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Magyar Sebeszet Jun 2024Bevezetés: A posztoperatív pancreasfistula mind proximalis, mind distalis pancreatectomia után a legjelentősebb sebészi szövődménynek számít. A...
Bevezetés: A posztoperatív pancreasfistula mind proximalis, mind distalis pancreatectomia után a legjelentősebb sebészi szövődménynek számít. A szakirodalomban nincs egyértelműen ajánlott, megbízható módszer ezen probléma kiküszöbölésére, emiatt történnek újítások szerte a világon. Jelen közleményünkben a technikai innovációinkról számolunk be. Anyag és módszerek: 2013. január 1-jétől 2023. november 30-ig terjedő időszakban 205 Whipple-műtétet végeztünk nyitottan, mely során a pancreatojejunalis anastomosist az általunk módosított dohányzacskó-öltéses módszerrel készítettük el. 2019. január 1. és 2023. november 30. között pedig 30 betegnél történt nyitott distalis pancreatectomia, amikor a pancreascsonkot az általunk kifejlesztett technikával, szabad rectus fascia-peritoneum grafttal fedtük, majd azt cirkuláris öltéssel rögzítettük. Közleményünkben ezen két módszerrel elért eredményeket ismertetjük. Eredmények: a demográfiai adatok megfeleltek a betegségnél szokásosnak. A posztoperatív ápolási idő és a transzfúzió igény terén észlelt különbségek tükrözték a kétféle beavatkozás eltérő invazivitását. A releváns pancreasfistula kialakulási rátája kedvező képet mutatott, Whipple-műtét után 7,3% volt, míg distalis pancreatectomát követően nem fejlődött ki. A reoperációs és a halálozási arányok megfeleltek az elvártaknak és korreláltak a műtétek kiterjedtségével. Következtetés: pancreas resectiók utáni komplikációk csökkentésére tett törekvéseink során a módosított dohányzacskó-öltéses pancreatojejunostomia és a pancreascsonk fedésére kidolgozott módszerünk egyaránt kedvező eredményekkel járt.
Topics: Humans; Pancreatic Fistula; Postoperative Complications; Female; Male; Pancreatectomy; Middle Aged; Pancreaticojejunostomy; Aged; Pancreaticoduodenectomy; Treatment Outcome; Adult
PubMed: 38941151
DOI: 10.1556/1046.2024.20002 -
Archives of Gynecology and Obstetrics Jun 2024Dense adhesion due to severe endometriosis between the posterior cervical peritoneum and the anterior sigmoid or rectum obliterates the cul-de-sac and distorts normal...
BACKGROUND
Dense adhesion due to severe endometriosis between the posterior cervical peritoneum and the anterior sigmoid or rectum obliterates the cul-de-sac and distorts normal anatomic landmarks. Surgery for endometriosis is associated with severe complications, including ureteral and rectal injuries, as well as voiding dysfunction. It is important to develop the retroperitoneal avascular space based on precise anatomical landmarks to minimize the risk of ureteral, rectal, and hypogastric nerve injuries. We herein report the anatomical highlights and standardized and reproducible surgical steps of total laparoscopic hysterectomy for posterior cul-de-sac obliteration.
OPERATIVE TECHNIQUE
We approach the patient with posterior cul-de-sac obliteration using the following five steps. Step 1: Preparation (Mobilization of the sigmoid colon and bladder separation from the uterus). Step 2: Development of the lateral pararectal space and identification of the ureter. Step 3: Isolation of the ureter. Step 4: Development of the medial pararectal space and separation of the hypogastric nerve plane. Step 5: Reopening of the pouch of Douglas.
CONCLUSION
Surgeons should recognize the importance of developing the retroperitoneal avascular space based on precise anatomical landmarks, and each surgical step must be reproducible.
PubMed: 38940845
DOI: 10.1007/s00404-024-07614-y -
Frontiers in Cardiovascular Medicine 2024Malignant mesothelioma (MM) is a rare and aggressive tumor that is found in the pleura and peritoneum. A few cases of MM in the pericardium and tunica vaginalis testis...
BACKGROUND
Malignant mesothelioma (MM) is a rare and aggressive tumor that is found in the pleura and peritoneum. A few cases of MM in the pericardium and tunica vaginalis testis have been reported. Moreover, primary occurrence in the atrium is extremely rare. The visual appearance of this tumor is similar to that of a common atrial myxoma, which makes it challenging for clinicians and radiologists to diagnose and treat this disease.
CASE DEMONSTRATION
An 18-year-old woman presented with symptoms of chest pain, shortness of breath, cough, and expectoration for 7 days. Echocardiography was performed on the patient, which revealed an atrial mass. Myxoma was one of the differential diagnoses. The tumor was an elliptical mass with tips, and the cut surface was jelly-like, similar to myxoma. After surgery, a pathologic examination of the biopsied tumor confirmed epithelial-type MM. During postoperative follow-up, no recurrence of the tumor was observed.
CONCLUSIONS
MM originating in the atrium is considered to be extremely rare. Consequently, clinicians can easily misdiagnose atrial MM as a myxoma. Moreover, to confirm the diagnosis, histopathologic biopsy, histomorphological characterization, immunohistochemistry, and molecular genetic testing are required. Therefore, clinical diagnosis and treatment of MM are challenging.
PubMed: 38938650
DOI: 10.3389/fcvm.2024.1398311 -
Renal Failure Dec 2024This study aims to establish a simplified and effective animal model of catheter malfunction caused by omental wrapped using negative pressure suction.
BACKGROUND
This study aims to establish a simplified and effective animal model of catheter malfunction caused by omental wrapped using negative pressure suction.
METHOD
The peritoneal dialysis catheter outlet was linked to a negative-pressure (0-75mmHg) suction pump to intensify the negative pressure. Different negative pressures were tested for model construction , a model of peritoneal catheter malfunction caused by omental wrapped was constructed in five beagles after catheter placement. Catheter drainage conditions and related complications were monitored before and after the model establishment.
RESULTS
In the vitro experiment, the overall success rate of constructed models was 90% (36/40). The total malfunction rate was higher in 62.5 mmHg (10/10) and 75 mmHg (10/10) than in 12.5 mmHg (8/10) and 37.5 mmHg (8/10). The outflow velocity of dialysate at 62.5 mmHg was significantly lower than that at 12.5 mmHg and 37.5 mmHg, without a statistically significant difference compared to 75 mmHg. In the experiment, catheter outflow velocity increased, and residual fluid volume decreased after omental wrapped (99.6 ± 6.7 ml/min vs. 32.6 ± 4.6 ml/min at initial five minutes, < 0.0001; 69.2 ± 16.3 ml vs. 581.0 ± 109.4 ml, < 0.001). And the outflow velocity was finally below 2 ml/min. No severe related complications (such as infection, organ damage, or bleeding) were observed through laparoscopic examination and dialysate tests seven days post-operation.
CONCLUSION
Utilizing negative pressure suction to increase negative pressure around catheter tip is a simple, safe, and effective method for establishing an animal model of omental wrapped leading to catheter malfunction.
Topics: Animals; Dogs; Omentum; Suction; Equipment Failure; Peritoneal Dialysis; Catheters, Indwelling; Disease Models, Animal; Male; Models, Animal
PubMed: 38938162
DOI: 10.1080/0886022X.2024.2369695 -
International Urology and Nephrology Jun 2024Acquired prostatic fistula (PF) was defined as a connection between the prostatic urethra and the rectum, symphysis, peritoneum, or ending freely in the periprostatic...
PURPOSE
Acquired prostatic fistula (PF) was defined as a connection between the prostatic urethra and the rectum, symphysis, peritoneum, or ending freely in the periprostatic area. This study aims to report our experience with PF presentation, diagnosis, and treatment.
METHODS
From January 2014 to February 2024, we retrospectively analyzed a prospectively maintained database from two urologic university hospitals to identify men with acquired PF. Diagnosis was based on post-intervention symptoms, including pneumaturia, fecaluria, rectal urine leakage, periprostatic inflammation or abscess, completed by radiological assessment using retrograde urethrogram, CT, or MRI. Standard cystoscopy and/or rectosigmoidoscopy assessed bladder and rectal integrity. Patients with post-prostatectomy fistulas were excluded.
RESULTS
Thirteen patients with a mean age of 66.54 ± 7.40 years were identified. The most commonly presenting symptoms were fecaluria/pneumaturia 54%, rectal urine leakage 31%, and recurrent urinary tract infection 31%. The mean time from the initial treatment to fistula development was 22.28 ± 20.53 months (0.1-59 months), and from diagnosis to repair was 3.5 ± 3 months (1-12 months). Cumulative closure rates (success rate) post-first and second attempts were 77% (10 patients) and 92% (12 patients), respectively; one patient declined definitive surgery, maintaining a persistent fistula after bladder drainage.
CONCLUSION
Clinical suspicion and detailed diagnosis are essential for formulating a tailored treatment plan for prostatic fistulas, which are successfully manageable in many patients. Complex cases benefit from a multidisciplinary approach, with individualized therapy based on etiology, severity, and recurrence of PF, facilitating effective closure.
PubMed: 38937414
DOI: 10.1007/s11255-024-04092-8 -
International Journal of Hyperthermia :... 2024The greater omentum is routinely resected during cytoreductive surgery (CRS), but few studies have analyzed the rationale behind this. This study aimed to assess the...
BACKGROUND
The greater omentum is routinely resected during cytoreductive surgery (CRS), but few studies have analyzed the rationale behind this. This study aimed to assess the prevalence of omental metastases (OM) and the correlation between macroscopically suspected and microscopically confirmed OM, in patients with pseudomyxoma peritonei (PMP) or colorectal peritoneal metastases (PM).
METHOD
All patients without previous omentectomy, treated with initial CRS and hyperthermic intraperitoneal chemotherapy for PMP or colorectal PM, at Uppsala University Hospital in 2013-2021, were included. Macroscopic OM in surgical reports was compared with histopathological analyses.
RESULTS
In all, 276 patients were included. In those with PMP, 112 (98%) underwent omentectomy and 67 (59%) had macroscopic suspicion of OM. In 5 (4%) patients, the surgeon was uncertain. Histopathology confirmed OM in 81 (72%). In patients with macroscopic suspicion, 96% had confirmed OM (positive predictive value, PPV). In patients with no suspicion, 24% had occult OM (negative predictive value, NPV = 76%). In patients with colorectal PM, 156 (96%) underwent omentectomy and 97 (60%) had macroscopic suspicion. For 5 (3%) patients, the surgeon was uncertain. OM was microscopically confirmed in 90 (58%). PPV was 85% and NPV was 89%. The presence of OM was a univariate risk factor for death in PMP (HR 3.62, 95%CI 1.08-12.1) and colorectal PM (HR 1.67, 95%CI 1.07-2.60), but not in multivariate analyses.
CONCLUSION
OM was common and there was a high risk of missing occult OM in both PMP and colorectal PM. These results support the practice of routine omentectomy during CRS.
Topics: Humans; Pseudomyxoma Peritonei; Male; Female; Colorectal Neoplasms; Peritoneal Neoplasms; Middle Aged; Omentum; Aged; Adult; Hyperthermic Intraperitoneal Chemotherapy; Cytoreduction Surgical Procedures; Aged, 80 and over
PubMed: 38937059
DOI: 10.1080/02656736.2024.2372356 -
International Journal of Molecular... Jun 2024Leptin regulates lipid metabolism, maximizing insulin sensitivity; however, peripheral leptin resistance is not fully understood, and its contribution to metabolic...
Leptin regulates lipid metabolism, maximizing insulin sensitivity; however, peripheral leptin resistance is not fully understood, and its contribution to metabolic dysfunction-associated steatotic liver disease (MASLD) is unclear. This study evaluated the contribution of the leptin axis to MASLD in humans. Forty-three participants, mostly female (86.04%), who underwent cholecystectomy were biopsied. Of the participants, 24 were healthy controls, 8 had MASLD, and 11 had metabolic dysfunction-associated steatohepatitis (MASH). Clinical and biochemical data and the gene expression of leptin, leptin receptor (), suppressor of cytokine signaling 3 (), sterol regulatory element-binding transcription factor 1 (), stearoyl-CoA desaturase-1 (), and patatin-like phospholipase domain-containing protein 2 (), were determined from liver and adipose tissue. Higher serum leptin and levels in the omental adipose tissue (OAT) and liver with MASH were found. In the liver, was positively correlated with leptin expression in adipose tissue, and was correlated with . In OAT, was correlated with insulin resistance and transaminase enzymes ( < 0.05 for all. In conclusion, we evidenced the correlation between the peripheral leptin resistance axis in OAT-liver crosstalk and the complications of MASLD in humans.
Topics: Humans; Leptin; Female; Male; Liver; Middle Aged; Omentum; Adipose Tissue; Adult; Fatty Liver; Receptors, Leptin; Suppressor of Cytokine Signaling 3 Protein; Insulin Resistance; Sterol Regulatory Element Binding Protein 1; Stearoyl-CoA Desaturase
PubMed: 38928125
DOI: 10.3390/ijms25126420 -
Techniques in Coloproctology Jun 2024Large tissue defects following pelvic exenteration (PE) fill with fluid and small bowel, leading to the empty pelvis syndrome (EPS). EPS causes a constellation of...
BACKGROUND
Large tissue defects following pelvic exenteration (PE) fill with fluid and small bowel, leading to the empty pelvis syndrome (EPS). EPS causes a constellation of complications including pelvic sepsis and reduced quality of life. EPS remains poorly defined and cannot be objectively measured. Pathophysiology of EPS is multifactorial, with increased pelvic dead space potentially important. This study aims to describe methodology to objectively measure volumetric changes relating to EPS.
METHODS
The true pelvis is defined by the pelvic inlet and outlet. Within the true pelvis there is physiological pelvic dead space (PDS) between the peritoneal reflection and the inlet. This dead space is increased following PE and is defined as the exenteration pelvic dead space (EPD). EPD may be reduced with pelvic filling and the volume of filling is defined as the pelvic filling volume (PFV). PDS, EPD, and PFV were measured intraoperatively using a bladder syringe, and Archimedes' water displacement principle.
RESULTS
A patient undergoing total infralevator PE had a PDS of 50 ml. A rectus flap rendered the pelvic outlet watertight. EPD was then measured as 540 ml. Therefore there was a 10.8-fold increase in true pelvis dead space. An omentoplasty was placed into the EPD, displacing 130 ml; therefore, PFV as a percentage of EPD was 24.1%.
CONCLUSIONS
This is the first reported quantitative assessment of pathophysiological volumetric changes of pelvic dead space; these measurements may correlate to severity of EPS. PDS, EPD, and PFV should be amendable to assessment based on perioperative cross-sectional imaging, allowing for potential prediction of EPS-related outcomes.
Topics: Humans; Pelvic Exenteration; Pelvis; Female; Postoperative Complications; Syndrome; Middle Aged; Omentum
PubMed: 38926191
DOI: 10.1007/s10151-024-02952-0 -
The British Journal of Surgery Jun 2024
Topics: Humans; Mesocolon; Cadaver; Colectomy
PubMed: 38922236
DOI: 10.1093/bjs/znae139 -
Annali Italiani Di Chirurgia 2024The aim of our study was to investigate the clinical results of omental flap application during pancreaticojejunostomy (PJ) anastomosis in pancreatoduodenectomy (PD)...
AIM
The aim of our study was to investigate the clinical results of omental flap application during pancreaticojejunostomy (PJ) anastomosis in pancreatoduodenectomy (PD) surgeries.
METHODS
The data of patients who underwent pancreaticoduodenectomy in our hospital were evaluated retrospectively. The patients were divided into two groups; patients with an omental flap (Group 1) and those without an omental flap (Group 2). The demographic and other characteristics of the groups and the incidence of postoperative pancreatic fistula (POPF) development were compared.
RESULTS
One hundred patients were included (39 females, 61 males) Group 1 consisted of 20 patients with omental flaps and Group 2 consisted of 80 patients without omental flaps. While no clinically significant (Grade B and C) leaks were observed in Group 1, both biochemical and clinically significant leak rates were lower in Group 1 compared to 4 patients (5%) in Group 2. There was no statistically significant difference compared with Group 2 (p > 0.05).
CONCLUSIONS
Although not statistically significant in this study, postoperative complication rates and the incidence of POPF tended to decrease in patients who underwent omental flaps.
Topics: Humans; Female; Male; Pancreatic Fistula; Pancreaticoduodenectomy; Pancreaticojejunostomy; Retrospective Studies; Surgical Flaps; Middle Aged; Omentum; Aged; Postoperative Complications; Adult
PubMed: 38918954
DOI: 10.62713/aic.3512