In contrast to classical appendectomy where the appendiceal stump is secured by a single or double ligature, in laparoscopic appendectomy various ways of securing the stump are mentioned. Each of these methods has advantages and disadvantages. Since different possibilities exist for closing the stump, it is very important to find the optimum method for closure of the appendiceal stump, bearing in mind their simplicity, biocompatibility and price. The aim of this review article has been to present the problem of securing the base of the appendix during laparoscopic appendectomy.

Introduction: Widespread opinion that penetrating chest injuries are more urgent, in terms of treatment and care, contributed to underestimation of the urgency of blunt chest trauma, which in most cases is treated conservatively. It remains an open question frequency when the injuries of the heart and pericardium are not timely diagnosed and surgically treated. Aim: To demonstrate the importance of well-timed surgical treatment of blunt chest trauma, when coupled with cardiac and pericardial injuries. Methods: At the Thoracic Surgery Clinic of the University Clinical Centre Banja Luka, Bosnia and Herzego vina, during period of 10 years (01.01. 2008 – 31.01.2018.), the total of 66 patients were treated for urgent thoracotomy due to clinically and radiologically unclear findings after blunt chest trauma. In general, diagnostic examinations, apart from laboratory analysis, included radiological imaging and Multi Slice Computed Tomography (MSCT) of the chest, followed by an ultrasound of the heart in cases when sternum was injured or when pericardial tamponade was suspected. Results presented in the study where obtained from the retrospective analysis of patients data. This work presents a retrospective observational cross-sectional study, which results in the assessment of the correctness of a particular diagnostic test. Statistical methods used: descriptive statistics, counting measures (frequencies and percentages), central tendency measures (arithmetic mean), variability measures (standard deviation). Results: Sixty six patients were treated with urgent thoracotomy after a blunt trauma of the chest due to the unclear clinical and radiological finding. In the case of 11 patients (10 men and 1 woman), presenting 16.6% of the total sample, pericardial and cardiac injuries were detected and treated intraoperatively. Further, in the case of the one patient, pericardiotomy and suturing of the right heart chamber where performed, with the creation of a pericardial window. Transthoracic echocardiogram was not used as the primary screening module, but rather as a diagnostic test for patients who had unexplained hypotension and arrhythmia. Radiographs of the chest showed cardiomegaly with or without epicardial fat pad sign suggesting a pericardial effusion. Conclusion: Blunt cardiac and pericardial injuries represent a serious therapeutic problem, which, if not treated properly, result in a high mortality rate. Echocardiography is the primary diagnostic method for initial detection of pericardial effusion. Pericardial fluid first accumulates posterior to the heart, when the patient is examined in the supine position. As the effusion increases, it extends laterally and with large effusions the echo-free space expands to surround the entire heart. The size of the effusion may be graded as small ( echo free spaces in diastole <10 mm, corresponding to approxymately 300 ml), moderate (10-20 mm, corresponding to 500 ml), and large ( >20 mm, corresponding to >700 ml). When the ability of the pericardium to stretch is exceeded by rapid or massive accumulation of fluid, any additional fluid causes the pressure with the pericardial sac. Early recognition, pericardiotomy with pericardial window creation and/or ventricular rupture suture remain the “gold standard” in the treatment of blunt cardiac and pericardial injuries.

Introduction: Laparoscopic cholecystectomy is now considered the procedure of choice that achieves a shorter recovery period after the surgery and reduction in the cost of treatment. Aim: The aim of the study is to prove which method: early or delayed laparoscopic cholecystectomy is the method of choice in the treatment of acute cholecystitis by examining: duration of hospitalization, conversion rate, duration of surgery, postoperative complications, and total cost. Methods: The study was conducted at the University Clinical Center of Republika Srpska as a retrospective-prospective study from May 1st 2013 until December 31st 2019. Patients diagnosed with acute cholecystitis were divided into two groups: Patients designated for early laparoscopic cholecystectomy within 72 hours of admission (group A–42 patients), Patients designated for initial conservative treatment followed by a delayed interval of 6-12 weeks until surgery (group B-42 patients). Results: In both groups, there were statistically significantly more female respondents. The results showed that the average cost of treatment in the early treated group was statistically significantly lower than the cost of treatment in the delayed treatment group. The patients in the early group had shorter hospitalization times (an average of 2.8 days and 5.6 days in the delayed group of patients), a smaller percentage of conversions (4.8% in the early and 16.7 in the delayed group of patients), the total cost of in the early group it was 1300.83 KM, while in the delayed group it was 1645.43 KM. Conclusion: Early laparoscopic cholecystectomy is a method to be preferred in surgical treatment.

Background/Aim: Benign prostatic hyperplasia (BPH) is a very common disease in older men. BPH involves the presence of signs of hyperplasia of the stromal and epithelial elements in the prostate with consequent enlargement of its volume. The aim of this study is to analyse the frequency of typical complications in the treatment of patients with benign prostatic hyperplasia and the effect of medicamentous treatment. Method: Patients diagnosed BPH were included in the prospective, one-year study. They were divided into 2 groups. The first group (30 patients) consisted of those ones, whose prostate volume was equal to or over 50 cm 3 , while and the second group (30 patients) comprised the subjects with prostate volume less than 50 cm 3 . The complications of BHP analysed are residual urine (RU), symptomatic urinary infection, haematuria, thickening of the detrusor wall, diverticulum in the bladder, ureterohydronephrosis, renal failure, bladder stone and acute urinary retention (AUR). Results: The majority of patients in both groups were aged 60-69. There was a statistically significant difference in the average value of RU between the groups at the first, second and fifth check-ups (p < 0.05), as well as the complication of symptomatic urinary infection, since the same occurred earlier in the first group than in the second group (p < 0.05). There was no statistically significant difference in complications: haematuria, detrusor wall thickening and diverticulum (p > 0.05). Complications: ureterohydronephrosis, renal failure, bladder stone, and AUR were not diagnosed in patients in either group. Conclusion: Relevant medical therapy leads to a reduction of RU and reduces the risk of complications caused by its presence. Other complications of BPH were rare or absent in both groups, suggesting that appropriate and timely applied medical therapy affects the course of BPH and reduces the risk of complications and the need for surgical treatment. Benefit from medicamentous therapy is equally repre-sented in both analysed groups of patients.

Background/Aim: Colorectal metastatic liver tumours are the most common secondary liver tumours. During the life of patients with colorectal tumorous, this liver metastases will develop either synchronously or metachronously in half of the patients. Approximately 25 % of patients with colorectal cancer diagnosis have secondary deposits in the liver and the additional 25 % of patients will develop metastases within five years. The objective was to investigate whether anatomic resections of the liver present a method of choice in surgical treatment of colorectal liver metastases compared to metastasectomy surgery. Methods: A total of 65 patients were divided into two groups. Patients in the first group underwent metastasectomies consisting in the removal of metastases and the surrounding liver parenchyma no more than 1 cm by Kelly clamp crushing technique or LigaSure vessel-sealing system. Patients in the second group were subjected to the anatomic resection of the liver where not only metastases were removed, but also the associated anatomical segment or section or half the liver, depending on the number and localisation of metastases. Results: The mean values (± standard deviation) of the overall survival for the first and the second group were 36 ± 4.8 months and 36 ± 2.6 months, respectively. The mean values (± standard deviation) of the disease-free survival in the first and in the second group were 18 ± 2.22 months and 22 ± 0.74 months, respectively. None of the found inter-group differences were statistically significant. Conclusion: It can be concluded that metastatic surgery for colorectal liver metastases and anatomic resections have almost the same results and are irreplaceable methods in the treatment of colorectal liver metastases.

Background: Tablet splitting is commonly used in clinical practice as a way to attain a desired drug dose and/or reduce its side effects, particularly among paediatricians and psychiatrists. However, uneven tablet scoring can lead to significant fluctuations of the administered doses, where subpotency or superpotency of drugs might harm the patients. The aim of this study was to evaluate the influence of tablet splitting on dose uniformity of diazepam by the utilisation of Ph. Eur. 9.0 and FDA recommendations. Methods: Mass variation of whole and half-tablets in parallel with the determination of their content uniformity were performed according to the pharmacopoeial methods. The weight loss after tablet splitting was assessed by employing FDA guidelines. It was also investigated if tablet splitting influenced the in vitro dissolution properties of diazepam tablets. Results: Diazepam whole tablets fulfilled the pharmacopoeial requirements in regard to all the investigated properties. The weight uniformity of scored diazepam tablets ranged from 63.80% to 122.55% label claim. The losses of mass after splitting diazepam tablets were 5.71%. Despite the average content of diazepam in half-tablets was found to be 104.24% label claim, the requirements of Ph. Eur. were not fulfilled. Diazepam content in half-tablets ranged from 0.76 mg to 1.21 mg, thus, patients might receive doses that vary by as much as 45%. However, after weight adjustment, diazepam content in each of the tested half-tablets was in the range of 85-115% of the average drug content meeting the Ph. Eur. criteria. Dissolution profiles of whole and half-tablets were found to be similar, following the Hixson-Crowell kinetic model. Conclusion: According to the results, splitting of diazepam tablets greatly influenced the drug content in the obtained parts, ie the dose accuracy was fully dependent of the ability to score the tablet into exactly equal halves.

Background/Aim. Surgeon-specific experience as measured by procedure volume can have a significant impact on survival of patients with rectal cancer (RC). The aim of this study was to determine whether an individual surgeon-specific volume of procedure influences early postoperative outcomes as well as to determine the strength of different groups of annual surgeon volume (ASV), as a predictor of outcomes in patients after RC resection up to 30 days postoperatively. Methods. This retrospective observational single center study involved a cohort of 546 patients of both sexes, operated for a 10-year period due to RC. Patients were divided into three groups, according to the annual volume of RC procedures of a surgeon who operated them. Seven outcomes were analyzed: the incidence of colorectal anastomotic dehiscence (CRAD), operative time, intraoperative blood loss, hospital stay, in-hospital death, the status of the circumferential resection margin (CRM) and the total mesorectal excision (TME) with number of lymph nodes, as well as some risk factors (several independent, dependent and ?confusing? variables) of importance for the outcome, to explain the difference. The strength of each group of surgeons and their effect on early outcome of treatment were determined. Results. The majority of surgeons (77.7%) belonged to the low and medium ASV, which performed a slightly higher number of surgeries (281) than the high volume group. The high-volume surgeon group was associated with significantly better results in four outcomes (CRAD, operating time, CRM, TME and number of lymph nodes). Conclusion. In our surgical institution, the high volume surgeon remains an important predictor of success of the RC surgery.

Spontaneous spleen rupture rarely occurs, and is primarily present in patients with splenomegaly. This is a life-threatening condition that, without adequate surgical treatment, always ends lethally. The very etiology of spontaneous atriumatic spleen rupture is not known, but it can often be associated with neoplastic diseases, liver cirrhosis, and some infectious diseases. Diagnosis is made by non-invasive methods (findings of red blood cell elements, ultrasonography, computerized tomography of abdominal CT, magnetic resonance NMR). The therapy consists of laparotomy, evacuation of the haemorrhagic content and removal of the spleen. Surgical treatment is successful, and as a postoperative complication, bleeding may occur as a result of inadequate care of the laryngeal artery and vein, and short gastric blood vessels. Here we presented a 58- year- old male patient who, due to a marked abdominal pain, low blood pressure, and low blood cell counts, was taken to hospital and successfully surgically treated at the Clinic for General and Abdominal Surgery.

Situs viscerum inversus totalis is a rare condition in which organs are transposed from the normal side to the opposite side in the abdominal and chest cavity. It occurs in a ratio from 1:5000 to 1:20000. In this case report, a case of a 50-year-old man who was diagnosed with the symptomatic presence of gallstones with the usage of ultrasound. The patient underwent the laparoscopic cholecystectomy, the surgical procedure lasted for 90 minutes, it was successfully completed and the patient was discharged on the first postoperative day.