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Biomedical subjects

O Bălă

Publications and source records attributed to O Bălă.

7 recordsLinked to original sources
PubMedDate not supplied

[Laparoscopic cholecystectomy: incidents and complications. Analysis of 8002 consecutive cholecystectomies performed at the Surgical Clinic III Cluj-Napoca].

Incidents and postoperative complications of laparoscopic cholecystectomy (LC) are analyzed based on a series of 8002 patients who underwent the procedure during a period of seven years. Conversion rate was 2.02% (161 cases) and 6 (0.07%) death were encountered. Intraoperative hemorrhage (2.43%) could be controlled by intraoperative haemostasis in all but 8 patients (bleeding from the hepatic bed and from the cystic artery) which required conversion. Lesions of the bile ducts occurred in 16 patients (0.2%), 13 of them being identified during the operation and solved by conversion or laparoscopic choledochorraphy (for a tangential lesion). Postoperative complications required re-intervention in 45 patients: 11 for bile leak, 19 for choleperitoneum, 6 for hemorrhage, 4 for subhepatic abscesses and 5 for remnant CBD lithiasis. There was 1 puncture of the Douglas pouch in a case of choleperitoneum, 7 laparoscopic re-interventions and 25 open surgery re-interventions. EST solved postoperative bile leaks (from the gallbladder bed) successfully in 7 cases and remnant CBD lithiasis (5 cases). So, 44% of the cases were treated by minimally invasive means (laparoscopic re-interventions or endoscopic procedures). The majority of the incidents and postoperative complications were linked to the presence of an acute cholecystitis and were partially due to some technical limits of the laparoscopic technique of the gallbladder bed peritonisation. The minimally invasive treatment of postoperative complications, was very efficient and offered optimum healing conditions.

Adult↗
PubMedDate not supplied

[Minimally invasive treatment of common bile duct calculi].

UNLABELLED: Miniinvasive treatment of lithiasis of the common bile duct hasn't reached yet a standard end point. There are multiple techniques used for it. In this study we evaluate its indications, possibilities and limits. MATERIAL AND METHOD: In a series of 14,024 biliary patients operated over 9 years 719 patients underwent open choledocolithotomy. In 173 (1.2%) of patients we used miniinvasive procedures as follows: 71 cases underwent sequential treatment, 91 laparoscopic treatment and in 11 cases the remnant calculi were extracted 1-6 days postoperative. RESULTS: Sequential treatment was the preferred treatment when the lithiasis of the common bile duct was detected preoperative. Transcistic extraction was more often performed for the lithiasis diagnosed intraoperative. The conversion to open surgery was performed in 13 cases, remnant calculi were early diagnosed in 11 patients and late diagnosed in 14 cases (the calculi were extracted by endoscopic sphyncterotomy). All patients were healed. DISCUSSIONS: The miniinvasive procedures have to be practiced as frequently as possible because of rapid healing and early recovery of the patients, despite some disadvantage of them. The choledocotomy and choledocoduodenostomy are exceptional techniques to be used in specific cases.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

[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↗
PubMedDate not supplied

[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↗
PubMedDate not supplied

[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↗
PubMedDate not supplied

[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↗