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Martin WT, Snyder KB, Stewart K, Sarwar Z, Starr WC, Grady A, Ball J, Raines AR, Cross A. Bridging the Gap: Comparison of Outpatient Clinic and Emergency Department Patients Undergoing Cholecystectomy. J Surg Res 2024; 300:183-190. [PMID: 38823268 DOI: 10.1016/j.jss.2024.04.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/19/2024] [Accepted: 04/28/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Literature shows failure of the outpatient clinic (OC) pathway after emergency department (ED) ultrasound diagnosis of symptomatic cholelithiasis (SC). We hypothesized SC to be more prevalent on final surgical pathology (FSP) in patients who successfully completed OC pathway. METHODS This retrospective single-institution chart review compared OC and ED patients with right upper quadrant (RUQ) pain and cholelithiasis whom underwent cholecystectomy. Clinical evaluation was considered positive if RUQ pain >4 h, or + Murphy's sign. Ultrasound was positive if two of these three were present: sonographic Murphy's, wall thickness > 4 mm, or pericholecystic fluid. Results were compared with FSP. RESULTS Six hundred-seven patients underwent cholecystectomy, 299 OC and 308 ED. OC was more likely to SC (23% versus 4.6%) (P < 0.0001) and ED acute cholecystitis (39.3% versus 4.7%). Chronic cholecystitis was the most common FSP in both OC (72%) and ED (56%) populations, of these, 73% of OC denied pain >4 h versus only 10% of ED (P < 0.001). Median time from evaluation to cholecystectomy was 14 d versus 14 h in the OC and ED respectively (P < 0.0001). CONCLUSIONS While chronic cholecystitis was the most common FSP in both OC and ED, the majority of OC reported RUQ pain <4 h delineating these presentations. Duration of pain should be utilized as algorithm triage. We recommend patients with pain episode <4 h should complete OC algorithm with expedited cholecystectomy within 14 d.
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Affiliation(s)
- W Taylor Martin
- Department of Surgery, The University of Oklahoma, Oklahoma City, Oklahoma.
| | - Katherine B Snyder
- Department of Surgery, The University of Oklahoma, Oklahoma City, Oklahoma
| | - Kenneth Stewart
- Department of Surgery, The University of Oklahoma, Oklahoma City, Oklahoma
| | - Zoona Sarwar
- Department of Surgery, The University of Oklahoma, Oklahoma City, Oklahoma
| | - William C Starr
- The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Anna Grady
- The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Jonathan Ball
- The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Alexander R Raines
- Department of Surgery, The University of Oklahoma, Oklahoma City, Oklahoma
| | - Alisa Cross
- Department of Surgery, The University of Oklahoma, Oklahoma City, Oklahoma
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Basunbul LI, Alhazmi LSS, Almughamisi SA, Aljuaid NM, Rizk H, Moshref R. Recent Technical Developments in the Field of Laparoscopic Surgery: A Literature Review. Cureus 2022; 14:e22246. [PMID: 35340455 PMCID: PMC8929761 DOI: 10.7759/cureus.22246] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 11/06/2022] Open
Abstract
The benefits of laparoscopic surgery (LS) include a speedy recovery, shorter duration of hospital stay, minimal postoperative pain, discomfort and disabilities, and better cosmetic outcomes (less scarring) that help an individual to resume normal daily activities and return to work. A comprehensive literature search on laparoscopic surgeries was conducted using different Internet-based search engines and databases from August 2021 to October 2021. The search was limited to articles published in the English language and those published between years 2005 and 2021. A total of 126 articles were initially identified. Two independent reviewers thoroughly examined the quality and content of the articles. Articles with duplicate data were excluded, and the remaining articles were screened and assessed by the titles and abstracts. After a vigorous assessment, we included data from 49 articles for this review process. Bibliographic management was done using the software “EndNote” (Thomson Reuters, New York, NY, USA). It was concluded that LS has become the technique of choice for virtually every kind of abdominal surgery, evident by numerous scholarly publications in this field. Level I evidence demonstrating the advantage of LS over open surgery has been reported for numerous operations, including fundoplication for gastroesophageal regurgitation disease, bariatric surgery for weight loss, and cancer resection. Advanced LS has subsequently been expanded to include hepatectomy, pancreatectomy, urology, and gynecology. Patients who are at risk of having elevated abdominal pressure during LS, however, should proceed with care. Recent advances in natural orifice transluminal endoscopic surgery, single-incision laparoscopic surgery, and robot-assisted laparoscopic surgery are promising.
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Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in Egyptian patients with morbid obesity. Ann Med Surg (Lond) 2022; 73:103235. [PMID: 35079369 PMCID: PMC8767301 DOI: 10.1016/j.amsu.2021.103235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/28/2021] [Accepted: 12/31/2021] [Indexed: 11/21/2022] Open
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Yan JN, Shao YF, Ye GL, Ding Y. Signet ring cell carcinoma hidden beneath large pedunculated colorectal polyp: A case report. World J Clin Cases 2021; 9:11071-11077. [PMID: 35047620 PMCID: PMC8678874 DOI: 10.12998/wjcc.v9.i35.11071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/05/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Large pedunculated colorectal polyps are not frequent among colonic polyps. We present a clinical case of a large pedunculated colorectal polyp with signet ring cell cancer infiltrating the submucosa and lymph node invasion in a patient who ultimately underwent additional surgery. Clinicians should attach importance to pedunculated colorectal polyps and choose the most appropriate therapy.
CASE SUMMARY A 52-year-old female farmer underwent routine screening colonoscopy and denied constipation, diarrhea, hematochezia, or other gastrointestinal symptoms. Her past medical history and general biochemical examination results were unremarkable. During the colonoscopy, a 25-mm pedunculated polyp in the sigmoid colon was identified. The superficial epithelium was macroscopically congestive, rough, and granular, showing characteristic features of adenoma. We first ligated the root of the pedunculated polyp using nylon loops as well as a titanium clip. Histopathological examination revealed high-grade intraepithelial neoplasia of the tumor surface and a negative margin with signet ring cell adenocarcinoma infiltrating the submucosal layer. The deepest infiltration was approximately 0.9 cm from the tumor surface and 0.55 cm from the stratum basale. We performed radical resection of the left colon with lymph node dissection after two weeks. The lesion was completely resected, and pathological assessment revealed signet ring cell adenocarcinoma infiltrating the submucosal layer as well as lymph node invasion (stage PT1N1M0 and grade IIIA in pathological grading, NRAS-, BRAF V600E-, KRAS-).
CONCLUSION This case highlights the importance of paying attention to the malignancy of large pedunculated polyps. Polyps or adenomas removed via endoscopy must be evaluated histologically. Even if adenomas may be fragile, endoscopy doctors should still remove polyps as completely as possible and choose perpendicular sections through the stalk and base to fix by formaldehyde solution.
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Affiliation(s)
- Jia-Ning Yan
- Department of Gastroenterology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo 315020, Zhejiang Province, China
| | - Yong-Fu Shao
- Department of Gastroenterology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo 315020, Zhejiang Province, China
| | - Guo-Liang Ye
- Department of Gastroenterology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo 315020, Zhejiang Province, China
| | - Yong Ding
- Department of Gastroenterology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo 315020, Zhejiang Province, China
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Hasan A, Elhawary A, Abdelaleem MF, Hegazy T, Nafie KM. Partial Hydatidiform Mole in an Ectopic Tubal Pregnancy. Cureus 2021; 13:e15455. [PMID: 34258118 PMCID: PMC8256449 DOI: 10.7759/cureus.15455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 11/17/2022] Open
Abstract
Fallopian tubal molar pregnancy is extremely rare, and the main diagnostic tool is the post-operative histopathological diagnosis, as the pre-operative diagnosis is difficult. We report a case of ectopic partial molar pregnancy in the right fallopian tube of a 35-year-old lady that was sent for routine histopathological examination with the clinical diagnosis of ectopic pregnancy and the histopathology report revealed an unusual result.
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Affiliation(s)
| | - Ahmed Elhawary
- Primary Health Care Centers, Ministry of Health, Taba, EGY
| | | | - Tarek Hegazy
- Obstetrics and Gynaecology, Ministry of Health, Tanta, EGY
| | - Khalid M Nafie
- Laboratory and Blood Bank, Prince Mishari Bin Saud Hospital, Ministry of Health, Baljurashi, SAU
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Eldsoky I, Ismaiel WF, Hasan A, Abdelazim MH, Ibrahim AAA, Alsobky ME, Mohammed AR. The predictive value of nasolacrimal sac biopsy in endoscopic dacryocystorhinostomy. Ann Med Surg (Lond) 2021; 65:102317. [PMID: 33981427 PMCID: PMC8085898 DOI: 10.1016/j.amsu.2021.102317] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND During dacryocystorhinostomy (DCR), the lacrimal sac wall biopsy is not routinely performed in our hospital, but it is recommended if there is a suspicion of underlying disease other than preoperatively or intraoperatively chronic inflammation. OBJECTIVE Most of patients with epiphora have different causes of nasolacrimal duct obstruction (NLDO). This study aims to examine how important routine lacrimal sac biopsy is during endoscopic DCR surgery. PATIENTS & METHODS The study included 50 patients with chronic unilateral epiphora. All patients underwent endoscopic DCR with NLD biopsy. Histopathologic analysis was performed for each specimen. RESULTS The findings of NLD biopsy showed chronic inflammation in 33 cases (66%), chronic dacryocystitis in 9 cases (18%), dacryolith with dacryocystitis in one case, granuloma in 4 cases (8%), rhinoscleroma in 2 cases (4%), and one case had a neoplasm. Histopathologic findings were inflammatory cellular infiltrates in 56%, 30% and 14% in mild, moderate and severe chronic inflammatory state (CIS) score, respectively. Fibrosis in 18%, 20% and 62% in mild, moderate and severe CIS score, respectively. Capillary proliferation in 64%, 32% and 4% in mild, moderate and severe CIS score, respectively. Chronic inflammatory signs in 64%, 32% and 4% in mild, moderate and severe CIS score, respectively. CONCLUSION Although neoplasm and granuloma are rare cause of lacrimal sac or duct obstruction requiring DCR, they were detected through nasolacrimal assessment and routine intraoperative lacrimal sac biopsy.
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Affiliation(s)
- Ibrahim Eldsoky
- ENT Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Wael Fawzy Ismaiel
- ENT Department, Faculty of Medicine, Al-Azhar University, Damietta Branch, Egypt
| | - Abdulkarim Hasan
- Pathology Department, Faculty of Medicine, Al-Azhar University, Cairo, 11884, Egypt
| | | | | | | | - Ahmed Rabie Mohammed
- Ophthalmology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Hasan A, Deyab A, Monazea K, Salem A, Futooh Z, Mostafa MA, Youssef A, Nasr M, Omar N, Rabaan AA, Taie DM. Clinico-pathological assessment of surgically removed abdominal wall endometriomas following cesarean section. Ann Med Surg (Lond) 2021; 62:219-224. [PMID: 33537134 PMCID: PMC7843362 DOI: 10.1016/j.amsu.2021.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Over the past few decades, the rate of Cesarean Section (CS) delivery has been rising rapidly and the prevalence of CS-associated complications including Abdominal Wall Endometriomas (AWE) increases with each additional operation. The aim of this study was to evaluate the clinical characteristics, histopathological diagnostic role and surgical management of post-CS AWE through a retrospective case review. METHODS We calculated the incidence of AWE and reviewed all the patients underwent surgical removal of Post-CS AWE during the period of 2012-2018 who were diagnosed, treated and followed up for 2-8 years at our tertiary hospital. RESULTS Thirty women with AWE were included. The main symptom in 2/3 of cases was cyclic pain and 4 cases (13.3%) had no symptoms. The mean interval between prior CS and appearance of symptoms was 55.2 months and the mean size of the excised mass was 42 mm. Free surgical margin was less than 9 mm in 9 patients (30%) but no recurrence was recorded among all the studied patients. Pre-operative FNAC diagnosis was performed for only 3 patients (10%) which helped in excluding other potential pathologies. The clinical-pathological agreement value for detection of the nature of the abdominal wall mass was 93.4%. CONCLUSIONS Patients with suspected AWE should undergo preoperative cytological biopsy to exclude alternative diagnosis. Wide surgical excision with margin of less than 1 cm could be accepted especially in case of weak abdominal wall. More studies on the post-CS complications; risks, prevention, early detection and proper management should be encouraged.
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Affiliation(s)
- Abdulkarim Hasan
- Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdou Deyab
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Khaled Monazea
- Department of General Surgery, Faculty of Medicine, Al-Azhar University, Assiut Branch, Egypt
| | - Abdoh Salem
- Department of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Zahraa Futooh
- Department of General Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Mahmoud A. Mostafa
- Department of Internal Medicine and Cardiology, King Fahad Hospital, Albaha, Saudi Arabia
| | - Ahmed Youssef
- Department of Surgical Oncology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Nasr
- Department of Histology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Nasser Omar
- Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ali A. Rabaan
- Molecular Diagnostic Labortaory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Doha M. Taie
- Department of Pathology, National Liver Institute, Menoufia University, Shebin El Kom, Egypt
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Baheeg M, Tag El-Din M, Labib MF, Elgohary SA, Hasan A. Long-term durability of weight loss after bariatric surgery; a retrospective study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2020.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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