Rozhledy v Chirurgii最新文献

Acute abdomen represents a large complex of acute situations in general surgery. There could be inflammatory (such as acute appendicitis, acute cholecystitis etc.), non-inflammatory (ileus), hemorrhage or traumatic situations (perforation of the gastrointestinal tract etc.). Our work presents two case reports of two not significantly ill female patients with an uncommon inflammatory process of the caecum. Acute typhlitis is an archaism for most of surgeons. It used to be a synonym for acute appendicitis; however, the modern literature defines this diagnose as a different disease - neutropenic enterocolitis. It is a rare but serious disease causing a right lower quadrant pain, often mimics acute appendicitis. Usually, it occurs in immunocompromised patients (patients after an immunosuppressive therapy, neutropenic patients, people with hematologic malignancies, AIDS positive patients, etc.); however, a few case reports of entirely healthy patients have been published. Nevertheless, there is however a limited number of these cases.

Introduction: Cholecystectomy is one of the most common operations in surgical departments. Complications after gallbladder removal are mainly bleeding, infection including abscess in the gallbladder bed or in the abdominal wall, wound dehiscence, acute pancreatitis or injury of the bile ducts. In the further course, hernias in the scar may appear after both laparoscopic and open cholecystectomy, strictures of the bile ducts and symptoms of the so-called postcholecystectomy syndrome. The presence of residual gallstones is rare, statistically reported in 0.08-0.3%.

Case report: The goal of our message is to present the case of a patient taken into our care 7 years after laparoscopic cholecystectomy indicated for cholecystitis with wedged lithiasis in the gallbladder neck, proven by ultrasound. In our department, the -patient was treated for a re-current fistula in the scar of the right subcostal area. Definitive -healing from the initial manifestation of the fistula occurred despite repeated revisions after the precise localization and removal of the retained gallstone.

Conclusion: Thanks to the use of an extensive spectrum of diagnostic methods and at the same time thinking about the rare causes of a recurrent purulent collection with a fistula, we purposefully searched for an infectious source. Only perioperative radiography with injection of contrast material identified the presence of a retained gallstone. It was possible to extirpate it from the space between the intercostal muscles and the peritoneum, thereby relieving the patient of her problems.

Introduction: Dislocation fractures of the distal lower leg require surgical treatment. If the quality of the soft tissues and skin does not allow primary suture of the wound, it presents a serious challenge for the surgeon. In our case, after reposition and fixation of the fractures, we were able to perform a fascia suture with a residual large skin and subcutaneous defect. We decided to use a combination of Amnioderm application and negative pressure therapy.

Methods: The authors describe the procedure for the treatment of an acute wound in a young, morbidly obese patient with an ankle injury following a traffic accident.

Discussion: Closure of the surgical wound in the field of swelling and hematoma is a frequent problem encountered in patients after ankle osteosynthesis. There are several possible approaches, one of which is the use of negative pressure therapy. Its effect can be enhanced by the application of Amnioderm.

Conclusion: Although this is the first use of the presented technique, based on our other general experience with Amnioderm and the frequent use of negative pressure wound therapy from other indications, we dare to say that it is a safe method that offers an effective solution to a complex, critical situation.

Since the beginning of carotid surgery, there has been an effort to find the safest technique for carotid endarterectomy and ensure sufficient brain perfusion during the procedure. Similarly, endovascular procedures have been modernized from simple balloon angioplasty to stent placement, and protective systems have been developed to prevent periprocedural embolization. The second half of the last century became an important stage in examining and comparing the results of carotid endarterectomy and carotid stenting, -searching for and establishing indication criteria in the context of highly effective antiplatelet -therapy. At the turn of the century, with the advent of modern techniques of regional anesthesia and intravenous analgosedation, most vascular departments gradually moved away from carotid surgery under general anesthesia and there was a renaissance of eversion endarterectomy techniques. From a vascular perspective, carotid surgery underwent a long, closely monitored development and defended its place as the first choice in the treatment of carotid stenoses.

Introduction: Takotsubo syndrome presents with the sudden onset of symptoms resembling with acute coronary syndrome with typical transient myocardial kinetic disorder. In the secondary form of the disease, the initial symptoms of the patient are extracardiac.

Case report: A 67-year-old female patient with a history of ischemic heart disease underwent urgent Hartmann's resection for sigmoid perforation due to Clostridium colitis. Two days after the primary surgery, during a planned surgical revision for another pathology, the patient developed cardiorespiratory failure. Due to the electrocardiographic finding of newly developed left bundle branch block and the echocardiographic image of extensive local kinetic disorder with severe systolic dysfunction of the left ventricle, the patient was indicated for selective coronary angiography with suspicion of acute coronary syndrome. The examination did not demonstrate coronary artery involvement. After the diagnosis of Takotsubo syndrome was established, the patient was successfully treated with gradual resolution of symptoms and normalization of left ventricular function.

Conclusion: Takotsubo syndrome is a diagnosis that can be potentially fatal and -should be a part of the differential diagnostic assessment in surgical patients when acute coronary syndrome is suspected. With properly adjusted therapy, the symptoms of this disease disappear without functional and morphological consequences.

Mediastinal lymphadenectomy plays a crucial role in the surgical treatment of -non-small cell lung cancer (NSCLC), as accurate staging significantly influences subsequent therapy. Robot-assisted thoracoscopic surgery (RATS) has emerged over the past decade as an advanced minimally invasive approach with the potential to achieve high oncological radicality. This review explores the outcomes of mediastinal lymphadenectomy performed using the RATS technique and compares them with those of video-assisted thoracoscopic surgery (VATS). In most studies, a higher, at least comparable, total number of lymph nodes was retrieved with RATS compared to VATS. The number of dissected nodal stations was comparable between RATS and VATS in most studies. Authors frequently highlight the advantages of robotic technology, including enhanced visualization, precise dissection, and the potential to detect occult nodal metastases. The technique is also associated with low morbidity and a feasible learning curve. Although robust long-term survival data are still lacking, current findings suggest that RATS may represent a safe and effective option for mediastinal lymphadenectomy in NSCLC, particularly in centres with established robotic programs.

Ocular traumas include a wide range of injuries from trivial conditions to extensive perforating injuries that can lead to visual function impairment of various ranges and even to the loss of the eye itself. In terms of first aid, not only an ophthalmologist but also a physician of any specialty can effectively intervene and minimize the consequences of these conditions. Open globe injuries represent prognostically the most severe conditions which have to be treated by an experienced ophthalmologist. Closed injuries are most commonly manifested as corneal erosions, foreign bodies on the surface of a globe or contusions of varying severity. These conditions do not always require urgent primary intervention by an ophthalmologist. The opposite is true for chemical traumas which are often caused by alkali. Urgent intervention consisting in eye lavage is crucial to minimize complications. Periocular tissue injuries can be divided into orbital skeletal fractures and soft tissue traumas of the orbit and eyelids. Acute conditions in ophthalmology also include inflammations of the eye and periocular tissue, of which endophthalmitis and retroseptal orbital cellulitis are the most prognostically serious. Acute retinal circulatory disorders include central retinal artery occlusion and acute ischemic optic neuropathy. Acute angle-closure crisis can be manifested as sudden severe pain of the globe, headache and blurred vision. The other most common causes of acute visual impairment are hemophtalmus and retinal detachment, the conditions which require specialized intervention of an ophthalmologist. Sudden conditions in ophthalmology require prompt diagnosis and early basic medical intervention which can be provided by a physician of any specialty and can significantly reduce subsequent complications. Ultimate treatment then belongs to the ophthalmologist.

Introduction: The modified Henry approach is predominantly used in the treatment of distal radius fractures. Over the years, it has undergone numerous modifications, and its original interpretation varies significantly. This summary also discusses other volar approaches to the distal radius. The original description of the approach is attributed to Arnold Kirkpatrick Henry, who, in his three publications, mentions the interval between the radial artery and the flexor carpi radialis muscle. Currently, many controversies are being debated, including extended approaches, techniques and options for transecting the pronator quadratus muscle, indications and methods for carpal tunnel release, transection of the brachioradialis muscle, and others. Variations: Anatomical structures visualized during the modified Henry approach are not highly variable. Occasionally, an accessory flexor carpi radialis brevis muscle and several variants of the pronator quadratus muscle may be present, which have only been described in case reports.

Conclusion: Among the many controversies debated regarding the modified Henry ap-proach, the most clinically significant are the proper release of the brachioradialis muscle and the early detection of carpal tunnel symptoms followed by appropriate intervention. Other volar approaches are used less frequently and typically in specific indications.

Facial loss injuries present a significant surgical challenge, often requiring not only the expertise of a plastic surgery specialist but also interdisciplinary collaboration. Special attention is given to acral structures, such as the nose, lips, and auricles. This article details each step in the reconstruction of these areas, including the use of flap plastics and microsurgical techniques. Emphasis is placed on the specifics of treating animal-induced injuries, with an overview of infection prevention and treatment strategies. The article also includes a list of replantation centers in the Czech Republic that provide care in cases of loss injuries requiring it. The aim is to offer a comprehensive overview of current trends and practical approaches for surgeons encountering these complex cases in outpatient practice.

Introduction: Not only in the Czech Republic, robotic surgery has passed through the rapid development and exponential increase numbers of procedures in all spheres of surgery. We focused on evaluation of our initial experience with robotic-assisted colon resection over 3 years.

Methods: This is a retrospective, monocentric study involving a total of 105 patients who underwent robotic surgery in the colon area from January 2021 till December 2023.

Results: A total of 49 women and 56 men underwent a robotic procedure. The average age was 65 years. In total, 63 right-sided hemicolectomies, 18 left-sided hemicolectomies, 22 colon sigmoid resections and 2 transverse colon resections were performed. The median console operation time was 205 min, 8 patients underwent a conversion of the procedure (7.62%). Postoperative complications were seen in a total of 21 patients (20%). The median length of stay was 6 days.

Conclusion: Robotic surgery in the colon area is an effective method of surgical treat-ment for oncological and benign diseases. The initial time demands of the procedures are balanced by the low surgical burden on the patient, with low perioperative blood loss, and with the oncological safety and radicality of the procedure in patients with cancer at the same time. And last but not least, the possibility of shortening the length of stay, with a low level of postoperative complications (Clavien-Dindo ≥ grade III below 3%) is a great advantage.