The authors present the technical aspects of perioperative safety during the microsurgery of cerebral aneurysms. We evaluated the advantages and disadvantages of the microvascular Doppler ultrasonography, the intraoperative digital subtraction angiography, the intraoperative transit time flowmetry, the intraoperative monitoring - motor evoked potentials and somatosensory evoked potentials, and the ICG videoangiography. The authors, based on their own experience, recommend combining different methods to eliminate the weak points of the individual specific methods. Combining the ICG with the flowmetry and the motor evoked potentials enhances safety during the surgery of cerebral aneurysms with the resultant reduction of the perioperative morbidity/mortality.

The aim of this article is a retrospective analysis of the results of three methods used for the repair of pectus excavatum between 1991 and 2012. 508 patients were operated on at the Department of Paediatric Surgery of the Second Faculty of Medicine, Charles University, and the Teaching Hospital in Motol between 1991 and 2012. 16 patients were older than 19 years (19-28 years). The average age of paediatric and adolescent patients was 14.2 years (5-19 years range). Boys (408) prevailed over girls (82), the ratio being 4.9:1. Open Holcomb technique was used to operate on 87 patients (17%), the Welch method was applied in 208 patients (41%). Minimally invasive repair of pectus excavatum (MIRPE) was used in 213 patients (42%) during the entire period of time. As for the 295 patients operated on by the open Holcomb and Welch method, the outcome was excellent in 239 (81%) of them. A favourable result with a small deformity remaining occurred in 44 patients (15%). Unfavourable result was found in 7 patients (2.5%): in these children, a deep excavation occurred 3-5 years postoperatively. In 5 patients (1.5%) we evaluated the result as recurrent chest wall deformity. The minimally invasive method (MIRPE) produced an excellent result in 182 out of 213 patients (85%). A favourable outcome was observed in 27 (22%), unfavourable result in 1 (0.5%) patient. In the last 15 years, minimally invasive repair of pectus excavatum has become popular worldwide. Due to very favourable cosmetic results and a relatively small, gradually decreasing number of complications, the proportion of patients requiring surgery to correct their deformity has risen sharply.

Some recent studies suggest that the blanket use of parenteral nutrition may be harmful in the event of short-term starvation due to acute illness. Utilization of endogenous substrate resources which are mobilized anyway due to acute illness or operation allows the organism to survive and recover from acute damage without nutritional support. Modern, less invasive procedures in surgery, good preoperative nutritional status and early recovery of food intake after surgery on the one hand and the side effects and risks of artificial nutrition on the other hand raise the question whether surgery in general still needs parenteral nutrition. Even on the basis of modern knowledge we cannot explain why, in standard administration of parenteral nutrition, there is a higher incidence of postoperative complications. Is parenteral nutrition directly toxic or useless, or are we just unable to avoid the side effects of improper application? In most cases, the body has protein and energy storage large enough to heal the wound and anastomosis. But the hypometabolic status of the starved organism requires more time for the healing process, and ubiquitous protein catabolism due to postoperative inflammation can exhaust the immune defences of the body. The importance of nutritional support and metabolic optimization is shifting to preoperative strengthening. Artificial feeding is used to stimulate protein synthesis which is necessary for healing on the one hand, and to replenish protein and energy reserves on the other. Protracted catabolism is a risk factor for prolonged immunosuppression and fatal loss of endogenous protein. Malnutrition is a significant cause of postoperative complications. In planned operations, artificial nutritional support is targeted at patients with low protein synthesis (persons with low food intake lasting several days), patients who are obviously malnourished, those with expected long starvation (5-7 days), and patients with high catabolism. Protein synthesis accelerates in a few days after nutritional support has been started. The nutritional indicators improve in a few weeks after nutrition has been initiated and the risk of postoperative complications due to malnutrition persists up to several months after surgery.

The aim of the study was to determine the relevance of CT examination in scapular fractures and to standardize it. A group of 163 patients with extra-articular fracture of the scapular body and neck was analysed. 3D CT was performed in 85 of them and 31 patients were operated on. This group served as the basis for evaluating the benefits of CT examination for the diagnostics of scapular fractures. CT scans are very helpful for the evaluation of the glenoid fossa and, where necessary, of the processes of the scapula. They, however, do not allow for a correct determination of the fracture types, those of the scapular body and neck in particular. Three-dimensional CT (3D CT) reconstruction is the only method allowing for the determination of the exact types of scapula fracture. In these reconstructions it is necessary to image the scapula from three standardized views, i.e. from posterior, anterior and lateral aspects, after subtraction of the ribs, the proximal humerus and the clavicle. All fractures of the scapular body and neck require 3D CT reconstruction.

The aim of the study was to determine the impact of anastomotic leakage on long-term outcomes after curative surgery for rectal cancer. The study included 174 patients who underwent elective, potentially curative open or laparoscopic resection with anastomoses for rectal cancer at the Department of Surgery of the University Hospital Ostrava from 1 January 2001 to 31 December 2009. Anastomotic leakage was defined as clinically or radiologically confirmed signs of local or diffuse peritonitis, gas, pus or stool from the drain, rectoscopy signs of anastomotic insufficiency, or rectovesical or rectovaginal fistula. The Cox proportional hazards model with forward selection was used to determine the influence of predefined baseline characteristics on overall, disease-free survival and recurrence. The results are presented as Hazard Ratio (HR) with 95% Confidence Interval (CI). Based on the Cox model, anastomotic leakage was not identified as a factor with a significant impact on overall or disease-free survival. Anastomotic leakage, however, has remained an independent risk factor for a higher local recurrence rate (Hazard Ratio: 6.621, 95% CI 1.289-34.020, p=0.024). On the contrary, anastomotic leakage was not identified as a statistically significant prognostic factor for the incidence of distant metastases. Anastomotic leakage represents an independent risk factor for a higher local recurrence rate after curative resection for rectal cancer.

Optimized staging of colorectal carcinoma (CRC) is essential for treatment planning and for estimating the prognosis of the disease. In addition to tumour size and the depth of bowel wall infiltration, the lymph node status is very important for the determination of the disease stage. For this reason, detection and assessment of the maximum number of lymph nodes is emphasized in the examination of resected segments of the large bowel. The number of lymph nodes (LNs) found in the segments resected depends on various circumstances. In our study, we focused on factors which could influence the number of pericolic LNs. We examined two groups of CRC patients. The first group included 30 patients within the age range of 32-50 years (average: 47.5 years) and the second group consisted of 90 patients aged between 51 and 87 years (average: 68 years). The tumours were localized in various parts of the colon, predominantly in the descending colon and the sigmoid colon. Rectal tumour was present in 23 patients; 13 of them underwent preoperative chemoradiation therapy and 10 of them received no preoperative therapy. The length of the resected colon segments (radical intervention) ranged from 6 to 51 cm. The size of CRC ranged from 0.5 to 15 cm (average: 4.5 cm). The maximum tumour invasion depth reached into the subserosal tissue and pericolic adipose tissue. The number of LNs found in 120 resected colon segments ranged from 1 to 60 LNs per case. The number of LNs showed differences among the patients and also depended on the location of CRC within the large intestine. In the resected segments of the ceacum with CRC, the average number of LNs was 11.5, whereas it was only 7 in rectal CRC. The largest volume of pericolic adipose tissue was found in the caecum, whereas the smallest volume was seen on the rectal circumference. In CRC patients aged 50 years or younger, the number of LNs was from 2 to 60 (average: 17). In contrast, the number of LNs ranged from 1 to 46 (average: 11) in patients older than 50 years. In resected segments that were 6 to 12 cm long, the number of LNs ranged from 1 to 18 (average: 8). In resected segments that were 12 to 51 cm long, the number of LNs was from 1 to 60 (average: 13.8). In 13 cases of rectal CRC with preoperative chemoradiation therapy, small LNs of an average length of 1-3 mm predominated, and the number of LNs ranged between 1 and 13 (average: 5). The required number of 12 LNs was reached in 4 resected parts of the rectum (31%). The number of pericolic LNs found in the resected segments of the colon and the rectum with CRC depends on various factors. Besides individual differences, the number of LNs is influenced by the CRC location in the colon, the extent of the resected pericolic adipose tissue, the patients age and the length of the segment resected. In cases of rectal CRCs, it is also influenced by preoperative chemoradiation therapy.

Double gallbladder, a congenital anatomic variation, represents approximately 2% of all congenital anatomic variations of the gastrointestinal tract, its incidence amounting to about 25 in 100 000. It has several types classified according to Boyden's criteria. The diagnostic method of first choice is ultrasonography. When the patient has no health complaints and cholecystolithiasis is present, no special treatment measures are required. The treatment option in symptomatic cholecystolithiasis is laparoscopic cholecystectomy. Only a few cases of double or triple gallbladder, in contrast to the high number of cholecystectomies, have been published in literature. The authors present a case of double gallbladder where the diagnosis was established more than three years after laparoscopic cholecystectomy

During the ten-year period (2002-2011), carotid artery surgery was performed in 1164 patients, with a mean age of 68 years (44 to 86 years), at the Department of Surgery, University Hospital in Pilsen. In total, 1304 procedures on internal carotid arteries were performed, and the ratio of procedures in men and women was 912/392. The ratio of procedures in asymptomatic vs. symptomatic findings was 938/366. The ratio of patients with unilateral vs. bilateral damage to the internal carotid artery was 930/234. All surgical procedures on internal carotid arteries were performed under locoregional anaesthesia. From the total number of internal carotid artery operations (1304), the 30-day mortality and morbidity rate was 1.46%.

This overview of the historical development in the definition of terms intra-abdominal hypertension and abdominal compartment syndrome focuses on the wide range of compartment syndromes and presents the issue of surgical or conservative management in the care for patients affected by the above-mentioned pathological abdominal conditions.