Περιεχομενα


Τόμος 23, Τεύχος 4
Οκτώβριος-Δεκέμβριος 2018


Ερευνητικές εργασίες
202A summary of immediate results in pancreatic and biliary surgery
Cianci P. , Tartaglia N. , Fersini A. , Ambrosi A. , Neri V.
Πλήρες Κείμενο | Περίληψη
The pancreatic surgery can result in high postoperative morbidity rates. Pancreatic resections are among the major surgical procedures such as pancreaticoduodenectomy (PD), Puestow, Beger—Frey procedure,distal resection etc., with operative mortality rates less than 5% , showing a stable reduction, referred to the last two decades, but also a stable high morbidity rates (30-60%). Pancreatic fistula is the most relevant complication of pancreatic surgery. Other specific complications of pancreatic surgery may occur with variable incidence: delayed gastric emptying after PD, postoperative hemorrhage following pancreatic resection in the immediate postoperative period or delayed 10-15 days, gastrojejunal anastomotic fistula after PD, enteric fistula after laparostomies/relaparotomies as treatment of infected pancreatic necrosis, intrabdominal abscess following necrosectomy for infected pancreatic necrosis by acute pancreatitis or after pancreatico-jejunostomy. Biliary surgery presents very variable range of complexity. The bile duct injuries are the major complications of biliary surgery; their incidence, very frequently related to cholecystectomy,with open or laparoscopic approach, varies from 0,2% to 0,8%. These injuries can be recognized during operative procedures or in the postoperative period, early or late. In any case the biliary injury can be followed by long-term morbidity, multiple radiological and surgical therapeutical procedures and mortality. Other complications are the biliary strictures due to pathological evolution of bile duct injury or of bilio-digestive anastomosis. The evaluation of omogenous clinical cases of biliopancreatic surgery’s complications, from our experience, can allow us to clarify the choices of the treatments. Pancreatic and biliary surgical complications include an ample range of clinical conditions. This study reviews the more common postoperative pancreatic and biliary complications, their prevention and treatment.
207Perineural invasion as a predictor of outcome after surgery for gastric cancer
Lianos G. , Bali C. , Roukos D. , Glantzounis G.
Πλήρες Κείμενο | Περίληψη
Background and Aims: Recently, extensive research is performed in order new prognostic factors for gastric cancer to be identified. The prognostic value of perineural invasion for gastric cancer remains controversial. Aim of this study was the evaluation of the prognostic role of perineural invasion in patients with gastric cancer. Material and Methods: This retrospective study included 104 patients (69 males – 35 females) with gastric adenocarcinoma treated with therapeutic (R0) gastrectomy. Perineural invasion and its prognostic relationship with patients’ survival was studied and analyzed. Results: In univariate analyses, perineural invasion was found to be statistically significant in relationship with patients’ survival (p=000). Notably, patients with perineural invasion presented 5-year survival rates of 13%, while patients without perineural invasion presented 5-year survival rates of 32%. However, in the multivariate statistical analyses, perineural invasion was not an independent prognostic factor for patients with gastric cancer and this could be due to the small sample size of our study. Conclusions: Our study revealed that perineural invasion in gastric cancer plays an important prognostic role and could be useful in detecting patients with poor prognosis after curative gastrectomy. The application of more ‘intensive’ chemotherapeutic regimens in perineural invasion-positive patients could improve their survival. Prospective studies with larger number of patients is necessary to be done, in order safe conclusions to be reached.
211Is weekend admission a risk factor for in-hospital mortality following colectomy?
Kapil Narain , Yoshan Moodley
Πλήρες Κείμενο | Περίληψη
Background: A potential “weekend effect”, related to increased mortality in colectomy patients admitted on a weekend, has been previously reported. This study sought to confirm the existence of this potential “weekend effect” in colectomy patients. Patients and Methods: This was an unmatched case-control study (459 cases and 1836 controls) of colectomy patients from the 2011 California State Inpatient Database (SID). Cases were defined as patients who suffered in-hospital mortality following their procedure, while controls were defined as patients who were discharged alive following their procedure. Other data extracted from the SID for this study included patient demographics, comorbidity, and other relevant information pertaining to the admission (including whether the admission occurred on a weekend). Data were analyzed using recommended methods for unmatched case-control studies. Results: Colectomy patients admitted on a weekend had a higher risk of in-hospital mortality when compared with colectomy patients admitted on a weekday (Odds Ratio: 1.34, 95% Confidence Interval: 1.01-1.78; p=0.043). Conclusion: Weekend admission is a risk factor for in-hospital mortality following colectomy. This has important implications with regard to planning admissions and operation dates for colectomies, with the future goal of addressing avoidable mortality associated with the “weekend effect”
215Appendiceal Neuroendocrine Tumors (aNETs) in Single Center: Literature review and a Case Series
Sarmukh Singh , Kerwin Teoh , Ramesh Thangaratnam , Chew Loon Guan , Zaidi Zakaria
Πλήρες Κείμενο | Περίληψη
The appendix is one of the most common single site for carcinoid tumor [1]. Histopathologically, appendiceal neuroendocrine tumors (aNETs) is mostly comprised of enterochromaffin (EC) cell type and derives from a subepithelial cell population, which is different from neuroendocrine tumor in other sites. Although rare, and usually detected incidentally in appendectomy, it is considered the most common type of appendiceal primary malignant lesion, and is found in 0.3%-0.9% of patients undergoing appendicectomy [2]. This tumor rarely presents with metastases. Despite being the most frequently occurring carcinoids, in surgical practice most surgeons encounter only one or two such lesions during their career. Therefore, it is important to define correct management of such a rare tumor. We would like to report a series of 2 aNETs found during appendicectomy in a single centre and discuss about management strategies.
218Food Flotilla for Myanmar - Surgical Operating Theater Setup in Nautical Aliya
Ahmad Fardi Sulaiman , Andee Dzulkarnain Zakaria , Wan Zainira Wan Zain , Mohd Nizam Hashim , Zaidi Zakaria , Raja Amin Raja Mokhtar , Theevashini Krishnasamy , Mohd Fahmi Zakariah
Πλήρες Κείμενο | Περίληψη
Recently in February 2017, groups of Non-Government Organizations (NGOs) from 13 countries involved in humanitarian mission Food Flotilla for Myanmar, mainly to deliver 2,200 tons of foods, medical aid and hygiene kits to the state of Rakhine and its borders, for the forgotten people of Rohingya. About 180 volunteers involved, media practitioners, former minister, members of Parliament (MP), religious leaders, crew, including the deployment of almost 30 medical personals including surgeons, anesthetist, emergency physicians, and medical officers making the 3 weeks voyage to hand humanitarian aid to the displaced Rohingya. The foods and humanitarian aids were loaded onto the working vessel, named Nautical Aliya and the voyage being successful delivered all aids to the needs. Being in the open sea for almost 21 days, medical personals being one of the main highlight. The author personally involved in the Food Flotilla for Myanmar, as a surgical registrar, with the help of 2 surgeons, anesthetist, and emergency physicians, we setup an operation theater in Nautical Aliya. Our aim is to cater all surgical emergency during the journey. This report details the way we setup the ship’s surgical operating theater, with the limitations, difficulties and resources.

Ενδιαφέρουσες περιπτώσεις
222Primary squamous cell carcinoma of the renal pelvis presenting as a complex fistula of the lumbar region
Paramythiotis D , Moysidis M , Karakatsanis A , Bangeas P , Michalopoulos A.
Πλήρες Κείμενο | Περίληψη
Malignant tumors of the renal pelvis are relatively rare, while squamous cell carcinoma (SCC) of the renal collecting system represents approximately 6-15% of all of them. There is a well-established relationship between SCC and urolithiasis, explained by the effects of chronic inflammation of the collecting system due to renal stones. Computed tomography (CT) of the abdomen and pelvis is the most valuable imaging technique to identify those lesions. In this study, we report a case of a 69-year-old male patient with recurrent, right lumbar fistulating abscess who presented to our outpatient clinic, as it failed to heal for more than three months. Further investigations revealed lithiasis (5.8cm) of the right renal pelvis and multiple renal stones in the lower calyces causing hydronephrosis. A large invasive neoplasm was found on the anatomic position of the right psoas and the patient was treated with nephrectomy and wide local excision of the surrounding tissues. Pathology report confirmed the diagnosis of SCC. High clinical suspicion for cancer is essential in similar cases, as renal pelvis tumors often present with atypical symptoms thus leading to a delayed diagnosis and poor outcome
225Malignant Solid Pseudopapillary Neoplasm of the pancreas with Recurrence and Metastasis
Chan CH , Ziyadi G , Johann FK , Leow VM , Manisekar KS
Πλήρες Κείμενο | Περίληψη
Solid pseudopapillary neoplasm (SPN) is a rare neoplasm of the pancreas. It has a wide variability and indeterminate nature of behaviour which are poorly understood, some have quoted as saying it’s a benign neoplasm with malignant potential. SPN usually shows an indolent behaviour, only rare cases recur and/or metastasize after complete resection. We reported a case of a 31-year-old lady with history of distal pancreatic SPN, diagnosed when she was 14 years old, who underwent distal pancreatectomy and splenectomy the same year. 2 years later, right hemihepatectomy was performed due to liver metastasis. She was well until a screening CT 3 phase of liver showed recurrent metastatic liver lesions and she underwent metastasectomy. Histopathological report showed metastatic solid pseudopapillary neoplasm.
228The 3.5ms rule of stimulation latency in identification of non- recurrent laryngeal nerve (NRLN): Is it always true?
Raflis RA , Hakim NA , Rohaizak M , Aina EN
Πλήρες Κείμενο | Περίληψη
A non - recurrent laryngeal nerve (NRLN) has a shorter course to enter the larynx and theoretically will have a shorter latency period on electromyography (EMG). Previous report has shown that latency shorter than 3.5ms has a very high sensitivity and specificity for diagnosis of NRLN. We present two different types of NRLN with latency period longer than 3.5ms. Case 1: A 42 year old lady presented with a right thyroid nodule and scheduled for a right hemithyroidectomy. During dissection and stimulation of the right vagus (V1), the latency period was normal at 5.2ms. Further dissection at the inferior pole of the gland failed to identify the recurrent laryngeal nerve (R1). The dissection and mapping performed lateral to the gland identified a type 2B NRLN, entering at the posterior aspect of the larynx. Case 2: A 40 year old lady presented with a large nodular goiter and underwent total thyroidectomy. Left hemithyroidectomy was uneventful. During right hemithyroidectomy, stimulation of the right vagus (V1) nerve at the mid - cervical region was absent. The stimulation was extended superiorly on the vagus and there was a good amplitude with latency of 3.88ms, with suspicion of a right NRLN. Further meticulous dissection confirmed type 1 NRLN. Stimulation of the vagus nerve (V1) in the early stage of thyroidectomy is useful in helping to identify NRLN especially type 1, either by looking at the point of stimulation or latency period. Care still should be taken during the dissection as the sensitivity varies according to the different types of NRLN.
230Ileo-caecal junction Endometriosis Caused Subacute intestinal Obstruction : A Rare Entity
Muhammad Haekal Khazalle , Iqtidaar Oaris , Faezahtul Arbaeyah , Wan Mohd Mokhzani Wan Mohd Mokhtar
Πλήρες Κείμενο | Περίληψη
Endometriosis is a common problem amongst women with an incidence of 5 – 15%. Ileo-caecal involvement is even more rare accounting for 1 – 7% and intestinal obstruction secondary to endometriosis occurs in around 23% of cases. We reporting a case of ileo-caecal endometriosis with subacute intestinal obstruction which was an incidental findings during elective open myomectomy by gynaecology team. Preoperative diagnosis of bowel endometriosis is difficult even with help of imaging. The management of bowel endometriosis intraoperatively is challenging as other possible differential diagnosis should be considered, specially tumour, inflammatory bowel disease and tuberculosis which are highly prevalent in our population.
233An Interesting Case of Retrocaecal Internal Herniation Causing Small Bowel Obstruction
Nurul Hana Mohamad Hassan , Zaidi Zakaria , Muhammad Aizat Tamlikha Ismail , Fitzgerald Henry , Ruhi Fadzlyana Jailani
Πλήρες Κείμενο | Περίληψη | video


Internal hernia is one of the rare causes of small bowel obstruction. A congenital mesenteric defect is very rare but can potentially cause internal hernia with consequent incarceration or strangulation of the small intestine. It has been reported in the field of paediatric surgery but rarely in adult. Herein, we report a case of congenital internal hernia in adult.

Εικόνες στη χειρουργική
235A rare cause of abdominal pain; giant mesenteric lipoma
Mehmet Zeki Ögüt , Arife Simsek , Mahmut Burak Kilci , Huseyin Kocaaslan , Cengiz Ara
Πλήρες Κείμενο | video



Εκπαιδευτικό video
236Atypical left hepatectomy for huge non-parasitic cyst of the left liver lobe
Papaziogas B. , Voloudakis N. , Kostakis I. , Sachoulidou A. , Papathanasiou L. , Kotoreni G. , Dipidis E. , Chatzimavroudis G. , Christoforidis E.
Πλήρες Κείμενο

Επιστολές προς Εκδότη
237Inflammatory myofibroblastic tumour rare cause of acute urinary retention
Hasmali Mohamad , Norra Harun , Mohd Nazli Kamarulzaman , Zaidi Zakaria , Abdul Hamid Ghazali , Mohd Nor Gohar
Πλήρες Κείμενο
239Meckel's Diverticulitis in Adulthood: A Revisit
Affirul CA , Firdaus H , Hanizah N , Salleh S
Πλήρες Κείμενο
242Non-resolving traumatic pneumothorax: is open thoracotomy still relevant?
Affirul CA , Yuzaidi M , Tiong VE , Rizal IA
Πλήρες Κείμενο