Transabdominal aortic replacement is the most widely accepted approach for aortic surgery. Several controlled studies report a more favorable outcome after an extraperitoneal incision, yet there are an equal number of papers with contradictory results. The aim of our study was to assess operative trauma after aortic surgery, depending on whether transperitoneal or extraperitoneal access was used. As a parameter for the extent of the surgical trauma the concentration of Interleukin 6 and acute phase proteins (CRP) was measured pre-, 6 h and 24 h after aortic surgery. One group consisted of 34 patients scheduled for aortic surgery for exclusion of an abdominal aortic aneurysm. The second group consisted of 26 patients who were operated on for aorto-iliac occlusive disease. Each group was subdivided into an equal group of patients operated on either extra- or transperitoneally. In the retroperitoneal aneurysm patients, a posterolateral access was favored, and in patients with occlusive disease an extraperitoneal anterolateral approach was chosen. As a result patients with an extraperitoneal incision and aorto-iliac occlusive disease required less postoperative respiratory support than those operated on transperitoneally. In this subgroup of patients there was a significantly reduced synthesis of Interleukin 6 and CRP. When a retroperitoneal posterolateral approach was required in aneurysm patients, there was no difference between groups. We conclude from our data that only patients with limited infrarenal aortic access can benefit, from the retroperitoneal incision in terms of a reduced immunological reaction.
We present the case report of a 68-year-old female patient who had a malignant gastrointestinal stromal tumor of the papilla of Vater. The abdominal CT showed a coin-shaped lesion in the liver (segment VIII). Intraoperative rapid histological examination detected an old parasitic hepatic cyst. To exclude metastasis, we performed duodenopancreatectomy with curative intention. The postoperative course was without complications and neither chemotherapy nor other adjunct treatment was necessary. Because of heterogeneity, the different localization, and in this case the rare localization, surgery of gastrointestinal stromal tumors is difficult. However, we adhered to oncological and therapeutic standards of surgery for papillary carcinoma. This case is discussed based on a review of the literature. However, until now there has been no case report of gastrointestinal stromal tumor of the papilla of Vater in the literature.
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.