The experience with Mini- or Less-open Sublay operation.

INTRODUCTION: The MILOS concept binds the benefit of the sublay mesh augmentation in the way of functional and morphological reconstruction of the abdominal wall without the need to use penetrating fixation elements and with the benefits of minimal surgical access. The transhernial approach is carried out at low cost with standard laparoscopic instruments. MATERIAL AND METHOD: The authors carried out retrospective analysis of the years 2018-2022. Included are all patients operated by the MILOS concept. The patients have suffered of the midline hernias type M according to European Hernia society, eventually combined with rectus diastasis. Authors present their own experience of this new treatment method. The evaluation of complications was performed. RESULT: In the observed time we have operated 61 patients. In the years 2018 and 2019 together 35 patients were treated, none in the year of 2020. Because of the COVID plaque was the 2020 "Year of restrictions". In the year 2021 and first quarter of 2022 we have already cured 26 patients. In this time 2 major complications and 3 minor complications were observed. Since the 2nd quarter of 2022 we have already upgraded to eMILOS. CONCLUSION: Our experience with this new hernia repair shows that this treatment possibility is feasible for general use also in small district departments without the need to use of robotic technology. This skill will be necessary for future F.E.B.S AWS (Tab. 2, Fig. 3, Ref. 15). Text in PDF www.elis.sk Keywords: incisional hernia, epigastric hernia, MILOS, Mini- or Less-open sublay operation, rectus diastasis, sublay mesh, uniport, abdominal wall surgery.

A 16-Year-Old Ukrainian Boy Shot at Close-Range to the Back of the Neck with a Handgun Who Required Surgical Removal of a 9×18-mm Bullet Shell from the Left Posterior Maxilla and Recovered Following Physical Therapy.

BACKGROUND The conflict in Ukraine during the past year has resulted in increased deaths and injuries to soldiers and civilians from military weapons and large and small caliber firearms. Unlike clinicians in some Western countries, until recently, clinicians working in Ukraine hospitals had little experience managing patients with gunshot wounds. CASE REPORT A 16-year-old boy was admitted as an emergency following a gunshot wound to the back of the neck from a Makarov pistol. The gun was reported to have been fired at a distance of more than 15 cm. Imaging showed the 9-mm bullet hit the cervical spine, causing nerve root involvement at C4 to C7, traveled upwards, and lodged in the left posterior maxilla. On examination, the patient had facial asymmetry and paralysis of the left shoulder, arm, hand, and wrist and was in pain and shock. Intubation and emergency surgery were performed, with the removal of a 9×18-mm bullet shell from the pterygopalatine fossa, deep to the infratemporal fossa, and posterior to the maxilla. The patient underwent postoperative physical therapy and continues to improve his physical function. CONCLUSIONS This report has shown the importance of immediate evaluation of gunshot wounds so that surgery can be planned and performed rapidly, with a view to postoperative recovery and active physical therapy.

Chronic pain in post-COVID syndrome.

Our body senses two types of pain, acute and chronic. Acute pain lasts for a short time. It occurs when our body wants to protect us from a dangerous situation. This way, our nerves are telling us that something is wrong. But if some time passes since our injury, treatment or surgery and the pain or discomfort persists, we are speaking of chronic pain. It is often difficult to determine its intensity or even prove its existence. The discomfort and pain are not relieved and physical pain may be accompanied by mental issues. At present, during the COVID-19 pandemic, chronic pain is becoming more prominent, and it is also associated with the post-COVID syndrome. In their efforts to help patients suffering from COVID-19, many new treatment protocols have been prepared and various antiviral drugs and other potentially useful drugs have been used (often without prior approval or testing). Basically, it was a kind of 'experimental' treatment. At present, thanks to quick therapy decisions and as part of COVID-19 prevention, we have succeeded in stabilising the situation all over the world. A relatively fast development of vaccines against SARS-CoV-2 with a view to achieve collective immunity has greatly contributed to this. On the other hand, 'quick decisions' have contributed to other significant issues which we are beginning to deal with now, i.e, in the effort to defeat the virus, many experts regarded the adverse effects of the medications used to be of secondary importance. In the article we would like to point out the other side of the 'successful' treatment of COVID-19, namely the possible iatrogenic conditions which significantly contribute to the post-COVID­19 syndrome and chronic pain. The importance of preventive measures over uncertain result of COVID-19 treatment is emphasised (Tab. 4, Fig. 1, Ref. 50). Text in PDF www.elis.sk Keywords: iatrogenic conditions; chronic pain; co-morbidity; pain syndrome; pandemic; post-COVID­19 syndrome.

Perioperative hemodynamic protective assessment of adaptive support ventilation usage in pediatric surgical patients.

BACKGROUND: The aim of this study was to evaluate the hemodynamic protective effects of perioperative ventilation in pressure-controlled ventilation (PCV) and adaptive support ventilation (ASV) modes based on non-invasive hemodynamic monitoring indicators. METHODS: The study included 32 patients who were scheduled for planned open abdominal surgery. Depending on the chosen ventilation strategy, patients were included in two groups of PCV mode ventilation (n=14) and ASV mode ventilation (n=18). The hemodynamic effects of the ventilation strategies were assessed by estimated continuous cardiac output (esCCO) and cardiac index (esCCI). RESULTS: Preoperative cardiac output (CO) was 6.1±1.3 L/min in group 1 patients and 6.3±0.8 L/min in group 2 patients, and preoperative cardiac index (CI) was 3.9±0.4 L/min/m2 in group 1 patients and 3.8±0.8 L/min/m2 in group 2 patients. The ejection fraction (EF) in group 1 subjects was 55.4%±0.3%; this rate was 56.5%±0.5% in group 2 subjects. Group 1 patients experienced a 14.7% CO decrease to 5.2±0.7 L/min, a 17.9% CI decrease to 3.2±0.6 L/min/m2 , and a 12.8% mean arterial pressure decrease to 82.3±9.4 mm Hg 30 minutes after the start of surgery. One hour after the start of surgery, the CO mean values of group 2 patients were lower than baseline by 7.9% and differed from the dynamics of patients in group 1, in whom CO was lower than baseline by 13.1%. At the end of the operation, the CO values were lower than baseline by 11.5% and 6.3% in patients of groups 1 and 2, respectively. Our data showed that the changes in EF during and after surgery correlated with CO indicators determined by the esCCO. CONCLUSIONS: In our study, perioperative ventilation in ASV mode was more protective than PCV mode and was characterized by lower tidal volume (16.2%) and driving pressure (12.1%). Hemodynamically-controlled mechanical ventilation reduces the negative impact of cardiopulmonary interactions.

Coincidence of splenic vein aneurysm and haemorrhagic cyst of the pancreas.

Pseudoaneurysm of the splenic vein is a rare entity which is associated with pancreatitis in 52 % cases. Pseudocysts of the pancreas create approximately 70 % of all cystic lesions of the pancreas. One of the most dangerous complications of pancreatic pseudocysts is bleeding into the cystic lumen. This is caused by perforation of the pseudoaneurysm of the splenic vein. Enzymatic damage of the splenic vein´s wall is the cause of pseudoaneurysm. The clinical condition varies. It can be asymptomatic or bring about haemodynamic instability. The diagnostic process of pseudoaneurysm of the splenic vein is difficult. This case study introduces a case of a 50­year­old man with the anamnesis of recurrent pancreatitis caused by alcoholism. He had abdominal pain and was diagnosed with a pseudocyst of the pancreas. Abdominal CT showed an extensive capsulated collection in the left subphrenic space, 23cm in diameter, with serosanguineous content and coagulations. The CT visualised the mass effect on the surrounding tissues and a complete deformation of the spleen. Between the collection and partially oppressed tail of the pancreas there was a venous pseudoaneurysm, 3.5cm in diameter. Considering its localization, it most probably originated from the splenic vein. Surgery was done. We did distal resection of the pancreas with a complete removal of the pseudocyst and spleen (Fig. 7, Ref. 11). Keywords: splenic vein, pseudoaneurysm, pancreatitis, pancreatic pseudocysts.

Primary hyperparathyroidism in pregnancy: a case of successful parathyroidectomy in the third trimester.

Primary hyperparathyroidism (PHPT) in pregnancy is rare and may be associated with increased maternal and fetal morbidity and mortality. The ideal timing for parathyroidectomy is during the second trimester, and parathyroidectomy in the third trimester is extremely rare. We present a case of a 32-year-old woman who was admitted to our hospital with severe hypercalcemia in the 36th week of her first pregnancy. Conventional bilateral neck exploration was performed and parathyroid adenoma was removed. The surgical procedure was tolerated well by the mother, and she delivered a healthy girl 10 days after surgery. The newborn had mild hypocalcemia that required minimal substitution postnatally; however, no tetany occurred. This case demonstrates that parathyroidectomy in the third trimester followed by spontaneous delivery may be performed safely.