Kirurgija raka debelog crijeva s obzirom na razlike u prognozi između desnostranih i lijevostranih tumora

Human colon is derived from the embryological midgut and hindgut resulting in the developement of the right and left colon respectively. Right-sided and left-sided colon cancers are not differentiated only based on the embryological origin, anatomical position and clinical manifestations, but there are also numerous studies which prove that heterogeneous genotype features exsist in right and left-sided colon cancers,with distinguishing types of chromosome and microsatellite instability and gene expression patterns. Accumulating evidence suggests that gut microbiota, which differs in right and left colon, also plays an important role in the development of colon cancer. Although the systemic oncologic treatment has changed recently for disseminated left and right colon cancer, the current surgical treatment of both cancer locations for stages I-III follows the same principles of radical surgical oncology and should be executed in the same manner.Ljudsko debelo crijevo nastaje iz embriološkog srednjeg i stražnjeg crijeva, odakle se formira desno- i lijevostrano debelo crijevo. Desno- i lijevostrani zloćudni tumori debelog crijeva ne razlikuju se samo prema embrionalnom podrijetlu, anatomoskoj lokalizaciji i kliničkim manifestacijama, nego i prema heterogenim genotipskim značajkama, s različitim vrstama kromosomskih i mikrosatelitskih nestabilnosti te različitim uzrocima ekspresije gena, što je i dokazano brojnim studijama. Sve veći broj istraživanja sugerira da i crijevna mikrobiota, koja je različita u desnom i lijevom debelom crijevu, također igra značajnu ulogu u razvoju zloćudnih tumora debelog crijeva. Iako se sistemno onkološko liječenje za metastatski prošireni karcinom debelog crijeva nedavno promijenilo, ovisno da li je primarna lokalizacija desno- ili lijevostrani karcinom debelog crijeva, sadašnje kirurško liječenje za stadije I-III slijedi principe radikalnog onkološkog liječenja i trebalo bi biti isto za obje lokacije karcinoma debelog crijeva

Otpust iz bolnice nakon elektivne nekomplicirane laparoskopske kolecistektomije: može li se skratiti poslijeoperacijski boravak u bolnici?

The aim of the study was to reevaluate the safety and feasibility of discharge 24 h after elective uncomplicated laparoscopic cholecystectomy. Since the introduction of laparoscopic cholecystectomy in our hospital, the minimum postoperative stay was considered to be two days based on surgeons’ experience. The study included 337 operations performed by 21 surgeons during 2016 in the Sestre milosrdnice University Hospital Centre. Conversion to open technique and cases of acute cholecystitis were excluded, while 15 patients had insufficient postoperative data. The mean length of stay was 2.38 (range 1 to 6) postoperative days, median two postoperative days. Serious complications involving suspected drain bile leakage and postoperative hemorrhage occurred in two (0.59%) patients, both in the first 24 h following surgery. One patient required emergency laparotomy on the first postoperative day. Readmission rate was 1.2%. The postoperative minor complication rate was 42 of 337 (12.46%); these included wound infections, urinary tract infections, symptoms included in postcholecystectomy syndrome, etc. The onset of these complications was mostly after postoperative day 3. The data obtained suggest that discharge on the first postoperative day after elective uncomplicated laparoscopic cholecystectomy should be considered safe and can be practiced in our hospital.Cilj studije bio je reevaluirati sigurnost i izvodljivost otpusta bolesnika u prva 24 sata nakon elektivnih laparoskopskih kolecistektomija. Od uvođenja laparoskopske metode u našoj ustanovi, prema iskustvu kirurga smatralo se kako je minimalni poslijeoperacijski boravak 2 dana. Studija je obuhvatila 337 operacija koje je proveo 21 kirurg u 2016. godini u KBC “Sestre milosrdnice”. Isključeni su slučajevi konverzije u otvorene operacije kao i slučajevi akutnog kolecistitisa. Kod 15 bolesnika nije bilo dovoljno podataka o poslijeoperacijskom tijeku. Prosjek poslijeoperacijskog boravka bio je 2,38 (1 do 6) dana, medijan je bio 2 dana. Ozbiljne komplikacije u vidu suspektnog curenja žuči i poslijeoperacijskog krvarenja pojavile su se kod dvoje (0,59%) bolesnika; oba slučaja dogodila su se unutar 24 sata od operacije. Kod jednog bolesnika indicirana je hitna reoperacija prvog poslijeoperacijskog dana. Stopa ponovnog prijma u bolnicu bila je 1,2%. Manje poslijeoperacijske komplikacije dogodile su se kod 42 (12,46% operiranih) bolesnika; ove komplikacije uključivale su infekcije rane, uroinfekcije, simptome postkolecistektomijskog sindroma itd. Ove komplikacije događale su se uglavnom nakon 3. poslijeoperacijskog dana. Prikupljeni podaci ukazuju na to da se otpust prvog poslijeoperacijskog dana nakon elektivne nekomplicirane laparoskopske kolecistektomije može smatrati sigurnim i provoditi tu praksu u našoj ustanovi

Usporedba vrijednosti serumskog i intraperitonealnog C-reaktivnog proteina u ranoj dijagnostici dehiscencije anastomoze nakon kirurgije debeloga crijeva

In colorectal surgery, anastomotic leakage is a serious complication, leading to higher postoperative morbidity and mortality. The aim of this study was to evaluate the accuracy of serum and intraperitoneal C-reactive protein (CRP) in early diagnostics of anastomotic leakage on the first four postoperative days after colorectal surgery. From January to October 2019, fifty-nine patients with colorectal carcinoma were operated on, with formation of primary anastomosis. Anastomotic leakage was diagnosed in eight patients. Comparing the levels of serum and intraperitoneal CRP, our study showed that serum CRP was a better predictor of anastomotic leakage. Serum CRP levels lower than 121 mg/L on postoperative day 4 were predictive of good healing of anastomosis.U kirurgiji debelog crijeva dehiscencija crijevne anastomoze je ozbiljna komplikacija koja dovodi do povećanja pobola i smrtnosti nakon operativnog zahvata. Cilj ove studije bio je utvrditi točnost serumskog i intraperitonealnog C-reaktivnog proteina u ranoj dijagnostici dehiscencije crijevne anastomoze u prva četiri poslijeoperacijska dana nakon operacije debelog crijeva. Od siječnja do kolovoza 2019. godine operirano je 59 bolesnika s rakom debelog crijeva uz uspostavu primarne crijevne anastomoze. Kod osam bolesnika dijagnosticirana je dehiscencija crijevne anastomoze. Uspoređujući vrijednosti serumskog i intraperitonealnog C-reaktivnog proteina naša studija je pokazala da je serumski C-reaktivni protein bolji biljeg u predviđanju dehiscencije crijevne anastomoze. Vrijednosti serumskog C-reaktivnog proteina manje od 121 mg/L četvrtog poslijeoperacijskog dana pokazatelj su dobrog cijeljenja anastomoze

Osjetljivost i specifičnost Fenyö-Lindbergova i Teicherova sustava bodovanja u dijagnostici akutne upale crvuljka u žena

The aim of the study was to assess diagnostic accuracy (sensitivity and specificity) of Fenyö-Lindberg and Teicher scores for distinguishing patients that need immediate surgical treatment from the others, in a female population from an urban setting. The study prospectively included 130 female patients admitted to the emergency department with abdominal pain indicating acute appendicitis. The scores and parameters of validity were calculated and compared to definitive diagnosis. For Fenyö-Lindberg score of -17 or less, 84.5% sensitivity, 55.6% specificity, 87.9% positive predictive value (PPV) and 48.4% negative predictive value (NPV) were recorded. For cut-off value greater or equal to -2, there was 59.2% sensitivity, 77.8% specificity, 91% PPV and 33.3% NPV. The Receiver Operating Characteristic (ROC) curve analysis of Fenyö-Lindberg score showed that the best single cut-off value for discriminating acute appendicitis in the study population was -15. For Teicher score, values greater than -3 yielded 89.3% sensitivity and 22.2% specificity, 81.4% PPV and 35.3% NPV. In conclusion, Fenyö-Lindberg score could be used as an additional tool to exclude appendicitis and avoid unnecessary appendectomies. Teicher score may help in recognizing patients with appendicitis. None of the two scores can indicate or decline appendectomy in all cases. Scoring systems may be useful for pointing to important clinical signs and symptoms in specific subpopulations.Cilj istraživanja bio je analizirati dijagnostičku točnost (osjetljivost i specifičnost) Fenyö-Lindbergove i Teicherove bodovne ljestvice u postavljanju dijagnoze akutne upale crvuljka u ženskoj populaciji u urbanom okruženju. U studiju je prospektivno uključeno 130 bolesnica primljenih u hitnoj službi s bolovima u trbuhu i sumnjom na akutni apendicitis. Rezultati i parametri valjanosti izračunati su i uspoređeni s obzirom na konačnu dijagnozu. Za vrijednosti Fenyö-Lindbergova zbira -17 ili manje nađena je osjetljivost od 84,5%, specifičnost od 55,6%, pozitivna prediktivna vrijednost (PPV) od 87,9% i negativna prediktivna vrijednost (NPV) od 48,4%. Za vrijednosti istoga zbira većeg ili jednakog -2 utvrđena je osjetljivost od 59,2%, specifičnost od 77,8%, PPV od 91% i NPV od 33,3%. Usporedba krivulja ROC za Fenyö-Lindbergov zbir pokazala je da je najbolja pojedinačna granična vrijednost u proučavanoj populaciji u svrhu diskriminacije akutne upale crvuljka -15. Za Teicherov zbir vrijednosti veće od -3 pokazale su osjetljivost od 89,3%, specifičnost od 22,2%, PPV od 81,4% i NPV od 35,3%. U zaključku, Fenyö-Lindbergov zbir se može koristiti kao dodatni alat u isključivanju upale crvuljka i izbjegavanju nepotrebnih operacija. Teicherov zbir može pomoći u prepoznavanju bolesnica s akutnom upalom crvuljka. Niti jedan zbir se ne može koristiti kao jedino sredstvo za indiciranje ili nepoduzimanje operacije akutne upale crvuljka u svim slučajevima. Bodovni sustav može biti koristan u isticanju važnih kliničkih znakova i simptoma u pojedinim skupinama bolesnika

Kronična pseudo-opstrukcija sigmoidnog kolona - prikaz slučaja

Chronic intestinal pseudo-obstruction (CIPO) is a rare syndrome characterized by signs of intestinal obstruction lasting for 6 months or more, in the absence of a definitive cause of obstruction. We report a case of CIPO in a 49-year-old female patient with a 6-month history of ongoing irregular bowel movements, manifested as constipation and diarrhea accompanied by abdominal pain and bloated feeling. Contrast-enhanced abdominal computed tomography and magnetic resonance enterography revealed focal thickening of a segment of the lienal flexure and intermittent areas of wider and narrower caliber along the sigmoid colon. No signs of a definitive cause of obstruction were found, but evidence for dolichosigma was revealed, which was later confirmed with colonoscopy. Due to persisting symptoms, the patient agreed to elective resection of the sigmoid colon. Following the procedure, symptoms regressed with a significant improvement in the quality of life. The patient has been regularly monitored in an outpatient setting and reports absence of the symptoms since the procedure. Pathophysiology of the resected section revealed more prominent lymphatic tissue, follicular arrangement, and reactively altered germinal centers, which can suggest CIPO.Kronična intestinalna pseudo-opstrukcija (KIPO) je vrlo rijedak sindrom obilježen znakovima intestinalne opstrukcije koji traju 6 mjeseci ili duže, a u odsutnosti definitivnog jasnog uzroka. U našem prikazu slučaja radi se o 49-godišnjoj bolesnici koja je više od 6 mjeseci imala stalne nepravilne stolice koje su se manifestirale izmjenom proljeva i konstipacije, a bile su praćene nadutošću i bolovima u trbuhu. Učinjenom obradom koja je uključivala kontrastnu kompjutoriziranu tomografiju i magnetsku enterografiju kod bolesnice je utvrđeno žarišno zadebljanje segmenta lienalne fleksure i isprekidana područja šireg i užeg kalibra duž sigmoidnog kolona. Nije nađen jasni uzrok opstrukcije, ali je otkrivena anatomska varijanta dolihosigme koja je kasnije potvrđena i kolonoskopijom. Zbog vrlo izraženih dugotrajnih simptoma koji nisu regredirali na konzervativne metode liječenja bolesnica je pristala na preporučenu elektivnu resekciju sigmoidnog kolona. Nakon zahvata simptomi su se povukli uz značajno poboljšanje kvalitete života, a bolesnica se redovito prati u gastroenterološkoj ambulanti. Patohistološki nalaz reseciranog dijela sigmoidnog kolona otkrio je istaknutije limfno tkivo, folikularni raspored i reaktivno promijenjene germinativne centre, što ide u prilog dijagnoze KIPO-a

The impact of the preoperative nutritional preparation in patients with colorectal cancer on incidence of anastomotic leak

U ovom istraživanju proučavala se povezanost prijeoperacijske nutritivne pripreme s visokoproteinskim nutritivnim pripravcima kod bolesnika s operabilnim rakom debelogacrijeva s pojavom dehiscencije crijevne anastomoze. Postavljena je hipoteza da će bolesnici koji su prije operacije pripremljeni s visokoproteinskim nutritivnim pripravcima imati manju učestalost dehiscencija anastomoze. Cilj istraživanja bio je ustanoviti povezanost prijeoperacijske nutritivne pripreme bolesnika rakom debeloga crijeva na učestalost dehiscencije crijevnih anastomoza. Dodatni ciljevi bili su utvrditi učestalost pothranjenost kod bolesnika s rakom debeloga crijeva, utvrditi da li prijeoperacijski nutritivni status bolesnika ima utjecaj na učestalost dehiscencija anastomoze i utvrditi da li je moguća ranija dijagnoza dehiscencija anastomoza mjerenjem vrijednosti serumskog CRP-a, te CRP-a i citokina( IL-6 i TNF-alpha) iz intraperitonealne tekućine prva četiri postoperacijska dana. Ukupan broj ispitanika bio je 100, koji su podijeljeni u dvije skupine. Prvu skupinu (N=50) su činili bolesnici s rakom debeloga crijeva koji primali, uz uobičajenu prehranu, i visokoproteinske nutritivne pripravke tijekom10 dana prije kirurškog zahvata, a drugu skupinu (N=50) bolesnici s rakom debelog crijeva koji su primali samo uobičajenu prehranu. Ustanovljeno je da su bolesnici koji su primali prijeoperacijski nutritivne pripravke imali statistički značajno manji broj dehiscencija anastomoze. Učestalost pothranjenosti kod ispitanika bila je 13%. Bolesnici koji su preoperativnim nutritivnim probirom okarakterizirani da su u nutritivnom riziku (NRS-2002 zbroj 3 i više) imali su više dehiscencija anastomoze. Bolesnici s hipoproteinemijom (ukupni serumski proteini manja od 66mg/L) i hipoalbuminemijom ( albumini manja od 35mg/L) imali su također veći broj dehiscencija. Mjerenje vrijednosti serumskog CRP-a, posebno 3. i 4.postoperacijski dan, pokazalo se kao najpouzdaniji marker rane dijagnostike dehiscencije anastomoze. Utvrdilo se da je mjerenje vrijednosti IL-6 i TNF-alpha u prva dva postoperacijska dana također dobar marker rane dijagnostike dehiscencije. Nutritivna priprema bolesnika s rakom debeloga crijeva, osobito kod bolesnika u nutritivnom riziku i kod pothranjenih bolesnika, mogla bi imati utjecaj na smanjenje učestalosti dehiscencije anastomoze kod takvih bolesnika, ali potrebna su daljnja istraživanja na većem broju ispitanika.In this research, we studied the correlation of preoperative nutritional preparation with high-protein enteral supplements in patients with colorectal cancer with occurence of anastomotic leakage. We set the hypothesis that patients who received preoperatively high-protein enteral supplements will have lower incidience of anastomotic leakage. Our goals were to determine the relationship between preoperative nutritional preparation in patients with colorectal cancer with incidence of anastomotic leakage.Also, we wanted to determine the incidence of malnutrition in patinets with colorectal cancer, the relationship between preoperative nutritive status of the patieents with incidence of anastomotic leakage and to determine the possibility od early diagnosis of anastomotic leakage with continuos measurement of serum CRP and CRP and cytokines (IL-6 and TNF-alpha) in intraperitoneal fluid. The total number of subjects was 100, divided into two groups. In the first group (N=50) were patients with colorecta cancer who received, with their usual diet, high-protein enteral supplement 10 days prior tothe surgery, while the second (N=50) group included patients with colorectal cancer who received only their usual diet. Anastomotic leakage was significantly lower in group of patients with preoperative nutritional preparation. The incidence of malnutrition was 13%. Patients with NRS-2002 score 3 and more had significantly higher incidence of anastomotic leakage.Patients with hypoproteinemia(serum protein levels lower than 66mg/L) and hypoalbuminemia (albumin levels lower than 35mg/L) had also higher incidence of anastomotic leakage. Measurement of serum CRP was a very usefull marker of early diagnosis od anastomotic leakage, especially on 3rd and 4th postoperative day. Levels of IL-6 and TNF-alpha can also be valuable markers in early diagnosis, on first two postoperative days. Nutritional preparation in patienst with colorectal cancer, especially in patients at nutritional risk and malnourished could lower the incidence of anastomotic leakage. However, larger studies should be conducted to confirm these findings

The impact of the preoperative nutritional preparation in patients with colorectal cancer on incidence of anastomotic leak

U ovom istraživanju proučavala se povezanost prijeoperacijske nutritivne pripreme s visokoproteinskim nutritivnim pripravcima kod bolesnika s operabilnim rakom debelogacrijeva s pojavom dehiscencije crijevne anastomoze. Postavljena je hipoteza da će bolesnici koji su prije operacije pripremljeni s visokoproteinskim nutritivnim pripravcima imati manju učestalost dehiscencija anastomoze. Cilj istraživanja bio je ustanoviti povezanost prijeoperacijske nutritivne pripreme bolesnika rakom debeloga crijeva na učestalost dehiscencije crijevnih anastomoza. Dodatni ciljevi bili su utvrditi učestalost pothranjenost kod bolesnika s rakom debeloga crijeva, utvrditi da li prijeoperacijski nutritivni status bolesnika ima utjecaj na učestalost dehiscencija anastomoze i utvrditi da li je moguća ranija dijagnoza dehiscencija anastomoza mjerenjem vrijednosti serumskog CRP-a, te CRP-a i citokina( IL-6 i TNF-alpha) iz intraperitonealne tekućine prva četiri postoperacijska dana. Ukupan broj ispitanika bio je 100, koji su podijeljeni u dvije skupine. Prvu skupinu (N=50) su činili bolesnici s rakom debeloga crijeva koji primali, uz uobičajenu prehranu, i visokoproteinske nutritivne pripravke tijekom10 dana prije kirurškog zahvata, a drugu skupinu (N=50) bolesnici s rakom debelog crijeva koji su primali samo uobičajenu prehranu. Ustanovljeno je da su bolesnici koji su primali prijeoperacijski nutritivne pripravke imali statistički značajno manji broj dehiscencija anastomoze. Učestalost pothranjenosti kod ispitanika bila je 13%. Bolesnici koji su preoperativnim nutritivnim probirom okarakterizirani da su u nutritivnom riziku (NRS-2002 zbroj 3 i više) imali su više dehiscencija anastomoze. Bolesnici s hipoproteinemijom (ukupni serumski proteini manja od 66mg/L) i hipoalbuminemijom ( albumini manja od 35mg/L) imali su također veći broj dehiscencija. Mjerenje vrijednosti serumskog CRP-a, posebno 3. i 4.postoperacijski dan, pokazalo se kao najpouzdaniji marker rane dijagnostike dehiscencije anastomoze. Utvrdilo se da je mjerenje vrijednosti IL-6 i TNF-alpha u prva dva postoperacijska dana također dobar marker rane dijagnostike dehiscencije. Nutritivna priprema bolesnika s rakom debeloga crijeva, osobito kod bolesnika u nutritivnom riziku i kod pothranjenih bolesnika, mogla bi imati utjecaj na smanjenje učestalosti dehiscencije anastomoze kod takvih bolesnika, ali potrebna su daljnja istraživanja na većem broju ispitanika.In this research, we studied the correlation of preoperative nutritional preparation with high-protein enteral supplements in patients with colorectal cancer with occurence of anastomotic leakage. We set the hypothesis that patients who received preoperatively high-protein enteral supplements will have lower incidience of anastomotic leakage. Our goals were to determine the relationship between preoperative nutritional preparation in patients with colorectal cancer with incidence of anastomotic leakage.Also, we wanted to determine the incidence of malnutrition in patinets with colorectal cancer, the relationship between preoperative nutritive status of the patieents with incidence of anastomotic leakage and to determine the possibility od early diagnosis of anastomotic leakage with continuos measurement of serum CRP and CRP and cytokines (IL-6 and TNF-alpha) in intraperitoneal fluid. The total number of subjects was 100, divided into two groups. In the first group (N=50) were patients with colorecta cancer who received, with their usual diet, high-protein enteral supplement 10 days prior tothe surgery, while the second (N=50) group included patients with colorectal cancer who received only their usual diet. Anastomotic leakage was significantly lower in group of patients with preoperative nutritional preparation. The incidence of malnutrition was 13%. Patients with NRS-2002 score 3 and more had significantly higher incidence of anastomotic leakage.Patients with hypoproteinemia(serum protein levels lower than 66mg/L) and hypoalbuminemia (albumin levels lower than 35mg/L) had also higher incidence of anastomotic leakage. Measurement of serum CRP was a very usefull marker of early diagnosis od anastomotic leakage, especially on 3rd and 4th postoperative day. Levels of IL-6 and TNF-alpha can also be valuable markers in early diagnosis, on first two postoperative days. Nutritional preparation in patienst with colorectal cancer, especially in patients at nutritional risk and malnourished could lower the incidence of anastomotic leakage. However, larger studies should be conducted to confirm these findings

The impact of the preoperative nutritional preparation in patients with colorectal cancer on incidence of anastomotic leak

U ovom istraživanju proučavala se povezanost prijeoperacijske nutritivne pripreme s visokoproteinskim nutritivnim pripravcima kod bolesnika s operabilnim rakom debelogacrijeva s pojavom dehiscencije crijevne anastomoze. Postavljena je hipoteza da će bolesnici koji su prije operacije pripremljeni s visokoproteinskim nutritivnim pripravcima imati manju učestalost dehiscencija anastomoze. Cilj istraživanja bio je ustanoviti povezanost prijeoperacijske nutritivne pripreme bolesnika rakom debeloga crijeva na učestalost dehiscencije crijevnih anastomoza. Dodatni ciljevi bili su utvrditi učestalost pothranjenost kod bolesnika s rakom debeloga crijeva, utvrditi da li prijeoperacijski nutritivni status bolesnika ima utjecaj na učestalost dehiscencija anastomoze i utvrditi da li je moguća ranija dijagnoza dehiscencija anastomoza mjerenjem vrijednosti serumskog CRP-a, te CRP-a i citokina( IL-6 i TNF-alpha) iz intraperitonealne tekućine prva četiri postoperacijska dana. Ukupan broj ispitanika bio je 100, koji su podijeljeni u dvije skupine. Prvu skupinu (N=50) su činili bolesnici s rakom debeloga crijeva koji primali, uz uobičajenu prehranu, i visokoproteinske nutritivne pripravke tijekom10 dana prije kirurškog zahvata, a drugu skupinu (N=50) bolesnici s rakom debelog crijeva koji su primali samo uobičajenu prehranu. Ustanovljeno je da su bolesnici koji su primali prijeoperacijski nutritivne pripravke imali statistički značajno manji broj dehiscencija anastomoze. Učestalost pothranjenosti kod ispitanika bila je 13%. Bolesnici koji su preoperativnim nutritivnim probirom okarakterizirani da su u nutritivnom riziku (NRS-2002 zbroj 3 i više) imali su više dehiscencija anastomoze. Bolesnici s hipoproteinemijom (ukupni serumski proteini manja od 66mg/L) i hipoalbuminemijom ( albumini manja od 35mg/L) imali su također veći broj dehiscencija. Mjerenje vrijednosti serumskog CRP-a, posebno 3. i 4.postoperacijski dan, pokazalo se kao najpouzdaniji marker rane dijagnostike dehiscencije anastomoze. Utvrdilo se da je mjerenje vrijednosti IL-6 i TNF-alpha u prva dva postoperacijska dana također dobar marker rane dijagnostike dehiscencije. Nutritivna priprema bolesnika s rakom debeloga crijeva, osobito kod bolesnika u nutritivnom riziku i kod pothranjenih bolesnika, mogla bi imati utjecaj na smanjenje učestalosti dehiscencije anastomoze kod takvih bolesnika, ali potrebna su daljnja istraživanja na većem broju ispitanika.In this research, we studied the correlation of preoperative nutritional preparation with high-protein enteral supplements in patients with colorectal cancer with occurence of anastomotic leakage. We set the hypothesis that patients who received preoperatively high-protein enteral supplements will have lower incidience of anastomotic leakage. Our goals were to determine the relationship between preoperative nutritional preparation in patients with colorectal cancer with incidence of anastomotic leakage.Also, we wanted to determine the incidence of malnutrition in patinets with colorectal cancer, the relationship between preoperative nutritive status of the patieents with incidence of anastomotic leakage and to determine the possibility od early diagnosis of anastomotic leakage with continuos measurement of serum CRP and CRP and cytokines (IL-6 and TNF-alpha) in intraperitoneal fluid. The total number of subjects was 100, divided into two groups. In the first group (N=50) were patients with colorecta cancer who received, with their usual diet, high-protein enteral supplement 10 days prior tothe surgery, while the second (N=50) group included patients with colorectal cancer who received only their usual diet. Anastomotic leakage was significantly lower in group of patients with preoperative nutritional preparation. The incidence of malnutrition was 13%. Patients with NRS-2002 score 3 and more had significantly higher incidence of anastomotic leakage.Patients with hypoproteinemia(serum protein levels lower than 66mg/L) and hypoalbuminemia (albumin levels lower than 35mg/L) had also higher incidence of anastomotic leakage. Measurement of serum CRP was a very usefull marker of early diagnosis od anastomotic leakage, especially on 3rd and 4th postoperative day. Levels of IL-6 and TNF-alpha can also be valuable markers in early diagnosis, on first two postoperative days. Nutritional preparation in patienst with colorectal cancer, especially in patients at nutritional risk and malnourished could lower the incidence of anastomotic leakage. However, larger studies should be conducted to confirm these findings

Discharge after Elective Uncomplicated Laparoscopic Cholecystectomy: Can the Postoperative Stay Be Reduced?

The aim of the study was to reevaluate the safety and feasibility of discharge 24 h after elective uncomplicated laparoscopic cholecystectomy. Since the introduction of laparoscopic cholecystectomy in our hospital, the minimum postoperative stay was considered to be two days based on surgeons’ experience. The study included 337 operations performed by 21 surgeons during 2016 in the Sestre milosrdnice University Hospital Centre. Conversion to open technique and cases of acute cholecystitis were excluded, while 15 patients had insufficient postoperative data. The mean length of stay was 2.38 (range 1 to 6) postoperative days, median two postoperative days. Serious complications involving suspected drain bile leakage and postoperative hemorrhage occurred in two (0.59%) patients, both in the first 24 h following surgery. One patient required emergency laparotomy on the first postoperative day. Readmission rate was 1.2%. The postoperative minor complication rate was 42 of 337 (12.46%); these included wound infections, urinary tract infections, symptoms included in postcholecystectomy syndrome, etc. The onset of these complications was mostly after postoperative day 3. The data obtained suggest that discharge on the first postoperative day after elective uncomplicated laparoscopic cholecystectomy should be considered safe and can be practiced in our hospital