Single incision laparoscopic cholecystectomy.

BACKGROUND: As surgeons embrace the concept of increasingly less invasive surgery, techniques using only a single small incision have begun to gain traction. Multiple case series managed by a single-incision laparoscopic cholecystectomy (SILC) have been published. The objective of this study is to describe the short-term outcomes of SILC in our institution. METHODS: A retrospective review was done for 51 patients who underwent SILC between 2009-2012. The operative time, surgical technique, conversion rate, and postoperative complications were reported. RESULTS: SILC was performed for 51 patients, all women, with a mean age of 35.6 years (range=19-62). Their body mass index(BMI) ranged from 16.8-35.6 kg m2 with a mean of 20.4. Twelve patients (23.52 %) had acute cholecystitis. The mean operating time was 58.6 minutes (range=45-95 min). Incidents were encountered in 6 patients (11.76%) and were related to intraoperative bleeding. There was a single conversion to the standard laparoscopic procedure (1.9%) and in 5 cases an accessory needle grasp was used (9.8%). Two patients (3.9%)presented postoperative complications (wound infections) and the mean hospital stay was 1.6 days. CONCLUSIONS: SILC is feasible and provides a promising alternative to natural orifice transluminal endoscopic surgery for scarless laparoscopic cholecystectomy. However, routine application of this novel technique requires an evaluation of its safety and cost effectiveness in larger studies.

Perforation of Meckel's diverticulum by foreign body, a rare complication.

Meckel's diverticulum is a congenital disorder that results from an incomplete obliteration of the vitelline duct. Meckel's diverticulum may give rise to bleeding, intestinal obstruction and inflammation; however, its perforation by a foreign body is an extremely rare life-threatening complication. We report ona 37-year-old male presenting symptoms and signs of acute abdomen with an initial suspicion of acute appendicitis.However, the right diagnosis was made only during exploratory laparoscopy when the appendix was found to be normal,whereas Meckel's diverticulum was found to be inflamed and perforated by a chicken bone. The patient was treated successfully with laparoscopic resection of the diverticulum, and had an uncomplicated postoperative course.

[Clinical epidemiological characteristics of patients with gastric cancer in emergency Municipal Hospital Moinesti]. / Caracteristici clinico-epidemiologice ale pacientilor cu cancer gastric asistati in Spitalul Municipal de Urgenta Moinesti in perioada 2000-2010.

UNLABELLED: Cancer is now a major public health problem by the size of the human, medical, economical and social implications as well as in industrialized and also in developing countries. Gastric cancer is a neoplasia with a starting point in gastric mucosa, representing one of the most common malignant visceral locations, being on the second most common after lung neoplasm. The aim is to highlight the incidence of gastric cancer in Emergency Municipal Hospital in Moinesti in relation with certain factors (age, sex, area of origin, personal habits, personal and family pathological history) for a period of eleven years. MATERIAL AND METHODS: The study has been conducted on a period of eleven years (2000-2010) and it included 77 patients with gastric cancer. The following parameters were evaluated: age, sex, area of origin, personal habits, personal and family pathological history. RESULTS: Distribution by years of study revealed that most of the cases were in 2009 (19 patients). The incidence of gastric cancer was over two times higher at men than at women, the ratio men/women being 2.34 to 1. The most common cases (n = 40) were reported in people over 61 years (the mean age was 60.32 +/- 111.87) and from rural areas (ratio rural/urban areas = 1.5:1). Only 15 patients (19.5%) had in the personal antecedents stomach or duodenal ulcer and half of the cases were smokers (49.35%). CONCLUSION: The profile of patient with gastric cancer was contoured: male, over 60 years, from rural areas, smoker and with a personal history of stomach or duodenal ulcer.

[Investigations for assessing some features suggestive of gastric cancer]. / Cercetari pentru evaluarea unor elemente de orientare a diagnosticului în cancerul gastric.

AIM: Based on new data, this investigation aimed at emphasizing the importance and the medical and socio-economic implications of an early diagnosis in gastric cancer. MATERIAL AND METHODS: The study included a series of 77 patients with gastric cancer admitted and treated at the surgical department of the Moinesti Municipal Emergency Hospital in the interval 2000-2010. Patients' data were obtained by clinical-epidemiological inquiry, laboratory and imaging investigations, and official statistical reports. Epidemiological and statistic-mathematical methods were used to process and interpret the collected data. RESULTS AND CONCLUSIONS: Hemoglobin and hematocrit levels as well as the presence of anti-Helicobacter pylori antibodies were determined by laboratory tests. Barium sulfate X-ray examination was performed in 52% of our patients; endoscopy concurrent with the histo-pathological examination of gastric biopsy samples showed that most tumors were of vegetative and ulcerative type, being prevalently located in the antropyloric area and lesser gastric curvature. Computer tomography proved to be the method of choice for tumor dissemination and staging. The late diagnosis of gastric cancer, with aggressive forms and poor prognosis, suggests the need of preventive population screening programs.

Single incision laparoscopic surgery (SILS) cholecystectomy. A novel technique.

INTRODUCTION: Since early nineties, laparoscopic cholecystectomy has become gold standard for cholecystectomy. Also, a high tendency of minimizing surgical trauma encourages the use of new approaches in laparoscopic surgery. A novel approach such as Single incision laparoscopic surgery (SILS) cholecystectomy has been describes. CASE REPORT: We report on a case of a 33-year-old female patient scheduled for elective laparoscopic cholecystectomy due to symptomatic ultrasonography verified cholelithiasis. A single 2.5-cm long semicircular infraumbilical skin incision was used. Pneumoperitoneum was established alter introduction of the predesigned trocar. Antegrade cholecystectomy was performed without stay suture placement. Postoperative course was uneventful. DISCUSSION: This article reports the authors' method of performing SILS cholecystectomy. SILS approach is feasible with new standard devices from the industry that offers slightly modified instruments for standard laparoscopic cholecystectomy. CONCLUSION: Single-incision laparoscopic surgery is a feasible way to perform cholecystectomy. A learning-curve is required and further work in the form of randomized controlled trials is needed to investigate the advantages of this new technique.

[Complicated postbulbar duodenal ulcer: the characteristics of its diagnosis and surgical technic and management]. / Ulcere duodenale postbulbare complicate: particularitati de diagnostic, tactica si conduita chirurgicala.

The paper reports on the authors experience used on 90 patient with complicated postbulbar ulcers (10% of the duodenal ulcers) with hemorrhage (23 cases), perforation (7 cases), duodenal stenosis (19 cases) and penetration pancreatic hepato-biliary (41 cases) period 1987-1996. The frequency of hemorrhagic complication was of 25%. As the hemorrhage due to postbulbar ulcer is favoured by vascular fistula, the sever character of the hemorrhage and the frequency of the recurrence, mainly the cataclysmic one, impose the radical surgery as early as possible. The following were used: large Reichel-Polya's gastrectomy (13 cases) Pean's gastro-duodenectomy + vagotomy (9 cases), gastrectomy for exclusion with hemostasis "in situ" and ligature of gastroduodenal artery + vagotomy (7 case). In 7 cases with perforation: Reichel-Polya's gastrectomy in 2 patients, Pean's gastrectomy in 2 cases, excision pyloroplasty (Judd) and vagotomy (3 cases). In the postbulbar ulcers penetrating into the pancreas or into hepatic pedicle the following were performed: Reichel-Polya's gastrectomy (8 cases), Pean's gastrectomy (11 cases of which 8 with vagotomy) gastrectomy for exclusion of ulcer in 22 cases of which 20 with vagotomy. In 14 patients with stenosed ulcers, Reichel-Polya's gastric resection (4 cases), Pean's gastrectomy (8 cases), gastrectomy for exclusion (7 cases). The conclusions may be drawn that the postbulbar ulcers are complicated ulcers that require differential surgical treatment, as early as possible for diminishing the postsurgical morbidity and mortality (6.6% mortality).