Conventional vs. Laparoscopic Appendectomy in Emergency Patients. Is There a Better Approach?

Introduction: Surgical treatment of acute appendicitis is relatively easy with a minimally invasive approach. Laparoscopy produces a very good image; applies less trauma, has better cosmetics and patients recover more quickly. However, its routine use requires prepared laparoscopic sets, trained personnel and specific organization. The main difficulties of both methods are associated with atypical anatomical locations and complicated forms of the disease.Aim: The objective of the study is to compare the reasons influencing the decision to choose a laparoscopic or a conventional approach for appendectomy. Surgeries performed in the span of four years in II-nd Surgery, Hospital Alexandrovska (2012-2016) were evaluated.Materials and Methods: The study covered 67 patients with acute appendicitis. Of those 8 (11.9%) were operated on with a laparoscopic approach . The average age was 27.4 years. There were 23 men (34.3%) and 44 women (65.7%). The average conventional intervention duration was 70 minutes, while in the laparoscopic procedure it was 55 minutes (

Optimizing the Learning Curve in Laparoscopic Colorectal Surgery

Introduction: In the recent decades, the surgical treatment of colorectal neoplasms is further developed with a minimally invasive approach, following the complex approach, modern guidelines and classic oncological principles. Any conventional operation can be performed via laparoscopy and in addition to that it produces a better image of the pelvis. Thus, a high-quality surgery, with a maximal sphincter conservation, minimal blood loss and quicker recovery of the patients can be carried out.Aim: The aim of this study was to analyze factors influencing the period of gaining experience with laparoscopic colorectal resections. We evaluated this surgery performed in the Second Surgery at the „Alexandrovska` Hospital (March, 2013-Februrary, 2016) for a period of three years.Materials and Methods: 317 patients with colonic and rectal neoplasms were operated on. Their average age was 61.4 and the gender distribution was - 172 males (54.3%) and 145 females (45.7%). Laparoscopic approach was planned in 37 (11.7%) of them. The following factors were taken into consideration: location of the tumor, the need to use automatic devices, duration of the surgery, etc. The compared indicators, related to decision making for laparoscopic approach, are the technique used and the obtained result, the duration of the intervention, financial resources and the number of conversions.Results: There were 5 are rectal amputations (13.5%), 14 anterior resection (37.8%) and two intersphincteric resections with coloanal anastomosis (5.4%), 6 (16.2%) right hemicolectomies, 5 left colectomies (13.5%) and three sigma resections (8.1%). The average postoperative stay reported was 6.2 days. The mean operative time was 212 minutes. A steady tendency to reduce it was observed (from 330 to 120 min.). Due to the advanced process, conversion was performed in 5 cases (13.5%).Conclusion: The use of automatic stapling devices and high-energy hemostatic devices predetermines the higher cost of the laparoscopic surgery. It gives the advantages of less postoperative pain and shortened hospitalization. The longer training curve depends on resource availability and personal technical skills. This use of this metehod gives the necessary advantage to patients without oncological safety compromise

Skin manifestations of COVID-19 in children: Part 2

The current COVID-19 pandemic is caused by the SARS-CoV-2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS-CoV-2 infection in children differ from those in adults, as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID-19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discussed one of the first and most widespread cutaneous manifestations of COVID-19, chilblain-like lesions. In this part of the review, we describe other manifestations, including erythema multiforme, urticaria and Kawasaki disease-like inflammatory multisystemic syndrome. In Part 3, we discuss the histological findings of COVID-19 manifestations, and the testing and management of infected children for both COVID-19 and any other pre-existing conditions

Skin manifestations of COVID-19 in children: Part 3

The current COVID-19 pandemic is caused by the SARS-CoV-2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS-CoV-2 infection in children differ from those in adults as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID-19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discuss one of the first and most widespread cutaneous manifestations of COVID-19, chilblain-like lesions, and in Part 2 we expanded to other manifestations, including erythema multiforme, urticaria and Kawasaki disease-like inflammatory multisystemic syndrome. In this part of the review, we discuss the histological findings of COVID-19 manifestations, and the testing and management of infected children for both COVID-19 and any other pre-existing conditions

Skin manifestations of COVID‐19 in children: Part 1

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