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Open access

Monika Proczko-Markuszewska, Tomasz Stefaniak, Łukasz Kaska and Zbigniew Śledziński

Early Results of Roux-en-Y Gastric By-Pass on Regulation of Diabetes Type 2 in Patients with BMI Above and Below 35 Kg/m2

The idea of surgical treatment of type 2 diabetes was established in the U.S. and was based on observation of patients after bariatric operations. Performed in cases of morbid obesity exclusion of the duodenum and anastomose the stomach with the central part of the intestines cause shortened absorbtion of nutrients, what showed a beneficial effect on weight loss, resolution of comorbidities and reduce the risk of developing cardiovascular diseases and cancer. Analysis of the results of surgical treatment of obese patients with type 2 diabetes confirmed the usefulness of surgical methods.

The aim of the study was to evaluate the impact of Roux-en-Y gastric by-pass (RYGB) on diabetes in patients with BMI below and above 35 kg/m2.

Material and methods. The study comprised 66 patients with DM2, who underwent Roux-en-Y gastric bypass due to morbid obesity (BMI above 35 kg/m2) and three patients with DM2 and BMI below 35 kg/m2. In patients with DM2 and BMI < 35 kg/m2 criteria for inclusion in the operational treatment were: DM2 difficult to be regulated pharmacologically lasting less than 10 years and BMI at the qualification about 35 kg/m2. Indications have been determined on the basis of three consecutive measurements of HbA1c values above 7%, and measurements of blood glucose (frequent fluctuations in blood glucose levels on the value of hypoglycemia to hyperglycemia).

Results. The criteria for diagnosing resolution of DM2 included the level of HbA1c < 6% and glucose fasting level below 100 mg/ dl. In a group of 66 patients with DM2 and obesity, regression of DM2 was observed in 48 patients (73%) as early as during the hospitalization. In 11 patients (16.7%) glycaemia and HBA1c were stabilized within 8 weeks after surgery. In 7 (10.6%) cases of patients with difficult to control DM2, there was still need for antidiabetic medication, but glycemic control was much more effective. After one year remission was observed in 89% of patients. In all three patients with DM2 and BMI < 35 kg/m2 total glycemic resolution of DM2 was observed during hospitalization. In this group there has been no postoperative complications. In the group of 66 obese patients with DM2 postoperative complications were found in 7 cases, they were related to infection and prolonged healing of surgical wound. One patient had an intraabdominal abscess located in the left subphrenic region, it was punctured under ultrasound guidance.

Conclusions. The ultimate evaluation of this method demands several years of meticulous clinical studies. Despite of that, considering high cost of life-long conservative therapy of DM2 and its complications, severe impact on quality of life and serious consequences of the disease, the surgical metabolic intervention may become the most resonable solution in many cases.

Open access

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).

Open access

Tomasz Śledziński, Monika Proczko-Markuszewska, Łukasz Kaska, Tomasz Stefaniak and Julian Świerczyński

Serum Cystatin C in Relation to Fat Mass Loss After Bariatric Surgery"

Serum cystatin C concentration, generally accepted as renal function marker, is associated with cardiovascular risk and metabolic syndrome. Recent studies indicate that cystatin C increases in human obesity and that adipose tissue contributes to enhanced serum cystatin C concentration in obese subjects.

The aim of the study was to assess whether a reduction in body and fat mass after bariatric surgery has any impact on serum cystatin C concentrations.

Material and methods. Serum from 27 obese patients were tested before and 6 months after bariatric surgery. Twenty healthy subjects with normal body weight served as controls. Serum cystatin C concentrations were assayed by ELISA.

Results. Serum cystatin C concentrations were significantly higher in obese patients compared with non-obese subjects. Decrease of body and fat mass after bariatric surgery resulted in improvement of several parameters associated with cardiovascular risk and metabolic syndrome, like serum lipids, blood pressure and insulin sensitivity. Surprisingly the mean postoperative serum cystatin C concentration was not significantly different from that before surgery. Serum creatinine and GFR also remained unchanged.

Conclusion. The results presented here suggest that serum cystatin C concentration is not tightly associated with body and fat mass loss in obese patients after bariatric surgery.

Open access

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.