[Severe acute pancreatitis - managing complications using a combination of minimally invasive approaches]. / Tezká akutní pankreatitida - resení komplikací kombinací miniinvazivních prístupu

In this case report, we describe the case of a 30-year-old obese patient with severe acute pancreatitis complicated during hospitalization by the development of infected necrosis, a pseudocyst and an abscess. We demonstrate a possible solution to these complications using a combination of minimally invasive approaches. The contribution of this case report resides in that it presents a combination of the percutaneous approach and the endosonographic approach in the treatment of pancreatic necrosis. We believe that in such an extensive necrosis of the pancreas as is described in our case, this combined approach is optimal. The condition for implementing such a procedure is a well-staffed and technically equipped workplace.

[Czech bariatry in 2010]. / Ceská bariatrie v roce 2010.

INTRODUCTION: It is only during the past two decades, when obesity has become to be considered a pandemic disorder. However, in 1953 Varco performed jejunoileal bypass as the world's first bariatric surgical procedure. 30 years later, Pesková performed the first bariatric surgery--a gastroplasty--in Czechoslovakia. From 1984 she started to perform fixed gastric bandages, through laparotomic app- roach at that time. The first laparoscopic fixed bandage in Czechoslovakia was performed in 1993. Over the years, the number of surgical procedures to treat morbid obesity, as well as the number of bariatric surgeons, continued to increase. In 2004, Czech Bariatric Section of the Czech Surgical Society and the Czech Society of Obesitology of the Czech Medical Association of J. E. Purkyne, were established. MATERIAL AND METHODS: 170 bariatric surgeries were performed in the Czech Republic in 1999. The majority of procedures included fixed gastric bandage, rarely, adjustable bandage was performed. At that time, bariatric procedures were performed at five sites only. However, over the past 10 years, bariatric surgery has largely developed in the Czech Republic. The exact number of bariatric procedures completed per year was unknown, therefore, 21 surgical clinics, at which bariatric procedures are performed, were contacted from January to June 2010. Heads of the clinics were asked to provide basic data on surgical treatment of obesity. The aim of the study was to analyze the situation in bariatric surgery in the Czech Republic at the end of 2009. A total of 18 clinics (85.8%) joined the study and provided their own statistical data. 14 of them perform over 20 bariatric procedures a year. RESULTS: The analysis data showed that, in 2009, a total of 1558 bariatric procedures were completed at 18 surgical clinics and approximately 1600 procedures were performed in the whole Czech Republic. However, out of the total, over 230 patients were foreigners. In 99% of bariatric procedures in morbid obese subjects, laparoscopic approach was used. CONCLUSION: Over the ten year period, the number of clinics performing over 20 bariatric procedures a year increased from five to 14 clinics and the number of bariatric procedures increased from 170 to 1600 procedures a year. It is 900% increase, compared to the year 1999! Nevertheless, compared to other countries, e.g. Austria, the number of bariatric procedures does not correspond with prevalence rates of obesity in the Czech Republic.

[Pseudoaneurysm of the hepatic artery presenting with hemobilia--a complication of laparoscopic cholecystectomy]. / Pseudoaneurysma arteria hepatica manifestující se hemobilií jako komplikace laparoskopické cholecystektomie.

INTRODUCTION: Hemobilia, defined as a bleeding into the bile duct, is a rare disease. One of its infrequent causes is a hepatic artery pseudoaneurysm, usually developed after arterial iatrogenic leasion. MATERIAL AND METHODS: A case review, presenting right hepatic artery pseudoaneurysm with a biliovascular fistula as a consequence of hepatic artery and bile duct injuries during "uncomplicated" laparoscopic cholecystectomy. DISCUSSION: Bile duct injury is one of the most serious complication after laparoscopic cholecystectomy. Hepatic artery may be injured simultaneously, resulting in the pseudoaneurysm and/or biliovascular fistula, presenting with hemobilia. Time interval from the injury to symptoms widely varies from few hours to weeks or even several months. CONCLUSION: Melena or hematemesis after recent laparoscopic cholecystectomy should be always suspicious from hepatic artery and/or bile duct injuries, manifesting with hemobilia.