Abstracts Book

Abstract Book

All abstracts were published as they were prepared by authors.

XVII Annual Meeting of the European Society of Surgery Malta 2013

Abstracts Book

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XVII Annual Meeting of the European Society of Surgery – Malta 2013

INDEX

Cutajar C.L.; THE HISTORY OF MEDICINE IN MALTA: OPENING SESSION.; Session BARIATRIC SURGERY Luigi Schiavo, Giuseppe Scalera, Alfonso Barbarisi PRE- AND POSTOPERATIVE NUTRITIONAL CONSIDERATIONS TO BETTER MANAGE BARIATRIC SURGERY PATIENTS. Gabriele De Sena, MD - Renato Sergio, MD - Vincenza Capuozzo, MD – Giovanni Giordano, MD - Francesco Iovino, MD - Giuseppe Scalera, MD PROPOSAL OF A BARIATRIC SURGERY UNIT: OUR EXPERIENCE Session UPPER GI SURGERY AND UPPER GI CANCER Jo Etienne Abela, Godfrey LaFerla; THREE-STAGE OESOPHAGECTOMY FOR END-STAGE ACHALASIA; Christian Petkov; HOW TO DIAGNOSE AND OPERATE SMALL BOWEL TUMORS; GIST: EXPERIENCE OF OUR SURGERY CENTER; Omar Sadieh,MD MRCS-Mahmoud Khashashneh MD MRCS-Nedal Shawagfeh,MD- Loai Bani Essa INCIDENTAL FINDING OF GALLBLADDER CARCINOMA. Dr K. Chircop, Dr S. Aquilina, Dr A. Mizzi; PERCUTANEOUS BILIARY DRAINAGE AND STENTING. THE FIRST AUDIT REPORT OF THE MALTESE EXPERIENCE; Lemaire J, Rosiere A, Bertrand C, Demoor V, Michel; SPLENECTOMY FOR MASSIVE SPLENOMEGALY (MS); Jo Etienne Abela, Mark Schembri; THE ANTERO-POSTERIOR APPROACH FOR LAPAROSCOPIC SPLENECTOMY IN SPLENOMEGALY; Ms Elaine Borg, Dr Doriella Galea, Dr Stephanie Azzopardi, Mr Mark Schembri; AUDIT ON PATIENTS’ PREFERENCE REGARDING SAME-DAY DISCHARGE POST-LAPAROSCOPIC CHOLECYSTECTOMY AT MATER DEI HOSPITAL; Session SAFETY IN THE OPERATING THEATRE Cutajar C.L.; OPERATING ROOM ERRORS; N Suleyman, E Williams, I Sagriotis, D L Stoker; WAITING TIME FOR LAPAROSCOPIC CHOLECYSTECTOMY AT A LONDON DISTRICT GENERAL HOSPITAL; N M Suleyman, J Wright; AN AUDIT OF POST-OPERATIVE PRESCRIBING AT A LONDON DISTRICT GENERAL HOSPITAL; Farhana Akter, Aneela Hameed, Mansoor Akhtar, Ayman Hamade; PREVENTION OF SURGICAL SITE INFECTION; Andrey Kudryavtsev, Valery Kryshen, Artem Breus; SAFETY MAINTAINING AFTER LAPAROSCOPIC STRANGULATED HERNIA REPAIR; Session THE ACUTE ABDOMEN František Vyhnánek; TRAUMA DAMAGE CONTROL SURGERY; Salvatore Guarino, Antonio Catania, Salvatore Sorrenti, Deborah Maria Giusti, Matteo Nardi, Carlo Di Marco, Grazia Savino, Enrico De Antoni; BLUNT TRAUMAS. MANAGEMENT OF INTRABDOMINAL INJURIES IN A UK MAJOR TRAUMA CENTER; Session COLO-RECTAL SURGERY AND PROCTOLOGY Gallo G, Ferrari F, Carpino A, Sena G, Silipo D, Vescio G, Sammarco G, Sacco R; WHAT’S THE FUTURE FOR THE MILLIGAN-MORGAN’S TECHNIQUE? Gallo G, Carpino A, Ferrari F, Ammendola M, Sena G, Vescio G, Sammarco G, Sacco R; THE SLIDE : OUR EXPERIENCE; Melnik Idit MD, Oleg Dukhno MD, Ornit Cohen M.MED Sc ,Dimitry Goldstein MD, Boris Yoffe MD FACS; WHEN TO GO SINGLE? A COMPARISON BETWEEN SINGLE PORT AND THE TRADITIONAL MULTIPORT TECHNIQUE FOR COLON RESECTIONS. Tikfu Gee, Emad H Aly; SCARLESS SURGERY!! SINGLE INCISION LAPAROSCOPIC SURGERY (SILS) - AN ALTERNATIVE SURGICAL APPROACH OF MINIMALLY INVASIVE SINGLE PORT SURGERY IN COLORECTAL SURGERY; Pierpaolo Sileri , Luana Franceschilli, Federico Perrone, Ilaria Carolina Ciangola, Ilaria Capuano, Federica Giorgi, Achille Lucio Gaspari; LAPAROSCOPIC VENTRAL RECTOPEXY FOR INTERNAL RECTAL PROLAPSE USING BIOLOGICAL MESH:A CRITICAL APPRAISAL AFTER 100 CASES; Session EMERGENCY SURGERY AND TRAUMA; Obondo CA, Moussa O, Muthukumarasamy G, White RD, McBride K, Bhat R, Beverage E, Brennan JC, Holdsworth R.; CLINICAL OUTCOMES OF ENDOVASCULAR TREATMENT IN CHRONIC SYMPTOMATIC MESENTERIC ISCHAEMIA; O. Sadieh, Asem Ghasoup,MD MRCS-Mahmoud Khashashneh,MD MRCS-Isamil Marey,MD-Adala Al Anzi,Abeer Al Anzi THE OUTCOME OF PATIENTS WITH BLUNT CHEST TRAUMA AND PULMONARY CONTUSION. Mrktich Mrktichyan, Hovhannes Sarkavagyan, Tigran Khachatryan, Armen Khanoyan, Artak Manukyan, Artur Sardaryan, Hayk Kikoyan; TRAUMATIC RUPTURE OF THE DIAPHRAGM; Kryshen V.,Kudriavtchev A.; TAPP MODIFYING TECHNIQUE FOR STRANGULATED INGUINAL HERNIA; Baras R. Karakas, M.D.1 , Aslinur Sircan-Kucuksayan, M. S.2, Gulsum uzlem Elpek, M.D. Prof. 3, Murat Canpolat, PhD. Prof. Dr.2; ASSESSMENT OF THE INTESTINAL VIABILITY BY DIFFUSE REFLECTANCE SPECTROSCOPY ON ISCHEMIA-REPERFUSION INJURY IN THE RAT; Marvan J., Bačová J., Antoš F., Fanta J.; SPECIFIC ISSUES IN THE MANAGEMENT OF AN ACUTE ABDOMEN IN PSYCHIATRIC PATIENTS; Dobbs T, Aveyard N, Bratby M, Hormbrey P; DEEP VEIN THROMBOSIS - HAVE YOU CONSIDERED MAY-THURNER SYNDROME? Session UPTODATE ON ENDOCRINE SURGERY Camenzuli C., Micallef A., Sammut Henwood K., Betts A.; DEMOGRAPHICS AND INCIDENCE OF THYROID CANCER: A POPULATION STUDY; Camenzuli C., Cassar N., Psaila J., Attard A.; USE OF CLOSED DRAINS UNDER SUCTION AFTER HEMITHYROIDECTOMY- A PRELIMINARY REPORT OF A RANDOMIZED CONTROLLED TRIAL.

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Nicola PALESTINI, Enrico BRIGNARDELLO, Milena FREDDI, Marco GALLO, Alessandro PIOVESAN, Guido GASPARRI; Impact of surgery on survival in anaplastic thyroid carcinoma. A case series of patients referred to a single institution between 1999-2012; G.Gallo; G.Tomaino; N.Innaro; R.Sacco; IONM: OUR EXPERIENCE; Marcin Barczynski, Aleksander Konturek, Małgorzata Stopa, Wojciech Nowak; SCREENING FOR PRIMARY HYPERPARATHYROIDISM IN ELDERLY PATIENTS BEFORE THYROID SURGERY: RESULTS OF A RETROSPECTIVE COHORT STUDY WITH FIVE-YEAR FOLLOW-UP.; Cherenko S., Larin O., Tovkay O.; DIFFERENT OPTIONS OF ENDOSCOPIC ADRENALECTOMY FOR DIFFERENT ADRENAL LESIONS: LESSONS FROM EXTENSIVE PERSONAL EXPERIENCE; Session DECISION MAKING AND TRADE-OFFS IN SURGERY Arthur Felice, MD, MSc. FRCS Ed, FEBS.; PROCESSES IN CLINICAL DECISION MAKING; Kevin Cassar; THE ROLE OF NON INVASIVE IMAGING IN CLINICAL DECISION MAKING AT A VASCULAR ONE STOP CLINIC; Jo Etienne Abela; MANAGEMENT OF COMPLICATIONS OF ACUTE SEVERE PANCREATITIS - INVITED TALK; Patrick Zammit; PREDICTION OF SUPERFICIAL BLADDER CANCER DISEASE PROGRESSION USING ARTIFICIAL NEURAL NETWORKS; Miroslav Jirik 1, Miroslava Svobodova 2, Hynek Mirka 3, Vladislav Treska 2, Jan Bruha 2, Vaclav Liska 2; LIVER SEGMENTATION AND VOLUMETRY FROM PREOPERATIVE CT IMAGES, MANUAL AND SEMIAUTOMATIC ESTIMATION; Noel Cassar, Joseph Debono; PREDICTING AXILLARY LYMPH NODE METASTASIS PREOPERATIVELY TO AVOID UNNECESSARY AXILLARY SURGERY? Rumyana Rumenova Smilevska, Andres Garcia Marin, Asuncion Candela Gomis, Valentin N. Rodriguez, Maria Mingorance Alberola, Elena Martinez Guerrero, Miguel Morales Calderon, Salvador Garcia Garcia; EARLY VS. DELAYED CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS EVIDENCE VS. EXPERIENCE; Ms Elaine Borg, Dr Adrian Mifsud, Ms Josephine Psaila; FEEDING POLICY FOR ACUTE SURGICAL ADMISSIONS; Gyorgy Lazar, Zsolt Simonka, Attila Paszt, Szabolcs Abraham, Janos Tajti; LAPAROSCOPIC AND OPEN SURGICAL TREATMENT OF COLITIS ULCEROSA - A RETROSPECTIVE ANALYSIS; Session POSTGRADUATE SURGICAL TRAINING Kevin Cassar; PROFESSIONALISM IN SURGICAL POSTGRADUATE TRAINING; Stroman L, Johnston M, Arora S, King D, Darzi A; CHANGES IN THE SURGICAL TEAM MODEL TO IMPROVE JUNIOR DOCTOR SUPERVISION: AN INTERVENTION STUDY; N. Pavia, S. Grixti, M. Brincat, O. Tsar, I. Knyazev, J. Mamo; EFFECT OF LAPAROSCOPIC SIMULATION TRAINING ON GYNAECOLOGICAL SURGERY; Angeliki Lintzeri, Xanthi Agrogianni, Ioannis Lintzeris; THE ROLE OF RADIOFREQUENCY ABLATION IN SURGERY TREATMENT; Session MISCELLANEUS SURGICAL TOPICS Darmanin M, Umana E, Debono J; MRI RESULT AND TREATMENT OUTCOME IN BREAST CANCER PATIENTS; Alexander Manchea; CORONARY SURGERY IN THE OVER 70’S: SHORT AND LONG-TERM OUTCOMES. IS IT WORTHWHILE? Ms E. Borg, Prof K. Cassar; PROSPECTIVE STUDY OF MANAGEMENT AND OUTCOME OF INPATIENT DIABETIC FOOT ULCERS AND GANGRENE ACCORDING TO WAGNER›S CLASSIFICATION IN A TERTIARY HOSPITAL IN MALTA; Hannah King, Amanda Rea, Nick Kalson, Georgios Akritidis, Bimbi Fernando, Fiona Mint, Seraphim Patel; QUALITY OF CONSENT DOCUMENTATION FOR MAJOR SURGICAL PROCEDURES REFLECTS THE OUTCOME OF THE CONSENT PROCESS; Gordon Caruana-Dingli; IMPROVING THE AESTHETIC OUTCOME OF BREAST CANCER SURGERY; Joseph Galea, Alexander Manche; GENERAL SURGICAL COMPLICATIONS FOLLOWING CABG; Ian Said, Kevin Cassar; IS DEEP TISSUE BIOPSY CULTURE SUPERIOR TO SUPERFICIAL SWAB CULTURE IN THE EVALUATION AND TREATMENT OF DIABETIC FOOT INFECTION? Aaron Casha,Alexander Manche, Ruben Gatt, Marilyn Gauci, Pierre Schembri Wismayer, Marie-Therese Camilleri-Podesta, Joseph N Grima; IS THERE A BIOMECHANICAL CAUSE FOR SPONTANEOUS PNEUMOTHORAX? Lara Sammut, Annalisa Montebello, Gianluca Bezzina, Ali Virk, Gerald Busuttil; AN AUDIT OF URINARY TRACT INFECTIONS AT THE UROLOGY UNIT AT MATER DEI HOSPITAL, MALTA; Max Mifsud, Kevin Cassar; RANDOMISED CONTROLLED TRIAL OF ELECTRICAL CALF MUSCLE STIMULATION IN INFRAINGUINAL BYPASS SURGERY; Poster Session Asem Ghasoup,MD MRCS, Omar Sadieh,MD MRCS- Mahmoud Khashashneh MD,MRCS-Ismai Marey,MD-Nedal Shawagfeh,MD,Adala Al Enzi, Abeer Al Enzi EARLY MARKERS OF ACUTE RESPIRATORY DISTRESS SYNDROME IN SEVERE TRAUMA PATIENTS. Borasi Andrea, Bossotti Maurizio, Bona Alberto, Bellomo Maria Paola, Manfredi Silvio, LAPAROSCOPIC APPROACH TO ACUTE APPENDICITIS: OUR 8 YEARS EXPERIENCE AND COST ANALYSIS. Butyrsky Olexandr, Dubovenko Viktor, Govorunov Igor, Butyrska Iryna, Makeieva Nadiia ABOUT OBLIGATORY NECK LYMPH NODE DISSECTION IN PAPILLARY THYROID CANCER. Kryshen V., Lyashenko P.; DYNAMICS OF CD -4 LYMPHOCYTES AT PERITONITIS DURING SORPTION DIALYSIS APPLICATION.

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Kryshen V., Lyaschenko P.; DYNAMICS OF ENDOGENOUS INTOXICATION DUE TO TRANSMEMBRANE DIALYSIS FOR PERITONITIS. Trofimov M.V.; DYNAMICS OF BLOOD SEROTONIN AT PATIENTS WITH BLEEDING GASTRO-DUODENAL ULCER. Kryshen V.P, Trofimov M.V.; DYNAMICS OF BLOOD CATECHOLAMINE AT PATIENTS WITH BLEEDING GASTRODUODENAL ULCER. Iarynko D.,Trofimov M., Kryshen V.,Iarynko A.; DYNAMICS OF BLOOD TYROSINE AT PATIENTS WITH BLEEDING GASTRODUODENAL ULCER. Manafov S.S.,Gerayzade R.B.; COMPARISON OF OPPORTUNITIES OF RADIOLOGICAL METHODS IN ACUTE INTESTINAL OBSTRUCTION CAUSED BY A COMPLICATED EXTERNAL ABDOMINAL HERNIA. Manafov S.S.,Gerayzade R.B.; OLE OF ULTRASOUND IN THE SELECTION OF TREATMENT STRATEGY FOR MALIGNANT LARGE-BOWEL OBSTRUCTION (LBO). Baris R. Karakas, M.D., S. Halide Akbas, M.D. Prof., Gulsum Ozlem Elpek, M.D. Prof., Fatih CELIK, M.D., Kemal Hakan Gulkesen, M.D., PhD. Assist. Prof., Nurullah Bulbuller, M.D., Assoc. Prof.; THE EFFECTS OF LUTEOLIN ON THE INTESTINAL ISCHEMIA/REPERFUSION INJURY IN MICE. Kirien Kjossev, Georgi Gurbev, Evgeni Belokonski, Ivan Teodosiev, Tihomir Atanasov.; IMPACT OF INTRAOPERATIVE COMPLICATIONS IN SURGERY FOR LIVER ECHINOCOCCOSIS. Mr. Matthew T. Fenech, Dr. James G Diamond; SILICONE OIL COMPLICATIONS IN RETINAL DETACHMENT REPAIR. Mr Noel Cassar, Dr Alistair Bezzina, Mr Ernest Ellul; FEMORAL HERNIA AUDIT AT MATER DEI HOSPITAL 2009-2011. Richard Apap Bologna, John Camilleri-Brennan MD, FRCS; PERIPHERAL VENOUS CANNULAS IN GENERAL SURGICAL WARDS: ARE WE FOLLOWING THE GUIDELINES? Liska Vaclav 1, Treska Vladislav 1, Daum Ondrej 2, Novak Petr1, Vycital Ondrej 1, Bruha Jan 1, Pitule Pavel 1; TUMOR INFILTRATING LYMPHOCYTES AS PROGNOSTIC FACTOR OF EARLY RECURRENCE AND POOR PROGNOSIS OF COLORECTAL CANCER AFTER RADICAL SURGICAL TREATMENT. Mark Portelli, John Camilleri-Brennan MD FRCS; ANALGESIA IN POST-OPERATIVE DAY SURGERY PATIENTS: STANDARDISED REGIME OR INDIVIDUAL VARIATION? Ethan Caruana, John Camilleri-Brennan MD FRCS; GENERAL PRACTITIONER REFERRALS TO THE COLORECTAL SERVICE: DO THEY CONFORM TO THE PUBLISHED GUIDELINES? K. Zarkov, Chr. Petkov, N. Nickolov, M. Nickolov; ASPECTS OF THE TECHNICAL POSSIBILITIES FOR SPHINCTER PRESERVATION IN ULTRA LOW ANTERIOR RECTAL RESECTIONS. Rumyana Rumenova Smilevska, Andres Garcia Marin, Asuncion Candela Gomis, Valentin N. Rodriguez, Maria Mingorance Alberola, Elena Martinez Guerrero, Miguel Morales Calderon, Salvador Garcia Garcia; INFLAMMATORY MARKERS AND ACUTE CHOLECYSTITIS Daniel Vella Fondacaro, Richard Apap Bologna, John Camilleri-Brennan MD FRCS; A PROSPECTIVE EVALUATION OF COMPLICATIONS ASSOCIATED WITH PERIPHERAL VENOUS CANNULATION IN SURGICAL PATIENTS. Eleanor Borg, Dr. Mark Brincat, Dr. Sarah Grixti, Dr. Norma Pavia, Mr. John Mamo; BLOOD LOSS AND TRANSFUSION REQUIREMENTS IN MYOMECTOMY PATIENTS AT MATER DEI HOSPITAL. Hasan Altun, Aziz Bora Karip, Ahmet Yalin Iscan, Kafkas Celik, Umit Akyuz, Birol Agca, Kemal Memisoglu EARLY AND LATE EFFECTS OF NISSEN FUNDUPLICATION SURGERY ON BODY WEIGHT. Ioannis Lintzeris, Xanthi Agrogianni, Angeliki Lintzeri; FLUID ADMINISTRATION IN PATIENTS WITH SEPTIC SHOCK. N. Pavia, S. Grixti, O. Tsar, I. Knyazev, J. Mamo; THE CHANGE FROM TRADITIONAL BURCH COLPOSUSPENSION TO LAPAROSCOPIC BURCH PROCEDURE. N. Pavia, S. Grixti, M. Brincat, O. Tsar, I. Knyazev, J. Mamo; EFFECT OF LAPAROSCOPIC SIMULATION TRAINING ON GYNAECOLOGICAL SURGERY. Ioannis Lintzeris,Angeliki Lintzeri,Xanthi Agrogianni,Georgios Chatzoulis,Venetsanos Ponirakos; SURGICAL WOUND INFECTIONS BY GRAM NEGATIVE BACTERIA AND ANTIMICROBIAL RESISTANCE. Farrugia A, Cassar K, Attard A, Abela J, Saliba K, Grech R, Mizzi A; ENDOVASCULAR COILING OF SPLENIC ARTERY ANEURYSMS - A SAFE AND EFFECTIVE ALTERNATIVE TO SURGICAL REPAIR. Rumyana Rumenova Smilevska, Andres Garcia Marin, Asuncion Candela Gomis, Valentin N. Rodriguez, Maria Mingorance Alberola, Elena Martinez Guerrero, Miguel Morales Calderon, Salvador Garcia Garcia; EARLY VS. DELAYED CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS - EVIDENCE VS. EXPERIENCE. Lara Sammut, Annalisa Montebello, Juanita Parnis, Gerald Busuttil; CASE REPORT - SACRAL HERPES ZOSTER: A RARE CAUSE OF ACUTE URINARY RETENTION. Xanthi Agrogianni,Angeliki Lintzeri,Georgios Vourliotakis, Venetsanos Ponirakos, Ioannis Lintzeris; CHRONIC PANCREATITIS AND PERSISTENT PLEURAL EFFUSION- AN UNCOMMON CLINICAL ENTITY. Dr Michelle Bugeja, Ms Josephine Psaila; A CASE OF STERNOCLAVICULAR SEPTIC ARTHRITIS IN A PATIENT WITH NO PREDISPOSING FACTORS. Omari Gibradze, Mamuka Mikadze, David Tevtoradze, Paata Meshveliani; RADICAL DUODENOPLASTY IN THE TREATMENT OF ELDERLY PATIENTS WITH DUODENAL ULCER COMPLICATED BY BLEEDING. Supreet Kaur,Gaurav Maheshwari, Iqbal Singh, R P Doley, Atul Joshi, Rajeev Kapoor, JD Wig; EMERGENCY OR ELECTIVE ABDOMINAL SURGERY IN ELDERLY PATEINTS: IS THERE A DIFFERENCE IN OUTCOME? Karakaş BR, Aslaner A, Gündüz UR, Çalış H, Karakoyun Demirci R, Öngen AN, Öner OZ, Bülbüller N.; IS THE DISTANCE OF LATERALIZATION IMPORTANT IN THE ASYMMETRIC MODIFIED LIMBERG FLAP PROCEDURE FOR THE SACROCOCCYGEAL PILONIDAL SINUS TREATMENT? Sammut M; THE USE OF PROPHYLACTIC ANTIBIOTICS IN SEVERE ACUTE PANCREATITIS. Nathania Bonanno, Simon Aquilina; THE ROLE OF C-REACTIVE PROTEIN AND WHITE CELL COUNT IN THE DIAGNOSIS OF ACUTE APPENDICITIS. Kibil W, Hodorowicz-Zaniewska D, Kulig J; MAMMOTOME BIOPSY IN DIAGNOSING AND TREATMENT OF INTRADUCTAL PAPILLOMA OF THE BREAST.

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Mr Karl Spiteri, Mr Joseph Debono; COMPARISON OF RADIO-GUIDED OCCULT LESION LOCALISATION (ROLL) VERSUS WIRE-GUIDED LOCALISATION (WGL) FOR BREAST CONSERVING SURGERY FOR IMPALPABLE BREAST CANCER. Khalid Akbari, Ragai Makar, Vivien NG, Simon Middleton, Daniel McGrath; THE INFLUENCE OF RESECTED SPECIMEN LENGTH AND TUMOUR DIAMETER ON LYMPH NODE HARVEST IN COLORECTAL CANCER. Lintzeris Ioannis, Alexiou Ioannis, Dimitriou Maria, Agrogianni Xanthi, Datsis Konstantinos, Perrakis Nikos, Nomikos Iakovos, Papaemmanouil Virginia; ISOLATION AND CHARACTERIZATION PREVALENCE AND ANTIFUNGAL SENSITIVITY OF CANDIDA SPP IN GREEK CANCER PATIENTS OF A SURGICAL UNIT. Kate Huntingford, Miriam Sterkel, Jo Etienne Abela; LAPAROSCOPIC INGUINAL HERNIA SURGERY - A SINGLE SURGEON’S EXPERIENCE. Lintzeris Ioannis,Alexiou Ioannis,Dimitriou Maria, Agrogianni Xanthi,Datsis Konstantinos, Perrakis Nikos, Nomikos Iakovos, Papaemmanouil Virginia; ISOLATION AND CHARACTERIZATION PREVALENCE AND ANTIFUNGAL SENSITIVITY OF CANDIDA SPP IN GREEK CANCER PATIENTS OF A SURGICAL UNIT.

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Authors - Cutajar C.L.; Afiliation - Dept of Surgery, The Medical School, University of Malta.; THE HISTORY OF MEDICINE IN MALTA: OPENING SESSION.; Situated in the middle of the Mediterranean sea, Malta has inherited diverse cultures, including those of medicine and health, mainly from mainland Europe. It has a long and rich tradition of medical practice particularly dating back to the advent of the Hospitaller Order of St John of Jerusalem. This presentation traces the development of medicine in the Maltese islands from ancient times to the present day in the context of medical developments in Europe and elsewhere.

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Session BARIATRIC SURGERY

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Authors: Luigi Schiavo, Giuseppe Scalera, Alfonso Barbarisi Afiliation: Department of Anaesthesiology, Surgery and Emergency Sciences, School of Medicine, Second University of Naples, Naples, Italy PRE- AND POSTOPERATIVE NUTRITIONAL CONSIDERATIONS TO BETTER MANAGE BARIATRIC SURGERY PATIENTS. Introduction: Bariatric surgery is an effective method of weight loss for the treatment of morbid obesity. Most of bariatric candidates are in state of “high calorie malnutrition” and show some dietary deficiency pre-operatively and needs to adjust their diet before they have bariatric surgery. Objectives: The aim of our study is to investigate the vitamin, mineral and trace element deficiency in patients who are considering bariatric surgery. Material and Methods: 10 obese patients (BMI of 40 Kg/m2 or more) undergoing laparoscopic adjustable gastric band or sleeve gastrectomy were analyzed, in addition to a full blood count, lipid profile and others biochemical markers, for the following micronutrient: iron, vitamin B12, folic acid, vitamin D, vitamin A, vitamin E and zinc. All the analysis were performed in a licensed clinical laboratory. Results: The above reported micronutrient screening tests enable us to recognize a pre-existing nutritional concerns with a prevalence of 55–70% for vitamin D, 30% for folate, 25 % for zinc and up to 40% for iron. Conclusion: Although an ample energy intake, most of bariatric surgery candidates show some dietary deficiency pre-operatively, with a prevalence for vitamin D, folate, zinc and iron. Therefore, regardless of the bariatric procedure proposed, a comprehensive screening is recommended, ideally in sufficient time to correct deficiencies before surgery. In conclusion, lifelong vitamin and mineral supplementation is influenced not only by the bariatric procedure performed but also by the preoperative status.

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Authors Gabriele De Sena, MD - Renato Sergio, MD - Vincenza Capuozzo, MD – Giovanni Giordano, MD - Francesco Iovino, MD - Giuseppe Scalera, MD Afiliation Department of Anaesthesiological, Surgical and Emergency Sciences - Second University of Naples PROPOSAL OF A BARIATRIC SURGERY UNIT: OUR EXPERIENCE Introduction. Bariatric Surgery has in a number of clinical studies proven to be the most effective treatment method to achieve sustainable weight reduction and to avoid or reverse obesity related complications. Method. Our Bariatric Surgery Unit offers surgical interventions for bariatric patients, predominantly laparoscopic, it includes a multidisciplinary team of highly trained bariatric surgeons, plastic surgeons, diabetologists, cardiologistd, bariatric nurses, physiotherapists, nutritionists and dieticians.In three years 157 (71 male, 86 female) mean age 37 (16 – 63) patients have addressed to our center; surgery was contraindicated in 35 patients; 122 underwent to baraitric surgery. We placed an indication of gastric banding for 56 patients (BMI 38,8 kg/m2) and of Sleeve gastrectomy for 66 patients BMI 46,2 kg/m2). 113 surgeries were performed whit traditional laparoscopy, 9 whit single-port laparoscopy, no one was converted to laparotomy. Diabetes was present in 13% of GB and 34 % of SG. Arterial hypertension was present in 5% of GB and 12 % of SG. Among patients who underwent SG 9 had amenorrhea and/or infertility. Depression, social and emotional issues were found in 36%. Results. About patients who underwent GB in 3 years of follow up they obtainded an excess weight loss (EWL) of 25,87% at 3 months; 34,84% at 12 months; 40, 68 % at 2 years; 42,32 % at 3 years. About patients who underwent SG in 2 years of follow up they e obtainded an EWL of 25, % at 3 months; 57,32% at 12 months; 63, 23 % at 2 years. Complications observed for GB were dysphagia 3,16%; esofagiete 1,6 %; Port disconnection 1,34 %; Port infection 1,25%; psychological disorders 0,51%, no slippage; no migration; no exitus. In 3 cases GB was removed laparoscopically. Complications that we observed for SG were dysphagia 2,24%; esofagiete 2, 41%; anemia 3,10 %; gastric fistula 0,61 %; no exitus. We observed a risolution of diabetes in 46 % of SG and 27% of GB; a whole resolution of amenorrhea and infertility and an improvement of blood pressure. Discussion. Obesity is a health and social problem because there are interactions of a multitude of societal, psychological, and physiological variables that do not allow a simply solution of the problem. According to our experience surgery alone is not effective to solve this social drama. A multidisciplinar approach seems the only way to get not only the weight loss but above all the improvement of quality of life, maximization of independence, and/or the return to a normal life in the community.

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Session UPPER GI SURGERY AND UPPER GI CANCER

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Authors - Jo Etienne Abela, Godfrey LaFerla; Afiliation - Mater Dei Hospital, Malta; THREE-STAGE OESOPHAGECTOMY FOR END-STAGE ACHALASIA; Introduction. Achalasia is a complex disorder characterised by an aperistaltic oesophagus and a hypertensive lower oesophageal sphincter. Materials and methods. We present the case of a 64 years old male with a 40 years history of dysphagia culminating in complete oesophageal failure complicated by the sudden emergence of rheumatoid arthritis of the upper limb joints, bilaterally. The diagnostic process and the patient’s management with jejunostomy feeding and oesophageal clearance followed by three-stage oesophagectomy will be described. The latter will be described in detail with illustration. Alternative surgical techniques and the reasons for not employing them in this case will be described. Results. The patient’s post-operative recovery was uneventful with satisfactory blue-dye and radiological contrast testing on day 5 and introduction of normal texture diet on day 8. He is well and thriving on follow-up. Conclusion. Three-stage oesophagectomy appears to be safe and effective treatment for end - stage achalasia even in the high-risk patient.

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Authors - Christian Petkov; Afiliation - First Surgical Department, Fifth General Hospital, Sofia, Bulgaria; HOW TO DIAGNOSE AND OPERATE SMALL BOWEL TUMORS; Objectives: As usual small bowel tumors are found on table during emergency surgery for bowel obstruction. To diagnose a small bowel tumor before operation is very rare and is a special skill. Aiming to reveal: What may suggest us about a small bowel tumor? What are the diagnostic methods and the algorithm to verify a small bowel tumor? What is the appropriate time for surgery and the radical operation of operation? To assess histopathology and survival. Methods: Clinical exam exhibits in bowel obstruction of different degree. Some had anemia. Diagnostics starts with native X-ray examinations, ultrasound; barium enema and colonoscopy are next step. Barium follow-through and CT scan are considered later. Radical operation comprises radical bowel resection and lymph node dissection along the superior mesenteric vein up to the lower edge of pancreas. Results: For 10 years we operated 18 small bowel tumor patients. Tumor was in mesenterium in 4 cases (leyomyoma and lyposarcoma) necessitating bowel resection. Invagination in 3 cases. Histopathology: Adenocarcinoma - 5; Carcinoid - 4; Schwanoma -2; Leyomyoma - 2; Lyposarcoma - 2; Inflammatory pseudotumor - 3. Frozen sections of lymph nodes were done in all cases, metastatic found in 2. Removed lymph nodes - 14 to 19 per patient; found metastatic - 2 to 10 in 4 patients. No major morbidity. No perioperative mortality. Detailed survival is presented. Ultrasound may exhibit abdominal tumor. Barium enema and colonoscopy are negative. If small bowel tumor is suggested barium follow-through or CT scan with swallowed and venous contrast medium should be performed for verifications. Histopathology was not and could not be evident before operation. Conclusion: Small bowel tumors are difficult to be diagnosed before operation. Macroscopic view of the tumor is not predictive for malignancy. Negative lymph nodes on express histopathology examination do not exclude malignancy - radical resection with lymphadenectomy should be done.

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Raffaele Costantini, Francesco Caldaralo, Paolo Innocenti; Afiliation - Institute of Surgical Pathology, G. D`Annunzio” University of Chieti, Italy; GIST: EXPERIENCE OF OUR SURGERY CENTER; Introduction: The diagnosis of GIST, rare gastrointestinal stromal tumors, is often difficult due to aspecific symptom onset in many cases. Surgery is the gold standard therapy, but its outcome largely depends on early diagnosis. Objectives: The aim of the study is to report the experience of our Surgery Center for GIST cases over 12 years. Material and Methods: GIST cases were retrospectively examined relative to the period January 2000-December 2012, for: sex and age of patients, symptoms, outcome of preoperative instrumental examinations (preoperative diagnosis of GIST: yes, no), localization of GIST, type of intervention, follow-up. Results: 19 patients (43-81 years) proved to have GIST while 1 preoperatively suspected GIST (77 years) was a false positive. Patients were either asymptomatic (14%) or presented aspecific symptoms in various combinations: dyspepsia, abdominal pain, anemia, melena, asthenia, anorexia. Preoperative diagnoses were: GIST in 4 cases (only 3 subsequently confirmed), leiomyoma (n.2), neoplasia (n.13), pancreas carcinoma (n.1). At surgery, GIST localization in the 19 positive patients was: 12 stomach, 3 duodenal, 3 ileal and 1 oesophageal. The false positive was: gastric Schwannoma. Interventions performed were: gastric wedge resection (n.5), Billroth II gastrectomy (n.9), distal oesophageal resection-oesophagoplastic (n.1), pancreaticoduodenectomy (Whipple procedure) (n.1), videoassisted ileal resection (n.3), de-rotation+duodenal resection (n.1). Three deaths occurred after 1, 9 and 12 months while no recurrence was observed in the remaining cases. Conclusion: Our casuistry confirms the difficulty in the preoperative diagnosis of GIST but also shows the optimal outcome of the surgical approach to treatment of this type of tumor.

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Authors- - Omar Sadieh,MD MRCS-Mahmoud Khashashneh MD MRCS-Nedal Shawagfeh,MD- Loai Bani Essa Afiliation - Princes Raia Hospital Irbid-Jordan , Al Bashir Hospital Amman-Jordan INCIDENTAL FINDING OF GALLBLADDER CARCINOMA. Background: Carcinoma of the gallbladder is the fifth most common gastrointestinal malignancy (and the most common of the biliary tract) and is usually discovered accidentally. Gallbladder carcinoma is diagnosed pathologically in 0.3-1.5% of cholecystectomy specimens. AIM and Objectives: To evaluate the impact of incidental gallbladder cancer on surgical experience and to establish the overall rate of gallbladder carcinoma. Methods: We retrospectively evaluated all consecutive cholecystectomies performed in our ward from (20072012) in order to Determine the incidence of gallbladder carcinoma and to identify common characteristics of this particular group of patients. Results: Of the 580 cholecystectomies performed in our ward from 2007-2012, gallbladder carcinoma was diagnosed in six patients (1.03%) but was not suspected prior to surgery in any of them. In accordance with the literature, the occurrence in women (4/6) was higher than in men (2/6). The mean age was 64 years (range 5590).The most common symptom was abdominal pain; the majority (5/6) had cholelithiasis, and the pathologic report confirmed the diagnosis of adenocarcinoma in all six patients. Conclusions: The overall incidence of unsuspected gallbladder carcinoma in our series was 1.03%. We could not find any common characteristics for this particular group of patients when compared to patients with non-malignant pathology.

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Authors - Dr K. Chircop, Dr S. Aquilina, Dr A. Mizzi; PERCUTANEOUS BILIARY DRAINAGE AND STENTING. THE FIRST AUDIT REPORT OF THE MALTESE EXPERIENCE; Background: Biliary obstruction requiring drainage is a common clinical scenario, with the majority of cases being managed endoscopically. Percutaneous intervention performed by skilled radiologists is a well-recognized treatment option, both for failed endoscopy cases and as well as for other specific case scenarios. Aim: This is a retrospective audit to evaluate the local practise with regards percutaneous biliary intervention. Does the local practice compare to the data published internationally? Methods: We performed a retrospective review of the percutaneous biliary interventions performed at Mater Dei Hospital, Malta in the last three years (40 cases). Using the medical imaging database and the individual patients hospital data, the population demographics, procedural indication, technical success, bilirubin shifts, survival curves and complication rates were individually evaluated. Results: Percutaneous biliary intervention is a safe and effective method for treating biliary obstruction. The local practice compares very closely to that published in the international literature.

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Authors - Lemaire J, Rosiere A, Bertrand C, Demoor V, Michel; Afiliation - Surgical Services, Mont-Godinne UniversitY Hospital, University of Louvain; SPLENECTOMY FOR MASSIVE SPLENOMEGALY (MS); Objective: Splenectomy for MS (i.e. weight > 1.5kg) is still considered a) to be hazardous and b) to provide poor palliation for haematologic cytopenias. Design: Analysis of the prospective records of 48 consecutive patients (30%) presenting debilitating MS taken out of our series of 161 splenectomy performed for haematologic diseases over the past three decades. Patients: Sex ratio 19F/29M; mean age 62 (median 64, range 26-83). Indications for operation are thrombo or pancytopenia (n=30) associated with major abdominal discomfort (n=40) in the course of lymphoma (n=30), myelofibrosis (n=8), polycythemia vera (n=3), and other rare diseases (n=7: 1 Niemann-Pick, 1 hystiocytosis, 2 microspherocytosis, 1 sideroplastic anemia with hemochromatosis, 1 idiopathic segmental portal hypertension, 1 autoimmune thrombocytopenic purpura). Surgical approach: Splenectomy was performed in 34 patients (71%) through an original oblique incision starting below the left costal margin at the level - and in the axis of the 9th intercostal space and descending toward the umbilicus. A median laparotomy was elected in the remaining 14 patients for less important MS (i.e. weight at 2kg) and/or associated with peritoneal surgery (5 cholecystectomy, 3 vagotomy, 1 left nephrectomy, 1 Nissen, 1 abdominal aortic aneurysma,). For all 48 cases, the splenic artery was ligated at the beginning of operation in order to realize an autotransfusion of the splenic blood content and to decompress the spleen. Results: The normal ratio of body weight to spleen weight in kg is between 250-500; in this study the mean was 32 (median 32, range 6-64). Postoperatively, one patient got abdominal wall hematoma and two had a second look operation 2 and 3 hours after initial surgery for active bleeding in the splenic bed. There was no operative or postoperative death. Mean hospital stay of 11 days (median 10, range 7-20); mean follow up (FU) of 51 months (median 52, range 2-180). Survival by the Kaplan-Meier estimator is interesting: so far 16 patients (33.3%) are alive more than 5 years after surgery compared with 13 deaths during FU (mean 21 months postop, median 22, range 2-41); 5 others have comprehensive FU of 10-10-16-16-18 months, and 14 others were lost after a mean FU of 24 months (median 24, range 2-53). Conclusion: Splenectomy for MS can be achieved with low morbidity and no operative mortality. It results in long term pain relief and improvement of hematologic cytopenias with a reasonable long term survival. However, the poor condition of those patients allows only one surgical attempt to solve the problem.

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Authors - Jo Etienne Abela, Mark Schembri; Afiliation - Mater Dei Hospital, Malta; THE ANTERO-POSTERIOR APPROACH FOR LAPAROSCOPIC SPLENECTOMY IN SPLENOMEGALY; Introduction. Laparoscopic splenectomy is usually reserved for small spleens involved in haemolytic disorders such as ITP and hereditary spherocytosis. Its use in malignant disease is still controversial and splenomegaly poses an operative challenge. Materials and methods. We explain the technique of the antero-posterior, artery first technique applied to laparoscopic splenectomy for the giant spleen. Two patients (one male and one female, aged 70 and 72 years respectively) with rituximab- refractory marginal cell splenic lymphoma became transfusion dependent with recurrent anaemia, leucopenia and thrombocytopenia. Their spleens measured 22 - 25cms on pre-operative imaging. The female patient had, in addition, symptomatic gall stone disease necessitating cholecystectomy (performed just prior to splenectomy). Pneumoperitoneum was achieved through an open umbilical cutdown and porst placed. Having gained access to the lesser sac, the splenic artery was controlled and then the short gastric and inferior polar vessels divided. the patient was then tilted to the right and the diaghragmatic and lieno-renal attachments divided. The pedicle was next slooped and divided with an Endo-GIA stapler after clearance of the pancreatic tail. Results. Operative time was an average of 180 minutes (excluding cholecystectomy). One patient required transfusion of one unit packed red cell concentrate intra-operatively. In one patient the spleen would not be manouvered into the specimen bag and it was therefore, delivered whole through a left iliac fossa Lanz incision. In the other patient the spleen was morcellated in a bag. Both patients were well after surgery and were discharged on the 3rd post-operative day. Conclusion. It appears that this approach, although slow, is safe and effective for massive splenomegaly. Morcellation can still provide an adequate histological specimen.

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Authors - Ms Elaine Borg, Dr Doriella Galea, Dr Stephanie Azzopardi, Mr Mark Schembri; Afiliation - Mater Dei Hospital; AUDIT ON PATIENTS’ PREFERENCE REGARDING SAME-DAY DISCHARGE POST-LAPAROSCOPIC CHOLECYSTECTOMY AT MATER DEI HOSPITAL; BACKGROUND Day-case laparoscopic cholecystectomy has been implemented in the UK in view of improvements in operative and anaesthetic techniques leading to shorter hospital stays. Concerns remain amongst Maltese surgeons regarding the feasibility and acceptability of day-case laparoscopic cholecystectomy in Malta. AIM The objective of this study is to assess patients’ preference of laparoscopic cholecystectomy to become a day-surgery procedure in Mater Dei Hospital, Malta. METHODA retrospective analysis of 95 patients undergoing elective laparoscopic cholecystectomy in Mater Dei Hospital was carried out during an 8-month period between January and August 2013. The patients’ demographics, and operative details including duration of procedure, intra-operative complications and conversion rate was accessed using iSOFT, Electronic Case Summary and medical files, accessible from the Medical Record Department at Mater Dei Hospital. After the patients were discharged from hospital, a telephone interview was conducted. Their social environment was assessed and the severity of complications including pain, nausea and vomiting was monitored using the 5-point scale. The patients were also asked whether they had a reliable primary healthcare provider and were asked whether they would cope if they were discharged on the same day of the procedure. Reasons to their answers were documented. RESULTS From the 95 patients included in this study, 25 (26%) were male and 70 (74%) female. The average age was 48.5 years (median 50; range: 16-81). On average the duration of the laparoscopic cholecystectomy was 86.2 minutes (range: 40-145). Intra-operative complications were documented in 11 cases (11.6%). The conversion to open cholecystectomy was in 2% of cases.90 patients (94.7%) have a primary healthcare provider/ general practitioner (GP). Of these, 67 patients (72%) claim that their GP is readily available. 75 patients (78.9%) claim that they would feel comfortable calling GP to manage post-operative complications. 43 patients (45%) said that they would cope at home if discharged on the same day, whilst 52 (55%) claimed they would not. The predominant reasons why the latter group did not opt for same-day procedure was due lack of adequate pain control, anxiety/ fear and better environment at hospital due lack of family support. CONCLUSION The majority of our patients (55%) prefer overnight stay post-laparoscopic cholecystectomy. Patient’s anxiety due lack of community support should be taken into consideration when planning day - case laparoscopic cholecystectomy.

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Session SAFETY IN THE OPERATING THEATRE

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Authors - Cutajar C.L.; Afiliation - The Medical School, University of Malta; OPERATING ROOM ERRORS; The health of a patient scheduled for surgery may be compromised by errors occuring in the operating room, usually unexpected but nevertheless foreseable and preventable. Often these are directly related to patient management, such as inappropriate pre- or per-operative medical treatment, or surgery on the wrong side or wrong limb. However, other errors can be extraneous to the surgery itself but attributable to failures directly attributable to short-comings of the operating room personnel. This paper will focus on two aspects, namely, a) equipment-related failures; b) retained surgical sponges and instruments. These are of concern not only becausae they directly impact on patient health, but also because of the medico-legal complications and compensation costs.

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Authors - N Suleyman, E Williams, I Sagriotis, D L Stoker; Afiliation - North Middlesex University Hospital; WAITING TIME FOR LAPAROSCOPIC CHOLECYSTECTOMY AT A LONDON DISTRICT GENERAL HOSPITAL; Introduction Index laparoscopic cholecystectomy reduces investigations, life-threatening disease, overall cost and elective waiting times. A 2007 audit found the median wait for cholecystectomy was 5 months and 12 out of 13 patients with acute cholecystitis had elective operations. 4 out of 13 were readmitted whilst on the waiting list. Patients with acute pancreatitis were waiting longer than guidelines advise for ERCP (< 72 hours) and cholecystectomy (< 2 weeks). Guidelines were publicised and discussion of patient eligibility for index laparoscopic cholecystectomy encouraged. A re-audit was conducted. Methods 108 cholecystectomies were performed between October 2012 and March 2013. Retrospective review of electronic records was used to identify waiting times between initial presentation and cholecystectomy +/- ERCP, number of admissions (including operation), length of stay and diagnosis. Findings were then compared against the BSG guidelines. Results The median wait for cholecystectomy from presentation is 146 days. All acute cholecystitis patients had an elective operation (n = 18) and of these, 5 were readmitted whilst on the waiting list. Of 13 patients presenting with gallstone pancreatitis, 3 were readmitted whilst on the waiting list. Patients with acute pancreatitis waited too long for ERCP (median 5 days, range 1-166 days) and cholecystectomy (median 138 days, range 50-277 days). Conclusion Waiting times for cholecystectomy, and ERCP where applicable, have not improved in this hospital despite previous intervention and remain below the BSG targets. Further improvements in service provision are required to meet targets and reduce the morbidity and number of readmissions in this patient group.

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Authors - N M Suleyman, J Wright; Afiliation - North Middlesex University Hospital, London, UK; AN AUDIT OF POST-OPERATIVE PRESCRIBING AT A LONDON DISTRICT GENERAL HOSPITAL; Introduction This audit was conducted following difficulties prescribing regular medicines for post-operative patients when on-call. Additionally there was anecdotal evidence of delays in patients receiving regular medications. Currently there is no guidance regarding responsibility for the completion of the drug chart for surgical patients, and thus recording allergies, prescribing VTE prophylaxis and regular medications. Methods Patients who were on regular medications admitted to General Surgery, Urology and Orthopaedics during April 2013 were identified from clinical notes after discharge. The drug chart for the hospital stay in question and clinical notes were used to collect data retrospectively from a total of 11 cases. Results 55% of drug chart allergy boxes were completed with a name and signature on the day of surgery. 18% had a 1day delay in completing allergy details. VTE prophylaxis was correctly prescribed and documentation completed without delay in 45% of cases. Regular medications took a mean time of 1.3 days to prescribe and 11% of regular medications were not prescribed at all. Conclusion The safety of post-operative patients was compromised due to the late documentation of allergies, prescribing of VTE prophylaxis and regular medications. Simple, low-cost initiatives could help improve safety of these patients.

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Authors - Farhana Akter, Aneela Hameed, Mansoor Akhtar, Ayman Hamade; Afiliation - QEQM Hospital; PREVENTION OF SURGICAL SITE INFECTION; Aims Evaluate current practices in the department of Colorectal Surgery in reducing post-operative surgical site infection. Methods Prospective observational study of 67 elective and emergency colorectal cases in June and July 2012 in a busy district general hospital. Surgical theatre lists and on-call lists were used to identify patients undergoing elective and emergency colorectal surgery. Patients were interviewed and notes studied to identify surgical site infections (SSI) during post-operative stay in the hospital. Telephone calls (consent obtained) were used to identify if patients had developed SSI at home within 30 days of operation. Results Only 1/67 patients were given wound infection advice preoperatively. Intraoperatively 38/67 (56.7%) had temperature regulated and 37/67 (55.22%) patients developed hypotension. Postoperatively only 15/67 (22.3%) patients had wound dressings changed aseptically. 22/67 (32.85%) patients developed SSI, 13/22 (59%) of patients with SSIs developed it during stay at hospital, 9/22 (41%) developed infection at home. All patients received antibiotics. Conclusions SSIs remain a significant problem in all patients following operation. However several measures can be used to reduce incidence of infection. Preoperatively all patients must be given information regarding wound infection and how to identify surgical site infection. Intraoperatively physiological parameters must be monitored, these parameters should be incorporated in the WHO Surgical safety checklist and compliance ensured. Postoperatively any dressings changed must be done so aseptically. We have seen that greater than fourty per cent of patients developed infection in the community and required antibiotics and were only identified following telephone consultation. It is thus prudent we ensure a robust follow up of patients take place to identify and treat surgical site infection promptly.

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Authors - Andrey Kudryavtsev, Valery Kryshen, Artem Breus; Afiliation - Dnipropetrovsk Medical Academy, common surgery department SAFETY MAINTAINING AFTER LAPAROSCOPIC STRANGULATED HERNIA REPAIR; Introduction: Laparsopic method proposes new and faster technology in strangulated hernia repair. This makes complication risk higher, and thus requires using known methods for their estimation and prevention. Aim of study: to implement objective methods for intra- and post operation complications control. Materials and methods: 46 patients operated using author’s modified TAPP method with one-sided strangulated hernia. Soft meshes of average size 10x15 cm were used. Electronic thermometry was used in many cases; programmed relaparoscopy was used in 2 cases. Results and discussion: specific technics modifications were used for all operated patients. Peristaltic grade, bowel glint, bowel temperature measured with electronic thermometer at strangulated and healthy areas were used. Programmed relaparoscopy was used in 2 cases in the 1st and 2nd day of postoperation period as prescribed, also in that time sanation of abdominal cavity was performed. All laparoscopic operations were finished by draining abdominal cavity with one or two drainages for period of 2-3 days with control of wound discharge, postoperation temperature curves, bowel peristaltic, flatus and bowel movement. All patients received standard antibacterial therapy. With all above-mentioned, patients operated laparoscopically have usual postoperational period flow with acceptable level of close postoperation complications. All patients were discharged from hospital at standard terms. Conclusion: usage of laparoscopic hernioplastic in cases of strangulated hernia asks for additional safety maintaining procedures. These can be operation methodic modifications, intraoperational electrothermometry , programmed relaparoscopy, and more strict control of patient vital functions on the whole.

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Session THE ACUTE ABDOMEN

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Authors - František Vyhnánek; Afiliation - Traumatological Centre, Department of Surgery, University Hospital, 3. Fakulty of Medicine, Charles University, Prague, Czech Republic; TRAUMA DAMAGE CONTROL SURGERY; Introduction. Damage control surgery has become well established in the past decade as the surgical strategy to be employed in the unstable trauma patients. The aim of this presentation was analysed trauma patients with damage control surgery to thoracic and abdominal injuries. Material, methods. A retrospective review of 71 victims undergoing emergency department thoracotomy / EDT / or damage control laparotomy / DCL / in a level 1 trauma centre over 11 years period was performed.There were 17 patients with blunt / 6 / or penetrating / 11 / thoracic trauma and 54 patients with blunt abdominal trauma. Results. In 6 victims undergoing EDT to blunt thoracoabdominal trauma was indicated for severe intraabdominal haemorrhage with heart arrest / 3 / or for lung laceration with major vascular haemorrhage / 3 /.From those 4 patients died . Penetrating heart injuries were treated in 11 patients with death in two. Overall mortality rate in EDT was 35 % due to haemorrhagic shock. 54 patients with blunt abdominal injuries were undergoing DCL to severe intraabdominal haemorrhage from solid organs trauma and or with contamination of abdominal cavity from perforation of GIT. Main organ damage included smashed hepatic injuires in 39 cases, splenic injuries in 18, GIT perforation in 11 , 5 with renal injuries, and urinary bladder perforation in 2 patients. From those in 5 were laparotomy combined with thoracotomy for associated severe lung injuries. A total of 40 patients survived / 74 % / and 14 died / 10 within 24 hours and 4 died 1-3 days after trauma. The trauma deaths were causes by severe primary injuries resulting in failure of circulation or craniocerebral injuries. Conclusion. Damage control surgery is the leading surgical strategy in emergency surgery for instable thoracic and abdominal injuries with haemorrhagic shock combined with signs of the „ lethal triad”. Surgeon should selected the rapid reasonable examination before operation and the proper time to perform damage control surgery to control bleeding and decontamination of abdominal cavity.

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Authors – Salvatore Guarino, Antonio Catania, Salvatore Sorrenti, Deborah Maria Giusti, Matteo Nardi, Carlo Di Marco, Grazia Savino, Enrico De Antoni; Afiliation - Department of Surgical Sciences „Sapienza” University of Rome; BLUNT TRAUMAS. MANAGEMENT OF INTRABDOMINAL INJURIES IN A UK MAJOR TRAUMA CENTER; Trauma is a leading cause of death in the UK, accounting for over 16 000 deaths per year representing the first cause of death in the population younger than 40 in the Western World and the fourth in the general population. Abdominal blunt traumas represent the 75% of all the blunt traumas. The intra-abdominal injuries typically are caused by a blunt force attributed to collisions between the injured person and the external environment and to acceleration or deceleration forces acting on the person’s internal organs. Spleen is the most frequent injured organ in abdominal blunt trauma, because its peculiar vascularization and anatomical position. The advantage of conservative management for grade I and II has been proved while its value is still debated for grade III and IV. Herby we present the experience on the management of splenic laceration in abdominal blunt trauma in the largest Major Trauma Center in UK with over 2400 trauma admissions per year. The retrospective analysis of the splenic laceration management proved that conservative management in the grade I and II lacerations is safe while for higher grade of splenic laceration, careful multidisciplinary opinion has to be taken for the decision making. The management of these patients represents a challenge and requires expert care from a large number of different specialties to give them the best chance of survival and recovery. Therefore the need of highly specialized Trauma Centers with specially trained medic and paramedic team capable to overcome the complexity of these cases.

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Session COLO-RECTAL SURGERY AND PROCTOLOGY

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Authors - Gallo G, Ferrari F, Carpino A, Sena G, Silipo D, Vescio G, Sammarco G, Sacco R; Afiliation - Chair of Clinical Surgery, Magna Graecia University, Catanzaro, Italy; WHAT’S THE FUTURE FOR THE MILLIGAN-MORGAN’S TECHNIQUE? Introduction: A variant to realize the hemorrhoidectomy sec. Milligan-Morgan is offered by the system LigaSure PreciseTM (LigaSure). Aim of study: In today’s new minimally invasive technology (HPS, THD slide) and mucoprolassectomy with stapler there is a place for the Milligan-Morgan? Material and Methods: The Ligasure Precise is an electrothermal bipolar device constituted by a radiofrequency generator able to perform the synthesis and hemostasis of arterial and venous vessels up to 7 mm in diameter realizing a complete and permanent synthesis of the vascular wall. In our Division of Emergency Surgery 58 patients(45 males and 13 females) with haemorrhoids of grade IV second Goligher and with eroded and bleeding mucosa were subjected to hemorrhoidectomy sec. Milligan-Morgan using the LigaSure Precise. Results: The mean operation time was 12 minutes. The score for postoperative pain according to the numerical scale verbal (VNS) was 6 after 24h and 48h after 5. Hospitalization was on average of 2.8 days (range 2-4).Surgical wounds have healed after a mean of 18.3 days. The return to work occurred after a mean of 10 days. Conclusions: The use of Ligasure Precise has shown significant advantages over the traditional technique: lower operating time, faster healing of wounds,reduced postoperative pain and early return to work. We have discovered that in the haemorrhoids of 4th grade with giants and pseudopolypoid nodules, eroded and bleeding mucosa, the Milligan-Morgan technique would be better to latest suspension techniques both for the low number of relapses both in consideration that in one of our cases the histologic examination showed an adenoma with high dysplasia.

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Authors - Gallo G, Carpino A, Ferrari F, Ammendola M, Sena G, Vescio G, Sammarco G, Sacco R; Afiliation - Chair of Clinical Surgery, Magna Graecia University, Catanzaro, Italy; THE SLIDE : OUR EXPERIENCE; INTRODUCTION: Various methods have been used in recent years for the surgical treatment of hemorrhoidal disease. Is in doubt that treatment with PPH-Stapler has had great resonance compared to the techniques which included the removal of hemorrhoidal`s packages whether performed with radiofrequency whether performed with ultrasound. AIM OF STUDY: The onset of serious complications has led many surgeons to develop and execute less invasive methods. Among these, the THD SLIDE certainly had an important development. MATERIAL AND METHODS: In the Operative Unit of Digestive Surgery of University Magna Graecia in Catanzaro were treated ,in 2012 , with THD SLIDE , 20 patients with hemorrhoidal disease including 14 males and 6 females with an age range 40 to 60 years. Three of the 20 patients had haemorrhoids classified with grade P3E3 according to PATE 2000 and the other 17 patients with grade P4E3. RESULTS: Our results showed a post-operative pain rated with VNS scale of 5.2 . The days of hospitalization were on average 2 except in one case. However there have been some early complications: 3 cases of bleeding ; 2 cases of urinary retention ; 6 cases of thrombosis and 8 cases of tenesmus. Late complications were the following : 4 cases of residual disease , 5 cases of late bleeding and 4 of thrombosis . CONCLUSION: In our experience the THD slide method it was a technique repeatable and safe for patients with prolapse lower than 1.5 cm. However, this tecnique has some limits in terms of recurrence although single nodule for prolapses greater 1.5 cm and is not recommended in bleeding and pseudopolipoid hemorrhoids with grade IV and with eroded mucosa.

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Authors - Melnik Idit MD,Oleg Dukhno MD, Ornit Cohen M.MED Sc ,Dimitry Goldstein MD, Boris Yoffe MD FACS; Afiliation - Department of General and Vascular Surgery,Barzilai Medical Center, Ashkelon, Israel. Affiliated with the Faculty of Health Sciences, Ben-Gurion University of the Negev.; WHEN TO GO SINGLE? A COMPARISON BETWEEN SINGLE PORT AND THE TRADITIONAL MULTIPORT TECHNIQUE FOR COLON RESECTIONS. Introduction: single incision laparoscopic technique is an emerging modality. Methods: We retrospectively reviewed the charts of all patients who underwent laparoscopic colectomies between October 2010 and December 2012. The cohort was divided into two groups, SILC and MILC, which were compared in terms of their intra-operative and early postoperative outcomes. Each group was then sub-divided according to the type of procedure, each of which was compared separately between SILC and MILC. The intra-operative parameters were total operative time, surgical margin involvement and the number of lymph nodes extracted. The postoperative parameters included length of hospital stay, 30-day readmission, maximum pain score, morbidity, and mortality. Results: Seventy five patients underwent laparoscopic colectomies (SILC-21/ MILC-54). Between the two groups, patient characteristics were not statistically different. A comparison of the groups intraoperative and postoperative results showed no statistically significant differences. Analyses of each procedure separately showed that when performing RH there was a trend (p = 0.08) of better oncological results with a higher mean number of lymph nodes extracted (23.5 Â± 3.16 vs. 17.19 Â± 6.93). In addition, LOS decreased (5.91 Â± 3.59 vs. 6.48 Â± 1.76, respectively), which was statistically significant (p = 0.05). Conclusions: Single incision approach for bowel resections is feasible and safe. Given our findings, we believe that SILC technique is an effective alternative to MILC when performing RH with the statistically significant benefits of lower LOS and better oncological results. However, the efficiency of the technique in LH or AR is still questionable and needs further evaluation.

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Authors - Tikfu Gee, Emad H Aly; Afiliation - General Hospital Kuala Lumpur (GHKL), Malaysia and Aberdeen Royal Infirmary (ARI), Aberdeen, Scotland.; SCARLESS SURGERY!! SINGLE INCISION LAPAROSCOPIC SURGERY (SILS) - AN ALTERNATIVE SURGICAL APPROACH OF MINIMALLY INVASIVE SINGLE PORT SURGERY IN COLORECTAL SURGERY; Background. Laparoscopic surgery has become the preferred choice of surgery because of its improved post operative outcomes in pain, recovery phase, duration of hospital stay and cosmetic appearance. Single Incision Laparoscopic Surgery (SILS) is a branch of laparoscopic surgery which utilises either specially designed single multi-channel port or standard ports that are introduced in to a single incision made to the skin. While SILS has succeeded conventional laparoscopic surgery in various procedures with better cosmetic appearances, there is still insufficient evidence to establish its superiority in the other post operative outcomes. Objective and Aims To compare the effectiveness of SILS in colorectal surgery using standard laparoscopic ports with conventional laparoscopic colorectal surgery in adult patients at four weeks post-surgery. To compare post operative outcomes between the two methods of surgery. To establish safety and feasibility of SILS using standard laparoscopic ports in colorectal surgery. Method 41 cases from January 2010 - December 2011 were reviewed in this retrospective study. Data from board-approved laparoscopy database on Single Incision Laparoscopic Surgery (SILS)-using standard ports and conventional laparoscopic surgery were collected using a data collection sheet. Results were tabulated on Microsoft Excel and analysed using the SPSS 17.0 software. Statistical difference in post-operative outcomes between the two procedures were noted and compared. Results Results from both colorectal surgeries (Right Hemicolectomy and Anterior Resection) shows that there were no significant differences in post operative outcomes between conventional method and SILS-using standard ports, in terms of age, BMI and operative time. However, post operatively pain score for day 1, 2 and 3 was statistically significant as SILS-using standard ports reported less pain compared to the conventional laparoscopic method. Conclusion SILS using standard laparoscopic ports are safe and feasible in the hands of an experienced laparoscopic colorectal surgeon, leaving behind an essentially scarless procedure around the umbilicus. Not only is this method cost effective, it produces a similar cosmetic outcome as the SILS using a single multi-channel port. While better pain outcome was reported with SILS using standard laparoscopic ports, further experience and evidence-based research are necessary to establish its superiority towards conventional laparoscopic surgery.

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Authors - Pierpaolo Sileri , Luana Franceschilli, Federico Perrone, Ilaria Carolina Ciangola, Ilaria Capuano, Federica Giorgi, Achille Lucio Gaspari; Afiliation - Department of Surgery, University of Rome Tor Vergata; LAPAROSCOPIC VENTRAL RECTOPEXY FOR INTERNAL RECTAL PROLAPSE USING BIOLOGICAL MESH:A CRITICAL APPRAISAL AFTER 100 CASES; Background: Laparoscopic Ventral Mesh Rectopexy (LVR) is constantly gaining wider acceptance as the preferred method of procedure to correct internal as well as external rectal prolapse associated with obstructed defaecation syndrome (ODS) and/or faecal incontinence. This procedure convinces with excellent functional outcomes associated with very little operative risk, even in older and fragile patients. These results are mostly obtained using synthetic mesh. Despite the improvement of the efficacy of the reconstructive procedure with reduction of the recurrence rate there is ongoing debate regarding the possible complications like erosions and infections with the use of synthetic mesh in close proximity of pelvic organs. Some biological meshes may serve as an alternative. Very few reports exist on the use of biological mesh for LVR. Therefore, no superiority of one mesh over the other can be established in terms of surgical complications, as well as short and longer term functional outcomes. In this critical appraisal we report our experience with this abdominal, minimally invasive and nerve sparing technique, using porcine dermal collagen mesh. Patients and Methods: Prospectively collected data on laparoscopic ventral mesh rectopexy (LVR) for internal rectal prolapse were analysed. All patients underwent preoperative evaluation with defaecating proctography and/or pelvic dynamic magnetic resonance imaging (MRI), full colonoscopy, anal physiology studies, and endo-anal ultrasound. Surgical complications and functional results of this technique in terms of constipation (expressed as Wexner Constipation Score = WCS) and faecal incontinence (expressed as Faecal Incontinence Severity Index = FISI) at 1 week; 1, 3, 6 and 12 months were analysed using Mann-Whitney U-test for unpaired data and Wilcoxon signed rank test for paired data (two-sided p-test). Results: Between April 2009 and April 2013, 100 consecutive patients underwent LVR for internal rectal prolapse. Two patients were lost during the follow-up and excluded. Mean symptom duration before surgery was 11+/9 years. Mean operative time was 85+/-40 minutes. Conversion rate to open technique was 1%. There was no postoperative mortality. Overall 16 patients experienced 18 complications (18%), including rectal perforation (1), small bowel obstruction (2), urinary tract infection (8), subcutaneous emphysema (3), wound haematoma (2), sacral long lasting pain (1), and incisional hernia (1). Median postoperative length of stay was 2 days. At the end of the follow-up the FISI score significantly improved to 3+/-2 from preoperative 8+/-3 (p 0.003). Incontinence improved in 86% of the patients and was completely cured in 72%. Similarly, WCS score significantly improved to 7+/-5 from preoperative 18+/-6 (p 0.002). Constipation improved in 92% of the patients and was cured in 80%. No deterioration of continence, constipation or sexual function was observed. Fourteen patients (14%) experienced prolapse persistence or recurrence. Conclusions: Laparoscopic ventral mesh rectopexy using biological mesh for internal rectal prolapse is a safe and effective procedure for improving symptoms of obstructed defecation and faecal incontinence.

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Session EMERGENCY SURGERY AND TRAUMA;

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Authors - Obondo CA, Moussa O, Muthukumarasamy G, White RD, McBride K, Bhat R, Beverage E, Brennan JC, Holdsworth R.; Afiliation - Forth Valley Royal Hospital. Department of Vascular Surgery; CLINICAL OUTCOMES OF ENDOVASCULAR TREATMENT IN CHRONIC SYMPTOMATIC MESENTERIC ISCHAEMIA; Endovascular therapy is emerging as a primary treatment for chronic mesenteric ischaemia (CMI). Due to the low incidence of the condition, published studies have involved small patient numbers. The aim of this study is to examine and document the clinical outcome of percutaneous angioplasty and stenting (PTAS) in patients with symptomatic CMI. During the period June 2002–June 2013, all patients who underwent PTAS for CMI in three hospitals were retrospectively included into this study. Patient demographics, lesion characteristics (stenosis/occlusion), major morbidity, recurrence and mortality were recorded. Twenty eight mesenteric vessels (13 superior mesenteric, 13 celiac and 2 inferior mesenteric) were treated in 25 patients (12 female and 13 male). Seven (25%) arteries were completely occluded and 21 (75%) had >60% stenosis. The mean age was 69 years and the most common symptom was postprandial angina (n=24, 96%). The average duration of symptoms was 9.6 months. Single vessel and two vessel PTAS was achieved in 84% (n=21) and 16% (n=4) respectively. There was no periprocedural mortality and major morbidity occurred in 2% (n=5). The median follow-up was 27.5 months. During this period, 18 patients (72%) reported symptom resolution, 5 (20%) recurrence and 2 were lost to follow-up. Re-intervention with clinical success was performed in 3 patients (12%) at a mean of 20 months from initial treatment. Seven patients (28%) died during the study period. Two (8%) of these were CMI-related deaths. This study supports published data advocating primary PTAS for symptomatic CMI. It is feasible, safe and clinically effective.

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Authors O. Sadieh, Asem Ghasoup,MD MRCS-Mahmoud Khashashneh,MD MRCS-Isamil Marey,MD-Adala Al Anzi,Abeer Al Anzi Afiliation - Saad Specialty Hospital,Khobar-KSA , Prince Abdul Mohsin General Hospital,Madinah-KSA THE OUTCOME OF PATIENTS WITH BLUNT CHEST TRAUMA AND PULMONARY CONTUSION. Introduction: Lung contusion is an entity involving injury to the alveolar capillaries, without any tear or cut in the lung tissue. This results in accumulation of blood and other fluids within the lung tissue. The excess fluid interferes with gas exchange leading to hypoxia pulmonary contusions following trauma may result in significant hypoxemia and decreased compliance which may progress over several days. Extensive contusions may result in respiratory difficulty or progress to adult respiratory distress syndrome, which increases mortality. Material and Method: A retrospective Study of all cases of trauma with pulmonary contusions admitted to our hospital from October 2011 to February 2012 Diagnosed on X-ray or CT scan. The cases were examined for age, type of injuries, admission APACHE II, SAPS II and SOFA scores, PaO2/FiO2 ratio, presence or absence of rib fractures, average positive fluid balance, average sedation dose, pulmonary hemorrhage, ventilator days, ICU days and hospital outcome. Result: There were 92 cases with multiple traumas admitted to ICU of them 35 cases with pulmonary contusions. 32male and 3 female, age 19-60 years. The mechanisms of injury were Head-on collision with heavy vehicles at high velocity, Hit and run accidents and fall from height or blunt injury to the chest due to fall of heavy machinery on the chest. Associated injuries included multiple rib fractures in 22 cases and the others 13 cases were with long bone fractures, abdominal injuries including splenic rupture, liver lacerations, pelvic fractures and head injury. 8 patients died 6 of them died in the ICU with refractory hypoxia and 2 patients died 1 week after transfer to a high dependency unit, one due to sepsis and the other due to massive haemothorax. In some patients the admission chest X-ray was normal, and worsened during the subsequent days others had infiltrates on the admission X-ray, diagnosis confirmed by Chest CT-SCAN in all cases. 6 cases of non survivors were classified as having ARDS and were severely hypoxic at the time of death. There was a significant difference in PaO2/FiO2 ratio at admission and throughout the ICU course, Non survivors had lower mean PaO2/FiO2 ratio throughout the ICU stay than survivors, (158 vs. 245), fluid balance and sedation dose, but not in ventilator days and ICU days. The incidence, frequency and amount of pulmonary hemorrhage were higher in the non survivors. Non survivors were more severely injured with higher admission mean APACHE II (14 vs. 7) and SAPS II (40 vs. 26) scores. However, the mean SOFA scores were not significantly different (non survivors 5.83 and survivors 3.83). Conclusion: Blunt trauma and pulmonary contusions can have a considerable mortality especially in the face of severe hypoxemia; attention to limit hypoxia and improve gas exchange should be undertaken early. Management of hemoptysis might improve outcome in pulmonary contusions.

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Authors –Mrktich Mrktichyan, Hovhannes Sarkavagyan, Tigran Khachatryan, Armen Khanoyan, Artak Manukyan, Artur Sardaryan, Hayk Kikoyan; Afiliation - Yerevan State Medical University after Mkhitar Heratsi,”SURB GRIGOR LUSAVORICH” MEDICAL CENTER, Yerevan, Armenia; TRAUMATIC RUPTURE OF THE DIAPHRAGM; Background: Diaphragmal raptures due to chest blunt traumas are often associated with polytraumas and accompanied by injures to other organs which leads to difficulty of proper and in-time diagnosis of such cases. The aim of this retrospective study was to analyze our experience with diagnostic methods and operative approach of traumatic rapture of diaphragm (TRD). Methods: 38 patients with TRD were treated in our hospital between 1993 and 2013. They were 34 men (89%) and 4 women (11%) ranging from 13 to 70 years. 29 patients (76%) showed a left TRD and 9 patients (24%) - right TRD. Multiple-associated injures were observed in 31 patients (82%), and isolated TRD - in 7 patients (18%). Causes of trauma included road traffic accidents for 33 patients (87%) and fall from height for 5 (13%). Results: TRD was diagnosed preoperatively in 32 patients (84%) by contrast X-Ray of gastrointestinal tract, abdominal ultrasound, and CT scan of the chest and abdomen. In 6 (16%) patients TRD was diagnosed during surgeries. We did not use pleural tapping to avoid iatrogenic injuries of abdominal organs. 27 patients (71%) underwent surgery upon 1 month of trauma episode, and the remaining 13 (34%) - after 1 month to 13 years. For surgical treatment, right lateral thoracotomy on the 6th interspace was performed in 9 (24%) patients with right TRD. The part of the diaphragm ruptured from the chest wall was repaired by simple interrupted suture to that wall on 1-2 interspaces above anatomical juncture-line which allowed restoring the diaphragm out of risky tension. 11 patients (29%) with old left TRD underwent left lateral thoracotomy on the 6th interspace by organs` pulling to abdomen and restoring the diaphragm. In both left and right TRDs the large diaphragmatic defects were repaired by polypropylene mesh. 18 (47%) patients with acute left TRD were treated by left lateral thoracotomy on the 6th interspace accompanied by upper-medial laparotomy (11 cases) and laparoscopy (7 cases) for comprehensive examination of abdomen and restoring lesions. We observed 3 deaths (8 %) - 2 from severe craniocerebral trauma and 1 from pulmonary thromboemboli. Conclusions: In right TRD, we recommend to repair diaphragm on 1-2 interspaces above anatomical juncture-line and in left TRD, to accompany thoracotomy with laparoscopy.

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Authors - Kryshen V.,Kudriavtchev A.; Afiliation - General Surgery Department, Medical Academy, Dnipropetrovsk,Ukraine; TAPP MODIFYING TECHNIQUE FOR STRANGULATED INGUINAL HERNIA; Introduction: Differences in surgical technique believed to be necessary at laparoscopic strangulated hernia repairing. Aim of study: to develop special laparoscopic method applicable for strangulated inguinal hernia emergency treatment. Materials and methods: Indications for laparoscopy: absence of contraindications for laparoscopy, absence of full intestinal obstruction symptoms. 46 patients undrerwent surgery. Authors proposed laparoscopic method due to one-sided strangulated hernia. At 38 cases object of incarceration was bowels. Modified TAPP and soft meches sized 10x15 cm on the average were used for hernioplasty. Results: There were following modifications in TAPP method: presence of strangulation ring caused necessity in hernial gates dissection for bowels release. Unlike open operations firstly dissection of hernial gate was performed , then inspected. Hernia gate dissection basing on our experience is better to perform remoted from large vessels and nervous tissue. These are fields at 2-3 and 10-11 clocks of conventional dial. Traction of strangulated ring was provided with surgical hook into abdominal cavity and outside of strangulated organ. There is massive tissue edema at affected zone, so to prevent bleeding and organ trauma we used to dissector or special hook instead of scissors. To estimate bowels life-ability - peristaltic grade, local glint and temperature measured with electronic thermometer at strangulated and healthy areas were used. We assume the programmed re-laparoscopy can also be conducted with such purpose and under circumstances. Conclusion: Laparoscopic hernioplasty could be free implemented at patients with strangulated inguinal hernia. The post-operation complications rate is acceptable. Although some surgery features needs standard technique modification in particular.

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Authors - Baras R. Karakas, M.D.1 , Aslinur Sircan-KuĂ§uksayan, M. S.2, Gulsum Ă–zlem Elpek, M.D. Prof.3, Murat Canpolat, PhD. Prof. Dr.2; Afiliation - 1Antalya Training and Research Hospital, Department of General Surgery, 2Biomedical Optics Research Unit, Department of Biophysics, Faculty of Medicine, Akdeniz University and 3Department of Pathology, Faculty of Medicine, Akdeniz University, Antalya, Turkey; ASSESSMENT OF THE INTESTINAL VIABILITY BY DIFFUSE REFLECTANCE SPECTROSCOPY ON ISCHEMIA-REPERFUSION INJURY IN THE RAT; Background: Intestinal tissue viability prediction in the treatment of acute mesenteric ischemia remains a challenge. We have utilized diffuse reflectance spectroscopy (DRS) to investigate the viability of bowel tissue after ischemia and reperfusion on an animal model in-vivo and in real-time. Methods: In this study, a total of 25 Spraque-Dawley rats were used. There were five study groups of rats bowel ischemia time. Superior mesenteric artery was occluded by a vascular clamp for different time periods (sham,30 min, 45 min, 60 min, and 90 min; n=5). Intestinal reperfusion was provided by releasing the clamps after each time period following the occlusion. Spectra were acquired by gently touching the optical fiber probe to the bowel tissue before ischemia, at the end of ischemia and after the reperfusion. Subsequently, the same bowel segments were removed for histopathologic examination. Results: Based on the correlation between the spectra acquired on the bowel segments and the results of histopathology, it is found that DRS is able to differentiate histopathological changing on intestinal ischemia-reperfusion injury in real time and in-vivo. Conclusion: DRS has potential to be used for the assessment of bowel viability in real time and in-vivo.

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Authors - Marvan J., Bačová J., Antoš F., Fanta J.; Afiliation - Surgical Department, 1st Medical Faculty, Charles Univerity, Hopital Na Bulovce, Prague; SPECIFIC ISSUES IN THE MANAGEMENT OF AN ACUTE ABDOMEN IN PSYCHIATRIC PATIENTS; Introduction: Our department is a neighbourhood medical facility for surgical patients from the largest psychiatric facility in the Czech republic. Therefore we come in contact with psychiatric patients almost every day. This subject of instruction will discuss specific care for those patients. Material: Presentation of patients admitted with diagnosis of an acute abdomen from the psychiatric facility in course of the last three years including visual documentation – case reports. Discussion and conclusion: Summary of currect knowledge about specific issues during diagnostic procedures in case of psychiatric patients pointing out the changes in pain perception, communication disorders, psychiatric medication which result in worsened (delayed) diagnostics of an acute abdomen. Specific issues when treating psychiatric patients at the surgical department: Adverse events of the antipsychotic medication in relation to surgical therapy and risks resulting from discotinuation of such medication. Differential diagnostics and therapy of the delirant state.

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Authors - Dobbs T, Aveyard N, Bratby M, Hormbrey P; Afiliation - Oxford University/ Oxford University Hospitals; DEEP VEIN THROMBOSIS - HAVE YOU CONSIDERED MAY-THURNER SYNDROME? Introduction: MTS is a condition whereby the left common iliac vein is compressed against the lumbar vertebrae by the right common iliac artery. Chronic arterial pulsation causes intimal hyperplasia, increasing the risk of venous stasis and iliofemoral DVT. Believed to be present in around 22% of the population, it is only reported in 2%–3% of patients that present with a lower extremity DVT [1]. MTS is therefore likely to be chronically underdiagnosed and could partially explain the overall predominance of DVT in the left leg [2]. Patient: A 32-year-old woman presented to the emergency department with acute-onset left leg pain. Duplex ultrasound scan demonstrated an iliofemoral deep vein thrombosis (DVT). CT venogram confirmed the presence of a left-sided iliofemoral DVT and demonstrated May–Thurner syndrome. She underwent emergency thrombectomy and stenting and has made a good recovery with no further thrombotic episodes. Result: The diagnostic work-up is often halted once a diagnosis of DVT is made. This case reminds us that the mechanical causes of DVT, such as MTS, should be considered in the differential diagnosis along side other causes such as hypercoaguable states. MTS should be especially considered in younger patients with otherwise unexplained iliofemoral DVT, particularly if recurrent and ipsilateral. Conclusion: Interventional radiology with mechanical thrombectomy and stenting is the treatment of choice for MTS. Therefore, given the need for an invasive surgical approach to the management of MTS, a missed diagnosis could lead to significant morbidity and mortality in the Emergency setting.

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Session UPTODATE ON ENDOCRINE SURGERY

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Authors - Camenzuli C., Micallef A., Sammut Henwood K., Betts A.; Afiliation - Mater Dei Hospital, Malta; DEMOGRAPHICS AND INCIDENCE OF THYROID CANCER: A POPULATION STUDY; Thyroid cancer is not an uncommon pathology. Although mortality from this condition is low, the condition and its treatment lead to significant morbidity. The aim of this study was to evaluate the incidence and the demographical characteristics of thyroid cancer in the Maltese population from 2008 to 2013. The mean yearly incidence of thyroid cancer was 39.2 with little inter-annual variations and a total of 195 documented cases. The most common subtype was papillary carcinoma followed by follicular carcinoma and then medullary carcinoma. Only one case of anaplastic carcinoma was recorded. Thyroid cancer was three times more common in females. Age demographics show a normal distribution curve with a wide range and mode at the 40 to 49 age group. There was no difference between the incidence of thyroid cancer in the different geographical areas of the country. In conclusion, thyroid cancer in Malta shows similar trends as published data. It is essentially a disease of young women. The research group proposes the development of a thyroid support group to help these patients assimilate better their condition.

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Authors - Camenzuli C., Cassar N., Psaila J., Attard A.; Afiliation - Mater Dei Hospital, Malta; USE OF CLOSED DRAINS UNDER SUCTION AFTER HEMITHYROIDECTOMY- A PRELIMINARY REPORT OF A RANDOMIZED CONTROLLED TRIAL. Introduction: Wound drainage after thyroidectomy is fairly standard, but this practice has been challenged. Objectives: The primary aim was to investigate whether use of closed suction drains had any effect on re-operation rates. The secondary aims included whether use of drains altered pain scores, patient satisfaction and complication rate. Method: Patients undergoing hemithyroidectomy under the care of one surgical firm were recruited. Patients were blindly randomised manually into two groups: drain or no drain. Standardised analgesic regimens were used. Patient demographics, co-morbidities, length of surgery, complications, pain scores and patient satisfactions scores were collected through a structured interview. Student T Test was used to statistically analyse results. Results: 21 participants have been recruited with the majority being females (86%). The mean age was 50.8 years (SD 14.5). The groups were homogeneous in terms of age, sex, BMI, co-morbidities, length of operation and thyroid status. There was no significant difference between pain scores (p values of 0.56 in the evening and 0.59 in the morning post operation) and patient satisfaction scores (p values of 0.14 in the evening and 0.15 in the morning post operation) between the groups. The only complication reported was hypocalcaemia in one patient of the drain group. No re-exploration or mortality was recorded. Conclusion: The preliminary result for this study shows a low complication rate with no significant differences in terms of patient satisfaction and pain scores between the groups. The research group will extend this RCT over the next year.

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Authors - Nicola PALESTINI, Enrico BRIGNARDELLO*, Milena FREDDI, Marco GALLO*, Alessandro PIOVESAN*, Guido GASPARRI; Afiliation - Departments of Surgery and *Oncology, University of Torino and A.O. Città della Salute e della Scienza di Torino, Italy; Impact of surgery on survival in anaplastic thyroid carcinoma. A case series of patients referred to a single institution between 1999-2012; Abstract content: Objective. We present our experience with surgical treatment followed by adjuvant therapy in selected patients with anaplastic thyroid carcinoma (ATC), including those with distant metastases (stage IVC). Patients and methods. Clinical and follow-up data for 55 patients (34 females; median age 73) referred to our Institutions from June 1999 and July 2012 were collected and analysed. Stage IVA patients were excluded. Thirty-one patients (56.4%) had distant metastases. Cases eligible for surgery were operated on with the intent to obtain a „maximal debulking” (i.e. total or near-total thyroidectomy and radical resection of the tumour with the involved regional lymph nodes, or minimal residual neck disease infiltrating vital structures); interventions that not achieved this goal were considered palliative operations. After surgery most cases received chemotherapy (paclitaxel or doxorubicin ± cis-platin) and/or radiotherapy, with adjuvant intent. Results. Surgery was possible in 41 patients (74.5%), and a „maximal debulking” was achieved in 29 cases (52.7%). Median overall survival was 5.5 months. Operated patients had a betted prognosis compared to those not eligible for surgical treatment (median survival: 6.5 vs. 1.5 months), with a 19.7% survival rate one year after surgery. Among the operated patients those who received a maximal debulking had a better survival, even in stage IVC, compared to the patients submitted to palliative operations (median survival: 6.6 vs. 3.2 months). The favourable effect of maximal debulking on survival was confirmed by multivariate analysis (HR = 5:36; 95% CI 2:34-12:27; p