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Acute mechanical bowel obstruction: Clinical presentation, etiology, management and outcome

World Journal of Gastroenterology 2007年第3期13卷 432-437页

作者： Haridimos Markogiannakis Evangelos Messaris Dimitrios Dardamanis Nikolaos Pararas Dimitrios Tzertzemelis Panagiotis Giannopoulos andreas larentzakis Emmanuel Lagoudianakis andreas Manouras Ioannis Bramis 1~(st) Department of Propaedeutic Surgery Hippokration Hospital Athens Medical School University of Athens Vasilissis Sofias 114 Avenue Athens 11527 Greece

AIM: To identify and analyze the clinical presentation, management and outcome of patients with acute mechanical bowel obstruction along with the etiology of obstruction and the incidence and causes of bowel ischemia, necrosis, and perforation. METHODS: This is a prospective observational study of all adult patients admitted with acute mechanical bowel obstruction between 2001 and 2002. RESULTS: Of the 150 consecutive patients included in the study, 114 (76%) presented with small bowel and 36 (24%) with large bowel obstruction. Absence of passage of flatus (90%) and/or feces (80.6%) and abdominal distension (65.3%) were the most common symptoms and physical finding, respectively. Adhesions (64.8%), incarcerated hernias (14.8%), and large bowel cancer (13.4%) were the most frequent causes of obstruction. Eighty-eight patients (58.7%) were treated conservatively and 62 (41.3%) were operated (29 on the first day). Bowel ischemia was found in 21 cases (14%), necrosis in 14 (9.3%), and perforation in 8 (5.3%). Hernias, large bowel cancer, and adhesions were the most frequent causes of bowel ischemia (57.2%, 19.1%, 14.3%), necrosis (42.8%, 21.4%, 21.4%), and perforation (50%, 25%, 25%). A significantly higher risk of strangulation was noticed in incarcerated hernias than all the other obstruction causes. CONCLUSION: Absence of passage of flatus and/or feces and abdominal distension are the most common symptoms and physical finding of patients with acute mechanical bowel obstruction, respectively. Adhesions, hernias, and large bowel cancer are the most commoncauses of obstruction, as well as of bowel ischemia, necrosis, and perforation. Although an important proportion of these patients can be nonoperatively treated, a substantial portion requires immediate operation. Great caution should be taken for the treatment of these patients since the incidence of bowel ischemia, necrosis, and perforation is significantly high.

关键词： Acute mechanical bowel obstruction Clinical presentation Etiology Management Outcome

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A new pancreaticojejunostomy technique: A battle against postoperative pancreatic fistula

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World Journal of Gastroenterology 2013年第27期19卷 4351-4355页

作者： Stylianos Katsaragakis andreas larentzakis Sotirios-Georgios Panousopoulos Konstantinos G Toutouzas Dimitrios Theodorou Spyridon Stergiopoulos Georgios Androulakis 1st Department of Propaedeutic Surgery Athens Medical SchoolHippocratio Athens General HospitalUniversity of Athens

AIM:To present a new technique of end-to-side, ductto-mucosa pancreaticojejunostomy with seromuscular jejunal flap formation, and insertion of a silicone stent. METHODS:We present an end-to-side, duct-to-mucosa pancreaticojejunostomy with seromuscular jejunal flap formation, and the insertion of a silicone stent. This technique was performed in thirty-two consecutive patients who underwent a pancreaticoduodenectomy procedure by the same surgical team, from January 2005 to March 2011. The surgical procedure performed in all cases was classic pancreaticoduodenectomy, without preservation of the pylorus. The diagnosis of pancreatic leakage was defined as a drain output of any measurable volume of fluid on or after postoperative day 3 with an amylase concentration greater than three times the serum amylase activity. RESULTS:There were 32 patients who underwent end-to-side, duct-to-mucosa pancreaticojejunostomy with seromuscular jejunal flap formation. Thirteen of them were women and 19 were men. These data correspond to 40.6% and 59.4%, respectively. The mean age was 64.2 years, ranging from 55 to 82 years. The mean operative time was 310.2 ± 40.0 min, and was defined as the time period from the intubation up to the extubation of the patient. Also, the mean time needed to perform the pancreaticojejunostomy was 22.7 min, ranging from 18 to 25 min. Postoperatively, one patient developed a low output pancreatic fistula, three patients developed surgical site infection, and one patient developed pneumonia. The rate of overall morbidity was 15.6%. There was no 30-d postoperative mortality. CONCLUSION:This modification appears to be a significantly safe approach to the pancreaticojejunostomy without adversely affecting operative time.

关键词： Whipple Pancreaticojejunostomy Technique Seromuscular jejunal flap Pancreatic fistula

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Transanal polypectomy using single incision laparoscopic instruments

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World Journal of Gastrointestinal Surgery 2011年第4期3卷 56-58页

作者： Dimitrios Dardamanis Dimitrios Theodorou George Theodoropoulos andreas larentzakis Maria Natoudi Georgia Doulami Christina Zoumpouli Haridimos Markogiannakis Stylianos Katsaragakis George C Zografos Department of Propaedeutic Surgery Athens Medical SchoolUniversity of AthensHippocration Hospital Department of Pathology Hippocration Hospital

Transanal excision of rectal polyps with laparoscopic instrumentation and a single incision laparoscopic port is a novel technique that uses technology originally developed for abdominal procedures from the natural orifice of the rectum. Transanal endoscopic microsurgery (TEM) is a well established surgical approach for certain benign or early malignant lesions of the rectum, under specific indications. Our technique is a hybrid technique of transanal surgery, a reasonable method for polyp resection without the need of the sophisticated and expensive instrumentation of TEM which can be applied whenever endoscopic or conventional transanal surgical removal is not feasible.

关键词： Polypectomy SILS Transanal endoscopic microsurgery Laparoscopy Endoscopy

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