Browsing by Author "Gunjić, Dragan (55220962400)"

Background/Aim. Gastric contraction modulation (GCM) with the implanted DIAMOND device improves glycemic control and decreases weight. The main aim of this study was to evaluate the early efficacy of GCM using the DIAMOND (previously named TANTALUS) System in the improvement of glycemic control measured by changes in glycosylated hemoglobin (HbA1c). The effects of GCM on weight loss, body mass index (BMI), reduction of the waist circumference and metabolic parameters other than HbA1c were also evaluated. Methods. A total of 18 adult patients with type 2 diabetes were surgically treated at the Department for Minimally Invasive Upper Digestive Surgery, Clinic for Digestive Surgery in Belgrade, Serbia, using gastric pacemaker (DIAMOND System) from November 2014 to March 2016. Out of the total number of patients, 11 finished week 16 visit and were enroled in this prospective cohort study. Results. During the observed period, the average weight loss amounted to 8.05 kg (p < 0.05). The average difference between the baseline fasting glucose level and the level after 16 weeks period is 2.56 mmol/L. Similar findings were noted in fasting insulin levels, with an average decrease of 6.44 m/U/L after 16 weeks. The majority of patients experienced a decrease in HbA1c value: in 4 patients higher than 2%, and in 4 patients up to 2% (p < 0.05). Lower level of fasting insulin with simultaneous decrease in fasting glucose indicates improvement in insulin sensitivity on week 16 [homeostatic model assessment of insulin resistance (HOMA IR) average 5.25]. Conclusion. Gastric stimulation using the DIAMOND System for 16 weeks causes significant early improvement in glycemic control and insulin resistance. There is an additional positive effect on weight loss, body mass index (BMI) and reduction of the waist circumference as a main parameter of the metabolic syndrome. © 2018, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved.

Introduction Neuroendocrine tumors of the pancreas are rare neoplasms. They are divided into two groups: functional and non-functional. Non-functional tumors represent a diagnostic challenge, given that they often remain asymptomatic and are diagnosed as an incidental finding. Case outline We present a patient in whom the tumor was discovered at the junction of the body and the tail of the pancreas, on the dorsal side. The patient had no specific symptomatology, there was no loss in body weight. Considering the diagnostic procedures conducted and the condition of the patient, we decided to perform laparoscopic enucleation. The procedure was carried out in a safe and efficient manner, so that operative and postoperative recovery was uneventful. The definitive histopathological examination confirmed the finding of a non-functional pancreatic neuroendocrine tumor. Conclusion Laparoscopic enucleation is an effective and safe treatment modality for neuroendocrine tumors of the pancreas with well-known advantages, as compared to open surgery, but there is always a tendency to improve the already existing results and thus to contribute, not only to treatment, but to the greater comfort of the patient. Keywords. © 2021, Serbia Medical Society. All rights reserved.

Introduction: There has been an increasing interest for the laparoscopic treatment of early gastric cancer, especially among Eastern surgeons. However, the oncological effectiveness of Laparoscopic Gastrectomy (LG) for Advanced Gastric Cancer (AGC) remains a subject of debate, especially in Western countries where limited reports have been published. The aim of this paper is to retrospectively analyze short- and long-term results of LG for AGC in a real-life Western practice. Materials and methods: All consecutive cases of LG with D2 lymphadenectomy for AGC performed from January 2005 to December 2019 at seven different surgical departments were analyzed retrospectively. The primary outcome was diseases-free survival (DFS). Secondary outcomes were overall survival (OS), number of retrieved lymph nodes, postoperative morbidity and conversion rate. Results: A total of 366 patients with stage II and III AGC underwent either total or subtotal LG. The mean number of harvested lymph nodes was 25 ± 14. The mean hospital stay was 13 ± 10 days and overall postoperative morbidity rate 27.32%, with severe complications (grade ≥ III) accounting for 9.29%. The median follow-up was 36 ± 16 months during which 90 deaths occurred, all due to disease progression. The DFS and OS probability was equal to 0.85 (95% CI 0.81–0.89) and 0.94 (95% CI 0.92–0.97) at 1 year, 0.62 (95% CI 0.55–0.69) and 0.63 (95% CI 0.56–0.71) at 5 years, respectively. Conclusion: Our study has led us to conclude that LG for AGC is feasible and safe in the general practice of Western institutions when performed by trained surgeons. © 2021, The Author(s).

Introduction Laparoscopic Heller-Dor operation, a standard method in the treatment of achalasia, has been performed at the Center for Esophageal Surgery of the First Surgical Clinic since April 2006. Objective The aim of this study was to present this surgical procedure and initial experiences after 36 consecutive laparoscopic Heller-Dor operations. Methods This partly retrospective, partly prospective study presented our results after laparoscopic Heller-Dor operation (presentation of the treatment method). We performed a standard anterior esophagocardioymiotomy, without releasing the posterior aspect of the cardia, and anterior partial fundoplication. The type and severity of symptoms and their duration were evaluated based on questionnaires fulfilled by patients. The diagnosis was made based on radiological, endoscopic and manometric findings. Laparoscopic surgery as the method of treatment was evaluated based on the duration of surgery, intraand postoperative complications, time interval until the initiation of oral feeding, length of hospital stay, need for additional therapeutic measures after the operation and effect of surgery on the severity of symptoms. Results Preopereratively, dysphagia was the predominant symptom in all patients, while regurgitation was much lower (44%). The average duration of operation was 127 minutes. Postoperative hospitalization lasted on the average 5.7 days. From 36 treated patients, 34 (94.4%) considered that the effect of treatment was good or excellent. Postoperative dysphagia was present in two patients (5.6%) and was successfully solved by balloon dilatation. Conclusion Laparoscopic Heller-Dor operation is an effective and safe surgical procedure in resolving symptoms of achalasia and today presents the method of the first choice in the treatment of this disease.

Introduction Repair of hiatal hernias has been performed traditionally via open laparotomy or thoracotomy. Since first laparoscopic hiatal hernia repair in 1992, this method had a growing popularity and today it is the standard approach in experienced centers specialized for minimally invasive surgery.; Objective In the current study we present our experience after 200 consecutive laparoscopic hiatal hernia repairs.; Methods A retrospective cohort study included 200 patients who underwent elective laparoscopic hiatal hernia repair at the Department for Minimally Invasive Upper Digestive Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia in Belgrade from April 2004 to December 2013.; Results Hiatal hernia types included 108 (54%) patients with type I, 30 (15%) with type III, 62 (31%) with giant paraesophageal hernia, while 27 (13.5%) patients presented with a chronic gastric volvulus. There were a total of 154 (77%) Nissen fundoplications. In 26 (13%) cases Nissen procedure was combined with esophageal lengthening procedure (Collis-Nissen), and in 17 (8.5%) Toupet fundoplications was performed. Primary retroesophageal crural repair was performed in 164 (82%) cases, Cleveland Clinic Foundation suture modification in 27 (13.5%), 4 (2%) patients underwent synthetic mesh hiatoplasty, 1 (0.5%) primary repair reinforced with pledgets, and 4 (2%) autologous fascia lata graft reinforcement. Poor result with anatomic and symptomatic recurrence (indication for revisional surgery) was detected in 5 patients (2.7%).; Conclusion Based on the result analysis, we found that laparoscopic hiatal hernia repair was a technically challenging but feasible technique, associated with good to excellent postoperative outcomes comparable to the best open surgery series. © 2014, Srp Arh Celok Lek. All rights reserved.

Introduction At the Department of Minimally Invasive Upper Digestive Surgery of the Hospital for Digestive Surgery in Belgrade, hybrid minimally invasive esophagectomy (hMIE) has been a standard of care for patients with resectable esophageal cancer since 2009. As a next and final step in the change management, from January 2015 we utilized total minimally invasive esophagectomy (tMIE) as a standard of care. Objective The aim of the study was to report initial experiences in hMIE (laparoscopic approach) for cancer and analyze surgical technique, major morbidity and 30-day mortality. Methods A retrospective cohort study included 44 patients who underwent elective hMIE for esophageal cancer at the Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia in Belgrade from April 2009 to December 2014. Results There were 16 (36%) middle thoracic esophagus tumors and 28 (64%) tumors of distal thoracic esophagus. Mean duration of the operation was 319 minutes (approximately five hours and 20 minutes). The average blood loss was 173.6 ml. A total of 12 (27%) of patients had postoperative complications and mean intensive care unit stay was 2.8 days. Mean hospital stay after surgery was 16 days. The average number of harvested lymph nodes during surgery was 31.9. The overall 30-day mortality rate within 30 days after surgery was 2%. Conclusion As long as MIE is an oncological equivalent to open esophagectomy (OE), better relation between cost savings and potentially increased effectiveness will make MIE the preferred approach in high-volume esophageal centers that are experienced in minimally invasive procedures. © 2015, Serbia Medical Society. All rights reserved.

In the Western countries, the incidence of esophaeal carcinoma is 3-6 cases per 100,000 persons. g Despite tremendous success of other therapeutic options, surgical treatment still represents the best therapeutic option whenever possible. For the long period, debate has centered on which of the a vailable surgical procedures is superior-transhiatal or transthoracic esophagectomy. Minimally invasive esophagectomy (MIE) could offer both minimally invasive approach and proper mediastinal lymph node dissection. Minimally invasive esophagectomy is safe and adequate, but time consuming and technically demanding procedure. It is procedure reserved for the surgeons experienced in open esophagectomy for cancer, and specially trained in advanced minimally invasive procedures. Even in that case, learning curve is steep.

Unlike benign pathology, progress of laparoscopy in performing cancer surgery has been slow because of fear of safety and oncological adequacy. However, the initial fear has been replaced by optimism as the results from a numerous studies have shown equivalent if not superior results to open surgery. Laparoscopic gastrectomy is safe and oncologic adequate, but time consuming and technically demanding procedure. Laparoscopic surgery has gained wide acceptance in the treatment of early gastric cancer, especially of the distal stomach. The use of laparoscopic surgery for the treatment of advanced gastric cancer remains controversial. Another open question that need complete evaluation is cost-effectiveness analysis of minimally invasive and open approach.

Background: RefluxStop™ is an implantable, non-active, single use device used in the laparoscopic treatment of GERD. RefluxStop™ aims to block the movement of the LES up into the thorax and keep the angle of His in its original, anatomically correct position. This new device restores normal anatomy, leaving the food passageway unaffected. Methods: In a prospective, single arm, multicentric clinical investigation analyzing safety and effectiveness of the RefluxStop™ device to treat GERD, 50 subjects with chronic GERD were operated using a standardized surgical technique between December 2016 and September 2017. They were followed up for 1 year (CE-mark investigation 6-months). Primary safety outcome was prevalence of serious adverse events related to the device, and primary effectiveness outcome reduction of GERD symptoms based on GERD-HRQL score. Secondary outcomes were prevalence of adverse events other than serious adverse events, reduction of total acid exposure time in 24-h pH monitoring, and reduction in average daily PPI usage and subject satisfaction. Results: There were no serious adverse events related to the device. Average GERD-HRQL total score at 1 year improved 86% from baseline (p < 0.001). 24-h pH monitoring compared to baseline showed a mean reduction percentage of overall time with pH < 4 from 16.35 to 0.80% at the 6-month visit (p < 0.001), with 98% of subjects showing normal 24-h pH. At 1 year: No new cases of dysphagia were recorded, present in 2 subjects, which existed already at baseline. Regular daily PPI usage occurred in all 50 subjects at baseline. At 1-year follow-up, only 1 subject took regular daily PPIs due to a too low placement of the device thereby prohibiting its function. None or minimal occasional episodes of regurgitation occurred in 97.8% of evaluable subjects. Gas bloating disappeared in 30 subjects and improved in 7 subjects. Conclusion: The new principle of RefluxStop™ is safe and effective to treat GERD according to investigation results. At 1-year follow-up, both the GERD-HRQL score and 24-h pH monitoring results indicate success for the new treatment principle. In addition, with the dynamic treatment for acid reflux, which avoids compressing the food passageway, prevalence of dysphagia and gas bloating are significantly reduced. Trial registration: ClinicalTrials.gov, NCT02759094. Registered 3 May, 2016, © 2020 The Author(s).

Introduction/Objective The objective was to assess the effectiveness of laparoscopic gastrectomy, analyzing short-term outcomes of laparoscopic radical gastrectomy in treatment of advanced gastric neoplasms. Methods We performed a prospective cohort observational study, which included 30 patients who underwent elective radical laparoscopic gastrectomy (total or subtotal) for stomach neoplasms, performed in the period between March 2013 and February 2017. Results Thirteen patients (43%) had been diagnosed with distal gastric tumors, seven (23%) with proximal gastric tumors, four (13%) with pangastric tumors, four (13%) with mediogastric tumors, and two (7%) with bicentric tumors. Mean operation duration was 286 minutes. The average blood loss was 183 mL. Conversion rate was 10% (three patients). Total of seven (23%) patients had postoperative complications, and mean intensive care unit stay was 1 day. Mean hospital stay after surgery was 13.08 days. The average number of harvested lymph nodes was 33.9, and R0 resection was performed in 87% patients. The overall 30-day mortality rate was 0%. Conclusion Although technically challenging, laparoscopic gastrectomy is a safe and oncologically adequate procedure in the radical surgical treatment of advanced gastric neoplasms. © 2018, Serbia Medical Society. All rights reserved.