The aim of this study was to validate City of Hope Quality of Life-Ostomy Questionnaire (CoH-QoL-OQ) for assessing the quality of life (QoL) of ostomy patients in the Republic of Croatia. The CoH-QoL-OQ is widely used, but has not been translated or validated so it can be used in the Republic of Croatia. This cross-sectional study encompassed 302 surgery patients with colostomy, ileostomy, or urostomy (182 (60.3%) male and 120 (39.7%) female), whose average age is 59 (M = 59.3, SD = 15.8). The CoH-QoL-OQ was translated into Croatian language using accepted guidelines for translation. Patients were recruited in a telephone conversation, followed by mail containing the CoH-QoL–OQ delivered to the home addresses of the patients who agreed to participate. The collected data were analyzed to verify psychometric properties of the questionnaire on the Croatian sample. All subscales showed high level of internal consistency (Cronbach α = 0.73–0.89). The test-retest reliability indicated a very satisfactory temporal stability (r = 0.99). The Confirmatory Factor Analysis (CFA), showed that the originally established model was not adequate for the data (χ² = 4237.88, p < 0.01, CFI = 0.540, NNFI = 0.481, RMSEA = 0.113). However, after modification that excluded problematic items, the data showed a better fit with the theoretical model (except for the LR chi-square test that remained statistically significant: χ² = 1144.28, p < 0.01, CFI = 0.869, NNFI = 0.855 RMSEA = 0.077). We conclude that the CoH-QoL-OQ is a valid, reliable, and reducible instrument for measuring the health-related quality of life (HRQoL) among Croatian patients with ostomy in clinical research and clinical practice.

The aim of the study was to investigate whether the COVID-19 pandemic caused an increased incidence of complicated appendicitis due to the late presentation when compared to the pre-COVID-19 period. Summary Background Data. Acute appendicitis is one of the most common surgical emergencies. During the coronavirus-19 (COVID-19) pandemic, there has been a reported delay in the presentation of some urgencies to the emergency hospital departments. Methods. A total of 427 patients who underwent surgical treatment due to suspected acute appendicitis from June 2019 to November 2020 were retrospectively included in this study. The patients were divided into two groups: the first (pre-COVID-19) group consisted of patients who had surgery before the onset of COVID-19 pandemic (n = 240), while the second (COVID-19) group consisted of those who were operated during the COVID-19 pandemic (n = 187). The primary outcome of the study was to compare the incidence of perforated appendicitis before and during the onset of COVID-19. Results. Overall, 84 patients (19.67%) were diagnosed with perforated appendicitis. We found a weak significance ( ) in the rate of perforated appendicitis between the pre-COVID-19 (17.08%) and the COVID-19 era (22.99%). Conclusions. We did not observe any significant difference in the complications of acute appendicitis before and during the COVID-19 pandemic in a university hospital in Rijeka. An emergent medical care should always be accessible.

Background/Objectives: MicroRNAs (miRNAs) regulate gene expression and are proposed as biomarkers in colorectal cancer (CRC). This study evaluated miR-185-5p, miR-141-5p, and miR-21-5p expression in CRC tissues; their association with tumor location, histopathology, and clinical outcomes; and the suitability of miR-16-5p and miR-151a-3p as housekeeping controls. Previous reports suggest tumor-suppressive roles for miR-185 and miR-141 and an oncogenic function for miR-21, though findings remain inconsistent. Methods: Paired tumor and adjacent normal tissues from 70 CRC patients were analyzed. RNA was extracted from FFPE samples, and miRNA expression quantified by RT-qPCR. Relative expression values were normalized to miR-151a-3p. Tumor–normal differences, localization effects, and associations with clinicopathological and outcome variables were assessed using repeated-measures ANOVA and non-parametric tests. Results: miR-185-5p and miR-141-5p were significantly reduced in tumors compared with normal mucosa while miR-21-5p was upregulated. miR-16-5p showed higher expression in normal tissue, indicating its instability and unsuitability as a housekeeping control. A modest but significant localization effect was observed for miR-185, while other miRNAs were minimally influenced by location. Baseline asymmetry between non-tumor samples, observed for miR-185-5p, further indicated sidedness effects. None of the miRNAs were associated with stage, histological type, grade, invasion, immune infiltration, progression, or five-year survival. Conclusions: miR-185-5p, miR-141-5p, and miR-21-5p show robust tumor–normal differences, supporting their diagnostic potential, while miR-16-5p is unsuitable as a housekeeper. Modest but significant localization effect was observed for miR-185 in right-sided tumors. None showed prognostic value in stage I–III CRC. Larger, location-stratified studies are warranted.

Aim: This study aimed to evaluate whether implantation of an autologous skin graft in the intersphincteric space, as part of the ASGIIFT procedure, improves the primary healing of complex transsphincteric cryptoglandular anal fistulas. Methods: A prospective observational IDEAL stage 2a study was conducted at a tertiary referral centre for minimally invasive colorectal surgery and proctology in Croatia between September 2021 and January 2023, with an 18‐month follow‐up. Preoperative pelvic MRI was performed in all cases, and 40 adult patients who met the inclusion criteria were included in the study. The primary outcome was the postoperative primary healing rate which was defined clinically. Secondary outcomes included postoperative continence disturbance, postoperative pain, time of healing and other postoperative complications (Wexner score and VAS – Visual Analogue Scale were used). The ASGIIFT procedure includes all standard steps of the LIFT technique (ligation of the intersphincteric fistula tract), with the addition of a pre‐prepared autologous dermal graft placed into the intersphincteric space. The study was approved by the institutional ethics committee. Results: Primary clinical healing was achieved in 35 patients (87.5%) within a median of 4 weeks postoperatively (range 3–6 weeks). Five initially unhealed patients showed conversion from transsphincteric to intersphincteric fistula during the follow‐up period and were subsequently treated by fistulotomy without complications. No patient experienced worsening continence, and no serious postoperative complications occurred. Conclusion: ASGIIFT appears to be a safe and feasible technique for treating transsphincteric anal fistulas, showing promising early results in this single‐centre IDEAL 2a study. Further prospective comparative studies are warranted to validate these initial findings.

Injuries of the biliary system are rare. They can broadly be divided into traumatic biliary injuries and iatrogenic biliary injuries. Former are usually part of associated abdominal trauma, blunt or penetrating, and latter are consequence of surgical, endoscopic or invasive radiological diagnostic or therapeutic procedures done in various liver, pancreatic or disorders or the part of upper gastrointestinal system. They occur more commonly than traumatic injuries but still are rare. Those injuries represent important aspect in healthcare system because of their complexity and diversity in management, associated morbidity and mortality and expenditure in healthcare systems. This chapter will put focus on those injuries, including their classification, etiology and mechanism of occurrence, clinical presentation, diagnosis, treatment options, postoperative complications, and, when iatrogenic injuries are concerned, methods for prevention of those injuries.