Mindaugas Kiudelis

1. Abstract 1.1. Introduction: Gastric syphilis is a rare and challenging diagnosis in clinical practice. Due to decreasing incidence of syphilis, the encounterment with the diagnosis became exceptionally rare. Kaunas regional Biomedical Research Ethics Committee approved the presentation of this case report (protocol no.BEC-LSMUC(R)-26). 1.2. Case Presentation: A 46 -year -old Caucasian female with a 3 months history of mild epigastric pain, followed by vomiting, weight loss, and early satiety. The symptoms and findings of instrumental examinations led to initial diagnosis of gastric cancer. Partial distal gastrectomy and D2 lymphadenectomy was performed and histological examination showed active chronic gastritis with dense lymphocytic and plasmocytic infiltration -alterations were in line the diagnosis of syphilis, which was further confirmed by serological tests. 1.3. Conclusion: Epigastric pain, anorexia, vomiting, weight loss, together with radiological, endoscopic and microscopic appearance of gastric syphilis may easily be confused with gastric lymphoma or carcinoma. Furthermore, endoscopic gastric biopsies show non-specific histological alterations. We suggest that in all patients with gastric symptoms mimicking neoplasm with nonspecific endoscopic or histological findings, VDRL and TPHA tests should be performed. 2. Keywords: Gastric Syphilis; Gastrectomy; Plasmocytic Infiltration

A steady decline in gastric cancer mortality rate over the last few decades is observed in Western Europe. However it is still not clear if this trend applies to Eastern Europe where high incidence rate of gastric cancer is observed. This was a retrospective non-randomized, single center, cohort study. During the study period 557 consecutive patients diagnosed with gastric cancer in which curative operation was performed met the inclusion criteria. The study population was divided into two groups according to two equal time periods: 01-01-1994 – 31-12-2000 (Group I – 273 patients) and 01-01-2001 – 31-12-2007 (Group II – 284 patients). Primary (five-year survival rate) and secondary (postoperative complications, 30-day mortality rate and length of hospital stay) endpoints were evaluated and compared. Rate of postoperative complications was similar between the groups, except for Grade III (Clavien-Dindo grading system for the classification of surgical complications) complications that were observed at significantly lower rates in Group II (26 (9.5%) vs. 11 (3.9%), p = 0.02). Length of hospital stay was significantly (p = 0.001) shorter (22.6 ± 28.9 vs. 16.2 ± 17.01 days) and 30-day mortality was significantly (p = 0.02) lower (15 (5.5%) vs. 4 (1.4%)) in Group II. Similar rates of gastric cancer related mortality were observed in both groups (92.3% vs. 90.7%). However survival analysis revealed significantly (p = 0.02) better overall 5-year survival rate in Group II (35.6%, 101 of 284) than in Group I (23.4%, 64 of 273). There was no difference in 5-year survival rate when comparing different TNM stages. Gastric cancer treatment results remain poor despite decreasing early postoperative mortality rates, shortening hospital stay and improved overall survival over the time. Prognosis of treatment of gastric cancer depends mainly on the stage of the disease. Absence of screening programs and lack of clinical symptoms in early stages of gastric cancer lead to circumstances when most of the patients presenting with advanced stage of the disease can expect a median survival of less than 30 months even after surgery with curative intent.

Currently, the most effective therapy for achalasia is laparoscopic Heller myotomy with partial fundoplication. The aim of this study was to compare the long-term results between 2 different laparoscopic operation techniques in achalasia treatment. Material and Methods. This was a retrospective study, where 46 achalasia patients were examined: 23 patients underwent laparoscopic Heller myotomy followed by the full gastric fundus mobilization, total hiatal dissection, and posterior Toupet (270°) fundoplication (group 1); other 23 patients underwent laparoscopic Heller myotomy with limited surgical cardia region dissection, not dividing the short gastric vessels and performing anterior partial Dor fundoplication (group 2). Long-term findings included the evaluation of postoperative dysphagia according Vantrappen and Hellemans and intensity of heartburn according the standard grading system. Results. The patients in these 2 groups were similar in terms of age, weight, height, and postoperative hospital stay. The median follow-up was 66 months in the group 1 and 39 months in the group 2 (P0.05). Clinically significant heartburn was documented in 39% of patients in the group 1 and only in 13% of patients in the group 2 (P<0.05). Conclusions. According our study results, both laparoscopic techniques were similarly effective (82.6% vs. 78.3%) in achalasia treatment. Postoperative heartburn was significantly more common (39% vs. 13%) after laparoscopic myotomy, followed by the full gastric fundus mobilization, total hiatal dissection, and posterior Toupet (270°) fundoplication.

Introduction : Laparoscopic appendectomy is a well-described surgical technique and has gained wide clinical acceptance. Laparoscopic appendectomy offers fewer wound infections, faster recovery and an earlier return to work in comparison to open surgery. However, concerns still exist regarding...

The aim of this study was to compare the effect of different kinds of surgical meshes on postoperative adhesion formation. Forty-two New Zealand White rabbits were studied. The rabbits were grouped into six groups, according to the type of surgical meshes (Prolene, Mersilene, Vypro, polytetraflouroethylene (PTFE), Proceed and control group) implanted into the peritoneum cavity. Thirty days after the operation, the relaparotomies were carried out, and any adhesions observed between the implanted mesh and tissues were evaluated and graded. The mean adhesion degree was 9.2 in the Mersilene mesh group, 9.5 in the Prolene mesh group, 9.7 and in the Vypro mesh group (P > 0.05). The mean adhesion degree was 1 in the control group, 2.75 in the Proceed mesh group and 2.25 in the PTFE mesh group. There was a significant difference in adhesion degree between the control, Proceed and PTFE groups and the Prolene, Mersilene and Vypro mesh groups. The adhesion degree was significantly lower in the Proceed and PTFE mesh groups when comparing them with the Prolene, Mersilene and Vypro meshes.

LIETUVOS CHIRURGŲ ASOCIACIJOS IR LIETUVOS IŠVARŽŲ REGISTRO REKOMENDACIJOS Audrius Gradauskas1, Vytautas Lipnickas2, Mindaugas Kiudelis31 Vilniaus miesto universitetinės ligoninėsChirurgijos klinika,Antakalnio g. 57, LT-10207 Vilnius;2 Vilniaus universiteto ligoninės "Santariškių klinikos"Gastroenterologijos, nefrologijos, urologijosir abdominalinės chirurgijos klinika,Santariškių g. 2, LT-08661 Vilnius;3 Kauno medicinos universiteto klinikųChirurgijos klinika,Eivenių g. 2, LT-50009 KaunasEl paštas: gradauskasa@one.lt,vlipnick@takas.lt, minkiud@yahoo.com Kirkšninė išvarža yra dažna liga, ji gydoma operaciniu būdu. Tai dažniausiai vyrams atliekama operacija JAV ir Vakarų Europoje bei trečia pagal dažnumą iš visų atliekamų operacijų pasaulyje. Nors pasiūlyta įvairiausių hernioplastikų modifikacijų, gydymo rezultatai kol kas nepatenkina lūkesčių. Po šių operacijų iki 10–20% išvaržų pasikartoja, o operuojant recidyvines išvaržas procentas dar didesnis. Šiuo metu kirkšninių išvaržų chirurginis gydymas dar yra kryžkelėje. Operacijos atliekamos ir tradiciniais būdais, ir naudojant aloplastines medžiagas – sintetinius tinklelius, ir naujausiais, laparoskopiniais metodais. Operuojant bet kuriuo būdu, svarbu ne tik išvaržos recidyvų, ankstyvųjų ir vėlyvųjų pooperacinių komplikacijų skaičius, bet ir paciento savijauta po operacijos, trumpas hospitalizavimo laikas, greita socialinė reintegracija į visuomeninį gyvenimą, taip pat mažos operacijos ir paciento nedarbingumo išlaidos. Pasaulyje atliekami įvairūs tyrimai, bet optimalaus kirkšninių išvaržų operacijos būdo ("auksinio standarto") dar nerasta. Vienas iš tokio pobūdžio darbų – pirmasis Lietuvoje perspektyvusis daugiacentris atsitiktinių imčių klinikinis tyrimas, vyko 2003–2004 metais. Šio tyrimo galutinių išvadų dar nėra, nes dabar vertinami gyvenimo kokybės pokyčiai ir socioekonominis efektas. 2004 metais buvo įkurtas Lietuvos išvaržų registras, į visoms gydymo įstaigoms išsiųstas anketas gauti atsakymai mažiau nei iš pusės. Norėdami rasti bendrą kalbą ir skatindami prisidėti prie Lietuvos išvaržų registro, rekomenduojame visų Lietuvos gydymo įstaigų chirurgams taikyti Nyhuso kirkšninių išvaržų klasifikaciją. Taip pat pateikiame trijų, pastaruoju metu pasaulyje labiausiai paplitusių kirkšninių išvaržų operavimo būdų aprašymą. Reikšminiai žodžiai: kirkšninė išvarža, klasifikacija, gydymas Groin hernia treatment standard LIETUVOS CHIRURGŲ ASOCIACIJOS IR LIETUVOS IŠVARŽŲ REGISTRO REKOMENDACIJOS Audrius Gradauskas1, Vytautas Lipnickas2, Mindaugas Kiudelis31 Vilnius City University Hospital, Clinic of Surgery,Antakalnio str. 57, LT-10207 Vilnius, Lithuania;2 Vilnius University Hospital "Santariškių klinikos",Clinic of Gastroenterology, Nephrology,Urology and Abdominal Surgery,Santariškių str. 2, LT-08661, Vilnius, Lithuania;3 Kaunas Medical University, Clinic of Surgery,Eivenių str. 2, LT-50009 Kaunas, LithuaniaE-mail: gradauskasa@one.lt,vlipnick@takas.lt, minkiud@yahoo.com Groin hernia is a common surgical disease. Hernioplasty is the most commonly performed operation in the United States and Western Europe and one of the commonest operations in the world. In spite of the different hernioplastic techniques we have, the postoperative results are unsatisfactory. The recurrence rate after primary repair is 10–20%, and this rate is significantly higher after secondary repair. Surgical treatment of groin hernia is in the crossroad. Operations for groin hernia are performed in a "classic historic way", using different synthetic materials and laparoscopically. The success of every operation depends not only on the low recurrence and postoperative complication rates, but also on the patient’s good quality of life after operation as well as on the low operation and socioeconomic costs. Many randomized trials are performed all over the world in order to find the best operation ("gold standard") for groin hernia, but untill now we have no such operation. The first multicenter, randomized, clinical study was performed in Lithuania in 2003–2004. Its task was to compare the different operation techniques in groin hernia surgery. Here we present an analyses of the final results of this study. The Lithuanian groin hernia register was established in 2004. A special questionnaire was sent to every Lithuanian hospital asking about different aspects of groin hernia surgical treatment. We have not get received half of the answers. In order to find an accord with every Lithuanian surgeon, we recommend to use the Nyhus hernia classification in everyday work. We offer a description of three nowadays most popular groin hernia surgical techniques. Keywords: groin hernia, classification, treatment