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Background: The novel surgical procedure transanal total mesorectal excision (taTME) has rapidly become an interest of research in order to overcome the shortcomings of laparoscopic surgery in the treatment of middle and low rectal cancer. taTME is a new natural orifice transluminal endoscopic surgery modality combining three rectal surgery techniques. Methods: A retrospective clinical study was conducted in a single centre for a period of 3 years, and herein we report on our first 25 taTME procedures in patients with middle and lower third rectal adenocarcinoma. Results: The main demographics were evaluated. The mean age of patients was 64 ± 12 years. There were predominantly males (72%) and 7 female patients (28%) with an average body mass index of 29 ± 4.8 kg/m2. High blood pressure, obesity, chronic heart insufficiency, chronic atrial fibrillation, and diabetes mellitus were commonly diagnosed in all patients. A circumferential resection margin >1 mm was achieved in 16% (n = 4), >2 mm in 40% (n = 10), and >3 mm in 44% (n = 11) of operated patients. The average CRM was 1.8 ± 0.9 cm. In 24% of cases, the distance of a tumour from the mesorectal fascia (MRF) was 1 mm from the MRF. Recovery to flatus was 3 ± 1 days. The average length of hospital stay was 11 ± 3 days. The overall postoperative morbidity was 8%, i.e. one (4%) complication classified as Clavien-Dindo degree I and one (4%) major (IIIb) complication. Subsequently, all patients successfully recovered and were discharged from hospital. During the follow-up period no cancer recurrence was observed. Conclusion: Our results nicely demonstrate that taTME can be safely performed with acceptable perioperative complications in patients with middle or lower third rectal cancer. In addition, the perioperative morbidity is also acceptable. However, taTME remains a technically highly demanding operation but is feasible and safe after the appropriate experience is gained. Nevertheless, larger multi-centre prospective randomised studies are ongoing to confirm the safety and to verify oncological results when compared to laparoscopic rectal surgery.

Background/Objectives: Anastomotic leakage remains the most devastating postoperative complication in colorectal surgery. The mechanical integrity of the newly formed colorectal anastomosis can be evaluated by visual inspection intraoperatively; both air leak and liquid leak tests are also used to evaluate the integrity of stapled colorectal anastomoses. It is not clear whether double-stapled anastomoses are more prone to leaks than single-stapled anastomoses. The aim of our study was to compare the methylene blue and the air leak test in the experimental setting of single-stapled and double-stapled porcine bowels. Methods: Twenty-four distal colons were excised from slaughtered pigs without delay. The proximal bowel end was closed with a linear stapler using blue cartridges. The bowels were randomly divided into single-stapled or double-stapled groups. Air leak and methylene blue leak tests were performed. A digital pressure monitor with a gradual pressure increase function was used to both gradually increase pressure within the bowel and to determine the pressure at which the stapler line disintegrated. Results: Air leakage occurred at a mean pressure of 51.62 (±16.60) mm Hg and methylene blue leakage occurred at 46.54 (±16.78) mm Hg (p = 0.31). The air and methylene blue leaks occurred at comparable pressures in single-stapled bowels and in double-stapled bowels (47.21 [±14.02] mm Hg vs. 50.96 [±19.15] mm Hg, p = 0.6). Conclusions: The methylene blue solution leak test is not inferior to the air leak test. There is no significant difference in bursting pressure between single-stapled and double-stapled anastomoses.

Introduction: Anastomotic leakage (AL) remains one of the most threatening complications in colorectal surgery with the incidence of up to 20%. The aim of the study is to evaluate the safety and feasibility of novel – trimodal intraoperative colorectal anastomosis testing technique. Methods and analysis: This multi-center prospective cohort pilot study will include patients undergoing colorectal anastomosis formation below 15 cm from the anal verge. Trimodal anastomosis testing will include testing for blood supply by ICG fluorescence trans-abdominally and trans-anally, testing of mechanical integrity of anastomosis by air-leak and methylene blue leak tests and testing for tension. The primary outcome of the study will be AL rate at day 60. The secondary outcomes will include: the frequency of changed location of bowel resection; ileostomy rate; the rate of intraoperative AL; time, taken to perform trimodal anastomosis testing; postoperative morbidity and mortality; quality of life. Discussion: Trimodal testing of colorectal anastomosis may be a novel and comprehensive way to investigate colorectal anastomosis and to reveal insufficient blood supply and integrity defects intraoperatively. Thus, prevention of these two most common causes of AL may lead to decreased rate of leakage. Study registration: Clinicaltrials.gov (https://clinicaltrials.gov/): NCT03958500, May, 2019.

BACKGROUND: AL remains one of the most threatening complications in colorectal surgery. Significant efforts are put to understand the pathophysiological mechanisms involved in the development of leakage and to create the strategies to prevent it. We aimed to determine whether intraoperative testing of mechanical integrity and perfusion of colorectal anastomosis could reduce the incidence of AL. METHODS: A systematic review and meta-analysis of papers published before November 2019 on PubMed, Scopus, Web of Science, and Cochrane Library databases and comparing intraoperative testing of the colorectal anastomosis with standard care were conducted. Odds ratios (ORs) and 95% confidence interval (CIs) were used to assess the association between intraoperative testing and AL. RESULTS: A total of 23 studies totaling 7115 patients were included. Pooled analysis revealed intraoperative tests, for integrity (OR 0.52, 95% CI 0.34-0.82, P

BackgroundAnastomotic leakage (AL) significantly impairs short-term outcomes. The impact on the long-term outcomes remains unclear. This study aimed to identify the risk factors for AL and the impact on long-term survival in patients with left-sided colorectal cancer.MethodsNine-hundred patients with left-sided colorectal carcinoma who underwent sigmoid or rectal resection were enrolled in the study. Risk factors for AL after sigmoid or rectal resection were identified, and long-term outcomes of patients with and without AL were compared.ResultsAL rates following sigmoid and rectal resection were 5.1% and 10.7%, respectively. Higher ASA score (III–IV; OR = 10.54,p= 0.007) was associated with AL in patients undergoing sigmoid surgery on multivariable analysis. Male sex (OR = 2.40,p= 0.004), CCI score > 5 (OR = 1.72,p= 0.025), and T3/T4 stage tumors (OR = 2.25,p= 0.017) were risk factors for AL after rectal resection on multivariable analysis. AL impaired disease-free and overall survival in patients undergoing sigmoid (p= 0.009 andp= 0.001) and rectal (p= 0.003 andp= 0.014) surgery.ConclusionASA score of III–IV is an independent risk factor for AL after sigmoid surgery, and male sex, higher CCI score, and advanced T stage are risk factors for AL after rectal surgery. AL impairs the long-term survival in patients undergoing left-sided colorectal surgery.

[straipsnis ir santrauka lietuvių kalba; santrauka anglų kalba] Įvadas. Anastomozės nesandarumas yra viena iš pavojingiausių komplikacijų, kylančių po storosios žarnos rezekcinių operacijų. Dėl šios pooperaciniu laikotarpiu pasireiškiančios komplikacijos pacientams didėja sergamumo ir mirtingumo rizika. Be komplikacijų ir pacientui sukeliamų klinikinių simptomų, anastomozės nesandarumas yra didelė finansinė našta ligoninei dėl atliekamų pakartotinių operacijų, didelio lovadienių skaičiaus, instrumentinių tyrimų ir kitų veiksnių, susijusių su anastomozės nesandarumo gydymu.Ligoniai ir metodai. Atliktas retrospektyvinis tyrimas. Tirti 39 pacientai, kuriems pooperaciniu laikotarpiu po storosios žarnos rezekcinės operacijos pasireiškė anastomozės nesandarumas. Analizuoti duomenys rinkti iš ligos istorijų protokolų ir naudojantis ligoninės elektronine sistema. Gydymo išlaidos skaičiuotos bendradarbiaujant su Vilniaus universiteto ligoninės Santaros klinikų Ekonomikos skyriumi. Anastomozės nesandarumo gydymo kaina lyginta su įprasto nekomplikuoto gydymo kaina ir su lėšomis, skirtomis pacientams gydyti, iš Valstybinės ligonių kasos.Rezultatai. Analizuoti 26 vyrų (66,7 %) ir 13 moterų (33,3 %) duomenys. Tiriamųjų amžiaus vidurkis – 69,5±13,6 metų, kūno masės indekso (KMI) vidurkis – 28,3. Ligoninės išlaidos šių pacientų anastomozės nesandarumui gydyti buvo didesnės negu lėšos, skirtos iš Valstybinės ligonių kasos (8 373,2±3 709,27 Eur vs. 4 097,1±1254,66 Eur) (p

Background: Retrorectal tumours are lesions with a wide range of histological differentiation that are often diagnostic and clinical challenges due to their rare occurrence. Many cases of t...

To compare perioperative colorectal cancer care and survival in patient cohorts operated in 2005 and in 2010 in Lithuania. Comparative observational cohort study was performed. The study was conducted in the three Lithuanian cancer hospitals. Patients, who underwent curative surgery for colorectal cancer in 2005 and 2010, were included. Demographic characteristics, distribution of the tumors, preoperative diagnostics and staging, surgical treatment, the quality of pathological examination, morbidity, and mortality were analyzed. One- and 5-year overall survival data were compared between the groups. Colorectal cancer diagnostics and treatment improved from 2005 to 2010 significantly. The disease was identified as stage III–IV for 45 vs. 48% of the patients; however, computed tomography staging scan was performed only for 5.9 vs. 17.8% in 2005 and 2010, respectively. Laparoscopic operations were performed 1.5 vs. 10.5% and abdominoperineal resections—42.7 vs. 31.7% in 2005 and 2010, respectively. The number of harvested lymph nodes was mentioned in 55.8 vs. 97.7% of the cases, whereas more than 12 lymph nodes were examined in 18 vs. 66.6% of cases after histological examination. The overall 5-year survival was 52.1 vs. 63.1% (p

Enterogenous cysts are a very rare congenital abnormality that can be found anywhere within the gastrointestinal tract, most commonly in the small intestine. The incidence is approximately one in 4500-10,000 live births. Diagnosis can be suggested by ultrasound (US), computed tomography (CT) scans or magnetic resonance imaging (MRI) findings, although histological examination confirms the definitive diagnosis.We present a case of enterogenous cyst in an adult female who underwent a resection of the tumour.After two years of observation, there is no evidence of tumour recurrence.

Background. Wound dehiscence is a life-threatening complication with the mortality rate up to 25 %. The objective of this study is to identify the risk factors for wound dehiscence after midline laparotomy in adult population. Methods. The case control study of patients, operated from January 2012 to May 2016, was performed. Patients, who underwent repeated laparotomy for wound dehiscence, were the cases group. Each case was matched by 3 control group patients undergoing similar primary operation. Following characteristics were observed: demographic, past medical and social history, concomitant diseases, intraoperative details, postoperative outcomes and were compared between the groups. Difference was significant, if p value was less than 0.05. Results. 100 patients were included in the study. There were 25 (25 %) patients of the cases group and 75 (75 %) patient of the control group. The majority of the patients were males (69 %). The mean age was 66.7 ± 10.8 years. Three risk factors were identified in the univariate analysis: male gender (88.0 %), wound infection (56 %) and cardiovascular diseases (88 %) for wound dehiscence with the mortality rate of 20 %. Conclusions. Wound dehiscence is a serious complication with a high mortality rate. The identification of preoperative and early postoperative risk factors may allow preventing and reduce the rate of wound dehiscence.

Įvadas Lietuvoje kasmet diagnozuojama apie 1500 kolorektalinio vėžio atvejų ir sergamumas šia liga kiekvienais metais didėja. Radi­kalus chirurginis gydymo būdas taikomas siekiant pašalinti vėžį ir taip pailginti pacientų išgyvenamumą. Po operacijos profi­laktinių patikrų metu suvėžėjusias pilvaplėvės ląsteles yra sunku diagnozuoti dėl klinikinių simptomų stokos ir nepakankamo vaizdinių tyrimų jautrumo. Todėl pacientams, turintiems rizikos veiksnius recidyvui atsirasti, tikslinga taikyti diagnostinę rela­parotomiją, kurios metu būtų atliekama HIPEC procedūra.Ligoniai ir metodai Atliktas retrospektyvusis tyrimas VULSK Pilvo chirurgijos centre. Tirti 321 pacientai, kuriems 2011–2014 m. diagnozuotas kolo­rektalinis T3–T4 stadijos neišplitęs navikas ir taikytas radikalus chirurginis gydymas. Į tyrimą įtraukti 208 pacientai. Analizuoti operacijų protokolai bei histologiniai navikų aprašai.Rezultatai Analizuoti 208 pacientų duomenys. 34 (16,3 %) pacientams buvo nustatyti pirminio naviko recidyvai. Recidyvavo 15 (26,8 %) T4 histologinio tipo navikų ir 19 (12,5 %) T3 navikų (p=0,013). Recidyvavimas pagal išplitimą į regioninius limfmazgius buvo 10 (9,8 %) N0, 12 (18,2 %) N1 ir 12 (30 %) N2 grupėse (p=0,012). Iš žarnos spindį užkimšusių navikų recidyvavo 7 (46,7%) (p=0,003). Statistiškai reikšmingo ryšio tarp recidyvų dažnio ir pirminio naviko lokalizacijos, histologinio tipo ir pirminio navi­ko perforacijos nenustatėme. Penkerių metų išgyvenamumas nenustačius ligos recidyvo buvo 24,65 %, o recidyvavus – 0 %.Išvados Atlikus radikalią kolorektalinio naviko šalinimo operaciją, svarbu šiuos pacientus stebėtis dėl galimo ligos recidyvavimo. Paci­entams, turintiems didelę riziką recidyvui atsirasti, yra tikslinga svarstyti relaparotomijos su CRS ir HIPEC galimybę.

Background No 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 methods Retrospective 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 χ2 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

Retrorectal lipoma, as well as other retrorectal tumours, is a relatively rare disorder. Retrorectal tumours accounted for 1 in 40,000 hospital admissions. We present a case of retrorectal lipoma, 15 cm × 10 cm × 8 cm in size, treated by the laparoscopic approach. The preoperative magnetic resonance imaging visualised a mass, 12 cm × 6.7 cm × 8.6 cm in diameter, in the retrorectal space, spreading toward the left obturator foramen. Surgery was indicated due to exclude malignant process certainly, because it is difficult to differentiate lipoma from low-grade liposarcoma on non invasive imaging. Laparoscopic extirpation of the tumour was performed. The overall operative time was 80 min. The diagnosis of lipoma was established on histological examination. The patient was discharged from hospital on the 2nd day after the surgery. We have found this minimally invasive operation to be an effective and well-tolerated treatment option, determined by the experience of the surgeon., Highlights • Retrorectal lipoma is a benign mesenchymal tumour composed of mature adipose tissue, located in the retrorectal space [1]. • Retrorectal tumours in adults are rare [[3], [4], [5], [6], [7], [8], [9]], Jao et al. found that retrorectal tumours accounted for 1 in 40,000 hospital admissions [5]. • Miscellaneous, non classified tumours account for 10–25% of all retrorectal tumors. Retrorectal lipomas are included in this group [4,7]. • These tumours usually affect middle-aged patients and occurs twice as often in women as in men [7]. • Retrorectal lipomas, as well as other benign retrorectal tumours, are often completely asymptomatic [4,6,8,9]. • They are usually found incidentally when performing a pelvic or rectal examination [4,9]. • Retrorectal lipomas also might give nonspecific symptoms, mostly from the compression of pelvic structures, viscera and nerves. Symptoms depend on the size of the tumour, its localisation, extension [3]. • Diagnosis and treatment of retrorectal tumours, including lipomas, remain difficult. Currently, computed tomography scan used in conjunction with magnetic resonance imaging scan is the gold standard in diagnosing retrorectal tumours [4]. • These methods are used to find out the size, structure of the tumour, its relationship with surrounding organs that is a necessary information for planning surgical approach [3,4,8]. • Biopsy should not be performed before a surgery [5,6]. • All retrorectal tumours, including lipomas, should be resected [3,6,7]. • In the presenting case laparoscopic surgery was indicated due to exclude malignant process, because it is difficult to differentiate lipoma from low-grade liposarcoma on magnetic resonance imaging [10].

Purpose To compare the results of laser hemorrhoidoplasty (LHP), excisional hemorrhoidectomy (EH), and sutured mucopexy (MP). Methods A randomized, parallel-group, double-blinded, single-center prospective study. Patients Symptomatic 2nd- or 3rd-degree hemorrhoids patients. Interventions Computer randomization sequence, patient blinding, operating surgeon blinding, and surgeon-evaluator blinding. LHP was performed using a 1470 nm diode laser. Up to 250 J of energy delivered per 1 hemorrhoid. The procedure was performed circumferentially. MP ligations were placed in the area of visible hemorrhoidal tissue. Standard EH was performed up to the level of the hemorrhoidal pedicle. Follow-up at 1 and 6 weeks and 1 year. Outcome measures Recurrence of symptoms requiring treatment, intensity, and duration of pain after the operation, patients’ quality of life, fecal incontinence, and patients’ evaluation of treatment. Results A total of 121 patients. Groups were even preoperatively. LHP took 15 min (SD 5.6), MP took 16 min (SD 5.58), and EH took 29 min (SD 10.3). Recurrence requiring treatment rate was 0% after EH, 10% after LHP, and 22% after MP, p = 0.004. LHP and MP were less painful than EH, p p Limitations Single-center study. Conclusions Laser hemorrhoidoplasty is a safe, minimally invasive option for hemorrhoids, more effective than MP and less effective than EH. Patients evaluate this technique better than the other two.

Transanal total mesorectal excision (taTME) is a new natural orifice translumenal endoscopic surgery modality combined of three rectal surgery techniques. Detailed analysis of the taTME is the object of this article. We submit the report of three taTME procedures for histologically confirmed rectal adenocarcinoma that were performed for the first time in Lithuania, Vilnius University Hospital Santariskiu Klinikos.

Background: Appendiceal mucinous tumour (AMT) is a very uncommon disease. We aimed to evaluate preoperative and postoperative characteristics as well as long-term outcomes of patients with appendiceal mucinous adenomas and peritoneal pseudomyxoma (PMP). Methods: A consecutive cohort of patients diagnosed with AMT were included in the study. Tumour recurrence and the development of PMP was diagnosed based on the patients' complaints, physical examination, imaging studies, and biopsy results. The calculation of survival rates was performed using the Kaplan-Meier method. Results: Between January 2003 and February 2013, 25 patients had AMT. 15 patients underwent appendectomy only (60%), 5 patients (20%) right hemicolectomy, 4 patients (16%) cytoreductive surgery (CRS) ± hyperthermic intraperitoneal chemotherapy (HIPEC), and 1 patient (4%) appendectomy with caecal resection. Another 2 patients underwent CRS and HIPEC 4 days and 3 years, respectively, following initial appendectomy. In the histopathologic examination, adenoma was diagnosed in 12 patients (48%); among these, low-grade PMP was found in 1 patient (4%). Low-grade appendiceal mucinous adenocarcinoma (AMCa) was diagnosed in 11 patients (44%); among these, low-grade PMP was found in seven cases (28%) and high-grade AMCa was diagnosed in 2 patients (8%). 2 of 8 PMP patients did not undergo CRS ± HIPEC because of comorbidities. The 5-year overall survival was 100% for the adenomas and 62% for PMP patients. Conclusion: AMT is a very rare entity with a considerably good outcome even in disseminated disease. CRS and HIPEC is a gold standard treatment for PMP with excellent prognosis. However, our results could still be improved in the future.

Tikslas. Apžvelgti Vilniaus universiteto ligoninės Santariškių klinikose gydytus pacientus, kuriems diagnozuoti retrorektiniaipresakraliniai navikai, įvertinti radiologinių tomografinių tyrimų taikymą jų diagnostikai. Apžvelgti naujausius straipsnius apie presakralinius-retrorektinius navikus ir jų radiologinę diagnostiką. Tyrimo medžiaga ir metodai. Naudojantis Vilniaus universiteto ligoninės Santariškių klinikose įdiegta elektronine ligos istorija ir joje esančia statistine paieškos sistema, iš galutinių diagnozių epikrizėse retrospektyviai rasti ligoniai, kuriems diagnozuotas ir histologiškai patvirtintas bei operuotas retrorektinis-presakralinis navikas. Į mūsų tyrimą pagal šiuos kriterijus įtraukta 11 pacientų, kurie nuo 2004 m. rugsėjo mėn. iki 2015 m. gegužės mėn. tirti ir gydyti VUL Santariškių klinikose. Kiti su šia patologija gydyti ligoniai, kuriems nebuvo atlikti radiologiniai tyrimai, į studiją nebuvo įtraukti. Atlikta iki 2015 metų publikuotų straipsnių apie retrorektinius-presakralinius navikus medicininėse duomenų bazėse literatūros apžvalga. Rezultatai. Per pastaruosius vienuolika metų VULK Santariškių klinikose radiologiškai diagnozuoti ir gydyti 11 pacientų su retrorektiniu-presakraliniu tumoru. Dauguma tirtų pacientų buvo vidutinio amžiaus moterys, jos sudarė 81,8 proc. Dažniausiai diagnozuoti ir gydyti nepiktybiniai navikai, dažniausiai diagnozuotas retrorektinis-presakralinis tumoras buvo cistinė hamartoma – 27,3 proc. Diagnostinė (priešoperacinė) kompiuterinė tomografija atlikta 4 pacientams (36,4 proc.), magnetinio rezonanso tomografija – 6 pacientams (54,5 proc.), kompiuterinės tomografijos ir magnetinio rezonanso tomografijos derinimas buvo taikomas vienam pacientui (9,1 proc.). Išvados. Retrorektiniai-presakraliniai navikai – retai pasitaikanti patologija. Kompiuterinė tomografija arba/ir magnetinio rezonanso tomografijos radiologinis ištyrimas operuojamiems ligoniams įgalina tiksliai nusakyti naviko pobūdį ir lokalų išplitimą. Tiksli priešoperacinė radiologinė diagnozė buvo suformuluota 90,9 proc. atvejų.

INTRODUCTION With the development and improvement of laparoscopic surgery, procedures have become common. However, post-operative complications occur when patients are released from hospital. These complications increase patients' morbidity and mortality. They also lead to re-hospitalization, an extended recovery period, and an increase in the cost of treatment. AIM To evaluate and determine the prognostic properties of C-reactive protein in the early diagnosis of postoperative complications after a laparoscopic colon resection. MATERIAL AND METHODS The prospective study included patients who underwent laparoscopic colorectal surgery in 2010-2014. The patients were divided into two groups - uncomplicated ones and those with complications. C-reactive protein concentrations in their blood serum were measured on the 2(nd), 4(th) and 6(th) day after surgery. Logistic regression analysis was used to evaluate the relation between C-reactive protein values measured on the 2(nd), 4(th) and 6(th) postoperative day and related complications. Receiver operating characteristic curves were used to determine the sensitivity and specificity of each C-reactive protein value measured on the 2(nd), 4(th) and 6(th) postoperative day. RESULTS One hundred and six patients were included in the trial; 14 of them had complications. On the second day, a C-reactive protein cut-off value of 88.6 mmol/l provided the highest sensitivity and specificity for predicting evolving complications, being 71.4% and 84.8% respectively (p = 0.003). The significant predictive cut-off value decreases and becomes more sensitive and specific each post-operative day. CONCLUSIONS It is possible to detect developing post-operative complications early on by monitoring C-reactive protein concentration levels in the blood serum on the 2(nd), 4(th), and 6(th) post-operative days.

Introduction : Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth most frequent cause of cancer-related death in the world. CRC screening programs have been widely introduced worldwide, allowing for early detection and removal of precancerous lesions and avoiding major surgical intervention. However, not all polyps are suitable for conventional and advanced colonoscopic polypectomy. Thus, laparoscopically assisted colonoscopic polypectomy (LACP) was introduced to clinical practice as a method of choice for these polyps and adenomas. Aim: To overlook our experience in laparoscopically assisted colonoscopic polypectomies and evaluate effectiveness and quality of the procedure. Material and methods : A retrospective analysis of a prospectively maintained database was performed. using the Vilnius University Hospital Santariskiu Klinikos patient database for the period from 2010 to 2016, resulting in 21 cases in which LACP was performed. All procedures were performed using combined laparoscopy and videocolonoscopy techniques. Morphology of adenomas was classified according to the Paris classification during the procedure. Creation of the database was approved by the Lithuanian Bioethics committee. Results: Twenty-two adenomas were removed from 21 patients, aged 65.33 ±8.9. There was no difference between male and female age, but occurrence of adenomas in females was 2-fold higher. The majority of removed lesions were localized in the cecum and mean size was 27.2 ±11.1 mm. The morphology of adenomas was distributed equally between 0–Is, 0–Ip, and 0–IIa, except one, which belonged to 0–III. Histological analysis revealed that tubulovillous adenoma occurrence was 1.4 times higher than tubulous adenoma. There was only one postoperative complication – bleeding from the adenoma resection site, which was managed by conservative means. One patient developed G2 adenocarcinoma at the polyp resection site and was referred for radical surgery. Conclusions : The LACP is a safe procedure with minimal risk to the elderly patient. Patient follow-up is essential for detection of recurrence.

Around the globe a new interest in the multidisciplinary management of peritoneal metastases using neoadjuvant chemotherapy, cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and adjuvant systemic chemotherapy has occurred. The combined use of these treatment modalities has required the creation of centers of excellence to manage patients with peritoneal metastases with a high level of success as well as a low incidence of adverse events.A 2-day workshop hosted by the Center of Abdominal Surgery, Vilnius University Hospital, with 230 participants was organized to explore the current practice in the Baltic states. Live surgery with video transmission initiated the efforts. Then, presentations by five experts from high-volume peritoneal surface malignancy centers were made and discussed. A summary of the efforts to date in Lithuania and Estonia was presented and collected for publication.The live surgery served as a focal point for all subsequent presentations. The five invited speakers reviewed the rationale, current literature, indications and contraindications, implementation, and current European guidelines for management. The results of CRS and HIPEC from five centers in Lithuania and Estonia currently active revealed 127 patients treated to date, half of whom carried a diagnosis of ovarian cancer. There was an incidence of major complications of 11.8% and a mortality of 1.6%. Data regarding long-term survival benefits will require further follow-up.Progress in peritoneal surface oncology in the Baltic states was confirmed. With a low morbidity and mortality, these clinical programs promise to provide continued benefit for patients with peritoneal metastases - a condition judged to be terminal in the past.Weltweit ist ein neues Interesse am fachübergreifenden Management von Peritonealmetastasen mithilfe von neoadjuvanter Chemotherapie, zytoreduktiver Chirurgie (ZRC), hyperthermischer intraperitonealer Chemotherapie (HIPEC) und adjuvanter systemischer Chemotherapie entstanden. Der kombinierte Einsatz dieser Behandlungsmethoden hat die Schaffung von Exzellenzzentren erfordert, um Patienten mit Peritonealmetastasen mit einem hohen Maß an Erfolg sowie einer geringen Inzidenz an Nebenwirkungen zu behandeln.Ein zweitägiger Workshop mit 230 Teilnehmern wurde vom Zentrum für Abdominalchirurgie des Vilnius University Hospital organisiert, um die derzeitige Praxis in den baltischen Staaten zu analysieren. Live-Chirurgie mit Videoübertragung stellte den Beginn der Zusammenarbeit dar. Darauf folgten Präsentationen von fünf Experten aus «High volume»-Zentren für Malignome der Peritonealoberfläche und anschließende Diskussionen. Zusammenfassungen der bisherigen Bestrebungen in Litauen und Estland wurden vorgestellt und zur Veröffentlichung gesammelt.Die Live-Chirurgie fungierte als Ausgangspunkt für alle nachfolgenden Präsentationen. Die fünf eingeladenen Referenten bewerteten die Vorgehensweise, die aktuelle Literatur, die Indikationen und Kontraindikationen, die Implementierung sowie die aktuellen europäischen Leitlinien für das Management. Die Ergebnisse der ZRC und HIPEC aus fünf derzeit aktiven Zentren in Litauen und Estland bezogen sich auf bislang 127 behandelte Patienten, von denen die Hälfte die Diagnose eines Ovarialkarzinoms erhalten hatte. Es lagen eine Inzidenz für schwere Komplikationen von 11,8% und eine Sterblichkeit von 1,6% vor. Daten zu langfristigen Überlebensvorteilen erfordern ein weiteres Follow-up.Fortschritte im Bereich der Onkologie der Peritonealoberfläche in den baltischen Staaten wurden bestätigt. Verbunden mit einer niedrigen Morbidität und Mortalität, versprechen diese klinischen Programme einen weiterhin fortgesetzten Nutzen für Patienten mit Peritonealmetastasen – ein Befund, der in der Vergangenheit mit einem tödlichen Verlauf assoziiert wurde.

Closure of a loop ileostomy is a relatively simple procedure although many studies have demonstrated high morbidity rates following it. Methods to reduce the number of complications, such as timing of closure or different surgical closure techniques, are investigated. The aim of this study was to evaluate the experience of the Abdominal Surgery Center at Vilnius University Hospital (VUH) 'Santariskiu klinikos' to review the complications after closure of loop ileostomy and to identify potential risk factors for postoperative complications.Data from 132 patients who underwent closure of loop ileostomy from 2003 to 2013 at the Abdominal Surgery Center of VUH were collected, including demographics, causes of ileostomy formation, additional diseases, time from creation to closure of ileostomy, anastomotic technique, duration of the operation, postoperative complications, and hospital stay after surgery. The operations were performed by 15 surgeons with varying experience assisted by surgical residents. Experience in ileostomy closure was defined by the number of procedures performed.Complications occurred in 24 patients (18.2%), with 20 of them having surgical complications: bowel obstruction (9 (6.8%)), wound infection (4 (3.0%)), peritonitis due to anastomotic leak (3 (2.3%)), intra-abdominal abscess (2 (1.5%)), anastomotic leak with enterocutaneous fistula (1 (0.76%)), and bleeding (1 (0.76%)). 4 patients had non-surgical complications: postoperative diarrhea (2 (1.5%)), urinary retention (1 (0.76%)), and deep vein thrombosis (1 (0.76%)). Most complications were classified as group II according to the Clavien-Dindo classification. 2 patients died (1.5%). The anastomotic technique used did not affect the outcome. The experience of the surgeon as judged by the frequency of the procedure was the main factor affecting postoperative morbidity significantly (p = 0.03).Our study revealed that the rate of postoperative complications and a smooth postoperative course after the closure of ileostomy was influenced by surgical experience.Der Verschluss eines protektiven Ileostomas ist ein relativ einfaches Verfahren, wenngleich viele Studien hohe nachfolgende Morbiditätsraten aufzeigen konnten. Die Methoden zur Verringerung der Anzahl an Komplikationen, wie z.B. zeitliche Planung des Verschlusses oder verschiedene chirurgische Verschlusstechniken, werden untersucht. Das Ziel dieser Studie war es, die Erfahrungen des Abdominal Surgery Center am Vilnius University Hospital (VUH) «Santariskiu klinikos» zu evaluieren, um die Komplikationen nach Verschluss eines protektiven Ileostomas darzustellen sowie die potenziellen Risikofaktoren für postoperative Komplikationen zu identifizieren.Die Daten von 132 Patienten wurden gesammelt, die zwischen 2003 und 2013 mit einem Verschluss eines protektiven Ileostomas im Abdominal Surgery Center des VUH versorgt worden waren. Hierzu gehörten auch die Demografie, Ursachen für die Ileostoma-Bildung, zusätzliche Erkrankungen, die Zeit von der Anlage bis zum Ileostoma-Verschluss, die Anastomosentechnik, die Dauer der Operation, postoperative Komplikationen und der Krankenhausaufenthalt nach dem Eingriff. Die Operationen wurden von 15 Chirurgen mit unterschiedlichem Erfahrungsgrad, unterstützt von chirurgischen Assistenzärzten, durchgeführt. Expertise im Ileostoma-Verschluss wurde anhand der Anzahl der durchgeführten Eingriffe definiert.Komplikationen traten bei 24 Patienten (18,2%) auf. 20 von ihnen hatten chirurgische Komplikationen: Darmverschluss (9 (6,8%)), Wundinfektion (4 (3,0%)), Peritonitis infolge von Anastomoseninsuffizienz (3 (2,3%)), intraabdominaler Abszess (2 (1,5%)), Anastomoseninsuffizienz mit enterokutaner Fistel (1 (0,76%)) und Blutungen (1 (0,76%)). 4 Patienten hatten nichtchirurgische Komplikationen: postoperative Diarrhö (2 (1,5%)), Harnretention (1 (0,76%)) und tiefe Venenthrombose (1 (0,76%)). Die meisten Komplikationen wurden der Gruppe II gemäß der Clavien-Dindo-Klassifikation zugeordnet. 2 Patienten verstarben (1,5%). Die verwendete Anastomosentechnik hatte keinen Einfluss auf das Resultat. In signifikanter Weise hauptverantwortlich für die postoperative Morbidität (0,03) war die Erfahrung des Chirurgen, die auf Basis der Anzahl der durchgeführten Eingriffe bestimmt wurde.Unsere Studie zeigte, dass die Rate der postoperativen Komplikationen und des reibungslosen postoperativen Verlaufs nach Ileostomie-Verschluss von der chirurgischen Erfahrung beeinflusst wird.

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastro- intestinal (GI) tract. Although the therapy targeted at inhibiting tyrosine kinases has shown dramatic results in metastatic and inoperable GISTs, the mainstay of treatment in primary localized forms remains surgical resection. Aim: To provide an overview of our experience of GIST diagnosis and management, with emphasis on comparison of minimally invasive and open surgical resection for primary GISTs. Material and methods: We retrospectively reviewed the medical records of all patients who underwent surgical removal of GISTs from 2008 to 2012. Patient demographics, clinical data, surgery, complications, histopathological data and clinical course were analyzed. Results: Forty-four patients were identified. Average age at diagnosis was 63 years. Minimally invasive (MIS) and open surgery (OS) were each attempted in 22 (50.0%) patients. Laparoscopic removal was performed in 20, laparo- endoscopic in 1, and laparoscopy-assisted endoscopic removal in 1. Conversion to an open procedure was performed in 4 (18.2%). We found significant differences in postoperative length of stay (8.5 days vs. 10.1 days, p < 0.001) and tumor size (2.93 cm vs. 5.78 cm, p = 0.018) between MIS and OS groups, respectively. Conclusions: Laparoscopic removal is safe and effective for GISTs not exceeding 6 cm. Gastroesophageal junction and cardia GISTs require careful preoperative evaluation and planning to remove safely. We recommend avoiding laparoscopic removal of these tumors due to the high rate of conversion (100.0%) to an open procedure. Laparo- endoscopic surgical approach is an appropriate technique for removal of small-sized intraluminal benign GISTs not involving the muscularis propria layer.

Sciatic hernia is considered to be the rarest hernia of pelvic floor with less than one hundred reports published worldwide. Lipoma in the hernia sac is even more unique pathology with only few cases reported in the literature. We report a case of gluteal lipoma protruding into pelvis, displacing rectum with bladder and presenting as a sciatic hernia. A 53-year-old male presented with an expanding, slightly reducible, right gluteal painful mass, back pain, dull pressure in lower abdomen and perianal region radiating to the right buttock, urgent urination and defecation. Lower back pain lasts for more than 7 years, other symptoms—6 months. No spinal pathology was found on X-ray. On examination patient seemed well nourished, BMI 29, abdomen was soft, without palpable masses or signs of peritonitis. Digital rectal examination showed no pathology. There was a reducible lump on the lateral side of right gluteus. Computer tomography (CT scan) demonstrated a large intra- and extra-pelvic fatty mass traversing the greater sciatic foramen. The tumor was surgically removed through lower middle laparotomy approach. Subsequent pathological examination revealed lipoma. The patient recovered uneventfully, was discharged 8 days later. MRI scan was advised following 1 year after the surgery. The presence of a gluteal mass should always suggest the possibility of a sciatic hernia.

Objective The optimal diagnostics and treatment of acute appendicitis continues to be a challenge. A false positive diagnosis of appendicitis may lead to an unnecessary operation, which has been appropriately termed negative appendectomy. The aim of our study was to identify the effectiveness of preoperative investigations in preventing negative appendectomy. Methods A retrospective study was performed on adult patients who underwent operation for suspected acute appendicitis from 2008 to 2013 at Vilnius University Hospital Santariskiu Klinikos. Patients were divided into two groups: group A underwent an operation, where appendix was found to be normal (non-inflamed); group B underwent an appendectomy for inflamed appendix. Groups were compared for preoperative data, investigations, treatment results and pathology findings. Results 554 patients were included in the study. Preoperative laboratory tests results of hemoglobin, hematocrit concentrations and white blood cell count were significantly higher in group B (p Conclusions In summary, acute appendicitis is still often misdiagnosed and the ratio of negative appendectomies remains rather high. Additional investigations such as observation and computed tomography should be used to prevent this.

Merkel cell carcinoma is an aggressive skin malignancy. Primary Merkel cell carcinomas are treated by wide radical excision with or without adjuvant radiotherapy, while benefits of adjuvant chemotherapy remain doubtful. There are only several cases of gastrointestinal metastases of Merkel cell carcinoma reported so far. We report a case of recurrent Merkel cell carcinoma with metastases to the stomach and the small intestines after wide excision of primary Merkel cell carcinoma.

Single incision procedures are evolving as part of minimally invasive surgery. In 2008, the SILS approach was first described for a right hemicolectomy. We report and describe the first two transumbilical single incision laparoscopic right hemicolectomies for benign disease, which were performed in Lithuania Vilnius University Hospital Santariskiu Klinikos.

Background: Cancer of the left colon with obstruction (CLCO) is a serious disease. Many surgeons perform one-stage resection with the on-table wash-out of the colon. However, there is uncertainty c

Background and objective Treatment options for colorectal cancer patients create the need to assess the quality of life (QoL) of colorectal cancer patients in the early postoperative period when changes are potentially greatest. The aim of the current study was to assess the QoL of colorectal cancer patients following open and laparoscopic colorectal surgery. Materials and methods A total of 82 consecutive patients requiring elective open or laparoscopic colorectal surgery were recruited to the study for three months in the three colorectal surgery centers of Lithuania. Patients completed the EORTC QLQ-C30 (version 3.0) questionnaire before surgery, 2 and 5 days, 1 and 3 months after operation. The EORTC QLQ-CR29 questionnaire was completed before surgery and at 1 and 3 months after operation. Analysis was done according to the manual for each instrument. Results EORTC QLQ-C30 reflected the postoperative recovery of QoL. The global health status, cognitive and emotional functioning came back to the preoperative level in one month after operation. Physical and role functioning for laparoscopic group was significantly improved in one month after operation and in three months for open surgery group respectively. Colorectal module EORTC-QLQ-CR29 found that future perspective increased significantly in laparoscopic group 1 month after operation. Conclusions The present study showed that majority of functional scale scores came back to the preoperative level during the first 3 months after colorectal cancer surgery. Differences in QoL according to surgical approach are mostly expressed on this period.