ABSTRACT
Background: Surgical treatment of recurrent gastroesophageal reflux disease (GERD) negatively affects patients' quality of life (QoL). Determination of risk factors is essential when considering a surgical approach. The present study aimed to evaluate short-term and long-term outcomes of primary laparoscopic Nissen fundoplication (LNF) and open Nissen fundoplication (ONF), as well as the risks of laparoscopic redo fundoplication. Methods: A retrospective cohort observational study was conducted from 2010 to 2021 at the National Research Center of Surgery (Almaty, Kazakhstan). Depending on the type of primary GERD surgical correction, 475 patients were stratified into two groups, namely LNF (n=117) and ONF (n=358). The outcomes and associated complications of LNF and ONF surgeries were assessed. The odds ratio of recurrent GERD in terms of risk factors was analyzed as well as post-intervention QoL. Results: Postoperative complications in ONF surgery were 2.7-fold higher than in LNF (P=0.0001). Moreover, intra-operative complications were higher with ONF surgery (7.7%) than with LNF (1.4%) (P=0.002). In cases with persistent clinical manifestations, the rate of redo fundoplication was the same after failed primary LNF and ONF. The risk factors associated with recurrent GERD, leading to redo fundoplication, were obesity (OR=2.16, P=0.473) and male sex (OR=3.0, P=0.272). One-year after LNF, 88.7% of the patients were satisfied with the outcome of the surgery. Conclusion: Recurrent symptoms of GERD and the rate of redo fundoplication were associated with obesity and the male sex. Obesity was the main risk factor, necessitating stringent selection of patients for surgical management of the disease.
Subject(s)
Gastroesophageal Reflux , Laparoscopy , Humans , Male , Fundoplication/adverse effects , Gastroesophageal Reflux/etiology , Gastroesophageal Reflux/surgery , Kazakhstan , Laparoscopy/adverse effects , Obesity/etiology , Obesity/surgery , Quality of Life , Retrospective Studies , FemaleABSTRACT
OBJECTIVES: Hepatocellular carcinoma is the predominant malignancy in patients with cirrhosis and chronic liver disease. Our aim was to assess the morphologic, radiologic, and immunologic charac teristics of hepatocellular carcinoma and liver cirrhosis concerning surgical treatment tactics. MATERIALS AND METHODS: We performed a cross-sectional analysis of a prospective study performed at the JSC National Scientific Center of Surgery (named after A. Syzganov). The study included 58 patients: 31 with hepatocellular carcinoma (53.4%) and 27 with chronic liver disease (46.6%). The average age of patients was 55.6 ± 1.7 years. RESULTS: Patients were tested for hepatitis B virus and hepatitis C virus infection. Patients with elevated levels of alfa-fetoprotein, alanine aminotransferase, and total bilirubin were detected. Morphologic signs of hepatocellular carcinoma with a predominance of a trabecular type rather than a solid type of tumor were found. Patients with hepatocellular carcinoma underwent surgical liver resection and transarterial chemoembolization before living-donor liver transplant. One-year survival rate of patients with hepatocellular carcinoma was 93.5%. CONCLUSIONS: The diagnosis and surgical options for hepatocellular carcinoma should be studied, taking into account the expanded laboratory characteristics of cancer.
Subject(s)
Carcinoma, Hepatocellular/diagnosis , Carcinoma, Hepatocellular/surgery , Hepatectomy , Liver Neoplasms/diagnosis , Liver Neoplasms/surgery , Liver Transplantation , Adult , Aged , Biomarkers, Tumor/blood , Biopsy , Carcinoma, Hepatocellular/immunology , Carcinoma, Hepatocellular/pathology , Clinical Decision-Making , Cross-Sectional Studies , Embolization, Therapeutic , Female , Hepatectomy/adverse effects , Hepatectomy/mortality , Hepatitis B/blood , Hepatitis B/diagnosis , Hepatitis B/immunology , Hepatitis B Antibodies/blood , Hepatitis C/blood , Hepatitis C/diagnosis , Hepatitis C/immunology , Hepatitis C Antibodies/blood , Humans , Kazakhstan , Liver Neoplasms/immunology , Liver Neoplasms/pathology , Liver Transplantation/adverse effects , Liver Transplantation/methods , Liver Transplantation/mortality , Male , Middle Aged , Neoplasm Grading , Predictive Value of Tests , Survival Rate , Time Factors , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
OBJECTIVES: Assess the safety and accuracy of renal static scintigraphy with introduction of the amendment coefficient for decay of 99m metastable (Tc-99m) at the calculation formula of capture percent Technemec 99m. MATERIALS AND METHODS: This study analyzes retrospectively the results of renal static scanning of 44 patients. Of this group of patients, 21 are Chornobyl Nuclear Power Station accident liquid ators who have arterial hypertension and chronic pyelonephritis. Renal scanning was carried out with Genesys EPIC single-photon emission computed tomography system. Calculation of the capture percent of the radiopharmaceutical Technemec 99m was executed in the standard way with introduction of the amendment coefficient Tc-99m to decay at the calculation formula of capture percentage Technemec. RESULTS: Significant differences by standard calculation method took place in the both the Chornobyl Nuclear Power Station accident liquidators and persons who were not subjected to the influence of a small radiation dosage (P < .05). CONCLUSIONS: A small radiation dose did not affect kidney function (P > .05) with introduction of the amendment coefficient for decay of technetium 99m; therefore, static scintigraphy is a safe method for assessing kidney structure and morphology. Introduction of amendment for decay of Tc-99m allowed false positive results in 11.9% of renal function assessments for patients with arterial hypertension and kidney dysfunction (P < .05). Calculation of the specific capture percent of radiopharmaceutical on 1 cm2 of visualization of renal parenchyma enabled a 29% increase in renal function identification accuracy.
