Rozhledy v Chirurgii最新文献

Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a relatively rare non-neoplastic proliferative mass of vascular origin arising from the red pulp of the spleen accounting for less than 1% of all splenic tumors. Accurate preoperative diagnosis is difficult due to the rarity of the pathology and lack of specific clinical and radiologic features, and final diagnosis of SANT is based on histopathologic and immunohistochemical studies. A 34-year-old male patient who presented with an incidentally found tumor of the spleen discovered on a routine CT examination. The patient underwent classic splenectomy. Pathological examination with immunohistochemical staining confirmed SANT of the spleen. SANT should be included in the differential diagnosis of focal pathology of the spleen due to the rarity of this disease and should be treated by further open or laparoscopic splenectomy with pathologic examination including mandatory immunohistochemical staining.

Introduction: Lung carcinoma represents a malignancy with the highest global mortality rate. Surgical treatment remains the cornerstone of curative therapy, with minimally invasive techniques currently dominating the field. This study aimed to compare post-operative pain in patients undergoing lobectomy for lung cancer via uniportal video-assisted thoracoscopic surgery (UVATS) vs. robotic-assisted thoracic surgery (RATS).

Methods: This prospective study included 140 patients (70 RATS, 70 UVATS) undergoing lobectomy with mediastinal lymphadenectomy. Patients assessed their pain using the Short-Form McGill Pain Questionnaire and visual analogue scale (VAS) on the 3rd and 14th postoperative days. We also analyzed the influence of age, gender, and BMI on pain perception and analgesic requirements.

Results: Patients following RATS exhibited significantly higher pain intensity compared to UVATS on both the 3rd (VAS 5.8 ± 2.0 vs. 3.8 ± 1.6; P < 0.00001) and 14th postoperative days (VAS 2.7 ± 1.1 vs. 2.2 ± 1.1; P = 0.00133). Combined analgesic therapy was more frequently required in the RATS group. Female patients demonstrated markedly higher pain intensity and analgesic requirements in both surgical approaches. Age and BMI had no significant impact on pain perception.

Conclusion: Robotic-assisted surgery is associated with higher postoperative pain compared to uniportal video-assisted thoracoscopy, with differences being more pronounced in female patients. We recommend implementing targeted analgesic strategies for robotic procedures and considering the use of 8-mm ports instead of standard 12-mm ports to reduce chest wall trauma.

We present a case report of a 26-year-old patient with an incidental finding of intra-abdominal fibromatosis (desmoid) in the small pelvis who presented to the urology outpatient clinic for erectile dysfunction. Ultrasound examination revealed hydronephrosis of the right kidney with parenchymal reduction, and a bulky tumor was detected in the small pelvis, which was compressing the right-sided ureter. The patient was followed up with a CT scan which confirmed a solid tumour in the small pelvis of unclear origin, the nature of the tumour and the treatment were discussed by the multidisciplinary team and a decision was made to resect the tumour. Pathologist confirmed sporadic variant of desmoid. Desmoid tumors are characterized by both locally aggressive carcinomas mimicking growth and frequent recurrences after resection, which may require subsequent oncological treatment. For these reasons, patients with desmoids should be fol-lowed up by an oncologist, ideally at centers experienced in treating this rare disease.

This paper provides a brief overview of current information and recommendations regard-ing acute imaging of adult patients to rule out cervical spine injuries. It summarizes the possibilities of plain X-ray examination of the cervical spine, which is technically demand-ing and has low diagnostic yield. Therefore, it is no longer recommended. Exceptions are locations where CT is not available and patients for whom exposure to medium or high doses of ionizing radiation is contraindicated. Routinely performed CT examinations of the cervical spine to rule out injury have a significant medical and financial impact. For this reason, internationally recognized criteria sets NEXUS (National Emergency X-Radiography Utilization Study) and CCR (Canadian C-spine Rule) have been introduced. These include information from the patient's history and clinical examination and are used to indicate the need for cervical spine CT to exclude trauma. Both systems are described and compared. According to some recommendations and in the opinion of the authors, combining the two systems could further improve their effectiveness.

Background: Surgical site infections (SSIs) are a major health and economic problem. Increased morbidity, prolonged hospital stay and the need for additional treatments increase the financial costs of healthcare institutions. The aim of this article is to analyze the incidence of SSIs, their impact on hospital length of stay and economic burden under Czech conditions.

Methods: We analyzed hospitalizations in the period from 1st January 2021 to 31st December 2024 that were classified as SSI according to the CZ-DRG. A total of 2,134 hospitalizations were included, of which 212 (9.93%) were complicated by SSI. We recorded the length of hospital stay, number of reoperations and their duration.

Results: SSI hospitalizations accounted for 9.93% of all cases but 25.3% of hospital days. The economic impact of SSIs was expressed as a case-mix of 24.07%. SSI cases required 19.66% of all operations and 16.43% of total operating time.

Conclusion: It is evident from the findings of this study that SSIs are not only a medical problem, but also an economic one. The economic analysis conducted in this study demonstrates that, even with higher reimbursement for SSI cases, this reimbursement does not cover the additional costs associated with prolonged hospitalization and the necessity for reoperations.

Introduction: Gastric diverticulum is a very rare condition and, in most cases, asymptomatic. Its diagnosis is challenging for diagnostic departments. Symptomatology of the larger gastric diverticula can imitate other illnesses for some time. Initially we can treat it like abdominal pain, gallbladder or kidney colic, back pain, or gastroesophageal, or duodenogastric reflux disease. Common use diagnostic examinations like X-ray of the abdomen or thorax, or ultrasound of the abdominal cavity often cannot find the origin of the problems. It is the least common gastrointestinal diverticulum, therefore its presence can be lost from the minds of the examination specialists. In case of successful diagnosis of the gastric diverticulum the next therapy is led due to clinical state of the patient and according to symptomatology. Almost all gastric diverticula are set for conservative therapy. We can decide for surgery when complications such as bleed-ing or signs of the perforation occur and according to some problems, which can limit the patient in common life (such as pain, dysphagia, odynophagia or reflux disease).

Case report: Authors present a case of a 64-years-old patient, which was examined for abdominal pain in the epigastrium with night episodes of gastroesophageal reflux and cough for 2 years. Contrast examination of the upper gastrointestinal tract was performed in the past, but did not reveal any pathology. Therefore, a recent gastrofi-broscopic examination of the stomach followed. The results were unclear and showed the possibility of the presence of hiatal hernia or stomach diverticulum untill computer tomography scans gave clear diagnosis of stomach diverticulum. It was located in the fundus area in the rear stomach wall and it was in intimate contact with the spleen and left adrenal gland. Because of patient's symptoms, robotic resection of the diverticulum was indicated after consultation.

Conclusion: Stomach diverticulum is a very rare anatomic abnormality in general. Surgical treatment is indicated in the low range of all stomach diverticula. Literature reviews show mostly single case reports or small groups of patients with stomach diverticula. There is no recommendation for treating management. Surgical approach should be individual and based on symptoms and complications connected to diverticulum presence.

Enteroatmospheric fistula (EAF) is one of the most severe and life-threatening surgical complications, significantly increasing the cost of patient treatment. It is classified as a postoperative complication, collectively referred to as abdominal catastrophes. EAF is a specific type of intestinal fistula that occurs when the intestinal lumen opens into an unhealed defect in the abdominal wall, leading to continuous wound contamination that complicates healing. Treatment of this complication is challenging, prolonged, and requires a multidisciplinary approach in three distinct phases. In the first phase, the goal is aggressive therapy of abdominal sepsis and management of its source. -After stabilizing the patient, the second, chronic phase focuses on care for the defect and reversing the nutritional status from catabolism to anabolism. Following the maturation of adhesions in the abdominal cavity, healing of the wound around the EAF, and adequate nutritional preparation, the patient undergoes the reconstructive phase, which involves restoring the continuity of the digestive tract and reconstructing the abdominal wall. Throughout all phases, the patient is at risk for numerous secondary complications related to malnutrition and prolonged hospitalization. Therefore, preventing the development of EAF is of paramount importance. The aim of this paper is to summarize current recommendations for the treatment of EAF and discuss some of the modern approaches to managing this condition.

In recent years, the significant progress in the outcomes of conservative treatment for patients with asymptomatic carotid stenosis has sparked discussions about the most effective invasive treatment. The necessity of such treatment is still being debated in certain cases. Several studies have already been conducted to find the most appropriate approach for asymptomatic patients with carotid stenosis, while others are still randomizing and awaiting results. A major unanswered question is whether revascularization is more beneficial than intensive conservative treatment, particularly in view of the lower stroke rates achieved in recent years without conventional or endovascular intervention. The long-term goal should be to identify a subset of patients who would benefit from conservative treatment. In this text, we summarize the issue in the context of the results of two recently completed pivotal studies.

Introduction: Robotic pancreaticoduodenectomy ranks among the routinely performed surgical procedures in world pancreatic centres. Since 2023, it has also been performed in the Czech Republic.

Case report: We present a case of a 65-year-old patient with accidentally found dilatation of the pancreatic duct. During the examination, a small tumor in the head of the pancreas was diagnosed. A robotic pancreaticoduodenectomy was performed. Due to the perioperative suspicion of invasion into the portal vein, the resection was performed. The operation and the course of hospitalization were uncomplicated, the patient was discharged on the 9th postoperative day.

Conclusion: Robotic pancreaticoduodenectomy is a method that combines the advantages of a minimally invasive approach and meets the requirements for safety and oncological radicality. Suspected venous invasion is not an obstacle to completing robotic surgery.

Neoadjuvant treatment for colon cancer, unlike rectal cancer, is rarely used. Its position in the treatment algorithm is not precisely defined. This treatment should be considered for locally significantly advanced tumors (cT4) with extensive nodal involvement. The neoadjuvant treatment plan should be determined in a multidisciplinary team setting. We describe the main clinical trials focused on neoadjuvant chemotherapy in colon cancer. A special subgroup is dMMR/MSI-high tumors, patients with such cancers are candidates for immunotherapy treatment. Immunotherapy can induce complete remission, but can also be accompanied by long-term or permanent toxicity of the treat-ment. Neoadjuvant immunotherapy of non-metastatic colon cancer is the subject of a number of clinical trials. Currently, no immunotherapy is registered in the EU for the neoadjuvant treatment of early colon cancer.