Publications by authors named "Samir Delibegovic"

44 Publications

A pandemic recap: lessons we have learned.

World J Emerg Surg 2021 09 10;16(1):46. Epub 2021 Sep 10.

Division of Trauma, Emergency Surgery, and Surgical Critical Care, LAC+USC Medical Center, Los Angeles, USA.

On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.
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http://dx.doi.org/10.1186/s13017-021-00393-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430288PMC
September 2021

Minimising in minimally invasive surgery through the use of a novel and flexible super elastic titanium needle suitable for a 3.5- and 5-mm trocar.

J Minim Access Surg 2021 Jun 9. Epub 2021 Jun 9.

Clinic for Surgery, University Clinical Center Tuzla; Department of Surgery, Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina.

The use of smaller ports in surgery is the next step in the evolution of minimally invasive procedures. We present findings, using a novel flexible needle made from a super elastic titanium alloy, which demonstrate that it is possible for a 26- and 30-mm needle to pass through a 3.5- and 5-mm trocar. This new approach results in less trauma and improved cosmetic effect in comparison to the classical 10-mm port. Traditional steps such as handling of the needle holders, loading the needle and placing it at the correct angle and direction, inserting the needle into the tissue and finally safely tying a knot remain the same as with the standard procedure. We propose that this improved type of needle creates a refinement opportunity to replace the classic ones during both laparoscopic and robotic surgeries.
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http://dx.doi.org/10.4103/jmas.JMAS_84_21DOI Listing
June 2021

The impact of EAES Fellowship Programme: a five-year review and evaluation.

Surg Endosc 2021 Jun 8. Epub 2021 Jun 8.

Department of General Surgery, Linköping University Hospital, 581 85, Linköping, Sweden.

Background: The European Association of Endoscopic Surgery (EAES) fellowship programme was established in 2014, allowing nine surgeons annually to obtain experience and skills in minimally invasive surgery (MIS) from specialist centres across the Europe and United States. It aligns with the strategic focus of EAES Education and Training Committee on enabling Learning Mobility opportunities. To assess the impact of the programme, a survey was conducted aiming to evaluate the experience and impact of the programme and receive feedback for improvements.

Methods: A survey using a 5-point Likert scale was used to evaluate clinical, education and research experience. The impact on acquisition of new technical skills, change in clinical practice and ongoing collaboration with the host institute was assessed. The fellows selected between 2014 and 2018 were included. Ratings were analysed in percentage; thematic analysis was applied to the free-text feedbacks using qualitative analysis.

Results: All the fellows had good access to observing in operating theatres and 70.6% were able to assist. 91.2% participated in educational activities and 23.5% were able to contribute through teaching. 44.1% participated in research activities and 41.2% became an author/co-author of a publication from the host. 97.1% of fellows stated that their operative competency had increased, 94.3% gained new surgical skills and 85.7% was able to introduce new techniques in their hospitals. 74.29% agreed that the clinical experience led to a change in their practices. The most commonly suggested improvements were setting realistic target in clinical and research areas, increasing fellowship duration, and maximising theatre assisting opportunities. Nevertheless, 100% of fellows would recommend the fellowship to their peers.

Conclusion: EAES fellowship programme has shown a positive impact on acquiring and adopting new MIS techniques. To further refine the programme, an individualised approach should be adopted to set achievable learning objectives in clinical skills, education and research.
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http://dx.doi.org/10.1007/s00464-021-08525-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186018PMC
June 2021

2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting.

World J Emerg Surg 2020 05 7;15(1):32. Epub 2020 May 7.

Trauma Service, Inkosi Albert Luthuli Central Hospital and Department of Surgery, Nelson R Mandela School of Clinical Medicine, Durban, South Africa.

Acute colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in the acute setting. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of acute left-sided colonic diverticulitis (ALCD) according to the most recent available literature. The update includes recent changes introduced in the management of ALCD. The new update has been further integrated with advances in acute right-sided colonic diverticulitis (ARCD) that is more common than ALCD in select regions of the world.
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http://dx.doi.org/10.1186/s13017-020-00313-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206757PMC
May 2020

Securing the base of the appendix during laparoscopic appendectomy.

Med Glas (Zenica) 2020 Aug;17(2):252-255

Clinic for Surgery, Clinical Center of Republika Srpska, Banja Luka, Bosnia and Herzegovina.

In contrast to classical appendectomy where the appendiceal stump is secured by a single or double ligature, in laparoscopic appendectomy various ways of securing the stump are mentioned. Each of these methods has advantages and disadvantages. Since different possibilities exist for closing the stump, it is very important to find the optimum method for closure of the appendiceal stump, bearing in mind their simplicity, biocompatibility and price. The aim of this review article has been to present the problem of securing the base of the appendix during laparoscopic appendectomy.
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http://dx.doi.org/10.17392/1131-20DOI Listing
August 2020

Tipp the Lichtenstein and Shouldice techniques in the repair of inguinal hernias - short-term results.

Acta Chir Belg 2021 Aug 25;121(4):235-241. Epub 2019 Dec 25.

Clinic for Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.

Objective: The Lichtenstein mesh technique is recommended as the standard surgical procedure for inguinal hernias. Shouldice is the best non-mesh technique. However, there are reports that the transinguinal preperitoneal technique (TIPP), which uses a preperitoneal mesh, has potential advantages in relation to the Lichtenstein and the Shouldice techniques.

Patients And Methods: Three hundred patients with inguinal hernias were randomized into three groups of hundred patients each: Group 1 whose inguinal hernia repair was performed using the Lichtenstein technique; Group 2 using the Shouldice technique; and Group 3 using TIPP. The parameters for monitoring were: length of operation, blood loss, length of hospitalization, length of incision, post-operative pain, and the patient's satisfaction level.

Results: The visual analog scale (VAS) score after 6, 12, 24 and 48 h, and 14 d was lower in TIPP than the Lichtenstein and Shouldice groups ( < .0001). The satisfaction level was higher in TIPP than in the Lichtenstein and Shouldice groups ( < .0001).

Conclusions: TIPP technique has advantages in comparison with the Lichtenstein and Shouldice techniques. This method takes a shorter time, the skin incision is smaller, the VAS score is lower and the patient satisfaction level is higher. These advantages are in balance with the higher costs of this procedure.
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http://dx.doi.org/10.1080/00015458.2019.1706323DOI Listing
August 2021

Adrenocorticotropic Hormone (ACTH) and Cortisol Monitoring as Stress Markers During Laparoscopic Cholecystectomy: Standard and Low Intraabdominal Pressure and Open Cholecystectomy.

Med Arch 2019 Aug;73(4):257-261

Department of Proctology, Clinic for Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.

Introduction: In this study we wanted to examine the hormonal responses due to stress exposure during laparoscopic cholecystectomy with standard (12-15 mm / Hg) (LCSP) and low (6-8 mm / Hg) (LCLP) intraabdominal pressure and open cholecystectomy (OC), with particular emphasis on stress hormone responses.

Aim: Determination of adrenocorticotropic hormone (ACTH) and cortisol stress hormones before and after laparoscopic cholecystectomy with standard and low insufflation pressure, determination of ACTH and cortisol values before and after open cholecystectomy and comparison of ACTH and cortisol values between the patient sub-groups.

Methods: In a prospective study conducted between July 2016 and February 2018, we involved 110 patients which were divided into two groups: 70 patients with laparoscopic cholecystectomy (LC) and 40 patients with open cholecystectomy (OC). The first group of patients was further divided into two subgroups of 35 patients, (subgroup LC with standard and subgroup LC with low intraabdominal pressure). All patients met the preset inclusion and exclusion criteria of the study. There were no statistically significant differences in the demographic characteristics of patients between the investigated groups. The stress hormones determined were adrenocorticotropic hormone (ACTH) and cortisol.

Results: During the first, second and seventh day postoperative day (POD),ACTH values were significantly lower (p <0.0001) in LCLP than in LCSP and OC groups. This was also the case for comparison in LCSP and OC groups. By comparing LC and OC groups during first, the second and seventh POD, there was a significant difference (p <0.0001) in the ACTH levels. The concentration of this hormone was higher in the OC group in all three cases. The first, second and seventh POD were also statistically significant (p <0.0001) in cortisol values and between LC and OC groups there was an increase in cortisol levels in patients operated by open method. There was also a significant difference (p <0.0001) in cortisol values measured between LCLP and LCSP groups in the investigated days. Cortisol levels were higher in patients in the LCSP group.

Conclusion: During open and laparoscopic cholecystectomy the response of the body to stress increased. The stress response of the organism during laparoscopic cholecystectomy was less than during open cholecystectomy. The stress response of the organism during laparoscopic cholecystectomy with low insufflation pressure ( 6-8mmHg) was less than during laparoscopic cholecystectomy with standard insufflation pressure (12-15mmHg).
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http://dx.doi.org/10.5455/medarh.2019.73.257-261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6853714PMC
August 2019

Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: a WSES observational study.

World J Emerg Surg 2019 15;14:34. Epub 2019 Jul 15.

Department of Surgery, Lumbini Medical College and Teaching Hospital Ltd., Tansen, Palpa Nepal.

Background: Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted.

Methods: This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018.

Results: A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0-1, 22.7% for those who had scores of 2-3, 46.8% for those who had scores of 4-5, and 86.7% for those who have scores of 7-8.

Conclusions: The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.
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http://dx.doi.org/10.1186/s13017-019-0253-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6631509PMC
September 2019

A randomised controlled study of preoperative oral carbohydrate loading versus fasting in patients undergoing colorectal surgery.

Int J Colorectal Dis 2019 Sep 15;34(9):1551-1561. Epub 2019 Jul 15.

Department of Surgery, University Clinical Center Tuzla, Trnovac St, 75 000, Tuzla, Bosnia and Herzegovina.

Purpose: This study aimed to evaluate the effect of preoperative carbohydrate oral (CHO) loading on the postoperative metabolic and inflammatory response, perioperative discomfort and surgical clinical outcomes in open colorectal surgery compared with a conventional fasting protocol.

Methods: Fifty patients were randomly allocated to either the intervention group (CHO), to receive preoperative oral carbohydrate supplementation, or the control group (FAST), to undergo preoperative fasting. Insulin resistance, insulin sensitivity, the Glasgow Prognostic Score (GPS) and IL-6 levels were analysed at 06 h on the day of surgery (T), 6 h after surgery (T) and at 06 h on postoperative day 1 (T) and postoperative day 2 (T). Thirst, hunger, dry mouth, weakness, anxiety and pain were assessed using the visual analogue scale (VAS) prior to anaesthesia induction and at 0-4, 4-8, 8-12 and 12-24 h after surgery. Surgical clinical outcomes included the return of gastrointestinal function, time to independent ambulation and postoperative discharge day.

Results: Postoperative insulin resistance was 30% lower (p < 0.03) and insulin sensitivity was 15% higher (p < 0.05) in the CHO group than in the FAST group. The GPS was lower in the CHO group at T (p < 0.001), T (p < 0.01) and T (p < 0.004). IL-6 serum levels were lower at the analysed postoperative time points in the CHO group (p < 0.001). The VAS well-being score was lower in the intervention group (p < 0.001); however, the VAS pain score was not significantly different between the groups. The evaluated surgical outcomes appeared earlier in the CHO group (p < 0.001).

Conclusion: A preoperative CHO drink reduced the postoperative metabolic and inflammatory response and improved subjective well-being and surgical clinical outcomes but did not diminish the VAS pain score.
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http://dx.doi.org/10.1007/s00384-019-03349-4DOI Listing
September 2019

Effect of Local Anesthesia on the Postoperative Pain After Laparoscopic Appendectomy.

J Laparoendosc Adv Surg Tech A 2019 Jan 27;29(1):65-71. Epub 2018 Sep 27.

2 Clinic for Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.

Background: Laparoscopic surgery causes less pain than traditional surgery; however, to relieve postoperative pain, surgeons frequently apply local anesthetic preemptively. The aim of this study was to assess the effect of different local anesthetics on pain intensity in patients who had undergone a laparoscopic appendectomy (LA), who received the anesthetic preemptively at incision sites and postemptively, intraperitoneally and trocar sites.

Patients And Methods: A total of 120 LA patients (men and women) were randomly assigned to 1 of the 4 groups (N = 30/group): Group 1: no peritoneal or local administration of local anesthetics during LA; Group 2: 5 mL of 1% lidocaine was applied at incision sites and 10 mL 1% lidocaine was injected under direct vision in the right iliac fossa area and around the stump of the appendix and trocar sites at the end of the procedure; Group 3: 5 mL of 0.5% levobupivacaine applied at incision sites +10 mL 0.5% levobupivacaine injected in the same place intraperitoneally and trocar sites at the end of the procedure; Group 4: 5 mL of 0.5% ropivacaine at incision sites +10 mL 0.5% ropivacaine injected in the same place intraperitoneally and trocar sites at the end of the procedure. Postoperative pain was assessed after 2, 6, 24, and 48 hours using a visual analogue scale (VAS).

Results: By comparing the average values of pain intensity using VAS, we observed significantly different average values of pain intensity in the levobupivacaine and ropivacaine (3 and 4) groups in comparison with the control Group 1 (P < .05) throughout the follow-up period.

Conclusion: We observed a reduction in postoperative pain, nausea, and vomiting in patients with LA who received intraoperative local anesthetic preemptively at the incision sites and postemptively, intraperitoneally. After the application of levobupivacaine the intensity of pain was significantly lower than in any other tested group.
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http://dx.doi.org/10.1089/lap.2018.0452DOI Listing
January 2019

Knowledge, awareness, and attitude towards infection prevention and management among surgeons: identifying the surgeon champion.

World J Emerg Surg 2018 17;13:37. Epub 2018 Aug 17.

30Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Despite evidence supporting the effectiveness of best practices of infection prevention and management, many surgeons worldwide fail to implement them. Evidence-based practices tend to be underused in routine practice. Surgeons with knowledge in surgical infections should provide feedback to prescribers and integrate best practices among surgeons and implement changes within their team. Identifying a local opinion leader to serve as a champion within the surgical department may be important. The "surgeon champion" can integrate best clinical practices of infection prevention and management, drive behavior change in their colleagues, and interact with both infection control teams in promoting antimicrobial stewardship.
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http://dx.doi.org/10.1186/s13017-018-0198-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6098571PMC
January 2019

The Quality of Life and Degree of Depression of Patients Suffering from Breast Cancer.

Med Arch 2018 Jun;72(3):202-205

Clinic for Surgery, University Clinical Center Tuzla, Bosnia and Herzegovina.

Introduction: Breast cancer and its treatment change the perception of mastectomized women of their physical appearance, which leads to depression and has a negative effect on the overall quality of life of those woman.

Aim: We wanted to assess the quality of life and the degree of depression of patients suffering from breast cancer, on the basis of a standardised questionnaire to assess the patients' quality of life (QLQ-C-30 BR-23), and the degree of depression using Beck's Depression Inventory (BDI, II).

Materials And Methods: The research was conducted on a sample of 160 patients, who were surveyed before and after the surgical procedure. The inclusion criteria for the research were: patients suffering from breast cancer aged between 18 and 70 years, cancer diagnosed by FNB or CORE biopsy. The patients were divided into two groups: patients having breast-conserving surgery and patients having radical surgical treatment.

Results: There were 47 or 39.37% patients who underwent breast-conserving surgery and 113 or 70.62% patients who underwent radical surgery. The results of the survey conducted show that there was no difference in the quality of life of patients before and after surgery, regardless of the type of surgical procedure undertaken. However, there was a significant different in the degree of depression between patients subjected to different surgical procedures, where the patients surveyed post-surgery after radical mastectomy showed a higher degree of depression than the patients surveyed after breast-conserving surgery.

Conclusion: There is no difference in the quality of life before and after surgery, regardless of the type of operation. However, there is a significant difference in the degree of depression in patients after radical mastectomy, who showed a higher degree of depression than the surveyed patients who underwent breast-conserving surgery.
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http://dx.doi.org/10.5455/medarh.2018.72.202-205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6021164PMC
June 2018

Prospective Observational Study on acute Appendicitis Worldwide (POSAW).

World J Emerg Surg 2018 16;13:19. Epub 2018 Apr 16.

28DEA, La Sapienza Università di Roma, Policlinico Umberto I, Rome, Italy.

Background: Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments.

Methods: This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study.

Results: A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%.

Conclusions: The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.
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http://dx.doi.org/10.1186/s13017-018-0179-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5902943PMC
September 2018

Introduction to Total Mesorectal Excision.

Med Arch 2017 Dec;71(6):434-438

Department of Colorectal Surgery, Clinic for Surgery, University Clinical Center Tuzla, Bosnia and Herzegovina.

Colorectal cancer is the second leading cause of mortality in the West, and rectal cancer accounts for about 25% of the colon cancers. The concept of total mesothelial excision (TME) was the most important event in surgery for rectal cancer of the last two decades, because even without a curative approach, it reduced local recurrence and extended 5-year survival.
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http://dx.doi.org/10.5455/medarh.2017.71.434-438DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5788513PMC
December 2017

The influence of the different forms of appendix base closure on patient outcome in laparoscopic appendectomy: a randomized trial.

Surg Endosc 2018 05 2;32(5):2295-2299. Epub 2017 Nov 2.

Department of Colorectal Surgery, Clinic for Surgery, University Clinical Center, Tuzla, Bosnia and Herzegovina.

Background: During laparoscopic appendectomy, the base of the appendix is usually secured by loop ligature or stapling device. Hem-o-lok and DS clips have been shown as alternative techniques. The aim of this study was to compare the clinical outcomes of various forms of securing the base of the appendix, in order to find the most suitable method.

Patients And Methods: The study included 120 patients with acute appendicitis randomly divided into four groups with 30 patients in each. In the first group, the base of the appendix was secured using an Endoloop, in the second group using a stapling device, in the third group using Hem-o-lok, and in the fourth group using a DS clip. The primary outcome was overall morbidity following securing the base of the appendix. Secondary outcomes were time of application and operative procedure, total length of stay, and surgical outcome.

Results: No morbidity was recorded in any group. The time of application was significantly longer in the Endoloop group than in the Stapler (P < 0.0001), Hem-o-lok (P < 0.0001), and DS clips (P < 0.0001) groups. The time of application in the Stapler group was significantly shorter than in the Hem-o-lok (P < 0.0001) and the DS clips (P < 0.0001) groups. The time of the operative procedure was significantly longer in the Endoloop than in the Stapler group (P < 0.0001). The time of the operative procedure in the Stapler group was significantly shorter than in the DS clips group (P < 0.0001) but did not differ significantly from the Hem-o-lok group (P = 0.199). The time of the operative procedure in the Hem-o-lok group was significantly shorter than in the DS clips group (P = 0.044).

Conclusion: All forms of closure of the appendix base are acceptable, but Hem-o-lok and DS clips have the best potential for further development, and will probably become the method of choice in securing the base of the appendix.
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http://dx.doi.org/10.1007/s00464-017-5924-zDOI Listing
May 2018

Morphological Changes in Blood Cells After Implantation of Titanium and Plastic Clips in the Neurocranium - Experimental Study on Dogs.

Med Arch 2017 Apr;71(2):84-88

Clinic for Surgery, University Clinical Center Tuzla, Faculty of Medicine, University of Tuzla, Bosnia and Herzegovina.

Introduction: Various studies confirm the biocompatibility and efficacy of clips for certain target tissues, but without any comparative analysis of hematological parameters. Therefore, we conducted a study to assess the possible association of the implantation of titanium and plastic clips in the neurocranium with possible morphological changes in the blood cells of experimental animals.

Materials And Methods: As a control, the peripheral blood smears were taken before surgery from 12 adult dogs that were divided into two experimental groups. After placing titanium and plastic clips in the neurocranium, the peripheral blood of the first group was analyzed on the seventh postoperative day, while the peripheral blood of the second group was analyzed on the sixtieth day. By microscopy of the blood smears, the following parameters were analyzed: the presence of poikilocytosis of the red blood cells, degenerative changes in the leukocytes and leukogram.

Results: There were no statistically significant differences between the mean values of the groups. Monocytosis was detected (first group 22.83 % and second 16.30 %), as well as neutropenia (46.80 %, in the second group). Degenerative changes to neutrophils and the occurrence of atypical lymphocytes were observed in the second experimental group (60 postoperative day).

Conclusion: A mild adverse effect from the biomaterials present in the neurocranium of dogs was detected, affecting the majority of leukocytic cells. A chronic recurrent inflammatory process was caused by the presence of the plastic and titanium clips in the brain tissue. No adverse effect of biomaterials on erythrocytes in the neurocranium was detected in the dogs studied. Further studies are necessary to explain the occurrence of degenerative changes in the neutrophils and lymphocytes.
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http://dx.doi.org/10.5455/medarh.2017.71.84-88DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5511527PMC
April 2017

Biocompatibility of Plastic Clip in Neurocranium - Experimental Study on Dogs.

Turk Neurosurg 2016 ;26(6):866-870

University Clinical Center Tuzla, Department of Surgery, Bosnia and Herzegovina.

Aim: A potential advantage of the use of the plastic clips in neurosurgery is their property of causing fewer artifacts than titanium clips as assessed by computed tomography and magnetic resonance scans. The biocompatibility of plastic clips was demonstrated in the peritoneal cavity, but their behavior in the neurocranium is not known.

Material And Methods: Twelve aggressive stray dogs designated for euthanasia were taken for this experimental study. The animals were divided into two groups. In all cases, after anesthesia, a craniotomy was performed, and after opening the dura, a proximal part titanium clip was placed on the isolated superficial Sylvian vein (a permanent Yasargil FT 746 T clip at a 90° angle, while a plastic Hem-o-lok clip ML was placed on another part of the vein). The first group of animals was sacrificed on the 7 < sup > th < /sup > postoperative day and the second group on the 60 < sup > th < /sup > postoperative day. Samples of tissue around the clips were taken for a histopathological evaluation.

Results: The plastic clip caused a more intensive tissue reaction than the titanium clip on the 7 < sup > th < /sup > postoperative day, but there was no statistical difference. Even on the 60 < sup > th < /sup > postoperative day there was no significant difference in tissue reaction between the titanium and plastic clips.

Conclusion: These preliminary results confirm the possibility for the use of plastic clips in neurosurgery. Before their use in human neurosurgery, further studies are needed to investigate the long-term effects of the presence of plastic clips in the neurocranium, as well as studies of the aneurysmal model.
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http://dx.doi.org/10.5137/1019-5149.JTN.13979-15.1DOI Listing
March 2017

Erratum to: The Influence of the Appendiceal Base Diameter on Appendix Stump Closure in Laparoscopic Appendectomy.

World J Surg 2016 11;40(11):2832

Department of Colorectal Surgery, Clinic for Surgery, University Clinical Centre, Tuzla, Bosnia and Herzegovina.

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http://dx.doi.org/10.1007/s00268-016-3709-5DOI Listing
November 2016

An Aggressive Form of MALT Lymphoma of the Stomach with Pancreas Infiltration.

Med Arch 2016 Jun 31;70(3):235-7. Epub 2016 May 31.

Clinic for Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.

Introduction: MALT lymphoma accounts for 7-8% of all B-cell lymphomas and at least 50% of primary gastric lymphoma, with the highest incidence at between 50 and 60 years of age. Aggressive forms are rare, as are indications for multi-visceral resection.

Case Study: A patient, 33 years old, was admitted to the tertiary hospital due to a biopsy at a small community hospital confirming adenocarcinoma of the stomach. She was Helicobacter pylori positive. CT showed thickening of the fundus and corpus wall, up to 2.7. cm., with numerous lymph nodes, along the small curvature and in the peripancreatic region, up to 1.5 cm in size. There was close contact between the changed and tumorous posterior wall of the stomach and the anterior surface of the pancreas. Neoplasm of the stomach was found that had infiltrated the body and tail of the pancreas and spleen hilum. Infiltration of the left crura of the diaphragm was also found, ex tempore biopsy showed inflammatory infiltration without elements of neoplasm. Total gastrectomy with omentectomy, and subtotal pancreatectomy and splenectomy were performed. Definitive patho-histological diagnosis confirmed MALT lymphoma of the stomach with pancreas infiltration, but no tumor cells were found on the spleen. Additional staining and immunohistological examination of the specimen from the community hospital showed that this was a misdiagnosis of carcinoma, and the specimen also contained MALT lymphoma.

Discussion: MALT lymphoma frequently occurs in the stomach. For patients with MALT, systematic staging is indicated. If MALT is considered in the differential diagnosis, multiple random systematic biopsies within the stomach wall are needed to optimize diagnostic accuracy. Samples should be subject to immune phenotype analysis6. The main tumor cells of MALT are: CD 20+, CD 5-, CD 10-, CD 23-, CD 43+-. It is obvious that this kind of analysis cannot be accomplished in a small community hospital in a poor country such as Bosnia and Herzegovina, and suspicion of MALT indicates referral to a tertiary center. Although the long term risk of transformation of MALT lymphoma into the aggressive form is low9, this case of the aggressive form of MALT indicates the importance of systematic staging.
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http://dx.doi.org/10.5455/medarh.2016.70.235-237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010062PMC
June 2016

Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA).

World J Emerg Surg 2016 15;11:33. Epub 2016 Jul 15.

Department of Infectious Diseases, Alfred Hospital, Melbourne, VIC Australia.

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.
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http://dx.doi.org/10.1186/s13017-016-0089-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4946132PMC
May 2018

Formation of adhesion after intraperitoneal application of TiMesh: experimental study on a rodent model.

Acta Chir Belg 2016 Oct 2;116(5):293-300. Epub 2016 Jun 2.

f Department of Orthopaedics, Institute of Clinical Sciences , Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.

Background: After laparoscopic repair of an incisive hernia, intraperitoneal prosthetic mesh, as a foreign material, is a strong stimulus for the development of adhesion, which may be the cause of serious complications. This experimental study compared three different meshes and their ability to prevent the formation of adhesion and shrinkage.

Methods: Ninety rats were divided randomly into three groups: in Group 1 Proceed mesh was implanted, in Group 2 Ultrapro mesh was implanted, and in Group 3 TiMesh was implanted. Mesh samples were fixed as an intraabdominal mesh in the upper part of the abdomen. Ten animals from each group were sacrificed on days 7, 28 and 60 post-surgery. After opening the abdomen, the formation of adhesion was assessed according to the Surgical Membrane Study Group (SMSG) score, the percentage of shrinkage of the mesh was established and inflammatory reaction scored.

Results: The SMSG score for adhesion was statistically significantly higher on all the postoperative days in the Proceed and Ultrapro mesh groups than in the TiMesh group which caused milder inflammatory reaction on 60th day than others meshes. The size of the mesh after 7 days was statistically significantly smaller in the Proceed and Ultrapro groups than in the TiMesh group, but after 60 days it was statistically significantly larger than in the TiMesh group.

Conclusion: The least formation of adhesion was noted in the TiMesh group, in which the highest level of shrinkage was noticed after 28 and 60 days. TiMesh has advantages over the other meshes studied, but a larger size mesh may be recommended for intraperitoneal application.
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http://dx.doi.org/10.1080/00015458.2016.1179513DOI Listing
October 2016

The Influence of the Appendiceal Base Diameter on Appendix Stump Closure in Laparoscopic Appendectomy.

World J Surg 2016 Oct;40(10):2342-7

Department of Colorectal Surgery, Clinic for Surgery, University Clinical Centre, Tuzla, Bosnia and Herzegovina.

Background: Closure of the appendiceal stump is the most critical part of laparoscopic appendectomy. Establishing the average diameter of the inflamed appendix, and forming the appropriate size of clip, endoloop or stapler length, would make this critical phase of laparoscopic appendectomy easier.

Methods: One hundred and fifty consecutive patients, with the diagnosis of acute appendicitis, were included in this study and divided into three groups according to the histological verification of the status of the infection, as follows: phlegmonous, gangrenous and perforated forms of acute appendicitis. The external diameter of the appendiceal base was measured, and the widest part of the appendix with the mesoappendix and the tip, with the help of Vernier callipers, and the measurement was expressed in millimetres.

Results: The average size of the appendiceal base in the phlegmonous form was 10.29 ± 3.13, in the gangrenous form 12.41 ± 3.56, and in the perforated form 12.42 ± 3.64. The maximal size of base was observed in the perforated form, 23.13 mm. The dimensions of the appendiceal base, the central part and the tip in the phlegmonous form were statistically significantly smaller than in the gangrenous and perforated forms of acute appendicitis. The size of the appendix did not differ statistically significantly in the gangrenous and perforated forms of acute appendicitis.

Conclusion: In view of the price, the size of the opening, radiological advantage and biocompatibility, the Hem-o-lok clip is the most effective, although its internal diameter should be increased. The DS clip is also effective, but the size of the opening sometimes makes application difficult, and possibly increasing the length of the legs and the opening would make this clip ideal. Staplers have the best characteristics, but their price means they are an option only for forms where it is not possible to close the stump using other methods.
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http://dx.doi.org/10.1007/s00268-016-3564-4DOI Listing
October 2016

Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study).

World J Emerg Surg 2015 16;10:61. Epub 2015 Dec 16.

Department of Surgery, University Hospital of Larissa, Larissa, Greece.

Background: To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression.

Methods: The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study.

Results: Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p < 0.0001). The multivariate logistic regression model was highly significant (p < 0.0001, R2 = 0.54) and showed that all these factors were independent in predicting mortality of sepsis. Receiver Operator Curve has shown that the WSES Severity Sepsis Score had an excellent prediction for mortality. A score above 5.5 was the best predictor of mortality having a sensitivity of 89.2 %, a specificity of 83.5 % and a positive likelihood ratio of 5.4.

Conclusions: WSES Sepsis Severity Score for patients with complicated Intra-abdominal infections can be used on global level. It has shown high sensitivity, specificity, and likelihood ratio that may help us in making clinical decisions.
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http://dx.doi.org/10.1186/s13017-015-0055-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4681030PMC
December 2015

Biocompatibility and adhesion formation of different endoloop ligatures in securing the base of the appendix.

JSLS 2013 Oct-Dec;17(4):543-8

Department of Surgery, University Clinic Center Tuzla, Tuzla, Bosnia and Herzegovina.

Background And Objectives: The common technique used in securing the base of the appendix is Endoloop ligature (Ethicon, Somerville, NJ, USA). Vicryl (polyglactin 910) (Ethicon) and polydioxanone (PDS) (Ethicon) Endoloop ligatures can be used. There are potential benefits of the use of PDS Plus (Ethicon) Endoloop ligature. However, the use of different materials may vary in terms of inflammation, foreign-body reaction, rate of infection in the surgical area, or rate of adhesion formation. An ideal suture would induce minimal inflammatory response and adhesion formation.

Methods: Ninety rats were randomized into 3 groups: group I, in which appendectomy was performed with Vicryl ligature; group II, in which appendectomy was performed with PDS ligature; and group III, in which appendectomy was performed with PDS Plus ligature. The animals were killed on the seventh, 28th, and 60th days after surgery. The secured stump was used for histopathologic and immunohistochemistry analysis, as well as evaluation of the formation of adhesions.

Results: Mild and moderate inflammation was more frequent in the PDS and PDS Plus groups than in the Vicryl group on the seventh postoperative day. There were no significant differences in the degree of inflammation on the 28th and 60th postoperative days. The lowest degree of postoperative adhesions was observed in the PDS group.

Conclusion: Milder postoperative inflammatory changes and a lower degree of postoperative adhesions were seen in the PDS ligature group, suggesting that this could be the standard Endoloop used to secure the base of the appendix.
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http://dx.doi.org/10.4293/108680813X13654754534116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3866057PMC
September 2014

Radiologic advantages of potential use of polymer plastic clips in neurosurgery.

World Neurosurg 2014 Mar-Apr;81(3-4):549-51. Epub 2013 Sep 22.

Department of Surgery, University Clinic Center Tuzla, Trnovac bb, and the Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina. Electronic address:

Background: Plastic clips are made of diamagnetic material and may result in fewer computed tomography (CT) and magnetic resonance artifacts than titanium clips. Considering that polymer plastic clips are increasingly being used in endoscopic surgery, our study examined the CT and magnetic resonance imaging (MRI) characteristics of plastic clips after application in the neurocranium and compared them with titanium clips.

Methods: Craniotomy was performed on the heads of domestic pigs (Sus scrofa domestica), and, at an angle of 90°, a permanent Yasargil FT 746 T clip was placed in a frontobasal, interhemispheric position. A plastic polymer medium-large Hem-o-lok clip was placed in the same position into another animal. After this procedure, CT of the brain was performed using Siemens 16 slice, followed by an MRI scan, on Philips MRI, 1.5 Tesla. The CT and magnetic resonance scans were analyzed.

Results: On axial CT sections through the site of placement of titanium clips, dotted hyperdensity with a high value of Hounsfield units (HUI) of about 2800-3000 could be clearly seen. At the site where the plastic polymer clips were placed, discrete hyperdensity was observed, measuring 130-140 HUI. MRI of the brain in which titanium clips were used revealed a hypointensive T1W signal in the interhemispheric fissure, with a hypointensive T2W signal. On the other hand, upon examination of the MRI of the brain in which plastic clips were used, the T1W signal described above did not occur, and there was also no T2W signal, and no artifacts observed.

Conclusions: The plastic clips are made of a diamagnetic, nonconductive material that results in fewer CT and MRI artifacts than titanium clips.
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http://dx.doi.org/10.1016/j.wneu.2013.07.127DOI Listing
June 2014

Basic principles of laparoscopic appendectomy.

Med Pregl 2012 Sep-Oct;65(9-10):383-7

Department of Surgery, University Clinic Center Tuzla.

Introduction: Laparoscopic appendectomy is one of the simplest laparoscopic procedures, which is gradually becoming the method of choice in treatment of acute appendicitis due to its advantages over open appendectomy. In South-Eastern Europe the use of laparoscopic appendectomy is still very limited although it is a very simple procedure, suitable for training laparoscopic techniques. Technique of Laparoscopic Appendectomy. This review article describes the position of the patient and surgical team during laparoscopic appendectomy, position of troacars and working instruments which result in expressive cosmetic effect, technique of laparoscopic appendectomy, different ways of securing the base of appendix. Complications of Laparoscopic Appendectomy. This review article describes management of complicated appendicitis, and intra- and post-operative complications.

Conclusion: Laparoscopic appendectomy has many advantages over open appendectomy. The risk of wound infection is lower, postoperative pain is weaker and the hospital stay is shorter.
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January 2013

Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study.

World J Emerg Surg 2012 Nov 29;7(1):36. Epub 2012 Nov 29.

Department of Surgery, Macerata Hospital, Macerata, Italy.

The CIAO Study ("Complicated Intra-Abdominal infection Observational" Study) is a multicenter investigation performed in 68 medical institutions throughout Europe over the course of a 6-month observational period (January-June 2012).Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.2,152 patients with a mean age of 53.8 years (range: 4-98 years) were enrolled in the study. 46.3% of the patients were women and 53.7% were men. Intraperitoneal specimens were collected from 62.2% of the enrolled patients, and from these samples, a variety of microorganisms were collectively identified.The overall mortality rate was 7.5% (163/2.152).According to multivariate analysis of the compiled data, several criteria were found to be independent variables predictive of patient mortality, including patient age, the presence of an intestinal non-appendicular source of infection (colonic non-diverticular perforation, complicated diverticulitis, small bowel perforation), a delayed initial intervention (a delay exceeding 24 hours), sepsis and septic shock in the immediate post-operative period, and ICU admission.Given the sweeping geographical distribution of the participating medical centers, the CIAO Study gives an accurate description of the epidemiological, clinical, microbiological, and treatment profiles of complicated intra-abdominal infections (IAIs) throughout Europe.
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http://dx.doi.org/10.1186/1749-7922-7-36DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539964PMC
November 2012

Complicated intra-abdominal infections in Europe: preliminary data from the first three months of the CIAO Study.

World J Emerg Surg 2012 May 21;7(1):15. Epub 2012 May 21.

Department of Surgery, Macerata Hospital, Macerata, Italy.

The CIAO Study is a multicenter observational study currently underway in 66 European medical institutions over the course of a six-month study period (January-June 2012).This preliminary report overviews the findings of the first half of the study, which includes all data from the first three months of the six-month study period.Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.912 patients with a mean age of 54.4 years (range 4-98) were enrolled in the study during the first three-month period. 47.7% of the patients were women and 52.3% were men. Among these patients, 83.3% were affected by community-acquired IAIs while the remaining 16.7% presented with healthcare-associated infections. Intraperitoneal specimens were collected from 64.2% of the enrolled patients, and from these samples, 825 microorganisms were collectively identified.The overall mortality rate was 6.4% (58/912). According to univariate statistical analysis of the data, critical clinical condition of the patient upon hospital admission (defined by severe sepsis and septic shock) as well as healthcare-associated infections, non-appendicular origin, generalized peritonitis, and serious comorbidities such as malignancy and severe cardiovascular disease were all significant risk factors for patient mortality.White Blood Cell counts (WBCs) greater than 12,000 or less than 4,000 and core body temperatures exceeding 38°C or less than 36°C by the third post-operative day were statistically significant indicators of patient mortality.
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http://dx.doi.org/10.1186/1749-7922-7-15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444376PMC
May 2012

The use of a single Hem-o-lok clip in securing the base of the appendix during laparoscopic appendectomy.

J Laparoendosc Adv Surg Tech A 2012 Jan-Feb;22(1):85-7. Epub 2011 Dec 6.

Department of Surgery, University Clinic Center Tuzla, Tuzla, Bosnia and Herzegovina.

Background: During laparoscopic appendectomy, the standard technique in securing the base of the appendix is by endoloop ligatures or a stapler. We earlier demonstrated the possibility of the application of a double Hem-o-lok(®) clip in securing of the base of the appendix. The application of only one plastic clip would, however, lower the cost of the laparoscopic procedure even further and shorten the surgery time. The objective of this prospective study was to evaluate the possible advantages of securing of the base of the appendix using only one Hem-o-lok clip.

Patients And Methods: The 90 patients with acute appendicitis were randomly divided into three groups: In the first group, the base of the appendix was secured using one endoloop ligature, in the second group using a 45-mm stapler, and in the third group using only one nonabsorbable Hem-o-lok clip. The data collected included age, gender, surgery time, time of endoloop/stapler/clip application, hospital stay, costs associated with these, and intra- and postoperative complications.

Results: There were no significant differences in hospital stay among the three groups of patients; but the average time of the operation was significantly longer in the endoloop group than in the stapler group (P=.002), whereas the endoloop and Hem-o-lok groups were not statistically different (P=.22). The time of application of the endoloop was significantly longer than for the stapler (P<.0001) and Hem-o-lok (P<.0001) groups. The time of application of the stapler was significantly shorter than that of the Hem-o-lok (P<.0001). However, the price of one endoloop is €28.85, for the stapler is €230.7, and for one Hem-o-lok clip is €2.35.

Conclusion: The use of one Hem-o-lok clip is as safe as an endoloop and/or stapler; however, the time of the laparoscopic procedure using the Hem-o-lok was shorter in comparison with the use of an endoloop, with the cost of the procedure being the lowest.
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http://dx.doi.org/10.1089/lap.2011.0348DOI Listing
May 2012

Tissue reaction to absorbable endoloop, nonabsorbable titanium staples, and polymer Hem-o-lok clip after laparoscopic appendectomy.

JSLS 2011 Jan-Mar;15(1):70-6

Department of Surgery, University Clinic Center Tuzla, Bosnia and Herzegovina.

Background And Objectives: The standard technique for securing the base of the appendix during laparoscopic appendectomy is by absorbable endoloop ligature, although clinical reports favor the use of the stapler. Nonabsorbable Hem-o-lok clips have been shown to be an alternative technique to this. However, it is currently not clear whether nonabsorbable clips have any effects on the intestine or promote infection in the surgical area.

Materials And Methods: Sixty Wistar albino rats were randomized into 3 treatment groups: group I (n=20) the base of the appendix was secured by endoloop 2-0 ligature; group II (n=20) dissection of the appendix was performed by a 45-mm thick stapler; and group III (n=20) the base of the appendix was secured by a Hem-o-lok plastic clip. The animals were sacrificed on the 14th and 28th days after surgery. The secured stump was used for histopathological examination.

Results: There were no significant differences in histopathological changes observed on the 14th postoperative day between the groups. On the 28th postoperative day, it was proved that mild and moderate inflammation is more frequent in the endoloop and Hem-o-lok groups than in the stapler group. Reaction to a foreign body is more frequent in the endoloop than in stapler and Hem-o-lok groups.

Conclusion: The mildest postoperative inflammatory changes were seen in the stapler group, followed by the Hem-o-lok group. However, because of the price of the plastic clip and the simplicity of its application, its use is still favored during laparoscopic appendectomy.
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http://dx.doi.org/10.4293/108680811X13022985131336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134701PMC
October 2011
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