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Primary parahiatal hernias:A case report and review of the literature

World Journal of Clinical Cases 2019年第23期7卷 4020-4028页

作者： Silviu Daniel Preda Stefan Patrascu Bogdan Silviu Ungureanu Daniel Cristian Vasile Bintintan Cristian M Nica Valentin Calu Victor Strambu Konstantinos Sapalidis Valeriu Marin Surlin 1^(st) Clinic of Surgery Clinical Emergency Hospital of CraiovaUniversity of Medicine and Pharmacy of CraiovaCraiova 200642DoljRomania Gastroenterology Clinic Clinical Emergency Hospital of CraiovaUniversity of Medicine and Pharmacy of CraiovaCraiova 200642DoljRomania Departament of General Surgery “Coltea”Clinical HospitalCarol Davilla University of Medicine and PharmacyBucharest 030171Romania 1^(st) Clinic of Surgery of Cluj Napoca Iuliu Hatieganu University of Medicine and Pharmacy Cluj NapocaCluj Napoca 400006ClujRomania 3^(rd) Clinic of Surgery Timisoara Emergency Clinical County Hospital“Victor Babes”University of Medicine and Pharmacy of TimisoaraTimisoara 300723Romania Clinic of Surgery “Elias”Emergency University Hospital BucharestUniversity of Medicine and Pharmacy“Carol Davila”Bucharest 011461Romania Clinic of Surgery of“Dr.Carol Davila”Nephrology Clinical Hospital University of Medicine and Pharmacy“Carol Davila”Bucharest 010731Romania 3^(rd) Surgery Clinic University General Hospital of ThessalonikiAristotle University of ThessalonikiSalonic 54636Greece

BACKGROUND Parahiatal hernias(PHHs)are rare occurring disease,with a reported incidence of 0.2%-0.35%in patients undergoing surgery for hiatal hernia.We found only a handful of cases of primary PHHs in the literature.The aim of this paper is to present a case of a primary PHH and perform a systematic review of the literature.CASE SUMMARY We report the case of a 60-year-old Caucasian woman with no history of thoracoabdominal surgery or trauma,which accused epigastric pain,starting 2 years prior,pseudo-angina and bloating.Based on imagistic findings the patient was diagnosed with a PHH and an associated type I hiatal hernia.Patient underwent laparoscopic surgery and we found an opening in the diaphragm of 7 cm diameter,lateral to the left crus,through which 40%-50% of the stomach had herniated in the thorax,and a small sliding hiatal hernia with an anatomically intact hiatal orifice but slightly enlarged.We performed closure of the defect,suture hiatoplasty and a“floppy”Nissen fundoplication.Postoperative outcome was uneventful,with the patient discharged on the fifth postoperative day.We performed a review of the literature and identified eight articles regarding primary PHH.All data was compiled into one tabled and analyzed.CONCLUSION Primary PHHs are rare entities,with similar clinical and imagistic findings with paraesophageal hernias.Treatment usually includes laparoscopic approach with closure of the defect and the esophageal hiatus should be dissected and analyzed.Postoperative outcome is favorable in all cases reviewed and no recurrence is cited in the literature.

关键词： Parahiatal Hernia Review Literature Case report

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Training and learning curves in minimally invasive pancreatic surgery:from simulation to mastery

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Journal of Pancreatology 2020年第2期3卷 101-110页

作者： Haney Caelán M. Karadza Emir Limen Eldridge F. de Santibanes Martin Kinny-Köster Benedict Müller Philip C. bintintan vasile V. Kulu Yakub Hackert Thilo Müller-Stich Beat-Peter Nickel Felix Department of General Visceral and Transplantation SurgeryHeidelberg University HospitalHeidelbergGermany Department of Surgery Hospital Italiano de Buenos AiresBuenos AiresArgentina Department of Surgery Clinic Beau-SiteBernSwitzerland Department of Surgery University Hospital Cluj NapocaCluj NapocaRomania

Background:Minimally invasive pancreatic surgery(MIPS)has developed over the last 3 decades and is nowadays experiencing an increased interest from the surgical community.With increasing awareness of both the public and the surgical community on patient safety,optimization of training has gained importance.For implementation of MIPS we propose 3 training phases.The first phase focuses on developing basic skills and procedure specific skills with the help of simulation,biotissue drills,video libraries,live case observations,and training courses.The second phase consists of index procedures,fellowships,and proctoring programs to ensure patient safety during the first procedures.During the third phase the surgeons aim is to safely implement the procedure into standard practice while minimizing learning curve related excess morbidity and mortality.Case selection,skills assessment,feedback,and mentoring are important methods to optimize this phase.The residual learning curve can reach up to 100 cases depending on the surgeons’previous experience,selection of cases,and definition of the parameters used to assess the learning curve.Adequate training and high procedural volume are key to implementing MIPS safely.

关键词： Laparoscopic surgery Minimally invasive surgery Robotic surgery Training

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