Successful treatment of gastrosplenic fistula after sleeve gastrectomy.

INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) is one of the most performed bariatric procedures. But it is also associated with serious and potentially life-threatening staple line-related complications, such as stomach leak and bleeding. CASE REPORT: The article describes a case of surgical treatment of an early fistula between the stomach and the spleen 3 weeks after LSG. We have focused our attention on the diagnosis and possible treatment options for this potentially life-threatening complication. CONCLUSION: Efforts to reduce the frequency of leakage after LSG include a number of different measures. It is advisable to have expert knowledge not only in primary bariatric surgery, but also in the management of problems and reoperations in gastrointestinal surgery. An individualized approach and multidisciplinary teamwork are essential for successful therapy.

Metastatic potential of T1a and T1b non-small cell lung cancer: analysis in the Czech population.

INTRODUCTION: Lung cancer is the most common cause of cancer death in the Czech Republic, in part due to its significant metastatic potential. The aim of this study was to collect real data on the metastatic potential and clinical characteristics of T1a and T1b lung cancer in the Czech population and to investigate potential factors that would predict an increased risk of lymph node metastasis. METHODS: Prospective-retrospective study conducted at the Department of Surgery of the University Hospital Ostrava during the period from January 1, 2015, to July 31, 2022. The study included patients who underwent lobectomy or bilobectomy for T1a and T1b non-small cell lung carcinoma. RESULTS: Out of a total of 165 patients with T1a and T1b lung carcinoma, 17.6% of patients were confirmed to have metastatic involvement of the lymph nodes (with 9.1% classified as N2 lymph node involvement). The highest percentage of positive lymph nodes was observed in patients with tumors located in the upper left lobe (29.5%) and lower right lobe (23.3%). Adenocarcinoma was the most commonly metastasizing carcinoma, with 21.1% of patients showing positive lymph nodes. Neuroendocrine carcinoma metastasized in 19.4% of cases, while squamous cell carcinoma did so in 6.8% of cases. The cumulative risk of having positive lymph nodes in T1a and T1b adenocarcinoma located in the upper left lobe reached 40.0%, of which the risk of N2 lymph node involvement was 25.0%. CONCLUSION: T1a/b non-small cell lung cancer exhibits significantly lower metastatic potential than T1c tumors and higher. Adenocarcinoma showed a 3-fold higher metastatic potential than squamous cell carcinoma, indicating the need for increased attention in the treatment of lung adenocarcinoma, especially in tumors localized in the upper left lobe, where a cumulative risk of lymph node metastasis of up to 40% was observed.

Innovative trends in surgery: a robotic approach to retrotracheal goitre.

The retrotracheal form is a rare variant of retrosternal goitre. The incidence is low, representing approximately 4% of all retrosternal goitres. The traditional approach to the treatment of this type of pathology is the cervical approach combined with high thoracotomy. Recently, however, new methods and technologies have begun to emerge that also open new possibilities for the surgical management of these conditions. The aim of this case report was to present the potential of a video-robotic approach in the treatment of retrotracheal goitre. The authors have successfully used this innovative method in the treatment of retrotracheal lesions, bringing hope for more effective and less invasive surgical interventions in this difficult-to-access area.

Allen-Masters syndrome as a cause of status ileus - case report.

INTRODUCTION: Internal hernias are rare and are encountered in a small percentage of cases. The hernia in the broad ligament of uterus (Allen-Masters syndrome) is a unique type of internal hernia which represents only approximately 4% of all internal hernias. CASE REPORT: We present the case of a 39-year-old woman admitted for clinical signs of mechanical bowel obstruction. CT examination revealed a dilated loop of small intestine in the left lower abdomen. The patient underwent laparoscopic surgery with the finding of an incarcerated small bowel loop in the ligamentum latum uteri. Small bowel deliberation and ligament defect suture were performed. CONCLUSION: A defect in the ligamentum latum uteri (Allen-Masters syndrome) is a rare diagnosis, usually discovered as an incidental finding in female patients with ileus. This syndrome may explain the vague problems of many patients whose symptoms include dyspareunia, dysmenorrhea, acute and chronic pelvic pain. Allen-Masters syndrome can be diagnosed and successfully managed by laparoscopic approach.

Laparoscopic repair of perforated peptic ulcer - routine procedure or targeted patient selection?

INTRODUCTION: Peptic ulcer is one of the most common diseases of the proximal gastrointestinal tract. Its complications are relatively common, the most serious one being peptic ulcer perforation with the incidence of about 10 cases per 100,000 population per year and the mortality rate of 10-40%. Surgical suture via laparoscopy or laparotomy is the only treatment option. The aim of the study was to compare the short-term results of laparoscopic and open repair of acute peptic ulcer perforation and evaluate the accuracy of the Boey scoring system in the Czech population. METHODS: Retrospective study conducted at the surgical department of the University Hospital Ostrava. The patients underwent laparoscopic or open repair of perforated peptic ulcer in 2017-2021. RESULTS: The study included 60 patients; laparoscopic repair was performed in 43.3% of the patients, and open repair in 56.7%. Postoperative morbidity was 70.0%, mild complications were reported in 23.3% of the patients, and severe complications in 16.7%. Patients undergoing the laparoscopic repair showed a higher incidence of mild as well as severe complications (26.9% vs 20.6% and 19.2% vs 14.7%) but also a higher incidence of an uncomplicated postoperative course. Overall postoperative mortality was 30.0% (laparoscopy 15.4%, laparotomy 41.2%). The study results confirmed the estimated baseline risk of mortality based on the Boey score. CONCLUSION: Laparoscopic repair may be the procedure of choice for patients with no or low risk factors. Patients undergoing laparoscopy showed a higher incidence of mild and severe complications. The higher mortality of patients after open repair is related to their worse initial clinical condition. Preoperative determination of mortality risk using the Boey score is accurate and appropriate in terms of choosing the surgical approach.

Our technique of thoracoscopic first rib resection - case report.

INTRODUCTION: First rib resection is a standard surgical treatment for decompressing the neurovascular structures in thoracic outlet syndrome (TOS). Historically, open approaches were used. In this report, we present technical details of thoracoscopic first rib resection. CASE REPORT: This year, we performed two operations in a row using this mini-invasive technique. Three ports were introduced. The used equipment included a laparoscopic camera (30 degree), endoscopic grasper, harmonic scalpel, long neurosurgical bone punch and a long intervertebral disc rongeur. The first rib was cut, separated and removed under thoracoscopic control. CONCLUSION: Thoracoscopic first rib resection for TOS is a safe and promising technique.

Latex and silicone drains in surgery − is the ban on rubber drains really a step forward or rather a step back?

The use of silicone and latex drains is an integral part of surgical practice. Experience and the review of the world literature show that silicone drain is characterized by a much lower rate of fibrotic reaction of the tissue around the drain. The ability of a latex, or rubber, or popularly called rubber drain, to induce the formation of ligaments in its surroundings is advantageously used in situations where the targeted formation of scar tissue is desired. This feature is absent in silicone drains. However, nowadays the rule in most surgical departments is to use almost exclusively silicone drains, which is based on prevention of latex allergy. This article is devoted to the description of the different and mutually irreplaceable use of silicone and latex drains. Subsequently, he also discusses the question of whether the twilight of the use of latex drains in modern medicine is really progress, or rather retrogression.

Technical modifications of appendiceal transection during laparoscopic appendectomy.

INTRODUCTION: Appendiceal transection is the most critical part of laparoscopic appendectomy (LAPPE). The aim of our study was to evaluate post-operative and economic outcomes of laparoscopic appendectomy with different technical modifications of transection of the appendix. METHODS: This was a prospective, randomized, unicenter clinical study comparing different techniques of appendiceal transection in patients with acute appendicitis during the study period (18 months). The patients were randomized to one of three arms - endoloop, hem-o-lok clips and the stapler. RESULTS: In total, 120 patients were enrolled in the study. The shortest operative time was noted in the hem-o-lok arm (37.3 minutes); mean length of hospital stay (3.7 days) was comparable in all study arms. Postoperative morbidity was 6.6%; all recorded complications were SSIs (Surgical Site Infections). The number of postoperative complications was comparable in all study arms. Mean direct costs of laparoscopic appendectomy were lowest in the hem-o-lok arm. According to our findings, LAPPE is not a profit making surgery irrespective of the type of appendiceal transection (mean profit in the study patients was CZK -4019). CONCLUSION: The rate of postoperative complications was similar for all the technical modifications of appendiceal stump closure. As indicated by the study outcomes, hem-o-lok clips have the potential of becoming the method of choice in securing the appendix base during LAPPE.

An alternative method of surgical treatment in refractory GERD following laparoscopic sleeve gastrectomy.

Obesity has become a global problem with increasing prevalence. Undoubtedly, bariatric surgery is the most effective way to treat morbid obesity. Laparoscopic sleeve gastrectomy (LSG) is currently the most commonly performed bariatric procedure worldwide. The prevalence of gastroesopha-geal reflux disease (GERD) is also increasing, a close association with increasing prevalence of obesity being regarded as the main cause of this trend. The relationship between LSG and GERD is still unclear, at least controversial. If GERD occurs in the postoperative period, the first therapeutic intervention is initiation of proton pump inhibitors (PPI) treatment, which is effective in the vast majority of patients. In patients resistant to this treatment, conversion to laparoscopic Roux en Y gastric bypass (LRYGB) is usually necessary. The authors present the case report of a patient who developed GERD in the longer postoperative period and conversion to LRYGB was not appropriate due to previous complications and surgical procedures. Therefore, this patient was managed operatively by an alternative method - hiatoplasty with partial posterior fundoplication. The success of the treatment was confirmed clinically by disappearance of GERD symptomatology postoperatively even after PPI discontinuation. LRYGB is the method of choice for GERD after restrictive bariatric procedures. However, some patients are not suitable for conversion to LRYGB, and alternative treatment options are therefore needed.

[Radiotherapy in the treatment of rectal cancer is it time to move on?] / Radioterapie v lécbe karcinomu rekta - cas na zmenu?

Multidisciplinary treatment approach in accordance with current guidelines represents a gold standard of care for patients with rectal cancer. Radical surgical resection is a fundamental and the only curative treatment modality. Patients with locally advanced rectal cancer (cT3-4N0M0 or anyTN1-2M0) are indicated for neoadjuvant radiotherapy or radiochemotherapy. However, there are many controversies regarding neoadjuvant radiotherapy indications in the available literature. Evidence-based medicine data suggest that neoadjuvant radiotherapy is associated with improved local control of the disease, but has no impact on patients survival. Moreover, neoadjuvant radiotherapy is associated with less favorable perioperative outcomes and significantly deteriorates anorectal function of patients after sphincter-preserving rectal resections.Key words: rectal cancer - radiotherapy - postoperative morbidity - survival - functional outcome.

[Current standards of care in the management of patients with abdominal sepsis]. / Soucasné standardy v péci o pacienty s brisní sepsí.

INTRODUCTION: Abdominal sepsis patient management is an issue of high current importance, and the amount of knowledge keeps increasing and changing the approach to critically ill patients with abdominal sepsis. METHODS: Literature search (in MEDLINE, PubMed and Google Scholar databases) was done, focused on identification of relevant studies. The aim of this paper is to provide a review of current trends in diagnosing and predicting the prognosis of, and recommended treatment standards for patients with abdominal sepsis. RESULTS: Abdominal sepsis is defined as the Systemic Inflammatory Response Syndrome (SIRS) with an abdominal infection requiring a surgical intervention to control the source; or SIRS with an infection within 14 days after any major surgery. Although many different monitoring and scoring systems exist, daily careful clinical examination is the most reliable diagnostic tool in identification of septic patients. Whenever abdominal sepsis is suspected, the gold standard comprises immediate administration of broad-spectrum antibiotics, transferring the patient to the intensive care unit, with surgical intervention and supportive intensive care based on current guidelines of the Surviving Sepsis Campaign. Source control surgery is the principal therapeutic modality for patients with abdominal sepsis. The most relevant negative prognostic factors include clinical signs of septic shock and the necessity of high doses of catecholamines. CONCLUSION: Early identification of septic patients and prompt implementation of a complex, evidence-based interdisciplinary approach are the principal conditions for improving healthcare outcomes of care provided to patients with abdominal sepsis.

[A giant gastrointestinal stromal tumour - a case report]. / Obrovský gastrointestinální stromální tumor - kazuistika.

Gastrointestinal stromal tumours represent a group of non-epithelial gastrointestinal tumours that have both benign and malignant character. Most frequently, they occur in the stomach and the intestine; however, as regards their overall incidence, they are rather infrequent tumour lesions. The present case report describes a rare bulky extragastrointestinal stromal tumour originating from the mesenterium in a young patient. Its anatomical and histological picture, diagnosis and treatment are described. Our work points to the necessity for physicians to also bear in mind the less likely options and highlights the role of surgery in the treatment of such voluminous findings.

[NOSE (Natural Orifice Specimen Extraction) in laparoscopic colorectal surgery]. / NOSE (Natural Orifice Specimen Extraction) v kolorektální chirurgii.

INTRODUCTION: The aim of this study was to asses our initial first experience with NOSE techniques in laparoscopic colorectal surgery with both transanal and transvaginal extraction. MATERIAL AND METHODS: In this prospective study, the authors analyzed data from patients in whom NOSE laparoscopic sigmoid, rectosigmoid and rectal resections were performed in the Department of Surgery, University Hospital Ostrava, from May 2011 to October 2011. A group of 7 patients was analyzed based on demographic characteristics (sex,age and BMI). Tumor localization, type of extraction (transanal/transvaginal), the number of removed lymph nodes, tumor size, histology and length of the specimen were also assessed. Furthermore, the following intraoperative data were evaluated: duration of the procedure, frequency of intraoperative complications and conversion rate. During the postoperative period, duration of hospitalization and morbidity rates were evaluated. RESULTS: The patient group included 2 male (28.6%) and 5 female (71.4%) subjects, their median age was 70 years (61-80), BMI 26,76 (24.76-34.67). The pathology was located in the sigmoid colon in 4 cases (57.1%) and in the proximal rectum in 3 cases (42.9%). Transanal extraction was performed in 5 patients (71.4%) and transvaginal extraction in 2 patients (28.6%). The average number of harvested lymph nodes was 13 (10-15), the average lenght of specimen was 16 cm (13-20) and the average tumor size was 4 cm (2-6). Histologically, adenocarcinoma was confirmed in 6 cases (85.7%), and low grade adenoma in 1 case (14.3%). The median duration of surgery was 205 min (140-300) and no intraoperative complications were recorded. No surgical conversion was required. No postoperative complications occured and the median duration of of hospital stay was 7 days (5-11). CONCLUSION: In the selected group of patients, NOSE technique proved to be a safe technique for laparoscopic colorectal procedures, reducing the risk of incisional complications while maintaining the principles of oncological radicality. Therefore, it may be considered a bridge towards NOTES (Natural Orifice Transluminal Endoscopic Surgery), surgery without scars.

[Nuss miniinvasive procedure for pectus excavatum in adolescents and adults]. / Miniinvazivní operace pectus excavatum u adolescentu a dospelých dle Nusse.

Pectus excavatum is a congenital chest wall deformity with depression of the sternum and adjacent costal cartilages. Severe forms of this deformity lead not only to psychosocial deprivation but also limit physical performance due to lung volume reduction and cardiac compression. Open surgical correction using stemochondroplasty represented the gold standard of surgical treatment of pectus excavatum. Miniinvasive technique of corrective steel bar insertion was published in 1998. Since then, so called Nuss operation has become widely accepted. Good experience with this type of the pectus excavatum correction have encouraged us to adopt this procedure. We use this technique not only in children and adolescencents but also in adults suffering from depressed anterior chest wall. We present our initial experience with the treatment of nine patients. We describe the benefits and pitfalls of the method which are known to us.

[Giant Zenker's diverticulum--case report]. / Obrovský Zenkeruv divertikl--kazuistika.

Zenker's diverticulum is one of the most common esophageal diverticuli. The reported prevalence in Czech population is approx. 0.5%, typically presents in the elderly. A small Zenker's diverticulum can be asymptomatic. When a diverticulum increases in size, it can cause regurgitation and dysphagia and the condition is often complicated by aspiration and reccurent pneumonia. The diagnosis can be made on a barium esophagogram and CT scan. Surgical therapy is the treatment most commonly offered and the prognosis is excellent. Here we report a 66-years-old male presenting with bleeding from large Zenker's diverticulum. He was immediately admitted to hospital. A computed tomography scan showed a large Zenker's diverticulum protruding into the right superior hemithorax. Resection was chosen as a therapeutic option. Due to the size of the diverticuli his recovery post operation was complicated by fever, bleeding into mediastinum from the place of resection and temporary functional esophagi disorder. Histological examination confirmed ulceration inside the diverticulum as the source of bleeding. Three weeks after the surgery the patient was discharged home in a stable condition with recovered swallowing and phonation.