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Czy profilaktyka żylnej choroby zakrzepowo-zatorowej jest konieczna przy zabiegach laparoskopowych? Komentarz do wytycznych SAGES – Guidelines for Deep Venous Thrombosis Prophylaxis During Laparoscopic Surgery

100%
Solecki M.
Current Gynecologic Oncology
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2015
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vol. 13
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issue 4
269-276
EN
Venous thromboembolism is a disease that includes both deep vein thrombosis and pulmonary embolism, which are associated with the formation of a blood clot (thrombus) within a deep vein, mainly in the lower limbs. So far, the scale of the problem of deep vein thrombosis and pulmonary embolism has not been thoroughly estimated in Poland. About 200,000 new cases per year are reported in the United States, and between 50,000 and 60,000 in Poland. Mortality due to pulmonary embolism, usually as a consequence of deep vein thrombosis, is estimated at 15–25%. Increasingly used minimally invasive surgical techniques are currently of interest to both, the young generation of surgeons and their patients. Laparoscopic cholecystectomy or bariatric surgery have become a standard. There is much controversy regarding the need for thromboprophylaxis in patients undergoing laparoscopic procedures. Efforts have been made by the Society of American Gastrointestinal and Endoscopic Surgeons to help medical practitioners decide in this regard. All laparoscopic procedures cause serum hypercoagualability. Polish societies have not specified their decisions regarding prophylaxis in laparoscopic surgery. Following general rules was only recommended. It seems fully justified to develop such indications or adopt the already existing standards based on literature data and experience.
PL
Żylna choroba zakrzepowo-zatorowa obejmuje zarówno zakrzepicę żył głębokich, jak i zatorowość płucną – związane z powstaniem zakrzepu w obrębie żył głębokich, głównie w kończynach dolnych. W Polsce skala problemu zakrzepicy żył głębokich i zatorowości płucnej nie została dotąd zbyt dokładnie oszacowana. W Stanach Zjednoczonych odnotowuje się około 200 tys. nowych zachorowań rocznie, w Polsce jest ich 50–60 tys. rocznie. Śmiertelność z powodu zatorowości płucnej, najczęściej będącej następstwem zakrzepicy żył głębokich, ocenia się na 15–25%. Coraz szerzej stosowane metody małoinwazyjne leżą obecnie w kręgu zainteresowań młodego pokolenia chirurgów i cieszą się dużym zainteresowaniem pacjentów. Standardem stały się laparoskopowa cholecystektomia czy chirurgia bariatryczna. Istnieje wiele kontrowersji dotyczących konieczności stosowania profilaktyki przeciwzakrzepowej u chorych poddawanych zabiegom laparoskopowym. Amerykańskie Towarzystwo Chirurgów Gastroenterologicznych i Endoskopowych podjęło starania, aby ułatwić praktykującym lekarzom decydowanie w tym zakresie. Każda procedura laparoskopowa powoduje nadkrzepliwość surowicy krwi. Polskie towarzystwa nie sprecyzowały swoich ustaleń co do profilaktyki w przypadku chirurgii laparoskopowej, zalecono jedynie stosowanie się do zasad ogólnych. Opracowanie takich wskazań lub zaadaptowanie już istniejących standardów na podstawie danych literaturowych i doświadczenia wydaje się w pełni uzasadnione.
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Intraoperative Ultrasound in the Treatment of Pancreatic Diseases

51%
Ćwik G., Solecki M., Wallner G.
Polish Journal of Surgery
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2015
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vol. 86
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issue 6
268-278
EN
Intraoperative ultrasound (IOUS) allows confirming and verifying the preoperative diagnosis. In many cases it allows correct determination of the severity of the disease, safe surgery performance and shortening its duration. Proper assessment of anatomic structures during the surgery and evaluation of the operating field after the treatment termination, in combination with their ultrasound evaluation that permits more complete assessment of radical treatment. The aim of the study was to define current indications for the use of intraoperative ultrasound in the treatment of pancreatic lesions, based on our own experience and the cited literature. Material and methods. The Clinic, where the authors work, uses intraoperative ultrasound in everyday practice. In this paper we try to share our experience in this imaging technique. Studies were compared before the procedure both in the ultrasound and CT examination rooms with the images obtained intraoperatively. Intraoperative examination was performed by the surgeon who performed assessment before the procedure, what enabled verification of diagnoses. Presented material refers to 102 IOUS procedures performed during laparotomy due to pancreatic lesions. Results and conclusions. IOUS is a reliable test for the evaluation of both inflammatory and acute lesions in the pancreas during the surgery of chronic, symptomatic pancreatitis. It correctly determines the extent of the planned surgery. In the case of pancreatic cancer it verifies local severity of the tumour lesions, assessing involving of the peripancreatic vessels, lymph nodes and the presence of local and distant metastases, including those in the liver. IOUS proved highly effective in the evaluation of endocrine and cystic pancreatic tumours. The study significantly improves the effectiveness of intraoperative BAC and aspiration or drainage of fluid reservoirs
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Doświadczenia własne w zastosowaniu śródoperacyjnej ultrasonografii w leczeniu powikłanych przypadków ostrego i przewlekłego zapalenia trzustki oraz nowotworów trzustki

51%
Ćwik G., Solecki M., Wallner G.
Journal of Ultrasonography
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2015
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vol. 15
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issue 60
56-71
EN
Both acute and chronic inflammation of the pancreas often lead to complications that nowadays can be resolved using endoscopic and surgical procedures. In many cases, intraoperative ultrasound examination (IOUS) enables correct assessment of the extent of the lesion, and allows for safe surgery, while also shortening its length. Aim of the research: At the authors' clinic, intraoperative ultrasound is performed in daily practice. In this paper, we try to share our experiences in the application of this particular imaging technique. Research sample and methodology: Intraoperative examination conducted by a surgeon who has assessed the patient prior to surgery, which enabled the surgeon to verify the initial diagnosis. The material presented in this paper includes 145 IOUS procedures performed during laparotomy due to lesions of the pancreas, 57 of which were carried out in cases of inflammatory process. Results and conclusions: IOUS is a reliable examination tool in the evaluation of acute inflammatory lesions in the pancreas, especially during the surgery of chronic, symptomatic inflammation of the organ. The procedure allows for a correct determination of the necessary scope of the planned surgery. The examination allows for the differentiation between cystic lesions and tumors of cystic nature, dictates the correct strategy for draining, as well as validates the indications for the lesion's surgical removal. IOUS also allows the estimation of place and scope of drainage procedures in cases of overpressure in the pancreatic ducts caused by calcification of the parenchyma or choledocholitiasis in chronic pancreatitis. In pancreatic cancer, IOUS provides a verification of the local extent of tumor-like lesions, allowing for the assessment of pancreatic and lymph nodes metastasis, and indicating the presence of distant and local metastases, including the liver. IOUS significantly improves the effectiveness of intraoperative BAC aspiration or drainage of fluid reservoirs.
PL
Zarówno ostre, jak i przewlekłe stany zapalne trzustki prowadzą często do powstania powikłań, które współcześnie rozwiązuje się na drodze zabiegów endoskopowych oraz operacyjnych. Śródoperacyjna ultrasonografia (IOUS) w wielu przypadkach umożliwia prawidłowe określenie rozległości zmian chorobowych, pozwala na bezpieczne przeprowadzenie zabiegu operacyjnego oraz skrócenie czasu jego trwania. Cel: W klinice, w której pracują autorzy, śródoperacyjne badanie ultrasonograficzne jest wykonywane w codziennej praktyce. W niniejszej pracy pragniemy podzielić się własnymi doświadczeniami w zastosowaniu tej techniki obrazowania. Materiał i metody: Badania śródoperacyjne przeprowadzane były przez chirurga, który dokonywał oceny przed zabiegiem, co pozwoliło na weryfikację rozpoznań. Przytoczony materiał dotyczy 145 procedur IOUS wykonywanych podczas laparotomii z powodu zmian chorobowych trzustki, w tym 57 zastosowanych w przypadku procesu zapalnego. Wyniki i wnioski: IOUS jest wiarygodnym badaniem w ocenie ostrych zmian zapalnych w trzustce, głównie w trakcie operacji przewlekłego, objawowego zapalenia tego narządu. Prawidłowo wyznacza zakres planowanej operacji. Badanie różnicuje zmiany torbielowate, guzy o torbielowatym charakterze, określa prawidłowy sposób drenażu lub weryfikuje wskazania do wycięcia zmiany chorobowej. Ocenia miejsce i zakres operacji drenażowych w przypadku nadciśnienia w drogach trzustkowych spowodowanego zwapnieniami miąższu lub kamicą przewodową w przebiegu przewlekłego zapalenia trzustki. W raku trzustki – weryfikuje stan miejscowego zaawansowania zmian guzowatych, pozwala na ocenę zajęcia naczyń okołotrzustkowych, węzłów chłonnych oraz wykazuje obecność przerzutów miejscowych i odległych, w tym w obrębie wątroby. IOUS znacznie poprawia skuteczność śródoperacyjnej BACC oraz aspiracji lub drenażu zbiorników płynowych.
4
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Evaluation of the utility value of percutaneous drainage of symptomatic hepatic cysts combined with an obliteration attempt

51%
Ćwik G., Wyroślak-Najs J., Solecki M., Wallner G.
Journal of Ultrasonography
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2016
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vol. 16
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issue 66
260-272
EN
Aim: The goal of the paper was to evaluate the procedure of percutaneous drainage of symptomatic hepatic cysts under the transabdominal ultrasound control combined with obliteration. Material and method: Within the period from 2005 to 2015, 70 patients diagnosed with a simple hepatic cyst of symptomatic nature were subject to hospitalization and treated at the 2nd General, Gastroenterological and Cancer Surgery of the Alimentary System Center and Clinics of the Medical University of Lublin. All the patients subject to evaluation were qualified to percutaneous drainage under an ultrasound control. The drainage utilized typical sets of drains with the diameter of at least 9 F, most often of pigtail type. The fluid aspirated form the cyst was dispatched for complex laboratory testing. Further, a 10% sodium chloride solution was administered to the cyst through the drain, in the volume depending on the previous size of the cyst and the patient’s reaction. Results: Patients reported for a re-visit within the period from 3 to 9 months following the procedure. Complete obliteration of the cyst was confirmed only in 8 patients (11%). Cyst recurrence was reported in cases when during the ultrasound evaluation, the diameter of the cyst following aspiration and obliteration enlarged to over 75% of the initial dimension. In this group, in 10 out of 12 examined (83%) there was a relapse of the previously observed ailments. Among patients, who has a cyst imaged within the period of observation, which had the diameter from 50% to 75% of the previous size, only in 6 cases (37.5%) the initial symptoms relapsed. Conclusions: The utilization of a drainage and obliteration enables one to achieve the acceptable result of the therapy as well as significant decrease in the number of previously reported ailments and symptoms described.
PL
Cel pracy: Celem niniejszej pracy była ocena procedury przezskórnego drenażu objawowych torbieli wątroby pod kontrolą ultrasonografii przezbrzusznej w powiązaniu z obliteracją. Materiał i metoda: W okresie od 2005 do 2015 roku 70 pacjentów z rozpoznaniem prostej torbieli wątroby o objawowym charakterze było hospitalizowanych i leczonych w II Klinice Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego Uniwersytetu Medycznego w Lublinie. Wszystkich ocenianych pacjentów tyzakwalifikowano do drenażu przezskórnego pod kontrolą USG. Do drenażu wykorzystywano typowe zestawy drenów o średnicy co najmniej 9 F, najczęściej typu pigtail, czyli „świński ogonek”. Aspirowany płyn z torbieli był wysyłany do kompleksowego badania laboratoryjnego. W dalszej kolejności poprzez założony dren podawano do jamy torbieli 10-procentowy roztwór chlorku sodu w objętości zależnej od wcześniejszej wielkości torbieli oraz od reakcji pacjenta. Wyniki: Pacjenci zgłaszali się na kontrolę w okresie od 3 do 9 miesięcy po zabiegu. Całkowite zarośnięcie jamy torbieli potwierdzono jedynie u 8 leczonych (11%). Za nawrót torbieli uznano przypadki, gdy w ocenie ultrasonograficznej średnica torbieli po aspiracji i obliteracji powiększyła się do ponad 75% początkowego wymiaru. W tej grupie u 10 z 12 badanych (83%) doszło do nawrotu wcześniej stwierdzanych dolegliwości. U pacjentów, u których w okresie obserwacji zobrazowano torbiel o średnicy od 50% do 75% wcześniejszej wielkości, tylko w 6 przypadkach (37,5%) ponowiły się pierwotne objawy. Wnioski: Zastosowanie drenażu oraz obliteracji pozwala na osiągnięcie akceptowalnego wyniku terapii, a także znacznego spadku wcześniej zgłaszanych dolegliwości i opisywanych objawów.
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What’s new about symptomatic reflux disease

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Solecki M., Wallner G., Masiak W., Ćwik G.
Polish Journal of Public Health
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2015
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vol. 125
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issue 1
17-19
EN
During the last 4 decades reflux disease (GERD) has evolved from being a rare clinical problem to a disease with high incidence. This automatically rises its social costs. First descriptions came from western countries only but nowadays there are many published papers from Asia and Middle East that can be found on the Internet. There is no clear explanation for this fact. Our understanding of GERD has changed over the time. At first GERD, hiatal hernia and oesophagitis were synonyms. Since the 1940s when the first manometrical studies were done it was concerned as lower oesophageal sphincter or peristaltic disfunction. The following years gave a definition of acid-peptic disorder. Nowadays all this concepts are mixed together and we are considering GERD as a heterogeneous clinical problem. In this paper we would like to present up-to-date knowledge about GERD.
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Combined Esophageal Multichannel Intraluminal Impedance and pH Monitoring (MII -pH) in the Diagnostics and Treatment of Gastroesophageal Reflux Disease and its Complications

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Masiak W., Wallner G., Wallner J., Pedowski T., Solecki M.
Polish Journal of Surgery
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2011
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vol. 83
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issue 9
488-496
EN
The technique of 24-hour esophageal multichannel intraluminal impedance monitoring combined with pH-metry (MII-pH) is currently considered to be the golden standard in the diagnostics of gastroesophageal reflux disease (GERD). The technique allows for differentiation of gas and liquid reflux as well as detection of non-acid reflux, which cannot be detected with other techniques that are based only on measuring the pH of gastric contents.The aim of the study was to assess the usefulness of MII-pH in the diagnostics and treatment of GERD and its complications.Material and methods. A group of 213 patients referred to II Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego Uniwersytetu Medycznego w Lublinie [the Second Faculty and Clinic of General and Gastrointestinal Surgery and Gastrointestinal Oncology at Medical University of Lublin] due to persistent symptoms of GERD and 21 volunteers without any clinical evidence of GERD underwent esophageal monitoring via MII-pH. The results were correlated with those of upper gastrointestinal tract endoscopy. The data gathered during MII-pH and endoscopy as well as information from questionnaires were entered into an MS Excel spreadsheet and subsequently analyzed with STATISTICA PL software.Results and conclusions. MII-pH proved to be considerably more useful than conventional pHmetry in recording acid reflux. The sensitivity of pH-metry based on the MII-pH technique was established at 74%. GERD-induced changes in the esophageal mucosa result in decreased impedance baseline. The presence and severity of inflammatory esophageal lesions was proven to be associated with acid reflux episodes and proximal reflux episodes. No direct relationship between the grade of GERD and the occurrence of non-acid reflux episodes was confirmed. Non-acid reflux episodes were shown to predispose to non-erosive reflux disease (NERD). The results of this study confirm that MIIpH is an essential technique in the diagnostics, as well as in assessment of the course of treatment and the severity of GERD.
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Morphological changes of the pancreas in course of acute pancreatitis during treatment with Ulinastatin

39%
Wallner G., Solecki M., Ziemiakowicz R., Ćwik G., Dyndor P., Maciejewski R.
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vol. 85
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issue 3
114-122
EN
Acute pancreatitis is a severe clinical conditio that causes significant mortality in patients. Since we do not have at the moment effective causal treatment research on the use of pro tease inhibitors can produce tangible benefits. In view of the growing number of cases and high mortality in severe AP with one hand, and the lack of a usal treatment research efforts undertaken to search for effective drugs for this disease seem to have deep reasons. Aim of the study was to determine the histopathological changes in the pancreas in the treatment of acute pancreatitis with Ulinastatin. Material and methods. The study was conducted in male Wistar rats weighing 250-300 grams. 150 individuals were used for the experiment, 60 of them were treated with Ulinastatin. Experimental acute pancreatitis was induced by the model proposed by Aho and Henckel using sodium taurocholate. Ulinastatin dose numer depended on the duration of the experiment. For histopathological examination pancreatic fragments weighing approximately 1 g each were taken. Assessment and documentation of histopathological preparations were made by light microscopy. Results. Evaluation of the histological preparations of various time groups showed significantly improved results after application of Ulinastatin, depending on the duration of the inflammation and the number of doses of the drug. Conclusions. Application for the treatment of UTI leads to inhibition of the inflammatory process at the stage of pancreatic edema and in cases of severe necrotizing course limits the progression of the disease which gives grounds for its clinical use in humans.
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Multichannel Intraluminal Impedance and pH Testing - A New Diagnostic Technique for Gastroesophageal Reflux Disease. Own Experience

39%
Wallner G., Solecki M., Huk J., Dąbrowski A., Majewski M., Dombroskyy A.
Polish Journal of Surgery
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2007
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vol. 79
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issue 7
490-495
EN
In 2001 FDA (Food and Drug administration, USA) gave its permission for simultaneous oesophageal intraluminal impedance examination and pH testing in the clinical practice. In 2002 in Porto, Portugal, a committee of international experts proposed a new classification of reflux types.Material and methods. From October 2005 to June 2006, we examined 36 patients sent to the clinic with GERD symptoms using a Sleuth® recording device.Results. The group of 36 patients (19 women and 17 men); mean age of 47 years with a range of 16-74 years) was examined. The mean length of time for the examination was 22 h 47 min, the shortest one lasting 18 h 36 min; brakes were caused by battery failure. 1509 episodes of reflux were confirmed by impedance channels. Only 538 (35.65%) of these reflux episodes were acidic or weakly acidic and 971 (64.35%) were non-acidic. There was one patient without acid reflux episodes during examination and only 12 non-acidic episodes. The proximal extend, defined as 15 cm above the LES, achieved 616 reflux episodes (40.82%). None of the patients had abnormal physical clearing times; 5 had extended chemical clearing times (13.8%) in recumbent positions.Summary. This paper is not a statistical evaluation of a MII-pH study and is only a report of our first experiences with this new diagnostic method. Objective evaluation of symptom correlation to reflux in MII and the chemical character of the refluxate gives a much more precise qualification to the best type of treatment. In cases of non-acidic reflux, MII-pH testing hastens decision making about surgery.
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Practical Aproach to Variceal Gastrointestinal Bleeding – Association of Polish Surgeons Guidelines

33%
Wallner G., Solecki M., Dąbrowski A., Ćwik G., Dąbrowski A., Matyja A., Lampe P., Dziki A.
Polish Journal of Surgery
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2015
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vol. 86
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issue 5
248-256
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