The aim of the study was assessment of the early and long-term results following surgery for Dupuytren's disease.Material and methods. In this study the treatment results of 74 patients with Dupuytren's disease were revealed. Patients were treated using fasciotomy, selective fasciectomy, subtotal fasciecotmy and dermofasciectomy. Patients were divided into two groups. Group I (n=35) was examined prospectively 3 times: prior to the surgery, 1 and 3 months after it. Group II (n=39) was examined retrospectively once between 3 to 7 years after the surgery. The examination took into account: occurrence of factors predisposing the disease to reappear (Dupuytren's diathesis), hand's function in patient's subjective opinion evaluated with DASH questionnaire and goniometrical measurement of the contracture.Results. Contracture reduction was observed in group I in 94% of patients. The average Total Loss of Extension before surgery was 123.85°, 3 months after operation - 54.51°. In group II the average Total Loss of Extension was 42.63°. Average DASH score in group 1 before surgery was 17.5. One month after the surgery a significant aggravation was observed (average score - 29.95). Three months after the surgery, there was an improvement and DASH score reduced to 15.02. The average DASH score in group II was 4.34. In both groups there was a correlation between patients' age and hand's function. Elder patients evaluated hand's function as better after the surgery. Recurrence of the disease was observed in 17% of patients in group 1 and 33% of patients in group II. Occurrence of predisposing factors (diathesis) increased probability of recurrence in group II. Significant differences in treatment results were not notified because of the surgery technique.Conclusions. This study reveals numerous problems with operative treatment of Dupuytren's disease: faint improvement of hand's function in primary months after surgery, large percentage of recurrences of the disease, a small number of patients with extension of fingers obtained as an outcome of the surgery.
Traumatic rupture of the pancreas is a rare and difficult diagnostic and therapeutic problem. The authors present a case of traumatic rupture of the pancreas (grade IV on AAST scale) where concurrent endoscopic and surgical management was used.
The aim of the study was to describe the authors' experience in performing laparoscopic restorative proctocolectomy with the formation of an intestinal reservoir of the J-pouch type, anal anastomosis and protective ileostomy.Material and methods. Between 2004 and 2011, a total of 23 patients underwent laparoscopic restorative proctocolectomy with the formation of an intestinal reservoir of the J-pouch type, anal anastomosis and protective ileostomy for ulcerative colitis (n = 17) or familial adenomatous polyposis (n = 6). A statistical analysis of the treatment outcomes was performed.Results. No intraoperative complications were observed and none of the patients required conversion or blood transfusions. The mean duration of the procedure was 4.08 hours (2.5-6.0 hours). The mean duration of hospitalization was 15.4 days (8-24 days). We observed three major postoperative complications requiring intervention: two cases of small bowel obstruction (one due to postoperative adhesions and the other due to volvulus) and one case of infection of the surgical and ostomy wound healed following ileostomy closure.Conclusions. For such extensive procedures as restorative proctocolectomy, laparoscopic techniques prove safe and are characterised by a better patient acceptance thanks to the low invasiveness and good cosmetic effects. The technological progress and the increasing experience in performing laparoscopy provide more and more arguments to support the selection of this method as the preferred method of treatment.
The authors presented a case of rectovaginal fistula in a 40-year old female patient after gastrointestinal tract continuity restoration (Hartmann's operation) performed because of iatrogenic rectal damage. The most likely cause of rectovaginal fistula development was the erroneous introduction of the stapler into the vagina and sigmoidovaginostomy during an attempt to reconstruct the continuity of the gastrointestinal tract. In order to reconstruct the continuity of the gastrointestinal tract the patient was subject to anterior rectal resection, sigmoidorectostomy, and closure of the fistula inside the vaginal wall by its duplication. Additionally, a double protective ileostomy was performed, which was subject to closure after three months.
The aim of the study was to assess whether intraoperative use of the "wound scrubbing" technique (iodine solution lavage followed by intensive scrubbing of the wound with a surgical drape) reduces the number of surgical site infection (SSI) incidents, considering patients after colorectal surgery.Material and methods. The study group comprised 98 patients qualified towards colorectal surgery during the period between November, 2007 and November, 2008. Patients were divided into two groups: Fifty patients were subject to the "wound scrubbing" technique (group I), while 48 patients constituted the control group (group II) where the wound was treated traditionally-subcutaneous tissue hemostasis was assured, least traumatically. In case of both groups subcutaneous tissue swabs were collected before wound suturing. Primary cutaneous sutures were applied in all patients. The diagnosis of a surgical site infection was based on the criteria established by the National Nosocomial Infectious Surveillance (NNIS) group.Results. According to the NNIS criteria, superficial SSI was diagnosed in 12 patients (12.3%): 4 from the "wound scrubbing" group (8%) and 8 from the control group (16.7%). Deep tissue infections were not observed. Gram-negative bacteria were most often isolated, both in case of group II patients, and SSI cases. Considering the "wound scrubbing" group 66% of intraoperative swabs proved to be sterile.Conclusions. 1. The "wound scrubbing" technique reduces the risk of SSI in case of patients subject to colorectal surgery. 2. Microbial contamination of the postoperative wound (groups II-IV, according to the NNIS) before the introduction of cutaneous sutures directly influences the frequency of surgical site infections.
The application of endoscopic clips is a routine technique for treatment of non-variceal upper gastrointestinal bleeding. Increasingly, this technique is used to treat complications after surgery, providing an alternative to surgical approach. The authors present two cases of successful endoscopic treatment of gastrointestinal fistulas.
Calcifiyng fibrous pseudotumor (CFPT) is a benign mesenchymal tumor diagnosed in children and young adults, located in the subcutaneous tissue of the trunk and limbs. Its intraabdominal localization is a unique rarity. The Authors of the study presented a case of a 48-year old female patient with an accidentally diagnosed small bowel mesentery tumor during surgery
Paraganglioma is a rare neoplasm originating from extra-adrenal pheochromocytes of the sympathetic and parasympathetic nervous system. It is usually benign and the treatment method of choice is a complete resection of the tumour. The authors present a case of 66-year-old female patient with a multifocal benign retroperitoneal paraganglioma, which was completely removed during surgery.