Polski przeglad chirurgiczny最新文献

<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.

<b>Introduction:</b> Gold standard treatment for locally advanced esophageal cancer is subtotal resection of the esophagus with resection of regional lymph nodes. Despite being performed in experienced and specialized centers, this procedure is associated with a high rate of complications. Complications such as anastomotic fistula and leakage can be life-threatening, primarily resulting from inadequate blood circulation in the anastomosis area. <br><br><b>Aim:</b> The aim of the study is to present the results of intraoperative indocyanine green (ICG) application in order to verify the adequate perfusion in esophagogastric anastomosis. <br><br><b>Materials and methods:</b> This is a single-center prospective analysis of 32 patients who underwent subtotal esophagectomy with regional lymph node resection for esophageal carcinoma. In all cases, intraoperative perfusion assessment using ICG fluorescence imaging (ICG-FI) was performed. Patient characteristics, comorbidities, and postoperative outcomes were analyzed, with treatment effects monitored for up to 1 year postoperatively. <br><br><b>Results:</b> Six patients required gastric conduit reduction due to poor blood perfusion visualized by intraoperative ICG-FI. Anastomotic leakage occurred in two cases, which were managed endoscopically with endo-vac therapy and esophageal stent placement. The remaining patients did not require additional surgical interventions during the postoperative course. <br><br><b>Conclusions:</b> The use of ICG dye in esophageal surgery appears to be a beneficial tool for objective assessment of perfusion that may be a valuable prediction factor in the postoperative course.

<b>Introduction:</b> Tension faecopneumothorax (TFP) is a rare but potentially lethal complication of missed diaphragmatic injuries, wherein the herniated intestine perforates, releasing gas and faeces-contaminated fluids in the pleural cavity. This leads to an increase in the intrapleural pressure to levels that exceed the atmospheric pressure and results in adverse effects, which include mediastinal shift, kinking of the great vessels, reduced venous return, and cardiovascular collapse. <br><br><b>Aim:</b> This article was composed to review the profile of the cases of tension faecopneumothorax arising as a complication of missed diaphragmatic injuries, as reported in the recent literature. <br><br><b>Materials and methods:</b> A systematic literature search was conducted through electronic databases, including PubMed, Scopus, and Google Scholar, using the keywords and terms 'tension faecopneumothorax ', 'delayed diaphragmatic rupture', 'missed diaphragmatic injury', 'delayed tension faecopneumothorax', and 'traumatic diaphragmatic herniation'. Only literature in English was considered for inclusion in this study, and the time frame of 20 years was fixed between 2004 and 2024. <br><br><b>Results:</b> A total of 12 cases with a mean age of 45.2 years were included in the review. Abdominal pain, respiratory distress, and hemodynamic instability were the major presenting clinical features, manifesting acutely or gradually with sudden deterioration. All the hernias were left-sided and herniation of transverse colon was found in 11 (91.7%) cases. All the cases were managed by laparotomy with or without thoracotomy. There was one mortality and intensive care for variable periods was required in 4 (33.3%) cases. <br><br><b>Conclusions:</b> Tension faecopneumothorax is a rare and potentially lethal complication of missed diaphragmatic injuries that may appear even after years of trauma. This condition needs to be considered as a possible differential diagnosis, when a patient of sudden onset respiratory distress is being evaluated, particularly if there is a past history of blunt or penetrating abdominothoracic trauma.

<b>Introduction:</b> Chronic kidney disease (CKD) is a global public health problem, occurring more frequently in developed countries. In Poland, it affects approximately 4 million people, which constitutes 10.8% of the population. End-stage renal disease (ESRD) requires renal replacement therapy - dialysis therapy or kidney transplantation. Kidney transplantation, supported by immunosuppressive therapy, is the preferred method of treating ESRD, improving the quality and length of life of patients.<b>Aim and Methods:</b> The aim of the study was to determine the long-term effects of kidney transplantation, including proper graft function, the frequency of adverse effects of immunosuppressive therapy, the degree of patient compliance with therapeutic recommendations, and the incidence of malignancies. A survey was conducted in a group of 137 patients who underwent kidney transplantation between 2006 and 2015. Hospitalization data were also analyzed, including age, body weight and blood type of the recipient.<b>Results:</b> Of the 137 patients studied, 61 were women and 76 were men. The mean age of the patients was 45.1 years. The most common etiology of CKD was glomerulonephritis. After kidney transplantation, 86.86% of patients declared normal graft function. Post-transplant weight gain was noted in 75.18% of patients. 11.68% of recipients developed malignancies, with an average time from transplantation to diagnosis of 5.1 years. Of the patients with cancer, 93.75% maintained normal graft function.<b>Conclusions:</b> Long-term effects of kidney transplantation are satisfactory, with a high percentage of patients maintaining normal graft function. Complications associated with immunosuppressive therapy are comparable to literature data. It is necessary to increase patient awareness of modifiable risk factors to improve treatment outcomes. The incidence of malignancy after transplantation is lower than in the literature, but the methodological limitations of the study must be taken into account. Cancer treatment had no significant effect on graft function in most cases.

<b>Introduction:</b> Ventral hernias are common among patients with liver cirrhosis.<b>Aim:</b> The aim of our work was to evaluate potential risk factors for major postoperative morbidity after ventral hernia repair in cirrhotic patients.<b>Material and methods:</b> A retrospective cohort study was performed in 45 consecutive cirrhotic patients that underwent ventral hernia repair between 2005 and 2022. Major morbidity was defined as Clavien-Dindo ≥ IIIa at 30 days postoperatively. Uni- and multivariate analysis was performed to identify risk factors for major postoperative complications.<b>Results:</b> In our cohort, we observed an overall postoperative 30-day morbidity rate of 53.33% (n = 24), with 40% (n = 18) of cases classified as Clavien-Dindo IIIa or above. Elevated serum creatinine level preoperatively was identified as a statistically significant risk factor, both in the uni- as well as the multivariate analysis for major morbidity (OR = 31.08; 95%CI [29.51-32.65]; P = 0.028).<b>Conclusions:</b> Increased creatinine levels were found to be a significant modifiable factor for major morbidity after ventral hernia repair in cases with cirrhosis. This finding underlines the impact of preoperative medical management of cirrhotic patients on postoperative outcome in this patient population.

<b>Introduction:</b> In various pathological conditions, including cancer, transforming growth factor-beta (TGF-β) emerges as a pivotal cytokine.<b>Aim:</b> This study sought to evaluate TGF-β concentrations in blood serum samples and explore potential associations between pre- and post-surgery TGF-β levels in patients with differentiated thyroid cancer and forms of nodular goiter.<b>Material and methods:</b> A total of 70 patients were included, aged 26 to 79, undergoing thyroidectomy for: differentiated thyroid cancer (11), neutral nodular goiter (46), and hyperactive nodular goiter (13). Serum TGF-β1 values were assessed using the Bio-Plex Pro™ Human Cytokine Assay from Bio-Rad Laboratories, and data were analyzed with Bio-Plex Manager™ software.<b>Conclusions:</b> This investigation aimed to provide insights into the dynamics of TGF-β concentrations in the context of thyroid pathologies, utilizing a comparative approach before and after surgical intervention.

<b>Introduction:</b> Papillary thyroid carcinoma (PTC) is the most common malignant thyroid cancer. However, its detection rateremains unsatisfactory. One of the most widely studied diagnostic methods in oncology is the use of microRNA (miR) molecules.Current literature indicates that miR-200c-3p, miR-221-3p, and miR-222-3p seem to be promising biomarkers of PTC.<b>Aim:</b> The aim of the study was to explore the usability of these circulating miRs as diagnostic biomarkers for PTC.<b>Materials and methods:</b> The study group (N = 20) included patients with post-operative histopathological confirmation of papillary thyroid carcinoma, while the control group (N = 10) consisted of patients who underwent thyroidectomy due to non-toxic nodular goiter (ntNG). A Real-Time PCR was used to assess the expression of each biomarker in blood serum.<b>Results:</b> The significant increase in miR-200c-3p expression in blood serum was observed among PTC patients (FC = 6.85)in comparison to controls (ntNG), while no significant differences were observed in the case of miR-221-3p and MiR-222-3pexpression between PTC and ntNG groups. The ROC curve analysis revealed that miR-200c-3p could be employed asa potential diagnostic tool in PTC.<b>Conclusions:</b> miR-200c-3p may have discriminative value in the diagnostics of PTC.

<b>Introduction:</b> <i>Pectus excavatum</i> (PE) is the most common chest wall deformity. Minimally invasive repair techniques based on the Nuss procedure are a mainstay of treatment. However, intraoperative cardiac injury, though rare, can be a devastating complication.<b>Aim:</b> This study aimed to evaluate a modification of the Nuss procedure designed to minimize the risk of serious complications.<b>Material and methods:</b> A retrospective analysis of medical records for 38 patients treated with a modified Nuss procedure forPE was conducted. The specific modifications to the surgical technique were described.<b>Results:</b> No intraoperative complications were observed in the analyzed patients. In 3 patients (7.9%), early complicationsafter surgery occurred, with none relating to the modification of the surgical technique.<b>Discussion:</b> Minimally invasive PE repair carries a risk of serious complications, prompting the development of variousmodifications. These modifications often involve techniques of sternal elevation and retrosternal dissection to achieve clearview throughout the procedure.<b>Conclusions:</b> The Nuss procedure with sternal elevation and thoracoscopic retrosternal dissection offers a simple andpotentially safer approach to PE repair.

<b>Introduction:</b> The laparoscopic method is a treatment method with proven effectiveness. In 2008, we started treating patients with this method. We present treatment results in unselected patients. This is a retrospective observation.<b>Aim:</b> The present article demonstrates the results of a 5-year postoperative follow-up in a group of patients who underwent laparoscopic colorectal surgery. We also assessed the importance of basic risk factors such as tumor stage, age, gender, type of complication, and conversion requirement for the survival of patients.<b>Material and methods:</b> In total, 212 patients with colon or rectal cancer were subjected to a standard laparoscopic procedure. In the case of rectal and sigmoid tumors, a mini-laparotomy was performed in the left iliac fossa. In the case of right hemicolectomy, an anastomosis was created above the abdominal walls. The results were statistically processed. As many as 80% (171) of patients were followed up.<b>Results:</b> Overall survival was 66.08%, while cancer-related survival - 61.4%. The cancer recurrence rate was 21.47%. In a multivariate analysis: assuming the same age of diagnosis, an increase in tumor stage by one category according to Dukes causes a 102.532-fold increase in the risk of death within the first 5 years after surgery.<b>Conclusions:</b> The results of laparoscopic colorectal cancer treatment in our material are similar to those reported in the literature. The most important prognostic factor for the long-term survival of patients in our material was the stage of cancer.