ABSTRACT
Infected pancreatic necrosis (IPN) is a serious complication of acute pancreatitis and requires surgical intervention.Minimally invasive surgery represented by video-assisted debridement has become the mainstream of IPN treatment,and laparoscope is an important video-assisted tool.Laparoscopy assisted debridement can effectively control the symptoms of IPN infection and improve the prognosis of patients.In the era of minimally invasive surgery,the optimal timing and strategy of IPN surgery is a topic worthy of reconsideration.With the centralization of IPN treatment and the extensive development of multidisciplinary team,the prognosis of IPN patients is expected to be further improved.
ABSTRACT
Primary splenic epithelial cyst is an unusual event in everyday surgical practice with about 800 cases reported until date in the English literature. Splenic cysts may be parasitic or non-parasitic in origin. Nonparasitic cysts are either primary or secondary. Primary cysts are also called true, congenital, epidermoid or epithelial cysts. Primary splenic cysts account for 10% of all benign non-parasitic splenic cysts and are the most frequent type of splenic cysts in children. Usually, splenic cysts are asymptomatic and can be found incidentally during imaging techniques or on laparotomy. The symptoms are related to the size of cysts. When they assume large sizes, they may present with fullness in the left abdomen, local or referred pain, symptoms due to compression of adjacent structures (like nausea, vomiting, flatulence, diarrhoea) or rarely thrombocytopenia, and occasionally complications such as infection, rupture and/or haemorrhage. The preoperative diagnosis of primary splenic cysts can be ascertained by ultrasonography (USG), computed tomography or magnetic resonance imaging, although the wide use of USG today has led to an increase in the incidence of splenic cysts by 1%. However, careful histopathological evaluation along with immunostaining for presence of epithelial lining is mandatory to arrive at the diagnosis. The treatment has changed drastically from total splenectomy in the past to splenic preservation methods recently.
Subject(s)
Cysts , Epithelial Cells , Splenic Diseases , Biomarkers/analysis , Biopsy , Cysts/diagnosis , Cysts/epidemiology , Cysts/therapy , Diagnostic Imaging/methods , Epithelial Cells/chemistry , Epithelial Cells/pathology , Humans , Immunohistochemistry , Predictive Value of Tests , Splenectomy/methods , Splenic Diseases/diagnosis , Splenic Diseases/epidemiology , Splenic Diseases/therapy , Treatment OutcomeABSTRACT
Relatar a experiência no reparo laparoscópico de seis casos de ureter retrocava. Foi realizado reparo laparoscópico do ureter retrocava através de duas vias de acesso: retroperitoneal e transperitoneal. O tempo cirúrgico médio foi de 90 minutos, não havendo diferença entre os acessos retro ou transperitoneal. Todos os pacientes receberam dieta no primeiro dia de pós-operatório e alta hospitalar no segundo dia. Foi realizado controle após três meses, por meio de urografia endovenosa com dilatação mínima e cintilografia renal com ácido dietilenotriaminopentacético, sem sinais de obstrução. Os pacientes foram seguidos por um período de até 120 meses, mostrando-se todos assintomáticos. A laparoscopia pode ser considerada um procedimento padrão para o tratamento do ureter retrocava, uma vez que estudos demonstram a superioridade desta quando comparada à cirurgia aberta; o acesso retroperitoneal ou transperitoneal é uma escolha pessoal do cirurgião, de acordo com sua experiência e prática.
The objective of the study was to report the experience of laparoscopic repair in 6 retrocaval ureter cases. Retrocaval ureter repair was made using two different techniques: the retroperitoneal and transperitoneal approach. The mean surgery time was 90 minutes, with no difference between the retroperitoneal and transperitoneal procedures. All patients were allowed to eat on the first postoperative day and discharged on the second day. Three months later, a control assessment was made using intravenous urography with minimal dilatation, and a diethylenetriaminepentaacetic acid renal scintigraphy with no signs of obstruction. The patients were followed for up to 120 months and all of them were asymptomatic. Laparoscopy can be considered a standard procedure to treat retrocaval ureter, since studies have shown that this technique is better than open surgery. The retroperitoneal or transperitoneal approach is up to the surgeon, according to his or her experience and practice
