The simplicity of application, shorter time of operation, and lower cost of hem-o-lok clips are advantages of this way of securing of the base of the appendix in relation to the standard endoloop procedure.

No abstract

complications for open cholecystectomy were: infection (2.73% ), hematoma in the wound (2.73% ) and urine retention (2.18%). Conclusion: It can be concluded that LC and OC are comparable procedures for the treatment of gall stone disease in terms of complications, results of this study demonstrate that LC is essentially a safe procedure with low complicatins, morbidity and mortality rate.

Introduction: In this study we wanted to examine the hormonal responses due to stress exposure during laparoscopic cholecystectomy with standard (12-15 mm / Hg) (LCSP) and low (6-8 mm / Hg) (LCLP) intraabdominal pressure and open cholecystectomy (OC), with particular emphasis on stress hormone responses. Aim: Determination of adrenocorticotropic hormone (ACTH) and cortisol stress hormones before and after laparoscopic cholecystectomy with standard and low insufflation pressure, determination of ACTH and cortisol values before and after open cholecystectomy and comparison of ACTH and cortisol values between the patient subgroups. Methods: In a prospective study conducted between July 2016 and February 2018, we involved 110 patients which were divided into two groups: 70 patients with laparoscopic cholecystectomy (LC) and 40 patients with open cholecystectomy (OC). The first group of patients was further divided into two subgroups of 35 patients, (subgroup LC with standard and subgroup LC with low intraabdominal pressure). All patients met the preset inclusion and exclusion criteria of the study. There were no statistically significant differences in the demographic characteristics of patients between the investigated groups. The stress hormones determined were adrenocorticotropic hormone (ACTH) and cortisol. Results: During the first, second and seventh day postoperative day (POD),ACTH values were significantly lower (p <0.0001) in LCLP than in LCSP and OC groups. This was also the case for comparison in LCSP and OC groups. By comparing LC and OC groups during first, the second and seventh POD, there was a significant difference (p <0.0001) in the ACTH levels. The concentration of this hormone was higher in the OC group in all three cases. The first, second and seventh POD were also statistically significant (p <0.0001) in cortisol values and between LC and OC groups there was an increase in cortisol levels in patients operated by open method. There was also a significant difference (p <0.0001) in cortisol values measured between LCLP and LCSP groups in the investigated days. Cortisol levels were higher in patients in the LCSP group. Conclusion: During open and laparoscopic cholecystectomy the response of the body to stress increased. The stress response of the organism during laparoscopic cholecystectomy was less than during open cholecystectomy. The stress response of the organism during laparoscopic cholecystectomy with low insufflation pressure (6-8mmHg) was less than during laparoscopic cholecystectomy with standard insufflation pressure (12-15mmHg).

ApstrAktUvod: Laparoskopska apendektomija tek u zadnje vrijeme postaje uobičajena metoda u tretmanu akutnog apendicitisa, premda ima dokazane prednosti u odnosu na klasičnu apendektomiju. U Bosni i Hercegovini se sporadično, tek u nekoliko centara, uvodi laparoskopska apendektomija kao metoda tretmana akutnog apendicitisa. Ovom smo studijom željeli usporediti dvije različite metode operativnog liječenja akutnog apendicitisa. Pacijenti i Metode: Tokom 20 mjeseci analizirali smo 498 pacijenata operiranih zbog akutnog apendicitisa te smo pratili vrijeme operativnog zahvata i dužinu ležanja, komplikacije hirurškog zahvata te razloge konverzije kod pacijenata operiranih laparoskopskom metodom. Rezultati: Vrijeme operativnog zahvata (minute) iznosilo je 96 min. u skupini operiranih klasičnim pristupom, a u laparoskopskoj 107 minuta, Prosječna dužina ležanja je bila u skupini operiranih klasičnim pristupom 3.9 dana, a u laparoskopskoj grupi 2.3 dana. Najčešća komplikacija u skupini operiranih klasičnim pristupom je bila infekcija operativne rane (56/452) i ileus (5/452), a u grupi operiranih laparoskopskom metodom ileus (1/46). Zaključak: Kod pacijenata operiranih laparoskopskom metodom rizik infekcije rane je manji, a boravak u bolnici kraći. Sa povećanjem iskustva hirurga, ova vrsta tretmana akutnog apendicitisa postaće metoda izbora.