Polski przeglad chirurgiczny最新文献

<b>Introduction:</b> Caspases play a key role in apoptosis, the disruption of which can lead to the proliferation of abnormal cell clones and tumor growth. Caspases' role as potential biomarkers has been confirmed in relation to many types of cancer.<b>Aim:</b> In this study, the authors focused on the European population with an average incidence of gastric cancer to investigatethe importance of caspases in gastric cancer.<b>Material and methods:</b> For this purpose, we evaluated the expression of representative caspases - an effector caspase-3 as well as caspase-8 and -9 initiating the apoptosis process, studying the cases of 53 patients who had been operated on in the Department of General Surgery and Surgical Oncology from 2010 to 2014. Also, we selected patients who had not received the neoadjuvant chemotherapy. An attempt was then made to identify correlations between caspase expression and clinical or pathological features of gastric cancers. The expression was evaluated by immunohistochemical reactions using monoclonal antibodies. Statistical analysis was performed, including parametric and nonparametric tests, like Kruskal-Wallis and Spearman's rho.<b>Results:</b> The study did not confirm a significant role of caspases in gastric cancer. We found no correlation with overall survival, tumor location, clinical stage, or its grade of histopathological malignancy as defined by World Health Organization (WHO). The possibility of using the selected caspases as biomarkers was not confirmed.<b>Discussion:</b> Our observations are significantly different from those described in the literature. This may indicate differences in tumour biology in different patient populations.<b>Conclusions:</b> In the study performed by the authors of this paper, no correlation of caspase-3, -8, and -9 IRS score with clinicopathological factors and long-term survival was found to be statistically significant.

<b>Introduction:</b> Laparoscopic sleeve gastrectomy (LSG) is one of the most popular bariatric surgeries, which contributes to a significant reduction in body weight and improvement of metabolic parameters. At the same time, gastroesophageal reflux disease (GERD) remains one of the key complications after this intervention.<b>Aim:</b> The aim of this study was to determine the main factors contributing to the development of GERD after LSG.<b>Materials and methods:</b> The study included 328 patients (mean age 42.3 9.6 years, mean BMI [body mass index] 41.7 6.1 kg/m) who underwent LSG in 2016-2022. Patients were divided into two groups: the study group (n = 72, 21.95%) - patients with occult GERD, the control group (n = 256, 78.05%) - patients without signs of the study disease. Before the operation, a comprehensive assessment of the patients' condition was performed, including the GERD-HRQL questionnaire and 24-hour pH monitoring (DeMeester index [IDM]). Latent GERD was defined as IDM>14.72 in the absence of symptoms. Postoperative disease was diagnosed on the basis of changes in GERD-HRQL and repeated pH metering 12 months after LSG. The Review Manager program was used for statistical analysis.<b>Results:</b> One year after surgery, 33.23% (n = 109) of patients developed clinically significant GERD. Among those who had latent disease before LSG, 76.38% (n = 55) developed symptoms of the disease. In the control group, the disease appeared in 21.19% (n = 54) of patients, and another 5.08% (n = 13) had a latent form of the disease. Statistical analysis revealed a strong association between the presence of latent disease before surgery and an increased risk of developing clinical disease after LSG (RR: 0.55, OR: 12.10, p<0.001). There was also a tendency to an increased risk of developing this disease in patients over 55 years of age, but this relationship was not statistically significant (p = 0.34), as well as female gender (p = 0.75).<b>Conclusions:</b> LSG is an effective method of treating obesity, but it can contribute to the development of GERD, especially in patients with occult disease. Considering that 76.38% of such patients developed symptoms of the disease after surgery, it is advisable to include preoperative 24-hour pH-metry in the standard examination for the timely detection of occult reflux.

<b>Introduction:</b> Umbilical hernias occur in approximately 2% of the population. The latest 2020 guidelines, due to changes in classification, recommend mesh implantation when the wall defect is larger than 1 cm, instead of 2 cm as the 2009 classification. A significant number of surgeons still perform umbilical hernia repairs according to the older classification.<b>Aim:</b> The aim of this study is to evaluate the usefulness of the new classification of primary umbilical hernias in determining the appropriate treatment method for patients.<b>Material and method:</b> A retrospective analysis was conducted on 1087 patients who underwent surgery in a single department between January 2016 and December 2022. Data were collected from an electronic database, including gender, age, comorbidities, body weight, duration of surgery, hernia size, and methods of treatment. The follow-up period ranged from over 1 to 7 years. Recurrence rates were assessed based on outpatient records and a phone survey. Hernias were classified according to the EHS/AHS guidelines as small, medium, and large. Both the old and new classification systems for hernias were used in the assessment. A detailed analysis was performed on hernias with a defect size of 1-2 cm, for which the EHS/AHS guidelines have changed their recommendations. The study was approved by the ethics committee and registered at ClinicalTrials.gov (ID NCT06530420).<b>Results:</b> The largest group of primary umbilical hernias consisted of small hernias. In over 90% of these cases, the defect was repaired using simple sutures. Hernias with a defect size of 1-2 cm were predominantly treated with sutures as well. Mesh implantation was associated with a higher rate of postoperative complications, such as hematomas and infections at the surgical site. No significant difference in the recurrence rate of 1-2 cm hernias was observed based on the method of treatment.<b>Conclusions:</b> The change in the EHS/AHS classification, and consequently the recommendations regarding treatment for hernias with wall defects of 1-2 cm, was not justified in the analyzed patient sample. Based on the results of our analysis, we conclude that the choice of treatment method for hernias with wall defects up to 2 cm should depend on the clinical situation and the surgeon's experience.

<b>Introduction:</b> Intercostal cryoablation has been widely adopted in many centers for the use during minimally invasive repair of pectus excavatum (MIRPE) due to its excellent postoperative pain control. However, there is a lack of studies comprehensively reviewing the scope and frequency of adverse effects after use of cryoanalgesia.<b>Methods:</b> We performed a systematic review of the literature from 2000 to June 2024 according to the PRISMA guidelines. The primary outcomes of interest were side effects and complications after use of cryoanalgesia during MIRPE procedure in children and adolescents.<b>Results:</b> An initial reference search yielded 1347 articles. Finally, after eligibility screening we chose 38 studies that we included in the further analysis. In our study, we demonstrated that the use of cryoanalgesia during Nuss procedure is reported to be associated with the risk of side effects. Although the risk of perioperative complications is low, possible problems include: loss of chest wall sensation, neuralgia, bar migration due to ignoring of activity restriction, dermatitis, lung injury and other.<b>Conclusions:</b> Despite the wide use of cryoanalgesia in pectus excavatum (PE) surgery in children and young adults, surgeon should be aware of possible side effects. This report is the first published study summarizing specific complications associated to use of intercostal cryoablation in PE surgery. In our opinion there is a substantial need for large randomized controlled studies in this topic.

<b>Introduction:</b> Lateral pancreaticojejunostomy (LPJ) remains the most commonly performed decompressive procedure for symptomatic patients with chronic pancreatitis (CP) and a dilated pancreatic duct (PD) who failed at either conservative or endoscopic treatment. An accurate interpretation of the long-term appearance of LPJ is mostly unknown.<b>Aim:</b> The aim of our study was to determine the utility of the longitudinal magnetic resonance imaging (MRI) in the long-termevaluation of the aforementioned anastomoses postoperatively.<b>Materials and methods:</b> The study was conducted among patients admitted to the Department of General and Transplant Surgery after LPJ between 2009 and 2018. Magnetic resonance imaging scans were performed in accordance with the routine schedule of follow-up.<b>Results:</b> The study group consisted of 25 patients (14 males) who underwent LPJ due to CP with dilatation of PD (mean 7.5mm [SD 3.69]) without calculi. Seven of them had the imaging examination performed within a one-year follow-up; the other18 patients were up to 10 years after surgery. The patency of the anastomosis was directly observed in 10 patients, in 11 patientsit was established on the basis of indirect features, and in the rest the first diagnosis was uncertain and required radiologicalreanalysis, during which the patency of all anastomoses was confirmed.<b>Conclusions:</b> MRI is an effective diagnostic tool that can be successfully used in a follow-up process after LPJ, as it allows to show the presence of pancreaticojejunal anastomosis. However, more studies regarding this subject should be conducted as we lack high-volume data.

<b>Introduction:</b> Anxiety before surgery, which may affect up to 80% of patients, contributes to postoperative complications and prolongs both hospital stay and recovery time. Thus, identifying patients with excessive anxiety and implementing appropriate interventions is essential.<b>Aim:</b> This study aimed to evaluate the effectiveness of a video-based educational intervention in reducing perioperative anxiety in patients scheduled for elective surgery in the general surgery department.<b>Materials and methods:</b> The study comprised 294 patients referred to the hospital for elective surgical procedures. Anxietylevels were evaluated using a translated version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) andState-Trait Anxiety Inventory Trait-5 (STAI-T5).<b>Results:</b> The Amsterdam Preoperative Anxiety and Information scale scores were found to be significantly lower in the videogroup compared to the control group. A significant correlation was found between the trait anxiety measured by the STAI-T5and the anxiety and information scores of the APAIS. The most frequently reported subjective concern was related to theinfluence of the possible failure of surgery on the fate of their families.<b>Conclusions:</b> Video-based educational intervention helps patients become familiar with the detailed description of the hospital stay and the course of surgery. Educational videos are effective in reducing preoperative anxiety and patient's need forinformation. Therefore, they should be increasingly implemented into everyday medical practice.

<b>Introduction:</b> Surgical treatment of obesity is a recognized method of treatment for this disease. There are several surgical methods used, but there is no silver bullet, as relapses and side effects occur after virtually every procedure.<b>Aim:</b> Vertical gastric banding, also known as BariClip implantation (Laparoscopic BariClip Gastroplasty [LBCG]), is not a popular surgical procedure in Poland; it is anatomically similar to LSG (Laparoscopic Sleeve Gastrectomy). The aim of this study was to assess weight loss following LSG and LBCG, as well as the incidence of one of the most common complications following sleeve gastrectomy: gastro-oesophageal reflux.<b>Material and methods:</b> As many as 110 patients were analyzed who underwent surgery between September 2022 and September 2023 in this group - 55 BariClip and 55 LSG. Patients were assessed after ten days /removal of sutures/, after one month, after six months, and after one year. Statistical analysis of the data was performed using descriptive and analytical statistics. Statistical significance of differences was assessed with the Student's t-test, and, when the assumption of a normal distribution was not met, with the non-parametric Mann-Whitney U test. The association between the incidence of postoperative reflux and the type of surgery was assessed using Pearson's Chi-square correlation tests.<b>Results:</b> In the early postoperative period, there was no statistically significant difference in weight loss between the LSG and LBCG groups. Only the weight loss at twelve months postoperatively was statistically significant (p<0.001). Gastroesophageal reflux was significantly more common in patients undergoing sleeve gastrectomy compared to those undergoing LBCG. In patients after sleeve gastrectomy, the risk of gastro-oesophageal reflux is 3.4 (CI 95% 1.20-9.37; p = 0.02) times higher at three months after surgery, 15.5 (CI 95% 4.33-55.81; p<0.001) times higher at six months after surgery, and up to 17.7 (CI 95% 5.62-56.03; p<0.001) times higher at six months after surgery compared to patients after LBCG surgery.<b>Conclusions:</b> The study groups (LSG <i>vs.</i> LBCG) showed weight reduction at comparable levels at up to 6 months. In contrast, after 12 months, a significant difference in weight reduction of 4.6 kg was observed after LSG. LBCG does not cause GERD, which is one of the most common complications after LSG; in the material presented here, the risk of GERD after LSG was shown to be 15.5 times higher than after LBCG at six-month follow-up, and at one-year follow-up, 17.7 times higher than after LBCG.

<b>Introduction:</b> Refeeding syndrome (RS) is a serious complication of nutritional therapy in critically ill patients, to which patients on surgical wards are particularly vulnerable. It is a potentially life-threatening, complex metabolic disorder that occurs in response to the implementation of overly aggressive, inadequate adaptive patient nutritional therapy, often exacerbated by malnutrition. Moreover, if an appropriate diagnostic and therapeutic process is not undertaken, RS itself becomes the cause of subsequent systemic complications such as respiratory failure, neurological disorders, circulatory failure or seizures. Identified risk factors for RS are mostly modifiable.<b>Aim:</b> The article reviews the literature on the current knowledge and recommendations regarding RS and provides practical recommendations to assist surgeons in effectively diagnosing and managing the syndrome during the perioperative period.<b>Methods:</b> A database query was conducted to identify the most recent information related to the topic of this study.<b>Results:</b> Treatment of RS in critically ill patients undergoing surgery is challenging due to overlapping symptoms of the underlying disease and coexisting severe metabolic disorders. Current guidelines recommend a gradual increase in energy intake and regular monitoring of a patient's metabolic status (especially phosphorus, potassium, and magnesium levels) during nutritional treatment.<b>Conclusions:</b> It is necessary to regularly follow the recommendations of scientific societies, which will take into account the specificity of the treatment of patients in the perioperative period with Refeeding Syndrome in the context of coexisting diseases to improve the quality and safety of care of these patients.

<b>Introduction:</b> Colostomy reversal is a common surgical procedure following oncological and non-oncological resections. Colostomy reversal is performed in 60% in of non-oncological patients, and in only 40% of patients operated on for oncological reasons. Postoperative course as a possible reason for a lower colostomy reversal rate remains a controversial issue.<b>Aim:</b> To compare postoperative outcomes of colostomy reversal in patients with oncological versus non-oncological indications for colostomy creation.<b>Materials and methods:</b> The multicenter, prospective Liquidation of Colostomy (LICO) study was conducted in 20 surgical departments in Poland between October 2022 and December 2023. Patients were divided into two groups based on colostomy indication: oncological (Group 1) and non-oncological (Group 2). Primary outcomes were the length of hospital stay (LOS), postoperative complications, and 30-day reoperation rates.<b>Results:</b> Among 126 patients (46 in Group 1, 80 in Group 2), Group 1 patients were older (median 67 <i>vs.</i> 55.5 years, p<0.05) and had a higher prevalence of ischemic heart disease (32.6% <i>vs.</i> 10%, p = 0.002). Median LOS was 7 days for both groups (p = 0.656). Complication rates (34.8% in Group 1 <i>vs.</i> 43.8% in Group 2, p = 0.32) and reoperation rates (6.5% <i>vs.</i> 12.5%, p = 0.289) showed no significant differences. Intraoperative blood loss, operative times, and Clavien-Dindo complication grades were comparable between groups.<b>Discussion:</b> The results challenge the assumption that colostomy reversal after oncological resections carries higher risks. Comparable outcomes suggest perioperative care and patient selection are more critical than the underlying indication for colostomy.<b>Conclusions:</b> Colostomy reversal outcomes, including LOS, complications, and reoperations, were similar between oncological and non-oncological patients, supporting its safety in properly selected oncological cases without active disease.<b>Significance of the study:</b> This study provides evidence to guide clinical decision-making and refine guidelines, ultimately improving outcomes for patients undergoing colostomy reversal.

<b>Introduction:</b> The process of obtaining informed consent for surgical procedures is a fundamental aspect of medical practice. However, it receive relatively little focus in medical literature. <br><br><b>Aim:</b> The aim of the study was to assess the practices of obtaining surgical consent across surgical specialties, with a special focus on general surgery. <br><br><b>Material and methods:</b> This was a survey study conducted among Polish surgical specialists and residents from October 1^st to November 30^th, 2024. The survey included 13 closed-ended questions covering demographic data, legal knowledge, and personal practices regarding informed consent. The survey was distributed via social media. <br><br><b>Results:</b> A total of 282 respondents participated in the survey. General surgeons made up the largest group (51.8%), followed by gynecologists (16.7%). Of the 11 surgical associations contacted, 4 confirmed that they provide consent forms for their members. More than half of the respondents (58.2%) were familiar with the current legal regulations on informed consent. The majority of surgeons (62.4%) reported providing information to patients themselves, although discrepancies in practice were noted, with residents and interns also involved in obtaining consent in some cases. Furthermore, only 12.4% of patients received the consent form during their pre-surgical qualification visit, with most patients seeing it the day before surgery. In 36.9% of cases, the operating surgeon was responsible for obtaining consent. <br><br><b>Conclusions:</b> The study highlights variations in practices regarding informed consent, with significant differences between specialties. The need for clearer legal frameworks and standardized procedures is emphasized to reduce legal risks and improve patient care.