RESUMEN

Intra-abdominal hypertension (IAH) contributes to organ dysfunction and leads to the development of the abdominal compartment syndrome (ACS). IAH and ACS are relatively frequent findings in patiens with severe acute pancreatitis (SAP) and are associated with deterioration in organ functions. The most affected are cardiovascular, respiratory and renal functions. The incidence of IAH in patients with SAP is approximately 60-80%. There is an accumulating evidence in human and animal studies that changes of perfusion, particularly to the microvasculature, are crucial events in the progression of acute pancreatitis (AP). The perfusion of the small and large intestine is impaired due to reduced arterial pressure, increased vascular resistence and diminished portal blood flow. Bacterial translocation has been described in patients with ACS, and this may apply to patients with SAP. Approximately 30-40% of SAP patients develop ACS because of pancreatic (retroperitoneal) inflammation, peripancreatic tissue edema, formation of fluid collections or abdominal distension. Surgical debridement was the preferred treatment to control necrotizing pancreatitis in the past. However, the management of necrotizing pancreatitis has changed over the last decade. The main objective of this article is to describe the association between IAH and AP and to emphasize this situation in clinical praxis as well (Fig. 1, Ref. 38).

Asunto(s)

RESUMEN

Gastric diverticula represent a rare pathological condition. They are usually asymptomatic and are often found only by accident during radiologic or endoscopic examination, or during autopsy. Their incidence is low and evenly distributed between men and women. Gastric diverticula are most frequently located on the posterior wall of the cardia and on the lesser curvature of the stomach. The authors present a case study of a 58-year-old patient with severe sideropenic anaemia, a marked weight loss and non-specific dyspeptic symptoms. The suspicion of a diverticulum was raised by a gastroenterologist during gastrofibroscopy and confirmed by a radiologist following a dynamic CT examination of the stomach. The diverticulum had an atypical location beneath the cardia on the greater curvature. The patient was indicated for surgery. During conventional laparotomy, resection of the diverticulum was performed using a linear stapler. The postoperative course was uneventful. Histology confirmed a false diverticulum. The patient is doing well, is asymptomatic, has put on 7 kg since the operation and her blood count is normal.

Asunto(s)

RESUMEN

Bilioenteric fistules are fairly rare, cholecystoduodenal fistules are the commonest type, accounting for 70-80% of cases. Cholecystoduodenal fistules usually occur as a consequence of cholecystolithiasis and cholecystitis. Their symptomatology is atypical and fistules are frequently detected during surgery. Preoperative diagnostic procedures include visualization methods, such as US, CT, MRI, resp.ERCP. Both conventional laparotomy, as well as laparoscopy may be used in the treatment of the disease. Each of the methods has its pros and cons. The authors present a case review of a 85-year old female patient with a cholecystoduodenal fistule, diagnosed prior to the surgical procedure. Conventional laparotomy was elected as a method of treatment and the outcome was successful.

Asunto(s)

RESUMEN

It is not so much the diagnosis that offers the surgeon a wide range of opportunities in the technical solutions of rectal prolapse. Currently there are at least 130 different techniques used in the surgical treatment of rectal prolapse and in fact none of these procedures has been shown most effective for any one patient. In this study, our intent is to describe the experiences of the authors with the treatment of rectal prolapse, to estimate the actual level of expertise of the surgeons in treatment of rectal prolapse, and to describe in which way to proceed in the future (Tab. 4, Fig. 3, Ref. 27). Full Text (Free, PDF) www.bmj.sk.

Asunto(s)

RESUMEN

All intraabdominal forms of recurrence of colorectal carcinoma, other than metastases in the liver, are considered a locoregional treatment failure. Maximum frequency of local recurrence of CRC occurs in the first two years following the initial potentially curative resection. Intensive follow-up in this period is therefore reasonable. It should be based on case history, clinical examination and examination of tumor markers (particularly CEA). Other examinations are indicated only for patients with abnormal findings or during normal annual check-ups. The salvage surgery for CRC recurrence covers a large scale of surgical performances from limited local resections up to extensive surgery including pelvic exenteration and peritonectomy. The potentially curative resection (R0 and R1) of colorectal carcinoma is a sole confirmed factor that has a direct positive influence on the overall survival of patients (Fig. 5, Ref. 21).

Asunto(s)

RESUMEN

Short bowel syndrome (SBS) is a malabsorption syndrome resulting from anatomical or functional loss of a significantly long small intestinal segment. A loss over 80% of the small intestinal length is associated with increased urgency for supportive parenteral nutrition and results in reduced overall survival of the patients. The ileocaecal valve (valvula Bauhini) loss results in bacterial contamination of the small intestine, affecting tolerability of the oral, ev. enteral nutrition. The authors present a case review of a 27-year-old patient with repetitive small intestinal resections. The last procedure included the Bauhini valve and, finally, the patient has only 70 cm of the jejunum preserved.

Asunto(s)

RESUMEN

Biliary ileus is a rare complication of cholecystolithiasis. The condition occurs predominantly in the elderly with incidence rates of 1-4%, according to the literature data. Most commonly, it develops as a complication of cholelithiasis which remained untreated or was managed conservatively, or as a complication of a gallbladder decubitus necrosis. The condition results in a cholecysto-duodenal fistula. In this case, the cholecystolithiasis is latent or is clinically manifested in a third of the patients. A total of 1560 cholecystectomies (1345 L-CHE and 215 conventional CHE) were performed in our clinic during a five-year period. Biliary ileus was an indication for operation only in two subjects, during the studied period. In the both cases, the diagnosis was established intraoperatively, although upon re-examination of the visualization modalities views (upright native abdominal views, CT scans) the authors concluded that the primary cause of the ileus could have already been identified, based on the above views.

Asunto(s)

RESUMEN

Appendical cystadenoma is one of the histological forms of the appendical mucocele. Preoperative diagnostics is difficult, however, due to potential iatrogennic rupture during a surgical procedure, is very important. The authors present a case review of a 62-year-old patient with itususception of the appendical cystadenoma, until now rarely reported in literature. Upon the preoperative diagnosis the appendical cystadenoma appeared as a caecal tumor or a tumor of the terminal ileum. A histological, intraoperative, diagnosis was established, followed by a final histological examination of the resected tissue. The authors discuss contemporary options of the preoperative diagnostic measures of the appendical tumors, stressing up all risks of aspiration cytology as well as risks of laparoscopic approach in this pathology management

Asunto(s)

RESUMEN

From the 1st January 1986 until the 31st December 1995 397 patients were operated on at the IInd Surgical Clinic of Medical Faculty, Comenius University in Bratislava because of colorectal cancer. Of them 325 patients were operated on electively and 72 patients were operated on as emergency cases. The authors analysed average survival time and the relationship between survival and preoperative level of CEA. The average survival time, without dividing into stages was 37.3 months, not involving patients with perioperative lethality of 43.1 months. 5 years survival without dividing into stages was 36.8%. Average survival of patients without dividing into stages with increased preoperative level of CEA was 28.7 months, in patients without increased level of CEA it was 42.5 months. 5-years survival in patients with normal preoperative level of CEA was 60.5%, in patients with increased level of CEA it was 35.7%. There was highest difference when dividing to subgroups based upon the stage of the disease between groups with stage pT4N0M0 and pT1-4N1-3M0. The positiveness or negativeness of the preoperative level of CE supports the staging of disease and supposes a significant difference in 5-years survival in patients especially in the mentioned stages. Although this difference is obvious, it is not possible to suppose individual prognosis of patients and the necessity of an adjuvant therapy. (Tab. 2, Ref. 31.)

Asunto(s)

RESUMEN

The authors analyze the importance of PTA, EAE and vascular reconstructive surgery of obliterative atherosclerosis on lower extremities. According to their own experiences the advantages and also negatives of particular treatment methods are discussed and studied group of patients is presented. On the basis of the achieved results the authors suppose that ischemic syndrome of lower extremities is attractive not only for vascular surgeon, but also for interventional radiologist. When properly indicated, particular treatment modalities can have substantiation in the treatment of obliterative atherosclerosis. (Tab. 9, Fig. 5, Ref. 29.)

Asunto(s)

RESUMEN

Operation of the biliary pathways in patients with obstructive jaundice is still associated with a significant morbidity and high mortality, in particular in geriatric patients. Recently in the therapy of icteric patients percutaneous or endoscopic drainage of the biliary pathways was introduced. At the Surgical Clinic of the Hospital with Policlinic, Bezrucova in Bratislava in 1988 52 patients with obstructive jaundice were hospitalized. In patients with more than three risk factors the authors introduced preoperative drainage of the biliary pathways. In patients with malignant disease they describe preoperative percutaneous transhepatic drainage with subsequent enterobiliary anastomosis with an in-dwelling drain. Of 52 patients 9 died, i.e. 17.3%. Non-surgical drainage of the biliary pathways in icteric patients reduces the number of risk factors, eliminates the adverse effects of jaundice and improves the prognosis of the icteric patient.

Asunto(s)

RESUMEN

Operations of hernias are among the most frequent operations in general and in the SSR they account for 11% of all operations. Despite this incidence of relapse is high and amounts to some 5-30%. In the Surgical Clinic of the Hospital with Polyclinic Bezrucova, the authors operated since April 1, 1988 134 inguinal hernias. They used Shouldice's technique. In the paper the surgical procedure is described. In a perspective study the authors did not record so far any relapses. The incidence of postoperative complications is 8.25%. Despite short-term experience the authors recommend this operation which meets all preprequisites of modern and reliable operations of inguinal hernia - high ligature of the sac, reinforcement of the floor of the inguinal canal, plastic operation of the annulus inguinalis internus and transposition of the funiculus spermaticus.

Asunto(s)

Asunto(s)

Asunto(s)