[Intussusception in adults]. / Felnóttkori invaginációk.

The authors report eight cases of intussusception of small and large intestine in adults during five years. 3 of the intussusception caused by simple tumors in five cases by malignant. In three cases were chronic presented long term signs and symptoms. Ileo-ileal invagination was diagnostised at 3 patients, ileo-caecal in one case and ileocolic intussusception also in one case. In 2 cases developed caeco-colic, in one case colo-colic invagination. Resection was strongly indicated in seven cases and wedge resection was done at the last patient. One patient has died of cerebral multiple embilization. They review the etiology and pathology, the signs and symptoms as well as the difficulties during diagnosis and treatment of the intussusceptions according to their own experience and literary datas. The authors draw the attention to the importance of the modern iconographic, tools, particularly the ultrasonography in the diagnosis of intussusception.

[Minimally invasive surgery in the management of Mirizzi syndrome]. / Minimálisan invazív sebészet a Mirizzi-szindróma gyógykezelésében.

An impacted gallstone in the cystic duct or in the Hartman's pouch with subsequent inflammation and edema resulting in extrinsic compression of the common hepatic or common bile duct with obstructive jaundice is known as Mirizzi's syndrome. The Mirizzi syndrome presents a difficult surgical challenge because of the dense adhesions and edematous inflammatory tissue cause distortion of the normal anatomy in Calot's triangle, leading to a great risk of bile duct injury. Therefore, a controversial issue the surgical strategy for the treatment of Mirizzi's syndrome since the introduction of laparoscopic cholecystectomy. The present study was undertaken to elucidate the applicability of microlaparotomy cholecystectomy in the management of Mirizzi's syndrome. Between December 1990 and December 1996 we operated on 16 patients for Mirizzi's syndrome. In 14 of these patients had type I of Mirizzi's syndrome, the remaining 2 had type II of this syndrome. In 13 of these patients the gallbladder were removed using 3-4 cm single microlaparotomy incisions. In the remaining 3 patients using 5.5 cm, 8 cm as well as 12 cm long incisions for the removal of the gallbladder, and placement T tube because of stenosis of the common hepatic duct, suture repair of the choledochal defect as well as choledochoplasty. In 12 of these patients the microlaparotomy cholecystectomy were done within 7 days of the onset of the obstructive cholecystitis. The postoperative stay of these patients were uneventful and they were discharged home 3 days after surgery. We conclude that early operation of the obstructive cholecystitis with Mirizzi's syndrome eliminates the serious stricture and fistula formation of Mirizzi's syndrome.

The removal of cystic duct and gallbladder remnant by microlaparotomy.

The so called "Postcholecystectomy Syndrome" may be due to various pathological biliary causes. While a very small number of patients may have symptoms attributable to problems related to cholecystectomy. Twenty five patients underwent a second operation on the bile ducts after cholecystectomy, cholecystostomy and choledocho-duodenostomy by micro and minilaparotomy between December 1990 and December 1996. The second most common causes for reexploration were cystic duct and gallbladder remnants (16%). After incomplete cholecystectomy they usually find that the cystic duct stump and the alot triangle embedded in inflamed scar tissue. For this reason the surgical risk is to high with laparoscopic surgery to reoperate for these pathological changes.

[Cystic duct syndrome and minimally invasive surgery]. / Cysticus csonk szindróma és a minimálisan invazív sebészet.

Cholecystectomy is an established successful operation which provides total relief of presurgical symptoms in up to 85% of patients. About 5% of patients after cholecystectomy experience severe episodes of upper abdominal pain, similar to those that they had prior to cholecystectomy. These so called postcholecystectomy syndromes may be due to biliary strictures, retained biliary calculi, cystic duct stump syndrome, stenosis or dyskinesis of the sphincter of Oddi. Postcholecystectomy symptoms caused by cystic stump and gallbladder remnant had been described early in this century and several papers have been published on the topic. During recent years laparoscopic cholecystectomy became popular but we have not found in the literature the mention of either that it could cause cystic duct stump syndrome or it could be used for its treatment. During the last seven years in 8 patients we found gallbladder remnants or cystic duct stumps causing their symptoms. Among the 8 patients 3 had laparoscopic and 5 classic cholecystectomies. After incomplete cholecystectomy we usually find that the cystic duct stump and the Calot triangle embedded in inflamed scar tissue. For this reason the surgical risk is to high with laparoscopic surgery to reoperate for these pathological changes. In all 8 cases the pathological cystic duct stumps and gallbladder remnants were removed using 3-4 cm single microlaparotomy incisions. The postoperative stay of these patients were uneventful and they were discharged home 2-3 days after surgery.