Introduction: Despite the progress that has been made regarding the diagnosis, a worrying percentage of patients are still admitted in an emergency, with complicated colorectal tumors, which often require interventions without a curative visa. The study aims to analyze the factors involved in choosing the type of surgical treatment. Patients and methods: We included in the study a group of 431 patients admitted and operated in an emergency for complicated colorectal cancer in the Surgery II Clinic of the Clinical Emergency County Hospital “Sf. Ap. Andrei” from Galați, between 2008-2017. We retrospectively analyzed the patients’ data and we made statistical correlations between the type of emergency surgery and epidemiological, clinical, paraclinical, and intraoperative factors. Results: Colostomy was mainly practiced in older patients (p<0.01), from rural areas (p<0.01), with associated cardiac diseases (p<0.01), with hydro electrolytic disorders (p<0.03), rectal tumors (p<0.01), peritoneal carcinomatosis (p<0.02), frozen pelvis (p<0.01). Hartmann's operations were associated with patients with: leukocytosis (p<0.01), intestinal perforation (p<0.01), sigmoid tumors (p<0.01). Internal derivations were associated with patients with: liver metastases (p<0.01), splenic angle tumors (p<0.01), tumors invading other organs (p<0.01), and stage IV of the disease (p<0.01). Resections with anastomosis were associated with transverse colon tumors (p<0.01), well-differentiated tumors (p<0.01). Conclusions: The type of emergency surgery performed correlated well with the age of patients, the area, the comorbidities, the history of the disease, cachexia, anemia, oligoanuria, hydroelectrolyte disorders, tumor complication, and location of the tumor, hepatic metastases, and tumors’ invasion in other organs, tumor grading and stage of the disease.
Introduction: The prognosis of patients with Zenker`s diverticulum is dependent mainly on the type of procedure performed, either surgical or rigid/flexible endoscopy. Purpose - evaluation of the redo procedure by reviewing correlations in patients with iterative procedures. Material and Methods: We included in the study 36 patients with cervicomediastinal Zenker diverticula treated from 2010 to 2017 at two university hospitals: Clinic of General and Esophageal Surgery. Mary Clinical Hospital Bucharest and Department of Diagnostic and Interventional Digestive Endoscopy of the Regional Institute of Hepatology and Gastroenterology Prof. Dr. Octavian Fodor, Cluj-Napoca. For the patients included in the study we studied correlations of patients with symptoms persistence and to those with reintervention with epidemiological, clinical and the treatment criteria. Results: Postprocedural symptoms we observed in 5 patients of the 29 treated endoscopically and 6 of the seven treated surgically. Statistical correlations were noted in patients with persistent symptoms after surgical treatment (p <0.01) with patients with diverticulectomy (54.5%) (p <0.01), grade III diverticula (36.4%) (p <0.01) statistical association was noticed in patients who have required reoperation and those with persistent symptoms (63.6%) (p <0.01) and with remaining dysphagia (100%) (p <0.01) and those with grade 2 dysphagia persistence (71.4%) (p <0.01), grade 3 diverticula (42.9%) (p <0.03) and the high number of comorbidities. (p <0.04) Conclusion: Undoubtedly, endoscopic treatment is being used more and more even for those cases that require further treatment. Reoperation has been necessary for patients with persistent dysphagia with voluminous diverticula and a high number of comorbidities.
