Polish Journal of Surgery最新文献

<b>Introduction:</b> Negative pressure wound therapy (NPWT) has been suggested as a gold standard for managing complex wounds and to reduce the time of healing and overall morbidity and mortality of the patient. </br></br> <b>Aim:</b> We have done a retrospective study to observe the outcome in patients managed with negative pressure wound therapy for varied etiologies. </br></br> <b> Methods:</b> Patients with complicated wounds including lower limb wounds post-debridement, upper limb wounds post-debridement, postoperative abdominal wound dehiscence, abdominal and chest abscess wounds post-debridement and amputation stumps, managed with negative pressure wound therapy were studied on the basis of wound outcome, total hospital stay, days of NPWT application and pressure and mode of NPWT. </br></br> <b>Results:</b> A total of 42 patients with complicated wounds were included in the study. Mean hospital stay was 16.2 days and mean NPWT application time was 8.29 days with NPWT being applied on average for 3.91 days post-procedure like debridement or amputation or after wound dehiscence in which debridement was not done. As many as 41.5% of wounds were closed with suturing, 48.8% healed by secondary intention and 9.8% were covered with split-thickness skin grafts. A significant observation was made for lower pressure being used for abdominal wound dehiscence (75 mmHg) compared to other wounds on limbs (mean 98.33 mmHg) (P < 0.001). Re-debridement after the 1st cycle of NPWT was needed in 40% of wounds managed with intermittent mode compared to 6.2% in continuous mode (P = 0.028). </br></br> <b>Conclusion:</b> NPWT can reduce and manage wound complications with improvement in the quality of life of patients when used at an appropriate time with knowledge of its mechanism and functionality.

<b> Introduction:</b> Low anterior resection (LAR) is the standard procedure for distal rectal cancer allowing anal sphincter preservation. Anastomotic leakage remains one of the most dangerous complications following LAR and its management is difficult. </br></br> <b>Aim:</b> This study reviews our experience of LAR with and without protective ileostomy (PI). </br></br> <b> Methods:</b> One hundred ninety-nine patients undergoing LAR resection for low rectal cancer in this centre during the period 2015-2019 were divided retrospectively into two groups. Group A underwent rectal resection and coloanal/rectal anastomosis with diverting ileostomy and group B without ileostomy. </br></br> <b> Results:</b> Among our patients, 20 had a covering ileostomy (stoma group);179 did not (control group). The stoma group comprised 14 men and 6 women ranging in age from 36 to 89 years (mean, 64.2 ± 10.5 years). Conventional v. minimally invasive surgery was 6/14. Anastomotic leakage occurred in 16/179 (8.93%) patients without a PI, and in 6/20 (30%) with a stoma (Tab. I.). Of the 16 patients experiencing an anastomotic leak, 3 (18.75%) from Group A and 5 (83.33%) from Group B were classified as Grade B leakage and were treated conservatively. As many as 13/16 (81.25%) in Group A and 1/6 (16.77%) in Group B were classified as Grade C leakage and required emergency surgery. </br></br> <b>Conclusion:</b> These results do not show a preventive effect on the occurrence of anastomotic leakage in low anterior resection, but may significantly reduce the need for further surgery due to septic complications in the early postoperative period. Selection of patients for protective ileostomy requires great care as its creation and closure are associated with severe complications.

Introduction: To investigate the influence of iliac vein stenosis on clinical course and recurrence of primary varicose veins after surgeryMaterials and methods: Thirty-three patients with primary varicose veins qualified for great saphenous vein stripping were analysed. The stenosis of common (CIV) and external (EIV) iliac vein was measured by IVUS and defined in three categories as minimal lumen area <90 mm2 for CIV and <75 mm2 for EIV, minimal lumen diameter <10 mm for CIV and <7.5 mm for EIV and area reduction >50%. The patients were assessed clinically and by Duplex ultrasound 48 to 72 months after the procedure. Any recurrence, the recurrence in the saphenofemoral junction (SFJ), change in Venous Clinical Severity Score ( VCSS), were analyzed in relation to the stenosis in the CIV and EIV.

Results: The follow-up was completed in 27 patients. Any recurrence and the recurrence in the SFJ were observed in 70% and 18.5% of patients, respectively. There were no statistically significant differences in any recurrence, the recurrence in the SFJ and VCSS in relation to CIV and EIV stenosis in any category.

Conclusions: Iliac vein stenosis does not influence the clinical course and recurrence of primary varicose veins after surgery.

<b>Introduction:</b> Perineal hernia (PH), also termed pelvic floor hernia, is a protrusion of intraabdominal viscera into the perineum through a defect in the pelvic floor. </br></br> <b>Aim:</b> The study was conducted to evaluate the cases of perineal hernia resulting as a complication of abdominoperineal resection (APR) of rectal cancer. </br></br> <b> Material and methods:</b> 30 cases from 24 articles published in reputable peer reviewed journals were evaluated for eight variables including [I] patient age, [II] gender, [III] time since APR, [IV] clinical presentation, [V] approach to repair, [VI] type of repair, [VII] presence/absence of pelvic adhesions [VIII] complications. </br></br> <b>Results:</b> There was a total of 30 cases (18 males and 12 females) with a mean age of 71.5 years. The time of onset of symptoms ranged from 6 days to 12 years. Perineal lump with pain was the chief presenting feature followed by intestinal obstruction. Different approaches were adopted to repair by various methods. </br></br> <b>Conclusions:</b> Perineal hernia as a complication of abdominoperineal resection is reported increasingly nowadays, as the approach to management of rectal cancer has gradually got shifted from open to minimally invasive in recent years. There is a need to spread awareness about this condition, so that it is actively looked for, during the postoperative follow-up. Management is surgical repair; the approach and type of repair should be individualized.

Background information: In recent years the composition of gut microbiome has been linked to development of several diseases. The goal of the following study was to establish whether it is connected to the outcome of bariatric surgery. The objective was to analyze the oral and gut microbiota of patients suffering from morbid obesity who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB).

Methods: The following is a prospective cohort study that was conducted between November 2018 and June 2019. Participants underwent LRYGB surgery. Patients then were assigned to group 1- success (surgical participants who achieved a percentage of excess weight loss [%EWL] >50%), group 2 (surgical participants who achieved a %EWL <50%). The follow up to establish the %EWL was conducted 6 months after the surgery. Before surgery, oral swabs were obtained, and stool samples were provided. The endpoint was the composition of the gut microbiota.

Results: Group 1 consisted of 4 participants; group 2 consisted of 2 participants. No participants were lost to follow-up during the study. Participants in group 1 had an oral microbiota that was enriched in the family Tissirelia of the phylum firmicutes. Gut microbiome of patients in group 1 was enriched with with Tanerella of the Bacteroidetes phylum. Group 2 did not present enriched microbiota by any of the analyzed organisms. Gut microbiota was enriched by deltaprotebacteria class (phylum Proteobacteria), bernesiellaceae of the phylum Bacteroidetes.

<b> Introduction:</b> Gastrointestinal neuroendocrine neoplasms arise from cells of the diffuse endocrine system (DES) located in the digestive tract. They are often diagnosed in an advanced stage, when distant metastases appear. Skin metastases of neuroendocrine tumors are extremely rare. </br></br> <b>Aim:</b> The aim of the study was to collect and analyze cases of skin metastases of gastrointestinal neuroendocrine neoplasms. </br></br> <b>Materials and methods:</b> A literature search across PubMed and Medline databases from 1969 up to 2021 was performed. We reviewed English literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The following keywords were used: "neuroendocrine tumor", "neuroendocrine neoplasm", "neuroendocrine carcinoma", "NET", "NEN", "skin and cutaneous metastases", "lymph nodes". The characteristics of patients, grading, tumor localization and other data that was found in publications were assessed. Case reports and case series were included. </br></br> <b>Results:</b> The initial search strategy yielded 14 results in PubMed and 3 in the Medline database. We removed duplicates after we imported the citations with a citation manager. We found 17 publications concerning skin metastases of neuroendocrine neoplasms. The analysis of 18 cases concerned 13 NECs and 5 NETs. In most cases, the metastases are small, painless and located on the scalp or lower extremities. Skin metastases may be the first symptom of the disease. The pancreas is the most common primary tumor site.</br></br> <b>Conclusions:</b> NEN metastases to the skin are often diagnosed with disseminated neoplastic process, which is associated with poor prognosis and high mortality. NET metastases to the skin may occur with an unknown primary site. Skin metastases of neuroendocrine tumors should be considered during the diagnosis of skin tumors.

<b>Aim:</b> The aim of this study is to compare the association of 2D and 3D imagery with technical performance and operative time during laparoscopic surgery. </br></br> <b> Material and methods:</b> A systematic review of the literature was conducted through an online search in databases such as PubMed, Cochrane, Embase and CNKI in order to identify articles published in English and Chinese from 2010 to 2020 that compared the clinical results of 2D and 3D laparoscopic gastric bypass surgery. </br></br> <b> Results:</b> A total of 50 articles were included in the qualitative analysis. Out of these, 5 articles that met the inclusion criteria were selected for analysis, according to which 3D laparoscopic surgery had a shorter surgery time than 2D laparoscopic surgery. </br></br> <b>Conclusions:</b> Compared with a 2D laparoscopic system, a 3D laparoscopic system can significantly reduce the operative time and errors and can increase the comfort of the surgeons performing laparoscopic gastric bypass surgery.

<b> Introduction: </b> Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a procedure which enables reconstruction of the continuity of the gastrointestinal track after resection of the large intestine and rectum. The most common diseases that require this type of resection include: ulcerative colitis and familial adenomatous polyposis. </br></br> <b>Aim:</b> The study aimed to determine the effectiveness of IPAA in the surgical treatment of the paediatric age group. </br></br> <b>Material and methods:</b> The research material was collected based on medical records of 21 patients who underwent proctocolectomy at the Department of Pediatric Surgery, Traumatology, and Urology of the Medical University of Poznan in 2000-2021. </br></br> <b>Results: </b> In a group of 21 patients, 11 children were qualified for proctocolectomy due to ulcerative colitis (UC), 6 due to familial adenomatous polyposis (FAP), 3 due to Hirschsprung's disease (HD), and one child due to Crohn's disease (CD). Early complications in treated patients included dehiscence of the postoperative wound, bleeding from the lower gastrointestinal tract and anastomotic leakage. Late complications included pouchitis, stenosis of the ileostomy, narrowing of the anastomotic site and soiling. Quality of life was rated at an average of 9-10 by 16 patients on a scale of 1-10. </br></br> <b>Conclusions:</b> IPAA is a proven method of reconstruction for the paediatric age group requiring proctocolectomy. Complications are common, most often related to the underlying disease and the clinical condition of the patients. Despite possible complications, patients rate their quality of life high on the scale. Each qualification for surgery should be carried out in a multidisciplinary team.

<b> Introduction:</b> The newest data has reported that endoplasmic reticulum (ER) stress and PERK-dependent Unfolded Protein Response (UPR) signaling pathway may constitute a key factor in colorectal cancer (CRC) pathogenesis on the molecular level. Nowadays used anti-cancer treatment strategies are still insufficient, since patients suffer from various side effects that are directly evoked via therapeutic agents characterized by non-specific action in normal and cancer cells. </br></br> <b>Aim:</b> Thereby, the main aim of the presented research was to analyze the effectiveness of the small-molecule PERK inhibitor NCI 12487 in an in vitro cellular model of CRC. </br></br> <b>Materials and methods:</b> The study was performed on colorectal cancer HT-29 and normal human colon epithelial CCD 841 CoN cell lines. The cytotoxicity was measured by XTT assay, evaluation of apoptosis was performed by caspase-3 assay, whereas cell cycle analysis via the propidium iodide (PI) staining. </br></br> <b>Results:</b> Results obtained have demonstrated that the investigated compound is selective only for HT-29 cancer cells, since at 25 μM concentration it significantly decreased HT-29 cells viability in a dose- and time-dependent manner, evoked increased caspase-3 activity and arrest in the G2/M phase of the cell cycle. Moreover, NCI 12487 compound markedly decreased HT-29 cells viability, increased caspase-3 activity and percentage of cells in sub-G0/G1, thus promoted apoptosis of cancer HT-29 cells with induced ER stress conditions. </br></br> <b>Conclusion:</b> Thus, based on the results obtained in this study it may be concluded that small-molecule modulators of the PERK-dependent UPR signaling pathway may constitute an innovative, targeted treatment strategy against CRC.