Polish Journal of Surgery最新文献

AbstractIntroductionType II and III (paraoesophageal and mixed) hiatal hernia treatment remains a technically difficult procedure carrying a risk of complications and recurrence as high as 40%. Using synthetic meshes entails possible serious complications; efficacy of biologic materials remains unclear and requires further research.AimThe aim of the article was to present the centres experience of type II and III large hiatal hernia treatment using the ligamentum teres and to draw attention to potential benefits of conducted procedures.Material and MethodsThe study enrolled 6 patients: 3 women and 3 men aged 37-58 with radiologically and endoscopically confirmed large paraoesophageal hernias. The patients underwent Nissen fundoplication and hiatal hernia repair using the ligamentum teres. The patients were followed up for six months with subsequent radiological and endoscopic assessment.ResultsDuring the six-month follow-up no clinical or radiological characteristics of hiatal hernia recurrence were observed in the patients. Two patients reported symptoms of dysphagia; mortality was 0%.ConclusionsHiatal hernia repair using the vascularized ligamentum teres may constitute an effective and safe method of large hiatal hernia repair.

AbstractAim:Inflammatory markers are effective in determining the prognosis of malignant diseases. The aim of this study is to investigate the relationship of HALP and LCR with tumor response after neoadjuvant chemoradiotherapy and their effects on prognosis in patients with locally advanced rectal cancer.

Methods: 88 patients who received nCRT with the diagnosis of LARC were included in the study. First, all patients were divided into 2 groups: patients with pathological and clinical complete response (pCR+cCR) group 1 and patients with non-complete response group 2. The 82 patients who underwent surgery were divided into two groups according to the TRG Dworak: good response and poor response groups. Inflammation markers such as HALP and LCR were obtained using biochemical parameters.

Results: HALP and LCR were higher in the complete response group than in the none-complete response group (p<0.05). When TRG 3-4 (good response group) and TRG 0-1-2 (poor response group) were compared, HALP and LCR were higher in the good response group (p<0.05). The cut-off point for the HALP value was 30.17, the sensitivity was 88.2%, and the specificity was 43.7%. The cut-off point for the LCR value was 0.402, the sensitivity was 88.2%, and the specificity was 63.4%. It was found that HALP and LCR calculated prior to neoadjuvant CRT could not predict overall survival.

Conclusions: We believe that inflammatory markers such as HALP and LCR can effectively identify rectal cancer patients who respond best to nCRT.

Introduction: Epidemiology and the outcomes of acute appendicitis in elderly people are very different from the younger patients. Aim of this study was to investigate the significance of frailty syndrome in the course of acute appendicitis.

Methods: All patients over 65 years old who underwent laparoscopic appendectomy between 2013 and 2021 in 2nd Department of General Surgery were included in the study. In our assessment Modified Frailty Index and Brief Geriatric Assessment were performed.

Results: In the analyzed period 106 appendectomies were performed in patients over 65 years old. Postoperative complications occurred in 13 patients (12.3%). Prolonged hospitalization (over 3 days) was observed in 48 patients (45.3%). Multivariate analysis showed that every ASA class (OR=2.406; 95% CI 1.089-5.316; p=0.030) and postoperative complication (OR=5.692; 95% CI 1.077-30.073; p=0.041) are risk factors for prolonged hospitalization. Our study identified diabetes (OR=5.956; 95% CI 1.391-25.510; p=0.016) as a risk factor for postoperative complications.

Conclusions: According to our study Modified Frailty Index and Brief Geriatric Assessment does not correlate with prolonged hospitalization or higher risk for postoperative complication after appendectomy in elderly people.

Dupuytrens disease is a common fibrotic disorder of the palmar aponeurosis characterized by the formation of nodules and cords, as well as development of progressive flexion deformities in the digits, leading to functional impairment. Surgical excision of the affected aponeurosis remains the most common treatment. Quite a few new information appeared about epidemiology, pathogenesis and particularly treatment of the disorder. The objective of this study is an updated review of scientific data in this topic. Results of epidemiologic studies showed that Dupuytrens disease is not so uncommon in Asian and African population as it was earlier believed. An important role of genetic factors on development of the disease in a proportion of patients was demonstrated, however, it did not translate neither to the treatment nor to the prognosis. The most changes concerned the management of Dupuytrens disease. A positive effect of steroids injections into the nodules and cords for inhibition of the disease in early stages was shown. In the advanced stages, a standard technique of partial fasciectomy was partly replaced by mini-invasive methods such as needle fasciotomy and collagenase Clostirdium hystolyticum injections. Unexpected withdrawal of collagenase from the market in 2020 resulted in considerable limitation of the availability of this treatment. It seems that updated knowledge on Dupuytrens disease may be interested and useful for surgeons involved in management of the disorder.

Introduction Currently, more and more cases of breast cancer are detected in the early stages of advancement. Removal of the minimum required tissue volume ensures that the proper shape of the breast is maintained. On the other hand, it is important to get negative tissue margins. Objective To present your own experience with the use of preoperative breast tumor determination using the Magseed marker. Material and methods On the eve of the procedure, a Magtrace magnetic marker was administered to determine the lymph nodes and, under ultrasound control, a Magseed magnetic marker to the tumor, and the site of the lesion was marked with a skin marker as the operated site. Before the skin incision, the lesion was located using intraoperative ultrasound and the Sentimag probe. After the tumor was excision, the presence of the marker was confirmed in the preparation using the magnetic method and the compatibility of the ultrasound image before and after the procedure. The results of the research group were 23 patients. Radicality of the procedure was achieved in 20 patients (87%). To assess the size of the preparation and tumor, a formula from the work of Angarita et al. on the volume of the ellipsoid was used. It was assessed what part of the excised preparation was a tumor marked using the Magseed marker. Cohorts of 11 patients at the beginning and end of the evaluated group were compared, showing a significant increase in this parameter. Together with the learning curve, you can identify the tumor much more precisely and save healthy breast tissues by improving the aesthetic effect in the breast range. Conclusions The method of localization of non-pallpatory lesions in the mammary gland using the Magseed marker is simple to use, and the high detection rate directly translates into a reduction in the percentage of non-radical treatments in the case of sparing treatment.

The authors present seven cases of surgical drape left in body cavities during surgical operations. The most common symptoms reported by these patients are analysed and the consequences of leaving a foreign body in the abdominal cavity are summarised. In the majority of cases, the time elapsed from the operation to the detection of the foreign body was an average of 17 months. In one case, the foreign body remained in the abdomen for 7 years. The most common symptom reported by patients was abdominal pain. Some patients also developed wound healing disorders with leakage of pus from the wound, fever, nausea and vomiting, weight loss or intermittent tarry stools. In most cases, the foreign body required reoperation to remove it. Major surgery with stoma creation or bowel resection was required. In one case described, the consequence of leaving a surgical drape was the death of the patient. In three cases, there was spontaneous expulsion of the surgical sling by the patient by natural means.

Background and aim: Our study aimed to review the presentation and outcomes of LFNF in patients with gastroesophageal reflux disease (GERD).Material and MethodThis study was conducted at the Florance Nigthengele Hospital, Istanbul, Turkey from January 2011 and August 2021. A total of 1840 (990 Female, 850 Male) patients underwent LFNF for GERD. Data including age, gender, coexisting diseases, presenting symptoms, duration of symptoms, time of surgery, intraoperative complications, postoperative complications, length of hospital stay and perioperative mortality were retrospectively reviewed.

Results: The mean age was 42,110,31 years. Heartburn, regurgitation, hoarseness and cough were common presenting symptoms. The mean symptom duration was 5.930.25 months. Reflux episodes > 5 min was 4.09 3. De Meester's score of the patients was measured as 32 17.8. The mean preoperative lower esophagus sphincter (LES) pressure was 9,2 1.4 mmHg and the mean postoperative LES pressure was 14.32.41mm Hg. The intraoperative complication rate was 1% and postoperative complication rate was 1.6%. There was no mortality due to LFNF intervention.

Conclusion: As an anti-reflux procedure, LFNF is a safe and reliable option for patients with GERD.

Background: A successful flap is dependent on its vascularity. During dissection, flap viability may become compromised due to inadequate perfusion from the vascular pedicle(s) on which the flap is based. Various methods have been proposed to determine viability of a flap both, intraoperatively and postoperatively. The ideal method must be simple, accurate, reproducible and safe. The purpose of this study was to study the role of fluorescein dye for prediction of flap viability.Materials & Methods: Thirty patients undergoing flap coverage for various defects were evaluated. Flaps were elevated and evaluated clinically for viability. Intravenous fluorescein was injected into the patients prior to flap inset and its course through the flap was monitored under ultraviolet light. Fluorescent areas were marked intraoperatively (size and location documented). Areas of viable flaps were documented on post-operative day 5 and comparisons made.

Result: The area of viable flap as determined using intra operative fluorescein dye administration corresponded to surviving flap area on post-operative day 5, in 27 of the 30 cases studied, giving positive predictive value of 90%. Overall, the dye had an accuracy of 99.03% compared to intraoperative clinical flap assessment accuracy of 95.70%. Marginal necrosis was seen in 16.6 % of all cases. No allergic reaction to the dye was observed.

Conclusion: - Accurate assessment of flap viability is an area of constant research. Use of intraoperative fluorescein dye for prediction of flap viability has an accuracy of 99.03% compared to intraoperative clinical flap assessment accuracy of 95.70%. In a few cases, the dye is prone to underpredict the area of viable flap tissue. The dye can be used to corroborate clinical asessment of viable flap tissue when used intraoperatively. The dye was found to be safe and easy to use.

Zaburzenia czynnociowe dna miednicy s zjawiskiem zoonym zalenym od ubytkw anatomicznych w ukadzie powiziowo-miniowym oraz od stanu ich unerwienia i jakoci tkanki cznej. Maj one rozmaite postacie i lokalizacje. Od ich konfiguracji zaley obraz kliniczny zaburze czynnociowych w tym obnianie dna miednicy, wypadanie narzdu rodnego, odbytnicy, rectocele, enterocele i cystocele. Rekomendacje dotycz zasad diagnostycznych oraz kompleksowego postepowania terapeutycznego. Istot leczenia chirurgicznego jest odbudowa architektoniki tkanek oporowych dna miednicy technikami beznapiciowymi z uyciem materiaw protetycznych. Umoliwia to przeprowadzenie skutecznego umocowania obniajcych si struktur i wypadajcych narzdw.

Pelvic fractures are life-threatening injuries with mortality as high as 40%. The major cause of death is pelvic exsanguination. Extraperitoneal pelvic packing has been suggested in recent years to be an effective method for hemorrhage control. This article briefly reviews the various aspects related to this procedure with emphasis on history, outcomes, technique and complications.