Korelacija između razine kolorektalne anastomoze i funkcije anorektuma

Anterior rectal resection is a standard surgical procedure for treating carcinomas of rectum and distal sigmoid colon. In many cases of anterior rectal resection, postoperatively some level of fecal incontinence may occur. The aim of our study was to evaluate the impact of the colorectal anastomosis level on anorectal functional disorder. In our prospective study, the participants were patients diagnosed with carcinoma of rectum or distal sigmoid colon. All patients underwent standard open or laparoscopic anterior rectal resection. Six months after the surgery, the function of anorectum was evaluated in all participants. Finally, 38 patients were analyzed, including 13/38 (34.2%) patients with high rectal anastomosis, 11/38 (28.9%) with mid rectal anastomosis and 14/38 (36.8%) with low rectal anastomosis. Patients with a lower level of anastomosis had a statistically significantly greater number of stools, higher urgency and discrimination impairment, more pronounced solid, liquid and gas incontinence, and greater need for diapers (p<0.05 all). Therefore, patients with lower anastomosis had a statistically significant impairment of their quality of life and higher Wexner score (p<0.001 for both analyses). Our study results suggested reduced neorectal capacity to be the main pathophysiological factor for the development of postoperative anorectal function impairment.Anteriorna resekcija rektuma je standardni operacijski zahvat kod liječenja karcinoma rektuma i distalnog dijela sigmoidnog kolona. U mnogim slučajevima anteriorne resekcije poslijeoperacijski se pojavljuje određena razina fekalne inkontinencije. Cilj naše studije bio je istražiti utjecaj visine kolorektalne anastomoze na funkcijski poremećaj anorektuma. Svi ispitanici su podvrgnuti standardnoj otvorenoj ili laparoskopskoj anteriornoj resekciji. Šest mjeseci nakon operacije funkcija anorektuma je evaluirana. Ukupno je analizirano 38 bolesnika, tj. 13/38 (34,2%) s visokom kolorektalnom anastomozom, 11/38 (28,9%) sa srednjom kolorektalnom anastomozom i 14/38 (36,8%) s niskom kolorektalnom anastomozom. Bolesnici s niže postavljenom anastomozom imali su statistički značajno veći broj stolica, češće su imali urgenciju i poremećaj diskriminacije, kao i jače izraženu krutu, tekuću i inkontinenciju plinova, češće su trebali pelene (p<0,05 za sve navedene analize). Sukladno tome, bolesnici s niže postavljenom anastomozom imali su statistički značajno jače narušenu kvalitetu života i viši Wexnerov zbir (p<0,001 za obje analize). Mišljenja smo da je smanjeni kapacitet neorektuma glavni patofiziološki čimbenik za razvoj poslijeoperacijskog funkcijskog poremećaja anorektuma

Single Incision Laparoscopic Cholecystectomy – A New Advantage of Gallbladder Surgery

In this study is demonstrated our experience in single incision laparoscopic cholecystectomy (SILS), compared to standard laparoscopic cholecystectomy. There were 48 single incision laparoscopic cholecystectomies (SILS) performed during one-year period (A group) and results have been compared with a group of 50 patients who underwent standard laparoscopic cholecystectomy (B group). Outcome measures included operative time, need for conversion, complications, additional analgesia for pain control after procedure, hospital stay and cosmetic outcome. The mean operative time was 46+/–3.5 min in A group, and 43+/–4 min in B patients group. Early postoperative complications were not detected. The mean hospitalization period was 2 days in both groups. Our experience suggests that SILS cholecystectomy can be performed with outcome similar to standard laparoscopic surgery while affording better cosmesis

Therapy of Umbilical Hernia during Laparoscopic Cholecystectomy

The aim of this study is to show our experience with umbilical hernia herniorrhaphy and laparoscopic cholecys- tectomy, both in the same act. During last 10 years we operated 89 patients with cholecystitis and pre-existing umbilical hernia. In 61 of them we performed standard laparoscopic cholecystectomy and additional sutures of abdominal wall, and in 28 patients we performed in the same act laparoscopic cholecystectomy and herniorrhaphy of umbilical hernia. We observed incidence of postoperative herniation, and compared patients recovery after herniorrhaphy combined with laparoscopic cholecystectomy in the same act, and patients after standard laparoscopic cholecystectomy and additional sutures of abdominal wall. Patients, who had in the same time umbilical hernia herniorrhaphy and laparoscopic chole- cystectomy, shown better postoperative recovery and lower incidence of postoperative umbilical hernias then patients with standard laparoscopic cholecystectomy and additional abdominal wall sutures

Two-Incision Laparoscopic Cholecystectomy – Our Experience

Cilj: Članak opisuje tehniku i rezultate izvođenja laparoskopske kolecistektomije kroz dvije incizije, primijenjene na 42 bolesnika, te ju uspoređuje sa standardnom laparoskopskom kolecistektomijom. Metode: Učinjena je laparoskopska kolecistektomija kroz dvije incizije (skupina A) u 42 bolesnika. Rezultati su uspoređeni s rezultatima standardne laparoskopske kolecistektomije (skupina B – 50 bolesnika). Rezultati: Srednje operacijsko vrijeme bilo je 45 ± 3,5 min (skupina A) i 43 ± 4 min (skupina B). Nisu zabilježene unutaroperacijske ili poslijeoperacijske komplikacije. Srednje vrijeme hospitalizacije bilo je jednako u objema skupinama. Zaključak: Laparoskopska kolecistektomija kroz dvije incizije jednako je siguran postupak kao standardna laparoskopska kolecistektomija kroz tri incizije, ali s boljim estetskim rezultatom te bez dodatnih troškova.Objective: This article describes the technique and the results of two-incision laparoscopic cholecystectomy performed on 42 patients, and compares it with standard cholecystectomy. Methods: Two-incision laparoscopic cholecystectomy (group A) was performed on 42 patients. Results were compared with standard laparoscopic cholecystectomy (group B) – 50 patients. Results: Mean operative time was 45 ± 3.5 min (group A), and 43 ± 4 min (group B). No intraoperative or postoperative complications were observed. Average hospital stay was equal in both groups. Conclusion: Two-incision laparoscopic cholecystectomy is equally safe as standard laparoscopic cholecystectomy with three incisions but with better cosmetic results and without the extra cost

Laparoskopska holecistektomija u cirotičnih bolesnika

In the beginning, liver cirrhosis was considered a contraindication for laparoscopic cholecystectomy, mostly for the same reasons as for other surgical procedures, i.e. mild to severe bleeding tendency, prolonged wound healing due to hypoproteinemia, and various metabolic disorders. The effect of CO2 pneumoperitoneum on the cirrhotic liver was also discussed. Results obtained by laparoscopic cholecystectomy in 24 liver cirrhosis patients are presented. The experience acquired since the introduction of laparoscopic procedures at our unit is briefly described. The index of conversion was 4.16% (1/24) and mortality rate 0. The mean length of hospital stay was 2.9 days. The use of laparoscopic cholecystectomy for gallstone disease is proposed in patients with liver cirrhosis as the first choice operative method of treatment.U početku razvoja laparoskopskih operacija žučnjaka ciroza jetre opisivala se kao jedna od kontraindikacija, uglavnom iz istih razloga kao i za druge kirurške zahvate kao što su sklonost krvarenju, produženo cijeljenje rana zbog hipoproteinemije, te razni metabolični poremećaji. Neki autori su prikazali i djelovanje CO2 pneumoperitoneuma na cirotičnu jetru. Ovdje su prikazani rezultati i iskustvo stečeno primjenom laparoskopske holecistektomije u 24 bolesnika s cirozom jetre. Nije bilo smrtnog ishoda. U jednoga je bolesnika učinjena konverzija zbog krvarenja. Prosječeno vrijeme hospitalizacije bilo je 2,9 dana. Na osnovi iskustva laparoskopska se holecistektomija preporuča kao metoda izbora u liječenju simptomatske holelitijaze u bolesnika s jetrenom cirozom

Laser Treatment in Hemorrhoidal Disease - Our Experience

Cilj: U ovome se članku iznose iskustva, tehnika i rezultati u 21 bolesnika s hemoroidalnom bolešću, koji su operirani diodnim laserom. Metode: Učinjena je hemoroidektomija diodnim laserom u 21 bolesnika s verificiranim II.-III. stupnjem hemoroidalne bolesti. Rezultati: Prosječno trajanje operacije bilo je 15 ± 2 minute, a prosječna hospitalizacija 24 sata. Tijekom 12-omjesečnoga praćenja nije zabilježen ni jedan neželjeni događaj u vidu krvarenja, infekcije ili recidiva bolesti u svih operiranih bolesnika. Dodatna analgezija bila je potrebna u četvero bolesnika. Zaključak: Uporaba diodnoga lasera predstavlja dodatnu metodu u liječenju hemoroidalne bolesti te je potrebna daljnja evaluacija u budućim studijama, koja će potvrditi uspješnost te metode.Objective: This article brings experiences, technique and results in 21 patients with haemorrhoidal disease treated with diode laser. Methods: In this study, 21 patients with II-III grade haemorrhoidal disease were included and treated with diode laser. Results: Average operation time was 15 + 2 minutes, with 24-hour hospitalisation. During the follow-up period of 12 months, there were no observed complications, such as bleeding, infections or recurrence. Extra anaelgetics were required in four cases. Conclusion: The use of diode laser in haemorrhoidal disease represents an additional treatment method, where as further studies are yet to evaluate and definitely confirm the successfulness of this method

Laser Treatment in Hemorrhoidal Disease - Our Experience

Cilj: U ovome se članku iznose iskustva, tehnika i rezultati u 21 bolesnika s hemoroidalnom bolešću, koji su operirani diodnim laserom. Metode: Učinjena je hemoroidektomija diodnim laserom u 21 bolesnika s verificiranim II.-III. stupnjem hemoroidalne bolesti. Rezultati: Prosječno trajanje operacije bilo je 15 ± 2 minute, a prosječna hospitalizacija 24 sata. Tijekom 12-omjesečnoga praćenja nije zabilježen ni jedan neželjeni događaj u vidu krvarenja, infekcije ili recidiva bolesti u svih operiranih bolesnika. Dodatna analgezija bila je potrebna u četvero bolesnika. Zaključak: Uporaba diodnoga lasera predstavlja dodatnu metodu u liječenju hemoroidalne bolesti te je potrebna daljnja evaluacija u budućim studijama, koja će potvrditi uspješnost te metode.Objective: This article brings experiences, technique and results in 21 patients with haemorrhoidal disease treated with diode laser. Methods: In this study, 21 patients with II-III grade haemorrhoidal disease were included and treated with diode laser. Results: Average operation time was 15 + 2 minutes, with 24-hour hospitalisation. During the follow-up period of 12 months, there were no observed complications, such as bleeding, infections or recurrence. Extra anaelgetics were required in four cases. Conclusion: The use of diode laser in haemorrhoidal disease represents an additional treatment method, where as further studies are yet to evaluate and definitely confirm the successfulness of this method

Two-Incision Laparoscopic Cholecystectomy – Our Experience

Cilj: Članak opisuje tehniku i rezultate izvođenja laparoskopske kolecistektomije kroz dvije incizije, primijenjene na 42 bolesnika, te ju uspoređuje sa standardnom laparoskopskom kolecistektomijom. Metode: Učinjena je laparoskopska kolecistektomija kroz dvije incizije (skupina A) u 42 bolesnika. Rezultati su uspoređeni s rezultatima standardne laparoskopske kolecistektomije (skupina B – 50 bolesnika). Rezultati: Srednje operacijsko vrijeme bilo je 45 ± 3,5 min (skupina A) i 43 ± 4 min (skupina B). Nisu zabilježene unutaroperacijske ili poslijeoperacijske komplikacije. Srednje vrijeme hospitalizacije bilo je jednako u objema skupinama. Zaključak: Laparoskopska kolecistektomija kroz dvije incizije jednako je siguran postupak kao standardna laparoskopska kolecistektomija kroz tri incizije, ali s boljim estetskim rezultatom te bez dodatnih troškova.Objective: This article describes the technique and the results of two-incision laparoscopic cholecystectomy performed on 42 patients, and compares it with standard cholecystectomy. Methods: Two-incision laparoscopic cholecystectomy (group A) was performed on 42 patients. Results were compared with standard laparoscopic cholecystectomy (group B) – 50 patients. Results: Mean operative time was 45 ± 3.5 min (group A), and 43 ± 4 min (group B). No intraoperative or postoperative complications were observed. Average hospital stay was equal in both groups. Conclusion: Two-incision laparoscopic cholecystectomy is equally safe as standard laparoscopic cholecystectomy with three incisions but with better cosmetic results and without the extra cost

Efficacy of Antimicrobial Triclosan-Coated Polyglactin 910 (Vicryl* Plus) Suture for Closure of the Abdominal Wall after Colorectal Surgery

This study compared Triclosan coated polyglactin 910 (Vicryl* Plus) with polyglactin 910(Vicryl*) on abdominal wall healing in colorectal surgery patients. 184 patients with colorectal cancer were included in the study. In 91, the abdominal wall was closed with the Vicryl* Plus, and in 93 patients with Vicryl*. Demographic characteristics, biochemical inflammatory parameters, wound appearance, length of hospital stay, postoperative wound complications and postincisional hernia were recorded. In the Vicryl* Plus group there was a shorter hospital stay (13.2±1.3 days; 21.4±2.8 respectively). In the Vicryl* Plus group inflammatory parameters decreased to normal within the first week whereas in the Vicryl* group remained increased. In the Vicryl* Plus group four patients had a wound discharge, seven had inflammatory reactions to the skin sutures. One dehiscence was noticed. In the Vicryl* group 12 patients had an SSI, 14 patients had inflammatory reactions to the skin sutures and 7 patients had a wound dehiscence. Closure of the abdominal wall using Vicryl*Plus decreases postoperative wound complications, length of hospital stay and is associated with a more rapid return of inflammatory markers to normal

PREHOSPITAL PAIN MANAGEMENT IN PATIENTS WITH HIP FRACTURE

Cilj rada: Prijelom kuka je značajan javnozdravstveni problem, osobito u bolesnika starije životne dobi, kod kojih predstavlja drugu dijagnozu po učestalosti tijekom stacionarnog bolničkog liječenja u Hrvatskoj. Iako su brojna istraživanja pokazala važnost što ranije procjene i liječenja boli u bolesnika s prijelomom kuka, a s ciljem smanjenja komplikacija i smrtnosti u kasnijem tijeku bolesti, liječenje boli tijekom hitnog medicinskog zbrinjavanja ove skupine bolesnika još uvijek se ne provodi sustavno, a literaturni podaci o primjeni analgetika i načinu transportne imobilizacije su ograničeni. Cilj ovog rada je utvrditi učinkovitost liječenja boli tijekom izvanbolničkog hitnog zbrinjavanja bolesnika s prijelomom kuka, te utvrditi učestalost primjene analgetika. Metode: Provedeno je analitičko presječno istraživanje u Zavodu za hitnu medicinu Varaždinske županije u razdoblju od 1. siječnja do 31. prosinca 2018. godine a koje je uključivalo bolesnike s kliničkom sumnjom na prijelom kuka. Rezultati: Tijekom 2018. godine ukupno je zbrinuto 187 bolesnika s kliničkom sumnjom na prijelom kuka. Bol je procijenjena u ukupno 92 % bolesnika. Jaka bol (NRS 7-10) zabilježena je u 19,8 % bolesnika, umjerena bol (NRS 4-6) u 57 %, blaga bol (NRS 1-3) u 19,8 %, dok je 3,5 % bolesnika bilo bez boli (NRS 0). Ukupno 90,4 % bolesnika nije dobilo analgeziju. U skupini bolesnika s jakom boli 67,6 % bolesnika nije primilo analgetik, dok je kod preostalih najčešće primjenjivan tramadol. Transportna imobilizacija primijenjena je u 43,9 % bolesnika. Najčešće su korištena rasklopna nosila ili vakuum madrac. Zaključak: Unatoč visokom postotku procjene boli dobiveni rezultati ukazuju na neodgovarajuću analgeziju i transportnu imobilizaciju u bolesnika s prijelomom kuka. Budući da se radi o bolesnicima starije životne dobi, od iznimne je važnosti uvesti analgetske protokole kako bi se poboljšalo liječenje i izbjegle negativne posljedice neliječene boli.Objective: Hip fracture is a signifi cant public health and personal issue, especially for elderly patients, where it is the second most common diagnosis in stationary hospitalization in Croatia. Although numerous research studies have revealed the importance of early assessment and pain management during emergency care of such patients, it is still not applied systematically, and literature data on the use of analgesics and immobilization during transport are limited. The objective of this study was to research prehospital pain management in patients with hip fracture, primarily the frequency of prehospital analgesic administration. Methods: We conducted a cross-sectional analytical study of patients with clinically diagnosed hip fractures at the Institute of Emergency Medicine of Varaždin County during a one-year period (from January 1, 2018 to December 31, 2018). Results: In 2018, a total of 187 patients with hip fracture were treated, 133 (71.1%) women, mean age 80.8±8.3 (median 79, mod 84) years. Level of pain was assessed in 92% of patients; strong pain (NRS 7-10) was present in 19.8%, medium pain (NRS 4-6) in 57%, mild pain (NRS 1-3) in 19.8% and no pain (NRS 0) in 3.5% of patients. Analgesics were not administered in 90.4% of all cases, specifi cally in 67.6% of the strong pain group. In the rest of cases, the most frequently applied analgesic was tramadol. Application of analgesics was somewhat more frequent in male patients but the difference was not statistically signifi cant. Immobilization during transport was not applied in 56.1% of cases, whereas in the remainder it was mostly done by use of scoop stretcher or vacuum mattress. Discussion: This study showed insuffi cient use of analgesics in spite of general recognition of the importance of pain treatment. The most frequently applied analgesic was tramadol, which is no longer recommended as a fi rst choice medication. There are limited research data on prehospital pain management in this group of patients, but also point out the inadequate use of analgesics in patients with hip fracture, as well in other trauma patients. Various factors infl uence the frequency and method of analgesic application and one of these is certainly emergency medical service staff education, which has a well-established benefi cial effect on the emergency patient care. Limitations of this study were retrospective data collection and the high likelihood that some of the patients were transported by ordinary patient transport service upon initial physician assessment. Therefore, the number of cases presented does not cover the total of all hip fracture cases in the Varaždin County in 2018. Conclusion: The great majority of patients with hip fracture did not receive analgesics during prehospital emergency care and in more than half of all cases there was no immobilization during transport. Although there was a tendency of more frequent application of analgesics in male patients, the difference was not statistically signifi cant. As the condition is mostly affecting elderly patients, it is very important to improve prehospital pain management during their emergency care, which could be achieved by better education of emergency medical service team members