[Mini-lap cholecystectomy]. / Minilaparotomijska holecistektomija.

In a selected group of patients, cholecystectomy through small incision, the so called minilaparotomy, has certain advantages over an operation throug classical laparatomy. Over a period of seven years, at the Surgical Ward of the Health Centre, Vranje, 504 patients were operated for gallbladder stones, 455 of whom by classical laparatomy (90.28%) and 49 patients by minilaparatomy (9.72%). Of 49 patients minilaparatomy cholecystectomy was successfully carried out in 45 patients (91.83%). Mortality, morbidity of major significance, or operative injuries to the main bile duct did not occur in this group of patients, in contrast to the group with classical laparatomy, where mortality of 0.66% and injuries of the main bile duct in 0.66% of the cases, were recorded. The hospital stay was shorter and working abilities were re-established faster in the group of patients with minilaparatomy operation. We conclude that in selected group of patients minilaparatomy cholecystectomy is a reasonable alternative to the classical operation.

[Ishiadic hernia (sciatic hernia)]. / Isijadicna kila.

The sciatic hernia is a protrusion of the peritoneal sac and its contents through the great or small sciatic foramen. This kind of hernia is an extremely rare. The authors present patient with ischiadic hernia and its operative repair. The preoperative diagnosis was a tumour (cyst) localized intraglutealy, but during operation sciatic hernia was found. Hernia was operatively removed making an oblique incision over the palpable mass, splitting the gluteous maximus, and exposing and opening the hernial sac, avoiding nerve and vascular injury by careful dissection of the sac. Then the sac was ligated and excised. Closing of the musculature defect was made with interrupted sutures of 000-Dexon, aproximating the gluteus maximus and medius muscles to the musculus piriformis. The authors consider that transgluteal approach has priority to transabdominal approach.

[Therapy of pouchitis after J-pouch ileoanal anastomosis (case report)]. / Lecenja zapaljena ileonusnog "rezervoara" pri ileoanusnoj anastomozi.

The ileal pouch-anal operation is the best procedure because it liberates the patient from ulcerative colitis i.e. from diseased mucosa of the large intestine. The ileal pouch forms a new reservoir for the storage of feces. Symptomatic pouch inflammation (pouchitis) appeared in 7-40% of the patients. The authors describe a 19-year-old young man with pouchitis after ileoanal J-pouch anastomosis. He had symptoms of "rectal" cramping, diarrhea, fever, anorexia and extraintestinal manifestations such as arthritis and uveitis, without hematochezia and erythema nodosum. Three times he was treated for pouchitis at the Ward of Surgery. Diagnosis was made on clinical symptoms, endoscopic examination, response to the therapy and exclusion of infectious enteritis. After receiving metronidazole, loperamide, sulfasalazine and infusions, all symptoms disappeared.

[Rupture of the spleen and the surgical approach]. / Ruptura slezine i operativni postupak.

In introduction, the authors present, theoretical considerations about divide of spleen injury, and give appropriate statistical data. In their material consisted of 25 traumatically ruptured spleens during period 1974-1988, they deal, among other questions, with necessity of drainage after splenectomy. As for operative procedure, they point out splenectomy, but also mention other surgical treatments that they are not familiar with. In conclusions they insist on early and precise diagnosis (especially in multi injured patients) and emphasize close relationship between drainage and local intraoperative finding.

[Drainage of the pericystic cavity in echinococcosis of the liver]. / Dranaza pericisticne supljine kod ehinokokusa jetre.

The authors emphasize that echinococcosis is cosmopolitan parasitosis and liver is the most often target organ. The most common complications are summarized. At any slightest doubt of the liver infection, the authors recommend modern diagnostic tools (ultrasonography CT) in liver examination. They analyze their lo years experience (20 hepatal). The conclusion is that basic therapeutic procedure is removing of pericyst content with hydatid membrane and residual cavity is treated later. The authors accept updated biac of liver echinococcosis treatment (radical removing of pericyst performing typical or atypical resection, or total lobectomy in case of lobar destruction). However they point out that drainage operations (marsupialization, external drainage with rubber drain, irrigation-aspiration drainage, T-drainage and internal drainage omentopeksia, anastomosis of the cavity with jejunal lumen) still have their place and value in Surgery.