INTRODUCTION: Bariatric surgery has a significant impact on dietary intake, weight loss, patient's metabolism and also on defaecation stereotypes. AIM: To investigate changes in bowel habits of morbidly obese patients after laparoscopic sleeve gastrectomy (LSG). MATERIAL AND METHODS: This was a prospective clinical cohort study conducted to assess changes in bowel habits after LSG in a single institution. RESULTS: In total, 124 patients were enrolled in the study (age 47.1 ±11.2 years, body mass index (BMI) 44.3 ±6.8 kg/m2). The mean weight loss 6 months after LSG was 29.1 ±11.1 kg; percentage excess weight loss was 56.2 ±20.4%. Before surgery, 35.5% of patients had constipation and 6.5% of patients had faecal incontinence (FI). No correlation was found between rising level of BMI and constipation or incontinence prevalence/severity. Data analysis has not confirmed increased prevalence/severity of postoperative constipation or incontinence 6 months after LSG. Out of the group of patients with preoperative constipation, clinically relevant improvement was noted in 45.5% of patients after the surgery. Among patients without constipation before surgery, impairment was noted in 21.2% of patients. Out of the group of patients with preoperative incontinence, improvement was found in 37.5% of patients; none of these patients reported clinically relevant impairment of incontinence symptoms. CONCLUSIONS: The present study has not revealed increased prevalence/severity of postoperative constipation or anal incontinence 6 months after LSG. Our findings suggest that weight loss in patients after LSG might be associated with an improvement of constipation symptoms of individual patients.

• Klíčová slova
• constipation, defaecatory disorders, faecal incontinence, obesity, sleeve gastrectomy,
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The aim of the present study was to explore incidence and severity of parastomal hernia (PSH) formation during the first 2 years after open/laparoscopic abdominoperineal resection (APR). METHODS: This was a retrospective cohort study conducted in a single institution. All patients who underwent laparoscopic/open APR for low rectal cancer within a 10-year study period were assessed for study eligibility. RESULTS: In total, 148 patients were included in the study (97 patients after laparoscopic APR; 51 patients after open APR). There were no statistically significant differences between study subgroups regarding demographic and clinical features. The incidence of PSH detected by physical examination was significantly higher in patients after laparoscopic APR 1 year after the surgery (50.5% vs. 19.6%, p < 0.001) and 2 years after the surgery (57.7% vs. 29.4%, p = 0.001). The incidence of radiologically detected PSH was significantly higher in laparoscopically operated patients after 1 year (58.7% vs. 35.3%, p = 0.007) and after 2 years (61.8% vs. 37.2%, p = 0.004). The mean diameter of PSH was similar in both study subgroups. The incidence of incisional hernia was significantly higher in patients who underwent open APR after 1 year (25.5% vs. 7.2%, p = 0.002) and after 2 years (31.3% vs. 7.2%, p < 0.001). CONCLUSIONS: The risk of PSH development after laparoscopic APR appears to be significantly higher in comparison with patients undergoing open APR. Higher incidence of PSH should be considered a potential disadvantage of minimally invasive approach to patients with low rectal cancer.

• Klíčová slova
• Abdominoperineal resection, Colostomy, Incidence, Incisional hernia, Laparoscopy, Parastomal hernia,
• MeSH
• dospělí MeSH
• incidence MeSH
• incizní kýla epidemiologie   etiologie   MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory rekta chirurgie   MeSH
• pooperační komplikace epidemiologie   etiologie   MeSH
• proktektomie škodlivé účinky   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

BACKGROUND: Anastomotic leakage presents the most feared complication after low anterior resection (LAR). A proximal diversion of the gastrointestinal tract is recommended to avoid septic complications of anastomotic leakage. The aim of the present study was to evaluate the benefits and risks of diverting ileostomy (DI) created during laparoscopic LAR because of low rectal cancer. METHODS: This was a retrospective clinical cohort study conducted to assess outcomes of laparoscopic LAR with/without DI in a single institution within a 6-year period. RESULTS: In total, 151 patients were enrolled in the study (73 patients without DI, 78 patients with DI). There were no significant differences between both groups regarding demographic and clinical features. Overall 30-day morbidity rates were significantly lower in patients without DI (23.3 vs. 42.3 %, P = 0.013). Symptomatic anastomotic leakage occurred more frequently in patients without DI (9.6 vs. 2.5 %, P = 0.090); surgical intervention was needed in 6.8 % of patients without DI. Post-operative hospital stay was significantly longer in the group of patients with DI (11.3 ± 8.5 vs. 8.1 ± 6.9 days, P = 0.013). Stoma-related complications occurred in 42 of 78 (53.8 %) patients with DI; some patients had more than one complication. Acute surgery was needed in 9 patients (11.5 %) because of DI-related complications. Small bowel obstruction due to DI semi-rotation around its longitudinal axis was seen in 3 patients (3.8 %) and presents a distinct complication of DI laparoscopic construction. The mean interval between LAR and DI reversal was more than 8 months; only 19.2 % of patients were reversed without delay (≤4 months). Morbidity after DI reversal was 16.6 %; re-laparotomy was necessary in 2.5 % of patients. CONCLUSIONS: The present study indicates that DI protects low rectal anastomosis from septic complications at a cost of many stoma-related complications, substantial risk of acute surgery necessity and long stoma periods coupled with decreased quality of life.

• Klíčová slova
• Anastomotic leakage, Laparoscopy, Low anterior resection, Protective ileostomy, Stoma complications,
• MeSH
• anastomóza chirurgická metody   MeSH
• časové faktory MeSH
• chirurgické stomie MeSH
• chirurgie trávicího traktu metody   MeSH
• délka pobytu MeSH
• ileostomie metody   MeSH
• kohortové studie MeSH
• kvalita života MeSH
• laparoskopie metody   MeSH
• laparotomie MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory rekta chirurgie   MeSH
• netěsnost anastomózy epidemiologie   prevence a kontrola   MeSH
• pooperační komplikace epidemiologie   chirurgie   MeSH
• rektum chirurgie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• střevní obstrukce epidemiologie   chirurgie   MeSH
• studie případů a kontrol MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH