Native nephrectomy in patients with autosomal dominant polycystic kidney disease in the kidney transplant program - single-center retrospective results of 2000-2020.

INTRODUCTION: Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disease that leads to chronic renal failure in about half of patients. It is a multisystemic disease with a predominance of kidney involvement, which significantly worsens the patient's health. Controversial issues include the indication and the timing and technique of nephrectomy of native polycystic kidneys. METHODS: A retrospective observational study focused on the surgical aspects of patients with ADPKD who underwent native nephrectomy at our institution. The group included patients operated on in the period 1/1/2000-31/12/2020. A total of 115 patients with ADPKD were enrolled (14.7% of all transplant recipients). We evaluated the basic demographic data, type of surgery, indications and complications in this group. RESULTS: Native nephrectomy was performed in 68 out of a total of 115 (59%) patients. Unilateral nephrectomy was done in 22 (32%) patients and bilateral in 46 (68%). The most common indications were infections (42 patients, 36%), pain (31 patients, 27%), hematuria (14 patients, 12%), gastrointestinal reasons (1 patient, 1%), respiratory reasons (1 patient, 1%), obtaining a site for transplantation (17 patients, 15%) and suspected tumor (5 patients, 4%). CONCLUSION: Native nephrectomy is recommended in symptomatic kidneys, or in asymptomatic kidneys when it is necessary to obtain a place for kidney transplantation, and in kidneys where a tumor is suspected.

Efficacy and safety of urgent carotid endarterectomy in patients with acute ischemic stroke.

INTRODUCTION: Acute symptomatic occlusion of the internal carotid artery (ICA) is associated with unfavorable prognosis. However, no clear definition of its optimal treatment exists. The aim of this study was to evaluate the efficacy and risks of urgent carotid endarterectomy (CEA) in patients with ischemic stroke due to acute extracranial ICA occlusion. METHODS: A retrospective analysis was performed of all consecutive patients undergoing urgent CEA for acute extracranial ICA occlusion during the period from July 2014 to June 2021. The primary outcome was functional independence at three months defined as modified Rankin Scale (mRS) score 2. Secondary outcomes included the severity of the neurological deficit at the time of discharge and its comparison with the preoperative condition as assessed using the National Institutes of Health Stroke Scale (NIHSS), the incidence of symptomatic intracerebral hemorrhage (ICH), and 30-day periprocedural mortality. RESULTS: During the study period, a total of 42 urgent CEAs were performed for acute extracranial ICA occlusions. The median preoperative NIHSS score was 7 (interquartile range [IQR] 5-13). The median time interval between the onset of symptoms and surgery was 290 minutes (IQR 235-340). Technical success rate of urgent CEA was 97.6% (41 patients). The median NIHSS at the time of hospital discharge was 2 (IQR 3-7; p.

Incarcerated left paraduodenal hernia case report and literature review.

INTRODUCTION: Left paraduodenal hernia is an internal herniation that develops due to anomalous fetal development. If incarcerated, it becomes an unusual cause of acute abdomen. CASE REPORT: This case report presents an uncommon case of a 39-year-old man with acute abdominal pain with vomiting. The patients medical history included recurrent subileous events and Crohn´s disease in long-term remission. CT scan of abdominal cavity indicated a possible mechanical obstruction of small bowel loops in the upper left abdominal quadrant. Incarcerated left paraduodenal herniation was identified during surgery. Repositioned small bowel loops did not require resection and the entrance of Landzert´s fossa was sutured. CONCLUSION: Left paraduodenal hernia is the most common congenital internal herniation. Although rare, it should be considered in the differential diagnosis of acute abdomen.

Aneurysm of pancreaticoduodenal arcade caused by medial arcuate ligament syndrome - case report and review of literature.

INTRODUCTION: Visceral artery aneurysms are rare vascular pathologies. They are usually incidental findings during the examination for other reasons. The most common clinical symptoms are nonspecific abdominal pain and bleeding caused by their rupture, with a severe clinical presentation. Aneurysms of pancreaticoduodenal arcade are more common in patients with well-developed collateral circulation due to the coeliac trunk stenosis or occlusion. CASE REPORT: In this case report the authors present a rare case of a patient with incidental finding of pancreaticoduodenal arcade aneurysm in the setting of severe stenosis of coeliac trunk origin caused by medial arcuate ligament compression. The diameter of the aneurysm was 40 mm and endovascular treatment was not possible because of unfavorable anatomical setting. The patient was successfully treated with resection of the aneurysm and the division of medial arcuate ligament during one surgery. CONCLUSION: There is no correlation between the diameter and the risk of rupture of the pancreaticoduodenal arcade aneurysm. Because of high morbidity and mortality of their rupture, most authors recommend active treatment of these aneurysms. The necessity to treat truncus coeliacus stenosis or occlusion remains a controversial issue.

Long-term patient follow-up after post-kidney transplant symptomatic lymphocele therapy.

INTRODUCTION: Symptomatic lymphocele could impair the function of a graft kidney. The aim of our research was to conduct a five-year follow-up after symptomatic lymphocele therapy. METHODS: Overall 50 patients undergoing the therapy of symptomatic lymphocele were enrolled in the study cohort. Demographic data, renal failure causes, indication of therapy and lymphocele management were retrospectively evaluated. Laboratory tests were done to evaluate serum creatinine, total plasma protein and albumin levels. Survival rates of the patients and of the grafts were analysed using Kaplan-Meier curves. RESULTS: The mean age of the 50 patients (44% females, 56% males) was 51.5±11.8 years, and the time between kidney transplantation and symptomatic lymphocele diagnosis was 12.8±21.5 months. Average lymphocele diameter was 71±35 mm. Causes of the native kidney failure were: glomerulonephritis (34%), tubulointerstitial nephritis (30%), polycystosis (24%), diabetic nephropathy (10%) and nephrosclerosis (2%). The therapy indications were: serum creatinine elevation (44%), graft hydronephrosis (38%), serum creatinine elevation associated with hydronephrosis (8%), infection associated with hydronephrosis (6%) and infection (4%). The lymphocele was managed by: open surgical intraperitoneal drainage (40%), percutaneous aspiration (26%), percutaneous long-term drainage (18%) and laparoscopic intraperitoneal drainage (16%). Mean serum creatinine levels at the time of the therapy and 60 months later were 231 µmol/L and 172 µmol/L, respectively; total plasma protein levels were 59 g/L and 69 g/L, respectively; albumin plasma levels were 36 g/L and 43 g/L, respectively. The five-year patient survival rate was 86% and the graft survival rate was 66%. CONCLUSION: Adequate management of symptomatic lymphocele stabilizes the graft function. If the post-transplant lymphocele is indicated for therapy, the therapy should be applied as soon as possible to prevent fibrous changes in the surrounding tissues. No patient death or graft loss had any direct relationship with lymphocele management.

Combined endovascular and surgical treatment of symptomatic tandem occlusion of common carotid artery and middle cerebral artery - case repor.

INTRODUCTION: Cerebrovascular events are among the most common causes of invalidity or death. The aim of treatment in acute cerebral ischemia is to restore the blood flow before irreversible necrosis of brain tissue and persistent neurologic deficit occur. Pharmacological, endovascular and surgical methods are employed in the treatment of these patients. CASE REPORT: The authors present a case report of a 56-year-old woman with acute cerebral ischemia caused by tandem occlusion of the left common carotid artery and the M1 segment of middle cerebral artery. In the initial phase the patient was treated by intravenous thrombolysis with minimal success. Common carotid artery was occluded and mechanical extraction of embolus was successfully performed through direct carotid bifurcation puncture. Almost complete regression of neurologic deficit occurred after the endovascular recanalization. Occluded common carotid stump and bifurcation was considered as a source of embolization and therefore, to prevent further cerebrovascular event, a subclavian-carotid bypass was performed on the 15th day after the stroke. CONCLUSION: In the reported patient with symptomatic tandem occlusion of common carotid artery and the M1 part of middle cerebral artery, recanalization of cerebral artery was attained by the combination of pharmacological and endovascular method. Consequent subclavian-to-carotid bypass was performed in tertiary prevention of further cerebrovascular event.

[Free-floating thrombus in the internal carotid artery treated by anticoagulation and delayed carotid endarterectomy]. / Volne vlající trombus ve vnitrní karotide lécený antikoagulací a odlozenou chirurgickou endarterektomií vnitrní karotidy.

UNLABELLED: Free-floating thrombus in the internal carotid artery is a rare clinical finding. Only case reports and small cohorts of patients are described in the literature. The authors present a case report of a patient with ischemic stroke due to arterio-arterial embolisation from ulcerated internal carotid artery stenosis with a free-floating thrombus. Initially, the patient was treated with anticoagulants, resulting in total dissolution of the free-floating thrombus based on ultrasound documentation, without any further symptomatic embolisation. Endarterectomy was performed in the second step for the critical stenosis of the internal carotid artery. After this combined treatment, the patient showed no neurological deficit. Currently, the opinion on optimal therapy of the free-floating thrombus in the internal carotid artery still remains unclear. KEY WORDS: free-floating thrombus - anticoagulation internal carotid artery.

Endovascular Management of Acute Embolic Occlusion of the Superior Mesenteric Artery: A 12-Year Single-Centre Experience.

PURPOSE: Retrospective evaluation of 12-year experience with endovascular management of acute mesenteric ischemia (AMI) due to embolic occlusion of the superior mesenteric artery (SMA). MATERIALS AND METHODS: From 2003 to 2014, we analysed the in-hospital mortality of 37 patients with acute mesenteric embolism who underwent primary endovascular therapy with subsequent on-demand laparotomy. Transcatheter embolus aspiration was used in all 37 patients (19 women, 18 men, median age 76 years) with embolic occlusion of the SMA. Adjunctive local thrombolysis (n = 2) and stenting (n = 2) were also utilised. RESULTS: We achieved complete recanalization of the SMA stem in 91.9 %. One patient was successfully treated by surgical embolectomy due to a failed endovascular approach. Subsequent exploratory laparotomy was performed in 73.0 % (n = 27), and necrotic bowel resection in 40.5 %. The total in-hospital mortality was 27.0 %. CONCLUSION: Primary endovascular therapy for acute embolic SMA occlusion with on-demand laparotomy is a recommended algorithm used in our centre to treat SMA occlusion. This combined approach for the treatment of AMI is associated with in-hospital mortality rate of 27.0 %.

Laparoscopic sleeve gastrectomy for morbid obesity with natural orifice specimen extraction (NOSE).

OBJECTIVE: An experience with laparoscopic sleeve gastrectomy using the natural orifice specimen extraction (NOSE) technique. BACKGROUND: Bariatric surgery is nowadays the only long term effective obesity treatment method. METHODS: Twenty one consecutive patients underwent laparoscopic sleeve gastrectomy with the use of natural orifice specimen extraction (NOSE) in the Surgical Clinic of Faculty Hospital Ostrava between May 2012 and August 2012. Inclusion criteria were the body mass index (BMI) higher than 35 kg/m2 or higher than 32 kg/m2 accompanied with relevant comorbidities. RESULTS: Among 21 patients in this series, there were three men (14.3%) and 18 women (85.7%). Their mean age was 40.9±10.2 years. Their mean preoperative BMI was 40.4±4.6 kg/m2. No patient had previous bariatric surgery, one patient had laparoscopic fundoplication. All operations were completed laparoscopically with no conversions to an open procedure. In two cases, laparoscopic cholecystectomy was performed and the gallbladder was extracted along with the gastric specimen by transgastric approach. CONCLUSION: Laparoscopic sleeve gastrectomy is a safe and effective bariatric procedure with low morbidity and mortality. Based on our initial experiences it could be an indication for NOSE with transgastric approach. Obese patients would benefit from this approach due to the elimination of wound complications (Tab. 2, Fig. 3, Ref. 22).

[Femoropopliteal deep vein thrombosis and popliteal artery pseudoaneurysm as a complication of multiple hereditary osteochondromatosis]. / Femoropopliteální zilní trombóza a pseudoaneuryzma popliteální tepny jako komplikace mnohocetné hereditární osteochondromatózy.

Osteochondromas (exostoses) are the most common benign bone tumours. In most cases, osteochondroma occurs as a solitary lesion. Hereditary multiple osteochondromatosis is an autosomal dominant disorder manifested by multiple exostoses most commonly located at the metaphyses of long bones, the iliac crest, the ribs, the vertebral borders, and scapulas. Vascular complications of multiple osteochondromatosis are very rare, most frequently affecting the popliteal artery. The authors report the case of a 27-year-old female patient with hereditary multiple osteochondromatosis that was complicated by femoropopliteal deep vein thrombosis and giant popliteal artery pseudoaneurysm.

[Optimizing the treatment procedure in crural ulcers - a pilot study of the surgical method]. / Optimalizace lécebného postupu u kozního trofického defektu bérce pilotní studie chirurgické metody.

INTRODUCTION: Current medical knowledge has provided us with a wide range of possibilities of treating chronic wounds. Over the recent decades, in particular, significant progress has been made in this field. The authors present an overview of current knowledge of chronic wound healing, pointing out the surgeons role in the process of chronic wound management. Using surgical therapy, we are able to heal a chronic wound in a shorter period of time, particularly if the treatment is accelerated by the application of platelet-rich plasma (PRP) as a source of growth factors. METHODS: The pilot randomized prospective study included four patients with chronic wounds of the lower leg after previous failure of conservative therapy who were indicated for skin transplantation. Following previous vacuum-assisted closure therapy, the patients undergoing skin transplantation were prospectively randomized into two groups. Autologous PRP was used in one of the groups and standard skin transplantation without PRP was performed in the other one. RESULTS: In the PRP group, 99% of the wound areas were healed on the 15th day after the operation. In the other group, 90% of the areas were healed on the 15th day following the operation. In the PRP group, complete healing of the defect occurred in both patients at 15 and 20 days post-surgery. In the second group, one patient completely healed within 28 days; the other one was not fully healed even at 3 months post-surgery. CONCLUSIONS: Most patient groups at great risk may benefit from the method using PRP, as well as patients with chronic wounds who have failed conventional methods available for both general and local therapy. This fact has been confirmed by the authors initial experience presented.Key words: platelet-rich plasma (PRP) - platelets wound healing chronic wound.

[Popliteal artery entrapment syndrome]. / Entrapment syndrom podkolenní tepny.

Popliteal artery entrapment syndrome is a rare cause of lower limb ischaemia. It is caused by an abnormal relationship between popliteal artery and its surrounding musculotendineous structures (anatomic entrapment). Functional popliteal entrapment is characterized by normal anatomic relationships within popliteal fossa. The true incidence is unknown, it usually affects young patients, typically men, and is clinically presented with symptoms of calf claudication, calf cramping, coldness and paresthesia. CT angiography and MR angiography have become an imaging technique of choice. The mainstay surgical procedure is popliteal artery release. In cases of popliteal artery damage autologous saphenous vein bypass grafting offers the best long-term results. Authors on the basis of two case reports describe the clinical course, diagnosis and surgical technique used in the treatment of patients with advanced popliteal artery entrapmentsyndrome.

[Kidney transplantation from donors dying of methanol intoxication]. / Transplantace ledvin od dárcu zemrelých na intoxikaci metanolem.

INTRODUCTION: Intoxicated patients represent only a minimum of the total number of cadaveric donors; however, their significance within the transplant program in the Czech Republic has recently been emphasized in connection with the so-called methanol affair. MATERIAL AND METHODS: A retrospective analysis of methanol-poisoned patients who were declared brain-dead and subsequently underwent organ removal for transplantation purposes in the University Hospital Ostrava was performed. In cooperation with other transplant centres (Institute for Clinical and Experimental Medicine, Transplant Centre of the University Hospital Hradec Kráilové, Centre for Cardiovascular and Transplantation Surgery in Brno) the graft function, postoperative morbidity and mortality was evaluated. RESULTS: During the study period (since September 2012), organs from three brain-dead donors as a result of methanol intoxication were retrieved in the Transplant Centre of the University Hospital Ostrava. Subsequently, six kidneys were transplanted (3 males, 3 females). Postoperative complications occurred in two patients (33.3%), one patient died (16.7%). In one case (16.7%), the graft failed. None of the graft recipients developed clinical or laboratory signs of methanol poisoning. CONCLUSION: Death due to methanol intoxication is not a contraindication to organ donation, graft function and patient survival being comparable to organs from non-intoxicated donors.

[Impact of anastomotic leakage on oncological outcomes after rectal cancer resection]. / Vliv dehiscence anastomózy na onkologické výsledky u resekcních výkonu pro karcinom rekta.

INTRODUCTION: The aim of the study was to determine the impact of anastomotic leakage on long-term outcomes after curative surgery for rectal cancer. MATERIAL AND METHODS: The study included 174 patients who underwent elective, potentially curative open or laparoscopic resection with anastomoses for rectal cancer at the Department of Surgery of the University Hospital Ostrava from 1 January 2001 to 31 December 2009. Anastomotic leakage was defined as clinically or radiologically confirmed signs of local or diffuse peritonitis, gas, pus or stool from the drain, rectoscopy signs of anastomotic insufficiency, or rectovesical or rectovaginal fistula. The Cox proportional hazards model with forward selection was used to determine the influence of predefined baseline characteristics on overall, disease-free survival and recurrence. The results are presented as Hazard Ratio (HR) with 95% Confidence Interval (CI). RESULTS: Based on the Cox model, anastomotic leakage was not identified as a factor with a significant impact on overall or disease-free survival. Anastomotic leakage, however, has remained an independent risk factor for a higher local recurrence rate (Hazard Ratio: 6.621, 95% CI 1.289-34.020, p=0.024). On the contrary, anastomotic leakage was not identified as a statistically significant prognostic factor for the incidence of distant metastases. CONCLUSION: Anastomotic leakage represents an independent risk factor for a higher local recurrence rate after curative resection for rectal cancer.

[Prevention of parastomal hernia using laparoscopic introduction of a prosthetic mesh--initial experience]. / Prevence parastomální hernie primoimplantací sít'ky laparoskopicky--první zkusenosti.

INTRODUCTION: Parastomal hernia is a very common complication after stoma formation. Current surgical procedures for repairing parastomal hernia have unsatisfactory results. The aim of this study was to evaluate our initial experience with laparoscopic prophylactic mesh placement at the time of stoma formation. MATERIAL AND METHODS: Four patients underwent laparoscopic abdominoperineal rectal cancer resection with prophylactic parastomal mesh placement. A specially designed mesh made of polyvinylidene fluoride with central funnel (Dynamesh IPST) was implanted using an intraperitoneal onlay technique. The surgical data, the frequency of mesh-related complications as well as the rate of parastomal henias were evaluated. RESULTS: The mean operating time for mesh placement was 15 min (10-25 min.). No mesh- related complications or infection was observed and no parastomal hernia could be detected clinically. To this date, the mean follow up time has been six months (4-8 months). CONCLUSION: Laparoscopic prophylactic parastomal mesh placement might be a safe and effective procedure with a potential to reduce the risk of parastomal hernia, at least in the short run. However, our experience is limited due to the small number of patients included in the study. Additional large trials with long term follow up are necessary.

[NOSE (Natural Orifice Specimen Extraction) in laparoscopic colorectal surgery]. / NOSE (Natural Orifice Specimen Extraction) v kolorektální chirurgii.

INTRODUCTION: The aim of this study was to asses our initial first experience with NOSE techniques in laparoscopic colorectal surgery with both transanal and transvaginal extraction. MATERIAL AND METHODS: In this prospective study, the authors analyzed data from patients in whom NOSE laparoscopic sigmoid, rectosigmoid and rectal resections were performed in the Department of Surgery, University Hospital Ostrava, from May 2011 to October 2011. A group of 7 patients was analyzed based on demographic characteristics (sex,age and BMI). Tumor localization, type of extraction (transanal/transvaginal), the number of removed lymph nodes, tumor size, histology and length of the specimen were also assessed. Furthermore, the following intraoperative data were evaluated: duration of the procedure, frequency of intraoperative complications and conversion rate. During the postoperative period, duration of hospitalization and morbidity rates were evaluated. RESULTS: The patient group included 2 male (28.6%) and 5 female (71.4%) subjects, their median age was 70 years (61-80), BMI 26,76 (24.76-34.67). The pathology was located in the sigmoid colon in 4 cases (57.1%) and in the proximal rectum in 3 cases (42.9%). Transanal extraction was performed in 5 patients (71.4%) and transvaginal extraction in 2 patients (28.6%). The average number of harvested lymph nodes was 13 (10-15), the average lenght of specimen was 16 cm (13-20) and the average tumor size was 4 cm (2-6). Histologically, adenocarcinoma was confirmed in 6 cases (85.7%), and low grade adenoma in 1 case (14.3%). The median duration of surgery was 205 min (140-300) and no intraoperative complications were recorded. No surgical conversion was required. No postoperative complications occured and the median duration of of hospital stay was 7 days (5-11). CONCLUSION: In the selected group of patients, NOSE technique proved to be a safe technique for laparoscopic colorectal procedures, reducing the risk of incisional complications while maintaining the principles of oncological radicality. Therefore, it may be considered a bridge towards NOTES (Natural Orifice Transluminal Endoscopic Surgery), surgery without scars.

Long-term results of laparoscopic versus open surgery for nonmetastatic colorectal cancer.

PURPOSE: Laparoscopic surgery for colon cancer has been proven safe, but controversy continues over implementation of laparoscopic technique for rectal cancer. The aim of this study was to compare the long-term outcomes of laparoscopically assisted and open surgery for nonmetastatic colorectal cancer. MATERIAL AND METHODS: From January 2001 to December 2006 all patients with nonmetastatic adenocarcinoma of the colon and rectum were considered for inclusion in this prospective non-randomised trial. The primary endpoint was overall survival, disease free survival and recurrence rate. Analysis was by intention to treat. RESULTS: A total of 365 resections were performed for nonmetastatic adenocarcinoma of the colon and rectum during the study period. Of those resections, 220 were colonic and 145 were rectal. In the patients with colon cancer 119 (54.1%) were operated laparoscopically and 101 (45.9%) by open surgery, in the patients with rectal cancer 75 (51.7%) were treated by laparoscopy and 70 (48.3%) by open technique. No statistically significant difference was found between the laparoscopic and open group regarding 5-year overall survival (p = 0.17 for colon cancer, p = 0.60 for rectal cancer), 5-year disease free survival (p = 0.25 for colon cancer, p = 0.81 for rectal cancer) and overall recurrence (p = 0.78 for colon cancer, p = 0.79 for rectal cancer). With respect to the tumor stage, in rectal cancer the probability of 5-year disease free survival was significantly higher in the laparoscopic group in stage III (p = 0.03). CONCLUSION: Laparoscopic surgery for colorectal cancer is an oncologically safe procedure that is associated with a survival and recurrence rate equal to open surgery.

[Surgical management of perforations during colonoscopy]. / Chirurgické resení perforací pri kolonoskopii.

INTRODUCTION: Colonoscopy is an effective both diagnostic and therapeutic method. Despite its wide use, however, colonoscopy may be associated with complications occurrence, of which the most serious is bleeding and perforation. Iatrogenic perforation can lead to the peritonitis with high morbidity and mortality. The relative frequency of perforation in diagnostic colonoscopies is 0.03-0.8%, for therapeutic colonoscopy 0.15-3%. The most iatrogenic perforations are located on sigmoid colon. PATIENTS AND METHODS: The endoscopic unit of University Hospital Ostrava performed a total of 7800 colonoscopy in the period between 1st January 2006 to 31st December 2010. In 8 patients (0.1%) occurred perforation of the colorectum. In all patients, this complication arose during diagnostic colonoscopy and was treated by surgery. Six patients (75%) were operated on within 24 hours from the performance of colonoscopy, 2 patients (25%) were operated after more than 24 hours. In 5 patients (62.5%) the left colon including rectum was perforated, in 3 patients (37.5%) perforation occurred in right colon. RESULTS: Postoperative complications occurred in 7 patients, postoperative morbidity was 87.5%. In 1 patient (12.5%) surgical revision was necessary. 2 patients died within 30 days after surgery, mortality was 25%. CONCLUSION: Iatrogenic perforation of the colorectum is one of the most serious complications during colonoscopy. Early and optimal treatment is crucial for the subsequent reduction of serious complications and mortality.

[Laparoscopic total gastrectomy]. / Laparoskopická totálni gastrektomie.

AIM: Laparoscopic total gastrectomy for cancer have been rarely adopted in Czech Republic. The aim of this study is to assess results of these procedures analyzing our series of patients. MATERIAL AND METHODS: From May 2002 to June 2010 43 laparoscopic total gastrectomies with lymphadenectomy were performed for patients with gastric cancer. Clinical and tumor parameters, perioperative characteristics, short term and long term results were analyzed retrospectively. RESULTS: Males were 27 (63%) and females were 16 (37%). Mean age was 65 years (range 48-80), mean BMI was 25.7 (range 18.7-37.0). 27 patients (63%) had an ASA score III and 16 patients (37%) had an ASA score II. The patologic stage (UICC) was 10 stage I (23%), 10 stage II (23%), 19 stage III (44%) and 4 stage IV (9%). The mean operation time was 292 minutes (range 180-400). Conversion was necessary in four cases (9%) and hand assisted technique was used in four cases (9%). The number of retrieved lymph node were 18 (range 4-32). Five laparoscopic total gastrectomies were estimated as palliative. Median time of hospitalization was 12 days (range 7-86). Overall morbidity was 37%, 5 patients (12%) were died related with postoperative complications. The 3-years overall survival was 50% and 5-years overall survival was 45%. CONCLUSION: Laparoscopic total gastrectomy is feasible and acceptable clinically and oncologically. Surgical skill and patient's selection are necessary.

["Low volume" laparoscopic nephrectomy for relative-to-relative transplantation]. / "Low volume" laparoskopická nefrektomie pro príbuzenskou transplantaci.

AIM: Worldwide, the number of suitable cadaverous donors is limited. Therefore, as a solution for patients with chronic renal failure appears to extend the group of living donors of healthy individuals who voluntarily donate kidney to relatives or emotionally related recipients. Given the altruistic circumstances of these operations, the main monitored parameters are security for donors and excellent graft function for recipients. Currently published works show that minimally invasive technique can guarantee comparable results with open access in both monitored parameters. The aim of this study is to asses our results with laparoscopic assisted living donor nephrectomy for transplantation. PATIENTS AND METHODS: In retrospective study we analyzed data of patients in whom laparoscopic donor nephrectomy was performed on the Surgical Clinic, University Hospital Ostrava in the period from May 13, 2002 to June 30, 2010. Group of 34 donors were analyzed according to demographic characteristics (sex, age, ASA classification and BMI). From the perioperative data were monitored length of operation and warm ischemia, blood loss, frequency of intraoperative complications and conversion rate. In the postoperative period were evaluated in donors length of postoperative hospitalization, frequency of early and late reoperations, causes of morbidity and mortality, dynamics of the levels of creatinine and in the recipients was monitored 1-year survival of the graft. RESULTS: There were 14 men (41%) and 20 women (59%), median age was 48 years (25-77 years), BMI 26.9 (18.7-37.0), 53% of patients were ASA II, 44% ASA I, 1 patient (3%) ASA III. Median length of operation was 180 min (90-300 min), warm ischemia 120 s (58-240 s), blood loss 50 ml (30-1000 ml). There was no conversion. Intraoperative complications occured in 3 donors (8.8%). The length of hospital stay was 7 days (3-26 days), morbidity rate was 14.7%, without mortality. Early reoperations were in 2 patients (5.9%), late reoperations were performed in 4 patients (11.8%). In donors an average increase of creatinine value was 35.5 micromol/l the first postoperative day. One-year graft survival in our cohort was 94.1%. CONCLUSION: For patients with terminal renal insufficiency the living donor kidney transplantation offers possibility to shorten time in waiting list and to ensure a better graft function with its longer survival. Minimally invasive laparoscopic technique (we prefer transperitoneal approach), represents a safe alternative to open operation.