Rozhledy v Chirurgii最新文献

Introduction: Gastric bypass has not gained as much popularity in the Czech Republic as technically simpler restrictive bariatric procedures, frequently with a fading long-term effect. The aim of the presentation is to point out the long-term results after two types of gastric bypasses.

Method: Retrospective analysis of prospectively collected data in an initial set of patients after laparoscopic RYGB (Roux Y gastric bypass) and OAGB/MGB (one anastomosis/mini gastric bypass) performed at Breclav Hospital in 2010-2013. Evaluation based on the BAROS system, according to weight development, comorbidities, psychological aspects, complications and reoperations.

Results: Data available for evaluation are from 32 patients out of a total of 60; the follow-up rate is 53%. The patients are lighter by 34 kg on average (0-64 kg); TBWL (total basic weight loss): 25.7%. The majority of operated diabetics are free of signs of diabetes, and all others have a reduced need for antidiabetic medication. Hypertension, sleep apnea and psychological assessment of life in 6 domains improved. Eight of the 32 followed patients underwent reoperation during 10 years; only 2 of these procedures were acute for complications (anastomotic ulceration), both in smokers; further elective reoperations included 2 conversions of OAGB/MGB to RYGB due to reflux, 2 corrective surgeries, and 2 procedures for a suspected internal hernia. There was no conversion from laparoscopic to open surgery, no peritonitis associated with a leak, and no mortality within 30 days. The BAROS score (5.56) indicates a "very good result" of the gastric bypasses after 10 years.

Conclusion: Gastric bypasses are safe and provide a high and lasting metabolic effect that meets the general expectations of an invasive intervention that can fundamentally improve the quality of treatment for otherwise incurable chronic diseases related to adiposity (so-called ABCD), especially type 2 diabetes.

Introduction: Thanks to mammographic screening and the improvement of breast cancer diagnostics, the detection of precancers is also increasing. They are defined as morphological changes of the mammary gland which are more likely to cause cancer. The evaluated precancers are atypical ductal hyperplasia (ADH), lobular carcinoma in situ (LCIS) and radial scar.

Methodology: In the period 1. 1. 2018-31. 12. 2022, we performed 1,302 planned operations for breast disease at the Surgical Clinic of Teaching Hospital Plzeň, of which 30 (2%) were precancer operations. ADH was confirmed 11×, LCIS 8×, and a radical scar 11×. The average age of the patients in all three groups was 56 years (27-85). Precancer was diagnosed 8× only by sonography, 3× by mammography and 19× by a combination of both methods. Subsequently, a puncture biopsy was always completed. We performed 28 tumor excisions with intraoperative biopsy and 2 mastectomies.

Results: In the case of ADH from puncture biopsy, ADH was confirmed intraoperatively 8×, DCIS was diagnosed 2×, and mucinous carcinoma 1×. In LCIS, no tumor was found by intraoperative biopsy 4×, LCIS was confirmed 1×, lobular invasive carcinoma was diagnosed 1×, mastectomy was performed 2× without intraoperative biopsy. In the radial scar, ADH was diagnosed 3×, sclerosing adenosis 6×, DCIS 1×, invasive carcinoma 1×. After the final histological processing of the samples, there was an increase in diagnosed carcinomas. In ADH, DCIS was confirmed 3×, DIC 2×, and mucinous carcinoma 1×. In LCIS, LIC was diagnosed 3×. In the radial scar, DCIS was confirmed 1×, and invasive carcinoma remain 1×. Thus, carcinoma was diagnosed in 11 patients (37%) thanks to the surgical solution. No patient underwent axillary node surgery. All 11 patients subsequently underwent oncological treatment, always a combination of radiotherapy and hormone therapy. All patients are alive, 10 patients are in complete remission of the disease, one with DCIS experienced a local recurrence after 4 years.

Conclusion: Surgical treatment of precancers of the breast makes sense, DCIS or even invasive cancer is often hidden in addition to precancer. Thanks to the surgical solution, the cancer was detected in time.

This paper provides a brief overview of current information and recommendations for surgical treatment of breast cancer in pregnancy, including three currently controversial areas - indications for breast-conserving surgery in the 1st trimester of pregnancy, indications for sentinel lymph node biopsy and its technique, and fetal monitoring during surgery.

Introduction: Lymphangiomas belong to the group of benign vascular tumors that originate in the lymphatic tissue. Up to 90% of cases manifest in children before the second year of life. In adults, their presence is very rare. In most cases, they are located in the head, neck and axilla. Intra-abdominal lymphangiomas are very rare and represent less than 1% of all cases.

Case report: The authors present the case of a 64-year-old female patient diagnosed with an intra-abdominal cystic lesion following a routine examination. A CT scan of the abdomen confirmed a cystic lesion located in the lesser omentum between the left lobe of the liver and the lesser curvature of the stomach. The patient was scheduled for laparoscopic exstirpation of the lesion. Histological examination confirmed the clinical diagnosis of cystic lymphangioma of the lesser omentum.

Conclusion: The etiopathogenesis of lymphangiomas remains unclear. Despite the fact that they are benign tumors, lymphangiomas tend to have an infiltrative pattern of growth, invading surrounding structures. The majority of cases are asymptomatic and the diagnosis is incidental. The gold standard in treatment remains complete surgical extirpation with microscopically negative margins.

Introduction: Spigelian hernia is a rare type of abdominal wall hernias which are often diagnosed when incarcerated. These hernias typically develop at the crossing point of the arcuate line and lateral portion of rectus abdominis muscle.

Case report: We present the case of a 44-year-old female patient admitted to our surgery unit for a painful lump in her right mesogastrium. Incarcerated atypical hernia in the right mesogastrium was suspected based on completed imaging assessments. Spigelian hernia was confirmed by preoperative findings. Interestingly, the patient applied interferon (multiple sclerosis therapy) at the site of the lump, which is why the diagnosis of lipodystrophy had been considered.

Conclusion: In general, the diagnosis of Spigelian hernia is difficult. From the anatomical point of view the clinical finding is not always specific. The risk of incarceration is relatively high, and thus even clinically silent findings are indicated for surgery.

Skin substitutes and covers are crucial across surgical disciplines, promoting interdisciplinary collaboration to meet varied clinical needs. While some medical professionals may encounter these products infrequently in their practice, understanding their properties and applications is paramount to provide optimal patient care. In this overview, we aim to provide healthcare professionals with essential information regarding skin substitutes and covers, equipping them with knowledge to navigate their use effectively across different clinical scenarios and to optimize patient outcomes. The speed of progress in tissue engineering and regenerative medicine is notable, driven by collaborative efforts among scientists, engineers, and clinicians. Technological advancements, increased funding, and a deeper understanding of cellular and molecular processes have accelerated research and development. However, challenges remain, such as achieving vascularization in engineered tissues, addressing immune responses, and ensuring long-term functionality of regenerated organs. Despite these hurdles, the field continues to evolve rapidly, offering hope for transformative medical solutions that may redefine the treatment landscape soon. In this article, we review the current selected commercially available epidermal, dermal, and total skin substitutes for wound healing.

Currently, no international consensus includes surgery as part of the standard of metastatic pancreatic ductal adenocarcinoma care. There is weak evidence to support the general introduction of surgical resection in the metastatic pancreatic ductal adenocarcinoma treatment. However, in the rare cases of oligometastatic spread there is increasing evidence that surgical intervention can lead to favourable outcomes. Individualisation of the care and tailored therapy refers not only to targeted treatment but also to the whole complex cancer care, including the indication for surgery. This review summarizes the current status of combined oncosurgical therapy in the multidisciplinary management of oligometastatic pancreatic cancer, together with our own experience, and discusses future perspectives, particularly regarding prognostic and predictive factors that could better predict this group.

Introduction: Antibiotic cement-coated intramedullary nails (ACCINs) are an increasingly popular method in the treatment of FRI (fracture-related infections). FRI is a major challenge that poses a major problem for the treating physician and the health care system, both in terms of cost of therapy, time required, and the complexity of treatment with an uncertain outcome. The aim of our report is to evaluate the results of surgical management using ACCINs in patients with FRI who were treated during a 5-year period at our institution.

Methods: A retrospective evaluation of the results of surgical treatment using ACCINs in patients with FRI treated at the Department of Trauma Surgery, University Hospital Brno and Faculty of Medicine, Masaryk University in Brno in 2018-2022. Based on the exclusion criteria, 5 out of 18 patients were excluded from the study for the following reasons: a follow-up period less than 6 months, chronic immunosuppressive drug therapy, and any oncological or autoimmune disease. Bone infections in the femoral diaphysis, tibial diaphysis and infections in the ankle joint were among the inclusion criteria for the use of ACCINs. The study population consisted of 13 patients (3 women, 10 men); mean age was 48 years and median age was 44 years. Three patients had an infection after osteosynthesis in the femoral diaphysis, 7 patients had an infection in the tibial diaphysis and 3 had an infection in the ankle joint.

Results: In our cohort, bone healing without any clinical and laboratory signs of infection or stable arthrodesis was observed in 7 (54%) patients. In 3 cases (23%), healing proceeded without any signs of infection. In 3 patients (23%), further surgical treatment was required because of fracture nonhealing (n=1) and because of the combination of bone nonhealing and infection (n=2). The overall limb salvage rate was 100%.

Conclusion: The use of ACCINs fulfills the three basic principles of bone infection therapy after thorough debridement: local action of antibiotics, filling of the dead space, and stabilization of the skeleton. ACCINs provide an effective method in the treatment of FRI of the diaphysis of long bones and septic arthritis of the ankle.

Fractures of the proximal humerus present a unique challenge in orthopedic practice due to the complex anatomy and biomechanical complexity of this region. The spectrum of injuries occurring here ranges from nondisplaced stable fractures to complex displaced fractures or fracture-dislocations. Historically, the treatment of these fractures has been the subject of much debate and treatment modalities have mainly involved a conservative approach, with surgical management being relatively rare. In recent decades, there has been a paradigm shift in the treatment of proximal humerus fractures not only due to advances in surgical techniques, but especially with the development of new types of angular-stable implants and modern total arthroplasties. The development and availability of high-quality imaging techniques have enabled better understanding of the nature of fractures and precise planning of surgical interventions. The main goals of treatment include restoration of function, pain relief and prevention of complications such as prolonged healing or non-healing and avascular necrosis. An individualized approach to each individual patient, considering all factors that affect the final outcome, appears to be essential in the choice of treatment. The aim of this review article is to provide an up-to-date overview of the current concept of treatment of proximal humerus fractures. Trends in nonoperative and operative treatment strategies, indications for each type of treatment, operative techniques, outcomes, and complications associated with each approach are summarized.

Introduction: Volkmann's ischaemic contracture (VIC) is a disabling condition resulting from tissue necrosis due to impaired vascular supply to the limb. Over the years VIC has become rare in developed countries with many different aetiologies described. It was alarming to have high incidence of established VIC in our practice in Nepal. A detailed analysis was conducted to accurately describe this issue.

Methods: We collected 47 cases of VIC over six years and noted the age, sex, district of origin and cause of VIC, duration of injury to presentation, and the grade of VIC. Then we compared these characteristics of VIC of each Nepal province and created a map to show the problematic regions.

Results: Out of 47 patients, 46 could have been prevented by an early treatment. The most common cause was a tight cast in 25 patients (53.19%), followed by unintentionally self-caused VIC by applying tight bandages in 21 patients (44.68%). Most cases came from province 6 (29.78%). Our group included three mild (6.4%), 35 moderate (74.5%) and nine severe (19.1%) cases of VIC. Only 14 cases (29.78%) had a timely fasciotomy in the past.

Conclusion: VIC is an irreversible complication of the compartment syndrome which is an easily preventable condition in the setting of developing countries. Our focus should, therefore, aim at preventing such disastrous conditions as 97.87% of cases we encountered could have been avoided by proper primary care. In the case of Nepal most cases came from province 6 and province 3.