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  • Author: Piotr Czyżewski x
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Tomasz Zieliński, Piotr Czyżewski and Marek Szczepkowski

Abstract

The operation to restore the continuity of the gastrointestinal tract is another surgical intervention in a given patient, which directly translates into an increased risk of complications during and after surgery. That is why proper qualification is important for the operation to restore the continuity of the gastrointestinal tract in terms of performance and efficiency of the anal sphincter apparatus, among other things.

The aim of the study was to evaluate the effect of restoring physiological defecation routes on the sphincter function and to observe the parameters of anorectal manometry in patients before and after surgery to restore the continuity of the gastrointestinal tract.

Material and methods. The study included 29 patients scheduled for restoration of the continuity of the gastrointestinal tract, 12 women and 17 men. The average age in the group was 62 years. Anorectal manometry was performed both before surgery as well as one month and three months afterwards in all patients. The average time to have a stoma was 12 months.

Results. The resting pressure in the anal canal (MRP) three months after the restoration of the continuity of the gastrointestinal tract increased by 30.4%. The maximum systolic blood pressure in the anal canal (MSP) increased by 22.2%. The value of recto-anal inhibitory reflex (RAIR) decreased by 19.2%. The length of the high pressure zone in the anal canal (HPZL) increased by 27%. The study results of visceral rectal sensation thresholds decreased by 23.3% for the sensation threshold, and 14.4% for the pressure threshold.

Conclusions. Restoring the continuity of the gastrointestinal tract improves the anal sphincter function which is evident in the parameters of anorectal manometry. The restoration of passage improves the sphincter function, and these changes are statistically significant.

Open access

Piotr Czyżewski, Marek Szczepkowski, Janusz Domaniecki and Aneta Dąbek

Abstract

Aging population, increases the number of major abdominal surgery (MAS) performed in the elderly. Main goal of physiotherapy after that surgery is prevention postoperative complications and reduction of functional limitation.

The aim of the study was to asses functional status elderly people after MAS during early postoperative physiotherapy.

Material and methods. In a prospective randomized study involved 34 patients scheduled for elective MAS, aged 65+. Patients were randomly assigned to receive PNF or conventional physiotherapy. The study included forced spirometry (FVC, FEV1, PEF) and functional tests (gait speed, up&go). Measurements were performed before surgery and the fourth day after surgery. Also analyzed age, sex, BMI and the level of postoperative independence (postoperative independence scale SAP). Kolmogorow- Smirnow test was used to check normal distribution, t-Student was used to check whether two sets of data differ significantly, and r-Pearsons for correlations testing. p values <0.05 were considered significant.

Results. After surgery the time of gait speed test and up and go test was significant longer in comparison to preoperative value. FVC%, FEV1%, PEF% values was decrease. In the PNF group was found significantly higher postoperative independence(SAP) and shorter length of stay in hospital compared to conventional physiotherapy group. Results of SAP and functional tests were significantly positive correlated.

Conclusions. Major abdominal surgery decrees efficiency of walking and lung ventilation after 65 year old in early postoperative period. Some techniques of the PNF concept used in improving older patients after the MAS may favourably affect the postoperative increase independence and reduce the time of hospitalization.

Open access

Piotr Czyżewski, Dominika Hryciuk, Aneta Dąbek and Marek Szczepkowski

Abstract

Early physiotherapy is an important part of the comprehensive treatment of patients after major abdominal surgery (MAS). Accelerated mobilization should be safe and requires the use of appropriate techniques. Most of the physiotherapists and surgeons recommends using abdominal belts. Opponents claim that belts have an adverse effect on lungs ventilation.

The aim of the study was to determine the effect of abdominal belt on lung ventilation efficiency in the early period after MAS.

Material and methods. The study involved 20 patients after MAS. Including 9 women and 11 men, aged between 40 to 90 years (x̅ 66.7). In the scheduled 7 patients and urgent 13. All of them were in the early period after surgery. Dynamic spirometry was performed twice in the postoperative period. For the first time wearing a belt, and then without the belt in the same group. Evaluated the forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF). For the analysis uses the Wilcoxon matched-pairs test and Spearman’s rank correlations. P values <0.05 were considered significant.

Results. The value of the ventilation indicators measured wearing abdominal belt were slightly lower than the values evaluated without the belt. The results are shown in percent predicted for age and gender, FEV wearing belt 52%, without belt 53%; FEV1 59% vs 61%; PEF 46% vs 51%. There were no statistically significant differences

Conclusions. There were no significant negative influence of abdominal belt on lungs ventilation in early period after MAS. There was no correlations between age, body mass index and changes in ventilation indicators.