Midgut volvulus in adult age associated with congenital malrotation - case report.

INTRODUCTION: Malrotation is understood as a congenital anomaly of the intestinal position formed during embryonic development. Disorders of intestinal rotation and its manifestations in adulthood are less common; the symptoms of these disorders are characteristic of childhood. An asymptomatic bowel rotation disorder occurs in up to 1 of 200 newborns and symptomatic malrotation occurs in 1 of 6,000 live newborns. The incidence of intestinal rotation disorders in adulthood is estimated to be between 0.0001% and 0.19%. Acute complications in adulthood include volvulus with ischemia of the small bowel. CASE REPORT: A 36-year-old man with a previously diagnosed bowel rotation disorder with intermittent abdominal pain was examined for sudden convulsive pain. The CT scan showed volvulus of small bowel. During surgery, a small bowel volvulus with venostasis and dilated mesenteric veins rotated 360 degrees clockwise, the mesenterium commune, and the presence of Ladds bands causing partial compression of the duodenum were found. The condition was managed surgically to derotate the loops into nonrotation with preserved viability of the intestinal loops, interrupt the Ladds bands and mobilize the duodenum, including fixation of the mesentery to the retroperitoneum and invagination appendectomy. The patient has been without problems and without any signs of complications based on his 2-year follow-up from the surgery. CONCLUSION: Early surgical treatment of intestinal malrotation complications helps maintain intestinal viability and can prevent the development of the short bowel post-resection syndrome. Prophylactic surgery should be considered in symptomatic rotation disorders, although the determination of the indication for surgery and its timing remain uncertain.

Management of ileocolic intussusception in the Czech Republic.

INTRODUCTION: Ileocolic intussusception is one of the most frequent causes of acute abdomen in infants and toddlers. The purpose of this study was to evaluate the treatment of ileocolic intussusception in the Czech Republic in 2019. METHODS: Fourteen departments of paediatric surgery participated in this multicentre retrospective study. A SurveyMonkey Inc. questionnaire was used for anonymous data collection of patients with ileocolic intussusception. RESULTS: In 2019, ileocolic intussusception was diagnosed in 162 patients; median age was 30 months (3 months to 9.5 years). Contrast enema was indicated in 133 patients, primary surgery in 14 patients and spontaneous reduction was found in 15 patients. All departments using contrast enema had a success rate of 89.5%; 12 departments approached the contrast enema procedure under general anaesthesia (including myorelaxation at 7 departments) and 2 departments under sedation. Contrast enema under general anaesthesia with/without myorelaxation was significantly more successful than contrast enema under sedation (108/113, 95.6% vs 11/20, 55%; p.

Current management of diffuse peritonitis - is postoperative continuous lavage still a relevant method of choice?

INTRODUCTION: Diffuse peritonitis is a serious disease with rather poor therapeutic results. Management traditionally consists in the surgical treatment of its etiology, combined with targeted antibiotic therapy and complex intensive care of the patient. The basic procedure includes the identification and treatment of the origin of peritonitis, followed by thorough abdominal cavity toilet, lavage and drainage. There are currently two major procedures for carrying out complex surgical care of a patient suffering from diffuse peritonitis. The first one is primary sanation of the abdominal cavity, in which toilet, peroperative lavage and postoperative drainage is performed. The second procedure involves similar steps, but postoperative irrigation with saline or another solution is performed, usually over 2448 hours - continuous lavage. Both procedures, albeit often modified, are still used in most surgical departments in the Czech Republic; therefore, we decided to compare them in terms of morbidity, mortality and hospital length of stay. METHOD: We conducted a prospective randomized study involving 55 patients with peritonitis operated on from 10/2012 to 4/2014. Whenever possible, we tried to use both methods alternately method regularly to enable randomization and ensure presentable outcomes. RESULTS: No statistically significant difference related to morbidity, mortality and hospital length of stay was recorded in our group. CONCLUSION: Based on our results, we can state that both methods are equal and suitable for all types of diffuse peritonitis without any impact on mortality, morbidity and hospital length of stay. Key words: peritonitis - drainage peritoneal lavage.

[Circumscribed and diffuse peritonitis: severe complications in bariatric and metabolic surgery; specifics related to their diagnosis and therapy]. / Cirkumskriptní a difuzní peritonitis: závazné komplikace po operacích bariatrické a metabolické chirurgie, specifika pri jejich diagnostice a terapii.

INTRODUCTION: Cases of localized and diffuse peritonitis are severe surgical conditions. Despite expanding possibilities for the diagnosis and therapy, patients with peritonitis, its diffuse form in particular, still suffer from high morbidity and mortality. The management of this condition, both in the healthy and especially seriously ill population, is not satisfactory. Recently, we have witnessed an increase in bariatric and metabolic surgery in response to an ever rising number of extremely obese patients worldwide. Bariatric patients belong to a group of seriously ill patients with a significant risk of post-operative complications due to an infection. Although their treatment is identical to that of the normal population, a great emphasis is put on early recognition of complications, and the decision on any potential surgical revision should be actively approached, often necessitating the absence of frequently lengthy paraclinical assessments. METHODS: We conducted a retrospective analysis of 346 obese bariatric patients undergoing surgical treatment for morbid obesity between August 2011 and August 2015. RESULTS: A total of 6 patients experienced severe complications including two cases of diffuse peritonitis, two cases of localized peritonitis and two cases of intraperitoneal bleeding. One patient died after her discharge from hospital due to toxic shock caused by stomach perforation. We describe two case reports in greater detail to highlight the importance of early detection of complications and a timely surgical intervention. CONCLUSION: In principle, bariatric patients are a severely ill population where standard diagnostic procedures for post-operative complications often fail. Clinical findings and the surgeons experience are commonly the only diagnostic signs that trigger a surgical revision. In contrast, surgical treatment of post-operative complications in obese patients with peritonitis is virtually identical to that in patients with normal or slightly increased BMI. It involves thorough toilette of the abdominal cavity, lavage and drainage. Due to high morbidity and large peritoneal surface, obese patients may deteriorate rapidly. Timely surgical intervention is thus the only proper therapeutic approach, even without any, often lengthy paraclinical assessments. KEY WORDS: peritonitis - bariatric surgery - complications in bariatric surgery.

[HELLP syndrome complicated by liver rupture - case report]. / HELLP syndrom komplikovaný rupturou jater - kazuistika.

OBJECTIVE: A case of HELLP syndrome complicated by liver rupture in the 36th week of pregnancy. DESIGNS: A case report. SETTING: Department of Obstetrics and Gynaecology, FN Olomouc. CASE REPORT: The authors report a case of 31 years old female patient who came to the hospital at 36th week of pregnancy with epigastric pain lasting about 14 days. The problems became worse in the last 10 hours. At admission, the patient was pale with repeatedly unmeasurable blood pressure, and she had lower limbs oedema. There was performed the caesarian section, during the operation the liver rupture was found. Both, patient and her baby, was saved thanks to the concerted interdisciplinary team work. CONCLUSION: One of the most serious complications of HELLP syndrome is liver rupture. It occurs in 3.8% of HELLP syndrome cases. The solution of this complication is to perform an acute operation. The operation is based on liver suture with application of deep mattress suture, applying hemostatic materials, liver compression by Mikulicz´s tamponade or ligation of liver artery. There is also possibility to use omentoplasty. If there is necessity of liver resection for necrotic focus, the argon coagulative laser is used preferably.

Retroperitoneal bronchogenic cyst: prenatal diagnosis of cystoid formation, its progression and surgery.

AIM: Presentation of a rare localization of bronchogenic cyst in retroperitoneum. MATERIAL: A case of a patient with retroperitoneal localization of a bronchogenic cyst with a prenatally diagnosed cystic formation. The surgery was indicated at the age of 6 owing to the progression of lesion. The histopathological examination of removed cyst revealed the diagnosis of bronchogenic cyst. For four years following the surgery, the patient was clinically free of complications. The regularly performed ultrasound examinations of the abdomen have been showing normal findings. CONCLUSION: Despite the fact that retroperitoneal localization of bronchial cyst is very rare it should be considered in differential diagnosis (Fig. 3, Ref. 16).

[An original reconstruction of stomach after gastrectomy for cancer]. / Vlastní modifikace rekonstrukce zaludku po gastrektomii pro karcinom.

The aim is to present gastrectomy/D2 lymphadenectomy technique with stomach substitution with "J-pouch". The description of gastrectomy/D2 lymphadenectomy with the following reconstruction of upper GI part comes from a standardized technique as well as from the experiences of the authors. The technique of "J-pouch" with the anti-reflux cuff is a reconstruction modification created by the authors. "J-pouch" is created in the aboral half of interponate jejunal loop with the following reconstruction with esophagojejunostomy end-to-side and antireflux cuff creation. On the distal end is the jejuno-duodenostomie side-to-end created. The reconstruction with "J-pouch" after gastrectomy is an advantageous technique. It creates the needed reservoir and retains the physiological orientation through duodenum. These two factors lead to the improvement of life quality for patients after gastrectomy. This technique is safe and standard to perform according to the authors' experience.

[Rare umbilical anomalies]. / Vzácné pupecní abnormality.

INTRODUCTION: Umbilicus is a scar, which is the place of the previous merger of the fetus with the umbilical cord. After birth, it has no known function, however, unless the umbilical annulus is completely closed, umbilical hernia may occur. Umbilical scar is also an area where may occur a number of anomalies that may be present alone or together with umbilical hernia. Failure of involution leads to persistence of omphalomesenteric duct and urachal remnants. These embryonic remnants may cause more or less significant clinical problems, or may be completely asymptomatic and may be diagnosed at random. MATERIALS AND METHODS: The authors present their own group of patients who were diagnosed and dealt with the defect omphalomesenteric duct or urachus. In past 7 years we observed 35 children with these abnormalities. A large group of patients represents incidental findings during elective surgery for umbilical hernia. Another large group are patients with symptomatic or asymptomatic Meckel's diverticulum. The anatomical observations, clinical manifestations, complications and treatment of these anomalies are mentioned. RESULTS: A total of 35 children were found with these birth defects. In 23 cases we observed omphalomesenteric duct disorders and 12 urachal remnants were reported. Of these, 12 abnormalities were found incidentally during elative procedure for umbilical hernia. Asymptomatic or symptomatic Meckel's diverticulum appeared in 16 cases. Surgical treatment included resection or exstirpation, if urachal anomaly was accompanied then partial resection of the bladder vertex was added. Postoperative complications emerged in 4 cases, three times it was ileus from adhesions 6 months after surgery, once postoperative cystitis appeared and was treated conservatively. CONCLUSION: Birth abnormalities of the umbilicus are relatively rare diseases that may occur in the pediatric population. Omfalomesenteric duct and urachal anomalies constitute a major group of these congenital disorders and are often associated with umbilical hernia. They can be diagnosed soon after birth or later in life. Surgical treatment involves excision or radical exstirpation to prevent early or late complications (urachal carcinoma in adulthood).

[Quality of life after gastrectomy]. / Kvalita zivota po gastrektomii.

AIM: The comparison of quality of life after gastrectomy. METHOD: Quality of life after gastrectomy is compared in open, prospective, randomised trial. The group with Roux-en-Y reconctruction and "J-pouch" reconstruction are compared. "J-pouch" is created using interponate jejunum loop with keeping duodenum in passage. The standardized questionnaire according to Eypasch is tool for comparison of quality life. The statistical evaluation was performed using Student t-test. RESULTS: 67 patients were analyzed altogether. The average quality of life in the group with Roux-en-Y reconstruction was 92.6 points and in the "J-pouch" group was 102.5 points. The statistical comparison of quality of life using Student t-test in the group with Roux-en-Y and "J-pouch" reconstructions confirmed significant difference (p = 0.0067). CONCLUSION: Quality of life in patient after gastrectomy represents the most important factors after surgery. The standardised questionnaries help to quantify quality of life and provide the necessary data for evidence based medicine. The statistical comparison confirmed the higher quality of life in patients with "J-pouch" reconstruction. The possibility of reconstruction providing better nutrition and higher quality of life should be considered.

[Iatrogenic bile ducts injuries]. / Iatrogenní poranení zlucových cest.

AIM: To evaluate therapeutic options and outcomes of repair of iatrogenic bile duct injuries during cholecystectomy, which were solved in our institution over the past five years. The incidence of this injury is stated in the range of 0-0.4% for open cholecystectomy and 0-0.7% for laparoscopic cholecystectomy. METHODS: Authors present a group of ten patients who were operated on for iatrogenic bile duct injury incurred during cholecystectomy in 2005-2009. All patiens were refered from other hospitals. Three men and seven women aged 20-71 years. The bile duct injury occured twice during open procedure and during laparoscopic procedure in eight. Incomplete lesion was idenified in one case, complete lesions with tissue loss were found in nine patients. Right hepatic artery injuries were found in four patients with tissue loss injury. Nine patients required reconstruction of the biliary tract using hepaticojejunoanastomosis with Roux-Y loop. RESULTS: The bile leak occurred in two patients after reconstruction. In one patient was required early percutaneous transhepatic drainage. The early death occurred in a patient with a complicated course, where our reconstruction of the biliary tract was already in the field of advanced biliary peritonitis as a third operation during 7 days. All other patients are monitored postoperatively at regular intervals in our clinic. They carried out clinical examinations and monitoring of liver enzymes. In the long interval from reconstruction (6-12 months) anastomotic stenosis occurred in three patients. Postoperative radiological intervention in the form of dilation of anastomosis and prolonged transient transanastomotic drainage was necessary (the duration of drainage was 6-7 months). CONCLUSION: Iatrogenic bile duct injury is a serious condition threatening the patient's life from the progressive failure of liver function on the basis of secondary biliary cirrhosis. Due to the nature of lesions arising from laparoscopic cholecystectomy (loss tissue injuries, thermal damage to surrounding structures, the hepatic artery injuries) reconstructions are extremely difficult. For most patients reconstructive operations are the last possible surgical procedures in this area, except for liver transplantation. Hilar reconstructions have a higher probability of stenosis of the anastomosis. If they occur, there are repeated cholangitis, which pass into the secondary sclerosing cholangitis and cause secondary biliary cirrhosis, with all the consequences of disease (portal hypertension, bleeding esophageal varices). For these reasons, it is necessary for careful long-term postoperative monitoring of liver function and good interdisciplinary cooperation, especially with the intervention radiologist in management postoperatively evolving stenosis of anastomoses. It is necessary for the early identification and indication of radiological interventions in order to prevent damage to the liver parenchyma.

Efficacy and complications of orbital fat decompression in Graves' orbitopathy: a systematic review and meta-analysis.

In Graves' orbitopathy, surgical decompression is often needed for functional and aesthetic reasons. This meta-analysis was performed to assess the efficacy and safety of fat removal orbital decompression (FROD) alone to treat exophthalmos in Graves' orbitopathy. A systematic search was conducted in PubMed/MEDLINE, Web of Science, and Cochrane Library for studies published before August 2018. Random-effects meta-analyses were applied; weighted means and weighted proportions with corresponding 95% confidence intervals (CI) were calculated. Study quality and quality of evidence for each individual outcome were analyzed. Of 1908 records initially identified, 13 observational studies were selected, representing 4820 orbits in 2514 patients. Weighted Hertel exophthalmometry was 23.10mm (95% CI 21.77-24.43mm) preoperative and 19.31mm (95% CI 17.81-20.81mm) postoperative. The weighted mean difference was 3.81mm (95% CI 3.41-4.21mm). Five studies reported an improvement of diplopia after surgery, occurring in 943 of 1172 patients (weighted proportion 0.50, 95% CI 0.15-0.85). Persistent new onset diplopia was reported in five studies, or 124 of 1277 patients (weighted proportion 0.15, 95% CI 0.03-0.27). No serious adverse events were reported. Results support the effectiveness and safety of FROD to treat mild-to-moderate exophthalmos in Graves' orbitopathy. Prospective and controlled trials are needed to improve the level of evidence.

[Gastric carcinoma surgery outcomes during 2004-2008]. / Výsledky chirurgické lécby karcinomu zaludku v období 2004-2008.

Gastric carcinoma is a malignancy, frequently manifesting itself in late stages, with metastatic spread into lymph nodes. Resection is the only curative therapy. A total of 149 gastric carcinoma patients were operated in the Ist Surgical Clinic during the studied five- year period. The pre-operative disease staging included the PET-CT examination, as a standard. Total gastrectomy (GE) was completed in 109 subjects, while 12 subjects underwent subtotal GE. The both procedures included D2 lymphadenectomy. In selected cases, the surgery included upper polar resection (7 subjects). Paliative resections or explorations were performed in 21 subjects. During the postoperative period, no complications were recorded in 90% of the patients, however, two subjects exited. The postoperative complications recorded included adhesive ileus in a single subject, subphrenic absces in two subjects, esophago-jejuno-anastomosis fistule in 8 subjects and a duodenal stub fistule in one female patient. Total or subtotal gastrectomy with D2 lymphadenectomy are standard procedures in gastric carcinoma patients. Mortality and morbidity rates of radical surgical procedures for gastric carcinoma should correspond with data presented in the literature.

Treitz's hernia.

Treitz's hernia is the eponymous name for a paraduodenal hernia. These are rare hernias that arise in the potential spaces and folds of the posterior parietal peritoneum adjacent to the ligament of Treitz. Presentation may be acute with small bowel obstruction or bowel ischaemia, or with chronic intermittent abdominal pain. Treatment is by surgery, due to the high (50%) lifetime risk of obstruction. Here, we present two cases from our own institution and review the literature regarding the embryology, anatomy, cross-sectional imaging and surgery of these fascinating hernias.

Do we really apply fast-track surgery?

AIM: The aim of this study is to show the current view on fast-track programs optimizing the perioperative care. METHODS: Authors searched Medline databases and identified current trials regarding all factors of fast-track programs. They analyzed these trials and identified the most important principles of fast-track programs based on trial analysis. RESULTS: The most important principles are consistent in all individual trials. Most of authors recommend 10-12 issues. All authors emphasize early mobilization of patients after surgery and early introduction of peroral nutrition. Fast-track programs shorten the duration of hospitalisation and decrease morbidity. CONCLUSION: The perioperative care is characterized by a range of trussing traditions. Fast-track surgery optimizes the perioperative care. It is a safe method according to the trials. The implementation of single fast-track surgery factors is very slow (Tab. 2, Ref. 49).

[Post-gastrectomy reconstruction]. / Rekonstrukce po gastrektomii.

AIM: Authors present review of current opinion in reconstruction of gastrointestinal tract after gastrectomy, in pouch benefit and benefit of retaining of the duodenum in food transit, and the importance of antireflux procedure. METHOD: Authors searched the Medline database for current trials regarding the reconstruction of gastrointestinal tract after gastrectomy. The key words were gastrectomy, reconstruction, and upper GI. The search was limited to those languages: English, German, and Czech. The authors identified 41 trials altogether. The trials were analysed regarding the pouch benefit and the retaining of duodenum in food transit. The comparison was done. CONCLUSION: The trials' results are not homogenous. Many patients are not possible to be evaluated because of the tumor recurrence with weight loss and other symptoms. There is no ideal reconstruction according to the trials. Patients can benefit from the reconstruction retaining the duodenum in food transit and with pouch creation. The retained duodenum in food transit is anormal stage from the anatomical and physiological view. In the case that pouch allows the proportional evacuation of food, the retaining of duodenum is advantageous. The pouch combined with antireflux procedure has a potential to improve life duality from longer perspective. On the other side, some authors present opinion that the reconstruction with pouch is too complicated with worse patient perioperative tolerance and its benefit is minimal. There is a very small number of prospective randomized trials which present a very small number of patients without statistical significance. It is important to perform a larger prospective randomized trial.

[What does NOTES yield?]. / Co prinásí NOTES?

INTRODUCTION: The aim of this review is to inform about the possibilities offered by NOTES (Natural Orifice Transluminal Endoscopic Surgery). This technique allows to access into the peritoneal cavity, respectively thoracic cavity, through natural orifices using endoscopical visualization. This technique unites the skills of surgeons and endoscopists. MATERIAL: The laparotomy or laparoscopy (in parallel into the thoracic cavity) was required for the access into the peritoneal cavity (thoracic cavity) historically. NOTES uses the following accesses: transgastric, PEG-like access, transcolical, transvesical, transvaginal with or without possible mini-laparoscopical control. Since the introduction of this method for the first time in 2004, many studies have been published. Using the databases Medline the authors searched the current view on NOTES technique. They focused on current possibilities offered by this technique. They searched advantages of this technique and its weak points as well. They looked at recommendations leading to the application of this technique for human. RESULT: More than 100 articles focusing on this subject were published together according to Medline. The single articles present animal studies, technical problems, and suggestions for technical equipment improvement and review articles. They are verbal presentation about successful transgastric or transvaginal appendicectomy or cholecystectomy by humans. CONCLUSION: They are many controversies obstructing introduction of this method into common praxis. This technique is undergoing an immense progression and it is not possible to only passively observe this dynamic development, but it is necessary to actively make the indications and contraindications for the possible usage of this method.

EVALUATION OF PERIPHERAL AND FOCAL VISION in PROPRIOCEPTIVE DIFFERENTIATION OF UNDERFOOT INVERSION ANGLES: COMMENT ON WITCHALLS, ET AL. (2013) (.).

A study by Witchalls, et al. (2013) mentioned that the addition of focal vision to proprioception testing with walking produces greater proprioceptive acuity than peripheral vision alone (measured ankle proprioception in athletes with or without chronic ankle instability during a stepping task on the Active Movement Extent Discrimination Apparatus; AMEDA). According to this study, people with impaired proprioception, e.g., athletes with chronic ankle instability, may profit from looking down during walking or running. This commentary notes that the active stepping task may not be truly comparable to rhythmic stepping, which is characteristic for walking. In addition, we suggest several amendments to the methodology for further studies related to ankle proprioception measurement, e.g., monitoring of proband eye attention during a stepping task or clear objective evaluation of the subject sample.

Reconstruction after total gastrectomy.

After total gastrectomy it is necessary to realize the reconstruction of the upper part digestive tract. It is necessary to choose the reconstruction method, which provides good life quality, and extensive physiologic regulation of gastrointestinal hormones after total gastrectomy. There is no ideal reconstruction method. Nowadays there are about 70 kinds of reconstruction methods. It is very important to preserve the duodenal passage. Also the production of reservoir is important. The conclusions of studies are not homogeneous. The patients can benefit from the reconstruction preserving duodenal passage and formed by pouch. (Fig. 1, Ref. 23.).

[The Lotheissen-McVay operation for inguinal hernia]. / Operace tríselné kýly podle Lotheissena-McVaye.

AIM: The authors evaluated the results of operation for inguinal hernia according to Lotheissen-McVay in their own group of patients. MATERIAL AND METHOD: During the period from July 1996 to October 1998 122 patients were operated by the method according to Lotheissen-McVay. The inguinal hernia was operated by this method in 120 cases and femoral hernia in 2 cases. RESULTS: There were 2 relapses in our group of patients, i.e. 1.64% (2/122). In both cases there was a coincidence with secondary healing. CONCLUSION: The operation according to Lotheissen-McVay is suitable method for surgical treatment of inguinal hernia.

[A new method of therapy of hemorrhoids using the PPH stapler and the Longo technique]. / Nová metoda v lécbe hemoroidálních uzlu pomocí stapleru PPH podle Longo.

The author wish to submit information on the use of a new method of surgical therapy of haemorrhoids about which they acquired information at a workshop of Ethicon Co. in Ljubljana (Slovenia). At the same time they want to demonstrate their first experience with introduction of the new method into practice.