Rozhledy v Chirurgii最新文献

{"title":"Hidden in the mesentery - surgical management of bleeding gastrointestinal stromal tumor in neurofibromatosis type I.","authors":"M Škrabal, T Vidim, K Veškrňa","doi":"10.48095/ccrvch2026134","DOIUrl":"https://doi.org/10.48095/ccrvch2026134","url":null,"abstract":"<p><strong>Introduction: </strong>This report on neurofibromatosis type 1 (NF1), also known as von Recklinghausen disease, highlights the diversity of clinical manifestations associated with this condition. In addition to the predominant neurological symptomatology, this work also reveals the rarer involvement of the gastrointestinal tract in the form of an associated gastrointestinal stromal tumor (GIST). NF1 is an autosomal dominant genetic disorder with multisystem involvement, most commonly affecting the nervous system, skin, and skeleton. In approximately 7% of patients with NF1, a GIST may develop, representing the most frequent intestinal manifestation of neurofibromatosis.</p><p><strong>Case report: </strong>The case of a female patient with genetically confirmed and previously known NF1 initially presented with vertigo, anemia, and melena, ultimately leading to the diagnosis of a bleeding GIST. The tumor was confirmed only through histological examination following intestinal resection.</p><p><strong>Conclusion: </strong>In patients with NF1, GIST typically presents as multifocal disease with distinct biological behavior and absence of classical mutations. The primary treatment is surgical resection, indicated based on symptoms or tumor size. Hemorrhage from GIST represents both a diagnostic challenge and a serious complication, which could be mitigated through targeted surveillance, facilitating earlier detection and optimal timing of intervention.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"105 3","pages":"134-141"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual and reproductive health after surgical procedures - the importance of multidisciplinary collaboration.","authors":"M Broul, A Hujová, R Maleček, M Vančo, J Banýrová, M Liegertová","doi":"10.48095/ccrvch202662","DOIUrl":"https://doi.org/10.48095/ccrvch202662","url":null,"abstract":"<p><strong>Introduction: </strong>Sexual and reproductive health remains under-recognized in surgical care despite its decisive impact on quality of life and overall outcomes.</p><p><strong>Methods: </strong>Narrative synthesis of recent guidance (EAU 2025, AUA 2024, ISSM/ESSM, NCCN/ASCO) and clinical evidence on sexual and reproductive sequelae after colorectal, vascular, and spinal procedures.</p><p><strong>Key findings: </strong>Core mechanisms include autonomic denervation, vascular/hormonal factors, pain/scarring, and altered body image.  Pelvic oncologic surgeries (low anterior resection, radical prostatectomy/cystectomy) are high-risk procedures. High-value interventions include early penile rehabilitation (PDE5 inhibitors ± vacuum device) and fertility preservation (gamete cryopreservation), local estrogens/lubricants and pelvic-floor physiother-apy in women, and psychosexual support within coordinated multidisciplinary care across both sexes.</p><p><strong>Conclusion: </strong>Embedding sexual and reproductive health into standard perioperative pathways (six-step algorithm: education, risk stratification, fertility preservation, nerve-sparing, discharge instructions, 6-12-week follow-up) is feasible in Czech practice and improves functional outcomes and patient satisfaction.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"105 2","pages":"62-67"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric cancer after bariatric surgery - a diagnostic challenge.","authors":"E Rada, Z Adamová, M Chrostek","doi":"10.48095/ccrvch2026123","DOIUrl":"https://doi.org/10.48095/ccrvch2026123","url":null,"abstract":"<p><strong>Introduction: </strong>Bariatric surgery is an effective treatment for severe obesity, offering substantial improvements in patients' metabolic profiles. However, increasing attention is being paid to potential long-term complications, including malignancies developing in the excluded portion of the stomach - an area that poses significant diagnostic challenges.</p><p><strong>Case report: </strong>We report the case of a 68-year-old woman with a history of biliopancreatic diversion, who was diagnosed with advanced diffuse gastric carcinoma 10 years after surgery. The clinical presentation was non-specific, and both laboratory and imaging studies repeatedly yielded false-negative results. A definitive diagnosis was established only during diagnostic laparoscopy - unfortunately, at a stage too advanced for curative treatment.</p><p><strong>Conclusion: </strong>This case underscores the risk of late-onset malignancy in the excluded stomach following bariatric surgery and highlights the considerable diagnostic difficulties. Early detection requires a high index of clinical suspicion, access to advanced endoscopic techniques, and close multidisciplinary collaboration. The absence of standardized screening protocols further hampers timely diagnosis.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"105 3","pages":"123-127"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perforation of Meckel's diverticulum with ectopic gastric mucosa.","authors":"A Truong, J Kizman, L Truong","doi":"10.48095/ccrvch2026142","DOIUrl":"https://doi.org/10.48095/ccrvch2026142","url":null,"abstract":"<p><p>Meckel's diverticulum is a congenital anomaly of the gastrointestinal tract that occurs in approximately 2% of the population. It is the result of incomplete obliteration of the vitelline duct (ductus omphaloentericus). During the fetal period, this duct connects the yolk sac with the primitive intestine and normally closes around the 5th-7th week of gestation. It is a true diverticulum because it contains all layers of the intestinal wall. Most diverticula are asymptomatic; however, they may lead to serious complications such as inflammation, perforation, obstruction, and bleeding. Our case report presents a case study of an 18-year-old patient who presented to the surgical outpatient clinic with several hours of abdominal pain in the right lower quadrant, mimicking acute appendicitis. However, the perioperative findings confirmed a different pathology: a perforation of Meckel's diverticulum.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"105 3","pages":"142-145"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overview of imaging in liver surgery.","authors":"T Husárová, T Koutný, J Pudil, Š O Schütz, M Rousek, T Tůma, Radek Pohnán","doi":"10.48095/ccrvch2026","DOIUrl":"https://doi.org/10.48095/ccrvch2026","url":null,"abstract":"<p><p>Continuous improvement in imaging techniques plays an integral part of the evolvement in liver surgery. Accurate imaging is necessary for the diagnostics and surgeon's preop-erative preparation, specifically for learning the individual anatomy, which is often var-iable in the liver, and for understanding the precise extent of pathology. A compelling area in preoperative evaluation is the assessment of the liver parenchyma function, for which the official guidelines have been published, specifying the precise indications, among other things. An upcoming method for assessing liver parenchyma function is magnetic resonance, which has the potential to evaluate both the volume and the func-tion of the future liver remnant. Beyond preoperative imaging, the real-time imaging directly in the operating room enables surgeons to perform the most complex procedures. With the growing establishment of minimally invasive approaches, fluorescent imaging using indocyanine green is increasingly utilized, presenting the main substitution of tactile perception during open resections in combination with ultrasound. The future potentially lies in targeted molecular imaging, which has the potential to eliminate the current shortcomings of imaging methods. We present an overview of current trends in liver imaging and a relevant literature.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"105 1","pages":"13-19"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gynecological causes of acute abdomen.","authors":"L Prajka, J Humplík, M Čedíková","doi":"10.48095/ccrvch202657","DOIUrl":"https://doi.org/10.48095/ccrvch202657","url":null,"abstract":"<p><p>This article focuses on gynecological causes of acute abdominal emergencies, which represent serious conditions requiring prompt diagnosis and treatment. It describes their pathogenesis, clinical presentation, diagnostic procedures, and therapeutic options. As a review paper, its aim is to identify the most common indications for urgent gynecological intervention and to facilitate differential diagnosis in acute zone, particularly within surgical outpatient departments. Gynecological causes are categorized into three main groups: non-infectious, infectious, and emergencies associated with early pregnancy. The article provides a detailed overview of expected findings from lab-oratory tests and transvaginal gynecological ultrasound examination. For each condition, surgical management is described, with laparoscopy being the preferred ap-proach in gynecological cases.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"105 2","pages":"57-61"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Probiotics and synbiotics in perioperative care for colorectal surgery - a future component of the ERAS protocol?","authors":"Z Adamová, M Filová, J Tisančinová, M Chrostek, R Slováček","doi":"10.48095/ccrvch202675","DOIUrl":"https://doi.org/10.48095/ccrvch202675","url":null,"abstract":"<p><strong>Introduction: </strong>Colorectal surgery is associated with a high risk of postoperative complications, particularly infections. In recent years, the role of the microbiome in this context has been increasingly discussed. Probiotics and synbiotics are being investigated as potential tools for modulating the microbial environment and improving surgical outcomes.</p><p><strong>Aim: </strong>This review article summarizes the available evidence from randomized con-trolled trials, meta-analyses, and systematic reviews evaluating the effects of probiotics and synbiotics on the incidence of complications and postoperative recovery in patients undergoing colorectal surgery. Current studies indicate that the administration of probiotics and synbiotics may reduce the risk of infectious complications, modulate systemic inflammatory responses, accelerate the restoration of bowel function, and shorten the duration of antibiotic therapy. Data regarding their impact on anastomotic leakage remain limited. The intervention appears to be well tolerated and safe.</p><p><strong>Conclusion: </strong>Perioperative administration of probiotics or synbiotics represents a promising and cost-effective intervention in colorectal surgery. However, larger and more standardized trials are required to prove the effect, determine the optimal composition, dosage, and duration of therapy before routine clinical implementation.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"105 2","pages":"75-79"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3D printed synthetic models for training minimally invasive pediatric surgery - our own experience and literature review.","authors":"P Zahradnikova, M Lindák, P Vitovič, M Laurovičová, T Tvrdoň, S Hnilicová, J Babala","doi":"10.48095/ccrvch202511","DOIUrl":"https://doi.org/10.48095/ccrvch202511","url":null,"abstract":"<p><p>Pediatric surgery is a medical specialty focused on the diagnosis, treatment, and postoperative care of children with congenital and acquired anomalies and diseases. The goal of pediatric surgeons is to ensure that children receive the best possible care while minimizing the risks and complications associated with surgical procedures. Contemporary pediatric surgeons face many challenges, including a decline in the number of children with congenital developmental defects, economic pressures, and efforts to increase efficiency, leading to reduced time spent on individual surgeries. This can limit the opportunity for thorough training of young surgeons. These challenges require innovative approaches and continuous improvement in educational and training methods. Minimally invasive surgery has become a significant part of pediatric surgery, offering benefits such as faster recovery, smaller surgical wounds, and lower risk of infection. However, minimally invasive pediatric surgery is technically demanding and requires excellent technical skills. The need to maintain and improve surgical skills demands ongoing training. Current educational methods increasingly rely on simulation technologies to enhance the quality and safety of training without risk to patients. The integration of 3D printing technology and imaging data from CT and MRI scans has opened new possibilities for creating highly realistic simulation models for minimally invasive surgery. These models accurately replicate the environment encountered in procedures like neonatal surgery. In this article, we present our experience with the development and creation of 3D-printed synthetic models designed for training thoracoscopic surgery of esophageal atresia with tracheoesophageal fistula. The aim of this review article is to provide an up-to-date overview of the literature on synthetic 3D-printed models designed for training in minimally invasive pediatric surgery.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"104 1","pages":"11-19"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical treatment of complications of duodenal diverticulosis.","authors":"P Křenovský","doi":"10.48095/ccrvch2025122","DOIUrl":"https://doi.org/10.48095/ccrvch2025122","url":null,"abstract":"<p><p>The duodenum is the second most common diverticula origin after the colon. 1-5% of duodenal diverticula develop complications, such as inflammation, perforation, or bleeding. The key points in the diagnosis of complications of duodenal diverticulosis are a good medical history, often with reference to upper endoscopy, CT scan, and a generally altered patient condition with a poor physical examination of the abdomen. Treatment of the complications of duodenal diverticulosis is conservative, endoscopic and surgical. Due to the high lethality of undiagnosed complications, an energetic approach is essential, especially in the case of perforation events. The patient clearly benefits from the procedure performed within 12 hours of the start of the clinical symptoms. The text presents a general overview of duodenal diverticulosis and the issue is documented on two case reports of the complications of duodenal diverticulosis from 2022 from our surgical department.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"104 3","pages":"122-126"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Damage control surgery - massive pulmonary embolism complicated by sever bleeding from the liver.","authors":"O Ťoupal, V Kurfirst, P Pták","doi":"10.48095/ccrvch2025211","DOIUrl":"10.48095/ccrvch2025211","url":null,"abstract":"<p><p>The patient suddenly experienced shortness of breath, collapse, and loss of consciousness at home. Layperson-performed, telephone-guided cardiopulmonary resuscitation was initiated, and upon the arrival of the emergency medical team, suc-cessful extended CPR was performed, after which the patient was transported to the emergency department at Hospital of České Budějovice. Basic stabilization of the clinical condition was carried out, the patient was secured, intubated, and transported to the CT scanner. A massive bilateral pulmonary embolism was verified byCT. Thrombolysis was immediately performed in the emergency room, circulation was stabilized, and the patient was transferred to the ICU. An hour later, the patient experienced severe circulatory instability in the ICU, requiring high-dose norepinephrine support. Ultrasound was performed, followed by a CT scan of the abdomen, which revealed massive hemoperitoneum. An urgent surgical consultation was performed, and surgery was recommended on a vital indication. An urgent laparotomy was performed on a hemodynamically unstable patient with the blood pressure 60/30 and the pulse 180/min. Despite massive circulatory support and erythrocyte transfusion, 4 liters of noncoagulable blood were drained from the hepatic region. The liver was torn in several places due to fractured ribs, most severely in the left lobe at the hepatic veins. Due to severe circulatory instability, the injury was -deemed inoperable, and it was decided to stabilize the condition with perihepatic packing, after which the patient was transferred to the ICU. The ICU continued conservative therapy, and there was a gradual reduction in the drainage output. A second-look operation was performed after 48 hours - revision of the original wound and removal of the drapes. Multiple fissures were found in the -right lobe, caused by broken ribs, with heavy bleeding from the dorsal hepatic veins. A combination of selective suturing and electrocoagulation of the fissures was performed. Due to ongoing circulatory instability, the decision was made to use perihepatic packing once again. The patient was left in the ICU for further circulatory stabilization, with a plan to do another surgical revision after stabilization in 48 hours. Another surgical revision was performed, revisiting the perihepatic space and performing an anatomical resection of liver segments II and III, followed by selective ligation of the hepatic vein. Hemodynamic stabilization was achieved. Postoperatively, a fluidothorax developed, which was managed by thoracic drainage, and acute acalculous cholecystitis, which was treated with puncture cholecystostomy. The patient is now primarily healed and has been started on long-term anticoagulation therapy by the angiologist. The cause of the pulmonary embolism was not determined.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"104 5","pages":"211-216"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}