Polski przeglad chirurgiczny最新文献

<b>Introduction:</b> Oesophageal cancer is one of the leading causes of malignant death worldwide, and its incidence has increased sixfold in recent decades. Although it ranks sixth in mortality and eighth in incidence worldwide, it is one of the least understood and described cancers, which is probably related to its highly aggressive course and poor treatment outcomes.<b>Aim:</b> The aim of this study was to review the current literature regarding the treatment of oesophageal cancer.<b>Results:</b> Surgical treatment is the most important stage of therapy, and advances in this field and the development of new surgical techniques have significantly improved the five-year survival and reduced the incidence of postoperative complications. However, surgical treatment of oesophageal cancer is considered one of the most extensive and invasive procedures in cancer surgery, resulting in a steep learning curve for oesophageal resection procedures, especially minimally invasive (MI) techniques. Nevertheless, in the early stages of disease, oesophageal resection is the only currently accepted and used procedure that can potentially lead to a cure. The results of several studies comparing conventional and MI approaches have demonstrated the superiority of MI oesophagectomy, which is associated with fewer perioperative complications and inhospital deaths, shorter operation times, shorter intensive care unit stays, and higher quality of life rates. The learning curve for hybrid surgery, which bridges the gap between classic and MI procedures, is much shorter than for fully MI procedures, which is particularly appealing for surgeons who lack extensive experience in laparoscopy and thoracoscopy.<b>Conclusions:</b> In conclusion, given the clear advantages of MI techniques over classic techniques, we believe that despite a longer learning curve and more difficult surgical procedures, MI techniques should be the target techniques for treating oesophageal cancer.

<b>Introduction:</b> Traumatic detachment of the lateral abdominal muscle group from the iliac crest occurs as a result of the acceleration mechanism when the body impacts a seatbelt during a head-on collision of motor vehicles. Due to the rare and variable nature of such defects, a standard treatment protocol has not yet been developed. As a result, the surgical technique and timing of the procedure are always planned individually. The optimal surgical method and type of implant for such cases remain undetermined. Given the anatomical location of the defect, surgical intervention utilizes techniques at the intersection of orthopaedics, reconstructive surgery, and herniology.<br><br><b>Aim:</b> Traumatic separation of the lateral abdominal muscles from the iliac crest, caused by blunt trauma, is a rare and complex injury. This study aims to present a novel surgical technique for managing such defects, focusing on the use of macroporous mesh fixation to the iliac crest with a ProTack stapler (Medtronic, Dublin, Ireland). <br><br><b>Materials and methods:</b> This paper describes the case of a patient with a traumatic detachment of the lateral abdominal muscle group from the iliac crest. The diagnosis was based on physical examination and computed tomography (CT). The surgery was performed 12 months after the initial injury and emergency surgical treatment of abdominal organs. Due to the size of the defect, an open approach was proposed. Adhesions were released, the preperitoneal space was dissected, and a macroporous implant measuring 26 × 28 cm was placed and fixed to the iliac crest using a ProTack stapler (Medtronic, Dublin, Ireland). The lateral abdominal muscles were reattached to the mesh to restore anatomical continuity. <br><br><b>Results:</b> Postoperatively, subcutaneous drainage was maintained for 9 days, and the use of a hernia belt was recommended continuously for 2 weeks, followed by 4 weeks during periods of increased physical activity. The patient was discharged on the third postoperative day. Primary wound healing and a satisfactory functional and aesthetic restoration of the abdominal wall were achieved. During a 12-month follow-up period, no hernia recurrence or other complications were observed. <br><br><b>Conclusions:</b> Traumatic detachment of the lateral abdominal muscle group is an extremely rare and serious medical condition. Randomized studies comparing approaches and surgical methods have not yet been conducted, and no standard treatment protocol has been established. The proposed treatment method, involving implant fixation to the bone using a stapler, appears to be a favorable therapeutic solution. Further experimental studies are needed to optimize the method and establish evidence-based guidelines.

<b>Introduction:</b> Dupuytren's disease is a common condition of the palmar aponeurosis, leding to contractures of the fingers. The disease onset is the formation of nodules in the palmar aponeurosis, which can be painful in some patients. Resection of the affected part of the palmar aponeurosis and release of finger contracture is a method of treating the advanced form of the disease, while in the early phase, awaiting progression has so far been recommended. Research presented over the past few years indicates the possibility of active treatment of early Dupuytren's disease to prevent the development of contractures.<b>Aim:</b> The aim of this article was a review of treatment modalities in the early Dupuytren's disease, mainly in terms of their efficacy, safety, and future perspectives.<b>Methods:</b> The current literature focusing on treatment modalities in early-stage Dupuytren's disease was reviewed.<b>Results:</b> To treat the early stage of the disease, various substances such as steroids, monoclonal antibodies, and <i>Clostridium histolyticum</i> collagenase were injected into the nodules. Radiotherapy and various methods of physical therapy were also used. The effectiveness of all these techniques was limited, although some, such as anti-TNF monoclonal antibody and radiotherapy, showed the ability to inhibit disease progression.<b>Conclusions:</b> Results of reviewed studies show that active treatment of the early stage of Dupuytren's disease has thepotential to prevent progression of finger contractures.

<b>Introduction:</b> Idiopathic granulomatous mastitis (IGM) is a rare, non-specific inflammatory breast disease. There are severalcontroversies regarding its standard treatment.<b>Aim:</b> We aimed to evaluate the efficacy of local corticosteroid injection compared to systemic steroids and combined treatment of both in IGM patients.<b>Methods:</b> In this randomized controlled clinical trial study, 115 IGM patients were randomly allocated to three groups of localsteroid injection (Betamethasone, n = 37), systemic steroid treatment (Prednisolone + MTX, n = 37), or combined treatment ofboth (n = 41) for a follow-up period of 10 months. Clinical presentations and outcomes were compared between the groups.<b>Results:</b> The mean age of the study patients was 35.6 years. The mean time to complete remission was 3.17, 4.33, and 6.37 months, and the relapse rate during the treatment was 0%, 5.26%, and 13.33% in the injection, combined, and systemic therapy groups, respectively. There was no significant difference between the clinical response to treatment rate and the recurrence rate during the follow-up between the groups. Four patients in the combined therapy group and 3 patients in the systemic therapy group had steroid side effects, with no side effects in the injection group.<b>Conclusions:</b> Steroid injection therapy is more effective than combined therapy and systemic therapy in terms of remission and relapse rate during the treatment, and is as effective as systemic therapy in the clinical response to treatment rate and the recurrence rate during the follow-up period. Regarding the lack of side effects of the steroid injection therapy, this approach could be considered among the first-line treatment options.

<b>Introduction:</b> Primary spontaneous pneumothorax (PSP) is a relatively rare condition in children, posing significantchallenges in its management and complicating efforts to identify those at higher risk of complications. Recent studieshave drawn attention to Nodular Histiocytic/Mesothelial Hyperplasia (NHMH) as an occasionally observed histologicalchange in this patient group. Differentiating NHMH from other potential neoplastic processes has become essential toensure accurate diagnosis and appropriate treatment.<b>Aim:</b> This study aimed to evaluate the frequency and clinical relevance of NHMH in pediatric patients with spontaneous pneumothorax at the Department of Pediatric Surgery in Cracow, Poland.<b>Materials and methods:</b> We conducted a retrospective re-analysis of histological images from patients who underwentsurgery for spontaneous pneumothorax between 2012 and 2024.<b>Results:</b> Our findings revealed a higher incidence of NHMH in patients who required reoperation after initial pneumothoraxtreatment.<b>Discussion:</b> The presence of NHMH, particularly in these cases of reoperation, suggests that chronic irritation of lung tissue, possibly due to the presence of emphysematous bullae, plays a significant role in its development.<b>Conclusions:</b> Recognizing NHMH in these patients is crucial for preventing misdiagnosis as a neoplastic process, which can have serious clinical implications.<b>Significance for the field:</b> Understanding this histological feature is important for guiding future therapeutic decisions andavoiding unnecessary interventions.

<b>Introduction:</b> Colorectal cancer (CRC) remains one of the leading causes of cancer-related morbidity and mortality worldwide, creating a need for continuous search for innovative diagnostic and disease monitoring methods. Traditional techniques, although effective, are highly invasive and may be associated with risks for patients, which prompts the development of less invasive alternatives. One such method is liquid biopsy - a technique for analyzing circulating biomarkers in body fluids.<b>Aim:</b> This paper describes the use of liquid biopsy in both the diagnosis and treatment monitoring of CRC. The article discusses three major classes of biomarkers used in this method: circulating tumor DNA (ctDNA), circulating tumor cells (CTC), and exosomes. Particular attention is paid to their role in cancer detection and monitoring of treatment response.<b>Discussion:</b> The accuracy and invasiveness of liquid biopsy biomarkers are compared with traditional biopsy techniques. It is emphasized that liquid biopsies can provide real-time insight into tumor dynamics while minimizing patient discomfort. The clinical applications of these biomarkers are discussed, focusing on their utility in early disease detection, prognostication of tumor outcome, and development of personalized therapeutic strategies. Particular emphasis is placed on their transformative potential in improving treatment outcomes for patients with colorectal cancer.<b>Conclusions:</b> Liquid biopsies are a key element in the evolving landscape of oncology care. Their development and use have the potential to significantly improve patients' quality of life and the effectiveness of cancer treatment.

<b>Introduction:</b> Presacral venous plexus (PSVP) is the lowest portion of the anterior external vertebral venous system, and injury to it with subsequent hemorrhage is a recognised and potentially lethal complication that may be encountered during pelvic surgical operations. Conventional hemostatic treatments may not be able to control this hemorrhage, and innovative techniques are required to address this issue.<b>Aim:</b> By examining the current techniques for managing PSVP hemorrhage, this study aims to remind the surgeons about possible management approaches that could effectively address this critical scenario.<b>Methods:</b> A systematic search of the PubMed database, Google Scholar, Web of Science, and ResearchGate was conducted to retrieve peer-reviewed scientific articles related to PSVP hemorrhage.<b>Conclusions:</b> There are several ways to establish hemostasis in these circumstances, and the patient's hemodynamic conditionand the exact location of the bleeder determine which approach is best. Therefore, it is imperative that surgeons' knowledge ofthese procedures be raised and that a variety of hemostatic medications be made available in operating rooms.

<b>Introduction:</b> The extent of observation bias in long-term surgical outcomes due to inadequate or unplanned follow-up in pilonidal sinus disease (PSD) studies is unclear. We made a hypothesis on the high risk of underreported recurrence in studies relying on the patients returning in case of recurrent disease (return on recurrence; ROR).<b>Aim:</b> To investigate and quantify the amount of bias associated with regular <i>vs.</i> return-on-recurrence follow-up of patients.<b>Materials and methods:</b> A total of 5.485 retrievable PSD publications were screened for eligibility, yielding 1.222 PSD studies with 135.349 patients treated, published between 1833 and 2023, included for analysis. Of these, 139 were Randomized Controlled Trials (RCT), 54 were ROR trials, and 1,029 were non-RCT non-ROR (N) trials. Recurrence rates were compared between groups<b>Results:</b> The five-year recurrence rates across all treatments in PSD were 18.9% for RCTs, 10.4% for N trials, and 12.4% forROR trials. Recurrence rates in the N and the ROR trials were statistically indistinguishable at ten-year follow-up (p = 0.1),whereas RCTs show significantly higher recurrence rates than N or ROR at 10-year follow-ups (p<0.001, p<0.001). Comparingonly primary open treatment, the five-year recurrence rate was 18.6% for RCT trials, 11.5% for N trials, and 4.1% for ROR trials.The recurrence rates at 10-year follow-up in the ROR and N trials were 20.1% and 19.7%, respectively. Notably, there was nodata available for 10-year follow-up in RCTs.<b>Conclusions:</b> Observation bias seems to significantly impact the results of ROR studies. Implementing a well-structured, all-encompassing patient follow-up at specific time intervals can effectively mitigate this bias, which might otherwise compromise the validity of our findings.<b>Significance of work:</b> The extent of observation bias in ROR studies compared to RCTs and non-RCTs remains unknown. Ourscrutiny of excision and primary open therapy, the largest therapeutic cohort globally, reveals ROR recurrence rates potentiallydeflated by three to fourfold relative to RCTs or non-RCT findings.

<b>Introduction:</b> The submental island flap, which is based on the submental vessels - the branches of the facial artery and vein - enables simple formation and relocation of the skin of this area.<b>Aim:</b> The goal of this study was a retrospective analysis of reconstructions in the head and neck region performed with pedicled submental flaps, including associated complications and oncological outcomes.<b>Material and methods:</b> A group of 15 patients with submental flap reconstruction (which was used to restore the continuity of the oral mucosa) was analyzed. All patients presented with locally low-advanced squamous cell carcinoma without nodal metastasis (T1-3, N0). The skin perforator was identified with a handheld Doppler device while raising the flap. The skin paddle was moved to the oral cavity. In all patients, the negative margins were confirmed by intraoperative frozen section histological analysis.<b>Results:</b> The vascular disturbances were found in two patients during the postoperative period. Complete flap loss was observed in one case, while in the other, 50% of the skin island became necrotic. Substitution of oral mucosa in the tongue, gum, or cheek with skin did not cause any problems. No significant disturbances in the mobility of the reconstructed tissues were noticed. The wound of the donor site healed without complications.<b>Conclusions:</b> The submental flap seems to be an interesting and uncomplicated reconstructive solution in the treatment of low-grade tumors of the oral cavity.

<b>Introduction:</b> Despite being a potentially avoidable complication, surgical site infection (SSI) remains the most common cause of postoperative complications in surgical wards. Timely medical consultation plays a crucial role in outpatient wound care when concerning symptoms related to wound healing arise. However, an excessive number of inpatient visits leads to a significant increase in patients attending general surgery clinics and the associated costs of postoperative care. Telemedicine (TM) may offer a solution to this problem. The iWound application facilitates wound healing monitoring and may aid in early detection of SSI symptoms.<br><br><b>Aim:</b> Therefore, this study aimed to characterize the group of patients utilizing the iWound application, conclusion of this analysis are included in this manuscript.<br><br><b>Materials and methods:</b> The study was conducted among adult patients who underwent either elective or emergency surgical procedures. Patients received access to the application during hospitalization for postoperative monitoring. Surveys regarding the use of the iWound application in the form of observation journals were conducted within 30 days postoperatively. The study does not bear the characteristics of a medical experiment, which was certified by the Bioethics Committee of the Poznań University of Medical Sciences, number 911/23.<br><br><b>Results:</b> The study included 104 participants aged 18-86 years, with 85.6% utilizing the application. The highest percentage of iWound users was observed in the 18-45 age group (94.4%). All participants who completed therapy with iWound reported satisfaction with its use during the recovery period. Four users developed SSI.<br><br><b>Conclusions:</b> The iWound application was most frequently utilized by younger individuals residing in urban areas and cigarette smokers. There was a higher percentage of willingness to use the application for postoperative wound monitoring among individuals undergoing major and emergency surgical procedures.