[Artificial bowel sphincter ten years later]. / Umelý sverac anu po deseti letech.

INTRODUCTION: Congenital anorectal malformation is the most common cause of fecal incontinence in children and young adults. Surgical treatment options are limited. One of the treatment methods is the implantation of an artificial bowel sphincter. The goal of this study was to investigate the efficacy of the artificial bowel sphincter in reaching long-term fecal continence in patients with anorectal malformation. METHODS: Young adults with fecal incontinence due to anorectal malformation were included in the study. Those who underwent an artificial bowel sphincter implantation were followed each year for a period of 10 years. Outcome measures included the level of continence and the need for reoperation including explantation. RESULTS: Out of the 20 patients with congenital anorectal malformation, nine underwent implantation. Three devices were explanted within the first year; two were permanently removed and one was replaced. Thus, after the first year, seven patients (78 %) had a functional artificial bowel sphincter. Four patients (44 %) had a fully functional artificial bowel sphincter at 10 years after implantation. Although the artificial bowel sphincter improved the level of continence in all patients, full continence was not achieved in any of them. In one patient the artificial bowel sphincter was explanted after 10 years upon her request and a colostomy was created. CONCLUSION: Artificial bowel sphincter is a potential treatment modality for fecal incontinence in patients with congenital anorectal malformation. The main reason for failure results from inability to accurately assess the extent of the anorectal malformation before device implantation. Changes in the perineal region consequent to previous operations are the main limiting factors for artificial bowel sphincter implantation.Key words: anorectal malformation - incontinence - artificial bowel sphincter - long-term results.

[Hirschsprungs disease in adults two case reports and review of the literature]. / Hirschsprungova choroba v dospelém veku dve kazuistiky a prehled literatury.

Hirschsprungs disease (HD) in adults is extremely rare, only three publications in Czech and Czechoslovak journals making reference to the condition after childhood. We present two cases of adult patients with HD. The first case is a 46-year-old male patient suffering from chronic constipation since childhood and diagnosed with megacolon at the age of 16; however, no further detailed diagnosis was done. At the age of 41, he developed a sigmoid perforation due to fecaloma and underwent urgent rectosigmoid resection and colostomy. 5 months later, Swensons coloanal anastomosis with diverting ileostomy was performed. Postoperative course was uneventful. He has two bowel movements a day. 7 years after the Swensons procedure, he also underwent adhesiolysis for acute bowel obstruction. His daughter was operated on due to HD at 16 days of age. The second case is a 57-year-old male patient. He suffered from chronic constipation and megacolon since 2 years of age and was diagnosed with congenital megacolon at the age of 19. However, no detailed diagnostics followed. He had a long interval between stools of up to 14 days. He underwent colonoscopy and, with a diagnosis of resistant Crohns disease, was referred to a surgical department where he was diagnosed with HD. Left hemicolectomy was first performed, followed by Swensons procedure with diverting ileostomy. All postoperative courses were uneventful. Currently he passes one or two soft stools a day. Adult HD is extremely rare. However, adult surgeons should consider it in case of refractory constipation since childhood associated with megacolon. Diagnosis is based on contrast radiography and rectal biopsy. Both Swensons and Duhamels procedures are suitable for surgical management. Left hemicolectomy with colonic rotation and coloanal anastomosis and/or proctocolectomy with J-pouch anastomosis are indicated in advanced forms of non-functional megacolon.Key words: adult Hirschsprungs disease - megacolon surgical therapy.

[Pilonidal sinus - diagnosis at the intersection of general and plastic surgery]. / Pilonidální sinus - diagnóza na pomezí vseobecné a plastické chirurgie.

INTRODUCTION: Pilonidal sinus predominantly affects young patients. Improper treatment results in long-term restrictions in everyday life and incapacity for work. The aim of the study was to find out what the results and current treatment options of pilonidal sinus are. MATERIAL AND METHODS: This is a retrospective analysis of 67 patients treated at the Department of Surgery of the Second Medical Faculty of Charles University and Motol Hospital in the period 20102013. We evaluated the type of surgery and infectious complications in the wound, as well as age, sex, BMI, smoking, employment of the patients, duration of wound drainage, length of hospital stay, time required to complete healing of the surgical wound, the surgeons erudition and disease recurrence. RESULTS: 50 (75%) patients underwent primary closure in the midline, Limberg flap was used in 15 (22%) patients. In 2 (3%) patients, the wound was left without suture. In the group of patients who had not undergone flap reconstruction, secondary wound healing occurred in 20 (40%) patients. In the group of patients where flap reconstruction was used, secondary healing occurred in 3 patients (20%). Relapse of the disease within one year occurred in the group of patients with primary suture in the midline in 4 (8%) patients; other patients had no recurrence. CONCLUSION: According to our experience as well as literary data, the treatment of choice is the extirpation of the sinus with primary suture beyond the midline using a flap reconstruction technique.

[Invasive zygomycosis of the large intestine in a diabetes patient]. / Invazivní zygomykóza tlustého streva u pacienta s diabetem.

Invasive mucormycosis is a rare, serious or even fatal condition. The authors diagnosed and successfully treated the disorder in a 62-year-old diabetes patient. The course of the disease, including justification of the surgical procedure are described in the case review. All treatment options were implemented and, after 121 days of hospitalization, the patient was released for homecare.

[Artificial sphincter in patients with congenital anorectal malformations]. / Umelý sverac u nemocných po kongenitálních malformacích anorekta.

Fecal incontinence represents one of consequences of congenital anorectal malformations (CAM) which continues in some patients even after surgeries performed due to malformation and reconstructions. Implantation of artificial bowel sphincter (ABS) is a new solution not proved in daily practice. The aim of the study is to prove the ABS implantation as a feasible solution even in young adults after CAM, which have never been continent, and to verify ABS implantation as a suitable solution. GROUP OF PATIENTS: 11 patients in the age between 18-25 y. were enrolled. 6 patients refused, 5 patients were operated on. 2 ABS implantations were performed. Due to perforation of rectal wall in 1 patient the implantation was postponed. In 2 patients preparative surgeries were performed. RESULTS: 2 patients with ABS implantation and 2 ones after prep surgeries healed primarily. Both ABS are fully functional. Special care is needed to adopt a new defecation habits. Patients with ABS registered increase of QOL score; all pts operated on are both of high motivation and satisfaction.

[Perioperative hypothermia and its sequelae]. / Perioperacní hypotermie a její dusledky.

UNLABELLED: Perioperative hypothermia is associated with the development of haemocoagulation, cardiovascular and metabolic disorders leading to an increased morbidity and mortality. The objective of the investigation was to assess the extent of hypothermia and its clinical and laboratory consequences. A group of 30 patients subjected to elective radical laparotomy on account of colorectal carcinoma was divided into to equivalent groups. To the first group heated infusions were administered, to the second group not heated ones. In all patients the central and peripheral temperature, rate of postoperative normalization of the temperature, postoperative thermal comfort, consumption of analgesics and biochemical and haematological parameters were monitored. RESULTS: In patients with non-heated infusions more marked and longer perioperative hypothermia was recorded with a significant alteration of the number of leucocytes and thrombocytes. In the other investigated indicators there was no significant difference between the two groups. Hypothermia did not cause serious complications in any of the patients. CONCLUSION: Although no serious clinical complications induced by hypothermia were recorded, the authors recommend an active approach and provisions for the perioperative maintenance of body temperature as a standard of contemporary perioperative care.

[Diagnosis and treatment of pelvic and perineal defects and fistulae and reconstructive surgery using a gluteus maximus flap]. / Nekolik poznámek k diagnostice a lécbe pánevních a perineálních defektu a pístelí a k plastice lalokem z velkého sedacího svalu.

In the form of a comment some aspects of diagnosis and treatment of unhealed pelvic and perineal defects and fistulas were analysed. Based on author's own experience with the treatment of 2 females with postradiation rectovaginal fistulas and 2 males with perineal sinus after proctectomy the authors discuss some advantages and technical aspects of pedunculated myoplasty by the gluteus maximus muscle.

[Tissue amino acids in patients with colorectal carcinoma]. / Tkánový aminoacidogram u nemocných s kolorektálním karcinomem.

Different catabolic conditions have their special characteristics of intracellular biochemical changes. The objective of the presented work is to assess the concentration of free amino acids in muscles of patients with colorectal carcinoma. In a group of 17 patients the free amino acid level was assessed in tissues and plasma. Material was collected on operation by biopsy of the rectus abdominis muscle, the concentration of different amino acids was assessed by the HPLCV method with fluorescent detection. For statistical evaluation the T-test was used. From the results ensues that in patients with colorectal cancer in plasma statistically significantly lower taurine, glutamine, valine, tyrosine levels were found, intracellularly significantly reduced levels of taurine, glutamic acid, methionine and ornithine were recorded. Significantly elevated intracellular levels of valine, isoleucine, leucine, tyrosine and phenylalanine were found. Assessment of the tissue aminoacidogram is the first step when attempting to influence the intracellular amino acid concentration by defined dietetic preparations.

[Malnutrition in a patient with short-bowel syndrome]. / Malnutrice nemocného se syndromem krátkého streva.

The short bowel syndrome is a relatively frequent complication of extensive resection and by reducing the absorption capacity the function of the gut is markedly impaired. An important part of postoperative care is therefore to ensure nutrition of these patients. The authors demonstrate on the case-history of a 40-year-old patient after repeated revision of the abdominal cavity on account of adhesions the development of severe malnutrition after jejunotransversoanastomosis. As the small intestine was not resected (concurrent blind loop syndrome), the patient was indicated for surgery. After surgery all complaints disappeared and the nutritional status improved.

[Augmentin and Tiberal in elective colorectal surgery (comparison of serum and tissue levels and clinical results]. / Augmentin a Tiberal v elektivní kolorektální chirurgii (Srovnání sérových a tkánových hladin a klinických výsledku).

In a group of 340 patients subjected to colorectal surgery for antimicrobial prophylaxis amoxicillin clavulanate (Augmentin) or ornidazole (Tiberal) was used, in both instances as short-term monoprophylaxis. To test the effectiveness of prophylaxis, the clinical results were evaluated, expressed by the number of infectious complications, as well as serum and tissue levels of the two preparations used for prophylaxis. In serum and tissue they reached the MIC level of the tested microbial spectrum; an inadequate level was found in all probands in subcutaneous adipose tissue. The clinical result of 4.8% infectious complications when using ornidazole and 3.2% when using amoxicillin clavulante resp. is considered as evidence of the effectiveness and correct selection of preparations and also of sufficient short-term prophylaxis.

[Primary resection of the large intestine]. / Primární resekce tlustého streva.

The authors evaluate their own group of 49 patients subjected in 1982-1990 to primary resection of the large intestine with an immediately established anastomosis. 32 patients (65.31) recovered per primam and were discharged on average after 14.9 days. A disorder of the anastomosis was recorded in 5 patients, i.e. on 10.2%. In the conclusion the authors express conditions essential for the safety of these operations.

[Our attitude to the so-called extended surgical procedures for colorectal carcinoma]. / Nase stanovisko k tzv. rozsíreným operacním výkonum pro kolorektální karcinom.

The authors present their experience with 29 extended operations performed on account of tumours of the sigmoid, rectosigmoid and rectum. These operations accounted for 13.4% of all operations on account of operable tumours of the colon and rectum in 1984-1988. In addition to the basic operation one organ was removed 11 times, two organs twice, three organs four times and four organs were removed en bloc twice. Complications occurred in 61% of the patients, the mortality rate was 6.9%. The authors submit an account of recent views published in the literature on the given subject with emphasis on en bloc resection, and conclude that when certain principles are respected, these extended operations are justified.