Percutaneous management of acute necrotizing pancreatitis

OBJECTIVES: The study aims to evaluate the efficacy of percutaneous necrosectomy (PN) performed under ultrasound control and of endoscopic necrosectomy through secondary sinus track (ENTSST) using nephroscope and cystoscope.MATERIAL AND METHOD: Puncture of fluid collections in the pancreas was performed under ultrasonographic control to 23 patients with acute necrotizing pancreatitis (ANP). ENTSST using nephroscope and cystoscope was performed to 47 patients after open or percutaneous necrosectomy and persistent sepsis (without satellite collection of CT).RESULTS: Seventeen patients (74%) treated with percutaneous necrosectomy recovered without open surgery. Two of this group died. The average hospital stay was 42 days. Twenty-three patients required an average of two (range 1-4) ENTSST.CONCLUSIONS: Based on our initial results we believe that the percutaneous necrosectomy and ENTSST in well selected patients might be the better choice than open necrosectomy and postoperative lavage. Common solution for these methods has not been reached yet

Manual Colonic Decompression - Faster Than On-Table Lavage in Obstructed Left Colon Cancer

We are presenting the advantage of manual decompression over the on-table lavage as a way of saving time during an emergency surgery in obstructed left colon cancer (OLCC). Introduction: Left colon cancer can present as an emergency due to obstruction in about 20% of the cases. Therefore, we are often forced to operate on these patients in conditions of an unprepared colon. Aim: We are presenting the advantage of manual decompression over the on-table lavage as a way of saving time during an emergency surgery in obstructed left colon cancer (OLCC).Materials and Methods: We analyzed 54 cases of acute left colon obstruction caused by colon cancer. All were operated as emergency cases in a condition of an unprepared colon. Both, manual decompression and on-table lavage were used for intraoperative colon cleansing (28/26, respectively).Results: The time used for on-table lavage was significantly longer than that for the manual decompression group (>0.05). In all patients, a segmental colon resection and primary anastomosis were done. Conclusion: On-table lavage was technically more challenging. In the future, in large series, we can expect complications with this method because of the weak place on the site of the appendectomy. Both manual decompression and on-table lavage can be used in cases of OLCC for colon cleansing as safe methods, with the only significant difference being time-saving with the manual decompression

The Chevrel Technique in the Treatment of Midline Giant Incisional Hernia

Introduction: Giant incisional hernia (GIH) is a serious pathological entity which is characterized with a massive loss of muscle and fascial tissue and a total impairment of the anatomical and physiological function of the anterior abdominal wall, which also leads to severe respiratory and visceral malfunction. Reconstruction is accompanied with a high rate of relapses, complications and even mortality.Materials and Methods: During a 15-year period (2000-2015), 319 patients in total have been operated on for midline GIH. Using the Chevrel classification, it is classified as an M4-W4R type of incissional hernia. The patients have been electively operated on under general endotracheal anesthesia. Standard reconstruction by Chevrel`s techniqe was used with the creation of a new linea alba. The defect on the anterior rectus sheath was covered with polypropylene mesh. Female to male ratio was 209/110 with a median age of 48 (31-72). The median BMI was 32.1. Concomitant cholecystectomies were done in 11 patients and dermolypectomies were performed on 31 at the same time.Results: There were no cases of intraoperative complications and mortality. Postoperative mortality, as a result of a perforated peptic ulcer was seen in one patient. The operative time after the improvement of the technique varied between 60-70 min. The average time of hospitalization was 8.8 days (range 7-21). SSI were noted in 56 (17%) patients. Seroma was a leading complication in our series. Partial necrosis of the skin was seen in 12 patients (4%). Hernia recurrence was observed in 7 patients (2.1%) during the follow-up period (6-48 months) in the controlled 284 patients.Conclusion: The original Chevrel technique consists of tissue reconstruction on the linea alba and approximation of rectus muscle, strengthened with a mesh lining. It represents an acceptable method with very good results. The low recurrence and complication rate, as well as the functional results, influence the acceptance of this method by highly specialized institutions that deal with the treatment of GIH

Head and neck malignant melanomas - clinical cases and treatment guidelines

Malignant melanomas are among the deadliest and fastest growing malignant tumors in human body. Although several decades ago they were considered rare, their frequency has increased dramatically in recent years.Our aim is to present several of our own cases of malignant melanoma in head and neck area and outline treatment guidelines.The extent of surgery is determined by the stage, location and size of the tumor: local excision; excision with sentinel lymph node biopsy; excision with selective modified or radical neck dissection. The advanced cases are treated by chemotherapy but the prognosis is poor. Promising seem to be the immuno-medications based on specific receptor antibodies.Good collaboration with dermatologists is important for early diagnosis - a fundamental prerequisite for therapeutic success.Der Erstautor gibt keinen Interessenkonflikt an

Biofibre® artificial hair implant: Retrospective study on 1,518 patients with alopecia and present role in hair surgery

To treat alopecia, there are many surgical and nonsurgical treatments available nowadays. In the surgical one, the Biofibre® hair implantation system represents an important innovation with artificial hair with special physical, chemical, and mechanical features and the new Biofibre® Automatic device. Implant on 1,518 patients has been reported in this study where the Biofibre® hair implant technique is performed on men and women with varying degrees of baldness and for the treatment of various causes of alopecia such as androgenetic alopecia, burns, and scars. According to our experience, this technique gives immediate and visible results without scarring or hospitalization and the aesthetic results are very encouraging for both male and female patients with a rapid recovery of self-esteem and psychological well-being

An international assessment of the adoption of enhanced recovery after surgery (ERAS®) principles across colorectal units in 2019–2020

AimThe Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units.MethodAn online survey was circulated amongst European Society of Coloproctology members in 2019–2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 (‘rarely’) to 4 (‘always’). Respondents were also asked to recall whether practice had changed since 2017. Subgroup analyses based on hospital characteristics were conducted.ResultsOf hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they ‘most often’ or ‘always’ adhered to most individual ERAS principles (18/25, 72%). Variability in the uptake of principles was reported, with universal uptake of some principles (e.g., prophylactic antibiotics; early mobilization) and inconsistency from ‘rarely’ to ‘always’ in others (e.g., no nasogastric intubation; no preoperative fasting and carbohydrate drinks). In alignment with 2018 ERAS guideline updates, adherence to principles for prehabilitation, managing anaemia and postoperative nutrition appears to have increased since 2017.ConclusionsUptake of ERAS principles varied across hospitals, and not all 25 principles were equally adhered to. Whilst some principles exhibited a high level of acceptance, others had a wide variability in uptake indicative of controversy or barriers to uptake. Further research into specific principles is required to improve ERAS implementation.AimThe Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units.MethodAn online survey was circulated amongst European Society of Coloproctology members in 2019–2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 (‘rarely’) to 4 (‘always’). Respondents were also asked to recall whether practice had changed since 2017. Subgroup analyses based on hospital characteristics were conducted.ResultsOf hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they ‘most often’ or ‘always’ adhered to most individual ERAS principles (18/25, 72%). Variability in the uptake of principles was reported, with universal uptake of some principles (e.g., prophylactic antibiotics; early mobilization) and inconsistency from ‘rarely’ to ‘always’ in others (e.g., no nasogastric intubation; no preoperative fasting and carbohydrate drinks). In alignment with 2018 ERAS guideline updates, adherence to principles for prehabilitation, managing anaemia and postoperative nutrition appears to have increased since 2017.ConclusionsUptake of ERAS principles varied across hospitals, and not all 25 principles were equally adhered to. Whilst some principles exhibited a high level of acceptance, others had a wide variability in uptake indicative of controversy or barriers to uptake. Further research into specific principles is required to improve ERAS implementation.A