The authors evaluate two groups of patients after laparotomy where during the postoperative period complete dehiscence of the laparotomic wound occurred. In the first group A the laparotomies were closed in anatomical layers by individual silon stitches, in group B for closure a single layer continuous PDS loop suture was used. After introduction of this technique the percentage of dehiscent laparotomies declined from 2,2% to 1,2%.
During the last decade, sacral nerve stimulation (SNS) has become a new perspective and effective method in the treatment of fecal incontinence. In the Czech Republic, SNSs have been used since 2010.From May 2010 to August 2011, sacral nerve stimulation was performed in 15 patients in FN Na Bulovce Surgical Clinic in Prague. All of the subjects were female patients and their mean age was 59 (46-68 years of age). The first phase of the treatment included the following procedures: percutaneous sacral nerve (S2-S4) examination, electrode implantation and subchronic stimulation. Permanent neurostimulator implantation was indicated in 14 out of the 15 subjects and over 50% of them experienced reduction in incontinence episodes. The following neurostimulators were used: Medtronic InterStim 3023 or InterStim II 3058. Stimulation parameters included 15 Hz frequency, pulse width of 210 micros and the stimulation range was between 1-3 V. The patients' follow up period was 1-15 months after the procedure.After the first phase of SNS, the morbidy rate was 7%. The morbidity rate after the permanent neurostimulator implantation was 0 %. Permanent neurostimulators were implanted in 14 out of the total of 15 subjects, i.e. the success rate was 93 %. Based on the incontinence recording sheet (diary) data collected from all the 14 subjects, the mean number of incontinence epizodes was 24 epizodes/week (+/- 13.0) before the stimulation and 4 epizodes/week (+/- 3.8) after the stimulation procedure. Cleveland Clinic Incontinence Score was assessed in the first 8 subjects and its mean value was 20 (+/- 0.7) before the procedure, vs. 7 (+/- 1.2) after the stimulation procedure. The both values were significantly lower after the stimulation procedure (p <0.05). No significant differences between the manometric values before the procedure and after the stimulation procedure were detected. SF-36 showed improvement in the quality of life, in particular in the parameters assessing social and mental functions. Nevertheless, there were no significant differences in any of the studied parameters.The initial experience with SNS in the Czech Republic showed over 50% improvement in continence rates in 93% of the subjects with introduction of stimulation electrodes and subchronic stimulation and over 50% improvement in 100% of the subjects, who underwent permanent neurostimulator implantations, and full continence was achieved in 33% of the subjects.
Objectives: We demonstrate a case report of the patient who suffered from advanced gastric cancer and was treated by means of surgery and HIPEC.Background: Gastric cancer is a therapeutic challenge in the European countries due to late diagnosis, advanced stages of the disease in time of diagnosis and early recurrence in cases where a radical surgery is possible.Method: The patient with an advanced gastric cancer (pT3N2M1 -peritoneal and ovarian metastases) was treated by means of radical surgery in combination with hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC).Surgical treatment was followed by a standard chemotherapy.Due to recurrence, there was the second look surgery one year later again with HIPEC procedure.Results: Patient survived 32 months after diagnosis and despite intraperitoneal recurrence she never developed clinically signifi cant ascites and she never suffered from intestinal obstruction.Conclusion: This case demonstrate a potential benefi t of new oncosurgical approach -radical surgery + HIPEC + EPIC in the treatment of gastric cancers (Tab.2, Fig. 6, Graph 4, Ref. 18).
In the submitted review of the literature the authors evaluate contemporary therapeutic possibilities of mesenterial desmoids. A more detailed pattern of cytotoxic and non-cytotoxic chemotherapy, actinotherapy and hormonal therapy is presented. Surgical resection is limited by the size of the tumour and above all by early detection before the size of 15 cm is reached. In larger tumours conservative treatment by a combination of non-cytotoxic and hormonal treatment is better. Actinotherapy of the intraabdominal region is not suitable. The percentage of relapses is high, a standard therapeutic procedure has not been elaborated so far. Despite rather surprising remissions of desmoids in individual cases the general results of different groups are not encouraging. In a case-history the authors describe their experience with the treatment of a young female patient with a mesenterial desmoid which, however, was not successful.
The author presents his own experience with the diagnosis and treatment of 19 patients with acute manifestations of toxic colitis. Patients with ulcerative colitis developed toxic colitis in 11 instances. The second most frequent background for the development of toxic colitis was pseudomembranous colitis. Conservative treatment before 72 hours was successful only in two patients. Seventeen patients were operated at varying intervals after the onset of the disease (1-21 days) and subtotal colectomy was performed with ileostomy and a mucous fistula of the rectosigmoid. The lethality in the whole group was 10.5%. All patients who died (2) were from the group operated on the 5th-7th day, while in the groups operated on the 2nd-5th and 14th to 21st day there were no deaths. In the group two cases of carcinoma were detected.
Peritoneal carcinomatosis (PK) of colorectal origin is a malignant tumour of the peritoneum caused by spreading of colorectal carcinoma (KRK) over the peritoneal surface of the abdominal cavity and its organs. PK occurs as a synchronous tumour in 1520% of patients, and as metachronous disease in 2550% of patients.A group of 66 patients operated on for PK was retrospectively evaluated; 18 patients were excluded due to insufficient data. We evaluated 48 patients in total (22 men and 26 women) with mean age of 58 and 53 years, respectively; 12 patients (25%) were aged over 65 years. The patients were operated on between 2000 and 2019 using the Sugarbaker´s method of maximal cytoreduction (CRS) + HIPEC (Hyperthermic Intraoperative Peritoneal Chemotherapy). We evaluated the length, median survival, the incidence of complications and lethality in relation to the Peritoneal Carcinoma Index (PCI) and the Completeness of Cytoreduction (CC) score. The patients were divided into two subgroups according to the PCI score (012 and >12, respectively) and the CC score (CC 01 and CC 23, respectively).The mean survival was 26.3 months in the group with PCI up to 12 and 21.4 months in patients with PCI above 12 (p=0.02). In the group with CC 01 the mean survival was 27.1 months, while in the patients with the CC 23 it reached 12.6 months (p=0.06). The morbidity rate requiring an intervention was 18.7% and the lethality rate was 6.25% in the entire group. The median survival of the entire group was 22 months (1334 months).Literary references and our results are comparable, confirming the high efficiency of this method both in our country and worldwide. The use of CRS and HIPEC, associated with acceptable mortality and morbidity in selected patients with PK of colorectal origin, results in a significant extension of overall survival (OS).
Peritoneal adhesions, the fibrotic bands that form between the surfaces in the peritoneal cavity following surgery, still pose a difficult clinical challenge.To evaluate the SprayShield™ Adhesion Barrier System (PEG ester amine solution and a buffer solution) in reducing post-operative adhesion formation.This was a prospective, multi-center, randomized, single blind study. A total of 11 subjects diagnosed with ulcerative colitis (UC) or familial adenomatous polyposis (FAP) were randomized: 8 to the SprayShield™ arm and 3 to the control arm. SprayShield™ was applied on the viscera directly under the midline peritoneal incision and at the site of ileostomy. During the follow-up surgery, the incidence, extent, and severity of post-operative adhesion formation were evaluated, as well as the time required to mobilize the ileal loop.In patients who received SprayShield™ the time required to mobilize the ileal loop at the ileostomy closure was slightly shorter and the incidence and severity of adhesions were somewhat lower vs. control subjects (NS).SprayShield™ was found to be easy to use, safe, and quick to apply, and performed well in adherence and conformity. The incidence and severity of adhesions were lower for SprayShield™ subjects vs. control subjects, but due to the limited number of patients there are not enough data to confirm the effectiveness of the SprayShield™ Adhesion Barrier System in prevention of adhesions.
The aim of the study was to assess functional results of surgical sphincter reconstructions for anal incontinence. From August 1999 to January 2007, 52 patients (females 50, males 2), 45 y.o.a. on average (24-69), underwent secondary anal sphincters reconstructions for fecal incontinence, resulting from birth injuries, event. in combination with sphincter weakening in pudendal neurophathy, or for post-anorectal surgery incontinence. Duration of the incontinence symptoms prior to the surgery was 2 months to 19 years. The overlap technique in combination with anterior levatorplasty was used in most subjects (n = 31). In 12 subjects, anterior sphincters and levators plication was performed. Four patients underwent overlap reconstructions only and five patients underwent complete sphincter reconstructions. Protective colostomy was performed in six patients. Six patients underwent additional postoperative biofeedback. Endoanal ultrasound was performed in all patients prior to their procedures. Terminal motor latency examination of the pudendal nerve was indicated in all patients with sphincter dysfunction without localized defects. Anal manometry was recorded prior and post-operatively. Incontinence was assessed using the St. Mark's incontinence score (0-13). The patients assessed the reconstruction results based on the Likert scale. The reconstruction was successfull in 46 patients (88.5 %), full continence was recovered in 20 (38.5 %) patients and improvement of incontinence was recorded in 26 (50 %) subjects. In six subjects (11.5 %), the reconstruction failed. The mean incontinence score reduction following the procedure was from 11.8 to 2.4. The short-term sphincter reconstruction results were successful in the majority of the subjects, the long-term results will be assessed in another study.
