[Comparative functional outcome of reverse shoulder prostheses implanted on degenerative and oncological indications]. / Degeneratív és onkológiai indikációk alapján beültetett reverz vállprotézisek funkcionális kimenetelének összehasonlítása.

INTRODUCTION: Several methods (bone graft, endoprosthesis) are used to reconstruct proximal humerus resections due to primary and metastatic tumours. One of the new procedures is the replacement of the joint surfaces and the removed proximal humerus end with reverse shoulder prosthesis, optionally supplemented with bone implantation (composite procedure) in the hope of achieving better shoulder function. AIM: The aim of this study was to compare the shoulder function of the patient group operated by the above procedure with reverse prosthesis to a patient group operated by indication of degenerative shoulder disease (rotator cuff arthropathy). METHOD: The study involved 23 patients (13 men, 10 women) who were operated between 2012 and 2016 in our institution. Among them, 15 had rotator cuff arthropathy indication of reverse prosthesis, while in 8 cases, resection of the humerus and prosthesis implantation were performed due to tumour lesions. The average age of our patients was 62.5 years (17-82) and the average follow-up was 23.5 months (5-57). We performed physical examination, X-ray pictures on their operated arm, and data were recorded and analysed based on functional score systems. RESULTS: The level of postoperative pain was almost the same in the two groups, but only the rotator cuff arthropathy group needed pain medications. In line with our expectations, we received slightly lower values by each of the three scoring systems in case of tumorous patients. The tumorous patients were satisfied with the results achieved. CONCLUSIONS: Following proximal humerus resections, reversed prosthesis implantation with occasional bone allografts is a reliable method of reconstruction, which approaches available functions and reliability as compared to non-tumour-indicating patients. Orv Hetil. 2018; 159(45): 1838-1843.

[Changes in the clinicopathological features of surgically treated lung cancer around the millennium]. / A mutétileg kezelt tüdorák klinikopatológiai jellemzoinek változása az ezredfordulónkon.

INTRODUCTION: Lung cancer is the most common malignant tumor in Europe and Hungary. In 2010, 10 557 new cases were registered in Hungary; 80-85% of these cases were associated with smoking. AIM: In our work we analyzed the data of lung cancer patients of the last 15 years retrospectively. METHOD: We examined the demographic characteristics, the histological type, the stage of the lung cancer, the type of the surgical procedure used, other supplemental treatment and survival retrospectively. RESULTS: Lung cancer has occurred 50 per cent more often among females in the last decade. This growth is due to the increase of adenocarcinoma cases. Thanks to the improving diagnostic modalities and the routine follow-up of oncological patients, the number of I/A cases has been doubled recently and the preoperative staging and physical condition check-up have become more accurate. Neoadjuvant treatment has been introduced, the proportion of sublobar resections has risen, the ratio of pneumonectomy and sleeve lobectomy has become equal, so many previously unresectable cases turned to be resectable and the tolerance of adjuvant therapy has also improved. Videothoracoscopic lobectomy has become an everyday practice, leading to a decrease in the operative stress on patients. CONCLUSION: In spite of this development, the five-year survival has not changed significantly, staying around 50%. Orv Hetil. 2018; 159(10): 391-396.

[Laparoscopic cecal wedge resection]. / Laparoszkópos coecumkúp-reszekciók.

INTRODUCTION: Several indications of cecal wedge resection can be found in the literature, but the most common ones are acute appendicitis, appendiceal mucocele and selected cecal polyps. PURPOSE: We summarize the indications, review the results of laparoscopic cecal wedge resections carried out in our department from 01.01.2010 till 31.12.2016. A case report is presented when cecal resection was carried out for a cecal polyp. PATIENTS: Between 01.01.2010 and 31.12.2016, 56 patients underwent a laparoscopic cecal wedge resection. The mean age was 42 years (14-83), 28 males and 28 females. In 46 cases, the indication was complicated acute appendicitis, in 6 cases appendiceal mucocele, in the case of four patients endoscopically unresectable benign cecal polyps. RESULTS: The average operating time was 65 minutes. For the procedure we used two 10 mm and one 5 mm port, the resection was performed by using 45 or 60 mm laparoscopic stapler. In 57.1% of the reviewed cases, abdominal drainage was applied. Conversion was necessary in the case of 3 patients (5.4%), once due to bleeding, twice due to technical problems. Surgical complications occured in 4 patients (7.1%), all of them from the complicated appendicitis group: one of grade I by Clavien-Dindo, 3 of grade III. The reoperation rate was 5.4% (3 patients): reoperation was accounted for an abdominal wall phlegmon, a pericecal abscess, and once the suspicion of abdominal abscess which was not verified. Perioperative death did not occur.

[Minimal invasive esophageal resection with anastomosis on the neck [McKeown]. Our experiences after 20 cases]. / Minimálisan invazív oesophagusreszekció nyaki anastomosissal (McKeown-mutét). Tapasztalataink 20 eset kapcsán.

OBJECTIVE: Esophageal resection is a traumatic intervention usually performed on patients with poor condition, resulting high mortality and morbidity. To improve the high incidence of complications, minimal invasive interventions were introduced. The results of the thoracoscopically and laparoscopically performed esophageal resection (McKeown) was investigated after 20 cases and the technical details of the surgical intervention are presented. PATIENTS AND METHOD: 20 thoracoscopic esophageal resection with laparoscopic gastric tube formation (sec. Akiyama) preparing the esophago-gastric anastomosis on the neck were performed in our department in the last four years. 1 patient with stricture and the other 19 patients with esophageal cancer were operated on, among them11 had T4 stage. 17 patient received neoadjuvant chemo-radiotherapy because of advanced disease. Regular follow up examinations were performed in the oncological outpatient department. RESULTS: 8 patients are alive after a mean follow up period of 25 months, 2 of them are treated oncologically because of recurrent disease. 19 patients were extubated within 12 hours after the intervention and the time spent in the intensive care unit were reduced to 1 or 2 days. The mean duration of the intervention was 320 minutes. Thoracoscopic dissection was performed in 8 patients without ventilation of the right lung using double lumen tracheal tube, among them 3 patients developed pneumonia in the postoperative period. The remaining 12 patients were operated with ventilated right lung, among them one patient developed pneumonia. One patient was converted because of injury of the thoracic aorta, after urgent thoracotomy we managed to suture the aortic wall. 1 patient died in 30 days after the operation, caused by leakage of the anastomosis, resulting mediastinitis and esophago-tracheal fistula. In two patients re-thoracoscopy and ligation of the thoracic duct was performed because of chylothorax refractory for conservative treatment. CONCLUSIONS: According to our observation the minimal invasive esophageal resection resulted in comparable oncological results with relevant reduction of mortality and morbidity compared to the open procedure. After procedures performed with ventilated lung further reduction of pulmonary complication was found. In case of tumors infiltrating the tracheal or the aortic wall, thoracotomy should be considered to explore the thoracic cavity and to carry out the dissection, if it is possible. Our results should be reinforced because of low number of patients.

[Laparoscopic resection of persistent patent urachus]. / Ductus urachus persistens laparoszkópos eltávolítása.

The urachus in the foetus is a fibromuscular duct, which connects the allantois to the bladder and it is usually occluded in the 4-5th gestation months. Incomplete occlusion of the urachus at the time of birth is considered to be physiological, but later it can lead to recurrent discharge and inflammation of the umbilicus. To establish the diagnosis, ultrasound is the first examination of choice. A 19-year old obese female patient presented with umbilical discharge, and a persistent urachus was detected by ultrasound. After incision of the peritoneum the duct was excised from the umbilicus to the dome of the bladder by 3-port laparoscopy where the duct was clipped. The operation time was 38 minutes. The patient required minor analgesia on one single occasion in the postoperative period and was discharged on the first postoperative day. The authors recommend laparoscopic operation for the urachal remnant; the enlarged duct on the ventral abdominal wall can be better detected from the umbilicus to the Retzius spatium with 30-degree camera, and the cosmetic outcome is also more favourable.

Surgical management of colonic diverticulosis: Issues of indications, treatment options, surgical solutions / A vastagbél-diverticulosis sebészi kezelése: Javallati dilemmák, kezelési lehetoségek, mutéti megoldások

Összefoglaló. Bevezetés: A vastagbél-diverticulosis a lakosság kb. 60%-át érinti, incidenciája folyamatosan növekszik. A betegek 6%-ánál van szükség sebészi beavatkozásra. Jelenleg nincs egységes irányelv, mikor indokolt elektív mutétet végezni. Módszer: Retrospektív módszerrel elemeztük az osztályunkon 2017. július 17. és 2020. április 30. között vastagbél-diverticulosis miatt operált betegek demográfiai és mutéti adatait, emellett a szövodmények arányát. Összehasonlítottuk az elektív (EM) és a sürgos mutétek (SM), illetve a nyitott és a laparoszkópos mutétek adatait. Eredmények: 38 operált beteg közül 19-nél történt EM, illetve 19 betegnél SM. A betegek átlagéletkora az EM-eknél 64 év, az SM-ek esetében 67 év volt. EM-nél az indikáció 12 esetben recidiváló diverticulitis, 5 esetben colovesicalis, 2 esetben colovaginalis sipoly volt. SM-nél az indikáció 17 esetben perforáció, 2 esetben hasüregi tályog volt. Az EM-ek 89%-a laparoszkópos módon került elvégzésre; az átlagos mutéti ido EM/SM esetében 96 perc/89 perc, az átlagos ápolási napok száma 17/14 volt. Az EM-csoportból 1 beteg, míg az SM-csoportból 5 beteg meghalt. Szignifikáns különbség volt a mutét típusa, a stomaképzés és a transzfúziós igény tekintetében. Nem találtunk szignifikáns eltérést a posztoperatív ápolási napok és a mortalitás tekintetében. Következtetés: Az elektív mutétek alacsonyabb morbiditása és mortalitása, illetve a laparoszkópos technika alkalmazhatósága miatt törekedni kell a tervezett mutétre. Nincs egységes irányelv a relatív mutéti indikáció felállításában: gasztroenterológus és sebész által felállított, személyre szabott kezelési stratégia szükséges. Véleményünk szerint indokolt a mutét, amennyiben igazolt diverticulosis esetében szigorú diéta mellett kiújul a gyulladás. Orv Hetil. 2020; 161(51): 2146-2152. INTRODUCTION: Colonic diverticulosis affects 60% of the population, incidence of the disease grows progressively. During its course, 6% of patients with diverticulosis will need surgical intervention. There is no current guideline when to carry out elective operation. METHOD: We analyzed demographics, surgical patient data and also post-operative complications of patients operated in our department due to colonic diverticulosis between 17-07-2017 and 30-04-2020 retrospectively. We compared the results of elective (ES) and acute surgeries (AS), also laparotomies versus laparoscopies. RESULTS: 19 out of 38 patients underwent ES and 19 AS. ES group average age was 64 years, and 67 in the AS group. Indications of ES were recurring diverticulitis in 12, colovesical fistula in 5 and colovaginal fistula in 2 cases. Indications of AS were perforations in 17 and intraabdominal abscesses in 2 cases. 89% of all ES were operated laparoscopically; average operation time in ES/AS was 96/89 minutes, average hospital stay was 17/14 days. 1 patient after ES and 5 after AS died. Significant difference was found between the groups with regard to the type of operation, frequency of colostomy creation and the need of blood transfusion but no significant difference was demonstrated in average hospital stay and mortality. CONCLUSION: Due to the lower morbidity and mortality rate as well as the benefits of laparoscopic approach, we should always opt for ES. No guideline for relative surgical indication exists: gastroenterologist and surgeon should make a personalized surgical plan. In our opinion, operation should be carried out if diverticulitis reoccurs while the patient is on strict diet. Orv Hetil. 2020; 161(51): 2146-2152.

[Resection of vena cava inferior infiltrating by liver tumors]. / A vena cava inferiort infiltráló májtumorok kapcsán végzett reszekciókról.

Introduction: Despite all new promising agents of oncotherapy, it is still liver resection that gives potential curative solution for primary and secondary liver tumors. The size of tumorous liver section for resection means no question any more but major vessel infiltration of tumor proposes challenge in liver surgery. Patients and method: Retrospective analysis was carried out covering 33 patients who underwent liver resection in St. Janos Hospital Surgery Department between 1st May 2017 and 1st May 2019. Demographic, surgical, histological data and postoperative course were taken into consideration and comparison with two of our patients who needed vena cava excision simultaneously with liver resection. Results: Patients with liver resection only (LR) had a mean operation time of 91.7 minutes, while operation time for patients with cava resection (CR) was 250 minutes. The average amount of blood transfusion was 1.2 units (200 ml) in group LR and 5 units in group CR. Among LR patients, resection was rated R0 in 23 and R1 in 8 cases, R2 resection could be performed in 2 cases, in group CR in both cases R1 resection was registered. 5 patients with colorectal liver metastasis were operated after previous chemotherapy. Two patients underwent laparoscopic liver resection and two had synchronous colorectal and liver resection, one of these was treated via laparoscopic approach. Conclusion: Liver resections in case of large vessel (vena cava, hepatic vein) infiltrating by liver tumors are indicated the most challenging procedures of liver surgery. The relating literature refers to oncological liver resections with vena cava excision and reconstruction to be safe and applicable. Orv Hetil. 2019; 160(33): 1304-1310.

[Minimally invasive endoscopic transcribriform resection of malignant lesions of the skull base]. / Minimálisan invazív, endoszkóppal asszisztált, transcribriform reszekció a koponyaalap rosszindulatú daganatainak sebészetében.

Introduction: Malignant tumours of the sinonasal region - including those with invasion of the skull base - necessitate surgical resection. The majority of the cases give an opportunity to perform the procedure via minimally invasive, endoscopic approach, without external, craniofacial surgery. Aim: To assess our clinical experience in treating anterior skull base malignancies, performing minimally invasive endoscopic transcribriform resection. Method: Between February 2015 and July 2017, four male and one female patient underwent minimally invasive, endoscopic skull base procedure. The mean age was 64.6 years (59-70, median: 66). Every surgery was performed via transnasal, endoscopic transcribriform approach. In two cases Kadish C esthesioneuroblastomas, while in one case a T3N0 sinonasal non-differentiated carcinoma, a T1N0 intestinal type adenocarcinoma and a T4N0 squamous cell carcinoma was the indication of surgery, respectively. Results: The mean follow-up time was 22.8 months, between 14 and 46 months. Intraoperative complications did not occur during the procedures. Regarding the postoperative period, liquorrhoea and pneumocephalus occurred in one case. Complications were solved with lumbar drainage. During follow-up, neither residual nor recurrent tumour was observed in our patients. Conclusion: Endoscopic transcribriform resection of the skull base malignancies is a safe and viable alternative to the traditional open approach. Orv Hetil. 2019; 160(40): 1584-1590.