Polski przeglad chirurgiczny最新文献

Introduction: Anaerobic bloodstream infections caused by Gram-negative bacilli are rare, but the mortality rate remains high. Increasing resistance complicates treatment strategies. Aim: This study aimed to assess the clinical and microbiological characteristics of BSIs caused by Bacteroides spp. and related genera, and to evaluate the antibiotic susceptibility of isolated strains in adult patients hospitalized in a multidisciplinary Polish hospital over a 10-year period. Materials and methods: A retrospective, observational, single-center study included adult patients diagnosed with anaerobic BSIs between 2014 and 2023. Microbiological identification was performed using MALDI-TOF MS. Antimicrobial susceptibility was evaluated via gradient diffusion assay and interpreted according to EUCAST. Results: Anaerobic BSIs caused by Bacteroides spp. and Phocaeicola spp. were identified in 24 patients (mean age: 65.6 years). B. fragilis was the most common isolate (62.5%). Mortality among these hospitalized patients was 46%, with a significantly higher risk observed in elderly patients (median age of deceased: 83 years). All isolates were susceptible to metronidazole and carbapenems; 25% showed resistance to clindamycin. Discussion: The study confirmed high mortality, significant age-related risk, and variable antimicrobial susceptibility. Notably, Bacteroides-related BSIs often originated from gastrointestinal and urinary sources and were associated with chronic comorbidities, including renal failure. Conclusions: Empirical treatment regimens must consider increasing resistance among anaerobes. Timely microbiological diagnostics, including anaerobic cultures and susceptibility testing, are essential to guide therapy and improve patient outcomes. Significance: This study underscores the necessity for ongoing surveillance of anaerobic BSIs and highlights gaps in empirical treatment practices, advocating for broader clinical awareness and targeted antimicrobial stewardship.

Z ogromną satysfakcją oddajemy do rąk Czytelników suplement Polskiego Przeglądu Chirurgicznego poświęcony72. Kongresowi Towarzystwa Chirurgów Polskich, który odbywa się w Warszawie w dniach 23-25 października 2025 roku.Jest to jedno z najważniejszych wydarzeń naukowych i integracyjnych środowiska chirurgicznego w Polsce, gromadzącezarówno uznanych ekspertów, jak i młodych badaczy oraz studentów zainteresowanych rozwojem tej dziedziny.

<b>Introduction:</b> Iatrogenic pseudoaneurysms are uncommon but increasingly encountered complications due to the rising number of percutaneous interventions. For minor lesions, conservative treatment, such as pressure or observation, is often effective. However, its effectiveness depends on many factors, which do not always allow for avoiding surgical intervention.<b>Aim:</b> The aim of this study is to evaluate the diagnostic and therapeutic strategies for iatrogenic pseudoaneurysms based on a single-center experience, with emphasis on treatment efficacy, safety, and clinical outcomes.<b>Material and methods:</b> From 2021 to 2023, 57 patients underwent surgery for iatrogenic pseudoaneurysms at the Department of General and Vascular Surgery, Clinical Hospital in Poznan. Patients were retrospectively divided into two groups: with (n = 22) or without (n = 35) prior conservative treatment. Groups were compared regarding demographics, primary procedures, diagnostic tests performed, pseudoaneurysm features, vascular access, need for red blood cell transfusion (CRC), and outcomes.<b>Results:</b> No significant differences were found between groups in gender, BMI, smoking, prior endovascular interventions, or anticoagulant use (p > 0.05). Differences were observed in the primary procedures causing pseudoaneurysms (p < 0.05). Conservative treatment was more frequent after coronary angiography, ablation, and thrombolysis. Direct surgery without conservative attempts was associated with procedures like peripheral angioplasty, pacemaker or electrode implantation, TAVI, vascular access placement/removal, and aneurysm embolisation. In both groups, no statistically significant differences were found when comparing the type of diagnostic test performed (p>0.05). No significant differences were noted in pseudoaneurysm size, multicellularity, arteriovenous fistula presence, access type, transfusion needs, or treatment outcomes (p>0.05).<b>Conclusions:</b> Management should be individualized, considering patient history, prior interventions, pharmacotherapy, and imaging. Treatment should balance efficacy and safety, guided by clinical status.

<b>Introduction:</b> The analysis of exercise tolerance and physical capacity plays a crucial role in the assessment of recovery and rehabilitation after surgery.<b>Aim:</b> The aim of the study was to assess physical capacity, exercise tolerance prior to and on day 2 after adrenalectomy on the basis of the six-minute walk test (6MWT) and Borg scale.<b>Material and methods:</b> The cohort study included 100 patients with adrenal tumors divided into the study group (SG,n = 50) and control group (CG, n = 50) who underwent adrenalectomy. SG patients met the criterion of inclusion: coexistingcardiovascular, respiratory, or other chronic diseases. The inclusion criteria for CG were the absence of other chronic systemiccomorbidities, age < 65 years. The 6MWT distance and Borg scale ratings (performed the day prior to and on the secondday after surgery) were analyzed according to the age, sex, comorbidities, adrenal and tumor size, hormonal type of adrenaldisease, type of surgery, and occurrence of postoperative complications.<b>Results:</b> Patients from SG covered significantly shorter distances (487.76 46.72 m in SG and 539.82 17.59 m in CG; p<0.001) anddemonstrated a higher level of exertion (p<0.001) before adrenalectomy and more often discontinued 6MWT after surgeries(p = 0.001) compared to CG. The authors confirmed a significant negative correlation between the age of the patients and sixminute walk distance (6MWD) before the operation in the study (rs = -0.40, p = 0.004) and control (rs = -0.74, p<0.001) groups.A significant decrease in the postoperative 6MWT distance (SG: to 231.35 4192 m, CG: to 236.82 54.10 m) and increasedintensity of dyspnea and fatigue according to the Borg scale were confirmed. SG patients were significantly more likely todevelop postoperative complications (p = 0.002).<b>Conclusions:</b> 6MWT is a useful tool to demonstrate physical capacity in patients before and after adrenalectomy. Patients with comorbidities more frequently discontinued 6MWT after surgery and had lower tolerance of physical effort compared to CG patients before and after surgery.

<b>Introduction:</b> Botulinum toxin type A (BTA) has emerged as a preoperative adjunct in complex ventral hernia repair, particularly in cases with loss of domain (LOD), yet volumetric evidence of its effect on abdominal wall geometry remains scarce.<b>Aim:</b> To evaluate the impact of BTA on abdominal cavity expansion and lateral muscle elongation in a patient with extreme LOD using volumetric computed tomography (CT) and geometric modeling.<b>Materials and methods:</b> A 61-year-old male with a giant left scrotal hernia and LOD (Tanaka index >25%) underwent BTA injections into the lateral abdominal wall, followed by CT imaging pre- and post-treatment. 3D reconstructions were generated to assess intra-abdominal volume and muscle lengths at three anatomical levels.<b>Results:</b> Abdominal cavity volume increased by 28.1% (13.74 L to 17.61 L), allowing safe visceral reintegration without abdominal compartment syndrome. The transversus abdominis exhibited the most pronounced elongation and volume gain (up to 329% elongation, 62% volume increase), while the external and internal obliques showed elongation with concurrent volume loss. The least elongation occurred at the costal level, highlighting anatomical rigidity in this region.<b>Discussion:</b> The results confirm that BTA-induced elongation varies by muscle and anatomical location. Minimal elongation at the subcostal level aligns with the known difficulty in closing M1-type hernias due to restricted superior abdominal wall mobility.<b>Conclusions:</b> BTA facilitated fascial closure by altering abdominal wall mechanics and increasing the intra-abdominal domain.<b>Significance:</b> This study is the first to combine volumetric and geometric modeling to objectively quantify BTA's mechanical impact, offering new insights into patient selection and planning for hernia repair with LOD.

<b>Introduction:</b> Colonic diverticular disease (diverticulosis) is a currently worldwide increasing gastrointestinal disorder with a particularly high prevalence in Western countries. The operative treatment of acute diverticulitis could be executed through open or laparoscopic techniques. A non-resectional procedure, namely laparoscopic peritoneal lavage (LPL) and drainage, has also been adopted as a less invasive treatment strategy to treat patients with diverticular perforation and purulent peritonitis.<b>Aim:</b> The present work was conducted to pool the currently available evidence regarding the safety and efficacy of LPL for the treatment of complicated perforated diverticulitis.<b>Methods:</b> The analysis included studies that compared patients who underwent LPL to those who underwent surgical resection. Fifteen articles were eligible for this review after searching the Scopus, PubMed Central, Cochrane Library, and Google Scholar databases.<b>Results:</b> The meta-analysis demonstrated that operative time and blood loss were significantly lower in the LPL group (p<0.001). The rates of overall morbidity and reoperation were comparable in the two groups (p = 0.57 and 0.74, respectively). There were significantly lower rates of cardiovascular (p < 0.001) and respiratory complications (p = 0.01), incisional/parastomal hernia formation (p = 0.02), ICU admission (p < 0.001), length of hospital stay (p < 0.001), permanent stoma formation (p < 0.001), and mortality (p < 0.001), and higher rates of sepsis (p = 0.03), intra-abdominal abscess formation (p < 0.001), and postoperative recurrence (p < 0.001) in the LPL group.<b>Conclusions:</b> Compared to the colon resection procedures for the treatment of complicated diverticulitis, laparoscopic peritoneal lavage had comparable overall morbidity and reoperation rates and lower rates of permanent stoma formation and mortality. Still, there is concern regarding the recurrence and intra-abdominal abscess formation.

Colorectal cancer (CRC) is a global health issue that frequently necessitates surgical treatment. Prehabilitation, a strategy designed to enhance patients' health status prior to surgery, has been recognized as an effective approach to improve surgical outcomes. Probiotics, celebrated for their positive impact on gut health, have been identified as a potential component of prehabilitation regimens for CRC patients. Nonetheless, the evidence supporting their efficacy in this setting is not yet definitive. This systematic review is intended to assess the role of probiotics in the prehabilitation of patients scheduled for colorectal cancer surgery.

<b>Introduction:</b> Since the very beginnings of colorectal surgery, it has been dominated by the effort to reduce postoperative infectious complications and to find a way to prevent the risks associated with the dehiscence of intestinal anastomoses. Despite the technical, technological, and scientific advances achieved in medicine over the last decades, the mortality and morbidity figures in elective gastrointestinal surgery remain at a low, but relatively constant level. They continue to represent a problem that leads to an extension of treatment time, postoperative recovery, length of inpatient treatment, and thus increased expenses for the health system. One of the methods that was supposed to lead to a reduction in infectious complications was the introduction of mechanical cleaning of the large intestine before planned surgery 120 years ago. Successes in the treatment of infections with the help of discovered antibiotics were combined with their prophylactic administration, together with mechanical bowel preparation (MBP).<b>Aim:</b> The main aim was to find pros and cons of MBP in connection with postoperative complications.<b>Materials and methods:</b> In our prospective, international study, we compared a group of patients from 2 clinical sites. In Slovakia this was the 3^rd Surgical Clinic, UNsP Merciful Brothers in Bratislava, and Klinikum Passau in Germany. A total of 418 patients with a benign or malignant colon disease who underwent elective resection were included in the study. Each center had its own preoperative colon preparation scheme. Patients were operated on by knowledgeable surgeons with at least 25 years of experience, either laparoscopically or conventionally. The monitored parameters were the type of operation, the execution of anastomoses, the conversion rate of laparoscopy to laparotomy, mortality, and morbidity. Postoperative complications were grouped into the following types: wound complications, intra-abdominal infections and anastomotic dehiscence, or the need for reoperation.<b>Conclusions:</b> We compared the obtained results with data from current world literature. With its conclusion, our study supported the currently prevailing opinion on mechanical cleansing of the large intestine, namely that it does not bring the desired effect on reducing perioperative infectious complications and dehiscence of anastomoses.

<b>Introduction:</b> Endoscopic retrograde cholangiopancreatography (ERCP) is widely used in the management of biliary andpancreatic disorders but carries a significant risk of complications, including post-ERCP pancreatitis (PEP), cholangitis,haemorrhage, and duodenal perforation. Despite technological advancements, these adverse events remain a global concern.A bibliometric analysis can elucidate publication trends, collaborative networks, and emerging themes in this evolving field.<b>Aim:</b> To analyze global research trends, authorship patterns, institutional and country contributions, and thematic shifts in post-ERCP complication research published between 2019 and 2025.<b>Methods:</b> A bibliometric analysis was conducted using the Scopus database. Articles and reviews in English, published between January 2019 and April 2025, were retrieved using a structured search strategy targeting ERCP complications. Data were analyzed using Microsoft Excel and VOSviewer (v1.6.20) to map publication trends, co-authorship networks, institutional output, country distribution, and keyword co-occurrence.<b>Results:</b> A total of 3,113 publications met the inclusion criteria. The number of articles increased steadily, peaking in 2024.The United States, Japan, and China were the most prolific contributors. "Post-ERCP pancreatitis" emerged as the dominanttheme, while recent years showed increasing focus on prevention, prediction models, and artificial intelligence. Collaborationwas highly centralised among high-income countries, with limited representation from low- and middle-income regions.<b>Conclusions:</b> Global research landscape on ERCP complications is expanding, with a shift towards data-driven and preventivestrategies. However, disparities in research quality, institutional dominance, and limited international inclusivity persist.Greater global collaboration and targeted capacity-building are essential to ensure equitable progress in ERCP safety andcomplication management.