Vytautas Lipnickas

Surgical management of gastrointestinal stromal tumors: a single center experience.

Introduction Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. Although the therapy targeted at inhibiting tyrosine kinases has shown dramatic results in metastatic and inoperable GISTs, the mainstay of treatment in primary localized forms remains surgical resection. Aim To provide an overview of our experience of GIST diagnosis and management, with emphasis on comparison of minimally invasive and open surgical resection for primary GISTs. Material and methods We retrospectively reviewed the medical records of all patients who underwent surgical removal of GISTs from 2008 to 2012. Patient demographics, clinical data, surgery, complications, histopathological data and clinical course were analyzed. Results Forty-four patients were identified. Average age at diagnosis was 63 years. Minimally invasive (MIS) and open surgery (OS) were each attempted in 22 (50.0%) patients. Laparoscopic removal was performed in 20, laparoendoscopic in 1, and laparoscopy-assisted endoscopic removal in 1. Conversion to an open procedure was performed in 4 (18.2%). We found significant differences in postoperative length of stay (8.5 days vs. 10.1 days, p < 0.001) and tumor size (2.93 cm vs. 5.78 cm, p = 0.018) between MIS and OS groups, respectively. Conclusions Laparoscopic removal is safe and effective for GISTs not exceeding 6 cm. Gastroesophageal junction and cardia GISTs require careful preoperative evaluation and planning to remove safely. We recommend avoiding laparoscopic removal of these tumors due to the high rate of conversion (100.0%) to an open procedure. Laparoendoscopic surgical approach is an appropriate technique for removal of small-sized intraluminal benign GISTs not involving the muscularis propria layer.

Laparoscopic approach in the treatment of large leiomyoma of the lower third of the esophagus

Leiomyoma of the lower third of the esophagus is a relatively rare disorder but the most common benign tumor of the esophagus. We present a case of an involuted esophageal leiomyoma, 11 cm in size, treated by the laparoscopic approach. The preoperative computed tomogram visualized a mass 3 × 1.5 cm in diameter in the lower esophagus without an eccentric lumen or compression of nearby organs. Resection of the tumor was indicated according to the patient‘s symptoms and to exclude malignancy. Laparoscopic enucleation of esophageal leiomyoma was performed. The overall operative time was 205 min. The diagnosis of leiomyoma was established on histopathology and immunohistochemistry staining. The patient resumed the intake of a normal diet on the 5th postoperative day and was discharged from hospital 8 days after the surgery. We have found this minimally invasive operation to be an effective and well-tolerated treatment option, determined by the experience of the surgeon.

Significance of Interdisciplinary Cooperation in the Treatment of Upper Gastrointestinal Mucosal and Submucosal Lesions: A Single Centre Experience

Background: Endoscopic submucosal dissection (ESD) was initially developed in Japan for the treatment of early gastric cancer. Meanwhile ESD has become the treatment of choice for mucosal and submucosal lesions of the oesophagus and stomach. Method: We retrospectively reviewed our data on ESD performed in the period from 2007 to 2011 for the treatment of 67 mucosal and 8 submucosal lesions. These procedures were applied for 60 patients (mean age 63.8 years; 37 female and 23 male). Results: In 4 patients, we found more than 1 lesion for which ESD was applied as a treatment procedure. In 3 patients, ESD was repeated for lesion recurrence in the same location. The ESD specimens were classified as having tumour-free margins in 64 (95.5%) cases; however, during follow-up we identified 7 (10.4%) patients with recurrent lesions, including 3 cases of recurrent hyperplastic polyps, 1 case of early gastric cancer located in the cardia region of the stomach, and 1 case of recurrent flat tubular adenoma in the antral part of the stomach. We experienced 6 cases (8.9%) of delayed post-procedural bleeding all of which were successfully controlled endoscopically. In 5 cases (7.5%), perforation complications occurred. Conclusion: Our first experience with ESD was not all smooth: while the complication rate did not exceed 10%, it was markedly higher than that stated in Eastern literature. We would like to put this down to the learning curve phenomenon. The close cooperation between gastroenterologists and abdominal surgeons was very important and will play a vital role for technological innovations and safety in abdominal medicine in the future.

Prevalence of Obesity and the First Experience of Laparoscopic Adjustable Gastric Banding in Lithuania

Background: The increasing weight of Lithuanians represents one of the greatest challenges confronting the medical society. The most effective treatment for morbid obesity is bariatric surgery, showing low major morbidity and mortality. Modern bariatric surgery was started in Lithuania with laparoscopic adjustable gastric banding (LAGB) in 2004. However, there is no published data concerning its results in the case of this particular ethnic population thus far. Patients and Methods: From April 2004 to June 2006, 100 patients underwent LAGB. Mean age was 45.8 years, preoperative body weight 136.2 kg and body mass index (BMI) 48.4 kg/m2. Data of clinical status, complications, initial excess weight loss (%IEWL), BMI and Bariatric Analysis and Reporting Outcome System (BAROS) were used for postoperative evaluation. Results: 15.1% of Lithuanian adults are obese, 20.3% of these have BMI > 35 kg/m2 and 7% BMI > 40 kg/m2. 100 consecutive patients treated with LAGB were evaluated postoperatively. The postoperative average %IEWL amounted to 38, 57, 72 and 84% after 6, 12, 18 and 24 months, respectively. There were complications in 3 patients but no postoperative deaths. Conclusions: The prevalence of obesity in Lithuanian adults is 15.1%. In a 1-year follow-up period LAGB proved to be effective for treatment of morbid obesity, with low complications rate and improved quality of life according to BAROS. LAGB results need to be verified in long-term follow-up.

Dvylikapirštės žarnos adenokarcinoma: etiologija, klinika, diagnostika, gydymas, prognozė ir klinikinis atvejis

Kristina Marcinkevicienė, Elena Zdanytė, Vytautas Lipnickas, Kestutis Strupas Vilniaus universiteto ligoninės Santariskių klinikų Pilvo chirurgijos centras, Santariskių g. 2, LT-08661 Vilnius El pastas: Vytautas.Lipnickas@santa.lt Sio straipsnio tikslas – aprasyti dvylikapirstės žarnos adenokarcinomos klinikinį atvejį, pateikti literatūros apžvalgą. Dvylikapirstės žarnos adenokarcinoma yra labai reta patologija, pasitaikanti 0,3–1% visų virskinimo trakto piktybinių navikų. Specifinių simptomų, kurie būdingi tik siai patologijai, nėra. Todėl dažnai liga diagnozuojama vėlyvos stadijos. Pagrindinis gydymo būdas yra chirurginis naviko pasalinimas. Atliekamos operacijos: pankreatoduodeninė rezekcija ir duodeninė segmentektomija. Naviko prognozė bloga: 5 metų isgyvenamumas po radikalios operacijos įvairuoja nuo 15% iki 60%. Straipsnyje pateikiame mūsų klinikoje gydyto 66 metų paciento klinikinį atvejį. Klinika buvo apie puse metų, nustatytas dvylikapirstės žarnos susiaurėjimas. Ligonis operuotas, histologiskai diagnozuota dvylikapirstės žarnos adenokarcinoma ir metastazės limfmazgiuose. Pagrindiniai žodžiai: dvylikapirstė žarna, adenokarcinoma, pankreatoduodeninė rezekcija Adenocarcinoma of the duodenum: etiology, clinics, diagnostics, management, prognosis, and case report Kristina Marcinkevicienė, Elena Zdanytė, Vytautas Lipnickas, Kestutis Strupas Vilnius University Hospital Santariskių Klinikos, Centre of Abdominal Surgery, Santariskių 2, LT-08661 Vilnius, Lithuania E-mail: Vytautas.Lipnickas@santa.lt The aim of this paper is to present a rare case of adenocarcinoma of duodenum and review the literature. Adenocarcinoma of duodenum is a very rare pathology. It presents 0.3–1% of all gastrointestinal tract malignant neoplasms. There are no specific symptoms for this disease. Therefore the disease is usually diagnosed at an advanced stage. Surgical resection is the only potentially curative treatment. Performed operations: pancreatoduodenectomy and duodenal segmentectomy. The prognosis of this neoplasm is bad. The five-year survival rate is from 15% to 60% for radical resection. We present a case of a 66-year-old man. He was ill about 0.5 year. Duodenal narrowing was defined. The patient was operated on: histollogicaly, duodenal adenocarcinoma and nodal metastases were diagnosed. Keywords: duodenum, adenocarcinoma, pancreatoduodenectomy

Complicated Course of Peutz-Jeghers Syndrome: Case Report

Peutz-Jeghers syndrome (PJS) is rare autosomal, dominantly inherited syndrome associated with gastrointestinal polyposis and characteristic skin pigmentation. The typical clinical manifestation of the disease occurs in the first two decades of life and is associated with complications secondary to intestinal polyps often requiring surgical treatment. Also patients need continuous surveillance due to higher risk of developing intraand extraintestinal malignancies. We present the case of young man with PJS who was operated for the fourth time due to complicated course of the disease causing recurrent intussusceptions. There were no pathological findings on admission, except for mild anemia and leukocytosis, though thorough evaluation of anamnesis conditioned quick and proper management of multiple intussusceptions.