Bevezetés: A posztoperatív hasi hegsérvek helyreállítása a mai napig kihívást jelent, annak ellenére, hogy steril műtétről van szó. Gondot jelent a sebfertőzés, amelyhez hozzájárul a betegpopuláció komorbiditása is. Idegen anyag beépítése mindig magában hordozza a fertőzés kockázatát. Sebfertőzés esetén a sérvkiújulás lehetősége 0,2–8%, míg ha a hálót is el kell távolítani, a kiújulás valószínűsége már 30% fölött van. A nyitott sebkezeléssel szemben a negatív nyomású terápia hatékonyabban segíti a sebgyógyulást és a beépített háló megmentését. Anyag és módszer: Tanulmányunkban összesen 30 beteg esetét elemezzük, akik 2015 és 2023 között estek át olyan ’onlay’ hálós hasfali sérvműtéten, amelynél sebgennyedés lépett fel. Mindegyik esetben sebváladék-tenyésztést és negatív nyomású sebkezelést végeztünk. 15 betegnél pálcás, míg a másik 15-nél pálcás, szivacsmintás és szövethengeres mintavétel történt. A pálcás mintavételek eredménye főleg bőrflórát mutatott ki, amely 71%-ban Gram-pozitív kórokozó volt. A szövethengeres és szivacsmintás tenyésztések eredményei már 50%-ban mutattak ki Gram-negatív kórokozókat. Eredmények: A szivacsmintás és szövethengeres tenyésztések többletinformációt hordoztak a bakteriális terhelésre vonatkozóan. A negatív nyomású sebkezelés hatására a háló eltávolítására nem volt szükség. Következtetés: A negatív nyomású sebkezelés során az antibiotikumválasztásban is segítséget nyújtott a többféleképpen levett tenyésztés. A hálómentés céljából alkalmazott vákuumkezeléssel a bakteriális terheltség csökken, és a granuláció mértéke felgyorsul. A sérvkiújulás és a háló eltávolítása jelentősen mérséklődik. Orv Hetil. 2026; 167(18): 714–721.

BACKGROUND/AIM:This study aimed to investigate the incidence, anatomical characteristics, and clinical implications of non-recurrent laryngeal nerves (NRLNs) discovered during thyroid surgeries and autopsies. PATIENTS AND METHODS:A total of 2,215 thyroid surgeries and 194 autopsies were reviewed, identifying 17 and 1 case of NRLN, respectively. Data regarding nerve anatomy, associated vascular anomalies, and patient medical history were collected and analyzed. Neck ultrasound examinations were subsequently performed on the 17 living patients, 5 months to 19 years post-surgery, by three radiologists specializing in head and neck soft-tissue imaging. Two radiologists were blinded to the specific nerve anatomy, while one was unblinded. RESULTS:Vascular anomalies of the aortic arch were described only by the unblinded radiologist. Among the 17 NRLN cases, three (16.7%) exhibited normal vascular anatomy. According to Toniato et al.'s classification, one case each was categorized as 2a, 2b, and one case involved a coexisting right NRLN and right RLN. No definitive recurrent paresis was observed, with only one patient experiencing transient palsy lasting 5 weeks. Histological evaluation revealed no structural differences between NRLN and RLN variants, although their epineurium and adventitia were notably thinner than those of the vagal nerve. CONCLUSION:Achieving blood-free conditions for meticulous dissection and preserving sympathetic nerve branches are essential for optimal functional outcomes in thyroid surgeries involving NRLNs.

INTRODUCTION:The repair of postoperative abdominal hernias remains a challenge to this day, even though the surgery is sterile. Wound infection is a problem, which is exacerbated by the comorbidity of the patient population. The incorporation of foreign material always carries a risk of infection. In the event of wound infection, the possibility of hernia recurrence is 0.2-8%, while if the mesh also needs to be removed, the probability of recurrence is over 30%. Compared to open wound treatment, negative pressure therapy is more effective in promoting wound healing and preserving the implanted mesh. MATERIALS AND METHODS:In our study, we analyze the cases of a total of 30 patients who underwent onlay mesh abdominal hernia surgery between 2015 and 2023, during which wound dehiscence occurred. In all cases, wound exudate culture and negative pressure wound therapy were performed. In 15 patients, swab samples were taken, while in the other 15, swab, sponge, and tissue roller samples were taken. Swab samples mainly revealed skin flora, which was Gram-positive in 71% of cases. The results of the tissue roller and sponge swab cultures showed Gram-negative pathogens in 50% of cases. RESULTS:The sponge swab and tissue roller cultures provided additional information on the bacterial load. Negative pressure wound therapy meant that the mesh did not need to be removed. CONCLUSION:During negative pressure wound therapy, cultures taken using multiple methods also helped in the selection of antibiotics. Vacuum therapy used for mesh removal reduces bacterial load and accelerates granulation. Hernia recurrence and mesh removal are significantly reduced. Orv Hetil. 2026; 167(18): 714-721.

Introduction Standard surgical management of GERD may result in troublesome postoperative food passageway-related sequelae (i.e., dysphagia, odynophagia, gas-bloat syndrome, inability to belch/vomit), significantly impacting quality of life. Five-year results after the RefluxStop procedure are presented, involving reconstruction of the anti-reflux barrier without encircling the food passageway, reducing such related sequelae. Methods RefluxStop surgery was evaluated in a prospective, single-arm, multicenter study with 50 GERD subjects. This report focuses on food passageway-related outcomes. Other basic outcomes (e.g., 24-h pH, PPI usage) are presented in a separate report with brief clinical correlation herein. Results Forty-four subjects completed 5-year follow-up; three participants were missing due to COVID-19 (i.e., two deaths and one bedbound with long-COVID) and three terminated early. Data from 3- and 4-year follow-up were carried forward in COVID-affected cases. Food passageway-related adverse events (AEs) between 2 weeks of surgical recovery and 5-year follow-up included: one case (2.1%) of dysphagia (and another case, mild dysphagia for 2 weeks postoperatively, viewed as normal recovery); one case (2.1%) of odynophagia; zero (0%) cases of inability to belch/vomit; and gas-bloating none/improved in 42 cases with only two worsening. These outcomes were well-aligned with improvement in total GERD-HRQL score (i.e., median 29.5 at baseline to 3.0 at 5 years), PPI usage (2.1%), and 24-h pH monitoring (i.e., mean 1.57% acid exposure time at 5 years). Conclusion RefluxStop surgery resulted in a favorable profile of food passageway-related outcomes throughout the 5-year study: no AE dysphagia in 97.9% of subjects; no AE odynophagia in 97.9%; whereof at 5 years: gas-bloating none/improved in 95.7%, and no inability to belch/vomit in 100%. For clinical correlation, 97.9% of subjects did not take PPIs at 5 years. These outcomes add resolution to the overall treatment effect of RefluxStop and may show potential preference in GERD patients who prioritize minimization of postoperative sequelae.

INTRODUCTION:RefluxStop surgery corrects all three components of the anti-reflux barrier without affecting the food passageway. Long-term 5-year safety and effectiveness clinical outcomes are presented from the RefluxStop CE mark trial, used in an FDA PMA submission. This comprehensive and meticulously controlled data are, therefore, presented across multiple reports with other outcomes in a separate complementary article. METHODS:A prospective, single-arm, multicenter clinical study was conducted to investigate RefluxStop surgery in 50 adults with chronic GERD, PPI use, GERD-HRQL score, 24-h pH testing, contrast-swallow x-ray, and serious/non-serious AEs presented. RESULTS:Forty-four (n = 44) subjects completed 5-year follow-up, whereof 91% underwent pH testing and contrast-swallow x-ray. Three subjects were withdrawn due to COVID-19 (two deaths and one long-COVID), all well-treated beforehand, at 3-4 years. PPI usage (including COVID-19 subjects) in 1/47 (2.1%). The median (IQR) total GERD-HRQL score improved by 90% (72-98%) from a baseline of 29.5 (33.0-24.0) to 3.0 (0.5-7.5) at 5 years (p < 0.001) and 24-h pH monitoring results improved by 90.4% to a mean total acid exposure time (pH < 4) of 1.57% from 16.35% at baseline (p < 0.001). No cases (0%) of device explantation, migration/erosion, or esophageal dilatation occurred during the study. Five-year contrast-swallow x-ray showed zero (0%) dislocations, migrations, or re-herniations. Five subjects (n = 5) experienced serious AEs of which all were resolved. Only two procedure-related AEs occurred between 1 and 5 years, one moderate dyspepsia and one mild dysphagia, subsequently resolved. CONCLUSION:The RefluxStop procedure demonstrated exceptional long-term 5-year outcomes. Only one subject took PPIs at follow-up. Both median GERD-HRQL scores and mean 24-h pH results improved by > 90% from baseline (p = 0.001). No device-related AEs, explantations, or migrations occurred during the 5-year study. Only two procedure-related AEs occurred between 1 and 5 years, one dyspepsia and one mild dysphagia (resolved). These objective and patient-reported results were robustly maintained from previously published 1- to 4-year data.

Bevezetés: Olyan sebészeti osztályokon, ahol kellő számú pajzsmirigyműtétet végeznek, viszonylag ritka szövettani diagnózisokkal is lehet találkozni. E szövettani diagnózisok ismerete fontos a kóreredet megértésében és a betegség terápiájának megválasztásában. Célkitűzés: Kísérletet teszünk amyloidstruma esetében, gyakoriságának meghatározására és társuló kórképekkel történő összefüggéseinek vizsgálatára. Módszer: 2001 és 2023 között 2215 pajzsmirigyműtétet végeztünk a Fejér Vármegyei Szent György Egyetemi Oktató Kórház Általános Sebészeti Osztályán, Székesfehérváron. Retrospektíven vizsgáltuk a szövettani eredményeket, majd a szövettani vizsgálat leletét összevetettük a beteg kórtörténetével. Eredmények: A 2215 operált esetből mindössze 2 esetben volt a szövettani diagnózis amyloidstruma, mely az összes eset mindössze 0,09%-a. Megbeszélés: Amyloidstruma rendszerint valamilyen egyéb kórképpel társulva jelenik meg. Eseteinkben krónikus veseelégtelenség, tartós dialíziskezelés mellett, illetve gyulladásos bélbetegség (morbus Crohn) kísérőjeként. A műtéti indikációt a megnagyobbodott pajzsmirigy által okozott mechanikus kompresszió képezte. Következtetés: Ismeretlen eredetű diffúz, kompressziós tüneteket okozó struma esetén gondolni lehet jóindulatú amyloidstrumára, de a pontos diagnózis többnyire csak a műtéti preparátum szövettani feldolgozásával tisztázódik. A totális thyreoidectomia megszünteti a beteg panaszait. Orv Hetil. 2025; 166(15): 588–591.

Bariatric surgery is proven to be the most effective treatment for obesity and its associated metabolic diseases. In this review article, we aim to present the current developments and specific aspects of metabolic surgery, based on the scientific literature and the current trends of some high-volume bariatric centers. In North America – as well as in Europe and Hungary –, the most common bariatric procedures are the laparoscopic Roux-en-Y gastric bypass and the sleeve gastrectomy. A relatively new malabsorptive procedure, the single anastomosis duodenal-ileal bypass, is also being performed with increasing frequency. This article provides an overview of the long-term outcomes of these surgeries in terms of weight loss and their impact on comorbidities, based on relevant scientific literature from recent years. We also discuss the main factors influencing the choice of surgical technique, such as gastroesophageal reflux disease, hiatal hernia, preoperative body mass index, and the severity of associated diseases. Revision options are also addressed. Given the essential role of a multidisciplinary approach in modern bariatric surgery, we briefly touch on endobariatric procedures as well. Considering the severity of obesity in Hungary and the increasing number of bariatric procedures in the country, we believe our article may be of interest to the Hungarian medical community. Orv Hetil. 2025; 166(32): 1243–1249.

Introduction: In surgical departments where a sufficient number of thyroid surgeries are performed, relatively rare histopathological diagnoses may also be encountered. Knowledge of these histopathological diagnoses is essential for understanding the etiology and selecting the appropriate treatment for the disease. Objective: We aimed to determine the prevalence of amyloid goiter and to examine its associations with related conditions. Method: Between 2001 and 2023, we performed 2,215 thyroid surgeries. We conducted a retrospective review of the histopathological findings and correlated these results with the patients' medical histories. Result: Out of the 2,215 operated cases, amyloid goiter was diagnosed histopathologically in only 2 cases, accounting for just 0.09% of all cases. Discussion: Amyloid goiter typically appears in association with other conditions. In our cases, it was linked to chronic renal failure with prolonged dialysis treatment and inflammatory bowel disease (Crohn's disease). The surgical indication is based on the mechanical compression caused by the enlarged thyroid gland. Conclusion: In cases of diffuse goiter with compression symptoms of unknown origin, amyloid goiter should be considered. Total thyroidectomy resolves the patient's symptoms. However, the exact diagnosis is usually confirmed only through the histopathological examination of the surgical specimen.

A bariátriai sebészet egyik alapműtéte a laparoszkópos Roux-Y gyomor bypass, amely hatékonyan képes csökkenteni a testsúlyt, és erőteljes hatással bír a metabolikus társbetegségekre. A műtét mortalitási és morbiditási mutatói standardizált technikát alkalmazva rendkívül kedvezőek. Jelen közleményünkben bemutatjuk a gyomor bypass műtétet, annak jellegzetes szövődményeit, hosszú távú eredményeit, illetve az osztályunkon alkalmazott műtéti technikát. A tanulmány az UHN – Toronto Western Hospital Minimálisan Invazív Sebészeti és Bariátriai Osztályán eltöltött egyéves fellowship tapasztalati alapján íródik. 2023-ban összesen 619 bariátriai beavatkozás történt. Ebből 372 (60,1%) primer laparoszkópos gyomor bypass műtét volt. Műtéti mortalitás nem fordult elő. Összesen 7 alkalommal történt 30 napon belüli osztályos visszavétel. Varratelégtelenség a vizsgált évben nem fordult elő. Posztoperatív vérzés miatt 1 esetben (0,27%) történt reoperáció. Az osztály bariátriai programjának összesített adatai alapján öt év után a teljes testsúlycsökkenés 26,8% volt. A laparoszkópos Roux-Y gyomor bypass műtét továbbra is az egyik leghatékonyabb bariátriai műtét. Standardizált technikát alkalmazva a műtét rendkívül biztonságos. A beavatkozásra gyakran egyedi hosszú távú szövődmények jellemzőek. Mivel Magyarországon is egyre több ilyen műtét történik, ezeknek az ismerete fontos lehet az általános sebész számára.

Bevezetés: Pajzsmirigyműtét kapcsán olyan sebészi megoldásra kell törekednünk, amely egyszerűvé és hatásossá teszi a hormonpótlást, és megelőzi a kiújulást. Ennek a leginkább az elvi lobectomia felel meg. Célkitűzés: Kísérletet teszünk a biztonságos radikalitás kritériumainak és műtéttechnikai aspektusainak meghatározására. Anyag és módszer: 2001 és 2023 között 2215 pajzsmirigyműtétet végeztünk, melyek közül 86,1% uni- vagy bilateralis lobectomia, 12,3% közel totalis resectio volt. Substernalis megjelenéssel 28,9%-ban, míg recidív elváltozással 5,3%-ban találkoztunk. Partialis sternotomiára 1,8%-ban volt szükség. Eredmények: Az operált 2215 pajzsmirigy-elváltozás 27,9%-a daganat, 19,6%-a hyperplasia, míg 18,1%-a gyulladás volt. A 216 papillaris carcinoma patológiai jellemzői közül az okkult forma (42,1%), az enkapszulált megjelenés (30,1%), a többgócúság (26,4%), a kétoldali megjelenés (12,5%) és a kevert jelleg (8,3%) érdemes kiemelésre. A centrális régió 41%-ban tartalmazott pozitív nyirokcsomót. A daganatokban szignifikánsan gyakoribb volt az egyidejű Hashimoto-típusú gyulladás, mint a hyperplasia. Átmeneti nervus recurrens bénulás 3,3%-ban, míg definitív 0,49%-ban fordult elő. Megbeszélés: A radikalitást a lehető legkisebb reziduális állomány elérése, míg a biztonságot az idegek és a mellékpajzsmirigyek funkciójának megőrzése jelenti. Ezt a két célt egyformán veszélyeztető tényezők: az állományban zajló gyulladás, daganat, substernalis elhelyezkedés, recidíva és a fel nem ismert centrális paratrachealis nyirokcsomóáttét. A rutinszerű idegpreparálással egybekötött thyreoidectomia eredményeit elemezve, csak a recidív elváltozások esetében volt szignifikánsan nagyobb a kiújult bénulások száma. Következtetés: A vérmentes műtéti terület biztosítása, az idegek preparálás alatti hűtése, a felső pólus ereinek ágankénti ellátása, illetve a nem gyulladásos szövetű pajzsmirigyek eltávolítása során szerzett preparatív gyakorlat segíti a biztonságos radikalitást nemcsak a daganatok, de a hyperplasia, gyulladás, sőt recidíva miatt végzett thyreoidectomia során is. Orv Hetil. 2024; 165(39): 1548–1557.

RefluxStop is a unique implant for laparoscopic treatment of gastroesophageal reflux disease (GERD). It restores normal function of the gastroesophageal junction without the unwanted effects of encircling the esophagus, circumventing adverse events (AEs) associated with conventional anti-reflux surgeries. Three-year follow-up of 50 patients with chronic GERD treated by RefluxStop was achieved in a prospective, single-arm, multicentric clinical trial analyzing safety and effectiveness of the procedure. The 3-year results included 47 of 50 patients. No cases of device-related AEs, erosion, device migration, or explantation occurred during the entire study period. Two AEs were reported between the 1- and 3-year results (1-year results previously published), including mild dysphagia (n = 1) and heartburn (n = 1). No subjects (n = 0/47) required regular daily proton pump inhibitor (PPI) therapy at 3-year follow-up. Subjects experienced a 93.1

RefluxStop is an implantable device for laparoscopic surgical treatment of gastroesophageal reflux disease (GERD) to restore and maintain lower esophageal sphincter and angle of His anatomy without encircling and putting pressure on the food passageway, thereby avoiding side effects such as dysphagia and bloating seen with traditional fundoplication. This study reports the clinical outcomes with RefluxStop at 4 years following implantation of the device. A prospective, single arm, multicenter clinical investigation analyzing safety and effectiveness of the RefluxStop device in 50 patients with chronic GERD. Available data are presented for 44 patients at 4 years with the addition of three patients at 3 years carried forward. At 4 years, median GERD-HRQL score was 90

Bevezetés: A sebekben jelen lévő kórokozók különböző sebességgel növekednek, kölcsönhatásba léphetnek egymással, hogy elősegítsék a szaporodásukat, és biofilmképző tulajdonságaik révén kolóniákat képeznek, gátolva az antibiotikumok hatékonyságát és a sebgyógyulást. A negatív nyomású sebkezelés csökkenti a seb baktériumterhelését. Célkitűzés: Tanulmányunk célja volt, hogy felmérjük a pálcika- és szivacsmintás tenyésztések közötti esetleges eltéréseket a fertőzött sebek negatív nyomású kezelése során, továbbá hogy megvizsgáljuk, különbségek esetén a szivacstenyészetből kimutatott további kórokozók milyen mértékben befolyásolhatják a sebgyógyulást és a sebkezelést. Módszer: 2018. január 1. és 2021. december 31. között összesen 147 beteg (88 férfi és 59 nő) adatait dolgoztuk fel. A retrospektív vizsgálatban 77 traumatológiai-ortopédiai, 49 általános sebészeti és 21 érsebészeti beteg adatainak elemzése történt. Eredmények: A pálcás és a szivacsmintás tenyésztések alapján traumatológiai-ortopédiai betegeknél 39%-ban, sebészeti esetekben 53,1%-ban, érsebészeti beavatkozásoknál 66,7%-ban mutatkozott eltérés. Figyelembe véve a tenyésztési eltéréseket, a sebzárás vagy a bőrrel való implantáció lehetősége a traumatológiai-ortopédiai betegeknél 85,6%, sebészeti esetekben 62,5%, érsebészeti beavatkozásoknál csupán 33,3% volt. A többi esetben nyitott sebkezelés történt. Megbeszélés: A csak a bőrflórára jellemző baktériumok okozta fertőzés esetén a seb jobban gyógyult, mint a polimikrobás flóránál. A legrosszabb gyógyhajlamot a multirezisztens kórokozók idézték elő. A polimikrobás és multirezisztens kórokozókat is tartalmazó sebek esetében a nyitott sebkezelés jobbnak bizonyult. A Gram-negatív, főleg biofilmképző patogén kórokozók hátráltatták a bőr megtapadását, vagy elősegítették annak lelökődését. A tenyésztések pozitivitása ellenére jó sebgyógyulást és magas sebzáródási arányt értünk el a negatív nyomású terápiával, a seb keletkezési típusától függetlenül. Következtetés: A negatív nyomású kezelés során a szivacsmintás tenyésztések többletinformációt hordozhatnak a pálcás mintavételhez képest. A szivacsból kitenyésztett, döntően Gram-negatív kórokozók módosíthatják a kezelés során az antibiotikumválasztást és a sebkezelést. Orv Hetilap. 2024; 165(2): 59–68.

Introduction: The pathogens in wounds grow at different rates, can interact with each other to promote their multiplication, and their biofilm-forming properties can form colonies that inhibit the effectiveness of antibiotics and wound healing. Negative pressure treatment reduces the bacterial load on the wound. Objective: In this study, we aimed to assess possible differences between stick and sponge specimen cultures during negative pressure treatment of infected wounds, furthermore, in the case of differences, to investigate the extent to which additional pathogens detected from sponge culture may affect wound healing and wound treatment. Method: Between January 1, 2018 and December 31, 2021, we processed data from 147 patients (88 men and 59 women). In this retrospective study, data from 77 trauma-orthopaedic, 49 general surgery and 21 vascular surgery patients were analysed. Results: Based on stick and sponge cultures, 39% of trauma-orthopaedic patients, 53.1% of surgical cases and 66.7% of vascular surgical cases showed a discrepancy. Considering the differences in culture, the possibility of wound closure or skin implantation was 85.6% in trauma-orthopaedic patients, 62.5% in surgical cases and only 33.3% in vascular surgery cases. Discussion: Wound healing was better in the case of bacterial infection caused by skin flora only than in the case of polymeric flora. The worst healing was caused by multidrug-resistant pathogens. For wounds with both polymicrobial and multidrug-resistant pathogens, open wound management was better. Gram-negative pathogens, mainly biofilm-forming pathogens, impeded skin adherence or promoted skin sloughing. Despite the positivity of the cultures, good wound healing and high wound closure rates were achieved with negative pressure therapy, regardless of the type of wound formation. Conclusion: Sponge sample cultures may provide additional information compared to stick sampling in negative pressure therapy. The predominantly Gram-negative pathogens cultured from sponges may modify antibiotic choice and wound management during treatment. Orv Hetil. 2024; 165(2): 59–68.

Introduction: In thyroid surgery, the primary objectives are to facilitate effective hormone replacement therapy and to prevent recurrent diseases. Thyroid lobectomy is often the optimal approach to achieve these goals. Objective: This study aims to establish the criteria for safety driven radicality and identify the appropriate surgical approaches. Methods: A total of 2215 thyroid surgeries were performed between 2001 and 2003. Among these, 86.1% were unior bilateral lobectomies, and 12.3% were near total resections. Substernal extension was observed in 28.9% of cases, and recurrent disease was found in 5.3%. Partial sternotomy was required in 1.8% of cases. Results: Of the 2215 thyroid specimens analyzed, 27.9% were tumors, 19.6% showed hyperplasia, and 18.1% exhibited inflammation. Among the 216 cases of papillary carcinoma, the occult form was present in 42.1%, encapsulated form in 30.1%, multinodular form in 26.4%, bilateral involvement in 12.5%, and mixed appearance in 8.3%. Lymph node involvement in the central region was detected in 41% of cases. Co occurrence of tumors with Hashimoto's thyroiditis was significantly more common than with hyperplasia. Transient laryngeal nerve paresis occurred in 3.3% of cases, while permanent paresis was observed in 0.49%. Discussion: Radicality in thyroid surgery aims to minimize residual tissue while ensuring the functional integrity of nerves and parathyroid glands. These objectives are challenged by tissue inflammation, cancer, substernal extension, recurrent disease, and undetected metastases in the central paratracheal lymph nodes. Our analysis of routine lobec tomies with meticulous nerve preparation revealed a significantly higher incidence of recurrent laryngeal nerve pare sis in cases involving recurrent disease. Conclusion: Maintaining blood free surgical conditions, cooling the nerves during preparation, meticulous dissection of nerves at the superior pole of the thyroid, and experience in excising non inflammatory thyroid tissue are crucial for achieving safety driven radicality. These practices are effective not only in cancer cases but also in the presence of hyperplasia, inflammation, and recurrent disease.

In our case report, we describe a rare form of metastatic colorectal carcinoma, in which tumor cells spread intraluminally and metastasis occurs with implantation mechanism far from the primary tumor. A 43-year-old male patient developed perianal abscess. After surgical intervention a fistula-in-ano appeared at the site of the abscess. Fistulotomy was performed in another hospital. A few months later, we admitted him to our department with an abnormal tissue proliferation appearing in the surgical area. Histology confirmed adenocarcinoma. Colonoscopy detected tissue proliferation in the sigmoid colon, causing a subtotal stenosis. Laparoscopic rectosigmoid resection and per anum tumor excision were performed. Detailed histological examination confirmed the same mucinous adenocarcinoma in the colon and the anorectal malformation. In this case, implantation mechanism is likely in the development of a synchronous tumor at the site of the fistula-in-ano. Implantation metastasis is considered rare, only a few cases have been reported in the international literature so far. We are not aware of any similar case reported from Hungary. Orv Hetil. 2023; 164(3): 110-113.

Esetbemutatásunkban a colorectalis adenocarcinoma áttétképzésének egy ritka formáját, tumorsejtek intraluminalis szóródása és implantációja révén kialakuló metasztázisát ismertetjük. 43 éves férfi betegünk anamnézisében periproctalis tályog miatt más intézetben feltárás, majd a tályog helyén kialakult analis sipoly miatt fistulotomia szerepelt. Néhány hónappal később a műtéti területen vérzékeny szövetszaporulat jelent meg, a szövettan adenocarcinomát igazolt. Az elvégzett kolonoszkópia során a colon sigmoideum területén szűkítő szövetszaporulatot találtak. Laparoszkópos rectosigmoidealis reszekciót és per anum tumorexcisiót végeztünk. A részletes szövettani feldolgozás az eltávolított bélszakaszban, illetve a per anum kimetszésben mucinosus adenocarcinomát igazolt. Esetünkben az analis sipoly helyén kialakult szinkrón tumor hátterében implantációs mechanizmus valószínűsíthető. Az ilyen implantációs metasztázis irodalmi ritkaságnak számít, csupán néhány eset közlése történt meg ez idáig a nemzetközi irodalomban. Magyarországról közölt hasonló esetről nincs tudomásunk. Orv Hetil. 2023; 164(3): 110–113.

Introduction Recent expert consensus on esophagogastric junction integrity highlights the importance of an acute angle of His, in addition to the crural diaphragm and lower esophageal sphincter [LES]. The RefluxStop procedure for GERD restores angle-of-His anatomy and maintains the intra-abdominal esophagus, without esophageal compression that can cause dysphagia and bloating. Excellent 6-month investigation results led to CE mark approval; long-term results are crucial to establish the role of this device.

OBJECTIVES:In this study, we aimed to assess the effectiveness of negative pressure wound therapy (NPWT) in a five-year patient cohort and to discuss the results in the light of literature data. PATIENTS AND METHODS:Between January 2012 and December 2016, a total of 74 patients (35 males, 39 females; median age: 60 years; range, 20 to 95 years) who received NPWT were retrospectively analyzed. The patients included 49 orthopedic and traumatology, 12 vascular surgery, and 13 general surgery patients. The efficacy of wound healing, bacterial load, and the impact of comorbidities on wound healing were examined. RESULTS:The distribution of wound types varied very widely. Certain comorbidities affected wound healing. In orthopedic traumatology patients, we observed mainly skin flora infection (57.14%), while in surgical and vascular patients, mixed flora (80%) and in many cases poly-resistant pathogens were present (methicillin-resistant Staphylococcus aureus 24%) A total of 43.3% of wounds were completely closed, while 44.6% of patients had a wound healing. Successful skin grafting was performed in 75% of wounds. CONCLUSION:This technique may be used as widely and as early as possible. However, further large-scale, multi-center, randomized clinical trials are needed worldwide to find a place for this technique in wound care and even in primary care.

BACKGROUND RefluxStop™ is an implantable, non-active, single use device to be used in the laparoscopic treatment of GERD. RefluxStop™ aims to block the movement of the LES up into the thorax and keep the angle of His in its original anatomically correct position. This new device restores normal anatomy, leaving the food passageway unaffected. METHODS In prospective, single arm, multicentric clinical investigation analyzing safety and effectiveness of the RefluxStop™ device to treat GERD, 50 subjects with chronic GERD had been included. They were operated using standardized surgical technique between December 2016 and September 2017 and followed up for one year (CE-mark investigation 6-months). Primary safety outcome was the prevalence of serious adverse events related to the device and primary effectiveness outcome reduction of GERD symptoms based on the GERD HRQL score. Secondary outcomes were the prevalence of the adverse events apart from serious, reduction of the total acid exposure time on 24-hour pH monitoring, reduction in average daily PPI dosage and subject satisfaction. RESULTS There were no serious adverse events related to the device. Average GERD-HRQL total score at 1 year improved 86% from baseline (p<0.001). 24-h pH monitoring compared to baseline showed a mean reduction percentage of overall time with pH<4 from 16.35% to 0.80% at the 6-month visit (p<0.001). At 1-year: No new cases of dysphagia were recorded, occurred in 2 subjects, both significantly reduced compared to baseline. Regular daily PPI use before surgery occurred in all 50 subjects. At the 1-year follow-up only 1 subject took regular daily PPIs due to too low placement of the device thereby prohibiting its function. None or minimal occasional episodes of regurgitation occurred in 97.8% of evaluable subjects. Gas bloating disappeared in 30 subjects and improved in 7 subjects. CONCLUSION The new principle of RefluxStop™ is safe and effective to treat GERD according to investigation results. At 1-year follow up visit, both the GERD-HRQL score and 24-h pH monitoring results indicate success for the new treatment principle. In addition, with the dynamic treatment for acid reflux, which avoids compressing the food passageway, prevalence of dysphagia and gas bloating are significantly reduced.