Objective: In this prospective study, we evaluated the effects of pneumoperitoneum on hepatic function during laparoscopic (LC) and open cholecystectomy (OC). Subjects and Methods: One hundred patients who underwent LC (n = 50) or OC (n = 50) were included in the study. The groups were similar in age, sex, weight and height. Following liver function tests (total bilirubin; γ-glutamyltransferase, GGT; alkaline phosphatase, ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) were obtained preoperatively and at 24 and 48 h postoperatively. Similar anesthesiologic protocol was used for both LC and OC. During LC, the intra-abdominal pressure was maintained within the conventional range of 12–14 mm Hg. Results: Total bilirubin, ALP, GGT and LDH levels remained unchanged from baseline in both groups without significant difference between them. A higher number of patients had increased values of ALT (26/50 vs. 5/50) and AST (23/50 vs. 6/50) in LC compared to OC group. Although the difference was statistically significant (p < 0.000 for ALT and p = 0.0004 for AST) the increased level decreased at 48 compared to 24 h. Conclusion: The results indicate that LC is associated with transient elevation of ALT and AST. The disturbances in the function of the liver after LC are self-limited and not associated with any morbidity in patients with a normal liver function.

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.

Laparoscopic closure of an acutely perforated duodenal ulcer is an alternative procedure to open surgery. With proper training and experience this procedure might overtake laparotomy and simple closure thereby reducing the post operative morbidity in terms of reduced wound pain, short hospital stay, likely reduced wound sepsis and hernia occurrence and post operative chest complications. We report a 63-year old man with acute perforation of duodenal ulcer who were submitted to an emergency laparoscopic repair, first time done on the Department of Surgery, Univerisity Clinical Center of Tuzla.

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.

UNLABELLED The aim this study was to analyse our management bile duct injuries following laparoscopic cholecystectomy. PATIENTS AND METHODS This prospective-retrospective study presents six cases of major bile duct injuries that occurred in our first 1000 laparoscopic cholecystectomies. Neuhaus et al. classification was used in this study. RESULTS Bile duct injuries following laparoscopic cholecystectomy were identified at 6 patients, on 2 patients the lesions were identified during laparoscopic cholecystectomy. Four types of lesions were identified: 2 patients with peripheral bile leak from the cystic duct (A2), 1 patient with the complete occlusionn of the common bile duct (B2), 1 patient with lateral injury of the common bile duct(C2) and one with the right hepatic duct injury (C1), 1 patient with transection of the common bile duct (D1). A total of 6 patients with biliary injuries following laparoscopic cholecystectomy were treated at our institution: a hepaticojejunostomy was performed in 2 patients, the sutures with the use of a T-tube was performed in 2 patients, occlusion the cystic duct was performed in 2 patients. One patient after primary hepaticojejunostomy required secondary hepaticojejunostomy because of the late stricture of the anastomosis. At this writing, all the patients are well and without problems after 1 to 4 years of follow-up evaluation. CONCLUSION The small lateral injuries of the common bile duct and peripheral leakages can be treated endoscopically, the extended lateral injuries and complete bile duct transection require surgical repair. The treatment plan must be individualized for every patient, depending on the injury type and condition of the patient.

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.

Case record of patients with lung abscess treated by postural drainage is presented in this paper. In young man with multiple explosive injuries lung abscess was formed two months after injury. A postural drainage with parenteral application of antibiotics has been performed. The expectoration was painful. At the seventh day there was no temperature, ESR was described at the tenth day. The general status was becoming better. At the seventeenth day patient was discharged from Hospital. Rig imaging was shown nearly completely resolution of lung abscess. Postural drainage was effective because of favorable localisation of abscess near the large bronchus and basely part of the lung.