[Impact of hyperbaric oxygen therapy on the clinical course of acute pancreatitis and systemic inflammation response syndrome].

Feasibility of hyperbaric oxygen therapy (HBO) as an efficient and safe adjunct to the standardized treatment protocol and its possible immunomodulatory impact were assessed in the prospective and controlled study of 44 patients with diagnosed acute pancreatitis (AP). The course of the disease was accompanied by systemic inflammatory response syndrome (AIRS) in all the patients on admission. The impact of AP and HBO on homeostasis, the number of performed operations, mortality rates, the levels of two cytokines, intraabdominal pressure, and side effects caused by HBO were evaluated. A treatment group consisted of 22 patients receiving HBO therapy for 3 days (twice a day) using a monoplace chamber under pressures of 1.7-1.9 ATA. Patients (n = 22) in the control group were managed in accordance with the standardized treatment protocol. The authors found more stable homeostasis, decreased mortality rate, and the number of operations in the HBO group. This type of additional therapy, possibly contributed to the decrease of intraabdominal pressure within the first six days after admission. The findings suggest HBO can affect an inflammatory response, by decreasing the levels pro-inflammatory cytokines and increasing those of anti-inflammatory ones.

A comparison of quality of life and postoperative results from combined PPH and conventional haemorrhoidectomy in different cases of haemorrhoidal disease.

OBJECTIVE: To compare the early postoperative results and late patient-related postoperative results by a Short-Form 36 quality of life survey after conventional haemorrhoidectomy and PPH procedure with additional surgical intervention in noncomplicated, complicated and delayed cases of the disease. METHOD: The comparison was made between comparable patient groups after conventional haemorrhoidectomy (n = 168) and after PPH with additional surgical intervention (n = 142). The early and late postoperative results and quality of life analysis according to SF-36 questionnaire were compared. RESULTS: The length of procedure was significantly shorter after the PPH procedure (37.4 vs 49.4 min). The amount of postoperative nonopiate analgesics was similar, but consumption of opiates was more in the conventional group. The rate of early postoperative complications was similar. In the PPH group significant improvement in all quality of life parameters was ascertained 6 months after operation, but 6 weeks after surgery several parameters in this group were lower. In the conventional group improvement was ascertained only for several parameters. The significant improvement of quality of life after PPH operations was ascertained especially at a mean period of 6 weeks. CONCLUSION: The PPH procedure performed in complex cases of the disease and combined with other surgical intervention because of the anorectal comorbidity assures better early postoperative results and better postoperative quality of life in a 6-month follow up in comparison with conventional haemorrhoidectomy. The continuation of quality of life studies with a longer follow up is required concerning Longo operation.

[Severe acute pancreatitis: role for laparoscopic surgery]. / Die Rolle der laparoskopischen Chirurgie bei schwerer akuter Pankreatitis.

UNLABELLED: Minimally invasive surgery is a new and promising treatment modality in the management of patients with severe acute pancreatitis (SAP). Aim of our study was the evaluation of our first experiences with laparoscopic surgery in the management of patients with SAP. METHODS: A total of 65 patients complied with Atlanta recommendations for SAP and were included into this retrospective study. Indications for laparoscopic surgery were SAP presented with intraabdominal or retroperitoneal exudates and detected by ultrasound (US) and/or contrast enhanced computer tomography (CT) scan, and the presence of acute calculous cholecystitis when 3 to 5 days of conservative treatment did not show clinical improvement and surgical treatment was considered. Patients with improvement after initial therapy received conservative therapy only. Bacteriological cultures were done for abdominal exudates and necrotic tissue obtained during surgery. RESULTS: Totally, 39 patients were operated and 26 were treated conservatively only. Laparoscopic surgery was started in 31 patients and completed in 26 patients. The overall conversion rate was 16.1 %. Laparoscopic drainage of the intraabdominal exudate was done in 26 patients including drainage of the lesser sac in five of them. Laparoscopic cholecystectomy in 25 cases and laparoscopically assisted jejunostomy in 6 cases were performed as a part of the procedure. Conventional surgery was the primary procedure in 8 patients. Peripancreatic abscess formation was observed in one case one month after laparoscopic procedure and was cured with conventional surgical drainage. Bile leakage from the cystic stump was successfully treated with endoscopic papillotomy in one case. All patients survived after laparoscopic procedures. Overall complication rate was 7.7 % and mortality reached 3.1 %. CONCLUSIONS: Laparoscopic drainage of the abdominal cavity, drainage of the lesser sac and revision of the retroperitoneal compartment can be safely carried out as an alternative to the conventional surgical approach. Laparoscopic cholecystectomy and/or jejunostomy may be additionally performed if indicated.