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  • ISSN: 2379-0911
    Current Issue
    Volume 5, Issue 3
    Review Article
    Thapa PB*, Maharjan DK, and Regmi S
    Background and aims: The foundation of the pancreatojejunostomy was popularized in 1935 by Whipple and colleagues. Despite significant progress in the surgical technique and perioperative management, morbidity of this procedure remains to be considerably high. Post operative pancreatic fistula (POPF) has been one of the major factors for morbidity and even mortality following pancreaticoduodenectomy and pancreaticoenteric anastomosis. This review will focus on various techniques, their modifications, shortcomings and complication in the management of pancreaticoenteric anastomosis.
    Material and methods: A search of various surgical guidelines, prospective randomized controlled trials, systemic Meta analysis, and case series was performed with regards to surgical techniques and complication in the management of a pancreaticoenteric anastomosis.
    Discussion: The major concern of a pancreaticojejunostomy (PJ) is post operative pancreatic leak. Various techniques have been used historically to stop the leakage. Even with the modifications these methods have similar complication rates, so the next factor that should be considered while choosing a PJ method would be related to the individual operator's experience. A pancreaticogastrostomy is the other alternative that was introduced into practice relatively recently and the advent of the laparoscopic and robotic technologies in surgery has provided a newer domain to pancreatic surgery.
    Conclusion: As post-operative pancreatic fistula (POPF) is a major source of morbidity and mortality surgeons should continue to use the familiar anastomotic technique and interchange of these techniques during surgery will result in decrease incidence of pancreatic fistula when done by experienced surgeons.
    Dominic Hegarty*
    The reported incidence of post thoracotomy pain syndrome (PTPS) 3 months after surgery ranges between 22% and 67% and it has a significant impact on patients' quality of life. The focus in the peri-operative period is to provide analgesia in order to avoid post-operative complications. Unfortunately there is a void in the literature about pain management options that may help PTPS in the weeks and months that follow surgery. All healthcare providers working in this area ought to be alert to the possibility of this syndrome. Pain physicians must be familiar with the range of conservative and interventional options from the simple intercostal blocks to neuromodulation. The objective of this article is (a) to highlight the conservative and interventional options available and (b) to underline that when treatment is utilized rationally, the possibility of controlling the pain becomes a reality.
    Kelly Cristine de Lacerda Rodrigues Buzatti*, Rodrigo Gomes da Silva, and Beatriz Deoti e Silva Rodrigues
    Although appendectomy has very low rates of morbidity and mortality, the surgical removal of a normal appendix remains controversial. The incidental appendectomy is performed when a normal appendix is removed during another abdominal procedure, whereas in the prophylactic appendectomy patients undergone surgery specifically to remove the appendix. The purpose of this article is to present a review of the literature on current concepts about "incidental appendectomy" and "prophylactic appendectomy". Although the exact organic function of the vermiform appendix is not clear, this tubular organ is useful for reconstructive surgery in urological, biliary and pediatric procedures. Since there is no reliable predictor for developing acute appendicitis, prophylactic and incidental appendectomy should be performed in specific situations for selected patients with low risk for surgical complications.
    Case Report
    Gonzalez W, Altieri PT*, Gonzalez-Cancel IF, Calderon R, and Banchs HL
    Patients presenting with carotid sinus syndrome (CSS) are predominantly from elderly population experiencing dizziness and syncope. According to the World Health Organization, falls lead to 20-30% of mild severe injuries and more than 50% of hospitalizations among people over 65 years and older. CSS is known as one of the main causes of falls and as an age-related factor in previous studies with an elderly population. It is characterized by the presence of an abnormal baroreflex response, leading to a systole and hypotension. In this report, we present a case of a 70 years old male with a history of peripheral vascular disease, severe obstructive carotid stenosis (90%) and the CSS mixed type. He have had syncopal episodes due to carotid hypersensitive, which required pacemaker (dual chamber) prior to surgery.
    Schlatterer Daniel*, Amersi Arish, Kessler Raymond, Eggers Ryan, and Kessler Bradley
    Introduction: Gunshot injuries may present a myriad of surgical challenges in wound closure and soft tissue reconstruction. Due to a broad variation in soft tissue damage and the degree of remaining bony integrity, the treatment of gunshot injuries may only be carried out after a thorough examination of the wound and debridement of all devitalized tissue. The definitive management will vary by case. On occasion, a wound may remain after debridements or infection onset that requires a unique closure approach. Especially, when a previous muscle flap has failed, or the patient refuses additional muscle flaps.
    Materials and method: A young male presented with an isolated GSW to his leg was treated initially with irrigations, debridements and an external fixator. A local soleus muscle flap with skin grafting achieved wound closure. In few weeks, a deep bony infection ensued. The resulting wound after infection debridement was closed with a series of sternal wires over rubber bolsters.
    Results: Following 8 weeks of culture specific antibiotics, the wound healed and the infection resolved. The patient resumed unrestricted weight bearing activities.
    Discussion: The soft tissue reconstructive ladder could benefit from an additional wound closure technique in complex situations such the case presented. Due to prior muscle flap complication, the patient's preference for additional muscle flaps was understandably small.
    Conclusion: This novel closure technique is simple to perform, with little expense to the patient. This method helped close an infected complex wound with a minimal biologic cost. Further work is required to define the limits and indications for this method.
    Kelly Cristine Lacerda Rodrigues Buzatti*, Beatriz Deoti e Silva Rodrigues, Luciana Costa e Silva, and Rodrigo Gomes da Silva
    Introduction: The appendix is usually found in the right lower quadrant of the abdomen but its tip may vary in location such as in the pelvis or in the left side of the abdomen leading to atypical presentations of acute appendicitis. In this article, we present a rare case report of acute appendicitis in the left upper quadrant of the abdomen.
    Case report: A 69-year-old previously healthy female patient attended to the emergency department complaining of abdominal pain in the left upper quadrant for about 36 hours, increase of white cell count (16 x 109/L) and C-reactive protein of about 200. Antibiotic therapy was immediately started due to the hypothesis of acute infectious disease of the abdomen. The abdominal ultrasound did not found the appendix and computed tomography (CT) scan of the abdomen initially reported diverticulitis as the diagnosis. In a further review of the CT scan images, the radiologist found the tip of the appendix in the left upper quadrant of the abdomen with a diameter of 10mm and surrounded by inflammatory signs. Laparoscopic appendectomy was performed and the patient was discharged home in the second postoperative day without surgical complications. Pathological examination confirmed acute appendicitis.
    Conclusion: Although acute appendicitis is the most common acute surgical disease of the abdomen, some of its unusual presentations can be challenging. In this scenario, image exams, laparoscopy or open laparotomy may be necessary for early diagnosis.
    Editorial
    Dominic Hegarty*
    Every year the International Association for the Study of Pain (IASP) chose a particular chronic pain area to highlight its clinical importance. This year it is the turn of post-operative pain to take center stage and post thoracotomy pain is one area that certainly warrants attention. The incidence of post thoracotomy pain syndrome (PTPS) 3 months after surgery ranges between 22% and 67% making it one of the highest reported causes of post-operative pain demolishingthe suffers quality of life.
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