Treatment Of Benign Diseases Research Articles

Quality of Life after Risk-Reducing Hysterectomy for Endometrial Cancer Prevention: A Systematic Review.

Risk-reducing hysterectomy (RRH) is the gold-standard prevention for endometrial cancer (EC). Knowledge of the impact on quality-of-life (QoL) is crucial for decision-making. This systematic review aims to summarise the evidence. We searched major databases until July 2022 (CRD42022347631). Given the paucity of data on RRH, we also included hysterectomy as treatment for benign disease. We used validated quality-assessment tools, and performed qualitative synthesis of QoL outcomes. Four studies (64 patients) reported on RRH, 25 studies (1268 patients) on hysterectomy as treatment for uterine bleeding. There was moderate risk-of-bias in many studies. Following RRH, three qualitative studies found substantially lowered cancer-worry, with no decision-regret. Oophorectomy (for ovarian cancer prevention) severely impaired menopause-specific QoL and sexual-function, particularly without hormone-replacement. Quantitative studies supported these results, finding low distress and generally high satisfaction. Hysterectomy as treatment of bleeding improved QoL, resulted in high satisfaction, and no change or improvements in sexual and urinary function, although small numbers reported worsening. There is very limited evidence on QoL after RRH. Whilst there are benefits, most adverse consequences arise from oophorectomy. Benign hysterectomy allows for some limited comparison; however, more research is needed for outcomes in the population of women at increased EC-risk.

Comparative Analysis of Transvaginal Ultrasound and Abdominal Ultrasound in the Diagnosis and Treatment of Benign Diseases in Obstetrics and Gynecology

Comparative Analysis of Transvaginal Ultrasound and Abdominal Ultrasound in the Diagnosis and Treatment of Benign Diseases in Obstetrics and Gynecology

Duodenum-preserving pancreatic head resections for surgical treatment of paraduodenal pancreatitis

Introduction. Up to date, no consensus exists on the surgical treatment of paraduodenal pancreatitis (PDP). Most authors prefer to perform pancreaticoduodenectomy when surgical treatment is indicated. However, such an aggressive approach may not always be justified for the treatment of benign disease. The aim of our study was to investigate the results of duodenum-preserving pancreatic head resections (DPPHR) for the treatment of PDP.
 Materials and methods. We performed a retrospective analysis of a database consisting of 112 patients with PDP treated in Shalimov National Institute of Surgery and Transplantology from 2014 to 2019. A total of 45 patients after DPPHR were included to the study. Such modifications of DPPHR as Frey’s, Beger’s and Berne’s procedures were used. The primary study endpoint was pain control assessed according to the Izbicki pain score before surgery and at follow-up visits. Secondary endpoints were defined as complication rate (Clavien — Dindo >2), hospital length of stay and 90-day mortality. All patients were followed-up for the assessment of pain cessation with a median of 33 months (range 8–54 months).
 Results. There were 42 males (93.3%) and 3 females (6.7%) in the study group. Preoperative Izbicki pain score result was 52.6 points. Follow-up pain score results were significantly lower at 11.7 points. Postoperative complication rate (Clavien — Dindo >2) was measured at 8.9%. Median hospital length of stay was 17.4 days. No mortality was recorded in the study group. All results were statistically significant (p<0.05).
 Conclusion. Application of DPPHR for the surgical treatment of PDP allows to achieve excellent results in terms of pain control (52.6 and 11.7 points on the Izbicki pain score before surgical intervention and at follow-up), while maintaining low complication (8.9%) and mortality (0%) rates.

Consideration in the management of renal cell carcinoma during the COVID-19 Pandemic.

ABSTRACTIntroduction:Recently the COVID-19 pandemic became the main global priority; main efforts and health infrastructures have been prioritized in favor of COVID-19 battle and the treatment of benign diseases has been postponed. Renal cell cancer (RCC) patients configure a heterogenous populations: some of them present indolent cases which can safely have postponed their treatments, others present aggressive tumors, deserving immediate care. These scenarios must be properly identified before a tailored therapeutic choice.ObjectivesWe propose a risk- based approach for patients with RCC, to be used during this unprecedented viral infection time.Materials and Methods:After a literature review focused in COVID-19 and current RCC treatments, we suggest therapeutic strategies of RCC in two sections: surgical approach and systemic therapy, in all stages of this malignance.Results:Patients with cT1a tumors (and complex cysts, Bosniak III/IV), must be put under active surveillance and delayed intervention. cT1b-T2a/b cases must be managed by partial or radical nephrectomy, some selected T1b-T2a (≤7cm) cases can have the surgery postponed by 60-90 days). Locally advanced tumors (≥cT3 and or N+) must be promptly resected. As possible, minimally invasive surgery and early hospital discharge are encouraged. Upfront cytoreduction, is not recommendable for low risk oligometastatic patients, which must start systemic treatment or even could be put under surveillance and delayed therapy. Intermediate and poor risk metastatic patients must start target therapy and/or immunotherapy (few good responders intermediate cases can have postponed cytoreduction). The recommendation about hereditary RCC syndromes are lacking, thus we recommend its usual care. Local or loco regional recurrence must have individualized approaches. For all cases, we suggest the application of a specific informed consent and a shared therapeutic choice.Conclusion:In the pandemic COVID -19 times, a tailored risk-based approach must be used for a safe management of RCC, aiming to not compromise the oncological outcomes of the patients.

Impact of COVID-19 pandemic on a daily-based outpatient treatment routine: experience of a radiotherapy department of a tertiary public/university hospital in Brazil

OBJECTIVES:To report the impact of the COVID-19 pandemic on patient attendance at a radiotherapy department two months after the implementation of specific policies regarding the pandemic.METHODS:The proposed treatment schemes, favoring hypofractionated schedules, and COVID-19 management strategies regarding irradiation are presented. Attendance after two months of implementation of these policies was measured and compared with that during the same period in 2019.RESULTS:A 10% reduction in the number of treated patients and a 26% reduction in the number of sessions was observed. The main impact was a decrease in the treatment of benign diseases and gastrointestinal tumors, with a general increase in breast cancer treatments. Eighteen (1.7%) patients were confirmed as having COVID-19 during radiotherapy in April and May 2020, three of whom were hospitalized, and one patient died because of COVID-19. Among the 18 patients, 12 had their treatments interrupted for at least 15 days from symptom appearance.CONCLUSION:There was a decrease in the number of treated patients in our radiotherapy department, with a greater decrease in the total number of sessions. This indicated, overall, a smaller number of fractions/patients treated, despite our efforts to maintain the treatment routine. We had several patients who were infected with COVID-19 and one related death during treatment in the first few months of the pandemic in São Paulo Brazil.

Long-term efficacy of low-dose radiation therapy on symptoms in patients with knee and hand osteoarthritis: follow-up results of two parallel randomised, sham-controlled trials.

Low-dose radiation therapy is commonly used as treatment for benign diseases, including osteoarthritis, in some countries (eg, Germany). We have previously presented our 3-month follow-up results of two randomised sham-controlled trials, in which no substantial effects of low-dose radiation therapy on clinical outcomes were seen in patients with knee and hand osteoarthritis. Here we report the 6-month and 12-month results of these studies. In one randomised sham-controlled trial, patients with knee osteoarthrosis were recruited, and in the other trial patients with hand osteoarthritis were recruited. All patients were recruited from the department of rheumatology of Sint Maartenskliniek (Nijmegen, The Netherlands) and the trials were undertaken in parallel. Patients were eligible if they had knee or hand osteoarthritis according to American College of Rheumatology (ACR) criteria, had a pain score of 5 or more on a 0-10 scale for at least 15 of the past 30 days, and did not meet 2011 modified ACR criteria for fibromyalgia. In each study, patients were randomly assigned (1:1), stratified by pain score (<8 vs ≥8) using a computer-generated randomisation list and stratified block randomisation, to low-dose radiation therapy (six fractions of 1 Gy low-dose radiation therapy in 2 weeks) or sham (six sessions with 0 Gy of radiation therapy in 2 weeks) intervention. Patients and researchers involved in patient contact or assessments were masked to group allocation, whereas the radiotherapy technologist who did the treatment was unmasked. Patients completed questionnaires (numeric rating scale of patients' global assessment and validated measures for pain and functioning) at baseline and at 1, 2, 3, 6, and 12 months after starting treatment. The primary outcome was the proportion of participants who responded according to the Outcome Measures in Rheumatology Osteoarthritis Research Society International responder criteria at 3 months, which has been reported previously. Here we report the proportion of participants who responded at 6 months and 12 months, and other clinical outcomes of pain, functioning, and patients' global assessment of their symptoms. We used logistic and linear mixed-models analyses to assess differences in number of responders and continuous outcomes. Safety was assessed in all participants who received at least one fraction of low-dose radiation or sham treatment. This study is registered with the Netherlands Trial Registry, NTR4574, and is closed to accrual. Between Oct 14, 2015, and May 3, 2017, 213 patients were screened for inclusion for the knee osteoarthritis study, of whom 55 were eligible and randomly assigned to low-dose radiation therapy (n=27) or sham intervention (n=28). In parallel, for the hand osteoarthritis study, 368 patients were screened and 56 were randomly assigned low-dose radiation (n=28) or sham intervention (n=28). Some minor imbalances in baseline demographic characteristics in terms of sex and age were seen in both the knee and hand cohorts. In the knee osteoarthritis cohort, 48 patients were assessible at 6 months and 50 were assessible at 12 months, and in the hand osteoarthritis cohort 52 patients were assessible at 6 and 12 months. We found no significant differences at 6 or 12 months in the proportion of participants who had a response for both groups. In the knee osteoarthritis group, at 6 months, the number of responders was nine (41%) of 22 patients who received low-dose radiation therapy versus nine (35%) of 26 patients who received the sham intervention (difference in proportion 7% [95% CI -20 to 33]; odds ratio [OR] 1·34 [95% CI 0·41 to 4·42]); and at 12 months, 13 (52%) of 25 patients versus 11 (44%) of 25 patients responded (difference in proportion 8% [-19 to 35]; OR 1·41 [0·45 to 4·48]). In the hand osteoarthritis group, at 6 months, the number of responders was seven (28%) of 25 patients who received low-dose radiation therapy versus 11 (31%) of 27 patients who received the sham intervention (difference in proportion 12% [-38 to 13]; OR 0·57 [0·18 to 1·81]); and at 12 months, eight (31%) of 26 patients versus seven (27%) of 26 patients responded (difference in proportion 4% [-20 to 29]; OR 1·23 [0·37 to 4·12]). We did not find any difference between groups in other clinical outcomes at 6 or 12 months. Three participants with knee osteoarthritis in the sham intervention group and two participants with hand osteoarthritis in the low-dose radiation therapy group had serious adverse effects, none of which were considered to be related to the intervention. We did not find evidence of a delayed effect of low-dose radiation therapy for patients with knee and hand osteoarthritis. Our placebo-controlled results suggest that the large effects of low-dose radiation therapy reported in clinical practice and observational studies can probably be explained by a regression to the mean effect and response to placebo. Dutch Arthritis Foundation and Stichting Landelijk Katholiek Reumacentrum, Netherlands.

Women’s perceptions of hysterectomy and alternative surgical treatments for benign pelvic pathologies: A Literature Review

Background: The evolving landscape of new technologies offering minimally invasive options for the treatment of benign pelvic diseases present with varying effectiveness and safety profiles. This raises questions regarding how patients make treatment decisions. Patients may perceive risk or benefits of a device/treatment differently than physicians or regulators responsible for determining whether a new device can be marketed. Methods: We reviewed publications in PubMed investigating patients’ perceptions of surgical treatments for benign pelvic pathology, including perceived benefits and risks. In addition, we explored the social and cultural factors influencing these perceptions and treatment decisions. Results: We included 16 studies in our literature review. Factors which were identified to influence women’s perceptions include: symptom relief; surgical complications and recovery times; impact on periods; child-bearing capacity; femininity; sexual desire and sexual dysfunction; cosmetic effects; emotional effects and risk of cancer. Our review revealed some heterogeneity in patients’ perspectives on factors (including benefits and risks) associated with surgical treatments for benign pelvic pathology. Women’s intrinsic factors including age, race, sexuality and child-bearing status may influence how they perceive the potential effects of their surgical options and influence their treatment decision. Conclusions: It is important to understand the trade-offs patients make as they consider competing surgical treatment options. Patient preference information from future patient studies could quantify patient perspective thereby providing additional information to patients, clinicians, current and prospective device developers. In addition, it may be used by regulators in their evaluation of surgical devices for the treatment of benign pelvic disease.

Pancreatic resections in elderly patients with high American Society of Anesthesiologists' risk score: a view from a tertiary care center.

More than 60% of patients affected by pancreatic cancer are ≥ 65years of age. Surgery represents the only potentially curative treatment for malignant pancreatic neoplasia and a useful treatment for benign diseases. To evaluate outcomes in elderly patients with ASA risk score 4 who underwent pancreatic resection compared to younger patients and elderly patients with lower anesthesiological risk. A consecutive series of 345 patients underwent pancreatic resection between 2010 and 2017 was reviewed. We compared three groups based on age at the time of surgery: < 65years (group A), 65-74years (group B), and ≥ 75years (group C). Patients in group C were split into two subgroups, ASA 1-3 versus ASA 4, and compared. Group A consisted of 117 (34%) patients, group B 128 (37%) patients, and group C 100 (29%) patients. Group C had a significantly higher incidence of comorbidity and ASA 4 status (p < 0.05), and of overall post-operative complications (p < 0.01), because of the higher incidence of post-operative medical complications. No differences in terms of overall surgical complications and post-operative mortality were reported. The mean overall survival was significantly lower for group C (p < 0.01), with no difference in mortality for cancer. Within group C, no differences were reported regarding surgical complications (p = 0.59), mortality (p = 0.34), and mean overall survival (p = 0.53) between ASA 1-3 and ASA 4 patients. Advanced age should not preclude elderly patients with pancreatic diseases from being treated surgically, and ASA 4 in subjects aged ≥ 75years should not be an absolute contraindication.

Quality indicators in the treatment of hemorrhoids

A quality indicator is a quantitative measure that can be used to monitor and evaluate the quality of certain operative procedures that may influence the result of atherapy. An indicator is not a direct measure of quality, it is merely atool to evaluate the performance of procedures and can indicate potential problem areas. Aliterature search was performed for parameters which could be included as indicators of quality in the treatment of hemorrhoids. In the treatment of benign diseases, such as hemorrhoids objective indicators (e.g. recurrence or survival rates in oncological diseases) cannot be used as quality indicators. Other indicators or core outcome factors must be used. From the patient's point of view other indicators are important (such as pain, complications, continence, days off work, etc.) than those for the colorectal surgeon, health insurance and healthcare provider. The most important indicators or outcome factors for treatment of hemorrhoids are postprocedural pain, patient satisfaction, complications, residual and recurrent symptoms, pain, quality of life, costs and duration of inability to work. In terms of outcome quality various quality indicators could be identified which also play a role in the guidelines; however, in this respect valid questionnaires or scores that enable a uniform assessment exist only in a few cases. In contrast, some indicators (e. g. costs, length of hospital stay) are strongly influenced by factors such as the healthcare system making these indicators unfeasible.

Лікування доброякісних захворювань гепатикохоледоха, ускладнених обтураційною жовтяницею, з використанням антеградних ендобіліарних втручань

Мета. Аналіз результатів лікування доброякісних захворювань гепатикохоледоха (ГХ), ускладнених обтураційною жовтяницею (ОЖ), з урахуванням використання антеградних ендобіліарних втручань.&#x0D; Матеріали і методи. Ретроспективно та проспективно проаналізовано результати лікування 34 пацієнтів з доброякісними захворюваннями ГХ, ускладненими ОЖ, в Інституті з 2011 по 2017 р.&#x0D; Результати. Для біліарної декомпресії у 15 (44,1%) пацієнтів (1-ша група) застосували антеградні ендобіліарні втручання. У 19 (55,9%) пацієнтів (2-га група) спроби виконати ретроградні втручання виявилися неефективними. Після біліарної декомпресії 24 (70,6%) пацієнтам виконали реконструктивно-відновні операції із застосуванням розробленого способу лікування холедохолітіазу (ХЛ) (Пат. України на корисну модель №126337), 2 (5,9%) пацієнтам з «ендоскопічно складними» формами ХЛ виконали мініінвазивні комбіновані втручання з антеградного та ретроградного доступів.&#x0D; Висновки. Застосовуючи антеградні ендобіліарні втручання, ми знизили частоту розвитку ускладнень біліарної декомпресії із 78,9 до 6,7% (ускладнення констатували у 15 пацієнтів 2-ї та у 1 пацієнта 1-ї групи); частоту розвитку ускладнень після реконструктивно-відновних операцій з 52,6 до 6,7% (ускладнення констатували у10 пацієнтів 2-ї та у 1 пацієнта 1-ї групи), а також летальність з 10,5 до 6,7% (померли 2 пацієнти 2-ї та 1 пацієнт 1-ї групи).

Well-differentiated thyroid cancer and robotic transaxillary surgery at a North American institution

BackgroundRecent studies from Asia have reported the safety and feasibility of robotic-assisted thyroid surgery. In the United States, several small series and case reports have been published, mostly regarding treatment of benign disease. The aim of our study is to report the safety and feasibility of robotic surgery for well-differentiated thyroid cancer patients at a North American institution. Materials and MethodsWe performed a retrospective cohort study using a prospectively collected single-center clinical database at Tulane University Medical Center. We included all well-differentiated thyroid cancer patients who underwent robotic-assisted or conventional cervical approach thyroid surgery with or without lymph node dissections at our institution from January 2015 to June 2017. Patient demographics and perioperative data were collected and analyzed. ResultsA total of 144 surgeries for thyroid cancer were performed; 35 (24.3%) were robotic-assisted. There were no significant differences in estimated blood loss, operative times, complication rates, specimen sizes, positive microscopic margins, number of lymph nodes removed with associated lymph node dissections, patient follow-up duration, or clinical recurrence rates between the two groups. Overall length of stay was shorter for robotic-assisted surgery, at 0.6 ± 0.9 d, versus 1.1 ± 1.2 d for conventional open surgery (P = 0.009). For robotic-assisted surgery, 19 patients (54.3%) were discharged on the day of procedure, and only one patient was admitted as inpatient to the hospital (2.9%). ConclusionsRobot-assisted thyroid surgery is a safe, feasible, and oncologically sound approach for a select group of well-differentiated thyroid cancer patients. However, long-term studies are needed.

Updated strategies in the treatment of benign diseases—a patterns of care study of the german cooperative group on benign diseases

PurposeRadiation therapy (RT) is a common treatment for benign diseases in Germany. Because the treatment concepts are inconsistent, we conducted this pattern-of-care study on behalf of the German Cooperative Group on Benign Diseases to evaluate treatment standards in Germany. Methods and materialsQuestionnaires were mailed to all radiation therapy facilities in Germany. We assessed the treatment equipment, annual number of patients, treatment indications, and, in particular, treatment strategies in patients with benign diseases in 2014. ResultsWe evaluated questionnaires returned by 116 participating institutions, of which 41 were ambulatory health care centers, 28 were private institutions, 27 were community hospitals, and 20 were university hospitals. On average, 2 linac accelerators and 2 megavoltage units were available in each institution. In 2014, a total of 36,830 patients were treated for benign diseases: 16,989 for degenerative diseases (peritendinitis humeroscapularis n = 2691; epicondylitis humeri n = 3788; heel spur n = 10,510); 14,936 for osteoarthritis (coxarthrosis n = 2230; gonarthrosis n = 2623; omarthrosis n = 2691; rhizarthrosis n = 2440; polyarthrosis n = 2297; others n = 2655); 1563 for hyperproliferative diseases (morbus Dupuytren n = 960; morbus Ledderhose n = 441; keloids n = 139; pterygium of the conjunctiva n = 3; other hyperproliferative diseases n = 20); 2440 for functional disorders (gynecomastia n = 843; Graves' disease n = 205; lymphatic fistula n = 178; heterotopic ossification prophylaxis n = 1214); 859 for stereotactic RT in the central nervous system (arteriovenous malformation n = 53; meningioma n = 425; acoustic neuroma n = 201; pituitary adenoma n = 131; others n = 49), and 43 for rare indications (pigmented villonodular synovitis n = 20 or vertebral hemangioma n = 23). The mean whole dose was <10 Gy in the treatment of degenerative disorders, 25 Gy for hyperproliferative diseases, 15 Gy for functional disorders, and <50 Gy for stereotactic RT. ConclusionsIn 2014, RT had an important role in the treatment of benign diseases. Because treatment concepts are inherent, we recommend treatment based on the guidelines written by the German Cooperative Group on Benign Diseases.

Experience of surgical treatment of thyroid and parathyroid diseases

Background. In our country some aspects of thyroid and parathyroid surgery are still discussed.&#x0D; Aim. To present our experience in surgical treatment of benign diseases of the thyroid and parathyroid glands.&#x0D; Materials and methods. A retrospective analysis of the results of surgical treatment of 1511 patients with thyroid and&#x0D; parathyroid disease was performed.&#x0D; Results. Thyroidectomy was performed in 73.6 % of cases with thyroid diseases. The frequency of postoperative&#x0D; complications: laryngeal paresis – 1.37 %, hypoparathyroidism – 0.84 %, hemorrhagic complications – 1.2 %. Selective&#x0D; parathyroidectomy was performed in 99 % of cases with primary hyperparathyroidism. Persistent hypoparathyroidism&#x0D; and laryngeal paresis have not been identified. Total parathyroidectomy with central neck dissection, upper mediastinum&#x0D; and upper horn of the thymus gland was performed in 66.3 % of cases with secondary hyperparathyroidism. Persistent&#x0D; laryngeal paresis was established in 3.3 % of cases, hemorrhagic complications – in 3.3 %.&#x0D; Conclusions. Constant analysis of our own results gives us reasons for our own attitude to the controversial issues&#x0D; of thyroid and parathyroid surgery. Presently, we prefer thyroidectomy in the treatment of diffuse toxic goiter and&#x0D; multinodular goiter, hemithyroidectomy – for the single-node goiter. In the surgical treatment of primary and uremic&#x0D; hyperparathyroidism, we consider mandatory the use of intraoperative monitoring of intact parathyroid hormone. When&#x0D; performing total parathyroidectomy, we perform the autotransplantation of the fragment of the parathyroid gland.

Comparison of the clinical efficacy of mammotome minimally invasive biopsy and conventional breast tumor resection for benign breast tumor

Objective To explore the treatment effect and application value of ultrasonic guided mammotome minimally invasive whirling surgery and open surgery for benign breast tumor. Methods 264 patients with benign breast diseases were randomly divided into observation group and control group, 132 cases in each group.The control group took open surgery, the observation group used mammotome minimally invasive surgery, rotary cutting system.Recorded clinical surgery treatment of the two groups. Results The operating time, intraoperative blood loss, operation scar size of the observation group were (18.27±3.05)min, (10.86±1.69)mL, (2.76±0.85)mm respectively, those of the control group were (53.48±6.17)min, (97.54±14.28)mL, (27.63±4.31)mm respectively, the differences between the two groups were statistically significant(t=58.7753, 69.2560, 65.0429, all P<0.05). In the observation group, breast deformation in 0 case, postoperative occurrence skin pigmentation in 1 case, itchy skin in 2 cases, with lateral swelling in 1 case, the patients′ satisfaction score was (93.42±3.89)points.In the control group, breast deformation in 5 cases, postoperative occurrence skin pigmentation in 8 cases, skin itching in 9 cases, lateral swelling in 7 cases, the patients′ satisfaction score was (88.16±1.45)points, the differences between the two groups were statistically significant(χ2=5.096, 5.636, 4.648, 4.604, t=14.557, all P<0.05). Conclusion Using ultrasonic guided mammotome minimally invasive rotary surgical treatment for benign breast diseases can shorten the operation time, reduce intraoperative bleeding, reduce the incidence of postoperative complications, patients' satisfaction is higher, and it is worthy of popularization and application in clinic. Key words: Breast neoplasms; Surgical procedures, Minimally invasive; Ultrasonography

Total pancreatic head resection with duodenum and bile duct preserving: a report of 31 patients

Objective To investigates the role of duodenum and bile duct preserving pancreatic head resection (DBPPHR) in treatment of benign or low-grade malignant diseases located in the head of pancreas. Methods The clinical data of 31 patients who underwent DBPPHR between April 2012 to May 2016 in Zhejiang Provincial People's Hospital and Zhangzhou Municipal Hospital of Fujian Province were analyzed retrospectively. Results Of the 31 patients, 4 patients underwent laparoscopic DBPPHR. One patient in the open group was converted to pancreaticoduodenectomy. For the open group, the mean operation time was (165.3±63.6) min; the mean estimated blood loss was (258.1±156.9) ml; and the mean postoperative stay was (11.7±6.3) days. The postoperative complications included 1 reoperation due to postoperative bleeding, 1 bile leakage and 13 patients developed grade A pancreatic fistula (48.2%). For the laparosco-pic group, the mean operation time was 350.0 (280.0~450.0) min; the mean estimated blood loss was 425.0 (250.0~600.0) ml; and the mean postoperative stay was 14 days. Three patients developed post-operative pancreatic fistula (grade A). The pathological diagnosis were: 12 patients with pancreatolithiasis, 8 patients with serous cystadenoma, 4 patients with branched intraductal papillary mucinous neoplasm, 5 patients with neuroendocrine tumor and 2 patients with mucinous cystadenoma. The follow-up period was 1~48 month, and there was no patient with diabetes or diarrhea. Conclusions DBPPHR was safe and efficacious. It is less invasive to treat benign or low-grade malignant diseases located in the head of pancreas. Key words: Pancreatic duct stone; Cystic-solid lesion, pancreas; Chronic pancreatitis; Duodenum preserving pancreatic head resection; Laparoscopic surgery

Use of Stents in Treatment of Benign and Malignant Esophageal Disease

Sponsoring Organization: European Society of Gastrointestinal Endoscopy (ESGE)Target Audience: GastroenterologistsBackground and Objective: The use of

Updated Strategies in the Treatment of Benign Diseases—A Patterns of Care Study of the German Cooperative Group on Benign Diseases

Abstract Purpose Radiation therapy (RT) is a common treatment for benign diseases in Germany. Because the treatment concepts are inconsistent, we conducted this pattern-of-care study on behalf of the German Cooperative Group on Benign Diseases to evaluate treatment standards in Germany. Methods and materials Questionnaires were mailed to all radiation therapy facilities in Germany. We assessed the treatment equipment, annual number of patients, treatment indications, and, in particular, treatment strategies in patients with benign diseases in 2014. Results We evaluated questionnaires returned by 116 participating institutions, of which 41 were ambulatory health care centers, 28 were private institutions, 27 were community hospitals, and 20 were university hospitals. On average, 2 linac accelerators and 2 megavoltage units were available in each institution. In 2014, a total of 36,830 patients were treated for benign diseases: 16,989 for degenerative diseases (peritendinitis humeroscapularis n = 2691; epicondylitis humeri n = 3788; heel spur n = 10,510); 14,936 for osteoarthritis (coxarthrosis n = 2230; gonarthrosis n = 2623; omarthrosis n = 2691; rhizarthrosis n = 2440; polyarthrosis n = 2297; others n = 2655); 1563 for hyperproliferative diseases (morbus Dupuytren n = 960; morbus Ledderhose n = 441; keloids n = 139; pterygium of the conjunctiva n = 3; other hyperproliferative diseases n = 20); 2440 for functional disorders (gynecomastia n = 843; Graves' disease n = 205; lymphatic fistula n = 178; heterotopic ossification prophylaxis n = 1214); 859 for stereotactic RT in the central nervous system (arteriovenous malformation n = 53; meningioma n = 425; acoustic neuroma n = 201; pituitary adenoma n = 131; others n = 49), and 43 for rare indications (pigmented villonodular synovitis n = 20 or vertebral hemangioma n = 23). The mean whole dose was Conclusions In 2014, RT had an important role in the treatment of benign diseases. Because treatment concepts are inherent, we recommend treatment based on the guidelines written by the German Cooperative Group on Benign Diseases.

Safety and feasibility of modified transumbilical laparoendoscopic single-site simple nephrectomy

Objective To evaluate the safety and feasibility of applying modified transumbilical laparoendoscopic single-site surgery(LESS) nephrectomy in the treatment of kidney benign diseases. Methods From June 2012 to February 2014, 15 patients(group A)with benign nonfunctioning kidney were performed transumbilical laparoendoscopic single-site simple nephrectomy by an experienced laparoscopic surgeon. From February 2014 to December 2014, 10 patients(group B)with benign nonfunctioning kidney underwent modified transumbilical laparoendoscopic single-site simple nephrectomy by the same surgeon. Group A has 8 males and 7 females, with an average age of (51.3±5.5)years and an average body mass index of(22.5±1.3)kg/m2. Of the 15 patients, 10 were left benign nonfunctioning kidney while 5 were right. The causes of nonfunctioning kidney included renal calculi(7 cases), ureteral calculi(6 cases), and ureteropelvic junction obstruction(2 cases). Group B contains 4 males and 6 females, with an average age of(48.4±8.3)years and an average body mass index of(21.5±1.7)kg/m2. Of the 10 patients, 6 were left side benign nonfunctioning kidney while 4 were right. The causes of nonfunctioning kidney included renal calculi(4 cases), ureteral calculi(5 cases), and renal tuberculosis(1 case). An approximately 4 cm transverse incision was made below the umbilicus for single-port access in Group A. Operations were performed using 30°10 mm laparoscope with conventional and bending instruments. A 10 mm trocar next to the single-port access was added in group B without making a new skin incision, but with two incisions in the muscular layer. As two independent incisions, one is used for the single-port access, while the other is used for the 10mm trocar. This modified technique improves the procedure of the operation. A comparison was made between the two groups. Clinical indicators were collected before, during and after the operation, and complications of both groups were analyzed retrospectively. Results In group A, one case was converted to conventional laparoscopic nephrectomy, and 2 cases was added a trocar. Total operating time was significantly longer in group A than in group B[(201.0±31.5)min vs.(170.0±19.6)min, P=0.011)], but modified technique resulted in greater intra-operative blood loss[(134.7±42.7)ml vs.(174.4±43.9ml, P=0.034)]. There were no significant differences in resuming diet, leaving bed, removing drainage, visual analogue pain scale and length of hospital stay between the two groups. There was no severe complications in both groups, but an approximately 4 centimeters scar. Conclusions Modified transumbilical laparoendoscopic single-site simple nephrectomy was safe and effective. It can effectively reduce the operating time and learning curve, with improved cosmetic result. Key words: Transumbilical; Single-site; Laparoscopic surgery; Simple nephrectomy

A Retrospective Review: Vaginal versus Abdominal Hysterectomy for Benign Gynecological Diseases in a Tertiary Canter

The aims are to review respectively 229 cases of hysterectomy and to find the factor affecting the decision of vaginal hysterectomy. Data collected from medical charts include age, nationality, parity, menopause, history of Dilation and curettage. The following data were obtained: the clinical presentation and the indication for hysterectomy. Postoperative complication includes the estimated blood loss, the number of days in hospital and ICU admission recorded. The route of hysterectomy found that 187 (82%) were abdominal and only 42 (18%) were vaginal. Factors significantly associated with the choice of vaginal approach: age, parity, smaller uterine size and prolapse. Factors affecting the decision of vaginal hysterectomy for treatment of benign diseases are identified as follows: if the age is more than 35 years or if the women already reach menopause, the presenting symptoms are not vaginal bleeding but prolapsed uterus and uterine size is less than 12 weeks.

Laparoscopic Colon Surgery for Benign Disease: A Comparison to Open Surgery

Backgrounds and Objectives: Today we are witnessed a growing number of minimally invasive surgical techniques for different diseases. Laparoscopic colon surgery as a minimally invasive surgery is currently growing in treatment of malignancies after proving his place in the treatment of benign diseases. We compare in this study results of laparoscopic colorectal surgery with open surgery. Methods: 36 laparoscopic colon resections performed for benign disease were compared to 36 open colon resections with respect to operating times, length of hospital stay, estimated blood loss, days until first postoperative bowel movement, and complications. Results: The laparoscopic colon resection group had decreased length of stay, less blood loss, earlier return of bowel function, and an equivalent number of complication. Duration of surgery was higher in the laparoscopic group. Conclusion: The use of laparoscopic colon surgery for benign disease not only affords the patient the advantage of the laparoscopic approach, but also allows the surgeon to gain experience for laparoscopic colon surgery in malignant disease.