Polski przeglad chirurgiczny最新文献

<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.

<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.