Tumor recurrence in a previous abdominal incision site in a patient with Endometrial Adenocarcinoma: A case report / Philippine Journal of Obstetrics and Gynecology

@#Endometrial cancer is frequently diagnosed at an early stage and exhibits a good prognosis. However, 10%–15% of tumors recur usually within 3 years. Common sites of recurrence are the vaginal vault and pelvis. Only a number of case reports exist for tumor recurrence in a previous incision site. We present a case of a 71‑year‑old Filipino woman, a diagnosed case of Endometrial Adenocarcinoma Stage III A, FIGO Grade 1, who underwent surgical management, chemotherapy, and radiation therapy 9 years prior, presenting with an abdominal mass at the inferior aspect of the previous surgical scar with the foul‑smelling discharge of 1‑year duration. Physical examination revealed a 6 cm × 4 cm, friable, movable, nontender abdominal mass, with associated edema of the mons pubis. Surgical resection showed that the mass was confined to the abdominal wall, with no extension beneath the fascia and no evidence of tumor in the pelvic and abdominal cavity. Histological examination revealed a moderately differentiated adenocarcinoma in the abdominal wall, confirming tumor recurrence in an atypical location, probably arising from the previous incision site.

Short-term clinical efficacy of robotic radical resection for high rectal cancer with transvaginal specimen extraction / 中华胃肠外科杂志

Objective@#To explore the short-term clinical efficacy of robotic radical resection for high rectal cancer with transvaginal specimen extraction.@*Methods@#A cohort study was carried out. The clinical data of consecutive patients with high rectal cancer who underwent robotic radical resection at the Department of General Surgery of The First Affiliated Hospital of Nanchang University from June 2017 to January 2018 were retrospectively analyzed. Inclusion criteria: (1) preoperative diagnosis of rectal cancer, and distance from tumor to anal margin≥10 cm undercolonoscopy; (2) T1-3 assessed by preoperative imaging examination, and no distant metastasis; (3) female, age≥50 years old, body mass index ≤ 30 kg/m2; (4) without radiotherapy and chemotherapy before surgery; (5) implementation of robotic radical surgery for high rectal cancer. Fourteen female patients undergoing transvaginal removal of specimen without abdominal incision were included in the no incision group with age of (62.2±9.3) years old and distance from tumor to anal verge of (12.5±0.9) cm. As the match of 1:2, 28 simultaneous patients of high rectal cancer undergoing traditional robotic surgery (surgery interval <8 months) were enrolled to the control group, with age of (60.6±12.8) years old and distance from tumor to anal verge of (11.3±3.8) cm. Short-term efficacy and safty were compared between two groups. Follow-up ended in September 2018.@*Results@#There was no significant difference in baseline data between the two groups (all P>0.05). Compared with the control group, the no incision group had longer operation time [(149.6±15.6) minutes vs. (130.9±12.9) minutes, t=-4.135, P<0.001], shorter time to postoperative flatus [(40.9 ±2.6) hours vs. (51.9±2.9) hours, t=12.049, P<0.001], lower pain score on the operation day and the first day after surgery (using Changhaipainstick) [(3.1±0.4) points vs. (4.6±0.7) points, t=7.458, P<0.001; (2.5±0.3) points vs. (3.3±0.5) points, t=6.142, P<0.001], shorter time to ground activity [(15.6±2.0) hours vs. (24.3±2.5) hours, t=11.102, P=0.030], and shorter postoperative hospital stay [(6.1±0.8) days vs. (7.2±1.3) days, t=2.806, P=0.008], whose differences were statistically significant. There were no significant differences in intraoperative blood loss, proportion of postoperative analgesia patients, and complication within 30 days after surgery (all P>0.05). In the no incision group and the control group,the tumor size was (3.1±0.4) cm and (3.6±0.9) cm, the proximal margin distance was (9.1±1.5) cm and (9.8±1.5) cm, the distal margin distance was (4.3±0.4) cm and (4.5±0.4) cm, the number of harvested lymph node was 15.8±2.4 and 15.2 ± 2.5, and the number of positive lymph node was 0.6±1.3 and 1.1±2.4, respectively, whose differences were not statistically significant (all P>0.05). The mean followed-up period was 10 months (7-14 months) in the no incision group, and 14 months (10-18 months) in the control group. No local recurrence and distant metastasis were found in both groups.@*Conclusion@#Robotic radical resection for high rectal cancer with transvaginal specimen extraction is safe and feasible with advantages of rapid postoperative recovery, less postoperative pain and short hospital stay.

An observational comparison of totally endoscopic Ivor-lewis esophagectomy over assisted abdominal mini-incision / 中华胸心血管外科杂志

Objective Comparative study on efficacy and complications between totally laparo-thoracoscopic Ivor-Lewis esophagectomy(LTILE)combined with jejunostomy,and esophagectomy with assisted abdominal incision.Methods Clinical data of 160 patients with mid-lower thoracic esophageal cancer who underwent thoracoscopic laparoscopic oesophagectomy within the same therapeutic group from January 2017 to July 2018 were retrospectively analyzed.79 patients underwent totally LTILE combined with jejunostomy;the rest 81 patients had LTILE with assisted abdominal incision and nasointestinal tube placement.Preoperative,intraoperative and postoperative clinical data and complicatioos were analyzed.Results There was no significant difference between two groups,including operation time,intraoperative blood loss,number of lymph nodes dissection,postoperative drainage and total treatment cost.In terms of the postoperative pain scores within 3 days,incision complications,pulmonary infection rate and postoperative hospitalization time,there were significant differences(P ＜ 0.05).Conclusion Complete LTILE with jejunostomy appeared to render better short-term clinical outcomes.

Clinical analysis of total laparoscopic resection for colorectal cancer by NOSES: a report of 50 cases / 中国内镜杂志

Objective?To investigate the feasibility, safety, operating essentials and the short-term therapeutic effect of total laparoscopic resection for colorectal cancer by Natural Orifice Specimen Extraction (NOSES).?Methods?The clinical data of 50 patients underwent total laparoscopic resection for colorectal cancer by NOSES from January 2016 to June 2017 were retrospectively analyzed.?Results?All of the 50 patients with colorectal cancer successfully received total laparoscopic resection by NOSES. None of the patients had serious postoperative complications and death related to the operation. The average operating time was (140.0 ± 29.0) minutes. The blood loss was (70.0 ± 23.4) ml. The number of lymph nodes harvested were (14.0 ± 2.3). There was no bacteria infection in abdominopelvic cavity post-operation and no recurrence occurred until the end of postoperative follow- up. Postoperative time of bed rest was (2.0 ± 0.5) days. The time of the first anal exhaust was (2.0 ± 0.5) days. The postoperative hospitalization stay was (8.5 ± 3.0) days. There was none case of lung infection while one case of anastomotic leakage. No cancer cells remained in resection margin. No local recurrence and metastasis was found in all patients after follow-up for 3 to 24 months.?Conclusion?Total laparoscopic resection for colorectal cancer by NOSES is safe and feasible, and has the advantage of minimally invasive, less pain, rapid rehabilitation, good cosmetic effect and less postoperative complications.

Effect of total laparoscopic resection for colorectal cancer by NOSE / 中国内镜杂志

Objective To investigate the operation process of the technology, safety and operability of total laparoscopic resection for colorectal cancer by natural orifice specimen extraction (NOSE). Methods 40 patients with colorectal cancer who met the inclusion criteria of NOSE method from April 2015 to June 2017 were randomly divided into control group (traditional laparoscope) and experimental group (NOSE group), 20 cases in each. The intraoperative and postoperative quality of life between the two groups were statistically analyzed. Results All the patients completed the target operation, and no other operative methods were transferred. No complications occurred in either group. There were statistically difference (P < 0.05) between the two groups of patients in the two indicators (time and blood loss), there was no statistically significant difference in hospital time (P > 0.05), there was statistically difference (P < 0.05) between the two groups of quality of life score (SF-36 scale) in somatic function, role function, pain, cognitive and overall health status of five dimensions, the NOSE group was superior to the traditional laparoscopic group. Conclusion There are advantages in totally laparoscopic colorectal cancer treated with whole NOSE method. The overall health is good, few restrictions on daily work and life, quicker recovery of physical function and role function. Therefore, the application can be promoted if the condition is allowed.

Application of lower abdominal incision surgery two analysis of ampicillin sodium in preoperative and postoperative infection rate and discuss the corresponding intervention measures / 中国生化药物杂志

Objective The infection rate and the corresponding intervention measures of postoperative application of ampicillin sodium to reduce abdominal incision after operation. Methods The control group in the conventional antibiotic administration based on preoperative, postoperative combined with ampicillin sodium; research group in the control group based on the use of the corresponding operation room intervention measures. Results The incidence of incision infection in study group (18.18%) was significantly lower than the control group (4.55%)(P<0.05); the control group SDS, SAS scores did not change significantly than before , SDS of the study group, SAS scale score was significantly lower than before (P<0.05). Conclusion Application of ampicillin sodium combined with the corresponding intervention measures can significantly reduce abdominal incision surgery in two postoperative infection rate and is conducive to protect the quality of life of patients, life safety.

Transanal everted extraction of laparoscopic rectal excision without abdominal incision: a report of 11 cases / 肿瘤研究与临床

Objective To assess the feasibility and short-term effect of transanal everted extraction of laparoscopic rectal excision without abdominal incision.Methods Eleven patients were operated by transanal everted extraction of laparoscopic rectal excision without abdominal incision.Results All the operations were accomplished successfully,the average operative duration was (189.5±25.2) min,the intra-operative blood loss volume was (25.4±9.4) ml,the average time to flatus was (38.9±8.6) h,the average postoperative hospital stay was (12.7±2.5) d,and the number of lymph nodes harvested was 13.5±4.1.There were no post-operative complications.Conclusion The technique of transanal everted extraction of laparoscopic rectal excision without abdominal incision is safe and feasible,but the long-term effects need more observation.

Effect of modified closed negative pressure drainage on abnormal healing of abdominal incision / 现代临床护理

Objective To explore the curative effect of modified closed negative pressure drainage on abnormal abdominal incision. Methods Sity-three patients with abnormal healing of abdominal incision in our hospital from January 2012 to June 2013 were selected as the observation group. Another 50 patients from January to December 2011 were assigned to the control group. The former was treated after debridement with human recombinant surface growth factor and modified closed negative pressure drainage,while the latter after debridement with anti-infection and dressings of ethacridine or gentamicinsolution as well as with infrared therapy. The two groups were compared in terms of the frequency,time and cost of changed dressings,and the healing time of the incisions.Results There was insignificant difference in the cost of changed dressings between the two groups(P>0.05). However,the differences were statistically significant in terms of the frequency and time of changed dressings and the healing time of the incisions(P<0.05). The observation group was significantly superior to the control group.Conclusions Modified closed negative pressure drainage is effective in accelerating the healing in abnormal abdominal incisions,reducing the frequency and the time of changed dressings,and easing the economic burdens of the patients,which is suggested to be popularized and applicable in the pimary hospitals.

Clinical research in application of alginate dressing in fat liquefaction of abdominal incision / 中国实用护理杂志

Objective To assess the efficacy of alginate dressing in fat liquefaction of abdominal incision. Methods 76 patients with fat liquefaction of abdominal incision in our hospital were divided into the experimental group (42 patients) and the control group(34 cases). Both groups were given preventive antibiotics. The penetration, times of dressing change, interval of dressing change, healing cost, wound infection, period Ⅱ wound healing, time for the medicine to start working, time of healing were observed in the two groups. All results underwent t test and χ2 test. Results No distinct difference of healing cost between the two groups was observed. The experimental group treated with alginate dressing was better than the control group in other clinical indexes after treatment. Conclusions Application of alginate dressing is beneficial to management of fat liquefaction of abdominal incision and reduce time of healing and hospital stay.

Reason analysis and nursing of abdominal incision dehiscence for patients after abdominal operation / 中国实用护理杂志

Objective To investigate the cause and nursing of the abdominal incision dehiscence.Methods The clinical data of 18 cases of abdominal incision dehiscence after surgery were analyzed retro-spectively from January 1998 to June 2008 in our hospital.Results Abdominal wound dehiscence was caused by various factors,such as basic disease,anesthesia during operation,suture techniques and postop-erative care.Conclusions We should pay attention to the relevant factors of incision dehiscence and make the appropriate care and treatment when patients are admitted to hospital.Correction of malnutrition,strengthening the treatment of basic disease,attention to suture technique ale helpful for reducing the inci-dence of abdominal incision dehiscence.

The tention-free repair of abdominal incision hernia with polypropylene mesh / 临床外科杂志

Objective To evaluate the effect of the tention free repair on patient with abdominal insicion hernia. Methods 15 cases of abdominal insicion hernia were reviewed, all of them were repaired with polypropylene mesh. The mesh was overlaid on the defect, continuously monofilament nonabsorbable suture was used to fix the mesh on the edge of the defect and the mesh must be overlapped 2 cm on fascia abdominal layer and fixed by suture. Prophylactic antibiotics was used routinely in single dose. Result No relapse was found in follow up(rang 15～38 month). Conclusion The tension free hernia repair with polypropylene mesh in patient with abdominal incision hernia is a safe and simple operation with minimal postoperative pain.

Laparoscopic-assisted small incision operation for the treatment of common bile duct stones / 中国微创外科杂志

Objective To investigate the feasibility of laparoscopic-assisted small incision exploration and stone extraction for the treatment of common bile duct stones. Methods Following the laparoscopic cholecystectomy, the location of the common bile duct was determined under laparoscope. A small abdominal incision was made at the corresponding site and the exploration of common bile duct and extraction of stones were conducted via the incision. Results Among a total of 17 cases, the operation was successfully accomplished in 16 cases and a conversion to open surgery was required in 1 case. The operative time was 90～160 min (mean, 120 min). The number of extracted stones per case was 1～4, with the maximum size of 2.5 cm. All the stones were removed on one session. Postoperative cholangiography 3～4 weeks after the surgery indicated no residual stones. Follow-up for 8～36 months (mean, 14 months) showed no residual stones or occurrence of cholangitis. Conclusions Laparoscopic-assisted small incision exploration and stone extraction for common bile duct stones is feasible, being readily to popularize in basic hospitals.

Histerectomias: estudo retrospectivo de 554 casos / Hysterectomies: a retrospective study of 554 cases

Objetivo: A histerectomia é uma operação muito realizada, entretanto há poucos trabalhos na literatura nacional sobre suas indicações, técnica e complicações. O objetivo deste trabalho é avaliar estes procedimentos realizados na Disciplina de Ginecologia e Obstetrícia da Faculdade de Medicina do Triângulo Mineiro. Método: Estudo retrospectivo de 470 histerectomias abdominais e 84 vaginais foi conduzido analisando as indicações, tempo de cirurgia e internação, tipo de incisão e morbidez. Resultados: As principaisindicações foram o mioma uterino e o prolapso uterino para as histerectomias abdominais e vaginais, respectivamente.As complicações intra-operatórias aconteceram em 3,4% e as pós- operatórias em 2,4% do total de casos. Nenhuma diferença estatística foi encontrada no número de complicações em relação ao tipo de incisão (vertical ou transversal). O tempo de cirurgia e o de hospitalização foram estatisticamente maiores nas incisões verticais. A hemorragia foi a mais freqüente complicação intra-operatória e a infecção da incisão operatória foi a mais freqüente no pós-operatório. Conclusões: A histerectomia é um procedimento de baixo risco, no entanto, a realização de revisões sobre indicações e complicações, e a pesquisa de melhores técnicas cirúrgicas são necessárias para torná-la cada vez mais segura.

Objective: Hysterectomy is a frequently performed surgery, but national literature gives limited informationregarding indications, technique and complications. The aim of this study is to evaluate our results with this operation performed by the Discipline of Gynecology and Obstetrics of the Faculty of Medicine of “Triângulo Mineiro”. Methods: A retrospective study of 470 abdominal and 84 vaginal hysterectomies was conducted in which the indications, operation time, abdominal approach, hospitalization time, and morbidity were analyzed. Results: Uterine myoma and uterine prolapse were the most frequent indications for abdominal and vaginal hysterectomies, respectively. Intra-operative (3.4%) and postoperative (2.4%) complications occurred in abdominal hysterectomies, with no significant statistical difference in theincidence of complications related to the type of incision (transverse or vertical). Operative time and hospital stay were significantly increased with the vertical incision. Hemorrhage was the major intraoperative complication and wound infection in postoperative complications. Conclusions: We concluded that hysterectomy is a low risk procedure although improvements in surgical technique and continued research are needed for a even safer procedure.