Laparotomy Approach Research Articles

Reproductive outcomes after surgical resection of isthmocele in secondary infertility.

To evaluate the reproductive outcomes after different approaches of surgical isthmocele excision in women with secondary infertility. The present study was conducted between November 2017 and February 2023 in the Department of Gynecological Endocrinology and Gynecology at Jagiellonian University Medical College, Krakow, Poland. Women with large isthmocele with residual myometrial thickness (RMT) <3 mm and secondary infertility were included in this retrospective study. Surgical removal of the uterine defect was performed either by the laparoscopic or laparotomic approach. Pregnancy outcomes were measured. Fifty-eight women aged 32.3 ± 3.5 years with a body mass index 22.9 ± 3.4 kg/m2 were included. Pregnancy was confirmed in 62.1% of women after surgical repair of isthmocele either via laparoscopy (n = 19) or laparotomy (n = 17) and 36 women (44.8%) women delivered healthy babies. There were no differences in the type of surgical approach used for isthmocele removal regarding pregnancy outcomes. Women in the laparotomic group had a higher number of abdominal surgeries (2.8 times) and longer postsurgical hospitalization (+85.7%). There were no differences between the laparoscopy and laparotomy groups regarding the duration of infertility, number of pregnancies, performed cesarean sections, and the type of cesarean sections (urgent vs planned). Surgical treatment should be offered to symptomatic women with isthmocele and secondary infertility. Given the absence of comparative studies, laparoscopic niche resection is the method of choice for a large uterine niche with an RMT <3 mm. Nonetheless, it offers comparable pregnancy outcomes to the laparotomic approach.

A Comparison of the Efficacy Between Mass Closure and Layer by Layer Closure of Midline Laparotomy and Its Influence on Wound Healing: A Prospective Study

Introduction: The midline laparotomy is the most common approach in surgery which gives access to viscera of the abdomen. Following surgery, the laparotomy wound is sutured by two techniques: mass closure and layer by layer closure. The primary objective of wound closure is to restore the function of the abdominal wall. However the method adopted for incision closure has an influence on the outcomes of wound healing. Our study wants to compare the two suture techniques in terms of efficacy and wound healing. Aims: To compare conventional layer by layer suture technique versus mass closure in terms of efficacy and wound healing in patients with midline laparotomy approach. Methods: A Prospective study with a population size of 94 was performed at the surgery department of Nepalgunj medical college teaching hospital, Nepalgunj, starting from September 2023 to May 2024. A pre-tested questionnaire containing structural, semi-structural, and open-ended questions in printed form was made as a data collection tool. All the people in this study were interviewed after receiving their consent. Patients were followed up for 3 months to rule out any post operative complications. Results: Total 94 patients were studied among which majority of patients were in 30-39 age group. Male outnumbered the females. Incidence of early complications like seroma, wound infection and wound dehiscence was more in layered closure group as compared to mass closure. Average time taken in layered vs. mass closure group is 15 vs 25 mins respectively. Overall wound healing was found more efficacious in mass closure group which is also cost effective than layered closure group. Conclusion: Mass closure technique is less time consuming, along fewer instances of surgical site infection and dehiscence with better overall compliance.

Survival associated with the use of sentinel lymph node in addition to lymphadenectomy in early-stage cervical cancer treated with surgery alone: A sub-analysis of the Surveillance in Cervical CANcer (SCCAN) collaborative study

AimThe aim of this study was to assess whether the use of sentinel lymph node (SLN) in addition to lymphadenectomy was associated with survival benefit in patients with early-stage cervical cancer. MethodsInternational, multicenter, retrospective study. Inclusion criteria: cervical cancer treated between 01/2007 and 12/2016 by surgery only; squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma, FIGO 2009 stage IB1-IIA2, negative surgical margins, and laparotomy approach. Patients undergoing neo-adjuvant and/or adjuvant treatment and/or with positive para-aortic lymph nodes, were excluded. Women with positive pelvic nodes who refused adjuvant treatment, were included. Lymph node assessment was performed by SLN (with ultrastaging protocol) plus pelvic lymphadenectomy (‘SLN’ group) or pelvic lymphadenectomy alone (‘non-SLN’ group). Results1083 patients were included: 300 (27.7 %) in SLN and 783 (72.3 %) in non-SLN group. 77 (7.1 %) patients had recurrence (N = 11, 3.7 % SLN versus N = 66, 8.4 % non-SLN, p = 0.005) and 34 (3.1 %) (N = 4, 1.3 % SLN versus N = 30, 3.8 % non-SLN, p = 0.033) died. SLN group had better 5-year disease-free survival (DFS) (96.0 %,95 %CI:93.5–98.5 versus 92.0 %,95 %CI:90.0–94.0; p = 0.024). No 5-year overall survival (OS) difference was shown (98.4 %,95 %CI:96.8–99.9 versus 96.8 %,95 %CI:95.4–98.2; p = 0.160). SLN biopsy and lower stage were independent factors associated with improved DFS (HR:0.505,95 %CI:0.266–0.959, p = 0.037 and HR:2.703,95 %CI:1.389–5.261, p = 0.003, respectively). Incidence of pelvic central recurrences was higher in the non-SLN group (1.7 % versus 4.5 %, p = 0.039). ConclusionAdding SLN biopsy to pelvic lymphadenectomy was associated with lower recurrence and death rate and improved 5-year DFS. This might be explained by the lower rate of missed nodal metastasis thanks to the use of SLN ultrastaging. SLN biopsy should be recommended in patients with early-stage cervical cancer.

Influence of Socioeconomic Deprivation on Surgical Outcomes for Patients With Sigmoid Diverticulitis in France: A Multicenter Retrospective Study.

To evaluate the relationship between socioeconomic deprivation and postoperative outcomes in patients who underwent colonic resection for sigmoid diverticulitis (SD). The potential impact of socioeconomic inequalities on the management of SD has been scarcely studied in the literature. Considering other gastrointestinal pathologies for which lesser access to optimal treatment and poorer survival have been shown, we hypothesize that deprivation could be associated with outcomes for SD. This multicenter retrospective study was conducted at 41 French hospitals between January 1, 2010, and August 31, 2021. The main outcome was the occurrence of severe postoperative complications on postoperative day 90, according to the Clavien-Dindo scale (≥3). The European Deprivation Index was used to approximate deprivation for each patient. Multiple imputations by a chained equation were performed to consider the influence of missing data on the results. Twenty percent of the 6415 patients operated on had severe postoperative complications at 90 days. In the multivariate regression analysis, increasing age, male sex, American Society of Anesthesiologists score ≥3, conversion to laparotomy or upfront open approach, surgical procedures, and perioperative transfusion were independent risk factors for severe postoperative complications. After adjusting for age, sex, body mass index, American Society of Anesthesiologists score, emergent setting, blood transfusion, indications for surgery, surgical approach, and procedures, the probability of severe postoperative complications increased with socioeconomic deprivation (P=0.026) by day 90. This study highlights the potential influence of socioeconomic deprivation on the surgical outcomes of SD. Socioeconomic deprivation should be considered as a risk factor for severe postoperative complications during the preoperative assessment of the patient's medical conditions.

Management for Cervical Cancer Patients: A Comparison of the Guidelines from the International Scientific Societies (ESGO-NCCN-ASCO-AIOM-FIGO-BGCS-SEOM-ESMO-JSGO).

Cervical cancer continues to have a significant incidence, despite global efforts in HPV vaccination campaigns. Managing this condition involves a diverse team of healthcare professionals. Research in this field is undergoing a period of great revolution in multiple areas, and international guidelines will soon have to adapt to new scientific evidence. This could be true mainly in locally advanced stages, and it could also be true for minimal invasive surgery. This paper aims to summarize and compare the most recent recommendations published by international gynecological oncological societies for patients with cervical cancer. From their comparison, common aspects and disagreements emerged, especially in the diagnostic pathway and follow-up strategies. Several issues that remain to be debated in the literature were addressed and compared, highlighting similarities and differences, from the role of the sentinel lymph node in early stages to that of the adjuvant hysterectomy in locally advanced tumors. On the surgical side, for this last subset of patients, currently, a laparotomic approach is recommended. At the same time, the advent of immunotherapy has just opened up new and promising scenarios in systemic treatment for locally advanced cervical cancer, and international guidelines will soon introduce it into their algorithms.

Ovariectomy in mouflons under field conditions: a comparative assessment of midventral and flank laparotomy approaches.

Ovariectomy is the best method to control the density of wild ungulate populations. The present study aimed to compare two surgical approaches of ovariectomy, via the flank and midventral, in mouflons under field conditions. A total of 20 female mouflons were enrolled in the study. The animals were divided randomly into two equal groups; group F animals were gonadectomized via the flank approach, while group L animals were sterilized via the linea alba access. The parameters evaluated were duration of surgery, duration of anesthesia, recovery time, intraoperative and postoperative complications, intraoperative nociception, and pain during the postoperative period. There were no intraoperative and postoperative complications. The evaluated parameters showed a very similar trend in both groups. Both techniques were found to be effective and safe in execution.

It is possible to avoid routine splenic flexure mobilization during left hemicolectomy and anterior rectal resection? A single center experience compared to the surgical reality.

Routine splenic flexure mobilization (SFM) during left hemicolectomy and high anterior rectal resection guarantees a well perfused and tension-free anastomosis, respecting current oncological criteria. According to the recent literature, only 70% of laparoscopic colorectal surgeons considered routine SFM mandatory. Because of its difficulty, SFM increases morbidity including surrounding organs injuries. The goal of the study is to report our experience in avoiding routine SFM during colorectal resection compared to the current surgical state of art. Data were collected retrospectively on elective left hemicolectomy without routine SFM performed in our unit between January 2015 to April 2020. Patients were recruited according to diagnosis, histopathology, operative time, ASA score, post-operative morbidity and mortality. Seventy-five oncological patients, underwent to surgery without SFM. The other 13 patients underwent to SFM due to technical issues. The mean operative time was 160.2±44.7 mins, significantly shorter than in patients whose SFM occurred (210.3 min). The morbidity rate was 1%, reintervention occurred in one patient. Eighteen-month median follow-up morbidity was 11% while mortality was 3%. Recurrence rate was of about 5%. As results from study data analysis, left colectomy can be conducted safely in both laparoscopic and laparotomic approach without SFM in selected cases. As reported in a recent meta-analysis, benefits of avoiding SFM concern reduced operative time without compromising postoperative outcome and respecting oncological criteria, as emerged by our results. Colorectal resection without SFM when is feasible, improves surgical approach reducing technical difficulties and avoiding splenic injuries.

Should an appendicectomy be performed in the presence of a macroscopically healthy appendix, during laparoscopic exploration?

Introduction: In contrast to the conventional laparotomy approach, the decision to perform an appendicectomy or not in the presence of a macroscopically normal appendix remains contentious during laparoscopic procedures. Our objective is to assess the rate of appendix conservation and conduct a literature review on the management of a macroscopically normal appendix intraoperatively. Materials and Methods: This was a descriptive, prospective, evaluative study involving 337 patients undergoing laparoscopic surgery for non-traumatic acute abdominal emergencies. Results: Of the 337 patients operated on, 190 were females (56.4%), with a mean age of 38 years ± 15 years (range 15 to 82 years). In 7 patients (2.1%), the appendix appeared macroscopically normal intraoperatively, despite preoperative diagnosis favoring acute appendicitis. These 7 patients (6 females and 1 male) all underwent thorough clinical examination and preoperative ultrasound, although CT scans were performed in only 3 patients. Among these 7 patients, 2 had ovarian cyst torsions, 2 had ruptured hemorrhagic ovarian cysts, 1 case was diagnosed as retrocaecal internal hernia, and in 2 patients, no etiology was identified. The appendix was preserved in all 7 cases. All patients received postoperative antibiotic therapy. No postoperative complications or surgical reinterventions were recorded. Conclusion: Our study demonstrates that a macroscopically normal appendix can be left in situ without postoperative complications or need for surgical reintervention.

Results of open prosthetics of abdominal aortic aneurysms using laparotomic and retroperitoneal approaches

The OBJECTIVE was to evaluate the results of surgical treatment of abdominal aortic aneurysm using laparotomic and retroperitoneal approaches.METHODS AND MATERIALS. The study included 206 patients operated on at the Department of Vascular Surgery of the Novgorod Regional Clinical Hospital from 2010 to 2018. All patients were divided into 2 groups. The first – 112 people, whose surgical intervention was performed through laparotomic approach. The second – 94 patients, approach to the aorta was made by the retroperitoneal technique according to Rob. comparison of non-specific life-threatening complications included the development of myocardial infarction and acute cardiovascular failure, acute respiratory distress syndrome and respiratory failure, the development of ischemic colitis and small bowel obstruction, which required repeated interventions. The development of acute renal injury was characterized as an increase in creatinine by 50 % from baseline or a decrease in glomerular filtration rate (GFR) by more than 25 %. This group of complications also included ischemic stroke, sepsis, and multiple organ failure. Wound complications included insolvency of postoperative wounds of retroperitoneal and laparotomic approaches, cases of eventration.RESULTS. When analyzing the incidence of nonspecific complications, it was found that in group I their frequency was 41 (46.6 %) clinical cases, and in group II – 26 (27.6 %) (p=0.173*). In group I, the incidence of cardiovascular complications significantly exceeded those in group II – 17 (15.2 %) vs 6 (6.4 %) (p*=0.046). The incidence of gastrointestinal complications was also significantly higher in group I – 9 (8 %) vs 1 (1.06 %) (p*=0.021). The frequency of deaths in groups I and II did not differ significantly in 7 (6.25 %) and 5 (5.3 %) cases (p*=0.77).CONCLUSION. As our study showed, retroperitoneal approach is a worthy alternative to laparotomy, mainly in case of repeated interventions, as well as in the presence of signs of visceral obesity of the patient. At the same time, laparotomic approach is associated with a higher risk of developing cardiovascular and gastrointestinal complications in the treatment of abdominal aortic aneurysms.

Isthmocele and Infertility.

Isthmocele is a gynecological condition characterized by a disruption in the uterine scar, often associated with prior cesarean sections. This anatomical anomaly can be attributed to inadequate or insufficient healing of the uterine wall following a cesarean incision. It appears that isthmocele may impact a woman's quality of life as well as her reproductive capacity. The incidence of isthmocele can range from 20% to 70% in women who have undergone a cesarean section. This review aims to sum up the current knowledge about the effect of isthmocele on fertility and the possible therapeutic strategies to achieve pregnancy. However, currently, there is not sufficiently robust evidence to indicate the need for surgical correction in all asymptomatic patients seeking fertility. In cases where surgical correction of isthmocele is deemed necessary, it is advisable to evaluate residual myometrial thickness (RMT). For patients with RMT >2.5-3 mm, hysteroscopy appears to be the technique of choice. In cases where the residual tissue is lower, recourse to laparotomic, laparoscopic, or vaginal approaches is warranted.

Predictive Factors of Non-Inflammatory Small Bowel Obstruction After Bowel Resection in Crohn's Patients.

The aim of the study was to investigate the risk factors associated with the development of small bowel obstruction (SBO) in Crohn's disease (CD) after small bowel resection (SBR) that are not due to active/recurrent inflammation. We conducted a retrospective cohort study of patients who had SBR for active or complicated CD. Abstracted data included demographics, phenotype, therapies for CD, endoscopic disease recurrence, and several surgical variables. The primary outcome was the development of non-inflammatory SBO (NI-SBO) within 5 years after SBR. A total of 335 patients were included. The cumulative rates of NI-SBO at 6 months, 1 year, and 5 years were 5 (1.5%), 8 (2.4%), and 29 (8.9%), respectively. Variables associated with the development of NI-SBO were active macroscopic or microscopic inflammation in the surgical margins (13 (56%) vs. 65 (27%), P = 0.004), open resection (vs. laparoscopic resection) (12 (41.4%) vs. 60 (19.5%), P = 0.0006) and a higher median number of previous resections (2 (interquartile range (IQR) 2 - 3) vs. 1 (IQR 1 - 2), P = 0.0002). Only 21% of patients who developed NI-SBO required surgical intervention. The incidence of NI-SBO after SBR in CD is low and associated with inflammation at the margins of the resected bowel, previous bowel resections, and an open laparotomy approach. Most NI-SBOs resolve with medical management.

Living-Donor Uterus Transplantation: A Clinical Review

Uterus transplantation (UTx) is currently the only available treatment for absolute uterine factor infertility. More than 90 uterus transplantations have been performed worldwide, mostly from living donors. Living-donor (LD) UTx is a challenging surgical procedure since it poses ethical issues, and it is a high-risk and invasive surgery with higher hysterectomy-related risks compared to conventional hysterectomy. A total of 59 living-donor hysterectomies have been reported in the literature, including 35 performed with a laparotomic approach, 20 with a robotic approach and 4 with a laparoscopic approach. The mean donor age was 45.6 ± 9.1 years, and 22 were unrelated with the recipients, 34 were emotionally related (27 mothers, 5 sisters, 2 mother’s sisters). The mean recipient age was 28.8 ± 4.5 years. Mayer–Rokitansky–Küster–Hauser syndrome was the most common indication for uterus transplant. Robotic living-donor hysterectomy had the longest operative time but resulted in a lower blood loss and postoperative stay compared to laparotomic and laparoscopic approaches. Twenty-nine births from LD-UTx have been reported, four after robotic living-donor hysterectomy and twenty-five after a laparotomic procedure. UTx is now an effective treatment for women with UFI. While living-donor UTx in some cases may be considered an experimental procedure, it offers the extraordinary possibility to give women the opportunity to have a pregnancy. Many efforts should be made to reduce the potential risks for donors, including the use of mini-invasive techniques, and the efficacy of UTx in the recipients, giving the potential harm of immunosuppression in a recipient of a non-life-saving organ.

A RARE UTERINE TUMOR: DISSEMINATED PERITONEAL LEIOMYOMATOSIS. CLINICAL OBSERVATIONS.

Disseminated peritoneal leiomyomatosis (DPL) is an extremely rare benign disease characterized by widespread lesions of the abdominal cavity, pelvis, and retroperitoneal space with tumor nodules of varying size and number, which are benign neoplasms consisting of smooth muscle fibers in their histological structure. To analyze clinical cases of DPL with a concise review of the current state of the DPL diagnosis and treatment. We analyzed 5 clinical cases of DPL of female patients aged 39-50 years (mean age 46.2 years) who underwent surgical treatment at the National Cancer Institute from 2010 to 2021. In all 5 patients, the diagnosis of DPL (8898/1) was verified according to pathological (using routine hematoxylin/eosin staining) and immunohistochemical (IHC) studies. All patients underwent surgical treatment with a laparotomy approach, the extent and radicality of which depended on the location and number of tumor lesions. At the time of follow-up, all 5 patients were alive and did not receive any special oncological treatment. DPL is characterized by a variety of clinical manifestations from polyserositis to acute abdomen, depending on the location and size of the main tumor focus. IHC analysis is the criterion for the final diagnosis, and radical removal of all tumor foci provides the best therapeutic prognosis. The treatment should be carried out in highly specialized cancer centers where surgeons have gained sufficient experience in performing cytoreductive surgery.

High-risk endometrial carcinoma in early stages: Hospital Italiano de Buenos Aires, oncological results

Endometrial cancer is the second most frequent gynecological tumor in Argentina, representing 6% of all cancers in women. The objective of this study is to evaluate the oncological and perioperative results in patients with high-risk endometrial cancer (HREC) limited to the uterus, treated at the Hospital Italiano de Buenos Aires, between January 2010-2018. Retrospective cohort study that evaluated perioperative results, disease-free survival at 2, 4 years in patients with HREC. Of a total of 123 patients, 74 met the inclusion criteria. Serous tumors were the most frequent histological type, n=38 (51%), while dedifferentiated tumors were the least frequent, n=2 (3%). Of all the patients included, 56 (76%) received at least one adjuvant treatment. Taxol platinum-based chemotherapy was implemented in 28 patients (38%), while 24 (33%) received a combination of chemotherapy and radiotherapy. The median follow-up time was 2.9 years. Disease-free survival in patients with stage IA at 2 and 4 years was 71% (95% CI 55-82) and 63% (CI 46-76), respectively, while those with stage IB were 53 (95% CI 33-70) and 38 (95% CI 19-58). Regarding the surgical approach, no significant differences were found in disease-free or overall survival when comparing the laparoscopic with the laparotomy approach (p=0.06). Only the FIGO stage showed an increased probability of death or relapse regardless of the type of adjuvant treatment and the type of surgery approach. Perioperative complications were similar in both approaches.

Comparative Analysis of Laparoscopy Versus Laparotomy Approaches in Treating Ectopic Pregnancy

Objective: To compare and analyze the effects of laparotomy (AS) and laparoscopic surgery (LS) on ectopic pregnancy (EP). Methods: The surgical trial initiated case extraction in January 2017 and concluded in May 2023. The subjects comprised 30 cases of EP, categorized into two groups of 15 cases each based on the selected surgical method during treatment for subsequent analysis and comparison. EP patients in Group A chose AS surgical treatment, while those in Group B opted for LS surgical treatment. The perioperative parameters, complication ratio, survival status score (SF-36), and postoperative curative effect values were compared between the two groups of EP patients. Results: Throughout the perioperative period, various parameters such as blood loss level, operation time, abdominal pain relief time, ambulation time, catheterization time, exhaust time, and hospitalization time were recorded and compared between the two groups of EP patients. Complication ratios were documented and compared in EP patients from both groups post-operation. The test results indicated a lower value for complications in Group B (P &lt; 0.05). SF-36 scores of EP patients in both groups were assessed and compared post-operation, with the test result indicating a higher value for Group B (P &lt; 0.05). The postoperative curative effects of EP patients in both groups were evaluated and compared, revealing overall similarity between the two groups (P &gt; 0.05). Conclusions: The curative effects of AS and LS surgery in EP are similar, but LS surgery demonstrates better prevention and control of complications, reduced bleeding and trauma, and faster postoperative body recovery. Consequently, the prognosis and survival status are superior in LS surgery, providing valuable reference points.

Technical and Clinical Outcomes of Laparoscopic-Laparotomic Hepatocellular Carcinoma Thermal Ablation with Microwave Technology: Case Series and Review of Literature.

To evaluate technical and clinical outcomes of intraoperative (laparoscopic/laparotomic) microwave ablation on HCC. This is a retrospective single-center study evaluating consecutive patients treated for very early/early-stage HCC with intraoperative microwave ablation from 1 July 2017 to 30 June 2023. In these patients, a percutaneous US-guided approach was excluded due to the nodule's suboptimal visibility or harmful location and liver resection for a deep position or adherences. Data about the clinical stage, surgical approach, liver pathology and nodules characteristics, technical success, complications, and follow-up were collected. Technical success was intended as the absence of locoregional persistence at follow-up CT/MRI controls. A total of 36 cirrhotic patients (M:F = 30:6, median age 67 years) were enrolled; 18/36 (50%) had a single nodule, 13/36 (36%) had two, 4/36 had three (11%), and 1/36 had four (3%). Among the patients, 24 (67%) were treated with laparoscopy, and 12/36 (33%) with a laparotomic approach. Sixty HCCs of 16.5 mm (6-50 mm) were treated for 7 min (2-30 min) with 100 W of power. A total of 55 nodules (92%) were treated successfully and showed no residual enhancement at the first postoperative follow-up; the other 5/60 (8%) underwent chemo/radioembolization. There was one complication (3%): a biliary fistula treated with percutaneous drainage and glue embolization. The average hospital stay was 3.5 days (1-51 days), and patients were followed up on average for 238 days (13-1792 days). During follow-up, 5/36 patients (14%) underwent liver transplantation, 1/36 (2%) died during hospitalization and 1 after discharge. Laparoscopic/laparotomic intraoperative HCC MW ablation is feasible in patients unsuitable for percutaneous approach or hepatic resection, with rare complications and with good technical and clinical outcomes.

Safety and efficacy of direct percutaneous endoscopic jejunostomy tube placement compared with surgical jejunostomy: a tertiary care analysis

Background and AimsJejunostomy tube placements provides enteral access for feeding in eligible patients who cannot meet the nutritional needs by mouth. They can be surgically placed laparoscopically (lap-J) or using conventional open laparotomy (open-J) approach. Recently, direct percutaneous endoscopic jejunostomy (DPEJ) has emerged as an alternative because of its low cost and shorter recovery times. We sought to retrospectively compared the procedural success rates and complications of these methods. MethodsPatients were identified by a querying of our health system patient database and the departmental database of patients who underwent DPEJ. The patients were divided into three cohorts based on the procedure: DPEJ, lap-J, and open-J. Patient age and BMI, procedure success rate, and complications rate were compared among the three groups. Results201 patients met inclusion criteria (65 DPEJ, 111 lap-J and 25 open-J). Procedural success rates were similar between the 3 groups (DPEJ 96.9%, Lap-J 99.1%, Open-J 100%, p=0.702). Rates of infection and bleeding were also similar between the 3 groups. There were no cases of GI perforation. Tube dysfunction for any reason that required complete removal and/or replacement within 90 days occurred more often in the surgical groups than in the DPEJ group (DPEJ 0%, lap-J 35.1%, open-J 40.0%, p<0.001). This was driven largely by increased rates of tube clogging and tube dislodgement in the surgical groups. ConclusionDPEJ is a safe and effective alternative to surgical jejunostomy in eligible patients and may be associated with decreased complication rates at 90-days.

Clinical Outcomes of Conservative Surgery for Diffuse Uterine Leiomyomatosis: Preliminary Experience of 17 Cases in a Single Center.

This study aimed to introduce the clinical outcomes of conservative surgery for diffuse uterine leiomyomatosis, which also included the specialized surgical technique. All patients with diffuse uterine leiomyomatosis underwent conservative surgery such as transient occlusion of the uterine arteries (TOUA) adenomyomectomy. All 17 surgeries were performed by a single surgeon between 2018 and 2021. The mean age of the 17 patients was 36.12 years old (range 29-48, SD = 5.4). Fourteen of the 17 patients received a previous myomectomy via a laparotomic (6, 35.3%), laparoscopic (6, 35.3%), or hysteroscopic (2, 11.8%) approach. The major symptom was menorrhagia (94.1%); the mean operation time was 97.06 min (70-160, SD = 22.71), and the mean estimated blood loss was 283.53 mL (20-1000, SD = 273.72). The mean hemoglobin level one day after the operation was 9.64 g/dL (7.2-13.1, SD = 1.85). The mean hospital stay was 6.47 days (6-8, SD = 0.62). The mean follow-up duration was 116.41 weeks (32-216, SD = 50.88). The recurrence rate was 5/17 (29.4%), and the recurrence-free interval was 50.6 weeks (27-87, SD = 23.71). In patients with diffuse uterine leiomyomatosis, who want fertility preservation and relief of disease-related symptoms, conservative surgery such as TOUA adenomyomectomy could be a good option to preserve the uterus. However, further studies are required to assess fertility outcomes with a long-term follow-up.

Solid pseudopapillary neoplasm – Management of an extremely rare case of pancreatic tumor in a young patient

Abstract Introduction: Franz Tumor or the solid pseudopapillary neoplasm is a very rare form of pancreatic cancer, that can be held responsible for approximately 0.2-2% of the exocrine pancreatic tumors. Case report: We report a case of a 20-year-old woman, without any comorbidities, admitted to our department accusing mild abdominal pain at the level of the left hypochondrium and epigastrium, that started approximately half a year ago. Computed tomography and magnetic resonance imaging showed a voluminous encapsulated tumor, with mixed structure, apparently adherent to the tail of the pancreas, left kidney and adrenal gland, though being unable to certainly establish its visceral origin. Management and results: After analyzing all aspects of the case, we decide in favor of a left subcostal laparotomy approach; the intraoperative aspect is that of a relatively well delineated mass, adherent at the level of the pancreatic tail, therefore a complete excision of the tumor alongside with the pancreatic tissue that came in contact with it was performed. The pathological analysis reveals an encapsulated tumor with solid and pseudopapillary structure, with hemorrhagic and cystic degeneration regions; therefore, we reach the following final diagnosis: pT3 stage pseudopapillary-solid pancreatic neoplasm. Conclusions: In spite of its malignant behavior and impressive tumor volume, the surgical intervention was curative with favorable prognosis.

Digestive cancer surgery in low-mid income countries: analysis of postoperative mortality and complications in a single-center study.

This study aimed to analyze postoperative and 90-day morbidity and mortality and their risk factors in all digestive cancer curative intent resections of a single digestive surgical department in a low-mid income country. All consecutive patients who underwent a surgical resection for digestive cancer with a curative intent between January 1, 2021, and December 31, 2021, were included. This is a retrospective analysis of a prospective cancer surgery database managed during the period. Patterns and factors associated with increased morbidity and mortality were analyzed and presented in tabular and descriptive forms. Seventy-six patients were included, 38 (50%) were men with a mean age of 59 years (±13.5). Forty patients (52.63%) had tumors locally advanced, staged CT3-CT4 on preoperative imagery. Thirty-three of our population (43.42%) had laparoscopic surgery (conversion rate at 12.12%). In immediate preoperative, the morbidity rate was 36.84%; among each, 7 patients (9.21%) had serious complications (>2 Clavien-Dindo grade), and mortality rate was 5.26%. At 90 days after surgery, morbidity remained the same, and mortality increased to 7.9%. Risk factors for increased morbidity and mortality were female gender, obesity, high levels of carcinoembryonic antigen, hypoalbuminemia, laparotomy approach, hand sewn anastomosis, prolonged operating time, and wide drainage (p < 0.05). This study provides figures on mortality and morbidity related to digestive cancer curative surgery in a low-mid income country digestive department and discusses risk factors increasing postoperative complications and death.