Laser haemorrhoidoplasty (LHP) with the 1470 nm diode laser in minimally invasive surgery for advanced haemorrhoid disease has been studied with respect to clinical variables, such as pain and complications, and intraoperative characteristics such as mucopexia, number of treated knots and energy consumed per patient. The study also included patient satisfaction, symptom relevance and cost effectiveness. Between November 2010 and November 2016, 497 patients (age 55 ± 14 years) were submitted to laser haemorrhoidoplasty with a 1470 nm diode laser in the centre for minimally invasive proctology in Siegen District Hospital. All operated patients were included in the study. Perioperative clinical and technical data up to 6 weeks and follow-up data up to 6 months were analysed prospectively. The mean duration of operation was 14 min (± 5.2). A mean of 2.7 knots of 2.7 size were treated per patient. The mean postoperative pain was 2.5/10 (VAS). Long-term symptom relevance was 86%, and patient satisfaction 91%. Complications occurred in 49 patients (9.9%): bleeding 1.8%, infection 1%, urine retention 1.8%, oedema/thrombosis/prolapse 6.6%. 8.8% of patients suffered a relapse within 6 months. There were significant differences in pain on the day of the operation, and the parameters mucopexia, 3 treated segments and energy level > 500 J (p < 0.05). Complications were more common when mucopexia was performed, with 3 treated knots and energy consumed per patient > 500 J. The only significant difference was for energy level > 500 J (p < 0.05). LHP is a safe, low pain and minimally invasive surgical procedure with long-term good patient acceptance and satisfaction and is suited for routine work. The energy applied should be reduced to a minimum. Complication rates are largely comparable with those of other minimally invasive conventional methods. Additional prospective studies must be performed, particularly in comparison to the Parks method, which gives similar functional results. With circular confluent findings, LHP cannot replace stapler hemorrhoidopexia.
Wilson’s disease is rare, but it affects 6-12% of patients with an indication for urgent liver transplantation. The main manifestations, in addition to the liver, are neurological and psychiatric, with evolution with fulminant hepatitis without neuropsychiatric symptoms being rarer. Despite the urgency, the prognosis for post-transplant patients averages 85% 5-year survival. In this report, we present the case of a female patient, 18 years old, with the onset of abdominal pain, jaundice and choluria that progressed to fulminant hepatitis and the need for urgent liver transplantation. The patient evolved postoperatively with septic shock due to herpetic encephalitis, duodenal ulcer with active bleeding and hepatic artery pseudoaneurysm. Despite measures for stabilization and the request for a transplant again, the patient died.
A doença de Wilson é uma rara patologia, porém, que engloba 6–12% dos pacientes com indicação de transplante hepático de urgência. As principais manifestações, além de hepáticas, são as neurológicas e psiquiátricas, sendo mais raro a evolução com hepatite fulminante sem sintomas neuropsiquiátricos. Apesar da urgência, o prognóstico para os pacientes pós-transplante é, em média, 85% de sobrevivência em cinco anos. Neste relato, é apresentado o caso de uma paciente mulher, 18 anos de idade, com início de dor abdominal, icterícia e colúria com evolução para hepatite fulminante e necessidade de transplante hepático de urgência. A paciente evoluiu no pós-operatório com choque séptico devido encefalite herpética, úlcera duodenal com sangramento ativo e pseudoaneurisma de artéria hepática. Apesar das medidas para estabilização e solicitação, novamente, de um transplante, a paciente evoluiu para óbito.
Introduction and importance
Duodenal trauma is rare, however, it has high morbidity and mortality rates. Surgical treatment modalities are employed depending on severity, ranging from simple sutures to complex pancreaticoduodenectomy cases.
Case presentation
A male patient had a circular saw accident, leading to evisceration in an extensive wound from the thoracoabdominal transition to the inguinal region, with 75% laceration of the second duodenal portion circumference, laceration in hepatic segments, section from right mesocolon to transverse colon, and multiple perforations in small bowel loops between 70 and 90 cm from the angle of Treitz. Laterolateral duodenum enteroanastomosis was performed with proximal jejunum and gastroenteroanastomosis with the distal loop of the small intestine at 90 cm from the Treitz angle, and a termino lateral enteroanastomosis between food and the biliary loop at 20 cm from the gastroenteroanastomosis.
Clinical discussion
This report presents a new surgical technique for patients with penetrating duodenal trauma associated with liver and intestinal injuries, to avoid the need for more complex procedures. In addition, it demonstrates postoperative management of complications, including confection of the enteroatmospheric fistula for feeding.
Conclusion
The technique described in this article proved to be a good option for treating these lesions, as evidenced by optimal postoperative results.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.