[Treatment of duodenal ulcer and its complications in the era of Helicobacter pylori. When and how long is the gastroenterologic-internal medicine therapy indicated and when is the surgical treatment necessary?]. / A nyombélfekély és szövódményeinek kezelése a Helicobacter pylori korszakában. Mikor és meddig indokolt a betegség gasztroenterológus-belgyógyászati kezelése, és mikor válik indokolttá a sebészi megoldás?

With the widespread use of modern H2-receptor antagonists, the proton pump inhibitors and Helicobacter pylori eradication therapy the number of antiulcer operations decreased spectacularly. The treatment of uncomplicated ulcus duodeni got nearly exclusively into internists' hands. Becoming enthusiastic over the excellent results of conservative therapy there are unjustified attempts to avoid the operation in the complications of ulcus duodeni, particularly in bleeding, but also often in perforation and stenosis. With the use of operation-substitute procedures the patients often get in a more unfavourable situation than an operation would offer performed in time and in acceptable conditions. The authors on the basis of their surgical experiences summarize in what cases the deliberation of surgical indication or the performance of an operation is needed in the era of Helicobacter pylori.

Laparoscopic cholecystectomy in acute cholecystitis.

The authors retrospective analyze the role of golden standard laparoscopic cholecystectomy for the treatment of acute cholecystitis. They make a comparison between the results of 50 early cholecystectomy and 44 "a froid" cholecystectomy (operation was postponed until 6 weeks after acute cholecystitis had healed). From January 1997 to December 1998 536 laparoscopic cholecystectomies were performed. In 491 cases (91.6%) laparoscopic, and in 45 cases (8.4%) traditional (opening) method was indicated. Converted cholecystectomies were in 36 cases (7.3%). Agreeing to the literature they can determine the optimal timing of the operation in 72 hours from the onset of acute cholecystitis [2, 4]. In this group (first group) there were 50 cases, with 14 conversions (28%). In the second group (postponed, so called "a froid" phase) there were 44 patients. From this group was the intraoperative diagnosis serious acute-subacute cholecystitis in 24 cases (54.54%) causing complicated laparoscopic cholecystectomy and resulting in 11 conversions (11/44: 25%). The causes of the higher rate of conversion were the grave inflammation and slow dissection of central formation. There were no serious complication and mortality in both groups. It was diagnosed bile leak (two cases) which ceased spontaneously, one haematoma in abdominal layers, and one trocar's hernia. The authors have recommended the laparoscopic cholecystectomy for early diagnose acute cholecystitis in order to prevent the complications and reduce the sick-leave. Supporting their viewpoint the most important clinical end economical facts are: the recurrence of inflammation forced urgent surgery and caused more complication in the course of "a froid" phase there were scrutable anatomical situation the patients recovered in a shorter time.