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Results of Surgical Treatment of Total Rectal Prolapse by Posterior Sutured Rectopexy

100%
Ziembikiewicz A., Krasnodębski I.
Polish Journal of Surgery
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2007
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vol. 79
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issue 11
692-700
EN
The aim of the study was to evaluate the immediate and delayed results of posterior rectopexy in the treatment of total rectal prolapse, its influence on constipation and fecal incontinence, as well as patient quality of life after the procedure.Material and methods. The study group comprised 70 patients who underwent the above-mentioned procedure at the Department of Proctology, Solec Hospital in Warsaw during the period between 1976 and 2003. The study group consisted of 62 female and 8 male patients, aged between 19 and 88 years (mean age 59.9 years). All patients underwent posterior rectopexy. Thirty (43%) of the surgical patients responded to the questionnaire, including 18 (26%) who presented for the postoperative examination. The following were determined: intraoperative complications, frequency of recurrence, fecal incontinence according to Wexner's scale, constipation, influence of the procedure on sphincter condition, and patients' quality of life.Results. All patients underwent total rectal prolapse surgery. Mortality and severe complications were not observed. Rectal prolapse recurrence was not observed. The percentage of intraoperative complications amounted to 4%, and that of postoperative complications 9%. Fecal continence improvement after the operation was confirmed on the basis of Wexner's scale. After surgery the percentage of patients with constipation slightly increased (80% vs 87%).Conclusions. Posterior rectopexy enables the treatment of total rectal prolapse, and is considered to be the most simple, effective and safe operative method, with a low rate of complications and recurrence in patients who qualify for laparotomy. Surgery significantly improves the patients' quality of life.
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Implementation of the Fast Track Surgery in Patients Undergoing the Colonic Resection - Own Experience

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Morończyk D., Krasnodębski I.
Polish Journal of Surgery
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2011
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vol. 83
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issue 9
482-487
EN
A perioperative care in the colorectal surgery has been considerably changed recently. The fast track surgery decreases complications rate, shortens length of stay, improves quality of life and leads to cost reduction. It is achieved by: resignation of a mechanical bowel preparation before and a nasogastric tube insertion after operation, optimal pain and intravenous fluid management, an early rehabilitation, enteral nutrition and removal of a vesical catheter and abdominal drain if used.The aim of the study was to compare the results of an implementation the fast track surgery protocol with results achieving in the conventional care regimen.Material and methods. Two groups of patients undergoing colonic resection have been compared. The study group was formed by patients treated with fast track concept, the control group - by patients who were dealt with hitherto regimen. Procedures needed stoma performing, rectal and laparoscopic surgery were excluded. The perioperative period was investigated by telephone call to patient or his family.Results. Statistical significant reduction was reached in a favour of the fast track group in the following parameters: the length of hospital stay (2.5 days shorter), duration of an abdominal cavity and vesicle drainage (3 and 2 days shorter respectively), postoperative day on which oral diet was implemented (2,5 days faster) and finally extended (1.5 days faster). There were no statistical difference in mortality, morbidity neither reoperation rate between two groups.Conclusion. The fast track surgery is a safe strategy and may improve a perioperative care.
3
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Fast Track Surgery Particularly in Case of Patients Undergoing Colonic Resection

100%
Morończyk D., Krasnodębski I.
Polish Journal of Surgery
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2011
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vol. 83
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issue 1
55-61
4
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Dr Hab. Stanisław Świtka, M.D. 1929-2009

99%
Krasnodębski I.
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issue 11
587-589
5
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Recommendations of Association of Polish Surgeons and Polish Society of Oncological Surgery Gastrointestinal Fistulae in Patients Treated for Malignancy - Diagnostics and Treatment

52%
Szawłowski A., Pertkiewicz M., Drews M., Dziki A., Krasnodębski I., Kulig J., Lampe P., Stojcev Z., Wallner G., Zegarski W.
Polish Journal of Surgery
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2008
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vol. 80
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issue 12
694-711
EN
Postoperative gastrointestinal fistulae occur more often in patients undergoing surgical treatment for oncological reasons than non-oncological reasons. Fistula is associated with a number of serious sequelae and complications: fluid and electrolyte abnormalities, acid-base abnormalities, local and systemic infection and progressive cachexia that increase morbidity, treatment duration and mortality. Development of fistula additionally delays or prevents specific treatment in oncology. For a patient, a fistula is associated with both physical and mental suffering resulting from concern over further therapy.Although the introduction of advanced surgical techniques, intensive postoperative care, total parenteral nutrition and modern enteral nutrition, resulted in decreased postoperative mortality, however the number of patients with gastrointestinal fistulae hospitalized in the departments of surgery is not decreasing. This may result from the fact that many patients still present for treatment in the advanced phase of their malignancy (clinical stage III/IV according to International Union Against Cancer - UICC) and consequently in worse general status, which poses a high risk of postoperative complications and requires more extensive procedures in progressively older patients. Thus gastrointestinal fistulae still remain a serious clinical problem. Main components of treatment of fistulae include: adequate draining, fighting of infections, artificial nutrition and drugs that decrease gastrointestinal secretion (e.g. somatostatin) that are intended to create conditions for spontaneous fistula healing. Some cases may require an early or late surgical intervention.
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