PURPOSE: Ileocecal resection (ICR) is the most frequently performed surgery in paediatric Crohn's disease (CD) patients. The aim of the study was to compare laparoscopic-assisted and open ICR. METHODS: Retrospective review of consecutive CD patients undergoing ICR between March 2014 and December 2021 was performed. The patients were divided into open (OG) and laparoscopic (LG) groups. Compared parameters included patients' demographics, clinical characteristics, surgery, duration of hospitalisation and follow-up. Complications were classified according to the Clavien-Dindo classification (CDc). Risk factors were identified using multivariable analysis. RESULTS: Sixty-two patients (29 females, 46.7%) were included in the analysis, forty-two patients in OG. The median duration of surgery was 130 in OG versus 148 in LG (p = 0.065) minutes. Postoperative complications were reported in 4 patients (12.1%). There was no significant difference in postoperative complications according to CDc (OG 7.14 vs LG 5%, p = 1). The median length of hospitalisation was 8 in OG and 7 days in LG (p = 0.0005). The median length of follow-up was 21.5 months. CONCLUSION: The laparoscopic-assisted approach had shorter hospital stay and was not associated with increased risk of 30-day postoperative complications. Laparoscopic surgery should be considered the preferred surgical approach for primary ICR.

• Keywords
• Crohn’s disease, Ileocecal resection, Laparoscopy, Paediatric surgery, Single-incision laparoscopic surgery,
• MeSH
• Crohn Disease * surgery   MeSH
• Child MeSH
• Hospitalization MeSH
• Laparoscopy * MeSH
• Humans MeSH
• Hospitals MeSH
• Postoperative Complications epidemiology   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

INTRODUCTION: The incidence of Crohns disease in the paediatric population has been increasing and requires surgical treatment in addition to conservative therapy. While surgical treatment used to be the last step after the failure of all conservative therapies, nowadays it is a standard part of complex treatment. Surgery can enter the treatment process at any stage of the disease and, with a proper indication, timing and preoperative optimization, it can induce immediate remission in patients. On the other hand, with inadequate or improper preoperative preparation and indication, surgical treatment can cause serious or even life-threatening complications. The spectrum of patients undergoing surgery is changing in the era of biological therapy. The aim of this review was to summarize the current knowledge of the impact of biological (anti-TNF alpha) therapy on the development of postoperative complications in children and adolescents operated for Crohns disease. METHODS: We present a review based on literature available in MEDLINE-PubMed and Embase databases. CONCLUSION: According to current knowledge, no association was found between biological treatment in the preoperative period and the development of postoperative complications in paediatric patients. Surgical treatment of paediatric patients with Crohns disease is one of standard treatment modalities.

• Keywords
• Crohn´s disease, Crohn‘s disease, biologic treatment, biological therapy, inflammatory bowel disease, laparoscopy, paediatric surgery, pediatric surgery,
• MeSH
• Crohn Disease * complications   MeSH
• Child MeSH
• Tumor Necrosis Factor Inhibitors MeSH
• Humans MeSH
• Adolescent MeSH
• Postoperative Complications epidemiology   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Names of Substances
• Tumor Necrosis Factor Inhibitors MeSH

INTRODUCTION: Congenital anorectal malformation is the most common cause of fecal incontinence in children and young adults. Surgical treatment options are limited. One of the treatment methods is the implantation of an artificial bowel sphincter. The goal of this study was to investigate the efficacy of the artificial bowel sphincter in reaching long-term fecal continence in patients with anorectal malformation. METHODS: Young adults with fecal incontinence due to anorectal malformation were included in the study. Those who underwent an artificial bowel sphincter implantation were followed each year for a period of 10 years. Outcome measures included the level of continence and the need for reoperation including explantation. RESULTS: Out of the 20 patients with congenital anorectal malformation, nine underwent implantation. Three devices were explanted within the first year; two were permanently removed and one was replaced. Thus, after the first year, seven patients (78 %) had a functional artificial bowel sphincter. Four patients (44 %) had a fully functional artificial bowel sphincter at 10 years after implantation. Although the artificial bowel sphincter improved the level of continence in all patients, full continence was not achieved in any of them. In one patient the artificial bowel sphincter was explanted after 10 years upon her request and a colostomy was created. CONCLUSION: Artificial bowel sphincter is a potential treatment modality for fecal incontinence in patients with congenital anorectal malformation. The main reason for failure results from inability to accurately assess the extent of the anorectal malformation before device implantation. Changes in the perineal region consequent to previous operations are the main limiting factors for artificial bowel sphincter implantation.Key words: anorectal malformation - incontinence - artificial bowel sphincter - long-term results.

• MeSH
• Anal Canal * abnormalities   surgery   MeSH
• Defecation MeSH
• Child MeSH
• Fecal Incontinence * etiology   surgery   MeSH
• Humans MeSH
• Young Adult MeSH
• Device Removal MeSH
• Reoperation MeSH
• Treatment Outcome MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Hirschsprungs disease (HD) in adults is extremely rare, only three publications in Czech and Czechoslovak journals making reference to the condition after childhood. We present two cases of adult patients with HD. The first case is a 46-year-old male patient suffering from chronic constipation since childhood and diagnosed with megacolon at the age of 16; however, no further detailed diagnosis was done. At the age of 41, he developed a sigmoid perforation due to fecaloma and underwent urgent rectosigmoid resection and colostomy. 5 months later, Swensons coloanal anastomosis with diverting ileostomy was performed. Postoperative course was uneventful. He has two bowel movements a day. 7 years after the Swensons procedure, he also underwent adhesiolysis for acute bowel obstruction. His daughter was operated on due to HD at 16 days of age. The second case is a 57-year-old male patient. He suffered from chronic constipation and megacolon since 2 years of age and was diagnosed with congenital megacolon at the age of 19. However, no detailed diagnostics followed. He had a long interval between stools of up to 14 days. He underwent colonoscopy and, with a diagnosis of resistant Crohns disease, was referred to a surgical department where he was diagnosed with HD. Left hemicolectomy was first performed, followed by Swensons procedure with diverting ileostomy. All postoperative courses were uneventful. Currently he passes one or two soft stools a day. Adult HD is extremely rare. However, adult surgeons should consider it in case of refractory constipation since childhood associated with megacolon. Diagnosis is based on contrast radiography and rectal biopsy. Both Swensons and Duhamels procedures are suitable for surgical management. Left hemicolectomy with colonic rotation and coloanal anastomosis and/or proctocolectomy with J-pouch anastomosis are indicated in advanced forms of non-functional megacolon.Key words: adult Hirschsprungs disease - megacolon surgical therapy.

• MeSH
• Anal Canal MeSH
• Anastomosis, Surgical MeSH
• Adult MeSH
• Hirschsprung Disease * complications   diagnosis   surgery   MeSH
• Middle Aged MeSH
• Humans MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Review MeSH

AIM OF STUDY: After the treatment of tumors, we often encounter a minimal residual sickness. However, the elimination of these leftover tumor cells is crucial for the patient. In the past years one of the most discussed options for this treatment is Imunotherapy, mainly by Dendritic cells. Dendritic cells are the most efficient cells out of the antigen presenting cell group. METHODS AND RESULTS: In the first part of the project, we perfected a technique of inducting a tumor on an experimental model. We inducted the tumor by the use of Carcinogenic substances or with the help of the Sarkom line imortalized fibroblasts. Another important part of the project was perfecting the method for the preparation of undeveloped dendritic cells from periphery blood monocytes. After these significant procedures were developed and perfected we moved onto the main part of the study. The Induction of a tumor by the carcenogenic substances Ethylennitrosamin and Phenobarbital was successful only in 20 % of the cases and therefore, was unusable for our experiment. We inducted the tumors with the Sarkom line method. After the application of dendritic cells into the tumor, a decrease in the development of the growth of the tumor was achieved. CONCLUSION: Imunotherapy using dendritic cells as a basis for treatment is a perspective method for treatment of tumors.

• MeSH
• Dendritic Cells immunology   transplantation   MeSH
• Neoplasms, Experimental pathology   therapy   MeSH
• Immunotherapy * MeSH
• Injections, Intralesional MeSH
• Rats MeSH
• Cell Line, Tumor MeSH
• Rats, Inbred Lew MeSH
• Rats, Wistar MeSH
• Dogs MeSH
• Neoplasm Transplantation MeSH
• Animals MeSH
• Check Tag
• Rats MeSH
• Dogs MeSH
• Animals MeSH
• Publication type
• English Abstract MeSH
• Journal Article MeSH

In this study we present the models of preventive and therapeutic vaccination of sarcoma-bearing rats with dendritic cells that present tumour antigens from killed tumour cells. We present the characteristics of dendritic cell-based vaccine and its capacity to induce anti-tumour immune response both in vitro and in vivo. We show that preventive vaccination efficiently prevents tumour growth. On the other hand, vaccination of rats with established tumours did not lead to eradication of the tumours. Despite the induction of a vigorous immune response after administration of dendritic cell-based vaccine and transient decrease in tumour progression, tumours eventually resumed their growth and animals vaccinated with dendritic cells succumbed to cancer. In both settings, preventive and therapeutic, dendritic cell-based vaccination induced a vigorous tumour-specific T-cell response. These results argue for the timing of cancer immunotherapy to the stages of low tumour load. Immunotherapy initiated at the stage of minimal residual disease, after reduction of tumour load by other modalities, will have much better chance to offer a clinical benefit to cancer patients than the immunotherapy at the stage of metastatic disease.

• MeSH
• Cell Death MeSH
• Dendritic Cells cytology   immunology   MeSH
• Fibrosarcoma immunology   pathology   prevention & control   therapy   MeSH
• Immunotherapy * MeSH
• Rats MeSH
• Cell Line, Tumor MeSH
• Rats, Inbred Lew MeSH
• Cancer Vaccines immunology   therapeutic use   MeSH
• T-Lymphocytes immunology   MeSH
• Vaccination * MeSH
• Animals MeSH
• Check Tag
• Rats MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH
• Names of Substances
• Cancer Vaccines MeSH

INTRODUCTION: The restoration of bowel continuity using multiple classic anastomoses is mostly impossible in unstable critically ill extremely low birth weight neonates. The parameters of healing of approximative anastomoses in which integrity and continuity of bowel is achieved with limited number of stitches were evaluated in an experimental study. MATERIAL AND METHODS: Small bowel anastomoses were performed in twenty-two adult male rats. An approximative ileo-ileal anastomosis was performed with five seromuscular-interrupted sutures only; in the control group the anastomosis was performed with the conventional technique of interrupted sutures. The mechanical and biochemical parameters were compared. RESULTS: All anastomoses in both groups healed well without obstruction. The mean operating time needed for an approximative anastomosis was shorter (16 +/- 7.1 min versus 23.6 +/- 6.2 min, p = 0.016). The strength of the approximative anastomoses on the 1st day after surgery was 55 +/- 15 torr; the strength of the conventional anastomoses was 55 +/- 42 torr. The strength of the approximative anastomoses after 7 days was 249 +/- 39 torr; the strength of the conventional anastomoses was 218 +/- 23 torr (p = 0.118). The activity of the collagenolytic enzymes matrix metalloproteinase-2 and matrix metalloproteinase-9 in the anastomotic area was significantly increased compared with the activity in samples of non-operated bowel. There was no significant difference in collagenolytic activity between both types of anastomoses. CONCLUSION: The approximative anastomosis is a time-saving alternative to conventional anastomoses with a comparable course of anastomotic healing, anastomotic strength, and changes in collagen metabolism.

• MeSH
• Anastomosis, Surgical methods   MeSH
• Biomarkers metabolism   MeSH
• Digestive System Surgical Procedures methods   MeSH
• Wound Healing * MeSH
• Ileum metabolism   surgery   MeSH
• Collagen metabolism   MeSH
• Rats MeSH
• Matrix Metalloproteinase 2 biosynthesis   metabolism   MeSH
• Matrix Metalloproteinase 9 biosynthesis   metabolism   MeSH
• Disease Models, Animal MeSH
• Rats, Wistar MeSH
• Suture Techniques * MeSH
• Intestine, Small surgery   MeSH
• Animals MeSH
• Check Tag
• Rats MeSH
• Male MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH
• Names of Substances
• Biomarkers MeSH
• Collagen MeSH
• Matrix Metalloproteinase 2 MeSH
• Matrix Metalloproteinase 9 MeSH

AIM: A technique of approximative anastomosis in witch integrity and continuity of bowel is achieved with limited number of interrupted seromuscular stitches was evaluated in experimental study. MATERIAL AND METHODS: Small bowel anastomosis were performed in twelve rats (Wistar, male) with weight range 197-242 g. An approximative anastomosis in the ileum of six rats was performed with five seromuscular-interrupted sutures only; in the second study group anastomosis was performed with conventional technique of interrupted sutures. The approximative anastomosis was evaluated concerning operating time, anastomotic healing, bursting pressure and adhesions in comparison to the conventional anastomosis. Statistics was calculated with Anova test. RESULTS: All anastomosis in both group healed well without obstruction. The median operating time needed for approximative anastomosis was shorter (31.7 +/- 1.6 minutes versus 35.2 +/- 1.5 minutes, p = 0.002). The strength of approximative anastomosis after 7 days was 249 +/- 39 torr; strength of standard anastomosis was 218 +/- 23 torr (p = 0.118). There were no significant differences in the others evaluated parameters between two study groups. CONCLUSION: In the animal model presented, the approximative anastomosis shows time saving alternative to standard anastomosis, with the same parameters of anastomotic strength, healing, and adhesions.

• MeSH
• Anastomosis, Surgical methods   MeSH
• Digestive System Surgical Procedures methods   MeSH
• Wound Healing MeSH
• Ileum surgery   MeSH
• Rats MeSH
• Models, Animal MeSH
• Rats, Wistar MeSH
• Suture Techniques * MeSH
• Animals MeSH
• Check Tag
• Rats MeSH
• Male MeSH
• Animals MeSH
• Publication type
• English Abstract MeSH
• Journal Article MeSH

Multifocal necrotizing enterocolitis (NEC) may result in extensive bowel necrosis and short bowel syndrome. Authors present case report of premature newborn (BW 1700 g, gestational age 30 w.) where an extensive multisegmental NEC of small and large intestine was found during first explorative laparotomy. Proximal jejunostomy 28 cm beyond ligament of Treitz was performed and the rest of involved intestine was left in situ. After 48 hours multiple small bowel resections were performed leaving 12 cm of small intestine (5 short segments) distal to the jejunostomy. Five approximative anastomoses were performed to restore continuity among these segments and ileocaecal valve. Each of approximative anastomosis was constructed with limited number of 4-6 interrupted stitches and all anastomoses healed without complication. Intestinal continuity between proximal jejunostomy and the reconstructed segment of ileum was reestablished nine weeks later. Total length of small bowel was 50 cm. The patient was discharged at the age of 5 months weighing 4145 g with supplemental pareneteral nutrition. The technique of rapid approximative anastomosis may contribute to save maximal intestinal length in cases with the risk of short bowel syndrome.

• MeSH
• Anastomosis, Surgical MeSH
• Digestive System Surgical Procedures MeSH
• Humans MeSH
• Enterocolitis, Necrotizing pathology   surgery   MeSH
• Infant, Premature, Diseases pathology   surgery   MeSH
• Diseases in Twins MeSH
• Infant, Newborn MeSH
• Intestines pathology   surgery   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Infant, Newborn MeSH
• Publication type
• English Abstract MeSH
• Journal Article MeSH
• Case Reports MeSH

To evaluate the results of use of T-tube ileostomy in selected cases of intestinal perforation in extremely low birth weight (ELBW) neonates. The records of 288 ELBW neonates treated at author's institution, from 1998 to 2003 were retrospectively reviewed to identify neonates operated for intestinal perforation with T-tube placement. T-tube was inserted into the bowel through the site of perforation or proximally to the perforated gut via separate stab incision. T-tubes were used in five ELBW neonates (BW 600-900 g, gestational age 25-27 weeks) with intestinal perforation, in four of them at the time of primary surgery and in one neonate 8 days after primary anastomosis. All patients survived and there were no serious complications related to the T-tube insertion. Median duration of T-tube placement was 4 weeks (range 3-8 weeks), full enteral feeding after T-tube insertion was achieved in 4 weeks (range 1-6 weeks). All sites of T-tube insertion closed spontaneously. T-tube ileostomy is an effective and safe technique for treatment of selected cases of intestinal perforation in ELBW neonates. With respect to the hypoperistalsis of immature bowel, we recommend the use of T-tube in all cases of isolated intestinal perforation in ELWB neonates.

• MeSH
• Ileostomy methods   MeSH
• Humans MeSH
• Infant, Extremely Low Birth Weight MeSH
• Infant, Newborn MeSH
• Intestinal Perforation surgery   MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Infant, Newborn MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH