Polish Journal of Surgery最新文献

<b>Introduction:</b> The anatomical location of the popliteal artery is one of the greatest challenges for percutaneous interventions. The biomechanical attributes of the vessel lead to higher rates of restenosis, stent fracture, and occlusion. Some surgeons consider the popliteal artery as a no stenting zone. Many specialists favor percutaneous transluminal angioplasty to be the first line of endovascular treatment in the popliteal artery with bail-out stent implantation if the results are suboptimal. The Supera peripheral stent system is a novel stent that has been manufactured with a high degree of flexibility and supposedly might be appropriate for implantation in the popliteal artery. </br></br> <b>Aim:</b> Evaluation of the performance of Supera stent in isolated popliteal artery disease in comparison to other methods of treatment. </br></br> <b>Methods:</b> As many as 92 articles were found in the databases and after full-text review, 4 studies matched the inclusion criteria and were evaluated. </br></br> <b>Results:</b> Primary patency rates of Supera implantation in an isolated popliteal artery at 12 months ranged from 68% to 90%. In all four studies, no stent fractures were observed. Only one study provided longer follow-up than 12 months and evaluated the performance of the Supera stent 36 months after implantation. </br></br> <b>Conclusion:</b> In conclusion, mentioned studies show promising and superior to other stent patency rates of the Supera stent regarding popliteal artery lesions. What is more, no stent fracture is promising regarding longer follow-up. However, more studies with longer follow-ups and direct comparison to other methods are required to fully evaluate Supera's performance in the popliteal artery.

Introduction: Superficial vein thrombosis of the lower limbs is a common condition encountered by a wide spectrum of clinical specialties. In contrast to deep vein thrombosis of the lower limbs though, there is significant variability in terms of its treatment with respect to the type and duration of pharmacotherapy, as well as regarding the potential role of operative management.

Methods: Systematic review of the literature in a best evidence topic manner, including only prospective and randomized controlled studies on the treatment of lower limb SVT, focusing on the emerged data over the last 5 years.

Results: A total of 17 prospective observational and randomized clinical studies met our set criteria. Despite the major differences in study designs, outcomes and intervention types, upfront pharmaceutical treatment with fondaparinux or intermediate dose of low molecular weight heparins, combined with regular clinical and radiological follow-up, seem to be effective and safe as first-line approaches. Upfront surgical treatment of lower limb SVT can also be safely performed in selected cases in the presence of clinical expertise.

Conclusions: Our review revealed the presence of considerable variability in the therapeutic options of the lower limb superficial venous thrombosis, highlighting the need for further randomized controlled trials in the field in order to establish and standardize its optimal treatment.

This document - "Polish Consensus on Gastric Cancer Diagnosis and Treatment - Update 2022" - represents an expert consensus following a year's worth of dedicated effort by a team of specialists throughout 2021, put forward in a conference in December 2021 in Krakow, and finalized below for publication in 2022. The effective date of this document is June 14th 2022. The work that went into updating this consensus was made under auspices of the Polish Society of Surgical Oncology and the Association of Polish Surgeons.

<b> Aim: </b> The study was conducted to analyse the recent peer-reviewed literature related to symptomatic spilled gallstones after Laparoscopic Cholecystectomy (LC). </br></br> <b>Materials and methods:</b> Articles published in the peer-reviewed journals of repute from 20122022 were evaluated for nine variables including: [I] age of the patient, [II] gender, [III] interval since index LC, [IV] index LC if emergent/difficult or elective/straightforward, [V] clinical presentation, [VI] spilled gallstones if detected by imaging, [VII] management, [VIII] approach to management, [IX] number of spilled gallstones. </br></br> <b>Results:</b> There were a total of 71 cases (37 males and 34 females) with a mean age of 63.7 years. The time of onset of symptoms from spilled gallstones, after index LC, ranged from 2 days to 15 years and 57 patients (80.3%) presented within 6 years. Forty (56.3%) patients were unaware of the fact that gallstone spillage had occurred during index LC. The retained gallstones were detected by imaging in 47 (66.1%) cases and they were multiple in 51 (71.8%). In 52 patients (73.2%), the stones manifested as abdominal abscess/foreign body granuloma; the other presentations being pelvic pain/fistula, intestinal obstruction, abdominal lump simulating malignancy, incidental finding of metastatic lesions and generalized peritonitis. The major approaches adopted to retrieve the retained stones included open surgery, laparoscopy and percutaneous drainage. There were two deaths (2.9%) due to spilled gallstones. </br></br> <b>Conclusion:</b> Retained gallstones represent a complication of laparoscopic cholecystectomy (LC) that has a potential to create morbidity and diagnostic difficulties, even after a substantial delay. There is a need to spread awareness about the adverse effects of spilled stones so that they are actively looked for and retrieved if gallbladder perforates during cholecystectomy. Whenever such a complication occurs, the patient should be properly informed and the details should be very clearly mentioned in the operation notes.

<b> Introduction:</b> Post-operative seroma formation is one of the most common complications following modified radical mastectomy (MRM). Quilting is a technique where the mastectomy flaps are sutured to the underlying chest wall muscles with sutures, obliterating the dead space. The authors hypothesised that post-mastectomy dead space obliteration by intermittent mastectomy flap fixation leads to decreased drain output and seroma formation. </br></br> <b> Material and methods: </b> A double-blinded randomised control trial with two arms was conducted from November 2019 to March 2021 in our institute located in India. Patients with non metastatic breast carcinoma planned for MRM were randomly categorised into two groups of 35 patients each. In the test group, each flap was fixed to the underlying muscle using four intermittent 3-0 polyglactin sutures, which was followed by skin closure, and only skin closure was done in the control group. </br></br> <b>Results:</b> The test and control groups did not differ significantly with respect to demographic and tumour characteristics. The average drain output of the test group (155.43 ml) was significantly less than of the control group (206.29 ml). The overall incidence of seroma formation is lower in the test group (5.7%) when compared to the control group (28.6%). The duration of hospital stay in the test group (4.63 days) was significantly shorter when compared to the control group (6.66 days). There was no significant increase in the overall operating time or complications like surgical site infection or skin dimpling due to flap fixation. </br></br> <b>Conclusions:</b> Fixation of MRM flaps is associated with better post-operative outcomes related to drain output and seroma formation without a significant increase in other morbidities or usage of resources.

Pancreatic cancer, despite significant progress in diagnosis and treatment still has poor prognosis. Surgical treatment remains the only cure option. Unfortunately, the percentage of patients in whom radical tumor removal is possible is less than 20%. Resection procedures are burdened with a high degree of difficulty, as well as a high complication rate. One of the important factors contributing to the high morbidity of the perioperative period is malnutrition, and rapidly progressing malnutrition which occurs in about 85% of pancreatic cancer patients. Abnormal nutritional status is closely related to a change in the composition in the body.The aim of the study was to determine the changes in the body composition of patients with pancreatic cancer and their consequences based on the results of the current research.The available reports have shown that the body composition of a patient with pancreatic cancer undoubtedly changes and is dependent on the stage, location and type of cancer. Furthermore, the fact if antitumor treatment is applied or not, also plays a significant role.It appears that in patients with pancreatic cancer, weight loss with a decline in parameters such as body fat and skeletal muscle mass appears early and worsens as the tumor grows and the disease progresses. The above data suggest that knowing the patient's body composition and observing its changes may be a prognostic factor for survival and the occurrence of complications. Additionally, there are reports that dosing chemotherapy based on body composition rather than conventional measures can help reduce the toxicity of the treatment. Therefore, knowing the patient's body composition seems to be an important aspect.

<b> Introduction:</b> Anastomotic leak after colorectal surgery is a serious complication that causes significant postoperative morbidity and mortality. </br></br> <b>Aim:</b> This study aimed to investigate the predictive value of increased postoperative carcinoembryonic antigen (CEA) in early intestinal anastomosis leakage in patients who underwent right hemicolectomy surgery.</br></br> <b>Material and methods:</b> In this prospective study, 535 patients who underwent right colon cancer surgery with stapled anastomosis were enrolled. A subset of 315 patients was included in the study after meeting the inclusion criteria. Preoperatively, their serum CEA levels were measured, and on postoperative days 3 and 6, the levels were measured again.</br></br> <b>Results:</b> Early AL occurred in 18 patients (5.71%). The mean SD age of patients was 65.06 11.69 years. Increased CEA level was associated with increased odds of intestinal AL among the patients after three and six days of surgery (OR after three days = 1.3; 95%CI = 1.11.5, OR after six days = 1.7 95%CI = 1.142.5). The mean CEA level significantly increased among patients with anastomose leakage (P-value < 0.001). </br></br> <b>Conclusion:</b> The results showed that increasing CEA levels can be used as one of the non-invasive markers in detecting early AL in patients with right colon cancer surgery.

<b> Introduction:</b> Given the high prevalence of breast cancer, developing quick and accessible diagnostics solutions is critical. The BIRADS classification is a reliable method for assessing and estimating the risk of malignancy in breast lesions. </br></br> <b>Aim:</b> The aim of this study was to compare the results of core needle biopsy of breast lesions and sonographic findings based on the BIRADS category in Yazd. </br></br> <b>Materials and methods:</b> This retrospective analytical study was done on all core needle biopsy specimens referred to Mortaz hospital, Yazd, Iran from 2010 to 2019. Demographic data such as age, laterality of the lesion, BIRADS category, and pathology reports were extracted from patients' hospital folders. Data were analyzed by SPSS version 21. P < 0.05 was considered statistically significant. </br></br> <b>Results:</b> In total, 514 cases with a mean age of 43.9 9.4 years were studied. Among them, 104 cases (20.2%) were malignant and 410 cases (79.8%) were benign. The most common benign and malignant lesions were fibroadenoma (24.9%), and infiltrative ductal carcinoma (83.7%) respectively. The most common BIRADS was class 4A (54.9%). Patients with benign lesions were mostly in the 3rd and 4th decade of life, while malignant lesions were more in the 4th and 5th decades, and this difference was statistically significant (P = 0.001). The correlation between ultrasound diagnoses (BIRADS) and pathology findings was statistically significant (P < 0.001). </br></br> <b>Conclusion</b>: Based on the results, there is a significant correlation between ultrasound outcomes according to BIRADS and pathology results, and the radiology-pathology accordance, owing to its high accuracy, can be very helpful in correctly diagnosing, monitoring, and managing the lesion.

Breast-conserving surgery (BCS) is the gold standard for cancer treatment. The major goal isto achieve tumor-free margins while maintaining a satisfactory aesthetic result. This task canbe accomplished with the use of modern oncoplastic methods.The goal of this study is to provide the preliminary results of surgical treatment for 20 patientswith breast cancer who had their resection defect repaired with pedicled dermal-subcutaneousflaps from nearby breast areas.

The article presents outcome of treatment of 31 patients, 28 men and 3 women, at a mean age of 37 years with excessive soft tissue defects within the hand, which were fitted with groin flaps. Long-term outcomes were assessed at a mean of 3,7 years following surgery (range 3-10) in 18 patients (58%) in a form of phone interview. Results. All flaps eventually healed, however complications occurred in 8 patients (26%). At a follow-up assessment most of the patients complained of slight pain when using the hand. Only 2 patients achieved full range of motion of the fingers in the operated hand, and remaining 16 reported various degree of limited fingers movements, both flexion and extension. None of patients considered his/her hand fully dexterous and a mean quickDASH score was 21,5 points what shows moderate impairment of hand function. The poorest outcomes were achieved in patients with tissue defects in fingers and in those who had performed simultaneous tendon repair. The results of this study show that a groin flap is useful in reconstruction of large and moderate tissue defects in the hand, which do not fit for covering by conventional methods.