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Background/Aim. Laparoscopic ventral hernia surgery, including intraperitoneal onlay mesh (IPOM), is as effective and safe as open surgery, with a lower recurrence rate. Some surgeons advocate laparoscopic primary fascial closure (PFC) with intraperitoneal mesh placement to reduce recurrence rates. The aim of this study was to compare the treatment outcome between two laparoscopic techniques: the PFC technique and mesh placement without suture closure (IPOM technique) for defects under 4 cm in patients with ventral hernias. Methods. The study sample was comprised of 50 patients who underwent laparoscopic ventral hernia surgery from January 1, 2018, until December 31, 2020. Half of the patients underwent only the IPOM technique (group of patients without the suture), while in others, this was preceded by the closure of the hernial ring (group of patients with the suture). All hernias were midline and all defects were under 4 cm. The studied groups were homogeneous according to gender and age. Comorbidities, complications, and postoperative comfort were monitored. Results. The most common (76%) hernias were primary, and the most common comorbidity was arterial hypertension (28%). One (2%) patient had intraoperative bleeding, and the most common postoperative complication was pain in 7 (14%) patients. After a threeyear follow-up, there were 10 (20%) patients with complications -- one hernia recurred, while 9 (18%) patients died. There was no difference in the types of occurrence of hernias, comorbidities, and intraoperative complications. The distribution of postoperative complications differed significantly (p = 0.007) between the groups. Pain was statistically significantly more prevalent in patients with sutures. During the first three months postoperatively, significantly more patients with sutures had chronic pain (χ² = 8.140; p = 0.004). Conclusion. We recommend the application of the PFC technique in selected ventral hernia repair cases, although it can lead to more frequent postoperative pain (which, fortunately, is easily treated). [ABSTRACT FROM AUTHOR]

Introduction. Acute appendicitis is the most common cause of the acute abdomen. Based on the idea that appendicitis is a progressive disease eventually leading to perforation, removal of the appendix is the gold standard of treatment. Material and Methods. The objective of the study is to determine if there is any difference in the occurrence of postoperative complications, and if hospitalization differs depending on the appendicitis surgery method used with the patients. A retrospective analysis was made using the data from the hospital sample of patients admitted to the University Hospital in Foca in the period from January 2019 to December 2021. Results. In the period that was retrospectively analyzed, 107 patients diagnosed with acute appendicitis were operated on. There was no statistically significant difference between the treated groups in relation to the degree of appendicitis, type and duration of symptoms, diagnostic procedures and the time that had elapsed from admission to surgery. The Alverado Score in the probable appendicitis group was 41.1%. The most common symptoms were palpation sensitivity in the inguinal region (84.1%), and pain in the right lower quadrant (69.1%), intraoperative findings of uncomplicated appendicitis 58%, and 25.2% intraoperative findings inconsistent with the pathohistological ones. Conclusion. Acute appendicitis is one of the most common emergency surgical conditions, which requires surgical intervention if not treated in time, and causes life-threatening consequences. Surgical treatment with selected techniques for faster establishment of the gastrointestinal tract function, shorter stay in the hospital, faster recovery and return to daily activities. [ABSTRACT FROM AUTHOR]

Introduction. Measuring the serum levels of human chorionic gonadotropin beta isoform (β-hCG) remains a crucial marker for diagnosing gestational trophoblastic neoplasms (GTNs). Choriocarcinoma is commonly diagnosed due to extremely high levels of β-hCG, but the presence of distant metastasis is not uncommon. Placental site trophoblastic tumors and epithelioid trophoblastic tumors remain an enigma because the levels of β-hCG are usually low. Case report. The first case report describes a 44-year-old woman, P2G3, admitted to the Clinic under the suspicion of molar pregnancy. She had vaginal bleeding with variable intensity, and her β-hCG was 1,837,787 mIU/mL. After two explorative curettages, the level of β-hCG declined, and a partial hydatidiform mole (HM) was diagnosed histopathologically. The patient was admitted to the Clinic on two occasions due to the increasing values of β-hCG. Since β-hCG failed to drop after two explorative curettages, a hysteroscopic biopsy, and one chemotherapy cycle, along with the suspicious ultrasonographic feature of metastatic GTN, and the fact that the patient has refused further chemotherapy, a total laparoscopic hysterectomy was performed. Choriocarcinoma was diagnosed after a histopathological exam was done. The second patient, a 50-year-old woman, P2G4, was admitted to the Clinic under the ultrasonographic suspicion of molar pregnancy. She was complaining of pelvic discomfort and frequent urination. Initial levels of β-hCG were 128,359 mIU/mL. Instrumental revision of the uterine cavity was performed, and partial HM was diagnosed histopathologically. Because of the increasing levels of β-hCG, ultrasonographical suspicion of the development of GTN in the uterine corpus, in accordance with the patient's age and the fact that she has regular menstrual cycles, total laparoscopic hysterectomy was performed, and a histopathological exam made the diagnosis of the placental site trophoblastic tumor. Conclusion. Laparoscopic hysterectomy could be a treatment of choice for the chemotherapy-resistant GTNs but also for choriocarcinoma in patients who have finished their reproductive activity and refuse to be treated with chemotherapeutics. [ABSTRACT FROM AUTHOR]

In the study by Bentrem et al. 51, the DFS of patients with R0 resection (a total of 371 patients), due to GC and a positive FCC in PLF, was 14.8 months, while patients with negative cytological findings had a DFS of 98.5 months. Liver metastases are more common in patients with intestinal tumor type (50% to 70% vs. 3% to 30% for diffuse type), while peritoneal dissemination is most common in patients with the diffuse type of gastric cancer (45% to 75% vs. 10% to 30% for intestinal type) 16-18. The hypothesis that FCC play a significant role in the occurrence of peritoneal metastases is justified by the fact that postoperative metastases are present in almost all patients with free cancer cells proven during operative treatment of gastric cancer, even in those with potentially curative resection 42. In the same year, in the Republic of Serbia, 1,100 patients (732 males and 368 females) were registered with GC, and 903 patients (587 males and 316 females) died, as indicated by the Cancer Registry data of the Public Health Institute "Dr. Milan Jovanovic Batut" 4. [Extracted from the article]

Introduction. De Garengeot’s hernia is a rare type of femoral hernia that contains the appendix within the hernia sac and it is found in 0.5–5% of cases. The incidence of appendicitis within the de Garengeot’s hernia is 0.08–0.13%. We present a case of de Garengeot’s hernia with a gangrenous appendicitis and an extensive literature review of published cases. Case Report. We present a case of a 68-year-old woman who underwent urgent surgery due to an incarcerated femoral hernia and preoperatively undiagnosed de Garengeot’s hernia with a gangrenous appendicitis within the femoral hernia sac. Conclusion. De Garengeot’s hernia is most commonly diagnosed intraoperatively and requires immediate surgery in order to avoid complications. There are no recommendations regarding the choice of surgical procedure for femoral defect repair. [ABSTRACT FROM AUTHOR]

Background/Aim. Laparoscopic colorectal surgery is now widely accepted surgical method in the treatment of malignant and benign colorectal diseases. It is getting constantly more supporters due to its positive effects on enhanced patient recovery. The aim of this study was to determine the safety of minimally invasive approach as well as perioperative data, oncologic results and postoperative data. Methods. Prospective observational cohort clinical study was carried out at the Department for Colorectal and Pelvic Oncologic Surgery, First Surgical University Hospital, Clinical Center of Serbia, Belgrade. We analyzed demographics records concerning the type of surgery, clinicopathological features and oncological data for all operated patients. Records on early postoperative follow-up were also evaluated. Results. Laparoscopic colorectal resection was performed in 60 patients. Mean age of patients was 65 (29-87) years. Majority of patients were man, 37 (62%) of them. The most common indication was colorectal cancer (43 patients, 71.6%); 12 (20%) patients were operated due to the colorectal polyps unfitted for colonoscopic resection and 5 (8.3%) were operated due to Crohn's disease. Average number of lymph node harvested in patients with colorectal carcinoma was 22.5 (6-52). We achieved negative resection margins in all patients operated due to carcinoma. Mean duration of hospital stay was 5 (4-12) days. Postoperative complications were encountered in 5 (8.3%) patients. Overall mortality rate was 1.7% (1 patient died due to thromboembolism). Conclusion. This study showed that initiation of laparoscopic colorectal resection is feasible and safe with short hospital stay, adequate oncologic resection and number of lymph node harvested. [ABSTRACT FROM AUTHOR]

Acute appendicitis (AA) is one of the most common non-obstetric indications for surgery in pregnant women. Even though it can present with a typical set of symptoms, in pregnancy due to the physiological and anatomical changes, an atypical presentation is more common. This makes the diagnosis of AA very complicated and it requires additional exams which include a blood work, CRP and imaging studies. Since leucocytosis and increased levels of CRP are physiological finding in pregnancy, those tests are not very helpful. MRI is the best imaging test in this situation, but its availability is limited. The treatment is surgical, and it includes two approaches: open appendectomy (OA) or laparoscopic appendectomy (LA). Even though many studies that predilect OA can be found, recent discoveries indicate that there is no statistically significant difference in the risk for the mother and foetus between the two approaches. Some studies introduce a non-operative approach as a valuable substitution for a surgical approach in case of AA especially in the areas where surgical care is limited or unavailable. AA in pregnancy is a condition that must be recognized and treated as soon as possible in order to avoid severe complications for the mother and the child. This review gives an integral approach to a pregnant woman with appendicitis, and it's based on the latest published literature. [ABSTRACT FROM AUTHOR]

Introduction. Uterus didelphys results when Mullerian duct fusion is completely arrested during development. We presented a rare case of nonobstructive uterus didelphys occurring simultaneously with an endometriotic cyst of the ovary. Case report. A twenty-nine-year-old, nulliparous patient was admitted to our Clinic for laparoscopic treatment of an endometriotic ovarian cyst. Diagnoses of right ovarian endometriotic cyst and nonobstructed uterus didelphys were established with bimanual pelvic exam and two-dimensional transvaginal ultrasound. Diagnoses were subsequently confirmed by laparoscopy and magnetic resonance imaging. Laparoscopic incision and drainage of the endometriotic cyst were performed, followed by biopsy and coagulation of endometriotic lesions. Histopathology confirmed ovarian endometriosis. Gonadotropin-releasing hormone analogue (GnRHa) was prescribed postoperatively, for a total of 3 months. Ten months after completion of treatment, the patients was without disease recurence. Conclusion. Nonobstructive uterus didelphys is rarely associated with ovarian endometriosis. [ABSTRACT FROM AUTHOR]

Introduction. Unilateral ovarian and Fallopian tube agenesis is an extremely rare anomaly that is usually associated with uterine and renal anomalies. This anomaly is usually incidentally detected during laparoscopy or laparotomy performed for other indications. We have reported a rare case of unilateral ovarian and Fallopian tube agenesis in an infertile patient with a normal uterus. Case report. A 34-yearold infertile patient was admitted to our clinic for laparoscopy and hysteroscopy, indicated for the right Fallopian tube occlusion and an endometrial polyp. The patient underwent laparoscopy and hysteroscopy. Unilateral right ovarian and Fallopian tube agenesis was diagnosed during laparoscopy. Upon exploration of peritoneal surfaces, omentum and intestinal serosa, neither ectopic nor remnant tissues of the ovary or Fallopian tube were found. Renal anomalies were not identified on the ultrasound examination. The hormone panel and karyotype were normal. Her partner's semen analysis was normal. The patient conceived spontaneously one year later. Serial ultrasound examinations showed normal fetal intrauterine growth and development. The patient vaginally delivered a live, female newborn at 40 weeks' gestation, weighing 3,350 grams, 53 cm long, with 9/10 Apgar scores at birth. The patient and her newborn were discharged home on the third postpartum day. Conclusion. Unilateral ovarian and Fallopian tube agenesis is rarely associated with a normal uterus. Laparoscopy is the gold standard in the diagnosis of ovarian and Fallopian tube agenesis. Unless other obstetric indications are present, this anomaly is not specific and it is not an indication for a Caesarean section, and vaginal delivery is a possibility at term pregnancy. [ABSTRACT FROM AUTHOR]

Introduction. Laparoscopic assisted vaginal hysterectomy is a surgical procedure with uterine artery ligation followed by vaginal removal of the uterus. The first laparoscopic assisted vaginal hysterectomy included mild uterine prolapse and uterine fibroids (15 patients, 62.5%). The surgery was carried out in two stages: the first, laparoscopic stage and the second, vaginal stage. The laparoscopic stage included mobilization of the bladder, ovaries and uterus to the level of uterine vessels. In the second stage, the cervix was approached vaginally and detached from the urinary bladder, after which the uterus with cervix and adnexa were removed through the vagina. Results. The average age of patients was 56.8 years, on average, the surgeries lasted 140 minutes and the mean blood loss was 190 ml. Two (8.3%) patients experienced bladder and ureteral injuries which were resolved by urologists. Laparoscopic assisted vaginal hysterectomy was the only procedure performed in 5 (20.8%) patients, whereas it was combined with anterior and/or posterior colporrhaphy in 14 (58.4%), with pelvic lymphadenectomy in 3 (12.5%) patients, and with uterine morcellation in 2 (8.3%) patients. Conclusion. There are no published controlled trials related to the use of laparoscopic assisted vaginal hysterectomy and total laparoscopic hysterectomy in Serbia. This paper presents the preliminary results of the laparoscopic assisted vaginal hysterectomy in 24 patients, comparing them with other techniques of hysterectomy conducted at the Clinic of Gynecology and Obstetrics, Clinical Center of Vojvodina in Novi Sad in the period 2014 - 2017. Laparoscopic assisted vaginal hysterectomy is a good option for surgical treatment of patient with combined pathology of genital organs. [ABSTRACT FROM AUTHOR]

Trauma je jedan od vodećih uzroka smrti u mlađoj populaciji širom sveta. Mnogi vodiči i modaliteti zbrinjavanja formulisani su da bi se obezbedio optimalni učinak lečenja i što bolja prognoza. Jedna od metoda koje se stalno razvijaju u ovoj oblasti je dijagnostička laparoskopija. Ova metoda ima dobre rezultate što se tiče ishoda, kako u hirurškom lečenju trauma tako i u elektivnoj hirurgiji. Laparoskopija je minimalno invazivna metoda za identifikovanje ili isključivanje povreda solidnih i šupljih organa abdomena u traumi. Usavršavanjem laparoskopskih tehnika otvara se mogućnost laparoskopskog operativnog lečenja za dobro odabrane pacijente sa abdominalnom traumom. Za pomenutu grupu pacijenata, laparoskopija je bezbedniji i jeftiniji metod dijagnostike od laparotomije, kada se ima u vidu dužina hospitalizacije i prevencija nepotrebnih („belih”) laparotomija. Postoji samo nekoliko randomiziranih studija koje upoređuju efekte dijagnostičke laparoskopije i laparotomije kod pacijenata sa traumom.. Ovaj rad ima za cilj da ukaže na razlike u laparoskopskim procedurama i laparotomiji i da naglasi rizike i prednosti svake od ovih procedura. [ABSTRACT FROM AUTHOR]

Adrenal cavernous hemangiomas are extremely rare non-functioning benign tumors. The majority of adrenal cavernous hemangiomas are diagnosed incidentally after surgery by histopathological examination. Case Report. We report a clinical case of a 57-year-old woman with adrenal cavernous hemangioma. On admission, the patient's adrenal-related hormones were in the reference range, so adrenal endocrine dysfunction was ruled out. The computed tomography scan revealed a well-circumscribed, round, heterogeneous right adrenal mass (32.3 x 55.4 mm). Iodinated contrast enhanced abdominal computed tomography showed a slight inhomogeneity. In this case, preoperative radiologic findings and absence of signs of local invasion indicated laparoscopic adrenalectomy. The patient underwent right transperitoneal adrenalectomy. Microscopic evaluation showed a sinusoidal dilatation and fibrotic septa, so postoperative diagnosis of adrenal cavernous hemangioma was made. Conclusion. In summary, we reported a case of an incidentally discovered non-functioning adrenal cavernous hemangioma treated by laparoscopic surgery. The diagnosis of adrenal cavernous hemangioma may be challenging, and it is commonly made after surgery, since it is frequently confirmed by histopathological examination. [ABSTRACT FROM AUTHOR]

Introduction. Infections caused by fungi of Fusarium species occur in immunocompromised individuals as disseminated diseases. Case Report. This case report presents a 5-year-old boy with acute lymphoblastic leukemia who developed a disseminated fusarium infection during reinduction chemotherapy. Fever was the main symptom and it lasted for 15 weeks. Refractory fever despite broad-spectrum antibiotics, as well as nausea, myalgia, pulmonary symptoms with detection of pulmonary infiltrates, liver and spleen involvement indicated an invasive fungal infection. The patient received fluconazole, voriconazole, liposomal amphotericin B and caspofungin. Since high temperature was persistent, diagnostic laparoscopy of the abdomen was done. Scattered lesions, up to 2 mm in diameter, were observed macroscopically on the surface of the liver and spleen. The liver culture was positive for Acinetobacter and Fusarium species. After 38 days of therapy with liposomal amphotericin B and 3 days of ciprofloxacin, the patient became afebrile. Itraconazole (according to the antimycogram) was continued during maintenance therapy. Abdominal ultrasound was completely normal after 5 months of treatment with itraconazole. This boy was our first patient with a disseminated fusarium infection. At that time, Fusarium was detected in the hospital water system and in hospital air samples. Conclusion. A timely diagnosis of invasive fungal diseases in children is a big challenge. Over the past decade, there has been an increase in survival rate of patients with invasive fusariosis due to much more common use of voriconazole or combined antifungal therapy. [ABSTRACT FROM AUTHOR]

Background/Aim. Endometriosis is a gynaecological disorder characterized by the presence of endometrial tissue outside the uterine cavity. The aim of this paper was to determine the effect of laparoscopic cystotomy and cystectomy on ovarian function, as well as to compare these two methods in terms of qualitative and quantitative damage to the ovaries, achieved pregnancies and recurrence. Methods. The prospective study, conducted in "Narodni Front" Obstetrics and Gynaecology Clinic in Belgrade at the Endoscopic Infertility Treatment Ward, included a total of 150 patients. The study group was represented by 100 patients who underwent a surgical treatment of endometrial ovarian cysts. The patients in the study group were divided into 2 subgroups: Subgroup I consisted of 50 patients who underwent a laparoscopic cystotomy (incision of the cyst and thermal coagulation) and subgroup II which included 50 women who underwent a laparoscopic cystectomy. The control group consised of patients who underwent a surgery due to tubal factor infertility. The following parameters of the ovarian function were tested: the ovarian volume, the antral follicle count, the presence of the preovulatory follicle on the operated ovary, the serum levels of anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), ovarian tumor marker (Ca 125), inhibin B, as well as the rate of achieved pregnancies one year after the surgery. Results. The ovarian volume and the antral follicle count as well as the FSH values were significantly higher in the control group in comparison with the patients in the study group. There were no significant differences in the ovarian volume, the antral follicle count, the AMH values and inhibin B values in the study group between the patients with cystectomy and those with the incision and coagulation of the cyst. Conclusion. Both surgical techniques diminished the ovarian reserve: cystectomy was more aggressive method in terms of the damage inflicted on the ovarian tissue, and incision with coagulation carried a higher risk of recurrence. [ABSTRACT FROM AUTHOR]

Endometriosis is defined as a functional endometrial tissue outside the uterine cavity. The ectopic endometrial tissue has been identified after gynecologic laparoscopy or laparotomy procedures in the skin, subcutaneous tissues, abdominal and pelvic wall musculature, and it represents amayor cause of acute or chronic recurrent abdominal or pelvic pain resembling the menstrual cycle. The frequency of abdominal wall endometriosis is approximately 1% of all women who had a cesarean delivery. A 39-year-old patient with a history of one prior Cesarean section, presented with continuous cyclical focal pain at the left part of cesarean scar site for the past 16 months, 23 months after Cesarean section. The patient underwent a mini laparotomy, when endometrioma was completely removed surgically. The PH diagnosis of endometriosis was based on the presence of all elements of the endometrial mucosa (glands, stroma and signs of fresh and old hemorrhage) in an inadequate place (anterior abdominal wall). Endometriosis is difficult to diagnose and it is often mistaken for other conditions such as a suture granuloma, incisional hernia, primary or metastatic cancer. Endometriosis can be prevented only with good surgical techniques and clinical practice as well as the proper care during primary surgery. [ABSTRACT FROM AUTHOR]

Fallopian tube disease is one of the most common causes of infertility in women that results from tubal damage or obstruction. The American Society for Reproductive Medicine classification, based on scoring system of tubal changes verified by laparoscopy, is most widely used in practice. The aim of the paper is to determine the involvement and stage of hydrosalpinx and surgical therapy options in patients treated for marital infertility due to tubal factors during the preparation for in vitro fertilization after laparoscopy. In the two-year period, at the Clinic for Gyneacology and Obstetrics, Clinical Center Niš, 75 patients underwent videolaparoscopy to confirm previously established diagnosis of hydrosalpinx. Surgical treatment performed depended on the severity stage of hydrosalpinx. Removed Fallopian tubes were submitted for a histopathological analysis to the Institute of Pathology, Clinical Center Niš. An early stage hydrosalpinx was diagnosed by laparoscopy in 32 tubes. Out of them, tubal removal was performed in 9 tubes, and reconstructive surgery in 21. The most conspicuous changes were present in 46 Fallopian tubes. Surgical removal was performed in 41 tubes, occlusion of the isthmic portion of the tube was present in 5 tubes, and no reconstructive surgery was performed (significant correlation p <0.001 between the stage of hydrosalpinx and type of surgery). HP analysis of the removed Fallopian tubes revealed chronic inflammation in 84.27%. It is necessary to employ always the same, clear criteria in the diagnosis and to select properly the patients who will benefit from hydrosalpinx surgery, either tubal removal or reconstructive surgery. [ABSTRACT FROM AUTHOR]

Background: Oxidative stress represents tissue damage caused by reactive forms of oxygen and nitrogen due to the inability of antioxidant mechanisms to reduce reactive forms into more stable ones. The aim of the study was to evaluate the influence of surgical trauma on nitric oxide (NO) and nitrotyrosine (NT) values in patients undergoing conventional and laparoscopic cholecystectomy. Methods: A prospective study included sixty patients from the Department of Emergency Surgery, Clinical Centre of Serbia who were operated for gallstone related chronic cholecystitis. All the patients enrolled in the study underwent cholecystectomy; the first group was operated conventionally (30 patients - control group), while the second group was operated laparoscopically (30 patients - treatment group). Results: There were no statistically significant differences in the values of NO and its postoperative changes in both groups, the conventionally operated group (p=0.943) and the laparoscopically operated group (p=0.393). We found an increase in NT values 24 hours postoperatively (p=0.000) in the conventionally operated patients, while in the group operated laparoscopically we didn't find statistically significant changes in the values of NT (conventionally operated group (p=0.943) and laparoscopically operated group (p=0.393)). Conclusions: In our study, we found a significant increase in NT values 24 hours postoperatively in conventionally operated patients i.e. the control group, vs. the treatment group. Further randomized studies are needed for a better understanding of the impact of surgical trauma on oxidative stress response. [ABSTRACT FROM AUTHOR]

Introduction. Kidney transplantation is a treatment modality for patients with end-stage renal disease. Nowadays, in the Western world, laparoscopic living donor nephrectomy represents the treatment of choice for graft retrieval. The aim of this paper was to present the laparoscopic living donor left nephrectomy technique. Results. Only one living donor nephrectomy has been performed at the Clinical Center of Vojvodina so far. The authors reviewed the literature data on the results and complications of laparoscopic living donor nephrectomies. Conclusion. Laparoscopic living donor nephrectomy is a feasible procedure, but according to most authors, it should be performed by surgeons with significant experience in laparoscopic nephrectomy. [ABSTRACT FROM AUTHOR]

Introduction. Retroperitoneal ectopic pregnancy is extremely rare, but potentially fatal condition due to possible massive hemorrhage, representing a great challenge to clinicians. Case report. We presented early retroperitoneal pregnancy in a patient with previous caesarean section, diagnosed at the sixth gestational week, located in the left broad ligament, primary treated by laparoscopy, which had to be converted to laparotomy due to massive intraoperative bleeding from the implantation site. Conclusion. High index of suspicion, combined with carefully interpreted clinical and ultrasound findings are crucial for the timely diagnosis of retroperitoneal pregnancy, before the occurrence of severe bleeding. The rising, even plateau of serum β-human chorionic gonadotropin (β-HCG) levels without identification of uterine or ectopic (tubal) pregnancy should cause suspicion on ectopic pregnancy in unusual location. [ABSTRACT FROM AUTHOR]

Background. The aim of this paper is to present a clinical case of laparoscopic repair of a uterine scar defect, to assess the effectiveness of treatment reviewing the latest literature sources, and to provide recommendations of uterine scar defect management. Materials and methods. We report the case of a 33-year-old woman with an insufficient uterine scar and one-year history of secondary infertility. Following this, she underwent corrective laparoscopic repair, successfully got pregnant two months later and carried pregnancy to full term. We discuss the prevalence of caesarean scar defects, their clinical symptoms, diagnostic methods, various treatment techniques, and their outcomes. Results and conclusion. Caesarean scar defects, insufficient uterine scars, isthmocele or scar dehiscence following a caesarean section involve myometrial discontinuity at the site of a scar previous caesarean section. These anatomical defects associated with prolonged menstrual bleeding, chronic pelvic pain, dysmenorrhea, dyspareunia and secondary infertility. Laparoscopic repair of the uterine scar defect is an effective method of treatment of secondary infertility. Patients with a previous history of caesarean section who present complaints of secondary infertility, need a detailed evaluation of the uterine scar before planning future pregnancies. [ABSTRACT FROM AUTHOR]

Laparoscopic cholecystectomy (LC) has become the "gold standard" in the surgical treatment of gallbladder disease. However, in some cases LC needs conversion to open cholecystectomy (OC). Preoperative assessment that should determine in which patient conversion should be performed as well as identification of the risk factors for conversion are relatively difficult and imprecise. The aim of this study was to identify the risk factors for conversion of LC to OC. We performed the retrospective analysis of 65 patients, of both genders, with gallbladder disease, operated in the period from 01/01/2007 to 06/ 2013, in whom conversion of LC to OC was performed. A total of 1292 laparoscopic cholecystectomies (LCs) was done in this period. The authors analyzed: total conversion rate; the conversion rate according to patient characteristics (age, gender, body mass index (BMI)); local pathological condition (acute cholecystitis, chronic complicated cholecystitis, simple calculosis or gallbladder polyposis); surgeon-related parameters (number of performed LCs and total surgical experience). Total conversion rate (conversion of LC to OC) was 5,03%. Higher conversion rate was registered in the female patients (53.84%), but there were no statistically significant differences. The highest conversion rate was registered in the groups of patients in the 6th and 7th decade (p<0.05). Conversion rate was higher in patients with BMI>30 (6.56%), compared with those with lower BMI, but there was no statistical significance. Patients operated for acute cholecystitis had statistically significantly higher conversion rate (26.95 %), compared with those with the diagnosis of chronic simple cholecystitis (1.16 %), complicated chronic cholecystitis (8.46%), benign gallbladder polyposis (3.5%,) (p<0.05). Surgeons with a lower number of performed LCs (25-50) had higher conversion rate (12.67%), compared with experienced surgeons that performed over 200 LCs (1.4%) (p<0.05). Conversions are statistically significantly more present in older patients during surgery, in patients with the diagnosis of acute or complex chronic cholecystitis, and in those operated by inexperienced surgeons. Gender, high BMI, anatomical anomalies and variations, previous laparotomy or technical problems were not statistically significant conversion factors. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the role of peripheral blood markers as additional diagnostic tools to transvaginal ultrasound (TVU) findings in the diagnosis of endometriosis. Methods: This study included 40 patients undergoing laparoscopy for suspected endometriosis from January to December 2012. Preoperative levels of serum CA125, CA19-9, CEA and mRNA expression levels for survivin and VEGF were obtained. Real-time PCR was used to determine relative gene expression. A new diagnostic score was obtained by deploying the peripheral blood markers to the TVU findings. Statistical methods used were Chi-square, Fisher's, Student's t-test or the Mann - Whitney test. Results: There was a statistically significant difference in serum CA125, survivin and VEGF levels in patients with endometriosis and those without endometriosis (p<0.001, p=0.025 and p=0.009, respectively). False negative TVU findings were noted in 3/13 patients (23.1%) with peritoneal endometriosis without ovaries involvement. High sensitivity (93.3%), specificity (90.0%), PPV (96.6%), NPV (81.8%) and accuracy (92.5%) were obtained for a diagnostic score based on TVU and significant peripheral blood markers (CA125, survivin and VEGF). Conclusions: Determination of serum CA125, mRNA expression levels for survivin and VEGF along with TVU can contribute to higher accuracy of the noninvasive diagnostic tools for endometriosis. [ABSTRACT FROM AUTHOR]

Introduction. Polycystic ovary syndrome is the most frequent endocrine disturbance in the reproductive period of women's life and the most frequent cause of anovulatory infertility. Ovulation and pregnancy in patients having polycystic ovary syndrome may be a result of a wide range of therapeutic options, and the treatment assumes a gradual approach - from simple noninvasive to expensive and demanding procedures. Material and Methods. A systematic literature survey concerning the efficiency of particular ovulation induction methods in respect of the reproductive outcome was carried out with the aim of establishing the algorithm for ovulation induction in infertile patients having polycystic ovary syndrome. The search was confined to clinical investigations performed on human subjects, reported in English in the period from the beginning of 2010 to June of 2014. Conclusion. As a conclusion of this systematic survey of the efficiency of ovulation induction methods, which confirms and supplements the knowledge in this field, it is possible to form the algorithm for ovulation induction in infertile patients having polycystic ovary syndrome, consisting of the following subsequent steps: 1) modification of life style, 2) induction with clomiphene citrate 3) use of metformin, 4) use of aromatase inhibitors, 5) application of gonadotropins and laparoscopic ovarian drilling - as a second-line treatment, and 6) assisted reproductive techniques. [ABSTRACT FROM AUTHOR]

Introduction. An abdominal pregnancy is a rare form of ectopic pregnancy and potentially life-threatening condition. It is difficult to make an early diagnosis of abdominal pregnancy. Case Report. We present a case of early primary abdominal pregnancy, diagnosed at 6th gestational week, located in the vesicouterine pouch and treated laparoscopically. Despite the rapidly decreasing serum β-human chorionic gonadotropin levels, the presence of the intraperitoneal blood allowed neither expectant management nor medical treatment, although the patient was hemodinamically stable at that moment. The absence of significant bleeding during the surgery and histopathological finding of placental villi with necrosis confirmed that, in this case, the abdominal pregnancy was already the subject of spontaneous involution. Conclusion. High index of suspicion and carefully interpreted clinical and ultrasound findings are crucial for timely diagnosis of early abdominal pregnancy before the occurrence of massive and potentially fatal intraperitoneal bleeding. [ABSTRACT FROM AUTHOR]

Background. The aim of this study was to evaluate the feasibility of laparoscopic ovarian transposition prior to radiation therapy on the preservation of hormonal function in the treatment of pelvic cancer. Materials and methods. A chart review of premenopausal women diagnosed with pelvic cancer, who underwent laparoscopic ovarian transposition to paracolic gutters, then received preoperative radiotherapy at the Center of Oncosurgery, Oncology Institute of Vilnius, from January 2010 to July 2013. Results. A total of 14 patients underwent laparoscopic ovarian transposition. Patients were divided into two groups by localisation of cancer: 2 (14.29%) patients diagnosed with rectal cancer and 12 (85.71%) with cervical cancer. Patients' age was from 24 to 42 years with a mean age of 33.71 (SD ± 5.22) years. The average age of the patients in the first group was 26 (SD ± 2.83) years. In the second group women, aged 29 and 42 years with a mean age of 35 (SD ± 4.35) years, were analyzed. Rectal cancer of stage III was diagnosed in both women of the first group. Tumor stage distribution in the second group, respectively: stage I - 2 cases (16.67%), stage II - 3 cases (25%), stage III - 7 cases (58.33%). Seven (58.33%) patients of the second group underwent complete endoscopic staging. In these groups of 14 patients there were 2 (14.3%) complications (injury of the inferior vena cava and postoperative abnormal vaginal bleeding). No postoperative exitus occurred. The mean duration of the operation was 2 hours 26 minutes ± 55 minutes (60-245 minutes), respectively, 2 hours 40 minutes ± 49 minutes (95-245 minutes) when laparoscopic staging and ovarian transposition was performed and 2 hours 12 minutes ± 1 hour 1 minute (60-245 minutes) when only ovarian transposition was performed. The hospitalization period ranged from 5 to 52 days (average 12 days). Conclusions. Laparoscopic ovarian transposition is a relatively safe and effective procedure for preserving ovarian function. This procedure should be considered in all reproductive age female patients who need to undergo pelvic irradiation as part of pelvic cancer treatment. [ABSTRACT FROM AUTHOR]

Background/Aim: Laparoscopic cholecystectomy is considered to be the gold standard for laparoscopic surgical procedures. In ASA III patients with concomitant respiratory diseases, however, creation of pneumoperitoneum and the position of patients during surgery exert additional negative effect on intraoperative respiratory function, thus making a higher challenge for the anesthesiologist than for the surgeon. The aim of this study was to compare the effect of intermittent positive pressure ventilation (IPPV) and pressure controlled ventilation (PCV) during general anesthesia on respiratory function in ASA III patients submitted to laparoscopic cholecystectomy. Methods. The study included 60 patients randomized into two groups depending on the mode of ventilation: IPPV or PCV. Respiratory volume (VT), peak inspiratory pressure (PIP), compliance (C), end-tidal CO2 pressure (PETCO2), oxygen saturation (SpO2), partial pressures of O2, CO2 (PaO2 and PaCO2) and pH of arterial blood were recorded within four time intervals. Results. There were no statistically significant differences in VT, SpO2, PaO2, PaCO2 and pH values neither within nor between the two groups. In time interval t1 there were no statistically significant differences in PIP, C, PETCO2 values between the IPPV and the PCV group. But, in the next three time intervals there was a difference in PIP, C, and PETCO2 values between the two groups which ranged from statistically significant to highly significant; PIP was lower, C and PETCO2 were higher in the PCV group. Conclusion. Pressure controlled ventilation better maintains stability regarding intraoperative ventilatory parameters in ASA III patients with concomitant respiratory diseases during laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]

In the presented study the authors focus on the use of laparoscopy and hysteroscopy to investigate possible directions of treatment for unexplained infertility and confirm the effectiveness of hydrotubation and pelvic peritoneum washing. Women diagnosed with infertility who had not achieved pregnancy within a year of unprotected intercourse had ovulation induction, intrauterine insemination (IUI) or both before laparoscopy and hysteroscopy. Before laparoscopy and hysteroscopy 152 women were diagnosed with unexplained infertility (prelaparoscopic unexplained infertility). Laparoscopy and hysteroscopy were carried out in the follicular phase of the menstrual cycle in combination with hydrotubation of methyl blue and pelvic peritoneum washing with one liter of ringer lactate. Results: 62 (40,8%)out of152 women who were diagnosed with unexplained infertility before laparoscopy and hysteroscopy received the same diagnosis after laparoscopy and hysteroscopy. The remaining 90 women were diagnosed with endometriosis, tubal factors and pelvic adhesions. 33 (53,2%) out of the 62 women with postlaparoscopic unexplained infertility achieved pregnancy within 10 months. 28 out of 33 patients (84,8%) achieved pregnancy within the first six months. Conclusions: The effective period after laparoscopy and hysteroscopy appears to be six months. Assisted reproductive technology should be considered after ten months. It is very important to clarify the cause of infertility using laparoscopy and hysteroscopy (postlaparoscopic unexplained infertility). Furthermore, it is difficult to explain why hydrotubation and pelvic peritoneum washing can improve the rate of pregnancy in postlaparoscopic unexplained infertility and further investigation is necessary. [ABSTRACT FROM AUTHOR]

Introduction. Laparoscopic appendectomy is one of the simplest laparoscopic procedures, which is gradually becoming the method of choice in treatment of acute appendicitis due to its advantages over open appendectomy. In South-Eastern Europe the use of laparoscopic appendectomy is still very limited although it is a very simple procedure, suitable for training laparoscopic techniques. Technique of Laparoscopic Appendectomy. This review article describes the position of the patient and surgical team during laparoscopic appendectomy, position of troacars and working instruments which result in expressive cosmetic effect, technique of laparoscopic appendectomy, different ways of securing the base of appendix. Complications of Laparoscopic Appendectomy. This review article describes management of complicated appendicitis, and intra- and post-operative complications. Conclusion. Laparoscopic appendectomy has many advantages over open appendectomy. The risk of wound infection is lower, postoperative pain is weaker and the hospital stay is shorter. [ABSTRACT FROM AUTHOR]

Medical experts are still at issue over the most suitable management of simple neonatal ovarian cysts exceeding 40mm and complex cysts of any size. The authors present surgical treatment of these cysts by classical laparotomy and laparoscopy. The study included 13 newborn babies surgically treated for 6 simple and 7 complex ovarian cysts. The diameter of the cysts ranged from 29 to 102mm. The age of children was from 2 days to 10 months. The open classical laparotomic approach was performed in 8 babies. In the laparotomy group, cystectomy was done in 3 infants with simple cysts. The other 5, presented with ovarian torsion, required salpingo-oophorectomy. Video - assisted cystectomy was the procedure for 3 simplex and one complex cyst with torsion. Laparoscopic adnexectomy was applied in one case with autoamputated cyst. Our small study demonstrates that laparoscopy is as safe and effective as classical laparotomy in managing neonatal ovarian cysts, but with better cosmetic results. [ABSTRACT FROM AUTHOR]

In this retrospective research parameters connected to the pathogenesis and treatment of pelvic endometriosis have been analyzed (surgical operation, age, surgical approach and conservativeness of the operation, spreading of the endometrioses to the surrounding pelvic organs) at Gynecology and Obstetric Clinic of Clinical Centre in Kragujevac during a five year period. The total number of observed patients was 88. They all had ovary cysts and a high value of the Ca 125 tumor marker and pathological verification of endometrioses. The greatest number of patients were in the age group 26-35 (56,8%). The most common procedure was radical surgical operation adnexectomy in 53 (60,2%) and hysterectomy in 24 (45,83%) patients (p<0,01). With almost equal probability both laparotomy and laparoscopy were performed (p>0,01). Ovary endometriosis was often joined with other pelvic organs endometriosis. [ABSTRACT FROM AUTHOR]

Background/Aim. A modern approach to surgical treatment of tuboperitoneal infertility is based on laporascopic techniques. The aim of this study was to compare results of tuboperitoneal infetility freatment by the use of laparoscopy and classical laparotomy. Methods. A retrospectiveprospective study on 66 women treated operatively form tuboperitoneal infertility was performed. Data from patient's anemnesis and those related to the surgical treatment results, obtained by the use of an inquiry, were used in retrospective and prospective analysis, respectively. Chi-square test was used in statistical analysis. P value < 0.05 was considered significant. Results. Classical laparotomy was used on 34 women in a period from 1996 to 1997, while 32 women were operated laparoscopically in a period from 1999 to 2000. The results were as follows: a total number of conceived women was 16 (24%), seven in the group I (20.6%) and nine in the group II (28.1%); 13 women were with one pregnancy, six in the group I (17.6%) and seven in the group II (22%). Twice pregnant were three women, one in the group I (2.9%) and two in the group II (6.2%). The resulting pregnancies were: five women with abortion spontaneous, two in the group I (5.9%) and three in the group II (9.4%); two women with extrauterine pregnancy in the group I (5.9%); three with pretemporal birth, one in the group I (2.9%) and two in the group II (6.2%), while six women were with the temporal birth, two in the group I (5.9%) and four in the group II (12.5%). Statistical analysis showed that there was no significant difference in the results between these two groups. Conclusion. Surgical treatment of tubeperitoneal infertility, regardless of the used methods (classical laparotomy or laparoscopy) was successful in a great number of women. These methods have a great advantage over in vitro fertilization, and they should not be ignored. [ABSTRACT FROM AUTHOR]

Intoduction: During laparoscopic cholecystectomy pneumoperitoneum (PP) allows visualization, approach and manipulation in the abdomen. However, PP may induce negative effects on a different organ function. Aim: Aim of this study was to assess influence of PP 8 mm Hg on renal function in 30 patients underwent laparoscopic cholecystectomy. Patients and Methods: To assess renal function following parameters were used: glomerular filtration rate (GFR), creatinine clearance, urine output, serum and urine osmolarity, serum K+, Na+, urea and creatinine in serum and urine. All parameters were determined before and an hour after gas insufflation. Urine output was measured over 24 h after gas desufflation. Results: Creatinine clearance and urine output an hour after PP application 8 mm Hg were significantly decreased than before application (91.3±26.8 vs. 72.3±15.8ml/min; 50.3±10.6 ml/h vs. 36.8±5.6 ml/h; p= .0001). Mean serum potassium level after PP application 8 mm Hg was significantly grater than before application (4.15±0.21 vs 4.03±0.24mmol/l; p= .0001) but they were in referent range. Mean serum sodium and osmolarity level after PP application 8 mm Hg has also been significantly grater than before application (144.9±8.6 mmol/l vs 141.3±5.3 mmol/l; p= .0048, 293.2±4.6 vs 291.5±5.7mosm/l; p= .0615), but they have also been in referent range. Mean urine potassium and osmolarity level after PP application 8 mm Hg were significantly grater than before application (83.3±20.9 vs 75.1±21.1mmol/l; p= .0001, 635.4±134.8 vs 631.0±148.6mosm/l; p= .7762). Conclusion: Low preassure pneumoperitoneum does not affects kidney function during laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]

Introduction. Indication for surgical drainage may be prophylactic or therapeutic. However, surgical drains may cause complications. These complications can arise either following laparoscopic or open surgery. One of the rare complications resulting from drainage includes herniation of abdominal viscera at the drain site. The most common herniated abdominal organ is the small bowel. Case report. A 75-year-old woman underwent laparoscopic hysterectomy for atypical endometrial hyperplasia. After the operation, she developed small bowel herniation in the abdominal wall at the drain site, which was confirmed by multislice computed tomography. The patient underwent emergency relaparotomy that identified drain site incarceration of an ileal loop. Following resection of the incarcerated bowel, her postoperative recovery was uneventful. Conclusion. This case presents rare causative mechanism of intestinal obstruction. The possible occurrence of hernias following surgical drainage must be kept in mind. [ABSTRACT FROM AUTHOR]

Introduction. Lipoma is a benign tumor of adipose tissue, the most common tumor of the human body soft tissues. As such, it can be found almost anywhere in the human body including the gastrointestinal system (incidence below 0.5%), but rarely in the sigmoid colon. Case report. This is a case report on symptomatic polyp of the sigmoid colon, which after one year, at control colonoscopy, caused suspicion to malignancy. Endoscopically diagnosed polipoid lesion was laparoscopically removed. The pathohistological diagnosis determined benign, submucosal, incapsulated lipoma of the sigmoid colon. Conclusion. Although lipomas of the gastrointestinal tract are rare, this case clearly indicates that we should not prematurely and without histologi-cal confirmation of malignancy do more extensive resection for a suspected malignancy. [ABSTRACT FROM AUTHOR]