ISSN / EISSN : 1392-0995 / 1648-9942
Published by: Vilnius University Press (10.15388)
Total articles ≅ 632
Latest articles in this journal
Lietuvos chirurgija, Volume 20, pp 95-102; https://doi.org/10.15388/lietchirur.2021.20.45
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.
Lietuvos chirurgija, Volume 20, pp 73-85; https://doi.org/10.15388/lietchirur.2021.20.43
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.
Lietuvos chirurgija, Volume 20, pp 68-72; https://doi.org/10.15388/lietchirur.2021.20.41
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.
Lietuvos chirurgija, Volume 20, pp 86-94; https://doi.org/10.15388/lietchirur.2021.20.44
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.
Lietuvos chirurgija, Volume 20, pp 12-19; https://doi.org/10.15388/lietchirur.2021.20.36
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.
Lietuvos chirurgija, Volume 20, pp 32-40; https://doi.org/10.15388/lietchirur.2021.20.39
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.
Lietuvos chirurgija, Volume 20, pp 20-26; https://doi.org/10.15388/lietchirur.2021.20.37
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.
Lietuvos chirurgija, Volume 20, pp 27-31; https://doi.org/10.15388/lietchirur.2021.20.38
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.
Lietuvos chirurgija, Volume 20, pp 41-45; https://doi.org/10.15388/lietchirur.2021.20.40
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.
Lietuvos chirurgija, Volume 19, pp 109-119; https://doi.org/10.15388/lietchirur.2020.19.30
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.