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Purpose: The study aimed to determine a simple diagnostic test that could predict the risk of anastomotic leakage in early postoperative period., Methods: A single-center, retrospective study was conducted. The electronic medical records of patients who underwent resection for rectal tumor between January 1, 2016, and December 31, 2021, in University Hospital Olomouc, were reviewed. The data included risk factors for leakage and laboratory parameters commonly obtained., Results: The decrease in platelets was significant as for the possibility of being a marker of anastomotic leakage; OR = 0.980 (p = 0.036). A decrease of 34 or higher predicts leakage with a sensitivity of 45 % (95 % CI: 23.1-68.5 %) and specificity of 81.1 % (95 % CI: 75.2-86.1 %). Postoperative leukocyte blood level (OR = 1.134; p = 0.019) and leukocyte level on postoperative day 1 (OR = 1.184; p = 0.023) were significant predictors for leakage. WBC values ≥ 8.8 predict leakage with a sensitivity of 70.0 % (95 % CI: 45.7-88.1 %) and specificity of 55.3 % (95 % CI: 48.4-62.0 %).  Hemoglobin blood level ≤ 79.5 predicts leakage with a sensitivity of 70.0 % (95 % CI: 45.7-88.1 %) and specificity of 62.2 % (95 % CI: 55.5-68.7 %)., Conclusion: Despite the fact that the specificity and sensitivity of the followed parameters are low, they could serve as markers useful for early diagnosis or suspicion for leakage (Tab. 5, Fig. 3, Ref. 14).

The frequent occurrence of E. coli positive for cyclomodulins such as colibactin (CLB), the cytotoxic necrotizing factor (CNF), and the cytolethal distending factor (CDT) in colorectal cancer (CRC) patients published so far provides the opportunity to use them as CRC screening markers. We examined the practicability and performance of a low-cost detection approach that relied on culture followed by simplified DNA extraction and PCR in E. coli isolates recovered from 130 CRC patients and 111 controls. Our results showed a statistically significant association between CRC and the presence of colibactin genes clbB and clbN , the cnf gene, and newly, the hemolytic phenotype of E. coli isolates. We also observed a significant increase in the mean number of morphologically distinct E. coli isolates per patient in the CRC cohort compared to controls, indicating that the cyclomodulin-producing E. coli strains may represent potentially preventable harmful newcomers in CRC patients. A colibactin gene assay showed the highest detection rate (45.4%), and males would benefit from the screening more than females. However, because of the high number of false positives, practical use of this marker must be explored. In our opinion, it may serve as an auxiliary marker to increase the specificity and/or sensitivity of the well-established fecal immunochemical test (FIT) in CRC screening.

Secondary peritonitis is the most common cause of inflammatory acute abdomen treated at general surgery departments. Only early and correct diagnosis may improve the prognosis of these patients. The authors compiled an interdisciplinary review of the basic principles of diagnosis and treatment of secondary peritonitis, which reflects current findings supported by evidence-based medicine. The work is based on published international literature but also shares opinions and experiences of the selected specialists. The presented work in its extent is not meant to substitute an in-depth study of the issue, but to allow a basic and quick review of the topic.

Introduction: The treatment of the stenoses of colorectal anastomoses represents a difficult area of colonic surgery. This is partly connected to the introduction of staplers and an increasing amount of sphincter-preserving surgeries. At our clinic, we solve the stenoses of colorectal anastomoses using a surgical rectoscope with a good effect., Material and Methods: We analysed retrospectively a group of 27 patients with benign stenosis of colorectal anastomosis of the medial and upper rectum who underwent surgery at our clinic in the period between January 2004 and December 2011. From the total amount of 27 patients, in 23 patients the stenosis was caused by the dehiscence of anastomosis, and in 4 patients the stenosis had a different etiology., Results: In the group of 27 patients, in 14 patients the stenosis of colorectal anatomosis was solved radiologically using a high pressure balloon. Total of 13 patients underwent surgery, in 10 of them we used the surgical rectoscope and 3 patients underwent an open abdominal procedure., Conclusion: The first method of choice in treatment of the stenoses of the colorectal anastomoses is a balloon dilatation. If this is not successful we can use the surgical rectoscope as a minimally invasive though effective and safe method.

Colorectal cancer, in patients with ulcerative colitis, is detected in the resected tissue of approximately 5% of patients, according to the literature. In our set of 82 patients operated on between the years 2000-2009, malignancy was confirmed in 9/82 patients (11%). In two young patients, the peroperative findings showed inoperable generalized carcinoma. The greater incidence of malignity is surely associated with inconsistent dispensarization of these patients.

Aim: Evaluate our more than seven year experience with transanal endoscopic microsurgical technique (TEM)., Materials and Methods: The authors prospectively evaluated a set of 393 patients who were operated using the TEM method., Results: Out of 393 patients, 371 (94%) were indicated for the procedure for rectal tumor; 82 of these tumors were malignant. Nine patients underwent a rectoplasty for rectal stenosis, and in five patients drainage of a perirectal fluid collection was performed. Four patients underwent the surgical procedure for bleeding from the rectal tumor and in four patients an ulcerous lesion was removed from the rectum. Complications in the set of patients with malignant or benign tumors of the rectum occurred in 21 (6%) cases. Ten patients had bleeding, three patients underwent surgical revision for peritonitis with dehiscence of the intraabdominal bowel suture after transmural resection, periproctal abscess occurred in five patients, rectovaginal fistula was observed in three patients. There was no postoperative mortality., Conclusion: Transanal endoscopic microsurgery has become a standard therapeutic procedure. In oncosurgery, for early stages of rectal tumors, it is an equivalent alternative to conventional surgery with the advantages of minimal morbidity, mortality, postoperative complications, and sexual and urological dysfunctions. This, however, is only true when indication criteria are strictly adhered to and principles of resection radicality are maintained.

Objective: The objective of the work was to evaluate five-year survival rates of patients with liver metastases from colorectal cancer following radiofrequency ablation (RFA). MATERIAL A METHOD: The authors prospectively evaluated a set of 32 patients indicated for radiofrequency ablation., Results: Patients who were indicated for RFA and for a combination of liver resection with RFA for metastasis from colorectal cancer had a one-year, three-year and five-year survival of 81%, 31% and 13%, respectively. Therefore 10 patients survived 3 years following the procedure and of these 4 obtained five-year survival., Conclusion: Radiofrequency ablation has become a generally accepted technique in the treatment of liver metastases. It is indicated in cases of lesions unsuitable for surgical resection, either due to large number and location or in patients with comorbidities where an extensive resection is contraindicated. Radiofrequency ablation has minimal complications and is considered on the borderline between a palliative and radical procedure.

For successful outpatient treatment of perianal duplicatures, it was necessary to solve two main problems. First was bleeding from wounds following excision of perianal duplicatures, which is often marked and "pulsating", as well as to accelerate defect healing after excision so as to eliminate or minimize sick leave following this outpatient procedure. To effectively stop acute bleeding we use Traumacel powder, which after applying to a tampon we apply to the bleeding site and by compression we facilitate its effect. Traumacel spray also has a significant haemostatic effect, which we spray directly onto the bleeding site, where it reacts and creates a strongly adhering coagulum, which has significant haemostatic properties. This effect may also be potentiated by applying compression in the form of tampon or longuette. After cessation of acute bleeding, as prevention against future seepage, surgical haemostatic materials are used, which adhere to the wound, or bleeding lesion, and are left in situ for approximately 12 hours. After stopping the bleeding, hydrocortisone and epithelializing cream is applied to the defects to support healing by significantly decreasing secretion from the wound and also significantly decreasing healing time by facilitating epithelization. At outpatient check-ups, wound surfaces treated as such are cleanly granulated without necrotic coating and with minimal surrounding redness. The total healing time is generally 2 weeks, whereas after 4 days the patients are almost without troubles. This effective healing not only lessens the patient's pain, but also improves the comfort of the patient and allows a more rapid return to daily activities.

Introduction: Liver resection is the preferred treatment for colorectal liver metastases. About 30 to 40 % of the patients survive for five years after radical resection of liver metastases. In contrast to that, patients who are not fit enough for radical resection of metastases and two are treated by chemotherapy survive only for 18 months on average. The survival of patients with non-resectable liver metastases can be improved by metastases destruction and subsequent chemotherapy. At present, radiofrequency ablation (RFA) is widely used for the destruction of liver tumours., Patients and Methods: In the four-year period (2000-2003), 190 patients with liver metastases of colorectal carcinoma have been operated upon at the 2 (nd) Surgical Department of University Hospital in Olomouc. Radical resection of metastases was carried out in 136 patients (71.5 %), RFA combined with liver resection was performed in 23 patients (12 %) and exclusive RFA of metastases was indicated in 31 patients (16 %). The patients were evaluated for the disease-free survival after one year and the survival rates at 12, 24 and 36 months after operation were determined., Results: 12 months after the operation no tumour progression was found in 115 patients (85 %) subjected to radical resection of liver metastases, in 16 patients (52 %) after sole RFA of metastases and in 15 individuals (65 %) who underwent liver metastasis resection combined with RFA of the remaining cancer foci. The survival of patients after 12, 24 and 36 months was 124 / 136 (91 %) 103 / 136 (76 %) and 79 / 136 (58 %) in the group of radical metastasis resection; after sole RFA of the metastases and subsequent chemotherapy, the survival at 12, 24 and 36 months amounted to 27 / 31 (87 %), 19 / 31 (61 %) and 8 / 31 (26 %) of the patients; in the group undergoing metastases resection combined with RFA and adjuvant chemotherapy patient survival at 12, 24 and 36 months was as follows: 19 / 23 (83 %), 13 / 23 (57 %), and 7 / 23 (30 %)., Conclusion: RFA combined with adjuvant chemotherapy considerably extends the survival of patients with liver metastases of colorectal carcinoma compared to chemotherapy alone. However, no difference in survival was found between our patients subjected to RFA of metastases and adjuvant chemotherapy and those patients undergoing resection of liver metastases combined with RFA of unresectable metastases and subsequent chemotherapy.

Background/aims: Radical surgery still plays a decisive role in the therapy of rectal cancer. Besides classical abdominal operations, an alternative is transanal endoscopic resection of rectal tumor at T1 and T2 stages. Indication for local resection of malignant rectal tumor requires an accurate preoperative staging., Methodology: The paper evaluates the accuracy of 3D endorectal sonography in rectal cancer staging. In the group of 78 patients the staging of preoperative 3D endorectal sonography was compared with a final histopathologic of the operative sample., Results: The results obtained indicate that the preoperative staging of malignant rectal tumor using 3D endorectal sonography represents 100% only in the pT1 stage. In the pT2 stage, the accuracy of 3D endorectal sonography is 72%, in pT3 and pT4 represents 92%., Conclusions: On the basis of our experience, complicated interpretation of findings obtained by 3D endorectal sonography occurs at limits of T2-T3 and T3-T4. In these localizations the peripheral reactive fibrous and inflammatory sections in the vicinity of tumor tissue often involve even the next layer of rectal wall and leads to overevaluation of invasion depth at endorectal sonography of rectal cancer.

Aim: Major hernias in sutures following abdominal surgical procedures make the patients' quality of life significantly worse. Our aim is to prove that, even now, the surgical management of such hernias has its cons and in most cases requires a plastic mesh application., Patient Subjects and Results: The authors operated 82 patients with hernias via the middle laparotomy. The patients had been primarily operated for their colorectal disorders. The incidence rate of the major hernias in sutures was 5.25% (82/1564). The defects of the abdominal wall were corrected using a prolene mesh placed intraperitoneally. Although in 11 patients the authors report postoperative complications in the sutures (1x absces, 6x seroma, a 4x infiltration), the long-term results of the above technique remain very positive. 2 patients had a relaps of the hernia and clinical manifestations of adhesions following the procedure were reported in 7 patients., Conclusion: The technique of the intraabdominally located mesh in the major postoperative hernias management enables tension-free procedures of the major defects of the abdominal wall to be conducted with very good long-term results.

The authors present a prospective study on a value of oncologic markers CEA and CA 19-9 in patients after curative therapy for colorectal adenocarcinoma. During a five-year follow-up in 320 patients, a significant elevation of CEA or CA 19-9 was documented in 71 patients (22.8 %), and resulted in tumour detection in 39/71 patients (55 %). Although the levels were defined as false positive in 32 patients (45 %), the importance of CEA and CA 19-9 monitoring is documented by elevated levels of oncomakers in 39/55 patients (71%) with metastases or local-regional recurrence of colorectal adenocarcinoma. (Tab. 3, Ref: 21.)

Spontaneous rupture of the oesophagus (Boerhaave's syndrome) is a life threatening disease the successful treatment of which depends on early diagnosis and effective comprehensive treatment. The authors present an account on three patients who were successfully treated on account of spontaneous rupture of the oesophagus.

In the period between February 2, 1988 and October 30, 1998, the investigators administered Sulperazon to 20 patients at the Surgery Department 1, University Hospital Olomouc, in whom they expected good clinical effect (i.e., high concentration in bill, effect on respiratory tract pathogens). Sulperazon was administered in 12 cases as a drug of first choice, in 8 cases as a drug of second choice. In all cases, relief from clinical symptoms of infection was observed within 5 days of treatment and in 83% of cases eradication of previously cultivated pathogen was achieved. Sulperazon was well tolerated and no side effects or impoivment of laboratory test were observed. In 4 cases, prolonged administration was complicated by candida superinfection. Sulperazon proved to be effective in surgery in treatment of infectious complications of bile duct and pancreas diseases and in thoracic cavity pathology.

In 1995-1997 at the First Surgical Clinic, Medical Faculty, Palacký University and Faculty Hospital Olomouc three patients were treated on account of obstruction of the pyloroduodenal region caused by Crohn's disease. The condition was treated by anastomosis, possibly with vagotomy, depending on the site of stenosis. Clinical, laboratory and endoscopic control examinations after a 6-month to 3-year interval revealed good results of this approach.

The authors present an account on four patients, treated because of colorectal carcinoma who had solitary secondaries of a colorectal tumour at less common sites. Twice a secondary in the urinary bladder wall was found once in the right cerebral hemisphere and once in the humerus.

During the five-year period between 1992-1996 at the First Surgical Clinic of the Medical Faculty, Palacký University and Faculty Hospital in Olomouc 22 patients were operated on account of ulcerative colitis. Twelve patients were subjected to primary operations on account of acute complications of the disease, ten patients are in the group of elective operations. As the incidence of ulcerative colitis in our population is not high there is little experience with treatment of this disease and ulcerative colitis is still a problem for gastroenterologists as well as surgeons. The authors draw attention to two factors which have an impact on surgical treatment of ulcerative colitis: 1. optimal time for indication of surgical treatment calls for treatment of patients in a specialized gastroenterological department, 2. Surgical treatment calls for a specialised team linked with the gastroenterological department concerned with treatment of ulcerative colitis.

The authors present an account on six patients with a primarily non-resectable tumour of the colon where radical resections were made in the second stage. Based on their experience they recommend an active approach to patients with primarily non-resectable tumours of the colon who have no signs of dissemination of the tumour. In these patients they recommend not only dispensarisation but also adjuvant chemotherapy and radiotherapy. In case of regressing tumourous infiltration they recommend resection of the tumour in the second or if necessary third stage.

The submitted retrospective study evaluates the long-term survival of patients treated on account of a malignant tumour of the rectum and rectosigmoid. The authors compare the results of radical surgery with rational radicality. Statistical evaluation of the survival of 170 patients subjected to radical surgery revealed significant differences as regards five-year survival of patients between these groups, although the differences of three-year survival are not statistically significant.

The authors evaluate the contribution of preoperative adjuvant radiotherapy in the comprehensive treatment of patients with a malignant tumour of the rectum and rectosigmoid. The five-year follow up of 159 patients subjected to radical surgery revealed statistically significant differences of the three-year survival of patients treated by a combination of surgery and rapid preoperative irradiation. However, radiotherapy did not affect the five-year survival of patients treated on account of a rectal tumour.

In a group of 56 patients with inoperable carcinoma of the esophagus treated at the authors' department during the last five years the authors analyse the possibilities of palliative treatment of dysphagia. As a criterion of success they consider life-long restoration of comfortable swallowing achieved during short-term hospitalisation with rapid return of the patient to home care. In the authors' opinion none of the methods is universal. Therefore it is important that a patient with carcinoma of the esophagus should be treated in a department which is familiar with the whole range of the problem.

The authors give an account of the occurrence of Crohn's disease in first grade relatives. Within a short time interval on account of Crohn's disease daughter, son and mother were operated.

The authors discuss a group of 88 dispensarized patients from a group of 153 operated during 1988-1992 on account of a malignant rectal tumour. Local regional relapses were found in 14 patients (15.9%). As the therapeutic results in local regional relapses are not satisfactory, the authors consider influencing of factors leading to more frequent local relapses after curative surgery of a malignant tumour as the fundamental problem.

The authors discuss the problem of relapses of gastric cancer, the conditions of its development and its possible treatment. As a basis they use experience with the treatment of 167 patients operated on account of this condition at the First Surgical Clinic in Olomouc in 1986-1993. In these patients 77 radical operations were performed, 25 developed a relapse of the tumor. Only in two patients it was possible to perform another resection--total gastrectomy. In these two re-resected patients the mean survival period was 9 months, in the remainder only two months. The authors conclude that in relapses of gastric cancer even several months' survival are a success.

In this paper the problem of Crohn's disease incidence among the nearest relatives is discussed. Within a short period of time a daughter, a son and their mother had to undergo an operation successively.

Method of interrupted ischaemization of the liver afflicted with metastases from colorectal cancer is not definitively evaluated yet. Using the literary reports the authors proposed (in cooperation with MEDIN) a instrument for compression of the liver artery, economically easy available. The reability of this instrument was tested in model conditions and his safety to the tested artery was proved on the experimental animal.