Browsing by Author "Veselinović, Milan (55376277300)"

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 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.

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.