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Background/Aim: Colorectal metastatic liver tumours are the most common secondary liver tumours. During the life of patients with colorectal tumorous, this liver metastases will develop either synchronously or metachronously in half of the patients. Approximately 25 % of patients with colorectal cancer diagnosis have secondary deposits in the liver and the additional 25 % of patients will develop metastases within five years. The objective was to investigate whether anatomic resections of the liver present a method of choice in surgical treatment of colorectal liver metastases compared to metastasectomy surgery. Methods: A total of 65 patients were divided into two groups. Patients in the first group underwent metastasectomies consisting in the removal of metastases and the surrounding liver parenchyma no more than 1 cm by Kelly clamp crushing technique or LigaSure vessel-sealing system. Patients in the second group were subjected to the anatomic resection of the liver where not only metastases were removed, but also the associated anatomical segment or section or half the liver, depending on the number and localisation of metastases. Results: The mean values (± standard deviation) of the overall survival for the first and the second group were 36 ± 4.8 months and 36 ± 2.6 months, respectively. The mean values (± standard deviation) of the disease-free survival in the first and in the second group were 18 ± 2.22 months and 22 ± 0.74 months, respectively. None of the found inter-group differences were statistically significant. Conclusion: It can be concluded that metastatic surgery for colorectal liver metastases and anatomic resections have almost the same results and are irreplaceable methods in the treatment of colorectal liver metastases.

Background/Aim: Benign prostatic hyperplasia (BPH) is a very common disease in older men. BPH involves the presence of signs of hyperplasia of the stromal and epithelial elements in the prostate with consequent enlargement of its volume. The aim of this study is to analyse the frequency of typical complications in the treatment of patients with benign prostatic hyperplasia and the effect of medicamentous treatment. Method: Patients diagnosed BPH were included in the prospective, one-year study. They were divided into 2 groups. The first group (30 patients) consisted of those ones, whose prostate volume was equal to or over 50 cm3 , while and the second group (30 patients) comprised the subjects with prostate volume less than 50 cm3 . The complications of BHP analysed are residual urine (RU), symptomatic urinary infection, haematuria, thickening of the detrusor wall, diverticulum in the bladder, ureterohydronephrosis, renal failure, bladder stone and acute urinary retention (AUR). Results: The majority of patients in both groups were aged 60-69. There was a statistically significant difference in the average value of RU between the groups at the first, second and fifth check-ups (p < 0.05), as well as the complication of symptomatic urinary infection, since the same occurred earlier in the first group than in the second group (p < 0.05). There was no statistically significant difference in complications: haematuria, detrusor wall thickening and diverticulum (p > 0.05). Complications: ureterohydronephrosis, renal failure, bladder stone, and AUR were not diagnosed in patients in either group. Conclusion: Relevant medical therapy leads to a reduction of RU and reduces the risk of complications caused by its presence. Other complications of BPH were rare or absent in both groups, suggesting that appropriate and timely applied medical therapy affects the course of BPH and reduces the risk of complications and the need for surgical treatment. Benefit from medicamentous therapy is equally represented in both analysed groups of patients.

Introduction: Gastrectomy is one of the most common surgical methods for the treatment of gastric cancer, which basically destroys the mechanism and digestion chemistry. Reconstruction after gastrectomy attempts to optimize the antireflux and nutritive component of the postgastrectomic syndrome. Objective: To determine which reconstructive method after gastrectomy has the optimal synthesis of antireflux and nutritional components. Patients and Methods: 111 patients were treated for gastric malignancies at the Surgical Clinic of the University Clinical Center in Banja Luka, which were operated with the intention of achieving curability. Results: Based on Fisher's exact probability test there is no statistically significant difference (p> 0.05) in mortality compared to the restoration of digestive continuity after gastrectomy. Reflux oesophagitis is the dominant modality of morbidity in omega-loop reconstruction (p 0.05) in late dumping syndrome in patients relative to individual gastric substitution options. In the Hunt-Lawrence-Rodino pouch reconstruction option, there is no statistically significant difference (p> 0.05) in the participation of individual modalities of meal quantity in relation to the condition before the disease or the modality of the nutritional status. . Conclusion: The results indicate the antireflux component of reconstruction Roux en Y and the advantage of the nutritive component in the loop modification (the creation of the Hunt-Lawrence-Rodino pouch).

Introduction. Colorectal metastatic liver tumors are the most common secondary liver tumors. During life, the liver metastases will develop either as synchronous or metachronous carcinomas in half of the total number of patients. At the time of the diagnosis, in approximately 25% of patients with colorectal cancer diagnosis, the presence of secondary deposits in the liver was observed, and an additional 25% of patients were to develop metastases within five years. Aim of the study. The objective was to demonstrate that anatomic resections of the liver present the method of choice in surgical treatment of colorectal liver metastases, when compared to metastasectomy. Patients and methods. The study included 70 patients, divided into two groups. Among the patients from the first group, metastasectomy consisted of the removal of metastases and the surrounding liver parenchyma no more than 1cm with the usage of Kelly-clysis technique or Ligasure device was performed. In patients from the second group, anatomic resection of the liver was performed upon which metastases were removed and the associated anatomical segment or section, that is, half of the liver depending on the number and localization of metastases. Results. The average value for the first group overall survival was 36 months with a standard deviation of 4.8 months. The average overall survival in patients from the second group was 36 months with a standard deviation of 2.6 months. The average value of disease-free survival in the first group was 18 months with a standard deviation of 2.22 months. In the second group, the median disease-free survival was 22 months with a standard deviation of 0.74 months. Conclusion. Overall survival in both types of operation is identical, and the average overall survival was 36 months. Disease free interval in the anatomical resection was 22 months, while it was 18 months in metastasectomy. From all the above it can be concluded that surgery is a fundamental and irreplaceable method in the treatment of liver metastases of colorectal cancer.

Introduction. The protective ileostomy is a procedure that is now increasingly used after the creation of low colorectal anastomosis, and after resection of rectal cancer. The protective ileostomy is a procedure that, to a lesser extent, affects the prevention of anastomotic colorectal dehiscence, but it has a much greater significance in reducing the severity of complications occurring after colorectal anastomosis dehiscence. However, the creation itself, as well as the closure of loop ileostomy are accompanied with certain complications. Aim of the study. The aim of this study was to determine the frequency and severity of complications of ileostomy and justification for its creation, within the test sample of 42 patients. Patients and Methods. The study was designed as a retrospective-prospective study. 42 patients. with created protective ileostomy that occurred after low colorectal anastomosis, were included in the study. The average age was 64.38 years with a standard deviation of 9.63 years. The youngest patient was 36 years old and the oldest patient was 77 years old. The representation of patients by gender was 29 (69%) male patients and 13 (31%) female patients. During the study, functions and complications associated with the created loop ileostomy, as well as the need for surgical treatment and the period until the sinking of ileostomy were monitored in patients. Results. Out of the total number of observed patient complications of ileostomy occurred in 8 of them (19%), and in 34 (81%) patients there were no complications. Out of the total number of complications, only in cases of 2 (4.8%) patients, there was the need for surgical treatment. In 1(2.4%) patient, ileostomy remained permanently. Conclusion. This study showed that the loop ileostomy after the creation of low colorectal anastomosis is accompanied with fewer complications. The resulting complications are successfully disposed by conservative treatment, and only rarely require surgical re-intervention.

So far, ALPPS (Associating liver and portal vein partition ligation for staged hepatectomy) operation has been performed only as an individual procedure in big specialized centers in developed countries. ALPPS is two-stage curative hepatectomy for which indication is inadequate, the so-called, future liver remnant (FLR). In the case report, we described the case of 63-year-old patient with verified colorectal cancer and large metastases in the liver, to whom we conducted simultaneous resection of the rectal cancer and liver metastases using the ALPPS technique with good clinical results.

Introduction: Laparoscopic cholecystectomy is now considered the procedure of choice that achieves a shorter recovery period after the surgery and reduction in the cost of treatment. Aim: The aim of the study is to prove which method: early or delayed laparoscopic cholecystectomy is the method of choice in the treatment of acute cholecystitis by examining: duration of hospitalization, conversion rate, duration of surgery, postoperative complications, and total cost., Methods: The study was conducted at the University Clinical Center of Republika Srpska as a retrospective-prospective study from May 1 st 2013 until December 31 st 2019. Patients diagnosed with acute cholecystitis were divided into two groups: Patients designated for early laparoscopic cholecystectomy within 72 hours of admission (group A-42 patients), Patients designated for initial conservative treatment followed by a delayed interval of 6-12 weeks until surgery (group B-42 patients)., Results: In both groups, there were statistically significantly more female respondents. The results showed that the average cost of treatment in the early treated group was statistically significantly lower than the cost of treatment in the delayed treatment group. The patients in the early group had shorter hospitalization times (an average of 2.8 days and 5.6 days in the delayed group of patients), a smaller percentage of conversions (4.8% in the early and 16.7 in the delayed group of patients), the total cost of in the early group it was 1300.83 KM, while in the delayed group it was 1645.43 KM., Conclusion: Early laparoscopic cholecystectomy is a method to be preferred in surgical treatment., Competing Interests: There are no conflicts of interest., (© 2020 Goran Janjic, Milan Simatovic, Velimir Skrbic, Reuf Karabeg, Dragan Radulj.)