A series of 34 patients with pancreatic resections was evaluated with respect to the occurrence o... more A series of 34 patients with pancreatic resections was evaluated with respect to the occurrence of local and general complications. Two groups were compared, depending on whether or not treatment with somatostatin was instituted. Postoperative morbidity and mortality were less frequent when somatostatin was given (resp. 50.0 and 5.5%) than when it was omitted (resp. 68.7 and 31.2%). Less complications were observed after resections performed for chronic pancreatitis than for pancreatic cancer in the non somatostatin-treated group. It is concluded that somatostatin treatment may be beneficial in preventing complications after elective pancreatic surgery.
Objective: Previous reports on the prevalence of diabetes in pancreatic cancer and chronic pancre... more Objective: Previous reports on the prevalence of diabetes in pancreatic cancer and chronic pancreatitis patients are based on inconsistent and equivocal criteria. The objective of this study is to prospectively assess with conclusive methods the preoperative glycaemic status of patients undergoing pancreatic surgery. We hypothesise that most of those patients are unaware of these disturbances in glycaemic status and that the prevalence is underestimated. Methods: During the last 2 years, patients referred for pancreatic surgery and without history of diabetes underwent a prospective preoperative screening with an oral glucose tolerance test (OGTT) and determination of the glycated haemoglobin level (HbA1c). The American Diabetes Association's criteria for diabetes and pre-diabetes were used. Beta-cell function and insulin sensitivity were calculated using HOMA2 indices. Impact on surgical policy has been scored. Results: 99 patients were screened, 25 had a history of diabetes. The other 74 underwent an OGTT and HbA1c determination. Only 29.7% (22/74) had a normal glucose metabolism, while 8.1% (6/74) had impaired fasting glucose, 21.6% (16/74) had impaired glucose tolerance, 6.7% (5/74) had a combination of both, and 33.8% (25/74) had undiagnosed diabetes. In 15.2% (15/99) of the patients, this preoperative assessment had an impact on surgical policy. Conclusions: 77.7% of patients referred for pancreatic surgery had some degree of (pre-)diabetes. In 70.3% of patients without a history of diabetes, these disturbances in glucose metabolism are a new finding. Physicians involved in pancreatic surgery should be aware of the frequently undiagnosed (pre-)diabetes and actively check for it. This prevalence is underestimated.
Organ donation after euthanasia has been performed more than 40 times in Belgium and the Netherla... more Organ donation after euthanasia has been performed more than 40 times in Belgium and the Netherlands together. Preliminary results of procedures that have been performed until now demonstrate that this leads to good medical results in the recipient of the organs. Several legal aspects could be changed to further facilitate the combination of organ donation and euthanasia. On the ethical side, several controversies remain, giving rise to an ongoing, but necessary and useful debate. Further experiences will clarify whether both procedures should be strictly separated and whether the dead donor rule should be strictly applied. Opinions still differ on whether the patient's physician should address the possibility of organ donation after euthanasia, which laws should be adapted and which preparatory acts should be performed. These and other procedural issues potentially conflict with the patient's request for organ donation or the circumstances in which euthanasia (without subse...
The efficacy of total parenteral nutrition and somatostatin was assessed in reducing output and p... more The efficacy of total parenteral nutrition and somatostatin was assessed in reducing output and promoting spontaneous closure of postoperative digestive fistulas. In a consecutive series of 23 patients, closure was achieved in 83% of patients after a mean fistula duration of 11.0 +/- 7.9 days and a mean of 13.2 +/- 7.0 days of drug treatment, and without mortality. A marked first-day effect (output drop > 50%) was noted in 60% of patients and had a good prognosis. Infection of the fistula markedly prolonged fistula closure time, but did not affect total outcome. Somatostatin has been shown to be very useful in the conservative treatment of digestive fistulas because of its ability to reduce output significantly and to accelerate spontaneous closure.
International journal of nursing practice, Jan 9, 2014
Malnutrition is a known problem in hospitals and nursing homes. This study aims to evaluate the p... more Malnutrition is a known problem in hospitals and nursing homes. This study aims to evaluate the prevalence of being at risk of malnutrition in community living adults receiving homecare nursing and to determine factors independently associated with this risk of malnutrition. Furthermore, it also aimed to describe aspects of current nutritional nursing care. Patients (n = 100) are screened with the Malnutrition Universal Screening Tool to evaluate their risk of malnutrition. A patient survey was used to analyse associated factors. In this population, 29% are at risk for malnutrition. Following a multivariate logistic regression analysis, 'loss of appetite' proved the most important factor. A survey for nurses (n = 61) revealed low awareness, poor knowledge, poor communication between stakeholders and a moderate approach of malnutrition. These findings should encourage homecare nurses to use a recommended screening tool for malnutrition and to actively observe and report loss ...
An observation on Pneumatosis Cystoides Intestinalis (PCI) in a 66-year-old man is reported. His ... more An observation on Pneumatosis Cystoides Intestinalis (PCI) in a 66-year-old man is reported. His general condition allowed a thorough clinical and laboratory investigation which resulted in the diagnosis of the disease and the avoidance of an unnecessary laparotomy. PCI is a relatively rare condition characterized by multiple intramural pockets of gas involving any portion of the gastro intestinal tract. Various theories reflect either a mechanical or a bacterial etiology. Most of the patients are asymptomatic although some experience gastrointestinal complaints. The majority of patients require no treatment.
Within a two year period, the diagnosis of acute dissection of a segment of the abdominal aorta w... more Within a two year period, the diagnosis of acute dissection of a segment of the abdominal aorta was made in five cases without aneurysmal dilation or leakage and with virtually no ischaemia. All patients presented with an atypical painful abdominal syndrome and the diagnosis was made by computed tomography. Only one patient, suffering persistent pain was treated by resection and graft interposition of the infrarenal aorta. All the others were treated conservatively and kept under close follow-up. Two of them died from intercurrent disease. The remaining three patients are doing well after 30 and 42 months conservative treatment and 43 months after surgery respectively. A non-complicated dissection of the abdominal aorta must be considered in the differential diagnosis of atypical painful abdominal syndromes. In cases of persistent pain, progression, ischaemia, aneurysmal dilatation or leakage, surgical treatment is mandatory. In uncomplicated cases conservative treatment is recommen...
Leukocyte infiltration in response to I/R injury is a well-known but poorly understood phenomenon... more Leukocyte infiltration in response to I/R injury is a well-known but poorly understood phenomenon. The contribution of neutrophils in this process is still controversial. Despite numerous data, little is known about exact numbers of infiltrating neutrophils. The role of monocytes/macrophages in this process is even more unclear. The role neutrophils in the kidney and other organs was reviewed. The variability in models and methods for neutrophil quantification were examined, along with carrying out a critical overview of depletion and anti-adhesion approaches. Nevertheless, the exact role attributed to neutrophils in the I/R process remains unclear.
A major problem in the surgical treatment of diffuse peritonitis is to obtain a complete clearanc... more A major problem in the surgical treatment of diffuse peritonitis is to obtain a complete clearance of septic foci in the peritoneal cavity which may lead to persistence of sepsis and multiple organ failure. We describe our experience with staged abdominal re-explorations using a Zipper system in 23 patients with a mean APACHE II score of 20.3 (s.e.m: 1.5). A total of 91 lavages were done in these patients. Overall mortality was 39%. None of the patients having an APACHE II score between 10 and 20 died whereas the predicted mortality was 15%-45%. After successful treatment, primary closure was possible in 8 of the 14 surviving patients. Large incisional hernias developed in 6 patients. One patient eviscerated two years after complete granulation of his laparostoma. Staged abdominal re-explorations using a Zipper system is an useful tool in the treatment of diffuse peritonitis.
This is believed to be the youngest patient to undergo a saphenous vein bypass for iatrogenic tra... more This is believed to be the youngest patient to undergo a saphenous vein bypass for iatrogenic trauma of the right superficial femoral artery. The infant had emergency right heart catheterisation and Rashkind septostomy for severe desaturation due to transposition of the great arteries. During the exposure of the saphenous vein, the superficial femoral artery was accidentally severed at it's origin. An attempt to restore the circulation by end-to-end anastomosis failed and resulted in persistent limb ischemia for over 4 hours. The baby was reoperated upon, the damaged part of the superficial femoral artery was resected and a saphenous vein graft interposed between the common and the distal superficial femoral artery.
It remains unclear which liver graft reperfusion technique leads to the best outcome following tr... more It remains unclear which liver graft reperfusion technique leads to the best outcome following transplantation. An online survey was sent to all transplant centres (n = 37) within Eurotransplant (ET) to collect information on their technique used for reperfusion of liver grafts. Furthermore, a systematic review of all literature was performed and a meta-analysis was conducted based on patients' mortality, number of retransplantations and incidence of biliary complications, depending on the technique used. Of the 28 evaluated centres, 11 (39%) reported performing simultaneous reperfusion (SIMR), 13 (46%) perform initial portal vein reperfusion (IPR), 1 (4%) performs an initial hepatic artery reperfusion (IAR) and 3 (11%) perform retrograde reperfusion (RETR). In 21 centres (75%), one reperfusion technique is used as a standard, but in only one centre is this decision based on available literature. Twenty centres (71%) said they would agree to participate in randomized controlled trials (RCT) if required. For meta-analysis, IAR vs. IPR, SIMR vs. IPR and RETR vs. IPR were compared. There was no difference between any of the techniques compared. There is no consensus on a preferable reperfusion technique. Available evidence does not help in the decision-making process. There is thus an urgent need for multicentric RCTs.
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, Jan 4, 2016
Many physicians and patients do not realize that it is legally and medically possible to donate o... more Many physicians and patients do not realize that it is legally and medically possible to donate organs after euthanasia. The combination of euthanasia and organ donation is not common practice, often limited by the patient's underlying pathology, but has nevertheless been performed more than 40 times in Belgium and the Netherlands since 2005. In anticipation of patients' requests for organ donation after euthanasia and contributing to awareness of the possibility of this combination among general practitioners and medical specialists, the Maastricht University Medical Center (MUMC) and the Erasmus University Medical Center Rotterdam have developed a multidisciplinary practical manual in which the organizational steps regarding this combined procedure are described and explained. This practical manual lists the various criteria to fulfill, and the rules and regulations the different stakeholders involved, e.g. the patient, the performing physician, the transplant coordinator,...
Studies in health technology and informatics, 1996
Endoscopy, a we know it today, is far from perfect. In an attempt to make the interventions as li... more Endoscopy, a we know it today, is far from perfect. In an attempt to make the interventions as little invasive as possible, the ergonomics of the procedure, for the surgeon, are often not dealt with at all. In an attempt to improve the surgeon-patient interface during endoscopic procedures, a new concept is presented to allow the surgeon a much more natural visual interaction with the inside of the patient. It is made possible for the surgeon to look around into the cavity, with a stereo endoscope, mounted on a robot arm. This robot arm is directed by the motion of the head of the surgeon.
BACKGROUND Due to the SARS - COV 2 pandemic related restrictions the 2020 Belgian Surgical Week (... more BACKGROUND Due to the SARS - COV 2 pandemic related restrictions the 2020 Belgian Surgical Week (BSW) was organized as a virtual congress, being the first surgical, virtual congress in Belgium. Since this was a new experience and probably not the last, we aim to share our experience to assist other professionals in organizing their virtual event. METHODS The "BSW-light" was organized by the RBSS in collaboration with a Professional Congress Organizer (PCO), which is described in detail. Analytical data of the event were provided by the PCO and a UEMS "live educational events participant evaluation form" based survey was sent out to all registered participant, using google forms, to evaluate the event. RESULTS During 2 days, 78 prerecorded presentations were broadcasted in 2 virtual conference rooms, each followed by a live Q & A session. The plenary session on the third day contained 8 live presentations, both from Belgium and from abroad. A total of 503 people registered for the congress, of whom 224 trainees. Each session attracted 158 visitors on average, each spending an average of 73 minutes.Attendees were satisfied with the technical aspect of the virtual congress, but they preferred an event that is at least partially live. CONCLUSION Although the "BSW-light" proved to be successful, a preference to meet in real live remained. However, given its potential, we should keep an open mind towards integrating the advantages of a virtual meeting into a live event.
BACKGROUND Belgium was one of the first European countries affected by the first wave of the Covi... more BACKGROUND Belgium was one of the first European countries affected by the first wave of the Covid-19 epidemic after Italy and France and has the highest rate of Covid-19-related deaths. Very few studies have evaluated the impact of the pandemic on surgical activity on a large scale. The primary objective of this national survey was to evaluate the impact of the first wave of the Covid-19 pandemic on surgical activities (elective non-oncological and oncological) in Belgian hospitals. METHODS A nationwide, multicenter survey was conducted in Belgium by the Royal Belgian Surgical Society (RBSS) board. The questionnaire focused on digestive surgical activity at different time points: period 1 (P1), before the epidemic; period 2 (P2), lockdown; and period 3 (P3), after stabilization of the epidemic. RESULTS The participation rate in the survey was 28.2% (24 out of 85 solicited hospitals), including 15 (62.5%) from the French speaking part of Belgium and 9 (37.5%) from the Flemish speaking part. Eighteen (75%) were non-academic and 6 (25%) were academic hospitals. All surgical activities were impacted by the Covid-19 pandemic except for the number of cholecystectomies. No statistical differences were observed between regions or according to the type of hospital. CONCLUSIONS Our national survey confirms that the COVID-19 outbreak has severely impacted in-person consultations and surgical activity for benign and malignant disease and for acute appendicitis. However, procedures for benign disease were much more affected than those for malignancies.
Aim: Pancreaticopleural fistula (PPF) is a rare complication of acute or chronic pancreatitis. Wh... more Aim: Pancreaticopleural fistula (PPF) is a rare complication of acute or chronic pancreatitis. When the pancreatic duct disrupts, pancreatic fluid may leak into the retroperitoneum and fistulate into the pleural cavity. Patients usually present with thoracic complaints, making it hard to suspect an abdominal etiology. Although PPF is uncommon, one must consider this diagnosis in patients with thoracic complaints and a history of alcohol abuse or pancreatitis. Methods: We present an illustrative case and review of the literature on PPF. Results: A 47-year old man was presented with recurrent PPF due to pancreas divisum, pancreatic stones and chronic exudative pancreatitis, resulting in unilateral empyema. After initial conservative treatment, operative measures were needed. We report omentoplasty against the diaphragmatic hiatus in combination with VATS (video-assisted thoracoscopic surgery) thoracotomy with decortication and debridement as a feasible operative option for resolving PPF. Conclusion: PPF is a rare complication of pancreatitis. The diagnosis is difficult to make and can be confirmed by thoracocentesis and proper imaging, preferably MRCP. Treatment options include conservative, endoscopic (ERCP) or surgical measures. Omentoplasty positioned against the diaphragmatic hiatus is a feasible technique for closure of PPF.
A series of 34 patients with pancreatic resections was evaluated with respect to the occurrence o... more A series of 34 patients with pancreatic resections was evaluated with respect to the occurrence of local and general complications. Two groups were compared, depending on whether or not treatment with somatostatin was instituted. Postoperative morbidity and mortality were less frequent when somatostatin was given (resp. 50.0 and 5.5%) than when it was omitted (resp. 68.7 and 31.2%). Less complications were observed after resections performed for chronic pancreatitis than for pancreatic cancer in the non somatostatin-treated group. It is concluded that somatostatin treatment may be beneficial in preventing complications after elective pancreatic surgery.
Objective: Previous reports on the prevalence of diabetes in pancreatic cancer and chronic pancre... more Objective: Previous reports on the prevalence of diabetes in pancreatic cancer and chronic pancreatitis patients are based on inconsistent and equivocal criteria. The objective of this study is to prospectively assess with conclusive methods the preoperative glycaemic status of patients undergoing pancreatic surgery. We hypothesise that most of those patients are unaware of these disturbances in glycaemic status and that the prevalence is underestimated. Methods: During the last 2 years, patients referred for pancreatic surgery and without history of diabetes underwent a prospective preoperative screening with an oral glucose tolerance test (OGTT) and determination of the glycated haemoglobin level (HbA1c). The American Diabetes Association's criteria for diabetes and pre-diabetes were used. Beta-cell function and insulin sensitivity were calculated using HOMA2 indices. Impact on surgical policy has been scored. Results: 99 patients were screened, 25 had a history of diabetes. The other 74 underwent an OGTT and HbA1c determination. Only 29.7% (22/74) had a normal glucose metabolism, while 8.1% (6/74) had impaired fasting glucose, 21.6% (16/74) had impaired glucose tolerance, 6.7% (5/74) had a combination of both, and 33.8% (25/74) had undiagnosed diabetes. In 15.2% (15/99) of the patients, this preoperative assessment had an impact on surgical policy. Conclusions: 77.7% of patients referred for pancreatic surgery had some degree of (pre-)diabetes. In 70.3% of patients without a history of diabetes, these disturbances in glucose metabolism are a new finding. Physicians involved in pancreatic surgery should be aware of the frequently undiagnosed (pre-)diabetes and actively check for it. This prevalence is underestimated.
Organ donation after euthanasia has been performed more than 40 times in Belgium and the Netherla... more Organ donation after euthanasia has been performed more than 40 times in Belgium and the Netherlands together. Preliminary results of procedures that have been performed until now demonstrate that this leads to good medical results in the recipient of the organs. Several legal aspects could be changed to further facilitate the combination of organ donation and euthanasia. On the ethical side, several controversies remain, giving rise to an ongoing, but necessary and useful debate. Further experiences will clarify whether both procedures should be strictly separated and whether the dead donor rule should be strictly applied. Opinions still differ on whether the patient's physician should address the possibility of organ donation after euthanasia, which laws should be adapted and which preparatory acts should be performed. These and other procedural issues potentially conflict with the patient's request for organ donation or the circumstances in which euthanasia (without subse...
The efficacy of total parenteral nutrition and somatostatin was assessed in reducing output and p... more The efficacy of total parenteral nutrition and somatostatin was assessed in reducing output and promoting spontaneous closure of postoperative digestive fistulas. In a consecutive series of 23 patients, closure was achieved in 83% of patients after a mean fistula duration of 11.0 +/- 7.9 days and a mean of 13.2 +/- 7.0 days of drug treatment, and without mortality. A marked first-day effect (output drop > 50%) was noted in 60% of patients and had a good prognosis. Infection of the fistula markedly prolonged fistula closure time, but did not affect total outcome. Somatostatin has been shown to be very useful in the conservative treatment of digestive fistulas because of its ability to reduce output significantly and to accelerate spontaneous closure.
International journal of nursing practice, Jan 9, 2014
Malnutrition is a known problem in hospitals and nursing homes. This study aims to evaluate the p... more Malnutrition is a known problem in hospitals and nursing homes. This study aims to evaluate the prevalence of being at risk of malnutrition in community living adults receiving homecare nursing and to determine factors independently associated with this risk of malnutrition. Furthermore, it also aimed to describe aspects of current nutritional nursing care. Patients (n = 100) are screened with the Malnutrition Universal Screening Tool to evaluate their risk of malnutrition. A patient survey was used to analyse associated factors. In this population, 29% are at risk for malnutrition. Following a multivariate logistic regression analysis, 'loss of appetite' proved the most important factor. A survey for nurses (n = 61) revealed low awareness, poor knowledge, poor communication between stakeholders and a moderate approach of malnutrition. These findings should encourage homecare nurses to use a recommended screening tool for malnutrition and to actively observe and report loss ...
An observation on Pneumatosis Cystoides Intestinalis (PCI) in a 66-year-old man is reported. His ... more An observation on Pneumatosis Cystoides Intestinalis (PCI) in a 66-year-old man is reported. His general condition allowed a thorough clinical and laboratory investigation which resulted in the diagnosis of the disease and the avoidance of an unnecessary laparotomy. PCI is a relatively rare condition characterized by multiple intramural pockets of gas involving any portion of the gastro intestinal tract. Various theories reflect either a mechanical or a bacterial etiology. Most of the patients are asymptomatic although some experience gastrointestinal complaints. The majority of patients require no treatment.
Within a two year period, the diagnosis of acute dissection of a segment of the abdominal aorta w... more Within a two year period, the diagnosis of acute dissection of a segment of the abdominal aorta was made in five cases without aneurysmal dilation or leakage and with virtually no ischaemia. All patients presented with an atypical painful abdominal syndrome and the diagnosis was made by computed tomography. Only one patient, suffering persistent pain was treated by resection and graft interposition of the infrarenal aorta. All the others were treated conservatively and kept under close follow-up. Two of them died from intercurrent disease. The remaining three patients are doing well after 30 and 42 months conservative treatment and 43 months after surgery respectively. A non-complicated dissection of the abdominal aorta must be considered in the differential diagnosis of atypical painful abdominal syndromes. In cases of persistent pain, progression, ischaemia, aneurysmal dilatation or leakage, surgical treatment is mandatory. In uncomplicated cases conservative treatment is recommen...
Leukocyte infiltration in response to I/R injury is a well-known but poorly understood phenomenon... more Leukocyte infiltration in response to I/R injury is a well-known but poorly understood phenomenon. The contribution of neutrophils in this process is still controversial. Despite numerous data, little is known about exact numbers of infiltrating neutrophils. The role of monocytes/macrophages in this process is even more unclear. The role neutrophils in the kidney and other organs was reviewed. The variability in models and methods for neutrophil quantification were examined, along with carrying out a critical overview of depletion and anti-adhesion approaches. Nevertheless, the exact role attributed to neutrophils in the I/R process remains unclear.
A major problem in the surgical treatment of diffuse peritonitis is to obtain a complete clearanc... more A major problem in the surgical treatment of diffuse peritonitis is to obtain a complete clearance of septic foci in the peritoneal cavity which may lead to persistence of sepsis and multiple organ failure. We describe our experience with staged abdominal re-explorations using a Zipper system in 23 patients with a mean APACHE II score of 20.3 (s.e.m: 1.5). A total of 91 lavages were done in these patients. Overall mortality was 39%. None of the patients having an APACHE II score between 10 and 20 died whereas the predicted mortality was 15%-45%. After successful treatment, primary closure was possible in 8 of the 14 surviving patients. Large incisional hernias developed in 6 patients. One patient eviscerated two years after complete granulation of his laparostoma. Staged abdominal re-explorations using a Zipper system is an useful tool in the treatment of diffuse peritonitis.
This is believed to be the youngest patient to undergo a saphenous vein bypass for iatrogenic tra... more This is believed to be the youngest patient to undergo a saphenous vein bypass for iatrogenic trauma of the right superficial femoral artery. The infant had emergency right heart catheterisation and Rashkind septostomy for severe desaturation due to transposition of the great arteries. During the exposure of the saphenous vein, the superficial femoral artery was accidentally severed at it's origin. An attempt to restore the circulation by end-to-end anastomosis failed and resulted in persistent limb ischemia for over 4 hours. The baby was reoperated upon, the damaged part of the superficial femoral artery was resected and a saphenous vein graft interposed between the common and the distal superficial femoral artery.
It remains unclear which liver graft reperfusion technique leads to the best outcome following tr... more It remains unclear which liver graft reperfusion technique leads to the best outcome following transplantation. An online survey was sent to all transplant centres (n = 37) within Eurotransplant (ET) to collect information on their technique used for reperfusion of liver grafts. Furthermore, a systematic review of all literature was performed and a meta-analysis was conducted based on patients' mortality, number of retransplantations and incidence of biliary complications, depending on the technique used. Of the 28 evaluated centres, 11 (39%) reported performing simultaneous reperfusion (SIMR), 13 (46%) perform initial portal vein reperfusion (IPR), 1 (4%) performs an initial hepatic artery reperfusion (IAR) and 3 (11%) perform retrograde reperfusion (RETR). In 21 centres (75%), one reperfusion technique is used as a standard, but in only one centre is this decision based on available literature. Twenty centres (71%) said they would agree to participate in randomized controlled trials (RCT) if required. For meta-analysis, IAR vs. IPR, SIMR vs. IPR and RETR vs. IPR were compared. There was no difference between any of the techniques compared. There is no consensus on a preferable reperfusion technique. Available evidence does not help in the decision-making process. There is thus an urgent need for multicentric RCTs.
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, Jan 4, 2016
Many physicians and patients do not realize that it is legally and medically possible to donate o... more Many physicians and patients do not realize that it is legally and medically possible to donate organs after euthanasia. The combination of euthanasia and organ donation is not common practice, often limited by the patient's underlying pathology, but has nevertheless been performed more than 40 times in Belgium and the Netherlands since 2005. In anticipation of patients' requests for organ donation after euthanasia and contributing to awareness of the possibility of this combination among general practitioners and medical specialists, the Maastricht University Medical Center (MUMC) and the Erasmus University Medical Center Rotterdam have developed a multidisciplinary practical manual in which the organizational steps regarding this combined procedure are described and explained. This practical manual lists the various criteria to fulfill, and the rules and regulations the different stakeholders involved, e.g. the patient, the performing physician, the transplant coordinator,...
Studies in health technology and informatics, 1996
Endoscopy, a we know it today, is far from perfect. In an attempt to make the interventions as li... more Endoscopy, a we know it today, is far from perfect. In an attempt to make the interventions as little invasive as possible, the ergonomics of the procedure, for the surgeon, are often not dealt with at all. In an attempt to improve the surgeon-patient interface during endoscopic procedures, a new concept is presented to allow the surgeon a much more natural visual interaction with the inside of the patient. It is made possible for the surgeon to look around into the cavity, with a stereo endoscope, mounted on a robot arm. This robot arm is directed by the motion of the head of the surgeon.
BACKGROUND Due to the SARS - COV 2 pandemic related restrictions the 2020 Belgian Surgical Week (... more BACKGROUND Due to the SARS - COV 2 pandemic related restrictions the 2020 Belgian Surgical Week (BSW) was organized as a virtual congress, being the first surgical, virtual congress in Belgium. Since this was a new experience and probably not the last, we aim to share our experience to assist other professionals in organizing their virtual event. METHODS The "BSW-light" was organized by the RBSS in collaboration with a Professional Congress Organizer (PCO), which is described in detail. Analytical data of the event were provided by the PCO and a UEMS "live educational events participant evaluation form" based survey was sent out to all registered participant, using google forms, to evaluate the event. RESULTS During 2 days, 78 prerecorded presentations were broadcasted in 2 virtual conference rooms, each followed by a live Q & A session. The plenary session on the third day contained 8 live presentations, both from Belgium and from abroad. A total of 503 people registered for the congress, of whom 224 trainees. Each session attracted 158 visitors on average, each spending an average of 73 minutes.Attendees were satisfied with the technical aspect of the virtual congress, but they preferred an event that is at least partially live. CONCLUSION Although the "BSW-light" proved to be successful, a preference to meet in real live remained. However, given its potential, we should keep an open mind towards integrating the advantages of a virtual meeting into a live event.
BACKGROUND Belgium was one of the first European countries affected by the first wave of the Covi... more BACKGROUND Belgium was one of the first European countries affected by the first wave of the Covid-19 epidemic after Italy and France and has the highest rate of Covid-19-related deaths. Very few studies have evaluated the impact of the pandemic on surgical activity on a large scale. The primary objective of this national survey was to evaluate the impact of the first wave of the Covid-19 pandemic on surgical activities (elective non-oncological and oncological) in Belgian hospitals. METHODS A nationwide, multicenter survey was conducted in Belgium by the Royal Belgian Surgical Society (RBSS) board. The questionnaire focused on digestive surgical activity at different time points: period 1 (P1), before the epidemic; period 2 (P2), lockdown; and period 3 (P3), after stabilization of the epidemic. RESULTS The participation rate in the survey was 28.2% (24 out of 85 solicited hospitals), including 15 (62.5%) from the French speaking part of Belgium and 9 (37.5%) from the Flemish speaking part. Eighteen (75%) were non-academic and 6 (25%) were academic hospitals. All surgical activities were impacted by the Covid-19 pandemic except for the number of cholecystectomies. No statistical differences were observed between regions or according to the type of hospital. CONCLUSIONS Our national survey confirms that the COVID-19 outbreak has severely impacted in-person consultations and surgical activity for benign and malignant disease and for acute appendicitis. However, procedures for benign disease were much more affected than those for malignancies.
Aim: Pancreaticopleural fistula (PPF) is a rare complication of acute or chronic pancreatitis. Wh... more Aim: Pancreaticopleural fistula (PPF) is a rare complication of acute or chronic pancreatitis. When the pancreatic duct disrupts, pancreatic fluid may leak into the retroperitoneum and fistulate into the pleural cavity. Patients usually present with thoracic complaints, making it hard to suspect an abdominal etiology. Although PPF is uncommon, one must consider this diagnosis in patients with thoracic complaints and a history of alcohol abuse or pancreatitis. Methods: We present an illustrative case and review of the literature on PPF. Results: A 47-year old man was presented with recurrent PPF due to pancreas divisum, pancreatic stones and chronic exudative pancreatitis, resulting in unilateral empyema. After initial conservative treatment, operative measures were needed. We report omentoplasty against the diaphragmatic hiatus in combination with VATS (video-assisted thoracoscopic surgery) thoracotomy with decortication and debridement as a feasible operative option for resolving PPF. Conclusion: PPF is a rare complication of pancreatitis. The diagnosis is difficult to make and can be confirmed by thoracocentesis and proper imaging, preferably MRCP. Treatment options include conservative, endoscopic (ERCP) or surgical measures. Omentoplasty positioned against the diaphragmatic hiatus is a feasible technique for closure of PPF.
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Papers by Dirk Ysebaert