Rozhledy v Chirurgii最新文献

{"title":"Position of surgical treatment in step-up management of severe acute pancreatitis.","authors":"J Sedláčková,&nbsp;J Zajak,&nbsp;B Jon,&nbsp;J Maňák,&nbsp;S Rejchrt,&nbsp;F Čečka","doi":"10.33699/PIS.2023.102.2.64-74","DOIUrl":"https://doi.org/10.33699/PIS.2023.102.2.64-74","url":null,"abstract":"<p><strong>Introduction: </strong>The incidence of acute pancreatitis has been increasing over the past twenty years and there is still no causal treatment available. Although cases of severe acute pancreatitis account for only about a fifth of all cases of acute pancreatitis, high morbidity and lethality call for an optimization and unification of treatment procedures.</p><p><strong>Methods: </strong>We operated on 27 patients suffering from severe acute pancreatitis in the past five years. We compared selected parameters such as gender, age, body mass index, aetiology, presence of type 2 diabetes, BISAP score, previous minimally invasive treatment and presence of the intraabdominal compartment syndrome.</p><p><strong>Results: </strong>The average age of men and women was similar in our group. Most patients were overweight or obese. Alcoholic aetiology was more common in men while biliary aetiology prevailed in women. The mortality rate was 26% in our group. The intra-abdominal compartment syndrome followed by emergency decompression surgery was present in one fourth of the patients. A minimally invasive approach was used in approximately in one half of the patients, and surgical treatment was used only in cases where the minimally invasive approach failed.</p><p><strong>Conclusion: </strong>After each surgical revision, clinical deterioration of the patient´s condition occurs during the first two to three days in response to operative stress. Therefore, the current trend in the treatment of acute pancreatitis is to proceed as conservatively as possible, or using the minimally invasive approach, and surgical treatment should be reserved only for conditions that cannot be managed otherwise. If surgical treatment is used, it is advisable to perform cholecystectomy, whatever the aetiology of the pancreatitis.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 2","pages":"64-74"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9475313","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":"Incidence of postoperative complications in patients with breast cancer depending on the type of drain.","authors":"V Procházka,&nbsp;A Závadová,&nbsp;J Žatecký,&nbsp;L Martínek","doi":"10.33699/PIS.2023.102.1.17-22","DOIUrl":"https://doi.org/10.33699/PIS.2023.102.1.17-22","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative complications in patients with breast cancer delay the initiation of adjuvant therapy, prolong the length of hospitalization and reduce the patients' quality of life. Although their incidence can be influenced by many factors, the connection with the type of drain is insufficiently studied in the literature. The aim of this study was to assess whether there is an association between the use of a different drainage system and the occurrence of postoperative complications.</p><p><strong>Methods: </strong>The data of 183 patients included in this retrospective study were collected from the information system of the Silesian Hospital in Opava and then statistically analyzed. These patients were divided into two groups according to the type of drain used - a Redon drain (active drainage) was used in 96 patients, and a capillary drain (passive drainage) was used in 87 patients. The incidence of seromas and hematomas, the duration of drainage and the amount of wound drainage were compared between the individual groups.</p><p><strong>Results: </strong>The incidence of postoperative hematomas was 22.92% in the group of patients with the Redon drain, and 10.34% in patients with the capillary drain (p=0.024). The incidence of postoperative seromas was comparable for the Redon drain (39.6%) or the capillary drain (35.6%) (p=0.945). No statistically significant differences were found in the drainage time or the amount of wound drainage.</p><p><strong>Conclusion: </strong>A statistically significantly lower incidence of postoperative hematomas was observed when using a capillary drain compared to the use of a Redon drain in patients after breast cancer surgery. The drains were comparable with respect to seroma formation. None of the studied drains was significantly more beneficial in terms of the total drainage time and the total amount of wound drainage.</p><p><strong>Key words: </strong>breast cancer, postoperative complications, drain, hematoma.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 1","pages":"17-22"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9130884","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":"Giant peritoneal loose body - case report.","authors":"M Rykovský, M Michal","doi":"10.33699/PIS.2023.102.9.366-370","DOIUrl":"10.33699/PIS.2023.102.9.366-370","url":null,"abstract":"<p><p>The article presents the case of a rare, free moving, completely benign intra-abdominal formation called \"giant peritoneal loose body\". In our case, an expansion of the left hypogastrium with central calcification, in intimate contact with intestinal loops, of rather benign etiology, reminiscent of a mesenteric calcifying fibrous tumor, was accidentally detected on CT angiography. A possible neoplastic process was suspected, and therefore PET/CT was completed, showing that the expansion had moved to the right hypogastrium, and the radiologist evaluated the finding as a possible teratoma not originating from an intestinal loop. Due to the still indeterminate nature of the expansion, an exploratory laparotomy was performed with the discovery of a loose ovoid mass without any vascular supply and unrelated to other structures, which was extracted and sent for histological examination. The result was surprising. According to the pathologist, it was a rare, completely benign intra-abdominal lesion called the \"giant peritoneal loose body\". This pseudotumor should be considered as a differential diagnosis whenever we accidentally detect an asymptomatic, freely moving intra-abdominal lesion with central necrosis or calcification, in order to avoid unnecessary surgery, because according to available information, only symptomatic ones should be surgically removed.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 9","pages":"366-370"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139577012","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":"Triple neurectomy following Lichtenstein repair of inguinal hernia.","authors":"B Jíšová, P Hladík, B East","doi":"10.33699/PIS.2023.102.9.363-365","DOIUrl":"10.33699/PIS.2023.102.9.363-365","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic pain is a distressing complication that can occur after inguinal hernia repair, affecting between 5% and 20% of patients as reported in literature. There are several reasons for chronic pain, including peripheral nerve irritation caused by surgical mesh or stitches. Preoperative pain is a risk factor for chronic pain.</p><p><strong>Case report: </strong>We present the case of a 59-year-old man who experienced chronic inguinal pain following Lichtenstein hernia repair. Conservative therapy was ineffective, and he subsequently underwent triple neurectomy without removal of the original polypropylene mesh. The patient experienced significant pain relief immediately after the surgery. There was no reported pain 1 month and 1 year post-surgery.</p><p><strong>Conclusion: </strong>The management of patients with chronic pain following hernia repair should be comprehensive and, ideally, centralized. Conservative procedures should be attempted first, but neurectomy and mesh removal may be necessary in cases where conservative measures are unsuccessful.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 9","pages":"363-365"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139577016","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":"The significance of glycocalyx in surgery.","authors":"L Hána, J Kočí, R Pohnán, D Řehák, D Astapenko","doi":"10.33699/PIS.2023.102.12.453-458","DOIUrl":"10.33699/PIS.2023.102.12.453-458","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical treatment is associated with an unwanted response of the organism to the so-called surgical trauma. This response is called surgical stress. Ischaemia-reperfusion injury is one of essential causes of tissue damage. It comprises functional and structural changes in tissue that occur after the restoration of circulation, after an episode of ischaemia. Necrosis of irreversibly changed cells and endothelial and mitochondrial-induced tissue swelling occur.</p><p><strong>Methods: </strong>Physiology, pathophysiology of endothelial glycocalyx: Endothelial glycocalyx is a 0.2 to 5 micrometres thin heteropolysaccharide layer that covers the endothelium on its intraluminal side. Backbone molecules of the glycocalyx include proteoglycans, glycoproteins, and glycosaminoglycans. Damage of the endothelial glycocalyx was described in trauma patients, in patients with septic shock, in ischemia and reperfusion injury, and during extensive surgical procedures. Approaches to prevent endothelial glycocalyx damage: Remote ischemic preconditioning was tested as a method of ischemia and reperfusion injury prevention during and after surgery. Nevertheless, the expected effect was not confirmed in performed meta-analyses. Endothelial glycocalyx damage can be prevented pharmacologically with a broad spectrum of substances, such as antithrombin III, doxycycline, hydrocortisone, etanercept, or nitric oxide donors. Hydrogen inhalation or albumin affects glycocalyx positively. Sulodexide provides a positive effect on the protection and reparation of endothelial glycocalyx. This proteoglycan with antithrombotic, fibrinolytic, hypofibrinogenemic, and lipolytic function is used for the treatment of venous diseases, ischaemic heart disease, and peripheral arterial disease. A positive effect of sulodexide on renal dysfunction was documented in a model of ischaemia and reperfusion injury. Equally, a positive effect of sulodexide was described on endothelium repair after its mechanical damage.</p><p><strong>Conclusion: </strong>Further research needs to be performed to evaluate the effect of endothelium-protectives on glycocalyx damage prevention and repair in ischaemia and reperfusion models involving large laboratory animals or in clinical trials in patients undergoing surgical revascularisation procedures.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 12","pages":"453-458"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139914049","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":"Maisonneuve ankle fracture.","authors":"J Bartoníček,&nbsp;P Fojtík,&nbsp;E Bunganičová,&nbsp;M Tuček","doi":"10.33699/PIS.2023.102.2.48-59","DOIUrl":"https://doi.org/10.33699/PIS.2023.102.2.48-59","url":null,"abstract":"<p><p>Maisonneuve fracture (MF) is defined as an ankle fracture-dislocation associated always with a fracture of the proximal quarter of the fibula and rupture of the anterior and interosseous tibiofibular ligaments. Other injuries are variable. Recent CT studies have demonstrated that MF is a far more complex injury than initially supposed. Therefore it is necessary to change substantially the current concepts related to this issue. MF is combined in about 80% of cases with a fracture of the posterior malleolus and also with malposition of the distal fibula in the fibular notch. An exact assessment of these injuries requires post-injury CT examination which should be used as a standard in MFs. The main goal of treatment is anatomical reduction of the distal fibula into the fibular notch. In case of avulsion of a larger fragment of the posterior malleolus, it is necessary to perform as the first step its reduction and fixation from the posterolateral approach and thus restore integrity of the notch. Closed reduction of the distal fibula is associated with malposition in up to 50% of cases and therefore open reduction from a short anterolateral approach is preferred. Accuracy of reduction should be always checked by postoperative CT scan.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 2","pages":"48-59"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9845545","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":"Abdominal emergencies in surgical oncology.","authors":"R Šefr,&nbsp;O Zapletal,&nbsp;P Krsička,&nbsp;I Novotný,&nbsp;M Pacal,&nbsp;L Němec,&nbsp;V Jedlička","doi":"10.33699/PIS.2023.102.2.60-63","DOIUrl":"https://doi.org/10.33699/PIS.2023.102.2.60-63","url":null,"abstract":"<p><strong>Introduction: </strong>In general, abdominal emergencies are urgent situations that require a prompt and correct diagnosis and treatment. They involve a broad spectrum of diagnoses and can occur in all age groups. The situation is often modified in oncologic patients according to the extent and level of progression of the primary oncological disease.</p><p><strong>Methods: </strong>A retrospective study was conducted to analyze the group of adult patients with abdominal emergencies treated in Masaryk Memorial Cancer Institute between 2011-2017.</p><p><strong>Results: </strong>In total, 601 patients underwent emergency surgery during the 7-year period. The causes included gastrointestinal obstruction (43%), intra-abdominal inflammatory complications (33%) and bleeding (17%). Acute appendicitis or cholecystitis was the cause in only less than 4% of all patients.</p><p><strong>Conclusion: </strong>The problems of acute abdominal emergencies in oncologic patients are substantially different from those in the general population, particularly in terms of the causes where gastrointestinal obstruction is the leading cause.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 2","pages":"60-63"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9475314","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":"Pneumoperitoneum, pneumomediastinum and subcutaneous emphysema following argon plasma coagulation treatment of colonic angioectasia.","authors":"P Horák,&nbsp;M Peregrinová,&nbsp;A Erbenová,&nbsp;T Žižková,&nbsp;J Fulík,&nbsp;J Fanta","doi":"10.33699/PIS.2023.102.3.130-133","DOIUrl":"https://doi.org/10.33699/PIS.2023.102.3.130-133","url":null,"abstract":"<p><strong>Introduction: </strong>The paper presents unusual symptoms as a complication of therapeutic colonoscopy.</p><p><strong>Case report: </strong>A 70-year-old polymorbid female patient in chronic dialysis program underwent argon plasma coagulation treatment of leaking angioectasias in the cecum and ascending colon. Shortly after the procedure she presented with shortness of breath and subcutaneous emphysema of the neck which was initially misdiagnosed as swelling. Further tests revealed pneumoperitoneum, subcutaneous emphysema and pneumomediastinum. Considering the high risks for our patient (comorbidities, obesity), a laparoscopic approach was indicated. During laparoscopy neither peritonitis nor intestinal perforation were found. The patient recovered without complications after further complex treatment.</p><p><strong>Conclusion: </strong>Shortness of breath and subcutaneous emphysema are not typically among the first symptoms of colonoscopic perforation. Our case confirms that we should bear this complication in mind and when suspected, the diagnostic process should be started without delay.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 3","pages":"130-133"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9675966","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":"Retroperitoneal abscess after urgent resection of the stomach in a geriatric patient treated with a surgical extraperitoneal approach - case report.","authors":"J Šimo,&nbsp;P Babál,&nbsp;V Javorka","doi":"10.33699/PIS.2023.102.1.37-41","DOIUrl":"https://doi.org/10.33699/PIS.2023.102.1.37-41","url":null,"abstract":"<p><p>Retroperitoneal abscess after abdominal and retroperitoneal surgery is a relatively rare but serious complication that most often occurs as a result of a healing disorder in the postoperative period. The incidence is not high, in the literature the cases are mostly reported as case reports with a serious clinical course, high morbidity and mortality. The most important factor of effective treatment, after successful diagnosis by CT examination is rapid evacuation of the abscess and retroperitoneal drainage, in which mini-invasive surgical or radiological drainage dominate as methods of choice. Surgical drainage, burdened by higher morbidity and mortality is considered the last resort after failure of mini-invasive methods. In our case report, we present a case of retroperitoneal abscess, arising as a complication after gastric resection, which was evacuated and drained primarily surgically due to unsuitability for radiological intervention.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 1","pages":"37-41"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10764920","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":"Postoperative delirium.","authors":"L Urbánek, P Urbánková, I Satinský, T Trávníček, I Penka, J Hruda","doi":"10.33699/PIS.2023.102.10.381-386","DOIUrl":"10.33699/PIS.2023.102.10.381-386","url":null,"abstract":"<p><p>Postoperative delirium is a serious complication occurring mainly in patients over 65 years. This complication is common in the above mentioned age group and has been described in up to 50% of patients. Postoperative delirium has a significant impact both on postoperative morbidity and mortality. Systematic and early detection of at-risk patients is essential to reduce the risk of postoperative delirium. Targeted efforts are then developed in thus identified patients to reduce the risk factors for developing delirium. An individualized approach to anesthesia is adopted during the surgery. Procedures that contribute to reducing the risk of developing delirium are preferred in the postoperative period. If this complication does occur, it is primarily preferred to manage any potential cause of the condition using non-pharmacological procedures. Pharmacological interven- tion should be reserved only for patients with a hyperactive form of delirium. The aim of the article was to shed more light on measures that help to prevent the delirium and on the therapeutic procedures used.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 10","pages":"381-386"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673592","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}