Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti
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Recurrent pectus excavatum is the most serious late complication after primary repair. Redo open repair (Highly Modified Ravitch Repair, HMRR) or minimally invasive repair of pectus excavatum (MIRPE) are usually performed in indicated cases. This paper focuses on the evaluation of available redo surgical techniques in adult and adolescent patients with recurrent pectus excavatum. ⋯ Despite our limited experience with both techniques in the treatment of recurrent pectus excavatum we believe that MIRPE should be regarded as a safe and effective technique for the redo repair in adolescent and adult patients.Key words: HMRR - MIRPE recurrent pectus excavatum.
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The recurrence rate of surgical treatment of incisional hernia is high. The material and surgical technique used to close the abdominal wall following every surgery contribute as important risk factors in incisional hernia formation. However, by optimising abdominal wall closure, many patients can be spared from developing this type of complication. ⋯ To consider using a prophylactic mesh in high-risk patients. To use the smallest trocar size adequate for the procedure and closing the fascial defect if trocars larger or equal to 10 mm are used in laparoscopic surgery. Key words: incisional hernia laparotomy laparotomy closure suturing material.
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The aim of this project was to compare and evaluate cortical sensorimotor adaptations as measured by brain fMRI (functional magnetic resonance imaging) in patients before and after surgery for cervical spondylotic myelopathy (CSM), i.e., after spinal cord decompression. ⋯ An average difference of anteroposterior cervical spinal canal distance before and after surgery of CSM was 2.67 millimetres, representing a 40% increase; the cross-sectional area of the spinal canal increased by 37% and that of the spinal cord by 36%. Functional MRI of the brain revealed significant activation especially in primary and secondary motor cortex and sensory areas in patients with CSM. After surgical decompression of the spinal cord, cortical activations and maximum Z-score decreased in the majority of areas. We proved decreased cortical activation on functional MRI of the brain after surgery in patients with CSM (evaluated according to MRI of cervical spine), even at an initial stage of the disease.
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Pilonidal sinus is a skin disease affecting the sacrococcygeal region caused by chronic irritation of the skin by ingrowing hairs that get pushed into skin sinuses and follicles. The acute form of the disease which is presented by subcutaneous abscesses very often develops into chronic suppurative subcutaneous fistula. The incidence of pilonidal sinus is approximately 26/100,000 people. Radical surgical excision using skin flaps is essential for successful treatment. ⋯ Limberg flap reconstruction and Karydakis procedure lead to better results in pilonidal sinus surgery, especially as regards lower recurrence rates and overall morbidity. Both of these procedures are relatively easy to perform and technically undemanding.
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Parastomal hernia is a common stoma complication. Surgical treatment is necessary in approximately 10 to 20% of cases. Mesh hernia repair gives significantly better results. The authors present their initial experience with laparoscopic repair of parastomal hernia using the modified Sugarbaker technique. ⋯ Laparoscopic hernia repair of parastomal hernia with modified Sugarbaker technique seems to be a safe method with a very low risk of postoperative complications, including hernia recurrence. .