Anterior transperitoneal laparoscopic approach of retroperitoneal tumour - clinical case.

We present our personal experience in the anterior transperitoneal laparoscopic approach of a retroperitoneal tumour.The case we have in view is that of a 48-year old female patient P.V., with congenital single left kidney. The patient has a retroperitoneal tumour mass of the right flank. Following investigations (ultrasound, CT with contrast), the tumour appeared well defined, of small dimensions (approximately 6-7cm diameter) and without anatomical relationships with large retroperitoneal vessels (inferior vena cava). For the laparoscopic excision of the tumour, we used an operating device adapted from the one used in right hemi-colectomy. After the coloparietal dissection, the access into the right retroperitoneal flank by means of laparoscopy is achieved by applying our procedure.The surgical intervention was quick and of a minimally invasive nature. Postoperative evolution was favourable, without any complications; the patient was discharged after 48 hours. In anatomic situations where the tumour anatomy is well defined and its size is acceptable, without dangerous anatomic relationships with large retroperitoneal vessels, attempted laparoscopic transperitoneal removal is the preferred option.

Two-step hepatectomy with right portal branch ligature for a right lobe metastasis.

Hepatic resection is the only treatment with possible curative effect both for primary and secondary tumors. An increase of the rate of resectability for tumors considered inoperable at first, and a decrease of the postoperative morbidity and mortality can be realized by right portal branch ligature and two-step hepatectomy. We would like to present the case of a patient with left bowel cancer with a hepatic metastasis. Right portal branch ligature was performed which was followed by systemic postoperative chemotherapy. The right portal branch occlusion was followed by right lobe atrophy and left lobe hypertrophy, confirmed by CT scanning. Three months after the portal occlusion the patient underwent a right lobe hepatectomy. The postoperative evolution was favorable, eight days of hospitalization were necessary. The portal branch ligature can be made in several cases of hepatic tumors to increase the resectability rate.

[Telescopic anastomosis in colorectal surgery]. / Anastomoza prin telescopare in chirurgia colonului.

UNLABELLED: The most frequent postoperative morbidity and mortality in the colorectal surgery is caused by the failure of the anastomosis. On the base of the statistics the postoperative mortality caused by the failure of the anastomosis can rise up to 20%. In the last decade a lot of types of anastomoses was initiated, for example: telescopic anastomosis, mechanical anastomosis with stapler, anastomosis with a bio-fragmentary ring. In the technique of the telescopic anastomosis, introduced from the beginning of 20th century, many changes had made. The experimental and the operative results shown that the telescopic anastomosis is a secure, fast and cheap procedure in the surgery of the colon. CONCLUSIONS: the telescopic anastomosis is applicable also in emergency, with a short septic time , easy procedure and doesn't need special instruments.

[Longitudinal Wirsung gastrostomy in the surgical management of chronic pancreatitis]. / Wirsungo-Gastrostomia longitudinala în tratamentul chirurgical al pancreatitei cronice.

UNLABELLED: The longitudinal pancreatico-jejunostomy is a commonly used procedure in the management of the chronic pancreatitis with dilated pancreatic duct (Wirsung), however the drainage of the dilated pancreatic duct is realizable with longitudinal Wirsungo-gastrostomy to. We present one clinical case of chronic pancreatitis with dilated pancreatic duct, where the pancreatic drainage was realized with an anastomosis between the dilated Wirsung duct and the posterior wall of the stomach (longitudinal Wirsungo-gastrostomy). RESULTS: One year after Wirsungo-gastrostomy (postoperative reevaluation of the patient) a general well condition without subjective accuses, ponderal increase and stabile glucidic metabolism was found. CONCLUSION: The Wirsungo-gastrostomy could represent an alternative procedure in the management of the chronic pancreatitis with dilated pancreatic duct.

[The surgical treatment of the parastomal hernia using prolene mesh]. / Tratamentul chirurgical a eventratiilor parastomale cu plasa prolen.

UNLABELLED: Parastomal herniation is a frequent complication in enterostomy. The therapeutic strategy consists in three approaches: local fascial repair, relocation of the stoma, local repair of the parietal defect using nonabsorbable meshes. In our clinic between 1997-2002 we used monofilament meshes placed in sublay position at four patients with parastomal herniation. At three patients we used midline laparotomy placing the mesh round the colostomy on preperitoneal space, after preparing the hernia sack. The size of the mesh goes beyond the parastomal parietal defect with 3-5 cm. At the fourth patient we placed the mesh round the preperitoneal segment of the colon using a combined intraperitoneal and parastomal procedure, the size of the mesh going beyond parastomal parietal defect in this case too with 3-5 cm. The immediately and delayed results was favorable. CONCLUSIONS: The parastomal herniation's surgical repair applying prolen mesh can be a therapeutic alternative with good results.

[Duodenum preserving cephalic pancreatectomy and pancreatico-gastrostomy in the surgical treatment of the chronic pancreatitis]. / Pancreatectomie cefalica cu pastrarea duodenului si pancreatico-gastrectomie în tratamentul chirurgical al pancreatitei cronice.

UNLABELLED: Cephalic pancreaticoduodenectomy had been introduced in surgery practice by O. Whipple, for the treatment for the cancer of ampulla of Vater, later this indication has also been extended to other pancreatic disorders including the cases of chronic pancreatitis. Cephalic pancreatectomy with the remaining of the duodenum used lately in the treatment of chronic pancreatic eliminates the disadvantages of the operation Whipple. Further on, we present a case of chronic pancreatitis where a cephalo-pancreatic resection has been done with the remaining of the duodenum, the pancreatic blunt being anastomosed with the stomach by pancreatico-gastrostomy, terminal-lateral, a cystoduodenostomy had being done to this patient. Ten months after the surgery, the patient is in a good general state, without subjective pain, putting weight, and a glucose metabolism without changes. CONCLUSIONS: Pancreatico-gastrostomy may represent a modality of solving the pancreatic blunt after the cephalic pancreatectomy with the remaining of the duodenum.