[Surgery of recurrent inguinal hernia using the Lichtenstein technique]
Schnorrer N Jr. Mraz P. Petrasovic N.
Chirurgicka klinika IDVZ, Dererova nemocnica, Bratislava, Slovenska republika.
The authors evaluated a group of patients operated in 1993-1996 on account of relapsing inguinal hernia by Lichtenstein's technique. During an average follow-up period of 24 months 28% of the patients had another relapse of inguinal hernia. Because of the poor results the authors changed in January 1997 the surgical tactics in relapsing inguinal hernias. They operate by Nyhus preperitoneal approach and by laparoscopy transabdominally, placing a net in a preperitoneal position (TAPP) with subsequent follow-up of the patients.
[Initial experience with treatment of choledocholithiasis using shock waves]
Vojacek P. Kral V. Havlik R. Prochazka V. Konecny M.
I. chirurgicka klinika FN, Olomouc.
From March 1996 till August 1997 at the First Surgical Clinic in Olomouc 18 patients with concrements in the biliary pathways were treated by shock waves. All patients were older than 68 years; residual choledocholithiasis was involved which could not be eliminated during ERCP because of the size of the size of the stone. In 125 instances treatment was successfully terminated, i.e. by crushing the stones and their elimination. Only in three patients it was necessary to resolve the situation by surgery. The authors confirmed that it is possible to treat by this method patients with choledocholithiasis and avoid the risk of surgery in particular in older patients.
[Restoration of digestive passage after total gastrectomy]
Aujesky R. Neoral C. Koranda P.
I. chirurgicka klinika FN, Olomouc.
In a group of 20 patients the authors evaluate possibilities of reconstruction of the digestive tract after TGE from the aspect of quality of life. The evaluating criterion are subjective complaints, the necessity to restrict the volume of meals and evaluation of the gastric substitution. The authors did not find a significant difference between reconstructions using a Roux loop and bilateral interposition of a jejunal loop between the oesophagus and duodenum, while the consider the creation of a reservoir very beneficial for the patient.
[Importance of examination of the portal circulation using contrast media when there are indications for surgical anastomosis]
Klein J. Kral V. Utikal P. Kocher M. Mikulasova J.
I. chirurgicka klinika FN Olomouc.
In a group of 79 patients hospitalized on account of haemorrhage associated with portal hypertension the authors evaluate the diagnostic yield of radiological and sonographic methods. Sonography is a non-invasive procedure and is useful for routine checks of the function of the anastomosis. Direct contrast examinations are essential in preoperative reflections and for evaluation of possible complications of an already established shunt. Indirect procedures are in the latter two instances inadequate and unreliable.
[Palliative treatment of inoperable esophageal stenoses using stents: long-term results, complications]
Kocher M. Dlouhy M. Neoral C. Gryga A. Duda M. Buriankova E. Aujesky R.
Radiologicka klinika FN, Olomouc.
The authors evaluate the effectiveness of palliative treatment of inoperable oesophageal stenoses by means of self-expandable stents in a group of 102 patients and discuss complications. In all patients after implantation of the stent dysphagia improved by at least two degrees. Eighty nine patients of the group died, the mean period of survival was 107 days. At the time of evaluation 13 patients survive, the mean survival period being 175 days. As to complications the authors recorded incomplete expansion of the stent (n = 1), fissuring of the tumour (n = 1), migration of the stent (n = 8), oesophagorespiratory decubital fistula (n = 4), ingrowth of the tumour into the stent (n = 4), obstruction of the stent by food (n = 7) and arterial haemorrhage (n = 1). The effectiveness of palliative treatment of inoperable oesophageal stenoses by self-expanding stents is high and prompt. The total number of complications is 22%, the mortality after surgery is zero. The majority of complications is easily resolved by methods of interventional radiology.
[Cisapride (Prepulsid) in the prevention of postoperative gastrointestinal atony]
Hep A. Prasek J. Filipinsky J. Navratil P. David L. Dolina J. Dite P.
III. interni klinika FNsP, Brno-Bohunice.
Administration of cisapride, 3 x 5 mg in a suspension one day before surgery and 30 mg 3 and 8 hours after abdominal surgery with subsequent administration of 2 x 30 mg in suppositories up to the time when oral ingestion is possible, hastens significantly the restoration of GIT motility as compared with placebo. It can be therefore recommended as effective medication in the prevention of complications caused by impaired motility of the digestive tract.
[Gangliocytic paraganglioma of the duodenum]
Man M. Ruzicka M. Fabian P. Habanec B.
Oddeleni vseobecne a digestivni chirurgie, FNsP Brno-Bohunice.
Gangliocytic Paraganglioma of the duodenum is rare neuroendocrine tumor. This type of the tumor can cause bleeding into the gastrointestinal tract and epigastric pain in this region. It can be difficult to differentiate this tumor from the primary tumor of the head of the pancreas growing secondary to the duodenum. The authors describe one such misdiagnosed case treated finally successfully by hemipancreatodecodenectomy.