Suprapapillary Biliary Stents Have Longer Patency Times than Transpapillary Stents-A Systematic Review and Meta-Analysis.

BACKGROUND AND STUDY AIMS: Endoscopic biliary stent placement is a minimally invasive intervention for patients with biliary strictures. Stent patency and function time are crucial factors. Suprapapillary versus transpapillary stent positioning may contribute to stent function time, so a meta-analysis was performed in this comparison. METHODS: A comprehensive literature search was conducted in the CENTRAL, Embase, and MEDLINE databases to find data on suprapapillary stent placement compared to the transpapillary method via endoscopic retrograde cholangiopancreatography in cases of biliary stenosis of any etiology and any stent type until December 2020. We carried out a meta-analysis focusing on the following outcomes: stent patency, stent migration, rate of cholangitis and pancreatitis, and other reported complications. RESULTS: Three prospective and ten retrospective studies involving 1028 patients were included. Suprapapillary stent placement appeared to be superior to transpapillary stent positioning in patency (weighted mean difference = 50.23 days, 95% CI: 8.56, 91.98; p = 0.0.018). In a subgroup analysis of malignant indications, suprapapillary positioning showed a lower rate of cholangitis (OR: 0.34, 95% CI: 0.13, 0.93; p = 0.036). Another subgroup analysis investigating metal stents in a suprapapillary position resulted in a lower rate of pancreatitis (OR: 0.16, 95% CI: 0.03, 0.95; p = 0.043) compared to transpapillary stent placement. There was no difference in stent migration rates between the two groups (OR: 0.67, 95% CI: 0.17, 2.72; p = 0.577). CONCLUSIONS: Based on our results, suprapapillary biliary stenting has longer stent patency. Moreover, the stent migration rate did not differ between the suprapapillary and transpapillary groups.

Clinical benefits of oral capecitabine over intravenous 5-fluorouracyl regimen in case of neoadjuvant chemoradiotherapy followed by surgery for locally advanced rectal cancer.

Background: During the last decade, one of the most important treatment options for locally advanced, potencially resectable rectal tumours was neoadjuvant chemoradiotherapy (CRT) followed by surgery. Methods: Effects of the neoadjuvant treatment on surgical outcomes were retrospectively analysed in 185 patients with stage T2-T4 and N0-2, resectable rectal tumour among two patient groups defined by radiosensitizer agents. Group 1 (n = 94) involved radiotherapy (RT) with 50.4 Gy total dose (25 × 1.8 Gy + 3 × 1.8 Gy tumour bed boost), and intravenous 5-fluorouracil (5-FU) (350 mg/m2) with leucovorin (20 mg/m2) on the 1-5 and 21-25 days, while Group 2 (n = 91) RT and orally administrated capecitabine (daily 2 × 825 mg/m2) on RT days. Surgery was carried out after 8-10 weeks. Side effects, perioperative complications, type of surgery, number of removed regional lymph nodes, resection margins and tumour regression grade (TRG) were analysed. Results: More favourable side effects were observed in Group 2. Despite the same rate of diarrhoea (Group 1 vs. Group 2: 54.3% vs. 56.0%), Grade 2-3 diarrhoea ratio was lower (p = 0.0352) after capecitabine (Group 2). Weight loss occurred in 17.0% and 2.2% (p = 0.00067), while nausea and vomiting was described in 38.3% and 15.4% (p = 0.00045) with 5-FU treatment and capecitabine respectively. Anaemia was observed in 33.0% and 22.0% (p = 0.0941). Complete tumour regression occurred in 25.3% after oral- and 13.8% after intravenous treatment (p = 0.049). Ratio of sphincter preservation was higher with laparoscopy than open surgery (72.3% vs. 39.7%) (p = 0.00001). Conclusion: The study confirms advantages of neoadjuvant chemoradiotherapy with oral capecitabine for rectal tumours, such as more favourable side effect profile and overall clinical outcome, with increased rate of complete tumour regression.

Selective intraoperative cholangiography should be considered over routine intraoperative cholangiography during cholecystectomy: a systematic review and meta-analysis.

BACKGROUND: Decades of debate surround the use of intraoperative cholangiography (IOC) during cholecystectomy. To the present day, the role of IOC is controversial as regards decreasing the rate of bile duct injury (BDI). We aimed to review and analyse the available literature on the benefits of IOC during cholecystectomy. METHODS: A systematic literature search was performed until 19 October 2020 in five databases using the following search keys: cholangiogra* and cholecystectomy. The primary outcomes were BDI and retained stone rate. To investigate the differences between the groups (routine IOC vs selective IOC and IOC vs no IOC), we calculated weighted mean differences (WMD) for continuous outcomes and relative risks (RR) for dichotomous outcomes, with 95% confidence intervals (CI). RESULTS: Of the 19,863 articles, 38 were selected and 32 were included in the quantitative synthesis. Routine IOC showed no superiority compared to selective IOC in decreasing BDI (RR = 0.91, 95% CI 0.66; 1.24). Comparing IOC and no IOC, no statistically significant differences were found in the case of BDI, retained stone rate, readmission rate, and length of hospital stay. We found an increased risk of conversion rate to open surgery in the no IOC group (RR = 0.64, CI 0.51; 0.78). The operation time was significantly longer in the IOC group compared to the no IOC group (WMD = 11.25 min, 95% CI 6.57; 15.93). CONCLUSION: Our findings suggest that IOC may not be indicated in every case, however, the evidence is very uncertain. Further good quality research is required to address this question.

Minimally invasive adrenalectomy ­ Operative and perioperative results of transperitoneal and retroperitoneal adrenalectomies performed at the University of Szeged Department of Surgery during 23 years / Minimálisan invazív adrenalectomia - 23 év alatt végzett transperitonealis és retroperitonealis adrenalectomiák operatív és perioperatív eredményei a Szegedi Tudományegyetem Sebészeti Klinikán

Aim. Our goal was to evaluate operative and perioperative data of retroperitoneal (RP) and transperitoneal (TP) adrenalectomies performed at the University of Szeged Department of Surgery. Patients and method. During a retrospective cohort study including 174 adrenalectomies (28 RP; 146 TP) performed between 1998 and 2021, the following parameters were evaluated: rate of previous abdominal surgeries, conversion rate, operative time, intraoperative blood loss, tumor size, histology, hospital stay, early and late complications. Results. With significantly higher rate of previous abdominal surgeries [TP vs RP: 68 (46.57%) vs 4 (14%) P = 0.0021], there was no markable difference in conversion rate [TP vs RP: 7 (4.79%) vs 5 (18%), P = 0.312]. Significantly larger tumours were removed with TP (TP vs RP: 58.05 vs 34.8 mm, P = 0.016), with no markable difference in intraoperative blood loss (TP vs RP: 67.85 vs 50.2 ml, P = 0.157). Operative time was significantly shorter in TP (TP vs RP: 86.3 vs 134.5 min; P = 0.024). The most frequent histology was adenoma (TP vs RP: n = 95; 65.06% vs 64.3%). Pheochromocytoma occurred in 11 (7.53%) and 5 (17.8%) cases in TP and RP, respectively. We found no significant difference in hospital stay (TP vs RP: 5.125 vs 4.61 day; P = 0.413). Five- and 2 cases of early complications were seen in TP (splenic injury, postoperative fever, severe intraoperative bleeding, severe hypokalemia, surgical site infection) and RP (2 severe intraoperative bleeding), respectively. One lethal case of ventricular fibrillation and one delayed complication (postoperative abdominal wall hernia) were observed in TP. Conclusions. Both TP and RP are safe and simply reproducible minimally invasive techniques. According to our observation, RP adrenalectomy seems to be reserved for smaller lesions, while TP proves to be successful in removing enlarged and also malignant lesions with significantly shorter operative time.

[Minimally invasive surgery for motility disorders of the oesophagus]. / A nyelocso motilitási betegségeinek minimálisan invazív sebészete

Introduction and aims. We present our experience with minimally invasive surgery for pharyngoesophageal (Zenker) diverticulums, epiphrenic diverticulums and achalasia cardiae focusing on the perioperative features and patients' quality of life. Patients and methods. Between 1 January 2003 and 31 December 2020, patients were selected with a symptom-causing Zenker diverticulum, epiphrenic diverticulum and achalasia cardiae. In 17 cases, transoral stapler diverticulostomy, in 23 cases transcervical diverticulectomy and cricomyotomy were done because of Zenker diverticulum, in 14 cases, laparoscopic transhiatal surgery was performed because of epiphrenic diverticula, while in 63 cases, laparoscopic Heller­Dor operation were carried out because of achalasia cardiae. Perioperative results, the quality of life outcomes of various surgeries were evaluated in mid- and long-term. Results/conclusions. The surgeries were performed with minimal blood loss, zero mortality and low morbidity. According to our result, the two different surgical approaches in the therapy of Zenker's diverticulum, the laparoscopic Heller­Dor procedure applied in the management of epiphrenic diverticulas and achalasia cardiae are safe and effective operations. In the long term, the symptom control in patients after minimally invasive surgeries is sufficient and only a small percentage of the patients may require additional medication therapy and/or reintervention due to persistent complaints.

Laparoscopic splenectomy in our practice at the University of Szeged Department of Surgery / Laparoszkópos lépsebészet a szegedi Sebészeti Klinikán

Since its introduction in 1991, laparoscopic splenectomy has been considered the gold standard in spleen surgery, and the advantages of this technique over open surgery are indisputable. The technique was initiated in the Department of Surgery, University of Szeged in 1994 and since then our working group has gained one of the greatest experiences in this field in Hungary. Based on our results, similarly to literature data, it may be established that laparoscopic splenectomy can be considered a surgical procedure with low morbidity after gaining the necessary experience. In our study, the bowel motility recovered earlier, and hospital stay was significantly shorter after laparoscopic procedures. We proved laparoscopic splenectomy is a safe method in cases of extremely large spleens, and the Pfannenstiel incision is a cosmetically acceptable alternative for the retrieval of the spleen. Although several medications are available for second-line ITP therapy, laparoscopic splenectomy provides the longest-lasting results. In our study, young age and a preoperative response to steroids (steroid-dependent cases) were positive predictors for the success of splenectomy. Based on our experiences in the case of an immediate complete response to splenectomy, relapse occurred significantly less often.

Laparoscopic technique in the surgical treatment of ulcerative colitis,short- and long-term results of the Department of Surgery in Szeged / Colitis ulcerosa laparoszkópos sebészi kezelése, rövid és hosszú távú eredmények a szegedi Sebészeti Klinikán

Introduction. An estimated 20­30% 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. Minimally invasive surgical technique is used during the surgical treatment of colorectal diseases in the Department of Surgery in Szeged since 2005. Aim. We aimed to compare the last 16 years' results of patients treated with conventional and laparoscopic methods. Methods. Between 01. 01. 2005. and 31. 03. 2021. 99 patients (53 female, 46 male) received surgery. The laparoscopic technique was used in 74 (74.7%) and the conventional method in 25 (25.3%) cases. General status of patients, early and late results of surgical treatment, and mainly complications were analyzed. Results. There was no difference between the groups in-hospital stay, the number of days spent in the intensive care unit and the need for transfusion. During the follow-up period the time to the recovery of the bowel function, and the occurrence of late complications were significantly lower in the laparoscopically operated group of patients. Conclusions. Laparoscopic surgical treatment can be used safely for both emergency and elective cases in UC patients. The short-term perioperative results and the morbidity showed no differences between the laparoscopic and open techniques. The long-term effect of laparoscopic surgery insured a lower rate of complications.

Goal-Directed Fluid Therapy Enhances Gastrointestinal Recovery after Laparoscopic Surgery: A Systematic Review and Meta-Analysis.

(1) Background: Whether goal-directed fluid therapy (GDFT) provides any outcome benefit as compared to non-goal-directed fluid therapy (N-GDFT) in elective abdominal laparoscopic surgery has not been determined yet. (2) Methods: A systematic literature search was conducted in MEDLINE, Embase, CENTRAL, Web of Science, and Scopus. The main outcomes were length of hospital stay (LOHS), time to first flatus and stool, intraoperative fluid and vasopressor requirements, serum lactate levels, and urinary output. Pooled risks ratios (RRs) with 95% confidence intervals (CI) were calculated for dichotomous outcomes and weighted mean difference (WMD) with 95% CI for continuous outcomes. (3) Results: Eleven studies were included in the quantitative, and fifteen in the qualitative synthesis. LOHS (WMD: -1.18 days, 95% CI: -1.84 to -0.53) and time to first stool (WMD: -9.8 h; CI -12.7 to -7.0) were significantly shorter in the GDFT group. GDFT resulted in significantly less intraoperative fluid administration (WMD: -441 mL, 95% CI: -790 to -92) and lower lactate levels at the end of the operation: WMD: -0.25 mmol L-1; 95% CI: -0.36 to -0.14. (4) Conclusions: GDFT resulted in enhanced recovery of the gastrointestinal function and shorter LOHS as compared to N-GDFT.

Surgical outcome of percutaneous transhepatic gallbladder drainage in acute cholecystitis: Ten years' experience at a tertiary care centre.

BACKGROUND: Percutaneous transhepatic gallbladder drainage (PTGBD) plays an important role in the treatment of elderly patients and/or patients in poor health with acute cholecystitis (AC). The primary aim of this study is to determine how these factors influence the clinical outcome of PTGBD. Moreover, we assessed the timing and results of subsequent cholecystectomies. PATIENTS AND METHODS: We retrospectively examined the results of 162 patients undergoing PTGBD between 2010 and 2020 (male-female ratio: 51.23% vs. 48.77%; mean age: 71.43 ± 13.22 years). Patient's performance status and intervention outcomes were assessed with clinical success rates (CSR) and in-hospital mortality. The conversion rate (CR) of possible urgent or delayed, elective laparoscopic cholecystectomies (LC) after PTGBD were analysed. RESULTS: PTGBD was the definitive treatment in 42.18% of patients, while it was a bridging therapy prior to cholecystectomy (CCY) for the other patients. CSR was 87.97%, it was only 64.29% in grade III AC. In 9.87% of the cases, urgent LC was necessary after PTGBD, and its conversion rate was approximately equal to that of elective LC (18.18 vs. 17.46%, respectively, p = 0.2217). Overall, the post-PTGBD in-hospital mortality was 11.72%, while the same figure was 0% for grade I AC, 7.41% for grade II and 40.91% for grade III. Based on logistic regression analyses, in-hospital mortality (OR 6.07; CI 1.79-20.56), clinical progression (OR 7.62; CI 2.64-22.05) and the need for emergency CCY (OR 14.75; CI 3.07-70.81) were mostly determined by AC severity grade. CONCLUSION: PTGBD is an easy-to-perform intervention with promising clinical success rates in the treatment of acute cholecystitis. After PTGBD, the level of gallbladder inflammation played a decisive role in the course of AC. In a severe, grade III inflammation, we have to consider low CSR and high mortality.

Surgical Treatment of Esophageal Achalasia in the Era of Minimally Invasive Surgery.

INTRODUCTION: We have analyzed the short- and long-term results of various surgical therapies for achalasia, especially changes in postoperative esophageal function. PATIENTS AND METHODS: Between January 1, 2008 and December 31, 2017, 54 patients with esophageal achalasia were treated in our institution. Patients scheduled for surgery underwent a comprehensive gastroenterological assessment pre- and post-surgery. Forty-eight of the elective cases involved a laparoscopic cardiomyotomy with Dor's semifundoplication, while two cases entailed an esophageal resection with an intrathoracic gastric replacement for end-stage achalasia. Torek's operation was performed on two patients for iatrogenic esophageal perforation, and two others underwent primary suture repair with Heller-Dor surgery as an emergency procedure. The results of the different surgical treatments, as well as changes in the patients' pre- and post-operative complaints were evaluated. RESULTS: No intra-operative complications were observed, and no mortalities resulted. During the 12 to 24-month follow-up period, recurrent dysphagia was observed mostly in the spastic group (TIII: 33%; diffuse esophageal spasm: 60%), while its occurrence in the TI type did not change significantly (14.5%-20.8%). As a result of the follow-up of more than two years, good symptom control was achieved in 93.7% of the patients, with only four patients (8.3%) developing postoperative reflux. CONCLUSIONS: The laparoscopic Heller-Dor procedure provides satisfactory long-term results with low morbidity. In emergency and advanced cases, traditional surgical procedures are still the recommended therapy.

Evaluation of the conversion rate as it relates to preoperative risk factors and surgeon experience: a retrospective study of 4013 patients undergoing elective laparoscopic cholecystectomy.

BACKGROUND: Our aim is to determine the relationships among patient demographics, patient history, surgical experience, and conversion rate (CR) during elective laparoscopic cholecystectomies (LCs). METHODS: We analyzed data from patients who underwent LC surgery between 2005 and 2014 based on patient charts and electronic documentation. CR (%) was evaluated in 4013 patients who underwent elective LC surgery. The relationships between certain predictive factors (patient demographics, endoscopic retrograde cholangiopancreatography (ERCP), acute cholecystitis (AC), abdominal surgery in the patient history, as well as surgical experience) and CR were examined by univariate analysis and logistic regression. RESULTS: In our sample (N = 4013), the CR was 4.2%. The CR was twice as frequent among males than among females (6.8 vs. 3.2%, p < 0.001), and the chance of conversion increased from 3.4 to 5.9% in patients older than 65 years. The detected CR was 8.8% in a group of patients who underwent previous ERCP (8.8 vs. 3.5%, p < 0.001). From the ERCP indications, most often, conversion was performed because of severe biliary tract obstruction (CR: 9.3%). LC had to be converted to open surgery after upper and lower abdominal surgeries in 18.8 and 4.8% cases, respectively. Both AC and ERCP in the patient history raised the CR (12.3%, p < 0.001 and 8.8%, p < 0.001). More surgical experience and high surgery volume were not associated with a lower CR prevalence. CONCLUSIONS: Patient demographics (male gender and age > 65 years), previous ERCP, and upper abdominal surgery or history of AC affected the likelihood of conversion. More surgical experience and high surgery volume were not associated with a lower CR prevalence.

Incarcerated gallbladder in inguinal hernia: a case report and literature review.

BACKGROUND: Treating hernias is one of the oldest challenges in surgery. The gallbladder as content in the case of abdominal hernias has only been reported in a few cases in the current literature. Cholecyst has only been described in the content of an inguinofemoral hernia in one case to date. CASE PRESENTATION: A 73-year-old female patient was admitted to the Emergency Department due to complaints in the right inguinal area, which had started 1 day earlier. The patient complained of cramp-like abdominal pain and nausea. Physical examination confirmed an apple-sized, irreducible hernia in the right inguinal region. Abdominal ultrasound confirmed an oedematous intestinal loop in a 70-mm-long hernial sac, with no circulation detected. Abdominal X-ray showed no signs of passage disorder. White blood cell count and C-reactive protein level were elevated, and hepatic enzymes were normal in the laboratory findings. Exploration was performed via an inguinal incision on the right side, an uncertain cystic structure was found in the hernial sac, and several small abnormal masses were palpated there. The abdominal cavity was explored from the middle midline laparotomy. During the exploration, the content of the hernial sac was found to be the fundus of the significantly ptotic, large gallbladder. Cholecystectomy and Bassini's repair of the inguinal hernia were performed safely. CONCLUSIONS: Following a review of the literature, it can be concluded that the finding of incarcerated gallbladder in the content of an inguinal hernia is a rare finding. No other similar emergency case and successful surgical intervention have been reported before.

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.

Evaluating the distribution of the locations of colorectal cancer after appendectomy and cholecystectomy.

BACKGROUNDS: The number of appendectomies and cholecystectomies performed is gradually increasing worldwide. An increasing incidence of colorectal cancer (CRC) after appendectomy and cholecystectomy has been reported, but the location of tumors in certain segments of the colon and rectum after appendectomy and cholecystectomy is still uncertain. We aimed to evaluate the distribution of the locations of colorectal cancer after appendectomy and/or cholecystectomy in patients who underwent CRC surgery. METHODS: We reviewed the medical records of patients who had undergone CRC surgery between 2015 and 2017 for the presence of previous appendectomy/cholecystectomy. Data were collected from the Colorectal Data Base of the University of Szeged, Department of Surgery. RESULTS: Surgery for CRC was performed in 640 patients during the study period. Data of 604 patients were analyzed. Appendectomy was performed in 100 patients (16.6%), cholecystectomy in 65 (10.8%), and both interventions in 18 (3%) before the CRC surgery. Out of those patients who underwent appendectomy alone, 92 (92%) had undergone appendectomy more than 10 years before the CRC surgery. Also in these 100 patients, the prevalence of right-sided colon cancer (CC) was 35% (n = 35), in comparison with the prevalence among the 504 other patients (20.4%, n = 103). The prevalence of right-sided CC among patients who underwent cholecystectomy alone was 36.9% (n = 24), in comparison with 21.2% (n = 114) of the 539 other patients. CONCLUSIONS: A significant left to right side shift in CRC was noted among patients who had previously undergone appendectomy/cholecystectomy. Because right-sided CC has a worse prognosis, the role of incidental appendectomy and routine cholecystectomy seems that need re-evaluation.

Laparoscopic transperitoneal and retroperitoneal adrenalectomy: a 20-year, single-institution experience with an analysis of the learning curve and tumor size [lap transper and retroper adrenalectomy].

BACKGROUND: The superiority of laparoscopic transperitoneal (TP) versus retroperitoneal (RP) adrenalectomy is an ongoing debate. METHODS: Data from 163 patients (TP: n = 135; RP: n = 28) undergoing minimally invasive adrenalectomy were analyzed. Both operative [intraoperative blood loss, previous abdominal surgery, conversion rate, operative time and tumor size] and perioperative [BMI (body mass index), ASA (American Society of Anesthesiologists) score, time of hospitalization, time of oral intake, histology and postoperative complications] parameters were compared. Both the learning curve (LC) and tumor size were analyzed. RESULTS: We found significant differences in the mean operative time (p = 0.019) and rate of previous abdominal surgery (p = 0.038) in favor of TP. Significantly larger tumors were removed with TP (p = 0.018). Conversion rates showed no significant difference (p = 0.257). Also, no significant differences were noted for time of hospitalization, intraoperative blood loss and postoperative complications. In terms of the LC, we saw significant differences in previous abdominal surgery (p = 0.015), conversion rate (p = 0.011) and operative time (p = 0.023) in favor of TP. Large (LT) and extra-large tumors (ELT) were involved in 47 lesions (LT: 40 vs. ELT: 7), with a mean tumor size of 71.85 and 141.57 mm, respectively. Mean intraoperative blood loss was 64.47 ml vs. 71.85 ml, time of hospitalization was 5.10 vs. 4.57 days and mean operative time was 76.52 vs. 79.28 min for LT and ELT, respectively. CONCLUSION: A shorter operative time and lower conversion rate in favor of TP were noted during the learning curve. TP proved to be more effective in the removal of large-, extra-large and malignant lesions. The RP approach was feasible for smaller, benign lesions, with a more prolonged learning curve.

[Guidance for transanal operations]. / Transzanális mutéti útmutató.

We summarized diagnostic, surgical treatment and follow-up principles of benign and early malignant lesions of the rectum. Our aim is to provide a nationwide practical synopsis of transanal minimally invasive surgical techniques which might be the basis of a Hungarian national audit of rectal polyp management.

[A comparative study of short- and long-term outcomes for transcervical versus transoral surgery for Zenker diverticulum]. / A Zenker-diverticulumok transcervicalis és transoralis sebészi kezelésének összehasonlító vizsgálata, rövid és hosszú távú eredmények.

INTRODUCTION AND AIM: We present our experience with open (transcervical diverticulectomy, cricomyotomy) and transoral surgery (transoral stapler diverticulostomy) for Zenker diverticulums. METHOD: Between 1 January 2006 and 31 December 2016, 29 patients were examined with a symptom-causing Zenker diverticulum. In 13 cases, transcervical surgery, in 16 cases, transoral surgery were performed. Perioperative and long-term results were evaluated and compared. RESULTS: Patients were operated on after an average of 31 months with complaints. In both groups, the leading symptoms were severe dysphagia and severe regurgitation. No intraoperative complication was detected. In the transoral group, one patient had to be reoperated on for bleeding, another patient developed pneumonia in the transcervical group. The average duration of the surgeries (42.5 versus [vs.] 98 minutes, p<0.001), the time to oral feeding (2.9 vs. 4.6 days, p<0.001) and the mean hospital stay (7.3 vs. 9.7 days, p<0.001) were significantly shorter in the transoral group than the transcervical group. 15 patients were completely symptomless postoperatively. After transcervical treatment, complaints were developed in 2 cases (moderate dysphagia and hoarseness). After transoral surgery, recurrent symptoms were observed in 6 patients, 4 had to be reoperated transcervically due to severe regurgitation. CONCLUSION: Transoral stapler diverticulostomy is a fast procedure and offers short hospital stay especially in comorbid, aged patients and intermedium diverticulum size. In the long term, some of the patients may require reintervention due to persistent regurgitation. The transcervical approach has higher perioperative morbidity, which can be performed in patients with less than 3 cm or large diverticulum size. Orv Hetil. 2019; 160(16): 629-635.