Polish Journal of Surgery最新文献

Aim: Postoperative infections (POIs) are associated with prolonged postoperative recovery, delayed adjuvant therapy, psychological problems, and poor long-term outcomes. The study aims to cross-compare the ratio-based preoperative parameters to predict POIs in patients with D2 gastrectomy for gastric cancer.

Materials and methods: A retrospective cohort and single-center study evaluated the data of 293 patients who underwent curative gastrectomy between January 2007 and November 2019 in a tertiary hospital in Istanbul. A receiver operating characteristic (ROC) curve was used to assess the ability of laboratory values to predict clinically relevant POIs. The predictive capacity of the neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), and CRP-albumin ratio (CAR) was calculated by the area under the curve. Then, the cutoff points were determined for all 4 indexes.

Results: POIs developed in 77 (26.2%) patients. Patients with POI had higher Charlson comorbidity index (CCI) scores and a longer length of hospital stay. ROC curve analysis revealed that NLR, LMR, and CAR were significantly effective in predicting POI, while PLR was ineffective. LMR was the best ability to predict the POI. According to multivariate analysis, CCI score 3, NLR> 3.8, and LMR 2.34 were independent risk factors influencing the POI.

Conclusion: Preoperative LMR was most predictive for POI. Although CAR predicted the development of the POI, it was not superior to LMR and NLR. PLR did not have any prediction for POI. In addition, increased comorbidity (CCI 3) was an independent risk factor for POI.

Introduction: One of the most critical factors determining survival in terms of colorectal cancers is diagnosis and treatment at an early stage. Diagnosis at an early stage is possible with screening programs carried out within preventive health services. In this study, we aimed to compare the results of patients who underwent colonoscopy due to fecal occult blood test (FOBT) positivity with those over 50 years of age who underwent colonoscopy with other complaints and to reveal whether FOBT test is still essential for screening programs.

Methods: This study included patients who underwent colonoscopy between January 2016 and December 2021. Patients were analyzed in two groups according to colonoscopy reasons: group I (FOBT-positive) and group II (other reasons).

Results: A total of 3393 patients were included in the study. The patients were divided into two groups for evaluation. Patients who underwent colonoscopy for FOBT positivity (Group I) and patients over 50 years of age who underwent colonoscopy for other reasons (Group II). When the colonoscopy findings were compared between the groups' inflammatory bowel diseases (p=0,03) were higher in group I, while normal colonoscopy (p=0,03) was found to be more common in group II. Polyps, malignancy, diverticulosis, and perianal diseases seem similar between the groups statistically.

Conclusion: FOBT can still be used in colorectal screening because it is inexpensive, widely available, has more participation due to non-invasiveness, and can be applied outside of clinical settings.

Background: Acute appendicitis is one of the most common causes of abdominal pain requiring surgical intervention. This study aimed to assess the impact of the COVID-19 pandemic on the morbidity, therapeutic management, and course of acute appendicitis.

Methods: This study retrospectively analyzed patients hospitalized at a general surgery department between 1 January 2019 and 19 March 2020 and compared them to patients hospitalized between 20 March 2020 (global pandemic declaration date) and 6 June 2021. Therefore, our analysis encompassed the period 443 days preceding the pandemic and 443 days after the start thereof. Other factors evaluated herein included sex, length of hospital stay, time from symptom onset, type of surgery, laboratory test results, histopathological diagnosis, and polymerase chain reaction test results for SARS-CoV-2 infection.

Results: Statistical analysis was conducted using statistical software IBM SPSS version 27. Significant differences in length of hospital stay, time from symptom onset to hospital admission, number of leukocytes, and type of surgical procedure were observed between groups of patients treated before and after the pandemic.

Conclusion: Acute appendicitis remained one of the most commonly encountered diseases requiring surgical intervention during the COVID-19 pandemic. Overall, significant differences were observed between patients treated before and after COVID-19 had been declared a pandemic.

Rekomendacje dotycz etiologii i klasyfikacji przetok odbytniczo-pochwowych a przede wszystkim zasad postpowania chirurgicznego. W leczeniu przetok zlokalizowanych w dolnej czci odbytnicy zastosowanie znajduj techniki wycicia kanau przetoki i warstwowego zamykania powstaego ubytku, w tym rwnie z rekonstrukcj aparatu zwieraczowego odbytu. Dla wzmocnienia rekonstruowanych tkanek stosuje si matryc kolagenowo-fibrynow TachosilR. W przypadku wysokich przetok odbytniczo-pochwowych wykonuje si usunicie zmienionego chorobowo odcinka jelita wraz z ujciem przetoki z jednoczasowym lub odroczonym odtworzeniem cigoci przewodu pokarmowego.

Solid pseudopapillary neoplasm (SPN) is an extremely rare tumor with low malignant potential which is generally located in the tail of the pancreas. The prevalence of SPN has increased with the recent advancement in radiological imaging. CECT abdomen and Endoscopic ultrasound-FNA are excellent modalities in preoperative diagnosis. Surgery is the main treatment modality of choice and a successful R0 resection is curative. We present a case of solid pseudopapillary neoplasm and included a summary of the current literature to provide a reference for the management of this rare clinical entity.

Background: Surgical-site infections (SSI) account for a large portion of morbidity with the rate of 500,000 cases per year from 27 million surgeries. Some researchers found that factors contributing to surgical wound infections are the number of bacteria contaminants, the bacterias virulence, the micro-environment around the surgical wound, and the immune system of the host.

Objective: To account the risk factors for surgical-site infections in neonatal and pediatric intensive care unit and apply them in a risk index for neonates and pediatrics in critical care unit.

Method: A cohort retrospective study was initiated to investigate risk factors for SSI at Tarakan General Hospital from January 2018 to July 2019. The different factors then analyzed with chi-square test, whereas the multivariate binary logistic regression model was used to examine independent risk factors for SSI.

Result: A total of 179 patients met the inclusion criteria. There were 66 patients in NICU and 113 in PICU. Bivariate analysis showed that SSI was associated with type of ward, operating room temperature, perioperative septicemia, length of stay, and the use of chlorhexidine bath-washing (p<0.05). Multivariate analysis identified three independent parameters correlating with the occurance of SSI: operating room temperature (odds ratio [OR] 12,510; 95% confidence interval [CI] 4,198 37,279; P<0.001); perioperative septicemia (OR 6,424; 95% CI 2,221 18,581; P=0.001); and the use of chlorhexidine bath-washing (OR 35,751; 95% CI 8,627 148,164; P<0.001).

Conclusion: From these three independent paramaters, we recommend a prognostic scoring for SSI in post operative NICUs and PICUs patients that still need another diagnostic, validity and realibility test to improve patients outcome.

Introduction: Road traffic accidents (RTA) are a major public health problem and one of the five leading causes of morbidity and mortality around the world. Use of two wheelers are growing rapidly especially inlow to middle income countries leading to an increase in RTA. 27% deaths related to accidents in India are among users of motorized two wheelers.

Aims: To study the pattern of head injuries in motorcycle riders wearing/not wearinghelmets.

Materials and methods: The study is designed as a prospective observational study. Study groups shall be initially categorized based on use of helmets and will be studied in terms of clinical presentation on admission. Basic epidemiological information will be collected in every patient. Case record shall be done in two parts.1) clinical survey 2) radiological survey . Survey is designed as per ATLS guidelines of assessment of trauma patients.

Results: Helmet wearers suffered significantly less head and traumatic brain injuries than the non-helmeted counterparts.

Conclusion: Helmets provide significant protection against the morbidity and mortality of Traumatic brain injury (TBI) as a result of road traffic accidents (RTA).

<b> Introduction:</b> Breast cancer is the most frequent invasive malignancy in women worldwide. There is a modifiable risk factor (such as serum vitamin D level) for this cancer. We decided to conduct this study since the influence of serum vitamin D levels on breast cancer is still controversial. </br></br> <b> Methods and materials:</b> In this analytical cross-sectional study, 103 patients who were diagnosed with breast cancer were included. Patients' demographic, clinical and pathological features were all recorded. After the laboratory provided the serum vitamin D level, it was included in the checklist. Serum vitamin D level was categorized into 3 groups: <10 ng/ml, 1030 ng/ml and >30 ng/ml. The chi-square test was used to assess the relationship between vitamin D levels and clinicopathological features of the patients in SPSS software. The results were considered statistically significant at P-value < 0.05. </br></br> <b> Results:</b> The mean age of the patients was 47.97 8.8 years. The mean serum vitamin D level was 28.72 19.9 ng and it was divided into three groups: 1) deficient (10 ng), which included 20 (19.4%) patients, 2) insufficient (10-30 ng), which included 48 (46.6%) patients, and 3) normal (>30 ng), which included 35 (34%) patients. Low vitamin D level (<320 ng/ml) was mainly detected in premenopausal cases (P-value = 0.001) with poor prognosis high grade of the disease (P-value = 0.001), positive nodal involvement (P-value = 0.025) and positive Ki-67 (P = 0.021). Furthermore, patients with lower serum vitamin D levels interact in fewer outdoor activities (P-value = 0.007), sleep less during the day (P-value = 0.001) and sleep later at night (P-value = 0.009). </br></br> <b>Conclusion:</b> Decreased serum 25(OH) D levels were linked with a higher histological grade of the tumor and lymph node involvement. Low serum 25(OH) D levels were also related to prognostic factors such as high Ki67 expression and the presence of negative hormone receptors (ER and PR). Our data support negative correlations between vitamin D levels and the risk of breast cancer with poor prognostic characteristics, based on observational research.

Introduction: The paper aims to establish the legal nature of the guidelines in the Polish legal system and the possible formal consequences of introducing such guidelines (litigation, professional responsibility) as well as practical implications concerning the method of treating patients.

Methods: Analysis is clarifying fundamental issues that largely determine the content of the study. The basic assumption is to analyze the legal nature of the prepared guidelines from the point of view of public law, i.e. from the point of view of the relations occurring between the state, as the primary public law entity, and individual, private entities, such as natural persons, legal persons, or organizational units without legal personality, i.e., to be more precise, e.g., the relations between state authorities and persons practicing the medical professionConclusions:Treatment guidelines fall outside the scope of the universally applicable law subsystem. Therefore, they do not constitute sources of universally binding law. 2. Furthermore, the guidelines do not constitute sources of domestic law, as the issuing bodies have no legal authority to issue them and to mould the legal situation of their addressees. 3. In the regulations shaping the rules of practicing the medical profession, both statutory and corporate (the Medical Ethics Code), the guidelines may constitute the basis for adjudicating on the professional (disciplinary) liability of a physician. 4. The guidelines may pose a barrier to the development of medicine, especially in cases where their issuance by ad hoc groups and the lack of updates lead to the consolidation of outdated clinical practice and inhibit the research potential generated from the bottom up.

Enhanced Recovery After Surgery (ERAS) is a complex system of procedures that necessitates multidisciplinary patient care during the preoperative, intraoperative, and postoperative phases. Over the last two decades, the ERAS protocol, which was initially described in colorectal surgery, has gradually expanded to other surgical specialties. Gynecological surgery is no exception, whether for benign or malignant conditions. The ERAS program's primary objective is to overcome the pathophysiological processes associated with surgical stress and to facilitate the patient's rapid recovery, while minimizing complications, hospital stays, and costs. The objectives of minimally invasive surgical procedures largely overlap with the objectives of the ERAS program. We analyzed scientific data from studies examining the ERAS system's application in minimally invasive gynecological surgery (MIGS) and present them in this review. The central question is whether the ERAS protocol can provide additional benefits beyond those inherent in minimally invasive surgical procedures.