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Capoccia Giovannini S, Podda M, Ribas S, Montori G, Botteri E, Agresta F, Sartori A, Chàrvàtova H, Aiolfi A, Antoniou SA, Arvieux C, Berrevoet F, Boermeester MA, Campanelli G, Chintapatla S, Christoffersen MW, Dahlstrand U, De la Croix H, Dietz UA, Ferreira A, Fortenly RH, Gaarder C, Garcia Urena MA, Gok H, Hernández-Granados P, Jisova B, Laver O, Lerchuk O, Lopez-Cano M, Mega M, Mitura K, Muysoms F, Oliva A, Ortenzi M, Petersson U, Piccoli M, Radu VG, Renard Y, Rogmark P, Rosin D, Senent-Boza A, Simons M, Slade D, Smart N, Smith SR, Stabilini C, Theodorou A, Torkington J, Vironen J, Woeste G, De Beaux A, East B. What defines an incisional hernia as 'complex': results from a Delphi consensus endorsed by the European Hernia Society (EHS). Br J Surg 2024; 111:znad346. [PMID: 37897716 DOI: 10.1093/bjs/znad346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 10/30/2023]
Affiliation(s)
- Sara Capoccia Giovannini
- Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Sonia Ribas
- Department of General Surgery, Centro Hospitalar Póvoa de Varzim-Vila do Conde, Póvoa de Varzim, Portugal
| | - Giulia Montori
- General Surgery Department, Azienda ULSS2 'Trevigiana', Hospital Vittorio Veneto, Treviso, Italy
| | - Emanuele Botteri
- Department of General Surgery, ASST Spedali Civili Brescia PO, Montichiari, Brescia, Italy
| | - Ferdinando Agresta
- General Surgery Department, Azienda ULSS2 'Trevigiana', Hospital Vittorio Veneto, Treviso, Italy
| | - Alberto Sartori
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Hana Chàrvàtova
- Faculty of Applied Informatics, Tomas Bata University in Zlín, Zlín, Czech Republic
| | - Alberto Aiolfi
- Department of General Surgery, RCCS Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Milan, Italy
| | - Stavros A Antoniou
- Department of Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | - Frederik Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation Service, University Hospital Medical School, Ghent, Belgium
| | - Marja A Boermeester
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - Giampiero Campanelli
- Department of Abdominal Wall Surgery, University of Insubria, Ospedale Galeazzi Sant' Ambrogio, Milan, Italy
| | - Srinivas Chintapatla
- Department of Surgery, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | | | - Ursula Dahlstrand
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Enköping Hospital, Enköping, Sweden
| | - Hanna De la Croix
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Ulrich A Dietz
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten, Olten, Switzerland
| | - Antonio Ferreira
- General Surgery Unit, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal
| | - Renè H Fortenly
- General Surgery Unit, Medical Faculty Sigmund Freud Private University, Vienna, Austria
| | - Christine Gaarder
- Department of Traumatology, University Hospital, Oslo University Hospital Ullevål, Oslo, Norway
| | - Miguel Angel Garcia Urena
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria Hospital Universitario del Henares Carretera Pozuelo-Majadahonda, Madrid, Spain
| | - Hakan Gok
- Hernia Istanbul®, Comprehensive Hernia Centre, Istanbul, Turkey
| | - Pilar Hernández-Granados
- General Surgery Unit, Hospital Universitario Fundación Alcorcón, Rey Juan Carlos University, Alcorcón, Spain
| | - Barbora Jisova
- Third Department of Surgery, First Medical Faculty of Charles University, Motol University Hospital, Prague, Czech Republic
| | - Orest Laver
- General Surgery Department, Uzhhorod City Central Clinical Hospital, Uzhhorod, National University Uzhhorod, Ukraine
| | - Orest Lerchuk
- Department of General and Endocrine Surgery, Lviv Regional Clinical Hospital, Lviv Danylo Halytsky National Medical University, Lviv, Ukraine
| | - Manuel Lopez-Cano
- Abdominal Wall Surgery Unit, University Hospital Vall d´Hebrón, Barcelona, Spain
- Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Manuel Mega
- Abdominal Wall Unit, Department of General Surgery, Local Health Unit of Castel Branco, Castel Branco, Portugal
| | - Kryspin Mitura
- University of Natural Sciences and Humanities in Siedlce, Siedlce, Masovian Voivodeship, Poland
| | - Filip Muysoms
- Department of Abdominal Wall Surgery, AZ Maria Middelares, Ghent, Belgium
| | - Andrè Oliva
- Department of General Surgery, Coimbra University Hospital, Coimbra, Portugal
| | - Monica Ortenzi
- Department of General and Emergency Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - Ulf Petersson
- Department of Surgery, Skane University Hospital, Malmö, Sweden
- Department for Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Micaela Piccoli
- General Surgery Unit, Civil Hospital of Baggiovara Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Victor G Radu
- Department of General Surgery, Life Memorial Hospital-Medlife Bucharest, Romania
| | - Yohann Renard
- University of Reims Champagne Ardenne, France, Unit of Visceral Surgery, Robert Debre University Hospital, Reims, France
| | - Peder Rogmark
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Danny Rosin
- Sheba Medical Centre, University of Tel Aviv, Tel Aviv, Israel
| | - Ana Senent-Boza
- Department of General and Digestive Surgery, Virgen del Rocío University Hospital, Seville, Spain
| | - Maarten Simons
- Department of Surgery, OLVG Hospital Amsterdam, Amsterdam, the Netherlands
| | - Dominic Slade
- Department of General Surgery, Salford Royal Hospital, Salford, UK
| | - Neil Smart
- Department of Gastrointestinal Surgery, Royal Devon and Exeter Hospital, Exeter, UK
| | - Stella R Smith
- General and Colorectal Surgery, Manchester Royal Infirmary, Manchester Foundation Trust, Manchester, UK
| | - Cesare Stabilini
- Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alexis Theodorou
- First Surgical Unit, Hygeia Hospital, Athens, Greece
- Department of Surgery, Aretaieio University Hospital, Athens, Greece
| | - Jared Torkington
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Jaanna Vironen
- Abdominal Centre, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Guido Woeste
- Department of General and Visceral Surgery, Agaplesion Elisabethenstift, Darmstadt, Germany
| | - Andrew De Beaux
- Department of General Surgery, Spire Murrayfield Hospital, Edinburgh, UK
| | - Barbora East
- Third Department of Surgery, First Medical Faculty of Charles University, Motol University Hospital, Prague, Czech Republic
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Bar N, Naaman E, Rosin D, Aviram E, Yanai H, Yehudai N, Walden R, Padova H, Kori M, Peled-Raz M, Tedgi D, Kabha E, Yerushalmi B, Gil Z, Wagner N, Karni T, Turner D. Shackling incarcerated people in Israeli hospitals-a multicentre study followed by a national intervention programme. Lancet 2023; 402:285-287. [PMID: 37459869 DOI: 10.1016/s0140-6736(23)01242-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 05/16/2023] [Accepted: 06/13/2023] [Indexed: 07/24/2023]
Affiliation(s)
- Nitai Bar
- Department of Radiology, Rambam Health Care Campus, Haifa, Israel
| | - Efrat Naaman
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Danny Rosin
- Department of General Surgery and Transplantation, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eliad Aviram
- Samson Assuta Ashdod Hospital, Ashdod, Israel; Faculty of Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Henit Yanai
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Noam Yehudai
- Tzafon Medical Center, Tiberias, Israel; Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Raphael Walden
- Division of Quality and Patient Safety, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Padova
- Department of Quality and Patient Safety, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Michal Kori
- Pediatric Gastroenterology Unit, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | | | | | - Baruch Yerushalmi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Ziv Gil
- Head and Neck Institute, Holy Family Hospital Nazareth, Nazareth, Israel
| | | | - Tamar Karni
- Breast Health Institute, Shamir Medical Center, Be'er Ya'akov, Israel; Israeli Medical Association, Ramat Gan, Israel
| | - Dan Turner
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Juliet Keidan Institute of Paediatric Gastroenterology, Hepatology, and Nutrition, Shaare Zedek Medical Center, Jerusalem, 91031, Israel.
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Aharoni M, Zager Y, Khalilieh S, Amiel I, Horesh N, Ram E, Gutman M, Rosin D. Reply to “Comments on ‘Laparoscopic fixation of volvulus by extra-peritonealization—a case series’”. Tech Coloproctol 2022; 26:685. [DOI: 10.1007/s10151-022-02652-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 05/29/2022] [Indexed: 10/18/2022]
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4
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Rosin D. COVID-19 Effect on Surgical Care. Isr Med Assoc J 2022; 24:332. [PMID: 35598059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Danny Rosin
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bar N, Naaman E, Asa A, Walden R, Yerushalmi B, Padova H, Yanai H, Pereg D, Mizrachi H, Shosberger A, Kori M, Peterfreund I, Wagner N, Karni T, Turner D, Rosin D. [CUFFING PRISONERS AND DETAINEES IN ISRAELI HOSPITALS - A MULTI-CENTER STUDY]. Harefuah 2022; 161:215-220. [PMID: 35466604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIMS To describe the extent of prisoner/detainee cuffing and characterize cuffing methods. BACKGROUND Thousands of prisoners and detainees receive medical treatment in Israeli hospitals every year. According to the Israeli law, cuffing during hospital stay should be an exceptional measure, to be considered only in cases of real threat of violence or escape, based on individual assessment. There is no documentation of cuffing rates in hospitals. METHODS A multi-center study in 12 hospitals was performed during 2020-2021. Data were collected prospectively or retrieved retrospectively from security records, when available. RESULTS A total of 1857 prisoners/detainees were documented, of whom 1794 (96.6%) were cuffed. Of the 241 hospitalized patients, 230 (95.4%) were cuffed. Details regarding cuffing methods were available for 185 hospitalized patients, revealing that at least 63 patients (68% of patients for whom details regarding cuffing to bed were available) were cuffed to the bed with opposite arm and leg in a cross position. Cuffing rates of prisoners under custody of the Prisons Authority, police and the Israeli Defense Forces, were 98.5%, 96.6%, and 83%, respectively. Impaired mobility for medical reasons was documented in 64 cases, of whom 85.9% were cuffed regardless. CONCLUSIONS Cuffing of prisoners/detainees in Israeli hospitals is performed non-selectively, in violation of the law. During hospitalization, cuffing is usually performed in a cross position, severely impairing mobility. Our findings highlight the need for routine documentation of cuffing due to its medical consequences and the responsibility of medical staff towards patients according to rules of ethics and regulations.
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Affiliation(s)
- Nitai Bar
- Department of Radiology, Rambam Health Care campus, Haifa
| | - Efrat Naaman
- Department of Ophthalmology, Rambam Health Care campus, Haifa
| | - Amit Asa
- Hospital Administrations, Assuta Ashdod hospital, Ashdod
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva
| | - Raphael Walden
- Division of Quality and Patients Safety, Sheba Medical Centre, Ramat Gan
| | - Baruch Yerushalmi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva
- Pediatric Gastroenterology Unit, Soroka University Medical Center
| | - Hagit Padova
- Division of Quality and Patients Safety, Tel-Aviv Sourasky Medical Center, Tel-Aviv
| | - Henit Yanai
- Section of Gastroenterology, Tel-Aviv Sourasky Medical Center, Tel-Aviv
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv
| | - David Pereg
- Cardiology Department, Meir Medical Center, Kfar Saba
| | - Hagar Mizrachi
- Hospital Administrations, Padeh Poriya Medical Center, Tiberias
- Azrieli Faculty of Medicine Bar-Ilan University, Ramat Gan
| | - Adi Shosberger
- The Juliet Keidan Institute of Pediatric Gastroenterology, Shaare Zedek Medical Center, Jerusalem
| | - Michal Kori
- Pediatric Gastroenterology Unit, Kaplan Medical Center, Rehovot
- Faculty of Medicine Hebrew University, Jerusalem
| | | | | | - Tami Karni
- Ethics Bureau, Israel Medical Association
- Breast Care Institute, Shamir Medical Center, Beer Yaakov
| | - Dani Turner
- The Juliet Keidan Institute of Pediatric Gastroenterology, Shaare Zedek Medical Center, Jerusalem
- Faculty of Medicine Hebrew University, Jerusalem
| | - Danny Rosin
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan
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Rosin D. Pilonidal Disease: Keep It Simple! Isr Med Assoc J 2022; 24:120. [PMID: 35187903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Danny Rosin
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Erez L, Schiby G, Amiel I, Naor S, Keren N, Rosin D, Barshack I, Canaani J. Association of Preoperative Clinical, Laboratory, Imaging, and Pathologic Data With Clinically Beneficial Pathology Among Routine Splenectomy Specimens. JAMA Netw Open 2021; 4:e2120946. [PMID: 34398203 PMCID: PMC8369355 DOI: 10.1001/jamanetworkopen.2021.20946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Previous studies have shown that uniform pathologic review of all splenectomy surgical specimens reveals new clinically actionable diagnoses only in a minority of cases. OBJECTIVE To examine whether the aggregate of clinical, laboratory, imaging, and pathologic preoperative data is associated with a clinically beneficial pathologic study for routine splenectomy surgical specimens. DESIGN, SETTING, AND PARTICIPANTS This single-center retrospective cohort study included all patients who underwent splenectomy from January 1, 2013, through December 31, 2018, at a single center. Clinical, imaging, and pathologic data were extracted from the institution's electronic medical records system. Data analysis was conducted from June to November 2020. EXPOSURES Undergoing splenectomy for trauma or diagnostic or therapeutic indications. MAIN OUTCOMES AND MEASURES Spleen pathology study resulting in a new medical diagnosis or change in medical management. RESULTS Overall, 90 patients (53 [59%] men) with a median (range) age of 59 (19-90) years underwent splenectomy for therapeutic purposes in 41 patients (45%), trauma in 24 patients (27%), diagnostic purposes in 15 patients (17%), and combined therapeutic and diagnostic purposes in 9 patients (10%). In 14 patients (15%) a new malignant neoplasm was found, and in 8 patients (9%), a new nonneoplastic medical condition was diagnosed. A new pathologic diagnosis resulted in change in medical management in 16 patients (18%). In patients without a prior diagnosis of cancer, 41 of 56 pathology biopsies (73%) were found to be normal whereas in 7 biopsies (13%), a new diagnosis of a hematologic malignant neoplasm was revealed (P < .001). Patients with clinical splenomegaly were significantly more likely to have a new pathologic diagnosis of cancer compared with patients without splenomegaly (15 of 26 [58%] vs 4 of 64 [7%]; P < .001). In 39 of 43 patients (91%) with normal presurgery imaging studies, normal spleen pathology was revealed, whereas in 14 of 17 patients (82%) with abnormal imaging studies, a new hematological malignant neoplasm was diagnosed following pathologic review of the spleen specimen (P < .001). Patients with gross abnormalities on macroscopic examination had a significantly increased likelihood of a hematological cancer diagnosis (17 of 40 [43%]) and a solid cancer diagnosis (4 [10%]) compared with patients with grossly normal specimens (4 of 49 [8%]; P < .001). CONCLUSIONS AND RELEVANCE In this cohort study, routine pathologic review of spleen specimens was clinically beneficial in patients with splenomegaly, abnormal imaging results, a prior diagnosis of cancer, and with grossly abnormal spleens.
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Affiliation(s)
- Lee Erez
- Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ginette Schiby
- Department of Pathology, Chaim Sheba Medical Center, Tel-Hashomer, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Imri Amiel
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shachar Naor
- Department of Pathology, Chaim Sheba Medical Center, Tel-Hashomer, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Keren
- Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Barshack
- Department of Pathology, Chaim Sheba Medical Center, Tel-Hashomer, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Canaani
- Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Khalilieh S, Horesh N, Cordoba M, Forschmidt E, Zager Y, Nadler R, Gutman M, Rosin D, Ram E. Surgical Outcomes of Minimally Invasive Trephine Surgery for Pilonidal Sinus Disease and Risk Factors for Recurrence. J Laparoendosc Adv Surg Tech A 2021; 32:288-292. [PMID: 33960849 DOI: 10.1089/lap.2021.0097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Minimally invasive surgical (MIS) techniques for pilonidal sinus disease (PNS) have gained popularity in recent years, due to faster recovery and lower complication rate compared with conventional methods. Our aim was to assess recurrence rate following MIS Trephine procedure for PNS and to identify possible risk factors for recurrence. Materials and Methods: A prospective cohort, including patients who underwent PNS Excision by Trephine MIS Procedure over 5 years in a large tertiary medical center was established. Patient data were collected from medical charts and patient telephone survey to asses recurrence rate. Results: Two hundred three patients underwent MIS Trephine procedure for PNS, with data available on 130 patients (64.2%). Overall recurrence and nonhealing wound rate was 33.07% (43 patients), with disease recurrence occurring in mean time of 13.3 months (range 2-47 months). Thirty-six patients underwent repeat MIS Trephine surgery with recurrence occurring in 6 patients (4.6%). Overall healing rate following repeat surgery was 91.5% (119 patients). Univariate analysis of preoperative and clinical factors, including body mass index (P = .77), smoking status (P = .53), number of sinus tracts (P = .78), previous abscess drainage (P = .45), and diameter size of the trephine blade (P = .72) demonstrated no correlation to disease recurrence following surgery. Multivariate Cox regression analysis showed similar results, with only young age (<30 years) associated with disease recurrence (P = .01). Conclusion: Recurrence following minimally invasive trephine excision for PNS is fairly high, but repeat surgery in recurring patients has a high rate of a successful outcome.
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Affiliation(s)
- Saed Khalilieh
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Nir Horesh
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Mordehay Cordoba
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Eyal Forschmidt
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Yaniv Zager
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Roy Nadler
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Mordechai Gutman
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Danny Rosin
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Edward Ram
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
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Aharoni M, Barash Y, Zager Y, Anteby R, Khalilieh S, Amiel I, Klang E, Goldes Y, Gutman M, Horesh N, Rosin D. Management of Acute Appendicitis during the COVID-19 Pandemic: A Single Tertiary Center Experience. Isr Med Assoc J 2021; 23:269-273. [PMID: 34024041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND The coronavirus disease-2019 (COVID-19) outbreak had an effect on healthcare. OBJECTIVES To evaluate the presentation and management of patients with acute appendicitis. METHODS A retrospective study was conducted of all patients presenting with acute appendicitis to the emergency department of a large tertiary center during March and April 2020. Clinical features, diagnostic workup, and management were compared. RESULTS Seventy-four patients presented with acute appendicitis during the pandemic compared to 60 patients during the same time the year before. There were no significant differences in patient demographics: age (P = 0.65), gender (P = 0.73), smoking status (P = 0.48). During COVID-19 patients were more likely to complain of right lower quadrant pain (100% vs. 78.3%, P < 0.01). Rates of surgical treatment was similar (83.8% vs. 81.7%, P = 1); mean operative time was longer during COVID-19 (63 ± 23 vs. 52 ± 26 minutes, P = 0.03). There were no significant differences in intra-operative findings including the presence of appendiceal perforation (16.3% vs. 14.5%, P = 0.8), abscess (6.1% vs. 9.7%, P = 0.73), or involvement of cecum or terminal ileum (14.28% vs. 19.63%, P = 1). Postoperative treatment with antibiotics was more prevalent during COVID-19 (37.1% vs. 18%, P = 0.04). Length of stay (1.82 ± 2.04 vs. 2.74 ± 4.68, P = 0.2) and readmission rates (6% vs. 11.3%, P =0.51) were similar. CONCLUSIONS The COVID-19 pandemic did not significantly affect the presentation, clinical course, management, and outcomes of patients presenting with acute appendicitis.
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Affiliation(s)
- Mor Aharoni
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yiftach Barash
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Zager
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roi Anteby
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Saed Khalilieh
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Imri Amiel
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Klang
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuri Goldes
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Horesh
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Nevo Y, Shaltiel T, Constantini N, Rosin D, Gutman M, Zmora O, Nevler A. Activity Tracking After Surgery: Does It Correlate With Postoperative Complications? Am Surg 2021; 88:226-232. [PMID: 33522277 DOI: 10.1177/0003134820988818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Postoperative ambulation is an important tenet in enhanced recovery programs. We quantitatively assessed the correlation of decreased postoperative ambulation with postoperative complications and delays in gastrointestinal function. METHODS Patients undergoing major abdominal surgery were fitted with digital ankle pedometers yielding continuous measurements of their ambulation. Primary endpoints were the overall and system-specific complication rates, with secondary endpoints being the time to first passage of flatus and stool, the length of hospital stay, and the rate of readmission. RESULTS 100 patients were enrolled. We found a significant, independent inverse correlation between the number of steps on the first and second postoperative days (POD1/2) and the incidence of complications as well as the recovery of GI function and the likelihood of readmission (P < .05). POD2 step count was an independent risk factor for severe complications (P = .026). DISCUSSION Digitally quantified ambulation data may be a prognostic biomarker for the likelihood of severe postoperative complications.
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Affiliation(s)
- Yehonatan Nevo
- Department of General Surgery (Surgery B), Chaim Sheba Medical Center, Tel-Aviv University, Tel Hashomer, Israel
| | - Tali Shaltiel
- Division of General Surgery, 36632Rabin Medical Center, Petah Tikva, Israel
| | - Naama Constantini
- Sports Medicine Center, Department of Orthopedic Surgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Danny Rosin
- Department of General Surgery (Surgery B), Chaim Sheba Medical Center, Tel-Aviv University, Tel Hashomer, Israel
| | - Mordechai Gutman
- Department of General Surgery (Surgery B), Chaim Sheba Medical Center, Tel-Aviv University, Tel Hashomer, Israel
| | - Oded Zmora
- Division of General Surgery, 37256Assaf Harofeh Medical Center, Zerifin, Israel
| | - Avinoam Nevler
- Department of General Surgery (Surgery B), Chaim Sheba Medical Center, Tel-Aviv University, Tel Hashomer, Israel
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11
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Shwaartz C, Pery R, Cordoba M, Gutman M, Rosin D. Laparoscopic Subtotal Cholecystectomy for the Difficult Gallbladder: A Safe Alternative. Isr Med Assoc J 2020; 22:538-541. [PMID: 33236550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The safe completion of cholecystectomy is dependent on proper identification and secure closure of the cystic duct. Effecting this closure poses a great challenge when inflammatory changes obscure the anatomy. Subtotal cholecystectomy allows for near complete removal of the gallbladder and complete evacuation of the stones while avoiding dissection in the hazardous area. OBJECTIVES To describe experience with laparoscopic subtotal cholecystectomy. METHODS Subtotal cholecystectomy was performed when the critical view of safety could not be achieved. Surgical technique was similar in all cases and included opening the Hartmann's pouch, removing stones obstructing the gallbladder outlet, and identifying the opening of the cystic duct, as well as circumferential transection of the gallbladder neck, closure of the gallbladder stump, and excision of the gallbladder fundus. Data retrieved from patient charts included demographics, pre-operative history, operative and postoperative course, and late complications. No bile duct injuries were observed in this series. RESULTS A total of 53 patients underwent laparoscopic subtotal cholecystectomy (2010-2018). Ten patients were operated during the acute course of the disease and 43 electively. Acute cholecystitis was the leading cause for gallbladder removal. Cholecystostomy tube was placed in 18 patients during acute hospitalization. The gallbladder remnant was closed and a drain was placed in most patients. Of the 53 patients, 42 had an uneventful postoperative course. CONCLUSIONS Laparoscopic subtotal cholecystectomy is an effective surgical technique to avoid bile duct injury when the cystic duct cannot safely be identified. Subtotal cholecystectomy has acceptable morbidity and obviates the need for conversion in these difficult cases.
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Affiliation(s)
- Chaya Shwaartz
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Pery
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechay Cordoba
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Zager Y, Horesh N, Dan A, Aharoni M, Khalilieh S, Cordoba M, Nevler A, Gutman M, Rosin D. Associations of novel inflammatory markers with long-term outcomes and recurrence of diverticulitis. ANZ J Surg 2020; 90:2041-2045. [PMID: 32856387 DOI: 10.1111/ans.16220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have emerged as markers of various outcomes of inflammatory and malignant diseases. The association of those markers with short-term outcomes of acute diverticulitis has been discussed in recent studies. This study aimed at evaluation of the association of NLR and PLR with long-term outcomes in patients presenting with acute diverticulitis. METHODS A retrospective single institute study included patients admitted with acute diverticulitis between 2012 and 2016. Associations were analysed of NLR and PLR values at admission with patient outcomes. RESULTS A total of 456 patients were included in the study. High NLR and PLR values were associated with complicated disease (P < 0.01 for both). Among patients with complicated diverticulitis, for those with high NLR, the interval to a recurrent episode of acute diverticulitis was shorter (68.3 days versus 83.7 days, P = 0.044). Patients with high NLR had higher mean number of readmissions (0.54 versus 0.34, P = 0.035). High NLR (10.06 ± 11.23 versus 7.6 ± 8.04, P = 0.012) and PLR (9.64 days ±10.56 versus 7.47 days ±8.225, P = 0.018) were associated with longer cumulative hospital stay due to acute diverticulitis. CONCLUSIONS High NLR and PLR values were associated with recurrence in acute diverticulitis in terms of shorter interval between recurrent episodes and longer cumulative hospitalization days.
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Affiliation(s)
- Yaniv Zager
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Nir Horesh
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Assaf Dan
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Mor Aharoni
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Saed Khalilieh
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Mordehay Cordoba
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Avinoam Nevler
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel.,Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mordechai Gutman
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
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13
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Ram E, Meyer R, Carter D, Gutman M, Rosin D, Horesh N. The efficacy of sacral neuromodulation in the treatment of low anterior resection syndrome: a systematic review and meta-analysis. Tech Coloproctol 2020; 24:803-815. [PMID: 32350733 DOI: 10.1007/s10151-020-02231-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/22/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sacral neuromodulation (SNM) has become one of the main treatment options in patients with fecal incontinence. The aim of this study was to determine the efficacy of sacral neuromodulation in the treatment of low anterior resection syndrome (LARS). METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search was conducted using the Pubmed, Embase, Ovid, and Cochrane databases, restricted to the English language and to articles published from 2000 to November 2018. RESULTS A total of 434 articles on the efficacy of SNM in the treatment of LARS were retrieved, and 13 studies were included in the final analysis, with a total of 114 patients treated with SNM for LARS The overall success rate excluding study heterogeneity was 83.30% [95% CI (71.33-95.25%)]. Improvement in anal continence was seen in several clinical and functional parameters, including the Wexner Score [10.78 points, 95% CI (8.55-13.02), p < 0.0001], manometric maximum resting pressure [mean improvement of 6.37 mm/Hg, 95% CI (2.67-10.07), p = 0.0007], maximum squeeze pressure [mean improvement of 17.99 mm/Hg, 95% CI (17.42-18.56), p < 0.0001] and maximum tolerated volume [mean improvement of 22.74 ml, 95% CI (10.65-34.83), p = 0.0002]. Quality of life questionnaires also demonstrated significant improvement in patients' quality of life, but were reported only in a small group of included patients. CONCLUSIONS SNM significantly improves symptoms and quality of life in patients suffering from fecal incontinence following low anterior resection.
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Affiliation(s)
- E Ram
- Department of Surgery B, Sheba Medical Centre, Tel Hashomer, Israel.
- Tel Aviv University, Tel Aviv, Israel.
| | - R Meyer
- Tel Aviv University, Tel Aviv, Israel
- Department of Gynecology and Obstetrics, Sheba Medical Centre, Tel Hashomer, Israel
| | - D Carter
- Tel Aviv University, Tel Aviv, Israel
- Department of Gastroenterology, Sheba Medical Centre, Tel Hashomer, Israel
| | - M Gutman
- Department of Surgery B, Sheba Medical Centre, Tel Hashomer, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - D Rosin
- Department of Surgery B, Sheba Medical Centre, Tel Hashomer, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - N Horesh
- Department of Surgery B, Sheba Medical Centre, Tel Hashomer, Israel
- Tel Aviv University, Tel Aviv, Israel
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14
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Horesh N, Abu-Ghanem Y, Erlich T, Rosin D, Gutman M, Zilberman DE, Ramon J, Dotan ZA. Management of Pancreatic Injuries Following Nephrectomy. Isr Med Assoc J 2020; 22:244-248. [PMID: 32286029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Pancreatic injuries during nephrectomy are rare, despite the relatively close anatomic relation between the kidneys and the pancreas. The data regarding the incidence and outcome of pancreatic injuries are scarce. OBJECTIVES To assess the frequency and the clinical significance of pancreatic injuries during nephrectomy. METHODS A retrospective analysis was conducted of all patients who underwent nephrectomy over a period of 30 years (1987-2016) in a large tertiary medical center. Demographic, clinical, and surgical data were collected and analyzed. RESULTS A total of 1674 patients underwent nephrectomy during the study period. Of those, 553 (33%) and 294 patients (17.5%) underwent left nephrectomy and radical left nephrectomy, respectively. Among those, four patients (0.2% of the total group, 0.7% of the left nephrectomy group, and 1.36% of the radical left nephrectomy) experienced iatrogenic injuries to the pancreas. None of the injuries were recognized intraoperatively. All patients were treated with drains in an attempt to control the pancreatic leak and one patient required additional surgical interventions. Average length of stay was 65 days (range 15-190 days). Mean follow-up was 23.3 months (range 7.7-115 months). CONCLUSIONS Pancreatic injuries during nephrectomy are rare and carry a significant risk for postoperative morbidity.
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Affiliation(s)
- Nir Horesh
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yasmin Abu-Ghanem
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Erlich
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Ramon
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zohar A Dotan
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Amiel I, Anteby R, Cordoba M, Laufer S, Shwaartz C, Rosin D, Gutman M, Ziv A, Mashiach R. Experienced surgeons versus novice surgery residents: Validating a novel knot tying simulator for vessel ligation. Surgery 2020; 167:699-703. [DOI: 10.1016/j.surg.2019.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/23/2019] [Accepted: 09/11/2019] [Indexed: 11/25/2022]
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Hoffman A, Ben Ishay O, Horesh N, Shabtai M, Forschmidt E, Rosin D, Gutman M, Ram E. Breast Cancer in Men: A Single Center Experience Over a Period of 22 years. Isr Med Assoc J 2020; 22:160-163. [PMID: 32147980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Male breast cancer (MBC) is a rare disease that is poorly understood. Treatment protocols are widely extrapolated from breast cancer in women. OBJECTIVES To review the experience with MBC of a single center in Israel over a period of 22 years. METHODS This single center retrospective study evaluated all patients diagnosed with MBC over a period of 22 years (1993-2015). Data were extracted from patient medical charts and included demographics, clinical, surgical, and oncological outcomes. RESULTS The study comprised 49 patients. Mean age at diagnosis was 64.1 ± 13.5 years. The majority were diagnosed at early stages (1A-2A) (54.4%), 30.6% were stage 3B mostly due to direct skin and nipple involvement, and 59.2% of the patients had node negative disease. All of the patients were diagnosed with invasive ductal carcinoma and 30.6% had concomitant ductal carcinoma in situ. Estrogen receptor (ER) status was predominantly positive and luminal B (HER2-) was the most common subtype. Of the patients, 18.4% were BRCA carriers. The majority of patients underwent mastectomy. Radiotherapy was delivered to 46.9% and hormonal therapy to 89.8%. Chemotherapy was administered to 42.9%. Overall survival was 79.6% with a median survival of 60.1 (2-178) months; 5- and 10-year survival was 93.9% and 79.6%, respectively. Progesterone receptor (PR)-negative patients had a significantly improved overall survival. CONCLUSIONS MBC has increasing incidence. PR-negative status was associated with better overall survival and disease-free interval. Indications to radiotherapy and hormonal therapy need standardization and will benefit from prospective randomized control trials.
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Affiliation(s)
- Aviad Hoffman
- Department of General Surgery, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofir Ben Ishay
- Department of General Surgery, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nir Horesh
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Shabtai
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Forschmidt
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edward Ram
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Amiel I, Anteby R, Cordoba M, Laufer S, Shwaartz C, Rosin D, Gutman M, Ziv A, Mashiach R. Feedback based simulator training reduces superfluous forces exerted by novice residents practicing knot tying for vessel ligation. Am J Surg 2019; 220:100-104. [PMID: 31806168 DOI: 10.1016/j.amjsurg.2019.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Technological advances have led to the development of state-of-the-art simulators for training surgeons; few train basic surgical skills, such as vessel ligation. METHODS A novel low-cost bench-top simulator with auditory and visual feedback that measures forces exerted during knot tying was tested on 14 surgical residents. Pre- and post-training values for total force exerted during knot tying, maximum pulling and pushing forces and completion time were compared. RESULTS Mean time to reach proficiency during training was 11:26 min, with a mean of 15 consecutive knots. Mean total applied force for each knot were 35% lower post-training than pre-training (7.5 vs. 11.54 N (N), respectively, p = 0.039). Mean upward peak force was significantly lower after, compared to before, training (1.29 vs. 2.12 N, respectively, p = 0.004). CONCLUSIONS Simulator training with visual and auditory force feedback improves knot-tying skills of novice surgeons.
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Affiliation(s)
- Imri Amiel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; Israel Center for Medical Simulation (MSR), Tel-Hashomer, Israel; Talpiot Medical Leadership Program, Sheba Medical Center, Israel.
| | - Roi Anteby
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.
| | - Moti Cordoba
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Shlomi Laufer
- Technion, Israel Institute of Technology, Haifa, Israel
| | - Chaya Shwaartz
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Danny Rosin
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Mordechai Gutman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Amitai Ziv
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; Israel Center for Medical Simulation (MSR), Tel-Hashomer, Israel
| | - Roy Mashiach
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; Israel Center for Medical Simulation (MSR), Tel-Hashomer, Israel
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18
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Horesh N, Hoffman A, Zager Y, Cordoba M, Haikin M, Rosin D, Gutman M, Lebedeyev A. Value of Routine Colonic Evaluation Prior To Ileostomy Closure. Isr Med Assoc J 2019; 21:728-731. [PMID: 31713360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Evaluation of low rectal anastomosis is often recommended prior to ostomy closure, but the efficacy of such evaluations is uncertain. OBJECTIVES To assess whether routine colonic preoperative evaluation has an effect on postoperative ileostomy closure results. METHODS We performed a retrospective study evaluating all patients who underwent ileostomy closure over 9 years. Patient demographics, clinical, surgical details, and surgical outcomes were recorded and analyzed. RESULTS The study comprised 116 patients who underwent ileostomy closure, of them 65 were male (56%) with a mean age of 61 years (range 20-91). Overall, 98 patients (84.4%) underwent colonic preoperative evaluation prior to ileostomy closure. A contrast enema was performed on 61 patients (62.2%). Abnormal preoperative results were observed in 12 patients (12.2%). The overall complication rate was 35.3% (41 patients). No differences in postoperative outcome was observed in patient gender (P = 1), age (P = 0.96), body mass index (P = 0.24), American Society of Anesthesiologists score (P = 0.21), and the Charlson Comorbidity Index score (P = 0.93). Among patients who had postoperative complications, we did not observe a difference between patients who underwent preoperative evaluation compared to those who did not (P = 0.42). No differences were observed among patients with preoperative findings interpreted as normal or abnormal (P = 1). The time difference between ileostomy creation and closure had no effect on the ileostomy closure outcome (P = 0.34). CONCLUSIONS Abnormal findings in preoperative colonic evaluation prior to ileostomy closure were not associated with worse postoperative outcome.
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Affiliation(s)
- Nir Horesh
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviad Hoffman
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Zager
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Cordoba
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marat Haikin
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Lebedeyev
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
BACKGROUND The use of acronyms in medicine is widespread, aiming to simplify and condense communication. Online communication in social media platforms seems to enhance the use of acronyms, but their efficiency in message delivery may be negated by their abundance and unfamiliarity, causing more confusion than clarity. We analyzed the use of acronyms in a closed Facebook group dedicated to abdominal wall reconstruction (AWR), as the rapid recent development of this field has resulted in many new acronyms. Our aim was to classify the different acronyms and create a public reference. METHODS The International Hernia Collaboration, a hernia-related Facebook group, now communicating more than 7500 surgeons from 99 countries, was studied, by extracting acronyms used since its inception in 2012. Acronyms were categorized and interpreted, to create a small dictionary comprised of several tables. RESULTS Commonly used acronyms were identified, as well as commonly used prefixes that modify the acronyms' meaning. Tables were created, classifying acronyms by their subject: 1.Anatomy2.Diseases and clinical conditions3.Techniques and materials. CONCLUSION The use of acronyms increased in social media-based communication. Aiming to simplify the language, the inflation of terms may have achieved the opposite, by adding a multitude of unfamiliar and confusing terms. We have created a public reference for AWR-related acronyms. Limiting the liberal creation of new acronyms is recommended, especially in a rapidly changing field as AWR.
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Affiliation(s)
- B Ramana
- Apollo Gleneagles Hospital, Kolkata, India.
| | | | - Brian Jacob
- Icahn School of Medicine, Mount Sinai Laparoscopic Surgical Center of New York, New York, USA
| | | | - Danny Rosin
- Department of General Surgery and Transplantation, Sheba Medical Center Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rosin D. Routine Breast Ultrasound in Young, Low-Risk Patients: the problem of unnecessary tests. Isr Med Assoc J 2019; 21:626. [PMID: 31542911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Danny Rosin
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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21
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INOUE T, Abe C, Tanaka S, Rosin D, Inagi R, Wada Y, Nanagaku M, Okusa M. SAT-137 NON-CANONICAL CHOLINERGIC ANTI-INFLAMMATORY PATHWAY-MEDIATED ACTIVATION OF PERITONEAL MACROPHAGES INDUCES HES1 AND BLOCKS KIDNEY INJURY. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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22
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Barda L, Nevler A, Rosin D, Shabtai EL, Gutman M, Shabtai M. [THE EFFECTS OF HORMONAL REPLACEMENT THERAPY (HRT) ON MAMMOGRAPHIC BREAST DENSITY AND ABNORMAL MAMMOGRAMS PROMPTING FURTHER INVESTIGATION]. Harefuah 2019; 158:239-243. [PMID: 31032556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIMS The purpose of this study was to portray and analyze the inter-relationship between the use of HRT, mammographic breast density and the finding of any mammographic abnormality that prompted further investigation such as core needle biopsy or additional imaging testing, while controlling for obstetric and relevant demographic data. BACKGROUND Mammographic breast density has been associated with higher risk of breast cancer and decrease in its sensitivity, while hormonal replacement therapy (HRT) in turn, has been implicated in increasing mammographic density and is considered a risk factor for breast cancer by itself. The inter-relationship between HRT, breast density and any mammographic or sonographic finding requiring further investigation has not been fully investigated. METHODS A total of 2,758 consecutive, screening mammograms performed during one year in a single academic medical center in Israel were analyzed. Each mammogram was supplemented by high resolution ultrasound. Density was measured by a visual, semi-quantitative, 5-grade scale, based on Boyd's classification and grouped into low density mammograms (LDM) (1-3) and high density mammograms (HDM) (4-5). Demographic and obstetric data, personal and family history of breast cancer, and the use of HRT were entered into the database. These parameters were correlated with breast density and any detected abnormality that prompted further investigation. Univariate and multivariate analyses as well as multivariate logistic regression were performed using SAS 9.2. RESULTS A significant difference in density was observed between pre- and post-menopausal women (p = 0.0001). However, the use of HRT in post-menopausal women was not associated with higher incidence of HDM (18.6%, n=110/592) compared to post-menopausal women without HRT (15.4%, n=211/1370) (p=n.s). Mammographic abnormality was more likely to occur in post-menopausal women without HRT (52%, n=711/1370) compared with women on HRT (38.7% n=229/592) (p = 0.0001). This held true for solid lump (p=0.0001), tissue irregularity (p=0.016) and calcifications (p=0.0005). Menopause was associated with higher likelihood (48%) of any mammographic finding compared with 41.6% in pre-menopausal women (p = 0.0017). A total of 266 women with mammographic findings prompting histological assessment were identified, revealing 105 malignant lesions. HRT in post-menopausal women was associated with lower incidence (28%) of malignancy compared to post-menopausal women without HRT (50%). CONCLUSIONS The present study, portraying the inter-relationship between mammographic breast density, any abnormal finding in screening mammograms, and the use of HRT has not found such treatment to be associated neither with increased density, nor with higher probability of finding malignancy. Furthermore, a lower incidence of mammographic abnormality was noted in HRT users. Albeit, further and larger studies are required to substantiate these findings. The results of this study do not support the notion that HRT increases the likelihood of malignancy or affects breast density.
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Affiliation(s)
- Liran Barda
- Department of Surgery, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
| | - Avinoam Nevler
- Department of Surgery, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
| | - Danny Rosin
- Department of Surgery, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
| | - Esther L Shabtai
- Tel Aviv University, Statistical Service, Communication Disorders, Tel Hashomer, Israel
| | - Mordechai Gutman
- Department of Surgery, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
| | - Moshe Shabtai
- Department of Surgery, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
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Rosin D. Outcome of Delayed Cholecystectomy after Percutaneous Cholecystostomy for Acute Cholecystitis. Isr Med Assoc J 2018; 20:651. [PMID: 30324786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Danny Rosin
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Horesh N, Rosin D, Dreznik Y, Amiel I, Jacoby H, Nadler R, Gutman M, Klang E. A Single Tertiary Center 10-Year Experience in the Surgical Management of Gastrointestinal Bezoars. J Laparoendosc Adv Surg Tech A 2018; 28:967-971. [PMID: 29641363 DOI: 10.1089/lap.2017.0752] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Gastrointestinal (GI) bezoars are the most common foreign bodies causing obstruction in the GI tract. They are frequently seen following upper GI tract surgery and surgical intervention is required often. The aim of this study is to describe the surgical management of GI bezoars. MATERIALS AND METHODS A retrospective cohort study, including all patients diagnosed with bezoars between May 2008 and May 2017, was conducted. Patient charts were reviewed, and demographics, clinical, surgical, and postoperative data were collected and analyzed. RESULTS Forty-five patients were included, with a mean age of 62.04 years (Range 18-91). Thirty patients underwent previous surgery (66.6%), most commonly surgical interventions for peptic ulcer disease (22 patients, 73.3%). Obstruction was most common in the ileum (27 patients, 60%). Thirty-nine patients (86.7%) required surgical intervention. Laparoscopy was attempted in 20 patients (51.2%), but conversion to open procedure was required in 11 patients (55%). Postoperative complication rate was 41%. No preoperative factors were found to be correlated with postoperative complications. Postoperative complications were associated with a longer length of stay (P = .006) and a higher readmission rate (P = .04). Patients treated with laparoscopy tended to have a lower BMI (P = .04), less previous surgeries (P = .04), and a bezoar located more proximally (P = .03), however, laparoscopy showed no benefit in complications rate, readmissions, and length of stay. CONCLUSIONS GI bezoars require surgical intervention at high rates. Postoperative complications are common. Completion of an upper GI endoscopy is important and should be performed at an early stage of management.
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Affiliation(s)
- Nir Horesh
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Danny Rosin
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Yael Dreznik
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Imri Amiel
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Harel Jacoby
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Roy Nadler
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Mordechai Gutman
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Eyal Klang
- 2 Department of Radiology, Chaim Sheba Medical Center, affiliated with The Faculty of Medicine, Tel Aviv University , Ramat Gan, Israel
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Pery R, Shaharabani E, Gazer B, Gutman M, Rosin D. Laparoscopic Fixation for Torsion of Transplanted Kidney: A Case Report. Transplant Proc 2017; 49:2378-2380. [PMID: 29198683 DOI: 10.1016/j.transproceed.2017.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 09/23/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Kidney graft torsion and subsequent acute kidney injury is a rare yet potentially devastating complication of intraperitoneal kidney transplant. We report a case of this elusive diagnosis and describe kidney salvage by using laparoscopic fixation. CASE REPORT A 49-year-old male patient presented with multiple episodes of anuric acute kidney injury 16 months after an uneventful combined orthotopic liver and kidney transplantation. After a thorough investigation, a diagnosis of kidney torsion was made, and the patient was urgently operated. Upon surgery, a complete torsion of a viable kidney was found. Laparoscopic fixation was achieved by using an absorbable mesh "pocket." The patient has experienced no similar episodes in the subsequent year. CONCLUSIONS Nephrologists and surgeons should be aware of this rare complication. Prompt diagnosis and operative repair are crucial to save the graft. Prophylactic nephropexy should be considered in all intraperitoneal transplantations.
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Affiliation(s)
- R Pery
- Department of General Surgery and Transplantation, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - E Shaharabani
- Department of General Surgery and Transplantation, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - B Gazer
- Department of General Surgery and Transplantation, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Gutman
- Department of General Surgery and Transplantation, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Rosin
- Department of General Surgery and Transplantation, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Dreznik Y, Horesh N, Gutman M, Gravetz A, Amiel I, Jacobi H, Zmora O, Rosin D. Preoperative Nutritional Optimization for Crohn's Disease Patients Can Improve Surgical Outcome. Dig Surg 2017; 35:442-447. [PMID: 29130989 DOI: 10.1159/000481408] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/10/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Preoperative preparation of patients with Crohn's disease is challenging and there are no specific guidelines regarding nutritional support. The aim of this study was to assess whether preoperative nutritional support influenced the postoperative outcome. METHODS A retrospective, cohort study including all Crohn's disease patients who underwent abdominal surgery between 2008 and 2014 was conducted. Patients' characteristics and clinical and surgical data were recorded and analyzed. RESULTS Eighty-seven patients were included in the study. Thirty-seven patients (42.5%) received preoperative nutritional support (mean albumin level 3.14 vs. 3.5 mg/dL in the non-optimized group; p < 0.02) to optimize their nutritional status prior to surgery. Preoperative albumin level, after adequate nutritional preparation, was similar between the 2 groups. The 2 groups differ neither in demographic and surgical data, overall post-op complication (p = 0.85), Clavien-Dindo score (p = 0.42), and length of stay (p = 0.1). Readmission rate was higher in the non-optimized group (p = 0.047). CONCLUSION Nutritional support can minimize postoperative complications in patients with low albumin levels. Nutritional status should be optimized in order to avoid hazardous complications.
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Kunin M, Dinour D, Rosin D. Intraperitoneal antibiotic administration for prevention of postoperative peritoneal catheter-related infections. Clin Exp Nephrol 2017; 22:448-452. [PMID: 28913721 DOI: 10.1007/s10157-017-1476-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/26/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND It is recommended that systemic prophylactic antibiotics be given immediately prior to peritoneal catheter insertion. This administration requires intravenous access and could be inconvenient in dynamic and unpredictable operation room schedule. Intraperitoneal antibiotics could be an alternative simple way for prevention of postoperative peritoneal catheter infections. METHODS Medical records from 109 patients undergoing permanent PD catheter placement procedures were reviewed retrospectively. Group I patients (66 patients) received intraperitoneal cefazolin through the inserted Tenckhoff catheter in operation room. Group II (43 patients) received intravenous cefazolin 2 h prior to the surgery. The effect of prophylactic antibiotics on the occurrence of peritonitis and exit site infection in the 14 days following surgical peritoneal dialysis catheter placement was evaluated. RESULTS During the follow-up period, one patients from group II (2.3%) and none from group I developed peritonitis (P = 0.3945). One patient from each group developed exit site infection (P = 1.000). CONCLUSION It was found that intraperitoneal antibiotics have the similar efficacy compared with intravenous antibiotics for postoperative peritoneal catheter-related infections' prevention. It does not require intravenous access and overcome the issue of unpredictable operation room schedule.
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Affiliation(s)
- Margarita Kunin
- Nephrology and Hypertension Institute, Sheba Medical Center and Sackler Faculty of Medicine, Tel-Hashomer, Israel.
| | - Dganit Dinour
- Nephrology and Hypertension Institute, Sheba Medical Center and Sackler Faculty of Medicine, Tel-Hashomer, Israel
| | - Danny Rosin
- Department of Surgery, Sheba Medical Center and Sackler Faculty of Medicine, Tel-Hashomer, Israel
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Gazer B, Rosin D, Bar-Zakai B, Willenz U, Doron O, Gutman M, Nevler A. Accuracy and inter-operator variability of small bowel length measurement at laparoscopy. Surg Endosc 2017; 31:4697-4704. [DOI: 10.1007/s00464-017-5538-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 03/20/2017] [Indexed: 12/19/2022]
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Nevler A, Har-Zahav G, Abraham A, Schiby G, Zmora O, Shabtai M, Gutman M, Rosin D. Laparoscopic Lymph Node Biopsy: Efficacy and Advantages. Isr Med Assoc J 2017; 19:231-233. [PMID: 28480676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Diagnosis of abdominal lymphadenopathy is challenging when not accompanied by peripheral lymphadenopathy. Computed tomography-guided core-needle biopsy has largely replaced open procedures in recent years, but this approach is limited by access to the anatomic region and the amount of tissue acquired. OBJECTIVES To demonstrate the feasibility of the laparoscopic approach in obtaining abdominal lymph node biopsies and to evaluate the diagnostic adequacy of the technique. METHODS We reviewed the data of patients who underwent laparoscopic lymph node biopsy between 2014 and 2014 in our department. Demographics, intra-operative parameters and postoperative course were examined, as were histological reports. Postoperative complications were categorized according to the Clavien-Dindo(CD) classification. RESULTS Between 2004 and 2014, 57 laparoscopic biopsies were performed for intra-abdominal lymphadenopathy. One case was a repeated attempt due to limited histologic material. The mean age was 49.5 ± 19.6 years. There were two conversions to open laparotomy, one due to small bowel injury and the other due to a sizable mass. Overall, 56 cases had full clinical data: 48 cases (85.7%) had CD=0, six (10.7%) had CD=1, one postoperative severe complication (CD=3) and one mortality (CD=5), which was related to preexisting hepatic insufficiency. Mean hospital stay was 1.6 days. Overall, adequate tissue samples were acquired in 96.7% and only 3 of these cases resulted in inconclusive diagnoses. CONCLUSIONS Laparoscopic lymph node biopsy is a viable alternative to the currently available methods of tissue retrieval. It provides an access for nodes which are inaccessible percutaneously, and may allow a superior diagnostic yield.
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Affiliation(s)
- Avinoam Nevler
- Department of Surgery and Transplantation
- Borenstein Talpiot Medical Leadership Program, 2012, Sheba MedicalCenter, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Avigdor Abraham
- Institute of Hematology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ginette Schiby
- Department of Pathology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Zmora
- Department of Surgery and Transplantation
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Rosin D. The Fixation on Fixation. IC on: Randomized Clinical Trial Comparing Cyanoacrylate Glue Versus Suture Fixation in Lichtenstein Hernia Repair-7-Year Outcome Analysis. World J Surg 2016; 41:114-115. [PMID: 27826768 DOI: 10.1007/s00268-016-3812-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Danny Rosin
- General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Rosin D. Total Extra-peritoneal Hernia Repair: Residency Teaching Program and Outcome Evaluation. World J Surg 2016; 41:106-107. [PMID: 27738834 DOI: 10.1007/s00268-016-3741-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Danny Rosin
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Horesh N, Wasserberg N, Zbar AP, Gravetz A, Berger Y, Gutman M, Rosin D, Zmora O. Changing paradigms in the management of diverticulitis. Int J Surg 2016; 33 Pt A:146-50. [DOI: 10.1016/j.ijsu.2016.07.072] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/21/2016] [Accepted: 07/26/2016] [Indexed: 12/15/2022]
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Horesh N, Klang E, Gravetz A, Nevo Y, Amiel I, Amitai MM, Rosin D, Gutman M, Zmora O. Jejunal Diverticulitis. J Laparoendosc Adv Surg Tech A 2016; 26:596-9. [DOI: 10.1089/lap.2016.0066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Nir Horesh
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Klang
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Radiology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Aviad Gravetz
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehonatan Nevo
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Imri Amiel
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Marianne Amitai
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Radiology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Zmora
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Horesh N, Saeed Y, Horesh H, Berger Y, Speter C, Pery R, Rosin D, Gutman M, Zmora O. Colonoscopy after the first episode of acute diverticulitis: challenging management paradigms. Tech Coloproctol 2016; 20:383-387. [PMID: 27170283 DOI: 10.1007/s10151-016-1478-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 04/28/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Colonoscopy is commonly recommended after the first episode of acute diverticulitis to exclude colorectal neoplasia. Recent data have challenged this paradigm due to insufficient diagnostic yield. The aim of this study was to assess whether colonoscopy after the first episode of acute diverticulitis is needed to exclude colorectal neoplasia. METHODS We performed a retrospective cohort analysis of medical records of patients admitted for the first episode of acute diverticulitis between January 2008 and December 2012. Ambulatory colonoscopy was routinely recommended at discharge. Clinical follow-up and telephone surveys were used for data collection. RESULTS Four hundred and twenty-five patients with a mean age of 62.6 years (range 21-98 years) were admitted during the 5-year period. Three hundred and ten (72.9 %) patients underwent colonoscopy at median time of 3.2 months after discharge. Five patients (1.6 %) of the 310 available for evaluation had malignant findings in colonoscopy. Of those, one patient had rectal carcinoma away from the inflamed site and one had colonic lymphoma. None of the 95 patients <50 years of age was found to have adenocarcinoma of the colon. CONCLUSIONS Cancer is rarely detected in colonoscopy following the first episode of acute diverticulitis. These results question this indication for colonoscopy, especially in patients under 50.
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Affiliation(s)
- N Horesh
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel.
| | - Y Saeed
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - H Horesh
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - Y Berger
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - C Speter
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - R Pery
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - D Rosin
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - M Gutman
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - O Zmora
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
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Horesh N, Shwaartz C, Amiel I, Nevler A, Shabtai E, Lebedeyev A, Nadler R, Rosin D, Gutman M, Zmora O. Diverticulitis: does age matter? J Dig Dis 2016; 17:313-8. [PMID: 27106275 DOI: 10.1111/1751-2980.12350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/01/2016] [Accepted: 04/18/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Acute diverticulitis has been traditionally associated with worse outcome in young patients, indicating a more aggressive surgical approach is required for them. The aim of this study was to assess whether acute diverticulitis was more virulent in young patients. METHODS A retrospective, cross-sectional study included all patients who were admitted for a first episode of acute diverticulitis between January 2004 and December 2013. The patients were divided into two groups (≤50 years and >50 years) based on their age. Patients' characteristics, clinical and surgical data were recorded and analyzed. RESULTS Overall, 636 patients were included in the database, including 177 (27.8%) in the younger group and 459 in the elder group. There were no significant differences between the groups in disease complexity, peritonitis, laboratory work-up, vital signs on presentation, bowel obstruction or the presence of fistula and abscess in need of drainage. Younger patients had more free extra-luminal air on computed tomography (CT) scan (P = 0.03). Surgical data, including the intra-operative modified Hinchey score and the need for emergency and additional surgery did not significantly differ between the two groups. Young patients had more readmissions (P = 0.01) due to acute diverticulitis, diverticular complications and elective surgery. Length of hospital stay (P = 0.0001) was longer and postoperative complications were more common in the elder patients. CONCLUSIONS The clinical presentation of acute diverticulitis does not seem to be worse in the young population. Younger patients tend to have a more severe presentation on CT scan and more readmissions, but this did not translate to a more severe disease course.
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Affiliation(s)
- Nir Horesh
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Chaya Shwaartz
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Imri Amiel
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Avinoam Nevler
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Esther Shabtai
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Alexander Lebedeyev
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Roi Nadler
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Oded Zmora
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
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Horesh N, Jacoby H, Dreznik Y, Nadler R, Amiel I, Dotan ZA, Gutman M, Shabtai M, Rosin D. Teaching Laparoscopic Adrenalectomy to Surgical Residents. J Laparoendosc Adv Surg Tech A 2016; 26:453-6. [PMID: 27128147 DOI: 10.1089/lap.2015.0625] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Laparoscopic adrenalectomy is the surgical treatment for various adrenal diseases. The procedure is a common surgical practice for urologists and general surgeons and requires fundamental laparoscopic skills, nowadays common in the surgical education of residents in these practices. The aim of this study is to assess whether laparoscopic adrenalectomy differs in outcome between certified and trained surgeons and surgical residents and whether the learning curve changes the endpoint of the surgery. MATERIALS AND METHODS A cohort retrospective study, including all adult patients who underwent laparoscopic adrenalectomy between June 2008 and June 2014, was conducted. Patients' demographic, clinical, and surgical data were recorded and analyzed. RESULTS Fifty-three patients were included in the database (21 men, 32 women) with a mean age of 54 years (range 17-77). The cause for surgery was most commonly a benign adrenal tumor (27 patients, 50.9%) followed by large nonfunctioning adrenal tumors (16 patients, 30.1%), and adrenal cancer (8 patients, 15%). Eighteen patients (33.9%) were operated by residents (4-6 years into the residency) and 35 patients by a certified senior surgeon (66.1%). Left-sided adrenalectomy was preferred to right-sided adrenalectomy for resident tutoring (P = .03). Overall, intraoperative complications were seen in 6 patients (11.3%) and postoperative complications were seen in 9 patients (16.9%). There were no differences in operation time (P = .36), intraoperative complications (P = .76), postoperative complications (P = .96), and length of stay (P = .34) between the patients operated by senior residents and certified surgeons. CONCLUSION Laparoscopic adrenalectomy is a complex surgical procedure that should be a part of the surgical training of surgery residents, as it is safe in guided hands.
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Affiliation(s)
- Nir Horesh
- 1 Department of Surgery and Transplantation B, Chaim Sheba Medical Center , Ramat Gan, Israel .,2 Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Harel Jacoby
- 1 Department of Surgery and Transplantation B, Chaim Sheba Medical Center , Ramat Gan, Israel .,2 Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Yael Dreznik
- 1 Department of Surgery and Transplantation B, Chaim Sheba Medical Center , Ramat Gan, Israel .,2 Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Roy Nadler
- 1 Department of Surgery and Transplantation B, Chaim Sheba Medical Center , Ramat Gan, Israel .,2 Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Imri Amiel
- 1 Department of Surgery and Transplantation B, Chaim Sheba Medical Center , Ramat Gan, Israel .,2 Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Zohar A Dotan
- 2 Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel .,3 Department of Urology, Chaim Sheba Medical Center , Ramat Gan, Israel
| | - Mordechai Gutman
- 1 Department of Surgery and Transplantation B, Chaim Sheba Medical Center , Ramat Gan, Israel .,2 Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Moshe Shabtai
- 1 Department of Surgery and Transplantation B, Chaim Sheba Medical Center , Ramat Gan, Israel .,2 Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Danny Rosin
- 1 Department of Surgery and Transplantation B, Chaim Sheba Medical Center , Ramat Gan, Israel .,2 Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
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Horesh N, Gutman M, Rosin D. Laparoscopic cholecystostomy tube-guided hepatotomy and cholecystolithotomy: alternative strategy for treatment of severe chronic cholecystitis. Ann R Coll Surg Engl 2016; 98:e65-7. [PMID: 26985702 DOI: 10.1308/rcsann.2016.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Laparoscopic cholecystectomy can be a challenging procedure in gallbladders with chronic disease. We describe a patient with chronic cholecystitis and difficult visualisation of the gallbladder at surgery who underwent laparoscopic hepatotomy along the drainage tube of the cholecystostomy. In this way, the gallbladder was identified to avoid non-visualisation of ductal anatomy. This exceptional solution should be added to the surgical options if anatomical recognition is difficult and complete removal of the gallbladder is too risky.
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Affiliation(s)
- N Horesh
- Chaim Sheba Medical Center , Tel Aviv , Israel
| | - M Gutman
- Chaim Sheba Medical Center , Tel Aviv , Israel
| | - D Rosin
- Chaim Sheba Medical Center , Tel Aviv , Israel
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Nevler A, Shabtai E, Rosin D, Hoffman A, Gutman M, Shabtai M. Mammographic Breast Density as a Predictor of Radiological Findings Requiring Further Investigation. Isr Med Assoc J 2016; 18:32-35. [PMID: 26964277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND High density breast mammography has been associated with a greater risk for breast cancer and an increased likelihood of false negative results. OBJECTIVES To assess whether the degree of mammographic breast density correlates with increased risk for the presence of radiographic findings requiring further histological investigation. METHODS Included in the study were 2760 consecutive screening mammograms performed in a large volume, early detection mammography unit. All mammograms were complemented by high resolution ultrasound and interpreted by a single expert radiologist. Breast density (BD) was evaluated using a semi-quantitative 5 grade scale and grouped into low breast density (LBD) and high breast density (HBD) mammograms. Demographic and all relevant obstetric, personal and family history of breast cancer data were recorded. RESULTS Of the 2760 mammograms 2096 (76%) were LBD and 664 (24%) were HBD. Mean age of the LBD and HBD groups was 59 ± 10.5 and 50.9 ± 9.3 years respectively (P = 0001). Breast density significantly correlated with presence of mammographic findings requiring further histological assessment (8.7% and 12.3% for LBD and HBD respectively, P < 0.01). In women younger than 60 years in whom histological assessment was required due to these findings, malignant pathology was significantly more prevalent in the HBD group (2.3% and 4.1% respectively, P = 0.03). Age, parity, patient history and HBD were identified as independent risk factors for any pathological mammographic finding. CONCLUSIONS Highly dense mammography, aside from being an indicator of higher risk for breast cancer, appears to be associated with a significantly higher incidence of findings that will prompt further investigation to achieve a definite diagnosis.
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Rosin D. Open Mesh Repair for Inguinal Hernia is Safer than Laparoscopic Repair or Open Non-mesh Repair—A Nationwide Registry Study of Complications. World J Surg 2015. [DOI: 10.1007/s00268-015-3048-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Shwaartz C, Haim N, Rosin D, Lawrence Y, Gutman M, Zmora O. Regional lymph node status after neoadjuvant chemoradiation of rectal cancer producing a complete or near complete rectal wall response. Colorectal Dis 2015; 17:595-9. [PMID: 25605475 DOI: 10.1111/codi.12902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/19/2014] [Indexed: 12/22/2022]
Abstract
AIM Transanal excision of the tumour site after complete response to chemoradiotherapy can determine the rectal wall response to treatment. This study was designed to assess whether the absence of tumour in the rectal wall corresponds to the absence of tumour in the mesorectum (true pathological complete response). METHOD A retrospective review identified patients who underwent preoperative chemoradiation therapy for advanced mid and low rectal cancer followed by routine pre-planned radical surgery with total mesorectal excision. Patients in whom the pathology specimen showed no residual tumour in the rectal wall (ypT0) or a ypT1 lesion were assessed for tumour involvement in the mesorectum. RESULTS Seventy-eight patients who underwent pelvic chemoradiation followed by radical surgery were reviewed. The rectal wall tumour disappeared in eight (ypT0). Of these, residual tumour was found in the mesorectum (ypT0N1) in one (12%) patient. Eleven patients were found to have ypT1 residual tumour. Of these, two (18%) had a final post-surgical staging of ypT1N1. CONCLUSION Complete rectal wall tumour eradication was achieved in 10% of the patients, and downstaging to ypT1 was achieved in 14%. In 15% (12% in ypT0 and 18% in ypT1) of these patients, residual tumour cells were evident in the mesorectum. This would probably have rendered these patients with residual disease had a nonradical approach of transanal excision of the original tumour site been employed. Caution should be taken when considering the avoidance of radical surgery.
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Affiliation(s)
- C Shwaartz
- Department of Surgery, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - N Haim
- Department of Surgery, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - D Rosin
- Department of Surgery, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Y Lawrence
- Department of Radiotherapy, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - M Gutman
- Department of Surgery, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - O Zmora
- Department of Surgery, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
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Wetzel S, Kerpel S, Rosin D, Freedman P. Malignant rhabdoid tumor of the floor of the mouth; case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2014. [DOI: 10.1016/j.oooo.2014.05.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Rosin D. Sutured Repair of Primary Small Umbilical and Epigastric Hernia: Concomitant Rectus Diastasis is a Significant Risk-Factor for Recurrence. World J Surg 2014. [DOI: 10.1007/s00268-014-2788-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Rosin D. IC on: Laparoscopic peritoneal dialysis catheter insertion using nitrous oxide under procedural sedation. World J Surg 2014; 39:133. [PMID: 25223741 DOI: 10.1007/s00268-014-2790-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Danny Rosin
- General Surgery & Transplantation, Sheba Medical Center, Tel Hashomer, Israel,
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Perri T, Korach J, Ben-Baruch G, Jakobson-Setton A, Ben-David Hogen L, Kalfon S, Beiner M, Helpman L, Rosin D. Bowel obstruction in recurrent gynecologic malignancies: Defining who will benefit from surgical intervention. Eur J Surg Oncol 2014; 40:899-904. [DOI: 10.1016/j.ejso.2013.10.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 10/12/2013] [Accepted: 10/30/2013] [Indexed: 11/25/2022] Open
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Abstract
If you would like to submit a book to the Annals for review, please send two copies to: Publications Department, The Royal College of Surgeons of England, 35–43 Lincoln’s Inn Fields, London WC2A 3PE. Book reviews are published at the discretion of the editor.
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Rosin D. Invited commentary on "Improved outcomes in the management of high-risk incisional hernias utilizing biological mesh and soft-tissue reconstruction: a single-center experience". World J Surg 2014; 38:1035-6. [PMID: 24499970 DOI: 10.1007/s00268-014-2472-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Danny Rosin
- General Surgery & Transplantation, Sheba Medical Center, Tel Hashomer, Israel,
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Affiliation(s)
- Danny Rosin
- Department of General Surgery & Transplantation, Sheba Medical Center, Tel Hashomer, Israel,
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Rosin D. Re: Lower Reoperation Rate for Recurrence After Mesh Versus Sutured Elective Repair in Small Umbilical and Epigastric Hernias: A Nationwide Register Study. World J Surg 2013; 37:2553-4. [DOI: 10.1007/s00268-013-2180-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pefani E, Panoskaltsis N, Mantalaris A, Georgiadis MC, Pistikopoulos EN, Aguilar-Mahecha A, Lafleur J, Seguin C, Rosenbloom M, Przybytkowski E, Pelmus M, Diaz Z, Batist G, Basik M, Tavernier J, Brunet L, Bazot J, Chemelle M, Dalban C, Guiu S, di Martino C, Lehtio J, Branca M, Johansson H, Orre M, Granholm V, Forshed J, Perez-Bercoff M, Kall L, Nielsen KV, Andresen L, Muller S, Matthiesen S, Schonau A, Oktriani R, Wahyono A, Haryono S, Utomo A, Aryandono T, Diaz Z, Gagnon-Kugler T, Rousseau C, Aguilar-Mahecha A, Alcindor T, Aloyz R, Assouline S, Basik M, Bachvarov D, Belanger L, Camlioglu E, Cartillone M, Chabot B, Christodoulopoulos R, Courtemanche C, Constantin A, Benlimame N, Dao I, Dalfen R, Gosselin L, Habbab F, Hains M, Haliotis T, Nielsen TH, Joncas M, Kavan P, Klink R, Langlaben A, Lebel M, Lesperance B, Mann K, Masson J, Metrakos P, McNamara S, Miller WH, Orain M, Panasci L, Paquet E, Phillie M, Qureshi S, Rodrigue D, Salman A, Spatz A, Tetu B, Tosikyan A, Tsatoumas M, Vuong T, Batist G, Ruijtenbeek R, Houtman R, de Wijn R, Boender P, Hilhorst R, Cohen Y, Onn A, Lax A, Yosepovich A, Litz S, Kalish S, Felemovicius R, Hout-Silony G, Gutman M, Shabtai M, Rosin D, Valeanu A, Winkler E, Sklair-Levy M, Kaufman B, Barshack I, Canu V, Sacconi A, Biagioni F, Mori F, di Benedetto A, Lorenzon L, di Agostino S, Cambria A, Germoni S, Grasso G, Blandino R, Panebianco V, Ziparo V, Federici O, Muti P, Strano S, Carboni F, Mottolese M, Diodoro MG, Pescarmona E, Garofalo A, Blandino G, Ho T, Feng L, Lintula S, Orpana KA, Stenman J, El Messaoudi S, Mouliere F, del Rio M, Guedj AS, Gongora C, Molina FM, Lamy PJ, Lopez-Crapez E, Rolet F, Mathonnet M, Ychou M, Pezet D, Thierry AR, Manuarii M, Tredan O, Bachelot T, Clapisson G, Courtier A, Parmentier G, Rabeony T, Grives A, Perez S, Mouret JF, Perol D, Chabaud S, Ray-Coquard I, Labidi-Galy I, Heudel P, Pierga JY, Caux C, Blay JY, Pasqual N, Menetrier-Caux C. Technology & tools development. Ann Oncol 2012. [DOI: 10.1093/annonc/mds163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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