Management of anastomotic leaks after oesophagectomy and gastric pull-up.

OBJECTIVE: To evaluate the effectiveness of endoscopic and surgical intervention in treating anastomotic leaks after oesophagectomy. BACKGROUND: Anastomotic leak after oesophagectomy is a severe complication associated with significant morbidity and mortality. This study aimed to analyse our experience with the management of anastomotic leak after oesophagectomy. METHODS: A retrospective study evaluated the treatment outcome and duration of treatment in patients with anastomotic dehiscence or conduit necrosis after oesophagectomy from November 2008 to November 2021. RESULTS: The group consists of forty-seven patients. Twenty-one (44.7 %) patients had dehiscence of the neck anastomosis, twenty patients (42.6 %) had dehiscence of the chest anastomosis, and six (12.8 %) patients had conduit necrosis. Nineteen patients with dehiscence were primarily treated by endoscopic insertion of a self-expanding metal stent with perianastomotic drainage; the other patients were primarily treated surgically. Mortality associated with anastomosis dehiscence was 27.7 % (thirteen patients). Stent use in treatment was a statistically significant parameter regarding the length of hospital stay and mortality. CONCLUSION: Self-expanding metal stents can reduce leak-related morbidity and mortality after oesophagectomy and may be considered a cost-effective treatment alternative (Tab. 2, Fig. 2, Ref. 21).

Uniportal thoracoscopic sublobar anatomical resections for small pulmonary nodules.

OBJECTIVES: The study aims to compare the thoracoscopic lobectomy and segmentectomy outcomes. BACKGROUND: Lobectomy is considered the standard treatment method for operable non-small cell lung cancer. Recent studies have suggested that segmentectomy seems to be an acceptable alternative to lobectomy for surgical management of early-stage non-small cell lung cancer. MATERIAL AND METHODS: This retrospective study included 475 patients who underwent thoracoscopic anatomical resection at the Thoracic Surgery Department at University Hospital Bratislava for malignant or benign pathology from October 2012 to December 2021. Thoracoscopic lobectomy was offered to 438 patients, and 37 were treated by thoracoscopic segmentectomy. RESULTS: We recorded no difference between groups considering age and gender. The most common findings in the thoracoscopic lobectomy and segmentectomy groups were primary lung cancer (73.44 %) and pulmonary metastases (59.5 %). Thoracoscopic lobectomy was associated with longer operative time (80.00 vs 110.00 min; p<0.001) and postoperative hospital stay (3.00 vs 4.00 days; p<0.001). Both procedures were associated with a similar incidence of both intraoperative (0 % vs 4.8 %; p=0.394) and postoperative complications (16 % vs 23 %; p=0.353). CONCLUSION:  Thoracoscopic segmentectomy is a safe and effective procedure. This technique is a viable alternative to thoracoscopic lobectomy in indicated cases. It is still not accepted as a standard procedure for lung cancer, and we would like to start a discussion on this topic (Tab. 5, Fig. 2, Ref. 20).

Tracheal resection and modified T-tube in the treatment of benign tracheal stenosis. A retrospective study of 48 patients.

OBJECTIVE: The objective was to prove efficiency of tracheal resection in the cohort of patients of our clinic and to introduce our own modification of T-cannula as a surgical alternative if tracheal resection is contraindicated. BACKGROUND: Benign tracheal stenosis, the most often represented by post tracheostomy (PTTS) and post intubation (PITS) stenosis, is a rare, but serious and potentially life-threatening medical condition. We present our experience with the management of the patients, who were referred with a benign tracheal stenosis. METHODS: In the retrospective study, patient's outcome was evaluated after tracheal resection or treatment with T-cannula from all the patients presented with a benign tracheal stenosis from January 2015 to January 2021. RESULTS: The cohort consists of forty-eight patients. Thirty-one (64,6 %) patients underwent a tracheal resection and seventeen (35,4 %) were treated with tracheostomy and T-tube insertion. In the series of patients after tracheal resection, we observed no mortality, complications occurred in ten (32,2 %) patients. They were spread proportionally; anastomotic complications were noticed in 5 (16,1 %) patients, as well as non-anastomotic complications. CONCLUSION: Tracheal resection is a safe and effective procedure with good results. T- tube insertion presents a surgical alternative if bronchoscopy is unavailable or failed (Tab. 4, Fig. 2, Ref. 20).

Surgical treatment of descending necrotising mediastinitis caused by odontogenic infection: a retrospective analysis of 20 patients.

OBJECTIVES: Analysing the results of patients with odontogenic descending necrotising mediastinitis (DNM) treated predominantly by transcervical approach. BACKGROUND: Odontogenic DNM is a rare but serious complication of dental disease and dental procedures. METHODS: Retrospective evaluation of 20 patients who underwent surgery for odontogenic DNM. RESULTS: The mean age was 33.95±12.24 years, and 18 patients (90 %) were men. Type I and diffuse form of DNM were identified in 8 (40 %) and 12 (60 %) patients, respectively. The mean time between the onset of symptoms and surgery was 7.16±4.23 days. The transcervical approach was used in 16 patients, combined cervicotomy and subxiphoid incision in three patients, and cervicotomy and posterolateral thoracotomy was used in one patient. Four patients were reoperated. The mean mediastinal drainage duration and postoperative length of stay (LOS) were 17.05±10.27 days and 20.70±10.87 days, respectively. Fourteen (70 %) patients received mechanical ventilation with a mean duration of 8.86±9.55 days. Comorbidities were present in five (26 %) patients; there were complications in 17 (85 %) patients. In-hospital mortality reached 5 % (1 patient). Thirty-five teeth were extracted. Lower mandibular molars represented 21 (62 %) of extracted teeth. Submandibular and submental spaces were the most affected by the presence of deep neck infection (five and four cases, respectively). CONCLUSION: This study supports the role of transcervical mediastinal drainage as an alternative approach in the surgical treatment of odontogenic DNM (Tab. 4, Fig. 2, Ref. 30).