Polish Journal of Surgery最新文献

Objectives: Most authors highlight the absence of international guidelines in the treatment of recurrent rectal prolapse (RRP), even among coloproctologists. However, it is clearly indicated that Delormes or Thierschs surgeries are reserved for older and fragile patients, so on the other hand, transabdominal surgeries are dedicated to generally fitter patients. The aim of the study is evaluation of surgical treatment effects for recurrent rectal prolapse (RRP)Methods: The study group comprised of 20 female and 2 male patients aged from 37 to 92 years (subjected to treatment last 20 years). Initial treatment consisted of abdominal mesh rectopexy (n=4), perineal sigmorectal resection (n=9), Delormes technique (n=3), Thierschs anal banding (n=3), colpoperineoplasty (n=2), anterior sigmorectal resection (n=1). The relapses occured between 2 to 30 months.

Results: Reoperations consisted of abdominal without (n=8) or with resection rectopexy (n=3), perineal sigmorectal resection (n=5), Delormes technique (n=1), total pelvic floor repair (n=4), perineoplasty (n=1). 11 patients (50%) were completely cured. 6 patients developed subsequent RRP. They were successfully reoperated (2 rectopexies, 2 perineocolporectopexies, 2 perineal sigmorectal resections).

Conclusions: Abdominal mesh rectopexy is the most effective method for RP and RRP treatment. Total pelvic floor repair may prevent RRP. Perineal rectosigmoid resection results of less permament effects of RRP repair.

Introduction: The restoration of bowel continuity is associated with significant postoperative morbidity. Aim: The aim of the study was to report the outcomes of restoring intestinal continuity in a large patient cohort.Material and methods: A retrospective analysis was conducted on 91 patients with terminal stoma who were qualified for restoration of GI tract continuity between January 2015 and March 2020. The following demographic and clinical characteristics were analyzed: age, gender, BMI, comorbidities, indication for stoma creation, operative time, the need for blood replacement, the site and type of the anastomosis, and complication and mortality rates.Results: The study group was comprised of 40 women (44%) and 51 men (56%). The mean BMI was 26.8 ±4.9 kg/m2. Only 29.7% of the patients (n = 27) were at normal weight (BMI: 18.5–24.9) and only 11% (n = 10) did not suffer from any comorbidities. The most common indications for index surgery were complicated diverticulitis (37.4%) and colorectal cancer (21.9%). The stapled technique was used in the majority of patients (n = 79, 87%). The mean operative time was 191.7 ±71.4 min.Nine patients (9.9%) required blood replacement peri- or postoperatively, whereas 3 patients (3.3%) required intensive care unit admission. The overall surgical complication rate was 36.2% (n = 33) and the mortality rate was 1.1% (n = 1).Discussion: Restoration of bowel continuity is quite a demanding and complex procedure and thus should be performed by an experienced surgical team. In the majority of patients, the complication rate represents only minor complications. The morbidity and mortality rates are acceptable and comparable to other publications.

BackgroundVenous thromboembolism (VTE) is common after bariatric surgery and extended prophylaxis is generally recommended. Low molecular weight heparin is the most commonly used agent but requires patients to be trained to self-inject and is expensive. Rivaroxaban is an oral daily formulation approved for VTE prophylaxis after orthopedic surgery. Efficacy and safety of rivaroxaban has been confirmed in major gastrointestinal resections by several observational studies. We report a single centre experience of using rivaroxaban as an agent for VTE prophylaxis in bariatric surgery. MethodsWe performed prospective cohort study assessing safety and efficacy of rivaroxaban as a medication for VTE prophylaxis in patients undergoing bariatric surgery in a single centre in Kyiv, Ukraine. Patients undergoing major bariatric procedure received perioperative prophylaxis of VTE with subcutaneous low molecular weight heparin and then were switched to rivaroxaban for total of 30 days starting on the 4th postoperative day. Thromboprophylaxis was performed in accordance with the VTE risks derived from the Caprini score. On the 3rd, 30th, 60th day after the operation, the patients underwent ultrasound examination of the portal vein, as well as the veins of the lower extremities. Telephone interviews were conducted 30 and 60 days after the surgery to evaluate the presence of complaints which may be characteristic for VTE as well as to assess compliance with the regimen and to assess patient satisfaction. Outcomes studies were incidence of VTE and adverse events related to rivaroxaban administration.Results110 patients were included in the study from July 2019 to May 2021. The average age of the patients was 43.6 years, the average preoperative BMI was 55 (35 to 75). One hundred and seven patients (97.3%) underwent laparoscopic intervention while three patients (2.7%) underwent laparotomy. Eighty-four patients underwent sleeve gastrectomy and twenty-six patients underwent other procedures, including bypass surgery. Average calculated risk of thromboembolic event was 5-6% based on Caprine index. All patients were treated with extended prophylaxis with rivaroxaban. The average follow-up period for patients was 6 months. There were no clinical or radiological evidence of thromboembolic complications in the study cohort. Overall complication rate was 7.2%, however, only one patient (0.9%) developed subcutaneous hematoma associated with rivaroxaban not requiring intervention. ConclusionExtended postoperative prophylaxis with rivaroxaban is safe and effective in preventing thromboembolic complications in patients undergoing bariatric surgery. It is preferred by patients and further studies should be considered to further evaluate its use in bariatric surgery.

Introduction: Correct surgical technique and perioperative care are two factors that can reduce the number of complications, improve treatment outcomes and shorten the length of hospital stay. The introduction of enhanced recovery protocols has changed the approach to patient care in some centers. However, there are significant differences among centers, and in some the standard of care has remained unchanged.

Aim: the goal of the panel was to develop recommendations for modern perioperative care in accordance with current medical knowledge in order to reduce the number of complications associated with surgical treatment. An additional goal was to optimize and standardize perioperative care among Polish centers.

Materials and methods: the development of these recommendations was based on a review of the available literature from the PubMed, Medline and Cochrane Library databases from January 1, 1985 to March 31, 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. Recommendations were formulated in a directive form and were assessed using the Delphi method.

Results and conclusions: 34 recommendations for perioperative care were presented. They cover aspects of pre-, intra- and post-operative care. Implementation of the presented rules allows to improve the results of surgical treatment.

Introduction: Postoperative peritoneal adhesions formed after abdominal surgery still continue to exist as an unresolved health problem.

Aim: The aim of the present study is to examine whether omega -3 fish oil has a preventive effect on postoperative peritoneal adhesions.

Methods: Twenty-one female Wistar-Albino rats were separated into 3 groups (sham, control, and experimental group), each consisting of 7 rats. In sham group, only laparotomy was performed. Both in control and experimental group rats; the right parietal peritoneum and cecum were traumatized to form petechiae. Following this procedure, unlike the control group, the abdomen was irrigated with omega-3 fish oil in the experimental group. Rats were re-explored on the 14th postoperative day and adhesions were scored. Tissue samples and blood samples were taken for histopathological and biochemical analysis.

Results: None of the omega-3 fish oil given rats developed macroscopically postoperative peritoneal adhesion (P=0.005). Omega-3 fish oil formed an anti-adhesive lipid barrier on injured tissue surfaces. Microscopic evaluation revealed diffuse inflammation with excessive connective tissue and fibroblastic activity in control group rats while foreign body reactions were common in omega-3 given rats. The mean amount of hydroxyproline in samples from injured tissues was significantly lower in omega-3 given rats than in control rats. (P=0.004).

Conclusion: Intraperitoneal application of omega-3 fish oil prevents postoperative peritoneal adhesions by forming an anti-adhesive lipid barrier on injured tissue surfaces. However, further studies are needed to determine whether this adipose layer is permanent or will be resorbed over time.

Background: This systematic review and meta-analysis analysed was set up to compare totally extraperitoneal mesh repair (TEP) and intraperitoneal onlay mesh placement (IPOM) in patients undergoing minimally invasive ventral hernia mesh surgery (MIS-VHMS).

Methods: A systematic literature searches of three major databases were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify studies that compared two techniques of MIS-VHMS: TEP and IPOM. Primary outcome of interest was major complications post-operatively, defined as a composite outcome of surgical-site occurrences requiring procedural intervention (SSOPI), readmission to hospital, recurrence, reoperation or death. Secondary outcomes were intraoperative complications, duration of surgery, surgical site occurrence (SSO), SSOPI, postoperative ileus, post-operative pain. The risk of bias was assessed using Cohranes Risk of Bias tool 2 for randomized controlled trials (RCTs) and Newcastle-Ottawa score for observational studies (OSs).

Results: Five OSs and two RCTs al including total number of 553 patients were included. There was no difference in primary outcome (RD 0.00 [-0.05, 0.06], p=0.95), incidence of postoperative ileus. Operative time was longer in TEP (MD 40.10 [27.28, 52.91], p<0.01). TEP was found to be associated with less postoperative pain at 24h and 7days after surgery.

Conclusions: Both TEP and IPOM were detected to have equal safety profile and do not differ in SSO or SSOPI rates, incidence of postoperative ileus. TEP has longer operative time but provides better early postoperative pain outcomes. Further high-quality studies with long follow up evaluating recurrence and patient reported outcomes are needed. Comparison of other transabdominal and extraperitoneal MIS-VHMS techniques is another direction of future research. PROSPERO registration: CRD4202121099.

IntroductionIn some clinical scenarios, stoma site may be located close to the abdominal wound edge impeding optimal wound management and stoma care. We present a novel strategy of utility NPWT for management of simultaneous abdominal wound healing with stoma presence. Material and methodsRetrospective analysis of seventeen patients treated with a novel wound care strategy was conducted. Application of NPWT within wound bed, around stoma site and skin between allows for: 1) separating wound from stoma site, 2) maintaining the optimal environment for wound healing, 3) protecting peristomal skin and 4) facilitating application of ostomy appliances.ResultsThe study group comprised of twelve female (70,6 %) and five male (29,4%) with the mean age of 49.1 18.4 years The most common underlying pathology was Crohn s disease (n-5; 29,4%). Since NPWT was implemented, patients had undergone from 1 to 13 surgeries. Thirteen patients (76,5%) required intensive care unit admission. The mean time of hospital stay was 65,3 28,6 days (range: 36 134). The mean session of NPWT was 10.8 5.2 (range: 5 - 24) per patient. The range of the level of negative pressure was from -80 to 125 mmHg. In all patients, progress in wound healing was achieved resulting in granulation tissue formation, minimizing wound retraction and thus reduction of the wound area. As a result of NPWT, wound was granulated entirely, tertiary intension closure were achieved or patients were qualified for reconstructive surgery.DiscussionNPWT is safe and useful therapy for complicated abdominal wounds with the presence of stoma close to wounds edges. A novel care strategy allows for simultaneous technical opportunity to separate stoma from wound bed and facilitate wound healing.

The new monograph concerning the dietetics in oncological diseases was discussed.

Abstractbackground: Gastroschisis is a common developmental anomaly of the abdominal front wall. The aim of surgical management is to restore the integrity of the abdominal wall and to insert the bowel into the abdominal cavity with the use of the primary or staged closure technique.The objective of this paper is to analyze our 20-year experience with surgical treatment of gastroschisis with primary and staged closure, to compare the postoperative course for the said techniques as well as to identify factors influencing the course and early results of treatment.

Methods: The research materials consist of a retrospective analysis of medical history of patients treated at the Pediatric Surgery Clinic in Poznan over 20 years period from 2000 to 2019. 59 patients were operated on: 30 girls and 29 boys.

Results: Surgical treatment was performed in all the cases. Primary closure was performed in 32% of the cases, whereas staged silo closure was performed in 68% of the cases. Postoperative analgosedation was used for 6 days on average after primary closures, and 13 days on average after staged closures. Generalized bacterial infection was present in 21% of patients treated with primary closures and 37% for staged closures. Infants treated with staged closure began enteral feeding considerably later (day 22) than those treated with primary closure (day 12).

Conclusions: It is not possible to indicate clearly which surgical technique is superior to the other based on the results obtained. When choosing the treatment method, the patient's clinical condition, associated anomalies, and the medical team's experience must be taken into consideration.