BACKGROUND The aim of this study were evaluated intraoperative and postoperative complication, and reasons for conversions among first 200 and last 200 procedures inside about 2 000 where we performed laparoscopic cholecystectomy in our clinic. MATERIAL AND METHODS Retrospective-prospective we analised overall complication rate, operative time and reasons for conversions in first and last 200 procedures where we performed laparoscopic cholecystectomy. We use the USA technique for operation with three troacars. Demografic dates about patients, intraoperative finding and hospital statistic was the same in both groups. RESULTS In the first group we have 8 (4%) intraoperative complications and 12 (4.8%) postoperative complications, the average operative time was 77.8 (+/- 12.01) minutes, and the number of conversions was 10 (5%). In first group we had two cases with intraopertive bleeding (1%), two cases with common bile duct injury (1%), three cases with adhesions (1.5%) and one cases of negative effects of resorption of CO2. In the second group we have 5 (2.5%) intraoperative complications, and 8 (4%) postoperative complications, the average operative time was 56.8 (+/- 12.03) minutes, and we done 5 (2.5%) conversions. The most important postoperative complications were: postoperative pancreatitis, deep veins thrombosis and postoperative abscess collection in both groups. We had statistically significant difference between first and last 200 procedures LC. Hospital stay were 3.10 (+/- 1.06) days for first, and 2.90 (+/- 67.09) days for second group. CONCLUSIONS Analyses of our results after first and last 200 patients showed lower rate of complications, conversions and reoperations in the second group. Our results we explain with better surgery technique, more experience of surgeons and better surgery equipment.

BACKGROUND In a very short time, malignant obstructions of distal choledochus cause a lot of damage to the liver function that may result in serious intra operative and postoperative complications and consequent high hospital mortality. Contradictory results with respect to the recovery of the liver function and origin of intra operative and postoperative complications lead us believe in the necessity of the evaluation of the preoperative placement of billiar stent in these patients, knowing that these patients see the doctor in the advanced stage of the disease with the relatively high level of the liver function damage. The goal of this research was a quantitative and qualitative analysis of intra operative and postoperative complications as well as high hospital mortality in both groups of subjects so that through this kind and scope of complications and mortality rate we could indirectly reach the conclusion relating to efficiency of the billiar stent placement. Another goal of the research was the analysis of liver tests before the operation and ten days after the operation with both groups of subjects so that, based upon the speed of their normalization, the conclusion could be reached in relation to the speed and level of the liver function recovery after the performed pancreatoduodenectomy. RESULTS The subjects from the first group had more expressed symptoms of jaundice and high temperature and fever whereas in respect to the other presented symptoms there was no statistically significant difference. Preoperative values of ALT and AST values and the total values of bilirubin and C-reactive protein were statistically significantly higher in the first group of subjects (p<0.05). Contrary to that, ALP and GGT enzymes value were higher but there was no statistically significant difference between the compared groups. After the operation the normalization of all mentioned parameters of the liver function occurs in both groups of subjects but ALT, AST, ALP and GGT enzymes values and total bilirubin values in the first group of subjects were closer to the reference values. Based upon these data we can conclude that the liver function recovery also was better and faster. By analyzing intra operative complications no statistically significant difference was found between the compared groups. The total ratio of postoperative complications was 32 %, compared to 40 %, which is not a statistically significant difference. With respect to fistula and infections there were no statistically significant differences. Other postoperative complications in both groups were almost equally present and are not statistically significant. CONCLUSION Better liver function recovery in the first group of subjects and the equal ratio of complications in both group of subjects, justifies the application of preoperative placement of billiar stent under our conditions.

Liver resections, because of its complexity, present a big challenge for every surgeon. A malignant diseases, which are the most frequent indications for this type of operations, additionally complicate job of the surgeons. Because the flag immunological system, in this type of patients, with reduced reserves of the liver, can have unforeseen postoperative consequence. The bleeding during and after operations presents one of the most difficult problems with liver resections. Introduction of the Pringle maneuver, reduce the risks for this operations to the minimum. The aim of this work at first is to analyze and compare functional parameters of the liver with or without intermittent hepatic pedicle clamping (HPC), for the purpose of the establishing invasivity and justification of its application. A statistical pattern was 30 patients with performed liver resections using intermittent HPC and 30 patients without using intermittent HPC, during liver resections. Results showed that performing liver resections with Pringle manuever do not have negative repercussions on the liver functions with less postoperative complications and postoperative hospital duration.

Most attacks of acute pancreatitis are self limiting, and the patients recover completely within days or weeks. In a few cases, however, the course is severe, with development of organ failure (single or multiple) and local complications such as necrosis, abscesses, and pseudocist. Between 01.01.2001-01.06.2004, 286 cases of acute pancreatitis were treated in our clinic. The purpose of this study is to represent indication for operative treatment of acute pancreatitis and its complications, according to the Atlanta classification. According to our date, the most frequent cause are changes on biliary tract. Of these 286 patients, 247 suffered from a mild or moderate type of acute pancreatitis and responded fully to medical treatment (215 patients) or to biliary tract surgery (32 patients). The hospital mortality of this group of patients was 2.4%. Surgery was indicated when the patients developed signs of an acute abdomen (9 patients), pancreatic pseudocyst (7 patients), progressiv icterus (2 patients), infection of pancreatic necrosis (10 patients), and pancreatic abscess (7 patients). Four patients with pancreatic necrosis were stable, and they had conservative treatment. The most difficult decision in the management of these patients is whether surgery is required and which of the complementary approaches to necrosectomy and drainage is appropriate. The hospital mortality of patients with severe acute pancreatitis was 28.2%. Multiple organ failure was the predominant cause of death.

Preoperative liver function have singificant influence on the morbidity and mortality, by performing liver resections. In addition to, intraoperative factors may contribute appearance, undesirable postoperative complications. Functional parameters, which we analized in this study (ALT, AST, albumins, bilirubin and prothrombin time), was measured preoperative and in the postoperative course. Study include 60 patients which are divided in two groups, at the basis Child-Pugh score, for the estimate operative risks. Results showes that, after liver resections frequently complications were in the group of patients with impaired liver functions, specially if the extensivity resections of the liver parenchyma, was the greatest.

Deduction of operation, holds in colorectal surgery, include good knowledge of anatomy and her connection in that area. Large bowel has special anatomy and functional mark. Intensive study of colorectal cancer bring about a new knowledge about anatomy of the large bowel, especially about vascular variations. We described the very importance characteristic of colon, rectum and anus in this article.

Locally advanced colorectal canter may require an intraoperative decision for the block resection of surrounding organs or structures to achieve complete tumour removal. This decision must weigh the risk of complications and death of multivisceral resection against a potential survival benefit. Little is known about the prognostic factors and their influence on the outcome of multivisceral resection for colorectal cancer. We demonstrate our experience with multivisceral resections for the primary colorectal cancer. Patients undergoing multivisceral resection for primary colon or rectal cancer between I-I.2000-I-VII.2003 were identified from retrospective database. Multivisceral resection was performed in 41 of 378 patients with a median age of 61 years. Postoperative rates of complications and death in 41 patients were 30.9% and 12.1%. Histologic tumour infiltration was shown in 58.3% of patients with curative resection. Multivisceral resection is safe, and long-term survival after curative resection is similar to that after standard resection. As the palliative resections cannot be predicted accurately at the time of surgery, every effort should be made to achieve complete tumour resection.

BACKGROUND Pulmonary function tests on the day after open upper abdominal surgery and cholecystectomy show decreases of 40% to 60% compared with preoperative determinations. In this prospective, study, we evaluated the pulmonary function during and after laparoscopic cholecystectomy (LC). PATIENTS AND METHODS Thirty patients were evaluated with preoperative and postoperative spirometry, arterial blood gas determinations and chast radiographs to quantitate the magnitude of postoperative pulmonary changes after LC. Spirometry and chast radiographs were made before and 24 h after operation. Blood gas analye were performed preoperative, and 24 h after operation. RESULTS Forced expiratory volume in 1 s (FEV: mean +/- SD values; preoperative: 3.12 +/- 0.78; postoperative: 2.33 +/- 0.80; P < 0.05), forced vital capacity (FVC; preoperative: 3.58 +/- 0.95; postoperative: 2.93 +/- 1.05; P < 0.05), peak expiratory flow (PEF; preoperative: 5.59 +/- 1.97; postoperative: 4.27 +/- 1.60; P < 0.05) and the midexpiratory phase of forced expiratory flow (FEF25-75; preoperative: 1.98 +/- 0.93; postoperative: 1.60 +/- 0.73; P < 0.05), were reduced 20-25% on average compared with preoperative values. Clinically important changes in arterial blodd gas values did not occur. Of 30 postoperative chest films, 9 showed the development of microatetelctasis. CONCLUSION Improved pulmonary function after laparoscopic cholecystectomy may account for the observed reduced rate of pulmonary complication after laparoscopic cholecystectomy.

AIMS Analysis of the reasons for reoperation after laparoscopic cholecystectomy. METHODS AND PATIENTS Retrospective-prospective analyses of the first 250 patients who undergone laparoscopic cholecystectomy. In 86% cases indication for operation was chronic calculosis of gallbladder. RESULTS Reoperation was performed at 6 patients (2.4%). The reasons of reoperation were: haematoma of gallbladder's loge (1), biliary fistulas (1), biliary peritonitis (1), abdominal abscesses (2), and perforated peptic ulcer (1). At 2 patients with intraabdominal abscesses, it was solved by laparoscopic drainage. The other complications were solved with laparotomy, also. We did not have lethal cases after reoperation. CONCLUSION Rate of postoperative complications was 2.4%, and all of them required reoperation. Our results are similar with results of the other authors.

In this paper, the authors analyzed the reasons for conversion of laparoscopic cholecystectomy (LH) into an open method (OH) in the group of 200 patients. In 8 (4%) patients the conversion of laparoscopic procedure was done. Reasons for conversion were the following: growth in abdomen (1.5%), empyema of gallbladder (1%), bleeding (0.5%), injuries of gallbladder tract (0.5%), and complications in pneumoperitoneum (0.5%). All complications because of which the conversion was performed were treated with classic surgical methods, and there were no death cases. The incidence of complications which required conversion of LH among our subjects is close to the reports of other authors with significantly larger number of patients.