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EN
Biliary stones are the most common etiology of acute pancretitis (AP). Pathomechanism of this etiology is based on common channel theory of Opie.Material and methods. 113 patients with ABP were included in the study - 91 with mild and 22 with severe form of ABP. 17 patients with cholelithiasis and choledocholithiasis without ABP served as controls. All the patients were submitted to the same model of treatment. Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sfincterotomy (ES) were performed in the day of admission and laparoscopic cholecystectomy within the next 24 hours. Bile specimens were taken from main bile duct (MBD) during ERCP and from gall-bladder (GB) during laparoscopic cholecystectomy. Bacteriological cultures, bile acids (BA) concentration and total and secretory form of IgA concentration were assessed in particular groups of patients.Results. No significant statistical differences of bile infection in MBD and GB were found between the analyzed groups of patients. Furthermore, the bile among the patients with severe ABP was more frequently infected, particularly when obtained from gall-bladder. Most common pathogens found in cultures were Gram negative bacteria. Interestingly, Gram positive cultures and fungi were also significant. The number of species of pathogens was of no significance for infection concerning both: source of bile and groups of patients. Mean concentrations of total BA were different between study groups of patients in MBD and in GB. It is worth mentioning, that the fraction of hydrophobic, secondary BA which are potentially more toxic, was increased in total concentration of BA in MBD particularly in patients with severe form of AP. Among patients with mild AP and controls these values were lower and similar.Conclusions. It seems that BA play as an aggressive factor during AP while in physiologic condition have a protective, antibacterial meaning.
EN
Laparoscopic surgery is becoming an approved technique in pancreatic surgery. It offers some advantages over an open approach due to shorter hospital stay and decreased complication rate. Regardless the technique the most significant problem of pancreatic surgery is postoperative pancreatic fistula. There are numerous methods attempted at reduction of its incidence. One of the possibilities is preoperative pancreatic duct stenting. It aims at decreasing the pressure in the pancreatic duct, which is supposed to facilitate pancreatic juice flow to the duodenum. The aim of the study was to determine the role of preoperative pancreatic duct stenting in pancreatic surgery. Material and methods. Nineteen patients undergoing laparoscopic pancreatic resection were enrolled into the study. Prior to the surgery, all of the patients were submitted for the Endoscopic Retrograde Choleangiopancreatography (ERCP) with pancreatic duct stenting. Following the subsequent laparoscopic pancreatic resection, all patients were monitored to detect the pancreatic fistula appearance. The pancreatic stent was removed 6‑8 weeks after the surgery. Results. With an exception of two patients, all other patients underwent successful ERCP with pancreatic duct stenting before the surgery. In one case the placement of the prosthesis failed due to a tortuous pancreatic duct. Five patients had an episode of acute pancreatitis including two severe courses as a complication of preoperative ERCP. One of the patient died due to severe GI bleeding 2 weeks after stenting. Among the procedures there were 15 distal pancreatectomies, two enucleations of the tumor localized in the uncinate process and in the body of the pancreas and one central pancreatectomy. The median time of surgery duration was 186 minutes (90‑300; ±56). No conversions to an open approach were necessary. Likewise, there was neither any major complications reported in a postoperative course nor incidence of pancreatic fistula in any of the patients undergoing surgery. Conclusions. Preoperative pancreatic duct stenting can decrease the incidence of pancreatic fistula. However, a number of serious complications exceed the potential benefit of this method.
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