Background: Urgent surgical treatment of bleeding gastric and duodenal ulcer is indicated in cases where there is no treatment by an interventional gastroenterologist and radiologist readily available, or there is no satisfactory response to the applied interventional procedure. Objective: The aim of our study is to show that there is the still large number of patients with massive bleeding gastric or duodenal ulcers who had to undergo emergency surgery, in order to achieve hemostasis, provide survival analisys, and to present a methode of the surgical procedure which we perfomed. Methods: This study analysed 49 patients in the period of 5 years (2013-2018), who underwent emergency surgery due to bleeding ulcer. All patients had one or more gastroscopies in order to stop the bleeding, which were ineffective. Surgical treatments which are used in managing ulcer bleedings depended on the localization of the lesion and how severe the bleeding is. Indicated treatment is direct compression of a bleeding blood vessel (ulcer niche), truncal vagotomy, pyloroplasty, gastroduodenal artery ligature, ligature of the right gastroepiploic artery. Resection procedures were performed as well: antrectomy, proximal, subtotal and total gastrectomy. All surgical treatments aimed to preserve the patients of gastrointestinal tract where such an approach could be carried out. Results: There were total of 49 patients who underwent surgical treatment of bleeding ulcer of which 31 are male (63,27%) and 18 are female (36,73%). The survival was 38,78% (19 patients); mortality 61,22% (30 patients). The most common surgical treatment was direct suture of a bleeding vessel with a ligature of the gastroduodenal and right gastroepiploic artery. When we observe the results of resection procedures subtotal gastrectomy was most commonly used. Surgical procedure performed were bilateral vagotomy, ligature of gastroduodenal and right gastroepiploic artery if the ulcer is localized in the antral, pyloric or duodenal region and not penetrating showed that there is no need for gastrotomy/duodenotomy and direct suturing of the bleeding vessel significantly reduces operative procedure, and saves the patient from additional surgical trauma and allows the desired hemostasis. In 5-10% of patients with bleeding ulcers, emergency surgery is indicated due to massive bleeding and hemorrhagic shock and then surgery is the only chance of survival. The primary goal of any surgery for bleeding ulcer is to establish bleeding control. massive ulcer bleeding. All these patients did not have the opportunity to avoid surgery and stop the bleeding with the treatment of an interventional gastroenterologist and radiologist. Survival is 38.78%, mortality is still high 61.22% but it is encouraging that without the application of surgical treatment it would be 100% in this group of patients. Conclusion: Regardless of the risk posed by surgical treatment of a bleeding ulcer, it still brings the patient the only chance for life in cases when the interventional radiological and gastroenterological approach has failed or been disabled. Surgical treatment of bleeding ulcer in cases when the gastroenterological and radiological approach is insufficient or disabled - Single center experience.

Background: Cholelithiasis is one of the most common issues affecting the gastrointestinal tract. The prevalence of cholelithiasis ranges from 11% to 36%. The prevalence is found to be associated with a number of factors including age, gender and ethnicity. Women have three times higher risk of developing this condition in comparison to men. Objective: This The aim of this study is to prove that occurrence of early and late postoperative complications is lower in patients who had three metal clips placed on cystic artery and ductus cysticus in comparison to the patients who had two metal clips placed. Methods: In this retrospective study we included all the patients who underwent acute laparoscopic cholecystectomy between January 1st 2021 and December 31st 2022 at the Department of Abdominal Surgery of University Clinical Centre Tuzla. Total number of patients included in the study is 148. A total of 1200 laparoscopic cholecystectomies were performed, of which 1052 patients had chronic calculus cholecystitis, and the performed laparoscopic cholecystectomies were part of elective surgical procedures. Remaining 148 patients had acute calculus cholecystitis, and were admitted and operated laparoscopically in an emergency protocol. Results:: Out of total amount of 82 laparoscopic surgeries were performed with the placement of two clips on the cystic artery and cystic duct, and 66 laparoscopic cholecystectomies with the placement of three clips on the cystic artery and cystic duct. Out of a total of 82 patients who were implanted with two clips, 6 of them had some of the postoperative complications. In the group of patients who had three clips implanted, none of the 66 subjects had any postoperative complications. Conclusion:: The study confirms that patients who underwent placement of three clips had lesser odds of developing complications, and that this occurrence is not accidental but rather a consequence of the choice of the surgical method.

Enteric viruses are commonly found obligate parasites in the gastrointestinal (GI) tract. These viruses usually follow a fecal-oral route of transmission and are characterized by their extraordinary stability as well as resistance in high-stress environments. Most of them cause similar symptoms including vomiting, diarrhea, and abdominal pain. In order to come in contract with mucosal surfaces, these viruses need to pass the three main lines of defense: mucus layer, innate immune defenses, and adaptive immune defenses. The following atypical gastrointestinal infections are discussed: SARS-CoV2, hantavirus, herpes simplex virus I, cytomegalovirus, and calicivirus. Dysbiosis represents any modification to the makeup of resident commensal communities from those found in healthy individuals and can cause a patient to become more susceptible to bacterial and viral infections. The interaction between bacteria, viruses, and host physiology is still not completely understood. However, with growing research on viral infections, dysbiosis, and new methods of detection, we are getting closer to understanding the nature of these viruses, their typical and atypical characteristics, long-term effects, and mechanisms of action in different organ systems.

INTRODUCTION Bosnia and Herzegovina (B&H) belongs to the countries of the Western Balkan located in Southeast Europe with an area of 51 129 km. The country is located in the continental part of Europe and extends to the Adriatic Sea. B&H is bordering Croatia in the north, west, and south; in the east, the country is bordered by Serbia, in the southeast by Montenegro, and in the southwest by the Adriatic Sea (Figure 1). According to the 2013 population census, B&H has 3 531 159 inhabitants, which is significantly less than in the 1991 census when the country counted 4 377 033. There are 2 219 220 people living in the Federation of B&H and 1 228 423 in the Republic of Srpska, and 83 880 people live in the Brčko District.

The association between urine amylase levels and the development of post-operative complications after Whipple resection is still unknown. The aim of this study was to determine the prognostic value of urine amylase levels for post-operative complications in patients who underwent Whipple resection. In this retrospective-prospective cohort study we analyzed amylase levels in urine, serum, and drains in 52 patients who underwent Whipple resection preoperatively and on Post-operative Day 1 (POD1) after the intervention. Patients were followed up for 3 months to assess their predictive value for post-operative complications. In patients with complications, urine amylase levels were significantly higher on POD1 than before resection (198.89 ± 28.41 vs. 53.70 ± 7.44, p=0.000). Considering the sensitivity and specificity of the urine amylase level on POD1, an area under the ROC curve of 0.918 was obtained (p<0.001, 95% Confidence interval [CI]: 0.894-0.942). Patients with urine amylase levels ≥140.00 U/L had significantly higher risks of post-operative pancreatic fistula (POPF) grade C (definition of POPF done according to the ISGP) (RR:20.26; 95% CI: 1.18-347.07; p=0.038), readmission to hospital (RR: 6.61; 95% CI: 1.53-28.58; p=0.011), reoperation (RR: 5.67; 95% CI: 1.27-25.27; p=0.023), and mortality (RR:17.00; 95% CI: 2.33-123.80; p=0.005) than patients with urine amylase levels <140.00 U/L. Urine amylase levels on POD1 displayed strong and significant positive correlations with serum amylase levels (r=0.92, p=0.001) and amylase levels in drains (r=0.86, p=0.002). We can conclude that urine amylase levels on POD1 have good prognostic value for post-operative complications after Whipple resection and might be used as an additional predictive risk factor.

Introduction: Cancelling elective procedures on the day of surgery presents a constant problem in all higher-level medical facilities, and the research of causes, consequences and possible solutions is the duty of every facility in order to enhance the quality of healthcare services. Methods: This prospective study included all patients that were scheduled for surgery from March 2016 to November 2018 in the operating rooms at our Department of Surgery, including both performed and cancelled cases. Cases by different surgical departments (general surgery, gynecology, orthopedics, urology, plastic surgery, ophthalmology and otorhinolaryngology) were all included. Results: Out of 8201 planned elective procedures from March 2016 to November 2018 at the General Hospital “Abdulah Nakas”, 7825 cases were performed and 376 cases (4.58%) were cancelled on the day of surgery. The most common reasons for cancelling a surgical procedure on the day of surgery were: lack of time to perform surgery, (33.51%), surgery cancelled due to medical/anesthetic reasons, (31.38%), surgical procedure cancelled by the surgeon on the day of surgery, (11.97%). Conclusion: This study has shown that the percentage of elective cases cancelled on the day of surgery at our institution stands at an acceptable 4.58%. The most common reasons for case cancellation on the day of surgery were identified. The majority of reasons for cancellation were avoidable, which means that appropriate steps could contribute to lowering the percentage of cancelled elective cases and an improved quality of healthcare services.

Cholecystostomy is considered to be a treatment option when conservative treatment of acute cholecystitis failed in elderly and critically ill patients. The aim of this paper is to present a cholecystostomy in the treatment of obstructive jaundice before the definitive operation for the underlying cause of jaundice. The patient in poor general condition with the obstructive jaundice was diagnosed to have a pancreatic head tumor. He had undergone the laparoscopic cholecystostomy. After improvement of the general condition and lower total bilirubin level, the patient had undergone to definitive procedure. It is shown that laparoscopic cholecystostomy can be a successful way for adequate bile drainage in a patient with poor general condition before the definitive treatment of obstructive jaundice.

Aim: Resection surgery on the colon and rectum are changing both anatomical and physiological relations within the abdominal cavity. Delayed functions of the gastrointestinal tract, flatulence, failure of peristalsis, prolonged spasms and pain, limited postoperative recovery of these patients increase the overall cost of treatment. Early consumption of coffee instead of tea should lead to faster restoration of normal function of the colon without unwanted negative repercussions. Method: This study is designed as a prospective-retrospective clinical study and was carried out at the Surgery Center Tuzla, during the year 2013/ 2014. Sixty patients were randomized in relation to the type of resection surgery, etiology of disease-malignant benign, and in relation to whether they were coffee users or not. Patients were divided into two groups. The first group of thirty patients was given 100 ml of instant coffee divided into three portions right after removing the nasogastric tube, first postoperative day, while the second group of thirty patients got 100 ml of tea. Monitored parameter was: time of first stool and the second group of monitored parameters was: whether there was returning of nasogastric tube or not, increased use of laxatives, whether there was anastomotic leak, radiologic and clinical dehiscence, audit procedures, or lethal outcomes in the treatment of patients. Results: A total of 61 patients were randomized into two groups of 30 int he group of tea and coffee 29 in the group, two patients were excluded from the study because they did not consume coffee before surgery. Time of getting stool in the postoperative period after elective resection surgery on the colon and rectum is significantly shorter after drinking coffee for about 15h (p <0.01). Also, the length of hospital stay was significantly shorter after drinking coffee (p <0.01). Time of hospitalization in subjects/respondents coffee consumers on average lasted 8.6 days with consumers of tea for 16 days. The incidence of postoperative complications was significantly lower after consumption of coffee (p <0.05). Conclusion: Postoperative consumption of coffee is a safe and effective way to accelerate the establishment of the bowel function after colorectal resection surgery.

Background. The role of multivisceral resection, in the setting of locally advanced gastric cancer, is still debated. Previous studies have reported a higher risk for perioperative morbidity and mortality, with limited objective benefit in terms of survival. Patient. A male patient, 55 years old, was admitted to the clinic of surgery for surgical treatment of bleeding gastric ulceration. Preoperative diagnostic evaluation was performed, and patient had undergone a surgical treatment which revealed a large mass in head of the pancreas, infiltrating the hepatoduodenal ligament and transverse mesocolon. Total gastrectomy, duodenopancreatectomy, and right hemicolectomy were performed. The digestive tube continuity was reestablished by deriving the double Roux limbs. Conclusion. The aim of this case presentation is to demonstrate a method of digestive tube reconstruction by performing the double Roux-en-Y reconstruction in advanced gastric cancer when the multivisceral resection is performed.

Introduction: Pancreatic injuries are not common after blunt and penetrating trauma, but can be challenging to diagnose and manage. Case report: Twenty-three year old man, injured during a fall from a motorcycle two days earlier, was admitted to Department of Surgery, University Clinical Centre Tuzla because of suspicion of pancreatic trauma. Immediately after hospitalization, patient underwent laboratory and radiological tests that revealed the existence of pancreatic trauma, so we opted for urgent surgical treatment. Surgery and early postoperative course were normal and the patient was discharged on the ninth postoperative day. Conclusion: Proper diagnosis and well-selected surgical treatment significantly increases the chances for recovery of these patients.