Among the techniques available for bariatric surgery, Roux-en-Y gastric bypass is safe and effective option. However, it may present with some complications such as marginal anasomotic ulcers, which can perforate and become serious surgical emergency.We present a case of 28-year-old female patient, with abdominal pain and vomiting with clinical presentation of diffuse peritonitis, radiological presentation of pneumoperitoneum and medical history of RYGB 3 years before, with suspected perforation after initial medical assessment and examination. Upper medial laparotomy was performed with large amount of fibrinopurulent content presented in abdominal cavity and perforated MU at medial anastomotic site. It was closed with omental patch, after thorough abdominal irrigation. The patient was discharged on the 10th day after surgery.One of the most common long-term complications after RYGB is the occurence of peptic ulcers and anastomotic stenosis. The main manifestation of untreated MU is perforation, which is urgent surgical and life-threatening condition. The perforated marginal ulcer is a complication of the RYGB procedure in bariatric surgery and is an acute surgical condition. Thorough irrigation of abdominal cavity and omentoplasty of the ulcer lesion is a safe and effective treatment of choice and it gives a good postoperative outcome.

Duodenocolic fistulas created by invasive cancer of the colon are rare complications. They are presented with serious electrolytic and nutritional disturbances due to vomiting, diarrhoea, abdominal pain, GI bleeding, and weight loss.In this paper, we present young male patient with malignant duodenocolic fistula between ascendant colon and D2 portion of duodenum and pancreatic head, treated with right hemicolectomy and pancreaticoduoedenectomy. Postoperative histopathology confirmed poorly differentiated colonic adenocarcinoma without spreading to lymph nodes and major vessels.Patient is still alive after three years of the operation which led as to conclusion that this type of radical operation may represent one of the best treatments for this rare complication, provides good quality of life and is prognostically justifiable.

Introduction: In everyday surgical practice, ventral hernia repair is one of the most commonly performed surgeries worldwide. Ventral hernioplasty can be performed either with open or laparoscopic approach and in this study both approaches use the IPOM technique of mesh placement. From the clinical experience so far, the laparoscopic approach is characterized by a lower rate of early postoperative complications, shorter hospital stay and a period of convalescence. The aim of the study was to compare early postoperative complications, duration of surgery, hospital stay, recurrence in the first year and convalescence period between patients undergoing open and laparoscopic access with IPOM ventral hernioplasty. Material and methods: The study was designed as a randomized, prospective, comparative study of 63 patients who met the inclusion criteria, operated by IPOM technique and divided into two groups: open access to 32 patients and laparoscopic access to 31 patients. Early postoperative complications, duration of surgery, hospital stay, recurrence in the first year, and convalescence were compared in both groups. Statistical processing and data analysis was performed in the statistical programme SPSS version 23.0. Values of p <0.05 were taken as statistically significant. Results: Regarding the early postoperative complications, it was found that the occurrence of seroma is more common in the laparoscopic group (p = 0.013), while in open hernioplasty the number of surgical site infections is significantly higher (p = 0.03). The hospital stay expressed in days is longer in open hernioplasty (p = 000001). Regarding the duration of the operation (p = 0.8) and the period of convalescence (p = 0.28), there is no statistically significant difference between the two groups. Discussion: The results shown by our experience shows that laparoscopic ventral IPOM hernia repair is characterized by lower rates of SSI, a shorter hospital stay, but without statistical significant benefit in terms of a period of convalescence, duration of surgery and recidive rate in the first year. Тhe choice of treatment and access should be based according to individual patient characteristics. A laparoscopic approach, due to its minimal invasiveness, should be more common in ventral hernioplasty.

Laparoscopic ventral hernioplasty has many advantages over the open access hernioplasty, but patients suffer severe pain in the first few days.Objectives of this study was comparison of early postoperative pain in Open and Laparascopic approach in IPOM hernioplasty and whether there was statistically significant difference in the intensity of postoperative pain during resting and activity.63 patients who met the inclusion criteria were included in a randomized, prospective, comparative study and were operated with the IPOM technique. They were divided into two groups: open and laparascopic access (32 and 31 patient, consequently). In both groups, postoperative pain was compared at eight time intervals during rest and activity, quantified using VAS. The statistical analysis was done in the statistical programme SPSS version 23.0.Patients undergoing laparoscopic hernioplasty had significantly higher pain intensities on the day of the intervention, the first and second day after the intervention (p<0.0001). On the third and seventh postoperative days, as well as one and six months after the intervention, there was no significant difference in pain intensity between the two methods during rest and activity.Patients after laparoscopic ventral hernioplasty suffer from severe pain in the early postoperative period and it is the biggest challenge and problem after these operations. This originates from transfascial sutures for mesh fixation in both groups and additionally multiple lesions of the parietal peritoneum in the laparoscopic method due to the numerous mesh fixations with tackers.

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