Smooth loop arterio-venous fistula.

The number of patients with End Stage Kidney Disease is continuously growing. There still are some difficulties in managing vascular access, creating it and dealing with all of its complications. Arterio-venous fistula is the ideal procedure increating the vascular access. Our goal is to present a surgical technique that we consider to be feasible in creating the brahio-cephalic arterio-venous fistula: the smooth loop fistula.If anatomically possible we prefer to create the barhio-cephalic fistula by using the median-basilica vein continued with the median cephalic vein to create a smooth loop between the brachial artery and the cephalic vein. By giving this J shape to the anastomosis there will be a smoother flow through the fistula, increasing its patency rate.

Arterio-venous fistula using nonpenetrating titanium clips (VCS).

UNLABELLED: Vascular access in haemodialysis is still accompanied by a high morbidity rate. Neointimal hyperplasia due to thrombosis is one of the main causes of vascular access failure. The purpose of this paper is to present the use of non-penetrating titanium clips (VCS) for the creation of an arteriovenous fistula and its outcome. MATERIALS AND METHODS: A male patient, 47 years old, with end-stage renal disease - ESRD - (2005) was addressed to our service, for a vascular access reintervention, after a failed forearm radio-cephalic fistula performed 3 months before. In January 2007, an arteriovenous fistula between the brachial artery and the median cubital vein using non-penetrating titanium clips (Anastoclip VCS) was created. RESULTS: The vascular anastomosis was performed in 17 min. After unclamping the artery, a solid pulse and consistent thrill were obtained at the level of the cubital fossa. The postoperative course was uneventful. The arteriovenous fistula remains functional 60 months post-surgery. CONCLUSIONS: The Anastoclip VCS system is versatile, safe to manipulate and enables fast anastomosis. Arteriovenous anastomosis performed with non-penetrating clips may be a solution with the potential to reduce postoperative complications and extend arteriovenous fistula patency in ESRD.

[Laparoscopy-assisted total vaginal hysterectomy with transperitoneal lymphadenectomy for early cervical cancer--surgical technique]. / Histerectomia totala vaginala asistata laparoscopic cu evidare ganglionara pentru cancer de col incipient--tehnica operatorie.

UNLABELLED: Cervical carcinoma remains an important health problem. The classical surgical approach for cervical cancer is radical hysterectomy (Wertheim's operation). Our paper presents the technique of laparoscopic assisted radical vaginal hysterectomy with transperitoneal lymphadenectomy, as well as the details for the dissection of obturator, paravesical, pararectal fossae, and parametrectomy. The major advantage of this techique is that the entire abdominal part of the procedure is performed under direct observation, therefore minimizing the visceral or vascular injury. CONCLUSION: Our experiences suggest that this type of approach is feasible and offers the possibility to remove a greather number of lymph-node as compared to the classical approach. An increased experince will prove helpful in performing the entire procedure laparoscopically.

[Gastric necrosis, rare complication after laparoscopic gastric banding--case report]. / Necroza gastrica, complicatie rara dupa gastric banding--prezentare de caz.

In the last years, laparoscopic gastric banding has become a popular surgical option for morbidly obese patients, because of the minimally invasive and easy surgical technique, its reversibility, and the possibility to calibrate the stoma. Gastric necrosis, as a complication of laparoscopic gastric banding, has been rarely reported. We present the case of a 34 -year-old pregnant patient (18 week pregnancy) with 5 days history of abdominal pain. She had undergone laparoscopic adjustable gastric banding 24 months earlier with a body mass index (BMI) of 43 kg/m2. Diagnostic workup was very difficult because the patient was pregnant and we can use only ultrasonography and clinically signs. After initial conservative management, the patient underwent urgent surgery and we found an anterior gastric prolapse through the band with necrosis of the herniated stomach. A longitudinal (sleeve) gastrectomy was performed. The postoperative evolution was god and the patient left our clinic after 9 day. Emergency sleeve gastrectomy could represent a good option to treat, in a safe way.

[The placement of Tenckhoff peritoneal dialysis catheter by laparoscopic approach--our experience]. / Plasarea cateterului Tenckhoff pentru dializa peritoneala prin abord laparoscopic--experienta noastra.

UNLABELLED: Ambulatory peritoneal dialysis is an alternative to haemo dialysis for patients with End Stage Renal Disease (ESRD). This study evaluates our experience in laparoscopic placement of Tenckhoff Catheter (TC) for peritoneal dialysis. METHODS: Between december 2000 and december 2007 in the II Surgical Clinic of Timisoara the laparoscopic implantation of the Tenckhoff catheter was performed in a lot of 56 patients with ESRD with mean age 53.04 years (limit between 17-80 years). In this lot of patients 66 laparoscopic procedures were performed--58 catheter implantation, 2 catheter changing, 2 repositioning, 2 adhesiolysis and 2 withdrawn. Mean operative time was 47.3 min. (limits 35-90 min.). RESULTS: Immediate functionality ratio (< 30 days) was 98.11% of cases. The immediate post-operative complications were: leakage of dialysis solution in three patients (5.35% of cases), bleeding from the incision in three patients (5.35% of cases) and one patient (1.78% of cases) with a migration of the TC, case who required replacement of the catheter performed also by laparoscopy. The late post-operative complications were: obstruction with omentum of the catheter in two patients (3.57% of cases), massive leakage in one patient (1.78% of cases), migration of the TC in one patient (1.78% of cases), tunnel infection in one patient (1.78% of cases) and peritonitis in two patients (3.57% of cases). In all these patients laparoscopy replacement of the catheter was required. The minor complications were: exit site infection in 3 patients (5.35% of cases), tunnel infection in 7 patients (12.5 % of cases), incisional hernia in one patient and pleural effusion in one patients (1.78% of cases). CONCLUSIONS: Laparoscopic placement of TC is a successful method compared to other procedures. The great advantage is the direct visualization and fixation of the TC in the pelvis.

[Benign esophageal strictures--outcomes of coloesophagoplasty in Surgical Clinic II Timisoara]. / Stenozele benigne ale esofagului --rezultate ale reconstructiei esofagiene cu colon în Clinica a II-a Chirurgie din Timisoara.

Esophagoplasty is obviously a proper choice of treatment; postoperative outcomes should be very good because of benign type of lesions, but morbidity-mortality are high due to the complexity of the intervention. Our purpose is to emphasize the utility of coloesophagoplasty like a very feasible surgical option, based to our short and long term outcomes. This paper relies on the retrospective analysis of all cases admitted to II-nd Surgical Clinic Timisoara in a 20 years period (1983-2002), having coloesophagoplasty for benign esophageal stenosis. There were performed 45 such interventions (16 men, 29 women); the mean age was 35.7 years (15-68 years). The pathology included postcaustic lesions (42 cases), peptic lesions (2 cases) and esophageal leiomyoma (1 case). Postoperative morbidity occurred in 22.6% of patients. The graft functionality was good and very good in 86.6% of patients at discharge. Postoperative mortality was 6.6%.