Hemobilia is an unusual type of gastrointestinal bleeding most frequently due to iatrogenic injury, trauma, or neoplasia. Acute cholecystitis as a cause of hemobilia is rare. We present the case study of a patient with bleeding from eroded gallbladder mucosa in the setting of severe calculous cholecystitis. The hemorrhagic episode was preceded by acute ERCP due to obstructive icterus with extraction of the calculi, followed by the development of severe acute pancreatitis. These factors initially misled the diagnosis. The bleeding was not hemodynamically important and routine diagnostic methods did not reveal its exact source. Direct choledochoscopy (SpyGlassTM) proved to be helpful in determining the right diagnosis, as it ruled out any injury or tumor in the main bile ducts and considerably supported the assumption of intrabladder bleeding. Surgical revision confirmed the cause, and subsequent cholecystectomy solved the whole problem.

• Klíčová slova
• cholangiocarcinoma, cholangioscopy, choledochoscopy, endoscopic intervention, hemobilia, hemorrhagic cholecystitis,
• MeSH
• akutní cholecystitida * diagnóza   diagnostické zobrazování   MeSH
• akutní nemoc MeSH
• cholecystitida * komplikace   chirurgie   MeSH
• gastrointestinální krvácení etiologie   MeSH
• hemobilie * komplikace   diagnóza   MeSH
• lidé MeSH
• pankreatitida * komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Surgical treatment is the most important part of multimodal management of rectal cancer. In recent years, minimally invasive surgery has been preferred. Minimally invasive procedures include laparoscopy and more recently robotic surgery. Robotic surgery has been developed to eliminate the shortcomings of laparoscopy, especially the parallel position of instruments and their limited movement. The advantages of a robotic system should be most apparent in narrow and deep spaces, i.e. the lesser pelvis. The aim of this study was to analyze the short-term results of robot-assisted surgery for rectal tumors. METHODS: The study is a retrospective analysis of a cohort of 220 patients with robotic-assisted surgery for rectal cancer. The cohort was analyzed in terms of length of surgery, blood loss, number of conversions to open surgery, completeness of TME, distal and circumferential resection margin positivity, length of hospital stays and number of 30-day rehospitalizations. In addition, 30-day postoperative morbidity and mortality were assessed using the Clavien-Dindo score. RESULTS: Robotic-assisted surgeries lasted an average of 184 minutes. In total, 5 operations were converted, i.e. 2.3%. Complete mesorectum was achieved in 90% of the patients. Severe postoperative complications, Clavien-Dindo score 3-4, were observed in 14% of the patients. Anastomotic complications occurred in 9.6% of the patients. The mean length of the hospital stay was 8.4 days. CONCLUSION: Robotic surgery for rectal tumors is a safe method with an acceptable rate of complications. An established training method and a high degree of standardization of the surgical procedures are indisputable advantages of robotic systems, making it possible to achieve very good results in a short time. In terms of perioperative and early postoperative outcomes, robotic surgery outperforms laparoscopic surgery in some parameters.

• MeSH
• laparoskopie * metody   MeSH
• lidé MeSH
• nádory rekta * chirurgie   patologie   MeSH
• pooperační komplikace etiologie   chirurgie   MeSH
• rektum chirurgie   MeSH
• retrospektivní studie MeSH
• roboticky asistované výkony * škodlivé účinky   metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Enhanced recovery after surgery (ERAS) protocols in colorectal surgery leads to improved quality of care and more efficient resource utilization. Despite these positive outcomes, the penetration of ERAS protocols in the Czech Republic is low. The aim of this study is to present a general methodology for implementing an ERAS protocol in colorectal surgery. METHODS: The methodology is based on the authors' extensive experience in implementing clinical protocols at various institutions in the Czech Republic, as well as published international experiences. This methodology is described in detail and supplemented with data obtained during implementation of an ERAS program at the author's institution. RESULTS: The preparatory phase includes in-depth quality of care audits and preparation of an ERAS protocol. The purpose of the audits is to identify areas of care where standardization or targeted changes in clinical practice are desirable. The implementation phase involves staff training, technical implementation support, protocol dissemination, adherence monitoring, and evaluation of a pilot phase with subsequent protocol adjustments. The evaluation phase involves data collection, maintaining a prospective database, and regular assessments. CONCLUSION: The presented methodology describes the individual steps in the process of implementing a clinical protocol into practice. This text can serve as a manual for implementing an ERAS protocol in colorectal surgery at any institution.

• Klíčová slova
• ERAS, clinical protocol, colorectal surgery, implementation, methodology,
• MeSH
• chirurgie trávicího traktu * MeSH
• délka pobytu MeSH
• klinické protokoly MeSH
• kolorektální chirurgie * MeSH
• lidé MeSH
• pooperační komplikace MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Bowel obstruction is one of the most common postoperative complications in pelvic surgery. In most cases, adhesive mechanical ileus of the small bowel is the cause. In procedures such as Hartmann's resection or abdominoperineal rectal resection, it seems that the large wound area on the pelvic walls and pelvic floor and the dead space after the removed rectum with mesorectum contribute to the ileus condition. The aim of this paper was to identify the risk factors for ileus after selected pelvic procedures and to map the possible ways of prevention and treatment of these complications. METHODS: We performed retrospective simple analysis of a set of 98 patients who underwent elective abdominoperineal resection of the rectum, pelvic exenteration or Hartmann's resection for rectal cancer between 2017-2022. Postoperative complications were recorded, especially bowel obstruction, and perineal wound or rectal stump healing complications. In all 9 patients, who needed reoperation, we searched for risk factors for ileus known from the literature. We also described the management of ileus. RESULTS: In the group of 9 patients subjected to detailed analysis, 8 risk factors were most common: male gender, obesity, history of radiotherapy, open surgery, requirement of adhesiolysis in primary surgery, large blood loss, difficult dissection, and impaired healing of the rectal stump/perineum. A total of 8 (88.9%) patients had a combination of 4 or more of the mentioned risk factors. CONCLUSION: Our results confirm the impact of risk factors known from the literature; furthermore, they indicate a connection with the formation of a dead space in the pelvis and with complications of the rectal stump or perineal wound healing. Some of the risk factors cannot be changed, and current preventive measures cannot completely prevent the formation of adhesions. It is therefore advisable to look for other materials and methods that would ideally limit the formation of adhesions and at the same time fill the dead space and thus separate it from the perineal wound.

• Klíčová slova
• Hartmann ́s resection, abdominoperineal rectal resection, dead space, postoperative ileus, small bowel obstruction,
• MeSH
• ileus * etiologie   MeSH
• lidé MeSH
• nádory rekta * chirurgie   radioterapie   MeSH
• pánev MeSH
• perineum chirurgie   MeSH
• pooperační komplikace etiologie   MeSH
• rektum chirurgie   MeSH
• retrospektivní studie MeSH
• střevní obstrukce * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

AIMS: Metamorphopsia is important symptom of macular disease. The most common simple detection method of metamorphopsia is Amsler grid. Usually it is used monocularly with best correction for near. Patient should evaluate grid deformation a describe position of the deformity. This method is based on qualitative principle. For quantitative evaluation we can use Software D Chart (Thomson Software Solution). This instrument enables evaluate degree and position of the metamorphopsia in central visual field. Our goal was to establish M-score values in group of young healthy subjects without correction (M-score natural), with cylindrical spectacle lens (M-score SL) and in group of patients with age related degeneration (M-score ARMD). OBJECTS AND METHODS: We had 33 probands divided into 2 samples. The first sample contains 15 young probands with average age 23 years without any eye pathology. The second sample contains 18 patients with ARMD (7 with dry form and 11 with wet form). In our study we used software D Chart (Thomson Software Solution). This software was use in Acer PC with touchable screen. We note total M-score in right eye of all probands. Level for statistic evaluation was set on p = 0.05. RESULTS: Natural M-score values for young probands was: median 0, minimum 0, maximum 2.3. With cylindrical lens we got these values: median 25.2, minimum 3.6, maximum 41.6. In second sample with probands suffer from ARMD we got these values: median 0.8, minimum 0, maximum 29.4. Wilcoxon non-parametric test was used for statistical evaluation. We proved statistically significant difference between all variables. M-score natural vs. M-score SL showed p < 0.001, M-score natural vs. M-score ARMD showed p = 0.04 and M-score SL vs. M-score ARMD showed p < 0.001. CONCLUSION: Our study showed statistically significant differences between variable M-score natural, M-score SL and M-score ARMD. We found that printed Amsler grid as well as its digital modification D Chart are suitable for determining metamorphopsia in central visual field. The main advantage of D Chart is quantitative evaluation of the test with M-score and digital registration of retinal changes during patient´s follow up.

• Klíčová slova
• ARMD, Amsler grid, D Chart, M-score, cylinder, spectacle correction,
• MeSH
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• oftalmologie * MeSH
• optometrie * MeSH
• poruchy zraku diagnóza   MeSH
• testy zrakového pole MeSH
• zraková ostrost MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: The aim of this study was to evaluate short-term outcomes of patients undergoing mini-invasive rectal resection within an ERAS (enhanced recovery after surgery) protocol. METHODS: A prospectively managed database of patients undergoing rectal operations performed at our department between January 2015 and April 2020 was retrospectively analyzed. An ERAS protocol was implemented into clinical practice at our department in April 2016 and mini-invasive rectal procedures in May 2016. The ERAS group consisted of all patients who underwent mini-invasive rectal resections or amputations within the ERAS protocol. The control group consisted of patients who underwent open procedures and received standard perioperative care. The extracted data included basic patient characteristics, surgical data, postoperative recovery parameters, 30-day morbidity, length of postoperative stay and 30-day rehospitalization. RESULTS: A total of 110 patients were included in the study: 67 patients in the ERAS group and 43 in the control group. Within the ERAS group 47 patients underwent robotic procedures and 20 had laparoscopic procedures. Patients in the ERAS group had significantly better clinical and laboratory recovery parameters except for postoperative nausea and vomiting. A significantly lower incidence of paralytic ileus (20.9% vs. 3%) and a shorter length of postoperative stay (13 days vs. 9 days) was found in the ERAS group. The rehospitalization rate and 30-day morbidity were not different between the ERAS and control group. CONCLUSIONS: Implementation of the ERAS protocol in combination with mini-invasive approaches leads to better short-term postoperative outcomes after rectal surgery.

• Klíčová slova
• rectal cancer – laparoscopy − robotic surgery – enhanced recovery − short-term outcomes,
• MeSH
• délka pobytu MeSH
• laparoskopie * MeSH
• lidé MeSH
• nádory rekta * chirurgie   MeSH
• pooperační komplikace epidemiologie   MeSH
• rektum chirurgie   MeSH
• retrospektivní studie MeSH
• urychlená pooperační rehabilitace MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Pelvic surgeries such as extirpation of the rectum or pelvic exenteration lead to a creation of a dead space, which can be cause of complication, such as bowel obstruction, perineal hernia, abscess or hematoma. A growing incidence of complication is expected in connection with the increasing use of laparoscopic and robotic approaches or ELAPE method. Since the bone structures do not allow compression, the only way to deal with the dead space is to fill it in. Present methods provide the filling with omental or myofascial flaps. The length and the mobility of the omental flap can be the limitation. Myofascial flaps are technically more demanding and bring the complications of a donor place. Synthetic or biological meshes do not deal with dead space problematic. Modern technologies using nanomaterials offer the possibility to produce a material with specific properties for example shape, inner structure, surface, or time of degradation. The modified material could also satisfy the requirements for filling the dead space after surgeries.

• MeSH
• biokompatibilní materiály MeSH
• lidé MeSH
• pánev chirurgie   MeSH
• pooperační komplikace prevence a kontrola   MeSH
• rektum chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• biokompatibilní materiály MeSH

This work deals with sensitivity and specificity in spectral OCT in detection of early glaucoma. Our goal was to evaluate data from RNFL analysis and compare them with resulted diagnosis of glaucoma neuropathy based on visual field changes. This retrospective study contains 31 subjects who undergone OCT examination in our department between years 2008 and 2017. Test statistic showed RNFL OCT sensitivity 63.64 % and specificity 90 %. Test ROC (receiver operating characteristic curve) showed AUC (area under curve) 0.734, which was statistically significant (p = 0.0097). We found that spectral OCT SLO with RNFL analysis is useful and effective instrument in analysis of glaucoma.

• Klíčová slova
• RNFL analysis, glaucoma, sensitivity, specificity, spectral OCT,
• MeSH
• glaukom diagnostické zobrazování   MeSH
• lidé MeSH
• nervová vlákna * MeSH
• nitrooční tlak MeSH
• optická koherentní tomografie * MeSH
• retinální gangliové buňky * MeSH
• retrospektivní studie MeSH
• senzitivita a specificita MeSH
• testy zrakového pole MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

UNLABELLED: Bouveret syndrome is a gastric outlet obstruction caused by impaction of a gallstone that passes through a cholecystoduodenal or cholecystogastric fistula. It is a rare disease, most common in elderly women with multiple comorbidities and high surgical risk. The diagnosis can be made either radiologically or endoscopically. Endoscopic extraction is the preferred therapeutic option. Surgical intervention is indicated when endoscopic methods fail. We describe a case of Bouveret syndrome in a 79 years old woman. The report is followed by a review of literature on the diagnostics and treatment of this rare syndrome. KEY WORDS: gallstones bilioenteric fistula gallstone ileus duodenal obstruction Bouveret syndrome.

• MeSH
• biliární píštěl komplikace   chirurgie   MeSH
• lidé MeSH
• nemoci duodena diagnostické zobrazování   etiologie   chirurgie   MeSH
• obstrukce duodena diagnostické zobrazování   etiologie   chirurgie   MeSH
• obstrukce vyprazdňování žaludku diagnostické zobrazování   etiologie   chirurgie   MeSH
• radiografie MeSH
• senioři MeSH
• střevní píštěle diagnostické zobrazování   etiologie   chirurgie   MeSH
• syndrom MeSH
• žlučové kameny komplikace   diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH

UNLABELLED: Perineal hernia is defined as a protrusion of intra-abdominal viscera through a defect in the pelvic floor. Primary hernias are extremely rare; secondary (postoperative) hernias following pelvic surgery, especially abdominoperineal resection or pelvic exenteration, are more common. Impaired perineal wound healing and neoadjuvant chemoradiotherapy in cancer patients are defined as main risk factors. A growing incidence of this complication is expected in connection with an increasing use of laparoscopic approaches and ELAPE. Despite the considerable time since the first described secondary perineal hernia in literature, patient series, prospective studies and treatment guidelines are still missing. The authors present a case of a 66-year-old man with secondary perineal hernia following a previous laparoscopic abdominoperineal resection for rectal cancer undergoing a surgical intervention. This was performed through an abdominal approach using a rectus abdominis muscle flap to repair the pelvic floor defect. KEY WORDS: perineal hernia - hedrocele - RAM - abdominoperineal resection.

• MeSH
• chirurgické laloky * MeSH
• incizní kýla diagnostické zobrazování   chirurgie   MeSH
• laparoskopie MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• musculus rectus abdominis transplantace   MeSH
• nádory rekta chirurgie   MeSH
• operace kýly * MeSH
• pánevní dno chirurgie   MeSH
• perineum chirurgie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH