Browsing by Author "Grubor, Nikola (57208582781)"

Introduction Accessory spleen represents ectopic spleen tissue separated from the body of the spleen, with the percentage share of 10–15% in a population. Case outline We present a female patient in which immune thrombocytopenic purpura was diagnosed 12 years previously and, after a failed initial treatment, it was decided by a hematologist to perform a laparoscopic splenectomy. The mentioned operation was carried out in a safe and efficient manner wherein the accessory spleen was detected and removed intraoperatively. The operative and postoperative course passed without any complications. The definitive histopathological findings confirmed previously set hematological diagnosis. Conclusion The laparoscopic approach is a superior modality in terms of diagnostic and therapeutic procedures when it comes to surgical removal of the accessory spleen. Taking into consideration the advantages of this approach presented and proven in literature, even in the case of diagnostically or intraoperatively overlooked accessory spleen or de novo discovered after the operation, there should be no dilemma which surgical approach should be applied. © 2020, Serbia Medical Society. All rights reserved.

Objective: Laparoscopic splenectomy became the standard surgical procedure in the 1990s. The goal of this study was to analyze the outcome of the patients who underwent laparoscopic splenectomy for the benign hematologic diseases of the spleen and compare its results with open splenectomy. Material and Methods: The study was conducted as a retrospective cohort study analyzing and comparing the data obtained from 196 patients' case records in the Clinic for Digestive Surgery, Clinical Center of Serbia, for the benign disorders of the spleen, divided into two groups: patients operated with laparoscopic technique and patients in whom classic splenectomy was performed. The analyzed parameters were divided into three groups as preoperative, intraoperative and postoperative. Results: In the laparoscopic splenectomy group, less intraoperative blood loss, lower incidental intraoperative complications and a shorter duration of surgery were recorded. The incidence of postoperative complications and reoperations was higher in the group of classically operated patients. Postoperative recovery, expressed by the duration of postoperative abdominal drainage, recovery of intestinal peristalsis and length of postoperative hospitalization, was significantly shorter in the laparoscopic group. Conclusion: Laparoscopic splenectomy is an effective and safe surgical procedure in the treatment of many benign diseases of the spleen. Improvement of the laparoscopic technique of surgical teams and technical improvement of the laparoscopic equipment can lead to even wider application of laparoscopic splenectomy as standard operative procedure, and thus to safer and better quality treatment of patients with wider spectrum diseases of the spleen. © 2019 Bilimsel Tip Yayinevi. All rights reserved.

Background: Concerns have been raised about discrepancies in COVID-19 mortality data, particularly between preliminary and final datasets of vital statistics in Serbia. In the original preliminary dataset, released daily during the ongoing pandemic, there was an underestimation of deaths in contrast to those reported in the subsequently released yearly dataset of vital statistics. Objective: This study aimed to assess the accuracy of the final mortality dataset and justify its use in further analyses. In addition, we quantified the relative impact of COVID-19 on the death rate in the Serbian capital’s population. In the process, we aimed to explore whether any evidence of cause-of-death misattribution existed in the final published datasets. Methods: Data were sourced from the electronic databases of the Statistical Office of the Republic of Serbia. The dataset included yearly recorded deaths and the causes of death of all citizens currently living in the territory of Belgrade, the capital of the Republic of Serbia, from 2015 to 2021. Standardization and modeling techniques were utilized to quantify the direct impact of COVID-19 and to estimate excess deaths. To account for year-to-year trends, we used a mixed-effects hierarchical Poisson generalized linear regression model to predict mortality for 2020 and 2021. The model was fitted to the mortality data observed from 2015 to 2019 and used to generate mortality predictions for 2020 and 2021. Actual death rates were then compared to the obtained predictions and used to generate excess mortality estimates. Results: The total number of excess deaths, calculated from model estimates, was 3175 deaths (99% CI 1715-4094) for 2020 and 8321 deaths (99% CI 6975-9197) for 2021. The ratio of estimated excess deaths to reported COVID-19 deaths was 1.07. The estimated increase in mortality during 2020 and 2021 was 12.93% (99% CI 15.74%-17.33%) and 39.32% (99% CI 35.91%-39.32%) from the expected values, respectively. Those aged 0‐19 years experienced an average decrease in mortality of 22.43% and 23.71% during 2020 and 2021, respectively. For those aged up to 39 years, there was a slight increase in mortality (4.72%) during 2020. However, in 2021, even those aged 20‐39 years had an estimated increase in mortality of 32.95%. For people aged 60‐79 years, there was an estimated increase in mortality of 16.95% and 38.50% in 2020 and 2021, respectively. For those aged >80 years, the increase was estimated at 11.50% and 34.14% in 2020 and 2021, respectively. The model-predicted deaths matched the non-COVID-19 deaths recorded in the territory of Belgrade. This concordance between the predicted and recorded non-COVID-19 deaths provides evidence that the cause-of-death misattribution did not occur in the territory of Belgrade. Conclusions: The finalized mortality dataset for Belgrade can be safely used in COVID-19 impact analysis. Belgrade experienced a significant increase in mortality during 2020 and 2021, with most of the excess mortality attributable to SARS-CoV-2. Concerns about increased mortality from causes other than COVID-19 in Belgrade seem misplaced as their impact appears negligible. © Dane Cvijanovic, Nikola Grubor, Nina Rajovic, Mira Vucevic, Svetlana Miltenovic, Marija Laban, Tatjana Mostic, Radica Tasic, Bojana Matejic, Natasa Milic.

Introduction According to the guidelines of the European Association of Endoscopic Surgery, any case where the maximum craniocaudal splenic diameter exceeds 20 cm is considered massive splenomegaly. In addition to metabolic, hematological, and hemodynamic problems, enlarged spleen may cause mechanical difficulties due to the pressure to surrounding organs and vascular structures. The aim of this paper is to present the surgical challenges and technique applied in massive splenomegaly, in a patient who had neglected the importance of regular medical checkups. Case outline We present a 62-year-old male patient who was admitted to hospital for treatment of previously clinically and radiologically verified splenomegaly but who neglected the importance of regular checkups and medical treatment. Splenectomy was performed with a splenic specimen 38 cm in its maximal diameter. Conclusion Taking into consideration all the possible benefits and possible complications of surgical treatment, including the quality of life of splenectomized patients, comprehensive preoperative assessment should be made, and surgical treatment selectively applied. © 2022, Serbia Medical Society. All rights reserved.

Spleen artery aneurysm represents the most common visceral aneurysm and the third most common splanchnic aneurysm. Most patients have no symptoms and are diagnosed as a part of other diagnostic focuses and examinations. In our study, we present a patient who, due to a spleen artery aneurysm localized in the spleen hilum, underwent laparoscopic splenectomy safely and effectively, without complications, with the use of hem-o-lok clips as a hemostatic technique for vascular elements of the spleen hilum. Our cases show that in addition to numerous advantages of the minimally invasive approach, there is the possibility to improve the laparoscopic technique in terms of safety and economic reasons by using hem-o-lok clips as a hemostatic technique for the vascular elements of the spleen hilum. © 2020, Association of Surgeons of India.

SUMMARY Introduction Cystic echinococcosis or hydatid disease is a parasitic disease, zoonosis, and is most commonly caused by Echinococcus granulosus larvae. It mainly occurs in endemic areas. The most common localization is the liver. Case outline In this paper, we will present our experience with a 67-year-old female patient diagnosed with an echinococcal cyst in the right lobe of the liver, as confirmed by computed tomography examination of the abdomen. The patient underwent laparoscopic partial pericystectomy with omentoplasty. The operation went without complications, as well as the postoperative period. Conclusion Laparoscopic partial pericystectomy is a safe and effective treatment of available hepatic hydatid cysts. Considering all the benefits of minimally invasive surgery, laparoscopic partial pericystectomy of hepatic hydatid cysts may be the treatment of choice, over the classical open surgery approach. © 2020, Serbia Medical Society. All rights reserved.

Introduction Accessory spleens can be found in up to 10% of the population, and their intrapancreatic occurrence is considered uncommon. When present, the intrapancreatic accessory spleen is usually found in the tail of the pancreas in about 1.7% of adult individuals. The infrequent presence of the accessory spleen in the pancreatic tissue could lead to inappropriate diagnosis and hence therapeutic approach, as they are commonly presented as a hypervascular node in the tail of the pancreas on abdominal CT and MRI, mimicking a well differentiated tumor of the pancreas or non-functioning pancreatic neuroendocrine tumor. Case Outline We present a 70-year-old female in whom a preoperative evaluation finding was highly suggestive of a non-functioning neuroendocrine tumor of the pancreatic tail. We performed spleen preserving laparoscopic distal pancreatectomy, and histopathological examination revealed the intrapancreatic accessory spleen. Conclusion Although infrequent, the presence of the intrapancreatic accessory spleen must be considered in the differential diagnosis of pancreatic tail tumors. © 2015, Serbia Medical Society. All rights reserved.

Methods of surgical treatment of hematological diseases of the spleen have changed significantly in the past decade. The introduction of laparoscopic and minimally invasiveprocedures as standard for solving a significant number of conditions in abdominal surgery, has led surgeons toincreasingly use laparoscopic surgery of the spleen. However, some unique anatomical characteristics of the spleen can lead to limitation in the application of laparoscopy. In this study, we investigated the application of laparoscopic splenectomy in the treatment of haematological disorders of the spleen, intraoperative and postoperative characteristics, the presentation ofoperational technique and the evaluation of the success of this procedure.In the treatment of benign hematological diseases, the effectiveness and efficiency of laparoscopy has been proven. The speculation of medical professionals is that laparoscopic splenectomy is an equal, if not the superior way of treating benign hematological diseases of the spleen in relation to the open procedure, and that there is a chance that laparoscopy might completely replace the classical surgery in most of it’s indications. © 2019, University of Kragujevac, Faculty of Science. All rights reserved.

Introduction Splenic artery aneurysm is the most common visceral aneurysm with a prevalence of 0.2–10%. It is the third most frequent abdominal aneurysm as well. It can be true or false. It occurs more often in women than in men. We present our experience with a 34-year-old female patient who underwent laparoscopic splenectomy due to the splenic aneurysm located in the splenic hilum. Case outline We present a case of a 34-year-old female patient diagnosed with an enlarged splenic artery during a routine abdominal ultrasound examination. Abdominal scan and computed tomography angiography showed saccular aneurysm of the splenic artery located in the hilum of the spleen, 24 × 17 mm in size. Given the good general condition and age of the patient, we decided to perform laparoscopic splenectomy. The operation was performed without complications, which was also the case with the postoperative flow. The patient was discharged from the hospital on the third postoperative day. Conclusion Laparoscopic splenectomy is a safe and effective modality for the treatment of splenic artery aneurysm, localized in the splenic hilum. Considering all the benefits of minimally invasive surgery, laparoscopic splenectomy should be the treatment of choice, over the classical open approach. © 2019, Serbia Medical Society. All rights reserved.

Background: Penile inversion vaginoplasty still remains the gold standard in genital gender affirming surgeries in transwomen. However, insufficiency of the penile skin due to either radical circumcision or puberty blockers presents great challenge in vaginal reconstruction. Peritoneal pull-through vaginoplasty is well known technique for the treatment of vaginal absence in cis-woman due to vaginal agenesis or trauma. Objective: We describe our laparoscopy assisted technique of using peritoneal flaps for neovaginal construction in male to female gender affirming surgery Methods: In period from March 2016 to June 2021, 52 transwomen, aged from 19 to 52 years (mean 27) underwent laparoscopy assisted peritoneal pull-through vaginoplasty. Indications were genital skin insufficiency (radical circumcision in 16, scrotal skin insufficiency in 3 and lichen sclerosis in 3 cases) and prepubertal blockers in 22 and 17 cases, respectively. In remaining 13 candidates, peritoneal pull-through vaginoplasty was preferable method of choice. Two peritoneal flaps are harvested from posterior bladder wall and anterior rectosigmoid peritoneum, using laparoscopy approach. Vaginal channel is created by combined perineal and laparoscopy approaches. Good vascularized peritoneal flaps are maximally mobilized and pulled-through to be joined with inverted penile skin. Peritoneal flaps are joined laterally to create neovagina. Gender affirming surgery is completed with reconstruction of external female genitalia, clitoris, labia minora and majora, and urethra. Vaginal packing is placed for 7 days postoperatively and followed by proper vaginal dilation for the first 12 months postoperatively. Results: Follow-up ranged from 6 to 69 months (mean 29 months). Complications occurred in 7 cases: 3 had prolonged hematoma of the labia majora, one had neovaginal introitus dehiscence and one had superficial necrosis of the left labia majora. None of the complications required additional surgeries. The depth of the neovagina at the control check-up in 6 months after surgery was 14.7 ± 0.5 cm, while width was about 3.4 ± 0.4 cm. Majority of patients (≈96%) were satisfied with the new genitalia, sensitivity, lubrication and possibility of engaging in sexual intercourse according to self-reports. One patient required reduction of the size of her clitoris because of hypersensitivity and the other one requested laser treatment of the incisional scars. Conclusion: Although known for quite a long time in vaginal reconstruction for cis-women with vaginal agenesis and different forms of vaginal absence, peritoneal pull-through vaginoplasty offers promising outcomes in transgender women, as an option that will give self-lubricating neovagina, with insignificant scarring and complications and high degree of patient's satisfaction. © 2022 Elsevier Inc.

Introduction Choledochal cysts are congenital anomalies manifested as focal or diffuse cystic dilatation of the bile ducts. They are mostly diagnosed in childhood. The magnetic resonance and surgical management are the gold standard diagnostic and treatment modality. Case outline We present a male patient who was presumed to have Mirizzi syndrome. This presumption was discarded by additional imaging procedures and by later surgical treatment. It was confirmed that it was a large choledochal cyst filled with stones. Considering the diagnosis and good patient’s general condition, we opted for surgical treatment. Conclusion There are several surgical techniques that can be used in the treatment of choledochal cysts, wherein each is intended as a complete resection of the cyst with histological confirmation. Operative techniques do not affect the outcome of the treatment, but the time and extent of surgical resection, as well as any metaplasia of the epithelium, do. © 2020, Serbia Medical Society. All rights reserved.

Introduction The most common indications for placing a biliary stent are benign and malignant diseases that interfere with the normal flow of bile through the extrahepatic bile ducts. This procedure carries the risk of developing early and late complications. Case outline We present a case of a 63-year-old female patient admitted to our hospital for additional diagnostics and treatment. At admission the patient reported the onset of the following symptoms several days prior to hospitalization: severe abdominal pain, predominantly in the upper quadrants, nausea, vomiting, and icterus. With the initial idea of carrying out non-surgical treatment of this condition, the patient was referred for endoscopic retrograde cholangiopancreatography for the purpose of endoscopic calculi extraction. However, due to technical difficulties, the aforementioned procedure was not carried out. Instead, upon endoscopic papillotomy, a plastic biliary stent was placed. The second day after the procedure, the patient reported passing dark stools. After that, an esophagogastroduodenoscopy was performed, which revealed a biliary stent in the duodenum, but without active bleeding. As part of the same procedure, the biliary stent was removed, and the next day the patient underwent surgical treatment. Conclusion In order to prevent and reduce the incidence of adverse effects and complications, special caution should be applied when performing the procedure. It is even more important to timely recognize the occurrence of complications and to treat them promptly, in order to achieve the best treatment outcomes possible. © 2023, Serbia Medical Society. All rights reserved.

Isolated hydatid cysts of the pancreas are rare lesions, even in endemic regions. In this report, we present the case of a 76-year-old patient who was admitted to our clinic with a diagnosis of a cystic lesion in the tail of the pancreas. On preoperative computed tomography (CT) and magnetic resonance (MR) examination, the cyst was characterized as a mucinous cystadenoma. A laparoscopic distal pancreatectomy followed. A histopathological examination revealed a large hydatid cyst in the tail of the pancreas. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.

Background: The aim of this work was to evaluate the prognostic potential of preoperative thrombocytosis for recurrence-free survival (RFS) and cancer-specific survival (CSS) among patients subjected to radical nephroureterectomy (RNU) due to UTUC. Patients and Methods: Analytical cohort was composed of a single-center series of 405 patients treated between January 1999 and December 2020. Thrombocytosis was defined as a platelet count exceeding the threshold value of 400 × 109 per L. Along with the Kaplan–Meier survival probability, Cox proportional hazard regression models were used. Results: Preoperative thrombocytosis confirmed in 71 patients (17.5%) was significantly associated with the higher pathological tumor stage, lymph node metastasis, prior bladder cancer diagnosis, and preoperative anemia. With a median post-surgical follow-up period of 33.5 months, 125 patients (30.9%) experienced disease recurrence. The recurrence rate among patients with normal platelet levels was 13.6%, compared with 22.2% in those with preoperative thrombocytosis (p < 0.03). The 5-year RFS estimates reached 36.6% in the thrombocytosis-confirmed group. Multivariate analysis implied that preoperative thrombocytosis was a significant independent prognosticator of both poor RFS (HR 2.22, 95% CI 1.14–4.31, p = 0.02) and CSS (HR 2.48, 95% CI 1.14–3.09, p = 0.01). Conclusions: Patients with a clinically significant elevation of platelet count prior to RNU were more likely to have UTUC with advanced tumor stages and lymph node metastases. Preoperative thrombocytosis was an independent predictor of RFS and CSS in patients who underwent radical nephroureterectomy. Furthermore, preoperative thrombocytosis may complement and refine UTUC clinical prediction algorithms as an independent indicator of adverse survival outcomes. © Society of Surgical Oncology 2024.

Introduction Myoid angioendothelioma of the spleen is an extremely rare form of a benign splenic tumor. There is no characteristic symptomatology for this disease. Case outline We present four patients operated on for myoid angioendothelioma of the spleen. Three patients were without problems while one had nonspecific problems. Two patients underwent laparoscopic surgery and two underwent open splenectomy. In all patients, the definitive diagnosis was confirmed by histopathological examination. By reviewing the aforementioned medical databases of published papers in English, we found a total of eight cases of myoid angioendothelioma of the spleen. In addition to the mentioned number, we have added our series of cases. Conclusion Twenty-one years after the discovery of myoid angioendothelioma of the spleen, the small number of cases presented in the literature is still a limiting factor in making conclusions and in learning lessons about this disease. © 2021, Serbia Medical Society. All rights reserved.

Visceral leishmaniasis (also known as kala-azar) is characterized by fever, weight loss, swelling of the spleen and liver, and pancytopenia. If it is not treated, the fatality rate in developing countries can be as high as 100% within 2 years. In a high risk situation for perioperative bleeding due to severe thrombocytopenia/coagulopathy, we present a rare challenge for urgent splenectomy in a patient with previously undiagnosed visceral leishmaniasis. A histologic examination of the spleen revealed a visceral leishmaniasis, and the patient was successfully treated with amphotericin B. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

Introduction Posttraumatic splenic cysts are most commonly the result of blunt force trauma to the abdomen. They usually develop from subcapsular or intraparenchymal hematomas and are typically asymptomatic. Diagnostics includes clinical history and radiological imaging procedures. Surgical treatment is the only curative modality of treatment. Case outline A 43-year-old female patient, without comorbidities, was admitted to the health institu-tion for additional diagnostics and surgical treatment. Laboratory test results were within the reference ranges, while serological test results for hydatid disease were negative. An abdominal CT examination was subsequently performed confirming a splenic cyst positioned in the central part of the spleen. After a laparoscopic partial pericystectomy of the cyst, we identified another smaller cyst of the spleen. Ac-cording to the estimation of the surgical team, the intraoperative appearance of the remaining tissue of the spleen was less than a third of the entire spleen. The decision was taken to perform a splenectomy in the best interests of the patient, bearing in mind the possibility of complications Conclusion Accurate diagnosis of posttraumatic splenic cysts remains a challenge, despite state-of-the-art radiological imaging procedures that are applied. In addition to the well-known modalities of treatment, the laparoscopic surgical approach, i.e., minimally invasive treatment, should be the one of choice, if the situation allows it. The laparoscopic approach is a diagnostic and therapeutic method whose effect can especially be observed when the intraoperative finding differs from the preoperative radiological finding. © 2022, Serbia Medical Society. All rights reserved.

[No abstract available]

Objective To identify the impact of preoperative pyuria on the bladder cancer recurrence and survival of patients who were treated surgically for UTUC. Patients and methods Study included 319 consecutive patients who were treated with RNU for UTUC. Cox proportional hazard regression models were used to evaluate the association of preoperative pyuria with outcome. Results Eighty patients (25.1%) had pyuria. Preoperative pyuria was associated with sex (P = 0.01), tumor focality (P = 0.01), tumor size (P = 0.05), tumor stage (P = 0.01), lymph node metastasis (P = 0.01), lymphovascular invasion (P = 0.02), and chemotherapy (P = 0.04). A total of 102 patients recurred, with a median time to bladder recurrence of 24.2 months. Bladder cancer recurrence-free survival rates for these 319 patients at 1, 3, 5, 7, and 10 years were 84.6, 72.4, 69.0, 68.3, and 68.0%, respectively. Preoperative pyuria was not independently associated with bladder cancer recurrence (HR 1.15; p = 0.5). Preoperative pyuria was associated with OS (HR 1.57; p = 0.02) and CSS (HR 1.65; p = 0.02). However, preoperative pyuria was not independently associated with OS and CSS (HR 1.07; p = 0.79). Conclusions Preoperative pyuria is unable to predict outcomes in a single-centre series of consecutive patients who were treated with RNU. © Springer Nature B.V. 2019.