Incarcerated lumbar hernia in the Petit´s triangle as a cause of large bowel obstruction.

Petits hernia is a rare defect in the abdominal wall located in the lower lumbar triangle. The herniation in the Petiti trigonum is complicated by bowel incarceration in about 9% of cases, most often of the large bowel. We present a case report of a 73-year-old patient with clinical manifestations of large bowel obstrution. The patient was admitted and indicated for urgent surgery. Incarcerated left lumbar hernia in the Petits triangle with herniation of sigmoid colon that showed no signs of ischemia was found. Reposition of the sigmoid colon and hernioplasty of the lumbar hernia was performed. There were no postoperative complications and the patient was discharged on postoperative day 9. The presented case report shows that the lumbar hernia (Petit) may result in bowel obstruction and thus may cause a life-threatening condition that requires urgent surgical intervention.

Liver Tuberculosis a case report.

Tuberculosis remains a global health issue affecting millions of people worldwide. Pulmonary form of tuberculosis presents 80-90% of cases with prevalence declining worldwide. On the other hand, extrapulmonary tuberculosis remains at the same level. Extrapulmonary tuberculosis cases are rare at our department. In our article we present a patient who underwent a liver resection with an unexpected finding of liver tuberculosis. In this form of tuberculosis it is difficult to establish a definite diagnosis since clinical symptoms and results of imaging tests maybe equivocal orin determinate. The rare occurrence and the fact that the majority of extrapulmonary tuberculosis cases are not transmitted to other patients lead to lower attention of health professionals. The goal of our article is to bring this rare form of tuberculosis to attention. Inclusion of this form of tuberculosis in differential diagnosis may help to establish correct a diagnosis and therapy. Key words: extrapulmonary tuberculosis - liver.

[Risk factors for anastomotic leakage following rectal resection - multicenter study]. / Rizikové faktory anastomotické insuficience po resekcích konecníku - Multicentrická studie.

INTRODUCTION: Anastomotic insufficiency (anastomotic leakage) is one of the most serious complications of the sphincter-saving rectal resections, with significant impact on patient morbidity and mortality. The risk rate of anastomotic leakage may be influenced by local anatomic conditions - tumour localisation and stage, possible technical problems in anastomosis construction (ischaemia, anastomosis under tension), and by complex factors associated with the patient - malnutrition, obesity, smoking, corticosteroid therapy and preoperative chemoradiation. MATERIAL AND METHODS: All sphincter-saving rectal resections that were performed between September 2011 and April 2014 in three centres of colorectal surgery, i.e. at Atlas Hospital in Zlín, the Czech Republic, and at Kosice-Saca Hospital and Dérers University Hospital in Bratislava, Slovakia, were included in the present multicentric prospective study. The incidence of anastomotic leakage in laparoscopic and open surgery was compared and the risk factors resulting in leakage occurrence were analyzed. RESULTS: Anastomotic leakage developed in 12 (10.9%) out of the total number of 110 patients. In the laparoscopic group (58 patients), the insufficiency occurred 4x (6.9%), in the 17 converted patients 3x (17.6%), and in the open surgery group (35 patients) the leakage occurred 5x (14.3%). There was no statistically significant difference between these groups. Nevertheless, patients with anastomotic leakage were only males (P=0.006), they had significantly lower pre-operative albumin levels (35.8 g/l vs. 38.3 g/l; P=0.03), as well as a lower pre-operative total protein level (60.8 g/l vs. 64.1 g/l; P=0.07), when compared to patients without insufficiency. Tumour distance from the anal verge in patients with anastomotic leakage was also significantly lower (10.8 cm vs. 12.8 cm; P=0.05). CONCLUSION: The following risk factors for anastomotic insufficiency after rectal surgery were identified: male gender, low pre-operative albumin and total protein levels, as well as decreasing tumour distance from the anal verge. The difference in the incidence of anastomotic insufficiency between laparoscopic and open surgery groups was not statistically significant.

[SILS appendectomy for acute appendicitis - two-year experience]. / SILS apendektómia pre akútnu apendicitídu - dvojrocné skúsenosti.

INTRODUCTION: The study aims to present our two-year experience with SILS (Single Incision Laparoscopic Surgery) appendectomy in patients operated on for acute appendicitis symptoms. The results obtained were analysed and then compared with patients operated by standard laparoscopy, as well as with data available from the published literature with emphasis on safety and advantages of a new operating technique. MATERIAL AND METHODS: A retrospective analysis of patients operated on at the Third Department of Surgery, Slovak Medical University, the Kosice-Saca Hospital, a.s., in the past two years was performed. Age, sex, BMI, length of operation, post-operative hospitalization period, occurrence of pre- and post-operative complications were evaluated. RESULTS: In the period from 1 November 2009 to 31 October 2011, 116 patients were operated on by the authors, 47 of them by the SILS technique. The group included 26 males and 21 females with average age of 37.13 years (18-80) and average BMI 26.3 kg/m2 (18-47.1). Average length of the operation was 54.81 minutes (30-100). The length of post-operative hospital stay was 3.83 days (2-6). An abscess in the surgical wound was found in three patients. One patient had to be reoperated due to a pericaecal abscessed hematoma. Incisional hernia was not observed in our group. CONCLUSION: Our results are comparable with the data from international published literature and confirm that the SILS appendectomy is a safe method and represents an appropriate alternative to the standard laparoscopic technique. It is suitable for surgeons with advanced experience in laparoscopy. Apart from the excellent cosmetic effect, other advantages or disadvantages in comparison with standard laparoscopy will require confirmation by prospective randomized studies.

[SILS cholecystectomy--analysis of the first 100 patients]. / SILS cholecystektómia - analýza süboru prvých 100 pacientov.

AIM: The purpose of the study is to evaluate the results of the group of patients underwent SILS cholecystectomy and compare them with the literature evidence. MATERIAL AND METHODS: The retrospective analysis of the first 100 patients underwent cholecystectomy through single SILS port was performed. The operation was carried out with standard laparoscopic instruments. The average age, sex, BMI, mean operative time and the length of postoperative hospitalization were recorded. RESULTS: The sex ratio was approximately 3:1 for women. The mean age in the group was 49 years, BMI 26.8 kg/m2, operative time 63 minutes and the length of postoperative hospitalization was 2.2 days. Two intraoperative complications were observed - cystis artery bleeding and leasion of common hepatic duct. Four patients required conversion to a conventional laparoscopic cholecystectomy and one to open procedure. Three wound complications during the postoperative period was observed. CONCLUSION: The results of analysis show the SILS cholecystectomy to be a good and comparable alternative to multiport cholecystectomy in the rate of complications, the length of hospitalization and postoperative recovery. The ideal candidates for the procedure are younger patients with lower BMI without the signs of acute inflammation. The further advantages, except excellent cosmetis result, is needed to confirm in randomized studies.