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Prevalence and Progression of Acute Pancreatitis in the Świętokrzyskie Voivodeship Population

100%
Głuszek S., Kozieł D.
Polish Journal of Surgery
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2012
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vol. 84
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issue 12
618-625
EN
Acute pancreatitis (AP) is a significant clinical problem. There have been no prospective epidemiological data on AP in Poland. The aim of this study is to estimate prevalence, etiology and severity of acute pancreatitis in the Świętokrzyskie Voivodeship population, involving risk factors of this disease. Material and methods. In 2011 prospective observation was conducted in all departments of surgery of the Świętokrzyskie Voivodeship. The inclusion criterion of the study, a definite diagnosis of AP, was met in 1044 hospitalized patients. According to our assumption that repeated hospitalization is considered as a new case if occurred more than 60 days after the previous one, 1004 patients were included in the further analysis. Results. The incidence rate was 99.96/100,000. Incidence rate among woman was 72/100,000 and incidence among men was 130.24/100,000 (p < 0.05). Median age of AP patients was 53 years. Median age among woman (65 years) was significantly (p < 0.005) higher than among man (47 years). Incidence rate for the first episode was 79.7/100,000 citizens. Main causes of AP included cholelithiasis (30.1%), alcohol (24.1%), coexisting cholelithiasis and alcohol abuse (2.9%), pancreatic cancer (1%), AP after ERCP (0.7%). Basing on modified Atlanta criteria, severe AP was diagnosed in 7%, moderate in 12.3%, and mild in 80.7% of patients. Mean duration of hospitalization of patients with severe AP was 14.8, moderate - 16,7, mild - 7.1 days. Mortality rate for AP was 3.9%. Mean age of deceased women was 74 years and was significantly higher than in the group of men (61 years). Mortality rate in severe AP was 52.9% and was significantly (p < 0.05) higher than mortality in moderate (no deaths) or mild AP (0.2%). Conclusions. Incidence rate of AP in the Świętokrzyskie Voivodeship population is among the highest in Poland. Our study indicates that new Atlanta classification, that differentiates between moderate and severe AP, needs to be implemented to the clinical practice, since the latter carries high mortality in severe cases.
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Gastrointestinal Bleeding in Patients Aged 85 Years and Older

81%
Kozieł D., Matykiewicz J., Głuszek S.
Polish Journal of Surgery
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2011
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vol. 83
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issue 11
606-613
EN
The aging of the population is associated with the increased risk of chronic diseases, and greater consumption of drugs used in their treatment, which may lead towards gastrointestinal bleeding.The aim of the study was to analyze the reasons, treatment results, complications and mortality connected with gastrointestinal bleeding in patients aged 85 years and older.Material and methods. The study comprised the retrospective analysis of 84 patients, aged between 85 and 97 years admitted to the Department of General Surgery with diagnosis of gastrointestinal bleeding, during the period between 2005 and 2010. The results were compared to a younger control group of 151 patients (mean age-53 years) with gastrointestinal bleeding, admitted to the department during the same period. Diagnosis was based on the history, physical examination, endoscopy, morphology and biochemical lab results. Analysis considered the therapeutic method used, treatment results, complications and hospital mortality. The endoscopic picture and risk of recurrent bleeding in patients with upper gastrointestinal hemorrhage was evaluated by means of the clinical Forrest scale. Results were subject to statistical analysis.Results. Most of the gastrointestinal bleeding cases considering patients aged 85 years and older concerned the upper gastrointestinal tract (41.67%). Thirty (35.71%) patients were on drugs affecting the coagulation system. On admission, the average hemoglobin concentration level in the elderly was comparable to results observed in case of the control group. Considering patients aged 85+, drugs affecting the coagulation system were used statistically more frequently, as compared to younger patients. Recurrence of bleeding was observed in 10 (11.9%) study group patients.Overall mortality due to gastrointestinal bleeding in elderly patients amounted to 20.24% and was statistically higher, as compared to the control group- 7.2%.Conclusions. Treatment results in case of gastrointestinal bleeding in the elderly patients (above 85 years) are burdened with a higher mortality rate. Different diagnostic and therapeutic methods should be applied in case of elderly patients (above 85 years), in order to increase their chance of survival. The problem of aging is an epidemiological phenomenon and gastrointestinal bleeding will become an increasing problem, needing to be solved in everyday clinical practice.
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The Risk of Surgical Treatment in Patients Aged 85+, with Special Consideration of Colorectal Cancer

81%
Stępień R., Głuszek S., Kozieł D., Kaczmarczyk M.
Polish Journal of Surgery
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2015
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vol. 86
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issue 3
132-140
EN
The increase in prevalence of chronic diseases in old age is concomitant with increasing risk of neoplasms requiring surgical treatment. The aim of the study was to assess the indications, treatment outcomes, complications and mortality associated with surgical treatment of patients aged 85 or more, with special consideration of colorectal cancer. Material and methods. The retrospective analysis involved a group of 94 patents (x = 88.9) aged 85 or more and treated surgically in the years 2006-2011. The results were compared with a randomly selected control group of 91 patients aged 45-75 (x = 56,4) and treated surgically in the same period. Results. Neoplastic diseases in the study group (85 ≥), compared with the control group (< 75), were a significantly more frequent indication for surgical treatment (p < 0.01). In the group of patients aged 85 or more, the most frequent indications for elective surgery were neoplasms of the skin and subcutaneous tissue (26.4%) and gastrointestinal neoplasms, mainly colorectal cancer (23.5%). Postoperative complications were significantly more frequent (p < 0.01) among patients aged 85 or more (n = 27; 34.8%) than in the younger group (n = 17; 18.7%). Postoperative mortality among patients undergoing emergency surgery was significantly higher (p < 0.05) in the senior group than in the group of younger patients. Conclusions. Surgical procedures in patients aged 85 or more are most frequently performed in the emergency setting, and their most common cause are neoplastic diseases. Emergency surgical treatment in patients aged 85 or more is associated with a significantly higher risk, compared with younger age groups, of developing multi-organ postoperative complications, usually leading to death. Elective surgical treatment in patients aged 85+ after appropriate preoperative preparation and in the group of younger patients shows similar early outcomes.
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Digestive System Fistula - A Problem Still Relevant Today

71%
Głuszek S., Korczak M., Kot M., Matykiewicz J., Kozieł D.
Polish Journal of Surgery
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2011
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vol. 83
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issue 1
32-41
EN
Digestive system fistula originates most frequently as a complication after surgical procedures, less often occurs in the course of inflammatory diseases, but it can also result from neoplasm and injuries.The aim of the study was to analyze the causes and retrospectively assess the perioperative procedures as well as the results of digestive system fistula treatment.Material and methods. Own experience in digestive system fistula treatment was presented. The subject group consisted of 32 patients treated at the General Surgery, Oncology and Endocrinology Clinical Department between 01.05.2005 and 30.04.2010 due to different digestive tract diseases. The causes of the occurrence of digestive system fistula, methods and results of treatment were analyzed.Results. The analysis covered 32 patients with digestive system fistula, among them 15 men and 17 women. Average age for men was 57 years (20-78), and for women 61 years (24-88). In 11 patients idiopathic fistula causally connected with primary inflammatory disease (7 cases) and with neoplasm (4 cases) was diagnosed, in 19 patients fistula was the result of complications after surgery, in 2 - after abdominal cavity injury. Recovery from fistula was achieved in 23 patients (72%) with the use of individually planned conservative therapy (TPN, EN, antibiotics, drainage, and others) and surgery, depending on the needs of individual patient. 5 patients (16%) died, whereas in 4 left (12%) recovery wasn't achieved (fistula in palliative patients, with advanced stages of neoplasm - bronchoesophageal fistula, the recurrence of uterine carcinoma).Conclusions. Recently the results of digestive system fistula treatment showed an improvement which manifests itself in mortality decrease and shortening of fistula healing time. Yet, digestive system fistula as a serious complication still poses a very difficult surgical problem.
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Iatrogenic bile duct injuries – clinical problems

61%
Głuszek S., Kot M., Bałchanowski N., Matykiewicz J., Kuchinka J., Kozieł D., Wawrzycka I.
Polish Journal of Surgery
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2015
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vol. 86
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issue 1
17-25
EN
Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures in surgical wards. Iatrogenic bile duct injuries (IBDI) incurred during the procedures are among postoperative complications that are most difficult to treat. The risk of bile duct injury is 0.2-0.4%, and their consequences are unpleasant both for the surgeon and for the patient. The aim of the study was analysis of iatrogenic bile duct injuries and methods of their repair,taking into consideration the circumstances, under which the injuries occur. Material and methods. The study group consisted of 16 patients who had suffered IBDI during surgery. The analysed parameters included sex, age, indications for surgery, the setting of the surgical procedure and the type of bile duct injury. Additionally, the time of injury diagnosis, type of repair and treatment outcome were assessed. The IBDI analysis used the EAES classification of injuries. The time of IBDI repair was defined as immediate, early or late,depending on the time that had passed from the injury. The analysis included complications seen after bile duct repair. Results. The study group consisted of 10 women and 6 men, aged 29-84. Patients underwent 6 classic cholecystectomies, 8 laparoscopic cholecystectomies, one gastrotomy to remove oesophageal prosthesis and one laparotomy due to peptic ulcer. IBDI was diagnosed intraoperatively in 4 patients. In 12 patients IBDI was diagnosed within 1-7 days. The diagnosis was based on endoscopic retrograde cholangiopancreatography and the results of biochemistry tests. According to the EAES classification, the injuries were of type 1 (4 patients), type 2 (8 patients), type 5 (3 patients) and type 6 (1 patients). Reconstruction procedures were performed during the same anaesthesia session in 3 patients, and in the early period in 13 patients. The main procedure was Roux-en-Y anastomosis (12 patients), with the remaining including bile-duct suturing over a T-tube (3 patients) and underpinning of an accessory bile duct in the pocket left after gallbladder removal (1 patient). The most common reconstruction complications included bile leak (3 patients), recurrent cholangitis (3 patients) and bile duct stricture (2 patients). Mortality in the study group was 12.5%. Conclusions. The procedures of laparoscopic and classic cholecystectomy are associated with a risk of IBDI, especially in the presence of inflammatory state of the gall-bladder. IBDI is a complex complication: its treatment poses a challenge for the operating surgeon, and even the most careful treatment adversely affects the patient’s lifedue to complications.
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