Polski przeglad chirurgiczny最新文献

Osteoarthritis of the fingers and wrist, whether primary or secondary, is the most common degenerative disease. Its incidence is increasing due to the aging of the population. Most of the patients can be treated conservatively with good effect, but when conservative treatment fails, surgical intervention is considered. Essentially, there are 2 types of operations for this disease - radical (bone excision, arthrodesis, arthroplasty with an implant), and non-radical (joint denervation). Denervation of the joints has obvious advantages such as non-compromising the joint anatomy, preservation of range of motion, avoiding of an implant and low rate of complications. Denervation can be offered to younger patients, whatever their functional demands. Preservation of the bony anatomy does not preclude any further, more radical surgical interventions. This article presents a comprehensive information about methods of denervation of particular joints within the hand and their effectiveness in osteoarthritis. The current literature provides convincing evidence that denervation is a reliable and reproducible surgical technique for painful osteoarthritic conditions of the hand. It should be considered in patients presenting with painful joints which are still mobile, regardless the initial aetiology.

<b>Introduction:</b> Obesity is strongly related to serious comorbidities that might affect the healing process. Elevated Body Mass Index (BMI) and insulin resistance have a significant impact on the development of the metabolic syndrome often leading to lethal cardiovascular complications.<b>Aim:</b> The aim of the study was to verify the correlation of BMI and insulin resistance with clinical parameters of moderately burned patients.<b>Materials and methods:</b> There were 149 patients enrolled in the study and their clinical data was retrospectively analyzed. The laboratory tests, insulin demand, BMI, and surgical procedures were evaluated on admission and discharge.<b>Results:</b> Burned patients who required insulin were characterized by worse laboratory results on admission to the burn unit, they had lower hemoglobin (HGB) levels (P = 0.0001), higher creatinine levels by 0.323 units (P = 0.009), higher C-reactive protein (CRP) by approximately 94 units (P = 0.0001), as higher procalcitonin (PCT) by approximately 0.5 units (P = 0.001) as compared to non-insulin-treated patients. Moreover, burned patients who required insulin stayed in the hospital for an average of 10 days longer. All patients from the insulin-demand subgroup had elevated triglycerides (Tg) levels on admission with increased indexes of insulin resistance.<b>Discussion:</b> Our study suggests that the protective effect of a higher BMI in burned patients, known as the 'obesity paradox' may be compromised by insulin resistance.<b>Conclusions and significance of the study:</b> The results show that elevated Tg on admission to the burn unit coexisting with a BMI over 25 kg/m² may be used as an important prognostic factor and may help with prediction of insulin demand and worse outcome in moderately burned patients.

<b>Introduction:</b> Hemorrhoidal disease is the most common disease treated in proctology ambulatories. Conservative treatment is the basic form of treatment for this disease. One of the elements of treatment may be preparations with myoand phlebotropic effects.<b>Aim:</b> To assess the effect of a multi-ingredient myophlebotropic dietary supplement used as an adjunct on the rate and effectiveness of symptom relief in patients with stage II and III hemorrhoidal disease.<b>Material and method:</b> Patients with stage II and III hemorrhoidal disease with clinical symptoms such as pain, burning, itching and bleeding were qualified for the study. The patients were divided into two groups. The control group (Group I) of 29 patients receiving standard local treatment plus placebo and the study group (Group II) of 32 patients receiving the same local treatment and a six-component myophlebotropic product. Symptoms were analyzed at the time of inclusion in the study (day 0), after 4 and 10 days of therapy. The severity of hemorrhoidal disease and the feeling of relief were assessed on the day of inclusion (W0) and after 30 days of therapy.<b>Results:</b> There were no statistical differences between the groups in terms of disease advancement, age, gender, and duration of symptoms. Compared to the moment of inclusion in the study (W0), after 4 days (W1), after 10 days (W2) of taking the multi- -component product, there was a statistically significant improvement in the VAS scale: spontaneous pain and pain during defecation. In the qualitative assessment (yes/no), there were statistically significantly fewer cases of burning in the anus and itching. The treatment did not affect the rate of spontaneous bleeding, which was low at the beginning of the study, but significantly reduced the rate of bleeding during defecation. After 30 days of observation, it was found that the improvement in the severity of hemorrhoidal disease symptoms was significantly higher in the group using the tested preparation. Relief after a month of the study (one-question method) was noted in the group of patients receiving the tested product.<b>Conclusions:</b> The tested six-component myophlebotropic product proved to be effective in reducing the severity of symptoms such as spontaneous pain, pain during defecation, burning/burning in the anus and bleeding during defecation. Statistical significance was demonstrated in the symptom's relief and reduction in the severity of hemorrhoidal disease.

<b>Introduction:</b> Due to a short history of laparoscopic sleeve gastrectomy (LSG) as an independent bariatric procedure, we stilllack studies providing analysis of the quality of life (QoL) in patients with type 2 diabetes mellitus (DM2).<b>Aim:</b> We aimed to assess the influence of LSG on QoL in obese patients with DM2.<b>Material and Methods:</b> Prospective, observational study included patients with: morbid obesity, body mass index (BMI) ≥ 35 kg/m and ≤ 50 kg/m², DM2 shorter than 10 years, qualified for LSG. Bariatric Analysis and Reporting Outcome System (BAROS) that included the Moorehead-Ardelt Quality of Life Questionnaire II (MA-QoLQII) score, and the SF-36 Health Survey (SF-36) questionnaire were used for repetitive assessment of QoL before LSG and after one and 12 months following surgery. Selected clinical and biochemical parameters were also repeatedly measured.<b>Results:</b> Thirty-three patients were included in the study (23 females). Patients' mean age was 45 10 years. BAROS significantly increased before LSG, one month, and one year after surgery (0.63 1.12, 2.94 1.90, and 4.97 2.08, respectively). The MA-QoLQII score significantly rose with an increase of excess body mass index loss (EBMIL) (P = 0.002) and remission of DM2 (P = 0.049), while inversely correlated with Homeostatic Model Assessment for Insulin Resistance index (HOMA-IR) (P = 0.003). Degenerative joint disease (P = 0.025) and average time of low glucose concentration in continuous glucose monitoring (CGM) (P = 0.005) had an inverse correlation with SF-36 Physical Component Summaries (PCS), standardized for cardiovascular comorbidity, EBMIL and HOMA-IR (P = 0.839; P = 0.086; P = 0.571, respectively). EBMIL (P = 0.003), remission of DM2 (P < 0.001) had a positive correlation with Mental Component Summaries (MCS), while HOMA-IR (P < 0.001) and count of low glucose concentration events (P = 0.022) had an inverse correlation with MCS, while standardized for average glucose concentration in CGM after 12 months (P = 0.586).<b>Discussion:</b> Significant improvement in QoL was observed in patients with DM2 after LSG. Remission of DM2, higher EBMIL, lower HOMA-IR, fewer and shorter low glucose concentration events in CGM after 12 months were factors that increased selected QoL scores.

<b>Introduction:</b> Obesity, as one of the main health problems worldwide, is associated with an increased risk of developing mental and eating disorders and negative eating habits. Bariatric surgery allows for rapid weight loss and alleviates the symptoms of concomitant diseases in obese patients.<b>Aim:</b> Pre- and postoperative estimation of mental disorders and eating behaviors in patients after Roux-en-Y Gastric Bypass (RYGB).<b>Material and methods:</b> Analysis of data from up to 5 years of follow-up including clinical examination and questionnaires.<b>Results:</b> Following parameters decreased after RYGB: anxiety and hyperactivity from 32.81% to 21.88%, mood disorders - 31.25% to 20.31%, substance abuse - 40.63% to 28.13%, emotional eating - 76.56% to 29.69%, binge eating - 50% to 6.25%, night eating - 87.5% to 20.31%. Postoperative rates of: negative eating habits, daily intake of calories and sweetened beverages, flatulence, constipation, and abdominal pain decreased, while the rate of food intolerance and emesis increased.<b>Conclusions:</b> In our patients, the occurrence of: mental and eating disorders, negative eating habits, daily calories, sweetened beverages, coffee intake decreased after weight loss (as a result of RYGB), but water, vegetables and fruit consumption increased. Lower rate of flatulence, constipation, and abdominal pain, but higher of food intolerance and emesis were also confirmed after RYGB.

<b>Introduction:</b> The development of endoscopic ultrasonography (EUS) has enabled extra-anatomical transmural access to the bile ducts, thus making it possible to perform endoscopic biliary anastomoses with the gastrointestinal (GI) tract and obtain extra-anatomical transpapillary access. EUS provides an alternative to the existing methods of biliary drainage (BD) for cases in which endoscopic retrograde cholangiopancreatography (ERCP) is ineffective.<b>Aim:</b> This study aimed to evaluate the efficacy and safety of extraanatomical endoscopic biliary access methods for the treatment of benign and malignant biliary strictures.<b>Material and methods:</b> This retrospective analysis included treatment results of all patients with obstructive jaundice and biliary strictures who were treated endoscopically in our department between 2016 and 2023. The study group comprised patients in whom EUS-guided transmural access was used during ERCP because of biliary strictures and the lack of transpapillary access.<b>Results:</b> Twenty-eight patients (14.66%) underwent endoscopic transpapillary biliary stenting via a transmural approach under EUS guidance. The remaining 163 patients (85.34%) underwent extraanatomical transmural biliodigestive anastomosis. Technical success was achieved in 186 of 191 (97.38%) patients. Clinical success was achieved in 170 of 191 (89.01%) patients. Complications were reported for 32 of 191 (16.75%) patients, including fatal complications for 6 of 191 (3.14%) patients.<b>Conclusions:</b> Advanced endoscopic techniques involving EUS-guided transmural access are effective and safe for biliary strictures. They provide an alternative to other drainage techniques when ERCP is ineffective and improve the quality of life of patients undergoing palliative treatment for biliary strictures with unresectable cancer of the biliopancreatic area.

<b>Introduction:</b> The prevalence of preoperative anemia is the highest in the group of colorectal cancer (CRC) patients and may reach over 75%. The prevalence of anemia in CRC patients increases even further following surgery. Approximately 75-80% of anemic CRC patients present with absolute or functional iron deficiency (ID). Preoperative anemia constitutes an independent risk factor for allogeneic blood transfusion (ABT), postoperative complications, prolonged length of hospital stay, and increased mortality. ABT is itself associated with increased morbidity and mortality.<b>Aim:</b> The aim of this review article was to present the pathophysiology and the current approach to the diagnostics and treatment of preoperative iron deficiency anemia (IDA) in CRC patients.<b>Material and methods:</b> Extensive search of medical literature databases was performed (Pubmed, Embase). The key words that were used were as follows: CRC, colorectal surgery, ID, IDA, intravenous iron, Patient Blood Management (PBM).<b>Results:</b> There are several laboratory parameters that can be used for IDA diagnosis, however, the simplest and most cost- -effective is reticulocyte hemoglobin equivalent (RET-He). Pathophysiologic features of IDA in CRC patients favor treatment with intravenous, as opposed to oral, iron formulations. Applying PBM strategies minimizes the exposure to ABT.<b>Conclusions:</b> Preoperative IDA is highly prevalent among CRC patients. Preoperative anemia is an independent risk factor for ABT, increased morbidity and mortality, as well as prolonged hospital length of stay. The same negative consequences are associated with ABT. Therefore, preoperative IDA in CRC patients needs to be screened for, diagnosed, and treated before surgery. Effective treatment of preoperative IDA in CRC patients is with intravenous iron formulations. ABT should be the treatment of last resort due to the risk of negative clinical consequences, including an increased rate of cancer recurrence.

In recent years, much has been written about the possibilities of using exogenous sodium butyrate in the prevention and treatment of gastrointestinal diseases, in prehabilitation, in peri- and postoperative treatment, as well as its local application. It became possible thanks to the development of a special formulation (microencapsulation technique) enabling the delivery of unstable butyrate compounds to the large intestine, where it is used primarily as a source of energy. It also plays a key role in maintaining body homeostasis by maintaining the integrity of the intestinal epithelium and stimulating the intestinal immune system. There is growing evidence of the effectiveness of sodium butyrate in various areas of health. The following article discusses the possibilities of using microencapsulated sodium butyrate in the prevention and treatment of gastrointestinal diseases from the perspective of a gastroenterologist and gastrointestinal surgeon.

<b>Introduction:</b> Incisional hernias are prevalent complications, with significant recurrence rates and associated surgical wound complications. Giant hernias, classified by the European Hernia Society (EHS) as exceeding 10 cm (width dimension), pose a challenge due to the "loss of domain" effect. Component separation techniques (CST), including anterior component separation (ACS) and transversus abdominis release (TAR), are established interventions but have drawbacks related to the irreversible alteration of abdominal wall anatomy and associated risks. An alternative approach involves the preoperative application of Botulinum Toxin A (BTA) to reduce lateral abdominal muscle tension, facilitating hernial defect closure.<b>Aim:</b> The aim was to assess the impact of BTA on reducing the necessity for CST, the occurrence of surgical site complications,and the need for further interventions.<b>Materials and methods:</b> A retrospective cohort study was conducted across two reference centers specializing in hernia treatment in Poland and Ukraine. The study compared outcomes between patients undergoing elective abdominal wall reconstruction surgery for giant hernias, specifically looking at the requirement for CST following preoperative BTA application. Patients were divided into two groups - those who received BTA injections 3-4 weeks prior to surgery (BOTOX group) and those who did not (NON-BOTOX group).<b>Results:</b> The study found that in the BOTOX group, a significantly lower proportion of patients required CST compared to the NON-BOTOX group (46 <i>vs</i> 84%, P-value = 0.000124). Additionally, the BOTOX group experienced fewer postoperative complications, suggesting a beneficial effect of BTA in simplifying surgical procedures and enhancing patient outcomes.<b>Conclusions:</b> The findings support the use of preoperative BTA injections as a valuable adjunct in the management of giant abdominal hernias. This approach not only facilitates fascial closure without the need for extensive CST but also potentially reduces perioperative trauma and postoperative complications. Preoperative BTA injections significantly reduce the need for CST in giant incisional abdominal hernia repairs, offering a less invasive and more effective approach to fascial closure. The most important role of BTA is "downstaging" the hernia before surgery. This study highlights the importance of considering BTA injections in preoperative protocols, advocating for broader acceptance and reimbursement to improve surgical outcomes and patient care in hernia surgery.

<b>Introduction:</b> Choledocholithiasis (CCL) is one of the most common serious health consequences of cholelithiasis. For years, evacuation of stones using endoscopic retrograde cholangiopancreatography (ERCP) has been the first-line treatment. In 10-15% of cases, gallstones cannot be removed using the above-mentioned method and auxiliary methods are necessary; these are so-called difficult gallstones. Surgical treatment is sometimes necessary. The European Society of Gastrointestinal Endoscopy (ESGE) has recommended the use of cholangioscopy, including direct peroral cholangioscopy (DPOC), as one of the main treatment methods since 2015.<b>Aim:</b> The following article aims to investigate the safety and efficacy of direct cholangioscopy with laser lithotripsy in the treatment of CCL.<b>Materials and methods:</b> The study was conducted at the Department of General and Transplant Surgery, Medical University of Lodz. From October 2022 to November 2023, 13 procedures of difficult gallstone evacuation from the bile duct were performed using the technique of direct cholangioscopy with laser lithotripsy.<b>Results:</b> Thirteen cases of difficult gallstones were retrospectively analyzed. The bile duct was intubated via the ampulla of Vater using direct cholangioscopy. The bile duct was cleared of gallstones using laser lithotripsy, followed by a Dormia basket or an extraction balloon to remove stone fragments. The procedure was performed successfully in all patients. No complications were observed.<b>Conclusions:</b> DPOC with laser lithotripsy seems to be an effective and safe method of clearing even very large gallstones from the bile duct. The relatively low price of tools and the resulting cost reduction may allow this procedure to become more popular.