[Analysis of postoperative complications following acute surgery for colorectal cancer]. / Colorectalis daganatok miatt végzett acut mutétek után észlelt szövodmények elemzése. Egy szemléletváltás hatása.

Our aim was to improve the outcome of emergency surgeries for colorectal cancer (CRC). Authors compared two periods: 2004-2006 and 2007-2011. Targeted cases were emergency admissions, in which the diagnosis of colorectal cancer is only revealed during work-up or during surgery. No other exclusion criteria were set. Analyzed main endpoints were anastomotic leak, postoperative mortality, resecability. ASA classification and TNM stages were assessed in order to learn morbidity and general condition prior to acute surgery. Considering the experience gained in prior period, in 2007, authors have made a change in treatment strategy. In following years leakage ratio became ten times lower and mortality was reduced by 5%. There is a great chance that fast work-up and preparation for surgery may decrease complications and mortality. The aim would be for CRC patients, is to reach surgery in an early stage of disease as possible, at least before complications develop.

[Our experience with totally extraperitoneal technique of laparoscopic inguinal hernia repairs modified by Stolzenburg]. / Stolzenburg szerint módosított teljes extraperitonealis technikával végzett laparoscopos lágyéksérvmutéteinkrol.

INTRODUCTION: Two current types of laparoscopic inguinal hernia repair are known: the TransAbdominal PrePeritoneal (TAPP) and the Totally ExtraPeritoneal (TEP) method. The mesh is placed in the preperitoneal space (sublay). Usually during TAPP method we fix the mesh with tacks or staples. In case of TEP fixation it is not necessary because the intraabdominal pressure keeps the implant in position. There is no significant difference between the two methods in terms of recurrence. The advantage of TEP is that the abdominal cavity remains intact, hence reduces the risk of intraabdominal injuries and adhesions. It is unnecessary to use special stapler or tacker. MATERIALS AND METHODS: Our team performed 50 TEP procedures in male patients with uni- or bilateral inguinal hernias in the period 2011-2013. We prepared the mesh in a special way according to Stolzenburg and placed it to the subfunicular area. We did not apply additional fixation (tacks, stitches) and drainage. Mean hospital stay was 1 day. We allowed complete physical activity 10-12 days after surgery. RESULTS: No recurrence was observed during the 2 years of follow-up. The mean operating time was 70 minutes. We performed conversion in 3 cases (Lichtenstein 2, TAPP 1). In one case there was an injury of the inferior epigastric artery. In two cases we have detected neuralgia in the postoperative period. CONCLUSIONS: After the learning curve the TEP method can be used safely with good functional results. The technique of mesh positioning reduces the risk of complications and provides cost-effectiveness.

Inpatients and specialists' opinions about natural orifice translumenal endoscopic surgery.

In the last three years, investigations on natural orifice translumenal endoscopic surgery (NOTES) have entered the clinical experimental phase. Our aim was to carry out the first cross-sectional survey in Hungary about inpatients and specialists' opinions concerning natural orifice surgery. A total of 155 patients were included in the survey from two hospitals. Patients received a handout that described in detail the various available techniques for cholecystectomy, plus a 10-item questionnaire. Respondents had to choose between undergoing laparoscopic or NOTES cholecystectomy, indicate the acceptable complication rate, provide the reason for their choice, and select an ideal orifice. Specialists attending lectures on NOTES at two Hungarian congresses were given a separate questionnaire that was designed for physicians. We measured their perceptions about the need for the new method and about the unsolved issues it involved, their choice of entry site, their assessment of which type of specialist should perform NOTES operations, and the timeframe that would be needed for the widespread adoption of the method. With complication rates presumed to be equivalent to each other, 53% of inpatients chose a NOTES operation over laparoscopy for a cholecystectomy. Those who had prior endoscopy (p = 0.03), prior open surgery (p = 0.03), or who were male (p = 0.05) were more likely to opt for NOTES. The preferred approach was transvaginal (49%) for women, and transcolonic (66%) for men. Regarding the specialists, 37% would like to use NOTES in their practice and 49% would undergo a NOTES procedure; of these, 43% were unable to indicate the ideal orifice, 22% preferred the vagina, 20% the stomach, and 15% a hybrid approach. A total of 54% of surgeons believed that there is a real demand for NOTES, whereas 37% felt that it is an unnecessary innovation.