BackgroundCongenital diaphragmatic hernia (CDH) is a congenital abnormality, rare in adults with a frequency of 0.17–6%. Diaphragmatic rupture is an infrequent consequence of trauma, occurring in about 5% of severe closed thoraco-abdominal injuries. Clinical presentation ranges from asymptomatic cases to serious respiratory or gastrointestinal symptoms. Diagnosis depends on anamnesis, clinical signs and radiological investigations.MethodsFrom May 2013 to June 2016, six cases (four females, two males; mean age 58 years) of diaphragmatic hernia were admitted to our Academic Department of General Surgery with respiratory and abdominal symptoms. Chest X-ray, barium studies and CT scan were performed.ResultsCase 1 presented left diaphragmatic hernia containing transverse and descending colon. Case 2 showed left CDH which allowed passage of stomach, spleen and colon. Case 3 and 6 showed stomach in left hemithorax. Case 4 presented left diaphragmatic hernia which allowed passage of the spleen, left lobe of liver and transverse colon. Case 5 had stomach and spleen herniated into the chest. Emergency surgery was always performed. The hernia contents were reduced and defect was closed with primary repair or mesh. In all cases, post-operative courses were uneventful.ConclusionOverlapping abdominal and respiratory symptoms lead to diagnosis of diaphragmatic hernia, in patients with or without an history of trauma. Chest X-ray, CT scan and barium studies should be done to evaluate diaphragmatic defect, size, location and contents. Emergency surgical approach is mandatory reducing morbidity and mortality.
Aim
There is no study in the literature that evaluates the cost‐effectiveness of robotic distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP). We performed a comparative study of RDP and LDP with the aim of evaluating clinical and cost‐effective outcomes.
Material and Methods
This is an observational, comparative prospective nonrandomized study. The primary end point was to compare the cost‐effectiveness differences between both groups. A willingness to pay of €20 000 and €30 000 per quality‐adjusted life year (QALY) was used as a threshold to recognize which treatment was most cost‐effective.
Results
A total of 31 RDP and 28 LDP have been included. The overall mean total cost was similar in both groups (RDP: €9712.15 versus LDP: €9424.68; P > .5). Mean QALYs for RDP (0.652) was higher than that associated with LDP (0.59) (P > .5).
Conclusion
This study seems to provide data of cost‐effectiveness between RDP and LDP approaches, showing some benefits for RDP.
41 patients were operated on for locally advanced cancer and for metastatic disease to the head of the pancreas. There were 13 (32%) patients with colon cancer, 12 (29%) -gastric cancer, 8 (20%) -malignant tumor of the duodenum, 3 (7%) -lymphoma, 3 (7%)kidney cancer and 2 (5%) -retroperitoneal sarcoma. Results: All combined resections were successfully performed. Resection margins in all patients were tumor-free. Morbidity was 44% (18 patients), including 8 patients with grade I -IIIa complications by Clavien-Dindo and 9 -with grade IIIb. 17 of these complications were successfully cured by operative or conservative treatment. There was 1 death in patient who developed a pancreatic fistula type C. 5-year overall survival was reached for 2 largest patient groups with colon and gastric cancer, which was 40 and 16%, respectively. Conclusions: Combined resections can improve overall survival for patients with non-pancreatic and non-biliary malignant tumors spreading to pancreas. Invasion of the malignant tumor to the head of the pancreas should not be contraindication to performing a combined surgery with PD if other non-resectable signs are absent.
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