Beata Jabłońska, Paweł Lampe, Adam Dziki, Andrzej Matyja, Zbigniew Śledziński and Grzegorz Wallner
Andrzej Rafał Hellmann, Stanisław Hać, Justyna Kostro, Marcin Hellmann and Zbigniew śledziński
Mateusz Jagielski, Marian Smoczyński, Michał Studniarek, Zbigniew Śledziński and Krystian Adrych
The paper presents description of the effective treatment of patients with extensive consequences of necrotizing pancreatitis. The strategy of treatment was to extend access to necrotic areas („step-up approach”). Applied endoscopic transmural access (transgastric), percutaneous access (transperitoneal) and surgical access. The cooperation endoscopist, surgeon and interventional radiologist gave very beneficial clinical effects in patients with extensive complications of acute pancreatitis.
Dariusz Zadrożny, Zbigniew Śledziński, Michał Studniarek, Sebastian Dobrowolski, Tomasz Gorycki, Walenty Adamonis and Kamil Bury
Percutaneus Thermoablation in Patients with Primary and Secondary Liver Cancer - Early Results
Liver is common place where the cancer occurs primary as well as secondary. Liver resection as a potentially healing method can be performed only in about 20% of patients. Prognosis in group of patients treated non-invasively is bad. Using high frequency thermal ablation which damages the neoplastic tissue in liver may lead to prolongation of life expectancy.
The aim of the study was to assess the early results of using the high frequency thermal ablation in patients with primary or secondary cancer.
Material and methods. During years of 2001-2007 371 patients underwent the 520 procedures of percutaneous RF thermal ablation under US control. Mean age of patients was 62.47 (19-85 ± 11.63). 175 women and 196 men were treated using this method.
Results. There were 10 early complications after thermal ablation (1.92% of procedures, 2.7% of patients). Two of them ended fatal (0.38% of procedures, 0.54% of patients). In seven cases absces formation were observed, one of them was the cause of death due to Clostridium perfingens infection. Cholerrhagia from damaged bile duct in cirrhotic liver caused the peritonitis and subsequent death of patient. Two patients suffered from sub-capsular hematoma of liver. 14 patients also suffered from long lasting pain (more than 14 days).
Conclusions. Percutaneous thermal ablation in primary or secondary liver tumors is safe and efficient procedure. Long term follow up will give the knowledge about the real value of the procedure.
Tomasz J. Stefaniak, Dariusz Łaski, Maciej Patrzyk, Justyna Bigda and Zbigniew Śledziński
Monika Proczko-Markuszewska, Jarosław Kobiela, Tomasz Stefaniak, Andrzej Łachiński and Zbigniew Śledziński
Postoperative PTH Measurement as a Predictor of Hypocalcaemia After Thyroidectomy
Hypocalcemia after thyroidectomy is the most common postoperative complication with reported incidence from 0.5% to even half of the operated patients. Hypoparathyroidism could be a result of careless or inadequate preparation during the surgical procedure. There is a variety of proposed options for prediction of the incidence of hypocalcemia. The most effective of them are the perioperative and intraoperative measurements of PTH level.
The aim of the study was to assess the potential correlation between the iPTH levels after the operation and development of hypocalcaemia. The possible prediction value of postoperative iPTH levels was to be evaluated assessed.
Material and methods. A prospective study was performed on 100 patients who underwent total thyroidectomy from January 2007 to June 2009. The total calcium level and intact human PTH (iPTH) levels were measured 24 hours before, 1 and 24 hours after the surgery.
Results. We have presented a significant correlation between early iPTH measurement and risk of hypocalcaemia. Moreover a significant correlation between the iPTH level 1 hour after operation with the calcium level 24 hours after the operation was demonstrated.
Conclusions. Early postoperative assessment of iPTH levels can be used to identify the group of patients at risk of hypocalcaemia after thyroidectomy. Pre-emptive calcium supplementation can lead to avoidance of complications causing prolonged hospital stay and most importantly to prevent severe hypocalcemia.
Monika Proczko, Łukasz Kaska, Jarek Kobiela, Tomasz Stefaniak, Dariusz Zadrożny and Zbigniew Śledziński
Recent years, obesity is a growing health problem also in patients with chronic renal failure and end it’s end stage. This situation has a negative impact both on the extension of the waiting period for transplantation, and the survival rate of the transplanted organ and the recipient. Weight loss through lifestyle modification before transplantation is ambiguous. Its well known fact of rapid body mass gain after transplantation, and finnaly the results of transplantation are not better than those of patients who have not reduced body weight.
The paper presents preliminary experience associated with bariatric operations of three chronic dialysed patients with morbid obesity BMI> 35 kg/m2, all patients had been treated by Roux-en-Y gastric by-pass (RYGB). All operated patients were classified as potential recipients were listed by Poltransplant. One of them three months after RYGB surgery underwent without complications a renal transplantation. Preliminary experiences based on operating these three caese confirmed the complete safety of this type of approach in patients with end-stage chronic kidney disease (CKD).
Paweł Mroczkowski, Stanisław Hać, Michał Mik, Maciej Berut, Łukasz Dziki, Rainer Kube, Zbigniew Śledziński, Hans Lippert and Adam Dziki
Preliminary Results of the First Quality Assurance Project in Rectal Cancer in Poland
When compared with other EU countries, Poland is in the last place in terms of efficacy of rectal cancer treatment. In order to remedy this situation, in 2008 Polish centres were given the opportunity to participate in an international programme for evaluating the treatment efficacy.
The aim of the study was to present the results obtained during the first two years of research.
Material and methods. The study protocol covered 71 questions concerning demographic data, diagnostics, risk factors, peri- and post-operative complications, histopathology, and treatment plan at discharge. The patient and unit data were kept confidential.
Results. From 1 January 2008 to 30 December 2009, there were 709 patients recorded, of which 55.9% were males. At least one risk factor was found in approx. 3/4 of patients, while approx. 1/3 of patients were classified to group 3 and 4 according to ASA. The mean distance of the tumour from the anal margin was 8.5 cm; approx. 70% of patients were in the clinical stages cT3 and cT4; metastases were observed in 18.8%. Transrectal endoscopic ultrasonography (TREUS) was performed in 23.7% of patients, magnetic resonance imaging (MRI) in 2.5% and computed tomography (CT) scan - in 48.1%. In close to half of the patients, anterior or low anterior resection of the rectum was performed, and abdominoperineal resection in 1/4 of the patients. Anastomotic leakage was seen in 3.8% of patients, while 1.8% died during hospitalisation.
Conclusions. It should be strived after that all the centres undertaking the treatment of rectal cancer should participate in the quality assurance programme. This should enable the achievement of good therapeutic results in patients with rectal cancer treated in Polish centres.
Tomasz Stefaniak, Joanna Dziedziul, Anna Walerzak, Katarzyna Adamczyk, Derek Gill, Ad Vingerhoets, Dominika Babinska, Magdalena Trus, Andrzej Lachinski and Zbigniew Śledziński
Impact of Menthal Representation of Disease and Wound-Related Subjective Perception of Disease on Convalescence After Surgical Treatment
Compared to open surgery, laparoscopic treatment has been shown to have several advantages, including lower levels of postoperative pain, faster recovery, and better cosmetic results. Nevertheless, the advantages of laparoscopy are being debated as possibly not being merely related to biomedical factors.
Material and methods. The study consisted of two sub-studies. In the first study, 150 healthy, previously unoperated volunteers, not employed in the health services, were included. Healthy volunteers, from the latter study, were given questionnaires that presented different sizes of post-operative wounds and examined their perception of the severity of the illnesses that were treated by surgery leading to these wounds. In the second study, data was collected from 65 laparoscopic cholecystectomy patients and 35 patients treated by the open approach cholecystectomy. Patients from the second study were examined prior to operation and 1 month after surgery with a questionnaire evaluating their subjective perception of the disease.
Results. Subjective perception of the severity of disease (SPSD) was similar between the laparoscopy and the open approach cholecystectomy patients before the operation (respectively, 6.25±1.7 and 6.06±2.2; ns). At the follow-up, a significant decrease of SPSD among laparoscopy patients was observed (post-op score = 3.28±0.8, p<0.05 in paired t-Student test), but not in the open approach patients (6.42±1.7, ns in paired t-Student test). The volunteers perceived that the disease of the laparoscopically treated patients was less serious than the disease of those treated with open surgery.
Conclusions. The authors would like to emphasize that the study presents a new approach to the explanation of the so called "laparoscopy phenomenon", i.e. much faster and smoother recovery after relatively larger and more serious surgical procedures. We believe that the benefits observed among the videoscopy patients might be, apart from immunological and pain-related factors, attributed to the psychological influence of cognitive representations of the disease severity on pain, analgetics use, and recovery.
Tomasz Stefaniak, Jacek Reszetow, Łukasz Żemojtel, Jarosłstrok;aw Kobiela, Wojciech Makarewicz, Łukasz Kaska, Jacek Krajewski, Monika Proczko-Markuszewska, Barbara Kwiecińska, Andrzej Łachiński, Andrzej Basiński and Zbigniew Śledziński
Videothoracoscopic Simultaneous Bilateral Posterior Splanchnicectomy - Initial Report
Chronic pain syndrome (CPS), accompanying pancreatic diseases, especially chronic pancreatitis and pancreatic cancer requires the strongest analgesic agents and is considered difficult to manage. Conservative methods are unsatisfactory and their side effects lead to serious somatic and mental comorbidities.
The aim of the study was to perform an initial evaluation of videothoracoscopic bilateral splanchnicectomy using the posterior approach, as the method of treatment in cases of advanced pancreatic cancer.
Material and methods. During the period between May and July 2005 there were 10 simultaneous bilateral videothoracoscopic splanchnicectomies (BVSPL) performed in patients with chronic pain syndrome, due to advanced pancreatic cancer, at the Department of General, Endocrinological and Transplant Surgery, Medical University of Gdańsk.
Results. All patients were discharged from the hospital on the second postoperative day. Subjective pain measured by the VAS scale changed from 84.3±7.6% before the operation to 25.3±5.3% during the first and second postoperative days. The median follow-up of patients was approximately 4 months (ranging between 2 and 6 months). The intensity of pain 2, 6, and 12 weeks after the procedure was 28.7±4.7%, 30.3±5.4% and 36.2±4.7%, respectively.
Conclusions. This is the first description of this safe and feasible method in the Polish surgical literature. The surgical procedure can be safely performed in most surgical departments equipped with videoscopic instruments. Moreover, the short learning curve enables surgeons to perform this procedure well after a short training period. In combination with good results concerning subjective pain reduction, it can be concluded that BVSPL should be incorporated into the spectrum of surgical procedures in most surgical departments in Poland.