INTRODUCTION:The global burden of peripheral artery disease is increasing worldwide. A subset of 5% of these patients ultimately reach the final stage with trophic defects, a condition clinically defined as critical limb-threatening ischemia. Revascularization remains the paramount treatment modality offering the greatest potential for limb preservation. We investigated whether performing direct revascularization according to the angiosome concept significantly influences (i) the superior healing of ischemic defects, (ii) optimized limb salvage rates, and (iii) reduced patient mortality in a cohort treated with femoropopliteal bypass. METHODS:This rigorous prospective clinical cohort study processed data from 143 patients after femoropopliteal bypass procedures performed at the AGEL Ostrava Vítkovice Hospital between January 2016 and December 2021-all patients presented with critical limb-threatening ischemia, specifically Fontaine stage IV. We employed advanced statistical methods, including Kaplan-Meier survival analysis and the Cox regression model, to evaluate the effect of direct revascularization versus indirect revascularization on primary outcomes: defect healing, limb salvage, and patient mortality. RESULTS:Statistical analysis robustly confirmed a statistically significant benefit of direct revascularization on (i) defect healing (p=0.02), (ii) limb salvage (p=0.02), and (iii) patient mortality (p=0.04). Specifically, direct revascularization significantly reduced amputation rates and improved overall survival compared to indirect revascularization. CONCLUSION:Despite the controversies in the literature and the absence of dedicated, large-scale, English-language published studies focusing specifically on the application of the angiosome concept in femoropopliteal bypasses, we demonstrated a statistically significant benefit of direct revascularization on defect healing, limb salvage, and mortality in this specific patient cohort. This evidence suggests that the angiosome concept extends its predictive power proximally to the femoropopliteal bypass targets. Practical application: In patients with critical limb-threatening ischemia, where the indication for femoropopliteal bypass is rendered borderline due to advanced local findings (high-risk Wound, Ischemia, and foot Infection classification) or severe overall comorbidity status, surgical intervention should be preferentially reserved for scenarios guaranteeing direct revascularization, as patients derive minimal benefit from non-targeted indirect revascularization in high-risk settings.

Mediastinal lymphadenectomy represents an integral component of anatomic lung resection in the surgical treatment of non-small-cell lung cancer. These procedures are now routinely undertaken utilising minimally invasive approaches. The present study aimed to compare the radicality of mediastinal lymphadenectomy during uniportal video-assisted thoracoscopic surgery (uVATS) and robotic-assisted thoracoscopic surgery (RATS) for anatomical pulmonary resection. This comparative study was undertaken at a university hospital between January 2020 and August 2025. We evaluated the radicality of mediastinal lymphadenectomy in two patient cohorts: those undergoing uniportal thoracoscopic resection and those undergoing robotic-assisted thoracoscopic resection. Radicality was assessed based on the number of lymph node stations retrieved from the eight stations corresponding to each hemithorax, enabling determination of the extent and completeness of lymphadenectomy. Two hundred patients were included in the analysis: 100 underwent uniportal thoracoscopic anatomic lung resection and 100 underwent robotic-assisted lung resection. A statistically significant difference was demonstrated in the number of lymph node stations retrieved between the groups, favouring RATS over uVATS in both hemithoraces—left: 7.2 versus 6.6 (p = 0.0035); right: 7.3 versus 6.4 (p < 0.0001). The 30-day postoperative morbidity rate was 28

Introduction The optimal surgical management of Lymph Nodes (LNs) following Neoadjuvant Systemic Therapy (NACT) remains a subject of clinical debate. Targeted Axillary Dissection (TAD) aims to improve staging accuracy by identifying the initially metastatic node. The prerequisite for TAD is the identification of the initially most prominent pathological nodule in the axilla before the start of treatment. Methods This study presents a retrospective observational study of breast cancer after Neoadjuvant Systemic Therapy (NACT), from 2021 to 2024. The study primarily focused on the diagnosis of LN conditions and the surgical procedures performed. This study included n = 58 female patients with biopsy-proven cN1 breast cancer. Results The patients with initially positive axillary LNs were evaluated. Before the start of NACT, the biopsy of the pathological node was performed and also labeled with a Magseed magnetic marker. After NACT, a standard sentinel lymph node protocol was performed with preoperative lymphoscintigraphy with Technetium colloid. Significantly, there was never a case in which a labeled node was negative while metastases were in other nodes. In 4/58 (6.9%) cases, the common sentinel nodes were negative, while the labeled TAD node was positive. Conclusion The labeled node appears to represent the status of LNs more accurately after NACT than conventional ones. The metastatic nodes can be spared with axillary dissection using neoadjuvant treatment and TAD; however, the long-term oncologic outcomes of this approach are not yet reliably known.

Introduction: Laparoscopic sleeve gastrectomy (LSG) is one of the most performed bariatric procedures. But it is also associated with serious and potentially life-threatening staple line-related complications, such as stomach leak and bleeding. Case report: The article describes a case of surgical treatment of an early fistula between the stomach and the spleen 3 weeks after LSG. We have focused our attention on the diagnosis and possible treatment options for this potentially life-threatening complication. Conclusion: Efforts to reduce the frequency of leakage after LSG include a number of different measures. It is advisable to have expert knowledge not only in primary bariatric surgery, but also in the management of problems and reoperations in gastrointestinal surgery. An individualized approach and multidisciplinary teamwork are essential for successful therapy.

INTRODUCTION Endofibrosis is a rare condition affecting blood vessels, occurring mainly among young healthy athletes. This condition arises as progressive stenosis of the iliac arteries, which attenuates the blood circulation of the limb, thus leading to pain during movement. Iliac artery compression was first described in 1984 among professional cyclists1. Some authors have reported that up to 10–20% of top athletes are affected2,3. Endofibrosis is one of the rare causes of peripheral artery disease, in which the exact prevalence is unknown, possessing no any accurate data. This comprehensive review is purposed to sum up the current knowledge of endofibrosis and ensure concise information about its etiology, and diagnostic and treatment modalities. In addition, two cases including imagery are purposed to be presented to illustrate the perioperative findings.

Objective: Acute appendicitis is the most common indication for surgical intervention during pregnancy for non-gynaecological or non-obstetric causes. The aim of this study was to compare perioperative and postoperative outcomes of acute appendectomies in pregnant and non-pregnant patients of childbearing age. Methods: A retrospective clinical study focused on the comparison of perioperative and postoperative outcomes of acute appendectomy in pregnant and non-pregnant patients of reproductive age between January 2012 and December 2021 at the University Hospital in Ostrava. Results: A number of 308 patients underwent acute appendectomy, 25 pregnant and 283 non-pregnant. There were no statistically significant differences in age, ASA (American Society of Anesthesiologists) classification, duration of complaints, baseline C-reactive protein values, sensitivity or specificity of sonography. A statistically significant difference was found in the leukocyte count between subgroups (P = 0.014) and in the number of laparoscopic procedures performed between the two subgroups (P < 0.001; 98.9% non-pregnant vs. 80.0% pregnant). There was also a statistically significant difference in the length of hospital stay, with the pregnant subgroup having a longer hospital stay (P = 0.014) and a statistically significant difference in the rate of postoperative complications between the defined subgroups (P = 0.039). Serious complications were described predominantly in the subgroup of pregnant patients, where they reached 12% compared to non-pregnant patients, where they were 2.8%. The mortality rate of the cohort was zero. Conclusion: The results of the study support the fact that pregnancy may be associated with complicated forms of acute appendicitis. Accurate and early diagnosis not only prevents the development of complicated forms of appendicitis but also reduces the number of negative appendectomies in pregnancy.

OBJECTIVE: This study aimed to evaluate our experience with the use of Magseed, the magnetic metallic marker, as a localization technique followed by Sentimag probe detection in patients with solitary intra-abdominal local metastases with subsequent resection of the lesions.METHODS: Five patients underwent resection after the lesion was marked with the Magseed magnetic marker. Prior to the surgery, a computed tomography scan of the chest and abdomen and/or positron emission tomography was performed to rule out the dissemination of the disease. The indication for surgery was evaluated in a meeting of a multidisciplinary team, and the placement of the magnetic marker under computed tomography control had been performed the day before the planned procedure. RESULTS: The present preliminary outcomes have revealed that Magseed might be a promising technique that is feasible and safe, particularly when the postsurgical anatomic conditions in the abdominal cavity are altered and the lesions are not visible or palpable. Surgical extirpation of lesions occurred without complications in each case. In all the cases, the resection was complete and curative, and one wound infection in all (20%), without any major complications, had occurred. The mean hospital stay was 6.6 days.CONCLUSION: Magseed utilization, as a localization technique, followed by Sentimag probe detection in intra-abdominal tumors has not been reported before. Improving the visualization and, consequently, the precise marking of the lesion with subsequent radical removal can prevent insufficient or excessive removal of healthy tissue, leading to a faster diagnosis and better overall clinical outcomes.

OBJECTIVE: Peptic ulcer perforation presents the most serious complication of ulcer disease with mortality that varies significantly depending on the age and conditions. The coronavirus disease 2019 pandemic was effective worldwide in 2020 and continues to date. The aim of this study was to investigate the initial clinical parameters and short-term outcomes of patients with acute peptic ulcer perforation before and during the coronavirus disease 2019 pandemic.METHODS: A retrospective cohort study was conducted in the Department of Surgery, University Hospital Ostrava, Czech Republic. The patients undergoing surgical modality of a simple suture of peptic ulcer perforation with/without omentoplasty in the post-coronavirus disease 2019 (January 1, 2020 to December 31, 2021) and the pre-coronavirus disease 2019 (January 1, 2018 to December 31, 2019) had been incorporated in this study.RESULTS: This study included a total of 46 cases (26 in the pre-coronavirus disease 2019, 20 in the post-coronavirus disease 2019). The age, body mass index, Boey score, duration of symptoms, surgery time, and length of hospital stay were comparable in both study subgroups. During the coronavirus disease 2019 pandemic, patients were admitted with a statistically significantly lower degree of perioperative risk according to the American Society of Anesthesiologists classification (p=0.013). Notably, 30-day postoperative morbidity was significantly higher in pre-coronavirus disease 2019 (73.1 vs. 55.0%, p=0.038). The mortality rate in the laparoscopic group was 13.6%, in the laparotomy group 41.4%, and the mortality rate was higher in pre-coronavirus disease 2019 than in post-coronavirus disease 2019 (34.6 vs. 20.0%, p=0.166). CONCLUSION: In fact, the coronavirus disease 2019 pandemic had not significantly influenced therapeutic management and short-term outcomes of patients undergoing acute surgical repair of peptic ulcer perforation.

OBJECTIVES:Acute appendicitis is the most common non-gynaecological indication for surgical intervention during pregnancy. The aim of this study was to compare perioperative and postoperative results of surgical treatment of acute appendicitis in the early and late stage of pregnancy. MATERIAL AND METHODS:This is a retrospective study focused on the evaluation of perioperative and postoperative results of appendectomy in pregnancy. The study included all pregnant patients who underwent laparoscopic or open appendectomy at the University Hospital Ostrava during the observed 10-year period (January 2012-December 2021). The patients were divided into two subgroups according to the stage of pregnancy in relation to the expected viability of the foetus (the viability limit was defined as the 23rd week of pregnancy). RESULTS:In the monitored 10-year period, a total of 25 pregnant patients underwent appendectomy. Comparing the two subgroups of patients, there were no statistically significant differences in any of the admission parameters. Laparoscopy was performed in 100% of the patients in the lower stage of pregnancy (< 23 g.w.) and in 61% of the subgroup of patients with more advanced pregnancy (> 23 g.w.); this difference was statistically significant (p = 0.039). Differences in subgroups regarding duration of surgery, risk of revision and 30-day postoperative morbidity were not statistically significant. In the subgroup of patients < 23 g.w., uncomplicated forms of appendicitis predominated (66%), whereas in the subgroup > 23 g.w., complicated forms predominated (69%); this difference was statistically significant (p = 0.026). When comparing the two subgroups of patients, there was a statistically significant difference in the length of hospitalization (p = 0.006). The mortality rate of the group was zero. CONCLUSIONS:The results of the study confirm the fact that advanced pregnancy may be related to complicated forms of appendicitis. Therefore, early appendectomy is still the method of choice. In accordance with the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) recommendations, laparoscopic approach is preferred in pregnant patients, even in advanced pregnancy.

Pancreatic steatosis (PS) has both metabolic consequences and local effects on the pancreas itself. Magnetic resonance imaging (MRI) is the most reliable non-invasive method for diagnosing PS. We investigated the impact of metabolic syndrome (MS) on the presence of PS, differences in individuals with and without PS, and the metabolic effects of bariatric procedures.Changes in anthropometric and basic biochemistry values and MS occurrence were evaluated in 34 patients with obesity who underwent a bariatric procedure. After the procedure, patients underwent MRI with manual 3D segmentation mask creation to determine the pancreatic fat content (PFC). We compared the differences in the PFC and the presence of PS in individuals with and without MS and compared patients with and without PS.We found no significant difference in the PFC between the groups with and without MS or in the occurrence of PS. There were significant differences in patients with and without PS, especially in body mass index (BMI), fat mass, visceral adipose tissue (VAT), select adipocytokines, and lipid spectrum with no difference in glycemia levels. Significant metabolic effects of bariatric procedures were observed.Bariatric procedures can be considered effective in the treatment of obesity, MS, and some of its components. Measuring PFC using MRI did not show any difference in relation to MS, but patients who lost weight to BMI < 30 did not suffer from PS and had lower overall fat mass and VAT. Glycemia levels did not have an impact on the presence of PS.

OBJECTIVE: The aim of the study was to evaluate the effect of body mass index on patients' short-term results following lung lobectomy. METHODS: In this retrospective study, we compared the perioperative and short-term postoperative results of obese (BMI >= 30 kg/m2) versus non -obese patients (BMI<30 kg/m2) who underwent anatomical lung resection for cancer. The two groups had the same distribution of input risk factors and the same ratio of surgical approaches (thoracoscopy vs. thoracotomy).RESULTS: The study included a total of 144 patients: 48 obese and 96 non-obese patients. Both groups had the same ratio of thoracoscopic vs. thoracotomy approach (50/50%), and were comparable in terms of demographics and clinical data. The g roups did not significantly differ in the frequency of perioperative or postoperative complications. Postoperative morbidity was higher among non-obese patients (34.4 vs. 27.1%), but this difference was not statistically significant (p=0.053). Hospital stay was similar in both study groups (p=0.100). Surgery time was significantly longer among obese patients (p=0.133). Postoperative mortality was comparable between the study groups (p=0.167).CONCLUSIONS: Obesity does not increase the frequency of perioperative and postoperative complications in patients after lung lobectomy. The slightly better results in obese patients suggest that obesity may have some protective role.

Endofibrosis is a rare disease that predominantly affects athletes and is caused by a gradual occlusion of the (usually iliac) artery due to a thickening of the intima. From our experience, we report in this article two cases with the entity of endofibrosis in females around 30 years old. The first case presented with acute limb ischemia, and the second one was with pain in the leg during exercise. In addition, both cases are professional cyclists. They were eventually diagnosed with endofibrosis and underwent surgical procedures. They are now pursuing their professional career successfully. Last but not least, endofibrosis might be classified as an occupational disease, particularly, in the case of professional athletes or cyclists.

An association of non-alcoholic fatty liver disease and hepatocellular carcinomaPrevalence A review of worldwide data indicates that NAFLD is a prevalent chronic disorder and different types of data reveal its prevalence ranging from 6% to 35% 4 .Some of the cases with NAFLD land up in the complication "HCC," as the data from a meta-analysis by Younossi et al. 1 indicate that the incidence of HCC is 0.44 per 1,000 person-years.However, liver cirrhosis is a complication of NASH and it further leads to HCC.Ascha et al. 2 reported that HCC was found in 2.6% of cases suffering from NASH-associated cirrhosis 1 .In addition, the increased death rate has been reported in cases suffering from NASH due to HCC, especially in NASH patients suffering from advanced fibrosis.Hashimoto et al. 5 reported a survival rate of nearly 83% in 5 years in those suffering from HCC, especially in NASH cases suffering from advanced fibrosis 5 .The steatohepatitic hepatocellular carcinoma (SH-HCC) variant was noted in approximately 35% cases of HCC: a distinctive histological variant of HCC in hepatitis C virus related cirrhosis associated with NAFLD/NASH 6 .

INTRODUCTION:Chronic defects and hernias of the abdominal wall are a common complication of repeated surgical procedures and/or their accompanying complications. Reconstruction of the abdominal wall is difficult in these defects/hernias and debates of an ideal method of treatment have not reached a conclusion. Primary suture is usually impossible. Onlay, inlay, sublay, underlay and IPOM plasty procedures have their limits and often lead to unsatisfactory results. CST (component separation technique) technique is a new therapeutic approach enabling a solution of large defects and hernias of the abdominal wall with very good short-term results. TAR (transversus abdominis release) is a posterior approach in CST. It releases transversus abdominis muscle (MTA) to mobilize the posterior sheath of the rectus abdominis muscle (MRA). TAR preserves MRA and its neurovascular bundle, creates a large space for mesh insertion and allows complex reconstruction of the abdominal wall.CASE REPORT:A 55-year-old patient underwent surgery for perforated diverticulitis of colon sigmoideum with diffuse peritonitis. Hartmans operation was performed. The patient was reoperated for colostomy necrosis and fascia dehiscence on the 7th postoperative day. After healing 6 months later, colostomy occlusion was indicated. The operation itself - colorectal anastomosis using an end-to-end circular stapler - was without complications. However, complications occurred in the postoperative period including an intra-abdominal abscess in the lesser pelvis and subsequent destructive phlegmona and necrosis of the abdominal wall, resulting in a non-healing extensive chronic abdominal wall defect. After the failure of conservative treatment, the chronic defect was excised and the abdominal wall was reconstructed using the TAR method.CONCLUSION:TAR is an acceptable method in the treatment of large defects and hernias of the abdominal wall, associated with low perioperative morbidity and low recurrence rates.

Epidermolysis bullosa or butterfly wing disease is a rare genetic disorder of connective tissue associated with the formation of blisters. The clinical manifestations are very diverse and affect not only the skin cover, but also mucosal surfaces of the gastrointestinal, urogenital and respiratory systems. A large proportion of patients suffer from severe constipation with the development of megacolon. The case report describes intestinal obstruction in a patient with a dystrophic form of epidermolysis bullosa which required surgical treatment.

Background. Non-alcoholic fatty liver disease (NAFLD), often associated with obesity and metabolic syndrome, manifests itself as steatosis, hepatic fibrosis, cirrhosis, or even end-stage liver disease. NAFLD causes inflammation, insulin resistance and cardiovascular complications. The current study aimed to evaluate the beneficial effects of bariatric surgery on biochemical parameters of hepatic functions in obese patients by comparing them before and one-year after the surgery. Methods. A total of 72 morbidly obese patients underwent bariatric surgery between 2016 and 2018. The incidence of diabetes mellitus in this group was 29%, median body weight was 124.5 kg (109.0-140.0) and mean body mass index (BMI) was 44.38 ± 6.770 kg/m2. The used surgical procedures included gastric bypass, sleeve gastrectomy, laparoscopic gastric plication, and single anastomosis duodeno-ileal bypass-sleeve gastrectomy. Biochemical parameters including ALT/AST ratio (AAR), NAFLD fibrosis score (NFS), hepatic fibrosis index (FIB-4) and Fatty Liver Index (FLI) were evaluated in all patients at the time of surgery and one year after the intervention. Results. Significant improvement after the intervention was observed in 64 patients. A significant reduction in body weight (P<0.0001), waist circumference (P<0.0001), and body mass index (P<0.0001) were observed. NAFLD liver fibrosis index changed significantly (P<0.0001), suggesting a trend of improvement from advanced fibrosis towards stages 0-2. The FIB-4 fibrosis index indicated significant improvement (P=0.0136). Besides, a significant decline in hepatic steatosis (P<0.0001) was observed after bariatric surgery as compared to the pre-surgery fatty liver conditions. Conclusion. Among the strategies to overcome NAFLD-associated impediments, bariatric surgery can be considered effective in reducing obesity and metabolic co-morbidities. Trial Registration: ClinicalTrials.gov (NCT04569396)

Granulomatozni mastitida (GM) je vzacne benigni zanětlive onemocněni prsu, ktere bylo poprve popsano Kesslerem a Wollochem v roce 1972. Klinicky se může projevovat jako jednostranna, obcas bolestiva, zvětsujici se rezistence prsu nebo jako tvrda nepravidelna masa. Pro hodnoceni GM je sonografie nejužitecnějsi diagnostickou metodou. K jiste verifikaci tohoto onemocněni vsak vede až odebrani bioptickeho vzorku. Histologicky je GM charakterizovana nekaseifikujicimi granulomy, casto ve spojeni s tvorbou mikroabscesů a pistěle. Pokud jde o preferenci lecby, existuje znacna heterogenita, což může vysvětlit vysokou miru recidivy, ktera se se bliži až k 50 %. Takova vysoka mira recidivy je alarmujici a dokazuje, že soucasne způsoby lecby nejsou optimalni. Ve světě jsou diskutovany 2 možnosti lecby: konzervativni strategie zahrnujici medikamentozni terapi kortikosteroidy proti chirurgickemu přistupu ve smyslu parcialni nebo totalni mastektomie. Vsechny možnosti konzervativni lecby jsou spojeny s vysokým rizikem recidivy a větsina pacientů nakonec vyžaduje chirurgický výkon. Rozhodujici pro uspěsnou lecbu je důkladna excize zanětlive tkaně, přicemž negativni chirurgicke okraje jsou spojeny s nizkou mirou recidivy. Operacni přistup ke GM vyžaduje dostatecnou radikalitu a předpoklada znalosti v oblasti rekonstrukcni chirurgie prsu, podobně jako při onkochirurgických zachovných operacich prsu. Pro pacienty s obavami z rozsahlejsi chirurgicke intervence vsak mohou být přijatelne alternativy lecby GM s uživanim peroralnich steroidů. V tomto clanku prezentujeme 6 kazuistik pacientů lecených na nasem pracovisti.

INTRODUCTION:Sebaceous carcinoma is a rare malignant tumor of the sebaceous glands. Sebaceous carcinoma occurs mainly in the head and neck region, rarely in trunk.  Case report: We present a case report of 63-year-old patient, operated on for sebaceous carcinoma in the right breast area. The patient underwent radical surgery, removal of the tumor with the skin, subcutaneous tissue, and the large pectoral muscle. The patient is in good clinical condition eight months after the surgery. She is being constantly monitored and so far, there are neither signs of local recurrence nor tumor progression.  Conclusion: Patients with rare tumors should be treated comprehensively with subsequent lifelong dispensarisation in specialized centers. Multidisciplinary medical teams are able to eruditely diagnose, recognize, treat and dispense patients.

Granulomatous mastitis (GM) is a rare benign inflammatory disease of the breast, first described by Kessler and Wolloch in 1972. Clinically, it can present as unilateral, sometimes painful, increasing breast resistance, or as a hard, irregular mass. Sonography is the most useful diagnostic method for GM evaluation. The only method for definitive diagnosis is the use of biopsy. In histological findings, GM is characterized by non-caseifying granulomas, often associated with microabscess and fistula formation. There is considerable heterogeneity in treatment options; this may explain the high recurrence rate which is close to 50%. Such a high recurrence rate is alarming and proves that current treatments are suboptimal. Two treatment options are discussed worldwide: conservative strategies involving drug therapy with corticosteroids versus a surgical approach involving partial or total mastectomy. All conservative treatment options are associated with a high risk of recurrence, and most patients require surgery in the end. Thorough excision of inflammatory tissue is crucial for successful treatment while negative surgical margins are associated with a low recurrence rate. The surgical approach to GM requires sufficient radicality and presumes knowledge in the field of reconstructive breast surgery, similarly to oncosurgical breast conservation operations. However, alternatives to GM treatment with oral steroids may be acceptable for patients concerned about surgery. This article presents six case reports of patients treated at our department.