149 research outputs found
Pelvic sepsis after stapled hemorrhoidopexy
No full textBosscha K contributed equally to this work; van Wensen RJA did the literature research and wrote the manuscript under the supervision of van Leuken MH and Bosscha K
A case of bowel entrapment after penetrating injury of the pelvis: don't forget the omentumplasty
Get PDFAbstract Bowel entrapment within a pelvic injury is rare and difficult to diagnose. Usually, it is diagnosed late because of concomitant abdominal injuries. It may present itself as an acute intestinal obstruction or, more commonly, as a prolonged or intermittent ileus. Therefore, one should be aware of this late complication and primarily take measures for avoiding bowel entrapment. This report describes an unusual case of bowel entrapment within a pelvic fracture after a penetrating injury, and discusses options for preventing such a complication.</p
Delirium after Emergency/Elective Open and Endovascular Aortoiliac Surgery at a Surgical Ward with a High-standard Delirium Care Protocol
No full textDelirium is a common problem in elderly patients undergoing surgery. Standard delirium care is not available at all surgical wards. We determined the incidence, risk factors, and outcomes of postoperative delirium among patients undergoing elective/emergency aortoiliac surgery at a surgical ward with high-standard delirium care. A prospective descriptive survey in 107 patients was conducted. High-standard delirium care was given to patients above age 65, consisting of an extended focus on risk factors and intensive screening. The Delirium Observation Scale was used as a screening instrument for delirium. Patients were classified as having delirium if they met the DSM-IV criteria. The overall incidence of delirium was 23%. The incidence was 14% after elective surgery. Delirium occurred in 59% after emergency surgery and more often after open than after endovascular aneurysm repair ( p < .01). Delirium was associated with age ( p < .01) and emergency surgery ( p = .01) and is an important and frequent complication after aortoiliac surgery.</jats:p
Use of a multi-instrument access device in abdominoperineal resections
No full textBackground: Laparoscopic colorectal surgery results in less post-operative pain, faster recovery, shorter length of stay and reduced morbidity compared with open procedures. Less or minimally invasive techniques have been developed to further minimise surgical trauma and to decrease the size and number of incisions. This study describes the safety and feasibility of using an umbilical multi-instrument access (MIA) port (Olympus TriPort+) device with the placement of just one 12-mm suprapubic trocar in laparoscopic (double-port) abdominoperineal resections (APRs) in rectal cancer patients. Patients and Methods: The study included 20 patients undergoing double-port APRs for rectal cancer between June 2011 and August 2013. Preoperative data were gathered in a prospective database, and post-operative data were collected retrospectively. Results: The 20 patients (30% female) had a median age of 67 years (range 46-80 years), and their median body mass index (BMI) was 26 kg/m2 (range 20-31 kg/m2). An additional third trocar was placed in 2 patients. No laparoscopic procedures were converted to an open procedure. Median operating time was 195 min (range 115-306 min). A radical resection (R0 resection) was achieved in all patients, with a median of 14 lymph nodes harvested. Median length of stay was 8 days (range 5-43 days). Conclusion: Laparoscopic APR using a MIA trocar is a feasible and safe procedure. A MIA port might be of benefit as an extra option in the toolbox of the laparoscopic surgeon to further minimise surgical trauma
Pulmonary Resection for Metastases from Colorectal Cancer
No full textIntroductionThe lung is the most common extraabdominal site for metastases from colorectal cancer. Patients with untreated metastatic disease have a median survival of less than 10 months and a 5-year survival of less than 5%. The purpose of this study was to evaluate long-term survival in patients who underwent pulmonary resection for metastases from colorectal cancer.MethodsBetween January 1990 and January 2005, 23 patients underwent 29 operations for resection of lung metastases.ResultsMedian age was 68 years (range: 46–80 years). Median follow-up was 30 months (range: 12–149 months). The 2- and 5-year overall survival rates were 64 and 26%, respectively. Of the 23 patients, 16 patients had a solitary lesion, and seven patients had multiple lesions. The 5-year survival rates were 23 and 33%, respectively (not significant). The median disease-free interval (DFI)—the interval between colon resection and the appearance of lung metastases—was 43 months (1–168). Ten patients had DFIs <36 months, and 13 patients had DFIs >36 months. The 3-year survival rates were 20 and 38%, respectively (not significant). Recurrence of lung metastases was diagnosed in seven patients; three patients underwent second resections. They are alive today, with a median follow-up of 18 months. Patients who did not undergo second resections had a median survival of 12 months.ConclusionsPulmonary resection for metastases from colorectal cancer does produce longer survival, even in patients with multiple lesions and recurrent metastases
False aneurysm of the profunda femoris artery, a rare complication of a proximal femoral fracture
No full textThe authors describe a false aneurysm of the profunda femoris artery caused by a bony fragment from the lesser trochanter after a proximal femoral fracture. False aneurysm as a complication of a hip fracture is rare; however it is essential to consider the possibility, more even so if there is inexplicable persisting pain after internal fixation. Symptoms are sometimes diffi-cult to judge, as they can be almost identical to usual symptoms after an operated hip fracture. In this case we present a female patient with persistent pain after a surgically fixed proximal femoral fracture. CT scan showed a false aneurysm caused by a bony fragment of the lesser trochanter. Because of the persisting mechanical stress from the bony fragment we decided to explore the false aneurysm and to remove the bony fragment. It is essential to be aware of adjacent vascular and neurological structures when a fracture is seen and operated o
Can micrometastases be used to predict colon cancer prognosis? Hopes for the EnRoute+ study
No full textSurgical oncolog
Impact of breast surgery on survival in patients with distant metastases at initial presentation: a systematic review of the literature
No full textAccording to current treatment standards, patients with metastatic breast cancer at diagnosis receive palliative therapy. Local treatment of the breast is only recommended if the primary tumor is symptomatic. Recent studies suggest that surgical removal of the primary tumor has a favorable impact on the prognosis of patients with primary metastatic breast cancer. We performed a systematic review of the literature to weigh the evidence for and against breast surgery in this patient group. Ten retrospective studies were found in which the use of breast surgery in primary metastatic breast cancer and its impact on survival was examined. The hazard ratios of the studies were pooled to provide an estimate of the overall effect of surgery, and the results and conclusions of the studies were analyzed. A crude analysis, without adjustment for potential confounders, showed that surgical removal of the breast lesion in stage-IV disease was associated with a significantly higher overall survival rate in seven of the ten studies, and a trend toward a better survival in the three remaining studies. Surgery of the primary tumor appeared to be an independent factor for an improved survival in the multivariate analyses from the individual studies, with hazard ratios ranging from 0.47 to 0.71. The pooled hazard ratio for overall mortality was 0.65 (95% CI 0.59-0.72) in favor of the patients undergoing surgery. This systematic review of the literature suggests that surgery of the primary breast tumor in patients with stage-IV disease at initial presentation does have a positive impact on survival. In order to provide a definite answer on whether local tumor control in patients with primary metastatic disease improves survival, a randomized controlled trial comparing systemic therapy with and without breast surgery is needed
Fulminant Acute Pancreatitis and Infected Necrosis: Results of Open Management of the Abdomen and “planned” Reoperations
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