Gallbladder adhesion degree as predictor of conversion surgery, common bile duct injury and resurgery in laparoscopic cholecystectomy: A cross-sectional study.

BACKGROUND: The gold-standard treatment for cholecystectomy, laparoscopic cholecystectomy, has remarkably variable outcomes and conversion rates. We investigated the gallbladder adhesion degree as a predictor of conversion surgery, common bile duct injury, and resurgery. METHODS: We reviewed 157 medical records and video recordings of laparoscopic cholecystectomy on patients with cholelithiasis with or without cholecystitis at three hospitals in Yogyakarta, Indonesia from January 2016 to December 2018. The degree of gallbladder adhesion is classified into 4 categories: no adhesion, <50% adhesion, 50%-buried GB, and completely buried GB. RESULTS: One hundred fifty seven patients were involved in this study, of whom 58 were males and 99 females with average age 49.2. Eighty-one patients out of 157 patients (51.6%) had gallbladder adhesion comprising of 61/157 (38.9%) with <50% adhesion and 20/157 (12.7%) 50%-buried GB. There is one incidence each of conversion surgery, CBD injury, and resurgery. The degree of GB adhesion has low degree of correlation with conversion surgery, CBD injury, and resurgery wirh r value of 0.156, 0.041, and 0.156 respectively. There is significant correlation between the degree of GB adhesion and conversion surgery and resurgery with p value of 0.032, and 0.032 respectively. There is no significant correlation between degree of GB adhesion and CBD injury with p value of 0.453. CONCLUSION: The degree of GB adhesion has low degree of correlation with conversion, CBD injury and resurgery. This study also showed that patients with high degree of gallbladder adhesion are still eligible for laparoscopic procedure performed by an experienced surgeon.

Tapering pressure of wall vacuum-assisted closure for the treatment of patients with pancreatic fistula in traumatic pancreatic injury: Report of two cases.

INTRODUCTION: Traumatic injury to the pancreas is rare and difficult to diagnose, requiring immediate operative management. It also has high mortality and morbidity rates. Postoperative pancreatic fistula is one of the complications that is considered a nightmare for digestive surgeons. The prevalence of POPF is estimated at 13%-41%, with 28% of mortality rate and the most common cause of death is retroperitoneal sepsis and hemorrhage. It requires complex treatment and a long duration of hospitalization of patients with a large cost burden. PRESENTATION OF CASE: Here we report 2 cases of POPF after pancreatic injury in abdominal trauma. The patients underwent emergency laparotomy. In the hospital ward, the patients developed wound dehiscence and a clear viscous pancreatic juice came out from the wound with high output. The installation of wall VAC using wall suction with pressure adjustments according to the number of products per day was performed. The patients showed good outcomes, the pancreatic juice output decreased and diminished, and the wound also narrowed and closed. DISCUSSION: VAC using wall suction is a device that applies the technique of NPWT and an emerging procedure used to treat patients with complex wounds. NPWT can reduce pooling of fluid, while reducing shear stress and tissue hypoxia at the wound edges, and stimulating the release of vascular endothelial growth factor in wound milieu. CONCLUSIONS: Tapering pressure of VAC using wall suction for treatment of pancreatic fistula in post laparotomy pancreatic injury patients is a simple and easy procedure with good outcomes.

Sweat Gland Tumor Microenvironment.

Malignant sweat gland tumors are rare cutaneous neoplasms and associated with poor prognosis. The process of tumorigenesis originating from sweat glands is complex and dynamic. The tumor is surrounded by an extracellular matrix (ECM) and stromal cells, as well as physiological state from the tumor microenvironment (TME). Various types of evidence suggest a variety of vital components of TME that interact with each other, ranging from fibroblasts, immune and inflammatory cells, vascular and lymphatic networks, and ECM. This chapter provides a comprehensive overview of sweat gland tumor microenvironment based on current studies of TME and describes the function of each component of TME in cancer initiation, progression, and invasion.

Anal encirclement using polypropylene mesh for high grade complete full-thickness rectal prolapse: A case report.

INTRODUCTION: Rectal prolapse is defined as protrusion of the rectal wall outside the anus caused by pelvic floor abnormalities. Operative repair is the only definitive treatment. Until now, there is no ideal surgical technique that can be used for all patients. PRESENTATION OF CASE: Here we report two cases of full-thickness rectal prolapse in elderly patients with high-risk comorbidities. A seventy and seventy-eight-year-old female patients presented with complaints of anal lumps. Their past medical history was significant for arrhythmia, hypertensive heart disease, and pneumonia. The patients then underwent surgical repair with mesh cerclage. The patients were hospitalized for three days after surgery. On days 3, 7, 14, and 6 months after surgery the patients did not complain of any recurrence nor complications. DISCUSSION: We did a modified anal encirclement surgical repair technique in managing these elderly patients with full-thickness rectal prolapse and high-risk comorbidities using mesh to prevent recurrence. CONCLUSIONS: Anal encirclement technique using mesh can be considered as an alternative procedure for the treatment of full-thickness rectal prolapse in elderly patients with high-risk comorbidities because this procedure is simple, safe, causes fewer postoperative complications, and also can prevent recurrence.

Nurse supervised combined refeeding and home parenteral nutrition in traumatic intestinal failure: A case series.

BACKGROUND: Intestinal failure is a decrease in intestinal function under the minimum absorption requirements of macronutrients, water, and electrolytes. Hartman's procedure with jejunostomy is used as a surgical procedure to prevent further damage in cases of abdominal trauma. Providing parenteral nutrition at home is needed to prevent nutritional deficiencies and prolonged length of stay. PRESENTATION OF CASE: We reported two cases, involving two men aged 25 and 14 years old who had peritonitis due to abdominal trauma and received laparotomy. Both patients had Hartman's procedures and jejunostomy less than 60 cm from the Treitz ligament. Both patients were diagnosed as bowel failure with an SGA C score. Supervised home parenteral nutrition was done by refeeding jejunostomy at the distal stoma. After supervision of parenteral nutrition, the SGA score increased from C to B. Three months later the patients underwent jejunal reanastomosis. Patients went home one week later without complications. At postoperative follow-up at one month and one year, both patients did not experience any complications. DISCUSSION: HPN is now a method used to provide nutritional support for patients with IF. This helps patients to meet their nutritional needs, also preventing psychosocial disorders and reduction of their quality of life. CONCLUSIONS: Based on these two cases, nurse supervised combined refeeding and home parenteral nutrition showed good results with an increase in nutritional status of SGA C to SGA B. Supervision of home parenteral nutrition can be considered as adjunctive therapy in patients with high intestinal failure before undergoing reanastomosis.

Elevated PSA level as a warning of mesh rejection risk after combined laparoscopic totally extraperitoneal hernia repair and transurethral resection of prostate: Case report.

BACKGROUND: Prostate hypertrophy and inguinal hernia are common health issues in men aged more than 50 years. Recently, many studies showed that prostatectomy and laparoscopic inguinal hernia repair could be performed at the same time. This report depicts mesh rejection after concomitant repair of bilateral direct inguinal hernia with TEP and TURP. PRESENTATION OF CASE: A 66-year-old man presented with bilateral direct inguinal hernia and enlargement of the prostate. Prostate biopsy shows atypical adenomatous hyperplasia accompanied by chronic inflammatory cells. Surgery was performed with laparoscopic TEP by using mesh and TURP. The patient underwent a combination of laparoscopic TEP and TURP. A single preoperative and postoperative dose of levofloxacin was administered. The laparoscopic TEP and TURP procedures were completed with no difficulty. Hematoma at the right inguinal occurred three weeks after the procedure. Bilateral inguinal abscess and sepsis occurred at 3-month follow-up. We performed laparotomy mesh evacuation and debridement, and found no recurrence of the hernia. DISCUSSION: Combined laparoscopic TEP hernia repair and TURP are feasible procedures. Bladder erosion caused by mesh might be the cause of mesh infection. However, the elevated PSA levels in this patient can be a warning sign of chronic infection in the prostate which can lead to complications of surgery. CONCLUSIONS: Elevated PSA levels can be a warning before doing a combination of TEP and TURP surgery because they can show signs of infection. However, further research is needed to ascertain the relationship between elevated PSA levels and complications of combination TEP and TURP surgery.

Adherence to preoperative hand hygiene and sterile gowning technique among consultant surgeons, surgical residents, and nurses: a pilot study at an academic medical center in Indonesia.

BACKGROUND: Healthcare-associated infections (HAI) is a major problem for patient safety and surgical site infection (SSI) is a type of HAI and the most common form of infection related to surgical health care. Transmission of microorganisms can be minimized by aseptic procedures. The main objective of this study is to compare adherence to preoperative sterile gowning and hand hygiene technique among consultant surgeons, surgical residents, and nurses. METHODS: This research was conducted by observing the implementation of the pre-operative sterile gowning and hand hygiene technique of abdominal surgery by consultant surgeons, surgical residents, and nurses using aseptic instrument tests of the Objective Structured Clinical Examination (OSCE) Faculty of Medicine Universitas Gadjah Mada from August 10, 2018 to September 10, 2018. Observations were made when participants performed hand scrubbing, gowning, and donning the gloves procedures. The observer completed mobile online forms, so that the medical personnel under observation did not know that they were being observed. RESULTS: Twelve consultant surgeons, 16 surgical residents, and 12 nurses were observed. All of the medical personnel showed a good score with total percentage mean 83.58%. The highest total mean score was achieved by consultant surgeons (86.39%), but mean score did not vary significantly between medical personnel (p = .091). In the hand scrubbing procedure, scrub the nail and palm using brush side and the skin of hand and arm using sponge side, in both hands had the lowest mean score (1.82 ± 1.152 of the maximum score of 4). While in the gowning procedure, taking and unfolding the sterile gown had the lowest mean score (1.97 ± .158 of the maximum score of 2). In the donning the glove procedure, grasping left glove with right hand and putting the glove over the left hand in opposite direction procedure had the lowest mean score (1.97 ± .158 of the maximum score of 2). CONCLUSIONS: The mean score of each group of health personnel in each section showed good results. Comparison of hand hygiene and gowning procedure performance between groups of health personnel did not show significant differences. However, larger scale research is needed after this pilot study.