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Usefulness of Electrosurgical Techniques in Thyroid Gland Surgery

100%

Kowalski B., Bierca J., Zmora J., Kołodziejczak M., Kosim A., Frączek M.

Polish Journal of Surgery

2012

vol. 84

issue 5

225-229

Wide propagation of new generation of electrosurgical devices such as bipolar vessel sealing systems (eg. Thermostapler® by EMED) enabled seamless closing of blood vessels with a diameter up to 7 mm while maintaining the necessary safety margin, as well as reducing the duration of the operation. We decided to verify these reports in our material.Aim of the study was comparison of thyroid surgery performed with the electrocautery tool - Thermostapler ® by EMED with surgery using classic hemostasis technique to evaluate the operative time and complications in the form of bleeding, recurrent laryngeal nerve paralysis, symptoms of hypoparathyroidism, and wound infection.Material and methods. We retrospectively analyzed 256 patients operated in the Department of General and Proctological Surgery Solec Hospital in Warsaw due to inert thyroid goitre. All patients underwent total thyroidectomy. Patients were divided into two groups. The first group consisted of 126 patients operated in 2000, using classic techniques of hemostasis. While the second group consisted of 130 patients operated in 2007-2008 with Thermostapler®. We compared duration of surgery and the incidence of postoperative complications.Results. The operative time was significantly shorter (average 18 minutes) in the second group of patients. We also recorded a statistically significant decrease in the incidence of complications in the group operated with Thermostapler.Conclusions. Use of bipolar vessel sealing system in a decisive manner shortens the duration of operation. Use of bipolar vessel sealing system also enables a radical reduction in the incidence of complications rate such as bleeding, recurrent laryngeal nerve paralysis, symptoms of hypoparathyroidism, and wound infection. In the future, similar studies should be performed to assess the real costs resulting from the use Thermostapler®.

Esophagogastric Junction Versus Gastric Carcinoma - Implications for Surgical Tactics on the Basis of Own Experience

100%

Frączek M., Hevelke P., Komorzycki K., Kotulski M., Kalinowski P., Górnicka B., Krawczyk M.

Polish Journal of Surgery

2007

vol. 79

issue 9

600-609

The exact prevalence and results of treatment of the carcinoma of esophagogastric junction (gastric cardia) are difficult to assess, and the data concerning thereof, presented in different series of patients, are frequently inconsistent. This phenomenon may result from terminological mess, resulting in different comprehension of the sole term "esophagogastric junction". That can be why the results of treatment of patients with this type of cancer are dispersed in the literature and may be as well found under "esophageal", as well as "gastric cancer" headings.The aim of the study was to present the current view of the pathogenesis, pathology and terminological issues concerning this tumor, interesting at least for its localization at the border of two viscera and two body cavities. On the basis of our own material, we also tried to delineate the implications of such a localization to surgical tactics.Material and methods. The patients with esophagogastric junction and more peripherally located gastric cancer were analysed in two groups, according to the date of resectional surgery performed: From 1989 to 1998 (group I), and from 1999 to 2005 (group II). In each group the patients with esophagogastric junction and peripheral gastric cancer were investigated separately. The influence of more aggressive approach to cardial cancer (additional thoracotomy approach) in group II patients on the cancer free tissue margin, number of metastatic lymph nodes excised, as well as on survival rate during a 5-years follow-up was assessed.Results. The results show, that the additional thoracotomy, despite the increase in postoperative complications rate (mainly affecting the respiratory system- 19 vs 4.3% at laparotomy alone), did not influence the perioperative motality in our patients (approximately 5% in all subgroups). Despite the additional thoracotomy approach, facilitating the safe lower esophageal resection, the cancer free margins of the excised specimens remained unsatisfactory (the target safe margin value of 7 cm), although some improvement can be noted as compared with group I patients. The interesting finding was, that the survival rates following gastrectomy for ‘peripheral’ gastric carcinoma has been remaining practically unchanged during the 20 years of this study. Survival rates following gastric cardia resection improved in group II patients, but the differences did not reach the statistically significant level. The difference in survival rate was increasing with time in favor of group II patients, its value being triple at 5 years from surgery (18 vs 6%) as compared with group I.Conclusions. We see the need for the development of a method allowing to select the patients with good prognosis, in whom further radicalization of resectional procedures (and subsequent treatment) would be justified by long-term disease-free survival.

Wytyczne leczenia przetok przewodu pokarmowego. Stanowisko Grupy Ekspertów Towarzystwa Chirurgów Polskich

68%

Sobocki J., Jackowski M., Dziki A., Tarnowski W., Banasiewicz T., Kunecki M., Słodkowski M., Stanisławski M., Zaczek Z., Richer P., Matyja A., Frączek M., Wallner G.

Polish Journal of Surgery

2021

vol. 93

issue 4

57-69

Wstęp: Nieszczelność przewodu pokarmowego należy do najtrudniejszych problemów w chirurgii przewodu pokarmowego. Związana jest ona z: wysoką chorobowością i licznymi powikłaniami, dużym ryzykiem zgonu, przedłużoną hospitalizacją oraz zwielokrotnieniem kosztów leczenia. Cel: Zadaniem zespołu było opracowanie zaleceń dotyczących leczenia przetok przewodu pokarmowego zgodnie aktualną wiedzą medyczną w celu ograniczenia śmiertelności oraz chorobowości związanej z leczeniem. Materiały i metody: Opracowanie niniejszych zaleceń oparto na przeglądzie dostępnego piśmiennictwa z baz PubMed, Medline i Cochrane Library z okresu od 1.01.2010 do 31.12.2020, ze szczególnym uwzględnieniem przeglądów systematycznych oraz zaleceń klinicznych uznanych towarzystw naukowych. Zalecenia sformułowano w formie dyrektywnej i poddano je ocenie metodą Delphi. Wyniki i wnioski: Przedstawiono 9 zaleceń wraz z omówieniem oraz uwagami ekspertów. Leczenie powinno być prowadzone w oparciu o zespół wielodyscyplinarny (chirurg, anestezjolog, specjalista żywienia klinicznego/dietetyk, pielęgniarka, farmaceuta, endoskopista).

Polish Consensus on Treatment of Gastric Cancer; Update 2013

68%

Kulig J., Wallner G., Drews M., Frączek M., Jeziorski A., Kielan W., Kołodziejczyk P., Nasierowska-Guttmejer A., Starzyńska T., Zinkiewicz K., Krawczyk M.

vol. 85

issue 9

544-562

1000 Liver Transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw - Analysis of Indications and Results

33%

Krawczyk M., Grąt M., Barski K., Ligocka J., Antczak A., Kornasiewicz O., Skalski M., Patkowski W., Nyckowski P., Zieniewicz K., Grzelak I., Pawlak J., Alsharabi A., Wróblewski T., Paluszkiewicz R., Najnigier B., Dudek K., Remiszewski P., Smoter P., Grodzicki M., Korba M., Kotulski M., Cieślak B., Kalinowski P., Gierej P., Frączek M., Rdzanek Ł., Stankiewicz R., Kobryń K., Nazarewski Ł., Leonowicz D., Urban-Lechowicz M., Skwarek A., Giercuszkiewicz D., Paczkowska A., Piwowarska J., Gelo R., Andruszkiewicz P., Brudkowska A., Andrzejewska R., Niewiński G., Kilińska B., Zarzycka A., Nowak R., Kosiński C., Korta T., Ołdakowska-Jedynak U., Sańko-Resmer J., Foroncewicz B., Ziółkowski J., Mucha K., Senatorski G., Pączek L., Habior A., Lechowicz R., Polański S., Leowska E., Pacho R., Andrzejewska M., Rowiński O., Kozieł S., Żurakowski J., Ziarkiewicz-Wróblewska B., Górnicka B., Hevelke P., Michałowicz B., Karwowski A., Szczerbań J.

Polish Journal of Surgery

2012

vol. 84

issue 6

304-312

The aim of the study was to analyze indications and results of the first one thousand liver transplantations at Chair and Clinic of General, Transplantation and Liver Surgery, Medical University of Warsaw.Material and methods. Data from 1000 transplantations (944 patients) performed at Chair and Clinic of General, Transplantation and Liver Surgery between 1994 and 2011 were analyzed retrospectively. These included 943 first transplantations and 55 retransplantations and 2 re-retransplantations. Frequency of particular indications for first transplantation and retransplantations was established. Perioperative mortality was defined as death within 30 days after the transplantation. Kaplan-Meier survival analysis was used to estimate 5-year patient and graft survival.Results. The most common indications for first transplantation included: liver failure caused by hepatitis C infection (27.8%) and hepatitis B infection (18%) and alcoholic liver disease (17.7%). Early (< 6 months) and late (> 6 months) retransplantations were dominated by hepatic artery thrombosis (54.3%) and recurrence of the underlying disease (45%). Perioperative mortality rate was 8.9% for first transplantations and 34.5% for retransplantations. Five-year patient and graft survival rate was 74.3% and 71%, respectively, after first transplantations and 54.7% and 52.9%, respectively, after retransplantations.Conclusions. Development of liver transplantation program provided more than 1000 transplantations and excellent long-term results. Liver failure caused by hepatitis C and B infections remains the most common cause of liver transplantation and structure of other indications is consistent with European data.

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Usefulness of Electrosurgical Techniques in Thyroid Gland Surgery

Esophagogastric Junction Versus Gastric Carcinoma - Implications for Surgical Tactics on the Basis of Own Experience

Wytyczne leczenia przetok przewodu pokarmowego. Stanowisko Grupy Ekspertów Towarzystwa Chirurgów Polskich

Polish Consensus on Treatment of Gastric Cancer; Update 2013

1000 Liver Transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw - Analysis of Indications and Results