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Megaureter je deskriptivni pojam koji označuje dilatirani mokraćovod. Definira se kao svaki retrovezikalni promjer uretera jednak ili veći od 7 milimetara, od 30.tjedna trudnoće na dalje. Klasifikacija se temelji na prisutnosti opstrukcije ili refluksa te prema uzroku. Četiri su kategorije megauretera: refluksni, opstruktivni, refluksni s opstrukcijom i nerefluksni/neopstruktivni, a svaki od njih s obzirom na uzrok može biti primarni i sekundarni. Megaureter se javlja nešto češće kod dječaka i to više na lijevoj strani. Primarni megaureter je drugi najčešći uzrok hidronefroze. Megaureter se obično detektira prenatalno kao slučajan nalaz. Djeca obično nemaju simptoma, a ako oni postoje onda su to obično rekurentne urinarne infekcije, bolovi u trbuhu, neobjašnjive temperature itd. Dijagnoza se obično potvrđuje ultrazvukom, a danas postoji i novija UZV metoda nazvana ceVUS koja je slična MCUG samo ne koristi ionizirajuće zračenje. Ako je potrebna daljnja obrada onda se rade još također i dinamička scintigrafija bubrega, MRU i fMRU. Inicijalno liječenje svih vrsta megauretera je konzervativno. Indikacije za kirurško liječenje su masivna hidroureteronefroza, progresivni gubitak bubrežne funkcije i neuspješno konzervativno liječenje. Postoje brojne metode kirurškog liječenja. Kod djece starije od jedne godine, reimplantacija uretera je metoda izbora liječenja. U početku se ona radila otvorenim pristupom koji je tehnički bio teško izvediv. S vremenom se razvijaju manje invazivne metode s boljim postoperativnim ishodima i smanjenom stopom komplikacija. Te metode uključuju laparoskopsku reimplantaciju uretera transvezikalnim pristupom i endoskopsku dilataciju balon kateterom. Od privremenih kirurških metoda tu su insercija dvostruke J-proteze, refluksna reimplantacija i postavljanje ureterostome. Megaureter is a descriptive term denoting dilated ureter. It is defined as any retrovesical diameter of the ureter equal to or greater than 7 millimeters, from the 30th week of pregnancy onwards. Classification is based on the cause and presence of obstruction or reflux. There are four categories of megaureters: reflux, obstructive, obstructive with reflux, and non-reflux / non-obstructive, and each of them can be primary or secondary, depending on the cause. Megaureter occurs more often in boys and is more commonly located on the left side. The primary megaureter is the second most common cause of hydronephrosis. Megaureter is usually detected prenatally as a random finding. Children are usually asymptomatic, and if symptoms exist, the patients usually present with recurrent urinary tract infections, abdominal pain, unexplained fever etc. The diagnosis is usually confirmed by ultrasound. Today there is a newer ultrasound method called ceVUS, which is similar to MCUG, but it does not use ionizing radiation. If further diagnosis is needed, then dynamic renal scintigraphy, MRU and fMRU are also performed. Initial treatment of all types of megaureters is conservative. Indications for surgical treatment are massive ureterohydronephrosis , progressive loss of renal function, and unsuccessful conservative treatment. There are numerous methods of surgical treatment. In children older than one year, ureteral reimplantation is the method of choice. Initially, it was done with an open approach that was technically difficult to perform. Over time, less invasive methods were developed with better postoperative outcomes and a reduced complication rate. These methods include laparoscopic reimplantation of the ureter by transvesical approach and endoscopic balloon dilatation. Temporary surgical methods include double J-stent insertion, reflux reimplantation, and ureterostomy placement.

Cilj istraživanja: Usporediti postranično termičko oštećenje tkiva crvuljka i klinički ishod laparoskopske apendektomije uporabom novog u odnosu na resterilizirani harmonični skalpel. Ispitanici i metode: Ukupno 100 bolesnika s akutnom upalom crvuljka koji su podvrgnuti laparoskopskoj apendektomiji je uključeno u randomizirani klinički pokus u dvije bolnice. Pomoću računalnog generatora slučajnih brojeva bolesnici su raspoređeni u dvije skupine: u prvoj je korišten novi, a u drugoj resterilizirani harmonični skalpel. Unutar grupa uspoređeni su rezultati patohistološkog mjerenja postraničnog termičkog oštećenja baze i mezenteriola crvuljka, brzina rezanja baze crvuljka, trajanje operacijskog zahvata, subjektivna ocjena funkcionalnosti uređaja, duljina boravka u bolnici i komplikacije. Rezultati: Medijan postraničnog termičkog oštećenja baze crvuljka u prvoj skupini (N=49) iznosio je 0,2 mm (IQR 0,1 - 0,2), u drugoj skupini (N=51), 0,1 mm (IQR 0,1 - 0,3) (P=0,644), dok je na mezenteriolu crvuljka u obje skupine postranično termičko oštećenje iznosilo 0,1 mm (IQR 0,1 - 0,2) (P=0,418). Medijan vremena potrebnog za transekciju baze u obje skupine bio je osam sekundi (IQR 7 - 9) (P=0,776). Medijan trajanja operacije također je bio usporediv među skupinama (22 min, IQR 20 - 30 naspram 25 min, IQR 21 - 35; P=0,233). Zabilježene su dvije poslijeoperacijske komplikacije u prvoj i jedna u drugoj skupini, što nije bilo statistički značajno (4% naspram 2%; P=0,536). Subjektivne ocjene kirurških instrumenta nisu bile statistički različite između skupina ni u jednoj promatranoj kategoriji. Zaključak: Rezultati naše studije podupiru ponovnu uporabu harmoničnih skalpela, posebno kad ekonomska ograničenja mogu otežati pristup minimalno invazivnoj kirurgiji širem krugu bolesnika. Rezultati dobiveni na laparoskopskoj apendektomiji ne mogu se izravno preslikati na druge, zahtjevnije kirurške zahvate., Background: The aim of this study was to compare lateral thermal damage of the appendix and clinical outcomes after laparoscopic appendectomy using new versus reused harmonic scalpels. Methods: A total of 100 consecutive patients with acute appendicitis who underwent laparoscopic appendectomy were enrolled in the two-center, randomized clinical trial. Using a computer random number generator, patients were allocated to new or reused groups. Histopathological measurement of lateral thermal damage of the appendiceal base and mesoappendix, speed of transection of the appendiceal base, duration of surgery, subjective rating of device functionality, length of stay, and complications were compared within groups. Results: The median lateral thermal damage on the appendiceal base in the new group (N=49) was 0.2 mm (IQR 0.1-0.2) and 0.1 mm (IQR 0.1-0.3) in the reused group (N=51) (P=0.644), while on the mesoappendix for both groups, thermal damage was 0.1 mm (IQR 0.1-0.2) (P=0.418). The median time required for base transection in both groups was eight seconds (IQR 7-9) (P=0.776). The median duration of surgery was also comparable between the groups (22 min, IQR 20-30 vs 25 min, IQR 21-35; P=0.233). Two postoperative complications in the new group and one in the reused group were recorded (4% vs 2%; P=0.536). Surgeons' subjective assessment of the instrument did not reveal significant differences between the groups in all of the investigated categories. Conclusions: The results of our study support the reuse of harmonic scalpels especially in the settings where economic constraints might hamper access to minimally invasive surgery to a larger number of patients. The results obtained on laparoscopic appendectomy might not be reproducible to other more demanding surgical procedures.

Background: Percutaneous internal ring suturing (PIRS) is a simple and popular technique for the treatment of inguinal hernia. The aim of this study was to analyze the learning curves during implementation of PIRS in our department. Methods: A total of 318 pediatric patients underwent hernia repair using the PIRS technique, by three pediatric surgeons with different levels of experience in laparoscopic surgery. These patients were enrolled in a prospective cohort study during the period of October 2015 until January 2021. Surgical times, intraoperative and postoperative complications plus outcomes of treatment were compared between the three surgeons with different levels of experience in laparoscopic surgery. Results: Regarding operative time a significant difference among the surgeons was found. Operative time significantly decreased after 25–30 procedures per surgeon. The surgeon with advanced experience in laparoscopic surgery had significantly less operative times for both unilateral (P=0.002) and bilateral (P=0.0001) hernia repair, compared to the other two surgeons. Perioperative complications, conversion, and ipsilateral recurrence rates were all higher in the beginning, reaching the benchmarks when each surgeon performed at least 30 PIRS procedures. The most experienced surgeon had the lowest number of complications (1.4%) and needed the fewest number of cases to reach the plateau. The other two surgeons with less experience in laparoscopic surgery had higher rates of complications (4.4% and 5.4%) and needed a higher number of cases to reach the plateau (P=0.190). Conclusion: A PIRS learning curve for perioperative and postoperative complications, recurrences, and conversion rates reached the plateau after each surgeon performed at least 30 cases. After that number was achieved, PIRS was shown to be a safe and effective approach for pediatric hernia repair. A Surgeon with an advanced level of experience in pediatric laparoscopic surgery adopted the technique more easily and had a significantly faster learning curve compared to the surgeons with less experience., Ciljevi: PIRS (eng. Percutaneous internal ring suturing) je relativno jednostavna i popularna kirurška tehnika za liječenje preponske kile u djece. Cilj ovog istraživanja bio je analizirati krivulju učenja tijekom implementacije PIRS-a u našoj Klinici. Metode: Ukupno 318 djece s preponskom kilom koja su operirana PIRS tehnikom, uključeno je u prospektivno kohortno istraživanje u razdoblju od listopada 2015. do siječnja 2021. godine. Duljina trajanja operacijskog zahvata, intraoperacijske i poslijeoperacijske komplikacije, kao i ishodi liječenja uspoređeni su između tri dječja kirurga s različitim razinama iskustva u laparoskopskoj kirurgiji. Rezultati: Duljina trajanja operacijskog zahvata značajno se razlikovala između dječjih kirurga uključenih u studiju te se značajno smanjila nakon što je svaki kirurg izveo 25–30 operacijskih zahvata. Duljinu trajanja operacijskog zahvata u djece s jednostranom (P=0,002) i obostranom (P=0,0001) preponskom kilom bila je značajno kraća u kirurga s naprednim iskustvom u laparoskopskoj kirurgiji, u usporedbi s ostala dva kirurga. Intraoperacijske komplikacije, stopa konverzija, kao i stopa recidiva bili su veći u početku studije, da bi dosegli plato kada je svaki kirurg izveo najmanje 30 zahvata. Najiskusniji kirurg imao je najmanji broj komplikacija (1,4%) i trebao je manji broj operacijskih zahvata da bi dosegao plato. Ostala dva kirurga, s manje iskustva u laparoskopskoj kirurgiji, imala su veću stopu komplikacija (4,4% i 5,4%) i bio im je potreban veći broj operacijskih zahvata da bi dosegli plato (P=0,190). Zaključci: Krivulja učenja po pitanju prijeoperacijskih i poslijeoperacijskih komplikacija, stope recidiva i konverzija za PIRS tehniku dosegnula je plato nakon što je svaki kirurg izveo najmanje 30 operacijskih zahvata. Nakon što je svaki kirurg uklhučen u studiju dosegnuo taj broj, pokazalo se da je PIRS siguran i učinkovit operacijski pristup u liječenju preponske kile dječje dobi. Kirurg s naprednom razinom iskustva u dječjoj laparoskopskoj kirurgiji lakše je usvojio tehniku i imao je značajno bržu krivulju učenja u usporedbi s kirurzima koji su imali manju razinu iskustva u dječjoj laparoskopskoj kirurgiji.

Meckelov divertikul je najčešća kongenitalna anomalija probavnog trakta, uz koju se veže „pravilo dvojke“. Nastaje nepotpunom obliteracijom omfalomezenteričnog kanala, poveznice primitivnog crijeva i žumanjčane vreće. Postoji široki spektar anomalija nastalih poremećajem obliteracije omfalomezenteričnog kanala, a Meckelov divertikul čini najčešću od njih. U pravilu se radi o asimptomatskoj malformaciji koja je prisutna u 2 % opće populacije s cjeloživotnim rizikom od razvoja komplikacija između 4,2 i 9 %. Komplikacije se u pravilu javljaju unutar dječje dobi, s medijanom pojave oko pete godine života. Crijevna opstrukcija, bezbolno krvarenje donjeg gastrointestinalnog trakta i divertikulitis s mogućom perforacijom najčešći su uzroci razvoja simptoma Meckelovog divertikula. Preoperativna dijagnostika ima nisku sposobnost detekcije Meckelovog divertikula zbog čega simptomatski pacijenti često bivaju podvrgnuti laparoskopiji kao dijagnostičkoj, ali ujedno i terapijskoj metodi. U slučaju pronalaska asimptomatskog Meckelovog divertikula slikovnom dijagnostičkom metodom ne preporuča se njegovo odstranjenje, dok se individualizirani pristup provodi u slučaju vizualizacije nepromijenjenog Meckelovog divertikula tijekom operativnog zahvata sukladno prisutnim čimbenicima rizika. Kirurška resekcija, to jest, divertikulektomija, klinasta ekscizija ili parcijalna resekcija crijeva indicirane su u slučaju razvoja komplikacija Meckelovog divertikula., Meckel’s diverticulum is the most common congenital anomaly of the digestive tract, to which the „rule of two’s“ is attached. It is caused by the incompletion of obliteration of the omphalomesenteric duct which connects the primitive intestine and the yolk sac. There is a wide range of anomalies developed by the incompletion of obliteration of the omphalomesenteric duct, and Meckel’s diverticulum is the most common one. In principle, it is an asymptomatic malformation that is present in 2 % of the population, with a lifelong risk of developing complications between 4,2 and 9 %. Usually complications occur during the childhood, in average, around the age of five. Intestinal obstruction, painless bleeding of the lower gastrointestinal tract and diverticulitis with possible perforation are the most common causes of Meckel’s diverticulum symptoms development. Preoperative diagnostics have a low ability to detect Meckel’s diverticulum, which is why symptomatic patients often undergo laparoscopy as a diagnostic but also therapeutic method. If an asymptomatic Meckel’s diverticulum is found by the imaging diagnostic method, it is not recommended to remove it. Rather, an individualized approach is carried out in case of visualization of the unchanged Meckel’s diverticulum during surgery, in accordance with the risk factors present. Surgical resection, by the process of diverticulectomy, wedge excision or segmental bowel resection, is indicated if complications of Meckel’s diverticulum develop.

Hernije jesu protruzije peritoneuma sa ili bez trbušnih organa odnosno njihovih dijelova kroz nasljedno ili stečeno oslabljeno mjesto u trbušnoj stijenci. U hernije ingvinalne regije spadaju direktna i indirektna ingvinalna te femoralna kila. Liječenje ingvinalnih i femoralnih hernija u pravilu je kirurško. Kirurške tehnike liječenja mogu se podijeliti na otvorene tehnike s napetošću i bez napetosti te na laparoskopske tehnike. Među otvorene tehnike s napetošću ubrajaju se Bassinijeva, Shouldiceova i McVayeva tehnika koje se, unatoč nekolicini jakih zagovaratelja, polako napuštaju. Zlatni standard u liječenju hernija je upotreba polipropilenskih mrežica, odnosno metode bez napetosti poput Lichtensteinove koje su jednostavnije i smanjuju broj recidiva. U današnje se vrijeme sve više okreće i prema laparoskopskim metodama liječenja hernija ingvinalne regije u koje spadaju TAPP i TEP pristup koji su značajno skuplji i kompliciraniji od otvorenih pristupa, ali pružaju bolju kvalitetu života pacijentu. U odabiru između otvorene i laparoskopske metode liječenja, kirurg mora u obzir uzeti značajke pacijenta, hernije, ali troškove operacije te vlastita ograničenja. Kako bi se poboljšala kvaliteta kirurške skrbi potrebno je ulagati u opremu i edukaciju liječnika te oblikovati zahvat prema potrebama i karakteristikama pacijenta., Hernias are protrusions of the peritoneum with or without abdominal organs or their parts through an inherited or acquired weakened place in the abdominal wall. Hernias of the inguinal region include direct and indirect inguinal hernias and femoral hernias. The treatment of inguinal and femoral hernias is usually surgical. Surgical techniques can be divided into open tension repairs and open tension-free repairs as well as laparoscopic techniques. Open tension repairs include Bassini’s, Shouldice’s and McVay’s techniques which, despite several strong advocates, are slowly being abandoned. The gold standard in the treatment of hernias is the use of polypropylene mesh, i.e. tension-free methods like Lichtenstein's that are simpler and reduce the number of recurrences. Nowadays, an increasing number of surgeons are turning to laparoscopic methods for the treatment of inguinal hernia such as the TAPP and TEP approach, which are significantly more expensive and complicated than open approaches, but provide a better quality of life for the patient. In choosing between open and laparoscopic methods of treatment, the surgeon must take into account the characteristics of the patient, of the hernia, but also the cost of surgery and their personal limitations. In order to improve the quality of surgical care, it is necessary to invest in the equipment and education of doctors and to design the procedure according to the needs and characteristics of the patient.

Background: Percutaneous internal ring suturing (PIRS) is a minimally invasive surgical technique of laparoscopic hernia repair in children under the control of a laparoscope placed in the umbilicus. The aim of this study was to evaluate the management and postoperative outcomes of PIRS for inguinal hernia repair in children. Methods: All children who underwent PIRS for an inguinal hernia, between February 2015 and February 2020, were included in a prospective cohort study. Patients' age at the time of surgery, gender, BMI, lateralization of hernia, surgical and anesthesia times, level of pneumoperitoneum, additional trocar introduction, length of hospital stay, intraoperative or postoperative complications and recurrences were recorded. Results: A total number of 228 inguinal hernia repairs were performed in 188 children (126 (67%) males and 62 (33%) females) with a median age of 4 (IQR 2, 6) years and median follow-up of 46 months. Right-side predominance was noted with 99 (52.7%) right hernia repairs, 49 (26.1%) left hernia repairs, and 40 (21.2%) bilateral hernia repairs. Median surgical time was 10 (IQR 8, 12) min for unilateral and 16 (IQR 14, 20) min for bilateral repair. Median level of pneumoperitoneum was 8 (IQR 7, 8) mmHg. Median hospital stay was 24 (IQR 8, 24) hours. Regarding intraoperative complications only three (1.3%) inferior epigastric veins injuries were recorded, without any consequences. During the follow-up period in three male children hydrocele was recorded, in two cases hydrocele resolved spontaneously and one required surgical treatment. No cases of suture granuloma, groin traction pain discomfort, deferent duct injury, umbilical hernia, iatrogenic cryptorchidism, testicular atrophy or recurrence were recorded. Conclusion: PIRS is a simple, safe and effective technique for inguinal hernia repair in children with excellent outcomes, cosmetic results and a low incidence of complications and recurrences rates. Cilj istraživanja: Perkutana plastika unutarnjeg otvora preponskog kanala (PIRS) je minimalno invazivna kirurška tehnika liječenja preponske kile u djece, koja se provodi pod nadzorom laparoskopa postavljenog u umbilikalnoj regiji. Cilj ove studije je procijena učinkovitosti i ishoda liječenja preponske kile u djece korištenjem PIRS metode. Ispitanici i metode: Sva djeca koja su operirana zbog preponske kile PIRS metodom, u razdoblju od 1. veljače 2015. do 1. veljače 2020. godine, uključena su u prospektivno kohortno istraživanje. Svakom djetetu zabilježene su slijedeće varijable: dob, spol, BMI, lateralizacija kile, duljina trajanja operacijskog zahvata i anestezije, razina pneumoperitoneuma, dodatno uvođenje trokara, duljina boravka u bolnici, intraoperacijske i/ili poslijeoperacijske komplikacije i recidivi. Rezultati: Ukupno je korištenjem PIRS metode operirano 228 kila u 188 djece (126 (67%) dječaka i 62 (33%) djevojčice) sa medijanom dobi od 4 (IQR 2, 6) godine i medijanom praćenja od 46 mjeseci. Desnostrana kila zabilježena je u 99 (52,7%), lijevostrana u 49 (26,1%) i obostrana u 40 (21,2%) djece. Medijan duljine trajanja operacijskog zahvata iznosio je 10 (IQR 8, 12) min za jednostrane i 16 (IQR 14, 20) min za obostrane kile. Medijan razine pneumoperitoneuma bio je 8 (IQR 7, 8) mmHg. Medijan duljine trajanja bolničkog liječenja bio je 24 (IQR 8, 24) h. Zabilježene su tri (1,3%) intraoperacijske komplikacije i to ozljede epigastričnih vena, koje su liječene konzervativno kompresijom, bez posljedica. Tijekom razdoblja praćenja, u troje muške djece zabilježena je hidrokela, u dva dječaka hidrokela se spontano povukla, dok je u jednog bio potreban kirurški zahvat. Nisu zabilježeni slučajevi granuloma u području kirurškog šava, boli u preponi, oštećenja duktusa deferensa, pupčane kile, jatrogenog kriptorhizma, atrofije testisa ili recidiva. Zaključci: PIRS je jednostavna, sigurna i učinkovita kirurška tehnika liječenja preponske kile u djece s izvrsnim ishodima liječenja i estetskim rezultatima te niskom učestalošću komplikacija i recidiva.

Background: Rate of perioperative respiratory complications between TI (tracheal intubation) and LM (laryngeal mask) airway remains unclear during pediatric anesthesia. The aim of this study was to compare the perioperative and postoperative respiratory complications between LM and TI in children undergoing percutaneous internal ring suturing (PIRS) for inguinal hernia. Methods: From October 2015 to February 2019, 135 pediatric patients (97 males and 38 females) with median age of 4 years, who underwent PIRS for inguinal hernia were included in study. Patients were divided in two groups. In group I (n=94) LM airway was used, and in group II (n=41) TI was performed. Demographic data, surgical and anesthesia times, ASA (American Society of Anesthesiologists) classification, muscle relaxation, level of pneumoperitoneum and complications of anesthesia were compared between the groups. Results: There were no significant differences between the two groups regarding age (P=0.435), sex (P=0.306), BMI (P=0.548), ASA classification (P=0.506), level of pneumoperitoneum (P=0.968) and duration of surgery (P=0.968). Duration of anesthesia was significantly shorter when LM was used compared to TI (25 min vs 36 min; P

Cilj istraživanja: Usporediti upalni odgovor organizma na operacijsku noksu između laparoskopski asistiranog perkutanog zatvaranja unutarnjeg preponskog kanala (PIRS) i otvorene modificirane Marcy tehnike u liječenju preponske kile u djece. Ispitanici i metode: Od svibnja 2017. do travnja 2018. ukupno 32 djece, srednje dobi od 4,5 godine, s jednostranom preponskom kilom, uključeno je u randomizirano prospektivno istraživanje. Ispitanici su podijeljeni u dvije skupine, koristeći program randomizacije, s obzirom na operacijsku tehniku. Iz venske krvi ispitivani su upalni parametri: leukociti, C-reaktivni protein (CRP), interleukin-6 (IL-6) i tumor nekrotizirajući faktor alfa (TNF-α), koji su mjereni u tri vremenske točke. Rezultati: Definiran je statistički značajan porast koncentracije svih mjerenih upalnih parametara kroz ispitivano vrijeme (P, Background and aim: The aim of this study was to compare inflammatory stress response between laparoscopic percutaneous inguinal ring suturing (PIRS) and open modified Marcy technique for pediatric inguinal hernia repair. Methods: From May 2017 to April 2018, 32 male children with median age of 4.5 years undergoing inguinal hernia repair were included in randomized controlled trial. The patients were divided in two groups, by using random number generator, depending on surgical approach. The blood was tested in 3 time frames for white blood cells count (WBC), C-reactive protein (CRP), Interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α). Results: Significant increase in concentration for all inflammatory biomarkers, that occur over time, has been found (P

Akutni apendicitis jedan je od najčešćih uzroka razloga indiciranja neopstetričkog operativnog zahvata u trudnica. Iako se može prezentirati klasičnom kliničkom slikom, u trudnoći je zbog fizioloških i anatomskih promjena atipična slika češća. To čini dijagnozu ovog stanja kompliciranom te ona zahtijeva osim kliničkog pregleda i daljnje pretrage. One uključuju diferencijalnu krvnu sliku i CRP te slikovne pretrage. Činjenica da leukocitoza u trudnoći ne predstavlja patologiju te da CRP može pokazivati tendenciju rasta potvrđuje da ove metode nisu pretjerano uspješne. Od slikovnih pretraga najbolja se pokazala magnetska rezonancija, ali je njezina dostupnost ograničena. Liječenje se provodi kirurški, pri čemu postoje različiti pristupi. Iako postoje brojni radovi koji preferiraju otvorenu nad laparoskopskom apendektomijom, novija istraživanja pokazuju kako nema značajnih rizika za majku i fetus kod korištenja laparoskopskog pristupa. U novije se doba spominje i konzervativni način liječenja antibioticima, ali zbog mogućih komplikacija on se izbjegava, osim u slučajevima nedostupne kirurške skrbi. Akutni apendicitis je stanje koje treba brzo riješiti kako bi se izbjegle komplikacije koje u nekim slučajevima mogu izazvati značajne posljedice za majku i dijete. U članku je prikazan cjelovit pristup trudnici s apendicitisom uz korištenje najnovije literature., 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.

Cilj istraživanja: Neadekvatno zbrinjavanje baze crvuljka dovodi do intraabdominalnih apscesa. Endoskopske omča i polimerski klip su najčešće korišteni u zbrinjavanju baze crvuljka u laparoskopskim apendektomijama. Cilj ovog istraživanja bio je procijeniti učinkovitost obiju navedenih tehnika s naglaskom na intraoperacijske i poslijeoperacijske komplikacije u odnosu na troškove. Ispitanici i metode: Od listopada 2011. do lipnja 2016., 277 bolesnika u kojih je učinjena laparoskopska apendektomija uključeni su u prospektivnu studiju. Bolesnici su bili podijeljeni u dvije skupine, ovisno o tehnici koja je korištena za zbrinjavanje baze crvuljka: 101 bolesnika u skupini polimerskog klipa i 176 u skupini endoskopske omče. Skupine su uspoređivane s obzirom na intraoperacijske i poslijeoperacijske komplikacije, duljinu hospitalizacije, trajanje operacijskog zahvata i različitost troškova operacije. Rezultati: Od 277 bolesnika u kojih je učinjena laparoskopska apendektomija nisu zabilježene intraoperacijske komplikacije, ali je zabilježeno 17 (6.1%) poslijeoperacijskih komplikacija. Bilo je 5 (1.8%) infekcija kirurške rane, 5 (1.8%) intraabdominalnih apscesa, 6 (2.1%) febrilnih stanja koja su trajala dulje od 3 dana i 1 (0.3%) krvarenje iz mjesta troakara. Nije nađena statistički značajna razlika u odnosu na intraoperacijske i poslijeoperacijske komplikacije između dvije ispitivane skupine (P=0.546). Operacijsko vrijeme bilo je za 10 min kraće u skupini u kojoj je korištena endoskopska omča (P, Objectives and background: An inadequate closure of the appendiceal stump leads to intra-abdominal surgical site infection. Endoloops and polymeric clip, have been most frequently used to close the appendiceal stump in laparoscopic appendectomy. The aim of this prospective trial was to evaluate the clinical outcomes of nonabsorbable polymeric clips in laparoscopic appendix stump closure in children by comparing the endoloop ligature. Patients and Methods: From June 2011 to June 2016, 277 children undergoing laparoscopic appendectomy were included in study. The patients were divided into two groups based on the technique used for appendiceal stump closure: there were 101 patients in the polymeric clips group and 176 in the endoloop group. The risk of intraoperative and postoperative complications, duration of surgery, hospital stay and costs of the operation were investigated for two different techniques to close the appendiceal stump. Results: Among the 277 patients who underwent laparoscopic appendectomy, there were no intraoperative complications and 17 (6.1%) postoperative complications. There were 5 (1.8%) wound infections, 5 (1.8%) intraabdominal abscesses, 6 (2.1%) children with fever and 1 (0.3%) trocar site bleedings. There were no significant differences between the groups with respect to intraoperative and postoperative complications (P=0.546). The median length of the operation was 10 min shorter when the polymeric clips were used (P

In the 1980s and 1990s, success of laparoscopic approach in cholecystetcomy introduced laparoscopy as a treatment option in various diagnosis. In past 20 years, laparoscopic approach became increasingly popular for treating patients with colorectal cancer. Numerous studies have stressed the advatages of laparoscopic approach compared to open surgery which is quantified in reduced blood loss, earlier postoperative bowel movements, lower complication rates and shorter hospital stay. These advantages led to laparoscopic approach being considered as a modality of treting colorectal cancer. Shorter hospital stay lead to reduction of overall costs of treatment, inspite of initial higher cost of laparoscopic procedure. Laparocospic approach in colorectal cancer treatment has better shortterm outcome, equal oncological safety and longterm results when compared to open surgery. Advantages and wider acceptance of laparoscopic surgery for colorectal cancer could improve quality of care of oncological patients and further reduce cost of treatment if implemented along with multimodal perioperative care program (enhanced recovery)., Krajem 80-tih i u početcima 90–tih godina prošlog stoljeća uspjesi laparoskopskog pristupa kod kolecistektomije otvorili su put za upotrebu ove tehnike u raznim bolestima. U posljednjih 20 godina, laparoskopski pristup je postao popularan izbor za liječenje pacijenata s rakom debelog crijeva. U mnogim studijama dokazana je prednost laparoskopskog pristupa u usporedbi s otvorenom operacijom koji se očituje kroz manje gubitke krvi, raniju uspostava motiliteta crijeva, nižoj učestalosti komplikacija i kraćim trajanje boravka u bolnici. Sve navedeno je dovelo do prihvaćanja laparoskopskog pristupa kao jednog od modaliteta liječenju raka debelog crijeva. Smanjenje trajanja boravka u bolnici dovodi do smanjenja ukupnih troškova liječenja, unatoč činjenici da su veći inicijalni operativni troškovi. Laparoskopski pristup u liječenju raka debelog crijeva pokazuje bolji kratkoročni ishod, ima jednaku onkološku sigurnost i jednaki dugoročni ishod kao i otvorene operacije. Prednosti minimalno invazivne kirurgije mogu poboljšati kvalitetu skrbi onkoloških bolesnika i dovesti do dodatnih ušteda u liječenju uvođenjem programa multimodalne perioperativne skrbi.