Burst abdomen (BA) is a severe complication after abdominal surgery, which often requires urgent repair. However, evidence on surgical techniques to prevent burst abdomen recurrence (BAR) is scarce. We conducted a retrospective analysis of patients with BA comparing them to patients with superficial surgical site infections from the years 2015 to 2018. The data was retrieved from the institutional wound register. We analyzed risk factors for BA occurrence as well as its recurrence after BA repair and surgical closure techniques that would best prevent BAR.:1 Abkürzungsverzeichnis 2 Einführung 2.1 Aufbau der Bauchwand und operative Zugangswege in der Abdominalchirurgie 2.1.1 Anatomie 2.1.2 Zugangswege 2.2 Wundinfektionen 2.3 Definition „Platzbauch“ 2.4 Risikofaktoren und Ursachen von Fasziendehiszenzen 2.4.1 Biochemische Einflüsse auf die Wundheilung 2.4.2 Mechanische und technische Faktoren 2.4.3 Allgemeine individuelle Faktoren 2.5 Management des Platzbauchs 2.6 Spätkomplikationen des Platzbauches 2.6.1 Narbenhernien 2.6.2 Intestinale Fisteln 2.6.3 Netzinfektion 2.6.4 Re-Dehiszenzen 3 Zielsetzung der vorliegenden Arbeit 4 Publikation 5 Zusammenfassung der Arbeit 5.1 Einleitung 5.2 Wundregister nosokomialer Wundinfektionen der Klinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie am Universitätsklinikum Leipzig 5.3 Risikofaktoren für Platzbäuche 5.4 Platzbauchentstehung 5.5 Chirurgische Verschlusstechnik 5.6 Re-Dehiszenzen 5.7 Limitationen der Analyse 6 Literaturverzeichnis 7 Anlagen 7.1 Darstellung des eigenen Beitrags 7.2 Selbstständigkeitserklärung 7.3 Lebenslauf 7.4 Publikationen 8 Danksagung

INTRODUÇÃO: Laparotomias de emergência apresentam alto risco de complicações e evoluem com deiscência da aponeurose (DA) em até 14,9% dos casos. O uso profilático de tela no fechamento da parede abdominal reduz a incidência de hérnia incisional após cirurgias eletivas, sem aumento significativo de morbidade. Porém, não há estudos que comprovem seu benefício na prevenção de DA e seu uso ainda é controverso em laparotomias de emergência e em cirurgias contaminadas ou infectadas. OBJETIVOS: Avaliar se o uso profilático de tela no fechamento da parede abdominal reduz a incidência de DA em pacientes submetidos a laparotomia de emergência, assim como a morbidade de sua aplicação. MÉTODOS: Foi realizado um ensaio clínico randomizado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Indivíduos com alto risco para DA e indicação de laparotomia mediana de emergência foram randomizados em grupos de sutura (síntese contínua da aponeurose com fio de polidioxanona e agulha de 36 mm, com objetivo de alcançar a relação entre os comprimentos do fio e da incisão igual ou superior a quatro) ou de tela profilática (síntese da aponeurose como no grupo de sutura, reforçada com tela pré-aponeurótica de polipropileno). Alto risco foi definido segundo escore de risco pré-operatório de Rotterdam adaptado. A equipe cirúrgica permaneceu cega no intraoperatório (randomização somente após síntese completa da aponeurose). RESULTADOS: De junho de 2015 a fevereiro de 2018, foram randomizados 145 pacientes, dos quais 30 foram excluídos (20,7%) por óbito ou reoperação nos primeiros 30 dias, não relacionados a intervenção do estudo; 52 foram alocados no grupo de sutura e 63 no de tela profilática. Ambos foram equivalentes quanto a dados demográficos e características clínicas, exceto idade, cuja média foi maior no grupo de sutura (66,1 anos vs 61,0 anos, p = 0,03). Os pacientes foram classificados como ASA III ou IV em 44 (38,3%) casos. Dentre as operações, 49 (42,6%) foram contaminadas ou infectadas, 63 (54,8%) envolveram a realização de ostomia e 89 (77,4%) foram cirurgias colorretais. Os tempos de internação hospitalar e em UTI foram semelhantes. O tempo operatório médio foi 50,8 minutos mais longo no grupo de tela profilática (p = 0,01). A DA ocorreu em sete casos do grupo de sutura (13,5%) e em nenhum do grupo de tela profilática (p = 0,003). Não houve diferença estatística em relação ao número de participantes que apresentou ocorrências de sítio cirúrgico (SSO) [15 (28,8%) vs 27 (42,9%), p = 0,12] ou ocorrências de sítio cirúrgico que necessitaram de intervenção (SSOPI) [9 (17,3%) vs 14 (22,2%), p = 0,51]. Porém, algumas SSO foram mais frequentes no grupo de tela profilática: seroma [3 (5,8%) vs 12 (19,0%), p = 0,03], infecção de sítio cirúrgico (SSI) [4 (7,7%) vs 13 (20,6%), p = 0,05] e deiscência superficial de ferida operatória [3 (5,8%) vs 15 (23,8%), p = 0,008]. Sete casos do grupo de tela profilática tiveram deiscência superficial com exposição de tela e foram tratados com curativos locais e cicatrização por segunda intenção, havendo resolução completa em menos de 90 dias. Nenhum caso necessitou de remoção completa da tela. Das SSO do grupo de tela profilática, 92,3% tiveram resolução espontânea ou com intervenções à beira-leito, o que aconteceu em 73,3% do grupo de sutura. CONCLUSÕES: A tela profilática pré-aponeurótica em laparotomias de emergência é segura e evita DA, com morbidade aceitável, em 30 dias / INTRODUCTION: Emergency laparotomies have a high risk of complication with reports of fascial dehiscence (FD) in up to 14.9% of cases. The use of onlay mesh in the closure of abdominal wall reduces incidence of incisional hernia after elective surgeries without increased morbidity. However, there are no studies demonstrating its benefit in FD prevention and its use is controversial in emergency laparotomies and in contaminated or infected surgeries. OBJECTIVES: To evaluate whether the use of onlay mesh in the closure of the abdominal wall reduces the incidence of FD in patients submitted to emergency laparotomy, as well as the morbidity of its application. METHODS: A randomized clinical trial was conducted at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. Patients at high risk for FD and indication of emergency midline laparotomy were randomized either to the suture group (running suture with polidioxanone thread and 36 mm needle size, aiming to achieve suture-to-wound length ratio of 4:1) or to the prophylactic mesh group (fascial closure as in the suture group, reinforced with polypropylene onlay mesh). High risk was defined according to the adapted Rotterdam preoperative risk model. The surgical team was blinded to the groups during the intraoperative period (randomization occurred only after complete fascial suture). RESULTS: From June 2015 to February 2018, 145 patients were randomized, 30 of whom were excluded (20.7%) because of death or reoperation, not related to the mesh procedure, in the first 30 days; 52 were allocated in the suture group and 63 in the prophylactic mesh group. Both groups were equivalent for demographic data and clinical characteristics, except for age, whose mean was higher in the suture group (66.1 years vs 61.0 years, p = 0.03). Patients were classified as ASA III or IV in 44 (38.3%) cases. Among the operations, 49 (42.6%) were contaminated or infected, 63 (54,8%) involved ostomy formation and 89 (77.4%) were colorectal surgeries. Hospital length of stay (LOS) and intensive care unit LOS were similar. Mean operative time was 50.8 minutes longer in the prophylactic mesh group (p = 0.01). FD occurred in seven cases of the suture group (13.5%) and none in the prophylactic mesh group (p = 0.003). There was no statistical difference between the groups regarding the number of patients with surgical site occurrence (SSO) [15 (28.8%) vs 27 (42.9%), p = 0.12], or surgical site occurrences that required procedural interventions (SSOPI) [9 (17.3%) vs 14 (22.2%), p = 0.51]. However, some SSO were more frequent in the prophylactic mesh group: seroma [3 (5.8%) vs 12 (19.0%), p = 0.03], surgical site infection (SSI) [4 (7, 7%) vs 13 (20.6%), p = 0.05] and superficial wound dehiscence [3 (5.8%) vs 15 (23.8%), p = 0.008)]. Seven cases of the prophylactic mesh group had superficial wound dehiscence with mesh exposure, treated with local dressings and healing by second intention, with complete resolution in less than 90 days. No case required complete removal of mesh. Of the SSO in the prophylactic mesh group, 92.3% had spontaneous resolution or with bedside interventions; the same occurred in 73.3% of the suture group. CONCLUSIONS: The onlay prophylactic mesh in emergency laparotomy is safe and avoids FD, with acceptable morbidity in 30 days

Submitted by Erika Demachki (erikademachki@gmail.com) on 2015-02-13T16:22:17Z No. of bitstreams: 2 Dissertação - Karine Evangelista Martins Arruda - 2009.pdf: 8715038 bytes, checksum: d21da1c098fc0bfd5e300a4c0e32fdb8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Erika Demachki (erikademachki@gmail.com) on 2015-02-13T16:23:07Z (GMT) No. of bitstreams: 2 Dissertação - Karine Evangelista Martins Arruda - 2009.pdf: 8715038 bytes, checksum: d21da1c098fc0bfd5e300a4c0e32fdb8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-02-13T16:23:07Z (GMT). No. of bitstreams: 2 Dissertação - Karine Evangelista Martins Arruda - 2009.pdf: 8715038 bytes, checksum: d21da1c098fc0bfd5e300a4c0e32fdb8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2009-01-16 / The effects of orthodontic treatment on periodontal structures have been studied in literature, especially regarding the integrity of alveolar bone and gingival health of the teeth to be displaced. The aim of this study was to evaluate the presence of alveolar defects (dehiscence and fenestrations) in patients with Class I and Class II division 1 malocclusions and in different facial types using cone beam computed tomography (CBCT). The sample comprised 159 tomography exams of patients with no previous orthodontic treatment, giving a total of 4319 teeth. The presence or absence of dehiscence and fenestration in the buccal and lingual surfaces was checked in axial and crosssectional views. The results showed that 155 patients (96.9%) presented some type of alveolar defect. The Class I malocclusion patients presented higher prevalence of dehiscences (35%) than those with Class II division 1 malocclusion. There was no statistically significant difference between the facial types. Lower incisors, lower canines and lower first premolars were respectively the teeth with more occurrences of alveolar defects. This study concluded that CBCT is indicated for patients who need extensive tooth movement and have unfavorable gingival biotype. / Os efeitos do tratamento ortodôntico nas estruturas periodontais tem sido objeto de estudo da literatura, principalmente quanto à integridade óssea e saúde gengival dos dentes a serem deslocados. O objetivo deste estudo foi avaliar a presença de defeitos alveolares (deiscências e fenestrações) em pacientes com maloclusão de Classe I e Classe II divisão 1 e em diferentes tipos faciais por meio de tomografia computadorizada volumétrica. A amostra foi composta de 159 exames tomográficos de pacientes indicados para tratamento ortodôntico, totalizando 4319 dentes avaliados. A presença ou ausência de deiscência e fenestração nas faces vestibular e lingual/palatina era observada em tomogramas axiais e transversais. Os resultados demonstraram que 155 pacientes (96,9%) apresentaram algum tipo de defeito alveolar. Os pacientes com maloclusão de Classe I apresentaram maior prevalência das deiscências (35%) em relação aos pacientes com maloclusão de Classe II divisão 1. Entre os tipos faciais não houve diferença estatisticamente significante. Incisivos inferiores, caninos inferiores e primeiros pré-molares inferiores foram respectivamente os dentes com maior ocorrência dos defeitos. Este estudo concluiu que a tomografia computadorizada volumétrica está indicada nos casos de pacientes que necessitem de movimento ortodôntico mais extenso e possuam biótipo gengival desfavorável.

Made available in DSpace on 2016-06-02T18:55:27Z (GMT). No. of bitstreams: 1 5930.pdf: 2008307 bytes, checksum: d0e45679fd9d345a26733ef3c1512046 (MD5) Previous issue date: 2014-03-28 / Financiadora de Estudos e Projetos / It is estimated that approximately 73 % of the world crops are pollinated by a bees. The constant alteration of habitats has led to the decline of pollinators, which may reflect limitations in the quantity and quality of the fruits and seeds grown, becoming one of the biggest problems when it comes to agricultural production. Studies with agricultural crops and their pollinators may contribute in seeking proposals that combine agriculture and conservation of forest fragments. The general objective of this work was to study aspects of Solanum lycopersicum L. hybrid Pizzadoro pollination. The specific objectives were: 1) verify if the floral morphology influences the behavior of the pollinator visits, 2) evaluate the richness of pollinating bees and pollinators at different distances from the Legal Reserve area, 3) compare the efficiency of three species of bees pollination in two treatments: spontaneous self-pollination, and pollination under natural conditions. The study was conducted on a conventional tomato cultivation in the municipality of Estiva Gerbi, Sao Paulo. Flowers were collected and observed under a stereomicroscope and scanning electron microscope. Efficiency was compared between Apis mellifera, Augochloropsis sp. and Exomalopsis sp. by Spears index. Observations and sampling were made in situ at 50, 100 and 150 meters from the Legal Reserve. It was found that the anther dehiscence is longitudinal and that the efficiency of pollination by A. mellifera (0.72) was similar to Exomalopsis sp. (0.85) and greater than Augochloropsis sp. (0.22). It is considered that the success of A. mellifera is associated with the floral morphology. Eleven species of insects, of which 7 were considered pollinators were found. Fifty eight floral visits were recorded, out of which 24 in quadrant A (50 m), 13 in B (100 m) and 21 in C (150 m), with A. mellifera dominant with 62.1% of visits, followed by Augochloropsis sp. and Oxaea flavescens both with 10.3%, Exomalopsis sp. with 6.9 %, Allograpta sp. with 5.2 % ,Bombus sp. with 3.4 % and Xylocopa sp. 1.7 %. The data indicates that the Legal Reserve played a key role in providing pollinators for tomato crops and therefore emphasizes the need for conservation and restoration of forest fragments to assist in increasing crop production. / Estima-se que aproximadamente 73% das plantas cultivadas mundialmente sejam polinizadas por alguma espécie de abelha. A constante alteração de habitats vem provocando o declínio de polinizadores, que pode refletir em limitações na quantidade e qualidade dos frutos e sementes cultivados, constituindo-se em um dos maiores problemas quando se trata de produção agrícola. Estudos com culturas agrícolas e seus polinizadores podem contribuir na busca de propostas que conciliem agricultura e conservação de fragmentos florestais. O objetivo geral do presente trabalho foi estudar aspectos relacionados com polinização de Solanum lycopersicum L. híbrido Pizzadoro. Os objetivos específicos foram: 1) verificar se a morfologia floral influencia no comportamento de visita do polinizador; 2) avaliar a riqueza de abelhas polinizadoras e visitantes florais em diferentes distâncias da área de Reserva Legal; 3) comparar a eficiência de três espécies de abelhas na polinização em dois tratamentos: kautopolinização espontânea, e a polinização em condições naturais. O estudo foi realizado numa área de cultivo convencional de tomate no município de Estiva Gerbi, São Paulo. Foram coletadas flores e observadas em estereomicroscópio e microscópio eletrônico de varredura. Foi comparada a eficiência de Apis mellifera, Augochloropsis sp. e Exomalopsis sp. pelo teste de Kruskal-Wallis. Observações e coletas foram feitas in situ a 50, 100 e 150 metros da RL. Verificou-se que a deiscência da antera é do tipo longitudinal e que não houve diferença entre as espécies de abelhas, ou seja, o número de sementes produzidas não depende da espécie de abelha. Considera-se que o sucesso de A. mellifera esteja associado à morfologia floral. Foram encontradas 11 espécies de insetos, das quais 7 foram consideradas polinizadoras. Foram registradas 58 visitas florais; dessas, 24 no quadrante A (50 m), 13 no B (100 m) e 21 no C (150 m), sendo A. mellifera dominante com 62,1% das visitas, seguida de Augochloropsis sp. e Oxaea flavescens ambos com 10,3%, Exomalopsis sp. com 6,9%, Allograpta sp. com 5,2%, Bombus sp. com 3,4% e Xylocopa sp. com 1,7%. Os dados indicam que a RL desempenhou um papel fundamental no fornecimento de polinizadores para a cultura de tomate e, por isso, enfatiza-se a necessidade de conservação e restauração de fragmentos florestais para auxiliar no aumento da produção da cultura.

<p>UVOD: Kolorektalna anastomoza koja se formira u dubini karlice radi uspostavljanja kontinuiteta gastrointestinalnog trakta nakon resekcije dijela crijeva ima svoje specifičnosti u toku formiranja, zarastanja, kao i kada se jave komplikacije. Na sam proces zarastanja kolorektalnih anastomoza utiču sistemski, lokalni i tehnički faktori. Bilo kakav kompromis po pitanju ovih principa nosi povećan rizik od komplikacija! Najteža komplikacija na anastomozi je dehiscencija. &bdquo;Samo neučinjena anastomoza neće dehiscirati&ldquo;. Ova stara hirur&scaron;ka poslovica je važeća i danas, a &scaron;to je anastomoza distalnija, mogućnost dehiscencije je veća, posebno kod niskih subperitonealnih anastomoza sa rektumom ili anusom. Učestalost dehiscencija ovih anastomoza u literaturi varira od 0,5 - 69 %, &scaron;to može ukazivati na kvalitet hirur&scaron;kog rada, kori&scaron;ćenje definicije dehiscencije, način dijagnostike, itd. Međunarodna grupa za karcinom rektuma definisala je dehiscenciju anastomoze kao defekt crijevnog zida, uključujući &scaron;avnu ili staplersku liniju neorektalnog rezervoara, &scaron;to dovodi do komunikacije između intra i ekstra luminalnog prostora. CILJEVI: Osnovni cilj ove studije je bio da se utvrde preoperativni i perioperativni faktori rizika značajni za nastanak dehiscencija kolorektalnih anastomoza, kao i značaj prokalcitonina i C-reaktivnog proteina u detekciji dehiscencija kolorektalnih anastomoza u subkliničkoj fazi bolesti. MATERIJAL I METODOLOGIJA: Istraživanjem je obuhvaćeno 100 pacijenata operisanih u elektivnom programu, kod kojih je urađena radikalna operacija karcinoma rektuma uz kreiranje dvostruke staplerske kolorektalne anastomoze. Svi pacijenti uključeni u istraživanje, odabrani metodom slučajnog izbora, bili su podijeljeni u dvije grupe. Grupa A: pacijenti kod kojih je urađena radikalna operacija karcinoma rektuma i kreirana primarna staplerska kolorektalna anastomoza. Grupa B: pacijenti kod kojih je urađena radikalna operacija karcinoma rektuma Hartmanovom procedurom u prvom aktu, a rekonstrukcija kontinuiteta gastrointestinalnog trakta uspostavljena u drugom aktu kreiranjem sekundarne staplerske kolorektalne anastomoze. Primjenom statističkih testova analizirani su preoperativni (pol, godine života, komorbiditeti, ASA skor, indeks tjelesne mase preoperativna primjena hemoradioterapije, laboratorijske analize) i perioperativni (vrijeme trajanja operacije, udaljenost anastomoze od anokutane linije, veličina tumora u cm, intraoperativna primjena krvi) faktori rizika za nastanak dehiscencije anastomoze kod obje grupe. Kod svih pacijenata drugog i četvrtog postoperativnog dana kontrolisane su vrijednosti C reaktivnog proteina i prokalcitonina u serumu, bez obzira da li su postojali ili ne klinički manifestni znaci dehiscencije anastomoze. Takođe, primjenom ROC krive analizirana je senzitivnost, specifičnost i dijagnostička tačnost C reaktivnog proteina i prokalcitonina drugog i četvrtog postoperativnog dana u detekciji dehiscencije kolorektalne anastomoze. REZULTATI: Nema statistički značajne razlike u pojavi dehiscencije anastomoze između primarnih i sekundarnih dvostrukih staplerskih anastomoza. Incidencija dehiscencija anastomoza je bila 11% u ukupnom uzorku. Osam pacijenata je reoperisano, dok su tri pacijenta tretirana konzervativno. Kod tri pacijenta, kod kojih je nastala dehiscencija i koji su reoperisani, zbog posljedice sepse i septičnog &scaron;oka nastupio je smrtni ishod. Pol, godine života, komorbiditeti, stadijum bolesti, dužina trajanja operacije, intraoperativna primjena krvi, nisu statistički značajni faktori rizika (p&gt;0,05) za nastanak dehiscencije primarnih i sekundarnih dvostrukih staplerskih kolorektalnih anastomoza. Udaljenost anastomoze od anokutane linije (&lt;7cm), veličina tumora preko 5 cm su statistički značajni faktori rizika za nastanak dehiscencije anastomoze. Postoji visoko statistički značajna razlika (p&lt;0,001) vrijednosti CRP-a i PCT-a četvrtog postoperativnog dana kod bolesnika sa i bez prisutne dehiscenecije kolorektalne anastomoze. Na osnovu ROC analize CRP&ndash;a za četvrti postoperativni dan, za graničnu vrijednost od 130 mg/l senzitivnost iznosi 82%, specifičnost 96% i dijagnostička tačnost 94%. Za graničnu vrijednost PCT-a od 0,78 ng/ml za četvrti postoperativni dan primjenom ROC krive utvrđena je sezitivnost 91%, specifičnost 92%, dok je dijagnostička tačnost bila 86%. Četvrti postoperativni dan CRP ima veću dijagnostičku tačnost i specifičnost u detekciji dehiscencije kolorektalne anastomoze u odnosu na PCT. ZAKLJUČAK: I pored velikog tehnolo&scaron;kog napretka, usavr&scaron;avanja hirur&scaron;kih tehnika, boljeg razumijevanja prirode maligne bolesti, unapređivanja intraoperativnog i postoperativnog kontinuiranog praćenja bolesnika, uvođenja novih antimikrobnih lijekova, problem u liječenju i pojava dehiscencija kolorektalnih anastomoza su i dalje značajno prisutni. Otkrivanjem dehiscencija kolorektalnih anastomoza u subkliničkoj fazi, identifikovanje preoperativnih i perioperativnih faktora rizika značajnih za nastanak dehiscencija, omogućilo bi da se dehiscencija ranije uoči i efikasnije rije&scaron;i.</p> / <p>INTRODUCTION: Colorectal anastomosis, which is formed deep in the pelvis because of establishment of continuity of gastrointestinal tract after resection of the part of intestines, has got its specifities during forming and healing process and when complications occur. Systemic, local and technical factors influence the healing process of anastomosis itself. Any kind of compromise in terms of these principles causes higher risk of complications! The most serious complication of anastomosis is dehiscence. &ldquo;Only anastomosis which is not carried out will not dehisce.&rdquo; This old surgical saying is still true, and the more distal anastomosis is, the possibility of development of dehiscence is higher, especially in lower subperitoneal anastomosis with rectum and anus. Incidence of dehiscence of these anastomosis in literature varies from 0,5 to 69 %, which may indicate the quality of surgical work, use of definition of dehiscence, kind of diagnostics etc. International group for rectal cancer defined dehiscence of anastomosis as a defect of intestinal wall, including suturing or stapler line of neorectal reservoir, which leads to communication between intra and extra luminal space. AIMS: Basic aim of this study was to determine preoperative and postoperative risk factors significant for the development of dehiscence of colorectal anastomosis, as well as significance of procalcitonin and C-reactive protein in detection of dehiscence of colorectal anastomosis at the subclinical stage of the disease. MATERIAL AND METHODOLOGY: The study included 100 patients operated on in the elective programme, on which radical operation of the rectal cancer was carried out with creation of double stapler colorectal anastomosis. All patients included in the study were randomly chosen and divided into two groups. Group A: the patients on which radical operation of the rectal cancer was carried out and primary stapler colorectal anastomosis created. Group B: the patients on which radical operation of the rectal cancer was carried out using Hartman&#39;s procedure in the first act, and reconstruction of the continuity of gastrointestinal tract was established in the second act by creation of secondary stapler colorectal anastomosis. By application of statistical tests preoperative (sex, age, comorbidities, ASA score, body mass index, preoperative application of haemoradiotherapy, laboratory analyses) and perioperative (duration of operation, distance of anastomosis from anocutaneous line, size of tumor in cm, intraoperative application of blood) risk factors for development of dehiscence of anastomosis in both groups were analysed. In all patients on the second and fourth postoperative day values of C-reactive protein and procalcitonin in the serum were analysed, regardless of the existence of clinically or non-clinically manifested signs of dehiscence of anastomosis. Also, sensitivity, specifity and diagnostically accurate C-reactive protein and procalcitonin on the second and fourth postoperative day in detection of dehiscence of colorectal anastomosis were analysed by application of ROC curve. RESULTS: There is no statistically significant difference in the development of dehiscence of anastomosis between primary and secondary double stapler anastomosis. Incidence of dehiscence of anastomosis was 11% in all samples. Eight patients were reoperated on, whereas three patients were treated conservatively. In three patients who developed dehiscence and were reoperated on, the death occurred due to sepsis and septic shock. Sex, age, comorbidities, stage of the disease, duration of operation, intraoperative application of blood were not statistically significant risk factors (p&gt;0,05) for the development of dehiscence of primary and secondary double stapler colorectal anastomosis. Distance of anastomosis from anocutaneous line (&lt;7cm), size of tumor over 5 cm were statistically significant risk factors for the development of dehiscence of anastomosis. There is highly statistically significant difference (p&lt;0,001) values of CRP and PCT on the fourth postoperative day in patients with and without dehiscence of colorectal anastomosis. On the basis of ROC analysis of CRP for the fourth postoperative day, for the bordering value of 130 mg/l sensitivity is 82%, specificity 96% and diagnostic accuracy 94%. For bordering value of PCT of 0,78 ng/ml for the fourth postoperative day, by application of ROC curve, the following values were determined: sensitivity 91%, specificity 92% and diagnostic accuracy 86%. CRP for the fourth postoperative day has got higher diagnostic accuracy and specificity in detection of dehiscence of colorectal anastomosis in relation to PCT. CONCLUSION: In spite of huge technological advance, improvement of surgical techniques, better understanding of the nature of malignant diseases, improvement of intraoperative and postoperative continuous follow up of the patient, introduction of new antimicrobial medicines, the problem in treating and development of dehiscence of colorectal anastomosis is still significantly present. Detection of dehiscence of colorectal anastomosis at the subclinical stage, identification of preoperative and perioperative risk factors significant for the development of dehiscence would help in early detection of dehiscence and contribute to more effective operations.</p>