[The Roux loop in modern digestive surgery. The experience of the Clinica de Chirurgie III Cluj-Napoca over a 6-year period (1985-1990)].
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Anastomosis, Roux-en-Y↗
Biomedical subjects
F Pop
Publications and source records attributed to F Pop.
[Late reinterventions after the surgical treatment of gastric and duodenal ulcer].
A number of 87 reinterventions performed during a 5-year-period for late complications of the gastric and duodenal ulcer surgery are analysed. In most of them (64 cases), the cause of the reintervention was a postoperative ulcer. A long afferent loop (6 cases), the dumping syndrome (4 cases), the stenosis of the anastomosis opening (6 cases) and the primitive neoplasm of the gastric stump (7 cases) represented other causes of reintervention. The immediate postoperative results were very good and good in 69 cases. The risks related to the specific character of this surgery materialized themselves in 14 postoperative complications (anastomotic fistulas, haemorrhages from the anastomosis, stress ulcers etc.), which required iterative operations; the postoperative death rate attained 3.4%. The analysis of these postgastrectomy syndromes is an opportunity to discuss about the failure factors in the surgery of the gastric and duodenal ulcer, the possibilities of exploration and the principles which should guide the reparative therapy.
Adult↗
[Analysis of various gastric carcinoma classification systems, through the prism of a study performed at Craiova IV surgery clinic].
INTRODUCTION: The aim of this work is to analyze the various gastric carcinoma classification systems, trying, at the same time, to establish connections between the anatomopathologic evolutionary and prognostic aspects. CASE MATERIAL AND METHODS: The study was performed on a series of 66 patients who undergone excision surgery for gastric carcinoma. The study material are 31 cases of gastric cancer diagnosed in Clinical Hospital CFR Craiova, and another 35 cases diagnosed at the "I.V. Babeş" Pathology and Medical Genetics Institute in Bucharest. The excised pieces underwent anatomopathological investigation using histopathological, histochemical and immunohistochemical methods. RESULTS: From the macroscopic point of view, the most common tumor pattern was Bormann 2 ulcerovegetative, targeting patients over 60 years of age. In what the invasion level is concerned, most carcinomas were sanctioned at the time when the tumor was invading the serous fluid (pT3) or even the perigastric tissue (pT4). The microscopic criteria was approached by us using Goseky's method, the most common being Goseky stages 2 and 4, in equal rations. The distribution of cases depending on the OMS differentiation degree, shows a preeminence of low differentiated carcinomas (G3). CONCLUSIONS: The abundance of classification methods in gastric cancer shows the complexity of the matter but none of the classifications is perfect.
Carcinoma↗
[Pancreatic pseudocyst--diagnosis, evolution, surgical treatment].
BACKGROUND: The pancreatic pseudocyst (PP) represents one of the most common complications of acute and chronic pancreatitis, patients with this severe pathology often undergoing surgical treatment. PATIENTS AND METHOD: This paper evaluates 133 cases that underwent surgical procedures for PP in the 3rd Surgical Clinic Cluj-Napoca during January 1993-April 2003, from a diagnostic and therapeutic point of view, emphasizing the modern imagistic methods for diagnosis and the modern surgical approach to PP. RESULTS: In 105 cases (79%) an internal drainage procedure was performed (including three cases that underwent laparoscopic drainage procedures and one case undergoing a laparoscopy assisted drainage procedure, all four cases with favorable postoperative outcome), external drainage procedures were performed in 25 cases (19%) and in three cases (2%) a pancreatic resection was performed. External drainage was performed only when internal drainage was not possible. Postoperative complications occurred only in patients with externally drained PP. DISCUSSION: The results of this study confirm that the internal drainage of PP, especially using the limb of jejunum Roux-en-Y technique (67 cases, 50%), represents the best approach to PP surgery, laparoscopic procedures being a valid option in performing an internal drainage.
Adult↗
[Laparoscopic pseudocysto-jejunostomy].
Laparoscopic surgery of the pancreas, acquisition of the recent years, finds application in the surgical management of pancreatic pseudocysts (PP). Among internal drainage procedures that can be performed through laparoscopic approach, the pseudocysto-jejunostomy technique (PJS) can be performed using only the standard laparoscopic instrument set. We submit the technique we used in performing a PJS on three patients admitted in our clinic. The postoperative outcome was favorable, having obtained identical results to those of the open approach. The mean duration of the interventions was 216.6 minutes. The mean postoperative hospitalization was 7 days. The laparoscopic approach allows internal drainage of PP in the form of PJS to be performed in good circumstances, also bringing about all the specific benefits of this type of surgery.
Adult↗
[Hepatic hydatid cyst ruptured in the peritoneum].
Romania is an endemic region for hydatid cyst and has a high incidence of hepatic hydatid cysts. If the intrabiliary rupture is the most frequent complication encountered, rupture in the peritoneum is rare, with exact data not available. Between 1993-2002 160 patients with hepatic hydatid cysts were operated. Six of them had an intraperitoneal ruptured cyst. Ultrasound raised the suspicion of hepatic hydatid cyst ruptured in the peritoneum in 4 cases, in one case the intact cyst migrated in the lower abdomen were it was mistaken for an ovarian cyst. After a thorough lavage with hypertonic serum, the parasite was evacuated, the pericyst partially removed and the cavity collapsed with non-absorbable sutures. The postoperative course was uneventful. Prophylaxis with benzimidazolic drugs started days 2-3 PO. At a follow-up between 1-4 years no peritoneal hydatidosis was detected. In the intraperitoneal ruptured hydatid cyst the hypertonic serum and benzimidazolic drugs can be useful in preventing peritoneal seedings.
Echinococcosis, Hepatic↗
[Laparoscopic cholecystectomy for porcelain gallbladder].
The porcelain gallbladder is uncommon type of chronically inflamed gallbladder wall considered to be associated with a high frequency of adenocarcinoma and subsequently not suitable for a laparoscopic approach. In 12,000 patients chosen for a laparoscopic cholecystectomy 4 porcelain gallbladders were diagnosed. In 2 cases the laparoscopic approach was successful. One conversion was due to an unconfirmed suspicion of gallbladder cancer and the other one to a fistula between the gallbladder and the common bile duct. Patients with a preoperative diagnosis of porcelain gallbladder must not be excluded from the laparoscopic approach yet a low threshold for conversion must be maintained in those with a cancer suspicion.
Adenocarcinoma↗
[A possible protocol for postoperative management in laparoscopic cholecystectomy].
The goal of the "Prospect" programme (sponsored by Pfizer) is to create possible evidence-based protocols related to the management of postoperative pain after certain type of surgical intervention (e.g. hernia repairs, hysterectomies, etc.). This article is introducing the protocol for laparoscopic cholecystectomy for both day-case and longer hospital admission cases. The protocol is designed for preoperative, intra and postoperative period, choosing only those measures which were effective for postoperative pain, published in the literature. We are also presenting an analyze of our 13,000 laparoscopic cholecystectomies, from "Prospect" protocol point of view, and what we should do to improve the management of postoperative pain.
Analgesics↗
[Helicobacter pylori: identification and correlation between its presence and the histological modification of the mucous membrane in the course of duodenal ulcer and chronic gastritis].
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Adolescent↗
[Sandostatin treatment in postoperative external digestive fistulae].
The aim of the conservative treatment of postoperative external digestive fistulae is to obtain a reduction of the output, thus favoring spontaneous closure and shortening outcome. A retrospective comparative study has been performed on two groups of patients with postoperative anastomotic gastrointestinal and pancreatic fistulae. Group A included 18 cases (14 anastomotic, 4 pancreatic fistulae) receiving conventional treatment only. Group B included 25 cases (18 anastomotic and 7 pancreatic fistulae) in which Sandostatin was associated to conventional therapy, using daily doses ranging from 0.1 mg to 0.3 mg, administered after variable intervals after fistulas' occurrence. Duration of treatment ranged from 1 to 25 days. In group A, 27.77% of the cases were cured in comparison with group B in which the healing rate increased to 56%. Global hospital mortality rate was 25.58% (11 cases). In group A this was 44.44% (8 cases) in comparison with group B with 12% (3 cases) only. As a conclusion of our study, the use of Sandostatin is remarkable effective in the treatment of external digestive postoperative fistulae. Thus a doubling of healing rate and a reduction by 73% of mortality rate was achieved.
Cutaneous Fistula↗