First Place in Orthopedic Surgery and Traumatology

Atlas Hospital secured first place as the best private hospital in Serbia in the field of orthopedic surgery and traumatology.
This category evaluates the expertise of orthopedic specialists, advanced surgical techniques, and the success rates in treating orthopedic conditions.
Atlas Hospital consistently follows global trends, implementing innovative treatment methods such as arthroscopic procedures and complex joint reconstructions.
Annually, the hospital successfully performs around 1,000 orthopedic surgeries.

Second Place in Plastic and Reconstructive Surgery

In the field of plastic and reconstructive surgery, Atlas Hospital achieved a prestigious second place. Led by Dr. Lazar Pajević, the founder of Atlas Hospital, the experienced team of plastic
surgeons delivers exceptional results using advanced techniques that include rhinoplasty, abdominoplasty, facelift surgery, blepharoplasty, otoplasty, breast augmentation, and
reconstructive procedures after trauma or illness.
The hospital is particularly recognized for ear reconstruction, distinguishing itself in the country and the region.

Third Place in Upper Digestive Tract and Spinal Surgery

In upper digestive tract surgery, Atlas Hospital ranked third due to exceptional results in treating conditions such as hiatal hernia, esophageal and stomach tumors, and bariatric surgery.
Precise diagnostics and modern laparoscopic procedures enable faster recovery and reduced postoperative complications.
The hospital also achieved third place in spinal surgery, with its experts excelling in performing microsurgical spinal procedures, correcting deformities, and adopting a multidisciplinary approach to the surgical treatment of herniated discs.

Fourth Place in Neurology and Neurosurgery

In the field of neurology and neurosurgery, Atlas Hospital secured fourth place, affirming its high-quality care for neurological and neurosurgical patients.
The neurosurgery department, led by Dr. Milenko Savić, has distinguished itself by applying cutting-edge surgical methods and following the latest medical trends.

About HCQW Organization

Health Care Quality Watch (HCQW) is an international organization that monitors and evaluates the quality of healthcare services in private and public healthcare institutions.
Assessments are based on several criteria, including the expertise of medical staff, hospital equipment, treatment success rates, and patient satisfaction.
Additional points are awarded for accreditation, which Atlas Hospital holds and renews annually under rigorous inspections.
HCQW’s recognition serves as a benchmark of excellence and a reference for patients seeking top-tier healthcare.

Atlas Hospital as a Synonym for Surgery

This recognition confirms that Atlas Hospital is a leader in the field of surgery within private healthcare, emphasizing expertise, professionalism, and a personalized approach to each patient.
Success across multiple medical specialties further strengthens the hospital's reputation as a center of excellence.

Don’t search the world – find it at Atlas!

Certificates

The post Atlas hospital in the top of private healthcare in Serbia: Top 5 recognitions in 4 categories appeared first on Atlas General Hospital.

In this post, we will provide you with an insight into how this test works, its limitations and advantages, and how it affects your pregnancy and the future of your family.

What is Non-Invasive Prenatal Testing (NIPT)?

NIPT analyzes the DNA (genetic material) of the baby isolated from the mother’s blood. In this way, the genetic material of the baby is analyzed with the possibility of identifying various chromosomal aberrations, such as trisomies, aneuploidies of sex chromosomes, as well as microdeletions (structural) disorders on chromosomes. 

The most important syndromes that can be detected by prenatal testing are Down syndrome, Patau syndrome, and Edwards syndrome. The prenatal test can also determine the sex of the baby.

How is the test performed?

The test is very comfortable for the pregnant woman – it involves a simple blood test (sampling of 10-20ml of venous blood – one tube).

When is the test performed?

The test is done after the completion of the 10th week of pregnancy. Blood sampling is preceded by an ultrasound examination by a gynecologist to determine the size of the fetus, which is necessary to assess the appropriate timing for the test. Of course, a normal ultrasound finding is a prerequisite for performing the test. Any suspicion of fetal abnormalities is a contraindication for non-invasive prenatal testing. The pregnant woman is then referred for other diagnostic procedures.

Prenatal test results

The test results are formulated to be easily understandable to the patient and are expected within 10 working days after sampling. In case of any doubts, the results can be interpreted together with the attending gynecologist or geneticist. 

A negative test result means that there is no evidence of the presence of the tested disorders. The accuracy is 99%, making the test very reliable. 

A positive test result provides information about the probable presence of one of the chromosomal disorders in the baby, but the likelihood of the test result actually being positive largely depends on the age of the pregnant woman and other risk factors. A positive NIPT result must therefore always be confirmed by invasive diagnostics – amniocentesis or chorionic villus sampling.

Which analyses does the Sequentia prenatal test offer?

The Sequentia prenatal test offers a wide range of analyses and is one of the most comprehensive of its kind on the market. In addition to the already mentioned trisomies, sex chromosome aneuploidies, microdeletions, and duplications that the test detects, the Sequentia palette also offers the possibility of identifying the Rh D factor of the baby in pregnancies where the mother is a carrier of a negative Rh D factor, and the father is a carrier of a positive one. For pregnant women with Rh-negative blood type, information about the Rh factor of the baby during pregnancy is very important, as it can help avoid the use of anti-D prophylaxis on one hand, and on the other hand, it can detect the risk of developing hemolytic disease of the fetus and newborn.

In the expanded offering of the Sequentia prenatal test, there is the possibility of analyzing both inherited and non-inherited diseases, which are analyzed directly on the fetus, unlike most tests that examine parents as carriers of mutations.

With each selected panel of the Sequentia test, it is possible to perform an analysis for spinal muscular atrophy for both parents. This way, parents can determine whether they are carriers of mutations responsible for this disease and whether there is a risk of transmitting it to their offspring.

The test can also be applied in twin pregnancies (including “vanishing twin”), but with limitations in the analysis of microdeletions and sex aneuploidies.

How to schedule and perform prenatal testing?

The entire procedure is very simple:

• Call our Call center to schedule a consultation with a gynecologist.
• When you decide to perform the test, come for an ultrasound examination, after which the blood necessary for the analysis will be drawn.
• If you opt for the option that includes inherited diseases, an additional sample of buccal swab (swab of the inner cheek) of the biological father of the child, or a sample of venous blood in an additional tube will be taken.
• The results are expected within 7 to 10 working days from the sampling and are sent, in agreement with the gynecologist, by mail or email. Genetic counseling is also available as part of the result interpretation.

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Symptoms of Hiatal Hernia

There are sliding (axial) and mixed (paraesophageal) hernias.

In sliding hiatal hernias, patients usually complain of symptoms such as heartburn (a burning sensation behind the breastbone) of varying intensity.

In contrast, large mixed (paraesophageal) hernias, due to their size, lead to mechanical symptoms such as shortness of breath (due to space occupation in the chest cavity), palpitations, fatigue, while incarcerated hernias can cause nausea, vomiting, food retention after meals.

Diagnosis of Hiatal Hernia

Patients with hiatal hernia should first be referred for a contrast radiograph with barium. During the examination, the patient drinks contrast, and on X-ray, it is visible how the contrast fills the esophagus first, then passes from the esophagus into the stomach, thereby showing the position of these organs in relation to the diaphragm. After that, patients need to undergo gastroscopy (upper gastrointestinal endoscopy) to assess the mucosa of the esophagus and stomach, exclude other possible diseases, and find objective indicators of the presence of gastric reflux, such as inflammation of the distal esophagus. In cases of suspected gastroesophageal reflux disease, diagnostics should be supplemented with pH monitoring. This examination allows us to accurately measure the time during which gastric (acidic) content is present in the esophagus.

A special group of patients complains of so-called extraesophageal symptoms resembling hoarseness of voice, persistent cough, throat discomfort, and feeling of a lump in the throat. With this group of patients, a detailed conversation with the completion of precise evaluation questionnaires is necessary. The examination in this group of patients must be supplemented by an examination by an ENT specialist who will evaluate the condition of the upper respiratory tract.

Treatment of Hiatal Hernia

It is necessary to carefully identify groups of patients who respond best to therapy. By assessing the response to drug therapy, it is possible to determine which patients can benefit most from the performed surgery.

Indications for surgical treatment of hiatal hernia include:

• Patients who are not motivated for lifelong intake of proton pump inhibitors
• Patients with confirmed Barrett’s esophagus or severe esophagitis
• Patients with persistent severe symptoms despite the use of optimal medical therapy

Hiatal Hernia Laparoscopy

The gold standard in the treatment of the above-mentioned esophageal diseases is minimally invasive surgery.

Laparoscopy is a technique for accessing the abdominal cavity through small incisions in the abdominal wall ranging from 5 to 12mm. Through specially made working channels (ports), and with the help of elegant instruments and a camera with a magnification of 5 to 10 times, we can access every part of the abdominal cavity and chest, adequately identify and solve the problem. These small incisions, compared to conventional surgeries, provide the opportunity for rapid recovery, reduce the risk of infection, allowing a return to regular activities within a few days. The advantage of the camera with magnification reduces the possibility of error in experienced hands to a minimum and allows the observation of the smallest details during the procedure.

How is the surgery performed?

The hiatal hernia operation involves returning the stomach from the chest cavity to its physiological position in the abdomen, after which the diaphragm with an enlarged opening is reconstructed with sutures. The surgery usually continues with the recreation of the mechanism (wrap – fundoplication) around the distal esophagus to prevent gastric acid reflux into the esophagus. At the end of the operation, under camera control, a drain is placed in the abdomen, as well as a nasogastric tube, which has a relieving role on the stomach until it regains its full function.

What is the recovery like after surgery?

The nasogastric tube is usually removed on the first day after surgery, while the abdominal drain usually remains until the second postoperative day depending on the content being evacuated. On the day of surgery, we encourage patients to stand up and walk with or without assistance. Water intake begins on the first day after surgery, while diet usually starts on the second or third day after surgery depending on the patient’s tolerance. Discharge from the hospital can be expected from the third to the fifth postoperative day. The stitches are removed 10 to 12 days after surgery, while a follow-up appointment with the surgeon is advised one month after surgery.

Postoperative Indications for Hiatal Hernia

Hiatal hernia surgery requires adjustment by the patient, and a diet based on mushy and mashed food is recommended for 3 weeks after surgery. We advise patients to maintain a constant body weight without excessive weight gain. It is also forbidden to lift heavy loads, over 5% of the patient’s body weight, for the next 6 months after surgery.

The post Treating Hiatal Hernia (Esophageal Hernia) appeared first on Atlas General Hospital.

Many national health associations and medical branches have taken on this trend, aiming to contribute to its treatment and prevention. Bariatric surgery has found its role in treatment, showing exceptional results in reducing patients’ body weight. 

However, bariatric surgery alone cannot provide a fully effective solution; rather, it requires a multidisciplinary team. In this article, we will explain the 3 main reasons why bariatric surgery is not suitable for implementation as a three-day medical tourism.

Bariatric surgery requires postoperative monitoring.

When someone offers a three-day solution in the form of medical tourism, it excludes the possibility of properly assessing the patient because it is necessary for the medical institution you entrust to follow you every step of the way in treatment. 

Treatment begins with biochemical testing, determining appropriate therapy (if necessary), psychological support, and dietary correction by a nutritionist. Only when conservative weight loss methods are exhausted should you consult with a surgeon. A bariatric surgeon must possess the skills of a responsible and high-quality abdominal surgeon who applies their basic knowledge to the highly specialized surgery that is bariatric surgery. 

Surgical techniques involve knowledge of manipulating the stomach, esophagus, small intestines, and sometimes the necessity for simultaneous resolution of other problems, such as gallstones or hiatal hernia. An experienced surgeon minimizes the possibility of complications and, with their knowledge of other aspects and diseases of the digestive tract, enables better postoperative results, both in terms of weight loss and improving quality of life and preventing other digestive tract symptoms. 

Surgical treatment by bariatric surgery does not only involve the period from entering the operating room to waking up from anesthesia but also requires several days of postoperative monitoring, which will enable early detection and adequate management of potential complications. The surgeon must be with the patient even weeks after the operation to anticipate and timely treat potential postoperative complications.

Bariatric surgery requires personal encounters

Although, understandably, price is significant in making decisions when it comes to everyday purchases, that principle should not be applied when it comes to health. 

The cost of a bariatric surgical procedure includes the use of the highest quality suture material and laparoscopic equipment. It is also necessary to involve a multidisciplinary team that will be available for proper preoperative preparation as well as postoperative treatment and early mobilization of the patient by the physiotherapy and physical medicine team. 

The ability to contact your surgeon at any time after discharge for any questions or concerns is of paramount importance for the success of the procedure. Communication with the surgeon via email or phone is not always effective because if there is a need for examination, it cannot be done at the facility where the patient was operated.

Bariatric surgery requires responsible treatment

Although today’s trends have led to the expansion of health tourism, serious surgical procedures should not be promoted as a three-day excursion where the patient will be accommodated in a five-star hotel and tour the city where the hospital is located. 

Bariatric surgery is a serious surgical branch dealing with patients who often have associated diseases that themselves exceed the offered tourist package. Responsible treatment leads to a reduction in potential postoperative complications, optimal outcomes of surgical treatment, as well as monitoring and support that are often needed for patients with pathological obesity.

Safe and responsible treatment at Atlas General Hospital

Atlas General Hospital is one of the leaders in the field of bariatric surgery and has a comprehensive expert team that will be with you every step of the way in treatment. Let safety be the primary principle in making decisions concerning your health – decisions made based on the cost of the intervention often turn out to be a gamble where your health is at stake.

The post 3 reasons why bariatric surgery is not suitable for three-day medical tourism appeared first on Atlas General Hospital.

Why is knee arthroscopy performed?

The most common indications for arthroscopy include:

• Meniscus injury;
• Anterior and posterior cruciate ligament injuries;
• Injuries to parts of the knee’s articular cartilage;
• Frequent inflammations in the knee joint;
• Baker’s cyst – a fluid-filled sac at the back of the knee joint;
• Fractures of the bones forming the knee joint.

How is the preparation for the surgery done?

Before the operation, an examination and consultation with the orthopedic specialist are necessary, along with adjusting the patient’s personal therapy in accordance with any accompanying diseases. 

Based on the doctor’s advice, a temporary discontinuation of blood-thinning medications may be necessary. Depending on the type of anesthesia, fasting from food and fluids is usually required for 12 hours before the surgery. If same-day discharge is planned, it is advisable to have a family member accompany the patient.

How many arthroscopic surgeries are performed annually at Atlas Hospital?

Atlas Hospital performs between 200 and 300 of these surgeries each year.

How is knee arthroscopy performed?

Through several small incisions (5-10mm) above the joint, using elegant instruments and a camera with 5 to 10 times magnification, every part of the joint cavity can be accessed to identify the cause of the problem. These small incisions, compared to traditional surgeries, allow for quick recovery, reduce the risk of infection, and enable a return to regular activities within a few days. 

Arthroscopy is the gold standard in diagnosing and treating sports injuries to the knee, facilitating the earliest return to training and other activities.

The advantage of the magnified camera minimizes the possibility of errors in experienced hands, leading to the observation of the tiniest details during the procedure. Arthroscopy can be performed under local, regional, spinal, and rarely general anesthesia, with the final decision made by the anesthesiologist in consultation with the orthopedic specialist.

Are complications possible?

Complications after arthroscopy are rare and may include bleeding within the joint capsule, wound infection, and potential side effects of anesthesia.

What is the recovery process after knee arthroscopic surgery?

In the immediate postoperative period, it is advised to follow the acronym:

R – rest – recommended rest and avoidance of strenuous activities;

I – ice – applying ice to the operated knee;

C – compress – wearing an elastic bandage or brace;

E – elevate – raising the limb above the level of the torso.

Adhering to these rules reduces the risk of swelling and pain. 

If these measures are insufficient, based on the doctor’s advice, pain relievers (analgesics) may be recommended. Depending on the indication for arthroscopy, immobilization of the joint and the use of walking aids (crutches, walker) may be necessary, along with starting regular physical therapy as early as possible, sometimes on the day of the surgery!

The cost of knee arthroscopy is 236,000 dinars. 

All costs are included in the price (comprehensive preoperative preparation – laboratory tests, internist examination, EKG, X-ray, anesthesiologist examination, surgery, one day of hospitalization, and follow-up).

The post Everything You Need to Know About Knee Arthroscopy! appeared first on Atlas General Hospital.

Characteristics of Back and Joint Pain

Global statistics indicate that over 80% of the population experiences some form of lower back pain at some point in their lives. Patients often try self-medication before seeking medical advice. It is common for several months to pass from the onset of pain symptoms to a doctor’s visit, leading to the development of chronic pain.

“The patient should first undergo an examination in primary healthcare, where they will receive initial therapy from their chosen general practitioner. If symptoms improve with nonsteroidal anti-inflammatory drugs (NSAIDs), are not associated with significant findings on magnetic resonance imaging, and do not cause serious functional impairment, treatment continues with the selected doctor. This approach can resolve more than 70% of all acute pains. Otherwise, if the pain persists or there is serious functional impairment, the patient is referred to an examination with a spinal surgeon,” explains Dr. Marko Aleksić, a specialist in orthopedics and traumatology.

“Chronic pain is a serious physical and psychological problem, and there is a direct connection between chronic pain and depressive disorders. In such situations, we always advise involving a neuropsychiatrist or psychiatrist in the treatment, because despite all our efforts, pain can persist for a long time and, of course, affect the patient’s quality of life and mental state,” says Dr. Marko Aleksić about the impact of chronic pain on the quality of life.

Treatment of Back and Joint Pain

The first line of defense includes nonsteroidal anti-inflammatory drugs (NSAIDs), which must be used for an extended period, not just a few days. These drugs provide immediate relief within a few days, and with prolonged use, they can have a curative effect. This addresses not only the symptom but also the cause—inflammation affecting nerves, spinal joints, cartilage, and bones.

“I recommend aceclofenac, specifically Aflamil, because it combines the best aspects of previously known drugs. In terms of anti-inflammatory response strength, it matches diclofenac but is similar to ibuprofen in terms of safety, which has been known as the drug with the least side effects. Aflamil is a unique drug that provides an adequate response not only to pain but also to inflammation, with the lowest incidence of side effects. These properties, especially its safety, allow us to use it for extended periods,” emphasizes Dr. Aleksić.

Long-term Use of Analgesics for Back and Joint Pain

In severe pain conditions, corticosteroid therapy may be introduced, but its use should be minimized due to its positive effect on inflammation and the seven negative side effects it carries. Balancing positive and negative effects is crucial. NSAIDs, which can be used for years with short breaks and stomach protection, play a significant role here. Detailed medical history, especially regarding the patient’s cardiovascular problems and previous stomach damage, should be considered when starting this therapy. Proper patient selection allows for long-term use of NSAIDs. This therapy has positive health effects even in patients with indications for surgical treatment or those who have already undergone surgery. After surgical intervention, pain may return, mainly due to spinal ossification. Despite surgery addressing acute pain and providing mobility, stability, and spine correction, some degree of pain may persist. In such cases, periodic use of NSAIDs is recommended when pain occurs but not within just a day or two, but at least every 2-3 weeks with proper stomach protection.

Lifestyle and Physical Activity

Physical activity can improve or worsen the condition, as mentioned by Dr. Marko Aleksić:

 “I recommend a few days of rest with active use of NSAIDs, primarily Aflamil with proton pump inhibitor, or other stomach protection. Early initiation of physical activity is ideal, even in acute lumbar syndrome when severe pain suddenly occurs. Ideally, the patient should be upright and walking after two days, as the spinal column is most stressed when sitting with the entire body weight on the buttocks. During active walking, the weight is distributed distally down the legs, so there is no prolonged pressure on a single point. Only after completing physical therapy with the use of NSAIDs, providing not only pain relief but also inflammation reduction, can we recommend more intense physical activity. This falls into the phase of maintaining improvement and preventing the recurrence of painful symptoms.”

“To help the spine bear the weight of the body, the first thing to pay attention to is whether the body mass index (BMI), indicating the ratio of body weight to height, is appropriate. Although this index is not an absolutely reliable parameter because not every weight is the same – the weight of an obese person is different from that of a muscular person – unfortunately, regardless of the constitution, the spine bears almost the same pressure. Therefore, it is crucial to consider body weight. Additionally, at this stage, exercise is recommended, including regular walking, swimming, and other activities to strengthen the muscles of the spinal column. Care should be taken in choosing and performing anaerobic activities because, despite their potential benefits, they can also be harmful if not selected or executed correctly. However, this is more in the hands of physiatrists than surgeons.”

In general, physical activity should be performed up to the pain threshold. It is also advised to avoid prolonged sitting, take 5-minute breaks every half hour, and use chairs with lumbar support.

What to Do When Back and Joint Pain Occurs

“If lower back pain occurs without significant trauma, lifting heavy weights, a traffic accident, or a similar injury, try NSAIDs first. I always recommend Aflamil in combination with Controloc or another proton pump inhibitor for stomach protection. If the pain does not subside within seven days, consult your chosen general practitioner. If the chosen doctor determines that the pain persists or is possibly associated with a more serious condition, they should refer the patient to someone who is highly specialized in that field. Regarding lifestyle, an active lifestyle is advised despite most of us sitting or standing at work. If sitting is inevitable, take breaks and stretch every half hour. Also, ensure that the chair provides adequate back support. The same applies to lying down and sleeping; choose a relatively firm surface. Pay attention to nutrition to prevent excessive weight gain, which is a definite risk for the onset of pain. Sports activities should be age and patient-condition appropriate. Aerobic activity, swimming, biking, walking are sufficient,” summarized Dr. Aleksić.

Biography:

Ass. Dr. Sci. Med. Marko Aleksić, specialist in orthopedics with traumatology, spinal surgeon, works at the Orthopedics and Traumatology Center of the Atlas General Hospital. In his clinical practice, he deals with almost all diseases of the spinal column, including trauma, deformities, and oncological pathologies in the spine, both in adults and children.

Source: Stetoskop.info

The post Causes and Treatment of Back and Joint Pain appeared first on Atlas General Hospital.

• Metabolic functions (it processes nutrients from food to create proteins necessary for the development and functioning of the body’s defense mechanisms).
• Production of bile, which helps eliminate unnecessary substances and aids in the breakdown of ingested fats.
• Detoxification, achieved through blood filtration and removal of toxins.

Due to its involvement in numerous processes in the body, the liver is exposed to hazardous agents and is susceptible to diseases. Viral infections, excessive alcohol consumption, smoking, use of narcotics, a diet high in fat, tumors, toxic damage, and the accumulation of iron or copper are just some of the risk factors that can lead to liver damage, hindering the organ from performing its vital functions.

What Kind of Liver Diseases Are There?

Liver diseases can manifest in various ways. Patients may complain of:

• Dull pain and discomfort below the right ribcage.
• Enlargement of the liver, sometimes palpable by the patient.
• Loss of appetite, nausea, and vomiting.
• Sudden weight loss.
• Dark urine and extremely pale (white) stools.
• Appearance of swelling in the abdomen or extremities.
• Yellow discoloration of the skin and whites of the eyes accompanied by itching.

Diagnosis

In the case of any of these complaints or a combination of them, it is necessary to consult a doctor. Following the doctor’s advice, blood tests, complete blood count, levels of bilirubin and liver enzymes, as well as levels of tumor markers, should be checked if there is suspicion of a malignant tumor.

In line with the results, some of the radiological examinations, such as ultrasound (with or without elastography for liver tissue), CT scans, and MRI scans of the abdomen, may be indicated.

Liver Disease Prevention:

• Eat a healthy and diverse diet while avoiding fatty foods;
• For those with a history of liver tumors, undergo regular check-ups as advised by the doctor;
• Maintain the recommended body weight;
• Consume moderate amounts of alcohol or avoid it entirely;
• Use medications strictly according to the doctor’s instructions;
• Practice safe sexual behavior;
• Avoid contact with someone else’s blood or body fluids.

When Is an Examination and Surgical Intervention Necessary?

Surgical treatment is indicated for liver tumors, symptomatic liver cysts causing issues in patients, and patients with liver failure requiring transplantation.

Liver tumors can be primary, originating from the liver tissue itself, or metastatic.

Primary Liver Tumors

The most common primary liver tumors are hepatocellular and cholangiocellular tumors, but there are also mixed forms with characteristics of both.

Hepatocellular carcinoma is significantly more common, diagnosed in about a million people worldwide every year. A risk factor for hepatocellular carcinoma is liver cirrhosis due to excessive alcohol consumption or viral infection (hepatitis). Only about 20% of these tumors occur in patients without liver cirrhosis.

It is characterized by aggressive biology with rapid disease progression, making early-stage diagnosis crucial, especially in patients who haven’t developed symptoms yet. This can only be achieved through strict screening programs for patients with liver cirrhosis and other risk factors. Due to the usually advanced stage at which patients present, only 10-30% of patients are diagnosed at a stage where surgical removal of the tumor is possible.

Factors influencing the decision on whether the patient can undergo surgery include:

• Patient’s condition (presence of other diseases, age)
• Liver condition (functional reserve of the cirrhotic liver)
• Stage of the disease (number and size of tumor nodules)

Primary liver tumors require anatomical liver resections (removal of the entire or multiple segments of the liver), emphasizing the importance of treatment by an experienced hepatobiliary surgeon.

Secondary (Metastatic) Liver Tumors

Secondary (metastatic) liver tumors occur due to the spread of tumors from other locations to the liver. Because of the liver’s specific vascularization (having both arterial and venous circulation), tumors from all abdominal and pelvic organs can affect this organ by spreading. About 80% of liver metastases originate from adenocarcinomas, most commonly colorectal, followed by gastric, pancreatic, and others…

If metastases develop in the liver, symptoms can vary depending on their number and location. Patients most commonly report pain and discomfort below the right ribcage, jaundice, abdominal swelling due to the accumulation of free fluid, weakness, loss of appetite, weight loss, etc.

Treatment of Liver Tumors

Metastatic liver disease can be treated in various ways, depending on the timing of metastasis detection, whether synchronous (at the same time as the primary tumor) or metachronous (after the surgery and treatment of the primary tumor).

Synchronous presentation is usually initially treated with chemotherapy and targeted biological therapy for better long-term disease control, followed by surgery. When surgically treating liver metastases, a sparing approach is used whenever possible, removing the metastasis with the surrounding liver tissue. This is not achievable if the tumor’s position jeopardizes any of the liver’s blood vessels, requiring more extensive (larger) liver resection.

Liver cysts require surgical treatment if it is a case of hepatic echinococcosis. Patients with simple liver cysts are also operated on when, due to their significant size, they exert pressure on surrounding organs, leading to issues that affect the patient’s quality of life.

Minimally Invasive Laparoscopic Liver Surgery

All the mentioned surgeries can technically be performed using a minimally invasive approach (laparoscopic) if there are no clear contraindications.

Laparoscopy is a technique that provides access to the abdominal cavity through small incisions in the abdominal wall, ranging in size from 5 to 12 mm. Through specially made working channels (ports), and with the help of elegant instruments and a camera with magnification of 5 to 10 times, we can access every part of the abdominal cavity and chest, adequately identify and solve the problem. These small incisions, compared to traditional surgeries, offer the possibility of rapid recovery, reduce the risk of infection, allowing a return to regular activities within a few days. The advantage of the magnifying camera minimizes the possibility of errors in experienced hands, leading to the observation of the smallest details during the procedure.

The post Considering Liver Surgeries? Here Is What You Should Know appeared first on Atlas General Hospital.

Considering its function, it is clear that esophageal disorders most commonly manifest as swallowing problems (dysphagia). The esophagus has a pronounced muscular layer that, at its beginning in the neck and transitioning into the stomach (in the abdomen), merges and forms a sphincter. This sphincter, in conjunction with the diaphragm, prevents the passage of acidic stomach contents back into the esophagus.

Inadequate function and relaxation of the lower esophageal sphincter can lead to food retention, as seen in patients with achalasia. In this article, we will further explain Esophagus illnesses as well as the procedures patients undergo for treatment.

Esophageal Cancer

The two most common esophagus cancers are squamous cell carcinoma and adenocarcinoma. They manifest similarly, but the risk factors are different. Basic risk factors for the formation of squamous cell carcinoma are alcohol consumption and smoking, excessive amounts of sour and spicy food, as well as being infected with the human papillomavirus (HPV).

Patients with achalasia have a higher long-term risk of developing squamous cell carcinoma, as do patients who have previously had laryngeal or oropharyngeal cancer. The main risk factors for adenocarcinoma are obesity and untreated reflux disease over multiple decades.

Symptoms of Esophageal Cancer

Patients often report feeling like food doesn’t pass through to the stomach or feeling like it stops in the chest. One of the other symptoms is intense unexplained weight loss over several months. Rarely, patients feel chest pain, commonly with bites of food that don’t go through the stomach. Every occasion of feeling like food stops in the chest and doesn’t go through to the stomach is a reason to visit a surgeon!

Diagnosis

During the diagnostic process, it is of utmost importance, if there’s the slightest doubt, to do an upper flexible endoscopy (gastroscopy), in order to adequately examine the mucosa of the esophagus, stomach, and duodenum.

In case of any type of abnormalities, biopsies are taken and then pathohistologically analyzed.

If esophageal cancer is confirmed, a CT scan of the neck, chest, and stomach should be done, with a double contrast (Oral and IV contrast). If there are doubts that the disease might be spreading, the doctor can suggest a stomach MRI, to further characterize the changes in the liver, or other methodical diagnostics (e.g., PET/CT scan).

If adenocarcinoma is confirmed before treatment initiation, the laboratory values of tumor markers (CEA, Ca 19-9, Ca 72-4) will be checked.

After completing the required diagnostics, patients are referred to an esophageal surgeon to determine the optimal treatment strategy. For locally advanced cases, individuals may be equipped with a nutritional stoma or undergo the placement of an esophageal stent for feeding. Subsequently, they are referred for neoadjuvant therapy aimed at reducing the stage of the disease (down-staging). If the disease is deemed resectable, surgery is then planned for the patients.

Hiatal Hernia

Hiatal hernia, or gastric hernia, is a very common condition where the stomach passes through the diaphragm into the chest. The frequency of this condition increases with age, and it is estimated that over 70% of patients over 70 years old have this condition.

Symptoms of Hiatal Hernia

There are sliding and paraesophageal hernias.

In sliding gastric hernias, patients usually report symptoms such as varying degrees of heartburn. In contrast, large mixed (paraesophageal) hernias, due to their size, lead to mechanical problems such as shortness of breath (due to occupying space in the chest), palpitations, and fatigue. In incarcerated hernias, nausea, vomiting, and food blockage after meals can occur.

Diagnosis

Patients with gastric hernia should first be referred for contrast radiography with barium. During the examination, the patient drinks contrast, and on the X-ray, the passage of contrast from the esophagus to the stomach can be observed, thereby showing the position of these organs in relation to the diaphragm.

It is also necessary to perform gastroscopy (upper flexible endoscopy) in order to assess the mucous membrane of the esophagus and stomach, exclude other possible conditions, and find objective indicators of the presence of gastric reflux.

In cases of suspected reflux disease, diagnosis should be supplemented with pH monitoring. This examination allows for the precise measurement of the time during which gastric contents are present in the esophagus.

A special group of patients complains of so-called extraesophageal symptoms, such as hoarseness, persistent cough, throat discomfort, and a feeling of a lump in the throat. A detailed conversation with the completion of precise evaluation questionnaires is necessary with this group of patients. It is important to identify with great care the groups of patients that respond best to therapy. By assessing the response to medication therapy, it is possible to evaluate which patients may benefit the most from the performed surgery.

Indications for surgical treatment include:

• Patients who are not motivated for lifelong intake of proton pump inhibitor medications.
• Patients with confirmed Barrett’s esophagus or severe esophagitis.
• Patients with persistent and pronounced symptoms despite the use of optimal medical therapy.

Achalasia and Esophageal Motor Disorders

Achalasia is a rare condition that occurs due to the inability of the lower esophageal sphincter to relax adequately. This condition leads to the retention of fluids and solid food in the esophagus, along with the eventual weakening of esophageal muscle activity during the progression of the disease.

The cause of the disease is not known, although it is believed to involve the deterioration of nerve centers within the esophageal wall that play a role in regulating muscle activity.

Symptoms of Achlasia

Patients with achalasia typically complain of food retention and weight loss. Food retention (dysphagia) usually progresses over several years, accompanied by a gradual, unwanted loss of body weight.

Diagnosis

When suspecting achalasia, it is crucial to use diagnostic methods to rule out malignant tumors of the esophagus and proximal stomach.

The diagnostic protocol typically begins with gastroscopy, during which we carefully examine the esophagus and its transition into the stomach. A common finding in patients with achalasia is the spasm (contraction) of the lower esophageal sphincter, making it challenging to pass the endoscope.

Contrast radiography with barium allows us to observe the dynamics of contrast medium passage through the esophagus, the time it stays in the lower part of the esophagus, as well as its diameter (width). It is also possible to observe the dynamics of the contraction of the muscular layer of the esophagus.

We complement the diagnostic process with manometry, which provides precise information about the condition of the muscular layer of the esophagus, its body, and the lower sphincter. Properly performed manometry allows for the classification of the type of achalasia.

Treatment of Achlasia

Temporary relief of symptoms in patients with achalasia can be achieved through pneumatic dilation, but a definitive solution can only be achieved through surgical treatment.

Minimal invasive surgery represents the gold standard in the treatment of the above-mentioned esophageal conditions.

Laparoscopy is a technique that provides access to the abdominal cavity through small incisions in the abdominal wall, typically ranging from 5 to 12 mm in size. Through specially created working channels (ports) and with the aid of sophisticated instruments and a camera with magnification of 5 to 10 times, we can access every part of the abdominal cavities and chest, effectively identifying and resolving the issue. These small incisions, compared to traditional surgeries, offer the potential for a rapid recovery, reduce the risk of infection, and allow a return to regular activities within a few days. The advantage of the magnified camera minimizes the possibility of errors in experienced hands, leading to the observation of the tiniest details during the procedure.

Thoracoscopy is a related procedure that allows us to access the thoracic cavity in the same way, through small incisions, without causing injury to the ribs and sternum.

The post What Should You Know About Minimally Invasive Esophagus Surgery appeared first on Atlas General Hospital.

In this article, we will discuss the symptoms, diagnosis, and treatment of the most well-known pancreatic diseases: pancreatitis and pancreatic cancer.

What does the pancreas look like?

The pancreas has a glandular structure with two parts: exocrine and endocrine. The exocrine part of the pancreas produces enzymes essential for digesting the food we consume and is connected through the main pancreatic duct to the intestines, where pancreatic enzymes reach their mature form and break down proteins and fats from food into nutrients, which are then absorbed in our intestines.

The endocrine part of the pancreas consists of numerous islets where specialized cells are grouped. These cells produce the main hormones for regulating blood sugar levels, insulin, and glucagon.

What is pancreatitis?

Inflammation of the pancreas is called pancreatitis, and acute and chronic forms are distinguished.

Acute pancreatitis

Acute pancreatitis occurs when pancreatic enzymes are activated within the organ itself, leading to damage to the glandular structures. This condition has various causes:

• Biliary pancreatitis occurs when a stone in the bile duct prevents the passage of pancreatic juices into the intestines, causing the enzymes to activate within the organ;
• Ethylic pancreatitis occurs due to the intake of a large amount of alcohol;
• Metabolic pancreatitis occurs due to high levels of fat in the blood;
• Drug-induced pancreatitis occurs when the intake of specific medications leads to enzyme activation and pancreatic damage;
• Idiopathic pancreatitis involves an unknown cause of the disease’s onset.

In most cases, acute pancreatitis is treated with medication therapy along with restricted food intake, while complications of acute pancreatitis (necrosis, formation of collections) can be treated surgically.

Chronic pancreatitis

Chronic pancreatitis is a prolonged form of the disease that arises from repeated acute episodes, most commonly occurring in patients with long-term excessive alcohol consumption.

Symptoms of this disease often include:

• Weight loss;
• Diarrhea accompanied by fat loss;
• Pain, which is most often the reason for surgical treatment.

How does pancreatic cancer manifest?

Pancreatic cancer (adenocarcinoma) is a malignant tumor of the exocrine part of the pancreas. The frequency of this tumor is increasing in Western Europe, primarily due to more prevalent risk factors and more effective diagnostics of this disease.

Risk factors for pancreatic cancer

their sixth and seventh decade of life, occurring more frequently in males. Patients with diabetes mellitus and long-term smokers have a higher risk of developing this disease.

Patients with pancreatic cancer may complain of various symptoms, such as:

• Upper abdominal pain spreading between the shoulder blades;
• Weight loss;
• Loss of appetite, nausea, and weakness;
• Yellow discoloration of the skin and eyes;
• Newly diagnosed diabetes mellitus.

Diagnosis of pancreatic cancer

Patients with the above-mentioned symptoms are initially referred for abdominal ultrasound. This method is easily accessible, does not expose the patient to radiation, and, depending on the experience of the radiologist, can scout for most pancreatic diseases. In such cases, the patient is referred for a CT scan or MRI of the abdomen. These examinations can clearly determine the tumor’s location, size, and relationship with surrounding blood vessels and organs, as well as the potential spread of the disease to the liver, peritoneum, omentum, and lungs.

Patients with suspected pancreatic cancer also need to have tumor marker values (CEA, CA 19-9) determined. In cases of suspected malignant disease spread, the patient may be referred for a PET-CT scan to definitively determine the character and malignant potential of suspicious changes.

If based on these methods, it is not possible to confirm the malignant nature of the changes in the pancreas or liver, the patient is usually referred for a biopsy under the guidance of ultrasound or CT examination.

Treatment

The treatment of pancreatic cancer depends on the stage of the disease and the tumor’s location. Pancreatic tumors, based on the possibility of surgical removal, are divided into:

• Resectable;
• Borderline resectable;
• Locally advanced;
• Metastatic.

Patients in the metastatic stage can be offered only palliative surgical treatment in case of jaundice or problems with food passage, such as nausea and vomiting. Still, the basis of their treatment lies in the application of chemotherapy and targeted biological therapy.

For patients with locally advanced tumors, according to contemporary global and European treatment guidelines, neoadjuvant therapy (chemotherapy) is recommended first to reduce the tumor before definitive surgery.

Depending on the location of the resectable tumor, either cephalic duodenopancreatectomy or distal pancreatectomy with or without splenectomy is performed.

Prevention of pancreatic cancer

Unfortunately, pancreatic cancer in advanced stages often has a poor prognosis. The best way to treat it is actually prevention, so complete elimination and avoidance of risk factors are advised.

Reducing the risk of pancreatic cancer involves:

• Quitting smoking and alcohol consumption;
• Maintaining a healthy body weight;
• Healthy diet.

Detection of precancerous lesions

Precancerous lesions of the pancreas include a group of intrapapillary mucinous neoplasms, i.e., cysts filled with dense contents that are most commonly discovered incidentally by a CT or MRI scan of the abdomen.

They usually do not cause symptoms but are always a reason for examination by an experienced hepatobiliary surgeon, as over time, these changes can lead to the development of pancreatic adenocarcinoma. This is a lengthy process, so regular CT scans are necessary, along with determining tumor markers, to identify patients at risk of malignant alteration.

Laparoscopic pancreatic surgery

In patients at risk of developing precancerous lesions, surgical treatment is indicated, performed by an experienced hepatobiliary surgeon using minimally invasive, i.e., laparoscopic, intervention.

Laparoscopy is a technique that provides access to the abdominal cavity through small incisions in the abdominal wall ranging from 5 to 12mm. Through specially made working channels (ports), using sophisticated instruments and a camera with an enlargement power of 5 to 10 times, this method allows access to every part of the abdominal cavity and chest, enabling adequate identification and resolution of the problem.

These small incisions, compared to conventional surgeries, allow for a faster recovery, reduce the risk of infection, and enable a return to regular activities within a few days. The advantage of the camera with enlargement minimizes the possibility of error to a minimum, so in experienced hands, it leads to the observation of the tiniest details during the procedure.

The post Everything you need to know about pancreatic diseases and surgery appeared first on Atlas General Hospital.

22–28 of January 2024

Cervical cancer is one of the few types of tumors that can be diagnosed, treated, and cured before reaching a dangerous stage. Prevention of this cancer involves appropriate screenings that are painless and easy to conduct.

Cervical Cancer Prevention Week is marked across Europe from January 22 to 28, 2024, to draw attention to the dangers of this cancer, as well as highlighting the significant opportunities for early detection and prevention.

What does cervical cancer prevention entail?

In Serbia alone, around 1,500 women are diagnosed with cervical cancer annually, and nearly 700 lose their lives. The majority of these deaths can be prevented if cancer is detected in the early stages.

As part of early detection, a cervical canal smear (PAP smear) is taken and the cervical cells are microscopically examined for potential cell changes indicative of precancerous alterations. Regular PAP smear screenings provide the opportunity to detect such precancerous changes early and permanently remove them through a minimally stressful procedure. This examination should be performed annually in women over the age of 20, and in women over 35, testing for the presence of human papillomavirus (HPV) is recommended every 3 years, along with PAP smear collection.

Since 2006, there has been a preventive vaccination against cervical cancer. It protects against infection against the most important types of human papillomavirus (HPV) that cause cancer, but it does not replace early detection. Vaccination is particularly recommended for young girls before their first sexual contact; however, even women who have already had HPV-induced changes on the cervix can receive this vaccine.

Frequently Asked Questions

Can cervical cancer be detected early and cured in the early stages?

Changes preceding cervical cancer can be detected early, and these changes are removed through various methods. Early stages of an already-formed cancer can be treated with a combination of surgical procedures and medications.

Who is most commonly affected by this disease?

Women under the age of 45 are most commonly affected by this disease, and increasingly, women under 30 are also affected. Therefore, it is extremely important to start preventive screenings in the months after the first sexual contact.

What causes cervical cancer?

In most cases, specific types of human papillomavirus (HPV) are the cause. They, along with other types of this virus, can be detected through a test that can be combined with the PAP smear.

How is the HPV virus transmitted?

The human papillomavirus (HPV) is transmitted through sexual contact.

What prevents the transmission of human papillomavirus?

Transmission of the virus is prevented by using condoms during sexual contact and timely vaccinating girls and boys aged 9 to 14. Vaccination is also possible after the age of 14.

Is it necessary to undergo preventive screening every year even if you have no symptoms?

Changes in the cervix caused by the HPV virus do not lead to symptoms. Since this virus leads to the appearance of genital warts, also known as condylomas, these may be the first signs that a person is infected with the virus.

Simultaneous occurrence of changes on the cervix and condylomas on the external genitalia is not mandatory, so a person can be infected without visible changes. For this reason, annual preventive screening is mandatory for every woman.

What does a preventive cervical screening include?

A preventive screening involves an examination of the external genitalia, followed by collecting a PAP smear from the cervix. Subsequently, the cervix is stained with special solutions and observed under magnification.

Changes in the color of cervical tissue under these solutions can provide information about possible cell changes. If necessary, a swab for the presence of human papillomavirus is taken, as well as various bacteriological swabs.

After this step, the gynecologist examines the potential painful sensitivity of the cervix and ovaries.

The internal reproductive organs of the woman, the uterus and ovaries, are visualized by ultrasound (vaginally).

The final step in the complete gynecological examination is a manual breast examination, performed for breast cancer prevention.

Is this examination painful, and how long does it take?

A complete gynecological examination is not painful and takes about 20 minutes. However, at certain moments, it can become mildly uncomfortable.

A comprehensive gynecological examination once a year can prevent the occurrence of many diseases of the female genital tract, with cervical cancer being one of the most dangerous.

Take notice that just half an hour annually for a preventive examination can determine the course of your life.

Dr Milica Petrović Kmezić

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