[Impact of antireflux surgery on gastroesophageal reflux-associated symptoms and quality of life.] / Laparoszkópos antirefluxmutétek hatása a gastrooesophagealis refluxszal járó tünetekre és a betegek életminoségére.

INTRODUCTION: Reflux disease has become endemic in the Western world. High quality hiatal reconstruction and fundoplication has a paramount importance in its therapy. While the primary goal of surgery is reducing reflux-associated disease burden, the evaluation and follow-up of disease-associated quality of life is essential. OBJECTIVE: In this study, we aimed to measure and evaluate the pre- and post-operative reflux-associated quality of life of patients undergoing surgery between 01. 12. 2015 and 31. 12. 2020 at a tertiary care hospital. METHOD: We utilized a health-related quality of life questionnaire both pre- and post-operatively. The main outcome measures were: patient-assessed heartburn, dysphagia, regurgitation, chest pain, nausea and vomiting. We also measured acid secretory medication use and patient satisfaction. RESULTS: We have assessed the pre- and post-operative questionnaries of 65 patients. All the symptoms above have decreased after surgery, and the changes were statistically significant (except for dysphagia). There was a tendency for minor weight loss after surgery. The use of acid secretion inhibitor medications decreased significantly. DISCUSSION: Our results are comparable to the outcomes of other tertiary care centers. Our workgroup has successfully adopted the diagnostic and therapeutic algorithms of the surgical care of reflux disease. CONCLUSION: If the proper indications for surgery are met, laparoscopic hiatoplasty and Toupet fundoplication are capable tools in decreasing reflux-associated symptoms and improving reflux-associated quality of life. Orv Hetil. 2023; 164(2): 57-63.

[Synchronous tumor treatment in the presence of gynecologycal cancer in three patients]. / Nogyógyászati daganatok esetén jelentkezo szinkrón tumorok együlésben való ellátása három eset kapcsán.

During the examination of patients, the probability of the occurrence of a secondary tumour is 15.2%, while that of a tertiary tumour is 1.3% [1]. The aim of this article is to draw attention to the fact that the surgical treatment of synchronous tumours in one session, if proper professional background is ensured, provides definite benefits for the patients. No protocols for the treatment of multiple tumours can be found in the relevant literature; mostly descriptions of cases are available to give orientation. The preoperative stage of the diseases, the examination protocol, the surgical procedure and the biopsy results are detailed in the study. In the article, the treatment of a triplex tumour - vulva, rectum and sigma tumour -, a large colon tumour and an endometrial adenocarcinoma with open surgery is described as well as the minimally invasive surgery of a rectal and synchronous endometrial adenocarcinoma with a patient who has gone through neoadjuvant therapy are presented. The three cases presented here prove that the surgical treatment in one session was clearly beneficial for the patients, let alone cost-efficiency. The article is not about the discussion of post-surgical or adjuvant treatments; decisions about these are to be made by the multidisciplinary professional committees of the hospitals, based on the particular situations. Orv Hetil. 2023; 164(2): 70-75.

[The primary surgical therapy of a synchronous sigmoid, rectal and vulvar cancer]. / Szinkron szigmabél-, végbél- és szeméremtesti daganat primer mutéti ellátása. Esetismertetés.

Malignant tumors were the leading cause of death in Hungary between 1990 and 2018 according to the central statistical office (www.ksh.hu). While the mortality of cerebrovascular diseases is decreasing, cancer-related mortality is getting worse, despite the improvement of both diagnostic and therapeutic opportunities. The exact number of synchronous double and triple cancers in Hungary is unknown, and their therapeutic pathways are unclear. Currently there is no data available regarding these questions in the National Cancer Registry. In this case report we present the diagnostic and therapeutic algorithm of a patient with a triple malignancy.

Our experience with the laparoscopic surgery of hiatal hernias / Tapasztalataink a rekeszsérvek laparoszkópos sebészetével.

Összefoglaló. Bevezetés: A hiatus hernia egy anatómiai betegség; gyakoribb elofordulása idosebbeknél jelezheti, hogy a betegség idovel elorehalad, súlyosbodik. Elhanyagolt esetben szövodmények alakulhatnak ki, melyek növelhetik a perioperatív mortalitást. Célkituzés: A laparoszkópos hiatusrekonstrukciók sebészetében szerzett mutéti tapasztalataink ismertetése mellett igyekeztünk statisztikailag alátámasztható korrelációt találni a rekeszizom-defektus anatómiai paraméterei, valamint a betegek életkora között. Módszer: Retrospektív tanulmányunk keretében elemeztük azon betegeinket, akik laparoszkópos hiatus hernia mutéten estek át egy 58 hónapos (2016. január-2020. október) vizsgálati periódus során. A rekeszi defektus méreteit endoszkópos vonalzóval a mutét közben megmértük, a hiatus oesophagei felszínét standard matematikai formula segítségével számoltuk ki. A sürgosséggel mutétre kerülo betegeink adatait külön elemeztük. Statisztikai analízis: A defektus mérete és a betegek életkora és magassága közötti korrelációt a Spearman-féle ró (ρ)-korreláció segítségével állapítottuk meg. A szignifikanciaszint p≤0,05 volt. Eredmények: Az elektív csoportban 142 operált páciensbol 47 beteg mérési adatai feleltek meg a kritériumoknak. Az átlagéletkor 64,7 ± 12,7 év volt, 33 páciens volt no (70,2%), az átlagos testtömegindex 28,8 ± 5,5 kg/m2 volt. A defektus haránt átméroje és felszíne szignifikáns pozitív korrelációt mutatott a betegek életkorával (p≤0,05). Akut indikációval 5 beteg került mutétre; a defektus méretét illetoen hasonló eredményeket tapasztaltunk, mint az elektív csoportnál, 2 esetben azonban súlyos szövodmények alakultak ki. Következtetés: A betegség mögött húzódó anatómiai okok jobb megértése és a megfigyeléseink alapján módosított sebésztechnika reményeink szerint csökkentheti a hosszú távú kiújulások számát a jövoben. Az idoben elvégzett elektív beavatkozás alacsonyabb mortalitással, kevesebb szövodménnyel és rövidebb hospitalizációval jár együtt. Orv Hetil. 2021; 162(19): 754-759. INTRODUCTION: Hiatal hernia is an anatomical disease, and the higher incidence for elderly patients suggests that it is progressing over time. Neglected cases can cause serious complications, raising perioperative mortality. OBJECTIVE: We are presenting our experience in laparoscopic hiatal reconstructions. Our main goal is to find a statistical correlation between the anatomical parameters of the hiatal defect and the patients age. METHOD: Surgical data were reviewed retrospectively for patients who underwent laparoscopic hiatal hernia repair between January 2016 and October 2020. Dimensions of the hiatal defect were measured intraoperatively with an endoscopic ruler. The defect size was calculated using a standard formula. The acute surgeries were analyzed as a separate arm of the study. STATISTICAL ANALYSIS: The correlation between the patients age and the size of the defect were calculated using Spearman's rho (ρ) correlation. The level of significance was p≤0.05. RESULT: In the elective group, out of 142 patients 47 met the inclusion criteria. The mean age was 64.7 ± 12.7 years, 33 patients were women, and the mean BMI was 28.8 ± 5.5 kg/m2. Patient age showed significant positive correlation with the transverse dimension and the size of the hiatal defect. 5 patients underwent surgery due to acute indications. We found similarities in the size of the defects; at 2 patients we documented severe complications. CONCLUSIONS: A better understanding of the underlying anatomical disorders and the consecutively modified surgical technique will hopefully reduce the long-term recurrencies in the future. The elective surgery performed in the right time results in lower mortality, less complications and shorter hospitalization time. Orv Hetil. 2021; 162(19): 754-759.

Effects of goal-directed crystalloid vs. colloid fluid therapy on microcirculation during free flap surgery: A randomised clinical trial.

BACKGROUND: Macro, and microcirculatory effects of crystalloids and colloids are difficult to compare, because interventions to achieve haemodynamic stability seldom follow similar criteria. OBJECTIVES: Our aim was to compare the effects of crystalloids and colloids on the microcirculation during free flap surgery when management was guided by detailed haemodynamic assessment. DESIGN: A randomised, controlled clinical trial. SETTINGS: The investigation was performed at the University of Szeged, Hungary. PATIENTS: Patients undergoing maxillofacial tumour resection and free flap reconstruction were randomised into groups treated with either intra-operative crystalloid (Ringerfundin, n = 15) or colloid (6% hydroxyethyl starch, HES, n = 15) solutions. INTERVENTIONS: Macrohaemodynamics were monitored by a noncalibrated device (PulsioFlex-PULSION). Central venous oxygen saturation, venous-to-arterial PCO2-gap, lactate levels and urine output were measured hourly. Maintenance fluid was Ringerfundin (1 ml kg h), and a multimodal, individualised, approach-based algorithm was applied to guide haemodynamic support. Hypovolaemia was treated with Ringerfundin or HES fluid boluses, respectively. The microcirculatory effects were assessed by laser-Doppler flowmetry (PeriFlux 5000 LDPM), with the probe placed on the flap and on a control area. Measurements were performed after the flap was prepared, then 1 and 12 h later. MAIN OUTCOME MEASURES: The primary end-point was microcirculatory perfusion as determined by laser-Doppler flowmetry. RESULTS: There was no difference between the groups regarding patient characteristics. Both groups remained haemodynamically stable throughout due to the use of approximately a 1.5 times higher total fluid volume in the Ringerfundin group than in the HES group: mean ±â€ŠSD: 2581 ±â€Š986 and 1803 ±â€Š497) ml, respectively, (P = 0.011). There was no significant difference in the microcirculatory blood flow between the groups. CONCLUSION: Our results showed that when fluid management was guided by detailed haemodynamic assessment, more crystalloid than colloid was needed to maintain haemodynamic stability, but there was no difference between the effects of crystalloids and colloids on the microcirculation. TRIAL REGISTRATION: ClinicalTrials.gov NCT03288051.

Autologous Dermis Graft Implantation: A Novel Approach to Reinforcement in Giant Hiatal Hernias.

OBJECTIVES: Nonreinforced tensile repair of giant hiatal hernias is susceptible to recurrence, and the role of mesh graft implantation remains controversial. Creating a new and viable choice without the use of high-cost biological allografts is desirable. This study presents the application of dermis graft reinforcement, a cost-efficient, easily adaptable alternative, in graft reinforcement of giant hiatal hernia repairs. METHODS: A 62-year-old female patient with recurrent giant hiatal hernia (9 × 11 cm) and upside down stomach, immediately following the Belsey repair done in another department, was selected for the pilot procedure. The standard three-stitch nonabsorbable reconstruction of diaphragmatic crura was undertaken via laparoscopic approach. A 12 × 6 cm dermis autograft was harvested from the loose abdominal skin. "U" figure onlay reinforcement of diaphragm closure was secured with titanium staples. The procedure was completed with a standard Dor fundoplication. One- and seven-month follow-ups were conducted. RESULTS: No short-term postoperative complications were observed. One-month follow-up showed normal anatomical location of abdominal viscera on computed tomography imaging. High-resolution manometry showed normal lower esophageal sphincter pressure. Preoperative abdominal complaints were resolved. Procedural costs were lower than the average cost following mesh graft reinforcement. CONCLUSION: Dermis graft reinforcement is a cheap, easily adaptable procedure in the repair of giant hiatal hernias, even in the setting of laparoscopic reoperative procedure.

An anterolateral thigh chimeric flap for dynamic facial and esthetic reconstruction after oncological surgery in the maxillofacial region: a case report.

BACKGROUND: The surgical management of malignant tumors in the head and neck region often leads to functional and esthetic defects that impair the quality of life of the patients. Reconstruction can be solved with prostheses in these cases, but various types of microsurgical free flaps can provide a better clinical outcome. CASE PRESENTATION: In this case report, the tumor and parts of the involved facial muscles and nerve were excised surgically from a 42-year-old patient after a third relapse of basal cell carcinoma in the left midface. The tissue defect was reconstructed with an anterolateral thigh chimeric type I fascio-myocutaneous flap, where the facial palsy was restored with a segmental branch of the femoral nerve and the involved mouth corner elevator muscles for the segmented vastus lateralis muscle. The 6-month follow-up revealed a good esthetic outcome, the soft tissue defect reconstruction with good functional activity of the reconstructed facial nerve and with acceptable mimic movements. There has been no subsequent recurrence. CONCLUSIONS: It is concluded that the chimeric type I anterolateral fascio-myocutaneous free flap can offer a good option for the esthetic and functional reconstruction of an extensive tissue defect in the maxillofacial region.

[Thoracodorsal artery perforator fasciocutaneous flap in the treatment of chronic hidradenitis suppurativa of axilla]. / Az arteria thoracodorsalis perforátor fasciocutan lebeny a krónikus axillaris hidradenitis suppurativa kezelésében.

BACKGROUND: The only definitive treatment of chronic axillar hidradenitis suppurativa (HS) that prevents relapses is 'in toto' excision of the infected glandular tissue. This way a deficiency emerges, which needs to be restored. Reconstruction with split skin graft (SSG) is a most common way of recovery, but thoracodorsal artery perforator (TDAP) fasciocutneous flap delivers better functional and aesthetic results. METHOD: Between May 2014 and July 2016, 14 patients underwent reconstructive surgery after excision of axillary HS, 2 of them had bilateral lesion. In 15 cases TDAP was used, in 1 case we used thoracodorsal artery capillar perforator flap (TAPcp). RESULTS: In all but 2 cases 1 dominant perforator was found. 1 flap had 2 dominant perforators and 1 flap was supplied by capillary perforators. Size of the flaps spread between 6 × 8 and 10 × 15 cm. 15 reconstructions were successful, 1 flap necrotised because of the lack of compliance of the patient. CONCLUSION: As a result of the glandular tissue excision carried out because of a chronic HS, a deficiency emerges. TDAP flap is an ideal solution for surgical reconstruction of axillar deficiencies, and a great alternative to SSG.

Surgical Management of Progressive Hemifacial Atrophy With De-Epithelialized Profunda Artery Perforator Flap: A Case Report.

Progressive hemifacial atrophy (PHA) is a rare disorder characterized by slow, unilateral atrophy of the soft tissues and bones of the craniofacial region. The defect becomes more pronounced with age, leading to esthetic and functional deficits. However, the proper timing and method of surgical reconstruction are still debated. The correction of this defect markedly influencing the quality of life of the patient can be achieved with less invasive to more invasive surgical approaches. A 21-year-old female patient with hemifacial atrophy and extensive alopecia presented to our clinic. Considering the body type and the expectations of the patient, a profunda artery perforator flap was applied for the reconstruction and esthetic improvement of the facial region. The facial asymmetry attenuated after the reconvalescence period. This case shows that in the up-to-date surgical treatment of severe PHA, the use of microvascular free flaps may provide a better approach when trying to achieve an acceptable esthetic result. This is the first time that a profunda artery perforator flap was used to restore facial asymmetry caused by PHA.

[Cooperation between the plastic surgery and the head & neck surgery departments in the treatment of unusual cases, Veszprém, Hungary, 2010-2015]. / Plasztikai sebészet és fej-nyak sebészet együttmuködése nem szokványos esetek ellátása kapcsán. Veszprém, 2010­2015.

INTRODUCTION: Handling problems in the head and neck region often requires a close cooperation between allied professions, just as in the challenging cases presented by us. Cases and methodology: With the first patient, we performed a radical surgery on the left side of the face due to recidivious basal cell carcinoma, followed by reconstruction using a Type I chimeric anterolateral thigh flap (ALT), while in the case of the second patient, we carried out a radical surgery on the right side of the face due to epithelial carcinoma and reconstruction with a Type I chimeric thoracodorsal flap. With our third patient, a reconstructive operation was performed due to left-sided congenital hemifacial microsomia, using a profunda artery perforator (PAP) flap. The fourth patient, due to the loss of the right hemi mandible as a result of an injury, went through a reconstructive procedure designed with Computer-Aided Design and Computer-Aided Manufacturing (CAD-CAM) technology, using a fibula free flap. RESULTS: All chosen reconstructive methods proved to be efficient and safe solutions in handling the problems. CONCLUSION: Through the cases presented, we intend to raise awareness of the importance of cooperation between maxillofacial and plastic surgery as well as of the ever-growing range of reconstructive opportunities through the flaps used.

[Medial sural artery perforator fasciocutaneous flap for the reconstruction of tongue and mouth base]. / Arteria suralis medialis perforator fasciocutan lebeny alkalmazása a nyelv és a szájfenék rekonstrukciójában.

BACKGROUND: Despite the well-known high donor site morbidity of the radial forarm flap, it has still remained the first option for the reconstruction of the tongue and the floor of mouth. However, a desire for an alternative, thin fasciocutaneous flap has led to the use of the median sural artery perforator flap. METHODS: Three patients had reconstructive surgery used MSAP flaps, after radical tumor excision. RESULTS: The flap was based in all cases on a dominant perforator vessel. The size of the skin paddles ranged between 20-32 cm2, and the length of the vascular pedicle between 8.2-11 cm. The mean thickness of the flap was 6.5 mm. CONCLUSION: MSAP flap is an ideal solution for surgical reconstruction in the oral cavity.

[Perineal soft-tissue reconstruction with vertical rectus abdominis myocutan (VRAM) flap following extended abdomino-perineal resection for cancer]. / Kiterjesztett abdominoperinealis rectumexstirpatiót követo gáttájéki rekonstrukció verticalis rectus abdominis myocutan (VRAM) lebennyel.

Perineal wound healing problems following extended abdomino-perineal resection of ano-rectal cancer represent a great challenge to the surgeon. Perineal soft-tissue reconstruction with a myocutan flap was thought to reduce surgical wound healing complications. A review of the relevant literature was carried out on perineal soft-tissue reconstruction with rectus abdominis myocutan (VRAM) flap following extended abdomino-perineal rectal resection for cancer. The more commonly used neoadjuvant chemo- and radiotherapy as well as extended surgical radicality resulted in increased perioperative risks, therefore combined procedures between the colorectal and plastic surgical teams are inevitable. This case report illustrates the above trend.

[Double DIEP flaps for unilateral breast reconstruction]. / Kettos DIEP lebenyek egyoldali emlorekonstrukcióban.

DIEP flap is a reliable option for autologous breast reconstruction after mastectomy. Previously performed lower median laparotomy can cause some difficulties in cases when more volume is needed than the DIEP flap harvested from one side can provide. We performed breast reconstruction using double hemi-DIEP flaps in three of the cases discussed. All patients recovered without complications and had a good aesthetic outcome. This method offers a safe opportunity and broadens the spectrum of breast reconstruction.

[Retroareolar breast cancer: oncoplastic resection technique with central quadrantectomy and reconstruction with Grisotti's inferior dermo-glandular flap]. / Retroareolarisan elhelyezkedo emlotumorok onkoplasztikai mutéte: centrális quadrantectomia és Grisotti-féle inferior dermoglandularis lebennyel való rekonstrukció

Centrally located breast cancers account for 5-20% of all breast cancer cases. Historically, patients with central breast cancers were not offered breast conservation surgery but conventional mastectomy only. The relatively frequent nipple-areola-complex involvement and consequent nipple-areolar resections with an adequate safety margin around the tumor usually result in an unacceptable cosmetic result. However, breast conservation surgery can be offered to these patients applyingoncoplastic surgical techniques. In this study, central quadrantectomy and breast reconstruction with Grisotti's dermo-glandular flap is evaluated.

[Combined transplantation of a free skin island flap supplied by a septo-cutaneous perforator of the posterior tibial artery and the underlying fibula for the full reconstruction of the mandible and the mouth floor]. / Az arteria tibialis posteriorból eredo direkt septocutan perforator ér által ellátott különálló borszigetlebeny és a fibula kettos szabad átültetése a mandibula és a szájfenék kombinált rekonstrukciója kapcsán.

Microsurgical transplantation of the osteo-cutaneous fibula as a free flap to reconstruct the defect following radical resection of a mouth floor's tumor is a well-known and often applied procedure. Anatomy of the vessels supplying this flap is recognized but it may have some rare and unexpected variations. In this case report we discuss the reconstruction of the middle and lateral parts of the mandible which was resected due to a T4 gingival tumor. Interestingly, the aforementioned segment of the fibula and the overlying skin island were supplied by different pedicles, both emerging from the posterior tibial vessels. Both flaps were transplanted using autologous arterial and venous grafts of the peroneal artery and vein in case of the fibula. We believe this case is worth publishing due to its relative rarity in the literature and the applied surgical method.

[Definitive treatment of multiple recurrences of sacral dermoid cysts using an inferior gluteal artery perforator fasciocutaneous flap]. / Többszörösen kiújult sacralis dermoid definitív megoldása az arteria glutealis inferior direct fasciocutan ágára nyelezett transzpozíciós lebeny alkalmazásával.

AIM: Treatment of sacral dermoid cysts (SDC) is a surgical challenge. Etiology and adequate operative technique of that are debated widely up to now, and recurrence rates remained high despite various surgical techniques applied. In cases of unsuccessfully operated and repeatedly recurrent SDC a fascio-cutaneous flap on the first perforating branch of the inferior gluteal artery (IGA) is a definitive procedure. MATERIAL AND METHOD: Following preparation and dissection of sidebranches of IGA in cadavers, a repeatedly recurrent SDC was operated. CONCLUSION: a flap harvested and transferred on the first superficial perforating branch(es) of the inferior gluteal artery offers a definitive and recurrence-free surgical solution for SDC.

[Reconstruction of soft tissue defect of the sole using an ALT flap]. / Talpi lágyrész-hiány pótlása ALT lebennyel.

Soft tissue defect of the sole is usually a quite challenging problem. In this case report the most frequently used reconstructive options of this problem are reviewed paying particular attention for the well applicable and reliable types. An ALT graft as a free flap to the sole offers a good possibility for coverage, which is resistant enough to mechanic strains.

[Pectoral major muscle-sling flap for treatment of recurrent subareolar abscess: a new surgical technique]. / Pectoralis major izomlebeny a recurráló subareolaris abscessus kezelésében: egy új mutéti módszer.

Recurrent subareolar abscess is an uncommon benign disease of the breast, which is caused by peri-ductal mastitis with various etiology. Radical surgical procedure is necessary for cure instead of inadequate courses of antibiotics or incisions. In some cases the use of the pectoral muscle sling flap can be an alternative technique for the treatment of recurrent subareolar abscess after repeated standard surgical treatment. A 36 year old woman, who successfully underwent this procedure, is presented here.