Biomedical subjects
Publications and source records attributed to Z Kala.
The authors describe fast, inexpensive and safe technique of appendicectomy enabling them to solve majority of all patients undertaking surgery for acute or chronic inflammation. It is very careful procedure performed through one umbilical port. This method combines the advantages of the minimal invasive surgery with the safe classic way of the appendix base closure.
Retroperitoneoscopy is a minimal invasive surgical technique enabling the diagnostics of the disease, as well as operative treatment of retroperitoneal organs. It is a very promising method especially for urologist, but of interest for general, vascular surgeon or gynecologist. The method is known since the end of sixties. Its routine introduction was enabled by technical advancement of laparoscopic surgery.
The development of revascularization techniques of the distal lower extremity dramatically diminished the need of lumbar sympathectomy. Which is indicated when patient with rest pain or with a profound gangrene of toes (which does not exceed the line of metatarsal articulation) could not be treated by vascular reconstruction. Lumbar sympathectomy could be done surgically or chemically, the efficiency of which is about 50%. The second to the fourth lumbar sympathetic ganglion could be resected with minimal invasivity, retroperitoneoscopically. This approach to lumbar sympathectomy opens further possibilities for operating in retroperitoneal space. Retroperitoneoscopy is well tolerated by patients.
The authors stress on the academic surgical departments the necessity of the development of both traditional and minimally invasive techniques of the groin hernia repair. They suggest to make patient selection based on the hernia type (Nyhus Classification) and patient's will and take account of an internal-anesthesiologic aspects. From four currently most often applied minimally invasive techniques they bring attention to the hernioplasty by exclusively extraperitoneal approach, till now seldom used by us.
The authors describe their experience with the endoscopic technique of upper thoracic sympathectomy. They evaluate it as an easily performed and safe method which gives great comfort to the patient as well as excellent functional and cosmetic results and involves a minimal burden and ensures rapid convalescence. It enables the surgeon to obtain a perfect orientation in the surgical field as well as safe and perfect preparation of the thoracic portion of the sympathetic nerve. The low cost is also important.
The authors describe the technique of laparoscopic gastrostomy and laparoscopic assisted gastrostomy. It is an alternative method for patients, when PEG (percutaneous endoscopic gastronomy) or other more physiologic way of food administration is not possible to perform.
Fibroscopy of the digestive system which in the majority of developed countries is quite common is in our country still not available in an adequate extent. The authors evaluate their experience in a surgical department covering a six-year period. A total of 4436 fibroscopic examinations were made incl. 3821 gastroscopies 615 ERCP and examinations of the papilla Vateri. They describe their experience with urgent endoscopy on account of haemorrhage into the GIT, pancreatitis or cholangitis. They emphasize the advantages of a maximal extension of endoscopic methods and their advantages, as compared with classical examination methods.
Early results of an initial non-selected group of 50 laparoscopic cholecystectomies (mean hospitalization 3.5 days, 6% conversions, no serious complications, no revisions, morbidity due to minor complications 6.3% and saved costs of postoperative hospital treatment 44.6%) confirm that this operation is feasible, safe, preferred by patients and well tolerated economical definitive treatment of cholecystolithiasis. On these grounds it is becoming a method of first choice. The safety of patients is ensured by steady care of the surgeon and his adequate training according to generally accepted principles.
The authors describe one possible way of endoscopic haemostasis, i.e. by bipolar coagulation. First they give an account of the principle of the method and technique of coagulation. Then they demonstrate on their own group of patients with haemorrhage into the gastroduodenum a 71% effectiveness of haemostasis by this method. In another 10% a temporary effect was achieved with the possibility of effective supplementation of the blood volume and thus an improved prognosis of surgery. In case of failure, in particular haemorrhage according to Forest Ia, they warn against any delay of surgery.
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Pneumatosis cystoides intestinalis (PCI) is a rare entity in which gas filled cysts are found within the intestinal wall. Conservative management and the treatment of underlying illnesses are recommended in most patients and surgery is usually indicated when acute and life-threatening complications such as bowel necrosis, perforation or peritonitis appear. The authors report a case of idiopathic pneumatosis cystoides intestinalis which, after repeated failure of conservative treatment including the oxygen therapy in hyperbaric chamber, was successfully treated by laparoscopic subtotal colectomy. A laparoscopically assisted approach proved to be a good indication in subtotal colectomy in cases of PCI that are non-responsive to standard conservative treatment.
The set consisting of 3 patients with esophageal achalasia diagnosed by manometry, pseudoachalasia excluded by esophagoscopy and endosonography, was treated with combined conservative procedure. Botulinum toxin 250u (Dysport) was applied to the area of lower esophageal sphincter and after 7 days balloon dilatation was carried out. Treatment efficacy was evaluated by the data obtained about the subjective condition, manometrically and endoscopically. The spine condition was evaluated in all patients before treatment and functional blockades were released by manual medicine and even by acupuncture. We succeeded in restoring propulsive peristalsis of the esophagus in all of them. It is objectively proven in the longest duration of 44 months in the case of a patient treated with a balloon dilatation.
Recently, the laparoscopic approach has been used more frequently for liver resection. The authors describe the method of laparoscopic resection of surface as well as subcapsulary metastases, which had previously been destroyed by radiofrequency ablation. This technique provides relatively easy, complete removal of the tumorous tissue. The disadvantages of the described technique are limited use (it is suitable only for surface lesions) and increased financial costs.
BACKGROUND/AIMS: Persistent postoperative dysphagia diminishes the good effect of laparoscopic anti-reflux surgery. An excessive increase of the intraoperative lower esophageal sphincter pressure (LESp) is supposed to be related to the persistent postoperative dysphagia and its knowledge could lead to the modification of the surgical technique followed by improved clinical outcomes. This study aims to describe the relation between the intraoperative LESp increase and the incidence of postoperative dysphagia and to find whether a combination of intraoperative manometry and mechanical calibration of the wrap is able to decrease the incidence of the persistent postoperative dysphagia. METHODOLOGY: The randomized, prospective, two-branch study included 39 patients suffering from symptoms of gastroesophageal reflux disease. All patients underwent pre- and postoperative manometry, 24-hour pH-metry and laparoscopic anti-reflux surgery. The intraoperative LESp was measured in the study arm only. RESULTS: A higher incidence of persistent postoperative dysphagia was revealed in patients with the intraoperative LESp increase more than 15 mmHg. This complication was not found in patients with the LESp increase under 8 mmHg with no impact on the efficacy of the surgery. The combination of the intraoperative manometry and the mechanical calibration of the wrap seems to bring the benefit only to a small number of the patients. CONCLUSIONS: According to our results, the intraoperative LESp measurement proved to be a useful supplementary method which was easy to perform, and which enables a modification of the surgical technique to decrease the incidence of the persistent postoperative dysphagia.
BACKGROUND/AIMS: Optimal surgical management of the patients suffering of chronic pancreatitis still remains a controversial problem. The base for the evaluation of patients is for us the Marseille-Roma classification from 1988 with 4 fundamental types of the disease. Surgical therapy is usually indicated in patients with intractable or continuous pain, stenosis of the common bile duct and duodenal stenosis. The source of the above mentioned problems is related to the head of the pancreas and we prefer as the procedure of choice duodenum sparing resection of the pancreatic head. METHODOLOGY: Seventy patients were treated by our team in the years from 1985 to 1995 surgically and 55 of these patients underwent resection of the head of the pancreas. RESULTS: Eighteen patients were treated by hemipancreatoduodenectomy and 37 patients by the duodenum sparing resection of the pancreatic head. CONCLUSION: Left sided resection and drainage procedures appear to be much less effective from the point of view of long term follow-up.