Jaromír Šimša

Gallstone ileus – a rare disease and still many discrepancies

ZusammenfassungGRUNDLAGEN: Gallensteinileus ist eine seltene Krankheit. Eine genaue Diagnose wird nur selten vor dem chirurgischen Eingriff durchgeführt. Optimale Heilungsstrategie, Indikation der Cholezystektomie und Behandlung der biliaren Fistel bleiben umstritten. METHODIK: Es wurden eine retrospektive Studie und Datenanalyse der Patienten, die wegen eines Gallensteinileus an der chirurgischen Abteilung des Universitätskrankenhauses Motol innerhalb der letzten 16 Jahre (1. Januar 1989 – 31. Dezember 2004) operiert wurden, durchgeführt. ERGEBNISSE: Die untersuchte Gruppe bestand aus 23 Patienten – 18 Frauen (78,3 %) im Durchschnittsalter von 76,5 Jahren und 5 Männer (21,7 %) im Durchschnittsalter von 76,9 Jahren. Die Enterolithotomie wurde bei 19 Patienten (82,7 %) durchgeführt. Die Sterblichkeit war hoch, die häufigsten aufgetretenen Probleme, die bei 10 Patienten (43,5 %) vorkamen, betrafen die Wundenheilung. Die Sterblichkeitsrate betrug 8,7 %. Weitere biliare Symptome wurden nur bei 3 Patienten (13 %) beobachtet. Alle waren mit herkömmlichen Steinen in den Gallenröhren verbunden. SCHLUSSFOLGERUNGEN: Ziel der optimalen Behandlung ist die rechtzeitige Diagnose und prompte Entfernung der Dünndarmobstruktion. Die Entherolithotomie scheint Methode der Wahl bei akutem chirurgischem Eingriff zu sein. Multiple Steine können bei bis zu 20 % der Patienten vorkommen und sollten nicht übersehen werden. Man sollte eine Cholezystektomie nur bei Patienten in gutem gesundheitlichem Zustand und mit bestehenden biliaren Symptomen und Cholezystolithiasis erwägen.SummaryBACKGROUND: Gallstone ileus is a rare disease. Definite diagnosis is rarely established before surgery. Optimal treatment strategy, indication to cholecystectomy and management of biliary fistula remains controversial. METHODS: A retrospective study and data analysis of patients operated on for gallstone ileus at the Department of Surgery, Motol University Hospital during the past sixteen years (1st January 1989 – 31st December 2004). RESULTS: The study group consisted of 23 patients – 18 women (78.3%) with a mean age of 76.5 years and 5 men (21.7%), mean age 76.9 years. Enterolithotomy alone was performed in 19 patients (82.7%). Observed surgical morbidity was high; wound healing problems were the most common, and occurred in 10 patients (43.5%). Mortality rates reached 8.7%. Further biliary symptoms were noted only in 3 patients (13%). All of them were associated with common bile duct stones. CONCLUSIONS: Early diagnosis and prompt release of the small bowel obstruction is the goal of optimal treatment. Enterolithotomy alone seems to be the method of choice at the time of acute surgery. Multiple stones can be found in up to 20% patients and should not be missed. Subsequent cholecystectomy should be considered only in patients in good general health with persistent biliary symptoms and cholecystolithiasis.

Impact of Postoperative Septic Complications on Recurrence of Colorectal Cancer

Background: About one third of patients racically resected for colorectal cancer develop during follow-up recurrence. Materials and methods: There were 1951 patients operated for colorectal cancer in Surgical Department, Thomayer Hospital Prague, from 1997 to 2015. Radical R0 operation underwent 68% of these patients. Postoperative complications occurred in 457 (34.6%) patients. Impact of postoperative complications on disease free interval was studied in a prospective study. Results: We identified minor complications in 90 patients (6.8%), moderate complications in 28 patients (2.1%), anastomotic leakage in 67 patients (5%) and severe septic complications in 20 patients (1.5%). Another 255 patients (19.3%) had a different, non-inflammatory complications (pulmonary embolism, bowel obstruction, heart failure, etc.). Significantly worse disease-free interval was found in patients with severe septic complications. Conclusion: In our cohort of R0 operated patients, postoperative complication is the second most important prognostic factor following TNM stage of the colorectal cancer. Severe septic complications has an adverse effect on the further course of the disease in terms of relapse. Other potentially septic complications such as anastomotic leakage have no essential impact on recurrence. Therefore, it is necessary to prevent the development of sepsis.

Consensus Statement on Mandatory Registration of Clinical Trials

ventions and research hypotheses, and basic methodology [2, 4] . The SJEG member journals will require registration of all prospective clinical trials as of July 1, 2007. Trials that begin after July 1, 2007 must register before enrollment of the first study subject, and trials that began before the deadline must register prior to editorial review. Submitted manuscripts must include the unique registration number in the abstract as evidence of registration. Authors submitting manuscripts reporting on unregistered clinical trials may request consideration of their papers if they can provide sufficient evidence of merit, although we anticipate that all clinical trials will be registered after July 1, 2007. The member journals of the Surgery Journal Editors Group (SJEG), in keeping with their commitment to high ethical standards and integrity in surgical publishing and surgical science, agree to adopt the position of the International Committee of Medical Journal Editors (ICMJE) [1, 2] requiring mandatory registration of all clinical trials, whether publicly-funded or commercially-sponsored, as a condition of consideration for publication. Additionally, the SJEG will require registration of Phase I and Phase II trials. Specifically, the SJEG supports the idea of promoting a publicly accessible clinical trial database as suggested by the World Health Organization (WHO) International Clinical Trials Registry Platform established in August 2005, which specifies 20 key study data reporting requirements [2] . The goal of the WHO initiative and this SJEG requirement, based on the ICMJE statement, is to promote transparency and honesty in reporting prospective clinical trial conduct and results (including negative results), to foster public trust, and to ensure that researchers behave in an ethically responsible manner toward patients and study participants [3] . The SJEG member journals will require all clinical trials that prospectively assign human subjects to medical interventions, comparison groups, or control groups for the purpose of examining the potential health effects of such interventions, to be registered in one of several free, publicly accessible, nonprofit electronically searchable databases such as the one administered by the National Library of Medicine (NLM), which is located at http://www.clinicaltrials.gov. The ICMJE defines medical interventions as those that include, among other things, drugs, surgical procedures, devices, behavioral treatments, and process-of-care changes [2] . The required minimal registration data set includes a unique trial number established by the registry, funding source(s), primary researcher and public contact person, ethics committee approval, trial recruitment information, interPublished online: March 27, 2007

Re: Gallstone ileus.

Accessible online at: www.karger.com/dsu consecutive patients in a period of 16 years), as published recently in European Surgery [2] , enterolithotomy alone seems to be the method of choice at the time of acute surgery. Further biliary symptoms after enterolithotomy are rare. Subsequent cholecystectomy should only cautiously be considered in patients in a good general condition with persistent biliary symptoms and proven cholecystolithiasis. Dear Sirs, We have read with interest the article concerning gallstone ileus in the recent issue of Digestive Surgery [1] . We appreciate all items of this presentation. Nevertheless, the authors recommended the onestage procedure including enterolithotomy, cholecystectomy and closure of the fistula as a treatment of choice. This is really a matter in controversy and we would like to make a slightly different recommendation. Based on our experience (23 References