[Laparoscopic hernioplasty TAPP in treatment of groin hernia--10 years experience]. / Laparoskopická hernioplastika TAPP v liecbe slabinovej prietrze--10-rocné skúsenosti.

AIMS: To analyse individual and institutional "learning curve" in laparoscopic transabdominal preperitoneal hernioplasty (TAPP) and to identify key moments in its introduction at surgical clinic. MATERIAL AND METHODS: Prospective unicentric clinical study. Longitudinal recording of information on age and sex of operated patients, type of hernia, size of implanted mesh, operative tactics and technique, complications and recurrence rate was performed. Obtained data was statistically analysed and tested repeatably, results interpreted with respect to need of modification of peri- and postoperative management. RESULTS: During the 10 year period 1058 laparoscopic hernioplasties TAPP were performed with overall recurrence rate 0.96% and zero conversion rate. Mean operating time was 60.15 +/- 24.27 minutes (30-175), 46.64 +/- 19.23 minutes in the last three years (last 541 patients). Thanks to prospective analysis of obtained results three important changes in the operative management were introduced: size of mesh enlarged from 7.5 x 15 cm to 10 x 15 cm, change of operating team and port sites set up and shift towards macroporous 3D-knitted light-weight polypropylene meshes. CONCLUSIONS: Crucial factor for successfull introduction of laparoscopic hernioplasty TAPP at surgical clinic is consistent follow-up which represents a source of valid information thus allowing to make important changes in patient management. TAPP represents demanding operation with significant individual and institutional learning curve. Operating time decreases significantly after 30 operations; with growing institutional experience recurrence rate decreases. Minimal size of implanted mesh should be 10 x 15 cm.

[Standard versus "hand-pump" vacuum extraction device]. / Standardní versus "hand-pump" vakuumextrakcní prístroj.

OBJECTIVE: Clinical evaluation of a standard vacuum delivery device and "hand-pump" vacuum delivery device. DESIGN: Retrospective clinical study. SETTING: Department of Obstetrics and Gynecology, City Hospital, Litomerice. METHODS: In the period between January 1993 and the end of December 2003 there were 81 deliveries by vacuum at our department, 55 of which (67.90%) were with standard vacuum delivery device and 26 (32.10%) with "hand-pump" vacuum delivery device. We evaluated the differences in the following parameters: 1. basic characteristics--maternal age, parity, gestational age, birth weight and type of labor, 2. early maternal morbidity--the presence of episiotomy, perineal and vaginal tears, blood loss, the need of blood transfusion, duration of hospitalization and postpartum incontinentia urinae and alvi, 3. early neonatal morbidity--pH a. umbilicalis, Apgar score and the presence of newborn's trauma. The differences found in individual groups were then used for statistics and evaluated. RESULTS: In comparison with standard vacuum delivery device the usage of "hand-pump" vacuum delivery device appears to be more convenient for its significantly higher reliability, especially due to construction and also for its favourable features at early neonatal morbidity. CONCLUSION: We have proved that the "hand-pump" vacuum delivery device is in comparison with standard vacuum delivery device more favourable with newborns and more convenient to use for its high reliability.