Purpose
Despite the minimally invasive nature of transanal hemorrhoidal dearterialization (THD) with Doppler arterial identification procedures, hemorrhoidectomy is still considered the gold standard procedure for hemorrhoidal disease. However, the classical techniques of hemorrhoidectomy have a high rate of postoperative complications. The main purpose of this study is to demonstrate the efficacy and complications of these techniques used for grades II and III hemorrhoids.
Methods
A retrospective (case-control) study was carried out from January 2009 to May 2014, and all patients undergoing surgical procedures for hemorrhoidal disease in two French clinics were considered. Application of inclusion and exclusion criteria identified 270 eligible patients (163 undergoing Doppler THD and 107 treated with Milligan Morgan hemorrhoidectomy). Statistical analysis was calculated considering immediate postoperative complications, functional results, chronic complications, and recurrences.
Results
Analysis of primary outcomes showed a significant difference between the 2 groups concerning postoperative pain, which had a lower rate in THD (P = 0.0001) and in postoperative bleeding (P = 0.02) than hemorrhoidectomy. However, long-term follow-up at three years showed a superior rate of recurrence in the THD group (P = 0.009).
Conclusion
The THD technique is a safe and effective procedure for grades II and III hemorrhoids, has lower rates of post-operative pain and bleeding, and allows faster hospital discharge; however, it also shows a higher rate of recurrence at three years of follow-up.
HighlightsEctopic thyroid is thyroidal tissue located far from its anatomic place.A patient under our observation displayed left submandibular swelling.The FNAC test report described a follicular adenoma.Based on the FNAC diagnosis, we surgically removed the mass.The post-operative follow-up was uneventful.
Introduction Ingestion of foreign bodies including dentures, fishbone, screw, and/or surgical devices can be a cause of morbidity, and it rarely could be fatal. Presentation of Case We present the first hitherto reported case of mussel shell ingestion, which caused acute abdominal pain in a 55-year-old woman. The shell pierced ileal loops, and it was found in the abdominal cavity. Discussion The accidental or voluntary ingestion of a foreign body is an uncommon event compared to the other causes of bowel perforation. It is fundamental to immediately remove the intestinal fluid, repair the tear, and prevent sepsis, because each delay in diagnosis can lead to a worst outcome. Conclusion In case of bowel perforation, it important for surgeons, who are dealing with these acute care patients, to be aware of different designs and constructions of possible foreign bodies, in order to be prepared to deal with different possible scenarios and be able to manage them properly.
Background
Laparoscopic Roux en Y Gastric Bypass (LRYGB) is a technically challenging operation with potentially severe surgical complications. A large number of tests have been proposed in order to early identify them in the immediate post-operative period but none was completely satisfactory. Actually, there is no data concerning the use of an early diagnostic protocol based on an intraoperative contrast swallow and a CT- scan at 48 h.
Methods and analysis
From may 2012 to February 2017, 281 patients underwent LRYGB. A 40 cc of iodinated water-soluble contrast (Gastrografin® or Telebrix®) was administered through the orogastric tube 5 min after the blue methylene test while 48 h later, they underwent a CT-scan. The early detection of the contrast liquid in the alimentary or bilio-pancreatic limb, in proximity of it or free in the abdomen were considered signs of bowel obstruction or anastomotic leak.
Results
220 were test negative while 35 patients were positive and a second look was carried out successfully. Considering our data, sensitivity was 0,97 (CI 95% = 91,85–100%) while specificity stated at 0,98 (CI 95% = 96,48–99,95%). The positive predictive value was 0,89 (CI 95% = 80,22–99,27%) and the negative predictive value was 0,99 (CI 95% = 98,66–100%).
Conclusions
This study gives a contribute to the existing issue of fast track in bariatric surgery for the early diagnosis of complications and patients’ readmission or non-discharge. In conclusion, the use of intraoperative iodinated water soluble contrast swallow and abdominal CT-scan at 48 h was a safe and accurate test in order to detect and treat any potential early surgical complication in LRYGB.
Highlights
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