Conference Schedule

Day1: August 6, 2018

Keynote Forum

Biography

Janusz S Targonski has finished Medicine from University of Gdansk in 1967, consultant of Surgery and Service in Collegium Medicum in Bydgoszcz Poland. Since 1978 living in Germany, he has been the Head of Departament of Gen Surgery 1980-86, served in University Witten Herdecke, has completed his PhD in 1986 and in 1994 Co-worker in Praxis Klinik Hagen Center of Ambulatory Surgery, Hagen Germany

Abstract

Autologous fat grafting started more than 100 years ago, but continuous technical progress and research results increased interest in this procedure. Ground-breaking was Coleman’s technique as a graft lipostructure and Klein tumescent technique of liposuction which facilitate application of this method. The author describes own research results of fat tissue harvesting (2009), preparing for transplantation through decantation and rubbing –pumping the fat tissue between two syringe, similar like producing sklero foam in phlebology. The overview of results of animals’ research and using of conditioning devices for preparation of fat are discussed. Despite the widely application: there is no evidence of harvesting, preparation and injection. The power point presentation shows preparation technique, preoperative and postoperative results and complications.

Biography

Ryska M, after Faculty of Medicine in 1978, he joined as an Internal Aspirant at the Surgical Clinic of the Faculty Hospital in Prague, in 1984 he worked for 4 months at the Surgical Clinic in Uppsala, Sweden, and from 1984 until 1992, a clinic assistant. In 1991 he graduated from a postgraduate surgical school at Hammersmith Hospital in London. In 1992 he habilitated from surgery (Friedly surgery in the treatment of choledocholithiasis) and until 1994 he worked as an assistant professor of surgery at the Surgical Clinic of the 3rd Medical Faculty of Charles University). In 1994 he joined the IKEM Cardiovascular and Transplantation Surgery Clinic and after completing a four-month internship at the Virchow University Surgical Clinic in Berlin under Prof. P. Neuhause started a liver transplant program at IKEM. In 1997 and 1998, he completed his monthly study stays in Mt. Sinai Hospital in New York and UCLA in Los Angeles. In 1998 he founded the IKEM Transplantation Surgery Clinic, where he worked as its head until 2004. Since 2004, when he was appointed Professor of Surgery, in 2005 he founded the Surgical Clinic of the 2nd Medical Faculty of the Charles University and the University Hospital Prague. For 4 months he was the Chief Medical Officer of the 6th Army Hospital of the Czech Army in Kabul (2008). Since 1 July 2010 he has served as Deputy Director of the Prague National Institute for Science and Education. From 12/2011 to 7/2014 he was a member of the Government Council for Science, Research and Innovation. From 1.4. 2014 is the chair of the newly established Agency for Health Research.

Abstract

Pancreatic cancer is solid malignant, chemoresistant tumour with unfavourable prognosis. Radical resection with adjuvant chemotherapy is only potential curable therapeutic modality enabling to prolong survival of 25% patients. Borderline conception contents active approach to primary non-resectable patients to reach resectability by neoadjuvant chemo (radio) therapy. Palliative and symptomatic therapy is indicated in about 70 % patients. In the case of suspicious of pancreatic cancer, patient should be referral to specialized centre. Effective diagnostic therapeutic approach only guarantees optimal quality of life of these patients.

Biography

Avgoustou C has specialized in General Surgery, working in the Greek National Health System since 1988, and his main areas of interest are Colon and Pelvic Surgery, Hepatobiliary Surgery, Gastric Surgery and Thyroid Surgery. He has been Director of Surgery in the Surgical Department of General Hospital of Nea Ionia ''Constantopoulion - Aghia Olga - Patission'' since 2008. He is Member of numerous Medical Societies. He has participated in hundreds of Congresses, with presentation of his work in 160, international in their majority. He has 111 publications, with 42 of them in international English-language Medical Journals. He has been trained in specific surgical topics, such as laparoscopic surgery, thoracic surgery, pelvic surgery etc.

Abstract

Aim: To describe difficulties, surprises and risks in urgent surgery in patients with complicated large paraesophageal hernia (PEH) and distal gastrointestinal obstacle.
Methods: Three cases with known PEH, I woman 78 yrs, II man 88 and III man 78, were urgently operated for strangulated/volvulised PEHs (I, II), and complete bowel obstruction due to strangulated dolichosigmoid volvulus (III). Cardiorespiratory embarrassment in all and sepsis in case I were encountered. Case I had coexistent incarcerated abdominal wall hernia, II had a previous-day gastroscopy that revealed a prepyloric lesion, and III a history of gastroesophageal reflux and constipation. Radiographies and chest-abdomen CT helped diagnosis. The findings are of in case I, after freeing the entrapped into the abdominal hernia bowel, the gastric fundus and body were found strangulated in mediastinum, fundus was ruptured, and antrum was ischaemic; total gastrectomy/splenectomy with stapled closure of esophagus and duodenum were performed. In case II, the whole stomach with prepyloric obstructive lesion was volvulised in mediastinum; distal gastrectomy/splenectomy, gastrojejunostomy, cruroraphy and fundopexy were performed. In case III, the strangulated dolichosigmoid volvulus was the prominent pathology, moreover, incarceration of gastric fundus and transverse colon in PEH sac were found; extended Hartmann's colectomy, caecopexy, reduction of PEH contents, cruroraphy and fundopexy were performed.
Results: Cases I and II were transferred intubated to ICU. Case I was never stabilized died after 50 hours; histology confirmed gastric necrosis. Case II was extubated at day 4, supported for pulmonary insufficiency, discharged at day 28; histology revealed antral ischaemia and obstructive prepyloric pT2 adenocarcinoma. Case III had uneventful outcome; histology revealed dolichosigmoid necrosis.  Follow-up of cases II and III (16 and 4 months respectively) is uneventful as far as the hernia complications are concerned.
Conclusions: Obstructive conditions distal to large PEHs may trigger acute complications in hernia sac contents, independently of the prominent indication to urgent surgery

Tracks

  • General Surgery and its Specialties | Advancements in Surgery | Oral & Maxillofacial Surgery | Plastic Surgery | Orthopaedic Surgery
Location: Salon 1
Speaker

Janusz S Targonski

MedBeauty Institute, Germany

Chair

Speaker

Ryska M

Charles University and Central Military Hospital, Czech Republic

Co Chair

Biography

Raunig Hermann after completing his studies of Medicine at the University of Graz Hermann Raunig, went on to obtain a degree in Otolaryngology in Leoben. He is a Member of the European Academy of Facial Plastic Surgery and the Austrian Academy of Cosmetic Surgery and Aesthetic Medicine. Furthermore, he undertook advanced specialist training as a Clinical Fellow in Facial Plastic and Cosmetic surgery from renowned centers in Swizerland, Germany, USA and South Africa. Additionally, he has published a soft technique for otoplasty and has written several chapters in a textbook about otoplasty. He works at his private practice as well as an ENT consultant at the hospital Spittal an der Drau. His main focus and surgical specialties as an ENT include: Otoplasty, Rhinoplasty and Blepharoplasty.

Abstract

Introduction: A hypertrophic conchal cavity will always complicate the shape of a malformed auricle. A reduction of the hypertrophic auricular cartilage must narrow the postauricular space, but must not narrow the auditory canal nor leave visible incision lines or buckles in the conchal cavity.
 
Objective & Methods: The proposed technique divides the protruding cartilage into a lateral and medial part. The medial part is flattened by scoring on its concavity and covered by a soft tissue pocket. The lateral part is sutured onto it.
 
Results: Since 2008 concha reduction was successfully performed in 620 ears. (Bilateral in 566 ears and unilateral in 54 ears)
 
Conclusion: The described technique is a very powerful cartilage saving method that allows harvesting conchal cartilage for rhinoplasty even decades after concha reduction. It is essential to avoid overcorrection.

Biography

Dominique P André Misselyn has graduated from Leuven University in 2003 as Surgeon. He is currently Trauma Surgeon at Gasthuisberg University Hospital. He has published several papers about calcaneal fractures and 3D imaging of this injury.

Abstract

The Sanders classification is the most used classification of calcaneal fractures, but it has a moderate inter-observer agreement. To improve this reliability, several authors tested the added value of 3D imaging but they were not really successful. After segmentation (virtual disarticulation), 11 intra-articular calcaneal fractures corresponding to different types of the Sanders classification were 3D-printed with a standard 3D-printer. The 3D-prints and their 2D-CT counterparts of the same fractures were presented separately to 24 observers (trainees, radiologists, foot surgeons). Inter-observer agreement for the Sanders classification was assessed by using the kappa coefficient values (Fleiss kappa, Brennan and Prediger weighted kappa). Three versions of the classification were considered: Sanders classification with subclasses, without subclasses and combining Sanders III and IV subclasses. The gold standard for classification was the peroperative findings by a single surgeon. The 3D print always yielded higher values for agreement and chance-corrected agreement. The (Brennan and Prediger) weighted kappa equaled 0.35 (for 2D) and 0.63 (for 3D) for Sanders with subclasses; (p=0.004), 0.55 (2D) and 0.76 (3D) for Sanders without subclasses (p=0.003); and 0.58 (2D) and 0.78 (3D) for the fusion of Sanders III and IV (p=0.027). There was also greater agreement with the peroperative evaluation, 88% vs 65 % (3D vs 2D, p<0.0001), and a higher percentage of Sanders III-IV with 2D compared to 3D, 56% vs 32% (p<0.0001). Based on this study we strongly advocate the use of 3D imaging of calcaneal fracture, with virtual disarticulation prior to perform osteosynthesis.

Biography

Fabiano Calixto Fortes de Arruda, is a Plastic Surgeon from Brazil, where he has completed his Msc and MBA. He has his expertise in Plastic Surgery, working with academic institutes and is also in practice. He is Chief of Department of Plastic Surgery and Burn unit of HUGOL/CRER.  He loves plastic surgery aesthetic and reconstructive. He has graduation in coaching to work as a leader and in financial aspects, living in the Midwest of Brazil; he is interested in development studies about areas of Plastic Surgery. He has many chapters of books and scientific articles, and he is publishing books about financial aspects.

Abstract

The alar nose is a structure build with mucous membrane, cartilage, subcutaneous tissue and skin. It is a functional and aesthetic structure of the nose with relevance, being affected by changes caused by nose surgery, infection and trauma. Recognition of the aesthetic and function alar rim at surgery creates a more elegant transition from the alar base to the tip. Surgery can cause iatrogenic concavity by the use of transdomal sutures, lateral crural suture spanning and removal of cephalic portion of lower lateral cartilage. Infection can destroy mucous membrane, cartilage and cause retraction. Trauma causes a loss of tissue resulting en retraction. These study present techniques to recovery functional and aesthetic structure of the nose, using cases about action specific in alar contour.

Biography

Turgut Donmez has completed his PhD from Istanbul University and Postdoctoral studies from Istanbul University Cerrahpasa School of Medicine. He is the Director of Premier General Surgery service organization. More than 40 articles and reports have been published in well-known magazines. He serves as a Member of arbitration in international scientific journals.

Abstract

Background: Postoperative pain and shoulder pain are the major complaints following laparoscopic cholecystectomy (LC). The aim of this study was to compare the impact of intraperitoneal bupivacaine versus spinal epidural anesthesia on pain relief after LC.
 
Patients & Methods: In a retrospective clinical study, there were three groups: group 1 (n: 49) LC under general anesthesia with intraperitoneal instillation with bupivacaine; group 2 (n: 51) LC under spinal epidural anesthesia and group 3 (n: 50) LC under general anesthesia. Patients were investigated regarding abdominal and shoulder pain (SP) using visual analog scale (VAS) in recovery room and at 6th, 12th and 24th hours postoperatively. Patients were also followed regarding postoperative analgesic requirements, nausea and vomiting, hypotension and patient satisfaction.
 
Results: There was no statistically significant difference in terms of gender, age, ASA, BMI mean among the groups. Patient satisfaction was higher in group 1 than group 2 and group 3 and statistically significant (4.89±0.30, 4.01±0.73, 3.28±0.49 respectively, p<0.001). SP just at the end of operation and 6th hours averages were statistically higher in group 3 compared to group 1 and group 2. On follow-up, the mean of SP 12th hour and 24 hours were found to be statistically significantly higher in group 2 than in group 1 (p<0.001). VAS just at the end of operation and 12th hour were statistically significantly higher in general group 3 than in group 1 and group 2, and in group 1 according to group 2. 6 hours and 24 hours VAS of group 3 was significantly higher than group1 and group2 (p<0.001).
 
Conclusions: Intraperitoneal bupivacaine washing in LC cases performed under general anesthesia or performing LC under spinal epidural anesthesia may be good options to reduce post operative pain/ shoulder pain and analgesic needs.

Biography

Amol Mittal has completed his MBBS in 2014 from Seth G S Medical College and KEM Hospital, Mumbai. Currently, he is pursuing MS General Surgery at B J Medical College and Sassoon General hospitals, Pune.

Abstract

 

Introduction: Simultaneous occurrence of Morgagni and the para-esophageal hernia is a rare clinical condition with eight case reports in the English-language literature and only four managed laparoscopically. We describe a case of a Septuagenarian patient with Morgagni and concomitant para-esophageal hernia treated laparoscopically.
 
Presentation of a case: A 71-year-old male patient, presented with a one-month history of regurgitation of acid, retrosternal burning and vomiting after eating. Computed tomography (CT) imaging demonstrated a large anterior diaphragmatic hernia, with herniation of bowel loops and anterosuperior displacement of the gastric antrum along with a grade III Para-esophageal hernia. The patient underwent simultaneous laparoscopic repair of Morgagni and para-esophageal hernia with mesh reinforcement with Nissen’s total anti-reflux fundoplication. The patient’s postoperative recovery was uneventful.
 
Discussion: A Morgagni hernia is a rare congenital condition consisting of a subcosto-sternal defect in the diaphragm. A para-esophageal hernia is a rare variant of a hiatus hernia. Morgagni and para-esophageal hernia may present with gastric volvulus or incarceration, requiring emergency treatment. Minimally invasive surgery is the preferred treatment, particularly for elderly patients and patients with comorbidities. The laparoscopic operation can provide excellent exposure and repair the hernia defect easily with minimal invasiveness and fewer complications.
 
Conclusion: This case report highlights the co-existence of Morgagni and para-esophageal hernias and validates the feasibility of laparoscopic repair of both hernias simultaneously.

Biography

Mariane Campopiano Abrahão Silva, occupational therapist, graduated from Medical School, University of São Paulo. In 2011, she was awarded with a scholarship from The School of Permanent Education of the University of São Paulo-Faculty of Medicine from Clinics Hospital. She completed the professional training in Occupational Therapy in Plastic Surgery and Burns in 2012 with an average mark of 9.96/10.  She completed the Latu Sensu graduate level program of Hand Therapy and Upper Limb Rehabilitation, offered by the Department of Occupational Therapy of the Biological and Health Sciences Center of the Federal University of São Carlos in 2013. Since she graduated, she has been working in renowned Brazilian’s hospitals, with splinting, hand rehabilitation and scientific research about upper limb rehabilitation. She is Member of the Brazilian Society of Hand and Upper Limb Therapy and she has been participating in researches, world congresses and symposia with published papers.

Abstract

The rehabilitation process is fundamental for the functional recovery during the pre and postoperative period of surgical cases from complex traumatic lesions of the hand and upper limb. Patient’s functional evaluation is the basis from which the procedures adopted by the hand therapist can be defined, analyzed and modified, according to the needs of each individual during the treatment. Currently, we observe that the rehabilitation beginning has been occurring more and more precociously; mostly on the first or second postoperative day according to the type of injury and the protocol adopted by the surgeon. This is a consequence of surgical techniques advances; more resistant sutures range which allow early passive motion; and the use of smaller incisions that decrease both the region trauma and the inflammatory process at the surgical site. The presence of the hand therapist during the surgical procedure can be of great value. The professional is able to evaluate the affected limb with the patient under anesthesia, which eliminates the "pain" factor. As a result, the therapist can observe more accurately if there are tendon retractions, joint contractures and joint stiffness. These complications are to the medical team so everyone will be aware about the challenges that will be faced during the patient’s rehabilitation and recovery. In addition, the hand therapist is also capable to fabricate splints in the surgical center if necessary. This procedure should be made exactly after the end of the surgery and after the dressing’s construction; in the final moments which the patient is still under anesthesia, aiming the right and best upper limb positioning without causing pain or discomfort to the patient. The hand therapist will continue to treat the patient in the outpatient setting, aiming the recovery of his autonomy and independence to perform ADLs with safety and quality.

Biography

Atilla Soran has completed his MD from University of Ankar, General Surgery Residency from Department of Surgery NHS Ankara Numune Teaching and Research Hospital, MPH from Graduate School of Public Health University of Pittsburgh. He holds different positions: Clinical Professor of Surgery, Director of International Breast Fellowship Program, Director of Lymphedema Program, and Director of Clinical Research for Breast Diseases. His research, clinical, and/or academic interests are Surgery in metastatic breast cancer, Lymphedema prevention and treatment, Optical Biopsy for breast lesions, Biomarker search for early breast cancer, Nomograms for prediction non-sentinel lymph node biopsy positivity, residual disease, Nomograms for lymphedema, Prediction model for predicting response to neo-adjuvant chemotherapy, Design of randomized studies for breast diseases. He is top oncologist in Pittsburgh, International Association of Oncologists, 2012. He was awarded Honorary Friendship Award, University of Uludag , Bursa Turkey, 2008; Man of Outstanding Accomplishment Award (DOFA), 2006; Fellow, American College of Surgeons, 2005; Best Physician and Scientist of the Year in Turkey, Baskent Group, Ankara, Turkey, 2005; Marquis Who’s Who in Science and Engineering, 2004-2005; Ege University Best Breast Cancer Research Award, Izmir, Turkey, 2000; Turkish Surgical Society-Sanofi Best Surgical Research Award, 1999.

Abstract

Background: The standard of care for management of distant metastasis in recurrent breast cancer (RBC) is systemic therapy. Metastatic site specific treatment is indicated in patients (pts) with symptomatic disease. There is limited data as to whether site specific intervention to distant metastasis in addition to systemic therapy would alter clinical outcomes and/or improve symptomatology. The aim of this retrospective study is to investigate short and long term outcomes in RBC pts who received intervention to distant site metastasis in addition to systemic therapy.

Methods: A prospectively-maintained cancer registry at a high-volume tertiary academic center was retrospectively reviewed for 435 RBC pts, from 2006 to 2016, who were diagnosed with stage I-III primary breast cancer (PBC). All pts had received standard of care treatment for PBC and had at least one distant metastatic lesion detected by radiological examination. Out of the 435 pts, 240 (55%) pts received additional interventions to the site of distant metastasis. Interventions to distant site metastases included surgery (OP), radiation therapy (RT), and radiofrequency ablation (RFA). Outcomes included post intervention morbidity, change of symptomatology and performance status (PS), length of hospital stay (LOS) due to intervention, and progression free survival (PFS).

Results: Two hundred forty pts (55%) underwent 544 interventions at total (2±1.7 (1-12) interventions per pts (Median ± SD (range)). The details of interventions were as follows; RT for bone (44%), RT for brain (38%), RT for other sites (4%), OP for bone (4%), OP for lung (3%), OP for liver (1%), OP for brain (4%), OP for other sites (2%), RFA for lung or liver (1%). Interventions were completed in 99% of cases. Complication data was adequately reported after 525 interventions. The most common complication for intervention was radiation dermatitis 15 (2.8%), and post intervention infection was diagnosed in 2 cases (0.4%); reoperation as well as hemorrhage rate was 0.2% (1/525). The data of symptom was available in 266 interventions, as well as the data of PS in 106 interventions. Improvement of symptoms was seen in 68% (180/266) of cases. PS was improved in 19% (20/106) of cases, and not changed in 68% (72/106) of cases after intervention. The data about LOS was reported in 279 interventions. 52% (144/279) of interventions were performed in an outpatient settings and the rest of the pts’ average LOS was 5±8.4 days (1-87). PFS for intervention was 4±0.3 months (M) (95% CI; 3-5) at any metastatic sites and 5±0.4 M (4-6) at the intervention site.

Conclusions: Our study demonstrated that intervention to distant metastatic site did not increase the rate of overall complications in pts with RBC. Symptoms improved in 68% with interventions. The final results of the study will demonstrate trends in PFS and overall survival.

Biography

Nugusu Ayalew has completed his BSc in Anaesthesia in 2012 from University of Gondar and MSc in Advanced Clinical Anaesthesia in June 2016 from University of Gondar School of Medicine and Health science. He is the Head of Anaesthesia Department at Dilla University and working as a Senior Clinical Anaesthetist, Research Adviser and Lecturer. He has published more than 2 papers in reputed journals.

Abstract

Background: Postoperative nausea and vomiting (PONV) is one of the most common and unpleasant symptoms affecting patients undergoing abdominal surgery under general anesthesia. It is also associated with complications such as gastric aspiration, bleeding, dehydration, wound dehiscence and delayed hospital discharge.
 
Objective: The aim of this study was to assess the effect of a sub hypnotic dose of Propofol on the occurrence and severity of PONV after open abdominal surgery under general anaesthesia.
 
Materials & Methods: A series of 72 adult (age 18) ASA class I or II patients, scheduled for open abdominal surgery were divided into a control group (n ¼ 36) and a Propofol group (n ¼ 36). The Propofol group was given 30 mg of 1% Propofol IV bolus after skin closure. All episodes and severity of PONV during the first 24 h after anaesthesia were evaluated.
 
Results: The overall incidence of PONV was significantly lower in Propofol group than the non-Propofol group during the first six postoperative hours (30.6% versus 66.7% respectively; p ¼ 0.002). There was a significant reduction in number of patients needing rescue anti-emetic during the first six postoperative hours in Propofol group when compared with none-Propofol group [5 (13.9%) and 15 (41.7%) respectively, (p ¼ 0.009)]. There were no significant differences between the groups with regard to their haemodynamic parameters and manifestations of respiratory depression.
 
Conclusion & Recommendation: Administration of a sub hypnotic intravenous dose of Propofol was effective in reducing the incidence and severity of PONV, and the need for rescue anti-emetic during the first six postoperative hours in patients undergoing open abdominal surgery under general anaesthesia. We recommend the use of 30 mg Propofol at the end of open abdominal surgery as part of multimodal approach for PONV.

Biography

Roberto Dell’Avanzato is Specialist in Surgery, Expert in aesthetic Medicine Surgery, Professor of Laser and Laser Liposuction (San Marino University) with a Master Degree in Aesthetic Surgery and a University Diploma in Mini-Invasive Surgery.

Abstract

Introduction: In October 2016, I started, as one of the first in Europe, my experience with a new procedure that represents the only FDA-cleared minimally invasive treatment clinically proven to improve the cellulite blemishes for nearly four years in only one session.
 
Materials & Methods: We report our experience after 15 months in 50 patients (48F; 2M) with cellulite treated in a single session. Follow-up were scheduled after 7 days (T7), 14 days (T14), 30 days (T30), 90 days (T90) and 180 days (T150) for all the 50 patients; 13 patients (1M) had a medical check at 12 months and 3 patients (1M) at 15 months. Outcome measures included subject photographs, Cellulite Severity Scale (CSS) and Global Aesthetic Improvement Scale (GAIS) assessment. Patient satisfaction and pain rating were also recorded. The treatment takes 45-60 minutes. Cellulite dimples are marked and the device is applied to stretch and stabilize tissue in a vacuum chamber, while local anesthesia is delivered. Then, a precise minimally-invasive subcutaneous release of the connective bands (TS-GS: stabilized-guided subcision) is performed with a micro-blade, without cuts or incisions. We have safely treated 6 to 45 sites in one session. After treatment, a light compression is applied and patients are able to return promptly to their daily life.
 
Results: The procedure treated successfully the primary structural cause of cellulite blemishes in all the 50 patients. Patient satisfaction was 87% at T90 in 50 patients (48F; 2M), 95% at T180 in 50 patients, 97% at 12 months in 13 patients (1M) and 100% at 15 months in 3 patients (1M). Transient treatment-related adverse events were mild in severity and the most common side effects reported were soreness and bruising. Among 50 patients, 95% had bruising at T7, 23% at T14 and no patient had bruising at T30. Soreness is reported in 100% of patients at T7, 19% at T14, 4% at T30 and 0% at T90. Global Aesthetic Improvement Scale (GAIS) and Visual Analog Scale (VAS) are also reported.
 
Conclusions: This revolutionary FDA-cleared procedure for the cellulite puckering combines a proven approach with an innovative technology to treat the primary structural cause of cellulite blemishes in posterior thighs and buttocks. This study confirms safety, and efficacy with vacuum-assisted precise tissue release for the treatment of cellulite, which is also strengthened by patients satisfaction.

Biography

 

Muhammad Aleem have completed his fellowship in General Surgery from Royal College of Surgeons Edinburgh and Dublin (Ireland) He has completed his basic and higher surgical training in Republic of Ireland and England. He has special interest in Laparoscopic Coloproctology. Currently he is working as a General Surgeon at Jersey General Hospital Channel Island of U K.

Abstract

Introduction: A continued debate exists regarding the timescale management of cholecystectomies; early versus delayed. On the contrary, delaying a procedure increases the risk of future gallstone related complications and perhaps re admissions.
 
Aim of study: This study looks to identify whether or not cholecystectomy procedures are undertaken using the most recent guidelines available and what this effect has on primary care: to see what proportion of patients are operated during the initial emergency presentation and how this influences any re-admissions, complications, conversion to open cholecystectomy and total number of bed nights occupied; to examine the local effects of cholecystectomy procedures on primary care. The study will examine waiting times and effects of delayed cholecystectomies in multiple GP attendances. 
 
Methodology: The study identified 100 patients who had undergone a cholecystectomy at Jersey General Hospital. Patients were identified using clinical coding on discharge summaries and operating theatre lists. 91 patient were admitted with cholelithiasis, 72 underwent cholecystectomies (Reviewed discharge summary and investigations individually). Of all patients presenting with acute cholecystitis, 47% (17/36) were managed ‘hot’. After exclusions (frail/comorbid, patient choice): 63%, 4/36 (11%) lap cholecystectomy for acute cholecystitis converted to open- all ‘hot’ gallbladders
 
Results: No statistical difference in those who developed bile duct injury, conversion to open procedure, operative length, quality of life or significant examples of mortality or morbidity. Total hospital stay reduced by 4 days in the early intervention group cost saving: £293 per early cholecystectomy. All acute cholecystitis presentations should be managed on initial presentation with laparoscopic/open cholecystectomy. Early laparoscopic surgery vs delayed should have a no-inferior rate of operative complications.
 
Conclusion: Doing more hot gall bladders in Jersey, this reduces re-presentations. The emergency list was dedicated for performing acute (hot) gallbladder.
 

Day2: August 7, 2018

Keynote Forum

Biography

Raunig Hermann after completing his studies of Medicine at the University of Graz Hermann Raunig, went on to obtain a degree in Otolaryngology in Leoben. He is a Member of the European Academy of Facial Plastic Surgery and the Austrian Academy of Cosmetic Surgery and Aesthetic Medicine. Furthermore, he undertook advanced specialist training as a Clinical Fellow in Facial Plastic and Cosmetic surgery from renowned centers in Swizerland, Germany, USA and South Africa. Additionally, he has published a soft technique for otoplasty and has written several chapters in a textbook about otoplasty. He works at his private practice as well as an ENT consultant at the hospital Spittal an der Drau. His main focus and surgical specialties as an ENT include: Otoplasty, Rhinoplasty and Blepharoplasty.

Abstract

Introduction: According to a lack of knowledge, otoplasty often is regarded as a minor cosmetic procedure. Antihelix plasty has become a symbol for otoplasty. Due to the big variety of antihelical malformations it can be very challenging to get a truly natural result.
 
Objective & Methods: The filing technique allows creating a smooth curvature of the superior crus and antihelical body by anterior access thus avoiding complications like hypertrophic scars or keloids in the post auricular space.  If needed, the inferior crus must be addressed and released.
 
Results: Since 17 years the presented method was performed in more than 2000 ears. It has proven to be superior to the standard techniques.

Biography

Punita Tripathi was a practicing Cardiac Anesthesiologist at India’s premier medical institute the All India Institute of Medical Sciences (AIIMS), New Delhi, before coming over to USA in 1996. There after she completed her Residency in Anesthesiology from Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA in 2002. Since 2002 she is on Faculty at Johns Hopkins University, Baltimore, MD. For the past five years she has been Director of Neurosurgical Anesthesia at Johns Hopkins Bayview Medical Center and has been actively involved in writing protocols for Awake Craniotomy and Anesthesia for Neurosurgical cases.  Her areas of interests are Neurosurgical Anesthesia, Thoracic Anesthesia and Obstetric Anesthesia. She has authored papers in reputable journals and written book chapters. 

Abstract

Introduction: Awake craniotomy with intraoperative brain mapping, allows for maximum tumor resection while monitoring neurological function and is used for lesions involving the eloquent areas of the brain, such as Broca's, Wernicke’s, or the primary motor area. Common techniques are MAC, using an unprotected airway, or the AAA technique, using a partially or totally protected airway.
 
Method: A prospective data collection and retrospective data analysis was conducted on 81 patients who underwent an awake craniotomy for an eloquent brain lesion over a 9 year period. 50 underwent anesthesia with the MAC technique and 31 patients underwent the AAA technique by a single surgeon and a team of anesthesiologists. MAC technique’s method has no set protocol for sedation, different medications for MAC based on the comfort level of anesthesiologist, requirements of the patient and whether the scalp block is working well. AAA technique’s method uses Propofol was used for induction followed by laryngeal mask airway placement. Anesthesia was maintained with sevoflurane until the patient was spontaneously ventilating and asleep. A complete scalp block was performed in all patients. Infiltrative block is performed at the pinning site, incision site and after craniotomy around the nerves supplying the duramater. Bupivacaine or Ropivacaine 0.5% with 1:200,000 of epinephrine is usually used
 
Resullts: The MAC and AAA groups had similar pre-operative patient and tumor characteristics. Mean operative time was shorter in the MAC group (283.5 minutes vs. 313.3 minutes; P: 0.038). Hypertension was the most common intraoperative complication seen (8% in the MAC group vs. 9.7% in the AAA group; P: 0.794). Intraoperative seizure occurred at a rate of 4% in the MAC group and 3.2% in the AAA group (P: 0.858). Awake cases were converted to general anesthesia in no patients in the MAC group and in 1 patient (3.2%) in the AAA group (P: 0.201). No cases were aborted in either group. The mean hospital length of stay was 3.98 days in the MAC group and 3.84 days in the AAA group (P: 0.833).

Biography

Dr. Ulf Thorsten Zierau, Born in 1960 at Magdeburg (GDR), he studied  medicine at Humboldt - Universität Berlin from 1982 - 1988, bachelor of medicine 1987, promotion and doctor of medicine 1988, assistant in surgery / vascular surgery in Charité Berlin from 1988 - 1994 (Prof. Wolff, Prof Bürger), specialization in vascular surgery in vein - center Mühlenberg Klinik Malente and university of cologne 1994 - 1996, chief of department vascular surgery at hospital Gransee from 1996-1997, own practice in vascular surgery and phlebologie since 2/1997 in Berlin, since 2012 also in Rostock. Dr. Zierau one of the first vascular surgeons who were allowed to work by means of catheter technology in the arterial system. This was due to the special training in the Chartitè, as well as to a study visit to the Stanford University in USA. There, together with a colleague from Potsdam and a colleague from Nuernberg, he was able to study catheter technology in the vascular system for the first time - and then put it into practice. So it was obvious that from 2002 we also used the various catheter systems in the venous system. And so it was only logical that Dr. Zierau - although a passionate surgeon and vascular surgeon - consistently works with the gentlest treatment methods when it comes to removing spider veins and varicose veins. This led to an all-changing decision in 2012 - no more radical surgery on the venous system! No stripping and no phlebectomy (check mark method) With the departure from the old surgical methods, the scalpel lost importance. Important were catheter and ultrasound. Overall, the path consistently led to gentle treatments, which resulted in a faster healing through the minimal intervention.Specialist in surgery, vascular surgeon and phlebologist - specialized in diagnostics and therapy of varicose veins and venous diseases - own practice since 1997 in Berlin - since 2002 catheter-assisted treatment methods - since 2012 Praxisklinik Rostock and the consequent dedication to minimally invasive catheter-assisted and ultrasound-guided therapies. - since 2017 member of the German Society of Phlebology (venous medicine)

Abstract

The paper is about long-time experiences in sealing truncal varicose veins: 6 years follow up in treatment of 1100 cases and 2000 truncal varicose veins. Since 18 years by now, varicosis has been increasingly treated endovenously. At the start, the rather inconvenient VNUS®Closure plus - procedure and the more convenient linear laser procedure were used, and these were followed in 2006 / 2007 by the bipolar RFITT® catheter, the VNUS® Closure Fast system and the radial laser. Thus, in the course of the last few years, plenty of experience has been gathered with endoluminal therapy, quality criteria have been defined and standards for the different techniques have been developed. I have begun with endovenous therapy in 2002, at first we have used the linear laser system, and in 2007 we changed to the RFITT - system and also began with the micro foam therapy. We at Saphenion in Berlin and Rostock have applied the Venaseal - Closure System for the first time in a great saphenous vein on 1st Aug’ 2012. Now we are working since 6 years with the super glue. We want to report about our actually long time experiences of a prospective single center comparative study of VenaSeal® – glue in the treatment of 2000 truncal varicose veins in 1100 patients.

Tracks

  • General Surgery and its Specialties | Neurosurgery | Orthopaedic Surgery | Advancements in Surgery
Location: Salon 1
Speaker

Punita Tripathi

Johns Hopkins University, Baltimore, Maryland, USA

Chair

Speaker

Raunig Hermann

Hospital Spittal, Spittal an der Drau, Austria

Co Chair

Biography

Dr. Ashok Chattoraj - Head Consultant, Department of Surgery, Tata Main Hospital, Jamshedpur. Working with Tata Steel, in this hospital since 1994. Completed M.B.B.S in 1986 from S.C.B. Medical College, Cuttack- M.S.(Master of Surgery) in General Surgery in 1994 from Grant Medical College, Mumbai. He is Fellow of the Indian Association of Gastrointestinal Endoscopic Surgeons (FIAGES). His areas of interest and work include Laparoscopic surgery, Surgical Oncology, Hepato-biliary surgery, he have 11 publications in various surgical journals. He had several national level & state level paper presentations in many conferences. He teaches and train surgical post graduate students who are pursuing the DNB degree course.

Abstract

14 cases of rectal cancer were treated laparoscopically along with 16 cases by traditional open abdomino perineal resection (APR) from Jan 2011 till Dec 2017. The morbidity and length of hospital stay for the laparoscopic group was low along with reduced pain and early return to work. The surgical outcomes in terms of wound healing, proper lymph node clearance along with the tumour were similar in both the groups. Stage 1 and Stage 2 diseases were taken in this study. The operating time was more in the laparoscopic group (4 hrs : 2.5 hrs) but the blood loss was more in the open group (670 mL: 920 mL). The post operative follow up of  both groups in terms of quality of life are similar. Patients who underwent Laparoscopic APR joined work in 15.5 days while those with open APR joined work after 28 days.

Biography

William Heseltine-Carp is a 4th year Medical Student at Cardiff University, currently completing an intercalation year in Neuroscience BSc. This project was completed with the help of Consultant General surgeon, Mr. Rhodri Williams, Department of Surgery, Royal Glamorgan Hospital, Llantrisant.

Abstract

Immediate insertion of an anatomical prosthesis that matches breast contour and excised mastectomy volume while retaining the enclosing skin envelope results in a natural and largely unaltered breast mound that readily matches the contralateral side. However, potential complications require careful short term follow up. We reviewed records of 78 patients who underwent a skin-sparing / immediate implant technique from 2009 to 2016 (15 with an uplift for ptosis). Mean age was 53 years (range 32 to 73). All received prophylactic IV antibiotic at the time of surgery. After initial discharge home, 32 patients received antibiotic treatment for various signs of infection: in-patient IV Teicoplanin (9 patients) and Co-amoxiclav (10) and more recently an equally effective oral combination of Flucloxacillin and Clindamycin (13). Signs of infection resolved promptly in 20 cases. Using a small submammary incision, 12 patients with ongoing symptoms underwent implant exchange, antiseptic pocket irrigation and insertion of Colotamp® (gentamicin sponge). Only 2 patients subsequently required implant removal. Microbiology identified “normal skin flora” in 10 cases and Staph aureus in 4. Wound edge necrosis required superficial debridement in 4 additional patients. Mean hospital stay was 3.1 days in uncomplicated cases and 7.2 days in those treated for infection. Complications were commoner in smokers. Skin preserving mastectomy with immediate permanent implant insertion now provides excellent cosmesis without recourse to flaps and more extensive surgery. Surgery is often carried out through a small incision and retraction traumatizes the edges which may require excision at the time or subsequently. The more prolonged subcutaneous dissection involved in this procedure seems to predispose to low grade infection, often with non-pathogenic organisms. Appropriate combination oral antibiotics can be effective in this context and avoid readmission. Despite apparent prosthesis infection, the described technique permits successful implant replacement. No acellular dermal matrices (ADMs) required removal as none were inserted, also an important cost saving.

Biography

Dewaraj Velayudhan has completed his MBBS from Kasturba Medical College, Manipal, India in 2018. Having a passion in Neurosurgery, he has involved in couple of neuro-related projects as an Assistant. This is his first venture in a neurosurgery-related project as a Principal Investigator.

Abstract

Traumatic brain injury is the most significant cause of death in trauma patients. Various prognostic methods have been implemented but none has predicted the outcome of patients precisely. Acute traumatic coagulopathy is a hypo-coagulable state that takes place in severely injured patients, including Traumatic Brain injury (TBI) patients. On the other hand, INR (International Normalised ratio) is a measure of the extrinsic pathway of coagulation, hence determining the clotting tendency of blood. INR reflects this hypo-coagulable state and has been found to be of prognostic significance in some studies done in multi-trauma patients. However, its value in isolated TBI patients has yet to be validated.  Being a routine initial investigation for trauma patients, INR has the potential to be a cost-effective prognostic tool. Our study aims to establish a predictive value of INR for isolated traumatic brain injury-related mortality thus, proposing INR as additional prognostic tool. This was done by analysing the INR values in relation to Glasgow Coma Score and Glasgow Outcome Score of 105 patients with isolated TBI patients.

Biography

Ivan Maly, Associate Professor, General and Vascular Out- patient Surgery Centre, Head Doctor, Prague, Czech Republic

Abstract

 
Methods: We have been performing the radical endovenous laser therapy, ELVeS, in the treatment of the chronic insufficiency of the saphenous veins since 2004. The 980 nm wave- length has been used until the end 2007, and the 1470 nm from 2008, to date. All patients underwent the procedure under conditions of aseptic operating theatre. In total, we treated 835 patients, the great saphenous veins in 724, the small saphenous veins in 103, bilateral in 102, the accesory veins in 77 cases. We always sought to treat simultaneously all varices on the extremities during the initial endo-laser therapy. All dilated branches were closed by la- ser, or instrumentally, or by sclerotisations.      
 
Results: Within 1 to 8 years after the procedure, 53.6% patients were examined. The partial recanalisations in the main veins were observed in 6.5% patientss with 980 nm and in 8.5% with 1470 nm device, the complete recanalisation in 2.8% pts with 980 nm and in 2.3% with 1470 nm device. All patients with recanalisations were reoperated. The recurrence in the groin was found in 2.8% pts with 980 nm and in 5.5% with 1470 nm device. The immediate complications after surgery were: longer lasting parestesia in 2.6 %, skin burn of mild degree in 1.6% , deep venous phlebotrombosis in 0.2% pts.
 
Ten conclusions: The indications for ELVeS of magistral veins and their branches must be established after the clinical and the ultrasound Doppler examination. This enables to determine the ex- tent of the surgery for the individual patient. ELVeS should be performed at surgery, angiosurgery or phlebology departements respectively, where the procedure can be modified or extended for example with crossectomy, ligature, instrumental resection of the branches, etc. We believe, that the standard approach to the ELVeS procedure is that it should be performed under aseptic conditions in the operating theatre with multiple choices of analgesia. The only out-patient setting often limits the extent of the radical treatment. The specialization of the physician shouldn’t limit the primary procedure. The ex-tent of the procedure should be determined after the basic examination, if and where the crossectomy, ligature, modified pinhole crossectomy, instrumental removal of too coiled branch, foam sclerotization, etc., is to be performed lege artis. The nature of the disease itself predicts, that the chronic venous insufficiency is a long term, sometimes even life long burden for the patients. It is determined genetically, profesionally static load, constitutionally overweight, hormonally contraception, and by bad habits smoking, etc. The primary extent of the procedure is the key factor of the  treatment in reducing the recurrence of the disease. Long term prevention of the recurrence of the disease including patients‘  follow up is also very important. This is the only way to reduce late complications and recurrences, e.g  in the extreme static load, sports, travelling, etc. While some authors emphasize also the established role and comeback of stripping or cryostripping surgical procedures, after their long term, 10 years and more, it is neces-sary to keep emphasizing big advantages of endovasal procedures, of course if the complexity of the primary treatment, including combined procedures, is respected. Concurrent price evaluation of the individual therapeutical methods is and will be, very important, also when compared to the traditional stripping method. Nowadays, no method of the radical treatment of the insufficiency of the superficial venous system can be considered obsolete for the above mentioned reasons. Recently, the combined procedures have been used more and more. We believe, that the future of the radical endo-laser closure of the insufficient superficial venous system of the lower limbs lies in a further improvement and wide use of fibers and laser energy with a wavelength around 1500 nm and with the possibility of a simultaneous percutaneous treatment of intracutaneous spider veins. Or even higher wavelength may be used. Further technical development is very likely in this area, as well as the establisment of internationally recommended standards of the treatment.

Biography

Emre Karadeniz has completed his MD from Osmangazi University School of Medicine and Residency from Baskent University School of Medicine. He has completed his Spine Surgery fellowship from Hacettepe University, Istanbul Spine Center in Turkey and BASS/BSS in England. He is working as a Lecturer and Spine surgeon at the Orthopedics and Traumatology Department of Kocaeli University Faculty of Medicine. He is the inventor of EFECE fixation systems. He has lots of national and international prizes for the invention of this EFECE Systems.

Abstract

EFECE Systems are patented newly defined fracture fixation systems. EFECE System contains; EFECE device, EFECE wire and surgical tools. Surgical tools are for compression of the fracture line, locking and unlocking the EFECE device and for cutting the EFECE wire. EFECE systems are totally suitable for percutaneous technique. EFECE device is cylinder-shaped with a 6-mm radius and a 5-mm length that features a hole for the insertion of a 1.2-mm EFECE wire. EFECE device contains 2 pieces that catch each other with threads. The top piece functions as a cap, whereas the second piece contains 3 gloves for the insertion of 3 balls. These balls have a 1.5-mm radius. The locking mechanism receives help from the balls in the cone-shaped gloves. In forward movements, the balls move back to the base of the cone. During pulling movements, the balls move to the narrow part of the cone and lock the EFECE wire.
 
Surgical technique: After reducing the fracture, EFECE wire should be passed across the fracture line. EFECE device should be advanced on the EFECE wire till the bone cortex, with the help of the patented tools, and then fastened with percutaneous technique. From the counter side of the EFECE wire, the second EFECE device must be advanced till the bone cortex too.  After completion of these steps, EFECE wire should be tensioned with EFECE wire stretcher and then EFECE device should be fastened percutaneously. The remaining part of the EFECE wire must be cut with the EFECE wire cutter.  With this last step of the surgical technique, skin incision can be closed. During implant removal; with unlocking the EFECE device, with the help of EFECE Magnets EFECE device can be detached from the EFECE wire easily. EFECE systems are able to achieve fixation with the help of thin EFECE wires. The fixation strength is not related to bone quality. Thin EFECE wire achieve fixation in difficult bone anatomy like elbow. Technique is completely percutaneous. Indication scale is wide and implant removal with magnets is also a new approach for implant technologies.

Biography

Nezar A Almahfooz is a Board degree certified general surgeon from the Council of Arab Board Surgery (CABS) 1992. He is Senior Consultant General, GIT, Bariatric and Metabolic surgeon in Faruk Medical City, Sulaymania, Leader and Director MIS surgery of Almowasat private hospital, Basrah-Iraq. He has pioneered the advanced laparoscopic and bariatric surgery in Iraq for the last 14 years. He has many international and regional memberships: Member Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Fellow of American College of Surgeons (FACS), Fellow of American Society for Metabolic and Bariatric Surgery (ASMBS), Member of the International Federation of Obesity Surgery (IFSO), Society of Laparoscopic Surgery (SLS), Egyptian and Arab societies of laparoscopic surgery (ESLS) and (ASLS), Establishing member of Iraqi Society of Metabolic and Bariatric Surgery (ISMBS). He has more than 21 published articles in general minimally invasive surgery, introduces many novel minimally invasive surgical techniques in Iraq.

Abstract

Background: Single incision laparoscopic surgery (SILS) is a natural evolution of minimally invasive surgery (MIS) era. The advent of SILS was in the field of gynecology 1969. SILS gain acceptance and has been introduced in general and bariatric surgery soon. Purpose was esthetic (scarless surgery), minimize parietal trauma, less pain and fast patient postoperative recovery. Despite these advantages, there is a concerned report of complications. Aiming to overcome the SILS complications, this novel technique; Single Incision Multiport Laparoscopic Surgery (SIMPLS) was innovated in Iraq.
 
Method & Procedure: SIMPLS is a single surgeon prospective study conducted from Aug’ 2009- Dec’ 2017, in four hospitals in Iraq with the same laparoscopic platforms. Technique was tested in different laparoscopic operative procedures on 133 different cases. 
 
Results: Cholecystectomy (n=76), sleeve gastrectomy (n=20), appendectomy (n=9), diagnostic laparoscopy (n=8), hydatid cystectomy liver (n=4), fundoplication (n=4), ovarian cystectomy (n=3), renal cystectomy (n=3), Removal of gastric band (n=3), small bowel surgery (n=20), and combined sleeve gastrectomy and hiatal hernia repair (n=1). Time spend initiating ports ranging from 9-12 minutes. No much difficulty or struggle faced using standard laparoscopy instruments. No conversion was reported till today. The cosmetic outcome found to be extremely acceptable by surgeon and patients. 
 
Specific complications & difficulties: One case difficult intra-corporal liver retraction, gall bladder retraction in a severely inflamed gall bladder, bleeding at (angle of His), hematoma and ecchymosis, no port incision infection, and no incisional hernia 
 
Conclusion: SIMPLS technique is introduced by author as novel procedure in Iraq 2009 and is valid till today. Similar technique started few years before in other centers. Benefits of the procedure: technically feasible, reproducible for expert devoted surgeons, shorter time ports initiation, excellent esthetic results, lowest cost, not associated with incisional hernia. I advise wider practice, more trials to confirm these findings. I suggest it for interested experienced minimally invasive surgeons.­­­­­
 

Biography

Hafsa Younus is a Surgical Trainee and is currently working as a Senior Researcher at King’s College Hospital London. She is an inquisitive Researcher with a special interest in new and novel techniques and innovative ideas to improve postoperative outcomes. She has published many papers in peer reviewed journals and is serving as a Reviewer of a reputed journal.

Abstract

Introduction: Obesity surgery mortality risk scoring system (OS-MRS) classifies patients into high, intermediate and low risk; based on age, body mass index, sex and other co- morbidities such as hypertension and history of pulmonary embolism. High risk patients not only have a higher mortality, but are more likely to develop post-operative complications necessitating intervention or prolonged hospital stay following bariatric surgery. Endoscopically placed duodenal-jejunal bypass sleeve (EndoBarrier) has been designed to achieve weight loss and improve glycaemic control in morbidly obese patients with clinically proven effectiveness. The aim of this study was to assess if pre-operative insertion of endobarrier in high risk patients can decrease morbidity and length of stay after bariatric surgery.
 
Materials & Methods: In between 2012 and 2014, a cohort of 11 high risk patients had an EndoBarrier inserted (E&BS Group) for one year prior to definitive bariatric surgery. These patients were compared against a similar group undergoing primary bariatric surgery (PBS Group) during same duration. The two groups were matched for age, gender, body mass index, co-morbities, surgical procedure and OS-MRS using propensity score matching. Outcome measures included operative time, morbidity, length of stay, ITU stay, readmission rate, percentage excess weight loss (%EWL) and percentage total weight loss (%TWL).
 
Results: Patient characteristics and OS-MRS were similar in both Groups (match tolerance: 0.1). There was no significant difference in total length of stay, readmission rate, %EWL and %TWL. Operative time, ITU stay, post-operative complications and severity of complications were significantly less in E&BS Group (p<0.05) with significant likelihood of planned ITU admissions in PBS group (p<0.05).
 
Conclusion: EndoBarrier could be considered as a pre-bariatric surgical intervention in high risk patients. It may result in improved postoperative outcomes in high risk bariatric patients.