ISSN / EISSN : 1392-0995 / 1648-9942
Current Publisher: Vilnius University Press (10.15388)
Total articles ≅ 553
Latest articles in this journal
Lietuvos chirurgija, Volume 19, pp 109-119; doi: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.
Lietuvos chirurgija, Volume 19, pp 120-127; doi:10.15388/lietchirur.2020.19.31
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.
Lietuvos chirurgija, Volume 19, pp 128-139; doi:10.15388/lietchirur.2020.19.32
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.
Lietuvos chirurgija, Volume 19, pp 101-108; doi:10.15388/lietchirur.2020.19.29
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.
Lietuvos chirurgija, Volume 19, pp 151-155; doi:10.15388/lietchirur.2020.19.35
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.
Lietuvos chirurgija, Volume 19, pp 92-100; doi:10.15388/lietchirur.2020.19.28
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.
Lietuvos chirurgija, Volume 19, pp 145-150; doi:10.15388/lietchirur.2020.19.34
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.
Lietuvos chirurgija, Volume 19, pp 140-144; doi:10.15388/lietchirur.2020.19.33
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.
Lietuvos chirurgija, Volume 19, pp 34-41; doi:10.15388/lietchirur.2020.19.23
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.
Lietuvos chirurgija, Volume 19, pp 27-33; doi:10.15388/lietchirur.2020.19.22
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.