje između siječnja 2008. i listopada 2012. godine kada je operirano ukupno 69 simptomatskih bolesnika s visokim stupnjem stenoze ACI (70-99 %). Kontrolni ultrazvuk karotidnih arterija (CD) rađen je sedmi poslijeoperacijski dan te nakon jednog, tri, šest i dvanaest mjeseci, a nakon toga jednom godišnje. Od ukupnog broja operiranih (n = 69), 27 (39 %) bolesnika bilo je sa svježe preboljelim IMU-om koji su operirani unutar tri tjedna od razvoja neurološke simptomatologije, a najranije četrnaest dana nakon razvoja inzulta i 42 (61 %) bolesnika sa simptomima TIA-e, a koji su operirani neposredno nakon završetka prijeoperacijske obrade. Od poslijeoperacijskih neželjenih događaja došlo je do razvoja IMU-a u 2 (2,63 %) bolesnika i 2 odgođene restenoze (2,63 %) endarterektomirane unutarnje karotidne arterije koje su zahtijevale endovaskularno liječenje. Zaključujemo da provođenje rane endarterektomije u klinički odabranih bolesnika s visokim stupnjem stenoze ACI, shodno našim rezultatima i rezultatima drugih studija, ne nosi veći rizik od kasne endarterektomije, a zasigurno snižava postotak recidiva IMU i TIA-a, koji su najčešći u ranom razdoblju razvoja neurološke simptomatologije.Carotid endarterectomy is the gold standard as a therapeutic regimen for patients with high grade symptomatic stenosis of the internal carotid artery (ACI). This study analyzed the effect of early carotid endarterectomy in patients undergoing an operative procedure 2-3 weeks after the development of ischemic neurologic symptoms, considering the frequency and type of complications in the postoperative period. Patients included in this study were those with significant symptomatic ACI stenosis (70%-99%), which caused ischemic stroke or transient ischemic attacks (TIA). Patients with ischemic stroke were operated within twenty days of the initial neurologic event, whilst in those with symptoms of TIA, surgery was performed immediately after diagnostic work-up. In all cases, carotid endarterectomy was performed under general anesthesia with the use of protective intraluminal shunt. In the vast majority of cases, tucking or Kunlin’s sutures of the distal intima were applied. All procedures were performed between January 2008 and October 2012, and the total number of patients was 69. All patients underwent the same follow up program. Follow up carotid ultrasound was performed routinely on postoperative day 7 and at 1, 3, 6 and 12 months. In this study, 27 (39%) patients suffered minor ipsilateral stroke and 42 (61%) patients had TIA symptoms with verified significant ACI stenosis. Postoperative complications were observed in four (5.26%) patients. Two (2.63%) patients developed ischemic stroke after the procedure and two (2.63%) patients developed ACI restenosis in the late postoperative period and were treated by endovascular stenting. In conclusion, we found that early carotid endarterectomy was of greater benefit than delayed endarterectomy, which is in keeping with the published studies. The leading observation was that in selected patients, early carotid end- arterectomy was not associated with a higher risk of postoperative complications in comparison with delayed endarterectomy and could be performed safely

RARE DISORDERS OF EXTRACRANIAL CAROTID ARTERIES

Prikazana su dva rjeđa slučaja bolesti ekstrakranijskih karotidnih arterija s osvrtom na način kirurškog liječenja. Radi se o zavojitosti (engl. coiling) unutarnje karotidne arterije (ACI). Oba su bolesnika podvrgnuta uspješnom kirurškom liječenju. U prvom slučaju opisana je simptomatska kombinacija presavinuća (engl. kinking) i zavojitosti ipsilateralne ACI, bez prateće stenoze ACI, a učinjena je resekcija ACI, uz reanastomozu. Druga je bolesnica imala dvostruku zavojitost ACI, odnosno ACI je formirala dvostruku petlju, uz subtotalnu simptomatsku stenozu početnog segmenta ACI. Pri operaciji je učinjena resekcija produženog segmenta, koja je uključivala i područje stenoze ACI, uz naknadnu reanastomozu. S obzirom na rijetkost navedenih bolesti karotidnih arterija i činjenice da dosada u literaturi nisu objavljene veće studije osim opisa pojedinačnih slučajeva, svako dodatno iskustvo i prikaz liječenja doprinijet će daljnjem razumijevanju i smjernicama u liječenju ovih rijetkih bolesti.Abnormalities of the internal carotid arteries (ACI) are rare findings, usually not linked with neurologic symptoms and frequently are diagnosed during routine duplex scanning or angiographic examination. These abnormalities are predominantly elongation of the vessel that leads to kinking, coiling or tortuosity of the artery, and the origin is congenital or acquired related to atherosclerosis. We report on two symptomatic cases related to elongation of ACI. The first case was a 56-year-old female that had bilateral coiling. The second patient was a 64-year-old female that suffered from symptomatic double coiling of the left ACI connected with high grade stenosis. In both cases, successful operation was done with resection of the elongated and stenosed ACI segment and reanastomosis of the ACI and common carotid artery. Postoperatively, symptoms were resolved. In symptomatic cases of isolated carotid elongations, surgical treatment is a better option than conservative medical treatment alone, whilst in asymptomatic ACI elongation, conservative medical treatment is advised

RARE DISORDERS OF EXTRACRANIAL CAROTID ARTERIES

Prikazana su dva rjeđa slučaja bolesti ekstrakranijskih karotidnih arterija s osvrtom na način kirurškog liječenja. Radi se o zavojitosti (engl. coiling) unutarnje karotidne arterije (ACI). Oba su bolesnika podvrgnuta uspješnom kirurškom liječenju. U prvom slučaju opisana je simptomatska kombinacija presavinuća (engl. kinking) i zavojitosti ipsilateralne ACI, bez prateće stenoze ACI, a učinjena je resekcija ACI, uz reanastomozu. Druga je bolesnica imala dvostruku zavojitost ACI, odnosno ACI je formirala dvostruku petlju, uz subtotalnu simptomatsku stenozu početnog segmenta ACI. Pri operaciji je učinjena resekcija produženog segmenta, koja je uključivala i područje stenoze ACI, uz naknadnu reanastomozu. S obzirom na rijetkost navedenih bolesti karotidnih arterija i činjenice da dosada u literaturi nisu objavljene veće studije osim opisa pojedinačnih slučajeva, svako dodatno iskustvo i prikaz liječenja doprinijet će daljnjem razumijevanju i smjernicama u liječenju ovih rijetkih bolesti.Abnormalities of the internal carotid arteries (ACI) are rare findings, usually not linked with neurologic symptoms and frequently are diagnosed during routine duplex scanning or angiographic examination. These abnormalities are predominantly elongation of the vessel that leads to kinking, coiling or tortuosity of the artery, and the origin is congenital or acquired related to atherosclerosis. We report on two symptomatic cases related to elongation of ACI. The first case was a 56-year-old female that had bilateral coiling. The second patient was a 64-year-old female that suffered from symptomatic double coiling of the left ACI connected with high grade stenosis. In both cases, successful operation was done with resection of the elongated and stenosed ACI segment and reanastomosis of the ACI and common carotid artery. Postoperatively, symptoms were resolved. In symptomatic cases of isolated carotid elongations, surgical treatment is a better option than conservative medical treatment alone, whilst in asymptomatic ACI elongation, conservative medical treatment is advised

Laser Treatment in Hemorrhoidal Disease - Our Experience

Cilj: U ovome se članku iznose iskustva, tehnika i rezultati u 21 bolesnika s hemoroidalnom bolešću, koji su operirani diodnim laserom. Metode: Učinjena je hemoroidektomija diodnim laserom u 21 bolesnika s verificiranim II.-III. stupnjem hemoroidalne bolesti. Rezultati: Prosječno trajanje operacije bilo je 15 ± 2 minute, a prosječna hospitalizacija 24 sata. Tijekom 12-omjesečnoga praćenja nije zabilježen ni jedan neželjeni događaj u vidu krvarenja, infekcije ili recidiva bolesti u svih operiranih bolesnika. Dodatna analgezija bila je potrebna u četvero bolesnika. Zaključak: Uporaba diodnoga lasera predstavlja dodatnu metodu u liječenju hemoroidalne bolesti te je potrebna daljnja evaluacija u budućim studijama, koja će potvrditi uspješnost te metode.Objective: This article brings experiences, technique and results in 21 patients with haemorrhoidal disease treated with diode laser. Methods: In this study, 21 patients with II-III grade haemorrhoidal disease were included and treated with diode laser. Results: Average operation time was 15 + 2 minutes, with 24-hour hospitalisation. During the follow-up period of 12 months, there were no observed complications, such as bleeding, infections or recurrence. Extra anaelgetics were required in four cases. Conclusion: The use of diode laser in haemorrhoidal disease represents an additional treatment method, where as further studies are yet to evaluate and definitely confirm the successfulness of this method

Effects of diclofenac, L-NAME, L-Arginine, and pentadecapeptide BPC 157 on gastrointestinal, liver, and brain lesions, failed anastomosis, and intestinal adaptation deterioration in 24 hour-short-bowel rats

Stable gastric pentadecapeptide BPC 157 was previously used to ameliorate wound healing following major surgery and counteract diclofenac toxicity. To resolve the increasing early risks following major massive small bowel resectioning surgery, diclofenac combined with nitric oxide (NO) system blockade was used, suggesting therapy with BPC 157 and the nitric oxide synthase (NOS substrate) L-arginine, is efficacious. Immediately after anastomosis creation, short-bowel rats were untreated or administered intraperitoneal diclofenac (12 mg/kg), BPC 157 (10 μg/kg or 10 ng/kg), L-NG-nitroarginine methyl ester (L-NAME, 5 mg/kg), L-arginine (100 mg/kg) alone or combined, and assessed 24 h later. Short-bowel rats exhibited poor anastomosis healing, failed intestine adaptation, and gastrointestinal, liver, and brain lesions, which worsened with diclofenac. This was gradually ameliorated by immediate therapy with BPC 157 and L-arginine. Contrastingly, NOS-blocker L-NAME induced further aggravation and lesions gradually worsened. Specifically, rats with surgery alone exhibited mild stomach/duodenum lesions, considerable liver lesions, and severe cerebral/hippocampal lesions while those also administered diclofenac showed widespread severe lesions in the gastrointestinal tract, liver, cerebellar nuclear/Purkinje cells, and cerebrum/hippocampus. Rats subjected to surgery, diclofenac, and L-NAME exhibited the mentioned lesions, worsening anastomosis, and macro/microscopical necrosis. Thus, rats subjected to surgery alone showed evidence of deterioration. Furtheremore, rats subjected to surgery and administered diclofenac showed worse symptoms, than the rats subjected to surgery alone did. Rats subjected to surgery combined with diclofenac and L-NAME showed the worst deterioration. Rats subjected to surgery exhibited habitual adaptation of the remaining small intestine, which was markedly reversed in rats subjected to surgery and diclofenac, and those with surgery, diclofenac, and L-NAME. BPC 157 completely ameliorated symptoms in massive intestinal resection-, massive intestinal resection plus diclofenac-, and massive intestinal resection plus diclofenac plus L-NAME-treated short bowel rats that presented with cyclooxygenase (COX)-NO-system inhibition. L-arginine ameliorated only L-NAME-induced aggravation of symptoms in rats subjected to massive intestinal resection and administered diclofenac plus L-NAME

Two-Incision Laparoscopic Cholecystectomy – Our Experience

Cilj: Članak opisuje tehniku i rezultate izvođenja laparoskopske kolecistektomije kroz dvije incizije, primijenjene na 42 bolesnika, te ju uspoređuje sa standardnom laparoskopskom kolecistektomijom. Metode: Učinjena je laparoskopska kolecistektomija kroz dvije incizije (skupina A) u 42 bolesnika. Rezultati su uspoređeni s rezultatima standardne laparoskopske kolecistektomije (skupina B – 50 bolesnika). Rezultati: Srednje operacijsko vrijeme bilo je 45 ± 3,5 min (skupina A) i 43 ± 4 min (skupina B). Nisu zabilježene unutaroperacijske ili poslijeoperacijske komplikacije. Srednje vrijeme hospitalizacije bilo je jednako u objema skupinama. Zaključak: Laparoskopska kolecistektomija kroz dvije incizije jednako je siguran postupak kao standardna laparoskopska kolecistektomija kroz tri incizije, ali s boljim estetskim rezultatom te bez dodatnih troškova.Objective: This article describes the technique and the results of two-incision laparoscopic cholecystectomy performed on 42 patients, and compares it with standard cholecystectomy. Methods: Two-incision laparoscopic cholecystectomy (group A) was performed on 42 patients. Results were compared with standard laparoscopic cholecystectomy (group B) – 50 patients. Results: Mean operative time was 45 ± 3.5 min (group A), and 43 ± 4 min (group B). No intraoperative or postoperative complications were observed. Average hospital stay was equal in both groups. Conclusion: Two-incision laparoscopic cholecystectomy is equally safe as standard laparoscopic cholecystectomy with three incisions but with better cosmetic results and without the extra cost

Laser Treatment in Hemorrhoidal Disease - Our Experience

Cilj: U ovome se članku iznose iskustva, tehnika i rezultati u 21 bolesnika s hemoroidalnom bolešću, koji su operirani diodnim laserom. Metode: Učinjena je hemoroidektomija diodnim laserom u 21 bolesnika s verificiranim II.-III. stupnjem hemoroidalne bolesti. Rezultati: Prosječno trajanje operacije bilo je 15 ± 2 minute, a prosječna hospitalizacija 24 sata. Tijekom 12-omjesečnoga praćenja nije zabilježen ni jedan neželjeni događaj u vidu krvarenja, infekcije ili recidiva bolesti u svih operiranih bolesnika. Dodatna analgezija bila je potrebna u četvero bolesnika. Zaključak: Uporaba diodnoga lasera predstavlja dodatnu metodu u liječenju hemoroidalne bolesti te je potrebna daljnja evaluacija u budućim studijama, koja će potvrditi uspješnost te metode.Objective: This article brings experiences, technique and results in 21 patients with haemorrhoidal disease treated with diode laser. Methods: In this study, 21 patients with II-III grade haemorrhoidal disease were included and treated with diode laser. Results: Average operation time was 15 + 2 minutes, with 24-hour hospitalisation. During the follow-up period of 12 months, there were no observed complications, such as bleeding, infections or recurrence. Extra anaelgetics were required in four cases. Conclusion: The use of diode laser in haemorrhoidal disease represents an additional treatment method, where as further studies are yet to evaluate and definitely confirm the successfulness of this method