Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti
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This paper deals with the results of recently published studies on the importance of the use of antibiotics in the treatment of uncomplicated diverticulitis. It is based on the articles available in the Medline database. ⋯ The prevalence of diverticulosis in the developed countries of the Western world is increasing and, along with it, the costs of treatment of diverticulitis. The use of antibiotics in the treatment of uncomplicated diverticulitis does not reduce the incidence of complications or shorten the treatment, nor does it reduce the risk of recurrence.
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The concept of the enhanced recovery after surgery (ERAS), also called fast-track surgery, is a complex of modern multimodal strategies intended to reduce the perioperative stress response and achieve faster postoperative rehabilitation and rapid recovery of normal physiologic functions. The effect of ERAS on reduction of length of stay and postoperative complications has been proven by randomized controlled trials. The recommendations are supported by substantial evidence, and they are guaranteed by the ERAS society and included in the European Society of Parenteral and Enteral Nutritions (ESPEN) guidelines. The aim of this study was to evaluate the compliance with ERAS protocol in surgical departments in the Czech Republic. ⋯ Protocol of modern perioperative care recommended by ERAS and ESPEN societies should be respected in clinical practice in the Czech Republic. According to the national survey most of the surgical departments do not accept ERAS guidelines. The most challenging procedures include the inadequately long interval of perioperative fasting, use of mechanical bowel preparation and routine insertion of invasions. Early oral intake is, according to the answers, often replaced by artificial enteral or parenteral nutrition.
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The authors describe their first experience with virtually navigated pelvic and spine screws based on perioperative CT navigation. ⋯ A short but intensive experience with perioperative CT navigation allows us to state: 1. CT navigation shortens the operating time and minimalizes the risk of screw malposition in multiple screw spine procedures; 2. CT navigation improves the introduction of iliosacral and pubic screws in pelvic fixations; 3. there is virtually no radiation load to the staff using the CT navigation; 4. mastering this technique will allow a wider use of miniinvasive screw insertion in the pelvis and other regions where minimal dislocation will enable miniinvasive internal fixation.
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The issue of achieving radical circumferential margin in laparoscopic rectal surgery has not yet been satisfactorily clarified. In this paper we have focused on circumferential margin assessment and the quality of the mesorectal excision, comparing laparoscopic and open resection for cancer of the middle and lower rectum. ⋯ As has been shown in our trial, the outcomes of laparoscopic and open approach in rectal cancer treatment are very similar. Particularly, mesorectal excision quality and negative CRM results have proven that the laparoscopic technique is safe and comparable to open surgery in rectal cancer treatment.
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The aim of this paper is to offer results of anatomic study of axillary course of intercostobrachial nerve (ICBN) and the effort of its saving in primary axilla clearance (PE), secondary clearance (SE) after previous positive sentinel nodes detection (SLN) and in re-clearance (RE) after previous axilla clearance in breast cancer and malignant melanoma. The correlation between possibility of ICBN saving and anatomic variant of ICBN and type of previous surgery was observed. ⋯ The anatomy of ICBN in axilla is variable. The standard variant of ICBN course is the most frequent (the trunk coming out of second intercostal space; no branches in axillary course). If other variants are present, there is significantly higher risk of perioperative injury. ICBN preservation is possible also after previous axilla clearance. Preparation is more difficult and the risk of injury is increasing with the degree of previous surgery radicality.