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Agnė Jankuvienė, Nadežda Ščupakova, Karolis Urbonas, Lilė Mikelevič, Renata Drutel, Robertas Samalavičius
Lietuvos chirurgija, Volume 20, pp 68-72; https://doi.org/10.15388/lietchirur.2021.20.41

Abstract:
Background. Cardiogenic shock caries high mortality and morbidity. Myocarditis patients developing cardiogenic shock refractory to medical treatment might benefit from extracorporeal membrane oxygenation or mechanical ventricular assist devices. Methods. A retrospective, single center observational study to assess the rate and outcomes of mechanical circulatory support of patients with fulminant myocarditis related cardiogenic shock. Short-term outcomes were evaluated. The primary endpoint of the study was hospital survival. Results. Two hundred ninetyone patient were supported with short-term mechanical assist devices at our institution during 12 year period. Among them, 4 (1.4%) were treated for myocarditis related cardiogenic shock. All patients were female, with a mean age of 34±4 years. In one case surgically implantable short-term mechanical assist device was used, in other three cases – extracorporeal membrane oxygenation. The mean duration of the support was 364±273 hours, mean intensive care unit stay – 35±29 days. Three of four patients were successfully weaned from the support and discharged from the hospital with complete heart function recovery. Conclusion. Patient with fulminant myocarditis, who would have died without the initiation of mechanical circulatory, had favorable short-term outcome with 75% survival rate.
Gustas Sasnauskas, Aivaras Grybas
Lietuvos chirurgija, Volume 20, pp 86-94; https://doi.org/10.15388/lietchirur.2021.20.44

Abstract:
Background. Recurrent proximal ureteral stricture is a complex rare disease that is difficult to treat. Post-operative scarring, impaired blood supply to the ureter, stricture-related stones, and chronic infection – all factors make the treatment even more complicated. Methods. There are various surgical procedures for ureteral reconstruction, however, most of them are very traumatic and quite often ineffective. Our case reports the first experience of treating a complicated recurrent proximal ureteral stricture with ureteroplasty using a buccal mucosa graft. Results. The patient had a 12-month post-operative follow-up. No stricture recurrence was observed and hydronephrosis decreased. Although the excretory function of the left kidney remained lower, serum creatinine became normal. The most important clinical outcome was the withdrawal of left flank pain. Conclusions. We are lacking high volume clinical trials for appropriate ureteral stricture treatment modality. All available publications in this field compare single cases or low volume studies. While buccal mucosa graft procedures are well established in urethral reconstruction, our case proves that buccal mucosa graft method can be successfully used for ureteroplasty as well, providing good post-operative functional outcomes.
Martynas Lukšta, Gustas Sasnauskas, Augustinas Baušys, Andrius Rybakovas, Justas Kuliavas, Rimantas Baušys, Kęstutis Strupas
Lietuvos chirurgija, Volume 20, pp 73-85; https://doi.org/10.15388/lietchirur.2021.20.43

Abstract:
Background. Gastric cancer remains one of the most common cancers in Lithuania and Worldwide. Surgical treatment is the only potentially curative treatment option for it. Historically open gastrectomy was considered as the gold standard approach. Although, the development of minimally invasive surgery and accumulation of the clinical data has led to the adoption of minimally invasive gastrectomy. Clinical cases. We present a series of 8 clinical cases who underwent minimally invasive surgery for early or locally advanced gastric cancer in Vilnius University Hospital Santaros Klinikos and the National Cancer Institute. Discussion. Large scale randomized controlled trials in Asia have proved that laparoscopic surgery is safe and oncologically effective for clinical stage I distal gastric cancer. The increa­sing amount of data supports the safety of minimally invasive gastrectomy for advanced or proximal gastric cancer. Most of the trials performed in Asia confirmed, that laparoscopic gastrectomy has some advantages, including: decreased blood loss, decreased post­operative pain, and morbidity. Recent randomized controlled trials of Western countries proved the safety of laparoscopic gastrectomy and the comparable 1-year long-term outcomes. Although, they failed to show improved recovery after minimally invasive surgery. Currently, there is sufficient evidence to adopt minimally invasive gastrectomy for gastric cancer into routine clinical practice in Lithuania. Conclusions. The first experience of minimally invasive gastric cancer surgery in Vilnius University Hospital Santaros Klinikos and the National Cancer Institute was successful. All gastrectomies were radical, and without major postoperative complications.
Domas Kurlavičius, Gediminas Rauba, Giedrė Stundžaitė-Baršauskienė
Lietuvos chirurgija, Volume 20, pp 95-102; https://doi.org/10.15388/lietchirur.2021.20.45

Abstract:
The article deals with one of the most complex hand injuries in the practice of plastic and reconstructive surgery – amputation of degloving the upper tissues of the upper limb. The clinical case of a woman who has suffered from this trauma, the course of treatment, remote functional and aesthetic results are presented.
Emrah Doğan, Hakan Hakan Avcı, Muge Kuzu Avcı, Korkut Bozkurt, Ozge Oral Tapan, Utku Tapan
Published: 16 April 2021
Lietuvos chirurgija, Volume 20, pp 27-31; https://doi.org/10.15388/lietchirur.2021.20.38

Abstract:
Cystic fibrosis (CF) is an autosomal dominant disease characterized by the dysfunction of exocrine secretory glands resulting from a mutation in the transmembrane regulator protein (CFTR) gene. As life expectancy increases in patients with cystic fibrosis secondary to advances in treatment, advanced age malignancies secondary to cystic fibrosis emerge. Especially, the frequency of gastrointestinal system malignancies and colon cancers increases with aging. Appendiceal tumors are a rare entity and constitute less than 1% of gastrointestinal tumors. We presented a villous adenoma encountered in an 18-year-old male patient with CF accompanied by clinical and radiological findings. Our case is the first reported appendiceal tumor that emerged in patients with cystic fibrosis.
Toni Risteski
Published: 16 April 2021
Lietuvos chirurgija, Volume 20, pp 20-26; https://doi.org/10.15388/lietchirur.2021.20.37

Abstract:
Background. Although, laparoscopic inguinal hernia repair in children is gaining ground as a safe, feasible, and popular method, still many pediatric surgeons continue to debate its safety, efficacy, and cosmesis in comparison with conventional open repair. Materials and methods. This was a prospective clinical study, that elaborated 98 female children aged 1–14 with clinically diagnosed indirect inguinal hernia. Equal proportions of 49 children were treated via laparoscopic (PIRS) either conventional open repair (OR). Outpatient clinic follow up was performed regardless of the type of the intervention, on the 7th day and 6 weeks after discharge. Results. The mean age of children in PIRS vs. OR group was 5.3±2.7 vs. 5.9±3.3 years. There was no significant differences between the groups related to age (p = 0.4221), weight (p = 0.5482), family history (p = 0.5377), and residency rural/urban (p = 0.3161). The average length of unilateral vs. bilateral PIRS repair (29.5±6.8 vs. 43.6±7.2 min) was significantly shorter than OR (44±4.2 vs. 97±8.1 min) for consequently p = 0.0023 vs. p = 0.00001. The post-operative hospitalization after PIRS repair was 14.1±3.1 hours and was significantly shorter compared to OR – 44±4.2 hours (p = 0.00001). In OR group, 4 (8.2%) children had postoperative nausea compared to none in PIRS group. Significantly bigger cosmetic satisfaction was found in PIRS compared to OM group (p = 0.0001). Conclusion. With due respect to OR as a gold standard, the proven advantages of PIRS are motivation for further improvement of this technique for the purpose of treatment of inguinal hernia of female children.
Rytis Tumasonis, Arūnas Petkevičius, Saulius Švagždys
Published: 16 April 2021
Lietuvos chirurgija, Volume 20, pp 12-19; https://doi.org/10.15388/lietchirur.2021.20.36

Abstract:
Aim. To evaluate and compare effectivenes of sacral and posterior tibial nerve stimulation for treating fecal incontinence.Methods. Systematic literature review was performed to compare sacral and posterior tibial nerve stimulation effectiveness. Research was performed in “Medline” database, using the “PubMed” website. English or lithuanian articles, published between 2008 and 2019, were included in our study. Results were described to assess the effect of interventions in each analysed article. We included 7 articles into meta-analysis. Articles compared the effectiveness of sacral or posterior tibial nerve stimulation with control groups or other treatment methods for managing fecal incontinence. Cochrane guidelines were used to perform this meta-analysis. Results. The results of meta-analysis suggests that sacral neuromodulation is superior to posterior tibial nerve stimulation to treat fecal incontinence compared to control groups or other treatments. Literature also suggest that after comparing these methods directly, sacral neuromodulation is superior to treat fecal incontinence a. Conclusion. Sacral neuromodulation is superior posterior tibial nerve stimulation to treat temporary or chronical fecal incontinence than and can be used as an alternative for surgical interventions.
Mantas Fomkinas, Mantas Kievišas, Kęstutis Braziulis, Rytis Rimdeika
Published: 16 April 2021
Lietuvos chirurgija, Volume 20, pp 32-40; https://doi.org/10.15388/lietchirur.2021.20.39

Abstract:
Objective. To evaluate the results of scaphoid bone proximal pole reconstruction with rib osteochondral autograft due to comminuted scaphoid fracture. Material and methods. We present a clinical case of fragmented scaphoid bone proximal pole fracture reconstruction by rib osteochondral autograft. The modified wrist function score of Green and O’Brien and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measuring scales were used for clinical evaluation before and 6 months after the reconstruction. Additio­nally, a literature review was conducted for case reports and previous literature reviews describing scaphoid bone proximal pole fracture surgical treatment. Medline (PubMed), ScienceDirect and UpToDate databases were used. Results. Conventional treatment methods for the treatment of comminuted proximal pole scaphoid bone fractures are often inappropriate due to technical issues or potential adverse outcomes. In these cases, reconstruction with rib autograft is possible. The study patient’s modified wrist function score of Green and O’Brien increased from 75 to 95 points out of 100 at 6 months postoperatively, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score decreased from 13.64 to 4.55 points. The results of this technique have been investigated in several studies (Sandow, 1998, 2001; Veitch et al., 2007). All subjects (22, 47 and 14 patients, respectively), except one, experienced improvement of wrist function – enhanced wrist movement, grip strength, reduced pain and restored wrist function to the pre-injury performance level. Conclusions. Scaphoid bone proximal pole fragmented fracture reconstruction with osteochondrial rib autograft achieves favorable recovery of wrist function and avoids complications or unfavorable functional consequences of alternative surgical procedures.
Vipin V. Nair, Pawan Sharma, Anand Katiyar, Abhishek Sharma
Published: 16 April 2021
Lietuvos chirurgija, Volume 20, pp 41-45; https://doi.org/10.15388/lietchirur.2021.20.40

Abstract:
Here we share an interesting case of severe trauma with tissue loss to nearly half of the back and a lacerated perineum in a Covid-19 positive patient in septic shock. This article highlights our experiences and hard lessons learnt in successful management of this complicated injury. Managing severe trauma is a challenge especially with respiratory failure resulting from Covid-19 infection. The patient reported to the hospital during a very difficult period, when proper medical care was difficult as hospitals and wards were filled with Covid positive patients. Managing patients was difficult especially wearing personal protective equipment round the clock. It’s a challenge when an entire team of surgeon, anesthesiologist, nursing staff and paramedics, rose above their daily call of duty to save the patient for her children. It was a fight against time and an many unknown enemy over three months for the entire team. The challenge to save a middle-aged patient from the claws of death against all odds was really miraculous. It was highly rewarding to see the patient going back to the family with a smile.
Brigita Siparytė-Sinkevičienė, Rytis Rimdeika
Published: 29 December 2020
Lietuvos chirurgija, Volume 19, pp 92-100; https://doi.org/10.15388/lietchirur.2020.19.28

Abstract:
People recovering from burn injury experience a wide range of challenges throughout their recovery. Currently, the survival is not the only important issue in the treatment of burns. As the advancement and amelioration in burn treatment have improved significantly, the patients’ recovery and abilities to return to their pre-burn functional status are of equal importance as well. The results of recent scientific literature review (Kazis et al.) demonstrate that 28% of burn survivors never return to any form of employment and only 37% of burn survivors regain the fullness of previous employment. Physical therapy is a critical, though painful, component of burn rehabilitation therapy and includes a variety of physiotherapy treatment methods such as exercise therapy, cardiopulmonary training, joint mobilization, positioning, splint adjustment, etc. The application of physiotherapy after burn injury was found to improve physical capacity, muscle strength, body composition, and quality of life. The use of early physiotherapy is also recommended in patients treated in the intensive care unit.
Narimantas Evaldas Samalavicius, Vitalija Nutautiene, Lina Butenaite, Rytis Markelis, Audrius Dulskas
Published: 29 December 2020
Lietuvos chirurgija, Volume 19, pp 140-144; https://doi.org/10.15388/lietchirur.2020.19.33

Abstract:
Background. Here we present a case of female patient suffering from bowel incontinence. Case report. The patient underwent unstimulated graciloplasty. Postoperative period was uneventful. After 4 weeks, a course of low frequency electric external stimulation in the area around the neurovascular bundle in the thigh was performed. Patient was evaluated 3 months postoperatively. On inspection, her anus was closed at rest. She stated moderate improvement in her continence and quality of life, her Wexner score was 10 and FISI score was 32 (prior surgery 19 and 44 accordingly). Conclusion. Adynamic graciloplasty seems to be a reasonable method of choice for faecal incontinence.
Karolis Černauskis, Sandra Kružyk, Gabrielė Šukytė, Linas Venclauskas, Mantas Sakalauskas
Published: 29 December 2020
Lietuvos chirurgija, Volume 19, pp 145-150; https://doi.org/10.15388/lietchirur.2020.19.34

Abstract:
Introduction. Liposuction is one of the most popular aesthetic surgical procedures. Liposuction is associated with weight loss, but the primary significance of this operation is body lines contouring. According to US plastic surgery statistics for 2018, liposuction surgery was ranked in the top five of cosmetic surgical procedures, and the most common area of suction in the body was the abdomen. One of the most difficult complications after this procedure is perforation of the small or large intestine, with a frequency of 0.014%. In order to avoid this complication, a comprehensive pre-operative, post-operative examination of the patient and ensuring the safety of the operation are important. We presenting a complicated clinical case of liposuction and literature review. Presentation of case report. In July 2019, a 49-year-old patient underwent surgery by plastic surgeons. Abdominal liposuction surgery was performed. On the first postoperative day, the patient complained of diffuse abdominal pain (VAS 7–8 points), but there were no clinical signs of peritonitis. The patient underwent urgent surgery following the development of a clinical picture of sepsis and peritonitis due to tomography. The operation started with diagnostic laparoscopy. On the left side of the abdominal wall, 4–5 mm abdominal wall defects were observed, and the intestinal cavity was rich in intestinal contents. No obvious injuries to the small intestine, colon or other abdominal organs were observed during laparoscopy. Therefore, a laparotomy was performed, during which two perforations of the small intestine were found and sutured. The postoperative period was smooth, with the patient discharged home after 11 bed days. Conclusions. Intestinal perforation after liposuction is a rare but dangerous complication. Although bowel injury is one of the most severe complications. Prevention is possible starting with a detailed clinical examination of the patient in the preoperative period. The postoperative period should be particularly important in light of the patient’s complaints and clinical symptoms. The presented clinical case shows what a complication of abdominal liposuction can be threatening and how important its early diagnosis and vigilance are.
Senol Tahir, Andrej Nikolovski, Martina Ambardjieva, Petar Markov, Dragoslav Mladenovik, Gjulsen Selim, Beti Zafirova-Ivanovska, Vlado Janevski
Published: 29 December 2020
Lietuvos chirurgija, Volume 19, pp 109-119; https://doi.org/10.15388/lietchirur.2020.19.30

Abstract:
Introduction. The diagnosis of acute appendicitis (AA), as the most common cause of acute abdominal pain, has changed in the past decade by introducing scoring systems in addition to the use of clinical, laboratory parameters, and radiological examinations. This study aimed to assess the significance of the four scoring systems (Alvarado, Appendicitis Inflammatory Response (AIR), Raya Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Tzanakis) in the prediction of delayed appendectomy. Materials and methods. The study included 100 respondents, who were diagnosed with AA in the period from January 2018 to February 2019 and were also operated on. In addition to the clinical, laboratory, and ultrasonographic examinations, four scoring systems (Alvarado, AIR, RIPASA, and Tzanakis) were used to diagnose AA. According to the obtained histopathological (HP) findings, the patients were divided into 3 groups: timely appendectomy, delayed appendectomy and unnecessary appendectomy. Using the sensitivity and specificity of all 4 scoring systems, ROC analysis was performed to predict delayed appendectomy. Results. In the study that included 100 patients (58% men, 42% women), after the appendectomy was performed, the resulting HP showed that 74% had a timely appendectomy, while 16% had delayed and 10% had an unnecessary appendectomy. For the prediction of delayed appendectomy, the area under the ROC curve showed a value of 0.577 for the Alvarado score, 0.504 for the AIR, 0.651 for the RIPASA, and 0.696 for the Tzanakis. Sensitivity and specificity for the Alvarado score was 54% and 62%, for RIPASA 62.5% and 63.5%, for Tzanakis 69% and 60.8%, respectively. Combining the three scoring systems (Alvarado, RIPASA, and Tzanakis), the surface area under the ROC curve was 0.762 (95% CI 0.521–0.783), with a sensitivity of 85% and a specificity of 62%. Conclusion. In our study, the diagnostic accuracy of RIPASA and Tzanakis showed better results than Alvarado, while AIR cannot be used to predict delayed appendectomy in our population. However, the simultaneous application of all three scoring systems, RIPASA, Tzanakis and Alvarado, has shown much better discriminatory ability, with higher sensitivity and specificity, as opposed to their use alone. Combining scoring systems should help in proper diagnosis to avoid negative appendectomy, but additional studies with a larger number of patients are needed to support these results.
Rūta Čiurlienė, Diana Žilovič, Karolina Eva Romeikienė, Evelina Šidlovska
Published: 29 December 2020
Lietuvos chirurgija, Volume 19, pp 120-127; https://doi.org/10.15388/lietchirur.2020.19.31

Abstract:
Objectives. To find out sentinel lymph node detection rate of low-risk endometrial cancer patients. To compare postoperative complications rate, lenght of a surgery, lenght of hospital stay and sensitivity of detecting lymph node metastasis between minimally invasive surgery with sentinel lymph node biopsy and abdominal surgery with systemic pelvic lymphadenectomy. Methods. Retrospective analysis of low-risk endometrial cancer patients, treated in National Cancer Institute (n = 103) history cases from 2018 10 untill 2019 12. I group – laparoscopic hysterectomy with sentinel lymph node biopsy (n = 35); II group – abdominal hysterectomy with systemic pelvic lymphadenectomy (n = 68). Both groups were homogeneous according to clinicopathological features. Results. Sentinel lymph node were detected in 97.1% cases. Sentinel lymph nodes in both sides were detected in 85.7% cases. Metastasis in regional lymph nodes were detected in 2 cases (5.7%) in group I and none group II. Postoperative complications rate in group I were 3.8% and 13% in group II. Conclusions. There are significantly less postoperative complications in endoscopic surgery with sentinel node biopsy for low-risk endometrial cancer treatment, also this method is more accurate in surgical staging in National Cancer Institute.
Gordana Bozinovks Beaka, Biljana Prgova Veljanovska, Milka Zdravkovska, Patricija Kalamaras
Published: 29 December 2020
Lietuvos chirurgija, Volume 19, pp 128-139; https://doi.org/10.15388/lietchirur.2020.19.32

Abstract:
Background / Objective. In our clinical study we have compared the results of intraoperative and postoperative period in patients with inguinal hernia treated operatively with Lichtenstein technique, where one of three different polypropylene meshes has been applied: polypropylene monofilament light mesh, polypropylene monofilament heavy mesh and self gripping polypropylene mesh. Follow up period have been one year. Methods. This study represents randomized, retrospective-prospective, comparative clinical study where 243 patients have been divided into three groups depends of prosthetic mesh that was applied with Lichtenstein technique. We have evaluated the connection between types of used mesh with some of followed parameters: postoperative pain intensity, postoperative patient mobilization, postoperative surgical site occurrences, duration of hospitalization, chronic pain, filling of foreign body in inguinal area and development of recurrences. Results. Patients with applied self gripping polypropylene mesh have significantly lowest pain, lowest hospital stay and lowest duration of surgical procedure than other two groups of patients. In term of chronic pain, only statistically significance we confirmed between the groups of heavy monofilament mesh and self griping polypropylene mesh, where higher number of patients from group with monofilament polypropylene light mesh reported chronic pain. In our study we confirmed that working status and patient age have significant influence on the intensity of postoperative pain in all three patients group. There is no statistical correlation between type of the mesh and surgical site occurrence rate. Conclusion. Patients with applied self gripping polypropylene mesh have significantly lowest pain, lowest hospital stay, lowest duration of surgical procedure and less number of patients experienced feeling of “foreign body” in their groin than other two groups of patients.
Aleksas Makulavičius, Giedrius Mazarevičius, Povilas Masionis, Matas Urmanavičius, Mindaugas Klinga, Valentinas Uvarovas, Narūnas Porvaneckas
Published: 29 December 2020
Lietuvos chirurgija, Volume 19, pp 101-108; https://doi.org/10.15388/lietchirur.2020.19.29

Abstract:
Background. The optimal treatment of acute Achilles tendon ruptures is still under debate. The purpose of this randomized controlled trial was to evaluate outcomes of open repair comparing with percutaneous procedure for Achilles tendon ruptures. Methods. 100 patients with acute Achilles tendon rupture were randomized in two groups: open “crown” type (group A) and percutaneous Bunnell type repair (group B). Absorbable suture was used in both groups. 87 patients were available for the mean follow up of 6 months. Results. No statistically significant difference was observed between groups in ATRS (Achilles Tendon Total Rupture Score), leg circumference, single heel rise, Achilles resting angle, time back to work and sports and overall patient satisfaction. Percutaneous technique was much faster. Overall 13 complications occurred in both groups (5 and 8 respectively). No deep infection occurred, no revisions were needed. Conclusions. Both techniques showed to be effective and safe when using absorbable suture material with a high patient satisfaction and a low complication rate, but percutaneous repair was significantly faster.
Aleksandar Mitevski, Petar Markov
Published: 29 December 2020
Lietuvos chirurgija, Volume 19, pp 151-155; https://doi.org/10.15388/lietchirur.2020.19.35

Abstract:
Introduction. Ventral hernia represents a problem for the surgeon and patients alike. eTEP repair is a technique that is minimally invasive, provides lower overall complication rates, decreased wound complications and the recurrence rates and shortens the length of stay in the hospital. Case. We present a case of a 48 year old patient who was admitted to our hospital for elective treatment of recurrent umbilical hernia. The patient had umbilical hernia repair 4 years ago, suture repair without mesh placement was performed according to the information given by the patient. On inspection there is visible supraumbillical scar, 12 cm in length with hernia bulging under the scar which is partially reducible on pressure. Discussion. The eTEP technique is closest to ideal because the abdominal cavity is not penetrated, is lessening the risk of visceral lesions and trocar site hernias, allows local or regional anesthesia, gives unsurpassed views of inguinal region and hernias and reproduces the technique of Rives-Stoppa. In favor to overcome the limitations deriving from the limited surgical field and restricted port set up, this technique has been modified based on the normal anatomy of the abdominal wall naming it depen­dently of the extension of the dissection and the location of the hernia. Conclusion. The extended-TEP (e-TEP) technique is based on the anatomical principle that the extraperitoneal space can be reached from almost anywhere in the anterior abdominal wall. It provides the most of the benefits for the patients but also requires great surgical skill and understanding of the anatomy of the anterior abdominal wall.
Gintaras Varanauskas, Gintautas Brimas
Published: 10 June 2020
Lietuvos chirurgija, Volume 19, pp 20-26; https://doi.org/10.15388/lietchirur.2020.19.21

Abstract:
Objective. Review articles with postoperative abdominal wall repair without mesh suturing (sutureless hernioplasty). Methods. A systematic search of the literature published from 01/01/2004 to 31/12/2018 was performed using Medline, PubMed and the Cochrane Library databases. The search was performed using the keywords: postoperative hernia, incisional hernia, mesh hernioplasty, sutureless repair, sutureless hernioplasty, sutureless herniotomy. Results. For the present analysis 5 publications were identified. The quality of each study was assessed. The information about operative methods, main results, conclusions and recommendations was collected. Conclusions. According to the results and conclusions of reviewed articles, it can be stated that postoperative abdominal wall hernia repair without mesh suturing is a safe and can improve postoperative results, but there is insufficient evidence to determine if it is associated with better outcomes than hernioplasty with mesh fixation. Further clinical studies are needed to clarify whether this method is clinically important.
Published: 10 June 2020
Lietuvos chirurgija, Volume 19, pp 55-61; https://doi.org/10.15388/lietchirur.2020.19.26

Abstract:
Myeloid sarcoma (extramedullary myeloblastoma, granulocytic sarcoma, chloroma) is an extramedullary isolated malignant tumor of myeloblasts and immature myelocytes. It can occur anywhere in the body as a solitary tumor or can be accompanied with acute myeloid leukemia. We are presenting a case of a young male patient that presented with sings of a small bowel obstruction and a palpable tumor mass in the abdomen. After uneventful postoperative period, the immunohistochemistry analysis reported an extramedullary myeloid sarcoma since a normal bone marrow biopsy was revealed.
Published: 10 June 2020
Lietuvos chirurgija, Volume 19, pp 51-54; https://doi.org/10.15388/lietchirur.2020.19.25

Abstract:
Introduction. One of the most common and serious complications of near-postoperative surgery after colon resection with anastomosis is intestinal leakage with a frequency of 1 to 24%. Therefore, it is very important to evaluate the factors that may determine the development of this complication. One of the etiological factors behind the development of this complication is the intestinal microbiota, which is playing an increasingly important role in this process. Nevertheless, there is still a lack of comprehensive clinical evidence on the influence of the intestinal microbiota on postoperative complications such as anastomotic leakage. Purpose. To evaluate the influence of intestinal microorganisms on anastomotic leakage after elective intestines surgery. Methods. A prospective study was performed at the Lithuanian University of Health Sciences Hospital, Kaunas Clinics, Clinic of Surgery. There were included patients who underwent colon surgery (right hemicolectomy, left hemicolectomy, sigmoid resection and closure of ileostomy). Intestinal mucosal biopsy performed before restoring intestinal integrity and sent for microbiological and antibiotic examination. Patients were also observed postoperatively for anastomotic leakage. Results. The majority of patients were treated for colon cancer – 46 (92.0%). In 19 patients crop (38.0%) grown one microorganism, in 12 (24.0%) – 2 microorganisms, in 5 (10.0%) – 3 microorganisms, in 1 (2.0%) – 4 types of bacteria. In the most of the crops were observed growth by E. coli – 30 (60.0%), Enterococcus spp. – 12 (24.0%), Bacteroides spp. – 4 (8.0%), Klebsiella oxytoca – 2 (4.0%), Beta hemolytic streptococcus – 2 (4.0%) patients. Citrobacter fundii, Citrobacter brakii, Parabacteroides distasonis, Proteus mirabilis, Klebsiella pneumoniae, Enterobacteriaceae daacea grew only in 1 (2.0%) patients crop. Postoperative anastomotic leakage diagnosed in 2 (4.0%) patients. Conclusions. The major microorganisms that grown were E. coli. Due to the small sample, tendency can not be predicted, but microorganisms that promote small blood vessels thrombosis may be one of the factors that cause anastomotic leakage.
, , Dragoslav Mladenovikj
Published: 10 June 2020
Lietuvos chirurgija, Volume 19, pp 34-41; https://doi.org/10.15388/lietchirur.2020.19.23

Abstract:
Background. Laparoscopic appendectomy is established method in the treatment of complicated appendicitis. Certain advantages of the technique do not fulfill the expectations for its superiority over the open appendectomy as when it is used for uncomplicated appendicitis. This is generally caused because of the high variety of postoperative complications reported in different series for complicated appendicitis. Material and methods. This prospective interventional clinical study analyzes 61 patients operated with laparoscopic and open appendectomy due to complicated appendicitis, with an end point of comparing the intra and postoperative complications in both groups. Results. Conversion in open appendectomy was forced in one patient (1.63%). The operative time was significantly shorter in the laparoscopic group (p = 0.048). Wound infection was significantly predominant in the open group (p = 0.045). Postoperative intraabdominal abscess occurred in one patient in the laparoscopic group (p = 0.52). The overall morbidity was 26.2% (7 patients in the laparoscopic, and 9 in the open group; p = 0.59). Length of stay was significantly shorter in the laparoscopic group (p = 0.00001). Conclusion. Certain significant advantages of the laparoscopic appendectomy as low incidence of wound infection, short hospitalization, less postoperative pain and faster socialization makes the laparoscopy up to date method in the treatment of complicated appendicitis.
Vitalii S. Groshilin, Viktoria G. Brizhak, Evgeny Y. Khoronko, , Yuri V. Khoronko
Published: 10 June 2020
Lietuvos chirurgija, Volume 19, pp 27-33; https://doi.org/10.15388/lietchirur.2020.19.22

Abstract:
Aim. Evaluation of the effectiveness and identification of the benefits of a video-assisted fistula treatment method using fistuloscopy, in comparison with traditional methods of surgical treatment of complex forms of chronic paraproctitis, trans- and extrasphincteric, relapsing rectal fistulas. Patients and methods. A complex analysis of the results of surgical treatment was carried out in 228 patients with chronic paraproctitis, transphincteric, ectrasphincteric, including recurrent rectal fistulas, divided into three groups (main and two control), depending on the surgical methods of chronic paraproctitis used. Results. The result of surgical treatment of pararectal fistulas in the three study groups was compared. The effectiveness of treatment was assessed by the results of immediate and long-term postoperative period. It has been established that the use of a video-assisted fistula treatment method using fistuloscopy excludes the presence of an extensive postoperative wound in the perianal region, which significantly reduces the likelihood of its secondary infection, and the sphincter trauma, and in fact virtually eliminates its insufficiency. The use of video-assisted method of treatment of fistulas made it possible to reduce the number of postoperative complications. Conclusion. The final results (92.7% of favorable outcomes) allow us to recommend a video-assisted treatment for fistulas for wide practical implementation.
Published: 10 June 2020
Lietuvos chirurgija, Volume 19, pp 62-70; https://doi.org/10.15388/lietchirur.2020.19.27

Abstract:
Melanocytic nevi are congenital, benign, pigmented proliferations. They have high risk of malignancy, most frequently transform to malignant skin melanoma and 70% it occurs in the first life decade. The risk of malignant transformation increases proportionately to their size. The best way to avoid those risks is early and radical excision. In 1996 on the market appeared the Integra™ artificial skin, has made it possible to improve the methods for the elimination of large congenital nevi and significantly reduce the risk of malignant melanoma, at an early age. 2011–2019, in Children’s Hospital, Affiliate of Vilnius University Hospital Santaros Clinics, the Integra™ was used to treat congenital melanocytic nevi in four children. Implantation of the skin substitute Integra™ has been successful for all the patients, the prognosis was good. The treatment of congenital melanocytic nevi is a necessity to avoid the risk of developing malignant melanoma. The rarity of this condition has led to the fact that so far there is no universal approach for all the cases. Integra™ artificial skin is an excellent choice for the treatment of congenital melanocytic nevi, especially for paediatric patients.
Published: 10 June 2020
Lietuvos chirurgija, Volume 19, pp 42-50; https://doi.org/10.15388/lietchirur.2020.19.24

Abstract:
Aim. The aim of the study was to evaluate and compare the quality of life (QoL) using platelet-rich plasma gel (PRP) and conventional treatment of chronic leg wounds. Methods. Randomized clinical trial was carried out in Hospital of Lithuanian University of Health Sciences Kaunas Clinics during 2014–2018. Patients (n = 69) included in the study were randomly grouped into 2 groups: 1) PRP, 2) Control. SF-36 questionnaire was used to evaluate QoL, visual analog scale was used to evaluate persistent pain associated with ulcer and wound exudate volume was also evaluated. Statistical analysis were performed with SPSS 23.0 package. Results. Patients in PRP group at the end of the treatment rated their QoL over control group patients (p < 0.05). Wound associated pain (PRP – 1.54; control – 2.85; p = 0.015) and pain associated sleep disturbance (p < 0.001) was lower in PRP group patients. Wound exudate volume was lower in PRP group patients at the end of the treatment (p < 0.05). Conclusion. The treatment with PRP is associated with less wound associated pain, less-common sleep disturbance, reduced wound secretion and improved quality of life compared to conventional treatment.
Published: 10 June 2020
Lietuvos chirurgija, Volume 19, pp 12-19; https://doi.org/10.15388/lietchirur.2020.19.20

Abstract:
Surgery remains the only potentially curative option for gastric cancer, although it is related to high postoperative morbidity and mortality rate. Approximately every second gastric cancer patient is diagnosed with sarcopenia, which is a significant risk factor for postoperative complications and poor long-term outcomes. However, sarcopenia is underestimated in routine clinical practice, since it remains the interest of clinical trials. Sarcopenia diagnostic criteria are not fully standardized, but it consists of tests for muscle strength, quantity and quality. They include grip strength, chair stand test, computed tomography, magnetic resonance imaging, ultrasound, bioelectrical impedance analysis and densitometry tests. Regarding the growing evidence for sarcopenia impact on surgical gastric cancer treatment results, it is a high probability that sarcopenia assessment will come to routine clinical practice. Although, until then there is a need for further clinical trials to standardize the diagnostic and to find effective treatment strategies.
Artūras Razbadauskas
Published: 12 October 2019
Lietuvos chirurgija, Volume 18, pp 127-206; https://doi.org/10.15388/lietchirur.2019.16303

Abstract:
Statement of purpose“Lietuvos chirurgija” (“Lithuanian Surgery”) is a peer-reviewed journal of the Association of Lithuanian Surgeons, the Lithuanian Association for Wound Care, the Lithuanian Association for Ambulatory Surgery,the Lithuanian Society of Endoscopists, the Lithuanian Society of Cardiothoracic Surgeons, the LithuanianSociety of Coloproctologists, the Lithuanian Society of Vascular Surgeons, the Lithuanian Society for MinimalInvasine Surgery, the Lithuanian Society of Neurosurgeons, the Lithuanian Society of Oncologists, the Lithuanian Society of Pathologists, the Lithuanian Society for Hand Surgery and Hand Rehabilitation, the Lithuanian Society of Traumatologists and Orthopedic Surgeons, the Lithuanian Society of Urologists,the Lithuanian Society of Paediatric Surgery, the Lithuanian Society of Maxillofacial Surgeons, the Lithuanian Society of Vertebrologists, Vilnius Surgical Society, Kaunas Region Surgical Society, Klaipėda Region SurgicalSociety, Šiauliai Region Surgical Society, Panevėžys Region Surgical Society.It has been designed to meet the needfor a rapid spreading of new and important information on the theory and practice of surgery and related sciences. The journal provides a rapid publication of original papers that contribute to knowledge in the fields of clinical surgery, experimental surgery and related sciences.The contributions are accepted in Lithuanian and English. The journal “Lietuvos chirurgija” is an officialperiodical (quarterly) scientific publication of the Lithuanian Republic. Selection of papers for publicationis based on the opinion of highly qualified reviewers who are supporters, consultants or members of the Editorial Board and the International Advisory Board.
, Gintaras Simutis
Published: 12 October 2019
Lietuvos chirurgija, Volume 18, pp 223-234; https://doi.org/10.15388/lietchirur.2019.18.14

Abstract:
Bile duct stones are a quite common (10–18%) complication of gallstone disease or an autonomous condition. New noninvasive diagnostic methods established in the last decades allow to confirm suspected choledocholithiasis with minimal risk of iatrogenic complications.In this literature review we discuss various scores for choledocholithiasis risk degree, different diagnostic investigations and management approaches including timing for invasive procedures.
Published: 12 October 2019
Lietuvos chirurgija, Volume 18, pp 259-266; https://doi.org/10.15388/lietchirur.2019.18.19

Abstract:
The bi-lobed skin rotational flaps are commonly used mainly to cover facial tissue defects on the nasal tip and dorsal side, also on head areas, where skin and surrounding tissues are tight. Recent literature shows that the bi-lobed flap is used to cover defects in other body areas as well.This report shows two clinical cases where the bi-lobed flap was used to cover large skin and soft tissue defects after the excision of pathologically damaged skin and soft tissue lesions of the popliteal and the chest area. In both cases the recipient areas were adequately covered, and donor sites were closed primarily.
Vita Klimašauskienė, Narimantas Evaldas Samalavičius
Published: 12 October 2019
Lietuvos chirurgija, Volume 18, pp 235-238; https://doi.org/10.15388/lietchirur.2019.18.15

Abstract:
Introduction. Colorectal cancer ranks third on the list of the most common cancers. In 1979 R. J. Heald described total mesorectam excision (TME) which became a gold standard for rectal cancer treatment. This operation is performed all over the world open, laparoscopic and robotic. Operating on low and very low rectal cancer, distal bowel mobilisation if often the most difficult part of the operation. Aa a solution to this problem transanal abdominotransanal rectal resection (TATA) and transanal total mesorectal excision (TaTME) were proposed. This article reviews the experience and short-term postoperative outcomes of TaTME performed in Klaipėda University Hospital.Methods. The first stage of surgery was performed with patient placed in the prone jackknife (Kraske) position. Using electrocauthery circular mobilisation of the rectum was performed starting at least 1 cm from the lower edge of the tumour. Up to 10 cm of the rectum was mobilised from below. The second stage was performed with patient in lithotomy position. Laparoscopic TME was performed. For 11 (78.57%) patients hand sown anastomosis was performed and for 1 (7.17%) patient stapler was used. 2 (14.28%) patients underwent the Hartmann’s procedure.Results. In period 2018.03–2019.10 TaTME was performed for 14 patients. The medium tumour high counting from dentate line was 2.54 (±1.28). 13 out of 14 patients were operated from 8 to 12 weeks after chemoradiotherapy. All (100%) rectal resections were radical (R0). On average 11.43 (±3.78) lymphnodes were harvested. 5 (35.71%) patients had complications after surgery.Conclusions. TaTME performed at Klaipėda University Hospital is effective operation for rectal cancer treatment.
Narimantas Evaldas Samalavičius
Published: 12 October 2019
Lietuvos chirurgija, Volume 18, pp 267-276; https://doi.org/10.15388/lietchirur.2019.16295

Abstract:
Publishes scientific surgical articles written by Lithuanian and foreign authors.
Matas Mongirdas, Audrius Untanas, Žymantas Jagelavičius, Ričardas Janilionis
Published: 12 October 2019
Lietuvos chirurgija, Volume 18, pp 239-245; https://doi.org/10.15388/lietchirur.2019.18.16

Abstract:
Background / objectives. The main treatment option for the first episode of primary spontaneous pneumothorax is chest tube drainage, however, whether delayed chest tube removal might influence the recurrence is unclear.Methods. A prospective study, which included 50 patients, with an initial episode of primary spontaneous pneumothorax was performed. Patients were randomized into two groups according to the chest tube removal time: 1-day and 5-days after the air-leak has stopped. All patients were followed-up for at least six months. Both groups were compared according to the recurrence rate and possible complications.Results. There were 39 (78%) men and the median age was 27 (23–35) years. Successful management with a chest tube was achieved in 43 (86%) patients, others were operated on because of the continuous air-leak or relapse of the pneumothorax after the chest tube was removed. Significant difference was not found comparing groups by age, gender, side, tobacco smoking, alpha-1-antitrypsin level, rate of prolonged air-leak, necessity of surgery, and the mean follow-up time. There was a significant difference between groups in hospitalization time: 1-day group – 6 (4–12), 5-days group – 8 (7–10) days, p = 0.017. Five (20%) patients from 1-day group and 3 (12%) from 5-days group had a recurrence, however the difference was not significant (p = 0.702). There were no significant differences comparing groups by the recurrence time or complications.Conclusions. The recurrence rate of primary spontaneous pneumothorax was higher if the chest tube was removed earlier, however not significantly. More data and longer follow-up are necessary to confirm these findings.
Published: 12 October 2019
Lietuvos chirurgija, Volume 18, pp 246-253; https://doi.org/10.15388/lietchirur.2019.18.17

Abstract:
Background / objective. Laparoscopic cholecystectomy is a safe procedure and the treatment of choice for acute cholecystitis. As an alternative treatment option in critically ill patients percutaneous cholecystostomy (PC) is performed.Methods. Retrospective review of patients who had undergone PC from 2008 to 2017 at the Department of Surgery, Hospital of Lithuanian University of Health Sciences Kaunas Clinics. Patients were reviewed for demographic features, laboratory tests, ASA class, complications, outcomes, hospital stay and mortality rate.Results. Fifty-four patients were included in the study. Forty patients (74%) were ASA III and ten patients (18.5%) – ASA IV. Statistically signi­ficant decrease in white blood cell count (from 14.26±6.61 to 8.65±5.15) and C-reactive protein level (from 226.22±106.60 to 51.91±63.70) following PC was observed. The median hospital stay was 13.06 (range 2–68) days and 30-day mortality rate 13%. There were no deaths directly related to procedure. For eleven patients (20.4%) delayed cholecystectomy was scheduled.Conclusions. PC is a reasonable treatment option for high-risk patients with acute cholecystitis and co-morbidities. It can be used as a temporizing treatment option or as a definitive treatment with a low number of delayed cholecystectomies.
Published: 12 October 2019
Lietuvos chirurgija, Volume 18, pp 218-222; https://doi.org/10.15388/lietchirur.2019.18.13

Abstract:
Publishes scientific surgical articles written by Lithuanian and foreign authors.
, Justė Maneikytė, Kęstutis Strupas, Ieva Šakalienė
Lietuvos chirurgija, Volume 18, pp 73-77; https://doi.org/10.15388/lietchirur.2019.18.8

Abstract:
Straipsnyje trumpai pristatoma nauja paciento paruošimo onkologinei pilvo organų operacijai strategija – priešoperacinė reabilitacija. Pirmieji klinikinių tyrimų rezultatai teikia vilčių, kad, taikant priešoperacinę reabilitaciją, susidedančią iš trijų komponentų: fizinių pratimų, mitybos nepakankamumo korekcijos ir psichologinio paciento paruošimo, galima pagerinti pacientų fizinę būklę, pooperacinę gyvenimo kokybę, net smarkiai sumažinti pooperacinių komplikacijų dažnį. Vis dėlto lieka neaišku, ar priešoperacinė reabilitacija yra tikslinga prieš visas operacijas, ar tik prieš tas operacijas, kurios yra ypač didelės apimties. Todėl, kol minėta metodika galės būti taikoma kasdienėje klinikinėje praktikoje, reikia naujų klinikinių tyrimų. Šie tyrimai turėtų atskleisti, prieš kokias operacijas paciento reabilitacija yra tikslingiausia, taip pat nustatyti, kokia konkreti priešoperacinės reabilitacijos metodika yra efektyviausia.
Lietuvos chirurgija, Volume 18, pp 77-91; https://doi.org/10.15388/lietchirur.2019.18.9

Abstract:
Akultetinės chirurgijos katedra buvo įsteigta 1940 m. Vytauto Didžiojo universitete Kaune. Ši katedra įkurta Medicinos fakulteto dekanui ir laikinajam Chirurgijos katedros vedėjui prof. Vladui Lašui reorganizavus tuo metu buvusią Chirurgijos katedrą į dvi atskiras – Fakultetinės chirurgijos ir Hospitalinės chirurgijos – katedras. Ilgainiui katedra keitė savo pavadinimus: iki 1982 m. (su pertrūkiais karo metu) ji išliko Fakultetinės chirurgijos katedra, 1982–1992 m. vadinosi II chirurgijos katedra, 1992–1998 – II chirurgijos klinika. Straipsnyje apžvelgtos Fakultetinės chirurgijos katedros ištakos Nepriklausomoje Lietuvoje ir pirmieji akademinės chirurgijos kūrėjai, šiandienos chirurgų mokytojai ir asmenybės: prof. V. Kanauka, prof. V. Lašas, A. Stropus, taip pat katedros ir klinikos vadovai: doc. J. Jaržemskas, doc. J. Karaliūnas, doc. J. Platūkis, prof. V. Zykas, prof. D. Venskutonis bei jų kolegos ir mokiniai. Apžvelgiama Fakultetinės chirurgijos kated­ros akademinė ir mokslinė raida bei indėlis Lietuvoje plėtojant proktologiją, nušviečiamas laikotarpis iki 1998 m., kai, vykdant chirurgijos katedrų ir klinikų reorganizaciją, tuometiniame Kauno medicinos universitete įkurta Bendrosios chirurgijos klinika.
, Ieva Ceslevičienė, Lina Poškienė, Algirdas Boguševičius
Lietuvos chirurgija, Volume 18, pp 107-111; https://doi.org/10.15388/lietchirur.2019.18.12

Abstract:
Background. Desmoid type fibromatosis of the breast is a rare fibroblastic proliferative disease. It may be sporadic or associated with trauma, Gardner’s syndrome, etc. Desmoid tumour of the breast is a benign, locally aggressive disease. However, it does not metastasize. Case report. We report a case of a 65-year-old woman with right breast desmoid type fibromatosis. Conclusions. Diagnosis of breast desmoid tumour is difficult: clinically and radiologically it may mimic carcinoma. Definitive diagnosis is proved just by histopathological examination results. First choice treatment of breast fibromatosis is a radical surgical excision.
, Renatas Aškinis, Agota Piščikaitė, Giedrė Smailytė, Saulius Cicėnas
Lietuvos chirurgija, Volume 18, pp 91-100; https://doi.org/10.15388/lietchirur.2019.18.10

Abstract:
Įvadas. Stemplės vėžys (SV) yra aštunta pagal dažnumą onkologinė liga ir šešta mirties dėl vėžio priežastis pasaulyje. Nepaisant pažangos šią ligą diagnozuojant ir gydant, bendrasis 5-erių metų reliatyvus išgyvenamumas siekia 15–25 proc. Straipsnio tikslas – apžvelgti 2008–2017 m. Nacionaliniame vėžio institute (NVI) gydyto SV atvejų gydymo patirtį, įvertinti operacinio, konservatyvaus ir paliatyvaus gydymo rezultatus, nustatyti ligonių išgyvenamumą. Tyrimo metodika. 2008–2017 m. NVI gydėsi 512 pacientų, sergančių SV. Ligoniams taikytas operacinis, paliatyvus operacinis, chemospindulinis, spindulinis, chemoterapinis ar simptominis gydymas. Statistinė analizė atlikta naudojant STATA 11 statistinę programinę įrangą. Rezultatai. Tirtų pacientų amžiaus vidurkis – 61,8 metai. Iš 512 tiriamųjų 63 buvo moterys (12,3 %), 449 – vyrai (87,7 %). I stadijos vėžiu sirgo 25 (4,9 %), II stadijos vėžiu – 74 (14,4 %), III stadijos vėžiu – 258 (50,4 %), IV stadijos vėžiu – 155 (30,3 %) pacientai. Dažniausia morfologija – plokščialąstelinė karcinoma (445 atvejai, 86,9 %), adenokarcinoma – 48 atvejai (9,4 %). Operuoti radikaliai – 75 (14,6 %), paliatyviai – 271 ligonis. Chemospindulinis gydymas taikytas 97 (19,0 %) ligoniams, spindulinis – 81 (15,8 %), chemoterapinis – 111 (21,7 %), simptominis – 148 (28,9 %). Po radikalių operacijų komplikacijų dažnis – 46,17 proc., mirtingumas – 10,67 proc. Dažniausia komplikacija – fistulė. Bendrasis reliatyvus išgyvenamumas: vienus metus – 33,91 proc., penkerius metus – 9,0 proc. Atsižvelgiant į gydymo rūšį, reliatyvusis 5-erių metų išgyvenamumas po radikalių operacijų siekė 26,53 proc., po chemospindulinio gydymo – 17,95 proc., po radioterapinio gydymo – 5,36 proc., po chemoterapinio gydymo – 1,92 proc., po simptominio gydymo – 1,92 proc. Išvados: Po radikalaus SV operacinio gydymo pooperacinių komplikacijų dažnis siekė 46,17 proc., mirtingumas – 10,67 proc. Po paliatyvaus operacinio gydymo komplikacijų dažnis siekė 4,5 proc., mirtingumas – 0,7 proc. NVI gydytų SV sergančiųjų bendrasis 5-erių metų reliatyvus išgyvenamumas – 9,0 proc. Reikšmingos įtakos išgyvenamumui turėjo taikytas gydymas, diagnozuotos ligos stadija ir pirminio naviko dydis.
Lietuvos chirurgija, Volume 18, pp 254-258; https://doi.org/10.15388/lietchirur.2019.18.18

Abstract:
Introduction. Cystic echinococcosis is a zoonosis caused by the larval stage of Echinococcus granulosus. In most of cases hydatid cysts are found in the liver but in rare cases a migration of the hydatid cyst can occur following rupture of hepatal pericist.Case. A 38 year old female presented with abdominal pain, fatigue, weakness and fever for more than three months. Computed tomography show segment II and IV hepatic per-magna cystic formations with dimensions: No I: 80×60×74 mm and No. II: 70×60×58 mm. Per magna cystic formation in the Douglas space, with dimensions of 93×90×62 mm with clearly expressed mass effect on surrounding organ structures.Discussion. Active hydatid disease may show migration of cysts due to rupture of hepatal pericyst, pressure difference between the anatomic cavities, and by contribution of gravity. Sudden death, anaphylactic shock and dissemination of disease can be seen with cystic content spillage into the peritoneal cavity.Conclusion. Migrated hydatid cysts are very rare parasitic manifestation presenting with symptoms deriving from the neighboring organs. They are diagnosed typically by CT and managed with evacuation of cysts following abdominal exploration. Full abdominal organ ultrasonography, with accent on the liver, should be performed in any case of intraabdominal simple cyst presence.
Narimantas Evaldas Samalavičius
Lietuvos chirurgija, Volume 18, pp 112-115; https://doi.org/10.15388/lietchirur.2019.13137

Matas Pažusis, Rūta Maželytė, Kristina Buzaitė, Žilvinas Saladžinskas
Lietuvos chirurgija, Volume 18, pp 101-106; https://doi.org/10.15388/lietchirur.2019.13142

Abstract:
Įvadas. Kolostomos dažniausiai formuojamos pacientams, kuriems nustatomos piktybinės kilmės kolorektalinės ligos. Praėjus tam tikram laikui, jei kolostoma yra ne nuolatinė, ji yra uždaroma. Pooperaciniu laikotarpiu gali pasireikšti komplikacijų: jungties nesandarumas, žarnų nepraeinamumas ar žaizdos infekcija. Tikslas – apžvelgti kolostomų uždarymo artimuosius rezultatus. Metodika. Atlikta retrospektyvi 2012–2017 m. LSMU KK Chirurgijos skyriuje dėl kolostomos uždarymo operuotų pacientų duomenų analizė. Analizuotos amžiaus grupės, komplikacijų ypatybės, lovadienių skaičius, kolostomos suformavimo priežastys. Gilintasi, ar prieš operaciją buvo taikytas neoadjuvantinis gydymas, nustatytas laikas iki kolostomos uždarymo. Nagrinėta, ar atlikta rezekcija, analizuotas jos tipas, jungties rūšis, operacijos trukmė ir pooperacinio laikotarpio eiga. Statistinė duomenų analizė atlikta naudojant Microsoft Excel programą. Rezultatai. Išanalizuotos 88 pacientų ligos istorijos. Pacientų amžiaus vidurkis – 56±1,6 metai (nuo 22 iki 84 m.). Pacientai operuoti dėl: riestinės žarnos vėžio (35 pacientai, 39,8 %), tiesiosios žarnos vėžio (11 pacientų, 12,5 %), storosios žarnos divertikuliozės (20 pacientų, 22,7 %), pilvo traumos po eismo įvykių (13 pacientų, 14,8 %), jatrogeninės riestinės žarnos perforacijos po kolonoskopijos (4 pacientai, 4,6 %), Krono ligos (1 pacientas, 1,1 %), paraproktito ir ischiorektalinio absceso (2 pacientai, 2,3 %), išeminio kolito (1 pacientas, 1,1 %), megakolono (1 pacientas, 1,1 %). Prieš suformuojant kolostomą atliktos šios operacijos: riestinės žarnos rezekcija (69 pacientams, 78,4 %), riestinės ir tiesiosios žarnos rezekcijos (19 pacientų, 21,6 %). Kolostomos buvo uždarytos po operacijos praėjus vidutiniškai 10,13±2,14 mėnesių. Segmento rezekcija atlikta 31 pacientui (36,5 %), kraštinė rezekcija – 54 pacientams (63,5 %). Kolostomų uždarymo operacijos trukmė – vidutiniškai 154,56±6,48 min. Bendras pacientų hospitalizacijos trukmės vidurkis – 9,43±0,62 dienos. Pooperacinis laikotarpis 69 pacientams (78,1 %) buvo sklandus. Šių pacientų vidutinė hospitalizacijos trukmė – 7,78±2,42 dienos. 19 pacientų (21,9 %) pooperacinė eiga buvo komplikuota (šių pacientų vidutinė hospitalizacijos trukmė – 15,05±9,58 dienų). Nesklandi po­operacinė eiga pasireiškė: širdies ritmo sutrikimu (4 pacientams, 4,5 %), seroma ir hematoma (5 pacientams, 5,7 %), žarnų nepraeinamumu (1 pacientui, 1,1 %), pykinimu (1 pacientui, 1,1 %), kraujavimu iš žarnyno (1 pacientui, 1,1 %), jungties nesandarumu (1 pacientui, 1,1 %), pilvo skausmais (1 pacientui, 1,1 %), karščiavimu (4 pacientams, 4,5 %). Vienam pacientui (1,1 %) susiformavo vesikorektalinė fistulė. Atliktos dvi (2,3 %) reoperacijos. Vienam pacientui atlikta relaparotomija dėl jungties nesandarumo, dar vienam – dėl žarnų nepraeinamumo. Mirčių nebuvo. Išvados: 1. Kolostoma uždaryta po operacijos praėjus vidutiniškai 10,13±2,14 mėnesių. 2. Po kolostomos uždarymo sklandi operacijos pooperacinė eiga fiksuota 69 pacientams (78,1 %). 3. Dažniausios po operacijos pasireiškusios komplikacijos: karščiavimas (4 pacientams, 4,5 %), širdies ritmo sutrikimas (4 pacientams, 4,5 %), seroma ir hematoma (5 pacientams, 5,7 %). 4. Komplikacijų dažnis, atsižvelgiant į specializuotų (gydytojų koloproktologų) ir nespecializuotų chirurgų atliktas operacijas, reikšmingai nesiskyrė.
, Vaiva Hendrixson
Lietuvos chirurgija, Volume 18, pp 62-71; https://doi.org/10.15388/lietchirur.2019.18.7

Abstract:
It is well recognized that severe traumatic brain injury causes major health and socioeconomic burdens for patients their families and society itself. Over the past decade, understanding of secondary brain injury processes has increased tremendously, permitting implementation of new neurocritical methods of care that substantially contribute to improved outcomes of such patients. The main objective of current treatment protocols is to optimize different physiological measurements that prevent secondary insults and reinforce the ability of the brain to heal. The aim of this literature review is to uncover the pathophysiological mechanisms of severe traumatic brain injury and their interrelationship, including cerebral metabolic crisis, disturbances of blood flow to the brain and development of edema, putting emphasis on intracranial hypertension and its current management options.
Olegas Deduchovas, Narimantas Evaldas Samalavičius
Lietuvos chirurgija, Volume 18, pp 18-22; https://doi.org/10.15388/lietchirur.2019.18.2

Abstract:
[full article, abstract in English; abstract in Lithuanian] In this retrospective study we report the first series of robotic cholecystectomies in Baltic countries. From Nov 2018 to Feb 2019, 13 robotic cholecystectomies were performed in Klaipėda University Hospital using the Senhance (TransEnterix) robotic system. Patients were diagnosed with symptomatic gallstone disease and had no life-threatening co-morbidities. We retrospectively investigated patient demographics and pre-, peri- and postoperative data. Five male and eight female patients were included in this study (n = 13). Mean age was 46 years (range 26–72); mean BMI was 26.7 kg/m² (range 21.1–37.7). Mean docking time was 18 min (range 8–27), and mean operative time was 85 min (range, 70–150). There were no conversions to standard laparoscopy or open surgery. There were no intra-operative complications. There was one post-operative bleeding from the gallbladder bed and subhepatic hematoma, successfully treated by laparoscopy. This study demonstrates the feasibility of robotic surgery in performing minimally invasive cholecystectomies.
, Raimundas Venckus
Lietuvos chirurgija, Volume 18, pp 33-37; https://doi.org/10.15388/lietchirur.2019.18.5

Abstract:
[straipsnis ir santrauka lietuvių kalba; santrauka anglų kalba] Dėl geresnių operacinių ir pooperacinių rezultatų urologai vis dažniau atlieka minimaliai invazyvias operacijas. Robotinė pieloplastika – vienas iš metodų, kuris palengvina pielourterinio segmento susiuvimą. Ši operacija mažiau vargina operuojantį gydytoją, trumpėja operacijos ir hospitalizacijos laikas. 2019 m. sausio 4 d. Klaipėdos universitetinėje ligoninėje atlikta pirmoji robotinė (Senhance Transenterixsistema) pieloplastika. Operuota 61 m. pacientė, turėjusi sunkių gretutinių ligų. Operacinis ir pooperacinis periodai praėjo be komplikacijų, ketvirtą parą pacientė išrašyta į namus. Po dviejų mėnesių pacientė kliniškai nusiskundimų neturėjo, atlikus KT tyrimą, nustatyta regresuojanti hydronefrozė po robotinės pieloplastikos. Įvertinus gautus rezultatus, galima teigti, kad robotinė pieloplastika yra minimaliai invazyvus, saugus ir efektyvus chirurginis metodas, išsiskiriantis labai greita paciento reabilitacija.
, Olegas Deduchovas
Lietuvos chirurgija, Volume 18, pp 13-17; https://doi.org/10.15388/lietchirur.2019.18.1

Abstract:
[full article, abstract in English; abstract in Lithuanian] Until recently, robotic surgery has been associated only with da Vinci robotic system. A novel Senhance® robotic system (TransEnterix Surgical Inc., Morrisville, NC, USA) has been introduced almost 5 years ago. Published reports on experience in colorectal surgery using this robotic platform is very limited. We present a prospective analysis of first 13 robotic colorectal surgeries in Klaipėda University Hospital, Klaipėda, Lithuania. 13 patients underwent various colorectal resections: 10 for colorectal cancer and 3 for colonic polyps. 7 were men and 6 women, age range 32–77 years, on an average 56 years. Among 10 patients with colorectal cancer, 3 had stage I, 3 stage II, 3 stage III and 1 stage IV colorectal cancer. 2 patients were operated for unremovable ascending colon adenomas and 1 underwent prophylactic subtotal colectomy with ileorectal anastomisis for familial adenomatous polyposis. Complication occurred in 1 case (7.7%). This patient underwent robotic abdominoperineal resection for low rectal cancer, developed postoperative bleeding from perineal wound on day 7 and had to be taken to operative room for oversuturing the bleeding vessel. Operative time was on an average 3 hours 50 minutes, ranging from 2 hours and 55 minutes to 6 hours and 10 minutes. In-hospital stay ranged from 5 to 16 days, on an average 7 days. Conclusion. Our experience with different types of robotic colorectal resections allows us to state that Senhance® robotic system is feasible and safe for colorectal surgery, and wider implementation of this system in our specialty worldwide is simply a question of time.
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