Ganglioneuroma in the papilla of Vater with neurofibromatosis type 1: report of a case.

Ganglioneuromas (GNs) are rare benign tumors and their association with neurofibromatosis type 1 (NF-1) is especially uncommon. We report in this article the case of a young woman, subjected to diagnostic work-up because of abdominal pain. Endoscopy and histology revealed not only a GN in the papilla of Vater, but also NF-1. Because of the size and macroscopic features of the lesion, we performed pancreatoduodenectomy, from which she recovered uneventfully. Histological examination of the resected tumor confirmed a diagnosis of GN.

[Our efforts to decrease surgical complications following pancreatic resections]. / Törekvéseink a pancreasresectiókat követo sebészi szövodmények csökkentésére.

INTRODUCTION: The most frequent surgical complications following pancreatic resections are pancreatic fistula and delayed gastric emptying. The aim of the authors was to analyse these complications in their own practice. MATERIAL AND METHODS: Clinical data of 287 patients were reviewed, who were radically operated on for malignant pancreatic or periampullary tumours during 14 years period. The most common neoplasm was pancreatic adenocarcinoma, located in the head of the pancreas. Pylorus-preserving pancreatoduodenectomy was most frequently performed. In the early period pancreatogastrostomy and double-layer pancreatojejunostomy were preferred during the reconstruction, as well as retrocolic duodeno-, and gastrojejunostomy, respectively. Later the authors turned to the single-layer implantation pancreatojejunostomy and to the antecolic reconstruction, the latter was completed with Braun anastomosis. RESULTS: In the postoperative course complications occurred in 39%, reoperation was done in 5.6%, and the early mortality rate was 3.8%. The rate of pancreatic fistula decreased to 5.9% following single-layer pancreatojejunostomy, and the difference was significant compared to the 17.6% rate after pancreatogastrostomy. Due to the antecolic reconstruction the frequency of delayed gastric emptying has reduced from 10.2% to 2.1%, which is a statistically significant difference. CONCLUSIONS: As a result of changes in the surgical techniques during the 14 years period, the frequency of pancreatic fistula and delayed gastic emptying has dramatically decreased, which underlines the need of continuous progress in surgical methods.

[Functional proctology at the University of Pécs]. / Funkcionális proktológia a Pécsi Tudományegyetemen.

INTRODUCTION: Functional proctological investigations have been introduced at Pécs University of Sciences 15 years ago. The Pelvic Floor Multidisciplinary Team has been re-launched after many years of pause in 2010. Experience of the team in the treatment of faecal incontinence and obstructed defecation syndrome is discussed. PATIENTS: In the past 3 years 9 patients underwent sphincter reconstruction for faecal incontinence. The Pelvic Floor Team in the past 1.5 year consulted 31 patients with constipation, who were considered by the referee for surgical intervention. Following investigations 10 patients underwent surgery, the rest of them were treated conservatively. Seven patients underwent perineal reconstruction with mesh, three patients had ventral rectopexy with additional levatoro-pexy. RESULTS: 78% of patients operated on for faecal incontinence reported full continence, 88% improvement. We invented a new symptom score with a maximum of 20 points to evaluate results of treatment of patients with Obstructed Defecation Syndrome. Patients who underwent perineal repair were interviewed pre and postoperatively. They scored 14 ± 2.83 and 5.4 ± 4.62 points, respectively (p = 0.0075). CONCLUSION: Functional proctological patients require a specialist approach from history taking through investigation to treatment. Majority of patients benefit from conservative treatment. Adequate patient selection is essential for successful surgical treatment. Symptom scores applied pre and postoperatively facilitate proper patient selection for various surgical methods.

[Comparison of wound infection rates after colon and rectal surgeries using triclosan-coated or bare sutures -- a multi-center, randomized clinical study]. / Sebfertozések gyakoriságának összehasonlítása colon- és rectummutétek után triclosan bevonatú varróanyag (PDS plus®) és azonos alapanyagú nem bevont varróanyag (PDS II®) felhasználása esetén - multicentrikus, randomizált, klinikai tanulmány.

BACKGROUND: Surgical Site Infection (SSI) is the third most frequent nosocomial infection, and accounts for 14-16% of all infections. While the treatment of SSI can be very costly, previous results indicated that triclosan may reduce SSI rate. Therefore, we carried out a prospective randomised trial to further evaluate the effect of triclosan after elective colorectal surgery. METHODS: Seven surgical units in Hungary were involved in a prospective, randomised, multicentric clinical trial to compare triclosan coated (PDS plus®) and uncoated (PDS II®) sutures for abdominal wall closure in elective colorectal surgery. Pre- and perioperative variables were recorded in an online database. The primary aims of the study were to determine the incidence of SSI and the pathogens associated with it, as well as evaluation of additional cost of treatment. RESULTS: 485 patients were randomised. SSI occurred in 47 cases (12.5%), of those 23 (12.23%) from the triclosan group (n = 188) and 24 (12.18%) from the uncoated group (n = 197, p = 0.982). In 13 (27.66%) cases late appearance of SSI was detected, of those 4 patients with triclosan coated suture (8.51%) and 9 patients with uncoated suture (19.15%, p = 0.041). There was no difference between the type of incisions or elective colon and rectal resections in terms of incidence of SSI. CONCLUSION: Beneficial effect of triclosan against Gram positive bacteria could not be confirmed in our study due to the relatively low number of patients with SSI. Furthermore, triclosan did not influence the incidence of SSI due to Gram negative bacteria. SSI rate decreased by 50% compared to our previous study, however, it was regardless of the use of coated or uncoated PDS loop. Finally, operative factors were more important than patient's risk factors in terms of incidence of SSI. In case SSI developed, delayed discharge from hospital as well as special wound care significantly increased overall cost of treatment.

Effect of triclosan-coated sutures for abdominal wound closure on the incidence of abdominal wound dehiscence: a protocol for an individual participant data meta-analysis.

INTRODUCTION: Acute abdominal wound dehiscence (AWD) or burst abdomen is a severe complication after abdominal surgery with an incidence up to 3.8%. Surgical site infection (SSI) is the biggest risk factor for the development of AWD. It is strongly suggested that the use of triclosan-coated sutures (TCS) for wound closure reduces the risk of SSI. We hypothesise that the use of TCS for abdominal wound closure may reduce the risk of AWD. Current randomised controlled trials (RCTs) lack power to investigate this. Therefore, the purpose of this individual participant data meta-analysis is to evaluate the effect of TCS for abdominal wound closure on the incidence of AWD. METHODS AND ANALYSIS: We will conduct a systematic review of Medline, Embase and Cochrane Central Register of Controlled Trials for RCTs investigating the effect of TCS compared with non-coated sutures for abdominal wound closure in adult participants scheduled for open abdominal surgery. Two independent reviewers will assess eligible studies for inclusion and methodological quality. Authors of eligible studies will be invited to collaborate and share individual participant data. The primary outcome will be AWD within 30 days after surgery requiring reoperation. Secondary outcomes include SSI, all-cause reoperations, length of hospital stay and all-cause mortality within 30 days after surgery. Data will be analysed with a one-step approach, followed by a two-step approach. In the one-step approach, treatment effects will be estimated as a risk ratio with corresponding 95% CI in a generalised linear mixed model framework with a log link and binomial distribution assumption. The quality of evidence will be judged using the Grading of Recommendations Assessment Development and Evaluation approach. ETHICS AND DISSEMINATION: The medical ethics committee of the Amsterdam UMC, location AMC in the Netherlands waived the necessity for a formal approval of this study, as this research does not fall under the Medical Research involving Human Subjects Act. Collaborating investigators will deidentify data before sharing. The results will be submitted to a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42019121173.

["Onlay" mesh provides significantly better results than "sublay" reconstruction. Prospective randomized multicenter study of abdominal wall reconstruction with sutures only, or with surgical mesh--results of a five-years follow-up]. / Kedvezobb mutéti eredmények "onlay" hálóval, mint "sublay" helyzetben beültetettel. Varrattal, illetve hálóbeültetéssel történo hasfal-rekonstrukció prospektiv, randomizált, multicentrikus vizsgálata--ötéves utánkövetés eredeményei.

BACKGROUND: There are several well-known procedures to treat abdominal wall hernias, but the results are quite controversial. The aim of study was to compare the results of different surgical modalities - mesh (onlay vs. sublay position) and suture repair - in the treatment of abdominal wall hernias. METHODS: A five-year randomized, multicentric, internet-based, clinical trial was started in 2002. 953 patients were included in the study and divided into two groups according to the size of hernia orifice. In group 'A' ( n = 494) the surface of hernia orifice was between 5-25 cm 2 (small hernia), and in group 'B' ( n = 459) it was above 25 cm 2 (large hernia). Patients of these two groups were randomized according to surgery: group 'A' (suture vs. mesh) and in group 'B' (mesh in onlay vs. sublay position). In group 'A' suture repair was performed in 247, and sublay mesh implantation in 247 cases. In group 'B' sublay ( n = 235) and onlay ( n = 224) mesh reconstruction was performed. The patients were followed-up for five years. RESULTS: 734 patients - 77% of all randomized cases - have completed the study. In the small hernia group significantly ( p < 0.001) higher recurrences occurred after suture repair ( n = 50-27%) than in mesh repair ( n = 15-8%). In the large hernia group onlay mesh reconstruction provided significantly better ( p < 0.05) results than sublay reconstruction, recurrence rate was much lower in onlay group [ n = 22 (12%) vs. n = 38 (20%)]. CONCLUSION: Mesh repair provides better results than suture repair. In case of large hernias the recurrence rate is higher after sublay reconstruction. The randomized trial was registered on www.ClinicalTrials.gov - ID number: NCT01018524.

[Long-term results of open tension-free or tension repair of inguinal hernias--retrospective study]. / A nyitott, feszülésmentes, illetve feszülés mellett végzett lágyéksérvmutét hosszú távú eredményei--retrospektív vizsgálat.

UNLABELLED: Authors discuss long-term results of inguinal hernia repairs. Patients were asked to fill in a questionnaire to compare five-year outcomes after tension-free and non-mesh inguinal hernia reconstructions. RESULTS: the trial is based on the assessement of 155 patients' replies. Recurrence rate in tension-free (TF) cases is 3.4% (4/116), while in suture repair (non-mesh - NM) group is 12.8% (5/39). The ratios of totally symptom-free patients are 83% (97/116 - TF) and 89% (35/39 - NM). Severe chronic pain occurred in 1.7% (2/116 - TF) and 7.7% (3/39 - NM). Early return to normal activity was 34% (39/116 - TF) and 29% (11/39 - NM). CONCLUSION: Based on this retrospective study Lichtenstein repair is superior to non-mesh open inguinal reconstruction, as regards recurrence rates, but chronic pain and recovery time show similar long term results in both groups, which is different from the relevant published literature.

[Treatment of pancreatic and periampullary tumours in our department in the last 10 years]. / Pancreas- és periampullaris tumorok kezelése az elmúlt 10 évben klinikánkon.

The authors analyse the results of 363 patients, who underwent surgery for pancreatic or periampullary tumours. There were 175 operable and 188 inoperable cases. The preoperative data (age, gender, site of the tumour, characteristic clinical signs), as well as surgical methods are overviewed. A pancreatoduodenectomy was most frequently applied as a curative surgery, while double-bypass was mainly performed for palliation. As far as postoperative complications, especially the rate of pancreatic fistula, which is influenced by the anastomotic method, are discussed. Reoperation and early postoperative mortality rate was 5,7% and 4,5% in the operable cases, respectively. These numbers were 1,6% and 6,9% among the inoperable cases. Following radical procedure adjuvant therapy followed surgical treatment, its results are also reported. In summary, curative surgical therapy and postoperative adjuvant treatment are necessary for a chance of long-term survival.

[Guidance for transanal operations]. / Transzanális mutéti útmutató.

We summarized diagnostic, surgical treatment and follow-up principles of benign and early malignant lesions of the rectum. Our aim is to provide a nationwide practical synopsis of transanal minimally invasive surgical techniques which might be the basis of a Hungarian national audit of rectal polyp management.

[The results of Lichtenstein operation for groin hernias--prospective multicenter study]. / Lágyéksérvek Lichtenstein mutéttel történo megoldásának eredményei. Prospektív multicentrikus tanulmány.

UNLABELLED: Authors describe the short and long term results of a prospective multicentric Lichtenstein-trial started in March 1999. For the first time in our country, the exchange of information between the participating institutes has been arranged via Internet. 1434 patients were admitted for primary hernia repair and included in the trial. However, only 714 (49.8 per cent) have attended at the last follow-up control 4 years after surgery. Premilene and Prolene meshes were used in the course of Lichtenstein's tension-free procedure. RESULTS: Wound suppuration occurred only in a very small number of the patients (0.76 per cent) and there was merely one occasion when the mesh implant had to be removed because of sepsis. The intensity of postoperative pain and demand for analgesics was very low. During the follow-up period of 4 years 16 recurrent hernias were diagnosed (2.4 per cent). A hydrocele developed in 8 patients (0.5 per cent) while necrosis of the testicle was found in 4 patients (0.27 per cent). We realised that both the attitude and practice of the institutes participating in the study has changed thoroughly and the Bassini-repair seems to be replaced by the Lichtenstein procedure in these surgical departments. CONCLUSION: The study has reached its objective in more aspects: First it helped to achieve a significant reduction in recurrence rates and it also has shown that there is no increase in wound suppuration. The great number of surgeons performing this kind of inguinal hernia repair and their good results also indicate that this operation in less depending on surgical skills and practice than the Bassini-repair. The study has largely contributed to the national spread of this operation and has doubtlessly verified the advantage of information and data processing through the Internet, ie. a prompt and correct evaluation of the data recorded

[Biological behavior of polypropylene meshes suitable for intra-abdominal implantation in animal model]. / Intraabdominalis implantatióra alkalmas polypropylene hálók biológiai viselkedésének vizsgálata állatkísérletes modellben.

The expected incisional hernia rate is between 11-20% after laparotomy. Using mesh repair the results of the hernioplasty have recently improved. However the complication of mesh implants--especially in intraperitoneal position--can be life threatening. Additionally the appropriate mesh is expensive. We tried to create a mesh, which can be used intraperitoneally and generates adhesion in the abdominal wall, but keeps the intraabdominal organs adhesion free. Our experiments were divided into four groups. In the first we used different materials to cover the intraperitoneal side of polypropylene mesh. In the second phase three different pore-sized meshes were compared. In the third part the biological behavior of three different material-reduced meshes were investigated. Based on our previous results in the last session we used only silicone membrane protected material-reduced polypropylene meshes to cover the abdominal defects. Our experiments have shown that intraperitoneal implant with silicone-covered Vypro (Ethicon)/Premilene (B. Braun Medical) mesh significantly decreases the formations of adhesion.

Surgical site infections after abdominal closure in colorectal surgery using triclosan-coated absorbable suture (PDS Plus) vs. uncoated sutures (PDS II): a randomized multicenter study.

BACKGROUND: Surgical site infections (SSI) are the third most common hospital-acquired infections and account for 14% to 16% of all such infections. In elective colorectal operations, the international SSI rate ranges from 4.7%-25%. In a previous retrospective study in this department, the SSI rate was unacceptably high (25%), and the promising different international evaluations of triclosan-coated suture materials encouraged us to create a multicenter randomized trial to improve our results. The main goal of this study was to compare triclosan-coated and uncoated absorbable suture (PDS Plus(®) with PDS II(®)) in elective colorectal operations. METHODS: This was an internet-based study involving seven surgical centers. All the elective colorectal operations were performed by experienced surgeons. For abdominal fascia closure, running looped PDS was applied; triclosan-coated or uncoated PDS was chosen by computer randomization. Pre-operative and peri-operative variables such as gender, body mass index, neoadjuvant therapy, type II diabetes mellitus, amount of wound dressing material used, nursing days, and microbiological results were recorded. After the operation, the patient's data and risk factors were collected in a password-protected online database. RESULTS: From 485 patients randomized, SSI was documented in 47 patients (12.5%), 23 (12.2%) in the group having triclosan-coated sutures (n=188) and 24 (12.2%) in the uncoated suture group (n=197), a non-significant difference. Of all SSIs, 13 (27.7%) were diagnosed only after discharge, being recognized in the outpatient setting, with four patients in the triclosan suture group (8.5%) and nine in the uncoated suture group (19.2%) being affected with no significant differences in the demographic data. Microbiological examinations, in addition to the same colon flora in both groups, revealed two gram-positive infections in the uncoated suture group. The hospital stay and costs of dressings were significantly higher in patients having SSIs. CONCLUSION: Compared with the previous retrospective studies of this department, the implementation of looped PDS decreased the incidence of SSI by one-half, whether the suture was triclosan-coated or not. It seems that patient factors are less important than operative factors in the occurrence of SSI, and there were no differences between elective colon and rectal operations in the development of incisional infections. No beneficial effect of triclosan against gram-positive bacteria, which has been reported in the literature, could be confirmed in our study. We could not show an effect against gram-negative enteric microorganisms. Higher additional costs and longer hospital stay with SSI were confirmed.