[An original reconstruction of stomach after gastrectomy for cancer]. / Vlastní modifikace rekonstrukce zaludku po gastrektomii pro karcinom.

The aim is to present gastrectomy/D2 lymphadenectomy technique with stomach substitution with "J-pouch". The description of gastrectomy/D2 lymphadenectomy with the following reconstruction of upper GI part comes from a standardized technique as well as from the experiences of the authors. The technique of "J-pouch" with the anti-reflux cuff is a reconstruction modification created by the authors. "J-pouch" is created in the aboral half of interponate jejunal loop with the following reconstruction with esophagojejunostomy end-to-side and antireflux cuff creation. On the distal end is the jejuno-duodenostomie side-to-end created. The reconstruction with "J-pouch" after gastrectomy is an advantageous technique. It creates the needed reservoir and retains the physiological orientation through duodenum. These two factors lead to the improvement of life quality for patients after gastrectomy. This technique is safe and standard to perform according to the authors' experience.

[Septic shock in a patient with the Fournièr gangrene with fatal outcome]. / Septický sok u pacienta s Fournièrovou gangrénou s fatálním koncem.

AIM: The authors present a case of a patient with developed Fournièr gangrene and septic shock. Fournièr gangrene belongs to the group of local non-specific infection of soft tissues (NSTI). Its incidence is relatively low, but the infection is extraordinary aggressive with a possible lethal end. MATERIAL AND METHOD: 39 years old patient with 4 days history of Fournier gangrene's development was admitted in irreversible septic shock. The initial APACHE II score was 36. The delay in treatment was an important factor in the further course of illness with lethal end. RESULTS: Above the mentioned 39 years old patient died because of septic shock. The hemorrhagic cystitis was the original source of infection with further development of Fournièr gangrene according to the pathological record. CONCLUSION: We often come across all different kinds of stages of sepsis from the MODS to the septic shock for patients with Fournièr gangrene. Causal treatment should be started early. The local surgical excision and wide broad antibiotic administrations are basic treatments in the context of other treatment modalities according to the current patient's needs. The adjuvant hyperbaric oxygen treatment takes place in patients with Fournièr gangrene as well and is beneficial. The following factor even worsens the illness prognosis: delay in diagnostic, higher age, anorectal origin of infection, the amount of organ with dysfunction or failure, diabetes mellitus and significant immunodeficiency.

[Post-gastrectomy reconstruction]. / Rekonstrukce po gastrektomii.

AIM: Authors present review of current opinion in reconstruction of gastrointestinal tract after gastrectomy, in pouch benefit and benefit of retaining of the duodenum in food transit, and the importance of antireflux procedure. METHOD: Authors searched the Medline database for current trials regarding the reconstruction of gastrointestinal tract after gastrectomy. The key words were gastrectomy, reconstruction, and upper GI. The search was limited to those languages: English, German, and Czech. The authors identified 41 trials altogether. The trials were analysed regarding the pouch benefit and the retaining of duodenum in food transit. The comparison was done. CONCLUSION: The trials' results are not homogenous. Many patients are not possible to be evaluated because of the tumor recurrence with weight loss and other symptoms. There is no ideal reconstruction according to the trials. Patients can benefit from the reconstruction retaining the duodenum in food transit and with pouch creation. The retained duodenum in food transit is anormal stage from the anatomical and physiological view. In the case that pouch allows the proportional evacuation of food, the retaining of duodenum is advantageous. The pouch combined with antireflux procedure has a potential to improve life duality from longer perspective. On the other side, some authors present opinion that the reconstruction with pouch is too complicated with worse patient perioperative tolerance and its benefit is minimal. There is a very small number of prospective randomized trials which present a very small number of patients without statistical significance. It is important to perform a larger prospective randomized trial.