Összefoglaló. Bevezetés: A vastagbél-diverticulosis a lakosság kb. 60%-át érinti, incidenciája folyamatosan növekszik. A betegek 6%-ánál van szükség sebészi beavatkozásra. Jelenleg nincs egységes irányelv, mikor indokolt elektív műtétet végezni. Módszer: Retrospektív módszerrel elemeztük az osztályunkon 2017. július 17. és 2020. április 30. között vastagbél-diverticulosis miatt operált betegek demográfiai és műtéti adatait, emellett a szövődmények arányát. Összehasonlítottuk az elektív (EM) és a sürgős műtétek (SM), illetve a nyitott és a laparoszkópos műtétek adatait. Eredmények: 38 operált beteg közül 19-nél történt EM, illetve 19 betegnél SM. A betegek átlagéletkora az EM-eknél 64 év, az SM-ek esetében 67 év volt. EM-nél az indikáció 12 esetben recidiváló diverticulitis, 5 esetben colovesicalis, 2 esetben colovaginalis sipoly volt. SM-nél az indikáció 17 esetben perforáció, 2 esetben hasüregi tályog volt. Az EM-ek 89%-a laparoszkópos módon került elvégzésre; az átlagos műtéti idő EM/SM esetében 96 perc/89 perc, az átlagos ápolási napok száma 17/14 volt. Az EM-csoportból 1 beteg, míg az SM-csoportból 5 beteg meghalt. Szignifikáns különbség volt a műtét típusa, a stomaképzés és a transzfúziós igény tekintetében. Nem találtunk szignifikáns eltérést a posztoperatív ápolási napok és a mortalitás tekintetében. Következtetés: Az elektív műtétek alacsonyabb morbiditása és mortalitása, illetve a laparoszkópos technika alkalmazhatósága miatt törekedni kell a tervezett műtétre. Nincs egységes irányelv a relatív műtéti indikáció felállításában: gasztroenterológus és sebész által felállított, személyre szabott kezelési stratégia szükséges. Véleményünk szerint indokolt a műtét, amennyiben igazolt diverticulosis esetében szigorú diéta mellett kiújul a gyulladás. Orv Hetil. 2020; 161(51): 2146–2152. Summary. Introduction: Colonic diverticulosis affects 60% of the population, incidence of the disease grows progressively. During its course, 6% of patients with diverticulosis will need surgical intervention. There is no current guideline when to carry out elective operation. Method: We analyzed demographics, surgical patient data and also post-operative complications of patients operated in our department due to colonic diverticulosis between 17-07-2017 and 30-04-2020 retrospectively. We compared the results of elective (ES) and acute surgeries (AS), also laparotomies versus laparoscopies. Results: 19 out of 38 patients underwent ES and 19 AS. ES group average age was 64 years, and 67 in the AS group. Indications of ES were recurring diverticulitis in 12, colovesical fistula in 5 and colovaginal fistula in 2 cases. Indications of AS were perforations in 17 and intraabdominal abscesses in 2 cases. 89% of all ES were operated laparoscopically; average operation time in ES/AS was 96/89 minutes, average hospital stay was 17/14 days. 1 patient after ES and 5 after AS died. Significant difference was found between the groups with regard to the type of operation, frequency of colostomy creation and the need of blood transfusion but no significant difference was demonstrated in average hospital stay and mortality. Conclusion: Due to the lower morbidity and mortality rate as well as the benefits of laparoscopic approach, we should always opt for ES. No guideline for relative surgical indication exists: gastroenterologist and surgeon should make a personalized surgical plan. In our opinion, operation should be carried out if diverticulitis reoccurs while the patient is on strict diet. Orv Hetil. 2020; 161(51): 2146–2152.

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Our prospective research included all of the patients who were admitted to the Surgical Department of St. John Hospital diagnosed with a malignant gastrointestinal tumor. Demographic (gender, age) and morphologic Abstract: Background Surgery may be the field of healthcare where malnutrition and sarcopenia have their greatest impact on patient morbidity and mortality. However, there are limited data on the nutritional status of surgical patients and the effects of prehabilitation on the outcomes of surgery. Methods A prospective analysis was conducted on all patients surgically-treated for malignant gastrointestinal tumors at St. John Hospital during a two-year period. The patient's gender, age, body weight, height, BMI and weight loss were registered, then a risk score was determined by the MUST survey. Measurement of the triceps and thigh skin-fold thickness and the circumference of the upper arm and thigh were done to calculate muscle area and muscle index, respectively. The body composition was assessed using an OMRON-BF511 device. Muscle function was evaluated based on hand clamping force measurement and activity tests. Patients who were diagnosed as being at-risk received preoperative prehabilitation, which included physiotherapy and nutritional therapy. Results A total of 231 patients (133 males/98 females) were analyzed. They had a mean age of 68.9 years (18~98). Seventy-four patients (32%) lost weight, with an average loss of 7 kilograms (3~15 kg). Anthropometric data showed an average upper-arm circumference of 27.4 cm (14.3~38.1) and thigh circumference of 44.7 cm (19.3~60.1), so the median muscle index was 1.29. The mean BMI was 26, which is above normal, and the elevated BMI was consistent documented in each patient subgroup stratified by age and tumor type. A body composition analysis was performed for 75 patients (44 male/31 female), who had a median age of 68 (37~88 y). The average BMI of these patients was 25.7 y and their average MUST score was 1.12. The total body fat percentage (of the total body mass) was 29.5%, total muscle was 30.1% and visceral fat was 10%. Thirty patients (40%) had sarcopenia, with a mean BMI of 28.7, fat comprising 34.2% of the body mass, visceral-fat 11%, and muscle 27.1 %, and their median MUST score was 1.23. Patients who received preoperative training (physiotherapy) showed improvements in physical function ranging from 12%~33%. Conclusion Gastrointestinal tumor patients have a higher than normal BMI regardless of age or tumor type. Patients with sarcopenia show measurable improvement after two weeks of prehabilitation.