Showing papers in "Hellenic Journal of Surgery in 2014"

A comparative study of inguinodynia following lichtenstein hernioplasty with or without elective neurectomy of ilioinguinal nerve

Abstract: A comparative study was carried out to study the incidence of inguinodynia following Lichtenstein hernioplasty with or without elective neurectomy of ilioinguinal nerve Fifty-six patients who underwent inguinal hernioplasty were studied The patients were randomly allocated into two groups: 28 underwent elective ilioinguinal nerve resection and the other 28 had careful nerve preservation Pain was assessed postoperatively at day 1, 7, 30, 60, 90, and 180 according to a 4-point scale ie none (A), mild (B), moderate (C), severe (D) The duration of hospital stay, resumption of normal daily activity and number of days off work were compared between the nerve resection (Case) and nerve preservation (Control) groups Follow-up on the first postoperative day revealed no significant difference in pain score between the two groups (P value > 005) Follow-up on postoperative days 7, 30, 90 and 180 revealed a significant difference in pain score between the two groups (P 005) Resumption of normal daily activity for the nerve resection group was (28+/−09) and for the nerve preservation group it was (37+/−08) days (P<005) Total days off work in the nerve resection group was (36+/−08) as opposed to (55+/−10) days (P <05) among the nerve preservation group Routine ilioinguinal nerve resection during inguinal hernioplasty is safe and easy to perform and decreases inguinodynia postoperatively Following this procedure, there is early return to normal daily activity and fewer days off work, though there are no differences in the duration of hospital stay as compared to patients undergoing preservation of ilioinguinal nerve

Z-plasty a rational and effective technique for pilonidal sinus

Abstract: Background Pilonidal disease is a commonly encountered problem with multiple surgical options. With Z-plasty, primary closure ensures faster healing while the alteration of local anatomy reduces recurrence.

A rare tumour of the breast: Carcinosarcoma

Abstract: We present a 55-year-old female patient with a mass in her right breast characterized by rapid growth and positive axillary lymph-nodes. The frozen section showed an aggressive malignacy of carcinosarcoma also known as metaplastic carcinoma which is a very rare tumour that accounts for just 0.08–0,2% of all brest cancers. We proceeded to perform a right modified radical mastectomy. We discuss the properties of this rare tumour and therapeutic challenges.

Aetiology, evaluation and management of rectovaginal fistula: A rare entity and a major surgical challenge

Abstract: Rectovaginal fistulas occur as a complication of surgery or radiation therapy, an obstetrical trauma, malignant process and inflammatory bowel disease. These fistulas comprise 5% of all anorectal fistulas. The presenting symptoms vary according to the characteristics of the fistula and the underlying cause. This review article evaluates in detail each of those aspects from a clinician’s perspective. Symptoms referring to the aetiology and process of evaluating the location, length and diameter of the fistula are described here in detail as critical to selecting the appropriate surgical technique. However, successful fistula healing is much less than certain after every repair attempt, even in the most experienced hands. Nevertheless, re-operation is deployed in such cases. A diverting colostomy might also be needed as a last resort to relieve the symptoms. Morbidity of a rectovaginal fistula is increased, and from a psychosocial perspective, it can dramatically alter the sexual and reproductive life of a female with consequences to her self-esteem. The surgical repair of rectovaginal fistulas is a challenge even for the most experienced and dedicated of anal surgeons. Healing rectovaginal fistulas with underlying aetiology might be an unattainable goal even with recurrent attempts, sometimes necessitating amputation surgery.

A short history of the invasion of robots in surgery

Abstract: The term ‘robot’ comes from the Czech word ‘robota’ which means forced labour, and it was first introduced by the Czech play writer Karel Capek in his fiction play “Rossum’s Universal Robots”. Initially, robots were used in the industry for hazardous tasks. Since 1985, they have invaded surgical practice, helping surgeons to perform delicate operations with precision. The passage from industrial robots to surgical robots was long. In this paper, the author makes a brief reference to the steps that were followed by the pioneers of the robotics in surgery up to the present day where the Da Vinci and Zeus are used in many fields of surgery such as general surgery, urology, ophthalmology, thoracic surgery etc.

An interesting case of a left paraduodenal hernia with peritoneal encapsulation presenting as acute intestinal obstruction

Abstract: Internal hernias commonly present as left duodenal, right duodenal, mesocolic, or retrocolic, intersigmoid hernias, as well as herniation through the foramen of Winslow and lesser sac herniation through an abnormal orifice [1]. Paraduodenal hernias are extremely rare entities, which may prove dangerous because of the high risk of bowel obstruction, strangulation and gangrene. These hernias are notorious because of non-specific signs and symptoms that can lead to diagnostic difficulties. We report the case of a left paraduodenal hernia with peritoneal encapsulation presenting as acute intestinal obstruction in a patient without any history of prior abdominal surgery. The patient underwent bowel reduction, adhesiolysis, resection of the sac, and repair of the defect. The patient’s recovery was uneventful.

Jejunojejunal intussusception caused by a jejunal gastrointestinal stromal tumour (GIST)

Abstract: Adult intussusception represents a challenge to the surgeon as it can cause acute, subacute or chronic non-specific obstruction and presents with dubious clinical features. A forty-six-year-old female presented with progressively worsening abdominal pain, mild abdominal distension, anorexia, profuse vomiting and constipation that had begun thirty six hours earlier. Primary or metastatic malignancies are responsible for 14–47% of all small bowel intussusceptions; in the large bowel 66% of cases have malignant aetiology. In contrast, abdominal X-rays display an intussusception as stacked coins or a coiled spring in the upper GI series and cup-shaped defect in contrast enema. The treatment of choice in adult intussusception is always surgical. Adult intussusception is a rare entity that may present a diagnostic dilemma due to its non-specific symptoms. However, controversy surrounds the need for reduction and extent of surgical resection.

Different forms of laparoscopic training: Review and comparison

Abstract: Aim To compare and evaluate the effectiveness of different forms of laparoscopic training.

Non-parasitic cysts in children - peculiarities in surgical management - report of three cases

Abstract: Aim-Background Non-parasitic cysts of the spleen are rare and usually random findings that are treated by a variety of surgical methods. The aim of our study is to present our experience in children and to point out the peculiarities in comparison with those of adults.

Pancreatic desmoid tumour: Extremely rare presentation in an elderly patient

Abstract: Background Representing approximately 0.03% of all tumours and 3% of soft tissue tumours, desmoid tumours (DTs) are neoplasms of fibroblastic origin characterized by the lack of a capsule. Isolated, sporadic, pancreatic desmoid tumours are extremely rare with only ten cases having been described previously.

Dyspareunia Due to Leiomyoma of the Urinary Bladder: An Unusual Presentation of a Rare Bladder Neoplasm

Abstract: Leiomyoma of the urinary bladder is a rare neoplasm of the bladder and accounts for 0.04 - 0.5% of bladder neo- plasms. Though most patients present with obstructive or irritative urinary symptoms, dyspareunia may be an un- usual presentation that should be kept in mind to avoid missing the diagnosis. Though MRI is considered to be the imaging modality of choice, cystourethroscopy with guided biopsy usually clinches the diagnosis. Surgical excision is the treatment of choice in this prognostically favourable tumour.

Milligan — Morgan haemorrhoidectomy — Complications

Abstract: Aims Based on a retrospective review of a personal experience with 480 modified Milligan-Morgan haemorrhoidectomies, technical suggestions for avoiding early and late complications are presented.

Extrapolating Veress needle for directional precision of secondary laparoscopic ports — A handy technique

Abstract: In today’s era of advanced laparoscopy, it is still not uncommon to encounter potentially lethal port site bleeding during placement of secondary trocars on the perietes This is usually due to the inadvertent transaction of a subcutaneous/ rectus sheath vessel/s by “blind” insertion of secondary trocar/s In this regard, we describe a simple and rapid technique of siting a trouble-free port track using a Veress needle

A prospective comparative study of the role of CT and MRI-MRCP in the preoperative assessment of obstructive jaundice and their intraoperative corroboration

Abstract: Background To compare the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging-magnetic resonance cholangiopancreatography (MRI-MRCP) in assessing the level and cause of obstruction in patients with obstructive jaundice, and to corroborate the preoperative diagnostic accuracy of MRI-MRCP and CT with operative findings.

Invasive techniques in diagnosis and staging of lung cancer

Abstract: Aim-Background During the staging process of lung cancer, accurate mediastinal lymph node staging is one of the more important factors to affect patient outcome. Accurate staging of the disease is important not only in determining prognosis but also in deciding the optimal treatment plan. The most significant treatment decision is establishing which patients can benefit from surgical resection and which should receive chemotherapy, radiation, or both. This paper reviews indications and current data regarding minimally invasive approaches for diagnosis and staging of lung cancer. In addition, current advances in diagnostic endoscopy for lung cancer will be reviewed.

Meckel's Diverticulum Perforation: Report of a Case and Review of the Literature

Abstract: Meckel’s diverticulum is the most common congenital anomaly of the small bowel. The majority of patients with this anomaly will remain asymptomatic; however, several complications can occur, including diverticulitis, haemorrhage, obstruction, intussusception, and perforation. A 39-year-old man was admitted to the emergency department after complaining of abdominal pain for the past few days. Upon worsening of his clinical status and after completing the diagnostic workup, he was taken to the operating theatre where he was found to have faecal peritonitis due to perforated Meckel’s diverticulum. Although it might be difficult to diagnose Meckel’s diverticulum pathology preoperatively, it should always be sought and identified during a laparotomy for acute abdomen in order to exclude the increased morbidities resulting from its complications.

Management of acute mesenteric isxcaemia: A retrospective analysis

Abstract: Aim-Background Acute mesenteric ischaemia (AMI), although an uncommon condition with a difficult diagnosis, has a high rate of complications and is associated with a high mortality rate. We reviewed our experience of patients presenting with AMI in order to evaluate the current management and factors associated with survival in a tertiary care hospital.

Seroma: An underestimated complication of vascular access for haemodialysis

Abstract: Aim The aim of the study is to describe a case-series of an underestimated complication of vascular access for haemodialysis like seroma

A solid pseudopapillary tumour of the pancreas

Abstract: Solid pseudopapillary tumour of the pancreas is a rare neoplasm which, for the most part, affects young women and has a relatively favourable prognosis with low malignant potential We report the case of a 48-year-old woman with a pseudopapillary tumour of the pancreas Abdominal computed tomography and magnetic resonance imaging showed a solid, cystic mass in the pancreas She was successfully treated with a cephalic duodenopancreatectomy The SPT is an infrequent tumour, typically affecting young women Surgical resection is generally curative, even in locally advanced or metastatic disease

Ileocaecal intussusception in a 7-year-old patient due to Burkitt’s lymphoma

Abstract: Intussusception is one of the most common paediatric emergencies, with a greater incidence during the first two years of life. Most cases are characterized as idiopathic. After this age, the incidence of intussusception steadily declines while, on the other hand, the possibility of an underlying causative disease, such as intestinal lymphoma, becomes increasingly stronger. We present the case of a 7-year-old Caucasian male that presented with non-reducible ileocolic intussusception due to a lead point, which proved to be a stage II Burkitt’s lymphoma. Resection, accompanied by chemotherapy, was successful, without complications, and with good response. Intestinal lymphomas may present with a varying clinical picture, from vague systematic symptoms to real surgical emergencies. General surgeons should be aware of that rare occasion where intussusception may be the result of an intestinal lymphoma, especially in children over the age of three, after which age an underlying lead point is more likely to exist.

Pyomyositis of the iliacus muscle - a diagnostic and therapeutic dilemma

Abstract: Pyomyositis is an uncommon primary bacterial infection of skeletal muscles, usually caused by Staphylococcus aureus. The iliacus muscle rarely becomes affected; when it does, it is often misdiagnosed as septic arthritis of the hip resulting in delayed diagnosis. The diagnosis, staging of the disease and differential diagnosis are established by CT and MRI. We report a case of iliacus muscle pyomyositis in a female adolescent which was initially managed with surgical drainage. The patient subsequently presented with recurrent symptoms and manifestations of sacroiliitis; she was readmitted and treated conservatively with hyperbaric oxygen therapy. This constitutes, as far as we know, the first reported use of hyperbaric therapy in the treatment of the condition.

Giant axillary lipoma — A rare case report with review of literature

Abstract: Background Lipomas are the most common mesenchymal soft tissue tumours encountered in surgical practice. They can occur anywhere in the body, but the common sites are subcutaneous tissue of trunk, nape of the neck and limbs. Giant lipomas measure more than 10cm in diameter and are very rarely seen in the axillary region. In such cases, cytology, ultrasonography and computed tomography are considered for complete assessment of giant axillary masses.

Fatal outcome of a lumbar incisional hernia originating at the surgical site of hip arthroplasty: An exceptionally rare case

Abstract: This article discusses an uncommon case of complicated incisional lumbar hernia secondary to total hip arthroplasty. A female patient with a history of bilateral total hip arthroplasty at another institution was hospitalized for acute oedematous pancreatitis and was treated conservatively. An initial abdominal computerized tomography showed the incidental finding of a left lumbar hernia in close relationship with a hip prosthesis. During the 30th day of hospital stay, the incisional hernia became incarcerated, and the intestinal contents strangulated. The severity of this complication finally led to the death of the patient. Despite their rarity, these hernias should be included within the differential diagnosis of flank masses and late hip arthroplasty symptomatic complications.

Treatment of varicose veins of lower limb: A prospective randomized comparison of radiofrequency ablation and conventional surgery

Abstract: Objectives To compare the effectiveness of conventional surgery and radiofrequency ablation in the treatment of varicose veins as regards 1) duration of procedure, 2) postoperative pain, 3) complications, 4) duration of stay in hospital and 5) return to normal routine work.

Single centre clinical study of a Greek patient population with triple-negative breast cancer

Abstract: The aim of this study is to describe the characteristics of triple-negative breast cancer (TNBC) among patients of a Greek population and investigate the extent to which international TNBC patterns apply to the particular ethnic group. In this single-centre, retrospective study, medical records of 1455 female patients undergoing breast cancer surgery from 1999 to 2013 were examined in order to identify TNBC patients and evaluate their clinicopathologic characteristics. In total, 91 TNBC patients (6.3%) were identified, with a median age of 50 years, 91.2% of whom had high-grade tumours. Only nine relapses and four deaths occurred during the study period. Overexpression of Ki-67 and p53 was observed in 95.5% and 76.8% of cases, respectively. Significant correlation was found between relapse and age at first breast surgery (p-value = 0.007) and also between Ki-67 and lymph vessel metastasis (p-value = 0.02). Our study revealed that in this specific population of Greek patients with breast cancer, TNBCs are characterized by aggressive prognostic factors such as increased expression of Ki-67, EGFR, mutations of p53, high grade and presence of metastatic disease to the regional lymph nodes with concomitant lymph vessel dissemination. The relationship between young age and TNBC reported in other international studies was not observed here. On the other hand, it seems that there is a strong correlation between age at first diagnosis and age at the time of relapse.

Is low anterior resection for rectal cancer equally efficient in the hands of non-expertised surgeons?

Abstract: Aim-Background To evaluate the local recurrence rate after potentially curative low anterior resection and to determine factors influencing local recurrence.

The Open New Simplified Totally Extra-Peritoneal (ONSTEP) inguinal hernia repair: Initial experience with a novel technique

Abstract: The Open New Simplified Totally Extra-Peritoneal (ONSTEP) inguinal hernia repair involves placing the greater part of a pre-shaped mesh in the preperitoneal space covering all hernia defects and the rest of it in the inguinal canal. Its advantages over the existing techniques include shorter operative time, faster learning curve, less postoperative pain, speedier return to normal activities, better cosmetic result and a lower recurrence rate. The purpose of this study is to present our initial experience of this novel method. Adult patients underwent inguinal hernia repair with the ONSTEP procedure. Patients were followed up for one year for pain, wound complications and recurrence. The pre-shaped mesh used for repairing the hernia defect was the Polysoft™ hernia patch. During a 1.5-year period (between the 1st January 2013 and the 30th June 2014) thirty three (33) patients underwent inguinal hernia repair with the ONSTEP procedure. The mean operative time was 33.28 (± 11.69) minutes, the time to discharge was 24h for all patients and the return to normal activity was between three and seven days. The overall wound complication rate was minimal and the overall recurrence rate was zero. No patient experienced residual or chronic pain at six months. Three patients had mild discomfort related to the memory ring; however, the pain subsided and did not necessitate its removal. The cosmetic result was very good immediately postoperatively, as well as at one and six months. All patients were very satisfied owing to minimal discomfort, good cosmetic result, no chronic pain and speedy return to normal activity. ONSTEP repair of inguinal hernia is a new technique which is fast to learn and perform, with a low complication rate and minimal recurrence rate. The overall cosmetic result and patient satisfaction is excellent. It is a safe alternative to other open and laparoscopic techniques.

“Reverse” needle-loading: A useful adjunct in laparoscopic education

Abstract: Intracorporeal suturing is an essential component of safe laparoscopic surgery. Loading a needle at an optimum angle as well as axis tends to dictate the level of comfort felt by the surgeon in “needle-diving”. However, it may not always be possible to have the needle in the desired ergonomic position. We describe a simple method of intracorporeal manipulation of a needle when its tip lies in the opposite direction. A standard co-axial needle-holder is used for this purpose.

Bezoar: An unusual cause of intestinal obstruction

Abstract: Aim-Background This article presents three cases of bezoar-induced small bowel obstruction (SBO) An uncommon entity, gastrointestinal bezoar (GIB) is reported to occur in 4% of all admissions for small bowel obstruction (SBO), with a prevalence in patients with a history of gastric surgery Accurate preoperative diagnosis is notoriously difficult, and conventional management often necessitates laparotomy Most bezoars are concretions of poorly digested food, which are usually formed in the stomach initially Owing to their lack of diagnostic features, bezoars are often associated with delayed treatment and increased morbidity

Effect of lipid disorders on arteriosclerosis in renal transplant recipients

Abstract: Background-Aim After a patient successfully receives a renal transplant, an increase in total serum cholesterol and triglycerides, a decrease in high density cholesterol, and normal level in low density cholesterol may be noted. Coronary artery disease is one of the main causes of morbidity and mortality in renal recipients. This study was performed in order to determine the lipid profile of patients with chronic kidney disease that received a renal transplant, and correlate the effect of the lipid profile with atherogenesis.