[The role of laparoscopy in the management of the right iliac fossa syndrome]. / Locul laparoscopiei în sindromul dureros de fosa iliaca dreapta.

Many cases of nonspecific right-sided lower abdominal pain syndromes are still difficult to diagnose regarding the accuracy of identifying which organ is suffering, in spite of the continuous development of various investigations. The aim of our study is to establish the limits of noninvasive explorations and to evaluate the benefits of laparoscopy approach of such cases. 45 patients, admitted and treated for right lower quadrant abdominal pain along 5 years in the Surgical Department of University Hospital "Caritas" Bucharest, were followed up. For all those patients, diagnostic uncertainty indicated laparoscopic exploration. Analyzing the cases, we noticed that the diagnosis was correctly established on the basis of non-invasive preoperative explorations in 13,33% of cases. In 11,11% of cases the diagnosis was completed by laparoscopy approach and in most cases (75,55%) was established by this procedure. The laparoscopic approach allowed diminishing the number of unnecessary appendectomies, detecting and resolving concomitant lesions with minimal parietal trauma and, essentially, avoiding "exploratory laparotomy".

[Allogenic blood transfusion and postoperative outcome -5-year experience in a digestive surgery unit]. / Transfuzia de sânge alogenic si evolutia pacientilor operati--experienta pe 5 ani a unei clinici de chirurgie.

The paper presents a retrospective study of a digestive surgery unit, evaluating the outcome of the patients who were operated and received blood transfusions over a 5 years time, compared with a random sample of patients operated during the same period and who did not receive transfusions. The patients were stratified by the type of operation and the ASA criteria. The paper also briefly reviews the literature on this topic. The study noted a prolonged postoperative course and overall hospitalization time, and an increase in the infectious complications and mortality rates in the study group, compared to the control group. The results of the study support a transfusion practice policy based on strict indications, and the use of alternatives to transfusion, whenever available.

[The therapeutic options in central hydatid cysts of the right hepatic lobe]. / Optiuni terapeutice în chisturile hidatice centrale ale lobului hepatic drept.

The authors of the article propose a method that is highly efficient and presents minimal risks in the treatment of hepatic hydatid cysts located in the central area of the right lobe. This "dangerous area" of the VIIIth segment generates the most delicate problems for the surgical treatment, due to limitation of therapeutic solutions and the highest rate of postoperative complications. The technique presented is that of external extraperitoneal transligamentous drainage introduced by D. Burlui in 1968. This technique should be considered as an alternative to lobectomies or wedge resections or to the direct external drainage of the remaining cavity, the latter being responsible for numerous complications. Considering the figures covering the past 35 years at Caritas Hospital, the authors note the decrease of corrective reinterventions from 27% to 10% after 1968. By associating cholecystectomy after 1983 they dropped to only 4%. The authors do not claim that the method should be universally applied but consider it obviously the choice in the treatment of hydatid cysts in the "dangerous area" in which other therapeutic methods are inappropriate (pericysto-digestive anastomosis) or excessive (right lobe resection), avoiding the problems of direct drainage.