Optimal Solution Volume for Luminal Preservation: A Preclinical Study in Porcine Intestinal Preservation.

BACKGROUND: Rodent studies suggest that luminal solutions alleviate the mucosal injury and prolong intestinal preservation but concerns exist that excessive volumes of luminal fluid may promote tissue edema. Differences in size, structure, and metabolism between rats and humans require studies in large animals before clinical use. METHODS: Intestinal procurement was performed in 7 pigs. After perfusion with histidine-tryptophan-ketoglutarate (HTK), 40-cm-long segments were cut and filled with 13.5% polyethylene glycol (PEG) 3350 solution as follows: V0 (controls, none), V1 (0.5 mL/cm), V2 (1 mL/cm), V3 (1.5 mL/cm), and V4 (2 mL/cm). Tissue and luminal solutions were sampled after 8, 14, and 24 hours of cold storage (CS). Preservation injury (Chiu score), the apical membrane (ZO-1, brush-border maltase activity), and the electrolyte content in the luminal solution were studied. RESULTS: In control intestines, 8-hour CS in HTK solution resulted in minimal mucosal changes (grade 1) that progressed to significant subepithelial edema (grade 3) by 24 hours. During this time, a gradual loss in ZO-1 was recorded, whereas maltase activity remained unaltered. Moreover, variable degrees of submucosal edema were observed. Luminal introduction of high volumes (2 mL/mL) of PEG solution accelerated the development of the subepithelial edema and submucosal edema, leading to worse histology. However, ZO-1 was preserved better over time than in control intestines (no luminal solution). Maltase activity was reduced in intestines receiving luminal preservation. Luminal sodium content decreased in time and did not differ between groups. CONCLUSIONS: This PEG solution protects the apical membrane and the tight-junction proteins but may favor water absorption and tissue (submucosal) edema, and luminal volumes >2 mL/cm may result in worse intestinal morphology.

[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.

[Endoscopy-assisted harvesting and free latissimus dorsi muscle flap transfer in reconstructive microsurgery]. / Recoltarea asistata-endoscopic si transferul liber a lamboului muscular de latissimus dorsi în microchirurgia reconstructiva.

Because of their generous dimensions, constant anatomy, great plasticity and well defined vascularization, muscles remain the preferred choice when approaching reconstruction of complex tissue defects resulting after trauma or oncological resections. The latissimus dorsi, represents a widely used flap when performing reconstructive microsurgery using free tissue transfer, but with important postoperative complications like seroma, donor-site hematoma and large scars. Along with the development of video assisted harvesting of muscular free flaps, the minimal invasive approach brings an important decrease of the donor site morbidity, followed by a faster healing. This article presents the case of a patient diagnosed with chronic osteomyelitis fistula, on the site of an older posttraumatic fracture at the level of the tibial diaphysis, where a large debridement of soft tissues and the involved bone was performed, followed by microsurgical reconstruction of the left over defect, using a free latissimus dorsi muscular flap harvested by endoscopic-assisted technique.

[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.