[Visceral reduction in surgical treatment of "impossibly" large abdominal hernias]. / Visceroredukce v operacním resení "nemozných" obrovských brisních kýl.

The authors present a group of 6 patients treated in 1996-2000 with giant "impossible" hernia the contents of which "lost their rights in the abdominal cavity". The patients involved were old polymorbid people (mean age 75 years), 5 suffered from acute, one from chronic obstruction of the gut. After intensive preparation the authors implemented a hernioplasty, using an excessive surgical mesh, reduced the volume of the abdominal contents by the omentum in all subjects, by the right colon in two and by a 0.5-1 m segment of the ileum in 3 patients. Only one extremely polymorbid patient died because of multiorgan failure on the 17th day after surgery. In 5 patients artificial ventilation was necessary from 2 hours to 17 days. As to complications, diarrhoea was recorded in one patient and infection of the mesh in another one. The authors conclude that the majority of "impossible" incarcerated hernias can be resolved by visceroreduction and enlargement of the volume of the abdominal cavity by inserting an excessive surgical mesh into the enlarged hernial neck. In elective operations of such hernias for the preparation forced reduction of the weight can be used and the technique of enlargement of the abdominal volume by intermittent pneumoperitoneum. In this way a giant "impossible" hernia can be treated without threatening the patient's life by cardiopulmonary failure.

[Primary carcinoma of the duodenum]. / Primární karcinom duodena.

The authors describe the case of a 70-year-old man with primary adenocarcinoma of the fourth segment of the duodenum. Due to the infrequency of the condition there was diagnostic and therapeutic uncertainty. After the endoscopic and bioptic diagnosis three months elapsed before an incorrectly indicated derivation operation and only after another month the tumour was resected. The exhausted patient developed postoperative pancreatitis with subsequent multiorgan failure to which he succumbed. The disease should be suspected even if the symptomatology is poor. The patient suffered only from nausea and anaemia. From the diagnostic aspect endoscopic examination is most useful for the oral segment of the duodenum and double contrast examination for the aboral one. The method of treatment is duodenopancreatectomy for the upper part and segmental resection for the distal part of the duodenum.

[Reoperation of gastric banding in obesity]. / Re-operace po gastrických bandázích pro obezitu.

From September 1988 till June 1997 the authors performed gastric banding for morbid obesity in 644 patients. In 14 (2.2%) reoperation was necessary: on account of stenosis of the stoma with excessive weight loss in 10, inadequate weight loss in four patients. Correction was performed by prolonging the circumference of the cuff in five and by re-banding of the stomach and creation of a stoma with a 12 mm diameter and a "small stomach" with a volume of 15 ml in nine patients. No death nor complications were recorded. The results with complete recovery of the condition were excellent in the group with excessive weight loss, more modest in the group with a small weight loss. The authors emphasize the necessity of comprehensive care of obese patients; an optimal bariatric operation must be followed by long-term follow-up of patients to achieve a change of lifestyle as regards dietary habits as well as regular physical activity.

[Gastric banding in the treatment of obesity]. / Gastrická bandáz v lécbe obezity.

Failure of conservative treatment of obesity stimulated the development of bariatric surgery. The authors performed in 1988-1995 GB in 248 obese patients with a mean overweight of 48.2 kg and with serious comorbidity. The mortality in the group was 1.6%, the morbidity 12.5%. Within 12 months after operation the overweight of the patients declined by 70%, within 24 months by 57%. In the majority of patients the comorbidity receded, the blood sugar level reached normal levels, dyspnoea and hypertension improved as well as the psychic state and social position. The attained results confirm that this treatment of morbid obesity is justified and the authors recommend its wider use. Perspectively laparoscopic gastric banding is associated with a reduced mortality and morbidity, however it is also associated with higher costs.

[Traumatic dissection of the duodenal wall in a child]. / Traumatická disekce steny duodena u dítete.

The authors present the case of a 6-year-old girl admitted to the department three days after a blunt abdominal injury. On surgical revision a dissecting haematoma of the wall of retroperitoneal duodenal sections was revealed. After its treatment and nutritive puncture jejunostomy the subsequent postoperative course was free from complications. This is an infrequent GIT injury in childhood which can be treated also by conservative methods.

[Video thoracoscopic splanchnicectomy in persistent epigastric pain]. / Videotorakoskopická splanchnikektomie pro úporonou epigastrickou bolest.

For palliation of persisting pain caused by inoperable malignity in the epigastrium or chronic pancreatitis a number of surgical and non-surgical operations of the splanchnic nerves was elaborated. Abdominal and thoracic approaches are associated with technical difficulties and burden the patient; blocks by puncture are associated with risk. The optimal procedure appears to be videothoracoscopic left-sided splanchnicectomy, the authors performed this operation in nine patients (in seven on account of a malignant process, in two on account of chronic pancreatitis). In all immediate alleviation of pain occurred, in two later some pain reappeared. Based on the favourable experience, the authors recommend this minimal invasive procedure.

[The Lichtenstein "tension free" operation for inguinal hernia]. / "The tension free" operace tríselných kýl podle Lichtensteina.

The authors present their experience with operations of 264 inguinal hernias in 238 subjects where Lichtenstein's technique was used. The principle of the operation is reconstruction of the posterior wall of the inguinal canal by means of a synthetic mesh-tension free. The attained results in this group (L) were compared with a control group of 68 operated patients (group C) where the classical McVaye technique was used. They did not find a difference in the time taken up by the operation or the time of hospitalization. The postoperative mortality was 0.4% in group L and 2.9% in group C, the morbidity was 15.5% and 42.6% resp. So far they did not record a case of relapsing hernia or rejection of the mesh. The operation is easy to perform, economically unpretentious, the postoperative pain is milder and the sensation of discomfort slighter than after the classical operation. With regard to the assembled experience, the authors recommend the new operation not only in inguinal but also other types of hernias where tension free repair is impossible. For reconstruction they use polyester mesh CHS 100 manufactured by the Hosiery Research Institute in Brno.