Surgical treatment of gastroesophageal reflux disease and Barrett's esophagus / A gastro-oesophagealis refluxbetegség és a Barrett-nyelocso sebészi kezelése

For the centenary of the Department of Surgery, University of Szeged we have investigated and summarized the results and outcomes of 779 anti-reflux surgery cases between 1. January 2000 ­ 31. May 2021. The indication for surgery was made in close collaboration with the internal medicine workgroup depending on the results of endoscopy and functional tests. The primer indication for surgery was medical therapy-resistant reflux disease. Based on our clinical practice we performed laparoscopic Nissen fundoplication in 98,2% of the cases. Besides the long- and short-term postoperative complications, we investigated the long-term effect of anti-reflux surgery on acid and bile reflux, and the improvement of the patients' quality of life using the Visick score, and modified GERD-HRLQ score. Our investigations have proven the effect of acid and bile reflux in the pathogenesis of Barrett's esophagus and furthermore we have confirmed that laparoscopic anti-reflux surgery restores the function of the lower esophageal sphincter and eliminates acid and bile reflux, so in certain cases Barrett's esophagus regression can be achieved. But due to the heterogeneity of GERD and Barrett's esophagus long-term and regular endoscopic control is necessary.

Use of laparoscopic technique in the treatment of ulcerative colitis / A laparoszkópia szerepe a colitis ulcerosa kezelésében

INTRODUCTION: An estimated 20-30% of patients with ulcerative colitis need surgery. The generally accepted procedure for the surgical treatment is total proctocolectomy with ileal pouch-anal anastomosis. Nowadays laparoscopic technique is used more frequently. AIM: Our aim was to compare the last 13 years results of patients treated with conventional and laparoscopic methods. METHOD: Between 01. 01. 2005 and 31. 05. 2018, 89 patients (n = 48 female, n = 41 male) received surgery. The mean age of the patients was 45.06 ± 14.4 and 39.8 ± 13.4 years in the laparoscopy and the open surgery groups. General status of patients, early and late results of surgical treatment, mainly complications and quality of life, were analyzed. RESULTS: There was no difference between the groups in hospital stay (10.3 ± 3.3 vs. 11.2 ± 3.7 days) and need for transfusion (2.6 ± 2.2 vs. 2.8 ± 1.7 units). During the follow-up period, the time to the recovery of the bowel function (1.2 ± 0.5 vs. 1.6 ± 0.7 days), the number of days spent in the intensive care unit (2.1 ± 0.9 vs. 2.5 ± 1.6 days) and the occurrence of late complications, such as intestinal obstruction, septic condition, postoperative hernias and 'other' complications were significantly lower in the laparoscopically operated group of patients. In the case of acute operations, the laparoscopic technique provided significantly better recovery of the bowel function (1.2 ± 0.4 vs. 1.8 ± 0.7 days). CONCLUSION: During the surgical treatment of ulcerative colitis, the minimally invasive technique provided more favourable perioperative results and a better long-term quality of life due to the lower rate of late complications and the more stable psychic status. Orv Hetil. 2020; 161(33): 1363-1372.

[Surgical treatment of liver metastasis in colorectal cancer with simultaneous liver resection]. / Colorectalis rák májáttéteinek sebészi kezelése szinkron májreszekcióval.

Metastatic liver disease is a challenging and life-threatening situation often with dismal prognosis. Nearly half of the patients with colorectal cancer develop liver metastasis during the course of their diseases. Hepatic resection is the treatment of choice in patients with colorectal liver metastasis. This study was conducted to compare the results of patients undergoing simultaneous liver and colorectal resection for synchronous liver metastasis and of those for whom a colorectal and liver resection was made separately. A retrospective analysis was performed on 1597 patients who underwent surgery because of colorectal cancer between January 1999 and December 2008. The results of the treatment were separately evaluated in case of the 152 patients who had liver metastasis. The proportion of the liver metastasis was 9.52%. The metastases arose in 40.8% from the rectum and in 31.8% from the sigmoid colon. It proved to be inoperable in 109 (71.7%) of the 152 patients who had liver metastasis. Simultaneous liver resection was performed because of synchronous metastasis in 14 (32.6%) cases (Group 1) and two step resection in 29 (67.4%) cases (Group 2). In case of synchronous operations only minor liver surgery was done. The mean size of the metastasis was 2.6 cm in diameter in Group 1 and 4.6 cm in Group 2 (p<0.005). The transfused blood volume was 0.3 U/patient. Only minor complications could be observed in Group 1. The hospitalization was 13.1 days in Group 1 and 11.7 days in Group 2. The mean survival time was 37.3 and 47.9 months (p<0.005). Simultaneous liver resection seems to be a safe procedure on those patients who develop small metastases with a limited number. However, the optimal timing of the liver resection and the identification of patients who will have the greatest benefit in survival still remain obscure.