[Cholecystoduodenal fistule as a consequence of calculouse cholecystitis in a female elderly patient]. / Cholecystoduodenálna fistula ako dôsledok kalkulóznej cholecystitídy pacientky vysokého veku (Kazuistika).

Bilioenteric fistules are fairly rare, cholecystoduodenal fistules are the commonest type, accounting for 70-80% of cases. Cholecystoduodenal fistules usually occur as a consequence of cholecystolithiasis and cholecystitis. Their symptomatology is atypical and fistules are frequently detected during surgery. Preoperative diagnostic procedures include visualization methods, such as US, CT, MRI, resp.ERCP. Both conventional laparotomy, as well as laparoscopy may be used in the treatment of the disease. Each of the methods has its pros and cons. The authors present a case review of a 85-year old female patient with a cholecystoduodenal fistule, diagnosed prior to the surgical procedure. Conventional laparotomy was elected as a method of treatment and the outcome was successful.

[How long to wait with operations for necrotizing pancreatitis?]. / Ako dlho cakat' s operáciou pre nekrotizujúcu pankreatitídu?

INTRODUCTION: Severe acute pancreatitis (pancreatitis with local and systemic complications) remains a therapeutical problem. Even more complicated is ESAP (Early Severe Acute Pancreatitis), which presents itself as a fulminant form (FAP--fulminant acute pancreatitis) and subfulminant form (SFAP--subfulminant acute pancreatitis). Severity of acute pancreatitis can be assessed with help of prognostic markers. Intensive conservative treatment as a part of "pancreatic unit" dominates the therapy. Couple things remain frequently discussed. First, indications for operative treatment, of which infectious complications of the necrosis and local intraabdominal complications are generally accepted. Second, optimal time of surgical intervention remains an issue discussed. Based on recommendations, patients should not be operated on in first two weeks of disease. AIM: Aim of the authors was to evaluate their own group of patients in terms of indication and timing of the surgical intervention. MATERIAL AND METHODS: Authors analyse group of patients with acute pancreatitis, hospitalised on IVth surgical clinic of Comenius University, Bratislava in years 2006-2007. There were 125 patients in this group, 47 of these were classified as SAP (severe acute pancreatitis). RESULTS: 13 patients were operated on, 12 for retroperitoneal abscessus, ACS (abdominal compartment syndrome) and septic state, one patient for FAP. Patients were operated on between 17th and 80th day with average 28.8 days after onset. Overall mortality was 9.6%, mortality for SAP 21.2% and 15.4% in operated patients. CONCLUSION: Authors conclude, that correctly timed surgical intervention does not aggravate mortality of patients with SAP, and ambition is to shift operation to time of necrosis and infection demarcation. Early indication in setting of failure of conservative treatment of ESAP remains discussed.

[The role of Hartmann's procedure and options for its reconstruction at the present time]. / Uloha Hartmannovej operácie a moznosti jej rekonstrukcie v súcasnosti.

INTRODUCTION: Hartmann operation (rectosigmal resection, blind closure of rectum and terminal sigmostomy) is one of the options of treatment of pathology of left colon. Despite great effort to treat such surgical conditions with primary anastomosis, Hartmann's operation is in selected cases preferred. It requires, though, secondary reconstruction, which might be associated with complications. AIM OF THE STUDY: Analyzing patients after Hartmann's operations with evaluation of risk, complications, morbidity and mortality. MATERIAL AND METHODS: Authors analyzed group of 61 patients, which were operated on in years 2004-2008, with Hartmann's operation performed. They state surgical conditions, Hinchey classification, risk rate according to ASA and MPI, and concommitant diseases. RESULTS: Of complications, most frequent were wound infections and pneumonia, nine patients (14.7%) died. In presented time period, nineteen reconstructions after Hartmann's procedure were performed. Morbidity in this category was high, no death was noted. Authors analyze factors, that influence decision of operation for pathology of left colon and possibilities of reconstruction after Hartmann's procedure. CONCLUSION: Authors state, that Hartmann's procedure has still its place in urgent operations. Reconstruction in feasible in high percentage of patients with minimal mortality, difficulty lies with high morbidity.

[The role of classical surgery in treatment of acute abdomen in oncological patients]. / Uloha klasickej chirurgie pri liecbe náhlych príhod brusných u onkologických pacientov.

Acute abdomen in patients with malignity may present itself as a first sign, or might manifest itself during therapy of diagnosed disease. Clinical picture might be modified by age of patients, comorbidity, and side effects of multimodal therapy. Authors analyze their group of patients, admitted to their department with malignant disease. They found out, that almost half of the patients was admitted urgently and had serious comorbidities. In operative therapy classical surgery dominated. Authors present in discussion causes of this unsatisfactory status, as well as literature references concerning urgent cases in different types of malignant diseases.

[The role of surgery in Crohn's disease treatment]. / Uloha chirurgického výkonu v liecbe Crohnovej choroby.

UNLABELLED: Crohn's disease is a chronic, transmural inflammatory disease of the gastrointestinal tract of unknown origin. Even though surgical therapy may relieve symptoms in patients with complications, it still remains, together with medicamentous therapy, palliative. According to literature, cummulative probability of operation is 78% during 20 years. AIM OF STUDY: Analysis of experiences with surgical therapy of complications of Crohn's disease and search for optimal method of surgical therapy. MATERIAL AND METHODS: Authors present group of patients, that were treated on their clinic for complications of Crohn's disease. In years 2006-2007 group consisted of 21 patients. Most common indications for hospitalisation were signs of perforative peritonitis and ileus, bleeding, fistulas and signs of acute appendicitis. RESULTS: Following recommendations, resections of sick bowel dominated, we performed appendectomy once, bleeding was treated conservatively. Diagnosis was confirmed histologically from resected material or from biopsy. No patient died in the group, all of them were sent for next treatment to gastroenterology. CONCLUSION: Preferred therapy are classical surgical approaches to the acute abdomen, the spectrum of laparoscopical operations is widening, but their advantages may disappear in operations of large inflammatory tumours. It is necessary to consider alternative ways of treatment.

[Experience with ventral hernioplasties according to Chevrel with "on-lay" prolene mesh]. / Skúsenosti s plastikou ventrálnych hernií podl'a Chevrela s "on lay" prolénovou siet'kou.

The authors present a retrospective study including 85 patients with ventral hernias Chevrel technique repairs. The study group included 33 males and 52 females, the mean age was 56.09 years. The procedure was indicated for incisional hernias in 58.8 % and for supraumbilical (epigastric) hernias in 25.9%. The aim of the retrospective study was to assess the Chevrel methodology in our patients. The following parametres were assessed: postoperative quality of life, patient satisfaction rates, complication rates and relaps rates. Furthermore, the authors intended to compare the outcomes of the Chevrel repair method with other, commonly used repair methods. The analysis had a form of questionnaires, with 39 (45.8%) patient respondents. The questionnaires were evaluated using a modified table and contingent tables in MS Excel. The authors focused, primarily, on the preoperative period and the postoperative quality of life. On average, the patients noticed the developed hernias 23.48 months prior to their surgery. In 72% of the patients, the hernia developed after surgeries, the mean time was 21.51 months after the preceding procedure. Over a half of the cases of incisional hernias included incisional hernias after appendectomies and cholecystectomies. The majority of postoperative complications included inflammation and incisional pain. 61.5% of the patients used abdominal belts after the procedure, 5% of the patients had to change their jobs and retired due to their invalidity. The patients assessed their quality of life on the following scale: 1 (the worst) to 10 (the best). 71.8 % of the patients reported postoperative improvement in their quality of life. 59 % of the patients reported complete satisfaction with the procedure, 79.5% of the patients reported overall satisfaction (7 - 10/10). The results clearly showed that the patient satisfaction rate depended on a surgeon, which makes the choice of a surgeon the risk factor of the procedure. In the study group, the relaps rate of 10.2% and the complication rate of 25% were recorded. The Chevrel method of relaxing incision and on-lay application of the prosthesis appears as a simple, safe, cheap and effective method of surgical management of ventral hernias with good outomes and susequent patient satisfation.

[The "pancreatic unit" in the treatment of severe necrotizing pancreatitis]. / "Pankreatická jednotka" v liecbe t'azkej nekrotizujúcej pankreatitídy.

The course of acute pancreatitis varies from mild, fortuitous forms to grave, life threatening disease. Approximately 80-90% of all forms are mild with low morbidity and mortality. The rest consist of severe, sometimes even fatal forms with present necrosis. It is active, conservative therapy which dominates, arising from new knowledge in interdisciplinary intensive care, together with enhanced possibilities of disease control. Capabilities of intensive care, elimination methods, endoscopy, interventional radiology, and other fields exceed abilities of surgical wards and thus require interdisciplinary approach. In accordance with international recommendations, the only way to meet these requirements is creation of specialized units dedicated to treatment of severe acute pancreatitis e.g. pancreatic units. Authors present their ideas of such pancreatic unit estabilished at their clinic. Professional experiences of authors come from 1350 patients being hospitalized with diagnosed acute pancreatitis throughout years 1990 to 2006.

[Giant retroperitoneal liposarcomas]. / Obrovské liposarkómy retroperitonea.

According to literature liposarcomas account to less than 0.1% of all human tumors, 13% of which are localiced retroperitoneally. Authors describe two cases of giant retroperitoneal liposarcoms treated in their department. CT findings and the course of the disease discussed. Conlusively authors remark of high probability of microscopical residual disease with need of patients' follow up with eventual reoperation and adjuvant radiotherapy.

[Prevention of the anastomosis dehiscence following low anterior rectal resections]. / Prevencia dehiscencie anastomózy po nízkych predných resekciách rekta.

Authors analyse 106 patients that were operated in their department by Dixon's method, in retrospective study. They analyse indications for operations, lesions distance in rectum, endosonographic and CT findings. Basic principles of the operation technique are adequate blood flow, sufficient colon mobilization and tightness of the anastomosis being supplemented with transanal pertubation. Out of early complications anastomosis dehiscence appeared in 6 patients (e.g. 5.6%) out of which 4 were treated conservatively and 2 were being reoperated on (by axial ileostomia and drainage). In discussion different opinions on preoperative preparation, neoadjuvant therapy, presacral drainage, transanal pertubation and other decompressive techniques are anticipated.

[Treatment of gunshot wounds of the liver]. / Moznosti osetrenia strelného poranenia pecene.

The objective of the work was to draw attention to the rising trend of gunshot wounds of the abdomen with affection of the liver. The authors analyze their own group of five patients with gunshot wounds of the liver incl. one who died during the resuscitation operation, another one on the 15th day from complications, two recovered without sequelae, and the fate of one was unknown as he was referred to another department. In the discussion the authors deal with diagnostic methods, classification of hepatic injuries, indications for surgical revision, trends of expectation tactics, complications and in particular possible therapeutic procedures leading to arrest of haemorrhage and definite treatment.

[Rupture of the laparotomy incision and its suture using Ventrofilm]. / Ruptúra laparotomickej rany a jej sutúra Ventrofilom.

The authors analyze a group of patients operated at their department with the objective to assess factors involved in the development of ruptures of laparotomic wounds and to evaluate resuture by suspended ventrofil stitches. In the whole group of 5554 laparotomized patients the incidence was 0.4%, in 1685 urgently operated patients the incidence was 0.9%. In the discussion the authors analyze some factors of rupture and consider the personality of the surgeon an important factor. For resuture suspended sutures using Ventrofil proved useful. The problem of suspending suture in primary operations in risk patients is still doubtful similarly as the closure of the laparotomic wound in abdominal compartment syndrome.

[Modern trends in the treatment of diffuse peritonitis]. / Moderné trendy v liecbe difúznych peritonitíd.

The authors describe new approaches to the treatment of diffuse peritonitis, using the Mannheim Peritonitis Index scoring system. Depending on the score, the authors determined the types of additional surgical procedures such as "sipping drainage", laparostomy and repeated laparotomies.

[The current method of staging gastrointestinal (GIT) tumors]. / Pokrocilost' nádorov GIT v súcasnosti.

The authors analyzed in a retrospective study the stage of carcinomas of the stomach and colorectum in their material. In 1996-1998 they operated 35 patients with gastric tumours and 77 patients with colorectal cancer. In both groups they operated more than 50% of the patients in the IIIrd or more advanced stage of the disease. 22.8% gastric tumours and 19.5% colorectal tumours were operated in the acute stage. The situation in the group is alarming, it is essential to improve the early diagnosis and thus also treatment in all links of the chain: patient--attending physician--surgeon--society.

[Methods of surgical treatment of necrotizing pancreatitis]. / Metódy chirurgického osetrenia nekrotizujúcej pankreatitídy.

The authors present a group of 49 patients operated on account of acute necrotizing pancreattis in 1990-1999. They describe the indications and methods of treatment. The principle of treatment was careful necrosectomy with an additional procedure which involved rinsing and drainage of the omental bursa, laparostomy ("open packing") or a combination of both methods. They re-operated 20 patients where they performed a total of 57 re-operations. Fifteen patients died (30.6%) which according to the literature corresponds to the mortality quoted in this group of the most severely affected patients.

[Complications of colostomy--how to avoid them]. / Komplikácie kolostómií--ako sa im vyhnút'.

According to data in the literature complications develop in association with colostomy in 20-66% of patients, occlusion of the colostomy occurs in 10-17%. The authors analyze their own group of 122 patients where in 1994-1998 a colostomy was made. Sixty-two patients were operated with developed ileus, 19 colostomies were later abolished and the passage per vias naturales was reconstructed. The authors recorded 38.5% complications, they were most frequent in axial transversostomies and sigmostomies, wound infections were most frequent. For prevention of complications the authors emphasize that stricter indications for colostomy should be used. The same applies to the selection of the type and site of colostomy and exact surgical technique, ATB prophylaxis and lavage, use of modern stomic appliances, perspectives of using the laparoscopic technique.

[Bile leak after surgery of the gallbladder and bile ducts]. / Unik zlce po operáciách zlcníka a zlcových ciest.

The authors present a brief review of the most frequent complications of operations of the gallbladder and biliary pathways and demonstrate a group of patients of the Department of Surgery of the hospital and policlinic Ruzinov in Bratislava treated during the last six years. They emphasize conservative treatment of escape of bile except cases of acute biliary peritonitis or peroperatively revealed lesions of the biliary pathways. In the conclusion they submit an algorithm of treatment of escape of bile after surgery of the gallbladder and biliary pathways.

[Carcinoma of the gastric stump]. / Karcinóm kýpt'a zalúdka.

The authors present a group of seven patients operated in 1992 to 1996 on account of carcinoma of the gastric stump. All patients had a Billroth II resection at the age of 52 to 77 years. The mean period after resection was 21.3 years. In three patients total gastrectomy was made, in three patients subtotal resection and only in one patient a palliative anastomosis. The mortality within 30 days was 0%. The survival period was not evaluated as the data were incomplete. In the discussion the authors mention factors pertaining to the predisposition and pathogenetic mechanisms of development of the disease. For prevention gastroenterological dispensarization is necessary and preference of a gastroenteroanastomosis with a minimal alkaline reflux (Roux-Y, Eiselberg a anastomosis).

[Personal experience with the Lichtenstein surgical method in recurrent abdominal hernia]. / Nase skúsenosti s pouzitím Lichtensteinovej plastiky pri operáciách recidivujúcich abdominálnych hernií.

The authors present a group of 21 patients treated with the method of Lichtenstein with the use of polypropylene mesh Prolen. They used the method of an "inlay" mesh for recurrent groin and epigastric hernias, mostly by men. The men:women ratio was 19:2. They emphasise better healing, early recovery to work and almost no wound infection by use of this method.

[Injury of the femoral vein--a complication in inguinal hernia surgery]. / Poranenie femorálnej zily--komplikácia operácie inguinálnej hernie.

In a 21-year-old patient with recurrence of the right-sided inguinal hernia the right femoral vein was injured during the operative repair. The vein had to be reconstructed by the use of the right saphena vein and anticoagulative therapy was begun. Since the coagulation parameters were satisfactory the haematoma was produced in the operative wound and had to be evacuated through the second operation. The next operative course was without complications and the patient with healed operative wound was discharged from the hospital at the 13th hospitalization day.

[Obstructive ileus--a complication of laparoscopic cholecystectomy]. / Obstrukcný ileus--komplikácia laparoskopickej cholecystektomie.

A 45-year old patient admitted with confirmed calculous pancreatitis underwent the laparoscopic cholecystectomy at the 14th day of the hospitalization. 4 days after the operation he had to be reoperated due to small-bowel-obstruction caused by the herniation of the loop through the supraumbilical port. The small bowel was reduced and plasty of the operative wound was done. Postoperative course was uncomplicated and the patient was discharged from the hospital 6 days after the operation.