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1.
Rozhl Chir ; 102(7): 283-297, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38286675

RESUMO

INTRODUCTION: Currently, bariatric surgery is the most effective treatment for the morbid obesity. It provides sustained weight loss as well as demonstrated positive effects on obesity-related comorbidities. The number of procedures performed worldwide has seen a sharp increase in the past twenty years. Therefore, an effort has been developed to establish a consensus in perioperative care based on best evidence. METHODS: The working group of the Joint Bariatric and Metabolic Surgery Section of the Czech Surgery Society and Czech Society of Obesitology prepared clinical practice guidelines for the ERAS (enhanced recovery after surgery) concept in perioperative care in bariatric surgery. The working group based its guidelines on ERAS guidelines published in 2021. The working group adopted the original text and then adapted the text and added its comments to specific items as appropriate. Electronic voting of all members of the working group was the final phase, by which the strength of consensus was expressed with respect to individual elements of the guidelines. RESULTS: The Czech working group reached a consensus with ERABS (enhanced recovery after bariatric surgery) guidelines for most elements. The quality of evidence is low for some interventions of the ERAS protocol for bariatric surgery. Therefore, extrapolation from other surgeries and fields is needed for evidence-based practice. CONCLUSION: The guidelines are intended for clinical practice in bariatric surgery with the ERAS protocol based on updated evidence and guidelines. It is based on recent and comprehensive ERAS guidelines adopted and adapted by the Czech working group of the Joint Bariatric and Metabolic Surgery Section of the Czech Surgery Society and Czech Society of Obesitology. Some supplementations and specifications are reflected in comments added to the Czech version.


Assuntos
Cirurgia Bariátrica , Recuperação Pós-Cirúrgica Melhorada , Obesidade Mórbida , Humanos , Cirurgia Bariátrica/métodos , República Tcheca , Obesidade Mórbida/cirurgia , Assistência Perioperatória/métodos , Votação
2.
Rozhl Chir ; 102(10): 381-386, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38302424

RESUMO

Postoperative delirium is a serious complication occurring mainly in patients over 65 years. This complication is common in the above mentioned age group and has been described in up to 50% of patients. Postoperative delirium has a significant impact both on postoperative morbidity and mortality. Systematic and early detection of at-risk patients is essential to reduce the risk of postoperative delirium. Targeted efforts are then developed in thus identified patients to reduce the risk factors for developing delirium. An individualized approach to anesthesia is adopted during the surgery. Procedures that contribute to reducing the risk of developing delirium are preferred in the postoperative period. If this complication does occur, it is primarily preferred to manage any potential cause of the condition using non-pharmacological procedures. Pharmacological interven- tion should be reserved only for patients with a hyperactive form of delirium. The aim of the article was to shed more light on measures that help to prevent the delirium and on the therapeutic procedures used.


Assuntos
Delírio , Delírio do Despertar , Humanos , Delírio do Despertar/diagnóstico , Delírio do Despertar/etiologia , Delírio do Despertar/prevenção & controle , Delírio/diagnóstico , Delírio/etiologia , Delírio/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Fatores de Risco
3.
Rozhl Chir ; 100(2): 60-65, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33910338

RESUMO

Malnutrition is a significant negative factor for surgical patients in the entire perioperative period. However, this factor can be controlled and is easy to detect in the outpatient setting. Starting from May 1, 2020, surgeons have the possibility to prescribe sipping under certain conditions for a limited period of 4 weeks. Thereby they have become able to strongly impact any altered nutritional status both preoperatively and postoperatively. The authors describe scoring questionnaires used for the detection of malnutrition and required by health insurance companies. Additionally, prescribing conditions and potential mistakes in the outpatient setting are analysed.


Assuntos
Desnutrição , Cirurgiões , Humanos , Desnutrição/diagnóstico , Desnutrição/terapia , Estado Nutricional , Pacientes Ambulatoriais , Inquéritos e Questionários
4.
Rozhl Chir ; 100(2): 66-73, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33910339

RESUMO

INTRODUCTION: Nutrition therapy becomes one of the fundamental conditions of a successful outcome in malnourished patients and in critically ill patients. The administration of enteral feeding in critically ill patients is mostly performed by continuous or cyclic feeding. On the contrary, the potential benefits of intermittent feeding include increased muscle protein synthesis. This review outlines the theory of a possible anabolic effect of intermittent feeding. The authors describe their experience with implementation of this method of administration in the intensive care unit including the follow-up of possible complications and adverse effects. METHODS: Six patients with intermittent feeding were followed retrospectively during the study period. In addition to demographic data, potential complications related to intermittent enteral feeding (aspiration pneumonia, increased gastric residual volume, abdominal discomfort, osmotic diarrhoea) were evaluated. RESULTS: The average time of intermittent feeding was 8 days. The sum of intermittent feeding days was 63. No aspiration followed by pneumonia was detected during this period. The gastric residual volume did not increase, either. Abdominal discomfort and osmotic diarrhoea were not observed in any patient. CONCLUSION: Although continuous and cyclic enteral feeding in critically ill patients remains the standard and the most common practice, it is considered as a non-physiological method with possible negative consequences for the patient. On the other hand, intermittent feeding is theoretically associated with respecting of the circadian rhythm and with activation of autophagy. Intermittent feeding increases muscle protein synthesis and supports the release of fatty acids. As shown by our observational study, intermittent administration of enteral nutrition in intensive care can be implemented without any adverse effects; however, it is more time consuming for the nurses.


Assuntos
Cuidados Críticos , Nutrição Enteral , Estado Terminal , Humanos , Unidades de Terapia Intensiva , Estudos Observacionais como Assunto , Estudos Retrospectivos
5.
Rozhl Chir ; 95(12): 425-431, 2016.
Artigo em Tcheco | MEDLINE | ID: mdl-28182437

RESUMO

INTRODUCTION: Sleeve gastrectomy (SG) as a single bariatric/metabolic procedure has been performed since 2003 in the world, and since 2006 in the Czech Republic. We report 10 years experience with SG in the Czech Republic from 2006 to 2015. METHOD: Prospectively collected data from 14 surgical departments was evaluated retrospectively using descriptive statistics for every year from 2006 to 2015 and subsequently evaluated and compared for the entire period. The number of the patients, mean age, mean weight and BMI at the time of surgery, the number of patients with T2DM after SG, mean follow-up, mean %BMIL (% Body Mass Index Loss), distance of the starting point of the resection line from the pylorus, the size of the calibration bougie, the rate of complications, and the number and type of conversion procedures were evaluated. RESULTS: 4134 sleeve gastrectomies were done in the Czech Republic from 2006 to 2015 with the mean follow-up of 32.9 months (range 2145 months) from the procedure. The mean weight at the time of surgery fluctuated between 114.2 kg and 128.9 kg; mean BMI fluctuated between 42.3 and 46.7. Mean %BMIL was 63.2% for the entire evaluated period. The distance of the starting point of the resection line from the pylorus changed from the mean 6.1 cm (range 67 cm) to mean 4.2 cm (range 36 cm) and the size of the calibration bougie changed from the mean 39.2 F (range 3642 F) to mean 37.1 F (range 3542 F). As regards early postoperative complications, bleeding from the resection line occurred in 1.4% and a leak from the staple line occurred in 1.1%. The gastroesophageal reflux disease and hiatal hernia occurred in 17.3% as the most frequent late complications. Conversion to another bariatric procedure was approached in 3.8% in the event of an unsatisfactory effect of the SG. CONCLUSION: Bariatric or metabolic surgery, respectively, is a safe and effective surgical method for the treatment of severe obesity and T2DM in morbidly obese patients. Currently, SG is the most widely used bariatric/metabolic procedure in the Czech Republic as well as in most other countries and the long-time results are similar in comparison with other authors.Key words: bariatric surgery - sleeve gastrectomy - resection line - complications.


Assuntos
Cirurgia Bariátrica/métodos , Gastrectomia/métodos , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/epidemiologia , Índice de Massa Corporal , Comorbidade , República Tcheca , Diabetes Mellitus Tipo 2/epidemiologia , Refluxo Gastroesofágico/epidemiologia , Hérnia Hiatal/epidemiologia , Humanos , Obesidade Mórbida/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Estudos Retrospectivos , Grampeamento Cirúrgico , Resultado do Tratamento
6.
Rozhl Chir ; 92(5): 235, 2013 May.
Artigo em Tcheco | MEDLINE | ID: mdl-23991477
7.
Rozhl Chir ; 88(7): 409-12, 2009 Jul.
Artigo em Tcheco | MEDLINE | ID: mdl-19750847

RESUMO

Perioperative nutritional intervention is an integral component of preoperative preperation and postoperative therapeutic strategy in surgical patients with undernutrition or in patients at severe nutritional risk. The guidelines based on clinical trials highlight the risk groups with benefit of artificial nutrition. The guidelines get over a lot of dogma from past decades. The introduction of these recommendations into practice reduces postoperative complications mainly in patients after major surgery, in patients with polytrauma, or in critically ill patients. The emphasis is put on shortening of preoperative starvation and on early postoperative enteral or peroral feeding.


Assuntos
Apoio Nutricional , Assistência Perioperatória , Humanos , Desnutrição/terapia
8.
Rozhl Chir ; 85(6): 273-6, 2006 Jun.
Artigo em Tcheco | MEDLINE | ID: mdl-16977863

RESUMO

Spontaneous pneumomediastinum is a presence of free air in the mediastinum without previous injury and without previously known lung disease. Spontaneous pneumomediastinum is infrequent and little known by physicians. Authors present a case report of three young men with spontaneous pneumomediastinum. There was no evident causation in two cases. In one case there was previous excessive sport activity. Main presenting symptoms were chest and neck pain, odynophagia, dysphonia, vomiting, and neck subcutaneous emphysema. Esophageal perforation was ruled out. All patients recovered spontaneously. Spontaneous pneumomediastinum is the benign disease. Its main importace is in differential diagnosis concerning especially esophageal perforation.


Assuntos
Enfisema Mediastínico/diagnóstico , Adulto , Humanos , Masculino , Enfisema Mediastínico/etiologia
9.
Rozhl Chir ; 84(3): 134-41, 2005 Mar.
Artigo em Tcheco | MEDLINE | ID: mdl-15938378

RESUMO

BACKGROUND: The present rationale appears to prefer early postoperative enteral nutrition to total parenteral nutrition. But no clear conclusions exist for demonstrating the clinical benefit of early postoperative enteral nutrition in patients after the major surgical resections of upper gastrointestinal tract. AIM: To compare the clinical impact of various types of the artificial nutrition by comparison of the postoperative complications. METHODS: Prospective, randomized, controlled clinical trial. Sixty-two patients were analyzed. In the group I (21 patients) the total parenteral nutrition was received, in the group II (20 patients) the standard enteral nutrition was received, in the group III (21 patients) the enteral nutrition enriched with glutamin, arginin and omega-3 fatty acids was received. Both enteral feedings were given early. All three nutritional regiments were isocaloric and isoproteinaceus. RESULTS: The postoperative complications were in 31 patients overall (11, 11, 9 patients in the each group I, II, III). Three patients died in the group I, 2 patients in the group II, and 1 patient in the group III. There were no significance differences (p < 0,05) in postoperative complications, both infectious and non-infectious reasons. CONCLUSION: The study has shown no impact of various type of artificial nutrition on clinical outcome in patients after major resections of upper gastrointestinal tract. There was no significant difference in infectious complications in the groups with enteral feeding. The combination of enteral and parenteral nutrition appears as optimum after major surgery of the upper gastrointestinal tract. It is necessary to realize more extensive studies of homogenous patients to find out the benefit of various types of arteficial nutrition in postoperative period.


Assuntos
Nutrição Enteral , Alimentos Formulados , Trato Gastrointestinal/cirurgia , Nutrição Parenteral Total , Complicações Pós-Operatórias , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios
10.
Rozhl Chir ; 84(1): 19-27, 2005 Jan.
Artigo em Tcheco | MEDLINE | ID: mdl-15813452

RESUMO

The aim of this work is to introduce a surgical procedure, which would make operations of distally located rectal carcinomas indicated for abdominoperineal extirpation of the rectum possible while maintaining intestinal continence and full functioning of the sphincter system. At the same time, we have aimed at the maximum use of all pros of contemporary miniinvasive surgical techniques. We have labelled our proposed surgical technique the "rendez-vous technique". The trial group includes the original group of 10 patients, who have been operated in our clinic since April 2004, using the rendez-vous technique. We are aware of the fact, that the trial group is small, however we believe that this trial group is the starting group, which will continue to enlarge and that it will bring results to the patients themselves, as well as for a valid prospective study in order to confirm or challenge the proposed method's effectiveness.


Assuntos
Microcirurgia/métodos , Proctoscopia/métodos , Neoplasias Retais/cirurgia , Feminino , Humanos , Masculino
11.
Rozhl Chir ; 82(8): 427-31, 2003 Aug.
Artigo em Tcheco | MEDLINE | ID: mdl-14619087

RESUMO

The subhepatic drainage is mandatorily used in the end of laparoscopic cholecystectomy in the majority of departments of surgery in Czech republic. The preoperative finding of advanced inflammatory alteration or bleeding in operative field is certainly the reason to do so. But it seems that obligatory drainage after uncomplicated laparoscopic cholecystectomy has no real foundation and it is suspiciously an expression of antiquated tradition. From January 1, 2001 to December 31, 2002 the prospective non-randomized study was performed: in the first group of patients the drainage of subhepatic space was used mandatorily (324 patients), in the second group the drainage was used only in indicated cases (365 patients). No statistically significant difference was found between the two groups in postoperative complications (biliary leak, intraabdominal abscess, reoperation). There was the significant difference in surgery times (55 min. in the group with mandatory drainage, 50 min. in the group with indicated drainage, p < 0.05), in term of hospital stay--the patients with mandatory drainage stayed longer in hospital (3.2 day, resp. 2.4 day, p < 0.05). In summary, the mandatory drainage of subhepatic space after laparoscopic cholecystectomy is not associated with lower incidence of postoperative complications. On the other hand, the mandatory drainage has significantly longer surgery time and longer length of hospital stay. The drainage is exceptionally indicated but not mandatorily in uncomplicated operations.


Assuntos
Colecistectomia Laparoscópica , Drenagem , Humanos , Estudos Prospectivos
12.
Rozhl Chir ; 82(7): 353-6, 2003 Jul.
Artigo em Tcheco | MEDLINE | ID: mdl-14502883

RESUMO

The advantages of mini-invasive procedures have been demonstrated in various surgical interventions. The aim of the authors was to describe, on the basis of their own experience obtained in a group of seven patients, the operation procedure of laparoscopic total gastrectomy, to discuss the advantages and to present their initial experience.


Assuntos
Gastrectomia/métodos , Laparoscopia/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/cirurgia
13.
Rozhl Chir ; 80(7): 345-8, 2001 Jul.
Artigo em Tcheco | MEDLINE | ID: mdl-11505686

RESUMO

Authors present case report of an adolescent girl with the large ovarian teratoma. Teratoma of the ovary was surprising finding during laparotomy which was indicated on the basis of acute abdomen. Tumorectomy was performed. Microscopic examination revealed differentiated mature teratoma. There were no signs of recurrence. Authors present short review of the literature concerning this rare diagnosis and the reason of acute abdomen.


Assuntos
Abdome Agudo/etiologia , Neoplasias Ovarianas/diagnóstico , Teratoma/diagnóstico , Adolescente , Feminino , Humanos , Neoplasias Ovarianas/patologia , Teratoma/patologia
15.
Rozhl Chir ; 77(10): 450-3, 1998 Oct.
Artigo em Tcheco | MEDLINE | ID: mdl-9863350

RESUMO

At the surgical clinic of the Faculty Hospital in Ostrava-Poruba since November 1993 till June 1998 20 laparoscopic gastrostomies were performed. The main indication was to ensure enteral nutrition in patients where, due to obstruction of the oesophagus, it was impossible to implement percutaneous puncture gastrostomy. The surgical procedure lasted on average 37 minutes and was completed successfully in all patients. Three patients died within thirty days. This procedure made it possible that eighty percent of the patients could be discharged from hospital and go home.


Assuntos
Gastrostomia/métodos , Laparoscopia , Adulto , Idoso , Idoso de 80 Anos ou mais , Nutrição Enteral , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Epidemiol Mikrobiol Imunol ; 44(3): 104-6, 1995 Sep.
Artigo em Tcheco | MEDLINE | ID: mdl-7489130

RESUMO

In a prevalence study of septicaemia at a surgical clinic 645 patients were followed up. The assembled data were compared with data from a similar study made in 862 patients which was implemented in different departments of Ostrava hospitals. In the two studies different criteria of sepsis were used. In the study conducted at the surgical clinic these criteria were more precisely specified and extended. This trebled the assessed number of sepses. From comparison of results of these studies ensues that more frequent bacteriological monitoring of patients in necessary.


Assuntos
Sepse/diagnóstico , Humanos , Sepse/mortalidade , Taxa de Sobrevida
17.
Rozhl Chir ; 74(4): 180-4, 1995 May.
Artigo em Tcheco | MEDLINE | ID: mdl-7570197

RESUMO

The investigation is based on data obtained by means of questionnaires from 62 surgical departments in the Czech Republic. The respondents performed to the data of December 31, 1993 a total of 9,439 laparoscopic cholecystectomies. Conversions accounted for 4.9%, some three quarters were called for by obscure anatomical conditions. The biliary pathways were injured (with the exception of the cystic duct) in 43 patients (0.46%). Peroperative biligraphy was performed in 2.6% of operated patients. Injuries of the digestive tract were recorded in 0.06% patients and injuries of blood vessels in 1.4% of patients. The morbidity in the group was 7.7% and the lethality 0.14% (13 patients). The authors compare the data with other nation-wide studies and demonstrate the advantages of laparoscopic cholecystectomy.


Assuntos
Colecistectomia Laparoscópica/estatística & dados numéricos , Colecistectomia Laparoscópica/efeitos adversos , República Tcheca , Humanos , Complicações Intraoperatórias , Complicações Pós-Operatórias , Reoperação
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