Introduction:Minimally invasive approches in treatment of acute necrotizing pancreatitis and/or infected pancreatic necrosis gain a notable advantage compared with open surgery. Aim:We present our experience in treatment of acute necrotizing pancreatitis by an original minimally invasive retroperitoneal necrosectomy technique, evaluate feasibility and safety of this method, compare our results to other studies. Patients and methods:A retrospective analysis of 22 patients with acute necrotizing pancreatitis and large fluid collections in retroperitoneal space was performed. All patients underwent retroperitoneal necrosectomy as an initial interventional procedure in treatment of infected pancreatic necrosis. Results:Sixteen males and six females aged between 24 and 60 with an average age of 42.59 ±7.3 years were included. Alcohol abuse was an etiologic factor of acute necrotizing pancreatitis for 18 patients (81.8%). Average time between diagnosis and performance of necrosectomy was 28.6 ±13.2 days. Ten patients (45.5%) did not undergo any additional intervention after initial retroperitoneal necrosectomy. Other 12 patients (54.5%) required additional procedures. 3 Medical Research ArchivesCopyright 2015 KEI Journals. All rights reserved 2 patients (13.6%) needed 5 or more reinterventions: 4 sonoscopically-guided drainages, 4 retroperitoneal renecrosectomies and 11 laparotomies. 9 patients (40.9%) required less than 5 reinterventions: 2 sonoscopically-guided drainages, 12 retroperitoneal renecrosectomies and 3 laparotomies. Most of reinterventions were performed due to insufficient drainage and bleeding. 63.6% of our patients did not require more than one reintervention. Postoperative hospitalisation ranged from 9 to 148 days with an average of 52.2 ±35.2 days. The mortality rate in our study was 0%. Conclusions:Minimally invasive techniques should be considered as a first-choice surgical option in treating patients with acute necrotizing pancreatitis whenever possible. Pancreatic necrosis occupying less than 30% and with massive fluid collections can be safely managed by an initial minimally invasive retroperitoneoscopic necrosectomy when an appropriate gap in the left retroperitoneum between the colon and the kidney exist.

BackgroundNo consensus on the optimal procedure for repair of rectal prolapse (RP) exist. We present the results of our 10 year experience of Vilnius University Hospital Santariskiu Klinikos. Patients and methodsRetrospective review was performed of the patients, operated on for rectal prolapse between 2005 and 2016. Patients were divided into two groups -internal recal prolapse (IRP) and complete rectal prolapse (CRP). Perioperative data between two groups were analysed. Statistical data analysis was carried out using the SPSS 20.0 software. To assess the difference between rectal prolapse groups of statistical methods the χ 2 test was used. Data were considered statistically significant at p < 0.05. Results 89 patients between 2005 and 2016 underwent surgical treatment for rectal prolapse at our department. IRP group included 52 (58,4%), CRP -37 (41,6%) patients. The male/female ratio was 1/6,4, the mean age was 58,3±15,2 years. Defecography was performed for 29 (32,6%)patients in IRP group and for 12 (13,5%) -in CRP group (p<0,001). 7 (7,9%) patients in CRP group had previous surgical procedure for RP while in IRP group there were none (p=0,02). The most common management of IRP included 6 strategies (n=25, 67,5% of group); of CRP -3 different procedures (n=38, 73,1% of group) (p=0,003). Mean hospital stay in IRP group was significantly (p=0,014) longer (9,78±4,6 days) than in CRP group (7,58±3,7 days). Mortality rate was 0 %. Mean follow-up (14 patients) was 20,93±17,21 months. ConclusionThere is no evidence-based consensus regarding treatment of rectal prolapse. Management of IRP covered a more diverse range of surgical options, including of open approach. Thus, hospital stay was longer, but no mortality occurred. Further follow-up for evaluation of long-term outcome is necessary. Key words: rectal prolapse, rectopexy, resection, laparoscopy 153Surgery for rectal prolapse -a single centre experience Įvadas Dėl vienos tiesiosios žarnos iškritimo gydymo strategijos nesutariama. Mes apžvelgėme tiesiosios žarnos iškritimo gydymą Vilniaus universiteto ligoninėje Santariškių klinikose. Pacientai ir metodaiRetrospektyviai tirti pacientai, operuoti dėl tiesiosios žarnos iškritimo 2005-2016 metais. Pacientai suskirstyti į dvi grupesviso storio iškritimo (CRP) ir vidinio iškritimo (IRP). Buvo palyginti perioperaciniai grupių duomenys. Duomenys apdoroti statistinio duomenų paketo SPSS 20.0 versija. Skirtumas tarp grupių lygintas remiantis chi kvadrato testu, vertintas kaip reikš-mingas, jei p vertė buvo < 0,05. Rezultatai Minėtu laikotarpiu operuoti 89 pacientai. Dėl vidinio iškritimo -52 (58,4 %), dėl viso storio iškritimo -37 (41,6 %). Vyrų ir moterų santykis buvo 1/6,4, vidutinis amžius -58,3 ± 15,2 metų. Defekografija atlikta 29 (32,6 %) IRP grupės ir 12 (13,5 %) -CRP grupės pacientams (p < 0,001). Septyni (7,9 %) CRP grupės pacientai praeityje buvo operuoti dėl tiesiosios žarnos iškritmo, o IRP grupėje anksčiau operuotų pacientų nebuvo (p=0,02). IRP grupės pacientai buvo operuoti šešiais būdais, o CRP -trimis būd...