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1
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Somatostatinoma of the Pancreas; Difficulties in Preoperative Diagnostic Approaches - A Case Report

100%
Dranka-Bojarowska D., Olakowski M., Lampe P.
Polish Journal of Surgery
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2007
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vol. 79
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issue 2
129-133
EN
Somatostatinoma is the rarest neuroendocrine tumor of the digestive tract. About 60% of somatostatinomas arise in the pancreas. This study presents a case of a 51-year-old male patient with tumor of the pancreas. Despite wide preoperative diagnostic examinations, it was impossible to determine the histological type of the tumor preoperatively. The patient was qualified for surgical procedure, during which the tumor was enucleated. The tumor was classified as somatostatinoma through immunohistochemical examination. The postoperative course was complicated by a small fluid collection, which arose in area of enucleation; the cistern was absorbed spontaneously. Currently, the patient is under surgical ambulatory care and is in general, in good condition.
2
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Video-Assisted Transhiatal Esophagectomy in the Treatment of Esophageal Cancer

100%
Lampe P., Olakowski M., Lekstan A.
Polish Journal of Surgery
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2008
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vol. 80
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issue 6
315-320
EN
The aim of the study was the analysis of sugical treatment of esophageal cancer using the video-assisted transhiatal esophagectomy (VTE).Material and methods. Between May 1994 and December 2001 a total of 115 patients with esophageal cancer underwent VTE. The study group included 102 men (89%) and 13 women (11%). Eighty - six (75%) had squamous cell carcinoma and 29 (25%) had adenocarcinoma.Results. The mean operative time was 4.5±1 h. Short-term complications occurred in 70 patients (60%), where the most common were pulmonary complications (27%, n=31), recurrent laryngeal nerve injury (17.4%, n=20), anastomotic stricture (14%, n=16) and anastomotic leak (10.4%, n=12). Early re-laparotomy was performed in 7 patients (6%). The hospital mortality rate was 9%. Follow-up included 86 patients. Long-term complications were present in 28 patients (33%). The most common complication was anastomotic stricture in 18 patients (21%). There was no statistical difference observed in survival betweeen patients operated on for squamous cell carcinoma or adenocarcinoma. Median postoperative survival was 10 months for squamous cell carcinoma and 16 months for adenocarcinoma. The 1-, 3- and 5-year survival rates were 42%, 10% and 5%, respectively, for squamous cell carcinoma and 63%, 16% and 0%, respectively, for adenocarcinoma.Conclusions. Video-assisted transhiatal esophagectomy is a useful method for esophageal cancer treatement. The use of this technique did not improve short- or long-term results of esophageal cancer management.
3
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Long-Term Results in the Surgical Treatment of Iatrogenic Bile Duct Injuries

100%
Jabłońska B., Lampe P., Olakowski M., Górka Z.
Polish Journal of Surgery
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2010
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vol. 82
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issue 6
354-361
EN
The aim of the study was analysis of long-term results in patients following different methods of the surgical treatment of iatrogenic bile duct injuries.Material and methods. Between January 1990 and March 2005, 138 patients - 37 (26.8%) men and 101 (73.2%) women were operated for IBDI in the Department of Gastrointestinal Surgery, Silesian Medical University in Katowice. The mean age was 52.9 (18-85) years. The following reconstructions were performed: Roux-Y hepaticojejunostomy (49), end-to-end ductal anastomosis (45), jejunal interposition hepaticoduodenostomy (27), bile duct plastic reconstruction (6), choledochoduodenostomy (2) and others (8). Long-term results were assessed based on anamnesis, physical examination and accessory investigations (laboratory an ultrasonography of the abdominal cavity). Obtained results were classified according Terblanche scale. Quality of life was classified according to the Karnofsky Performance Score.Results. Information of long-term results was obtained in 91 (66%) patients. Long-term results according to Terblanche classification were the following: I grade - 58 (63.7%) patients, II grade - 14 (15.4%) patients, III grade - 13 (14.3%) patients, IV grade (recurrent anastomosis stricture) - 6 (6.6%) patients. Quality of life according to Karnofsky Performance Score was very good (the highest number of 100 points) in most (40.5%) patients.Conclusions. Surgical reconstructions of IBDI are procedures that require maximal precision and knowledge of different methods of reconstruction of biliary tract continuity. The choice of the method depends on the situation in the operation area. Achievement of successful long-term results is possible in referral centers experienced in hepatobiliary surgery.
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Surgical Treatment of Iatrogenic Biliary Injuries - Early Complications

88%
Jabłońska B., Lampe P., Olakowski M., Lekstan A., Górka Z.
Polish Journal of Surgery
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2008
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vol. 80
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issue 6
299-305
EN
The aim of the study was the analysis of early complications following different methods of surgical treatment for iatrogenic biliary injury (IBI).Material and methods. From January 1990 to March 2005, 138 patients with iatrogenic biliary injuries were operated on in the Department of Gastrointestinal Surgery of Silesian Medical University in Katowice. The most frequent iatrogenic biliary injuries were caused by open and laparoscopic cholecystectomy. Clinical symptoms in patients included the following: pain, jaundice, pruritus, nausea, vomitus and cholangitis signs. The following diagnostic examinations were performed before surgical procedures: laboratory investigations and radiological examinations - including ultrasonography of the abdominal cavity, cholangiography, endoscopic retrograde cholangiopancreatography, computed tomography and magnetic resonance-cholangiography. The level of biliary injury was classified according to Bismuth. The following reconstruction methods were performed: Roux-Y hepaticojejunostomy in 49 patients, end-to-end ductal anastomosis in 45 patients, jejunal interposition hepaticoduodenostomy in 27 patients, bile duct plastic reconstruction in 6 patients, choledochoduodenostomy in 2 patients and other methods in 8 patients.Results. The mean duration of hospitalization was 31 days. The mean duration of operation was 4.5 hours. Early complications were observed in 22 (16%) patients. The following early complications were noted: bile collection in 11 patients, intra-abdominal abscess in 4, wound infection in 13, peritonitis in 2, cholangitis in 2, eventeration in 1, pneumonia in 7 and acute circulatory insufficiency in 3 patients. Seven (5%) early re-operations were performed: 2 due to biliary-enteric anastomosis dehiscence, 1 due to eventeration, and 4 due to bile collection or intra-abdominal abscess. Three (2%) hospital deaths were noted: 1 due to due acute circulatory insufficiency, 1 due to liver necrosis and acute respiratory and circulatory insufficiency, and 1 due to biliary-enteric anastomosis dehiscence, bile collection, peritonitis, and acute circulatory and respiratory insufficiency.Conclusions. Surgical reconstructions of iatrogenic biliary injuries are procedures that require maximal precision and knowledge of different methods of reconstruction of biliary tract continuity. The choice of the method depends on the situation in the operation area. In treatment centers experienced in iatrogenic biliary injuries, early complications occur in 16% of surgical patients. Mortality does not exceed 2% of surgical patients.
5
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Concentration of Gelatinases and Their Tissue Inhibitors in Pancreatic Inflammatory and Neoplastic Tumors and Their Influence on the Early Postoperative Course

76%
Lekstan A., Olakowski M., Jabłońska B., Łabuzek K., Olakowska E., Filip I., Lampe P.
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vol. 85
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issue 2
65-72
EN
Pancreatic cancer (PC) is the fourth leading cause of death in the world, due to neoplastic disease. Chronic pancreatitis (CP) is a progressive disease leading towards pancreatic fibrosis. The aim of the study was to assess the impact of matrix metalloproteinases 2 and 9 (MMP2 and 9) and their tissue inhibitor (TIMP 1 and 2) concentrations in case of PC and CP tissue homogenates on early treatment results of patients subject to pancreatic resections. Material and methods. The study group comprised 63 patients, including 25 (39.68%) female and 38 (60.32%) male patients. Group 1 (CP) consisted of 31 patients with CP (F: M = 10/21). Group 2 (PC) consisted of 32 patients with PC (F: M = 15:17). The pancreatic tumor samples were collected from the resected pancreas, being subject to electrophoresis and immunoenzymatic studies. After confirming their activity, MMP2, MMP9, TIMP1, TIMP2 concentrations were determined. Correlation analysis of MMPs and TIMPs concentrations was performed in relation to the following: tumor diameter, age, BMI, hospitalization, duration of symptoms and surgery, blood loss, incidence of perioperative complications. Results. Group differences were presented in terms of: age, BMI, ASA, duration of symptoms, jaundice, tumor diameter, time of operation. There were no differences considering weight loss, blood loss, extent of resection, and hospitalization. Significant MMPs and TIMPs concentration differences between groups were demonstrated. Conclusions. Comparison of PC to CP tissue samples showed significantly higher levels of metalloproteinases and TIMPs in the former. Positive correlations of MMP1, TIMP1 and 2 with tumor diameter (CP) were observed, and MMP2 with the duration of surgery and blood loss (PC). There was no MMPs and TIMPs concentration levels influence on the incidence of postoperative complications.
6
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Distal Pancreatectomy - OWN Experience

64%
Olakowski M., Jabłońska B., Braszczok Ł., Lekstan A., Bednarek P., Bratek A., Bocheńska A., Lampe P.
Polish Journal of Surgery
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2012
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vol. 84
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issue 6
298-303
EN
The aim of the study was the retrospective analysis of early results after distal pancreatectomy (DP).Material and methods. During the period between January, 2000 and December, 2010 distal pancreatectomy was performed in 73 patients, including 32 (43.83%) male, and 41 (56.16%) female patients. Average patient age amounted to 53.92 ± 14.37 years. Surgery was performed by means of laparoscopy or the classical method.Results. The mean duration of the procedure amounted to 179.79 ± 59.90 minutes. Fifty-nine (80.82%) patients were subject to splenectomy. After the resection the pancreatic stump was hand-sewn in 69 patients. Pancreatoenterostomy was performed in 4 (5.47%) patients. Early postoperative complications occurred in 11 (15%) patients. Reoperation was required in two (2.7 %) patients. The postoperative mortality rate amounted to 2.7%. The average hospitalization period after surgery amounted to 12.72 ± 9.8 (1- 66) days.Conclusions. Distal pancreatectomy performed in a center experienced in pancreatic surgery is a safe procedure characterized by a low rate of complications and mortality.
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