Long-term effectiveness, outcomes and complications of bariatric surgery.

Dietary imbalance and overeating can lead to an increasingly widespread disease - obesity. Aesthetic considerations aside, obesity is defined as an excess of adipose tissue that can lead to serious health problems and can predispose to a number of pathological changes and clinical diseases, including diabetes; hypertension; atherosclerosis; coronary artery disease and stroke; obstructive sleep apnea; depression; weight-related arthropathies and endometrial and breast cancer. A body weight 20% above ideal for age, gender and height is a severe health risk. Bariatric surgery is a set of surgical methods to treat morbid obesity when other treatments such as diet, increased physical activity, behavioral changes and drugs have failed. The two most common procedures currently used are sleeve gastrectomy and gastric bypass. This procedure has gained popularity recently and is generally considered safe and effective. Although current data show that perioperative mortality is low and better control of comorbidities and short-term complications is achieved, more randomized trials are needed to evaluate the long-term outcomes of bariatric procedures. This review aims to synthesize and summarize the growing evidence on the long-term effectiveness, outcomes and complications of bariatric surgery.

Surgical complications in COVID-19 patients in the setting of moderate to severe disease.

The coronavirus disease 2019 (COVID-19) pandemic has had a considerable impact on the work of physicians and surgeons. The connection between the patient and the surgeon cannot be replaced by telemedicine. For example, the surgical staff faces more serious difficulties compared to non-surgical specialists during the COVID-19 pandemic. The primary concerns include the safest solutions for protecting healthcare staff and patients and the ability to provide adequate surgical care. Additionally, the adverse effects of any surgery delays and the financial consequences complicate the picture. Therefore, patients' admission during the COVID-19 pandemic should be taken into consideration, as well as preoperative measures. The COVID-19 situation brings particular risk to patients during surgery, where preoperative morbidity and mortality rise in either asymptomatic or symptomatic COVID-19 patients. This review discusses the recent factors associated with surgical complications, mortality rates, outcomes, and experience in COVID-19 surgical patients.

Resolution of experimental pneumothorax by room air.

UNLABELLED: Observation alone is advised only for primary spontaneous pneumothoraces with less than 20 percent of the lungs collapsed. In such cases, it is the resorption capabilities of the visceral pleura that are solely relied upon. The AIM of the present experimental study was to demonstrate the capabilities of the pleura for pneumothorax resolution by room air. MATERIAL AND METHODS: The study was conducted with six laboratory animals (New Zealand white rabbits, weighing 2.5-3.5 kg), in which right total pneumothorax was induced. Conventional chest X-rays at intervals of 2 days were used to monitor the changes in the size of the pneumothorax until its final resolution. The size of the pneumothorax was estimated by the Light index. RESULTS: Total resolution of the pneumothorax occurred within 12 days after it was induced. The average rate of pneumothorax resolution was 6.63% (SEM +/- 0.20)/daily. CONCLUSION: The study imitates initial clinical observation in pneumothorax. Despite the fact that the study demonstrates resolution of total pneumothorax (100%), observation only is inappropriate as a treatment modality in patients with more than 20% collapse of the lung.

Descending necrotizing mediastinitis of odontogenic origin--personal experience and literature review.

UNLABELLED: Descending necrotizing mediastinitis is the most severe form of mediastinal infection. The aim of the study was to present the optimal diagnostic and treatment approach to this severe, life-threatening condition. PATIENTS AND METHODS: Three patients (men, aged 75, 73, and 63) with descending necrotizing mediastinitis hospitalised between April 2007 and February 2009 have been included in the study. The diagnosis of the condition was made based on cervico-thoracic computed tomography and surgical findings. The surgical treatment in each of the cases included bilateral longitudinal cervicotomy, transversal suprasternal cervicotomy and posterior-lateral thoracotomy. RESULTS: The period between the initiation of ambulatory treatment of the dental infection and diagnosing the mediastinitis was 9, 8 and 11 days, respectively. Engagement of all cervical spaces and mediastinal sections with polybacterial (three or more agents) dental infection, originating from third and fourth lower molars was present in each of the patients. Chronic alcoholism and diabetes are factors influencing the course of mediastinitis. The outcome in all the three patients was lethal (within 72 hours). CONCLUSION: Success in the treatment of descending necrotic mediastinitis of odontogenic origin may be expected only in case of early diagnose and aggressive cervical and mediastinal drainage, performed by bilateral longitudinal cervicotomy and posterior-lateral thoracotomy.

Adult Bochdalek hernia simulating left pleural effusion: a review and a case report.

The authors present a rare case of congenital diaphragmatic Bochdalek hernia in an adult stimulating left pleural effusion. The diagnosis of left pleural effusion was made on the basis of conventional chest X-ray and ultrasonography. The definitive diagnosis of Bochdalek hernia was made by left video-assisted thoracoscopy. The patient was successfully treated operatively by conventional surgery--a combination of left thoracotomy and median laparotomy. The reported case supported the view that Bochdalek hernia in adults presents usually with atypical chronic abdominal and respiratory symptoms. Surgical treatment should best be performed, according to the authors, by competent surgeons with good command of both the thoracic and abdominal approaches to the diaphragm.

Surgical treatment of necrotizing pancreatitis and complicated forms of cholecystopancreatitis.

The authors present a retrospective clinical analysis of 25 operated patients with necrotizing pancreatitis and severe cholecystopancreatitis. The severity of the disease was evaluated by the Ranson scale. Diagnosis was made using all available contemporary diagnostic methods. Eleven of the patients were operated in the first 2-5 days after admission because of severe form of acute pancreatitis resisting medical therapy (Ranson > 3) and 8 patients with infected necrotizing pancreatitis underwent surgery within 2-3 weeks after the disease onset. Five of the patients died (26.32%). Only one patient died (16.66%) out of the patients of the second group including patients with acute complicated cholecystopancreatitis (n = 6). The authors think that treatment of acute pancreatitis at its onset should be mainly conservative. Laparotomy should be resorted to only in cases of uncertain diagnosis. Surgery or percutaneous drainage should be used in infected necrotizing pancreatitis and the most favorable term of operation is 2-3 weeks after the disease onset. Severe pancreatitis associated with gallstone disease and its complications require emergency surgery.

Occlusive ileus as a complication of large intestinal diverticulosis (contribution of two cases).

After a short literature review of diverticulosis of the colon and its complications, the authors give a thorough description of two cases treated by them for sigmoid colon diverticulosis complicated with occlusive ileus. The patients were males aged 68 and 74 years. In both cases the authors had difficulties in making the precise intraoperative diagnosis. Since exclusion of malignancy was impossible (in emergency conditions immediate histological verification was not possible). Hartman's operation ensuring oncological radicalism was performed. The intestinal passage was restored at the second stage of operation. The final histological verification detected chronic inflammatory process due to diverticulosis that had lead to stenosis and occlusion of the intestinal lumen. On the basis of the two cases described herein and the available literature data, the authors accept Hartman's operation as a method of choice in the treatment of occlusive ileus resulting from large intestinal diverticulosis in elderly patients in impaired general condition. If feasible in emergency conditions immediate histological examination should be used to exclude neoplastic process of the colon.