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Open access

Bartosz Goyke, Elżbieta Goyke, Tomasz Śledziński, Krystian Adrych, Sylwia Raczyńska, Zbigniew Śledziński and Julian Świerczyński

Human Serum Paraoxonase Activity Decreases After Vertical Banded Gastroplasty*

The aim of the study. Investigation of the effect of vertical banded gastroplasty (VBG), which is an effective method of treating patients with morbid obesity on serum paraoxonase (PON) activity.

Material and methods. Serum PON activity was measured in twenty eight morbidly obese patients 6 and 12 months after surgery. PON activity was also measured in the serum and liver of rats maintained on a restricted diet for one month.

Results. We found that VBG-induced significant reduction in body weight and serum PON activity at 6 and 12 months after surgery. Similar patterns of decreases in serum paraoxonase activity in obese patients after VBG were observed in A, AB and B paraoxonase/esterase phenotypes. After VBG, several clinically relevant events occurred: a) a decrease of serum triacylglycerol concentration was observed; b) no significant changes in total serum cholesterol and LDL-cholesterol concentrations were found; c) serum HDL-cholesterol concentration increased slightly.

Paraoxonase activity in the serum of rats maintained on a restricted diet, which induced approximately 30% and 50% of rat body weight and fat mass loss, respectively, was lower than in control animals.

Conclusions. This study indicates that after VBG significant decreases in serum paraoxonase activity occur in obese subjects. It is likely that less food ingestion and possibly a different type of food consumed by the obese subjects after VBG (compared to type of food consumed before surgery) may contribute to decreases in serum PON activity.

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

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 J. Stefaniak, Dariusz Łaski, Maciej Patrzyk, Justyna Bigda and Zbigniew Śledziński

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

Bartosz Skonieczny, Maciej Pytka, Tomasz Stefaniak, Wojciech Skonieczny, Zbigniew Grzybowski and Zbigniew Śledziński

Factors Influencing Frequency of Conversion During Laparoscopic Cholecystectomy

The aim of the study was to evaluate factors influencing the frequency of conversion during laparoscopic cholecystectomy; to observe dynamic trends concerning frequency of classic versus laparoscopic cholecystectomies; and to evaluate correlations between the experience of a surgeon and conversion incidence.

Material and methods. A retrospective study was performed, reviewing the records of 3337 patients operated on for gallbladder stones from January 2000 to December 2005 in three hospitals in the Pomeranian Region of Poland: Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk; Department of Surgery, 110th Military Hospital in Elbląg and Department of Surgery, Hospital in Słupsk.

The main issues evaluated were: dynamic changes in frequency of laparoscopic versus classic cholecystectomies; frequency of conversions, reasons for conversion; correlation between experience of a surgeon and conversion incidence; and demographic data.

Results. Out of 3337 patients, there were 2390 (71.62%) females and 947 (28.3%) males. For these patients, 1493 procedures (45.2%) were performed as classical, 1804 (54.06%) as laparoscopic, and 176 (9.7%) as converted from laparoscopy to open procedure. Sex distribution in the laparoscopic group was 1352:452 (F:M 74.9%:25.05%) and in the converted group was 107:69 (60.8%:39.2%).

The main problems relating to conversion during laparoscopic cholecystectomy were: adhesions - 108 (61.36%), gall-bladder perforations - 8 (4.5%), tumors - 10 (5.6%), technical problems - 28 (15.9%), hemostasis problems - 11 (6.25%), unrecognizable anatomical structures - 24 (13.6%), complications of ‘e fundo’ cholecystectomy - 24 (13.6%) and equipment problems - 4 (2.27%).

It was also observed that SHO's and surgeons with greater experience are performing more conversions during laparoscopic procedures.

Conclusions. Laparoscopic cholecystectomy is a safe procedure recommended as a gold standard for gallbladder stone treatment. Frequency of this procedure is rising in centers in the Pomeranian region.

The highest incidence of conversions is associated with adhesions after previous open operations.

Consultants perform earlier conversion due to greater experience and better estimation of risk factors.

Open access

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.

Open access

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.

Open access

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.

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.