Laparoscopic Cholecystectomy in Cantonal Hospital Livno, Bosnia and Herzegovina and University Hospital Center Split, Croatia

Cholecystectomy is the most frequently performed operation in abdominal surgery. The aim of this study was to compare the operative procedure and outcomes of the laparoscopic cholecystectomy in two hospitals, the University Hospital Center Split and the Regional Hospital in Livno. A total of 97 patients who underwent laparoscopic cholecystectomy for cholelithiasis at University Hospital Center Split and 86 patients from Regional Hospital in Livno, both groups sampled in 2005 were included in this study. Differences in patients’ age, gender, operation time, total hospital stay, number of trocars` ports, antibiotic and parenteral therapy, and complications were analyzed. There were significantly fewer men than women who underwent laparoscopic cholecystectomy in both hospitals. The mean age of the patients undergoing laparoscopic cholecystectomy at University Hospital Center Split was higher than that of the patients at Regional Hospital in Livno. The operation time was shorter at the University Hospital Center Split than that at Regional Hospital in Livno. There was a significant difference, in favor of the University Hospital Center Split, in the number of patients who received postoperative antibiotics and parenteral therapy, with fewer patients who received postoperative therapy in Split. At the Regional Hospital in Livno fewer trocars were used for laparoscopic cholecystectomy. The average hospital stay of patients undergoing laparoscopic procedures at University Hospital Center Split was shorter than that of patients at Regional Hospital in Livno. Two complications occurred in postoperative period at the University Hospital Center Split and one complication was noticed in hospital in Livno. In conclusion, there were no major complications in postoperative period. It is also encouraging to find that there was significant improvement of surgical approach and technique at the hospital in Livno during the period of time analyzed in this study

Laparoscopic Cholecystectomy in Cantonal Hospital Livno, Bosnia and Herzegovina and University Hospital Center Split, Croatia

Cholecystectomy is the most frequently performed operation in abdominal surgery. The aim of this study was to compare the operative procedure and outcomes of the laparoscopic cholecystectomy in two hospitals, the University Hospital Center Split and the Regional Hospital in Livno. A total of 97 patients who underwent laparoscopic cholecystectomy for cholelithiasis at University Hospital Center Split and 86 patients from Regional Hospital in Livno, both groups sampled in 2005 were included in this study. Differences in patients’ age, gender, operation time, total hospital stay, number of trocars` ports, antibiotic and parenteral therapy, and complications were analyzed. There were significantly fewer men than women who underwent laparoscopic cholecystectomy in both hospitals. The mean age of the patients undergoing laparoscopic cholecystectomy at University Hospital Center Split was higher than that of the patients at Regional Hospital in Livno. The operation time was shorter at the University Hospital Center Split than that at Regional Hospital in Livno. There was a significant difference, in favor of the University Hospital Center Split, in the number of patients who received postoperative antibiotics and parenteral therapy, with fewer patients who received postoperative therapy in Split. At the Regional Hospital in Livno fewer trocars were used for laparoscopic cholecystectomy. The average hospital stay of patients undergoing laparoscopic procedures at University Hospital Center Split was shorter than that of patients at Regional Hospital in Livno. Two complications occurred in postoperative period at the University Hospital Center Split and one complication was noticed in hospital in Livno. In conclusion, there were no major complications in postoperative period. It is also encouraging to find that there was significant improvement of surgical approach and technique at the hospital in Livno during the period of time analyzed in this study

Uloga ocjenskih ljestvica Injury Severity Score i Abbreviated Injury Scale u liječenju traumatskih ozljeda parenhimskih organa trbuha

Th e aim of this study was to investigate the infl uence of etiology, types of injury, levels of consciousness and the Injury Severity Score (ISS) and Abbreviated Injury Scale (AIS) values on the selection of treatment modality and survival in patients with injuries of parenchymal abdominal organs. Case records of 224 patients treated for traumatic injury of parenchymal abdominal organs from January 2003 until December 2015 were reviewed. Th e values of ISS and AIS of injury severity were calculated and compared to the values obtained according to the etiology, state of consciousness and survival. Of the 224 patients, 172 (76.8%) were treated by surgical approach and 52 (23.2%) were treated conservatively. Th e mean patient age was 40.1}18.3 years. Th ere were 97 (43.3%) polytrauma cases. Of the 224 injured patients, 143 (63.8%) were treated with transfusions of blood products. Two hundred and six (92%) patients survived. Th e mean AIS and ISS values were signifi cantly lower in patients that survived (AIS=3; ISS=28) than in those that died (AIS=5; ISS=34) (p<0.001). Th ere was a statistically signifi cant diff erence in AIS and ISS values between conscious (AIS=2.7; ISS=25.9) and unconscious (AIS=3.2; ISS=33) patients (p<0.001). Of the 224 patients that did not survive, 18 (8%) were hemodynamically unstable. Survival depended on hemodynamic stability at admission; the ISS and AIS values were associated with the injuries and state of consciousness at admission. Hemodynamic stability, state of consciousness, and ISS and AIS values were the quality predictors of survival after abdominal traumatic injury.Cilj ovoga rada bio je istražiti utjecaj etiologije, vrste ozljede, stanja svijesti te vrijednosti ocjenskih ljestvica Injury Severity Score (ISS) i Abbreviated Injury Scale (AIS) na izbor načina liječenja i preživljenje u bolesnika s traumatskim ozljedama trbuha. Povijesti bolesti 224 bolesnika liječenih zbog traumatskih ozljeda parenhimskih organa u razdoblju od siječnja 2003. Do prosinca 2015. godine retrospektivno su pregledane. Izračunate su vrijednosti ISS i AIS i uspoređene s vrstom ozljede, stanjem svijesti i etiologijom nastanka ozljede. Od ukupno 224 bolesnika, 172 (76,8%) ih je liječeno kirurškim pristupom, a 52 (23,2%) konzervativno. Srednja dob bila je 40,1}18,3 godina. Devedeset sedam (43,3%) bolesnika bilo je politraumatizirano. Od ukupnog broja bolesnika 143 (63,8%) ih je liječeno transfuzijama krvnih pripravaka. Ukupno je preživjelo 206 (92%) bolesnika. Srednje vrijednosti AIS i ISS bile su značajno niže u bolesnika koji su preživjeli (AIS=3; ISS=28) u odnosu na one koji su umrli (AIS=5; ISS=34) (p<0,001). Također je utvrđena statistički značajna razlika u vrijednostima AIS i ISS između bolesnika koji su bili pri svijesti (AIS=2,7; ISS=25,9) i onih koji su kod prijma bili bez svijesti (AIS=3,2; ISS=33) (p<0,001). Od ukupnog broja bolesnika 18 (8%) bolesnika koji nisu preživjeli bili su hemodinamski nestabilni. Preživljenje ovisi o hemodinamskoj stabilnosti pri prijmu, a vrijednosti ISS i AIS ovise o vrsti ozljeda i stanju svijesti pri prijmu. Hemodinamska stabilnost, stanje svijesti, ISS i AIS vrijednosti pokazali su se kao prediktori preživljenja u bolesnika s traumatskim ozljedama trbuha

Influence of ERAS protocol on postoperative outcomes after elective colorectal resection surgery: A prospective cohort study- two years single center experience

Background ERAS (Enhanced Recovery After Surgery) protocol is a multimodal pathway of perioperative surgical care consisting of evidence-based procedures. ERAS protocol is hardly accepted by medical staff because it often opposes well established practice. Methods We analyzed length of hospital stay, postoperative complications, time until first stool passage and introduction of normal nutrition in patients undergoing elective colorectal resection surgery in University Hospital Center Split from October 2016. to October 2018. Patients were divided into 4 groups considering operation type (open/laparoscopic) and application of ERAS protocol (good/poor). Application of 60% or more ERAS steps was considered as well performed protocol. Results Groups Laparoscopy/ERAS and Open/ERAS had shorter postoperative hospital stay (Median, IQR; days) than groups Laparoscopy/non-ERAS and Open/non-ERAS (LE 5, 4-8 , OE 6, 5-9 vs LNE 7, 5-8,5 , ONE 7, 6-12). Similar difference was shown in times until first stool passage. Patients operated laparoscopically had shorter times until normal food tolerance (Median, IQR; days): LE 3, 2-3, LNE 3, 2-4 than patients who underwent open surgery (OE 3, 3-4, ONE 4, 3-5). In addition, laparoscopically operated patients had lower overall morbidity (P<0.001). Incidence of unplanned operations and hospital readmissions did not differ significantly among groups. Conclusions Well performed ERAS protocol can improve length of hospital stay and time until first stool passage in both open and laparoscopic types of operation. Optimal combination for colorectal resection is laparoscopic surgery with ERAS protocol. If open surgery is done, it should be preferably applied with ERAS protocol as well

Formation of Adhesions at Surgical Meshes in a Rat Experimental Model

Abdominal wall hernias are surgical problem that are easily solved with laparoscopic surgery. The determining factor for the success of the operation is the right choice and use of surgical mesh as the support material. The most common complication of surgical mesh placement is the formation of adhesions. Aim of this paper is to determine whether there is a statistic difference in formation of adhesions between different surgical meshes in lab environment. Wistar rats were used as the experimental model. After the anaesthesia a 1x1 cm defect of the abdominal wall was made, but the skin was left intact. The mesh was placed directly on the internal organs. The experiment considered four different mesh types. After set time periods of one, two or four weeks the animals were sacrificed and the amount of formed adhesions were evaluated based on the modified Diamond scale. Immediately after the first week we found a statistically significant difference in the adhesion occurrence rate between compared materials. The smallest amount of adhesions was caused by polypropylen + polydoksanon mesh, and the most by polypropilen mesh. Polypropylen + polyglactin mesh showed significant reduction of adhesion formation between the tested weeks. We can conclude that polypropylen + polydoxanon meshes are superior for ventral hernia operation, because those defects are in close contact with the internal organs and it is very important to have the smallest amount of adhesions

Giant Perianal Angiomyofibroblastoma – A Case Report

A 45-year old female had a long history of slow growing perianal tumor at the right side of her anus. Encapsulated tumour was found intraoperatively and completely excised using the Harmonic Scalpel. Tumour was well-circumscribed and relatively firm; measuring 12x6x4 cm. Histologically it was composed of oval to spindle cells with minimal nuclear atypia, set in mucous matrix with numerous thin-walled blood vessels. Immunohistochemically, expression of smooth- -muscle actin and desmin, as well as estrogen and progesterone receptor were found in the tumour cells. The diagnosis of angiomyofibroblastoma was established. This rare benign tumour typically involves vulvovaginal, pelvic and perinal region. It is important to separate this neoplasm from locally invasive aggressive angiomyxoma and low grade fibromyxoid sarcoma, which can arise in the the same localisation. The patient was discharged on the third postoperative day and no recurrence was noted in 18 months follow-up

Atipična manifestacija nemikrocelularnog karcinoma pluća: metastaze u ingvinalne limfne čvorove kao prvi znak recidiva bolesti

A case is presented of a 67-year-old male patient with atypical non-small cell lung cancer, where inguinal lymph node metastases were the first sign of disease relapse. The patient had a long-term smoking history of 30 cigarettes per day, with no other important personal or family medical history data. Because of prolonged cough, the patient underwent diagnostic procedure, which revealed squamous cell carcinoma of the lung (stage IIIB, T3N2M0). Concomitant radiochemotherapy and consolidation chemotherapy according to PE protocol was administered. Multislice computed tomography performed upon chemotherapy completion showed almost complete tumor regression and withdrawal of mediastinal lymph node enlargement, and the patient felt well. However, in the next few months, enlarged lymph nodes appeared in both inguinal regions. Histopathologic analysis revealed metastatic lung cancer. Four months after the presentation of enlarged inguinal lymph nodes, lung cancer metastases were also diagnosed in the liver and lumbosacral spine. Despite additional treatments, the patient died four months later. Although it is well known that inguinal lymph nodes can harbor lung cancer metastases, in our patient inguinal lymph node metastases were the first sign of lung cancer relapse.Prikazuje se slučaj 67-godišnjeg bolesnika s neuobičajenim razvojem kliničke slike planocelularnog karcinoma pluća, kod kojeg su metastaze u preponskim limfnim čvorovima bile prvi znak recidiva bolesti. Dugogodišnji je pušač koji puši oko 30 cigareta na dan, a osobna i obiteljska anamneza su bez osobitosti. Zbog dugotrajnog kašlja učinjena mu je dijagnostička obrada koja je pokazala da se radi o planocelularnom karcinom pluća (stadij IIIB, T3N2MO). S obzirom na stadij proširenosti tumora ordinirano je provođenje konkomitantne radio-kemoterapije i konsolidacijske kemoterapije, prema protokolu PE. Iako je kontrolna kompjutorizirana tomografija pokazala gotovo potpunu regresiju tumora i iako se bolesnik osjećao značajno bolje, nekoliko mjeseci nakon provedene konsolidacijske kemoterapije pojavili su se povećani limfni čvorovi u obje preponske regije, patohistološka analiza kojih je pokazala metastatski planocelularni karcinom pluća. Četiri mjeseca nakon pojave metastaza u preponskim limfnim čvorovima dijagnosticirane su metastaze u jetri i lumbosakralnoj kralježnici. Unatoč provedenoj terapiji bolesnik je preminuo. Iako je poznato da preponski limfni čvorovi mogu biti sijelo metastatskog karcinoma pluća, ovdje se opisuje slučaj gdje su povećani preponski limfni čvorovi bili prvi znak recidiva bolesti

Naša iskustva u liječenju opstrukcijskog ikterusa

The aim of the study was to estimate the prevalence and causes of obstructive icterus in patients operated on during the 2003-2004 period at University Department of Surgery, Split University Hospital in Split. In addition, data on the patient age and sex, type of surgical treatment, and existence and impact of risk factors on operative outcome were analyzed. Data on 114 patients with obstructive icterus treated at the Department during the 2-year period were retrospectively analyzed. Obstructive jaundice is a disease predominantly affecting female population (61.4% of patients), mostly those aged 60-74 (40% of patients). Cholelithiasis with choledocholithiasis is the most common cause of obstructive jaundice. Therefore, the most frequently used procedure for obstructive jaundice is cholecystectomy with or without choledochotomy and concrement extraction. The number of patients diagnosed with obstructive icterus shows a considerable increase. Although the same surgical methods have been applied for years, endoscopic surgery has gradually displaced classic methods of surgical treatment.Cilj rada bio je ispitati učestalost i uzroke opstrukcijskog ikterusa kod bolesnika koji su u razdoblju od 2003. do 2004. godine operirani u Klinici za kirurgiju Kliničke bolnice Split. Uz navedeno analizirali smo dob i spol bolesnika, vrstu primijenjenog kirurškog liječenja, te postojanje i utjecaj čimbenika rizika na ishod kirurškog liječenja. U dvogodišnjem razdoblju retrospektivno su analizirani podaci 114 bolesnika koji su zbog opstrukcijskog ikterusa liječeni u Klinici za kirurgiju KB Split. Opstrukcijska žutica je bolest koja pretežito zahvaća žensku populaciju (61,4% bolesnika) i to najčešće u dobi od 60 do 74 godine (40% bolesnika). Kolelitijaza s koledokolitijazom i dalje je najčešći uzrok opstrukcijske žutice. Sukladno navedenom, najčešće izvođeni zahvat u liječenju opstrukcijske žutice je kolecistektomija s koledokotomijom i ekstrakcijom konkrementa ili bez toga. Broj bolesnika kojima se dijagnosticira opstrukcijski ikterus pokazuje značajan porast. Iako se već dugi niz godina u liječenju primjenjuju iste kirurške metode, endoskopska (laparoskopska) kirurgija postupno istiskuje klasične oblike kirurškog liječenja

Formation of Adhesions at Surgical Meshes in a Rat Experimental Model

Abdominal wall hernias are surgical problem that are easily solved with laparoscopic surgery. The determining factor for the success of the operation is the right choice and use of surgical mesh as the support material. The most common complication of surgical mesh placement is the formation of adhesions. Aim of this paper is to determine whether there is a statistic difference in formation of adhesions between different surgical meshes in lab environment. Wistar rats were used as the experimental model. After the anaesthesia a 1x1 cm defect of the abdominal wall was made, but the skin was left intact. The mesh was placed directly on the internal organs. The experiment considered four different mesh types. After set time periods of one, two or four weeks the animals were sacrificed and the amount of formed adhesions were evaluated based on the modified Diamond scale. Immediately after the first week we found a statistically significant difference in the adhesion occurrence rate between compared materials. The smallest amount of adhesions was caused by polypropylen + polydoksanon mesh, and the most by polypropilen mesh. Polypropylen + polyglactin mesh showed significant reduction of adhesion formation between the tested weeks. We can conclude that polypropylen + polydoxanon meshes are superior for ventral hernia operation, because those defects are in close contact with the internal organs and it is very important to have the smallest amount of adhesions

Acute Appendicitis and Ileal Perforation with a Toothpick Treated by Laparoscopy

A 69-year-old man underwent an emergency laparoscopic procedure after the acute appendicitis diagnosis has been established. Laparoscopic exploration showed inflamed appendix and perforation of terminal ileum with a swallowed part of the wooden toothpick. The treatment consisted of typical laparoscopic appendectomy and laparoscopic removal of the foreign body, followed by laparoscopic closure of the perforation site and lavage of the abdominal cavity. The postoperative course was uneventful and the patient was discharged from the hospital on day 3 after the operation