Primary perineal hernia: a case report.

INTRODUCTION: We present the case of a female patient with anterior primary perineal hernia. CASE REPORT: Our 63-year-old obese patient presented with recurrent “inguinal hernia“ at the Hernia Centre of Liberec. However, she was diagnosed with perineal hernia and was indicated for hernioplasty. Combined abdominal and perineal approach was used. One year has elapsed from the surgery and the patient shows no signs of recurrence. CONCLUSION: Primary perineal hernia is a challenge for every herniologist. We managed the case using a combined approach with the use of two meshes.

Current view on prostheses in herniology (hernia meshes) - classifications, indications, advantages and disadvantages of different implants, complications J. Skach, M. Slamborova, V. Blecher, P. Hromadka, R. Gurlich.

Hernia repair is one of the most commonly performed surgical procedures worldwide. Reinforcement of the tissue with a surgical mesh requires the implantation of much over 1 million meshes per year worldwide. Implant design remains a critical challenge for the prevention of hernia recurrence. Currently available implants exhibit a wide spectrum of different characteristics. This review summarizes the specifics, advantages, limitations, complications and functionalities of commonly accessible prostheses. There is still no ideal mesh for every surgery.

[Monster hernia programme in Hernia Centre Liberec]. / Program monstrózních kýl v Kýlním centru Liberec.

INTRODUCTION: The authors introduce a unique programme in the Czech Republic focused on extreme herniology. Patients with giant complex ventral hernias (monster hernias) have been concentrated in a high-volume hernia center with the most advanced perioperative intensive care since 2012. The authors present their single centre experience with the support of literature. RESULTS: Between 20122015 we operated on 36 patients with a giant complex hernia. Minimal inclusion criteria for enrolment in the very heterogeneous group included: a defect over 15 cm wide, loss of domain of 20% and higher, and the mean surface area of at least 225 cm².We consider not only advanced abdominal wall reconstruction techniques to be essential in the treatment of giant complex ventral hernias. Open component separation, endoscopic component separation technique, bariatric procedures, panniculectomy, abdominoplasty, advancement flaps, skin grafting, preoperative progressive pneumoperitoneum, CT volumetry, individual binders tailoring, crane pulley and many others (see the text) should all be included in the armamentarium of such specialized, high-volume hernia centres. The anatomy, function and aesthetics should be inseparable parts of preoperative planning. Apart from the operation there are three major aspects in the treatment of the so called monster hernias: tailoring, preconditioning and complex postoperative care. NPWT (negative pressure wound therapy) should be easily accessible in case of extensive skin necrosis with mesh infection after major abdominal hernia repairs. Using negative pressure we have saved 100% of infected prostheses from explantation (including MRSA, ESBL..). CONCLUSION: Monster hernia programme is challenging for both the patient and the surgeon. It is costly, time consuming, associated with a high complication ratio (high morbidity and recurrence) and is designed for patients with a significant health, social, work, sexual and sports handicap, and with the risk of further severe or irreversible health problems. KEY WORDS: hernia component separation abdominoplasty volumetry.

[Swimming pool suction injury: etiology, profylaxis and management]. / Úraz podtlakem v bazénu: etiologie, prevence a management.

Swimming pool suction injuries are unique and rare with a substantive risk of fatal consequences. Little children under the age of 8 are the most frequent victims with serious injuries. Drownings of different seriousness are also a usual part of accidents. The case of a 19 year old man trapped in the gluteal area by a unsecured suction drainage hole illustrates the uniqueness of this problem in an interesting way. Prophylactic arrangements are well known but the problem is with their strict application. Fatal causes excluding drowning include hypovolemic shock from the sudden redistribution of intersticial fluid and blood and also the evisceration of the bowel and other abdominal organs. Localised often bizarre and large swellings and sufusions can be treated nonoperatively in the vast majority of cases. For the prevention of these injuries it is important to inform the public and increase their awareness to these injuries. It is also crucial for the correct management of these injuries a deeper awareness of this issue and a sharing of experiences and solutions with other experts.Key words: vacuum - accident - entrapment - compartment syndrome.

[Lymphangioma of the retroperitoneum treated laparoscopically]. / Retroperitoneální lymfangiom laparoskopické resení

A case report of a female patient with pathological liquid collection in the retroperitoneum with chronic and recurrent pain in the epigastric region and dyspepsia. After a safe laparoscopic approach and removal of a cystic tumour, the finding was histologically described as lymphangioma.

[Chylous mesenteric cyst]. / Chylózní mezenteriální cysta.

The authors present a case report of a female patient with a recurrent mesenteric cyst. Chylous cyst is one of rare diagnoses of a cyst close to the pancreas in patients with no history of acute pancreatitis. Chylous cysts need to be managed radically; otherwise, given their nature, they are likely to recur.

[Peroperative detection of pulmonary lesions during mini-invasive surgery]. / Peroperacní detekce plicních lézí pri mininvazivní operative.

Currently, peroperative palpatory examination of the lungs represents standard method, however the development of the new mini-invasive surgery techniques devoid of palpable facilities, demands utilization of different procedures. The authors present their experiences involving detection of pulmonary lesions during thoracoscopic surgery visually, by endoscopic instruments, preoperative dye marking and peroperative ultrasonography via an endoscopic ultrasonic probe (all performed in Liberec District Hospital a.s.). The article describes operation techniques and tactics of thoracoscopic surgeries performed with pulmonary pathological processes in both subpleural and pulmonary parenchyma locations.

[Thoracoscopic anatomical lung resection--lobectomy]. / Torakoskopická anatomická resekce v rozsahu lobektomie.

The authors bring their first experience with a purely endoscopic anatomical lung resection - lobectomy with mediastinal lymphadenectomy. At the department of surgery, Liberec Hospital, we have, so far, done 5 operations using this new technique. Once left superior lobectomy and 4 left inferior lobectomies were carried out. We describe the procedures and surgical tactics in thoracoscopic operations using modern staplers and haemoclips. The aim was to compare the results and benefits of purely endoscopic versus "classical" operations and to dismantle the myth of the extreme finacial intensiveness of this procedure.