Dragan Basaric - Academia.edu (original) (raw)

Papers by Dragan Basaric

Research paper thumbnail of Splenectomy for Visceral Leishmaniasis Out of an Endemic Region: A Case Report and Literature Review

Medicina

Visceral leishmaniasis (also known as kala-azar) is characterized by fever, weight loss, swelling... more 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.

Research paper thumbnail of Oxaliplatin-induced Hepatic Sinusoidal Obstruction Syndrome: Histology

Sinusoidal obstruction syndrome („blue liver syndrome“) has been frequently associated with oxali... more Sinusoidal obstruction syndrome („blue liver syndrome“) has been frequently associated with oxaliplatin-based neoadjuvant chemotherapy in patients with colorectal liver metastasis. Hepatotoxic vascular lesions in the nontumourous liver parenchyma result in hypoperfusion and tissue hypoxia leading to lower tumour response to oncologic treatment and to increase the risk of liver metastasectomies. Hepatic parenchyma injuries could be aggravated by hepatic resection itself. Contrary to standard surgical techniques, radiofrequency assisted liver resection significantly reduce harmful intraoperative blood loss and perfusion-reperfusion effects. High-grade vascular lesions such as hemorrhagic centrilobular necrosis and peliosis are less frequent in cases of radiofrequency-assisted liver recetions and might be associated with better clinical outcome in these patients.

Research paper thumbnail of Total Upper Transversal Hepatectomy

Research paper thumbnail of The effect of routine lymphadenectomy of the hepatic basin on the duration of the liver resection due to colorectal carcinoma metastases

Vojnosanitetski pregled

Background/Aim. Today, lymphatic metastases are only a relative contraindication for the surgical... more Background/Aim. Today, lymphatic metastases are only a relative contraindication for the surgical treatment of colorectal carcinoma (CRC). The aim of this study was to evaluate the effect of routine lymphadenectomy of the hepatic basin on the duration of the liver resection for CRC metachronous liver metastases. Methods. A total of 50 patients with CRC metachronous liver metastases underwent the liver resection with routine hepatic basin lymphadenectomy. Results. Larger volume of metastases (in mL), the number of affected segments, and the number of metastases as well the diameter of the largest lesion (in mm), determine the duration of the liver resection itself and the surgical procedure overall. The duration of lymphadenectomy was 25?55 min (32.2 min on average). Conclusion. Routine lymphadenectomy of the hepatic basin following the liver resection for CRC metachronous liver metastases, minimally prolongs the duration of the operation.

Research paper thumbnail of Histopathology of Hepatic Sinusoidal Obstruction Syndrome After Neoadjuvant Oxaliplatin-Based Chemotherapy

Serbian Journal of Experimental and Clinical Research

Sinusoidal obstruction syndrome („blue liver syndrome“) has been frequently associated with oxali... more Sinusoidal obstruction syndrome („blue liver syndrome“) has been frequently associated with oxaliplatin-based neoadjuvant chemotherapy in patients with colorectal liver metastasis. Hepatotoxic vascular lesions in the nontumourous liver parenchyma result in hypoperfusion and tissue hypoxia leading to lower tumour response to oncologic treatment and to increase the risk of liver metastasectomies. Furthermore, hepatic parenchyma injuries could be aggravated by hepatic resection itself. Contrary to standard surgical techniques, radiofrequency assisted liver resection significantly reduce harmful intraoperative blood loss and perfusion-reperfusion effects. We compared histological alterations in 59 specimens of bloodless radiofrequency-assisted liver recetions made for colorectal metastases to those in 38 specimens of standard liver resections. In general, the main histologic alterations in both examined groups related to oxaliplatin include SOS lesions (69.35%), fibrosis (50.95%) and st...

Research paper thumbnail of Extrahepatic hydatidosis – Unusual localization with surgical significance

HPB

Patient education and informed consent process 3. Evaluation of clinical data and collection of l... more Patient education and informed consent process 3. Evaluation of clinical data and collection of labs/tissue specimens 4. Implementing quality and performance improvement projects Results/conclusion: The roles of APPs in hepatobiliary research continue to evolve and expand. It represents an opportunity for APPs to not only advance academically and professionally but also to enhance the visibility and contributions of the APP on the hepatobiliary surgical oncology interprofessional team. This integration allows to improve the quality and efficiency of research outcomes in a possibly more cost-effective manner. Future studies are needed to validate the impact of the APP contributions to hepatobiliary surgical oncology research.

Research paper thumbnail of Surgical treatment of cystobiliary communications in hepatic hydatidosis

HPB

2. Patient education and informed consent process 3. Evaluation of clinical data and collection o... more 2. Patient education and informed consent process 3. Evaluation of clinical data and collection of labs/tissue specimens 4. Implementing quality and performance improvement projects Results/conclusion: The roles of APPs in hepatobiliary research continue to evolve and expand. It represents an opportunity for APPs to not only advance academically and professionally but also to enhance the visibility and contributions of the APP on the hepatobiliary surgical oncology interprofessional team. This integration allows to improve the quality and efficiency of research outcomes in a possibly more cost-effective manner. Future studies are needed to validate the impact of the APP contributions to hepatobiliary surgical oncology research.

Research paper thumbnail of Actinomycotic hepatic abscess in woman with longstanding intrauterine contraceptive device

We present a case of a 50 year-old female bearing an intrauterine contraceptive device for 20 yea... more We present a case of a 50 year-old female bearing an intrauterine contraceptive device for 20 years who was diagnosed with abdominopelvic actinomycosis with liver dissemination. The patient was successfully treated by a combination of surgical resection and a 3-month course of amoxicillin.

Research paper thumbnail of Incisional Hernia: Difficult Cases 2

Hernia : the journal of hernias and abdominal wall surgery, 2015

INCISIONAL HERNIA: DIFFICULT CASES 2 © Springer-Verlag 2014 C016:01 OUTCOMES OF COMPLEX ABDOMINAL... more INCISIONAL HERNIA: DIFFICULT CASES 2 © Springer-Verlag 2014 C016:01 OUTCOMES OF COMPLEX ABDOMINAL WALL RECONSTRUCTIONS WITH TRANSVERSUS ABDOMINUS RELEASE (TAR) WITH RETROMUSCULAR PORCINE BIOLOGIC MESH REINFORCEMENT YNovitskyI, M Fayezizadehl, A Majumderl, S Yeel, C Petrol, S Orensteinl ICase Comprehensive Hernia Center, Cleveland, USA Introduction: The choice of mesh type and operative technique for major abdominal wall reconstructions remains debatable. Posterior component separation with TAR allows for wide sub lay mesh reinforcement with durable reconstruction and has been gaining in popularity in recent years. Although the use of biologic grafts has been associated with mixed results, outcomes of abdominal wall reconstructions with sub lay biologic mesh have not been elucidated well to date. We aimed to evaluate our outcomes of TAR reconstructions with retromuscular porcine biologic mesh reinforcement. Methods: All patients undergoing TAR reconstructions with biologic mesh between 2010-2013 were identified in our prospective database and analyzed. Briefly, all patients had bilateral TARs with retromuscular mesh fixation with 8-10 transabdominal sutures and linea alba reconstruction ventral to the mesh. Main outcome measures included patient demographics, hernia and wound characteristics, post-operative wound complications and recurrence. Multivariate analysis was used to determine predictors of hernia recurrence. Results: Forty-five patients (mean age 55, mean BMI 35) were included in the analysis. The mean hernia size was 296 +1120 cm2 with a mean width of 14 +12.9cm. The average number of prior abdominal surgeries was 4.7 with an average of 2.1 previous hernia repairs. A vast majority of repairs (87%) were performed in clean-contaminated, contaminated and dirty fields (56%, 28%, and 3%, respectively). Seventy percent of patients had a history of a prior wound infection. All patients received a non-cross-linked porcine dermis mesh; mean mesh size was 660 cm (range, 400-900 cm). Postoperatively, 12 (26.7%) patients developed a surgical site infection (SSI): eight (17.8%) superficial, three (6.7%) deep, and one organ space. Three of the SSIs required a procedural intervention. There were no instances of mesh explantations. With a mean follow-up of24.2 months, there have been 6 (13.3%) recurrences. Of the factors analyzed, an increased ASA and a development of an SSI were associated with hernia recurrence. Conclusion: Complex hemias repaired with TAR and retromuscular porcine biologic mesh reinforcement are associated with low rate of serious peri operative wound/mesh complications. In addition, our approach resulted in a fairly low rate of hernia recurrences in this complex cohort of patients. We believe that the TAR approach and retromuscular mesh placement may be beneficial when biologic mesh reinforcement is chosen during complex abdominal wall reconstructions. C016:02 COMPARISON OF BIOLOGIC AND SYNTHETIC MESH IN ABDOMINAL WALL RECONSTRUCTION IN VHWG GRADE 3 AND 4 PATIENTS USING COMPONENT SEPARATION TECHNIQUE G Woestel, A Reinischl, WO Bechsteinl I Department of Surgery Goethe University, Frankfurt, GERMANY The use of synthetic or biologic implants for abdominal wall reconstruction in contaminated fields is still controversial. There is data promoting the use of biologic material for contaminated cases as well as data showing the safety of synthetic meshes in those patients. The Ventral Hernia Working Group (VHWG) created a grading system helping to define the individual risk of patients, stating that synthetic meshes should be avoided in grade 3 and 4 cases. We analyzed our patients undergoing abdominal wall reconstruction using component separation technique (CST) with regard to the use of either biologic or synthetic implants. For better comparability only VHWG grade 3 and 4 patients were included in the comparison. From 2/2010 to 9/2014 we performed a total of 52 abdominal wall reconstructions using CST in complex incisional hernias. For 21 (40.1%) we used acellular porcine dermal matrix (StratticeTM, BIO) and for 31 (59.6%) of the patients synthetic mesh (SYNTH) was implanted. According to the VHWG 17/21 (81 %) patients in the biologic group and 10/31 (32%) in the synthetic group were classified as grade 3 and 4. A closure of the midline was achieved in 13117 (76.5%) patients in the BIO and 9110 (90%) in the SYNTH group, the mesh was placed retrorectus in 7 (41.2%) and 8 (80%) cases respectively, intraperitoneal in 10 (58.8%) and I (10%) case, and in I case a synthetic mesh was placed onlay. A postoperative wound infection was reported in 11117 (64.7%) of the BIO and 6110 (60%) of the SYNTH patients and was treated successfully using negative pressure wound therapy (NPWT) in 9111 (81.8%) and 5/6 (83%) respectively (n.s.). There was no need for removing a StratticeTM, in I case a synthetic mesh has to be removed due to bowel leakage and I synthetic mesh was changed during reoperation. The…

Research paper thumbnail of Hepatocelularni karcinom udruzen sa ehinokoknom cistom jetre kao dijagnosticki problem

Acta chirurgica iugoslavica, 2014

The presence of benign and/or malignant liver lesions is not easy to determine, especially differ... more The presence of benign and/or malignant liver lesions is not easy to determine, especially differentiated. Preoperative diagnosis has to include more procedures for correlation of data in order to establish the correct diagnosis and proper treatment. The case of a 72-year-old female patient who was admitted because of the appearance of persistent dull pain under right rib cage. Ultrasound and CT findings verify the presence of two changes in the right liver, various radiographic characteristics. One change was good, other cystic. The presence of easily elevated tumor markers (AFP) in favor of hepatocellular carcinoma. The nature of other types of cystic changes was not clear. Intraoperatively and histologically confirmed to be a simultaneous presence of hepatocellular carcinoma and hydatid cysts in the right lobe of the liver. Surgical treatment is the only solution for the simultaneous treatment of both changes in the liver.

Research paper thumbnail of Radiofrequency-assisted liver resections for metastatic colorectal cancer: Technique and feasibility

Acta chirurgica iugoslavica, 2014

Radiofrequency (RF)-assisted resection techniques are associated with minimal blood loss providin... more Radiofrequency (RF)-assisted resection techniques are associated with minimal blood loss providing safe hemostasis of the transected liver 1-3 parenchyma. Different RF-assisted liver resection techniques have been developed. The presented RF technique is the sequentional coagulate-cut liver resection technique (?The Belgrade technique?) and the difference from other techniques is the way the electrode is used. A coagulate-cut liver resection cycle can be described as a process of creating a 30-mm long and 6-8 mm wide cylinder of coagulated and desiccated liver tissue by applying RF energy through the non-insulated tip of the electrode inserted into the liver parenchyma and then dividing the coagulated tissue by surgical scalpel or scissors. From January 2001 to January 2014, 830 RF-assisted liver resections were performed for various indications at the HPB unit of the Clinic for Digestive Surgery, Clinical center of Serbia, Belgrade. Among 830 liver resections, 470 resections were p...

Research paper thumbnail of Overlooked nasal foreign body with a 48-year latent period

Acta chirurgica iugoslavica, 2008

Foreign bodies of the nose are relatively frequent in pediatric population, while in the adults, ... more Foreign bodies of the nose are relatively frequent in pediatric population, while in the adults, they are usually seen in disturbed persons. Overlooked nasal foreign bodies may be singled out as a special entity. They become rhinolites over time with latent period of several decades. Our paper illustrates an overlooked foreign body in the nose - i.e. encrusted plastic bead which, after the asymptomatic period of 48 years, induced the unilateral mucopurulent and ichorous secretion from the nose. Rhinolite should be suspected if radiological diagnostics detected calcified mass in the nose together with unilateral nasal symptomatology. Surgical removal of rhinolite results in complete management of such problem. This case indicates the significance of medical history data and examination of nasal cavity in any adult patient with unilateral nasal symptomatology which is refractory to conservative treatment. Computerized tomography of paranasal sinuses is an important adjunct diagnostic ...

Research paper thumbnail of Klinička studija UCNT bolesnika sa cervikalnim nodalnim tipom bolesti

Acta chirurgica iugoslavica, 2004

Indifferentiated carcinoma of the nasopharyngs is clinicaly-histological-imunologic entity which ... more Indifferentiated carcinoma of the nasopharyngs is clinicaly-histological-imunologic entity which is often diagnosed in our country .There are three clinical types, but nodal cervical type of disease is the most interesting type for surgeons while the combined type is more interesting for otolaryngologist. Among seventy-seven patients diagnosed with undifferentiated carcinoma of the nasopharyngs with nodal cervical type of disease, on the Institute of Otolaryngology and Maxillofacial Surgery Clinical Center of Serbia during the period between 1993.-1997. there were N0-21%, N1-49%, N2-18% i N3-12%, no mater of the T category .The disease more often occurs between male population (2:1), mostly between age 41 -60. The rate for five year period of surviving for two different chemioterapeutical protocols is as follows: for categories NO and N1-20% for mono Zorubicin and 61% for the same category for Z-CDDP. The same rate for categories N2 and N3 is 11% for mono Zorabicin and 33% for the s...

Research paper thumbnail of Hepatocellular carcinoma: From clinical practice to evidence-based treatment protocols

World Journal of Hepatology, 2015

Hepatocellular carcinoma (HCC) is one of the major malignant diseases in many healthcare systems.... more Hepatocellular carcinoma (HCC) is one of the major malignant diseases in many healthcare systems. The growing number of new cases diagnosed each year is nearly equal to the number of deaths from this cancer. Worldwide, HCC is a leading cause of cancer-related deaths, as it is the fifth most common cancer and the third most important cause of cancer related death in men. Among various risk factors the two are prevailing: viral hepatitis, namely chronic hepatitis C virus is a well-established risk factor contributing to the rising incidence of HCC. The epidemic of obesity and the metabolic syndrome, not only in the United States but also in Asia, tend to become the leading cause of the long-term rise in the HCC incidence. Today, the diagnosis of HCC is established within the national surveillance programs in developed countries while the diagnosis of symptomatic, advanced stage disease still remains the characteristic of underdeveloped countries. Although many different staging systems have been developed and evaluated the Barcelona-Clinic Liver Cancer staging system has emerged as the most useful to guide HCC treatment. Treatment allocation should be decided by a multidisciplinary board involving hepatologists, pathologists, radiologists, liver surgeons and oncologists guided by personalized -based medicine. This approach is important not only to balance between different oncologic treatments strategies but also due to the complexity of the disease (chronic liver disease and the cancer) and due to the large number of potentially efficient therapies. Careful patient selection and a tailored treatment modality for every patient, either potentially curative (surgical treatment and tumor ablation) or palliative (transarterial therapy, radioembolization and medical treatment, i.e., sorafenib) is mandatory to achieve the best treatment outcome.

Research paper thumbnail of Laparotomija kao metoda izbora u postavljanju dijagnoze peripankreaticne tuberkulozne limfadenopatije

Acta chirurgica Iugoslavica, 2015

Peripancreatic lymph node tuberculosis is a rare disease with a difficult diagnosis. The case of ... more Peripancreatic lymph node tuberculosis is a rare disease with a difficult diagnosis. The case of a 61-year-old patient who was admitted because of intermittent dull pain in upper abdomen lasting 3-4 months followed by nausea, loss of appetite and body weight. The applied diagnostic procedures indicate a change in the head of the pancreas. The method of choice for establishing a definitive histopathological diagnosis is the biopsy of the lesion. Biopsy changes can be done using U.S., CT, Endo U.S. and laparoscopy. Surgery is a last resort only to establish a definitive histopathological diagnosis.

Research paper thumbnail of Razlike u hirurškom lečenju maksilarnih sinuzitisa

Acta chirurgica iugoslavica, 2005

Research paper thumbnail of Short-term outcomes after distal pancreatectomy: Experience from Clinical Center of Serbia

Research paper thumbnail of Razlike u hirur�kom lecenju maksilarnih sinuzitisa

Acta Chirurgica Iugoslavica, 2005

Research paper thumbnail of New viewpoint to histological classification of malignant epithelial tumors of nasopharynx

Acta Chirurgica Iugoslavica, 2005

Malignant tumors of nasopharyngeal epithelium differ clinically depending on the course of diseas... more Malignant tumors of nasopharyngeal epithelium differ clinically depending on the course of disease and applied therapy. They are presented in regard to the sex, age, smoking habits, alcohol usage and nutrition factors. Various studies already showed various etiological-causal links with Epstein-Barr virus (EBV). This leads to diversity of various morphological and histological types of diseases belonging to various classifications. In this work we presented 60 diagnosed and treated cases with malignant tumor of nasopharyngeal epithelium in the Institute for Otorynolaringology and maxillofacial surgery of Clinical Center of Serbia. All of them were pato-histologicaly examined and 24 of them received serological examination in regard to the concept of association between malignant epithelial tumour and EBV. An important correlation between histopathology and serology was found. Finally, the terminology used by WHO classification is not optimal for further histological determination of nasopharyngeal malignancy; therefore we recommend the French classification of C. Micheaua.

Research paper thumbnail of Is There any Benefit from Expanding the Criteria for the Resection of Hepatocellular Carcinoma in Cirrhotic Liver? Experience from a Developing Country

World journal of surgery, 2012

BACKGROUND: Patients with large-size (>10 cm) hepatocellular carcinoma (HCC) in Child B cirrho... more BACKGROUND: Patients with large-size (>10 cm) hepatocellular carcinoma (HCC) in Child B cirrhosis are usually excluded from curative treatment, i.e., hepatic resection, because of marginal liver function and poor outcome. This study was designed to evaluate the feasibility of the radiofrequency (RF)-assisted sequential "coagulate-cut liver resection technique" in expanding the criteria for resection of large HCC in cirrhotic livers with impaired liver function. METHODS: Forty patients with Child-Pugh A or B cirrhosis underwent liver resection from December 1, 2001 to December 31, 2008. Of these, 20 patients (13 Child-Pugh A and 7 Child-Pugh B) with advanced stage HCC (stage B and C according to Barcelona-Clinic Liver Cancer Group) underwent major liver resection. The two groups were comparable in terms of patient age, liver cirrhosis etiology, tumor number, and size. RESULTS: All resections were performed without the Pringle maneuver. There was no significant difference...

Research paper thumbnail of Splenectomy for Visceral Leishmaniasis Out of an Endemic Region: A Case Report and Literature Review

Medicina

Visceral leishmaniasis (also known as kala-azar) is characterized by fever, weight loss, swelling... more 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.

Research paper thumbnail of Oxaliplatin-induced Hepatic Sinusoidal Obstruction Syndrome: Histology

Sinusoidal obstruction syndrome („blue liver syndrome“) has been frequently associated with oxali... more Sinusoidal obstruction syndrome („blue liver syndrome“) has been frequently associated with oxaliplatin-based neoadjuvant chemotherapy in patients with colorectal liver metastasis. Hepatotoxic vascular lesions in the nontumourous liver parenchyma result in hypoperfusion and tissue hypoxia leading to lower tumour response to oncologic treatment and to increase the risk of liver metastasectomies. Hepatic parenchyma injuries could be aggravated by hepatic resection itself. Contrary to standard surgical techniques, radiofrequency assisted liver resection significantly reduce harmful intraoperative blood loss and perfusion-reperfusion effects. High-grade vascular lesions such as hemorrhagic centrilobular necrosis and peliosis are less frequent in cases of radiofrequency-assisted liver recetions and might be associated with better clinical outcome in these patients.

Research paper thumbnail of Total Upper Transversal Hepatectomy

Research paper thumbnail of The effect of routine lymphadenectomy of the hepatic basin on the duration of the liver resection due to colorectal carcinoma metastases

Vojnosanitetski pregled

Background/Aim. Today, lymphatic metastases are only a relative contraindication for the surgical... more Background/Aim. Today, lymphatic metastases are only a relative contraindication for the surgical treatment of colorectal carcinoma (CRC). The aim of this study was to evaluate the effect of routine lymphadenectomy of the hepatic basin on the duration of the liver resection for CRC metachronous liver metastases. Methods. A total of 50 patients with CRC metachronous liver metastases underwent the liver resection with routine hepatic basin lymphadenectomy. Results. Larger volume of metastases (in mL), the number of affected segments, and the number of metastases as well the diameter of the largest lesion (in mm), determine the duration of the liver resection itself and the surgical procedure overall. The duration of lymphadenectomy was 25?55 min (32.2 min on average). Conclusion. Routine lymphadenectomy of the hepatic basin following the liver resection for CRC metachronous liver metastases, minimally prolongs the duration of the operation.

Research paper thumbnail of Histopathology of Hepatic Sinusoidal Obstruction Syndrome After Neoadjuvant Oxaliplatin-Based Chemotherapy

Serbian Journal of Experimental and Clinical Research

Sinusoidal obstruction syndrome („blue liver syndrome“) has been frequently associated with oxali... more Sinusoidal obstruction syndrome („blue liver syndrome“) has been frequently associated with oxaliplatin-based neoadjuvant chemotherapy in patients with colorectal liver metastasis. Hepatotoxic vascular lesions in the nontumourous liver parenchyma result in hypoperfusion and tissue hypoxia leading to lower tumour response to oncologic treatment and to increase the risk of liver metastasectomies. Furthermore, hepatic parenchyma injuries could be aggravated by hepatic resection itself. Contrary to standard surgical techniques, radiofrequency assisted liver resection significantly reduce harmful intraoperative blood loss and perfusion-reperfusion effects. We compared histological alterations in 59 specimens of bloodless radiofrequency-assisted liver recetions made for colorectal metastases to those in 38 specimens of standard liver resections. In general, the main histologic alterations in both examined groups related to oxaliplatin include SOS lesions (69.35%), fibrosis (50.95%) and st...

Research paper thumbnail of Extrahepatic hydatidosis – Unusual localization with surgical significance

HPB

Patient education and informed consent process 3. Evaluation of clinical data and collection of l... more Patient education and informed consent process 3. Evaluation of clinical data and collection of labs/tissue specimens 4. Implementing quality and performance improvement projects Results/conclusion: The roles of APPs in hepatobiliary research continue to evolve and expand. It represents an opportunity for APPs to not only advance academically and professionally but also to enhance the visibility and contributions of the APP on the hepatobiliary surgical oncology interprofessional team. This integration allows to improve the quality and efficiency of research outcomes in a possibly more cost-effective manner. Future studies are needed to validate the impact of the APP contributions to hepatobiliary surgical oncology research.

Research paper thumbnail of Surgical treatment of cystobiliary communications in hepatic hydatidosis

HPB

2. Patient education and informed consent process 3. Evaluation of clinical data and collection o... more 2. Patient education and informed consent process 3. Evaluation of clinical data and collection of labs/tissue specimens 4. Implementing quality and performance improvement projects Results/conclusion: The roles of APPs in hepatobiliary research continue to evolve and expand. It represents an opportunity for APPs to not only advance academically and professionally but also to enhance the visibility and contributions of the APP on the hepatobiliary surgical oncology interprofessional team. This integration allows to improve the quality and efficiency of research outcomes in a possibly more cost-effective manner. Future studies are needed to validate the impact of the APP contributions to hepatobiliary surgical oncology research.

Research paper thumbnail of Actinomycotic hepatic abscess in woman with longstanding intrauterine contraceptive device

We present a case of a 50 year-old female bearing an intrauterine contraceptive device for 20 yea... more We present a case of a 50 year-old female bearing an intrauterine contraceptive device for 20 years who was diagnosed with abdominopelvic actinomycosis with liver dissemination. The patient was successfully treated by a combination of surgical resection and a 3-month course of amoxicillin.

Research paper thumbnail of Incisional Hernia: Difficult Cases 2

Hernia : the journal of hernias and abdominal wall surgery, 2015

INCISIONAL HERNIA: DIFFICULT CASES 2 © Springer-Verlag 2014 C016:01 OUTCOMES OF COMPLEX ABDOMINAL... more INCISIONAL HERNIA: DIFFICULT CASES 2 © Springer-Verlag 2014 C016:01 OUTCOMES OF COMPLEX ABDOMINAL WALL RECONSTRUCTIONS WITH TRANSVERSUS ABDOMINUS RELEASE (TAR) WITH RETROMUSCULAR PORCINE BIOLOGIC MESH REINFORCEMENT YNovitskyI, M Fayezizadehl, A Majumderl, S Yeel, C Petrol, S Orensteinl ICase Comprehensive Hernia Center, Cleveland, USA Introduction: The choice of mesh type and operative technique for major abdominal wall reconstructions remains debatable. Posterior component separation with TAR allows for wide sub lay mesh reinforcement with durable reconstruction and has been gaining in popularity in recent years. Although the use of biologic grafts has been associated with mixed results, outcomes of abdominal wall reconstructions with sub lay biologic mesh have not been elucidated well to date. We aimed to evaluate our outcomes of TAR reconstructions with retromuscular porcine biologic mesh reinforcement. Methods: All patients undergoing TAR reconstructions with biologic mesh between 2010-2013 were identified in our prospective database and analyzed. Briefly, all patients had bilateral TARs with retromuscular mesh fixation with 8-10 transabdominal sutures and linea alba reconstruction ventral to the mesh. Main outcome measures included patient demographics, hernia and wound characteristics, post-operative wound complications and recurrence. Multivariate analysis was used to determine predictors of hernia recurrence. Results: Forty-five patients (mean age 55, mean BMI 35) were included in the analysis. The mean hernia size was 296 +1120 cm2 with a mean width of 14 +12.9cm. The average number of prior abdominal surgeries was 4.7 with an average of 2.1 previous hernia repairs. A vast majority of repairs (87%) were performed in clean-contaminated, contaminated and dirty fields (56%, 28%, and 3%, respectively). Seventy percent of patients had a history of a prior wound infection. All patients received a non-cross-linked porcine dermis mesh; mean mesh size was 660 cm (range, 400-900 cm). Postoperatively, 12 (26.7%) patients developed a surgical site infection (SSI): eight (17.8%) superficial, three (6.7%) deep, and one organ space. Three of the SSIs required a procedural intervention. There were no instances of mesh explantations. With a mean follow-up of24.2 months, there have been 6 (13.3%) recurrences. Of the factors analyzed, an increased ASA and a development of an SSI were associated with hernia recurrence. Conclusion: Complex hemias repaired with TAR and retromuscular porcine biologic mesh reinforcement are associated with low rate of serious peri operative wound/mesh complications. In addition, our approach resulted in a fairly low rate of hernia recurrences in this complex cohort of patients. We believe that the TAR approach and retromuscular mesh placement may be beneficial when biologic mesh reinforcement is chosen during complex abdominal wall reconstructions. C016:02 COMPARISON OF BIOLOGIC AND SYNTHETIC MESH IN ABDOMINAL WALL RECONSTRUCTION IN VHWG GRADE 3 AND 4 PATIENTS USING COMPONENT SEPARATION TECHNIQUE G Woestel, A Reinischl, WO Bechsteinl I Department of Surgery Goethe University, Frankfurt, GERMANY The use of synthetic or biologic implants for abdominal wall reconstruction in contaminated fields is still controversial. There is data promoting the use of biologic material for contaminated cases as well as data showing the safety of synthetic meshes in those patients. The Ventral Hernia Working Group (VHWG) created a grading system helping to define the individual risk of patients, stating that synthetic meshes should be avoided in grade 3 and 4 cases. We analyzed our patients undergoing abdominal wall reconstruction using component separation technique (CST) with regard to the use of either biologic or synthetic implants. For better comparability only VHWG grade 3 and 4 patients were included in the comparison. From 2/2010 to 9/2014 we performed a total of 52 abdominal wall reconstructions using CST in complex incisional hernias. For 21 (40.1%) we used acellular porcine dermal matrix (StratticeTM, BIO) and for 31 (59.6%) of the patients synthetic mesh (SYNTH) was implanted. According to the VHWG 17/21 (81 %) patients in the biologic group and 10/31 (32%) in the synthetic group were classified as grade 3 and 4. A closure of the midline was achieved in 13117 (76.5%) patients in the BIO and 9110 (90%) in the SYNTH group, the mesh was placed retrorectus in 7 (41.2%) and 8 (80%) cases respectively, intraperitoneal in 10 (58.8%) and I (10%) case, and in I case a synthetic mesh was placed onlay. A postoperative wound infection was reported in 11117 (64.7%) of the BIO and 6110 (60%) of the SYNTH patients and was treated successfully using negative pressure wound therapy (NPWT) in 9111 (81.8%) and 5/6 (83%) respectively (n.s.). There was no need for removing a StratticeTM, in I case a synthetic mesh has to be removed due to bowel leakage and I synthetic mesh was changed during reoperation. The…

Research paper thumbnail of Hepatocelularni karcinom udruzen sa ehinokoknom cistom jetre kao dijagnosticki problem

Acta chirurgica iugoslavica, 2014

The presence of benign and/or malignant liver lesions is not easy to determine, especially differ... more The presence of benign and/or malignant liver lesions is not easy to determine, especially differentiated. Preoperative diagnosis has to include more procedures for correlation of data in order to establish the correct diagnosis and proper treatment. The case of a 72-year-old female patient who was admitted because of the appearance of persistent dull pain under right rib cage. Ultrasound and CT findings verify the presence of two changes in the right liver, various radiographic characteristics. One change was good, other cystic. The presence of easily elevated tumor markers (AFP) in favor of hepatocellular carcinoma. The nature of other types of cystic changes was not clear. Intraoperatively and histologically confirmed to be a simultaneous presence of hepatocellular carcinoma and hydatid cysts in the right lobe of the liver. Surgical treatment is the only solution for the simultaneous treatment of both changes in the liver.

Research paper thumbnail of Radiofrequency-assisted liver resections for metastatic colorectal cancer: Technique and feasibility

Acta chirurgica iugoslavica, 2014

Radiofrequency (RF)-assisted resection techniques are associated with minimal blood loss providin... more Radiofrequency (RF)-assisted resection techniques are associated with minimal blood loss providing safe hemostasis of the transected liver 1-3 parenchyma. Different RF-assisted liver resection techniques have been developed. The presented RF technique is the sequentional coagulate-cut liver resection technique (?The Belgrade technique?) and the difference from other techniques is the way the electrode is used. A coagulate-cut liver resection cycle can be described as a process of creating a 30-mm long and 6-8 mm wide cylinder of coagulated and desiccated liver tissue by applying RF energy through the non-insulated tip of the electrode inserted into the liver parenchyma and then dividing the coagulated tissue by surgical scalpel or scissors. From January 2001 to January 2014, 830 RF-assisted liver resections were performed for various indications at the HPB unit of the Clinic for Digestive Surgery, Clinical center of Serbia, Belgrade. Among 830 liver resections, 470 resections were p...

Research paper thumbnail of Overlooked nasal foreign body with a 48-year latent period

Acta chirurgica iugoslavica, 2008

Foreign bodies of the nose are relatively frequent in pediatric population, while in the adults, ... more Foreign bodies of the nose are relatively frequent in pediatric population, while in the adults, they are usually seen in disturbed persons. Overlooked nasal foreign bodies may be singled out as a special entity. They become rhinolites over time with latent period of several decades. Our paper illustrates an overlooked foreign body in the nose - i.e. encrusted plastic bead which, after the asymptomatic period of 48 years, induced the unilateral mucopurulent and ichorous secretion from the nose. Rhinolite should be suspected if radiological diagnostics detected calcified mass in the nose together with unilateral nasal symptomatology. Surgical removal of rhinolite results in complete management of such problem. This case indicates the significance of medical history data and examination of nasal cavity in any adult patient with unilateral nasal symptomatology which is refractory to conservative treatment. Computerized tomography of paranasal sinuses is an important adjunct diagnostic ...

Research paper thumbnail of Klinička studija UCNT bolesnika sa cervikalnim nodalnim tipom bolesti

Acta chirurgica iugoslavica, 2004

Indifferentiated carcinoma of the nasopharyngs is clinicaly-histological-imunologic entity which ... more Indifferentiated carcinoma of the nasopharyngs is clinicaly-histological-imunologic entity which is often diagnosed in our country .There are three clinical types, but nodal cervical type of disease is the most interesting type for surgeons while the combined type is more interesting for otolaryngologist. Among seventy-seven patients diagnosed with undifferentiated carcinoma of the nasopharyngs with nodal cervical type of disease, on the Institute of Otolaryngology and Maxillofacial Surgery Clinical Center of Serbia during the period between 1993.-1997. there were N0-21%, N1-49%, N2-18% i N3-12%, no mater of the T category .The disease more often occurs between male population (2:1), mostly between age 41 -60. The rate for five year period of surviving for two different chemioterapeutical protocols is as follows: for categories NO and N1-20% for mono Zorubicin and 61% for the same category for Z-CDDP. The same rate for categories N2 and N3 is 11% for mono Zorabicin and 33% for the s...

Research paper thumbnail of Hepatocellular carcinoma: From clinical practice to evidence-based treatment protocols

World Journal of Hepatology, 2015

Hepatocellular carcinoma (HCC) is one of the major malignant diseases in many healthcare systems.... more Hepatocellular carcinoma (HCC) is one of the major malignant diseases in many healthcare systems. The growing number of new cases diagnosed each year is nearly equal to the number of deaths from this cancer. Worldwide, HCC is a leading cause of cancer-related deaths, as it is the fifth most common cancer and the third most important cause of cancer related death in men. Among various risk factors the two are prevailing: viral hepatitis, namely chronic hepatitis C virus is a well-established risk factor contributing to the rising incidence of HCC. The epidemic of obesity and the metabolic syndrome, not only in the United States but also in Asia, tend to become the leading cause of the long-term rise in the HCC incidence. Today, the diagnosis of HCC is established within the national surveillance programs in developed countries while the diagnosis of symptomatic, advanced stage disease still remains the characteristic of underdeveloped countries. Although many different staging systems have been developed and evaluated the Barcelona-Clinic Liver Cancer staging system has emerged as the most useful to guide HCC treatment. Treatment allocation should be decided by a multidisciplinary board involving hepatologists, pathologists, radiologists, liver surgeons and oncologists guided by personalized -based medicine. This approach is important not only to balance between different oncologic treatments strategies but also due to the complexity of the disease (chronic liver disease and the cancer) and due to the large number of potentially efficient therapies. Careful patient selection and a tailored treatment modality for every patient, either potentially curative (surgical treatment and tumor ablation) or palliative (transarterial therapy, radioembolization and medical treatment, i.e., sorafenib) is mandatory to achieve the best treatment outcome.

Research paper thumbnail of Laparotomija kao metoda izbora u postavljanju dijagnoze peripankreaticne tuberkulozne limfadenopatije

Acta chirurgica Iugoslavica, 2015

Peripancreatic lymph node tuberculosis is a rare disease with a difficult diagnosis. The case of ... more Peripancreatic lymph node tuberculosis is a rare disease with a difficult diagnosis. The case of a 61-year-old patient who was admitted because of intermittent dull pain in upper abdomen lasting 3-4 months followed by nausea, loss of appetite and body weight. The applied diagnostic procedures indicate a change in the head of the pancreas. The method of choice for establishing a definitive histopathological diagnosis is the biopsy of the lesion. Biopsy changes can be done using U.S., CT, Endo U.S. and laparoscopy. Surgery is a last resort only to establish a definitive histopathological diagnosis.

Research paper thumbnail of Razlike u hirurškom lečenju maksilarnih sinuzitisa

Acta chirurgica iugoslavica, 2005

Research paper thumbnail of Short-term outcomes after distal pancreatectomy: Experience from Clinical Center of Serbia

Research paper thumbnail of Razlike u hirur�kom lecenju maksilarnih sinuzitisa

Acta Chirurgica Iugoslavica, 2005

Research paper thumbnail of New viewpoint to histological classification of malignant epithelial tumors of nasopharynx

Acta Chirurgica Iugoslavica, 2005

Malignant tumors of nasopharyngeal epithelium differ clinically depending on the course of diseas... more Malignant tumors of nasopharyngeal epithelium differ clinically depending on the course of disease and applied therapy. They are presented in regard to the sex, age, smoking habits, alcohol usage and nutrition factors. Various studies already showed various etiological-causal links with Epstein-Barr virus (EBV). This leads to diversity of various morphological and histological types of diseases belonging to various classifications. In this work we presented 60 diagnosed and treated cases with malignant tumor of nasopharyngeal epithelium in the Institute for Otorynolaringology and maxillofacial surgery of Clinical Center of Serbia. All of them were pato-histologicaly examined and 24 of them received serological examination in regard to the concept of association between malignant epithelial tumour and EBV. An important correlation between histopathology and serology was found. Finally, the terminology used by WHO classification is not optimal for further histological determination of nasopharyngeal malignancy; therefore we recommend the French classification of C. Micheaua.

Research paper thumbnail of Is There any Benefit from Expanding the Criteria for the Resection of Hepatocellular Carcinoma in Cirrhotic Liver? Experience from a Developing Country

World journal of surgery, 2012

BACKGROUND: Patients with large-size (>10 cm) hepatocellular carcinoma (HCC) in Child B cirrho... more BACKGROUND: Patients with large-size (>10 cm) hepatocellular carcinoma (HCC) in Child B cirrhosis are usually excluded from curative treatment, i.e., hepatic resection, because of marginal liver function and poor outcome. This study was designed to evaluate the feasibility of the radiofrequency (RF)-assisted sequential "coagulate-cut liver resection technique" in expanding the criteria for resection of large HCC in cirrhotic livers with impaired liver function. METHODS: Forty patients with Child-Pugh A or B cirrhosis underwent liver resection from December 1, 2001 to December 31, 2008. Of these, 20 patients (13 Child-Pugh A and 7 Child-Pugh B) with advanced stage HCC (stage B and C according to Barcelona-Clinic Liver Cancer Group) underwent major liver resection. The two groups were comparable in terms of patient age, liver cirrhosis etiology, tumor number, and size. RESULTS: All resections were performed without the Pringle maneuver. There was no significant difference...