Laparoscopic cholecystectomy is a safe and common procedure, but it can be associated with some complications. These complications may occur during the surgery or in the following days or weeks. We will highlight some complications or risks of laparoscopic cholecystectomy through three clinical images while explaining the preventive measures [1,2].
61-year-old man suffered an electric shock at a low voltage alternant current while repairing electrical wiring at work. The patient was admitted to regional hospital and after stabilizing his healthy status and regaining consciousness, he was transferred to our workplace. On admission, the patient was conscious, on the head there were an entrance and exit wounds in left frontotemporal and frontoparietal regions of IIIIVth degree electric current burns, a sutured linear wound. Necrectomy of deep burns by electric current on the head in the frontoparietal area on the left side as well as the frontotemporal area on the left, including part of the left upper eyelid and eyebrow, was performed under general anesthesia. Tangential removal of pathologically changed parts of the frontal bone, the lateral edge of the orbit, M.Orbicularis OC.l.Sin, m. temporalis was performed. The defect of soft tissue in the left temporoparietal area was solved by reconstructive surgery. rotational: 1 fasciocutaneous and 1 musclecutaneous flap. Defect in the left frontoparietal area was solved by a rotational fasciocutaneous flap from the biparietal area. In postoperative course necrotic tip of the flap near left lateral eyedge was solved by local plasty respectivelly skin grafting. After this the healing of the wounds was continued and finished and the patient was discharged from our workplace after 20 days of hospitalisation.
Agenesis of the gallbladder is a rare congenital anomaly. The aim of this study is to explore, through the case we present, the epidemiological aspects of this anomaly as well as the specificities of diagnosis and therapeutic management. The patient is a 35-year-old individual with no significant medical history, who presented with hepatic colic and an ultrasound showing a sclerotic and atrophic gallbladder. A laparoscopic cholecystectomy was indicated. Intraoperatively, the gallbladder was not visualized, even after examining various ectopic sites for the gallbladder.
Small bowel obstruction secondary to ingested fish bone is an exceedingly rare occurrence, particularly among the elderly, accounting for less than 1% of cases necessitating surgical intervention. This article reports a case of an 84-year-old male who presented with acute abdominal pain and bilious vomiting for seven days after accidentally swallowing a fish bone. Computed Tomography (CT) of the abdomen and pelvis indicated sub-acute bowel obstruction, revealing a linear foreign body in the jejunum with a focal collection. An emergency exploratory laparotomy uncovered a pocket of pus containing the fish bone in the mesentery of the jejunum, with evidence of perforation at approximately 150 cm distal to the duodenojejunal flexure.
Malignant Obstructive Jaundice (MOJ) is typically caused by malignant tumors of hepatopancreatic biliary origin and less frequently by metastatic primary malignancies of non-hepatopancreatic biliary origin. MOJ is associated with an unusually high risk of malnutrition. Therefore, effective screening of nutritional status is especially important for early detection of MOJ. We recommend the indocyanine green retention test combined with the nutritional risk screening for assessment and dynamic real-time monitoring of nutritional status to improve the treatment outcomes of MOJ patients.
The advancement in minimally invasive approach via a transcatheter route for dealing with valvular regurgitation has been exponential the last decade. State of the art devices and complex algorithms produced utilising artificial intelligence technologies dominating our life and will be the near future direction of modern healthcare systems. The evolving technique of edge- to- edge repair for the management of secondary Mitral Regurgitation (MR) has revealed contradictory results in the past as it has been depicted in two major clinical trials which sparked major debates [1,2]. The 5- year data of the COAPT trial [3] published last year shows survival benefit for the patients but despite this profound benefit, the mortality and the hospitalisation rate remains high in this cohort of patients. The advancement in artificial intelligence technology and the progress of regenerative medicine may constitute the mean on the effort of developing new therapeutical techniques for the complex secondary mitral regurgitation.
Objective: We aimed to evaluate recent trends and outcomes of thoracic aortic intervention in comparison to isolated Aortic Valve Surgery (AVR) in patients with a Bicuspid Aortic Valve (BAV). Methods: Patients with BAV from the National Inpatient Sample (2009-2020) who underwent thoracic aortic and/or aortic valve surgery were identified. Covariates included age, sex, aortic aneurysm, dissection, concomitant comorbidities, concomitant surgeries, insurance, and hospital status. A sensitivity analysis was performed in patients without isolated aortic surgery, endocarditis, aortic dissection, or non-elective admission. Results: There were 122,104 patients with BAV, of which 38,973 underwent direct aortic surgery with or without AVR while 83,129 underwent isolated AVR. The proportion of AVR decreased from 68% in 2009/2010 to 61% in 2019/2020, with a peak of 82% in 2015/2016. In aortic surgery patients, mortality risk increased by 86% (aOR:1.86, CI:1.29-2.69), with an independent increased risk of mortality for females by 35% (aOR:1.35, CI: 1.04-1.73), aortic dissection by 5-fold (aOR:5.10, CI:3.06-8.48), and concomitant cardiac surgery by 101% (aOR:2.01, CI:1.55-2.63). After excluding patients for the sensitivity analysis, female sex was no longer associated with higher mortality risk. In-hospital complications such as stroke, sternal wound complications, bleeding, cardiac arrest, and respiratory complications were all higher in direct aortic surgery patients. Conclusion: Direct aortic surgery management for BAV has been increasingly advised. As expected, in-hospital mortality and complications were more frequent in aortic surgery. Continued effort to select on patients who would benefit from addressing aortopathy at the time of their index operation is important.
Amyand’s hernia is a rare condition characterized by the presence of the appendix within an inguinal hernia. Although rarely seen, strangulated Amyand’s hernia is a surgical emergency requiring immediate management to avoid potentially serious complications. This condition, named after the French surgeon Claudius Amyand [1], is estimated to affect around 1% of inguinal hernia cases, with a prevalence of appendicular inflammation of only 0.1% [2]. It is more common in children, due to the permeability of the vaginal process [3]. In such situations, a practical approach involving immediate surgical exploration is warranted. Prompt treatment is essential to avoid serious complications, such as appendicular perforation or peritonitis. Surgical expertise, careful clinical assessment and patient-centered decision-making are essential for the successful management of these emergency cases. In conclusion, strangulated Amyand’s hernia is a rare condition that requires prompt surgical management. In emergency situations, early surgical exploration is recommended to avoid potential complications. This clinical observation illustrates the importance of practical decision-making in the management of such emergency cases, and highlights the need for a multidisciplinary approach involving surgical expertise and thorough clinical evaluation.
Echinococcus cysts are found mostly in the liver and lung, but they can occur in any parts of the body. However, complicated pelvic echinococcosis is seen in China. We report cases of nine complicated echinococcal cysts with ureteral stenosis localized in the pelvis. These cases were diagnosed preoperatively by color Doppler ultrasound and computed tomography or magnetic resonance imaging. We pre-placed the double “J” tube 1-7 days before surgery, which improved the renal function of the patient, and at the same time used the double “J” tube for directional navigation during surgery to avoid ureteral injury. All patients were successfully treated and recovered, then discharged. The results showed that preimplantation of a ureteral double “J” tube before ureteral stenosis effectively prevented ureteral injury and reduced the occurrence of complications.
During the last decades, several studies have shown improved short- and long-time survival after Coronary Artery Bypass Grafting (CABG). Despite the greater reduction in postoperative mortality, there is still a concern whether cardiac surgery is primarily palliative pain relieving and delaying mortality or offers survival equal to or better than the background population. Method and Results: The study was based on 19,948 single CABG patients performed from 2000-2020, obtained from the mandatory Western Denmark Heart Registry and not previous exposed to cardiac surgery. Overall, the mortality declined from the first to the last 5-year study period, with 63.6% in 1-year mortality and 41.1% in 5-year mortality. Gender perspective evaluation revealed significant differences. The female mortality was, except for the last 5-year period, significantly higher than men (5.21% vs 3.73% in 1-year mortality, P<0.0001), underlined further by men almost balancing the population mortality after 5 years, while females never caught up. Comorbidity and postoperative complications had great negative impact on survival, but even without comorbidity or complications, females constantly showed higher mortality than the female population. Thus, the definitive result showed a remarkable difference between genders, comparing the study group and population 10-year survival, being 69.3% vs 63.8% in men and 64.3% vs 68.8% in females. Conclusions: Females have a substantial higher mortality than males after CABG when compared to the background population. Males seem to catch up with population mortality 4-5 years after surgery, while females continue to have a lower survival than the background population.
Sarcopenia is the subclinical loss of skeletal muscle and strength and has been extensively studied in both cancer and surgical patients. Patients with sarcopenia are particularly vulnerable to major physiological stressors including surgery and surgical complications. Sarcopenia has thus gained significant recognition as an important prognostic factor for both complications and survival in cancer patients. The aim of this review was to evaluate the current literature on the effect of sarcopenia on the treatment and prognosis of pancreatic cancer. The prevalence of sarcopenia in pancreatic cancer patients range between 20 and 65% due to the heterogeneous groups of patients, difference in disease stage, and the different methods of measuring sarcopenia. Sarcopenia would be more accurately assessed by utilizing both imaging and clinical data, such as frailty. Although malnutrition could be responsible for the attenuated healing process of pancreatic anastomosis the relationship between sarcopenia and outcome following pancreaticoduodenectomy is debated. Most studies showed a higher risk of postoperative pancreatic fistula formation in patients with concurrent sarcopenia and high fat mass (sarcopenic obesity). Sarcopenia seems generally to be associated with lower survival. The assessment of sarcopenia can therefore lead to changes in management strategy, patient selection, and improved informed consent prior to surgical resection of pancreatic cancer. An improved prediction of clinically relevant pancreatic fistula formation after pancreatic surgery using preoperative computed tomography scan, including a fistula risk score using sarcopenic obesity and subcutaneous fat area will be useful. Although treatment for sarcopenia still remains an area of research a protocol to improve nutrition and fitness preoperatively may improve sarcopenia and surgical outcome.
The current era has evolved from topical wound therapy to the concept of holistic wound management. There was a time when the wound was considered as a “hole” for the treatment purposes but now the management has changed to treatment of the wound as “whole”. The slow rate of healing, complications, wastage of resources and associated cost is detrimental to the patients with chronic wounds and a burden to the organizations. Now, the spectrum of wound care has expanded to an international inter-professional wound care approach. The “Diabetic Foot” is a leading cause of chronic wound and has become a pandemic as per experts in the field. The awareness about wound care is growing up day by day and all the contributions are from various sources that include setting up of local wound care teams and practices in the hospitals, streamlining the work, knowledge sharing and of course publication of scientific data in the reputed journals. This review is an attempt to update the current status of wound care at a global scale in order to identify issues from the perspective of patients, care providers, logistics and management of wounds. The newer advances and approaches in the wound care have been discussed. This might help in formulating future strategies for better outcomes.
Abdominal cocoon is referred as a complete or partial small bowel encapsulation caused by dense fibrocollagen membranes leading to acute or chronic small bowel obstruction. It was first termed as peritonitis chronic fibrosain capsulata by Owtschinnikow in 1907 and finally abdominal cocoon by Foo in 1978 [1]. It is most commonly seen in adolescent girls of tropical and subtropical region though few cases of male have also been reported in literature [1,2].
Background: With the introduction of the use of seatbelts in cars, mortality following motor vehicle collisions has decreased significantly. They have, however, introduced a set of injuries comprising abdominal wall bruising and intra-abdominal injuries. Injuries may consist of traumatic abdominal wall disruption. Closed rupture of rectus abdominis following seatbelt related trauma is rare. Case Presentation: We present the case of a 68 years old male who presented with a closed rupture of the rectus abdominis without other intra abdominals injuries, following a high velocity road traffic accident. He was brought in with an acute abdomen and a seatbelt sign upon which the decision was made to perform emergency laparotomy. After further management, the patient was discharged with no further complaints. Conclusion: Our case highlights the need for suspicion, investigation and subsequent surgical management of intra-abdominal injury following identification of this rare consequence of seat belt trauma.
Today 80 percent of hysterectomies in patients with benigne and malignant disease are done by endoscopic procedures. Clear indications for Laparoscopic Subtotal Hysterectomy include a cervix free of any disturbances, a multifibroid uterus and the wish of the patient to reserve the normal function of her pelvic organs. Laparoscopically this procedure can be easily performed without any side effects. Recently in China Li, Zi-Jun et al. [25] 2020 described a new technique called Anterograde Vaginal Subtotal Hysterectomy (AVSH) which appears to be much more complicated than our Kiel based LSH initiated by Kurt Semm in 1991 [13]. It is the aim of this chapter to line out the easiness and beauty of Laparoscopic Subtotal Hysterectomy (LSH). This is not intended to be a research paper but a historical development presentation for LSH.
Millions of surgeries are performed each year across the globe. However, the COVID-19 pandemic greatly impacted the number of surgeries performed and the patient outcomes. Prior to the pandemic, the patients undergoing surgeries faced a slightly high mortality risk due to common complications, especially if they had critical co-morbidities. However, it is worth while to evaluate if being infected with COVID-19 exacerbates or has no effect on the post-operative condition of these patients. Researchers used to describe COVID-19 as simply a respiratory disease, but it is now known to be an illness that leads to systemic effects. New findings are evaluating the long-term impact of this illness, so it is beneficial to observe its prognosis after undergoing a surgical procedure. This review summarizes the recent progress in this area of research. Such a study might help healthcare professionals to develop a complete understanding of COVID-19 and to know how to provide effective postoperative care.
Giant condylomata acuminata is a rare intermediate state between benign condyloma and squamous cell carcinoma. They are related to HPV 6 & 11 infections and if left untreated can increase in size and become destructive. This case was managed in a multidisciplinary setting, involving the use of preoperative vascular intervention and surgical resection by plastic surgery and gynaecology teams. Small focuses of early squamous cell carcinoma were present when the surgical specimen was examined. We discuss the important considerations when managing patients presenting with similar chronic lesions and the processes involved in managing this case the way we did.
Tonsillectomy is one of the most frequent surgical procedures done worldwide. While the surgical procedure may take less than 10 minutes, there is a significant related morbidity due to per- and post-operative bleeding, post-operative pain and delayed return to normal activity and diet [1]. There is no consensus on the optimal method and device for surgery; use of cold dissection or coblation or diathermia scissors, with electro-cautery as needed; are advocated by different authors. The BIZact ™ vessel seal instrument (Medtronic, Mansfield, MA, USA) is a new technology with continuous measurements of tissue impedance, in order to deliver minimally bipolar energy for dissection and vessel sealing, with minimal thermal damage of remaining tissue [2]. The purpose of the present prospective, partly double-blinded study, was to evaluate the usefulness of BIZact for surgery in a population of adult tonsillectomy patients, in terms of: safety, bleeding, perioperative easiness and time consume, as well as postoperative parameters such as pain, resumption of oral intake, bleeding and overall satisfaction.
Solid and Pseudopapillary Tumors (SPT) of the pancreas are a rare entity, occurring essentially in young women, radiological examinations lead to the diagnosis while the positive diagnosis is based on immunohistological study. The primary treatment modality for SPTs condition is surgical intervention. Our case aims to recall, when encountering a pancreatic mass in a young woman, that it is crucial for surgeons, radiologists, and pathologists to take into account the possibility of solid and pseudopapillary tumor. This is due to the favorable prognosis and unique treatment approaches associated with SPT, as opposed to other types of pancreatic tumors.
Background: In recent years, with the deepening of the anatomical cognition of the inguinal region and the renewal of the hernia repair concept, inguinal hernia repair has become increasingly mature surgical approach. However, no matter how the hernia repair modes change, the treatment and repair of the hernia ring has always been the focus, so that the treatment of the hernia sac has been neglected. Materials and Methods: From March 2014 to May 2019, there were 132 patients underwent inguinal hernia repair with “Undissociate Spermatic cord” theory (Undissected Spermatic cord and hernia sac, hernia ring and sac exclusion) in the First Affiliated Hospital of Harbin Medical University and the First Hospital of Harbin. Results: All the operations were completed smoothly. The patients included 126 males and 6 females. There were 74 cases underwent open surgery and 58 cases underwent laparoscopic surgery (TAPP and TEP). In the open group, the mean operation time was 33.4min, and the mean blood loss was 7.1ml. The mean hospitalization time was 4.6d. In the laparoscopic group, the mean operation time was 74.4min, and the mean blood loss was 7.5ml. The mean hospitalization time was 4.7d. There were no complications occurred in our groups. All the patients were followed up for 18~63 months (mean of 41.5 months) without recurrence. Conclusion: Following the “Undissociate Spermatic cord” theory, the inguinal hernia repair could be convenient operation, low complication rate and recurrence rate. The function of spermatic cord was also retained. “Undissociate Spermatic cord” theory is a safe and feasible novel idea for inguinal hernia repair.
