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Background: Amyand's hernia (AH) is a rare type of inguinal hernia, containing the appendix in the hernia sac irrespective of the presence of appendicitis. Appendiceal mucocele represents a dilation of the appendix with an accumulation of mucinous material and could be either a benign or a malignant process. Herein we report an exceptionally rare case of a perforated appendiceal mucocele within an AH. Case report: A 77-year-old male patient, underwent surgery for right incarcerated inguinoscrotal hernia. He was found to have a perforated, phlegmonous, and dilated appendix dislocated from the caecum, with peri-appendicular purulent content with fibrin deposits within the hernia sac. Also, the last ileal loop, caecum, ascendant colon, and the right testicle within the hernia sac, were compromised due to the septic process around. A right hemicolectomy and orchiectomy, followed by a herniorrhaphy without using a synthetic mesh, was performed. Histopathological examination revealed a perforated benign appendiceal mucocele associated with phlegmonous appendicitis and fibrinous peritonitis. Conclusions: This case report describes a rare combination of entities: an AH that presented as an incarcerated hernia and was diagnosed intraoperatively with a perforated, phlegmonous, and dilated appendix, proving to be an appendiceal mucocele.
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Background and aims: This study aimed to investigate the relationship between baseline characteristics of obese patients and histopathological findings on resected gastric specimens resulted after laparoscopic sleeve gastrectomy. Methods: Seventy-seven patients undergoing laparoscopic sleeve gastrectomy in a university surgical department from Romania were included in the present study. Demographic data, preoperative Body Mass Index values, and their relationship with the histopathological findings of resected gastric specimens were statistically analyzed. Results: The mean age of patients included was 40.2 ± 11.05 years and the mean Body Mass Index was 43.5 ± 7.8 kg/m2; 71.4% of the patients were female. Active chronic gastritis was the most common gastric pathology (39%) encountered. Helicobacter pylori infection was present in 27.2% of the cases. Normal gastric histology was found in 33.7% of the specimens. A strong statistically significant association was noted between Helicobacter pylori infection and active chronic gastritis (p<0.0001). Similarly, a statistically significant association was observed between age, Body Mass Index, and intestinal metaplasia (p=0.005 and p=0.009 respectively). No malignancies were found. Conclusions: Our study results show that the incidence of active chronic gastritis and Helicobacter pylori infection is relatively high in obese patients. Considering this, we conclude that it is important to send the resected gastric specimens for histopathological analysis after laparoscopic sleeve gastrectomy.
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This paper aims to revisit the relationship between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy in obese patients by reviewing the recent available literature, in the form of a narrative review. The interpretation of the current evidence is challenged by the fact that published data are contradictory and comparison between studies is difficult. Most studies investigate the presence of gastroesophageal reflux disease by assessing only the symptoms reported by patients. A few studies have objectively investigated gastroesophageal reflux disease by functional tests and endoscopic evaluation. Also, the surgical technique of laparoscopic sleeve gastrectomy plays an important role in the incidence of postoperative gastroesophageal reflux disease. In conclusion, surgeons must be aware of the existence of gastroesophageal reflux disease and, at the same time, patients should be informed regarding the possible effect of laparoscopic sleeve gastrectomy on gastroesophageal reflux disease.
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BACKGROUND AND AIMS: Laparoscopic sleeve gastrectomy is at present the most popular bariatric procedure due to its significant effect on weight loss, resolution of comorbidities and improvement in the quality of life. However, there are not many studies showing its medium and long term efficacy and safety in Eastern Europe. We aim to report the outcomes of laparoscopic sleeve gastrectomy as a primary bariatric procedure from a single surgical department. METHODS: This is a retrospective analysis of obese patients who underwent laparoscopic sleeve gastrectomy between 2009 - 2016 in our department. Outcomes were analyzed in terms of weight loss, comorbidity resolution and quality of life changes. RESULTS: A number of 70 patients were included in the study, with a mean age of 47.6 ± 9.8 years. Mean initial Body Mass Index was 47.4 ± 6.4 kg/m2. The mean percentage of excess weight loss during follow-up was 78.2% at 12 months, 80.2%, 76.7%, 74.7%, 72.8%, 73.3%, 74.1%, 67.2%, 64.07%, 69.7% at 24, 36, 48, 60, 72, 84, 96, 108 and 120 months, respectively. Weight regain occurred in 61 (87.1%) patients during the postoperative period. The mean weight regained was 8.1 ± 4.8 kg at 24 months postoperatively. Regarding the quality of life, 83% of patients declared an increase in self-esteem. Resolution of diabetes, arterial hypertension, and obstructive sleep apnea syndrome occurred in 80%, 42.5% and 70.1% of patients respectively. CONCLUSIONS: Laparoscopic sleeve gastrectomy is an effective procedure, with good outcomes in the medium and long term, although a tendency for weight regain was noted after 2 years. Resolution of comorbidities is comparable with that reported in the literature, namely an improvement of the quality of life.
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Background: Core needle biopsy (CNB) is an alternative to surgical biopsy in establishing the histopathological diagnosis of mammary lesions. AIM OF THE STUDY: The aim is to determine the accuracy of ultrasound guided CNB (US-CNB) in establishing breast cancer diagnosis. MATERIALS AND METHODS: We retrospectively analyzed the data of US-CNB patients between May 2012 - December 2014. One hundred sixty-three biopsies were performed in 155 patients. To assess the diagnostic accuracy of US-CNB, the results were correlated with the gold-standard of surgical excision of the breast lesions, thus, 90 patients (94 breast lesions) were included in the study group. We calculated the concordance of the results using the Kappa Coefficient, sensitivity and specificity using the ROC curve and the false-negative rate. Results: US-CNB identified 74 (79%) malignant lesions, 1 (1%) precursor high-risk lesion, and 19 (20%) benign lesions. Concordance between histopathological results was 96.8% (kappa: 0.91). The 94.2% (kappa: 0.80) consensus of the histological type could be calculated for 70 invasive carcinomas. The 61.8% (kappa: 0.41) concordance of the histological grade could be calculated for 55 invasive carcinomas. Sensitivity and specificity were 98.6%, and 100%, respectively. The false-negative rate was 1.3%. Conclusions: US-CNB is an excellent alternative to surgical biopsy in establishing the histopathological diagnosis of breast lesions, provided it is performed by a specialized team and there is clinical-radiological-histopathological concordance in all cases.
