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Endoscopic Treatment of the Choledocholithiasis - Effectiveness, Safety and Limitations of the Method

100%
Peterlejtner T., Szewczyk T., Firkowski P., Zdrojewski M.
Polish Journal of Surgery
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2012
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vol. 84
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issue 7
333-340
EN
Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is accepted referred method of treatment of the choledocholithiasisThe aim of the study. Evaluation of efficacy and safety of the endoscopic treatment of the biliary tract stones.Material and methods. Results of 3309 Endoscopic Retrograde Cholangio-Pancreatography (ERCP) carried out in Division of Endoscopy of the General Surgery Department in the period 2000 - 2010. The retrospective analysis of the indications, process, findings and final results of 1698 ERCP and Endoscopic Sphincterotomy (ES) was performed with intention to treat of the biliary tract stones.Results. The 883 (52%)patients with coexisted gall-bladder and biliary tract stones were the principal group. The second group included 580 (34.2%) patients with residual choledocholithiasis after cholecystectomy and biliary tract surgery. Moreover ERCP, ES and endoscopic evacuation of biliary stones have been urgently carried out in 159 (9.4%) cases with acute biliary pancreatitis. Lastly ERCP with re-sphincterotomy and removal of the stones was performed in 75 (4.4%) patients with recurrent choledocholithiasis. The procedure was effective in 1561 (92%) patients. When removal of the stones was not possible, decompression of the biliary tract by implantation of the plastic stent was done in 63 (3.7%) cases. Ineffective procedure was noted in 74 (4.3%) patients. The most commonly observed complication was acute pancreatitis. Because of: post ES bleeding, acute haemmorhagic and necrotic pancreatitis, impacted Dormia basket and peripapillary duodenal perforation 10 patients (0.5%) had to be operated. Two patients (0.1%) died.Conclusions. 1. Endoscopic treatment of choledocholithiasis is highly effective but risk factors of complications with urgency an intensive conservative management and surgical intervention have to be considered. 2. After ES, if surgical evacuation of the stones have to be carry out, post operative biliary tract drainage (by T tube) is not necessary.
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Comparison of Microaspiration Around Taperguard Tube Cuffs and Standard Tracheal Tubes in Obese Patients Subjected to Surgery Under General Anesthesia

88%
Gaszyńska E., Ratajczyk P., Wieczorek A., Szewczyk T., Gaszyński T.
Polish Journal of Surgery
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2015
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vol. 86
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issue 3
107-110
EN
Tracheal secretion leakage might lead to ventilator-associated pneumonia. Standard tracheal tube cuffs are cylindrical in shape. Bronchial tree aspiration is observed in the presence of leakage past tracheal tube cuffs. The new TaperGuard tracheal tube has a cuff in the shape of a cone, preventing from the development of microtubules and microaspiration. The aim of the study was to compare standard tracheal tube cuffs with TaperGuard tubes, in terms of protection from microaspiration under general anesthesia. Material and methods. The observational study evaluated incidents of leakage during general anesthesia with intubation and mechanical ventilation in patients with significant obesity. The study group comprised 20 patients with the BMI >40 kg/m2 subjected to elective surgery under general anesthesia with intubation and mechanical ventilation, randomly divided into two subgroups: standard tracheal tube and TaperGuard tube. Results. In 4 of 10 patients with standard tracheal tubes we observed leakage around the cuff. In case of TaperGuard tubes no such leakage was observed. Conclusion. TaperGuard tubes protect against microaspirations, while standard tracheal tubes have no such properties.
3
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Colonoscopic Polypectomy - Evaluation of the Effectiveness and Safety (Single Center Experience)

76%
Peterlejtner T., Szewczyk T., Buczyńska E., Zdrojewski M., Firkowski P., Kwiasowski R., Wojtowicz Ł.
Polish Journal of Surgery
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2011
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vol. 83
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issue 8
438-442
EN
Colonoscopy is currently accepted as the golden standard in the detection of pre-malignant lesions, and reduction of the incidence of colorectal cancer in patients with adenomatous polyps.The aim of the study was to determine the diagnostic value of colonoscopy in case of patients with clinical symptoms suggesting the possibility of colorectal pathology, as well as evaluate the technical aspects and results of colonoscopic polypectomies, considering the efficacy and safety of the above-mentioned procedures.Material and methods. Retrospective analysis of the course and results of the polypectomies performed during 3638 colonoscopies was undertaken, considering patients with suspicion of colorectal pathology.Results. Complete colonoscopy with cecal intubation was performed in 3310 (91%) cases. Colonoscopic polypectomies were performed during 806 (22.1%) examinations. Single polyps were detected in 459 (56.9%) cases, while multiple lesions in 347 (43.1%) cases. The total number of removed polyps amounted to 1184. There were 882 (74.6%) adenomas of which 225 (25.5%) were considered as an advanced pathology. Moreover, the pathologist detected 4 malignant polyps with features of adenocar-carcinoma. In case of 30 examinations, adenomas coexisted with colorectal cancer and were removed preoperatively. Post-polypectomy bleeding was observed after 15 (1.7%) polypectomies, although only two patients required surgery. Moreover, amongst the 343 rectal polyps, 19 (6%) non-pedunculated lesions were surgically removed (18 of them by means of the trans-anal approach).Conclusions. The method proved effective and the polyps were detected and removed in more than 22% of the colonoscopic examinations. In two (0.28%) cases surgical intervention was required, in order to stop post- polypectomy bleeding from the polyp's peduncle. Some of the rectal polyps (6%) had to be surgically removed. Preoperative endoscopic "clearance" of large bowel polyps, facilitated the adjustment of the resection margin in subsequent colorectal cancer surgery.
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