Journal of Surgery

Because of rarity and clinical challenges arising from different anatomic location, our understanding of optimal management of mucosal melanoma remains limited. The most common sites for primary mucosal melanoma are head and neck followed by anorectal, and vulvovaginal regions. Data are limited but improved understanding has led to change in management from more radical excision to conservative surgery with negative margins. We try to summarize available evidences for management this uncommonly described entity.

In this modern era, the major aims of most of the GI surgeons have been a minimal invasive approach towards surgery, thereby reducing the various complications associated with the surgery. Till now open appendectomy has been practiced a lot for the treatment of acute appendicitis. The 3port laparoscopic approach is widely used and now considered as a gold standard treatment for acute appendicitis currently the 3-port laparoscopic appendectomy. In recent years, laparoendoscopic single site surgery (LESS) has become a major focus of study, with even difficult procedures achieved using this technique, which uses a single port, rather than the traditional 3-ports for the removal of the diseased appendix laparoscopically known as Single Incision Laparoscopic Appendectomy (SILA). This is a comparatively minimal approach towards surgery as minimal invasive surgery. Therefore the purpose of this review is to compare the outcomes of SILA versus traditional 3-port laparoscopic appendectomy and hence giving an idea of whether SILA is an alternative to replace the traditional approach as the new treatment of choice in coming future.

The hungry bone syndrome is considered in literature as being a complication following parathyroidectomy and it refers to the rapidly installed, severe, prolonged, and in most cases clinically manifested hypocalcaemia, which is sometimes accompanied by hypophosphatemia and hypomagnesemia. It appears due to the rapid demineralization of the dystrophic bone as a result of the sudden drop in the seric level of the parathyroid hormone. The prevalence of this complication is reported in literature with different variations, the number reported ranging from 4-95% depending on the type of affection - i.e. primary hyperparathyroidism or renal secondary hyperparathyroidism, but also on the geographical areas where the respective reports have been filled. The high preoperatory level of calcaemia, seric parathyroid hormone and alkalyne phophatase correlate statistically with the risk of postoperatory hungry bone syndrome appearance; the elderly patients present a higher risk for this complication, increasingly because this category of patients is oftenly associated with D hypovitaminosis and insufficient intake of nutritional calcium. The syndrome semiology is one of a hypocalcaemia and the curative treatment is initially a symptomatic one of fighting the severe postparathyroidectomy hypocalcaemia and only later a patogenic one, aiming to remineralize the distrofic bone. The purpose of this review is to describe the main epidemiologic, physiopathologic and clinical aspects of hungry bone syndrome but also of presenting prevention and treatment methods for this complication of parathyroidectomy.

Endometriosis is categorized as one of the chronic benign gynecologic diseases, which causes pelvic pain and infertility, affecting almost 10% of reproductive-age women. Deeply infiltrating endometriosis (DIE) is a specific entity of endometriosis, responsible for painful symptoms, which are related to the anatomic location of the lesions. In this paper, we aim to review the current literature regarding the post-surgery quality of life improvement for DIE. Irrespective of its low sensitivity and specificity, vaginal examination and evaluation of specific symptoms should be emphasized as a basic diagnostic tool in detecting endometriosis. This will help in planning further DIE related therapeutic interventions. Out of several, transvaginal ultrasound (TVUS) has been reported as one of the widely used and excellent tools to diagnose DIE lesions in different locations (rectovaginal septum, retrocervical and paracervical areas, rectum and sigmoid and vesical wall).

Introduction: Mastectomy has well-known effects on both physical health status of the patients as well as on their mental life (self-image, daily activities, social integration, lifestyle, etc.). The aim of this study was to identify the physical and psychological factors associated with post-mastectomy distress.
Material and Methods: Thirty-one women aged 39 to 69 years old (mean age 57 +/- 7.85 years old) who underwent surgery for tumour excision responded to questionnaires on their current physical and psychological well-being following surgery. 83.33% of the patients underwent mastectomy, 10% lumpectomy, and 6.67% both interventions. Age at the time of surgery ranged from 33 to 67 years old (mean 48.30 +/- 7.54). Fifty percent of the patients had no family cancer history, 30% had a family cancer history, and 16.67% were not aware of their family antecedents.
Results: Over half of the women were satisfied with their arm and trunk mobility and the ability to perform strenuous or prolonged exercise; 60% of patients were satisfied and very satisfied with the postoperative scar. 78.56% feel comfortable when making short trips (weekend). A higher depression score was identified in patients who received chemotherapy compared to those who received hormonotherapy, radiation therapy or targeted therapy.
Conclusions: The quality of life of mastectomized patients is influenced by the level of satisfaction with body image, perceived physical state, and independence in activities of daily living, and type of therapy. The age at the time of surgery, time passed since surgery or educational level, had no influence on the quality of life.

Ileosigmoid knot, also known as compound volvulus, is an unusual and a rare cause of intestinal obstruction. We are reporting a case of ileosigmoid knot in a 25-year-old male, who presented with features of acute intestinal obstruction, peritonitis and hypovolemic shock. On immediate exploration after resuscitation, we found minimal haemorrhagic intraperitoneal fluid and gangrenous total colon, gangrenous distal ileal loop twisted around the base of the gangrenous sigmoid loop. Total colectomy with distal ilectomy (50 cms), Hartmann’s procedure with end ileostomy was done. After 3 months we performed ileorectal anastomosis.

Gastric metastases from primary renal cell carcinoma (RCC) are uncommon, but not as rare as once thought. These metastases frequently present with upper gastrointestinal (UGI) bleeding. We report two such cases, and utilising lessons learnt from them, and from a literature review, propose a model of treatment for UGI bleeding secondary to metastases from RCC primaries. Both patients presented with clinically significant UGI bleeding secondary to RCC metastasis to the stomach. A literature search was conducted and a qualitative review of the published case reports and studies were undertaken. The two cases were discussed in a multi-disciplinary setting to plan management. One patient underwent gastric wedge resection; the second patient received palliative radiotherapy. Cessation of bleeding was achieved in both cases. A total of 48 cases were identified from the literature search. The reports indicate that surgery for gastric metastases has favourable outcomes in patients who do not have concurrent metastases. Palliative radiotherapy in this setting has not previously been described. A model of how these patients could be managed was subsequently constructed; the key question to answer is how disseminated the disease is. Treatment modalities are still debated and should be discussed on a case-by-case basis. However, the literature suggests that surgical intervention has good therapeutic and prognostic benefit in patients with isolated metastatic disease to the stomach. For those with widespread metastases, there are several management options available. We advise that radiotherapy should also be considered as an option in the management of patients with bleeding lesions and concurrent metastatic disease.

The incidence of retained foreign body deep in the maxillofacial region has increased greatly in recent years. Retained foreign bodies following a penetrating trauma may pose a diagnostic difficulty for an Oral and Maxillofacial surgeons. The case of XR-negative impacted foreign body located deep in the infratemporal region is described. The operation was carried out under local anesthesia and impacted by foreign body (plastic pen cap) was found by deep finger palpation, grasped with a hemostat and retrieved out successfully.

Gastric cancer associated with pregnancy is quite rare, and it is often diagnosed late due to misinterpretation of clinic presentations as pregnancy-related digestive symptoms. Most pregnancy-associated gastric cancer is often at its advanced stage at the time of diagnosis. The difficulties in the early diagnosis of gastric cancer in pregnant women deter timely surgical treatment for the disease. We reviewed the existing literature using the key words “pregnancy” and “gastric cancer”. 65 cases, including 62 cases reported previously in China and 3 cases that we report here, were accumulated. The analysis of these and other 29 cases from Japan revealed that the pathology of such kind of tumor mostly were poorly differentiated diffuse carcinomas. Some further examinations should be conducted timely on the pregnant patients with persistent gastrointestinal symptoms for the differential diagnosis of hyperemesis gravidarum. As soon as gastric cancer was diagnosed, a therapeutic plan should be promptly made by obstetric and gastric cancer specialists.

Introduction: Incisional abdominal hernias develop up to 11.5 % of laparotomy incisions. The most difficult to repair are hernias with significant loss of domain. The basic principle of treating abdominal incisional hernia entails restoring the anatomical and physiological integrity of the wall. Ideally, thisinvolves the use of local musculo-aponeurotic tissue with a good blood supply and innervations. In the case of large defects, it is necessary to use alloplastic materials in order to reduce the tension load on the suture itself. Emergency surgery is indicated especially in the case of intestinal obstruction or strangulation.

Presentation of Case: The present report describes the case of emergency surgical treatment of intestinal obstruction in large abdominal incisional hernia by 77-year old man. We used reposition and onlay technique with with biodegradable mesh to repair the abdominal wall.

Discussion: Emergency surgery for bowel obstruction primarily aims to resolve bowel obstruction and restore intestinal viability. In this case we present that techniques without bowel resection or stoma are safer as the other. Large hernias with loss of domain can be repaired only by an open method and the onlay method is the simplest and most versatile technique in this case.

Conlusions: Emergency surgery in incisional hearnias is a challenging surgical problem due to risk of the preoperative and postoperative complications. Team involving general and plastic surgeons and anaesthetist is required.

Hydatidosis is a zoonosis produced by the larval stage of Echinococcus granulosus, with an endemic distribution, mainly in the rural areas. Frequently it is localized in the liver (60%) or in the lungs (30%), with most of the patients being asymptomatic. The positive diagnosis is based on ultrasonography, CT or MRI scans, as well as immunological studies (ELISA). The management of hydatidosis includes medical treatment with Albendazole in association with surgical treatment, which may be achieved by open surgery or laparoscopic approach. We present the case of a 5 year-old patient, who was admitted to hospital for recurrent episodes of epistaxis, shortness of breath and abdominal fullness and was diagnosed with hepatic and pulmonary hydatidosis. We decided to perform a laparoscopic Lagrot pericystectomy and postoperative medical treatment with Albendazole, with favorable outcome.