Abstract:

Esophageal perforation after endoscopic instrumentation is a surgical emergency. Prompt diagnosis and treatment have a significant impact on mortality. In the setting of esophageal cancer, iatrogenic perforation presents a difficult challenge for surgical management as primary repair is not feasible. In this chapter, we describe the use of a minimally invasive Ivor Lewis esophagectomy for the management of an iatrogenic esophageal perforation in a patient with metastatic esophageal cancer.

Authors:

Navrose Grewal, M.D., Chief Resident, Department of Surgery, University of California, Irvine Medical Center, Orange, California, Khaled El-Badawi, M.D., Clinical Instructor of Surgery, Department of Surgery, University of California, Irvine Medical Center, Orange, California, Ninh T. Nguyen, M.D., Professor of Surgery, Department of Surgery, University of California, Irvine Medical Center, Orange, California

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Abstract:

Routine use of vascular sealing and dissecting devices was implemented in our Tertiary Center of Endocrine Surgery with a high volume of thyroid operations. Beginning with a prospective randomized trial on 82 patients that compared thyroid surgery with assistance of a new, high-frequency-powered electrothermal device (PreciseÔ, Covidien, Boulder, Colorado) to conventional thyroid surgery, approximately 30% of operation time was saved in the group using the device. Surgeons were then free to decide whether to use LigaSure (PreciseÔ), an ultrasonic device (FocusÔ, Ethicon Endo Surgery, Cincinnati, Ohio), or the classic tie-and-knotting procedure. This change of procedure resulted in an increase of surgery with devices, when compared to classic procedures from 20.2% to 98.4%, during a period of 5 years with 2,591 patients. The equal results of device-supported thyroid surgery were demonstrated when 100 consecutive patients with PreciseÔ and FocusÔ were compared, by measuring time of surgery (-36% or 43 min) and postoperative morbidity. The authors advocate the use of vascular sealing and dissecting devices for thyroid operations and, especially, for surgical units with high operative frequency.

Authors:

Peter E. Goretzki, M.D., Chief, Department of General Surgery, Abdominal Surgery, Coloproctology, and Hernia Surgery, , Lukaskrankenhaus, Neuss, Germany, Katharina Schwarz, M.D., Assistant Director Endocrine Surgery, Department of General Surgery, Abdominal Surgery, Coloproctology, and Hernia Surgery, Lukaskrankenhaus, Neuss, Germany, Berhard J. Lammers, M.D., Chief Operating Doctor, Coloproctology and Hernia Surgery, Lukaskrankenhaus, Neuss, Germany

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Abstract:

Neoadjuvant therapy has become the standard of care in locally advanced resectable rectal cancer. Increasingly, anti-angiogenic agents are incorporated into neoadjuvant therapy regimens. There is a need for the availability of biomarkers that allow one to select and monitor therapy. Functional imaging using dynamic MRI or PET in combination with mathematical modeling allows the monitoring of early vascular effects of therapy. In parallel, molecular imaging targeting a variety of tumor angiogenesis-associated moieties is under preclinical development. This chapter addresses the rationale, methods, and clinical data related to functional imaging of therapy response in rectal cancer.

Authors:

Peter Smeets, M.D., Radiologist, Departments of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium, Wim Ceelen, M.D., Ph.D., Surgical Oncologist, Department of Surgical Oncology, Ghent University Hospital, Ghent, Belgium

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Abstract:

Various techniques of stapled intestinal anastomoses are performed in gastroenterological surgery. Little is known about which technique is optimal. The intestines of a domestic pig were used in this study. Stapled intestinal anastomoses of three types—functional end-to-end anastomosis (FETEA), stapled side-to-end anastomosis (STEA), and stapled end-to-end anastomosis (EEA)—were constructed using pig intestines. The times for constructing anastomoses, length of the completed anastomosed intestine, strength of anastomoses, and bursting locations were measured and recorded on each group. The times required to construct FETEAs (60 S.D. 1.4 sec) were significantly less than those required for STEAs (191.5 S.D. 46.4 sec) and EEAs (274.5 S.D. 54.5 sec). The mean lengths of the completed anastomosed intestine were significantly different for FETEAs (89 S.D. 8.2 mm), STEAs (135 S.D. 6.1 mm), and EEAs (156 S.D. 6.5 mm). The bursting pressures were not significantly different among the three groups. FETEAs are superior in terms of requiring less surgical time. EEAs are superior in terms of the length of anastomosed intestines. In conclusion, anastomotic techniques should be selected properly in consideration of these features.

Authors:

Kiyonori Kanemitsu, M.D., Postgraduate, Kentaro Kawasaki, M.D., Ph.D., Reader , Tadahiro Goto, M.D., Postgraduate , Yasuhiro Fujino, M.D., Ph.D., Assistant Professor, Takashi Kamigaki, M.D., Ph.D., Lecturer , Daisuke Kuroda, M.D., Ph.D., Lecturer , Yoshikazu Kuroda, M.D., Ph.D., Professor, Department of Gastroenterological Surgery , Kobe University Graduate School of Medicine , Tokyo, Japan

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Abstract:

The treatment of neurogenic and traumatic fecal incontinence (FI) as may result from severe anal sphincteric destruction is problematic. A novel technique for the treatment of these cases is presented. The study comprised 44 patients, which included 28 with neurogenic and 16 with traumatic FI. Patients were divided into two equal groups. Two fascia lata slings (FLS) were applied in Group 1, while one sling was used in Group 2. Investigations comprised manometric and electromyographic studies. The procedure consisted of performing a curvilinear incision behind the anal orifice, and the supralevator region was entered. The middle of an FLS was sutured to the back of the upper part of anal canal. Each of the two limbs of the sling was passed forward through an incision on the pubic ramus and was sutured to the periosteum of the pubic ramus. This was preformed in Groups 1 and 2. A second FLS was added in Group 1. Its center was sutured to the front of the mid anal canal and its two limbs to the coccyx. Satisfactory results (continence scores 1 and 2) were obtained in 63.6% of Group 1 and 36.4% of Group 2. Significant postoperative anal pressure increase occurred in scores 1 to 3 in Group 1 and in scores 1 to 2 in Group 2. Anal pressure increase was more prominent in Group 1 than in Group 2. The continent effect of the operation appears to be due to the increase of anal pressure, anal canal elongation, and recto-anal angulation. The operation is indicated in FI of the idiopathic or traumatic type with excessive sphincteric loss. It is simple and easy and performed under no cover of colostomy.

Authors:

Ismail A. Shafik, M.Ch., M.D., Assistant Professor in Surgery (Lecturer), Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt, Ahmed Shafik, M.D., Ph.D., Professor and Chairman, Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt

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Abstract:

The effect of an albumin polymer instillation (Bioglue®; Cryolife, Inc., Kenneaw, GA, USA) during breast cancer surgery on postoperative seroma formation was evaluated. Two groups of 34 consecutive patients, treated during operation with and without polymer, were followed postoperatively by weekly ultrasound and clinical evaluation. Seroma was aspirated when the volume exceeded 250 mL. Statistical comparison between 33 of the patients with adhesive- and 32 with non-adhesive-treated patients showed that the former patient group clearly outperformed the latter in production (p<0.001) and duration (p<0.01) of seroma. Seroma outcome depended on body mass index (BMI) (>30 & <30, p<0.007), not on patient age (p<0.240) or nodes ratio (p<0.613). Repeated aspirations were made in 37.5% non-polymer treated- and 21.21% polymer-treated patients. The findings demonstrated that use of albumin polymers during breast cancer surgery lowers postoperative seroma outcome significantly.

Authors:

Evangelos Athanassiou, M.D., Ph.D., Assistant Professor of Surgery, Nikolaos Vamvakopoulos, Ph.D., Professor of Biology, Fani Nakopoulou, M.D., Radiologist, Ioannis Fezoulidis, M.D., Professor of Radiology, Dimitrios Zaharoulis, M.D., Assistant professor of Surgery, Michael Spyridakis, M.D., General Surgeon, Constantinos Hatzitheofilou, M.D., Professor of Surgery, Departments of Surgery, Radiology, and Biology & Genetics, University of Thessalia Medical School, Larisa, Greece

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