Περιεχομενα


Τόμος 24, Τεύχος 3
Ιούλιος- Σεπτέμβριος 2019


Ερευνητικές εργασίες
115Association Between an Incomplete Mucosal Doughnut and Prolapsed Haemorrhoid Recurrence After Stapled Haemorrhoidopexy: A Cross Sectional Study
Mohamad Fairuz MS , Mazlan L , Nur Afdzillah Abdul Rahman , Sagap I
Πλήρες Κείμενο | Περίληψη
Aim: A cross sectional study was performed on patients who underwent stapled haemorrhoidopexy to assess the association between the completeness of the mucosal doughnut formed after surgery with prolapsed haemorrhoid recurrence. Patients with grade 2-4 internal haemorrhoids going for elective stapled haemorrhoidopexy for the first time were eligible.Patients and methods: This study had 2 phases of data collection, where a retrospective data collection was conducted from January 2007 to September 2015, and a prospective data collection and enrolment from September 2015 and ended in September 2017. Operative notes will be reviewed for proper documentation of completeness of the mucosal doughnut from each surgery. The clinic notes of the patients from the retrospective set were reviewed to determine presence and onset of recurrence, while patients in the prospective set were then assessed for recurrence at the stated time interval until June 2017. A total of 134 patients were enrolled into the study by then. The primary endpoint of the study was to assess for recurrence of prolapsed haemorrhoid.Results: A total of twelve patients developed recurrent prolapsed haemorrhoids at the six month assessment. Three of these patients had an incomplete mucosal doughnut during their stapled haemorrhoidopexy. Overall recurrence rate for this centre was 9.83% and P value obtained was 0.18.Conclusion: There is no significant association between an incomplete mucosal doughnut obtained after stapled haemorrhoidopexy and prolapsed haemorrhoid recurrence.
119Evaluation of the effect of local anesthetic wound infiltration and intra peritoneal instillation on post laparoscopic cholecystectomy pain
Hazem Nour , Hatem Mohammad , Fady Fayek
Πλήρες Κείμενο | Περίληψη
Background; Laparoscopic cholecystectomy (LC) is one of the most common operations performed in the last 2 decade. (LC) is associated with less postoperative pain than open cholecystectomy, abdominal and shoulder pain after (LC) are a considerable causes of patients distress, both are the primary reasons of prolonged convalescence and overnight hospital stay. Many methods have been tried to treat post (LC) pain as, Non-steroidal anti‑inflammatory drugs, local infiltration with local anesthetics, epidural and intrathecal opioids and local anesthetics, intercostal nerve blocks as well as intraperitoneal instillation (IPI) of saline and local anesthesia (LA), saline and LA solution decreases the overall pain sensation after laparoscopic cholecystectomy. Other reported benefits of IPI of LA in laparoscopy is earlier discharge, decreases opioid consumption and postoperative nausea and vomiting and improves pulmonary function during the postoperative course.Patient and methods; 74 patients divided into 2 groups each consists of 37 patients, 1st group the control group. the 2nd group received intraperitoneal lidocaine 2% in the undersurface of diaphragm and at the gall bladder bed, and infiltration around the incisions.Results; There is significant improvement in the pain scores in patients who received local anesthetics in the 1st postoperative 24 hours.Conclusion; lidocaine 2% Local anesthetic Intraperitoneal instillation of and wound infiltration decreases the post-operative pain and improves patients recovery in cases of laparoscopic cholecystectomy
123Comparison of Choledochoduodenostomy and Simple Choledochotomy with T-Tube Drainage as Surgical Intervention For Choledocholithiasis
Bahtiyar Muhammedoğlu , Eyüp Mehmet Pircanoğlu , Erol Pişkin , Mehmet Sertkaya , Mesüt_Özdedeoğlu
Πλήρες Κείμενο | Περίληψη
Introduction: In spite of the developments in modern medicine, choledocholithiasis remains a problem that sometimes could not be resolved with endoscopic interventions. We aimed to discuss the advantages and disadvantages of choledochoduodenostomy and simple choledochotomy with T-tube drainage. Materials/Method: Forty-eight patients with choledocholithiasis enrolled for the study were divided into two groups as simple choledochotomy with T-tube drainage and choledochoduodenostomy. Liver and kidney function tests were obtained at the first and third postoperative days. Length of stay, total hospital cost, mean operation time and complications were also noted.Results: Choledochoduodenostomy group was significantly older. To prevent misinterpretations, we calculated the corrected levels of each biochemical parameter. Only creatinine was found to be related to age. Corrected creatinine levels were significantly higher in the T- tube group on both first and third postoperative days. Total and direct bilirubin levels were also higher in the T–tube group on both first and third postoperative days. Mean operation time and total hospital costs were similar for the two groups. Hospitalization duration was longer after choledochotomy with T-tube drainage. Conclusion: Surgical procedures could be alternative or salvage therapy for choledocholithiasis after failed non-surgical procedures. Even though many surgeons hesitate to perform bilioenteric anastomoses due to possible complications, many studies had proven that choledochoduodenostomy has similar outcomes with simple choledochotomy and drainage. Both surgical procedures could be conducted safely in technically experienced centers.
127A Retrospective Study On The Association Of Prior Low Dose Aspirin Therapy In Diabetics With Helicobacter Pylori Infection
Mohamad Fairuz MS , Arief H
Πλήρες Κείμενο | Περίληψη
Helicobacter pylori is one of the most common bacterial infection in the world causing a significant impact on public health. The infection is usually asymptomatic, but when symptom arises, it is commonly tested for via endoscopy and the CLO (Campylobacter Like Organism) test. Due to the majority of patients being asymptomatic and a variable time frames of presentation, studying and establishing a temporal relationship between H. pylori and predisposing factors can be very challenging. Previous studies have shown that H. pylori infection is more prevalent among diabetic patients. Aspirin is now more commonly used in the prophylactic management of diabetic patients and is also known to be associated with gastric mucosal damage. This retrospective study investigates any association of Low Dose Aspirin (LDA) therapy in diabetics with H. pylori infection. The study involves endoscopic records of 274 diabetic patients who received and without LDA respectively, and analysis showed there is an association between LDA therapy in diabetics with H pylori infection, whereby LDA group had a lower H. pylori infection (n=0.02).
136Fully covered metallic mega stents use in the management of post-laparoscopic sleeve gastrectomy leakage, is it beneficial?
Hatem Mohammad , Mohamed Farouk Amin , Hany Mohamed , Hazem Nour
Πλήρες Κείμενο | Περίληψη
Background: Laparoscopic sleeve gastrectomy (LSG) is one of the mostly performed bariatric surgical procedures. LSG has many advantages as there is no anastomosis, it is performed easily and the gastric antrum is preserved. However, this procedure has some complications, the most disquieting of them is the stable line leakage, it is the main source of postoperative morbidity and mortality after LSG. Method: This study was conducted between January 2015 and February 2019 on eight patients diagnosed with post laparoscopic sleeve gastrectomy staple line leak. Underwent endoscopic fully covered mega stent insertion to cover the leak defect, 7 of them underwent rapid stent insertion and one delayed for management of peritonitis.Results: The stent managed to control leak in 7 patients successfully mean time 31.8 ±SD7.1 days, one case needed stent reposition. One patient needed ROUX en Y gastric bypass (RYGB).Conclusion: Endoscopic fully covered mega stent insertion is a safe effective method for treatment of post laparoscopic sleeve gastrectomy staple line leak

Ενδιαφέρουσες περιπτώσεις
140Internal Hernia After Roux En Y Gastric Bypass: A Paradigm Shift Of Practice
Juhanis Safira Johari1 , Reynu Rajan2 , Mustafa Mohd Taher2 , Mohd Aznan Shuhaili2 , Iman Ghoneim2 , Nik Ritza Kosai2
Πλήρες Κείμενο | Περίληψη
Laparoscopic Roux en Y gastric bypass (LRYGB) surgery is among the most commonly performed bariatric procedure providing excellent results with low morbidity and mortality. One of the most common and also most devastating complication that can arise after LRYGB is an internal hernia, where parts of the bowel pass through a defect, be it meso-jejunal, Petersen’s (in antecolic RYGB) or transverse mesocolic (in retrocolic RYGB). The occurrence of internal hernia is usually within the first 20 months post procedure and the symptoms that patient might presented with, may vary from non-specific abdominal discomfort to fulminant acute small bowel obstruction. The low incidence of internal hernia after LRYGB procedure made primary closure of the defects not routinely practiced. Laboratory investigations are of not much help in diagnosis and Computed Tomography (CT) imaging does not always give the characteristic appearance as described in textbooks or literature.We report two cases of internal hernia post LRYGB. Case 1, a 34-year-old lady presented at 13 months after LRYGB with chronic abdominal pain, laboratory investigations were unremarkable and CT scan showed abnormal orientation of superior mesenteric artery, which was posterior to mesenteric vein, raising suspicion of internal herniation. Diagnostic laparoscopy revealed internal herniation via Petersen’s and meso-jejunal defects. Case 2, a 47 year old man, 15 months post LRYGB presented with biliary colic, treated for cholelithiasis, intraoperatively incidental finding of internal hernia through large Petersen’s and meso-jejunal defects. Both cases achieved closure laparoscopically with non-absorbable sutures in continuous manner. With these presented cases, although studies showed the incidence of internal herniation relatively small, 0.2-8.8%, we recommend primary closure of all defects to reduce the incidence of internal hernias.
144Classical Hodgkin Lymphoma Presenting as Rapidly Enlarging Obstructive Thyroid Mass: A Rare Occurrence
Suria Hayati Md Pauzi , Tengku Nor Diana Mariana Tengku Abu , Muhammad Rohaizak
Πλήρες Κείμενο | Περίληψη
Background: Primary thyroid lymphoma accounts for less than 5% of all thyroid malignancy, most of which is non-Hodgkin, B-cell type while thyroid Hodgkin lymphoma (HL) is a very occurrence.Case Presentation: 22-year-old lady presented with 3-month history of rapidly enlarging thyroid mass associated with dysphagia and hoarseness of voice. CT scan showed a large thyroid mass associated with multiple cervical lymphadenopathy, trachea narrowing and a small lung nodule. An intraoperative frozen section evaluation of mass showed discohesive malignant cells suggestive of lymphoma. Tumour debulking and tracheostomy was performed. Histopathological examination of the debulking specimen showed presence of Reed-Sternberg and Hodgkin cells which is positive to CD30, CD15 and PAX5 in the background of mixed inflammation that confirmed the diagnosis of Classical Hodgkin Lymphoma.Conclusion: Although rare, Hodgkin lymphoma (HL) should be considered as one of the differential diagnosis of a rapidly-enlarging thyroid mass in a young female. FNAB is useful as an initial evaluation of a thyroid mass however, it is usually non-confirmatory of HL. The final pathological diagnosis should be made on bigger biopsy or excised specimen. An accurate pre-operative diagnosis obviates the need for total thyroidectomy although surgery may be necessary in cases of airway obstruction.
149Giant Retroperitoneal Ganglioneuroblastoma Encasing Abdominal Aorta In Children: A Case Report And Concise Review Of Literature
Oon Zhi Lim , Mohd Shahrulsalam Mohd Shah , Norsuhana Omar , Boon Seng Yeoh , Hidayah Hayati Hashim
Πλήρες Κείμενο | Περίληψη
Background: Neuroblastic tumors develop when the sympathetic nervous system failed to mature. Neuroblastic tumors are rare but it represents the most common neurogenic tumor and ranked third in childhood malignancy. Ganglioneuroblastoma is a subset of neuroblastic tumor that is intermediate in differentiation.Case presentation: We describe a giant retroperitoneal ganglioneuroblastoma in a 5-year-old child, showing disease progression despite chemotherapy. The patient underwent laparotomy for tumor excision. This retroperitoneal tumor can be resistant to chemotherapy and potentially grow into a very large size encasing major vessels, thereby complicating excision. This article will highlight the need to report such case to update medical practitioner and surgeons on current knowledge on neuroblastic tumors and provide a concise literature review.Conclusion: Giant retroperitoneal ganglioneuroblastoma is rare and this case illustrates its refractory nature to chemotherapy leading to the need for surgical involvement. Neuroblastic tumors have close relation with blood vessels that complicate surgery, therefore surgeons require knowledge to perform a safe surgery. Current recommendation requires imaging to identify image-defined risk factors and histopathology to gauge the suitability of surgical intervention
152Endoscopic Treatment of Pancreatic Ascites: Judgement Between Risks and Benefits
Leow VM , Hasnan MN , Thamarai Velan K , Ikhwan Sani M , Manisekar K. S
Πλήρες Κείμενο | Περίληψη
Pancreatic ascites is a rare complication of acute and chronic pancreatitis. The underlying cause of this complication likely is leakage from a pancreatic pseudocyst or ductal disruption. Treatment includes medical therapy and surgery. Here we described a patient with abdominal pain and ascites with a history of chronic alcoholism. The abdominal computed tomography scan revealed the presence of massive ascites and endoscopic retrograde cholangiopancreaticography showed pancreatic duct dehiscence. A pancreatic stent was inserted but the patient ultimately died as a result of septic shock with multi-organ failure. This case report highlights how difficult it is to manage patients with pancreatic ascites
155Umbilical Metastasis Of Gallbladder Carcinoma
D. Paramythiotis , M. Moysidis , I. Tsomidis , A. Karakatsanis , P. Goulas , S. Apostolidis , A. Michalopoulos
Πλήρες Κείμενο | Περίληψη
Background: Umbilical metastasis is not a common clinical entity. Of all the gastrointestinal tumors, no more than 1-3% will develop metastatic disease to the umbilicus. Those metastases more often originate from the stomach and colon in male patients, while they usually are secondary disease from ovarian and endometrial cancer in females. In almost a third of the patients involved, the location of the primary disease will remain unknown.Case presentation: We present a case of a 94-year-old male patient, complaining of a painless mass in his umbilicus, erythema and fluid discharge. Imaging investigation with a CT scan of his abdomen and pelvis revealed a distended gallbladder with irregular and thickened wall, with contiguous liver infiltrations. A 4cm mass at the umbilicus was also recognized. An excision biopsy was performed to confirm the diagnosis of the metastatic gallbladder carcinoma. No further treatment was offered to the patient as per his own will. During consultation, the advanced age and comorbidities, along with the poor prognosis of the disease itself played a key role to the decision making. The patient died within the next year from the diagnosis.Conclusion: Gastrointestinal and pelvic malignancies will not often metastasize to the umbilicus. Nevertheless, umbilical metastasis will be the first clinical sign of the disease in almost 30% of cases and is accompanied with poor prognosis. Although most umbilical lesions are of benign nature, a clinician should always exclude an underlying malignancy through thorough investigations.

Εικόνες στη χειρουργική
158A rare anatomical case of purulent pericarditis on a male cadaver: clinical and surgical considerations
Konstantinos Koutsouflianiotis , George Paraskevas , Eleni Zagelidou , Iakovos Geroudis , George Noussios
Πλήρες Κείμενο

Εκπαιδευτικό video
159Laparoscopic repair of an epigastric hernia with a new self-expandable mesh
Grigoris Chatzimavroudis , Georgia Kotoreni , Nikolaos Voloudakis , Stefanos Atmatzidis , Ioannis Koutelidakis , George Paraskevas , Vasileios Papaziogas
Πλήρες Κείμενο | video



Επιστολές προς Εκδότη
160Acute Limb Ischemia Resulting in Major Amputation Following Cisplatin and Fluorouracil in Treatment of Sinonasal Cancer
Lenny Suryani Safri , Krishna Kumar , Tan Jih Huei , Henry Tan Chor Lip , Mohamad Azim Md Idris , Hanafiah Harunarashid
Πλήρες Κείμενο
162Liver Abscess Ruptured In The Abdominal Wall: A Rare Complication In A Child
A. Ndong , JN. Tendeng , NA. Ndoye , A. Dieye , AC. Diallo , MR. Elmansouri , DA. Dia , J. Nibogora , ML. Diao , PMM. Nyemb , I. Konaté
Πλήρες Κείμενο
164Rare case of Hepatogastric Fistula Following Liver Abscess in Immunocompromised Patient
Mohammad Alif Yunus , Ahmad Fardi Sulaiman , Andee Dzulkarnaen Zakaria , Mohd Nizam Hashim , Ikhwan Sani Mohammed , Zaidi Zakaria
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Νεκρολογία
167Νεκρολογία Κώστα Σαλιάγκα
Εμμ. Χρ, Χριστοφορίδης
Πλήρες Κείμενο