Biomedical subjects

L Alecu

Publications and source records attributed to L Alecu.

13 recordsLinked to original sources

PubMedDate not supplied

[Mechanical suture in colorectal surgery].

THE OBJECT: Of this work was the study of using, as well as the utility of the mechanical sutures in colorectal surgery; because of the special caution needed to be taken for any colonic or rectal suture, more than any other digestive segment. The frequency of the postoperative fistulas after the suture and anastomosis is higher at this level and so it increases the period and costs of the hospitalization. MATERIAL AND METHOD: We studied the possibilities of performing and evolution of 64 mechanical sutures for 19 patients, with colorectal pathology, hospitalized in our department from july 1999 to december 2000. RESULTS: We performed 64 mechanical sutures, as followed: 47 in open surgery and 17 in laparoscopic. From all these, 56 was bowel sutures, 8 of them were vascular (in laparoscopic, for cutting the most important vascular pedicles). We did 18 anastomosis: 15 in open and 3 in laparoscopic surgery. It was 2 postoperative fistulas from all 56 intestinal sutures (3.57%). We haven't any intra or postoperative bleeding from the vascular anastomosis. It was 3 intraoperative bleeding from the intestinal anastomosis, and only 1 case of postoperative bleeding (5.26% of the cases: 1.56% of all mechanical sutures). In only one case, the mechanical suture couldn't be initially done, but it succeeded after the removing of the segment of the bowel involved. CONCLUSIONS: Mechanical sutures offers a high level of safety to the colorectal anastomosis. It provides a very good vascularization to the anastomosis and decreases the time needed for performing the suture or anastomosis, versus manual sature. Also, for the patients with rectal ampular neoplasm, it creates the possibility of anal sphincter preservation by making a low colorectal anastomoses--which is difficult by manual suture.

Adenocarcinoma↗

PubMedDate not supplied

[Intraoperative ultrasonography, dissection with ultra-shears and trans-cystic choledochoscopy during laparoscopic approach in obstructive lithiasis icterus case].

The authors present the case of a 48 years old male with lithiasis obstructive icterus who was operated by laparoscopic transcystic approach with choledochoscopy. This minimally invasive technique was very spectacular trough the using of laparoscopic ultrasonography, dissection with Ultra-Shears device and transcystic choledochoscopy. Careful watching of abdominal laparoscopic view and transcystic choledochoscopic view is the particularity of laparoscopic transcystic management of choledocholithiasis. This metod don't let us to explore the biliary tract before the junction between common bile duct and cystic duct.

Cholecystectomy, Laparoscopic↗

PubMedDate not supplied

[The systematization and the etiopathogenicity of diaphragmatic hernias].

The author, based on up to date published dates, intends to present the classification and ethiopathogeny of the diaphragmatic hernias, except the aesophagic hiatus oms. This is an interesting chapter of the borderline surgery (abdominal and thorax). They are placed on the second position in frequency (after the hiatal hernias) in the diaphragmatic pathology; they are internal hernias, through congenital or obtained holes which allow to abdominal viscera to pass into thorax. They are--in the most cases, even elderly ones-congenital, result of the abnormalities in the embrionary growth of the diaphragm. A special place' is represented by the traumatic hernias.

Hernia, Diaphragmatic↗

PubMedDate not supplied

[Dedifferentiated liposarcoma of the omentum].

The authors present the case of a 56 years old patient, from the surgery department, with the diagnostic: "Tumoral abdominal mass". Ultrasound investigation and CT-scan suspicioned a malignant omental tumor. Intraoperator, we found a tumor with macroscopic malignant features (sarcomatous like), greow in omentum; the large border of the stomach being fixed but not invaded by it; the dorsal parietal peritoneum of the right lumba and the little omentum were involved, too. We removed all of the sarcomatous tumor, large omentum, small omentum and the gastric fixed segment. Also, the parietal dorsal peritoneum with metastasis, was surgically removed. The patient's postoperator evolution was very good. The histological report established the diagnostic: "dedifferentiated liposarcoma of the omentum". We considered the case to be interesting because of the difficulties in diagnostic and the rarity of it.

Diagnosis, Differential↗

PubMedDate not supplied

[Cortico-suprarenal carcinoma].

The authors show the case of a 69 years old male with a large corticosuprarenalian tumor that was detected on an random abdominal echographic examination. The patient was operated in the General Surgery Department. of Prof. Agrippa Ionescu Hospital, Bucharest. We performed ablation of the large left suprarenalian gland malign tumor with left nephrectomy, splenectomy and partial pancreatectomy. The hystopathological examination reveals a diffuse corticosuprenalian carcinoma. The case is interesting because of low incidence of this kind of malign tumor and also of the unusual tumor evolution in a long time up to its large size (12 cm in diameter).

Adrenal Cortex Neoplasms↗

PubMedDate not supplied

[Diagnosis of diaphragmatic hernia].

Diaphragmatic hernias (congenital and traumatic) belongs to thoracoabdominal surgery which is a borderline chapter. Considering frequency, they are on the second place in the diaphragmatic pathology, after hiatal hernias. The author presents the criterias of the clinical examination, based on the bibliographic datas: also by presents the imagistic investigations used for identification of the diaphragmatic hernias, excepting the oesophageal hiatus hernias. There are some particular features appearing in the diagnostical algorithm, too.

Diagnosis, Differential↗

PubMedDate not supplied

[Serous cysts of the spleen treated by laparoscopic surgery].

The authors present two case of a 25 years and 32 years old male patients with serous cysts of spleen that were detected on an random abdominal ultrasonography. Abdominal pain in the left hypocondrium was only symptom of this patients. The patients was operated by laparoscopic method, with Ultra-Shears and intraoperative ultrasonography examination. This kind of techniques give us the opportunity to performed the ablation of the cysts with preservation of the spleen with fast full recovery.

Adult↗

PubMedDate not supplied

[Gastric stromal tumor treated by laparoscopic surgery].

UNLABELLED: The authors describe a 59 years old female patient, with a gastrointestinal stromal tumor located on the posterior wall of the gastric funds, who was treated successfully by laparoscopic wedge resection (with clear resection margins), through an anteriorly placed gastrotomy, thus allowing an endoscopic linear cutter Endo GIA, to excise the tumor with a cuff of normal gastric tissue. The anterior gastrotomy was performed with Ultra-Shears. Delivery of the tumor through the gastrotomy is essential for success. The operative time was 110 minutes. The tumor was diagnosed as a gastrointestinal stromal submucosal tumor (of low-grade malignancy) and immunohistochemicaly, this tumor was positive for CD 34. CONCLUSION: Posterior gastric tumor can be removed using laparoscopic surgery.

Female↗

PubMedDate not supplied

[Intraoperative ultrasonography during laparoscopic surgery].

AIM: Of this study is the introduction and the results evaluation of laparoscopic ultrasonography performed. MATERIAL AND METHOD: We realize a prospective study about laparoscopic ultrasonography performed in 37 cases with laparoscopic surgical treatment. The Aloka SSD 2000 mobile scanner is used. This system make possible the use of an linear-array transducer, with mechanical flexibility and availability of Doppler analysis. Most frequently we used intraoperative ultrasonography in laparoscopic cholecystectomy as an alternative for cholangiography to exclude CBD pathology. Because of various surgical pathology with laparoscopic approach, the laparoscopic ultrasonography utilization range was vastly. RESULTS: In all the cases we could performed the laparoscopic ultrasonography. In 6 of 27 cases with laparoscopic cholecystectomy we found pathological disorders of bile ducts. CBD with diameter found between 5-12 mm. We properly saw the distal segment of CBD in 23 cases (89.2%), and common hepatic duct in 26 cases (97.3%). The quality of visualization was very good in 21 cases (83.8%) and moderate in 6 cases (16.2%). We easy identify CBD stones and we successfully used Doppler color mode in differentiating vascular from non-vascular from non-vascular structures. Laparoscopic ultrasonography performed in a case with left colon cancer excluded liver metastasis and lymph nodes metastasis. CONCLUSIONS: 1. Laparoscopic ultrasonography combines the advantages of diagnostic laparoscopy and intraoperative contact ultrasonography; 2. Laparoscopic ultrasonography is a simple and very efficient intraoperative examination procedure; 3. Laparoscopic ultrasonography is the technique to choose in CBD intraoperative exploration; 4. Laparoscopic ultrasonography improve abdominal malignancy exploration, thus modifying therapeutic decisions; 5. Color Doppler mode guides the surgeon's steps in difficult directions.

Cholelithiasis↗

PubMedDate not supplied

[Mechanical suture in classic and laparoscopic general surgery].

AIM: Of this working is the study of employment the mechanical suture in general surgery classic and laparoscopic. MATERIAL AND METHOD: We analysed the possibility of accomplishment and postoperatory evolution of 104 mechanical sutures performed in 24 patients, with diverse surgery pathology, operated in Department of General Surgery, between January 1999 and January 2000. RESULTS: Mechanical sutures allowed us to minimize the duration of surgical interventions and to perform some difficult anastomotic assembles (sometimes including creation of organ substitute). We had only two postoperatory fistulas and two postoperatory haemorrhages from anastomotic area (both cases because of bad closing of clips, through tissue excess between anvil and cartridge of the stapler). CONCLUSIONS: There are certain advantages in using mechanical sutures (versus manual sutures) consisting in decreasing of time period, both in operation itself and in hospitalization, despite their high level cost.

Diverticulosis, Colonic↗

PubMedDate not supplied

[Laparoscopic choledochoscopy].

AIM: Of this study was to evaluate the treatment of common bile duct stones (CBDS) by laparoscopic choledochoscopy. MATERIAL AND METHOD: Between 1997-2002, 9 patients (with age between 42-75 years) were treated laparoscopic for CBDS: 8 cases with choledocholithiasis; 1 case with pancreatic neoplasm. Laparoscopic choledochoscopy was performed in 7 cases (84.4%). We used the choledochoscope Pentax of 5 mm diameter and with work canal. RESULTS: We performed the CBD exploration with: transcystic approach-1 case; choledochotomy-6 cases. The CBD diameter was between 1.2-1.5 cm. The bile duct stones diameter were between 0.5-1.5 cm. We performed with successfully the laparoscopic choledochoscopy exploration and extraction of CBD stones to all patients. External biliary drainage (transcystic duct and with Kehr-tube) were done systematically. The major complication (choleperitoneum) occurred in 2 cases (28.5%). The occurrence of residual ductal stones was 0. CONCLUSION: The laparoscopic treatment of choledocholithiasis is feasible, safe and efficient.

Adult↗

PubMedDate not supplied

[Consideration regarding 20 antireflux laparoscopic operations for hiatal hernia].

AIM: To evaluate the clinical, therapeutical and evolutive aspects of the patients with hiatal hernia with laparoscopical approach. MATERIALS AND METHODS: Retrospective analysis of 20 patients diagnosed with hiatal hernia and operated, laparoscopical, between 13.01.1999-10.04.2002. RESULTS: At 18 cases (90%), were sliding hiatal hernia and at 2 cases (10%), were paraesophageal hiatal hernia. There were performed laparoscopical: 1 (5%) Dor anterior hemi-fundoplication, 4 (20%) Rosetti fundoplication, 3 (15%) Toupet posterior hemi-fundoplication and 11 (55%) Nissen fundoplication. For the dissection, the ultrasound scissors (Ultra-Shears) was used and for the suture of the both diaphragmatic crus and the wrap, the Endo-Stitch. There were reported 1 (5%) optional conversion and 3 cases (15%) with bleeding solved by clipping and hemostatic suture. No postoperative complications, deaths intra and postoperative were reported. The average duration of the intervention decreased in time, due to the experience, from 180 to 60 minutes, but in accordance with the complexity of the procedure (Nissen-Toupet-Dor). At 2 (10%) cases with Nissen fundoplication was reported a transitory dysphagia, which was remitted between 1-2 months. We noticed a decreasing of the duration of hospitalisation for the antireflux laparoscopical interventions, compared with the classic methodes. CONCLUSIONS: There is a tendency of the laparoscopical approach of hiatal hernia to come the standard in the GERD, due to his minimal invasive character, significantly reducing costs and good postoperative results.

Adult↗

PubMedDate not supplied

[Intraoperative diagnosis of common biliary duct using laparoscopic ultrasonography].

THE AIM: Of the study is to show the advantages and limits of laparoscopic echography in exploration and diagnosis of common biliary duct lithiasis, as it is evidenciated in the experience of our surgical department. MATERIAL AND METHODS: Between 31.03.1997-31.12.2002 we have made 878 laparoscopic interventions to patients with hepatho-biliary pathology. We made a prospective study and performed 116 laparoscopic ultrasonography examinations for exploration of the liver and bile ducts. We used an Aloka SSD 2000 device with a linear laparoscopic flexible transductor. RESULTS: We obtained a very good visualization in 97 cases (83.6%) and medium visualization in 19 cases (16.4%). The medium time of the examination was 10 minutes (variations between 5-20 minutes). We discovered pathological modifications in principal bile duct and cystic using color Doppler examination in acute and chronic inflammatory lesions with important anatomical modifications. CONCLUSIONS: 1. laparoscopic ultrasonography it is an ideal technique in common bile duct lithiasis diagnosis, with 90-98% precision. 2. intraoperative ultrasonography does not need preliminary dissection of cystic and offers the possibility of exploration of the liver and pancreas. 3. it needs a learning curve and collaboration between surgeon and ultrasonography specialist.

Cholecystectomy, Laparoscopic↗