Lietuvos chirurgija <p>Founded in 1993. Publishes scientific surgical articles written by Lithuanian and foreign authors.</p> Vilniaus universiteto leidykla / Vilnius University Press en-US Lietuvos chirurgija 1392-0995 <p>Please read the Copyright Notice in&nbsp;<a href="">Journal Policy</a>.&nbsp;</p> Ureteroplasty Using Buccal Mucosa Graft in Complicated Long Segment Ureteral Stricture: Clinical Case Report <p><span class="char-style-override-4">Background.</span>&nbsp;Recurrent proximal ureteral stricture is a complex rare disease that is difficult to treat. Post-operative scarring, impaired blood supply to the ureter, stricture-related stones, and chronic infection – all factors make the treatment even more complicated.&nbsp;<br><span class="char-style-override-4">Methods.</span>&nbsp;There are various surgical procedures for ureteral reconstruction, however, most of them are very traumatic and quite often ineffective. Our case reports the first experience of treating a complicated recurrent proximal ureteral stricture with ureteroplasty using a buccal mucosa graft.&nbsp;<br><span class="char-style-override-4">Results.</span>&nbsp;The patient had a 12-month post-operative follow-up. No stricture recurrence was observed and hydronephrosis decreased. Although the excretory function of the left kidney remained lower, serum creatinine became normal. The most important clinical outcome was the withdrawal of left flank pain.&nbsp;<br><span class="char-style-override-4">Conclusions.</span>&nbsp;We are lacking high volume clinical trials for appropriate ureteral stricture treatment modality. All available publications in this field compare single cases or low volume studies. While buccal mucosa graft procedures are well established in urethral reconstruction, our case proves that buccal mucosa graft method can be successfully used for ureteroplasty as well, providing good post-operative functional outcomes.</p> Gustas Sasnauskas Aivaras Grybas Copyright (c) 2021 Gustas Sasnauskas | Aivaras Grybas 2021-05-06 2021-05-06 20 2 86 94 10.15388/LietChirur.2021.20.44 Editorial Board and Table of Contents <p>&nbsp;&nbsp;</p> Narimantas Evaldas Samalavičius Copyright (c) 2021 Authors 2021-05-06 2021-05-06 20 2 57 67 Mechanical Circulatory Support for Myocarditis Complicated by Cardiogenic Shock <p><em>Background.&nbsp;</em>Cardiogenic shock caries high mortality and morbidity<span class="char-style-override-4">.&nbsp;</span>Myocarditis patients developing cardiogenic shock refractory to medical treatment might benefit from extracorporeal membrane oxygenation or mechanical ventricular assist devices.&nbsp;<br><em>Methods.</em>&nbsp;A retrospective, single center observational study to assess the rate and outcomes of mechanical circulatory support of patients with fulminant myocarditis related cardiogenic shock. Short-term outcomes were evaluated. The primary endpoint of the study was hospital survival.&nbsp;<br><em>Results.</em>&nbsp;Two hundred ninetyone patient were supported with short-term mechanical assist devices at our institution during 12 year period. Among them, 4 (1.4%) were treated for myocarditis related cardiogenic shock. All patients were female, with a mean age of 34±4<span xml:lang="ar-SA">&nbsp;</span>years. In one case surgically implantable short-term mechanical assist device was used, in other three cases&nbsp;– extracorporeal membrane oxygenation. The mean duration of the support was 364±273<span xml:lang="ar-SA">&nbsp;</span>hours, mean intensive care unit stay&nbsp;– 35<span xml:lang="ar-SA">±2</span>9<span xml:lang="ar-SA">&nbsp;</span>days. Three of four patients were successfully weaned from the support and discharged from the hospital with complete heart function recovery.&nbsp;<br><em>Conclusion.</em>&nbsp;Patient with fulminant myocarditis, who would have died without the initiation of mechanical circulatory, had favorable short-term outcome with 75% survival rate.</p> Agnė Jankuvienė Nadežda Ščupakova Karolis Urbonas Lilė Mikelevič Renata Drutel Robertas Samalavičius Copyright (c) 2021 Authors 2021-05-06 2021-05-06 20 2 68 72 10.15388/LietChirur.2021.20.41 Initial Experience of Minimally Invasive Gastrectomy for Gastric Cancer in Vilnius University Hospital Santaros Klinikos and National Cancer Institute: Clinical Case Series and Literature Review <p><span class="char-style-override-5">Background. </span>Gastric cancer remains one of the most common cancers in Lithuania and Worldwide. Surgical treatment is the only potentially curative treatment option for it. Historically open gastrectomy was considered as the gold standard approach. Although, the development of minimally invasive surgery and accumulation of the clinical data has led to the adoption of minimally invasive gastrectomy.&nbsp;<br><span class="char-style-override-5">Clinical cases.&nbsp;</span>We present a series of 8 clinical cases who underwent minimally invasive surgery for early or locally advanced gastric cancer in Vilnius University Hospital Santaros Klinikos and the National Cancer Institute.&nbsp;<br><span class="char-style-override-5">Discussion.&nbsp;</span>Large scale randomized controlled trials in Asia have proved that laparoscopic surgery is safe and oncologically effective for clinical stage I distal gastric cancer. The increa­sing amount of data supports the safety of minimally invasive gastrectomy for advanced or proximal gastric cancer. Most of the trials performed in Asia confirmed, that laparoscopic gastrectomy has some advantages, including: decreased blood loss, decreased post­operative pain, and morbidity. Recent randomized controlled trials of Western countries proved the safety of laparoscopic gastrectomy and the comparable 1-year long-term outcomes. Although, they failed to show improved recovery after minimally invasive surgery. Currently, there is sufficient evidence to adopt minimally invasive gastrectomy for gastric cancer into routine clinical practice in Lithuania.&nbsp;<br><span class="char-style-override-5">Conclusions.&nbsp;</span>The first experience of minimally invasive gastric cancer surgery in Vilnius University Hospital Santaros Klinikos and the National Cancer Institute was successful. All gastrectomies were radical, and without major postoperative complications.</p> Martynas Lukšta Gustas Sasnauskas Augustinas Baušys Andrius Rybakovas Justas Kuliavas Rimantas Baušys Kęstutis Strupas Copyright (c) 2021 Authors 2021-05-06 2021-05-06 20 2 73 85 10.15388/LietChirur.2021.20.43 Combined Reconstructive Surgery after Complex Hand Injuries: Clinical Case and Review of Literature <p><span class="jlqj4b">The article deals with one of the most complex hand injuries in the practice of plastic and reconstructive surgery – amputation of degloving the upper tissues of the upper limb.</span><span class="viiyi">&nbsp;</span><span class="jlqj4b">The clinical case of a woman who has suffered from this trauma, the course of treatment, remote functional and aesthetic results are presented.</span></p> Domas Kurlavičius Gediminas Rauba Giedrė Stundžaitė-Baršauskienė Copyright (c) 2021 Authors 2021-05-06 2021-05-06 20 2 95 102 10.15388/LietChirur.2021.20.45 Comparison of Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (TNS) for Treatment of Fecal Incontinence: Literature Review and Meta-analysis <p><em>Aim.</em>&nbsp;To evaluate and compare effectivenes of sacral and posterior tibial nerve stimulation for treating fecal incontinence.<br><em>Methods.</em>&nbsp;Systematic literature review was performed to compare sacral and posterior tibial nerve stimulation effectiveness. Research was performed in “Medline” database, using the “PubMed” website. English or lithuanian articles, published between 2008 and 2019, were included in our study. Results were described to assess the effect of interventions in each analysed article. We included 7 articles into meta-analysis. Articles compared the effectiveness of sacral or posterior tibial nerve stimulation with control groups or other treatment methods for managing fecal incontinence. Cochrane guidelines were used to perform this meta-analysis.&nbsp;<em>Results.</em>&nbsp;The results of meta-analysis suggests that sacral neuromodulation is superior to posterior tibial nerve stimulation to treat fecal incontinence compared to control groups or other treatments. Literature also suggest that after comparing these methods directly, sacral neuromodulation is superior to treat fecal incontinence a.&nbsp;<em>Conclusion.</em>&nbsp;Sacral neuromodulation is superior posterior tibial nerve stimulation to treat temporary or chronical fecal incontinence than and can be used as an alternative for surgical interventions.</p> Rytis Tumasonis Arūnas Petkevičius Saulius Švagždys Copyright (c) 2021 Authors 2021-04-16 2021-04-16 20 2 12 19 10.15388/LietChirur.2021.20.36 Editorial Board and Table of Contents <p>&nbsp;&nbsp;</p> Narimantas Evaldas Samalavičius Copyright (c) 2021 Authors 2021-04-16 2021-04-16 20 2 1 11 Laparoscopic treatment of inguinal hernia in female children – national experience <p><em>Background.&nbsp;</em>Although, laparoscopic inguinal hernia repair in children is gaining ground as a safe, feasible, and popular method, still many pediatric surgeons continue to debate its safety, efficacy, and cosmesis in comparison with conventional open repair.&nbsp;<em class="char-style-override-4">Materials and m</em><em class="char-style-override-4">ethods.</em><span class="char-style-override-5">&nbsp;</span><span class="char-style-override-4">This was a prospective clinical study, that elaborated 98&nbsp;female children aged 1–14 with clinically diagnosed indirect inguinal hernia. Equal proportions of 49&nbsp;children were treated via laparoscopic (PIRS) either conventional open repair (OR). Outpatient clinic follow up was performed regardless of the type of the intervention, on the 7</span><sup class="char-style-override-6" xml:lang="en-US">th</sup><span class="char-style-override-4">&nbsp;day and 6</span><span class="char-style-override-5">&nbsp;</span><span class="char-style-override-4">weeks after discharge.&nbsp;</span><em class="char-style-override-4">Results.&nbsp;</em><span class="char-style-override-4">The mean age of children in PIRS vs. OR group was 5.3±2.7 vs. 5.9±</span><span class="char-style-override-4">3.3&nbsp;years. There was no significant differences between the groups related to age (p&nbsp;=&nbsp;0.4221), weight (p&nbsp;=&nbsp;0.</span><span class="char-style-override-4">5482), family history (p&nbsp;=&nbsp;0.5377), and residency rural/urban (p&nbsp;=&nbsp;0.3161). The average length of unilateral vs. bilateral PIRS repair (29</span><span class="char-style-override-4">.5±6.8 vs. 43.6±7.2&nbsp;min) was significantly shorter than OR (44</span><span class="char-style-override-4">±4.2 vs. 97±8.1&nbsp;min) for consequently p&nbsp;=&nbsp;0.0023 vs. p&nbsp;</span><span class="char-style-override-4">=&nbsp;0.00001. The post-operative hospitalization after PIRS repair was 14.1±3.1 hours and was significantly shorter compared to OR&nbsp;– 44±4.</span><span class="char-style-override-4">2&nbsp;hours (p&nbsp;=&nbsp;0.00001). In OR group, 4 (8.2%) children had postoperative nausea compared to none in PIRS group. Significantly bigger cosmetic satisfaction was found in PIRS compared to OM group (p&nbsp;=&nbsp;0.</span><span class="char-style-override-4">0001).&nbsp;</span><em class="char-style-override-4">Conclusion.</em><span class="char-style-override-5">&nbsp;</span>With due respect to OR as a gold standard, the proven advantages of PIRS are motivation for further improvement of this technique for the purpose of treatment of inguinal hernia of female children.</p> Toni Risteski Copyright (c) 2021 Authors 2021-04-16 2021-04-16 20 2 20 26 10.15388/LietChirur.2021.20.37 Low-grade Appendiceal Mucinous Neoplasm (Appendiceal Villous Adenoma) with Cystic Fibrosis: A Case Report <p>Cystic fibrosis (CF) is an autosomal dominant disease characterized by the dysfunction of exocrine secretory glands resulting from a mutation in the transmembrane regulator protein (CFTR) gene. As life expectancy increases in patients with cystic fibrosis secondary to advances in treatment, advanced age malignancies secondary to cystic fibrosis emerge. Especially, the frequency of gastrointestinal system malignancies and colon cancers increases with aging. Appendiceal tumors are a rare entity and constitute less than 1% of gastrointestinal tumors. We presented a villous adenoma encountered in an 18-year-old male patient with CF accompanied by clinical and radiological findings. Our case is the first reported appendiceal tumor that emerged in patients with cystic fibrosis.</p> Emrah Doğan Hakan Hakan Avcı Muge Kuzu Avcı Korkut Bozkurt Ozge Oral Tapan Utku Tapan Copyright (c) 2021 Emrah Doğan | Hakan Hakan Avcı | Muge Kuzu Avcı | Korkut Bozkurt | Ozge Oral Tapan | Utku Tapan 2021-04-16 2021-04-16 20 2 27 31 10.15388/LietChirur.2021.20.38 Scaphoid Fracture Reconstruction with Rib Autograft: Case Report and Literature Review <p><em>Objective.&nbsp;</em>To evaluate the results of scaphoid bone proximal pole reconstruction with rib osteochondral autograft due to comminuted scaphoid fracture.&nbsp;<em>Material and methods.</em><span class="char-style-override-5">&nbsp;</span>We present a clinical case of fragmented scaphoid bone proximal pole fracture reconstruction by rib osteochondral autograft. The modified wrist function score of Green and O’Brien and&nbsp;<em>Quick Disabilities of the Arm</em>,&nbsp;<em>Shoulder and Hand</em>&nbsp;(QuickDASH) outcome measuring scales were used for clinical evaluation before and 6<span xml:lang="ar-SA">&nbsp;</span>months after the reconstruction. Additio­nally, a literature review was conducted for case reports and previous literature reviews describing scaphoid bone proximal pole fracture surgical treatment.&nbsp;<em>Medline</em>&nbsp;(<em>PubMed</em>),&nbsp;<em>ScienceDirect</em>&nbsp;and&nbsp;<em>UpToDate</em>&nbsp;databases were used.&nbsp;<em class="char-style-override-6">Results.</em><span class="char-style-override-7">&nbsp;</span><span class="char-style-override-6">Conventional treatment methods for the treatment of comminuted proximal pole scaphoid bone fractures are often inappropriate due to technical issues or potential adverse outcomes. In these cases, reconstruction with rib autograft is possible. The study patient’s&nbsp;</span>modified wrist function score of Green and O’Brien<span class="char-style-override-6">&nbsp;increased from 75 to 95 points out of 100 at 6 months postoperatively, and the&nbsp;</span><em>Quick Disabilities of the Arm, Shoulder and Hand</em>&nbsp;(QuickDASH)<span class="char-style-override-6">&nbsp;score decreased from 13.64 to 4.55 points. The results of this technique have been investigated in several studies (Sandow, 1998, 2001; Veitch et al., 2007). All subjects (22, 47 and 14 patients, respectively), except one, experienced improvement of wrist function</span><span class="char-style-override-6" xml:lang="ar-SA">&nbsp;</span><span class="char-style-override-6">– enhanced wrist movement, grip strength, reduced pain and restored wrist function to the pre-injury performance level.&nbsp;</span><em>Conclusions.</em><span class="char-style-override-5">&nbsp;</span>Scaphoid bone proximal pole fragmented fracture reconstruction with osteochondrial rib autograft achieves favorable recovery of wrist function and avoids complications or unfavorable functional consequences of alternative surgical procedures.</p> Mantas Fomkinas Mantas Kievišas Kęstutis Braziulis Rytis Rimdeika Copyright (c) 2021 Authors 2021-04-16 2021-04-16 20 2 32 40 10.15388/LietChirur.2021.20.39