We present three rare entities of mucinous tumors: appendiceal mucinous adenomas, enteroid mucinous cyst and pseudomyxoma peritonei, the latter as a developmental course or separate idiopathic etiology of mucinous tumors. We attempted to clarify the term of pseudomyxoma peritonei, a poorly understood condition, characterized by a diffuse intraperitoneal collection of gelatinous fluid with mucinous tumoral implants on the peritoneal surfaces. With this rare condition it is often difficult to establish the histological and developmental malignant or benign characteristics. We analyzed 4 patients admitted during the period of February 2000 - February 2002 in the First Surgical Clinic of St. Spiridon Hospital and in addition we referred to the current approach in the recent literature. In three of the four patients the diagnosis was possible preoperatively by imaging techniques and consequently they were operated by laparoscopic procedure for the complete removal of tumor cells at macroscopic level. We preferred to administrate chemotherapy accordingly to the malignant/ benign aspect, choosing the long term follow up of the patients to ward off the eventual relapse. We considered the future state of these cases to be uneventful, with a real chance of long term survival. In conclusion, the symptoms are not always specific, allowing errors in diagnosis. Imaging techniques offer real elements of diagnosis. Laparoscopic techniques could offer an oncologic approach with no less benefit compared to open surgery. This methodology also allows different surgery for a different pathology at the same time. The origin of these tumors is more frequently digestive and less ovarian.
Abdominopelvic actinomycosis is a rare chronic or subacute bacterial infection caused by Actinomyces israelii, a Gram-positive anaerobic bacterium that normally colonizes the digestive and genital tracts, clinically presented as an inflammatory mass or abscess formation.We reviewed the medical records of the patients from our clinic with abdominopelvic actinomycosis who underwent surgery between 2002 and 2022. In this period, 28 cases (9 men and 19 women) were treated. The mean age was 43.36 years and they were hospitalized for abdominopelvic tumors or inflammatory tumors in 15 cases and inflammatory disease in 13 cases.Causes of actinomycosis in the studied group were an intra-uterine contraceptive device in 17 cases, foreign bodies in 2 cases, diabetes in 4 cases, stenting of the bile duct in 1 case, and immunodepression. For 6 patients, we performed surgery by open approach and for 21 patients by a laparoscopic approach. For nine patients, abdominopelvic actinomycosis had been mimicking a colon malignancy (cecum and ascending colon, four cases; transverse colon, two cases; and on the greater omentum, three cases) and for six patients, a pelvic tumor (advanced ovarian cancer). After surgery the patients underwent specific treatment with antibiotics, with good results. In two cases we discovered and treated hepatic actinomycosis, one case by a laparoscopic approach and one case by a percutaneous approach. In our lot we noticed three recurrences that required reintervention in patients who had had short-term antibiotics due to non-compliance with treatment out of four such cases.For abdominopelvic malignancies, actinomycosis should be included in the differential diagnosis, as well as for inflammatory bowel diseases and bowel obstructions. We have a wide range of patients considering the rarity of this condition. Long-term antibiotics are necessary to prevent recurrence.
Splenic cysts are classified as primary (parasitic and nonparasitic) or secondary cysts. The aim of this study was to evaluate the efficacy of laparoscopic approach in surgical treatment of splenic cysts and abscesses.Between 2002 and 2017, 17 patients underwent laparoscopic approach for splenic cysts and abscesses: 9 laparoscopic splenectomies (4 hydatid cysts, 3 primitive nonparasitic cysts, one posttraumatic cysts and one abscess) and conservative laparoscopic treatment 8 patients (2 hydatid cysts, 2 primitive nonparasitic cysts, 2 secondary cysts and 2 abscesses). The lateral approach with a four-trocar technique was used. Patient demographics, diagnosis, and outcomes were reviewed.In laparoscopic splenectomy, spleen volume was 300 ml and blood loss 30 - 65 ml. There are 3 conversions and 2 postoperative complications (Clavien II). No late complications were observed during the follow-up.The laparoscopic approach to splenic cysts offers many advantages and may be the treatment of choice for this pathology. Spleen-preserving techniques should be attempted in every case of splenic cyst types 1,2,3, especially non-parasitic cysts, in young patients.Abcesses, Splenic cysts, Laparoscopic approach, Laparoscopic splenectomy, Laparoscopic cyst excision.Le cisti spleniche sono classificate in cisti primitive – parassitarie e non parassitarie – o secondarie. Lo scopo di questo studio era di valutare l’efficacia dell’accesso laparoscopico nel trattamento chirurgico delle cisti e degli ascessi splenici. Tra il 2002 e il 2017, 17 pazienti sono stati sottoposti con accesso laparoscopico ad intervento chirurgico per cisti e ascessi splenici: 9 splenectomie laparoscopiche (4 cisti idatidee, 3 cisti primitive non parassitarie, una cisti post-traumatica e un ascesso) e trattamento laparoscopico conservativo 8 pazienti (2 cisti idatidee, 2 cisti primitive non parassitarie, 2 cisti secondarie e 2 ascessi). È stato utilizzato l’approccio laterale con una tecnica a quattro trocar. I dati demografici dei pazienti, la diagnosi e gli esiti sono stati rivisti. Risultati: nella splenectomia laparoscopica, il volume della milza era di 300 ml e la perdita di sangue di 30 - 65 ml. Ci sono state 3 conversioni e 2 complicanze postoperatorie (Clavien II). Non sono state osservate complicanze tardive durante il follow-up. In conclusione l’utilizzo dell’accesso laparoscopico per l’eliminazione di cisti spleniche offre molti vantaggi e può essere il trattamento di scelta per questa patologia. Le tecniche di conservazione della milza dovrebbero essere tentate in ogni caso di cisti spleniche di tipo 1,2,3, in particolare cisti non parassitarie, in pazienti giovani.
Primary peritoneal hydatidosis is an extremely rare ( 2% of all intra-abdominal hydatid disease). Peritoneal hydatid disease is secondary to liver or splenic involvement following spontaneous rupture or accidental spillage during surgery. Methods: We made a retrospective study based on the analysis of the database of the I Surgery Clinic of the University Emergency Hospital „St. Spiridon ”from Iași, with peritoneal hydatid cyst, including all the data from the medical files. Between 1991 and 2021 a total of 18 patients were operated for primary (3) or secondary peritoneal cysts (15). During the same period, 1002 cases of hydatid cyst with various locations were treated in the Iasi Surgery Clinic: 805 abdominal (714 hepatic, 43 splenic, and 18 peritoneal) and 197 extra abdominal (thoracic, cervical, muscular, retroperitoneal, etc.). The incidence of hydatid diseases has decreased over time from 35 cases per year to 18 cases per year. In the year of the COVID pandemic (2020) the incidence decreased to 10 cases per year.Most of the patients with peritoneal hydatidosis were asymptomatic or had atypical symptoms. The diagnosis was based on the preoperative history, rupture of the cysts, serology, ultrasound and computer tomography. Open surgery was the procedure of choice (16 cases) with conservative (13 cysts) and radical (3 cysts) methods. The laparoscopic approach was performed in 2 cases of primary peritoneal hydatid cysts. Results: The outcome of surgery was good without postoperative mortality or severe morbidity and the recurrence rate was 22.2%. Conclusions: Peritoneal hydatidosis is a rare disease; it is important to prevent the disease. Clinical signs and symptoms are nonspecific for a long time.We suspect this diagnosis in the case of abdominal cystic tumors especially in endemic regions. The diagnosis is made based on the history of operated hydatid disease, clinical signs, imaging and immunological tests. Total surgical excision of hydatid cysts or partial perichystectomy after evacuation of the inactivated cyst is the chosen treatment. Proper perioperative medical treatment prevents recurrence. Long-term follow-up is necessary to detect and treat any recurrence.
Ovarian dermoid cysts (mature cystic teratomas) are a benign type of germ cell tumours and the most common ovarian neoplasms in women of fertile age. The aim of this study was to analyze the safety of the laparoscopic approach in ovarian dermoid cysts.We performed a prospective study between 2006 and ' 2010 including 38 mature cystic teratomas treated either laparoscopically or by open access. All preoperative and postoperative data were included in an MS Access database and statistically analysed with SPSS v. 17 for Windows.The study group was divided into 2 subgroups according to the approach: laparoscopic (25 cases - 2 conversions) and classic (13 cases). The mean age of the patients was 40.34 years (range 19-74): 36.92 years for laparoscopic group and significantly higher 46.21 years for open approach group. Twelve cases were admitted as emergencies either because of complications (torsion or rupture of the teratoma) (11 cases) or associated with acute appendicitis (one case). The latter did not influence the decision for open or laparoscopic approach. Only 29 out of 38 cases had preoperative measurement of CA 125. CA 19-9 was performed in 27 cases and elevated levels were found in 21 cases (78%). Cysts over 10 cm presented higher values of CA 19-9. The mean cysts diameter was 11.29 cm (range 2-27 cm): 13.93 cm mean cyst diameter for open approach vs 9.75 cm for laparoscopic approach. The specimen removal required aspiration of the content for cysts bigger the 10 cm in laparoscopic approach. Mean hospital stay was 4.05 days (range 2-6 days) for the laparoscopic group, significantly lower when compared with the open approach group: 6.96 days (range 5-16 days).Laparoscopic management of ovarian dermoid tumours is a safe and efficient procedure. It does not increase complications rate in comparison with the open approach, offering a shorter hospital stay, a quick recovery and very important, it allows a conservative treatment, especially in premenopausal women who want to be pregnant.
Gastric leiomyoma is a rare gastric neoplasia. The laparoscopic method may treat various gastric tumors, including benign leiomyoma by wedge resection without opening the gastric cavity. The laparoscopic approach to submucosal tumors of the stomach is technically feasible, is safe, and has good postoperative results. It should be considered a viable alternative to open surgery. Herein, we describe a case of laparoscopic wedge resection of gastric leiomyoma.
Between March, 31, 1993 and December, 31, 1997 in the Ist Surgical Clinic was performed laparoscopic cholecystectomy on 1458 patients (1290 females). Clinical selection of patients was made also by preoperative echography. Cholelithiasis was present in 94% of cases. Chronic cholecystitis was detected in 77.7% of cases and acute cholecystitis in 19.13% of cases. Laparoscopic cholecystectomy was realised by retrograde dissection. Conversion to open cholecystectomy was made in 6.1% of cases. Associated laparoscopic operations: appendectomies, genital adnexectomies, omentectomies. In uncomplicated cases (98%), evolution was good with early postoperative mobilization and discharge after 48 hours.
Laparoscopic cholecystectomy (LC) has become the gold standard in the treatment of symptomatic cholelithiasis. Some patients require conversion to open surgery and several preoperative variables have been identified as risk factors that are helpful in predicting the probability of conversion. The aim of this study was to analyze the factors that make LC difficult and determine conversion to open approach: Our study includes: 6985 cases which underwent LC and 1430 cases with open cholecystectomy, between March 1993 and April 2005 in our clinic of general surgery. The overall conversion rate was 5.1% (deliberate conversion--299 cases, conversion of necessity--62 cases). The conversion rate has decreased from 17.5% in 1993 to 3.2% in recent years. The most conversion happen after a simple inspection or a minimal dissection caused by the existence of perforation (105 cases), the discovery of a difficult anatomic situation (63 cases) or of another pathology (14 cases); more rarely, the conversion was necessary in the principal time, doing to hemorrhage (26 cases), impossible dissection (41 cases), visceral injury (1 case) or even at the end of the operation, doing to hemorrhage, loss piece or stone (10 cases), and other situations (101 cases). Significant predictors of conversion were acute cholecystitis , choledocholithiasis, past history of acute cholecystitis, male gender, gall bladder wall thickness exceeding 6 mm. In conclusion, based on our experience, we suggest limiting OC to patients with proven contraindications to LC (i.e., Mirizzi syndrome or systemic illness incompatible with general anesthesia or pneumoperitoneum), attempting LC in all other cases. Decision to convert to open approach is a proven of surgical maturity. Conversion must be decided from the beginning, in the moment of the recognition of a difficult situation and not after the occurrence of a complication.
Two patients underwent a transabdominal laparoscopic Heller myotomy for achalasia. All patients had barium esophagograms. preoperative endoscopy, esophageal manometry. There were no surgical morbidity and the average hospital stay was 5 days. Excellent result was reported by one patients and good result by one. Laparoscopic Heller myotomy is a safe and effective treatment for achalasia.
Background.There are two entities for intestinal obstruction:acute-in emmergency department,and chronical -in private practice,seen by several physicians,with previous surgery interventions and multiple adhesions.Matherial and method: retro/prospective study of cases cohort operated in the last 5 years (2016)(2017)(2018)(2019)(2020) in The First Surgical Clinic of Iasi with intestinal/colonic obstructed neoplasia by laparoscopy and classical approach.Results:we found 985 cases with occlusion(7.15%from total number of operations):454(46%) were tumoral,531(54%) were nontumoral;72 (7.3%) cases were operated by laparoscopy;the mean age was 80y for classic operations and 70y for laparoscopy without difference between tumoral and nontumoral;predominant sex was men(60%);laparoscopic approach was utilised in 60cases for tumoral occlusion,12 for nontumoral oclusions.ASA II and III were predominant with comorbidities: cardiac(60%), hepatic(40%), anemia(30%), pulmonar(20%) and others(80%); postoperative morbidity was local(20%) and general(20%);mortality was 10%;hospitalisation was 10 days;most of the tumors were in T3G2 stage;the resection was R0 with 20 lymph nodes excised.Discution:for assesement of the patient status is necessary to evaluate the hystoric,physical examination,abdominal distension degree,cardio-pulmonary and haemodinamic status,paraclinical electrolytes, creatinine and amylases,abdominal echo,Tx and CT-scan.For laparoscopic approach may be some contra indications:arterial hypotension,multiple laparotomies(hostile abdomen),massive abdominal distension, high obesity,third semester pregnancy and intracranial hypertension.It is necessary to stabilise the patient by:iv hydrating,infusions of electrolytes,decompression of the intestine,informed consent around laparoscopic/classic operative risks and benefits,possibility of bowel resection and stomy.The surgeon must be able to know to explore all the spaces of the entire abdomen and the entire bowel and to resect/make the anastomosis or stomy,classical or laparoscopic.If we start with laparoscopy and we find perforation,necrosis,neoplasia,adherences or the cause of occlusion is not found,it is necesarly to make a laparotomy.Levard(France), Chosidow (Switzerland), Navez(Belgium),Bailey(Australia) and Strikland(USA) found 33%conversion from laparoscopy to classical approach,15% morbidity and 1.5% mortality in their cohorts cases with bowel obstruction.Conclusion:Laparoscopy may be utilised in bowel obstruction because we may avoid 50% of laparotomies.The technique is in evaluation,it is safe in trained hands if we select very well the patients and the team.
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