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Open access

Marcin Strzałka, Maciej Matyja and Kazimierz Rembiasz


Nowadays laparoscopy is used frequently not only in elective surgery but also in abdominal emergencies, including acute appendicitis. There are several techniques used to close the appendicular stump during laparoscopic appendectomy.

The aim of the study was to present the results of minimally invasive appendectomies performed with the use of titanium clips.

material and methods. Patients operated on laparoscopically for acute appendicitis with the application of titanium clips between October 2012 and December 2013 were included in the study. We reviewed retrospectively patients` data including: age, sex, duration of the surgical procedure and hospital stay, mortality, intraoperative and postoperative complication rates.

Results. There were 93 patients (mean age=33.8 years, SD=15.23) in the analyzed group, including 60 men (mean age=33.5 years, SD= 15.07) and 33 women (mean age=33.9 years SD=15.26). The aver-age duration of the surgical procedure was 66 min (SD= 33.15). The average length of hospital stay was 3.38 days (SD=1.62). No intraoperative complications were observed in the analyzed group. Post-operative complication rate was low (6 cases, 6.5%). No mortality was observed.

Conclusions. Laparoscopic appendectomy with the application of titanium clips for closure of the appendicular stump is safe, associated with low complication rates and should be considered as a routine technique in everyday surgical practice.

Open access

Andrzej Budzyński, Anna Gwóźdź, Jan Kulawik, Marcin Strzałka and Maciej Matłok

Laparoscopic Spleen Preserving Procedures

Laparoscopic splenectomy evolved into one of the principal operations of the spleen. High short- and long-term morbidity associated with asplenia has prompted surgeons to implement spleen preserving procedures.

The aim of the study was to evaluate laparoscopic spleen preserving procedures with regard to their feasibility and treatment results.

Material and methods. Prospective evaluation of treatment results in patients submitted to laparoscopic operations of the spleen in 2nd Department of General Surgery CM UJ in Cracow.

From August 1998 until May 2009 we performed 278 laparoscopic operations of the spleen. The group consisted of 164 females and 114 males, of which 256 (92.09%) patients were operated on electively and 22 (7.91%) in emergency settings. 235 patients (84.53%) were assigned to total splenectomy (most for ITP - 142 patients). In 43 patients (15.47%) the laparoscopic spleen preserving procedure was attempted. The indications included rupture of the spleen, cysts, tumors and abscess.

Results. Laparoscopic spleen preserving procedure was successfully performed in 23 out of 43 patients (53.49%). There were 9 excisions of the splenic cysts, 8 hemostases from ruptured spleen, 5 resections of the tumors and one drainage of the abscess. Postoperative complications were observed in 16 (7.66%) patients after total splenectomy, including 8 (3.4%) infectious. 3 patients (6.98%) after spleen preserving procedure were re-operated due to bleeding. There were no infectious complications in this group.

Conclusions. There is a limited number of indications for laparoscopic procedures preserving splenic parenchyma. Despite high failure rate attempts to perform laparoscopic spleen sparing operation are usually beneficial due to low risk of complications, particularly infections.

Open access

Maciej Matyja, Marcin Strzałka and Kazimierz Rembiasz


It is generally agreed that laparoscopic appendectomy is a valuable operative method.

The aim of the study was to evaluate cost-effectiveness of three different techniques used to close the appendix stump.

Material and methods. We conducted a retrospective study that compared three groups of patients who were operated on laparoscopically for acute appendicitis in 2013 at our institution. We used an endoscopic clip to close the appendix stump in the first group (n=20), endoscopic stapler was applied in the second group (n=20), and in the third group of patients the appendix base was closed with a laparoscopic suture (n=20). These groups were matched by age, sex and BMI.

Results. The average operative cost was the highest in the second group. Cost of the laparoscopic appendectomy with the application of the endoscopic clip was significantly lower (first group) and comparable to the third group. Observed differences in total hospitalization costs were associated only with the chosen appendix stump closure technique.

Conclusions. Clip closure of the appendix base is an easy and cost-effective procedure. The laparoscopic suture technique is the cheapest but technically demanding. According to our experience endoscopic stapler may be useful in some cases, although it is the most expensive method.

Open access

Marcin Strzałka, Andrzej Budzyński, Andrzej Bobrzyński, Piotr Budzyński and Anna Gwóźdź

Analysis of Conversion Rates and Reasons in Minimally Invasive Surgery

Nowadays the number and range of laparoscopic procedures is quickly increasing and contraindications are limited. But laparoscopic operations cannot be performed in every case, what leads to conversion.

The aim of the study was to present the conversion rates and reasons in different types of laparoscopic procedures, both emergency and elective.

Material and methods. 7685 patients operated laparoscopically in the 2nd Department of General Surgery of the Jagiellonian University between 1993 and 2008 were included in the study. Minimally invasive approach was used at the beginning in 608 patients with acute appendicitis (average age = 28,4 years), in 101 patients with perforated peptic ulcer (average age = 46.4 years), in 236 patients who underwent splenectomy (average age = 41 years), in 166 patients who had adrenalectomy (average age = 53 years), in 117 patients who underwent Nissen fundoplication (average age = 44,4 years), in 834 individuals who had inguinal hernia repair (average age = 49.4 years), in 5311 who had cholecystectomy (average age = 52.1 years and in 212 patients who underwent other procedures.

Results. The conversion rates in the analyzed period were 2.88% in whole material, in case of appendectomy 3,95%, perforated ulcer operation 19,80%, splenectomy 2.12%, adrenalectomy 1.81%, Nissen fundoplication 1.71%, inguinal hernia repair 0.96% and cholecystectomy 2.92%. Emergency surgery was related to higher (4.98%) conversion rate than elective procedures (1.88%). Most frequently convestions were related to technical reasons (2,48%), than enforced by complications (0.41%).

Conclusion. Most conversions were caused by technical reasons, not complications. The change of the approach from laparoscopic to open one was more frequent in case of emergency procedures.

Open access

Marcin Strzałka, Maciej Matyja, Maciej Matłok, Marcin Migaczewski, Piotr Budzyński and Andrzej Budzyński

Laparoscopic single access technique is a next step in development of minimally invasive surgery.

The aim of the study was to present results of different laparoscopic single incision procedures and evaluate application of this technique.

Material and methods. 102 patients (15 males and 87 females) who underwent laparoscopic single incision procedure from 15th October 2009 to 31st December 2012 were included in the study.

Results. In the analyzed period we performed 72 cholecystectomies (70.6%), 8 left adrenalectomies (7.8%), 3 right adrenalectomies (2.9%), 7 splenectomies (6.9%), 5 spleen cysts unroofings (4.9%), 2 appendectomies (2%), 1 Nissen fundoplication procedure (1%), 1 removal of the adrenal cyst (1%) and 3 concomitant splenectomies and cholecystectomies (2.9%). There were 3 technical conversions to multiport laparoscopy, but no conversion to open technique. Complications were observed in 5 patients (4.9%). Average operation time was 79 min (SD=40), average hospitalization time 2.4 day (SD=1.4).

Conclusions. Laparoscopic single incision technique is a safe method and can be used as a reasonable alternative to multiport laparoscopy in different minimally invasive procedures especially in young patients to whom an excellent cosmetic effect is particularly important.

Open access

Anna Zacharko-Siembida, Jose Luis Valverde Piedra, Bolesław Strzałka and Marcin Bartłomiej Arciszewski


The quantities and distribution patterns of serotonin-immunoreactive (serotonin-IR) enterochromaffin cells (EC) were studied immunohistochemically in the small intestine of suckling piglets stimulated with red kidney bean lectin, and in nonstimulated, control animals. The co-expression patterns of serotonin with somatostatin (SOM) or corticotropin releasing-factor (CRF) were also studied. After the lectin treatment, the increased numbers of EC were noted in the duodenum of experimental animals. Lectin stimulation did not change the proportions of EC in the jejunum and ileum. In the duodenal epithelium of the lectin-stimulated piglets, the vast majority of serotonin-IR EC were distributed at the basis of crypts. After the lectin administration, the proportions of serotonin-IR/SOM-IR EC were statistically similar in all sections of the small intestine. No upregulation of CRF was found in duodenal, jejunal, and ileal EC of lectin-treated animals. The findings demonstrated that red kidney bean lectin increased the serotonin reservoir in the duodenum, and thus may be an effective stimulant of the gut maturation in suckling mammals.

Open access

Maciej Matyja, Marcin Strzałka, Anna Zychowicz, Damian Kołodziej, Kazimierz Rembiasz and Andrzej Budzyń


One of the most commonly performed surgeries in general surgery wards with laparoscopic technique as a method of choice is gall-bladder excision. In addition to -the commonly used conventional laparoscopic cholecystectomy single incision laparoscopic cholecystectomy is getting more and more attention. Despite many works and studies comparing these methods, there is still a shortage of results assessing efficiency of this new surgical technique. The aim of the study was to evaluate cost-effectiveness of this method in Polish financial reality. We have analyzed costs of three different surgical techniques: conventional (multi- incision) laparoscopic cholecystectomy, SILC and ‘no -port’ SILC. Material and methods. We conducted a retrospective study that compared three groups of patients who underwent treatment with conventional laparoscopic cholecystectomy (n=20), SILC (n=20) and no-port SILC (n=20). These groups were matched by age, sex and BMI. Following parameters were analyzed: complication rate, operative time, operative costs, length of hospital stay, hospitalization costs. The SILC cases were performed with one of the three-trocar SILC ports available on the market. The ‘no- port’ SILC cases were performed by single skin incision in the umbilicus, insertion of one 10 mm trocar for the operating instrument, another instrument and scope were inserted directly thorough small incisions in the aponeurosis without a dedicated port Results. The average operative cost was significantly higher in the SILC group comparing to the conventional laparoscopy group and the no-port SILC group. There was no significant difference in complication rate, operative time, length of hospital stay, or hospitalization costs between the three groups Conclusions. Currently the cost of the dedicated SILC port does not allow a regular use of this procedure in Polish financial reality. According to our experience improved cosmesis is the only advantage of the single incision laparoscopy, therefore we believe that it is reasonable to consider this technique in a a very selected group of patients.