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Anatomical Aspect of Nerve-Preserving Surgery for Rectal Cancer

100%
Gryglewski A., Kibil W., Walocha J., Kulig J.
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vol. 85
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issue 5
289-293
2
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Mammotome Biopsy Under Ultrasound Conrol in the Diagnostics and Treatment of Nodular Breast Lesions - Own Experience

100%
Kibil W., Hodorowicz-Zaniewska D., Kulig J.
Polish Journal of Surgery
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2012
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vol. 84
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issue 5
242-246
EN
Mammotome biopsy is an effective, minimally invasive, novel technique used in the verification of breast lesions.The aim of the study was to assess the value of ultrasound-guided vacuum-assisted core needle biopsy (mammotome biopsy) in the diagnostics and treatment of nodular breast lesions, considering own data.Material and methods. Analysis comprised 1183 mammotome biopsies under ultrasound control performed in 1177 female patients during the period between 2000 and 2010, at the Regional Clinic for Early Diagnostics and Treatment of Breast Lesions, I Chair and Department of General Surgery, Jagiellonian University, Collegium Medicum.Results. The average patient age amounted to 41.7 years. The size of the investigated lesions ranged between 4 and 65 mm (mean - 12 mm). The histopathological examination result was as follows: fibrocystic lesions (n=285), adenofibroma (n=477), adenosis sclerosans (n=188), hyperplasia without atypy (n=58), phyllode tumor (n=2), papilloma (n=14), hamartoma (n=1), atypical hyperplasia (n=25), in situ ductal carcinoma (n=4), in situ lobular carcinoma (n=5), infiltrating ductal carcinoma (n=114), infiltrating lobular carcinoma (n=4), non-diagnostic result (n=6). The histopathological diagnosis was obtained in 99.5% of cases. Patients diagnosed with atypical hyperplasia or cancer were qualified for surgery, according to accepted standards. The presence of a hematoma was the most common complication after the biopsy, observed in 16.5% of patients.Conclusions. The obtained results confirmed the high value of ultrasound-guided biopsies in the diagnostics of nodular breast lesions. The method is safe, minimally invasive, with few complications, providing a good cosmetic effect. In case of benign lesions with a diameter of less than 15 mm the mammotome biopsy enables to completely excise the lesions, being an alternative to open surgical biopsies. The mammotome biopsy should become the method of choice considering the diagnostics of nodular breast lesions.
3
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Mammotome biopsy in diagnosing and treatment of intraductal papilloma of the breast

88%
Kibil W., Hodorowicz-Zaniewska D., Popiela T. J., Szpor J., Kulig J.
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vol. 85
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issue 4
210-215
EN
Intraductal papilloma is a benign breast tumor which needs histopathological verification because of the risk of cancer coincidence. The aim of the study was to assess the value of the mammography-guided and ultrasound-guided vacuum-assisted core biopsy in the diagnosis and treatment of intraductal papillomas of breast and to answer the question if mammotome biopsy allows to avoid surgery in these patients. Material and methods. In the period 2000-2011, a total of 2246 vacuum-assisted core biopsies were performed, of which 1495 were ultrasound-guided and 751 were mammography-guided (stereotaxic). In 76/2246 patients (3.4%), aged 19-88 years (mean age was 51,5) histopathological examination confirmed intraductal papilloma. Results. Atypical lesions were accompanying intraductal papilloma in 16/76 cases (21%). Open surgical biopsy performed in these group revealed invasive cancer in 3 women. In all 60 cases (79%) with benign papilloma in biopsy specimens, further clinical observation did not show recurrence or malignant transformation of lesions. Conclusions. Vacuum-assisted core biopsy is a minimally invasive and efficient method used for diagnosing intraductal papilloma of the breast. If histopathological examination confirms a benign character of the lesion, surgery may be avoided but regular follow-up is recommended. However, in all cases histopathological diagnosis of papilloma with atypical hyperplasia, should always be indication for surgical excision.
4
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Treatment of Esophageal Achalasia - Pneumatic Dilatation Vs Surgical Procedure

76%
Kawiorski W., Popiela T., Kibil W., Richter P., Kulig J., Popiela T.
Polish Journal of Surgery
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2007
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vol. 79
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issue 11
635-642
EN
Esophageal achalasia, one of the most common motor activity disturbances of the upper gastrointestinal tract, continues to pose a significant diagnostic and therapeutic problem, especially in patients with milder forms of the disease.The aim of the study was to evaluate and compare treatment results (pneumatic dilatation, cardiomy-otomy) in patients with esophageal achalasia, as well as determine the usefulness of intraoperative, continuous manometric monitoring of the corrected segment of the "esophagogastric junction" (evaluation of myotomy).Material and methods. The study group comprised 104 patients, including 71 female and 33 male, treated at the Department during the period between 1997 and 2004. The mean patient age was 43.5 years, ranging between 19 and 75 years. The duration of the disease ranged between 5 months and 22 years.Every patient was subjected to endoscopy, histopathological, radiological and manometric examinations, before treatment. The therapeutic model was based on a two-staged management process. During the initial stage of therapy, patients were subjected to 2-3 pneumatic dilatations. A lack of response to treatment was considered treatment failure and these patients qualified for surgery - Heller's myotomy with antireflux treatment (fundoplication). Cachectic patients requiring immediate surgical intervention were excluded from the study.Results. Following pneumatic dilatation, good or very good results were obtained in 73 (70.2%) of the 104 patients. Procedures were repeated in only 8 (11%) patients, due to the recurrence of dysphagia. The remaining 31 (29.8%) patients underwent surgery with simultaneous intraoperative manometric control of the performed myotomy.Conclusions. Based on the obtained results, one can confirm the significant efficacy of pneumatic dilatation, which is considered the ultimate therapy. In the case of patients in whom we were not able to obtain good clinical results, one observed improved esophagogastric passage, which in turn improved nutritional parameters before planned surgical intervention.Intraoperative esophageal manometry enabled us to accurately evaluate the correctness of myotomy, which seemed to be an indispensable element in the prevention of disease recurrence.
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