[10 years of sleeve gastrectomy in the Czech Republic in terms of the surgical procedure]. / 10 let sleeve gastrectomy - tubulizace zaludku v Ceské republice z hlediska operacního výkonu.

INTRODUCTION: Sleeve gastrectomy (SG) as a single bariatric/metabolic procedure has been performed since 2003 in the world, and since 2006 in the Czech Republic. We report 10 years experience with SG in the Czech Republic from 2006 to 2015. METHOD: Prospectively collected data from 14 surgical departments was evaluated retrospectively using descriptive statistics for every year from 2006 to 2015 and subsequently evaluated and compared for the entire period. The number of the patients, mean age, mean weight and BMI at the time of surgery, the number of patients with T2DM after SG, mean follow-up, mean %BMIL (% Body Mass Index Loss), distance of the starting point of the resection line from the pylorus, the size of the calibration bougie, the rate of complications, and the number and type of conversion procedures were evaluated. RESULTS: 4134 sleeve gastrectomies were done in the Czech Republic from 2006 to 2015 with the mean follow-up of 32.9 months (range 2145 months) from the procedure. The mean weight at the time of surgery fluctuated between 114.2 kg and 128.9 kg; mean BMI fluctuated between 42.3 and 46.7. Mean %BMIL was 63.2% for the entire evaluated period. The distance of the starting point of the resection line from the pylorus changed from the mean 6.1 cm (range 67 cm) to mean 4.2 cm (range 36 cm) and the size of the calibration bougie changed from the mean 39.2 F (range 3642 F) to mean 37.1 F (range 3542 F). As regards early postoperative complications, bleeding from the resection line occurred in 1.4% and a leak from the staple line occurred in 1.1%. The gastroesophageal reflux disease and hiatal hernia occurred in 17.3% as the most frequent late complications. Conversion to another bariatric procedure was approached in 3.8% in the event of an unsatisfactory effect of the SG. CONCLUSION: Bariatric or metabolic surgery, respectively, is a safe and effective surgical method for the treatment of severe obesity and T2DM in morbidly obese patients. Currently, SG is the most widely used bariatric/metabolic procedure in the Czech Republic as well as in most other countries and the long-time results are similar in comparison with other authors.Key words: bariatric surgery - sleeve gastrectomy - resection line - complications.

[Czech bariatry in 2010]. / Ceská bariatrie v roce 2010.

INTRODUCTION: It is only during the past two decades, when obesity has become to be considered a pandemic disorder. However, in 1953 Varco performed jejunoileal bypass as the world's first bariatric surgical procedure. 30 years later, Pesková performed the first bariatric surgery--a gastroplasty--in Czechoslovakia. From 1984 she started to perform fixed gastric bandages, through laparotomic app- roach at that time. The first laparoscopic fixed bandage in Czechoslovakia was performed in 1993. Over the years, the number of surgical procedures to treat morbid obesity, as well as the number of bariatric surgeons, continued to increase. In 2004, Czech Bariatric Section of the Czech Surgical Society and the Czech Society of Obesitology of the Czech Medical Association of J. E. Purkyne, were established. MATERIAL AND METHODS: 170 bariatric surgeries were performed in the Czech Republic in 1999. The majority of procedures included fixed gastric bandage, rarely, adjustable bandage was performed. At that time, bariatric procedures were performed at five sites only. However, over the past 10 years, bariatric surgery has largely developed in the Czech Republic. The exact number of bariatric procedures completed per year was unknown, therefore, 21 surgical clinics, at which bariatric procedures are performed, were contacted from January to June 2010. Heads of the clinics were asked to provide basic data on surgical treatment of obesity. The aim of the study was to analyze the situation in bariatric surgery in the Czech Republic at the end of 2009. A total of 18 clinics (85.8%) joined the study and provided their own statistical data. 14 of them perform over 20 bariatric procedures a year. RESULTS: The analysis data showed that, in 2009, a total of 1558 bariatric procedures were completed at 18 surgical clinics and approximately 1600 procedures were performed in the whole Czech Republic. However, out of the total, over 230 patients were foreigners. In 99% of bariatric procedures in morbid obese subjects, laparoscopic approach was used. CONCLUSION: Over the ten year period, the number of clinics performing over 20 bariatric procedures a year increased from five to 14 clinics and the number of bariatric procedures increased from 170 to 1600 procedures a year. It is 900% increase, compared to the year 1999! Nevertheless, compared to other countries, e.g. Austria, the number of bariatric procedures does not correspond with prevalence rates of obesity in the Czech Republic.

[Benefits and risks of urologic laparoscopic surgery in adult patients]. / Výhody a rizika laparoskopických operací u dospelých pacientu v urologii.

The paper describes the advantages and disadvantages of the laparoscopic operations, the number of which steadily rises in urology. The laparoscopic surgery is considered to be a benefit regarding the short postoperative hospital stay, painless postoperative course, and virtually non-existing postoperative paralytic ileus. As disadvantage are deemed the long learning curve for the operating personal, and high economical costs, which could be cut down only if short off-work period in productive population is included. In the paper, the pathophysiological guidelines are outlined and emphasized during the laparoscopic operation, which the surgical and anesthesiological teams have to have in mind. On the own cohort of patients, the numbers and types of operations are described, which have been done at our department.

[Laparoscopic transperitoneal adrenalectomy in hormonally-active adrenal tumors]. / Laparoskopická transperitoneální adrenalektomie u hormonálne aktivních nádoru nadledvin.

Laparoscopic adrenalectomy is considered the "gold standard" in adrenal surgery for benign functioning (and non-functioning) tumors. Laparoscopy meets criteria of miniinvasive surgery with minimal postoperative pain, short hospital stay and an outstanding cosmetic effect, the radicality of the procedure, open surgery and laparoscopy are equally effective. In cooperation with endocrinological department focused on detection of functioning adrenal tumors, the diagnostic and therapeutic procedure seems to be very efficient, so that the primary goal of rapid cure could be achieved. Patients after laparoscopic adrenalectomy mostly do not need chronic antihypertensive medication and only those after bilateral adrenalectomy (Cushing's disease) require life-long low dose hydrocortisone therapy. In pheochromocytomas, total excision of the tumor is considered to be a life-saving procedure, although up to 20% may recur as hereditary or as a part of von Hippel-Lindau's disease.

[Laparoscopic excision of endometriosis of the rectovaginal septum using the Diomed laser]. / Laparoskopická excize endometriózy rektovaginálního septa Diomed laserem.

OBJECTIVE: Laparoscopic excision of deep endometriosis of rectovaginal septum and evaluation of technical capabilities of Diomed laser. DESIGN: Prospective pilot study. SETTING: Department of Gynaecology and Minimally Invasive Surgery, Na Homolce Hospital, Prague. METHODS: Eight patients with clinically and laparoscopically diagnosed endometriosis of the rectovaginal septum were selected for laparoscopic surgery. The extent of the lesion was assessed by vaginal palpations and laparoscopic visualisation of the Douglas space with a sponge forceps inserted into the posterior vaginal fornix and using rectal probe simultaneously. To exclude rectal wall infiltration baryum radiography was performed. RESULTS: 7 out of 8 patients experienced a complete disappearance of symptoms such as dyspareunia, dysmenorrhea and pelvic pain. Follow-up is in the range of 1-12 months. SUMMARY: Deep infiltrating rectovaginal endometriosis is a specific disease very different from peritoneal or ovarian endometriosis. A more precise term is rectovaginal adenomyosis. Radical laparoscopic excision is needed. Although simple this is demanding pelvic surgery, the results are gratifying. The use of a laser seems superior to dissection technique.

[Fractures of the distal end of the forearm and treatment with external fixation]. / Zlomeniny distálního konce predloktí lécení zevní fixací.

Fractures of the distal end of the forearm are common fractures treated at surgical departments with standard equipment. The results, when conservative procedures are used, are not always ideal and redislocation of fragments on the 14th-21st day spoils the satisfaction of the anatomical reposition immediately after the accident. The authors demonstrate the use of external fixation devices in these fractures and the advantages of the method, as compared with the conservative procedure, in particular in unstable fractures. The objective of the submitted paper is not a randomized study as this is beyond the possibilities of the authors department but to demonstrate a more radical "approach" to these fractures. The advantage of this method is the possibility of anatomical reposition and maintenance of this position throughout the time of healing of the fracture, and the possibility of earlier rehabilitation of the wrist.

[Laparoscopic appendectomy at the Department of Surgery in Jablonec nad Nisou]. / Laparoskopické apendektomie na chirurgickém oddelení v Jablonci nad Nisou.

The paper deals with experience regarding laparoscopic appendectomy at the Department of Surgery in Jablonec nad Nisou. Between May, 1992 and Jan. 1, 1994 the authors performed 82 operations. They are listed in a table according to pathological findings and the number of complications according to a described classification. In the author's opinion the advantage of the new method is, as compared with the classical open one, a shorter time of hospitalization and a substantially shorter period of convalescence.