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"PURPOSE: To assess the safety and feasibility of laparoscopic gastrectomy (LG) for gastric cancer patients with a history of abdominal surgery (HAS).METHODS: This retrospective study analyzed data collected from gastric cancer patients with HAS, who underwent LG between 2004 and 2015. We compared the clinicopathological features that correlated with conversion to open surgery and the development of severe postoperative complications (Clavien-Dindo classification of grade III or higher).RESULTS: Of the 41 patients identified, 6 (14.6%) required conversion to open surgery. The incidence of conversion to open surgery was associated with a history of lower gastrointestinal tract surgery (p = 0.009), attempted laparoscopic total gastrectomy (p = 0.002), and excessive blood loss (p < 0.001). Severe postoperative complications developed in six patients (14.6%). Although the development of complications was associated with high postoperative serum C-reactive protein, the type of past abdominal surgery was not significantly correlated with severe complications.CONCLUSIONS: LG was feasible for gastric cancer patients with a HAS, but for those with a history of lower abdominal surgery or those who require total gastrectomy, surgeons should carefully consider the indications for LG."

"Pendahuluan : Pembedahan laparoskopik abdomen memerlukan anestesia yang dalam dan relaksasi otot yang maksimal untuk memperbaiki lapang pandang pembedahan dan menurunkan angka komplikasi pascabedah. Pemberian dosis tinggi rokuronium dan sevofluran terkadang tidak terhindarkan. Penelitian ini bertujuan untuk mengetahui apakah pemberian magnesium sulfat sebagai adjuvan akan menurunkan konsumsi sevofluran dan rokuronium pada bedah laparoskopik abdomen.Metode : Penelitian ini merupakan studi acak tersamar ganda yang mengikutsertakan 42 pasien yang menjalani laparoskopik bedah abdomen. Sampel dilakukan pengkelompokan dengan metode acak tersamar ganda, rasio 1:1, kedalam dua kelompok. Kelompok pertama adalah kelompok yang mendapatkan magnesium sulfat 10% (A) sebanyak 25 mg/kgbb bolus dalam 30 menit dilanjutkan dengan 10 mg/kgbb/jam selama intrabedah. Kelompok kedua adalah kelompok plasebo (B) yang diberikan volume yang sama NaCl 0,9%. Sevofluran diberikan selama tindakan anestesi untuk mempertahankan nilai BIS 40-60. Rokuronium tambahan diberikan jika nilai TOF Count ≥1. Kedua kelompok kemudian akan dinilai konsumsi sevofluran dan rokuronium selama tindakan sebagai tujuan utama dan dilakukan penilaian rerata tekanan arteri, nadi dan waktu ekstubasi sebagai tujuan tambahan. Hasil : Konsumsi sevofluran secara signifikan lebih rendah pada kelompok magnesium (A) dibandingan dengan kelompok plasebo (B) [9.57(±2,79) VS 12.35 (±4,95) ml/jam] dengan p value  = 0.031. Konsumsi rokuronium juga secara signifikan lebih rendah pada kelompok magnesium (A) dibandingkan kelompok plasebo (B). [0.36(±0.09) VS 0,47(±0,16) mg/kgbb/jam] dengan p value 0.01. Terdapat perbedaan signifikan tekanan rerata arteri pasca-insuflasi, tetapi tidak ada perbedaan signifikan nadi maupun waktu ekstubasi. Kesimpulan : Pemberian magnesium sulfat sebagai adjuvan anestesi umum dapat menurunkan konsumsi sevofluran dan rokuronium pada bedah laparoskopik abdomen.

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Background: Deep anesthesia and neuromuscular relaxation are needed in laparoscopic abdominal surgery to reduce possibility of postoperative complication and improve surgeon satisfaction. High dose of rocuronium and sevoflurane might be needed. This study aimed to investigate administration magnesium sulfate as adjuvant would reduce rocuronium and sevoflurane consumption in patient who went laparoscopic abdominal surgery.

Methods: This study was a double blind randomized controlled trial involving 42 patient who underwent abdominal laparoscopic surgery. Subject were blindly randomized into two groups at a 1:1 ratio. First group received magnesium sulfat as A groups (loading dose 25 mg.kg-1 over 30 minutes and followed by 10 mg.kg-1.hr-1) during surgery and second group was B group was administered the same volume of NaCl 0.9%. Sevoflurane was administered to maintain anesthesia depth within BIS range 40-60. Supplementary of rocuronium intraoperative was given if TOF Count reached ≥ 1. All group was assessed for sevoflurane and rocuronium consumption as primary outcome. Both groups mean arterial pressure, heart rate and time of extubation also assessed as secondary outcome.

Result: Consumption of sevoflurane significantly lower in magnesium group [9.57(±2,79) VS 12.35 (±4,95) ml.hr-1] with p value  = 0.031. Consumption of rocuronium is also significantly lower in A groups than in B groups [0.36(±0.09) VS 0,47(±0,16) mg.kg-1.hr-1] with p value = 0.01. There is significant mean arterial pressure differences during post-insuflation. Meanwhile there is no difference on heart rate  and time of extubation between two groups

Conclusion: Administration of magnesium sulfat as adjuvant in general anesthesia reduce sevoflurane and rocuronium consumption during laparoscopic abdominal surgery."

"Penelitian ini bertujuan untuk mendapatkan gambaran tentang pengaruh kombinasi teknik relaksasi sistematik dan terapi analgesik terhadap rasa nyeri pasien pasca bedah abdomen di RS Haji Jakarta. Disain penelitian ini menggunakan metode quasi eksperimental dengan pendekatan pretest posttest group design. Sampel berjumlah 46 orang yang diambil secara purposive sampling. Kelompok intervensi menerima terapi analgesik dan teknik relaksasi sistematik dan kelompok kontrol menerima analgesik standar. Peneliti mengajarkan teknik relaksasi sistematik lewat walkmann kepada pasien kelompok intervensi dan pasien mempraktikkan teknik tersebut pada periode preoperasi. Setelah pembedahan pasien mendengarkan instruksi relaksasi melalui walkmann selama 15 menit, dua kali sehari selama dua hari. Pasien diinstruksikan untuk tidur telentang dalam posisi yang nyaman di tempat tidur, menutup kedua mata dan melemaskan bagian-bagian tubuh yang dimulai dari kaki, tungkai, paha dan terus bergerak ke bagian tubuh bagian atas hingga kepala. Pasien diajarkan untuk megendalikan nafas dan bersikap pasif agar merasakan relaksasi pada setiap langkah relaksasi. Pada akhir sesi, pasien diminta membuka mata dan tetap berbaring selama beberapa menit. Rasa nyeri diukur dengan menggunakan visual analogue scale (VAS). Evaluasi penelitian dilakukan pada hari kedua setelah intervensi. Hasil penelitian menunjukkan rata-rata rasa nyeri sebelum intervensi antara kelompok intervensi dan kelompok kontrol adalah berbeda tapi tidak bermakna (p=0,40), namun setelah intervensi terlihat berbeda secara bermakna antara kelompok intervensi dan kelompok kontrol (p=0,004). Umur tidak mempengaruhi rasa nyeri pada pasien pasca bedah abdomen setelah mendapatkan intervensi analgesik ditambah teknik relaksasi sistematik (p=0,97), jenis kelamin berpengaruh terhadap rasa nyeri (p=0,008) dan jenis kelamin laki-laki merasakan nyeri lebih sedikit dibandingkan perempuan dan letak insisi mempengaruhi nyeri pasca bedah abdomen (p=0.09). Rekomendasi hasil penelitian adalah perawat sebaiknya memberikan edukasi tentang cara mengatasi nyeri pasca pembedahan abdomen pada periode pre operasi agar pasien dapat melakukannya secara mandiri.

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The aim of this study was to describe the effects of systematic relaxation technique combined to analgesic therapy on postoperative pain in post abdominal surgery patient in Haji Hospital. The design was an quasi-experimental with pretest-posttest group design. The subjects were forty six (n=46) patients undergoing abdominal surgery. The sampling methode was purposive sampling, a non probability sampling. The intervention group received analgesic and relaxation systematic technique. The control group was given analgesic routine. In the preoperative surgical ward, the researcher taught systematic relaxation to the subjects in intervention group with an introductory walkmann. Subjects practiced using the technique in the preoperative periode.

After surgery, subjects listened to relaxation technique on the walkmann during 15-minutes, two times a day for 2 days postoperatively. Patients were directed by walkmann instruction to lie down in comfortable position in bed, close their eyes, and relax each part of the body, starting with the feet, lower legs, hips and moving up to the head. Patient taught to control their breathing and to maintain a passive attitude and allow relaxation occuring at its own pace. At the end of the session, subjects were asked to open their eyes and lie quitely for a few minutes. Sensation of pain was assessed before and after the test on visual analogue scale (VAS).

No difference was found for pain before treatment using between the intervention group and control group (p=0,40). Changes in pain sensation after the test indicated significantly greater relief in the intervention group compared to the control group. Posttest pain scores were significantly lower in the treatment groups than in the control group (p=0,004). Age did not affect pain sensation in post abdominal surgery patient after given anelgesic intervention combined with systematic relaxation technique (p=0,97). Sex affected pain sensation (p=0,008) and men may be less postoperative pain compared to women, and incisions site did not affected post abdominal surgery pain (p=0,09).

It's recommended to give education technique to alleviate pain in preoperative periode thus the patient can perform it independently after abdominal surgery."

"PURPOSE: Interstitial pneumonia (IP) is a progressive and irreversible fibrosis and can be fatal if acute exacerbation (AE) occurs. While a useful risk-scoring system has been established for lung surgery, no risk evaluation exists for AE of IP related to non-pulmonary surgery. The objective of this review is to describe the management for patients with IP.METHODS: We experienced three hepatectomy cases with IP. The first was a 72-year-old male patient diagnosed with hepatocellular carcinoma. Preoperative computed tomography (CT) revealed IP with reticular shadow at the base of both lungs. After hepatectomy, his IP became acutely exacerbated and did not improve with steroid or sivelestat treatment. The second was a 74-year-old male patient diagnosed with hepatocellular carcinoma, and the third was a 75-year-old male patient with liver metastasis. In both these cases, CT revealed a reticular shadow in the lung fields, with increased serum KL-6 levels. We administered pirfenidone for perioperative management, during which time no respiratory complications occurred.RESULTS: Perioperative management with pirfenidone for hepatectomy accompanied by IP was successful in our cases.CONCLUSION: We reviewed reports on the perioperative prevention, intraoperative risk factors, and treatment of postoperative AE of IP and summarized the perioperative management techniques for IP patients undergoing non-pulmonary surgery."

"This book is the first manuscript dedicated entirely to Desmoid Tumors. Written by prominent clinicians, researchers and advocacy group experts, patients and professionals alike will find this to be a comprehensive review. Clinical presentation, imaging guidelines and treatment paradigms are highlighted. Both the sporadic and heredity forms (Familial Adenomatous Polyposis) will be discussed. A thorough discussion on the unique issues in children with DT is included. A portion of the book will address the role of the APC gene, the β-catenin protein and the role of mutations in the genesis of DT. Emerging cutting edge research techniques will be revealed. Also included is a thoughtful discussion on the controversial labelling of desmoid tumors as benign and the consequences of such a designation. The role of advocacy groups in supporting research and in promoting awareness of rare diseases such as DT will be outlined. This book will serve as basis to prepare clinicians, researchers and patients to embark on the quest for a cure for desmoid tumors."

"This is the first time a book about laparoscopy in emergency abdominal surgery has been published. Numerous articles have been published in specific surgical journals, but, until now, there has not been a book that collates all the aspects of this little-known field. The aim of this volume is to achieve a complete and easy presentation of all the implications associated with laparoscopy in emergency abdominal surgery. The book should be a manual that can be easily consulted by digestive, general, and specialized surgeons, especially in an emergency. The authors’ contributions are founded on evidence-based medicine, which give the book scientific credibility, but this is coupled with their experience of daily practice, which adds an important complementary dimension to evidence-based medicine. This is balanced by an emphasis on clarity and accessibility, because the ultimate aim of the book is educational. "

"Although there has been a slow but steady decrease in incidence, gastric cancer remains the second leading cause of cancer death worldwide. Several aspects of the oncological and surgical management are still controversial and so gastric cancer represents a challenge for the surgeon. This book aims to delineate the state of the art in the surgical and oncological treatment of gastric cancer, describing the new TNM staging system, the extent of visceral resection and lymphadenectomy focusing on the different open and minimally invasive surgical techniques and discussing intraoperative chemohyperthermia and neoadjuvant and adjuvant treatment. Operative endoscopy and endoscopic ultrasonography are also discussed, as these now have an important role in both diagnostic work-up and palliative care of gastric cancer patients. Only a multidisciplinary approach involving the surgeon, gastroenterologist, and oncologist can produce the comprehensive and integrated overview that today constitutes a winning strategy for the optimization of results.What we hope we have achieved is a flexible, up-to-date, exhaustive publication, rich in illustrations and consistent with evidence-based medicine."

"Radiology of the post surgical abdomen provides a comprehensive overview of all abdominal operations involving the gastrointestinal tract, pancreas, hepatobiliary and genitourinary systems. Each chapter is fully illustrated with artists' drawings and radiological images of normal post operative anatomy. The complications associated with each procedure are described alongside imaging examples. Written by experts in the field, Radiology of the post surgical abdomen provides the reader with key teaching points emphasising differentiation between normal post-operative anatomy and complications."