Laparoscopic repair of perforated peptic ulcer is not prognostic factor for 30-day mortality (a nationwide prospective cohort study).

BACKGROUND: Laparoscopic surgery has become increasingly popular in treating perforated peptic ulcer (PPU). However, currently it is not recognized as a prognostic factor for mortality within this group of patients. The aim of this study was to investigate whether laparoscopic surgery was an independent mortality risk factor in patients treated surgically for perforated peptic ulcer. MATERIALS AND METHODS: This was a Danish nationwide cohort study based on prospectively collected data of 1008 patients treated surgically for PPU between September 2011 and December 2015. A propensity score matching analysis, considering most of the known prognostic factors for mortality and baseline characteristics, was used to adjust mortality estimates in patients treated with open and laparoscopic surgery. The primary outcome was postoperative 30-day mortality. RESULTS: The study population comprised 1008 patients; 507 were treated laparoscopically and 501 by open surgery. There was significantly higher mean age, and higher ASA scores, as well as other mortality risk factors in the open surgery group. The unadjusted 30-day mortality was significantly lower in patients undergoing laparoscopic surgery compared to open surgery (HR = 0.48, 95% CI: 0.36-0.65). After matching and weighting controls, the adjusted difference in mortality was reduced and was not significant (HR = 0.82, 95% CI: 0.59-1.15). The 30-day mortality was 13.1% for laparoscopy and 14.7% for the matched controls in the open surgery group. CONCLUSIONS: Compared to open surgery, laparoscopic surgery in patients with PPU does not reduce short term mortality. More well powered randomized clinical trials are needed to investigate the role of laparoscopic surgery in treatment of patients with PPU.

Early Diagnosis of Colonic Anastomotic Leak With Peritoneal Endoscopy.

BACKGROUND AND OBJECTIVES: At present, we do not have a reliable method for the early diagnosis of colorectal anastomotic leakage (AL). We tested peritoneal flexible endoscopy through a port placed in the abdominal wall in the early postoperative course, as a new diagnostic method for detection of this complication and evaluated the suggested method for safety, feasibility, and accuracy. METHODS: Ten swine were randomized into 2 groups: group A, colorectal anastomosis without leakage; and group B, colorectal anastomosis with leakage. A button gastrostomy feeding tube was inserted percutaneously into the peritoneal cavity. Colorectal anastomosis (with or without defect) was created 48 hours after the first operation. The swine were examined by peritoneal flexible endoscopy 8 and 24 hours after the colonic operation, by a consultant surgeon who was blinded to both the presence and the allocated location of the of the anastomotic defect. RESULTS: None of the animals showed signs of illness 48 hours after the intraperitoneal gastrostomy tube placement. More than half of the anastomosis circumference was identified in 60 and 10% of the animals at endoscopy 8 and 24 hours, respectively, after the anastomosis was created. Excessive adhesion formation was observed in all animals, irrespective of AL. The sensitivity and specificity of endoscopy in detecting peritonitis 24 hours after AL were both 60%. CONCLUSIONS: Peritoneal endoscopy is a safe and simple procedure. Visualization of the peritoneal cavity in the early postoperative course was limited due to adhesion formation. Further studies are needed to clarify the accuracy of the procedure and to address additional methodological concerns.

[Pancreatic carcinoid]. / Karcinoid pankreasa.

Carcinoid tumours arise from argentaffine cells or from a primitive stem cells which may differentiate into anyone of a variety of adult endocrine-secreting cells. Carcinoid tumour of the pancreas is a very rare tumour with less than 50 cases reported in world literature. In literature it is denoted "pancreatic serotoninoma" or "serotonin-producing pancreatic tumour". Due to its rarity the tumour is an unusual cause of carcinoid syndrome. As the carcinoid tumour of the pancreas does not always causes carcinoid syndrome its absence does not necessarily exclude the existence of the tumour. The tumour is frequently malignant. Over 50% of patients have metastases at the time of surgery. This is the reason why radical surgery is not possible in a number of patients. Excisional surgery offers the best chance for recovery or long term survival. We report on a 57-year-old woman with carcinoid syndrome caused by malignant carcinoid tumour of the head of the pancreas without liver or other distant metastases; it was successfully excised with pylorus preserving cephalic duodenopancreatectomy (after Longmire-Traverso) and radical lymphadenectomy. The diagnosis was established on the basis of histologic and immunohistochemical findings. The patient is symptom free for more than eight months.

[Fibroma of the root of small intestine mesentery]. / Fibrom korena mezenterijuma tankog creva.

Fibromas are rarely localized in the abdomen, but almost always in the mesentery or omentum. We present a 63-year old woman in whom the examination of the upper abdominal pain showed a well distinct abdominal mass at the level of the lower edge of the pancreas. During the operation a tumour, 100 x 87 x 70 mm in size, from the radix of small bowel mesentery, was excised. Seven months later the patient is symptom-free with normal ultrasonographic and CT findings.

[Duodenal obstruction due to chronic pancreatitis]. / Opstrukcija duodenuma usled hronicnog pankreatitisa.

Chronic pancreatitis may cause a number of obstructive complications. Obstructions of the pancreatic and common bile duct are the most frequent, obstruction of the duodenum is rare and obstruction of the colon is very rare. Duodenal stenosis caused by chronic pancreatitis is usually moderate so that the surgical treatment is not necessary except if operation is necessary for other obstructive complications. The severe isolated duodenal stenosis for which surgery is mandatory is rare. We present a 46-year old male suffering from chronic alcoholic pancreatitis causing almost complete duodenal obstruction in whom surgical treatment was necessary. The truncal vagotomy and gastroenterostomy were performed. With abstinence of alcohol, low fat diet and substitute therapy more than 3 years after surgery the patient is symptom-free. He regained the previous weight and shows tendency to become fat.