Abstract: While small gastric trichobezoars may be removed via gastroscopy, large trichobezoars require surgical removal by gastrotomy through abdominal incision. We present a case of a successful minilaparotomy removal of a giant (2500-g) gastric trichobezoar in a 15-year-old girl with marginal psychological disturbances.
Abstract: BACKGROUND: The last decades have been characterized by a rapid growth in minimally invasive techniques for acute and chronic cholecystitis. The aim of our study was to analyze 10 years of experience with the mini-laparotomy cholecystectomy. METHODS: From 1994 to 2004, we performed 2295 mini-laparotomy cholecystectomies, including 1028 patients with acute and 1267 patients with chronic cholecystitis. There were 1780 women and 515 men. We utilized a special surgical tool kit with a system of circular and small hook-retractors incorporating an illuminator and long surgical instruments. Our surgical approach was carried out using a 3-5 cm longitudinal incision located immediately above the gallbladder with a muscle splitting technique. RESULTS: The mean time of operation was 64.5+/-24.5 min and the conversion rate was 3.7%. Intraoperative complications occurred in 25 cases (1.1%), including 4 cases (0.17%) of biliary tract injury. Cholecystectomy was combined with intervention on the choledochus and the papilla of Vater in 133 patients with choledocholithiasis. Postoperative complications developed in 4.1%. Five hundred and five patients (22%) required opioid analgesics on the first postoperative day. The mortality rate was 0.17%. The mortalities involved patients who had severe concomitant diseases and required urgent surgery for acute cholecystitis. Patients operated for acute cholecystitis had significantly higher rates of postoperative complications (5.8% vs. 2.8%), need for opioids (25.5% vs. 19.2%) and mortality (0.39% vs. 0%). CONCLUSIONS: Mini-laparotomy cholecystectomy is an alternative to laparoscopic approach in the surgical treatment of acute and chronic cholecystitis.
Abstract: BACKGROUND: Laparoscopic adrenalectomy is an excellent alternative to open surgery, while there are doubts in regard to laparoscopic treatment of pheochromocytoma due to its unsteady intraoperative hemodynamics. The goal of the study was to define optimal surgical approach to pheochromocytoma. METHODS: A total of 99 patients with pheochromocytoma were operated from 1990 to 2002. Nine, 28, 40, and 22 patients were operated respectively through laparoscopic (group 1), thoracophrenotomic (group 2), lumbotomic (group 3), and laparotomic (group 4) approaches. Intraoperative parameters including those related with hemodynamic stability were studied. Postoperative analgesic medication, complications, and hospital stay were registered. RESULTS: Mean operative time was 132 +/- 49 min, 104 +/- 29 min, 81 +/- 30 min, and 129 +/- 40 min, respectively, in groups 1, 2, 3, and 4. Thoracophrenotomic approach had a minimal time from starting of adrenal dissection to central adrenal vein crossing on the right side and lumbotomic approach on the left side. Laparoscopy showed longest length of that period on both sides. However, we observed more stable intraoperative dynamics during laparoscopic adrenalectomy in comparison with any traditional open approaches on both sides. Mean blood loss was 178 +/- 112 ml, 410 +/- 255 ml, 314 +/- 163 ml, and 420 +/- 398 ml, respectively, in groups 1, 2, 3, and 4. Blood transfusions were required in 0%, 35.7%, 20%, and 13.6% of cases, respectively, in groups 1, 2, 3, and 4. Using laparoscopic approach resulted in significant decrease of prescription of opoids, postoperative hospital stay, and rate of postoperative complications. Among traditional approaches lumbotomy presented better postoperative results due to its less invasive nature. CONCLUSION: Laparoscopy is a method of choice to pheochromocytoma in experienced hands. Open approaches are still feasible. Among traditional approaches lumbotomy should be preferred. Thoracophrenotomy can be justified only for major tumors on the right side. Laparotomy is indicated in selected cases of extraadrenal pheochromocytoma.
Abstract: Manifestations of pheochromocytoma have some specific features in children. The aim of this study was to explore epidemiologic differences of the disease course in children and adults, the principal causes of pheochromocytoma recurrence, and the optimal extent of an operative intervention in a group of patients with initial manifestation of their tumor during childhood. A total of 520 patients with pheochromocytoma underwent surgery from 1957 to 2001. The mean age of the patients was 39.3 +/- 9.2 years; 50 patients (9.6%) were 16 years or under (children's group). There were 213 males (41%) in the general group and 32 males (62%) in the children's group. Bilateral adrenal lesions were present in 68 patients (13.1%), including 16 of the 50 children (32%). The tumors were extraadrenal in 36 patients (6.9%), including 9 of the 50 children (18%). The combination of pheochromocytoma and a hereditary syndrome was present in 36 cases (6.9%). Follow-up was obtained in 260 patients, including 46 children. Length of follow-up varied from 4 to 25 years (average 8.4 +/- 1.9 years). The pheochromocytoma recurred in 49 patients (18.8% of surveyed patients), with a true recurrence (a tumor in the region of the primary operation or metastases) in 16 patients (6.15%). A true pheochromocytoma recurrence was noted in 6 of the 50 children (12.0%). Organ-sparing tactics for multicentric adrenal lesions was a principal cause of the true recurrence. Therefore we believe it is necessary to perform a radical operation, which includes adrenalectomy and removal of the tumor, in patients with a high risk of recurrence.
Abstract: Motivations to writing scientific medical articles are outlined as well as types of medical publications and requirements to a good article. Market of medical papers is analysed and algorithm of search for a journal for sending publication is presented. Correlations between medical practice and science, training of personnel and co-authorship are considered.
Abstract: BACKGROUND: Laparoscopic adrenalectomy is a promising alternative to open surgery although concerns exist in regard to laparoscopic treatment of pheocromocytoma. This report compares the outcome of laparoscopic and conventional (open) resection for pheocromocytoma particular in regard to intraoperative hemodynamic stability and postoperative patient comfort. METHODS: Seven patients laparoscopically treated (1997-2000) and nine patients treated by open resection (1990-1996) at the National Hospital (Rikshospitalet), Oslo. Peroperative hemodynamic stability including need of vasoactive drugs was studied. Postoperative analgesic medication, complications and hospital stay were recorded. RESULTS: No laparoscopic resections were converted to open procedure. Patients laparoscopically treated had fewer hypertensive episodes (median 1 vs. 2) and less need of vasoactive drugs peroperatively than patients conventionally operated. There was no difference in operative time between the two groups (median 110 min vs. 125 min for adrenal pheochromocytoma and 235 vs. 210 min for paraganglioma). Postoperative need of analgesic medication (1 vs. 9 patients) and hospital stay (median 3 vs. 6 days) were significantly reduced in patients laparoscopically operated compared to patients treated by the open technique. CONCLUSION: Surgery for pheochromocytoma can be performed laparoscopically with a safety comparable to open resection. However, improved hemodynamic stability peroperatively and less need of postoperative analgesics favour the laparoscopic approach. In experienced hands the laparoscopic technique is concluded to be the method of choice also for pheocromocytoma.
Abstract: BACKGROUND: Laparoscopic adrenalectomy is safe and effective for small adrenal tumors, but its role for large adrenal tumors and the influence of tumor size on the outcome of laparoscopic adrenalectomy have been questioned. PATIENTS AND METHODS: Thirty-one patients with unilateral adrenal tumors operated on between January 1997 and April 2000 were selected for this study. The indications for surgery were Conn's adenoma in 16 patients, pheochromocytoma in 7 patients, Cushing's adenoma in 4 patients, and incidental lesions in 4 patients. The patients were divided in two groups: 19 patients with tumors <3.5 cm (Group I) and 12 patients with tumors > or = 3.5 cm (Group II). The outcomes of the two groups were compared. RESULTS: None of the laparoscopic procedures was converted to open surgery. The tumor size correlated with operative time (r = 0.434; P = 0.015) and blood loss (r = 0.513; P = 0.003), with both being significantly greater for larger tumors. No patient required a blood transfusion during or after surgery. One preoperative complication occurred in Group I. There was no peroperative complication in Group II. The median postoperative hospital stay and opioid requirement did not differ significantly between the groups. One patient in Group I developed pneumonia, while no postoperative complications were recorded in Group II. CONCLUSION: Surgery for large adrenal tumors can safely be performed laparoscopically with outcomes comparable to those of surgery for small tumors.
