Albanian Journal of Trauma and Emergency Surgery 2024-01-20T03:01:54+00:00 Agron Dogjani Open Journal Systems <p><strong>The</strong><em><strong> Albanian</strong><strong> Journal of Trauma and Emergency Surgery</strong></em>&nbsp;<strong><em>(AJTES)</em></strong> is the official publication of the Albanian Society for Trauma and Emergency Surgery (ASTES), which comes out two times a year.</p> <p><em>AJTES</em>&nbsp;is an open-access, peer-reviewed journal that promotes interest, knowledge, and quality of care in emergency and trauma surgery.</p> <p>Under the editorship of <em>Prof. Dr. Agron Dogjani,&nbsp;MD, Ph.D., FACS, FISS,&nbsp;</em><em>AJTES</em><em>&nbsp;</em>provides an in-depth, national, and international forum for the most authoritative information on major clinical problems in the fields of trauma and emergency surgery, surgical education, and not only...&nbsp;</p> <p>Contributions are reviewed and selected by distinguished doctors from across Albania and worldwide who make up the Editorial Board.&nbsp;</p> <p><strong><em>ISSN:</em></strong> 2616-4922 <em><strong>(Online)</strong></em>; <em><strong>ISSN:</strong></em> 2521-8778 <em><strong>(Print)</strong></em></p> <p><a href=""><strong></strong></a></p> <div dir="auto"> <ul> <li class="show"><strong><em>Impact Factor Value </em></strong>based on the International Citation Report (ICR) <ul> <li class="show">for the years&nbsp;2020-2021 = <strong>1.022</strong>;</li> <li class="show">for the years 2021-2022 = <strong>1.131</strong>;&nbsp;</li> <li class="show">for the years 2022-2023 = <strong>1.573</strong>;&nbsp;</li> </ul> </li> <li class="show"><strong>ICV - Index Copernicus Value</strong> <ul> <li class="show">for the year 2019 = <strong><span style="text-decoration: underline;">77.13</span></strong>;</li> <li class="show">for the year 2020 = <strong><span style="text-decoration: underline;">88.13</span></strong><u>;</u></li> <li class="show">for the year&nbsp;2021 = <span style="text-decoration: underline;"><strong>100.00 </strong></span>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;</li> </ul> </li> <li class="show"><strong>ISRA JIF - </strong><span style="text-decoration: underline;">2,197</span>;</li> <li class="show"><strong>GIF -&nbsp;</strong>2.394;</li> <li class="show"><strong>International License.</strong> CC BY-NC 4.0</li> </ul> </div> Surgical Treatment of Abdominal Aortic Aneurysms. A Retrospective Study. 2024-01-20T03:01:53+00:00 Edmond Nuellari Saimir Kuci Albana Kenga Denis Kosovrasti Alfred Ibrahimi Ervin Bejko <p><strong><em>Introduction:</em></strong> Surgical treatment of abdominal aortic aneurysms poses a significant challenge in the field of vascular surgery, with numerous factors influencing operative technique and surgical outcome.</p> <p>This study aimed to assess the outcomes of open surgical treatment for patients with abdominal aortic aneurysms at the Vascular Surgery Service of University Hospital Centre “Mother Teresa” Tirana and provide recommendations for improving outcomes.</p> <p><strong><em>Material and Methods:</em></strong> A single-center, non-randomized, retrospective study of the results of open surgical treatment of abdominal aortic aneurysms in 206 patients from January 2008 to December 2015 was performed at the Vascular Surgery Service of University Hospital Centre “Mother Teresa” Tirana. The study only included patients with a histologically confirmed diagnosis of abdominal aortic aneurysm, while patients with ruptured abdominal aortic aneurysm were excluded.</p> <p>The study evaluated the incidence of abdominal aortic aneurysms, clinical and imaging findings of the disease (ultrasound, tomographic, and arteriographic), frequency of involvement of the iliac artery in the pathological process, and postoperative complications. Transabdominal access was the most commonly utilized, while retroperitoneal access was deemed the safest. No significant differences in recurrence rates were noted between the two approaches.</p> <p><strong><em>Results:</em></strong> During the study period, 206 patients underwent surgery for AAA and met the inclusion criteria. Of these, 188 (91.3%) were male and 18 (8.7%) were female. The mean age of the patients was 67.8±5.7 years, with 67.7±5.9 years for men and 69±3.1 years for women. There were no statistically significant differences in age between genders (p&gt;0.05).</p> <p><strong><em>Conclusion:</em></strong> In all other cases of abdominal aortic aneurysms, surgical treatment should be strongly recommended. Finally, given the clinical benefits of using surgical treatment of asymptomatic aneurysms to reduce mortality, it is necessary to conduct an economic assessment of the feasibility of abdominal aortic aneurysms screening in the population over 55 of the age of both sexes.</p> <p>&nbsp;</p> 2024-01-20T00:00:00+00:00 ##submission.copyrightStatement## Comparison of postoperative complications using Harmonic scalpel and LigaSure in thyroid surgery 2024-01-20T03:01:51+00:00 Francesk Mulita Elias Liolis Levan Tchabashvili Konstantinos Tasios Vasileios Papanikos Christos Tsilivigkos Andreas Antzoulas Georgios-Ioannis Verras <p><strong>Background</strong>: Thyroid surgery is the most common operation in the field of endocrine surgery. The aim of this study was to compare the use of LigaSure vessel (LS) and Harmonic scalpel (HS) in 1599 total thyroid surgeries between January 2008 and December of 2022, with regards of analysis of surgical complications, duration of hospital stay and operative surgical time.</p> <p><strong>Methods</strong>: In this retrospective study patients have been categorized into two groups: Group A included 718 patients from January 2008 to May 2013 when LigaSure vessel was used, and the Group B included 881 patients from June 2013 to December 2022 when Harmonic scalpel was used. A summary of the total number of postoperative complications cases, surgical time and the duration of hospital stay between the two groups is presented.</p> <p><strong>Results</strong>: There was no significant difference in the sex, age, and mean operating time between the two groups (P&gt;0.05). Either major bleeding or wound infection occurred in 4 (0.6%) or 14 (1.9%) of the patients undergoing thyroidectomy when LS was used compared to 4 (0.5%) or 15 (1.7%) of the patients undergoing thyroid surgery when HS was used (P&gt; 0.05 and P&gt; 0.05, respectively). In addition, either hypoparathyroidism or temporary recurrent laryngeal nerve palsy was observed in 91 (12.7%) or 39 (5.4%) of the Group A patients compared with 98 (11.1%) or 44 (5%) of the Group B patients (P&gt; 0.05 and P&gt; 0.05, respectively).</p> <p><strong>Conclusion</strong>: &nbsp;The current study demonstrates that thyroidectomy can be safely performed with both devices without increasing the risk of complications.</p> 2024-01-20T00:00:00+00:00 ##submission.copyrightStatement## The Lacing Dermatotraction Suturing Technique 2024-01-20T03:01:49+00:00 Ashwath V.H. Venkataramana Manjunath Byadigere Abdul Razack Harindranath Ranganath Aeiman Saniya Hussain Arish Suraj Pattar <p><strong><em>Introduction: </em></strong>Hailing from a tertiary government-aided center, infected surgical wounds varying from diabetic foot and necrotizing fasciitis to surgical site infection are by far the most common cluster of cases encountered in our practice. Due to an overall lack of patient education on wounds, most of these patients present late, necessitating extensive debridement and tissue loss.</p> <p><strong><em>Aim and Objective</em></strong>: To describe the lacing dermatotraction technique and to study its application in aiding early secondary closure of infected surgical wounds.</p> <p><strong><em>Material and Methods: </em></strong>An interventional Study was conducted at VICTORIA Hospital, Bangalore, from February 2020 to October 2021. Fifty-four patients with Infected wounds were debrided until healthy margins were obtained, followed by applying the shoelace tension lacing suture. This consisted of an infant feeding tube running under loops of prolene fixed 1 cm away from the edge of the wound. One end of the IFT is anchored to the skin, and the other is held in position with single throws of no-1 silk suture, which can be loosened at the next sitting for adequate wound exposure, which aids in better debridement. The tension suture is again tightened to attain the maximal possible wound approximation.&nbsp;&nbsp; Thus, constant traction on the skin edges creates progressive closure until secondary closure is achieved.</p> <p><strong><em>Results: </em></strong>54 Patients were enrolled<strong><em>,</em></strong> consisting of 8 amputation stump infections, 11 diabetic foot, 14 disarticulations, five bed sore, 12 fasciotomies, three mastectomy flap necrosis, and one traumatic avulsion. There were 38 males and 16 females, with a mean age of 53.4 years. The mean duration of the wound at presentation was 17 days, and they were subjected to an average of 11 days of debridement. Mean wound dimensions - length= 11.02cm, breadth=4.86cm and area = 53.55 cm<sup>2</sup>. On applying the lacing, the wounds were debrided for an average of 8.85 days with 2.9 tightening. Secondary closure was achieved in 45 (83.33%) patients,.</p> <p><strong><em>Conclusion:</em></strong> The lacing technique is inexpensive and safe to achieve early secondary closure of infected wounds. It avoids the need for skin grafts, reducing the need for anesthesia, hospital expenditure, and duration of hospital stay of patients.</p> <p>&nbsp;</p> 2024-01-20T00:00:00+00:00 ##submission.copyrightStatement## Challenges with Life-Threatening Injuries in the Room of Reanimation. 2024-01-20T03:01:50+00:00 Basri Lenjani Agron Dogjani Nuhi Arslani Ilirian Lenjani <p style="font-weight: 400;"><strong><em>Introduction:</em></strong> Patients with life-threatening injuries are a significant concern in the emergency department (ED). These injured people require timely care, as their lives depend on it, and a longer wait can result in organ failure, irreversible damage, and poor survival outcomes.</p> <p style="font-weight: 400;">The purpose of this research is the evaluation, epidemiology, management, diagnosis, treatment, systematization, and the results obtained for the injured in life-threatening cases with trauma, reducing morbidity, disability, and mortality while increasing survival.</p> <p style="font-weight: 400;"><strong><em>Material and Methods.</em></strong> In this retrospective study, we researched and analyzed the data of patients with critical traumatic injuries in DE treated from January-December 2021</p> <p style="font-weight: 400;"><strong><em>Results.</em></strong> During the study period, we analyzed 75,899 ED patients. Of these, 627 cases, or 0.83%, were severely injured and traumatically admitted as a life-threatening traumatic medical emergency in the resuscitation room. Attacked age were males 507 cases or 80.87% and females 120 cases 19.13% and over 16 were 46 cases or 6.67%. The main problem in the admission of the sick was the injured with disorders of consciousness, shock, cardiac, and respiratory failure, as well as issues at the systemic level.</p> <p style="font-weight: 400;"><strong><em>Conclusion.</em></strong> During the study period, we analyzed 75,899 ED patients. Of these, 627 cases, or 0.83%, were severely injured and traumatically admitted as a life-threatening traumatic medical emergency in the resuscitation room. Attacked age were males 507 cases or 80.87% and females 120 cases 19.13% and over 16 were 46 cases or 6.67%. The main problem in the admission of the sick was the injured with disorders of consciousness, shock, cardiac, and respiratory failure, as well as issues at the systemic level.</p> <p style="font-weight: 400;">Also, these critically injured require structured and well-organized care in the DE in the resuscitation room, with educated medical staff, nurses, and support staff trained with the mandatory BLS, BTLS, PHTLS, and ATLS courses, implementing and developing the algorithms standardized for structured care of the critically injured.</p> <p style="font-weight: 400;"><strong><em>Keywords:</em></strong> DE, traumatic, life-threatening medical emergency, CPR. monitoring, management,</p> <p>&nbsp;</p> 2024-01-20T00:00:00+00:00 ##submission.copyrightStatement## Percutaneous Cannulation for Minimally Invasive Cardiac Surgery: The Safest and Effective Technique for the Future. 2024-01-20T03:01:49+00:00 Saimir Kuci Alfred Ibrahimi Marsela Goga Ermal Likaj Selman Dumani Andi Kacani Altin Veshti <p><em><strong>Introduction:&nbsp;</strong> </em>In recent years, contemporary minimally invasive cardiac surgery techniques have been used in many cardiac surgical clinics.</p> <p>With the expansion of minimally invasive operations, ECMO, and some interventional therapies, the current cardiac surgical landscape requires a thorough knowledge of peripheral cannulation techniques. A venous cannulation that is not flawlessly performed can lead to serious life-threatening complications in several steps. The technique we describe step by step is the current gold standard in terms of safety and efficacy: from the use of ultrasound for ultrasound-guided puncture to the safe advancement of super stiff guidewires using a sentinel catheter and concluding with smooth insertion of the venous cannula over the stiff guidewire up to the SVC. Moreover, a list of bailout maneuvers to solve complications and a report of institutional clinical experience since adopting this technique are presented.</p> <p><strong><em>Conclusion: </em></strong>In our experience, however, the fact is that patients' perceptions and expectations have changed. Patients increasingly ask for a therapeutic approach that leaves the sternum intact. Those doctors who want to meet this new challenge must realize that minimal incisions in cardiac surgery require excellent technical skills. For this reason, doctors should become familiar with current study data.</p> <p>&nbsp;</p> <p>&nbsp;</p> 2024-01-20T00:00:00+00:00 ##submission.copyrightStatement## Our Experience in Carotid Endarterectomy. A Retrospective Study 2024-01-20T03:01:52+00:00 Edmond Nuellari Edvin Prifti <p><strong><em>Introduction:</em></strong> Carotid endarterectomy (CEA) operations have been more frequent in our practice in recent years, primarily for asymptomatic patients. In this article, we present our experience in this field.</p> <p><em>Ojectives.</em> Primary endpoints were death and stroke within 30 days of the procedure for asymptomatic patients. Secondary endpoints were acute myocardial infarction within 30 days of the process and peripheral nerve injury in all patients.</p> <p><strong><em>Patients and Method: </em></strong>This is a retrospective review of our recent experience. Data of&nbsp; 219 consecutive CEA, 177 in asymptomatic patients, operated on from January 2004- February 2009 by our equip are collected; all the patients were diagnosed with Duplex scanner and confirmed with multi-slice CT scanner angiography. Endarterectomy was performed either with loco-regional or general anesthesia with selective use of a shunt. Combined anti-aggregation with Clopidogrel and Aspirin was the rule at discharge. Patients were controlled for new neurological and cardiac events 30 days after the operation.</p> <p><strong><em>Results: </em></strong>One asymptomatic patient had a major stroke and died. In this group, the stroke and mortality rate is 1,69%. No peri-operative new acute myocardial infarction happened in any patient. Peripheral nerve lesions occurred in 2,7 %of all procedures.</p> <p><strong><em>Conclusions: </em></strong>CEA is a safe treatment for asymptomatic internal carotid stenoses in the hands of an experienced vascular surgeon. Our results for asymptomatic carotid stenoses are according to international guidelines' recommendations.</p> <p>&nbsp;</p> 2024-01-20T00:00:00+00:00 ##submission.copyrightStatement## Construction Industry Causes of Injuries, Management of EMS and Its Impact on Public Health 2024-01-20T03:01:48+00:00 Basri Lenjani Andi Lenjani Agron Dogjani Luljeta Abdullahu Nuhi Arslani Dardan Lenjani Floriana Memedaliu Ilirian Lenjani <p style="margin: 0cm; line-height: 150%;"><em><strong><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">Introduction</span></strong></em><strong><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; color: #0e101a;"><span data-preserver-spaces="true">:&nbsp;</span></span></strong><span data-preserver-spaces="true"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">Injuries in construction are not a rare occurrence and cause a strain on the health care service. By having education on workplace hazards, trained first aiders, and an effective accident emergency response system, the occurrence of illness/injuries will reduce and hence the number of fatalities.</span></span></p> <p style="margin: 0cm; line-height: 150%;"><span data-preserver-spaces="true"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">The purpose of this research is the evaluation, epidemiology, management, diagnosis, treatment, systematization, and the results obtained about the construction industry for injury in life-threatening cases with trauma, reducing morbidity, disability, and mortality while increasing survival. Solving problems for severe traumas in the health system of Kosovo, such as with professional staff, doctors and nurses, dedicated spaces, medical equipment, drugs, consumables, poor diagnostics, non-decisional consultations, as well as their timely and timely delivery. seeks political health solutions to solve this problem.</span></span></p> <p style="margin: 0cm; line-height: 150%;"><em><span data-preserver-spaces="true"><strong><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">Material and Methods;&nbsp;</span></strong></span></em><span data-preserver-spaces="true"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">In this retrospective study, we researched and analyzed the data of patients with construction-related injuries in ED treated from January-December 2021&nbsp;</span></span></p> <p style="margin: 0cm; line-height: 150%;"><em><span data-preserver-spaces="true"><strong><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">Results;&nbsp;</span></strong></span></em><span data-preserver-spaces="true"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">During the study period, we analyzed 75,899 ED patients. Of these, 420 cases, or 0.06% were injured. In the research, 420 cases of injuries were investigated, investigating all age groups arising from construction-related activities for 2021.</span></span></p> <p style="margin: 0cm; line-height: 150%;"><em><span data-preserver-spaces="true"><strong><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">Conclusion;&nbsp;</span></strong></span></em><span data-preserver-spaces="true"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">To reduce workplace injuries an organization must carry out regular risk assessments, conduct physical assessments for demanding roles, provide safety and wellness training regularly, train and appoint first aid marshals, hire qualified workers, hire enough workers, keep workspaces clean and walkways clear, post proper signage, Provide adequate lighting, education and training on staff emergency response systems via courses BLS-D BTLS, PHTLS ATLS.&nbsp;</span></span></p> <p style="margin: 0cm; line-height: 150%;">&nbsp;</p> 2024-01-20T00:00:00+00:00 ##submission.copyrightStatement## Current Perception of Nature vs.Nurture Debate among Students at the University of Medicine of Tirana 2024-01-20T03:01:51+00:00 Ervin Marku Xhesika Miska Ledi Neçaj <p style="font-weight: 400;"><strong><em>Introduction:</em></strong><em>&nbsp;</em>One topic still debated in the scientific community and beyond is the influence of genetic or environmental factors on an individual's behavior. The essence of this debate lies in discussing the role and impact of genetic and environmental factors on an individual's behavior, known otherwise as the nature-nurture debate.</p> <p style="font-weight: 400;">In a survey-type study, we sought to assess perceptions of the&nbsp;<em>nature-nurture</em>&nbsp;argument among first-year technical medical sciences students at the University of Tirana, Albania.</p> <p style="font-weight: 400;"><strong><em>Materials and Methods:</em></strong>&nbsp;A cross-sectional study was conducted using a survey-type questionnaire on a sample of 100 first-year medical university students at the Faculty of Medical Technical Sciences, University of Medicine in Tirana, in April 2023. The questionnaire was based on six specific questions underlying the potential impact of genetic (nature) and environmental factors (nurture) influencing certain types of behavior, such as personality, sexual orientation, and intelligence—or psycho-emotional stress.</p> <p style="font-weight: 400;"><strong><em>Results:</em></strong><strong>&nbsp;</strong>According to the analysis of the data collected on our sample of students, 84.9% of them perceive that acquired factors (nurture) influence more than innate factors (nature) in forming personality traits, whereas 15.1% perceive&nbsp;the opposite.&nbsp;After adjusting for potential confounders, environmental factors remained statistically significant compared with genetic factors (odds ratio 1.42, 95% CI 0.65 to 0.97).&nbsp;</p> <p style="font-weight: 400;"><strong><em>Conclusion:</em></strong>&nbsp;Genetic and sociological research has shown that&nbsp;genetics,&nbsp;life experiences, and&nbsp;<em>environmental factors</em> influence the expression of key traits in shaping behavior. In this study, we confirm the perception of this interaction among medical students. For some aspects of behavior, students are less likely to believe in genetic explanations and more likely to believe in environmental causes.</p> 2024-01-20T00:00:00+00:00 ##submission.copyrightStatement## Atrial Fibrillation following CABG Surgery. Our Experience with 100 Patients 2024-01-20T03:01:47+00:00 Saimir Kuci Alfred Ibrahimi Marsela Goga Fation Hamiti Ervin Bejko Stavri Llazo Jonela Burimi Esmerilda Bulku <p><strong><em>Introduction: </em></strong>Atrial fibrillation (AF) is the most common complication of cardiac surgery,&nbsp;occurring in 10-40% of patients. Postoperative AF (POAF) refers to new-onset AF in a patient without a history of AF that occurs within the first four weeks after cardiac surgery. While POAF can be transient and without consequences, it may lead to severe complications, increasing mortality and morbidity in the postoperative period. Risk factors can be patient-related, intraoperative, and postoperative.</p> <p>This study aimed to estimate the frequency of AF in patients after CABG combined with valvular replacement or not. Identification of patients vulnerable to arrhythmia will allow targeting of those most likely to benefit from prophylactic therapy.&nbsp;</p> <p><strong><em>Material and Methods: </em></strong>The presented study is a prospective study of 100 patients undergoing elective CABG from February to April 2022 with a mean age of 66 ± 13 years, 30% women, undergoing CABG at the University Hospital Centre “Mother Teresa” Tirana, that developed POAF.</p> <p><strong><em>Results: </em></strong>Postoperative atrial fibrillation occurred in sixteen patients (16%) at a median of 3.7 days after cardiac surgery (2nd – 7th day). 94% (15) of POAF occurred in CABG only, and 6% (1) in the combined intervention (AVR et CABG).</p> <p><strong><em>Conclusion: </em></strong>AF is the most common complication after CABG. The occurrence is not dependent on the type of intervention (only CABG or combined with valve replacement), the number of vessels that underwent bypass grafting, or the type of vessel. Electrolytic imbalance should be assessed during the postoperative course of patients who undergo CABG.</p> <p>&nbsp;</p> 2024-01-20T00:00:00+00:00 ##submission.copyrightStatement## The Benefit of Open Rives-Stoppa Procedure in Complex Incisional Hernia. 2024-01-20T03:01:47+00:00 Bledi Masati Asfloral Haxhiu Marsel Dhima Tomi Punmira Gentian Zikaj Alfred Ibrahimi Agron Dogjani <p style="font-weight: 400;"><strong><em>Introduction:</em></strong> Ventral hernia is one of the most common general surgical pathologies. An incisional hernia will develop in 10–15% of patients with an abdominal incision, and the risk increases to up to 23% in those who develop surgical site infections.</p> <p style="font-weight: 400;">Ventral hernia repairs are mostly elective (90%) procedures, but the repair methods are highly variable.</p> <p style="font-weight: 400;">Popularized in Europe by Rives and Stoppa, the retromuscular technique has proven to be very effective, with a 94.2% probability of having the lowest odds for recurrence and a 77.3% probability of having the lowest odds for SSI.</p> <p style="font-weight: 400;">The study aimed to evaluate our experience at a secondary care center performing Rives-Stoppa repair for abdominal ventral and incisional hernias.</p> <p style="font-weight: 400;"><strong><em>Materials and Methods: </em></strong>Between April 2019 and August 2021, 46 patients in the practice at a secondary regional hospital, Teni Konomi, Korce, Albania, underwent a Rives-Stoppa incisional hernia repair.</p> <p style="font-weight: 400;"><strong><em>Results:</em></strong> There were 14 (31%) males and 32(69%) females (age range 31-75).</p> <p style="font-weight: 400;">Most incisional hernias were midline xiphoid-pubic incision and supraumbilical, with several subcostals (2 right and 1 left) hernias<strong>.</strong>At the time of repair, most incisional hernias were symptomatic and evident on physical exam. In four cases, the hernia sac was incarcerated at the presentation time.</p> <p style="font-weight: 400;"><strong>Conclusion: </strong>The Rives-Stoppa technique has excellent long-term results and low morbidity in patients with large primary or recurrent incisional hernias. It is the gold standard for most surgeons.</p> <p style="font-weight: 400;"><strong>Keywords: Incisional&nbsp;</strong>Hernia, mesh, polypropylene, abdominal wall surgery, rectus muscle</p> 2024-01-20T00:00:00+00:00 ##submission.copyrightStatement## The Gallstone Ileus, a Retrospective Study and Review of the Literature 2024-01-20T03:01:53+00:00 Nuhi Arslani <p><strong><em>Introduction</em></strong><em>:</em> Gallstone ileus (GI) is a rare complication of cholelithiasis and is one of the most irregular forms of all mechanical bowel obstructions. It is, however, a more common cause of non-strangulating mechanical small bowel obstruction, accounting for 1% to 4% of all patients and up to 25% in the elderly.</p> <p>The diagnosis is often delayed since symptoms may be intermittent, and investigations may fail to identify the cause of the obstruction. As a result, gallstone ileus continues to be associated with relatively high rates of morbidity and mortality.</p> <p>The cornerstone of healing is the removal of the stone that represents obstruction<strong>. </strong>As is the case with cholelithiasis, women are more frequently affected.</p> <p><strong><em>Material and Methods</em></strong><em>:</em> This article aims to review the incidence of gallstone ileus in our country in the literature, addressing the pathophysiology, clinical presentation, radiological findings, and treatment options. A literature search was done on gallstone ileus for 2005-2018.</p> <p><strong><em>Results:</em></strong> The patients in the study presentation were both genders and older. They all came to INP because of abdominal pain and general nausea. All had CRP elevation present. Leukocytosis was present in only 2/3 of patients. AST was elevated in one patient and ALT in 2. All changes in laboratory parameters indicate the instability of marker changes and, consequently, the unreliability of use alone without other diagnostic methods. A CT scan was performed on all three patients, but one still needed to be uploaded to the system at the time of writing.</p> <p><strong><em>Conclusions:</em></strong> Ileus due to gallstones is a rare disease. It is an uncommon cause of mechanical small bowel obstruction. It is a rare complication of chronic cholecystitis and occurs when a gallstone passes through a fistula between the gallbladder and small bowel before becoming impacted at the ileocecal valve. The use of radiological imaging is invaluable in the diagnosis of gallstone ileus. These authors recommend a low threshold for investigation. There is evidence for using AXR as a quick first-line investigation; however, CT scanning is a powerful and gold-standard tool to diagnose the condition and guide its management.</p> <p>&nbsp;</p> 2024-01-20T00:00:00+00:00 ##submission.copyrightStatement## Emergency Treatment of Ruptured Abdominal Aneurysm 2024-01-20T03:01:52+00:00 Edmond Nuellari Maxim Llambro <p style="font-weight: 400;"><strong><em>Introduction:</em></strong> Abdominal aneurysm is considered a formidable pathological condition that requires prompt treatment. Its progressive increase leads to rupture and massive internal bleeding, which requires the most effective medical care. However, despite the improvement in medical equipment and postoperative care, mortality due to ruptured abdominal aneurysms is still close to 50%, which is primarily related to the severity of the pathology and open surgical intervention.</p> <p style="font-weight: 400;"><strong><em>Materials and Methods:</em></strong> 46 patients diagnosed with rupture of the abdominal aorta took part in the study. Selection criteria were a history of abdominal aortic rupture, conservative/operative treatment for the disease, and absence of other complications (acute renal failure, liver infarction) that could affect the results of the study.</p> <p style="font-weight: 400;"><strong><em>Results:</em></strong> Since January 2018, 46 cases of ruptured AAAs have been diagnosed. In all forty-six cases, surgical intervention was used: open surgery or endovascular technique. All 100% of patients had a previous history of diagnosed abdominal aortic aneurysm, for which they underwent periodic ultrasound examinations.</p> <p style="font-weight: 400;">As a result of the study, it was found that endovascular aortic aneurysm correction is the optimal method for both planned and emergency treatment of aortic aneurysm and its rupture. According to the Cochrane Specialized Register, it was established that endovascular repair is associated with a reduction in early morbidity and mortality after abdominal aneurysm, compared with other methods of surgical treatment. Furthermore, the study found that, unlike open surgery methods, endovascular techniques are associated with a lower risk of complications in the form of intestinal ischemia.</p> <p style="font-weight: 400;"><strong><em>Conclusions:</em></strong> Inferior quality studies and lack of information limit the conclusions of this review. From the statistical data shown in this paper, it can be concluded that there is a difference between endovascular and open methods of treatment of abdominal aortic aneurysm rupture. Mortality within the first 30 days after treatment and short-term complications are significantly lower in patients using EVAR. Systemic complications are also more prevalent in patients who were prescribed open surgical treatment.</p> 2024-01-20T00:00:00+00:00 ##submission.copyrightStatement## Periosteal Lipoma Compressing Peripheral Nerves 2024-01-20T03:01:50+00:00 Florian Dashi Mishel Qirinxhi Aurora Muça Arba Cecia Norik Bardhi Denis Qirinxhi Ridvan Alimehmeti <p style="margin: 0cm; line-height: 150%;"><em><strong><span style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">Introduction:&nbsp;</span></strong></em><span style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">Lipoma is a common benign, slow-growing soft tissue neoplasm. Periosteal lipomas of the proximal radius causing posterior interosseus nerve (PIN) palsy are the rarest.&nbsp;</span></p> <p style="margin: 0cm; line-height: 150%;"><span style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">Due to specific anatomical relationships, proximal antebrachial lipomas can easily compress PIN. We present a case report and report on the related literature.</span></p> <p style="margin: 0cm; line-height: 150%;"><em><strong><span style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">Material and Methods:&nbsp;</span></strong></em><span style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">A 55-year-old female was admitted complaining of a progressively growing lump in the anterior-lateral antebrachial region near the<em><strong>&nbsp;</strong></em>left elbow. The recent onset of weakness in finger extension was more evident during manual work.&nbsp;</span></p> <p style="margin: 0cm; line-height: 150%;"><span style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">MRI showed a well-defined oval lesion in the dorsal aspect of the proximal radius bone with inter-muscular laying between m. supinator et extensor carpi radialis brevis of 7x5x3 cm in diameter. EMG study confirmed PIN compression syndrome.</span></p> <p style="margin: 0cm; line-height: 150%;"><span style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">An en-block extirpation was performed through extensor muscles. PIN and its muscular branches were well preserved. Histological examination confirmed lipoma. The postoperative course was uneventful, and a good recovery was seen within 12 days.&nbsp;</span></p> <p style="margin: 0cm; line-height: 150%;"><span style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">We revised three other similar cases operated for the same Clinical diagnosis by our team.&nbsp;</span></p> <p style="margin: 0cm; line-height: 150%;"><span style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">Pertinent literature was reported.&nbsp;</span></p> <p style="margin: 0cm; line-height: 150%;"><em><strong><span style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">Discussion:&nbsp;</span></strong></em><span style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">Periosteal radius lipoma related to compression of PIN has rarely been reported in the literature. We say our operative series and the surgical technique. MRI and EMG are the standard diagnostic methods. The intermuscular approach is safe for total tumor removal in experienced hands.</span></p> <p style="margin: 0cm; line-height: 150%;"><em><strong><span style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">Conclusion:</span></strong></em><span style="font-size: 11.0pt; line-height: 150%; color: #0e101a;">&nbsp;Periosteal lipoma compressing PIN is a rare clinical finding. Total removal may be obtained through an intermuscular approach. Intraoperative monitoring can assist in preserving tiny PIN branches</span></p> 2024-01-20T00:00:00+00:00 ##submission.copyrightStatement## Management of Perforated Sigmoid Diverticulitis with Associated Retroperitoneal Abscess and Generalized Peritonitis 2024-01-20T03:01:48+00:00 Kastriot Haxhirexha Aferdita Ademi Agron Dogjani Roland Alili Ferizat Dika – Haxhirexha Blerim Fejzuli Teuta Emini – Rushiti <p><em><strong>Introduction:</strong></em>&nbsp;Diverticulitis represents a relatively common pathology within the gastrointestinal tract. While diverticula can occur throughout the digestive system, their prevalence is notably higher in the left colon, particularly in the sigmoid region. This condition predominantly affects middle-aged and elderly males. The most effective diagnostic methods for this disease are colonoscopy and computed tomography (CT) with contrast. Although severe complications of diverticulitis are infrequent, the optimal classification of these complications has been described by Hinchey.</p> <p><em><strong><span lang="EN-US">The article aims </span></strong></em><em><span lang="EN-US">to </span></em>show the case of a young patient with complicated diverticulitis with perforation and generalized peritonitis, classified as stage III-IV<span lang="EN-US">,</span> according to Hinchey<span lang="EN-US">.</span></p> <p><em><strong>Case report:</strong></em><strong>&nbsp;</strong>A 43-year-old female patient was urgently admitted to the General Surgery Clinic at Tetovo Clinical Hospital, presenting with severe generalized abdominal pain and signs of peritoneal irritation. Comprehensive diagnostic imaging revealed a large retroperitoneal abscess located above the psoas muscle, accompanied by a significant accumulation of free fluid, suspected to be pus, in the abdominal cavity. Following initial resuscitation, surgical intervention was undertaken. Intraoperative findings included advanced inflammatory changes in the sigmoid colon, characterized by thickened fibrotic walls and a partially constricted lumen. A large abscess was also identified in the retroperitoneal space between the spleen and left kidney. Given these findings, resectioning the distal descending colon and most of the sigmoid colon was considered necessary. The retroperitoneal abscess was incised, its contents aspirated, and a thorough cavity debridement was performed. Subsequently, the Hartmann procedure was executed. Postoperatively, due to the patient's deteriorating condition, she was transferred to the intensive care unit for continued treatment. The patient was discharged from the hospital in stable condition on the tenth day following the surgery.</p> <p><em><strong>Conclusion:</strong></em>&nbsp;While complications from sigmoid diverticula are uncommon, they can occasionally be extremely severe and pose a significant risk to patient survival.</p> 2024-01-20T00:00:00+00:00 ##submission.copyrightStatement## A Report of Two Cases with Caseous Annular Calcification of the Mitral Valve. 2024-01-20T03:01:49+00:00 Ermal Likaj Selman Dumani Alessia Mehmeti Laureta Dibra Ervin Bejko Edlira Rruci Altin Veshti <p><strong><em>Introduction:</em></strong> Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annulus calcification, a chronic and degenerative mitral valve fibrous ring process. It usually carries a benign prognosis. The prevalence of CCMA is about 0.06%-0.07% of the population. CCMA is generally diagnosed incidentally and can be confused with other intracardiac masses such as cardiac tumors, abscesses, vegetation, or calcified thrombi. Multimodality imaging, including TEE, cardiac computed tomography, and cardiac magnetic nuclear resonance, can easily differentiate CCMA from other masses and help avoid unnecessary surgery. CCMA is typically located in the basal area of the posterior mitral valve, and the calcification seems like a round, large, soft mass with a central echo-dense location.&nbsp;CCMA may have a benign course, but it may sometimes be complicated with mitral valvular dysfunction, systemic embolization, or conduction abnormalities in the scenarios mentioned above, as well as when the diagnosis is unclear, surgery is indicated. Mitral valve replacement should be preferred compared to mitral valve repair.</p> <p><strong><em>Conclusions:</em></strong> It is important to note that the decision for mitral valve replacement, including CAC cases, should be individualized based on various factors, including the patient's clinical condition, symptoms, severity of valve disease, and associated comorbidities.</p> <p>As scientific understanding and research progress, there may be ongoing developments and refinements in the conservative and surgical management of CCMA.</p> 2024-01-20T00:00:00+00:00 ##submission.copyrightStatement## Successful Awake Caudal Anesthesia for Incarcerated Inguinal Hernia Repair in an Ex-Premature Baby at 8 Weeks of Age. 2024-01-20T03:01:54+00:00 Nerses Kyurkchyan Fabien Masse Vahe Kharatyan Khachatur Kyurkchyan <p><em><strong>Introduction</strong></em>: Caudal anesthesia is a standard procedure in pediatric anesthesia because of its excellent safety and success rate. Usually, it is administered after general anesthesia, but in selected neonatal populations, awake caudal anesthesia is a method of choice.</p> <p>Prematurely born, low birth weight neonates are more prone to complications from general anesthesia than term neonates, even after simple surgery. Among these complications, post-operative apnea is the most common.</p> <p>Caudal epidural anesthesia in awake neonates is a recognized technique that enables the avoidance of general anesthesia and the complications associated with it. In skilled hands, it is also theoretically easier to perform consistent caudal anesthesia than an awake subarachnoid block. In our case, we report a successful awake caudal anesthesia in an ex-premature baby in the emergency setting for incarcerated inguinal hernia repair.</p> <p>To our knowledge, this case report on this topic has yet to be published in Armenia.</p> <p><em><strong>Conclusion:&nbsp;</strong></em>Neuraxial (spinal, epidural, caudal) awake anesthesia is the method of choice for lower abdominal surgery in preterm infants. Both spinal and caudal anesthesia are effective methods; awake caudal anesthesia is a method of choice because of the success rate and lower analgesic requirements in the post-operative period.</p> <p>&nbsp;</p> <p>&nbsp;</p> 2024-01-20T00:00:00+00:00 ##submission.copyrightStatement## Surgical Site Infections with MRSA in young Patients 2024-01-20T03:01:50+00:00 Aferdita Ademi Ferizat Dika – Haxhirexha Aulona Haxhirexha Blerim Fejzuli Kastriot Haxhirexha Teuta Emini – Rushiti <p><strong><em>Introduction:</em></strong> Surgical site infections (SSIs) pose a global health concern. While various pathogenic microorganisms can cause SSIs, a predominant causative agent is Staphylococcus aureus, particularly its methicillin-resistant strain (MRSA). MRSA, known for its resistance to multiple antibiotics, significantly complicates treatment options, leading to increased morbidity. In some cases, particularly among patients with pre-existing comorbidities, MRSA infections can prove fatal. Moreover, eradicating MRSA from hospital settings presents a formidable challenge.</p> <p>This study aims to report on two young, otherwise healthy patients who developed MRSA infections in their surgical wounds during hospitalization.</p> <p><strong><em>Case Descriptions:</em></strong> A 22-year-old female patient developed an MRSA infection following an appendectomy and a 12-year-old male patient exhibited similar complications post-orchiopexy. In both cases, MRSA presence was confirmed through microbiological cultures a few days post-surgery. Repeated cultures indicated successful MRSA eradication after isolation and initiation of targeted antibiotic therapy based on antibiograms. Once their general health stabilized, the patients were discharged and continued outpatient antibiotic treatment for a prescribed duration.</p> <p><strong><em>Conclusion:</em></strong> These cases emphasize that MRSA infections, typically associated with elderly patients or those with underlying health conditions, can also occur in younger, healthier individuals. Eradicating these infections remains a significant challenge for healthcare facilities encountering MRSA.</p> <p><strong><em>Keywords:</em></strong> Staphylococcus aureus, Methicillin-resistant, young patients, Surgical site infections.</p> 2024-01-20T00:00:00+00:00 ##submission.copyrightStatement## Allergic Acute Coronary Syndrome: A Case Report and Literature Review 2024-01-20T03:01:53+00:00 Mehmet Hoxha Ester Ndreu Etleva Qirko Loloçi <p><strong><em>Introduction:</em></strong> Kounis Syndrome was first described in 1991 by Kounis and Zavras as “the concurrence of chest pain during an allergic reaction, accompanied by clinical laboratory findings of classical angina pectoris caused by inflammatory mediators released during the allergic insult” [1].</p> <p>The mechanism of Kounis Syndrome most likely involves the release of cytokines through mast-cell degranulation, which leads to coronary vasospasm and atheromatous plaque erosion or rupture following the allergic reaction to an allergen.[2]</p> <p>The treatment is specific to acute coronary syndrome and anaphylaxis, with the added complication that the drugs used, while indicated in each of the two disorders separately, may present contradictions when administered jointly in one patient.[3]</p> <p>The purpose of this review is to briefly revise the existing literature regarding its overlooked diagnosis and contradictory joint management of anaphylaxis and acute coronary syndrome.</p> <p>We will conduct a brief review of the current literature on Kounis Syndrome while describing a suspected case of a female patient presented with both anaphylaxis symptoms and angina pectoris.</p> <p><strong><em>Conclusions:</em></strong> Kounis syndrome is defined as the co-incidental occurrence of an acute coronary syndrome with hypersensitivity reactions following an allergic reaction. Treatment of allergic reactions may be sufficient in type I KS. In contrast, coronary intervention is needed in the other two types, accompanied by vasodilator drugs, including nitrates and calcium antagonists, each of which may have contradictory effects.</p> 2024-01-20T00:00:00+00:00 ##submission.copyrightStatement## Surgical Treatment of Uncomplicated Pilonidal Sinus with the Simple Closed Technique - New Findings of Pilonidal Sinus Treatment from Albania. 2024-01-20T03:01:54+00:00 Marius Dettmer Dietrich Doll Matthias Maak <p>Dear Editor,</p> <p>Concerning the article of Bollano E et al. “Surgical treatment of uncomplicated Pilonidal Sinus with a simple closed technique” has been gathering our attention. In this LTE, we would like to critically discuss some of the author's statements. Firstly, the stated pathophysiology of PSD is an outdated theory. Furthermore, primary midline closure, as postulated by the author, is not the surgical procedure of first choice, as several large reviews have shown.</p> <p>The letter discusses the rationale behind adopting the simple closed technique, highlighting its efficacy and potential advantages. By presenting data from our experiences in Albania, we aim to contribute valuable insights to the global discourse on pilonidal sinus treatment.</p> <p>This letter is a noteworthy addition to AJTES, offering fresh insights into the treatment landscape of pilonidal sinus. We trust the editorial team will find the content aligned with the journal's objectives and scope.</p> <p>Your consideration of this submission is highly appreciated, and we look forward to the possibility of contributing to the journal's ongoing dialogue on innovative surgical approaches.</p> <p>&nbsp;</p> 2024-01-20T00:00:00+00:00 ##submission.copyrightStatement##