Surgery, Gastroenterology and Oncology

Introduction: Globally, gliomas account for > 70% of all brain tumors. In Iraq, there is a tendency towards a higher rate of gliomas. The Iraqi Cancer Registry in 2019 stated that central nervous system tumors were among the top three cancers in Iraq and the top ten cancers in Sulaymaniyah.

Method: In this hospital-based frequency analysis study, information from 104 glioma patients was reviewed. Data were then subjected to critical analysis, taking into consideration all relevant factors related to demographic data (age, sex, and ethni....[more]

Highlights:

A randomized controlled study (RCT) that discusses the impact of biliopancreatic limb length, gastric pouch length, and total small bowel length on weight loss and nutritional parameters after One-anastomosis gastric bypass (OAGB).

Longer BPL lengths (200 cm) in OAGB are associated with greater %TWL and %EWL compared to shorter limb lengths (150 cm).

Patients with longer BPL lengths (170 cm and 200 cm) exhibit significantly higher rates of postoperative nutritional deficiencies, particularly in serum albumin, calcium, iron, and fe....[more]

Background: Rectal cancer is a common malignancy worldwide. Management of rectal cancer is multimodal. Preoperative chemoradiotherapy, particularly for low rectal cancer, plays an important role in downstaging and facilitating surgery. Objective: This study aimed to evaluate the outcomes of preoperative chemoradiotherapy in patients with low rectal

cancer at Hanoi Medical University Hospital.

Materials and Methods: A retrospective study of 56 patients with low rectal cancer who received preoperative chemoradiotherapy at Hanoi Medica....[more]

Background: Phyllodes tumors (PT) of the breast represent a rare entity of breast neoplasms, their unpredictable behavior and high recurrence potential present these tumors as a clinical challenge. Those tumors necessitate careful diagnostic evaluation and management. Our retrospective study aims to discuss the different clinico-pathological features as well as different management approaches for phyllodes tumors.

Methods: A retrospective review of 175 PT patients diagnosed and treated in our institution between 2006 and 2023 was conducted.....[more]

Background: Surgical site infection (SSI) remains one of the most common postoperative complications, contributing significantly to patient morbidity, prolonged hospital stay, and healthcare costs. Understanding local SSI patterns is essential for improving surgical outcomes. Purpose: to investigate SSI in Nassiryia teaching hospital in terms of pattern and hospital readmission rate.

Methods: This prospective study included 300 patients who underwent various surgical procedures. Data on demographic characteristics, comorbidities, surgical d....[more]

Background: The trend of prophylactic neck dissection for clinically nodal-negative papillary thyroid carcinoma (PTC) is still a subject of controversy. Despite the risk of higher morbidities, a more selective approach based on risk factors has been proposed. Systemic inflammation highlights the potential of preoperative neutrophil-to-lymphocyte ratio (NLR) as a convenient biomarker in predicting nodal metastasis. This review aims to evaluate the potential of preoperative NLR in predicting occult nodal metastasis in PTC.

Methods: We conduc....[more]

Purpose: Many factors, including body composition, can influence the prognosis of colo-rectal cancer (CRC). This study aimed to investigate the effect of sarcopenia on survival in patients subjected to elective resection of colorectal cancer.

Methods: The study included 93 patients with adenocarcinoma of the colon or rectum scheduled for elective resection. Sarcopenia was diagnosed by CT scan measurement of the total cross-sectional area of the psoas muscles (TPA).

Results: Sarcopenia was detected in 29 patients (31.....[more]

Background: The present study aims to review the feasibility, safety and short-term outcome of single port robotic-assisted cholecystectomy with common bile duct (CBD) exploration for complicated biliary stone with the Da Vinci SP™ (Intuitive Surgical Inc., Sunnyvale, CA, USA) system.

Materials and Methods: Retrospective analysis of single port robotic-assisted cholecystectomy and CBD exploration for synchronous gallbladder (GB) and CBD lithiasis, between June and December 2024. Data on patient demographics, perioperative investigations, ....[more]

Severe acute pancreatitis presents a clinical challenge due to its rapid progression and potential for multiple organ failure. We present a case study detailing the management of a 43-year-old male with a history of ankylosing spondylitis, axial spondylarthritis, chronic alcohol and tobacco use, admitted with epigastric pain, nausea, and vomiting indicative of severe pancreatitis. Laboratory workup revealed markedly elevated triglycerides and inflammatory parameters and radiological findings were consistent with acute pancreatitis. The patient rapidly deteriorated, progressing wi....[more]

Background: One of the most prevalent solid tumors in men is prostate cancer which is caused by a lack of apoptosis, which leaves cancerous cells that refuse to die. Consequently, triggering apoptosis is a common approach for anticancer treatments to destroy tumor cells. The bacterial biofilm's EPS (Exopolysaccharides) is paying attention as a potential novel cancer treatment source.

Methods: This study targeted to determine the anti-cancer capabilities of EPS extract and its impact on the expression of the genes Bcl-2, Bax, p53, casp....[more]

4th Jaipur Surgical Festival (JSF) 2024

Naina Kumar¹, VK Kapoor²

¹Department of Surgical Oncology, Sawai Man Singh (SMS) Medical College Jaipur, Rajasthan, India

²Department of Surgical Gastroenterology, Mahatma Gandhi Medical College & Hospital, Jaipur, Rajasthan, India

“Successes, every surgeon can discuss but it takes utmost courage to come up and talk about the complications.”

Jaipur – aka the Pink City – the ca....[more]

Background: Hemorrhoidal disease is one of the most common anorectal conditions, significantly affecting quality of life. Current treatment trends are shifting toward minimally invasive techniques that preserve supporting tissues, reduce postoperative pain, and shorten recovery. Laser hemorrhoidoplasty (LHP) uses laser energy to vaporize, coagulate vessels, induce fibrosis, and reduce hemorrhoidal volume without excision. However, large-scale evidence on its efficacy and safety remains limited. Objectives: To evaluate the efficacy and safety of LHP, analyze factor....[more]

Background and Aim: Acute Mesenteric Ischemia (AMI) is a serious vascular emergency with significant fatality and a jumping rate in covid-19 patients. This research investigated many of the cases diagnosed with COVID-19 that were identified with the diagnosis of AMI, and it presented the primary and secondary outcomes, including mortality, with their predictors.

Materials and Methods: The study was conducted at four centers managing COVID-19 patients diagnosed with AMI in two countries between March 1, 2020, and July 1, 2023.

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Background: The cases classified as Bethesda III - Atypia of Undetermined Significance (AUS)/Follicular Lesion of Undetermined Significance (FLUS) are seen as a “gray zone” in thyroid cytopathology. Many previous studies have shown a wide variation in malignancy rates of Bethesda III thyroid nodules in different regions and institutions across the world. Objective: We want to describe the differential malignancy rates of FNACs diagnosed as Bethesda III based on cytological sub-classification and to assess the significance of demographic and ultrasonogr....[more]

Background: Gallstone disease (GSD) is a prevalent illness worldwide. Study aimed to investigate the association of Xbal (rs 693) G/A and TLR4 – rs 4986791 C/T genes with gallbladder disease.

Material and Methods: Over the course of three months, from October 2020 to December 2021, samples were taken from fifty healthy persons and one hundred patients with a diagnosis of gall bladder infection from Al. Hilla Teaching Hospital. The patients' ages ranged from fifteen to seventy-one years. TLR4 –rs 4986791 C/T and Xbal (rs 693....[more]

Background: Breast cancer (BC) is the most prevalent and lethal among female cancers. To reduce the risk of radiation-induced lung damage, a technique employed for left-sided breast cancer is the Deep Inspiration Breath Hold (DIBH). The study aimed to assess the impact of DIBH using the ABC device on lung dosage in left breast cancer radiotherapy.

Material and Methods: A dosimetric study was conducted involving 50 females diagnosed with left breast cancer. Treatment was conducted at Baghdad ROC using 3DCRT and at Al-Safeer Oncology Center.....[more]

Background: Among the most common malignancies worldwide, bladder cancer is among the most common. Iraq has seen a dramatic spike in the number of reported cases and deaths from this illness over the last few decades. Aim. Examining interleukin-10 expression in human bladder cancer with the main objective of discovering relevant connections between it and clinic-pathological variables is the fundamental purpose of this study. Using this marker to differentiate between basal and luminal bladder tumors is another goal.

Material and Methods: ....[more]

Although GISTs can occur in any part of the digestive tract, most gastrointestinal stromal tumors (GISTs) are found in the stomach. They are generally asymptomatic but may grow and form large masses. We report the case of a nearly asymptomatic patient with a large tumor (around 25 cm) that was successfully removed, followed by adjuvant treatment with tyrosine kinase inhibitor (TKI).

INTRODUCTION

Gastrointestinal stromal tumors (GISTs) are non-epithelial tumors of the gastrointestinal tract. These mesenchymal tumors acc....[more]

Background: Patients with abdominal cancers may present with advanced disease either locally or metastatic and so, accurate staging help in selection of the appropriate treatment plan (curative or palliative). Up to 50% of patients diagnosed with colorectal cancers (CRC) and 40% of patients diagnosed with pancreatic cancers will have  metastatic hepatic lesions during the course of the disease, where 7% of patents with CRC and 14% of patients with advanced gastric cancers will develop peritoneal metastases. Despite advances in pre-operative imaging used for d....[more]

Objectives: to assess the diagnostic role of the hysteroscopy in endometrial cancer

detection compared to pathology as a gold standard.

Methodology: This is a descriptive diagnostic accuracy study, including 136 women

attending to National Cancer Institute, Cairo University outpatient clinic and presenting with post-menopausal bleeding or any ultrasound diagnosed endometrial mass, in the 2 year interval from July 2021 till July 2023. Ultrasound, Hysteroscopy and hysteroscopic guided biopsy were....[more]

Cancer is a disease with major societal impact with 18.1 million cases reported globally in 2020. About 16% of all oncological disorders are malignant gynaecological tumours, the most common types being cervical, endometrial and ovarian cancer. The classic methods of treating these diseases are surgery, radiotherapy chemotherapy and different combinations of them, and they are directed against the tumor cell itself. This necessitates the searchfor more and more new and effective therapeutic approaches. Advances in genomic and molecular techniques have led to the introduction of pe....[more]

Objective: To present a novel technique for the placement of omental patch aiming to prevent post-operative leak in order to decrease post-operative morbidity, prolonged hospitalisation and mortality.

Summary Background Data: Peptic ulcer perforation is a common life-threatening emergency and requires urgent surgical solution. Graham patch and modified Graham patch are the two most widely used techniques for omental patch repair. However, the post-operative leak rate following these techniques could be between 3.33% and 6.7%.

....[more]

Introduction: Cervical cancer (CC) continues to be a significant problem in Bulgaria, with very high morbidity and mortality. The reasons for this are manifold – besides the lack of

primary prevention and screening, there are also issues related to the treatment process. This study aims to collect results and analyses data on the initial management of CC, focusing on preoperative radiotherapy and its negative impact on the survival of patients with this type of cancer in Bulgaria.

Materials and methods: This is a retrospectiv....[more]

Introduction: Volvulus of the ascending colon is a rare cause of large bowel obstruction and presents because of its mesentery with excessive mobility allowing it to rotate on its axis. It is usually due to a congenital or acquired anatomical variation. Objective: To describe volvulus of the ascending colon as a rare complication in a young patient, whose diagnosis was mistaken for sigmoid volvulus and diaphragmatic hernia.

Case report: We present the case of a 27-year-old woman who presented with periumbilical abdominal pain, nausea, vomi....[more]

Background/Aim: Major complications of biliary surgery, such as laparoscopic cholecystectomy, include bile duct injury. Surgeons with extensive experience in the hepatobiliary system may find it difficult to address severe cases of bile duct injury. The purpose of this research was to assess various therapeutic approaches for bile duct injuries, and to determine which was superior in terms of injury type and presentation time (early or late), as well as improvement in quality of life.

Methods: Research on 80 patients was undertaken at XXX ....[more]

Introduction: Cervical cancer incidence is decreasing in the western world, but the disease remains the most common gynecological malignancy worldwide. About one-third of treatedwomen will have recurrence during follow-up, most often in the first two to three years after the initial treatment, leaving many with limited treatment options and poor prognosis.

Case report: We present a case of a 63-year-old female who was operated for cervical cancer, underwent post-operative radiochemotherapy and had a locoregional recurrence in an unusual lo....[more]

Introduction: We present an extremely rare case of gastric outlet obstruction (GOO) in a young male attributed to hydrops of the gallbladder resulting from recurrent episodes of acute acalculous cholecystitis. Remarkably, approximately one and half years prior to this presentation, the patient was diagnosed with confirmed acute acalculous cholecystitis and had tested positive for Covid 19 ,despite exhibiting no respiratory symptoms.

Case report: While it is established that Patients with acute acalculous cholecystitis can develop gallbladd....[more]

Background: The early detection of colorectal anastomotic leakage (CAL) remains challenging despite advancements in diagnostic methods. Reliable markers are needed to reduce patient morbidity and mortality. Cytokines in drain fluid and systemic cytokine levels have shown potential as predictive markers for CAL, but more robust evidence is required. This systematic review and meta-analysis aimed to evaluate the importance of peritoneal and serum or plasma interleukin-6 (IL-6) levels in the early detection of CAL after colorectal surgery in colorectal cancer patient....[more]

Background: Alcohol consumption is increasing worldwide, as being the most popular drug used for recreational purposes. Excessive consumption leads to irreversible liver damage, and since 2015 alcoholic cirrhosis has become the main indication of liver transplantation (LT).

Methods: Our aim was to create the epidemiological profile, of the cirrhotic patient who consumes alcohol and is considered a candidate for LT. Evaluation of alcohol consumption by applying three screening questionnaires: CAGE, AUDIT-C and FAST. Survival rates and LT ev....[more]

Objective: Patients with acute diverticulitis (AD) have an increased risk of underlying colorectal cancer (CRC), however those with uncomplicated AD may have the same underlying population risk. Despite evidence suggesting these patients may not require further endoscopy, published guidelines still recommended Colonoscopy as standard post-diverticulitis management. A practical approach to the definition of bowel wall thickening may improve negative predictability, a potential impediment to omitting colonoscopic followup.

Material and Methods: A 2-year (July 2....[more]

Introduction: The functional laparoscopic gastric bypass with fundectomy and gastric remnant exploration (LRYGBfse) has been described in attempt to overcome the intrinsic limitations of the LRYGB with promising results. However, the detailed learning curve related to this innovative procedure has not been assessed.

Materials and Methods: Retrospective multicenter study from December 2010 to January 2015. Data were prospectively collected from one surgeon experienced in laparoscopic surgery. The cumulative summation methodology (CUSUM) was....[more]

Background: Patient reported outcomes are valuable components in the assessment of results of treatment for peripheral arterial disease (PAD). The aim of the study was to translate the six item Vascular Quality of Life Questionnaire (VascuQoL-6) survey into Romanian, and to validate the psychometric performance of the questionnaire in a representative cohort of patients with lower extremity arterial disease.

Material and Methods: Translation of the VascuQoL-6 questionnaire was performed following accepted methodology. The overall validatio....[more]

Introduction: Esophagectomy has a crucial role in the treatment of esophageal cancer. Several different surgical techniques have been performed in order to achieve better post-surgical and oncological outcomes. In this systematic review and meta-analysis, we compare two procedures – Ivor Lewis and McKeown – regarding their impact on morbidity.

Methods: In March 2021, records from Pubmed, Scopus, Web of Science and ClinicalTrials.gov were retrieved. Eligible studies included articles evaluating morbidity outcomes of Ivor Lewis e....[more]

Background and Aim: to compare the early outcome results of laparoscopic versus open management as laparoscopic management seems to have multiple attractions for surgeons with marked controversy.

Materials and Methods: All patients of Gastroduodenal perforation were included and randomized for laparoscopic or open repair. The data obtained from the diagnostic flowchart, operative details, postoperative morbidities, and mortalities were collected for statistical analysis.

Results: sixty-six patients were assigned to....[more]

Cervical cancer is the fourth most common gynecological malignancy. It is a major health problem commonly affecting women in a young age. It is well known that the majority of cervical cancer cases are related to human papilloma virus. Therefore, in Europe the rate of cervical cancer is expected to decrease due to human papilloma virus vaccination (1-3). However, the discrepancy in cervical cancer cases is clearly seen between Eastern and Western European countries. Moreover, the estimated age-standardized incidence rate of cervical cancer is the highest in Bulgaria among all Euro....[more]

Introduction: Volvulus of the ascending colon is a rare cause of large bowel obstruction and presents because of its mesentery with excessive mobility allowing it to rotate on its axis. It is usually due to a congenital or acquired anatomical variation.

Objective: To describe volvulus of the ascending colon as a rare complication in a young patient, whose diagnosis was mistaken for sigmoid volvulus and diaphragmatic hernia.

Case report: We present the case of a 27-year-old woman who pr....[more]

Background: The most common types of true epithelial exocrine pancreatic cystic neoplasms are serous cystic neoplasms (SCNs), mucinous cystic neoplasms (MCNs), intra-ductal papillary mucinous neoplasms (IPMNs), and solid pseudo-papillary neoplasms (SPPNs). Both open and laparoscopic pancreatic surgeries are major procedures with significant morbidity and mortality rates. This study aimed to determine the outcomes of laparoscopic pancreatic surgery in managing true exocrine epithelial pancreatic cystic neoplasms in terms of postoperative pancreatic fistula and recu....[more]

Aim: This study aimed to examine whether there is a relationship between spleen radiation doses and hematological parameters in gastric cancer patients.

Materials and Methods: The patients who received chemoradiotherapy for nonmetastaticlocally advanced gastric cancer were analyzed retrospectively. The dose parameters evaluated were spleen  V5, V10, V15, V20, V25, V30 and mean spleen dose (MSD). Blood tests were evaluated at the beginning of the treatment (basal), in the 12-14 fractions of the treatment (mid-treatment), in  he firs....[more]