[Insufficient anastomoses in sigmoideal and rectal resections. A retrospective study conducted in a surgical clinic in Hradec Králové]. / Insuficience anastomóz u resekcí sigmoidea a rekta. Retrospektivní studie na chirurgické klinice v Hradci Králové.

INTRODUCTION: Anastomotic insufficiency is the primary cause of postoperative morbidity and mortality following resection procedures of the large intestine and rectum. MATERIAL AND METHODOLOGY: In the retrostpective study, the authors analysed rates of rectal and sigmoideal anastomotic insufficiencies in patients operated for rectal and sigmoideal carcinomas in the Faculty Hospital Surgical Clinic in Hradec Králové from 2000 to 2004. At the same time, the authors analysed risk factors of the insufficiencies. The subject of protective derivation stomies is discussed. RESULTS: In the group with primary colorectal anastomosis, the anastomotic insufficiency occured in 11% of the group subjects, in the group with primary sigmoideal anastomosis in 9.1% of the group subjects. Out of the total of 215 subjects, the anastomotic insufficiency occurred in 23 subjects (10.7 %), 6 cases were fatal and the overall postoperative mortality was 1.56 % . In the anastomotic insufficiency group, it reached 13.04 %. The difference between the studied groups is significant (p<0,001, OR = 10.5). CONCLUSION: Postoperative mortality in sigmoideal and rectal resection procedures correlates with anastomotic insufficiency.

A modified radiofrequency-assisted approach to right hemihepatectomy.

AIMS: To evaluate a modified radiofrequency-assisted approach to right hemihepatectomy. METHODS: Following a bilateral subcostal incision and intraoperative ultrasonography, the liver was mobilized in the standard manner, and a cholecystectomy was performed. The portal vein was isolated, encircled, and ligated. After demarcating the liver parenchyma, coagulation necrosis was achieved using a radiofrequency-assisted device along the line demarcated for transecting the liver parenchyma. The actual transection of the liver parenchyma and the right portal vein was done using a surgical scalpel along the radiofrequency-coagulated line. The right hepatic vein was coagulated using the radiofrequency sealer or by stitching in the resection plane. The hepatic artery was not dissected and was sealed together with the bile ducts in the resection plane using the radiofrequency instrument. The hepatic vein was not divided. RESULTS: Between July 2005 and July 2006, a total of 49 liver resections were performed in our unit. Of these, the radiofrequency-assisted technique was used in 33 cases with metastatic disease; 14 of these cases had right hemihepatectomies, including 2 repeat resections. The mean operation time was 180min (range, 120-240min), and the average blood transfusion was 0.14U (range, 0-2U). Postoperatively, there was no morbidity, such as bleeding, infection, or biliary fistula, related to the liver resection technique, and no patients died as a result of surgery. In 8 out of the 14 right hemihepatectomies, a right-sided pleural effusion was observed; 3 of them required evacuation. CONCLUSION: This paper describes a modified radiofrequency-assisted hemihepatectomy, which allows one to obtain control of the portal blood flow going into the resected part of liver. The modified approach appears to be simple and safe.

[Radiofrequency assisted liver resection in non-cirhotic liver. Initial clinical experience]. / Radiofrekvencne asistovaná resekce v necirhotických játrech. První klinické zkusenosti.

AIM OF THE STUDY: To evaluate the radiofrequency assisted liver resection using Habib sealer (RITA Medical System, Inc., Mountain View, CA). METHODS: The operation time, liver transection time, transfusion units used, and postoperative complications were recorded in a prospective way. RESULTS: 22 liver resections were performed between July 2005 and December 2005, 15 of them were done using radiofrequency technique. Twelve anatomical resections and three non-anatomical resections were performed in total. The mean operation time equalled 155 (120-240) minutes. An average of 0.6 (0-4) transfusion units was used. In 13 of the 15 operations, which represent 86% of the patients, no transfusions were used. Postoperatively, no major bleeding from the resection plane was noted and no biliary fistula was observed. CONCLUSIONS: Radiofrequncy assisted liver resection is a safe technique with the major benefit of minimal perioperative blood lost.