27 research outputs found
Development of the Greek version of the University of Washington Quality of Life questionnaire for patients with head and neck cancer
No full textThe University of Washington Quality of Life (UW-QOL) questionnaire, created in 1993 to evaluate health related quality of life, has been widely used in English-speaking populations and translated and validated in other languages. The aim of the present study was to carefully translate and psychometrically validate the UW-QOL questionnaire in Greek. The revised version of the questionnaire was obtained by forward and backward translation of the original English version, according to internationally accepted guidelines. Validation was performed in 120 patients with head and neck cancer treated in a Greek Anticancer Institute in Athens, during their follow-up visits. Eligible patients completed the Greek version of the questionnaire and two other previously validated quality of life questionnaires (EORTC QLQ H&N35 and C-30). Related data and the patients' demographics were extracted from the patient's notes. Strong internal consistency (mean Cronbach α value of 0.83) was shown, with good construct validity. Statistically significant differences were noted between tumour staging and treatment modality and global quality of life. Strong correlation was shown between previously validated EORTC questionnaires and the translated UW-QOL questionnaire. In conclusion, the Greek version of the UW-QOL questionnaire appears to be culturally appropriate and psychometrically valid. © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved
Combined Robotic-Assisted Bio-absorbable Mesh Placement and Gluteal Fasciocutaneous Flap Reconstruction: a Novel Technique for the Repair of a Symptomatic Perineal Hernia Following Extralevator Abdominoperineal Resection for Rectal Cancer
No full textExtralevator abdominoperineal resection for rectal cancer has predominated over the common technique during recent years providing better oncologic results. However, extralevator abdominoperineal resection has been associated to a higher incidence of wound complications and perineal hernia. Several risk factors including preoperative pelvic radiotherapy, laparoscopic abdominoperineal resection, women, previous hysterectomy, obesity, coccygectomy, long small bowel mesentery, postoperative wound infection, and open pelvic peritoneum have been correlated to increased perineal hernia rate. Despite the minor clinical manifestation of a perineal hernia, its effect on the quality of life remains remarkable. Therefore, the surgical management of a perineal hernia after abdominoperineal resection is still a challenge for colorectal surgeons. Several techniques have been used including biologic meshes and myocutaneous flaps. Nevertheless, the ideal technique has not yet been proved. During last years, colorectal surgeons have utilized minimally invasive techniques such as robotic repair of perineal hernias. We presented the first case in the literature of a combined approach of robotic-assisted repair using a bio-absorbable mesh and a gluteal fasciocutaneous flap reconstruction. © 2021, Association of Surgeons of India
Saliva stress biomarkers in ERCP trainees before and after familiarisation with ERCP on a virtual simulator
No full text
Routine abdominal drains after laparoscopic sleeve gastrectomy: a retrospective review of 353 patients
No full textComplications after laparoscopic sleeve gastrectomy (LSG) are usually silent and difficult to interpret. Our purpose was to evaluate the utility of routine placement of intraperitoneal drains at the end of LSG in detection and management of postoperative complications. This is a retrospective study of all patients that underwent LSG by a standard operative team in a 3-year period. Patients were enrolled in Group A when an intraperitoneal drain was placed and Group B when not. Three hundred and fifty-three patients underwent LSG with a median preoperative BMI of 46.4 k/m2. Two hundred and one patients were enrolled in group A and 152 in group B; the two groups were comparable in their characteristics. Staple line leak, bleeding, and abscess were observed in 4%, 2.9%, and 2.5% of group A and 2.6%, 1.9%, and 1.9% of group B and the differences did not reach statistical significance. In 50% of patients with drain and leak, per os blue de methylene test was negative and in another 50% leak took place after the fourth postoperative day when drain was already taken off. Abscesses were observed significantly more often in patients that had suffered postoperative bleeding (p < 0.001) or had undergone laparoscopic adjustable gastric banding (LAGB) in the past (p = 0.02). Placement of drains does not facilitate detection of leak, abscess, or bleeding. Furthermore, they don't seem to eliminate the reoperation rates for these complications. Maybe patients with previous LAGB and intraperitoneal bleeding could benefit from placement of a drain that will remain for more than 5 days.Obes Sur
The impact of robotic surgery on the treatment of benign esophageal and gastric disease: early experience of a specialized unit
No full textLaparoscopic surgery is a well-established approach in the surgical treatment of reflux, hiatal hernia and esophageal motility disorders such as achalasia. Robotic platforms have only recently been incorporated in surgery for esophageal motility disorders and their exact value remains to be determined. In the present study, we present the preliminary results of our early experience with a case series of benign upper gastrointestinal diseases treated using the robotic system in our department. Data on all consecutive patients undergoing surgery for benign upper gastrointestinal tract (UGI) disease during the last 5 years (01/2029–12/2023) was prospectively collected and retrospectively reviewed. All patients attended regular follow-up appointments. Patients with relapse or deterioration of their symptoms were referred for objective testing using high-resolution manometry and/or 24-h impedance pHmetry. A total of 34 patients were included in our series. Fourteen patients with achalasia underwent robotic Heller myotomy and modified Dor fundoplication, sixteen patients underwent hiatal hernia repair with fundoplication and four patients had a Nissen fundoplication for reflux esophagitis. The median postoperative Eckardt score of the patients treated for achalasia was 2 and a median GERD score of 1 was recorded for patients treated for reflux. Two patients with achalasia were evaluated with manometry due to temporary symptom relapse. The manometric findings were unremarkable. The incorporation of the robotic approach in the surgical treatment of benign UGI diseases is safe and feasible with excellent perioperative and postoperative functional results. Further experience and investigation will allow for reliable comparison to the laparoscopic approach. © The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature 2024
Rectoanal repair versus suture haemorrhoidopexy: a comparative study on suture mucopexy procedures for high-grade haemorrhoids
No full textThe isolated application of Doppler-guided haemorrhoidal artery ligation (DGHAL) may fail due to the increased reprolapse rate for high-grade haemorrhoids. DGHAL has been combined with a proctoscopic-assisted transanal rectal mucopexy of the prolapsing tissue. The technique is called rectoanal repair (RAR) and is an evolution of various mucopexy and suture haemorrhoidopexy (SHP) techniques. A prominent external component may require minimal (muco-) cutaneous excision (MMCE) of protruding anoderm or minor cutaneous excision of skin tags. Fifty-seven patients with symptomatic Goligher grade III and IV haemorrhoids underwent DGHAL followed by either RAR or SHP. In 26 cases, the addition of MMCE was necessary. No significant differences were observed between the two approaches with regards to pain scores measured with visual analogue scale (VAS). On postoperative day 1, mean pain score at rest was 5.81 (+/- 2.23 SD) after SHP versus 5.08 (+/- 2.35 SD) after RAR, while mean pain score at first defecation was 7.31 (+/- 1.6 SD) versus 7.52 (+/- 1.83 SD). There was no difference in the duration of analgesic requirements, postoperative complications and residual prolapse between the 2 procedures. The addition of MMCE did not affect postoperative pain nor analgesic requirements. With the exception of 8 patients who still had with skin tags or minimal protrusion, the remaining of patients (86 %) were asymptomatic and recurrence-free at an average follow-up of 20 months. Overall, 94.8 % of patients stated that they were satisfied with the results, and 91.2 % that they would repeat it if necessary. Performance of either SHP or RAR after DGHAL is a safe and effective surgical tactic for advanced grade haemorrhoids. Our initial results do not confirm any superiority of RAR over traditional SHP
Could FiLaC™ be effective in the treatment of anal fistulas? A systematic review of observational studies and proportional meta-analysis
No full textAim: Fistula Laser Closure (FiLaC™) is a novel sphincter-preserving technique that is based on new technologies and shows promising results in repairing anal fistulas whilst maintaining external sphincter function. The aim of the present meta-analysis is to present the efficacy and the safety of FiLaC™ in the management of anal fistula disease. Method: The present proportional meta-analysis was designed using the PRISMA and AMSTAR guidelines. We searched MEDLINE, Scopus, clinicaltrials.gov, Embase, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar databases from inception until November 2019. Results: Overall, eight studies were included that recruited 476 patients. The pooled success rate of the technique was 63% (95% CI 50%–75%). The pooled complication rate was 8% (95% CI 1%–18%). Sixty-six per cent of patients had a transsphincteric fistula and 60% had undergone a previous surgical intervention, mainly the insertion of a seton (54%). The majority had a cryptoglandular fistula. Operation time and follow-up period were described for each study. Conclusion: FiLaC™ seems to be an efficient therapeutic option for perianal fistula disease with an adequate level of safety that preserves quality of life. Nevertheless, randomized trials need to be designed to compare FiLaC™ with other procedures for the management of anal fistulas such as ligation of intersphincteric fistula tract, anal advancement flaps, fibrin glue, collagen paste, autologous adipose tissue, fistula plug and video-assisted anal fistula treatment. Colorectal Disease © 2020 The Association of Coloproctology of Great Britain and Irelan
Could FiLaC™ be effective in the treatment of anal fistulas? A systematic review of observational studies and proportional meta‐analysis
No full textGastrointestinal Stromal Tumor (GIST) in Long Standing Crohn’s disease on Anti-TNF Therapy
No full textIntroduction
Patients suffering from inflammatory bowel disease (IBD) are at increased risk for developing cancer. Adenocarcinomas are the most commonly observed tumors of the gastrointestinal tract whereas data on gastrointestinal stromal tumor (GIST) in IBD patients is limited. GIST is a neoplasm that originates from the interstitial cells of Cajal in the smooth muscle layers of the gastrointestinal tract. [1] The association between GIST and Crohn’s disease (CD) is debated, as the tumor inconsistently present in areas of inflammatory activity. We report an interesting case of CD maintained on Infliximab, who presented with a flare that revealed GIST in the stomach. To our knowledge, this is the first reported occurrence of GIST in stomach in a patient with CD maintained on anti-TNF therapy.
Case Report
A 40-year-old Caucasian man with a history of small bowel Crohn’s disease on infliximab therapy presented with a two-day history of abdominal pain, hematochezia, and diffuse joint pain. Upon admission, the patient was hemodynamically stable and afebrile, with a blood pressure of 140/70 mmHg, heart rate of 90 beats per minute, and respiratory rate of 14 per minute. Physical exam was remarkable for abdominal distension and diffuse abdominal tenderness. Complete blood count, comprehensive metabolic panel, and C-reactive protein were within normal range. The patient reported no history of alcohol abuse, smoking, recent abdominal procedures, or trauma. The patient had computed tomography (CT) of the abdomen done that revealed a 2.5-centimeter exophytic mass in the stomach with possible liver metastases (Fig. 1). Endoscopic ultrasound (EUS) guided biopsies of the exophytic mass confirmed gastrointestinal stromal tumor (GIST) on fine needle aspiration and flow cytometry results (Fig. 2,3). The patient underwent surgical resection without complication and is back to his usual state of health.
Discussion
GIST is the most common mesenchymal neoplasm in the gastrointestinal tract [1,2]. The annual incidence of GIST has been reported as 11-19.6 per million [3,4], however a more recent analysis in 2015 estimates the annual incidence to be 6.8 per million with a 53% predominance in males and 73% predominance in Caucasians [5]. Individuals are typically diagnosed with GIST in their seventh decade of life [5].
Immunologically, it is reported that 70-80% of GIST have a mutation in the KIT gene, leading to a continuously active KIT receptor, independent of its activating ligand [1]. KIT activation leads to overexpression of the protein CD117. In KIT-negative GIST, a small number are observed to have a mutation in platelet-derived growth factor receptor-a (PDGFRA). Dysregulated activation of either of these genes results in uncontrolled cell growth and survival. It is estimated that 10-15% of GIST do not have mutations in either KIT or PDGRFA, and while they are considered wild-type, they are shown to express high levels of KIT [1]. More recently, Novelli et al. found that the presence of proteins CD117 and DOG1 had the highest sensitivity and specificity for GIST [6].
The majority of GIST develop in the stomach (60%), with the jejunum and ileum representing the next most common site of involvement (30%) [7]. Several prognostic factors have been researched, most notably tumor location and mitotic index. Emory et al. found that GIST originating from the esophagus had the highest survival rate, followed by those that arose from the stomach, small bowel, colon/rectum, and omentum/mesentery in decreasing order [8]. Additionally, mitotic index, defined as the number of mitotic figures per high-power field (HPF), is reported an independent prognostic factor, with greater than 10 mitotic figures per 50 HPF showing the largest difference in survival in gastric GIST [8]. Small bowel GIST exhibited minimally different survival curves with respect to mitotic index. Age was also found to be an independent prognostic factor of survival in GIST [8].
Later research by Miettinen demonstrated that larger gastric GIST with a diameter of 10cm and 5 mitotic figures per 50 HPF carried a lower metastatic risk in comparison to gastric GIST with diameter of \u3e 5cm but with \u3e 5 mitotic figures per 50 HPF [9]. This may suggest that in gastric GIST, mitotic index carries the most prognostic value. Miettinen found that in intestinal GIST, a diameter of \u3e 5cm and \u3e 5 mitotic figures per HPF each independently carried a moderate or high risk of metastasis, respectively. Intestinal GIST carried a 39% tumor-related mortality rate, compared to 17% for gastric GIST [10,11].
Currently, surgery is the primary treatment modality for nonmetastatic GIST that is technically amenable to resection. Imatinib, a tyrosine kinase inhibitor (TKI), may be used as neoadjuvant therapy or as initial therapy for nonresectable disease [12]. Imatinib directly binds to the KIT protein and prevents further signaling [1]. This medication first demonstrated favorable treatment effects in 2002, with over 50% of the 147 patients showing at least a partial response to therapy [13]. Some patients develop resistance to Imatinib, prompting the development of alternative TKI therapy. Currently, Sunitinib is FDA approved for Imatinib-resistant GIST [14], with a host of other TKI’s and alternative therapies under investigation [1].
In 2012, Körner examined glucagon-like peptide-2 receptor (GLP-2) expression in a variety of neoplasm and found that 68% of the GISTs expressed this receptor in the intestinal myenteric plexus [15]. Additionally, this receptor was expressed in high density in patients with Crohn’s disease. Interestingly, this expression was absent in active or inactive ulcerative colitis as well as Hirschsprung’s disease [15].
Table 1: GIST with concurrent IBD.
Author (ref)
Age, Sex
IBD
Symptoms
Location of GIST
Imaging or operative findings
Pfeffela, 1999 [16]
51, M
CD
Weight loss, Abdominal pain, Fever, Fatigue
Ileum
Large tumorous lesions in the right lower abdomen (terminal ileum) measuring 8 × 5 × 6 cm
Grieco, 2002 [17]
57, F
UC
Melena, progressive anemia
Ileum
Solid mass in the left pelvic cavity with a diameter of 7 cm
Mijandrusić Sincić, 2005 [18]
81, M
CD
Ileus
Meckel’s diverticulum
Dilated loops of intestine with large packets of gas and anti-peristalsis
Kaiser, 2006 [19]
64, M
UC
Severe bleeding, abdominal distension
Omentum
8 cm mass attached to greater omentum
Ruffolo, 2010 [20]
59, M
UC
Rectal bleeding
Rectum
0.5 cm GIST located 20 cm from anal adenocarcinoma
Theodoropoulos, 2009 [21]
45, M
CD
Abdominal pain, vomiting, constipation, bloating
Jejunum and Ileum
6 mm GIST within jejunoileal intussusception
Bocker U, 2008
[22]
26, F
CD
Abdominal cramping, gastrointestinal bleeding
Duodenum
Ulcerated lesion noted 140 cm past proximal duodenum on enteroscopy
Gianluca, 2016 [7]
38, M
CD
Asymptomatic
Small bowel
A mass found along the small bowel
Gianluca, 2016 [7]
53, M
UC
Abrupt postoperative bleeding
Stomach
No evidences of masses at surgery. Gastric bleeding at endoscopy
Present paper
40, M
CD
Abdominal pain, hematochezia
Stomach
2.5 cm exophytic mass in the stomach with possible liver metastases
CONCLUSION
Our case of Crohn’s disease diagnosed with gastric GIST sheds light on a rare link between two separate disease entities native to the gastrointestinal system. While there exists a well-known association between inflammatory bowel disease and colon cancer, other malignancies are described much less frequently in the literature. The development of gastric GIST with underlying Crohn’s disease is a rare occurrence, but is one that should be kept in mind when evaluating patients with inflammatory bowel disease found to have new masses on imaging.
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