Pub Date : 2023-10-12DOI: 10.5604/01.3001.0053.9291
Julia Fuss, Anna Voloboyeva, Valeriy Bojko, Victor Polovyj, Aleksander Maloshtam
Introduction: Acute cholangitis belongs to urgent conditions in surgery, which are accompanied by high mortality and require clear diagnosis and immediate treatment. One of these biomarkers is the neutrophil-lymphocyte ratio (NLR), but the insufficient number of studies does not allow judging its value as a marker of infectious complications in hepatobiliary surgery.Aim of the study: to determine the predictive value of the neutrophil-leukocyte ratio as a predictor of infectious complications after hepatobiliary surgery.Methods: We evaluated 229 patients with acute cholangitis who underwent biliary drainage. The severity of acute cholangitis was graded according to the Tokyo 2018 guideline. Patients were dichotomized according to the acute cholangitis severity (mild/moderate vs. severe), and blood culture positivity. The baseline NLR, white blood cell (WBC) count, and C-reactive protein (CRP) levels were compared between groups.Results: Of the 229 acute cholangitis patients analyzed, 83 (36.3%) had mild, 111 (48.5%) had moderate, and 35 (15.2%) had severe acute cholangitis. Positive blood culture (n = 114) was more frequently observed in the severe acute cholangitis group than the mild/moderate cholangitis group (83% vs. 43%, p < 0.001). The NLR was significantly higher in patients with severe cholangitis, shock, and positive blood culture. Conclusion: The neutrophil-lymphocyte ratio is a reliable predictor in predicting the risk of developing infectious complications in acute cholangitis. The high predictive value of CRP and PCT, as well as high availability and low cost of performing a clinical blood test, make NLR a more promising test in clinical practice.
简介:急性胆管炎属于外科急症，死亡率高，需要明确诊断和立即治疗。其中一个生物标志物是中性粒细胞-淋巴细胞比率(NLR)，但由于研究数量不足，无法判断其作为肝胆外科感染并发症标志物的价值。研究目的:确定中性粒细胞-白细胞比作为肝胆手术后感染性并发症预测指标的预测价值。方法:229例急性胆管炎患者行胆道引流术。急性胆管炎的严重程度根据东京2018指南进行分级。根据急性胆管炎的严重程度(轻度/中度vs重度)和血培养阳性对患者进行分类。比较两组间基线NLR、白细胞(WBC)计数和c反应蛋白(CRP)水平。结果229例急性胆管炎患者中，轻度83例(36.3%)，中度111例(48.5%)，重度35例(15.2%)。重度急性胆管炎组血培养阳性(n = 114)的发生率高于轻度/中度胆管炎组(83% vs. 43%， p <0.001)。严重胆管炎、休克和血培养阳性患者的NLR明显更高。结论:中性粒细胞与淋巴细胞比值是预测急性胆管炎感染性并发症发生风险的可靠指标。CRP和PCT的高预测价值，以及临床血液检测的高可用性和低成本，使NLR在临床实践中更有前景。
{"title":"Neutrophil to lymphocyte ratio in predicting complications and prognosis in patients with acute cholangitis","authors":"Julia Fuss, Anna Voloboyeva, Valeriy Bojko, Victor Polovyj, Aleksander Maloshtam","doi":"10.5604/01.3001.0053.9291","DOIUrl":"https://doi.org/10.5604/01.3001.0053.9291","url":null,"abstract":"Introduction: Acute cholangitis belongs to urgent conditions in surgery, which are accompanied by high mortality and require clear diagnosis and immediate treatment. One of these biomarkers is the neutrophil-lymphocyte ratio (NLR), but the insufficient number of studies does not allow judging its value as a marker of infectious complications in hepatobiliary surgery.Aim of the study: to determine the predictive value of the neutrophil-leukocyte ratio as a predictor of infectious complications after hepatobiliary surgery.Methods: We evaluated 229 patients with acute cholangitis who underwent biliary drainage. The severity of acute cholangitis was graded according to the Tokyo 2018 guideline. Patients were dichotomized according to the acute cholangitis severity (mild/moderate vs. severe), and blood culture positivity. The baseline NLR, white blood cell (WBC) count, and C-reactive protein (CRP) levels were compared between groups.Results: Of the 229 acute cholangitis patients analyzed, 83 (36.3%) had mild, 111 (48.5%) had moderate, and 35 (15.2%) had severe acute cholangitis. Positive blood culture (n = 114) was more frequently observed in the severe acute cholangitis group than the mild/moderate cholangitis group (83% vs. 43%, p < 0.001). The NLR was significantly higher in patients with severe cholangitis, shock, and positive blood culture. Conclusion: The neutrophil-lymphocyte ratio is a reliable predictor in predicting the risk of developing infectious complications in acute cholangitis. The high predictive value of CRP and PCT, as well as high availability and low cost of performing a clinical blood test, make NLR a more promising test in clinical practice.","PeriodicalId":43422,"journal":{"name":"Polish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136014470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-12DOI: 10.5604/01.3001.0053.9251
Tomasz Klimczak, Janusz Strzelczyk
BackgroundGastroesophageal reflux (GERD) is one of the most common disorders of the alimentary tract. Apart from troublesome symptoms, untreated GERD can lead to Barrett’s esophagus and, as a consequence, esophageal adenocarcinoma. Up to date, most typical treatment of GERD is PPI pharmacotherapy. However, in a number of cases this treatment is not sufficient or the patient does not tolerate PPI-group drugs. In these cases interventional therapy is recommended. Up to date, laparoscopic fundoplication was the only suggested option. Other, minimally-invasive procedures such as Stretta, MUSE, TIFF or EsophyX were not recommended due to the lack of clinical data. In 2014 professor H.Inoue from the Digestive Diseases Center, Showa University in Japan reported the first series of novel, endoscopic anti-reflux procedures: anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation (ARMA).MethodsWe conducted our prospective, single center study in 30 patients ( 14 female, 16 male) with PPI-refractory GERD. All patients underwent FSSG and GERD-HRQL evaluation and GE junction pressure study prior, 6 weeks and 6 months after the procedures. After the procedure, all patients received PPI treatment for 4 weeks.ResultsWe successfully completed the procedures in all 30 patients. Mean procedure time was 42 minutes. No complications occurred. In 86,67% (26) of our patients, we achieved a total remission of GERD symptoms, FSSG scores < 6 and GERD-HRQL scores < 8. ConclusionsThe results of our study show that ARMS and ARMA are simple, safe, improve GERD-related symptoms and restore the GE junction’s anti-reflux capacity.Keywords: ARMA, ARMS, Endoscopic GERD treatment, Endoscopic surgery, Refractory GERD
{"title":"Endoscopic anti-reflux mucosectomy (ARMS) and Endoscopic anti-reflux ablation (ARMA) as a potential treatment for gastroesophageal reflux- single center experience","authors":"Tomasz Klimczak, Janusz Strzelczyk","doi":"10.5604/01.3001.0053.9251","DOIUrl":"https://doi.org/10.5604/01.3001.0053.9251","url":null,"abstract":"BackgroundGastroesophageal reflux (GERD) is one of the most common disorders of the alimentary tract. Apart from troublesome symptoms, untreated GERD can lead to Barrett’s esophagus and, as a consequence, esophageal adenocarcinoma. Up to date, most typical treatment of GERD is PPI pharmacotherapy. However, in a number of cases this treatment is not sufficient or the patient does not tolerate PPI-group drugs. In these cases interventional therapy is recommended. Up to date, laparoscopic fundoplication was the only suggested option. Other, minimally-invasive procedures such as Stretta, MUSE, TIFF or EsophyX were not recommended due to the lack of clinical data. In 2014 professor H.Inoue from the Digestive Diseases Center, Showa University in Japan reported the first series of novel, endoscopic anti-reflux procedures: anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation (ARMA).MethodsWe conducted our prospective, single center study in 30 patients ( 14 female, 16 male) with PPI-refractory GERD. All patients underwent FSSG and GERD-HRQL evaluation and GE junction pressure study prior, 6 weeks and 6 months after the procedures. After the procedure, all patients received PPI treatment for 4 weeks.ResultsWe successfully completed the procedures in all 30 patients. Mean procedure time was 42 minutes. No complications occurred. In 86,67% (26) of our patients, we achieved a total remission of GERD symptoms, FSSG scores < 6 and GERD-HRQL scores < 8. ConclusionsThe results of our study show that ARMS and ARMA are simple, safe, improve GERD-related symptoms and restore the GE junction’s anti-reflux capacity.Keywords: ARMA, ARMS, Endoscopic GERD treatment, Endoscopic surgery, Refractory GERD","PeriodicalId":43422,"journal":{"name":"Polish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136014471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-12DOI: 10.5604/01.3001.0053.9183
Sylwia Kustalik, Piotr Klejszmit, Jacek Kordiak, Edyta Santorek-Strumiłło, Sławomir Jabłoński
Wound dehiscence is a relatively rare complication after laparotomy consisting of dissection of thepost-operative wound and prolapse of the viscera outside the abdominal cavity and has been shownto be associated with a higher mortality rate. Known risk factors for this condition includemalnutrition and the coexistence of inflammation or cancer.The main purpose of this thesis was to investigate the association between the occurrence of postlaparotomy and the nutritional status of the patient as expressed by selected protein markers.The study was retrospective and based on an analysis of patients treated at the in-house centre fromJanuary 2014 to December 2020. It included a group of patients undergoing laparotomy procedureswho developed evectasia and a group of control group of patients who underwent laparotomy anddid not develop wound dehiscence after the procedure.The analysis showed that lower serum albumin levels were associated with a higher risk of wounddehiscence in patients who underwent laparotomy due to acute abdominal disease. The study andcontrol groups differed significantly in levels of: Hgb, total protein, CRP, lymphocytes, albumin, PCT,NRS.
{"title":"Analysis of the influence of selected protein parameters that are markers of nutritional statusand inflammatory markers on the occurrence of wound dehiscence after laparotomy.","authors":"Sylwia Kustalik, Piotr Klejszmit, Jacek Kordiak, Edyta Santorek-Strumiłło, Sławomir Jabłoński","doi":"10.5604/01.3001.0053.9183","DOIUrl":"https://doi.org/10.5604/01.3001.0053.9183","url":null,"abstract":"Wound dehiscence is a relatively rare complication after laparotomy consisting of dissection of thepost-operative wound and prolapse of the viscera outside the abdominal cavity and has been shownto be associated with a higher mortality rate. Known risk factors for this condition includemalnutrition and the coexistence of inflammation or cancer.The main purpose of this thesis was to investigate the association between the occurrence of postlaparotomy and the nutritional status of the patient as expressed by selected protein markers.The study was retrospective and based on an analysis of patients treated at the in-house centre fromJanuary 2014 to December 2020. It included a group of patients undergoing laparotomy procedureswho developed evectasia and a group of control group of patients who underwent laparotomy anddid not develop wound dehiscence after the procedure.The analysis showed that lower serum albumin levels were associated with a higher risk of wounddehiscence in patients who underwent laparotomy due to acute abdominal disease. The study andcontrol groups differed significantly in levels of: Hgb, total protein, CRP, lymphocytes, albumin, PCT,NRS.","PeriodicalId":43422,"journal":{"name":"Polish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136014468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-12DOI: 10.5604/01.3001.0053.6850
Akash Akash, Neeraj Saxena
1.1 BackgroundWound infection is the most common post-op complication encountered after open appendectomy. Various studies comparing risk of superficial surgical site infection (SSI) in primary closure (PC) and delayed primary closure (DPC) of wound has been conducted in the past. But there is no uniform consensus regarding the method of wound closure. So aim of this study was comparison of both wound closure techniques.1.2 Material and MethodsThis was prospective study, enrolled 50 patients who underwent open appendectomy. Patients’ demographics, characteristics and operative findings were recorded. Those who were elder than 18 years and had appendectomy with a right lower quadrant incision were included. Patients with any comorbidity, morbid obesity and pregnancy were excluded. Patients were randomized to undergo two techniques of wound closure namely PC and DPC. On follow-up at one week and one month, SSI, post-op pain and LOS were compared among two groups. Clinical assessment included a visual analog scale (1-10) for pain.1.3 ResultsIn our study incidence of SSI in DPC group was significantly lower when compared to PC group (p value=0.0002) while post-op pain and LOS was not significant on comparison between two groups. 1.4 ConclusionWe concluded that DPC was superior to PC of wound in terms of reduction of incidence of superficial SSI. Although with respect to LOS and post-op pain the two techniques of wound closure were not different.Keywords: Superficial Surgical Site Infection, Primary Closure, Delayed Primary Closure, Complicated Appendicitis.
{"title":"SUPERFICIAL SURGICAL SITE INFECTION IN DELAYED PRIMARY VS PRIMARY WOUND CLOSURE IN COMPLICATED APPENDICITIS-Open label Randomised Control Trial","authors":"Akash Akash, Neeraj Saxena","doi":"10.5604/01.3001.0053.6850","DOIUrl":"https://doi.org/10.5604/01.3001.0053.6850","url":null,"abstract":"1.1 BackgroundWound infection is the most common post-op complication encountered after open appendectomy. Various studies comparing risk of superficial surgical site infection (SSI) in primary closure (PC) and delayed primary closure (DPC) of wound has been conducted in the past. But there is no uniform consensus regarding the method of wound closure. So aim of this study was comparison of both wound closure techniques.1.2 Material and MethodsThis was prospective study, enrolled 50 patients who underwent open appendectomy. Patients’ demographics, characteristics and operative findings were recorded. Those who were elder than 18 years and had appendectomy with a right lower quadrant incision were included. Patients with any comorbidity, morbid obesity and pregnancy were excluded. Patients were randomized to undergo two techniques of wound closure namely PC and DPC. On follow-up at one week and one month, SSI, post-op pain and LOS were compared among two groups. Clinical assessment included a visual analog scale (1-10) for pain.1.3 ResultsIn our study incidence of SSI in DPC group was significantly lower when compared to PC group (p value=0.0002) while post-op pain and LOS was not significant on comparison between two groups. 1.4 ConclusionWe concluded that DPC was superior to PC of wound in terms of reduction of incidence of superficial SSI. Although with respect to LOS and post-op pain the two techniques of wound closure were not different.Keywords: Superficial Surgical Site Infection, Primary Closure, Delayed Primary Closure, Complicated Appendicitis.","PeriodicalId":43422,"journal":{"name":"Polish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136014330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-12DOI: 10.5604/01.3001.0053.9292
Michal Wysocki, Maciej Borys, Krystyna Gałązka, Maciej Stranek, Andrzej Budzyński
IntroductionThe determinants influencing the risk for complications of laparoscopic distal pancreatectomies (LDP) are not yet fully defined, thus we aimed to determine risk factors for serious perioperative morbidity after LDP with spleen preservation, LDP and radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas (RAMPS).Material and methodsRetrospective cohort study of consecutive patients that underwent LDP between January 2019 and December 2022. Study group included patients with serious perioperative morbidity (III – V grades in Clavien-Dindo classification) during 30-days period after operation. Control group consisted of patients without serious perioperative morbidity. 142 patients were included into the following study.ResultsSerious perioperative morbidity occurred in 33 (23.24%) operated patients, while mortality included 3 cases (2.11%). 9/68 (13.2%) patients had serious perioperative morbidity after LDP with spleen preservation (27.3% of perioperative morbidity group). 13/51 patients, i. e. 25.5%, after LDP with splenectomy included in perioperative morbidity group (39.4%). 11 out of 23 patients (47.8%) had serious perioperative morbidity after RAMPS (33.3% of perioperative morbidity group). In multivariate logistic regression need for splenectomy during pancreatectomy (OR 3.66, 95%CI 1.20-11.18) and tumor above 28 millimeters in size (OR 3.01, 95%CI 1.19-9.59) were independent risk factors for serious perioperative morbidity.ConclusionNeed for splenectomy during laparoscopic distal pancreatectomy and tumor size above 28 millimeters were independent risk factors for serious perioperative morbidity after laparoscopic distal pancreatectomies.
{"title":"Splenectomy and tumor size are risk factors for serious perioperative morbidity of laparoscopic distal pancreatectomies","authors":"Michal Wysocki, Maciej Borys, Krystyna Gałązka, Maciej Stranek, Andrzej Budzyński","doi":"10.5604/01.3001.0053.9292","DOIUrl":"https://doi.org/10.5604/01.3001.0053.9292","url":null,"abstract":"IntroductionThe determinants influencing the risk for complications of laparoscopic distal pancreatectomies (LDP) are not yet fully defined, thus we aimed to determine risk factors for serious perioperative morbidity after LDP with spleen preservation, LDP and radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas (RAMPS).Material and methodsRetrospective cohort study of consecutive patients that underwent LDP between January 2019 and December 2022. Study group included patients with serious perioperative morbidity (III – V grades in Clavien-Dindo classification) during 30-days period after operation. Control group consisted of patients without serious perioperative morbidity. 142 patients were included into the following study.ResultsSerious perioperative morbidity occurred in 33 (23.24%) operated patients, while mortality included 3 cases (2.11%). 9/68 (13.2%) patients had serious perioperative morbidity after LDP with spleen preservation (27.3% of perioperative morbidity group). 13/51 patients, i. e. 25.5%, after LDP with splenectomy included in perioperative morbidity group (39.4%). 11 out of 23 patients (47.8%) had serious perioperative morbidity after RAMPS (33.3% of perioperative morbidity group). In multivariate logistic regression need for splenectomy during pancreatectomy (OR 3.66, 95%CI 1.20-11.18) and tumor above 28 millimeters in size (OR 3.01, 95%CI 1.19-9.59) were independent risk factors for serious perioperative morbidity.ConclusionNeed for splenectomy during laparoscopic distal pancreatectomy and tumor size above 28 millimeters were independent risk factors for serious perioperative morbidity after laparoscopic distal pancreatectomies.","PeriodicalId":43422,"journal":{"name":"Polish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136014331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-20DOI: 10.5604/01.3001.0053.8925
Kamil Nurczyk, Norbert Nowak, Tomasz Orczykowski, Dariusz Duma, Renata Gieroba, Grzegorz Wallner, Tomasz Skoczylas
Background: Neoadjuvant chemotherapy (NAC) is a part of the current standard of care in a locally advanced gastric adenocarcinoma (GA) and esophago-gastric junction adenocarcinoma (EGJA), but only patients with good pathomorphological response (pR) to NAC benefit from prolonged overall survival. The study aims to evaluate ApoA-I and ApoB as candidate pre-treatment biomarkers of pR to NAC in patients with GA and EGJA.Method: Serum samples were collected from 18 patients with GA and 9 with EGJA before the initiation of NAC to determine the ApoA-I and ApoB levels. After NAC tumor regression grade (TRG) was evaluated in resected specimens according to Mandard’s tumor regression grading system and correlated with pre-treatment ApoA-I and ApoB serum concentration, and ApoB-to-ApoA-I serum concentration ratio.Results: We found a positive correlation of ApoA-I level and pR (95% CI: -0.863 to -0.467; p < 0.0001), a negative correlation of ApoB level and pR (95% CI: 0.445 to 0.857; p < 0.0001), a negative correlation of ApoB-to-ApoA-I ratio and pR (95% CI: 0.835 to 0.964; p < 0.0001).Conclusions: ApoA-I and ApoB levels, and ApoB-to-ApoA-I ratio are candidate pre-treatment predictors of pR to NAC in GA and may help to guide personalized therapy.
{"title":"ApoA-I and ApoB levels, and ApoB-to-ApoA-I ratio as candidate pre-treatment biomarkers of pathomorphological response to neoadjuvant therapy in gastric and esophago-gastric junction adenocarcinoma","authors":"Kamil Nurczyk, Norbert Nowak, Tomasz Orczykowski, Dariusz Duma, Renata Gieroba, Grzegorz Wallner, Tomasz Skoczylas","doi":"10.5604/01.3001.0053.8925","DOIUrl":"https://doi.org/10.5604/01.3001.0053.8925","url":null,"abstract":"Background: Neoadjuvant chemotherapy (NAC) is a part of the current standard of care in a locally advanced gastric adenocarcinoma (GA) and esophago-gastric junction adenocarcinoma (EGJA), but only patients with good pathomorphological response (pR) to NAC benefit from prolonged overall survival. The study aims to evaluate ApoA-I and ApoB as candidate pre-treatment biomarkers of pR to NAC in patients with GA and EGJA.Method: Serum samples were collected from 18 patients with GA and 9 with EGJA before the initiation of NAC to determine the ApoA-I and ApoB levels. After NAC tumor regression grade (TRG) was evaluated in resected specimens according to Mandard’s tumor regression grading system and correlated with pre-treatment ApoA-I and ApoB serum concentration, and ApoB-to-ApoA-I serum concentration ratio.Results: We found a positive correlation of ApoA-I level and pR (95% CI: -0.863 to -0.467; p < 0.0001), a negative correlation of ApoB level and pR (95% CI: 0.445 to 0.857; p < 0.0001), a negative correlation of ApoB-to-ApoA-I ratio and pR (95% CI: 0.835 to 0.964; p < 0.0001).Conclusions: ApoA-I and ApoB levels, and ApoB-to-ApoA-I ratio are candidate pre-treatment predictors of pR to NAC in GA and may help to guide personalized therapy.","PeriodicalId":43422,"journal":{"name":"Polish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136378999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-20DOI: 10.5604/01.3001.0053.8966
Tomasz Banasiewicz, Waldemar Machała, Maciej Borejsza Wysocki, Maciej Lesiak, Sebastian Krych, Małgorzata Lange, Piotr Hogendorf, Adam Durczyński, Jarosław Cwaliński, Tomasz Bartkowiak, Adam Dziki, Wojciech Kielan, Stanisław Kłęk, Łukasz Krokowicz, Krzysztof Kusza, Piotr Myśliwiec, Michał Pędziwiatr, Piotr Richter, Jacek Sobocki, Marek Szczepkowski, Wiesław Tarnowski, Wojciech Zegarski, Michał Zembala, Krzysztof Zieniewicz, Grzegorz Wallner
One of the target of perioperative tratment in surgery is decreasing intraoperative bleeding, which increases the number of perioperative procedures, mortality and treatment costs, and also causes the risk of transfusion of blood and its components. Trying to minimize the blood loss(mainly during the operation) as well as the need to transfuse blood and its components (broadly understood perioperative period) should be standard treatment for a patient undergoing a procedure. In the case of this method, the following steps should be taken: 1) in the preoperative period: identyfication of risk groups as quickly as possible, detecting and treating anemia, applying prehabilitation, modyfying anticoagulant treatment, considering donating one's own blood in some patients and in selected cases erythropoietin preparations; 2) in the perioperative period: aim for normothermia, normovolemia and normoglycemia, use of surgical methods that reduce bleeding, such as minimally invasive surgery, high-energy coagulation, local hemostatics, prevention of surgical site infection, proper transfusion of blood and its components if it occurs; 3) in the postoperative period: monitor the condition of patients, primarily for the detection of bleeding, rapid reoperation if required, suplementation (oral administration preferred) nutrition with microelements (iron) and vitamins, updating its general condition. All these activities, comprehensively and in surgical cooperation with the anesthesiologist, should reduce the blood loss and transfusion of blood and its components.
{"title":"Principles of minimize bleeding and the transfusion of blood and its components in operated patients – surgical aspects","authors":"Tomasz Banasiewicz, Waldemar Machała, Maciej Borejsza Wysocki, Maciej Lesiak, Sebastian Krych, Małgorzata Lange, Piotr Hogendorf, Adam Durczyński, Jarosław Cwaliński, Tomasz Bartkowiak, Adam Dziki, Wojciech Kielan, Stanisław Kłęk, Łukasz Krokowicz, Krzysztof Kusza, Piotr Myśliwiec, Michał Pędziwiatr, Piotr Richter, Jacek Sobocki, Marek Szczepkowski, Wiesław Tarnowski, Wojciech Zegarski, Michał Zembala, Krzysztof Zieniewicz, Grzegorz Wallner","doi":"10.5604/01.3001.0053.8966","DOIUrl":"https://doi.org/10.5604/01.3001.0053.8966","url":null,"abstract":"One of the target of perioperative tratment in surgery is decreasing intraoperative bleeding, which increases the number of perioperative procedures, mortality and treatment costs, and also causes the risk of transfusion of blood and its components. Trying to minimize the blood loss(mainly during the operation) as well as the need to transfuse blood and its components (broadly understood perioperative period) should be standard treatment for a patient undergoing a procedure. In the case of this method, the following steps should be taken: 1) in the preoperative period: identyfication of risk groups as quickly as possible, detecting and treating anemia, applying prehabilitation, modyfying anticoagulant treatment, considering donating one's own blood in some patients and in selected cases erythropoietin preparations; 2) in the perioperative period: aim for normothermia, normovolemia and normoglycemia, use of surgical methods that reduce bleeding, such as minimally invasive surgery, high-energy coagulation, local hemostatics, prevention of surgical site infection, proper transfusion of blood and its components if it occurs; 3) in the postoperative period: monitor the condition of patients, primarily for the detection of bleeding, rapid reoperation if required, suplementation (oral administration preferred) nutrition with microelements (iron) and vitamins, updating its general condition. All these activities, comprehensively and in surgical cooperation with the anesthesiologist, should reduce the blood loss and transfusion of blood and its components.","PeriodicalId":43422,"journal":{"name":"Polish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136375666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-15DOI: 10.5604/01.3001.0053.8854
Tomasz Banasiewicz, Jarosław Kobiela, Jarosław Cwaliński, Piotr Spychalski, Patrycja Przybylska, Karolina Kornacka, Dagmara Bogdanowska-Charkiewicz, Magdalena Leyk-Kolańczak, Maciej Borejsza-Wysocki, Dominika Batycka-Stachnik, Rafał Drwiła
Prehabilitation is a comprehensive preparation of a patient for primarily surgical treatments. Its aim is to improve the patient'sgeneral condition so as to reduce the risk of complications and ensure the fastest possible recovery to full health. Thebasic components of prehabilitation include: improvement of nutritional status, appropriate exercises to improve functioning,psychological support, and help in eliminating addictions. Other important aspects of prehabilitation are: increasinghemoglobin levels in patients with anemia, achieving good glycemic control in patients with diabetes, treatment or stabilizationof any concurrent disorders, or specialist treatment associated with a specific procedure (endoprostheses, ostomyprocedure). This article organizes and outlines the indications for prehabilitation, its scope, duration, and the method to conductit. Experts of various specialties related to prehabilitation agree that it should be an element of surgery preparationwhenever possible, especially in patients with co-existing medical conditions who have been qualified for major procedures.Prehabilitation should be carried out by interdisciplinary teams, including family physicians and various specialists in thetreatment of comorbidities. Prehabilitation requires urgent systemic and reimbursement solutions.
{"title":"Recommendations on the use of prehabilitation, i.e. comprehensive preparation of the patient for surgery","authors":"Tomasz Banasiewicz, Jarosław Kobiela, Jarosław Cwaliński, Piotr Spychalski, Patrycja Przybylska, Karolina Kornacka, Dagmara Bogdanowska-Charkiewicz, Magdalena Leyk-Kolańczak, Maciej Borejsza-Wysocki, Dominika Batycka-Stachnik, Rafał Drwiła","doi":"10.5604/01.3001.0053.8854","DOIUrl":"https://doi.org/10.5604/01.3001.0053.8854","url":null,"abstract":"Prehabilitation is a comprehensive preparation of a patient for primarily surgical treatments. Its aim is to improve the patient'sgeneral condition so as to reduce the risk of complications and ensure the fastest possible recovery to full health. Thebasic components of prehabilitation include: improvement of nutritional status, appropriate exercises to improve functioning,psychological support, and help in eliminating addictions. Other important aspects of prehabilitation are: increasinghemoglobin levels in patients with anemia, achieving good glycemic control in patients with diabetes, treatment or stabilizationof any concurrent disorders, or specialist treatment associated with a specific procedure (endoprostheses, ostomyprocedure). This article organizes and outlines the indications for prehabilitation, its scope, duration, and the method to conductit. Experts of various specialties related to prehabilitation agree that it should be an element of surgery preparationwhenever possible, especially in patients with co-existing medical conditions who have been qualified for major procedures.Prehabilitation should be carried out by interdisciplinary teams, including family physicians and various specialists in thetreatment of comorbidities. Prehabilitation requires urgent systemic and reimbursement solutions.","PeriodicalId":43422,"journal":{"name":"Polish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135437893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-15DOI: 10.5604/01.3001.0053.8609
Aleksandra Iljin, Bogusław Antoszewski, Tomasz Szewczyk, Aneta Sitek
Purpose: To determine whether the rate of slimming following bariatric surgery depends on the sex, type of bariatric surgery, time elapsed from surgery and body weight components.Materials and methods: The material comprises the results of three series of anthropometric measurements in 91 obese patients (before bariatric surgery, after about 3 months and after about 6 months from bariatric surgery). Inclusion criteria: all patients of Polish origin who were admitted to hospital from July 1, 2017 to January 31, 2019 for the purpose of surgical treatment of obesity, and who expressed written consent for surgery and participation in the study. Measurements included: body weight components assessed by electric bioimpedance metod. Results: Reduction of all features was higher after SG than GB (p<0.0001), higher in the first quartile than in the secondo quartile after surgery (p<0.0001) and higher for fat mass than for other components of body weight (p<0.0001). Sex of patients, type of bariatric surgery, time elapsed from operation and type of body weight component constitute interactive modifiers of the reduction rate.Conclusion: After bariatric surgery the reduction of fat mass is quicker in men than in women. SG and RYGB lead to higher reduction of fat mass GB. Only after SG among all three analyzed operative procedures the rate of body weight components reduction does not decrease in the second quartile after surgery. The above information should be taken into account when creating an algorithm for handling a patient after bariatric surgery.
{"title":"Selected factors affecting the rate of reduction of body weight components during the first six months after bariatric surgery: cohort study","authors":"Aleksandra Iljin, Bogusław Antoszewski, Tomasz Szewczyk, Aneta Sitek","doi":"10.5604/01.3001.0053.8609","DOIUrl":"https://doi.org/10.5604/01.3001.0053.8609","url":null,"abstract":"Purpose: To determine whether the rate of slimming following bariatric surgery depends on the sex, type of bariatric surgery, time elapsed from surgery and body weight components.Materials and methods: The material comprises the results of three series of anthropometric measurements in 91 obese patients (before bariatric surgery, after about 3 months and after about 6 months from bariatric surgery). Inclusion criteria: all patients of Polish origin who were admitted to hospital from July 1, 2017 to January 31, 2019 for the purpose of surgical treatment of obesity, and who expressed written consent for surgery and participation in the study. Measurements included: body weight components assessed by electric bioimpedance metod. Results: Reduction of all features was higher after SG than GB (p<0.0001), higher in the first quartile than in the secondo quartile after surgery (p<0.0001) and higher for fat mass than for other components of body weight (p<0.0001). Sex of patients, type of bariatric surgery, time elapsed from operation and type of body weight component constitute interactive modifiers of the reduction rate.Conclusion: After bariatric surgery the reduction of fat mass is quicker in men than in women. SG and RYGB lead to higher reduction of fat mass GB. Only after SG among all three analyzed operative procedures the rate of body weight components reduction does not decrease in the second quartile after surgery. The above information should be taken into account when creating an algorithm for handling a patient after bariatric surgery.","PeriodicalId":43422,"journal":{"name":"Polish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135487029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-06DOI: 10.5604/01.3001.0053.8610
Sajad Ahmad Salati, Lamees Sulaiman Alsulaim, Mohammed Ahmed Elmuttalut, Mohammed Alfehaid, Saleh Ahmad Alsuwaydani
ABSTRACTAim: The study was conducted to systematically analyze the recent peer-reviewed literature related to tumoral pseudoangiomatous stromal hyperplasia (PASH) in males. Materials and methods: Articles published in peer-reviewed journals of repute from 2012–2023 were evaluated for eight variables, including: [i] age of the patient; [ii] clinical presentation; [iii] laterality (unilateral or bilateral); [iv] associated breast disorder; [v] systemic co-morbidity if any; [vi] imaging modalities that helped in diagnosis; [vii] treatment; and [viii] recurrence.Results: There were 10 cases ranging in age from 1 year to 67 years (mean 34.5 years). 8 cases (80%) had breast lumps, and 2 cases (20%) had axillary lumps at presentation. Pain was not a prominent symptom. Six cases (60%) had another breast disorder at presentation, and three cases (30%) had significant systemic co-morbidities, including diabetes and renal insufficiency. The greatest dimension of the lumps ranged from 2 cm to 12 cm, with 80% of the lumps being below 5 cm in size. Imaging modalities utilized in evaluation included breast ultrasound (USG), mammograms, computerized tomography (CT), and magnetic resonance imaging (MRI). All the cases were treated surgically, and the final diagnosis was made only after the analysis of the surgical specimen. Recurrence was recorded in two (20%) cases.Conclusion: Tumoral PASH is a benign myofibroblastic proliferation disorder rarely reported in males. This condition should be considered a differential diagnosis of breast or axillary lumps, and evaluation accordingly should be initiated. The recommended course of treatment is adequate surgical excision with regular clinical and radiological follow-up.
{"title":"Tumoral pseudoangiomatous stromal hyperplasia (PASH) of the male breast: a systematic analysis.","authors":"Sajad Ahmad Salati, Lamees Sulaiman Alsulaim, Mohammed Ahmed Elmuttalut, Mohammed Alfehaid, Saleh Ahmad Alsuwaydani","doi":"10.5604/01.3001.0053.8610","DOIUrl":"https://doi.org/10.5604/01.3001.0053.8610","url":null,"abstract":"ABSTRACTAim: The study was conducted to systematically analyze the recent peer-reviewed literature related to tumoral pseudoangiomatous stromal hyperplasia (PASH) in males. Materials and methods: Articles published in peer-reviewed journals of repute from 2012–2023 were evaluated for eight variables, including: [i] age of the patient; [ii] clinical presentation; [iii] laterality (unilateral or bilateral); [iv] associated breast disorder; [v] systemic co-morbidity if any; [vi] imaging modalities that helped in diagnosis; [vii] treatment; and [viii] recurrence.Results: There were 10 cases ranging in age from 1 year to 67 years (mean 34.5 years). 8 cases (80%) had breast lumps, and 2 cases (20%) had axillary lumps at presentation. Pain was not a prominent symptom. Six cases (60%) had another breast disorder at presentation, and three cases (30%) had significant systemic co-morbidities, including diabetes and renal insufficiency. The greatest dimension of the lumps ranged from 2 cm to 12 cm, with 80% of the lumps being below 5 cm in size. Imaging modalities utilized in evaluation included breast ultrasound (USG), mammograms, computerized tomography (CT), and magnetic resonance imaging (MRI). All the cases were treated surgically, and the final diagnosis was made only after the analysis of the surgical specimen. Recurrence was recorded in two (20%) cases.Conclusion: Tumoral PASH is a benign myofibroblastic proliferation disorder rarely reported in males. This condition should be considered a differential diagnosis of breast or axillary lumps, and evaluation accordingly should be initiated. The recommended course of treatment is adequate surgical excision with regular clinical and radiological follow-up.","PeriodicalId":43422,"journal":{"name":"Polish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135205202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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