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Laparoscopic Spleen Preserving Procedures

100%
Budzyński A., Gwóźdź A., Kulawik J., Strzałka M., Matłok M.
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issue 12
619-627
EN
Laparoscopic splenectomy evolved into one of the principal operations of the spleen. High short- and long-term morbidity associated with asplenia has prompted surgeons to implement spleen preserving procedures.The aim of the study was to evaluate laparoscopic spleen preserving procedures with regard to their feasibility and treatment results.Material and methods. Prospective evaluation of treatment results in patients submitted to laparoscopic operations of the spleen in 2nd Department of General Surgery CM UJ in Cracow.From August 1998 until May 2009 we performed 278 laparoscopic operations of the spleen. The group consisted of 164 females and 114 males, of which 256 (92.09%) patients were operated on electively and 22 (7.91%) in emergency settings. 235 patients (84.53%) were assigned to total splenectomy (most for ITP - 142 patients). In 43 patients (15.47%) the laparoscopic spleen preserving procedure was attempted. The indications included rupture of the spleen, cysts, tumors and abscess.Results. Laparoscopic spleen preserving procedure was successfully performed in 23 out of 43 patients (53.49%). There were 9 excisions of the splenic cysts, 8 hemostases from ruptured spleen, 5 resections of the tumors and one drainage of the abscess. Postoperative complications were observed in 16 (7.66%) patients after total splenectomy, including 8 (3.4%) infectious. 3 patients (6.98%) after spleen preserving procedure were re-operated due to bleeding. There were no infectious complications in this group.Conclusions. There is a limited number of indications for laparoscopic procedures preserving splenic parenchyma. Despite high failure rate attempts to perform laparoscopic spleen sparing operation are usually beneficial due to low risk of complications, particularly infections.
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Laparoscopic Transperitoneal Approach to Adrenal Gland Malignancies

86%
Rembiasz K., Budzyński A., Kulawik J., Matłok M., Migaczewski M., Hubalewska-Dydejczyk A., Gołkowski F.
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issue 12
609-618
EN
Even though there is not enough good data, the use of laparoscopic approach in malignant disease is regarded by some controversial issue. On the other hand it seems that transperitoneal access to the adrenal gland allows for effective and safe oncological removal of adrenal gland neoplasms.The aim of the study was to present our experience with the use of transperitoneal approach in patients with adrenal gland malignancies.Material and methods. From March 2003 till May 2009 we performed 200 laparoscopic transperitoneal adrenalectomies. There were 82 hormonally silent tumors (1.5-14 cm in diameter) and 118 hormonally active (63 pheochromocytomas, 26 Conn's syndrome, 25 Cushing's syndrome and 4 virylizing tumors).Results. 197 procedures were completed laparoscopically and 3 were converted (including one for inability to assess resectablility of the tumor). 14 tumors (7%) were overtly malignant; 7 arising form the adrenal (adrenal cortex - 3, pheochromocytoma - 3, lymphoma - 1) and 7 metastatic (squamous cell cancer of the lungs - 2, clear cell carcinoma of the kidney - 2, collecting duct carcinoma of the kindey - 1, hepatocellular cancer - 1, NET lung tumor - 1). Further 19 tumors (9.5%) were assessed histologically as potentially malignant (pheochromocytomas - 16, tumors of neural origin - 2, oncocytomas - 1). One malignant tumor was unresectable other were operated radically. Progression of the cancer was observed in 3 patients with metastatic tumors.Conclusions. Laparoscopic transperitoneal adrenalectomy allows for safe and radical removal of adrenal gland malignancies. Longer follow-up and larger patients volume are needed for better evaluation of long-term results.
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Occurrence of New Adenomas in Patients After Performed Radical Endoscopic Polypectomy

86%
Matłok M., Budzyński A., Pędziwiatr M., Bahyrycz J., Kulawik J., Zazula M., Kuczia P.
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issue 12
628-634
EN
The aim of the study was to analyze recurence of large intestine adenomas after polypectomy and its co-incidence with DNA microsatellite instability (MSI).Material and methods. Among 2880 patients who underwent polypectomy during colonoscopy in our department from June 2004 to February 2007 we revealed adenomas in 259 cases (8.99%). Then we chose 97 patients who agreed to participate in further study. Mean age of the group was 65.1 yrs. In these patiens we removed 207 adenomas of the large intestine. Within 90-360 days all of the patients underwent control colonoscopy in our department. All removed lesions were verified histologically and genetically to determine presence of microsatellite instability.Results. In 15 (17.4%) patients we revealed recurence of adenomas. Microsatellite instability was detected in 16 (18.6%) patients. The recurence of polyps was more frequent in patients with MSI (4 cases - 25%) than in patients without MSI (11 cases - 15.7%).Conclusions. In our opinion further study may help to determine the group of patients with faster adenoma recurence. In those cases more frequent colonoscopy may be justified.
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