Publications by authors named "Alexandru Dan Sabau"

5 Publications

  • Page 1 of 1

Clinical and therapeutic features of acute cholecystitis in diabetic patients.

Exp Ther Med 2021 Jul 13;22(1):758. Epub 2021 May 13.

4th Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania.

The present study aimed to compare the clinical, paraclinical, intraoperative findings, and postoperative complications in acute cholecystitis in diabetic patients vs. non-diabetic patients. A 2-year retrospective study was performed on the patients who underwent emergency cholecystectomy for acute cholecystitis between 2017 and 2019 at the 4th Department of Surgery, Emergency University Hospital Bucharest. The diabetic subgroup numbered 46 eligible patients and the non-diabetic one 287 patients. Demographics, the severity of the clinical forms, biological variables (including white cell count, urea, creatinine, coagulation and liver function tests) comorbidity status, surgical approach, postoperative complications, and hospital stay were analyzed. Statistical analyses were performed to assess comparative results between the aforementioned data (SPSS V 13.0). The CCI and ASA risk classes were increased in the diabetic group, with 34.78% of patients having 3 or more associated comorbidities. No statistically significant associations were demonstrated between diabetes and the severity of the cholecystitis and risk for conversion. Postoperatively both minor complications such as surgical site infections and major cardiovascular events were more common in the diabetic subgroup (P=0.0254), well associated with the preoperative status and baseline cardiovascular comorbidities. Laparoscopic cholecystectomy is a safe procedure for diabetic patients, which can provide the best outcomes, by decreasing the risks of surgical wounds. Attentive perioperative care and good glycemic control must be provided to minimize the risk of complications.
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http://dx.doi.org/10.3892/etm.2021.10190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8135114PMC
July 2021

Safety of Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly: A Multivariate Analysis of Risk Factors for Intra and Postoperative Complications.

Medicina (Kaunas) 2021 Mar 2;57(3). Epub 2021 Mar 2.

3rd Department Surgery, Faculty of Medicine, "Lucian Blaga" University Sibiu, 550169 Sibiu, Romania.

This study investigates the impact of age upon the safety and outcomes of laparoscopic cholecystectomy performed for acute cholecystitis, by a multivariate approach. A 2-year retrospective study was performed on 333 patients admitted for acute cholecystitis who underwent emergency cholecystectomy. The patients included in the study group were divided into four age subgroups: A ≤49 years; B: 50-64 years; C: 65-79 years; D ≥80 years. Surgery after 72 h from onset ( = 0.007), severe forms, and higher American Society of Anesthesiologists Physical Status Classification and Charlson comorbidity index scores ( < 0.001) are well correlated with older age. Both cardiovascular and surgical related complications were significantly higher in patients over 50 years ( = 0.045), which also proved to be a turning point for increasing the rate of conversion and open surgery. However, the comparative incidence did not differ significantly between patients aged from 50-64 years, 65-79 years and over 80 years (6.03%, 9.09% and 5.8%, respectively). Laparoscopic cholecystectomy (LC) was the most frequently used surgical approach in the treatment of acute cholecystitis in all age groups, with better outcomes than open cholecystectomy in terms of decreased overall and postoperative hospital stay, reduced surgery related complications, and the incidence of acute cardiovascular events in the early postoperative period ( < 0.001). The degree of systemic inflammation was the main factor that influenced the adverse outcome of LC in the elderly. Among comorbidities, diabetes was associated with increased surgical and systemic postoperative morbidity, while stroke and chronic renal insufficiency were correlated with a high risk of cardiovascular complications. With adequate perioperative care, the elderly has much to gain from the benefits of a minimally invasive approach, which allows a decreased rate of postoperative complications and a reduced hospital stay.
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http://dx.doi.org/10.3390/medicina57030230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002041PMC
March 2021

Indocyanine Green-Enhanced Colorectal Surgery-between Being Superfluous and Being a Game-Changer.

Diagnostics (Basel) 2020 Sep 24;10(10). Epub 2020 Sep 24.

IVth Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania.

Nowadays, surgical innovations incorporate new technological conquests and must be validated by evidence-based medicine. The use of augmented reality-assisted indocyanine green (ICG) fluorescence has generated a myriad of intraoperative applications such as demonstration of key anatomical landmarks, sentinel lymph nodes, and real-time assessment of local blood flow. This paper presents a systematic review of the clinical evidence regarding the applications of ICG near-infrared (NIR) fluorescence in colorectal surgery. After we removed duplicate publications and screened for eligibility, a total of 36 articles were evaluated: 23 on perfusion assessment, 10 on lymph node mapping, and 3 on intraoperative identification of ureters. Lack of homogenous studies, low statistical power, and confounding evidence were found to be common amongst publications supporting the use of ICG in colorectal surgery, raising concerns over this seductive technique's cost efficiency and redundancy. The compiled data showed that ICG NIR fluorescence may be a game-changer in particular situations, as proven for low colorectal anastomosis or lateral pelvic lymph node dissection, but it remains controversial for routine use and sentinel lymph node assessment. Further randomized studies are needed to confirm these conclusions. Future research directions include tumor-targeted fluorescence imaging and digital software for quantitative evaluation of fluorescence.
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http://dx.doi.org/10.3390/diagnostics10100742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600504PMC
September 2020

Laparogastroscopy and Esophageal Stenosis.

Chirurgia (Bucur) 2018 Jan-Feb;113(1):137-143

Purpose: An original technique using laparoscopic instruments in a gastric endocavitary work chamber with potential for esophagus, stomach and D1 vizualisation. The main purpose of laparagastroscopy is to improve the quality of life of the patient disabling by the esophageal tumor. This method has several advantages: providing physiological feeding, harvesting materials for histopathological examination, solving eso-tracheal fistulas concurrently with the proposed operation and hemostatic role through compression, low energy and plastic consumption, rapid socio-economic reintegration, mental psychological care of the patient. Patients and The paper deals with 162 cases with different tumors of the esophagus, patients with different grades of esophageal stenosis, different stages of esophageal neoplasm. Both the patients with eso-tracheal fistulas and those with gastro- or jejunostoma were included. From 162 cases, 33 cases (20%) with cervical esophageal neoplasm, 66 (41%) cases with thoracic esophageal neoplasm and 63 (39%) cases with abdominal esophageal neoplasm. The histopathological type is 37% adenocarcinomas and 63% squamous carcinomas. From total number of cases, 87 (54%) had no metastasis, and 75 (46%) had secondary determinations. The most frequent localization of metastasis was pulmonary, followed by liver (Fig. 1) and bone. The analysis of this intervention has shown that complications have been much lower both in terms of their numerical value and their severity, a longer survival time with a much higher satisfaction index is ensured.

Conclusion: Esophageal endoprosthesis (EPE) through laparagastroscopic approach should be a a reserve procedure instead of a disabling gastrostomy or jejunostomy. EPE is an extremely effective procedure specially by keeping the physiology of food bowl. The approach is minimally invasive with minimal attack on the body with significant plastic and aesthetic reductions. This procedure allows the prosthesis to be viewed both during and after stenting to check its correct position. This method increases the survival time by keeping a relatively normal regimen.
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http://dx.doi.org/10.21614/chirurgia.113.1.137DOI Listing
June 2018

Clinical and histological aspects of malignant inverted sinonasal papilloma. Two case reports.

Rom J Morphol Embryol 2016 ;57(1):289-94

Faculty of Medicine, "Lucian Blaga" University of Sibiu, Romania;

The inverted sino-nasal papilloma is a benign epithelial lesion, ranging from 1% to 5% of the tumors that reside in this area. It is characterized by a tendency towards local bone destruction, recurrence and malignant transformation. This is a presentation of two cases diagnosed and surgically treated for malignant inverted papiloma, which started in the epithelium of the maxillary sinuses. The cases had in common the late presentation of the patient to the surgeon, thus the local destruction was significant with extension towards the eye socket and the base of the skull. The treatment of choice was the surgical resection of the maxillary bone with a prosthetic reconstruction of the defect followed by radiotherapy. After a careful analysis of the two cases, a series of statements regarding the diagnosis and treatment of this rare pathology were recommended.
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March 2017