Introduction:The formation of gallstones in the gall bladder is very common. It is now considered that approximately 10% to 15% of the adult population has gallstones. It is more frequent in women than men. Etiologies are various and include: age, sex, diet, sudden weight loss, etc. According to the report of the US National Institute of Health, it is estimated that 6.3 million men and 14.2 million women, aged 20-74 years in the United States has calculosis of the gallbladder, due to which every year is performed about 700,000 cholecystectomy. Case report: Male patient, aged about 40 years, admitted at the Clinic and laparoscopic surgery was performed in our department for chronic, as multiple, symptomatic gallbladder calculi. Intraoperative findings showed chronically inflamed, curled gall bladder, and wall thickening. After the first postoperative day there is no content in the drain bag and it is taken out, and the patient leaves the hospital without any problems. The seventh post-operative day occurred abdominal pain, weakness and fatigue, with striking yellow skin and visible mucous membranes. Clinical, laboratory and echo determined abdomen full of fluids, so it was suspected lesion of the bile duct. Urgent revision was performed. Intraoperative was found a lesion of the common bile duct in the form of a complete interruption. Created is anastomosis through transhepatic drain according to Pradera. Early and late postoperative flow was entirely normal with normal laboratory and echofindings. Control, contrast imaging through a drain showed the orderly flow of extrahepatic bile ducts, with minimal extravasation of contrast. Conclusion: At the Department of Surgery of General Hospital in Konjic laparoscopic cholecystectomy is performed since 1999. In the beginning it was done by three trocars (European style), and later, in order to prevent complications or injury of the bile duct is performed surgery with four trocars (American style). The number of complicated procedures in our hospital does not differ from similar indicators in foreign surgical facilities.

Introduction:Epidemiological characteristics of colorectal cancer indicate that in the U.S. colorectal cancer is the second leading cause of death from malignancy, just behind lung cancer. In the 2000 there were approximately 130,200 new cases, of which 56,300 had lethal outcome. In the past 15 years, the incidence and mortality rate has been declining, especially in women. Colorectal cancer is mainly found in people older than 50 years. Carcinoembryonic antigen (CEA) is insufficiently specific for the early detection of the disease. Its normal value is less than 5 g/L in the serum. Elevated levels of CEA after surgery indicate a lack of radical surgery, residual neoplasm, hidden distant metastases or recurrent disease. Unfortunately, only 10-15% of patients with recurrent disease can be successfully re-operated (isolated metastases in the liver or lungs). Colorectal cancer is predominantly adenocarcinoma, the tumor has relatively slow growth. While symptoms occur relatively early, distant metastases have relatively late appearance.Goals:The goals of this study were to remind the fundamental facts about the nature of this disease, to stress the importance of early detection of BC-screening programs, to draw attention to contemporary attitudes in the field of diagnosis and treatment of colorectal cancer, and to show the experience in the treatment of this disease at the Surgical Departments of the General Hospital in Konjic.Results:In the period from 2008-2012 years, at the Surgical Department of the General Hospital in Konjic surgically treated are 34 patients who had colorectal malignancy. There were 21 (65 %) male and 13 females (35%). All patients belonged to the age group of 50-75 years. Only five patients or 15 % prior to admission to the hospital had been diagnosed with a malignant process. All others, or 85% of the total sample, were admitted to the hospital as emergency cases (erosive gastritis), and after, shorter preparation underwent surgery. Only five (15%) of patients were admitted electively, already diagnosed with colorectal tumors by colonoscopy. Total number of lethal outcomes at the department was 8 (24%). Three patients died due to cardio-respiratory failure and MOF, and 5 patients due to anastomotic failure and septic shock.Conclusion:In conclusion we can say that in our institution it is necessary to obtain the proper equipment (colonoscope) and educate personnel, so we can introduce colonoscopy as the mandatory screening method of examination, particularly for vulnerable groups.

Introduction:Familial adenomatous polyposis (FAP) is a rare autosomal, dominant hereditary disease, which affects both sexes equally (1-10). FAP accounts for less than 1% of all colon cancers and is estimated to occur in one of 8,300 live births. It is characterized by numerous adenomas scattered throughout mucosa of the colon and rectum.Case Report:The patient is a 62 years old man, admitted at the Surgical Department of the General Hospital in Konjic on May 18 2010 with gastrointestinal problems including: hard stool, often splattered with fresh blood, irregular and that causes the patient a lot of problems. The final diagnosis was median laparatomy supra et infraumibilicalis. Exploratio cavi abdominalis. Colectomy totalis et ileo-recto anastomosis TT cum staypler (33Ch). Loop ileostomy. Drainage cavi abdominalis N I (uno). Early postoperative course was generally regular. Control laboratory findings show the reference value. After ten days of hospitalization, the patient was discharged on the home recovery, with practically given instructions for care and use of stoma bags. For the secondary surgery was planned ileostomy closure, and regular post-operative endoscopic control.Conclusion:Most of the listed surgical intervention in case of FAP treatment localized in the colon can be performed by open (classic), or laparoscopic methods. Duration of postoperative stay in the hospital depends on the patient’s general condition and the type of performed surgery. It is usually about 7 days. After hospital treatment, recovery at home is from 4-6 weeks. Patients can usually return to work or school 6-8 weeks after surgery. After surgery, patients lives will be completely normal. Sexual and social activities remain the same, while either procedure does not affect the ability of a man or woman to have offspring.

Introduction:Epidemiological characteristics of colorectal cancer indicate that in the U.S. colorectal cancer is the second leading cause of death from malignancy, just behind lung cancer. In the 2000 there were approximately 130,200 new cases, of which 56,300 had lethal outcome. In the past 15 years, the incidence and mortality rate has been declining, especially in women. Colorectal cancer is mainly found in people older than 50 years. Carcinoembryonic antigen (CEA) is insufficiently specific for the early detection of the disease. Its normal value is less than 5 g/L in the serum. Elevated levels of CEA after surgery indicate a lack of radical surgery, residual neoplasm, hidden distant metastases or recurrent disease. Unfortunately, only 10-15% of patients with recurrent disease can be successfully re-operated (isolated metastases in the liver or lungs). Colorectal cancer is predominantly adenocarcinoma, the tumor has relatively slow growth. While symptoms occur relatively early, distant metastases have relatively late appearance.Goals:The goals of this study were to remind the fundamental facts about the nature of this disease, to stress the importance of early detection of BC-screening programs, to draw attention to contemporary attitudes in the field of diagnosis and treatment of colorectal cancer, and to show the experience in the treatment of this disease at the Surgical Departments of the General Hospital in Konjic.Results:In the period from 2008-2012 years, at the Surgical Department of the General Hospital in Konjic surgically treated are 34 patients who had colorectal malignancy. There were 21 (65 %) male and 13 females (35%). All patients belonged to the age group of 50-75 years. Only five patients or 15 % prior to admission to the hospital had been diagnosed with a malignant process. All others, or 85% of the total sample, were admitted to the hospital as emergency cases (erosive gastritis), and after, shorter preparation underwent surgery. Only five (15%) of patients were admitted electively, already diagnosed with colorectal tumors by colonoscopy. Total number of lethal outcomes at the department was 8 (24%). Three patients died due to cardio-respiratory failure and MOF, and 5 patients due to anastomotic failure and septic shock.Conclusion:In conclusion we can say that in our institution it is necessary to obtain the proper equipment (colonoscope) and educate personnel, so we can introduce colonoscopy as the mandatory screening method of examination, particularly for vulnerable groups.

Introduction:Records about the fractures of the distal humerus could be founds in the scriptures written long before Christ (Hippocrates 300 to 400 BC). During the twilight of science development and of any scientific work (the Middle Ages), little has been written about this problem. Between the 1700 and 1800 much was discussed about the controversies between the correct position and immobilization. In the early twentieth century view on the treatment of fractures of the distal humerus begins to change dramatically, from the former passive to active surgical treatment. The sudden turnaround followed thanks to the intensive development of technology, especially new imaging technology.Material and methods:We observed a period of 4 (four) years (1998 to 2002), and only hospital patients of certain age. As database are used the histories of the disease. The patients were followed for one year and at the same time, we analyzed (clinical) early complications after three (3) months and late complications (X ray), after a year. Among the early complications we observed most often lower motility and contraction, and of late we have followed the morphological deformation–cubitus varus and valgus.Results:Using x-ray images, we measured Baumann’s (en face) and lateral condylar angle (profile) after one year in the operated group and the group treated conservatively SPDH type III in children. We calculated the arithmetic mean (x) and a standard deviation (SD) in both groups. Using chi square and t–test, with the probability of 95%, we showed that there is a significant difference between operative and conservative treatment of SPDH type-III in children, according to Gartland.Conclusion:All humerus fracture type-III by Gartland in children should be surgically treated. Surgery should be undertaken in a time frame of 6 hours. Surgery should be done in these cases by the specialized institutions (Clinical Hospital Centre). The success of treatment in such institutions corresponds to the results achieved in the world (93.0%). We must be sure to adopt and implement a scheme of treatment of fractures of the distal humerus in children. Required is faint trail, OPF, lateral (Kaplan) approach, exceptionally for some articular fractures posterior approach by Campbell, fixation with two or more Kirchner’s needles, usually cross-set at an angle of 30°, vacuum drainage with cast immobilization.