Proximal protective stoma by low anterior resection of the rectum - When? How? How long?

There is an evolution in the diagnostic algorithm of rectal cancer. In this condition preoperative investigations assist in deciding the optimal treatment. The relation of the tumor edge to the circumferential margin (CRM) is an important factor in deciding the need for neoadjuvant treatment and determines the prognosis. Those with threatened or involved margins are offered long course chemoradiation to enable R0 surgical resection. Endoanal ultrasound (EUS) is useful for tumor (T) staging; hence EUS is a useful imaging modality for early rectal cancer. Magnetic resonance imaging (MRI) is useful for assessing the mesorectum and the mesorectalfascia which has useful prognostic significance and for early identification of local recurrence. Computerized tomography (CT) of the chest, abdomen and pelvis is used to rule out distant metastasis. Identification of the malignant nodes using EUS, CT and MRI is based on the size, morphology and internal characteristics but has drawbacks. Most of the common imaging techniques are suboptimal for imaging following chemoradiation as they struggle to differentiate fibrotic changes and tumor. In this situation, EUS and MRI may provide complementary information to decide further treatment. Functional imaging using positron emission tomography (PET) is useful, particularly PET/CT fusion scans to identify areas of the functionally hotspots. In the current state, imaging has enabled the multidisciplinary team of surgeons, oncologists, radiologists and pathologists to decide on the patient centered management of rectal cancer. Functional imaging may play an active role in identifying patients with lymph node metastasis and those with residual and recurrent disease following neoadjuvant chemoradiotherapy in near future

Is the Laparoscopic Surgery Contraindicated in Cases of Complicated Acute Cholecystitis?

Тhe curative possibilities for acute cholecystitis could be just conservative treatment, early cholecystectomy up to the 72nd hour, and delayed cholecystectomy after conservative treatment and election of the timing of the surgery. The early laparoscopic cholecystectomy is accepted as a modern `gold standard`. In it, the results, according to the rise of the learning curve, are marked as similar and compatible with these of the elective cholecystectomies. The problem of the curative tactics in the cases of complicated acute cholecystitis remains controversial and there is no consent on the timing and the kind of the intervention. They should be defined according to the patho-morphologic alterations and the kind of the complications found, as well as according to the general state and the co-morbidity of the patient. The opinions on the possibilities for a laparoscopic approach in these cases vary from total denial to absolute enthusiasm as an end in itself. We analyzed retrospectively 54 patients with complicated acute cholecystitis out of a total of 517 operated on for acute cholecystitis in our clinic over a three-year period. The cases were differentiated by gender, age, pathomorphological form of the cholecystitis and by the kind of complications. The applied pre-operatively therapeutic approach in the different forms of complications was inspected. The intraoperative, the early and late post-operative results were analyzed. In conclusion, we accept that in cases with complicated acute cholecystitis the laparoscopic surgery is available and is not an absolute contraindication, but each case should be assessed individually