ISSN / EISSN : 13920995 / 16489942
Current Publisher: Vilnius University Press (10.15388)
Total articles ≅ 545
Latest articles in this journal
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 51-54; doi:10.15388/lietchirur.2020.19.25
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.
Lietuvos chirurgija, Volume 19, pp 20-26; doi:10.15388/lietchirur.2020.19.21
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.
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.
Lietuvos chirurgija, Volume 19, pp 1-11; doi:10.15388/lietchirur.2020.18361
Lietuvos chirurgija, Volume 19, pp 71-80; doi:10.15388/lietchirur.2020.18362
Lietuvos chirurgija, Volume 19, pp 62-70; doi:10.15388/lietchirur.2020.19.27
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.
Lietuvos chirurgija, Volume 19, pp 12-19; doi:10.15388/lietchirur.2020.19.20
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.
Lietuvos chirurgija, Volume 19, pp 42-50; doi:10.15388/lietchirur.2020.19.24
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.
Lietuvos chirurgija, Volume 19, pp 55-61; doi:10.15388/lietchirur.2020.19.26
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.