Surgery associated with lymphadenectomy may sometimes result in a lymphorrhagia, which usually resolves spontaneously within a few days, sometimes becoming a refractory complication to the treatment. In the case of large flows, particular attention should be paid to hydro-electrolytic and protein losses. We present the case of a patient with persistent lymphorrhagia after a cephalic duodenopancreatectomy for a pancreatic head tumor. From the 5th postoperative day, the patient had a milky-like secretion on the subhepatic drainage tube. The discharge rate was variable, between 500 and 1500 ml per day, requiring parenteral administration of amino acids, plasma and electrolyte solutions. The postoperative progression was slowly favorable, with the patient discharge on the 25th day following surgery. There are several treatment options for a lymphorrhagia following an extended lymphadenectomy, from intensive parenteral therapy to peritoneal-venous shunt or ligation of the lymphatic vessel responsible for the production of lymphorrhagia. In this case the conservative treatment had a favorable result.

The incidence of postoperative pain in patients operated for inguinal hernia can reach up to 40% of cases, depending on different authors, and depending on the approach used in the surgical treatment of these patients. Currently, there are two commonly accepted ways of surgical treatment of inguinal hernias, the classic approach with polypropylene mesh (Liechtenstein technique) and the laparoscopic approach. The purpose of this study was to conduct a comparative analysis on the need for analgesic medication in patients treated for inguinal hernia either by classic (group A) or by laparoscopic (group B) approach. Surgical meshes were used in all patients enrolled in our trial. The average age of the patients included in this study was 53.79 years, ranging from 20 to 88 years. Regarding the distribution of cases by gender, we observed in the studied lots that 12 cases were women (11.53%) and 92 cases were males (88.46%). In female patients, the classic inguinal hernia approach was performed in 3 cases (25% of cases), and in 9 cases the laparoscopic approach was performed in the surgical treatment of the inguinal hernia (75% of the cases). In male patients, laparoscopic approach was performed in 33 cases (35.86% of cases), and in 59 cases the surgical approach was performed in a classical manner using the Liechtenstein technique (64.13% of the cases). From the statistical analysis of the data we noticed a statistically significant difference in the need for analgesic medication administered to these patients (p = 0.0001). Although surgical correction of inguinal hernia, both classic and laparoscopic approaches, provide adequate treatment for these patients, in case of the laparoscopic technique, immediately after the operation, the need for analgesic medication is lower compared to the classical technique.

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Introduction: Our study investigated the importance of inflammation markers – ratio of platelets and lymphocytes (PLR), ratio of neutrophils and lymphocytes (NLR) and ratio of lymphocytes and monocytes (LMR) – as predictive markers in the occurrence of fistula or stenosis in patients diagnosed with gastric adenocarcinoma who underwent gastric resections.Materials and Methods: We conducted a retrospective study of 178 patients diagnosed with gastric adenocarcinoma. The included patients were divided into 3 groups: group 1 (77 patients, who underwent lower gastrectomy), group 2 (27 patients, who had upper polar gastrectomy otherwise known as proximal gastrectomy), group 3 (74 patients, who underwent total gastrectomy). Ratios of PLR, NLR, respectively LMR were calculated for all patients.Results: Out of 178 patients 52 (29.2%) developed postoperative stenosis and 16 patients (9.0%) had postoperative fistulae. The occurrence of anastomotic stenosis was associated with significantly higher preoperative platelet counts (p=0.043) and PLR values (p=0.023). ROC curve analysis indicated that the optimal PLR value for the prediction of gastric stenosis was 198.4 (AUC= 0.609, sensitivity: 59.6%, specificity: 61.9%). For the prediction of fistulization PRL also displayed the highest performance among the analyzed hematological parameters (AUC=0.561, sensitivity: 43.7%, specificity: 81.5%, cut-off value 116.6.Conclusion: Our study indicates the importance of PLR as e predictive factor in the occurrence of anastomotic complications (fistulae or stenosis) immediately following surgery in patients with gastric adenocarcinoma that undergo gastric resections. Further prospective studies on larger groups of patients are required, considering that PLR, NLR and LMR will be key markers in the clinical management of patients with gastric cancer.

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