The impact of tumor stage, lymph node status, and peritoneal lavage cytology on recurrence rates is significant. Tumor, nodal, and lavage cytology status can be organized hierarchically in relation to time of recurrence. Cytology is most important, with positivity rendering long-term prognosis unfavorable. When comparing surgical techniques (open versus laparoscopic), we found no significant difference in recurrence rates. Our study has shown that conventional peritoneal lavage cytology is a prognostic factor in the case of patients undergoing curative colorectal operations.

Case-matched comparison of short and middle term survival after laparoscopic versus open rectal 303 1 3 SummaryBackground Individual surgeons' experience and surgical outcome remain major contributors towards the successful treatment of rectosigmoid malignancy.Methods Only elective and curative resections (i.e. absence of distant metastases) were selected into each group to ascertain homogeneity and match for tumour stage. In all, 100 successive open rectal and rectosigmoid resections were compared with 100 similar laparoscopic procedures between 1st February 2005 and 31st December 2009 performed. A retrospective analysis was carried out and the patients were subsequently followed up until 30th April 2012.Results Anastomotic insufficiency was found in two patients (laparoscopic) and in five patients (open). The two groups were also compared for hospital stay and operating time (laparoscopic group spent statistically significant less time, operating time were statistically significant shorter). During the follow-up period (laparoscopic group 41.6 months, open group 39.8 months) similar survival and recurrence rates were found: locoregional recurrence 1 and 4, distant metastases 20 and 22, respectively. There were 13 cancer deaths in laparoscopic group to 19 in open group, the average 3-year survival being 76 % and 69 %, respectively. The long-term oncological results in more advanced tumours are superior, albeit not significantly. The difference in incidence of incisional herniae (laparoscopic:open = 4:18) identified during the follow-up period was found significant.Conclusion When comparing laparoscopic with open rectal and rectosigmoid resections there could be no inferior oncological outcome identified, hence the two techniques can be considered equivalent; in fact, due to its advantages laparoscopic rectosigmoid cancer surgery is the preferred option over open. Review304 Case-matched comparison of short and middle term survival after laparoscopic versus open rectal

Absztrakt: Bevezetés: A laparoszkópos colontumor-sebészet létjogosultságát több I/a szintű evidencia támasztja alá. A sigmatumorok és felső harmadi rectumtumorok esetén is kiváló korai és késői eredményekről számoltak be a laparoszkópos sebészet javára. A kemoirradiált rectumtumorok sebészetében kevés az ilyen szintű irodalmi állásfoglalás. Anyag és módszer: 2006. 01. 01. és 2011. 12. 31. között 196 beteg kapott neoadjuváns kezelést alsó és középső harmadi rectumtumor miatt a BAZ Megyei Kórház Sebészeti Osztályán. A 196 beteg közül 12 beteg nem volt követhető, így 184 beteg adatait elemeztük. Laparoszkóposan operáltunk 67 beteget, ebből 15 esetben konverzió történt. Nyitott műtétet végeztünk 117 betegnél. Eredmények: A Dukes-stádiumok hasonlóak voltak, az ASA-stádium szintén. A betegek BMI tekintetében sem mutattak jelentős különbséget. Az eltávolított specimenek hossza és a tumorméret is hasonló volt. A betegség kiújulását meghatározó faktor a körkörös reszekciós szél (CRM) érintettsége, a TME komplett kivitelezése, mely saját anyagunkban a laparoszkópos technikánál is megfelelő volt, nem találtunk szignifikáns eltérést (khí-négyzet teszt, p = 0,94). A műtéti idők a laparoszkópos, konvertált és nyitott csoportban hasonlóak voltak, nem volt szignifikáns különbség. Az ápolási idő a laparoszkópos csoportban volt a legrövidebb, de a Mann–Whitney-teszt nem mutatott szignifikáns különbséget. Jelentős különbség mutatkozott a laparoszkópos és nyitott csoport transzfúzióigényében. A két csoport között a nyitott hátrányára szignifikáns eltérés mutatkozik (khí-négyzet teszt, p = 0,04). Betegeink utánkövetése során sem a betegség kiújulásában, sem a túlélésben nem találtunk szignifikáns különbséget. Konklúzió: A laparoszkópos műtét rövid távú előnyei mellett onkológiailag is biztonságos a rectum kemoirradiált tumorainak megoldására.

The widespread use of tension free surgical techniques and the modern, tissue-friendly surgical meshes have led to the development of new surgical techniques. The increasing importance of minimal invasive surgery became apparent in abdominal wall reconstructions, too, and their use has been justified by literature data. This procedure combines the advantages of minimal invasive surgery with tension free technique. The authors discuss 102 patients operated with abdominal wall hernias using a laparoscopic technique. There were 978 abdominal wall hernia operations in our department between 1 January 1999 and 31 December 2006, of which 102 cases were done laparoscopically. The average size of the abdominal wall defects was 62 square cm (minimum size: 12, maximum size: 160). The average size of the implanted surgical mesh was 300 square cm (min size: 150, max size: 750). Operating time was between 30 and 180 minutes. (The average time was exactly 70 minutes.) The hospital stay was between 1 to 7 days (4 days on average). Two recurrences were observed during the follow-up so far. The follow-up was from 2 to 96 months, with an average of 18 months. The laparoscopic technique significantly decreased the complication and recurrence rate, and shortened hospital stay compared to open surgery. Furthermore, laparoscopic technique improves aesthetic outcome, too. In addition, the authors found that small, hidden incisional hernia orifices could be explored and closed more easily with laparoscopic hernia repair.

Total situs inversus (SIT) is a rare congenital disorder in which all abdominal and thoracic organs are in reversed position. A 57-year-old man with SIT presented with change in bowel habits and rectal bleeding.Colonoscopy and abdomino-pelvic CT scan confirmed a constricting sigmoid lesion with normal tumor-marker levels. In our department the elective laparoscopic colon resection with lymphadenectomy is the preferred alternative of open surgery and is the chosen method in about 60 percent of cases. This is the first documented case report in Hungarian of a laparoscopically resected sigmoid tumour in a patient with SIT. We believe that with appropriate knowledge of anatomy and advanced routine in laparoscopic surgery laparoscopic resection can be a safe method even in a special case like this one was.