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Open access

Patryk Fiszer, Sadegh Toutounchi, Ryszard Pogorzelski, Ewa Krajewska, Witold Cieśla and Maciej Skórski

Laparoscopic Adrenalectomy - Assessing the Learning Curve

Laparoscopic adrenalectomy (LA) has become the "gold standard" for treatment of most of adrenal tumors in last few years. It has many benefits comparing to open surgery, but still is considered as complicated procedure requiring experienced surgical team.

The aim of the study was to assess the learning curve of laparoscopic adrenalectomy and the outcome of the first consecutive 154 LA.

Material and methods. 154 consecutive patients undergoing LA between 2007 and 2010 were reviewed. Collected data included: patients demographics, clinical and histological diagnosis, side and length of operation, conversions to open surgery, complications and hospitalization time. Learning curve was evaluated by dividing all patients into three groups (group I - first 50 patients, group II - second 50 patients and group III last 54 patients). Differences between the groups were analyzed.

Results. There were 154 LAs performed. Indications for LA were hormonally inactive adrenal adenoma(n=57), Conn's syndrome (n=30), Cushing's syndrome (n=28), pheochromocytoma (n=27), adrenal cyst (n=8), and others (n=4). Mean tumor size was 45.28 mm. There were 79 left-sided and 75 right-sided procedures and the average time of hospitalization was 4.64 days. Mean operative time was statistically different between the groups (216.2 min. - 164.6 min. - 131.9 min.; p<0.01) as well as the number of conversions to open surgery (18% - 4% - 3.7%; p=0.013). There was not any significant difference in the number of complications between analyzed groups (2% - 2% -3.7%).

Conclusion. To improve the outcome of LA it is necessary to perform approximately 40 to 50 procedures.

Open access

Patryk Fiszer, Ryszard Pogorzelski, Sadegh Toutounchi, Małgorzata Szostek, Ewa Krajewska, Wawrzyniec Jakuczun, Robert Tworus and Maciej Skórski

Results of General Surgical Treatment of Patients Over 80 Years of Age in Single-Site Experience

The aim of the study was to evaluate the results of general surgical treatment of patients over 80 years of age.

Material and methods. Three hundred and four patients aged 80 to 105 years with general surgical disorders, treated in 2005-2009, were retrospectively included in the study. The collected information included demographic data, coexisting diseases, the mode of admission, the diagnosis, the method and result of treatment, and also potential complications and 30-day mortality. The data were subjected to statistical analysis.

Results. The study group included 186 women and 118 men. Two hundred patients (65.8%) were admitted in an emergency setting. The most common causes of immediate hospitalisation were: mechanical ileus (26.5%), gastrointestinal bleeding (22%), trauma (16%), and gall-bladder disorders (8.5%). The remaining 104 (34.2%) patients were operated upon on an elective basis. An emergency operation was required by 121 (60%) of the patients admitted in an emergency setting; the remaining ones were treated conservatively. Hernia plasties (27.5%), cholecystectomies (15.3%), colorectal resections (13.2%), strumectomies (11.2%) and endoscopies (6.1%) predominated among elective surgeries.

The total number of complications and mortality were 19.4% and 14.5%, respectively. The number of complications and mortality were significantly higher in the group of patients admitted in an emergency setting (25.5% and 20.5%, respectively) than in patients admitted on an elective basis (8.7% and 2.9%, respectively), p<0.01.

The mean duration of hospitalisation was 9.7 days (1 to 60 days), with a small difference between the groups of patients treated on an elective and emergency basis (8.5 and 10.4 days), p=0.181.

Conclusions. The results of surgical treatment of elderly patients do not significantly differ from the results of treatment of the general population. Much worse results, coupled with a significant increase in mortality, are observed in patients admitted and treated on an emergency basis.

Open access

Ryszard Pogorzelski, Patryk Fiszer, Sadegh Toutounchi, Ewa Krajewska, Małgorzata M. Szostek, Robert Tworus, Wawrzyniec Jakuczun and Maciej Skórski

Anastomotic aneurysms may develop after any type of vascular surgery, in different areas of the arterial system, and require reoperation. The frequency of occurrence of the above-mentioned is estimated at 1-5%.

Material and methods. During the period between 1989 and 2010, 180 patients with 230 anastomotic aneurysms were subject to surgical intervention at the Department of General and Thoracic Surgery, Warsaw Medical University. The study group comprised 21 (11.7%) female and 159 (88.3%) male patients, aged between 30 and 87 years (mean age - 62.8 years). In relation to the number of anastomoses aneurysms were diagnosed in 2.1% of cases. Twenty-four (10.4%) patients were diagnosed with recurrent aneurysms.

Results. Surgical procedures performed were as follows: artificial prosthesis implantation (119), reanastomosis (40), patch plasty (25), graftectomy (19), prosthesis replacement (9), and stent-graft (7) implantation. 195 (84.8%) aneurysms were subject to planned surgery, while 35 (15.2%) required emergency intervention.

77.8% of patients were diagnosed with aseptic aneurysms, while the remaining 22.2% with infected perioperative aneurysms.

Good treatment results were obtained in 149 (82.8%) patients. Limb amputations were performed in 19 (10.5%) cases. Twelve (6.7%) patients died as a consequence of infection and general complications.

Conclusions. Vascular reoperations are a difficult clinical problem and are burdened with a high rate of complications. The above-mentioned often require complex treatment, in order to improve therapeutic results.

Open access

Ewa Krajewska, Sadegh Toutounchi, Patryk Fiszer, Witold Cieśla, Ryszard Pogorzelski, Tomasz Bednarczuk, Andrzej Cieszanowski, Izabela Łoń and Maciej Skórski

Adrenal Tumors - Diagnostics and the Factual Situation

The study presented three cases of patients diagnosed with adrenal tumors subject to surgical intervention during the past 6 months in our Department. The patients presented with radiological diagnostic difficulties, as to the character and location of the primary tumor.

The aim of the study was to demonstrate differences between radiological examination results and the factual situation observed during the adrenalectomy. In all the presented cases patients' were subject to laparoscopic intervention. In two cases conversion to open surgery was necessary. The histopathological results of the surgically removed samples were as follows: leiomyoma, myoperycytoma and pheochromocytoma. In selected cases imaging examinations might be of limited value, especially when determining the character and location of the primary lesion of the adrenal gland.

Open access

Ryszard Pogorzelski, Sadegh Toutounchi, Patryk Fiszer, Ewa Krajewska, Robert Tworus, Małgorzata M. Szostek, Wawrzyniec Jakuczun and Maciej Skórski

Abstract

Anastomotic aneurysms occurs at various levels of arterial system. Determining their location and incidence rate required investigation of large patient clinical material. Material and methods. In the years 1989-2010 in local centre 230 anastomotic aneurysms were operated in 180 patients. Results. For 187 (81.3%) patients anastomotic aneurysms were localised in the groin, while for remaining 43 (18.7%) they occurred in other localisations. In aortic arch branch they occurred four times (1.7), in descending aorta - three times (1.3%), in abdominal aorta - 14 (6.1%) and in iliac arteries - 6 (2.6%). While for anastomosis with popliteal artery they were diagnosed in 16 (7%) patients. Own clinical material was compared with literature data. Conclusions. Anastomotic aneurysms in over 80% of cases occur in the groin, remaining percentage corresponds to other localisations.

Open access

Ryszard Pogorzelski, Patryk Fiszer, Sadegh Toutounchi, Małgorzata M. Szostek, Ewa Krajewska, Wawrzyniec Jakuczun, Robert Tworus and Maciej Skórski