A 16-year-old girl with an asymptomatic large splenic cyst. The disease was discovered by an accidental ultrasound of the abdomen due to a urinary infection. The patient was followed up conservatively for 3 years, and after the gradual enlargement of the cyst, laparoscopic surgery was indicated. The operation and postoperative follow-up for a period of 6 months is satisfactory.

Introduction: The role of Radio frequent Generator (RF) has been extended from simple tumor ablation to routine hepatic resection. RF energy precoagulates the tissue and thus allows the closure of small blood vessels and bile ducts. The development of surgical techniques and modern technological advances have enabled liver resections to be significantly surgically better controlled in the sense of bleeding, and are more successful and safer for patients. The RF generator has its advantages and disadvantages and as such can be equally used in resective liver surgery. Aim: Display the intraoperative and postoperative complications among patients that had been subjected to liver resection using a RF generator (RF resection), compared to those that had been subjected to liver resection without the use of RF generators (classical liver resection methods of CC resection). Material and methods: The study included 60 patients of both sexes which had resective operative surgery or metastasectomy on the liver due to the basic process. The study was conducted at the Clinic for General and Abdominal Surgery of the Clinical Center of the University of Sarajevo in a four-year period. The study was designed as a comparative study of outcome and postoperative complications of surgical treatment, i.e. resective liver interventions using two operating techniques (RF–liver resection and Classical resection techniques on the liver). Results: The highest number of surgical procedures was due to colorectal cancer. A slightly smaller number was performed due to primary liver cancer and gallbladder cancer. The highest number of surgical interventions remain on non-anatomic resections. Smaller number remains to large resective operations. The length of hospitalization was significantly correlated with blood loss (r = 713 p = 0,000) and the average hospitalization time ranged from 10.5 to 53.3 days. Conclusion: We have shown that the use of RF generators does not significantly reduce intraoperative and postoperative complications. There is a justification for using both techniques for resection on the liver. The resective liver operation depends mostly on the personal stance and the surgeons training.

INTRODUCTION Liver is made up of functionally indipendent parts or segments, and segmentation is based on course and ramification of blood vessels and bile ducts whereby each segment represents separate territory of the liver. Most severe complication is a postoperative liver insufficiency that demands complex treatment, is followed by high mortality and demans specific treatment including liver transpaltation. MATERIALS AND METHODS Study was designed as retrospective and included patients who underwent liver resection at Clinic for abdominal surgery of Clinical Centre University Of Sarajevo (CCUS) during period 2010-2012. The study included 44 patients at the Clinic of abdominal surgery. RESULTS There were 6 (13.6%) hepatocellulare carcinomas, also 6 (13.6%) echinococcus cysts, the rest (72.8%) were different liver tumors. In the study group, following complication have been percepted; biliary leak (defined as the level of bilirubine in drainage fluid exceeding 5.0 mg/dl (> 85 micromol/l) more than 7 days), postoperative hipoalbuminemia, the need for reintervention as well as letal outcome. Complications were percepted in 7 patients (15.9%). In patient with no complication the lenght of hospitalization was 8-12 days while in thoose with complications hospitalization was prolonged to max 25 days. CONCLUSION Majority of resections have beed done due to metastatic tumors, slightly lower number due to primary tumor (hepatocellulare carcinoma). Postoperative complications correlated with older age, comorbidity and higher blood loss during operation. One of the most often complications in our casuistics was biliary leak.

INTRODUCTION Polytrauma is defined as an injury where they are affected by at least two different organ systems or body, with at least one life-threatening injuries. Given the multilevel model care of polytrauma patients within KCUS are inevitable weaknesses in the management of this category of patients. OBJECTIVE To determine the dynamics of existing procedures in treatment of polytrauma patients on admission to KCUS, and based on statistical analysis of variables applied to determine and define the factors that influence the final outcome of treatment, and determine their mutual relationship, which may result in eliminating the flaws in the approach to the problem. MATERIAL AND METHODS The study was based on 263 polytrauma patients. Parametric and non-parametric statistical methods were used. Basic statistics were calculated, based on the calculated parameters for the final achievement of research objectives, multicoleration analysis, image analysis, discriminant analysis and multifactorial analysis were used. From the universe of variables for this study we selected sample of n = 25 variables, of which the first two modular, others belong to the common measurement space (n = 23) and in this paper defined as a system variable methods, procedures and assessments of polytrauma patients. RESULTS AND DISCUSSION After the multicoleration analysis, since the image analysis gave a reliable measurement results, we started the analysis of eigenvalues, that is defining the factors upon which they obtain information about the system solve the problem of the existing model and its correlation with treatment outcome. CONCLUSION The study singled out the essential factors that determine the current organizational model of care, which may affect the treatment and better outcome of polytrauma patients. This analysis has shown the maximum correlative relationships between these practices and contributed to development guidelines that are defined by isolated factors.

Polytrauma is defined as injury that have affected at least two different organ systems or organs, with at least one of them is life-threatening. It as a sum of severe anatomical and functional impairments, whose evolution is difficult to predict and often questionable outcomes. According to statistics obtained from MTOS (Major Trauma Outcome Study) and TARN (Trauma Audit Research Network) totals up to 10% of all hospitalized injuries. Accompanied by a high mortality rate, especially in the population of young and middle-aged, which in the levels of the organization of our health service is 25-35%. The causes of polytrauma are numerous, and the most common consequence of road accidents, falls, violent crimes with the actions and use of weapons, natural disasters, wars, mining accidents etc. The mortality rate in polytrauma depends on many factors related to all levels of care polytraumatised person in the organization of the health system. According to data from the NTDB ACS for 2004. mortality rate in polytrauma was 18,04% (with ISS value 16-24, mortality rate was 6,21%, and with ISS value >24 mortality rate was 33,05%). TARN data it has about 17,7%. The aim of our study is to make the quantification of polytrauma in a five-year period (2000. to 2004.) taken care of at the Clinical Center University of Sarajevo, to process data received by multiple scoring for each individual patient and to calculate and display total mortality rate in the sample with the comparison of results from the MTOS and TARN baseline norms.

Carcinoma pancreas takes fourth place based on the representation of carcinoma digestive methodology. Morbidity is about 16% of total morbidity carcinoma digestive system. Early discovery is relatively tough and resection in comparison to discovered cases amounts only 2-5% cases, and in the last period it increased from 10-15%. According to the data of different authors, localization of tumor in the head of pancreas is between 70% and 84% cases. Two times is more often on the male individuals. When we are talking about contraindications of cephalic duodenopankreatectomy in each case absolute contraindication is considered present of liver metastasis and carcinoma peritoneuma. Most of the authors, mainly, present general contraindications such as: resection of lazier, ascit and general condition of patient. Contraindication for the operation is extended ikterus with albminima below 30 g/l. This type of exam shows serious damage of the function of liver. Elison and sur in 1984 noticed that preoperative bilijarna decompresy can decrease postoperative mortality up to 30%, which refers to all operations as well as palliative and radical. Older patients (above 70 years) with pre-comatose or comatose conditions and the patients with the size of the tumor of head pancreas above 1.5 cm, as well as patients with infiltration of veins mesenteric or ports are considered inoperative since resection of large blood veins as well as total pankreatektomia is not prolonging life of patient. Mortality on the cephalic duodenopankreatectomy is oscillating and in the literature data it is found from 10%, and above 30% and in high specialized institutions about 5% or even 0%. According to the statement of the clinic Mayo in 89 cases surviving above five years has been less then 5% and average survival was 1.03 years. Hower is mentioning that five year survival in USD amounts about three pro mile. In our subject we have analyzed operated cases in one year. For the whole year it was operated 14 patients. Considering the number of citizens which are treated at KCUS, it is higher number from the statistics found in the literature. Only one patient had bilirubin, which was within normal limits, while all other patients were operated with increased value of bilirubin. Albumins below 30 g/l were present on the four patients. Ten patients had the size of tumor above 2 cm. One patient after post operation died which amounts to 7, 14% cases and coincides with the facts from the literature. In the conclusion indication for the radical operative treatment of tumor of head pancreas are expanding and operative mortality is decreasing.

OBJECTIVE To evaluate the influence of the laparoscopic tehnique in healing of hernia from the perspectives of time to full recovery, return to work and complications. TYPE OF STUDIES: Randomized, prospectiv study. All relevant factors, should be important to evaluate operative method. Laparoscopic operative treatment has several advantages over classical operative techniques. Main advantage is less tissue damage and consequently less possibility of postoperative complications. Furthermore, period of rehabilitation for patient is shorter, with less pain and shorter period for recovering. PATIENTS AND METHODS A group of 60 qualified patients was formed with non complicated inguinal hernia. Patients of both gender, aged 19-68, were preoperatively examined. Intraoperative wounds during operation were defined as an intraoperative complications. In postoperative course complications were divided on immediate, early and late postoperative. Patients were re-examined during hospitalization, in the periods of one month, six month, one year and two years after operation. RESULTS We had no intraoperative complications. Two immediate complications were observed scrotal swelling and hematoma. Two early postoperative complications were also noted a general disuric complication and purulent wound inflammation. As well we have noted only one late complication; pain in inguinal region. We had two relapsing hernias. Duration of hospital treatment was 1-7 days with average of 2,5 days for examined group. Overall absence was 10 day and patients were back to job under full physical activities. CONCLUSION In non complicated inguinal hernia, laparoscopic tehnique have less complications than classic methods, shoter time to full recovery and to return to work.

Operations malignity on the colon and rectum belong into a group of risky operational treatment, which has a high percentage of early postoperational complications in comparison to the other operational treatments in digestive surgery. To determine the precentage of the postoperational complication of the resectional treatment on the colon and rectum, obtained results compare with the experience of the other authors. Analysed 439 patients operated from malignity on the colon and rectum in five year period (1998-2002). Bleeding after the postoperation had 8 patients (1.82%). Dehiscentio anastomosis has been evident in 21 patient (4.78%). Interintestinal apscess has been evident in 4 patients (0.91%). The infection of operational would of the 45 patients has been (10.25%). Dehiscentia of the operational wound of 10 patients has been (2.27%). Ileus in early postoperational stage has been evident in 16 patients (3.64%). The Total number of reoperation based on the analysed complications has been evident in 50 patients (11.38%). As e conclusion we can see that ours results coincides with the experience of the other authors.