[Stapler procedure for anal prolapse and hemorrhoids: long-term results]. / Dlouhodobé výsledky longovy operace hemoroidu a análních prolapsu.

INTRODUCTION: The surgical treatment of internal hemorrhoids and anal canal prolapse using stapler technique was introduced to clinical practice by Longo, as soon as in 1993. Few years later, Czech surgeons became familiar with this technique, and even it is being performed in many surgical departments of our country at the present time. At the Dept. of Surgery, Teaching Hospital Hradec Králové, this surgical method has been carried out since 1999. THE AIM OF THIS WORK: To analyze the long-term results of the Longo's operation. This study has been based on the retrospective documentation analysis complemented by a questionnaire-survey. METHODOLOGY: It is the retrospective documentation study complemented by a questionnaire-survey. The patients received a questionnaire asking questions regarding their subjective feelings and opinions on surgical treatment, as well as on recent status of the illness. Furthermore, the medical documentation was analysed with particular attention to the post-operative period with regard to complications, analgetic therapy need, operation-time, length of the hospital stay and recovery time. RESULTS: Since 1999, the authors have used stapler technique in internal hemorrhoids operations in 71 patients. From this number 65 patients who were operated on at least one year before the follow-up analysis was performed were included into the study. 51 patients completed and gave back the questionnaire. Average following time was 5.5 years. 92 percent of the patients are very satisfied with the Longo's operation. Low rate of complications, small postoperative pain and early recovery are the basic merits of the hemorrhoids operation with use of stapler technique. CONCLUSION: We think of Longo's operation in indicated cases as safe and suitable for the hemorrhoids therapy.

[Numbers of lymph nodes in large intestinal resections for colorectal carcinoma]. / Pocet uzlin u resekcí tlustého streva pro kolorektální karcinom.

INTRODUCTION: Precise evaluation of lymph nodes in the surgical specimen is crucial for the staging and subsequent decision about the adjuvant therapy in colorectal cancer. Prognosis of the patients can be assessed only in cases when at least 12 lymph nodes in the surgical specimen are examined. AIM OF THE WORK: To evaluate the radicalism of resections for colorectal carcinoma after introducing laparoscopic approach. METHODS: We compared all resections for primary colorectal cancer and rectal cancer (C 18-C20) performed in the Department of Surgery in University Hospital Hradec Králové in the years 2005 and 2008 and we evaluated numbers of examined lymph nodes in the surgical specimens. The patients with recurrent tumours and the patients with complete pathological response (negative histology) after neoadjuvant therapy were excluded from the study. RESULTS: 117 patients were included in the study in 2005, 2 of them were operated laparoscopically. 155 patients (more by 32.5%) were included in the study in 2008, 53 of them (34.2%) were operated laparoscopically. In tumours of the right part of the colon (C180-C184) treated by right hemicolectomy: on an average 7.9 (+/- 5.3) lymph nodes were examined in the specimens in 2005, and 15.3 (+/- 7.0) lymph nodes in 2008. In tumours of the left part of the colon (C185-C186) treated by left hemicolectomy: 6.5 (+/- 5.1) lymph nodes were examined in 2005, and 19.6 (+/- 15.6) in 2008. In tumours of the sigmoid colon (C187) 9.1 (+/- 6.9) lymph nodes were examined in 2005,and 15.4 (+/- 7.9) in 2008. In tumours of the rectosigmoid junction (C19) 8.0 (+/- 6.9) lymph nodes were examined in 2005, and 17.8 (+/- 11.2) in 2008. In rectal cancer (C20) 5.2 (+/- 4.5) lymph nodes were examined in 2005, and 13.6 (+/- 12.5) in 2008. There is a significant difference in a number of examined lymph nodes in patients without neodadjuvant treatment compared to those with neoadjuvant chemoradiotherapy and neoadjuvant radiotherapy. In 2005, in an average 3.7 (+/- 3.3) lymph nodes were removed in rectal resections after neoadjuvant chemoradiotherapy, in 2008 in an average 7.6 (+/- 6.1) lymph nodes were removed. In 2005, in an average 5.1 (+/- 3.7) lymph nodes in rectal resections after neoadjuvant radiotherapy were removed, in 2008 6.3 (+/- 4.3) lymph nodes were removed. In 2005, in an average 7.0 (+/- 5.5) lymph nodes in rectal resections without neoadjuvant therapy were removed, in 2008 20.9 (+/- 14.1) lymph nodes were removed. Laparoscopic resections were comparable with open resections regarding the number of examined lymph nodes in our group of patients. CONCLUSION: Introducing the laparoscopic approach to resections of colorectal carcinomas did not decrease radicalism of the operation as to the number of removed lymph nodes.

[Clostridial sepsis and gas gangrene of the abdominal wall after cholecystectomy]. / Klostridiová sepse a plynatá snet' brisní steny po cholecystektomii.

Clostridial sepsis is a rare complication after intraabdominal operations, mostly fatal. According to our knowledge only two papers describing clostridial sepsis as postoperative complication in 4 patients were published in the Czech literature, only one of them survived. Authors present a case report of patient operated on for cholecystolithiasis and obstructive icterus where within 48 hours after cholecystectomy the clostridial sepsis and gas gangrene of the abdominal wall developed and that were successfuly managed.

Importance of the anorectal manometry in chronic anal fissure.

This publication presents the results of postoperative manometric investigations of 77 patients with anal fissure treated within the time span 1985-1997 by lateral sphincterotomy (LS). Results of manometric investigations are compared with digital anal examinations and subjective complaints of patients. Digital anal examination correlated with manometry results in 52 cases (68%). The correspondence between these two results was proved in 48 cases when normal finding was present. An increased sphincter tonus was found in 3 patients, all of them having the anal fissure recurrences. A marked sphincters insufficiency, which had been manifested by stool and gas incontinence was found in one case. When searching for the reason of this complication we found out that this operation procedure had been performed by an unexperienced team of surgeons. In 25 cases (32%) the digital anal assessment and manometric measurement were different. Nevertheless, the clinical symptoms in this group of patients were rather poor. To conclude we may state that manometry provides important data for preoperative evaluation of anal sphincter function and should be performed prior to lateral sphincterotomy operation at least in women.

[Intraoperative enteroscopy--personal experience from 1995 to 2002]. / Intraoperacní enteroskopie--vlastní zkusenosti z období 1995-2002.

Authors present their experience with the intraoperative enteroscopy method--an invasive technique of small bowel examination. It is performed under narcosis at an operating theatre (i.e. in co-operation with surgeon and anaesthesiologist). The endoscopy-performing physician becomes one of the members of the operating team. The advantage of the method is the possibility to examine of the whole small intestine and to solve immediately the pathological findings by endoscopic or surgical intervention. The examination is invasive and the correct indication is mandatory. Authors report their results of 18 intraoperative panendoscopies of small intestine.

[Personal experience in the treatment of perianal fistulas]. / Vlastní zkusenosti s lécením perianálních pístelí.

The authors describe the therapeutic results assembled with perianal fistulae in 130 patients. The best and most reliable method for treatment of the above mentioned lesions is discision or excision of the fistula followed by the so-called "open method" of healing. Since 1988 by this method 74 patients were treated where only two relapses were recorded. Postoperative treatment is simple, dietetic provisions are not necessary. Regular digital control of the wound hastens granulation. After rapid epithelization the wound heals by an almost linear scar. As in particular intersphincteric and low transphincteric fistulae calt for careful sphincterotomy of an appropriate extent it is essential that these operations should be performed by a surgeon adequately experienced in proctosurgery.

[The Lichtenstein "tension free" operation for inguinal hernia]. / "The tension free" operace tríselných kýl podle Lichtensteina.

The authors present their experience with operations of 264 inguinal hernias in 238 subjects where Lichtenstein's technique was used. The principle of the operation is reconstruction of the posterior wall of the inguinal canal by means of a synthetic mesh-tension free. The attained results in this group (L) were compared with a control group of 68 operated patients (group C) where the classical McVaye technique was used. They did not find a difference in the time taken up by the operation or the time of hospitalization. The postoperative mortality was 0.4% in group L and 2.9% in group C, the morbidity was 15.5% and 42.6% resp. So far they did not record a case of relapsing hernia or rejection of the mesh. The operation is easy to perform, economically unpretentious, the postoperative pain is milder and the sensation of discomfort slighter than after the classical operation. With regard to the assembled experience, the authors recommend the new operation not only in inguinal but also other types of hernias where tension free repair is impossible. For reconstruction they use polyester mesh CHS 100 manufactured by the Hosiery Research Institute in Brno.

[Diverticulosis of the small intestine--case report]. / Divertikulóza tenkého streva--kazuistika.

The authors describe the case of a 86-year-old female patient admitted to hospital with acute abdomen of the inflammatory type. The condition developed in the course of cca three days with sudden deterioration on the day of admission to hospital. Contrast X-ray examination revealed perforation of the distended jejunum and surgery revealed diffuse peritonitis the source of which was the mentioned perforation associated with mechanical ileus caused by malrotation and adhesions of the small intestine. An additional finding which, however, dominated on X-ray examination of the gastrointestinal tract when using contrast material and on revision of the peritoneal cavity was multiple diverticulosis of the small intestine. The uncommon finding on the small intestine and the relatively sparse data in the literature on diverticulosis of the jejunum and ileum made us submit the case-history for publication.

[Appendiceal mucocele]. / Mukokéla apendixu.

Appendiceal mucocele is a rare condition encountered it only 0.07-0.4% of all appendectomies. The male to female ratio is 1:4 and an average age at the time of diagnosis is over 50 years. Mucocele of the appendix is defined as appendiceal obstruction leading to lumen distension with accumulation of mucoid material. The disease ranges from benign forms to malignant cystadenocarcinoma. The cause of the obstruction may be classified based on histology into four groups. These groups include simple mucocele, mucosal hyperplasia, cystadenoma, and cystadenocarcinoma. Abdominal ultrasound and CT scan may suggest the diagnosis. The authors discuss two cases of simple appendiceal mucocele. A 48-year-old man presented with acute right lower quadrant pain. Ultrasound examination was performed and the structure in the right iliac fossa was reported as an periappendiceal abscess. The patient underwent acute exploratory laparotomy, which revealed an appendiceal mucocele filled with gelatinous material. It was performed ileocoecal resection. A 65-year-old man presented with abdominal distension and discomfort of several week duration. At laparotomy, a smooth cystic tumor of the appendix was found. This patient underwent appendectomy alone. Pathology revealed an simple appendiceal mucocele.

The changing pattern in peptic ulcer surgery.

The authors analyse the methods of treatment for the peptic ulcer disease (PUD) in two 5-year periods (group A 1979-1983, group B 1985-1989). From these groups patients with perforated gastroduodenal ulcer were excluded. In the first period 206 operations were carried out using nearly exclusively classical partial gastrectomies of both types (94 per cent). The second period involves 94 operations, where the most frequent type of operations was the proximal gastric vagotomy (40.4 per cent), and vagotomy with anthrectomy in the Roux-en-Y modification (26.6 per cent). The number of operations for a complicated PUD has increased from 43.2 per cent to 53.2 per cent, the ratio between the duodenal and gastric ulcer has changed from 3:1 to 2:1. The mortality was 5.3 and 4.7 per cent respectively, the morbidity 14.5 and 13.8 per cent respectively. The authors confirmed their accordance with the world-wide trend of diminution of the proportion of surgically treated PUD and a shift in the pattern of surgical methods towards the non-resective and more physiological procedures.