Vascular graft infection in the aortoiliac territory - our view in the light of European Society for Vascular Surgery Guidelines the retrospective observation study.

INTRODUCTION: Vascular graft infection in the aortoiliac territory (abdominal VGI) is undoubtedly one of the most serious complications in vascular surgery. The treatment is burdened with high mortality and morbidity rates. In 2020, the Guidelines on the Management of Vascular Graft and Endograft Infections were published by the European Society for Vascular Surgery (ESVS). In the light of these guidelines, we decided to review retrospectively all patients who presented to our institution with abdominal VGI. METHODS: Retrospective observational study of patients presented with abdominal VGI treated in our institution between 20112019 (9 years). The primary goal was to elucidate the rate of vascular graft infection in aortoiliac reconstructions performed between 20112019 and also the mortality rate in the patient cohort operated for this complication. The secondary goals were to evaluate the success rate and the complication rate in different types of reconstructions. RESULTS: In the defined period between 20112019 we performed 363 open aortoiliac reconstructions. During the same period we treated altogether 15 patients with abdominal VGI, whose primary reconstruction was mostly performed before 2011 (11 patients). In our cohort of patients who underwent reconstruction between 20112019 we observed a graft infection only in 4 cases (1.1%). In the group of 15 patients with abdominal VGI, the male gender prevailed (14 patients). The mean age at the time of primary reconstruction was 61 years. Most of our reconstructions were performed for occlusive disease (14 cases). All infected grafts were aortobifemoral (1 unilateral aortofemoral). They were all late infections with an average presentation time of 61 months since the primary reconstruction (15180 months). Early mortality rate was as high as 27% (4 patients) and overall mortality was 40%. The secondary reinfection rate after primary treatment was 33%. CONCLUSION: Treatment of abdominal VGI is still burdened with high mortality and morbidity rates. The current ESVS guidelines provide valuable guidance for the diagnosis and management of VGI. It nevertheless remains obvious that the treatment needs to be tailored individually in a multidisciplinary team environment.

[Cost-effectiveness of negative pressure wound therapy in outpatient setting]. / Farmakoekonomika ambulantní terapie ran kontrolovaným podtlakem.

INTRODUCTION: The negative pressure wound therapy (NPWT) is an effective local treatment method of many non-healing wounds. NPWT is routinely used for inpatient treatment in the Czech Republic; however, no clinical data is available for systematic outpatient treatment. METHODS: The prospective non-randomized study was used to compare the clinical impact and cost-effectiveness of diabetic leg-ulcer and foot-ulcer negative pressure treatment in outpatient and inpatient settings. The aim of the study was to assess the effectiveness of outpatient NPWT on the basis of wound bed evaluation, to detect and quantify pre-expected reductions in the total costs of the therapy, and to compare the efficacy of both treatment options. Enrolled subjects included inpatients (n=36, NPWT systems RENASYS GO or PICO) and outpatients (n=28, PICO system). NPWT was concluded when the wound bed had been totally covered by granulation tissue, or when serious health problems occurred. We monitored the ulcer area, wound bed trait, number of NPWT dressing changes, length of NPWT, intensity of pain (VAS scale), presence of complications, and treatment costs. RESULTS: We found comparable clinical efficacy of outpatient (n=28)/inpatient (n=36; statistically non-significant differences in healing of ulcers verified based on wound bed development and reduction of ulcer areas in time) NPWT, the same risk of complications associated with NPWT (statistically non-significant differences in the function of both technologies and in complications developed during follow-up) as well as similar long-term results (statistically non-significant differences in the count of amputations). The total costs for outpatient wound treatment were statistically significantly lower (EUR 600 versus EUR 1300, p=0.001), and so were the average one-day-NPWT costs (EUR 30 versus EUR 120, p=0.001). CONCLUSION: We demonstrated that outpatient diabetic-foot-ulcer NPWT provided the same clinical efficiency as inpatient NPWT, while outpatient NPWT was less expensive, less painful and better tolerated than inpatient NPWT.

[Laparoscopic cholecystectomy in outpatient surgery clinic]. / Laparoskopická cholecystektómia v ambulantnej chirurgii.

AIM: Based on literature data and their own experience, the authors present a view that, in a selected group of patients, ambulatory laparoscopic cholecystectomy may be performed with no increased risks and with good outcomes. MATERIAL AND METHODS: The retrospective study presents a group of 93 patients, 72 females and 21 males, who underwent ambulatory laparoscopic procedures for symptomatic cholecystolithiasis in the Podlesí Hospital Centre of Miniinvasive Surgery, from January 2003 to the end of June 2006. 61.3% of the patients were in their forties and fifties, 69.9% of the patients were classified as ASA II, according to the surgical risk. Half of the patients had an ideal body weight, according to their body mass index (BMI) assessment. RESULTS: No peroperative or postoperative complications were recorded in the above, closely selected group of patients. 84 patients (90.3%) were discharged to homecare on the day of the procedure. Nine patients (9.7% required hospitalization for the first postoperative night and they were discharged the following morning, i.e. within 24 hours after the procedure. None of the subjects, discharged after the ambulatory procedure, required rehospitalization. CONCLUSION: Similarly to studies presented in the literature worldwide, the authors concluded that laparoscopic cholecystcctomy performed in the outpatient regime appears an appropriate surgical method in closely selected patient groups. In our setting, out of the total of 618 operated patients, who underwent laparoscopic cholecystectomy during the studied period, 15.4% could be managed using the above method.

[Laparoscopy in the colorectal carcinoma treatment]. / Laparoskopia v liecbe kolorektálneho karcinómu.

AIM: The authors present their experience and results with laparoscopic surgery in the colorectal carcinoma treatment in the Centre of Miniinvasive Surgery of the Podlesí-Trinec hospital. METHODOLOGY: In this retrospective study, the authors present a group of 148 patients with colorectal carcinomas operated by their team from 1st January, 2002 to 30th June, 2004. RESULTS: The authors completed resection procedures in 133 patients. In 15 patients, with respect to the extent of their disorder, the authors had to apply derivation colostomies, to construct by-pass ileotranversal anastomoses or to complete the procedures with exploration laparoscopies. CONCLUSION: Thank to miniinvasive techniques, laparoscopy has found its place also among the colorectal carcinoma treatment methods. The presented results, in accordance with other studies published in literature worldwide, present this method as a suitable one for a patient and fulfilling all criteria of the onco-surgical radicality.

[Laparoscopic therapy of inguinal hernia--transabdominal onlay mesh (TOM)]. / Laparoskopická liecba inguinálnej hernie--TOM (Transabdominal Onlay Mesh).

AIM: A presentation of the authors experience and results with the TOM (Transabdominal Onlay Mesh) when using the laparoscopic method for the inguinal hernia treatment. MATERIAL AND METHOD: The laparoscopic treatment method of the inguinal hernia has been used in the Centre of the miniinvasive surgery in Podlesí since October 1992. Until September 2003, we had operated 4910 patients, who were treated for 5399 inguinal hernias. From January 1999 to October 2003 we operated 3550 inguinal hernias in 3183 patients using the TOM method (367 hernia cases were bilateral). RESULTS: The average operation time in cases of uncomplicated hernias during unilateral surgical procedures is 21.4 minutes and during bilateral procedures is 31.5 minutes. Complications totaled 1.268% (peroperative 0.282% and postoperative 0.986%) The average patients age was 51.3 years (17-91). There were 87.8% males and 12.2% females. 96 patients were assigned to the one-day surgery programme. CONCLUSION: We believe that the use of the TOM method in the laparoscopic treatment of the inguinal hernia is grounded and that, with further development of new prosthetic materials, it will obtain a broader spectrum of applications.

[Methods of intraperitoneal placement of mesh in laparoscopic surgery of inguinal hernias (IPOM--Intraperitoneal Onlay Mesh)]. / Metoda intraperitoneálne polozené sít'ky u laparoskopické plastiky tríselné kýly (IPOM--Intraperitoneal Onlay Mesh).

BACKGROUND: Intraperitoneal onlay mesh is a new method of laparoscopic inguinal hernia repair shortening an operative time and reducing its cost, which is very safe and less burdening a patient. METHODS: 325 males and 37 females at the mean age of 47.3 years were operated on electively for symptomatic inguinal hernia by IPOM method. In all cases we used a polyester mesh impregnated with silicone. RESULTS: The mean operative time was 18 minutes for unilateral procedure and 28 minutes for bilateral one. There was no serious complication during the operation even the post-operative time and no recurrency following this type of the operation. CONCLUSION: IPOM hernioplasty can be a method of choice in the inguinal hernia repair because of this procedure is very simple, cheap and safe for a patient. We have to wait for a long-term results to validate the hitherto existing ones, even if they are very optimistic.