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Iatrogenic Bile Duct Injury. A Significant Surgical Problem. Assessment of Treatment Outcomes in the Department's Own Material

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Bobkiewicz A., Krokowicz ł., Banasiewicz T., Kościński T., Borejsza-Wysocki M., Ledwosiński W., Drews M.
Polish Journal of Surgery
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2015
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vol. 86
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issue 12
576-583
EN
Iatrogenic bile duct injuries (BDI) are still a challenging diagnostic and therapeutic problem. With the introduction of the laparoscopic technique for the treatment of cholecystolithiasis, the incidence of iatrogenic BDI increased. The aim of the study was a retrospective analysis of 69 patients treated at the department due to iatrogenic BDI in the years 2004-2014. Material and methods. In this paper, we presented the results of a retrospective analysis of 69 patients treated at the Department due to iatrogenic BDI in the years 2004-2014. The data were analysed in terms of age, sex, type of biliary injury, clinical symptoms, the type of repair surgery, the time between the primary surgery and the BDI management, postoperative complications and duration of hospital stay. Results. 82.6% of BDI occurred during laparoscopic cholecystectomy, 8.7% occurred during open cholecystectomy, whereas 6 cases of BDI resulted from surgeries conducted for other indications. In order to assess the degree of BDI, Bismuth and Neuhaus classifications were used (for open and laparoscopic cholecystectomy respectively). 84.1% of patients with confirmed BDI, were transferred to the Department from other hospitals. The average time between the primary surgery and reoperation was 6.2 days (SD 4). The most common clinical symptom was biliary fistula observed in 78.3% of patients. In 28 patients, unsuccessful attempts to manage BDI were made prior to the admission to the Department in other centres. The repair procedure was mainly conducted by laparotomy (82.6%) and by the endoscopic approach (15.9%). Hepaticojejunostomy was the most common type of reconstruction following BDI (34.7%). Conclusions. The increase in the rate of iatrogenic bile duct injury remains a challenging surgical problem. The management of BDI should be multidisciplinary treatment. Referring patients with both suspected and confirmed iatrogenic BDI to tertiary centres allows more effective treatment to be implemented.
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Comparison of the Effectiveness of the Treatment Using Standard Methods and Negative Pressure Wound Therapy (NPWT) in Patients Treated with Open Abdomen Technique

84%
Szmyt K., Krokowicz Ł., Bobkiewicz A., Cybułka B., Ledwosiński W., Gordon M., Alammari A., Banasiewicz T., Drews M.
Polish Journal of Surgery
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2015
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vol. 87
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issue 1
22-30
EN
Open abdomen technique is a surgical treatment in which the fascia and skin are left open in order to reduce the value of the intra-abdominal pressure. According to the World Society of the Abdominal Compartment Syndrome (WSACS) normal values of the intra-abdominal pressure are between 5 and 7 mm Hg. Intra-abdominal hypertension occurs when the pressure value is equal to or exceeds 12 mm Hg. The aim of the study was to compare the results of the open abdomen treatment using standard methods and negative pressure wound therapy. Material and methods. The study was in the form of a retrospective analysis of the documentation of the patients treated with open abdomen technique. The study included 37 patients treated in the Department of General and Endocrine Surgery and Gastroenterological Oncology and in the Department of Anesthesiology and Intensive Care of the Medical Sciences since 2009-2012. Patients were divided into two groups: group 1 (n = 20) was treated with standard surgical procedures (laparostomy, repeated peritoneal cavity lavage) and group 2 (n =17) was treated using negative pressure wound therapy (NPWT). The analysed clinical data included the period of hospitalization and clinical outcome (survival vs death), the occurrence of enteroatmospheric fistulae, cyclical determination of the quantitative C-reactive protein levels. Results. The number of deaths during hospitalization in the group treated with NPWT was lower than in the group treated with standard methods (3 vs 9). The number of fistulae during hospitalization in the group treated with NPWT dropped as compared to the group treated using standard procedures (18% vs 70%). The decrease in the CRP levels was recorded in the group treated with NPWT and its increase - in the group treated with standard methods. Conclusions. The use of NPWT in patients requiring open abdomen treatment is reasonable due to the positive results with respect to survival rates and the decrease in the number of gastrointestinal fistulae. It is necessary to train the physicians in using this type of therapy in the form of workshops and in the clinical setting.
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Surgical methods of treatment of intestinal passage disturbances with the characteristics of constipation in patients with intestinal stoma based on own experience

84%
Krokowicz Ł., Sławek S., Ledwosiński W., Bobkiewicz A., Borejsza-Wysocki M., Kuczyńska B., Szmyt K., Paszkowski J., Drews M., Banasiewicz T.
Polish Journal of Surgery
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2015
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vol. 87
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issue 4
160-165
EN
Stoma is an intestinal fistula created in emergency or by elective indications, and it is done to drain out the digestive tract content. In some patients there is a disturbance passage of gastric contents through the stoma, which may take the form of chronic constipation or even periodic subileus that will sooner or later require surgical treatment. The aim of the study was the assessment of the causes and method of treatment of constipation in patients with intestinal stoma. Material and methods. A total of 331 patients with stoma followed by Ostomy and Proctology Outpatient Clinic were included in the study in the years 2011-2014. The study included 146 women and 185 men and the average age was 61.3 ± 12.7 years. Within the entire froup, 273 patients had the end stoma performed whereas in 58 patients the loop stoma was created. The highest percentage of patients were the ones with diverticulosis and colorectal cancer, i.e. 132 and 114 patients respectively. A stoma was created in 35 patients due to inflammatory bowel disease (IBD), in 23 patients because of cancer, in 14 as a result of injuries and in 13 due to rectovaginal fistula. Results. Out of the entire group subject to study (331 patients) 93 patients (28.1%) suffered from constipation. 50 patients with constipation required surgical intervention. The most common indication for surgical treatment was the parastomal hernia (36 patients, 72%), other indications were the narrowing of the stoma (5 patients, 10%), its collapse (6 patients, 12%) or prolapse (3 patients, 6%). Parastomal hernia was responsible for 84% of constipation within the stoma and 86.1% were treated with laparotomy (31 out of 36 patients). Other causes of constipation were the stomal stenoses (5 patients), collapse of the stoma (6 patients) and stomal prolapse (3 patients). All patients were treated surgically with a good final result. Conclusions. Constipation associated with dysfunction of the stoma in most cases should be treated surgically. Parastomal hernia is the most common cause of constipation in the stoma. Treatment should be performed in due time because of the possibility of developing complications, especially dangerous one is a strangulated parastomal hernia and ischemia of stoma.
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