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E Bobocescu

Publications and source records attributed to E Bobocescu.

18 recordsLinked to original sources
PubMed1999

Elective laparoscopic sigmoid colectomy for diverticulitis. Results of a prospective study.

BACKGROUND: We undertook a prospective evaluation of elective laparoscopic sigmoid colectomy for diverticulitis in order to assess the risks and benefits of this approach. METHODS: Between November 1992 and November 1996, 54 consecutive patients were included in this study. Their mean age was 59 +/- 13 years (range, 36-81). The number of attacks of diverticulitis before colectomy ranged from one to four (mean, 2.2 +/- 0.7). The operative technique consisted of elective division of the inferior mesenteric vessels, left colonic flexure mobilization, and colorectal anastomosis using the cross-stapling technique. RESULTS: Five procedures (9.2%) were converted. The primary cause for conversion was obesity. These patients had a simple postoperative course. There were no postoperative deaths. Three patients (6.1%) developed abdominal complications, and four patients (8.2%) had abdominal wall complications. Postoperative paralytic ileus lasted only 2.3 +/- 0.7 days (range, 1-6), allowing for a rapid reintroduction of regular diet. The mean postoperative hospital stay was 6.4 +/- 2.7 days (range, 4-15). CONCLUSIONS: Elective laparoscopic colectomy for diverticulitis is feasible in most cases. In most cases, the operative risk is low and the postoperative course is uneventful. Elective sigmoid laparoscopic colectomy should be considered a good therapeutic option for symptomatic diverticulitis.

Adult↗
PubMed1998

[Results of laparoscopic treatment of abdominal emergencies].

The purpose of this retrospective study was to evaluate the results of the laparoscopic surgical treatment of abdominal emergencies. From May 1991 to September 1995, 200 patients operated by laparoscopy for an acute abdomen were included in this study. The decision to treat the patient by laparoscopy was taken by the surgeon on duty. There were 101 males and 99 females with a mean age of 41 +/- 20 years (range 11-90 years). The main indications for operation were: acute appendicitis (109 patients), acute cholecystitis (52 patients), small bowel obstruction (14 patients) and perforated duodenal ulcer (14 patients). There was no hospital mortality. One per cent of patients experienced an operative complication which was treated by laparotomy. Conversion to laparotomy was needed in 13% of cases. The morbidity rate was 9% and reoperation by laparotomy for acute generalized peritonitis secondary to small bowel perforation was necessary in two cases. Mean postoperative hospital stay ranged from 4 to 7 days. The authors conclude that surgical laparoscopic treatment of the common abdominal emergencies is safe. The conversion rate is low as is the complication rate. These conclusions should be confirmed by a prospective study.

Abdomen, Acute↗
PubMed1996

[Laparoscopic colectomy: technique and results].

Laparoscopic preparation before colectomy consists of freeing the colon laparoscopically followed by a small elective laparotomy for resection and anastomosis. From January 1993 to October 1994, we performed 86 consecutive planned colectomies including 16 (19%) which had laparoscopic preparation. In 3 of these cases (19%) the procedure was converted to laparotomy due to difficult dissection. The 13 patients with complete laparoscopically prepared colectomy were retained for this study. There were 9 men and 4 women, mean age 54 +/- 14 years (range 34-79). Indications for surgery were benign tumor (n = 4), metastatic cancer (n = 3), diverticulosis (n = 3), volvulus of the pelvic colon (n = 2), and endometriosis involving the sigmoid (n = 1). Operative procedures were: short segmentary colectomy (n = 6), sigmoidectomy (n = 5), right colectomy (n = 2). Surgery duration was 280 +/- 75 minutes (range 150-390). The post-operative period was uneventful in all patients. Bowel activity resumed on the second day after surgery in most patients. Mean hospitalization time was 7.4 +/- 1.4 days (range 5-10 days). Laparoscopically prepared colectomy is a reliable simple method providing good patient comfort post-operatively. This technique should find its place in surgery of the colon.

Adult↗
PubMedDate not supplied

[Current problems of surgical tactics and technics in gastric neoplasms].

The authors have investigated 413 cases with gastric neoplasms that have been operated over a period of 20 years. It was noted that the operability index, and the resectability index have not improved in time. Only in 39,3 percent of the patients subtotal gastrectomy was possible, while 12,1 percent underwent total gastrectomy, 6,2 percent palliative interventions, and the remaining 42,4 percent had only exploratory laparotomy. The authors conclude that the principle of exeresis within the limits of oncological security applies only to limited tumours, without extraparietal extension. The maintenance of a gastric sector, either in the para-cardial or in the juxta-pyloric area, depending on the location of the tumour, is almost always possible, providing a good-quality anastomosis without diminishing the oncologic characteristics of the intervention.

Adult↗
PubMedDate not supplied

[Surgery of operative lesions of the principal biliary passages].

The authors present their experience acquired in 30 cases of surgical interventions performed for the correction of accidental lesions of the main biliary pathway. The essential parameters are discussed in this paper, which determine the degree of difficulty of the corrective interventions. Indications are also discussed concerning tactical and technical aspects depending on the level of the lesion, as well as in relation with its type. The authors present some particular aspects of prostheses used in the derivations which they have made with a corrective purpose.

Adult↗
PubMedDate not supplied

[Particular operations in surgery of gastric ulcer under the protection of vagotomy].

There are particular situations in the frame of the surgery of gastric ulcers, when the use of classical techniques--such as extensive resections, or sub-total resections--represents a risk factor and raising doubts about the vital prognosis of the patient (dehiscence, fistula, etc.). This is especially true for highplaced lesions, the removal of which supposes either an upper polar resection, or an almost total gastrectomy. This raises some problems with suture which are doubtful, as well as the risk of the "small stomach" syndrome or the risk of accelerated evacuation. The authors suggest several possibilities for the surgery of gastric ulcers under the protection of vagotomy, which allow a good immediate and late evolution. These include the medio-gastric resection, the so-called "saddle" resection, and the excision-suture resection, all being carried out under the protection of vagotomy associated to piloro-plastia. Making use of these procedures the authors have been able to maintain a more conservative attitude with regard to the stomach pouch, and to avoid some of the sequellae of the operated stomach.

Gastrectomy↗
PubMedDate not supplied

[Splenic hemangiosarcoma].

The authors present a case of splenic hemangiosarcoma which was encounter-a group including some 600 splenectomies. Hemangiosarcomas represent only 3% of all malignant splenic tumours. This clinical observation is of particular interest because of the extreme rarity of such cases. It is also interesting because of the conditions which have determined the intervention, as well as by the prolonged survival of the patient.

Hemangiosarcoma↗
PubMedDate not supplied

[Decompression of the duodenum, using the extraperitoneal route, in upper digestive tract fistulas].

Over the last 20 years a total of 45 cases with digestive fistulae of various origins have been hospitalized in the Surgery Clinic of the "Caritas" Hospital. In this paper a group of 21 cases with gastro-duodenal and anastomotic fistulae are considered, for the solution of which re-interventions were necessary. The authors present a procedure for temporary decompression of the duodenum, according to an original technique. The method allows to recover the digestive segment involved by healing of the fistulae in satisfactory conditions. The technical simplicity of the procedure is stressed, as well as the possibilities for postoperative radiological control, the strictly extraperitoneal traject of the tube, all representing qualities which give the technique considerable credit.

Adult↗
PubMedDate not supplied

[Oddi's sphincterotomy in treatment of primary sclerous cholangitis].

In the paper are presented a total of 9 patients with primitive sclerous cholangitis that were hospitalized in the Surgical Department of the "Caritas" Hospital with this rare nosologic entity. The etiology of the disease is neither precise nor incontroversial. Primitive sclerous cholangitis raises particularly difficult problems, because of the high mortality rate (all patients die before the 6-th year after the diagnosis has been established. The ineluctable evolution of the disease toward secondary billiary cirrhosis has generated major difficulties in the choice of the treatment. Corticoid therapy and immunosuppressive drugs have been proven inefficient in improving the prognosis. The classical surgical therapy includes methods that are not followed by stable results since the icteric syndrome will show temporary remission, in spite of the fact that the chronic hepatopathy will continue its independent evolution. The authors have not achieved satisfactory results with the classical surgical techniques, which include external biliary draining and peri-hepatic artery neurectomia (either isolated or combined), not with the internal derivations. Since 1971 the authors have used oddian sphincterectomy in the treatment of sclerous cholangitis. The method was introduced following a long clinical and histopathologic study. The immediate and the late results obtained with this technique recommend it as a choice one because it will lead to disappearence of the jaundice and to stabilization of the hepatic lesions.

Adult↗
PubMedDate not supplied

[Gastroesophageal patching with a jejunal loop in subtotal resections of the stomach].

The authors present a technical variant for re-establishing transit following sub-total gastric resections performed for extensive juxta-cardial lesions in which exeresis on the gastric wall also involves the right side of the terminal oesophagus. A "patch" of anastomotic jejunal loop is used in which the right segment of the assembly (the oesophagus and the right side of the gastric portion) does not take a direct part to the formation of the stoma. Two cases of gastric carcinoma are presented in which the extension of the lesions made necessary a strictly oesocardial proximal sectioning. The technique provides a wide stoma, without any risks of oesocardial obstruction. The method can be used in the gastric ulcers that are sited immediately under the cardia, allowing a sub-total resection with extirpation for the lesion. The authors suggest the use of this technique for the lesions high on the small curvature that cannot be extirpated with the classical technique due to the risk of stenosis of the cardial stoma as a result of the preparation of the oeso-cardial assembly. In this way the disadvantages of the exclusion technique introduced by Kelling and Madlener are avoided, as well as the risks of the high polar gastrectomy practiced by the Deloyers technique.

Esophagus↗
PubMedDate not supplied

[Benign gastric tumors. Unusual forms. Therapeutic considerations].

The authors present a study preformed on 38 patients with benign gastric tumours, representing 8.4% of the total number of gastric neoformations. Aspects related to the site of the tumours are discussed, as well as data concerning frequency, clinical and radiologic aspects, histologic characteristics, and the possible relationship with gastric cancers. A series of cases are described, the particularities of which may lead to diagnosis errors, and aspects are discussed in relation to surgical treatment of benign gastric tumours. The authors have mostly performed the excision of the tumours or a limited gastric resection, and obtained good results with this conservative attitude.

Adult↗
PubMedDate not supplied

[A controversial problem: Oddi sphincterotomy in cholangitis].

The classical treatment of angiocholitis consists in desobstruction of the hepatic choledocus duct followed by external biliary drainage. However, this technique is unsuccessful in 66% of the cases, and this leads to difficult surgical reinterventions. In our casuistics are included 196 suppurated angiocholitis of various etiologies : lithiasis, hidatic cyst, post-hidatic angiocholitis, pure oddian angiocholitis etc. The Oddian component is present in a remarkable high number of cases (66%) and this is the reason why neglecting sphincterotomy may be followed by unfavourable results. In the paper the authors present their viewpoint, and the results of 128 interventions on the Oddi sphincter in patients with angiocholitis.

Ampulla of Vater↗