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1
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The Conditioning and Danger in the Treatment of Patients with Terminal Injuries

100%
Brongel L., Budzyński P.
Polish Journal of Surgery
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2007
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vol. 79
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issue 7
465-467
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Ultrasound in Diagnosing Torso Injuries

71%
Budzyński P., Kuliś M., Brongel L., Trybus M., Hładki W.
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issue 11
497-502
EN
In patients with torso injuries, especially the ones with suspicion of injuries of intraabdominal organs, prompt making of diagnosis and decision about further management plays crucial role. Nowadays ultrasound is the first imaging technique used in Emergency Room in such cases.The aim of the study. Assessment of the value of ultrasound in diagnostics of patients with torso injuries, especially in qualification for operative or conservative treatment.Material and methods. 808 patients with an average age of 44.92 with torso injuries treated in the Department of Emergency Medicine and Multiple Injuries of 2nd Chair of General Surgery, Medical College of Jagiellonian University from 2004 to 2008, in whom ultrasound according to FAST protocol was used were included in the study. Results of sonographic examinations were verified during surgical operation (in patients treated surgically), or with the use of computed tomography (in patients treated conservatively), or on the basis of post-mortem examination (in patients who died due to sustained injuries), or on the basis of clinical course of hospitalization.Results. Sensitivity of ultrasound in the study material amounted to 90.43%, while specificity as much as 99.44%. Positive predictive value (so percentage of patients with truly positive result amongst the patients with positive result of diagnostic test) for whole study material was 95.5 while negative predictive value was 98.75.Conclusion. Results of the study confirm that ultrasound constitutes imaging technique of unique value in diagnostics of patients suffering from torso injuries, especially the circulatory unstable ones, allowing for precise qualification for prompt surgery.
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Analysis of Conversion Rates and Reasons in Minimally Invasive Surgery

71%
Strzałka M., Budzyński A., Bobrzyński A., Budzyński P., Gwóźdź A.
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issue 12
648-654
EN
Nowadays the number and range of laparoscopic procedures is quickly increasing and contraindications are limited. But laparoscopic operations cannot be performed in every case, what leads to conversion.The aim of the study was to present the conversion rates and reasons in different types of laparoscopic procedures, both emergency and elective.Material and methods. 7685 patients operated laparoscopically in the 2nd Department of General Surgery of the Jagiellonian University between 1993 and 2008 were included in the study. Minimally invasive approach was used at the beginning in 608 patients with acute appendicitis (average age = 28,4 years), in 101 patients with perforated peptic ulcer (average age = 46.4 years), in 236 patients who underwent splenectomy (average age = 41 years), in 166 patients who had adrenalectomy (average age = 53 years), in 117 patients who underwent Nissen fundoplication (average age = 44,4 years), in 834 individuals who had inguinal hernia repair (average age = 49.4 years), in 5311 who had cholecystectomy (average age = 52.1 years and in 212 patients who underwent other procedures.Results. The conversion rates in the analyzed period were 2.88% in whole material, in case of appendectomy 3,95%, perforated ulcer operation 19,80%, splenectomy 2.12%, adrenalectomy 1.81%, Nissen fundoplication 1.71%, inguinal hernia repair 0.96% and cholecystectomy 2.92%. Emergency surgery was related to higher (4.98%) conversion rate than elective procedures (1.88%). Most frequently convestions were related to technical reasons (2,48%), than enforced by complications (0.41%).Conclusion. Most conversions were caused by technical reasons, not complications. The change of the approach from laparoscopic to open one was more frequent in case of emergency procedures.
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Endoscopic-Ultrasound Guided Drainage of the Pancreatic Pseudocyst

71%
Rembiasz K., Bednarek M., Budzyński P., Poźniczek M., Budzyński A.
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issue 12
641-647
EN
The aim the study was the evaluation of the treatment results of the internal ultrasound and gastroscopy-guided pancreatic pseudocysts.Material and methods. From 1994-2008 at the 2nd Department of General Surgery UJ CM there were 126 patients (incl. 45 female and 81 male) treated for pancreatic pseudocyst. Mean age of the women was 41.05 years (25-81) while men 48 years (19-79). Ultrasound and gastroscopy-guided drainage by the means of insertion of double pig tail drain was attempted in 46 patients (17 female and 29 male). Mean diameter of the cyst was 11.02 cm (from 2.5-20 cm).Results. Out of 46 patients assigned to the internal ultrasound, gastroscopy guided drainage, the procedure was technically feasible in 39. Internal marsupialization was successful in 24 patients (52.17%). We did not observe serious complications mentioned in the literature incl. iatrogenic injuries of the intraabdominal organs or fistulas. Drain was removed after 5 month (1-9 month).Conclusions. Endoscopic drainage consists an interesting minimally invasive approach in the management of pancreatic pseudocyst. More precise inclusion criteria could increase its efficacy.
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Quality of Life and Disability as a Result of Multiple Injuries

62%
Hładki W., Lorkowski J., Brongel L., Trybus M., Nazimek R., Kuliś M., Budzyński P.
Polish Journal of Surgery
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2007
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vol. 79
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issue 3
218-223
EN
The aim of the study was the comparison of quality of life as a result of multiple injury in the aspect of disability.Material and methods. The study group comprised 1259 patients treated effectively in the years 1989-2003 whose degree of injuries amounted to at least 18 scores in the Injury Severity Scores (ISS). The prospective study included 827 (65.9%) patients. Their quality of life as a disability was determined.Results. The results of the treatment in the successive 5-years periods were compared and statistically analyzed. In the first 5 years 71.8% persons were assessed as disable. In the second 5-years period 51.5% were found to be disabled. In the third 5-years period 47.3% of people present disability. The decrease in the number of individuals disable and increase in quality of life were observed.Conclusions. The highest quality of live improvement and the decrease in the amount of the disabled people was noted in the second 5-years period and was statistically significant related to first 5 years. The improvement of quality of life was decreased also in the third 5-years period related to second 5-years period, but the difference was not statistically significant. The increase of injuries severity and age was one of reasons of reduction positive changes in the last 5-years period.
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Application of the Single Access Technique in Laparoscopic Surgery

62%
Strzałka M., Matyja M., Matłok M., Migaczewski M., Budzyński P., Budzyński A.
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vol. 85
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issue 2
73-77
EN
Laparoscopic single access technique is a next step in development of minimally invasive surgery. The aim of the study was to present results of different laparoscopic single incision procedures and evaluate application of this technique. Material and methods. 102 patients (15 males and 87 females) who underwent laparoscopic single incision procedure from 15th October 2009 to 31st December 2012 were included in the study. Results. In the analyzed period we performed 72 cholecystectomies (70.6%), 8 left adrenalectomies (7.8%), 3 right adrenalectomies (2.9%), 7 splenectomies (6.9%), 5 spleen cysts unroofings (4.9%), 2 appendectomies (2%), 1 Nissen fundoplication procedure (1%), 1 removal of the adrenal cyst (1%) and 3 concomitant splenectomies and cholecystectomies (2.9%). There were 3 technical conversions to multiport laparoscopy, but no conversion to open technique. Complications were observed in 5 patients (4.9%). Average operation time was 79 min (SD=40), average hospitalization time 2.4 day (SD=1.4). Conclusions. Laparoscopic single incision technique is a safe method and can be used as a reasonable alternative to multiport laparoscopy in different minimally invasive procedures especially in young patients to whom an excellent cosmetic effect is particularly important.
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Models of Certain Types of Surgical Shock Based on the Assessment of Selected Critical Parameters

62%
Budzyński P., Brongel L., Nazimek R., Kuliś M., Hładki W., Lorkowski J., Trybus M.
Polish Journal of Surgery
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2007
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vol. 79
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issue 5
346-352
EN
The aim of the study was to devise models that describe three types of surgical shock based on a set of simple biochemical and clinical parameters and establish a method of assigning new patients to each surgical shock scenario.Material and methods. Prospective analysis included patients hospitalized in IInd Chair of Surgery from 2001 to 2005 who belonging to the following groups: multiple injuries (at least 7 points according to LSO), upper GI bleeding (in patients requiring blood transfusions during first day) and severe acute pancreatitis (at least 3rd degree according to Trapnell's scale). A set of nineteen parameters was evaluated on the first, fourth and seventh day in every patient. Discrimination analysis was used for statistical analysis with calculation of Mahalanobis squared distances between groups that reflect their reciprocal differences. Discrimination functions were calculated allowing the assignment of a new observation to one of the models. Eventually, reliability of categorizing patients to the studied groups was evaluated.Results. Differences among the groups - reflected by Mahalanobis squared distances - proved statistically significant in every studied day. Overall, the ratio of proper classifications according to discrimination functions equaled about 87%. The most common mistake in categorizing was observed in groups of multiple injuries and acute pancreatitis - due to similar pathophysiological processes leading through SIRS to MOF.Conclusions. The abovementioned results indicate that the presented models can be successfully used in diagnostic processes, especially in emergency cases. The set of clinical and biochemical parameters used is simple and easy to obtain even in non-specialized centers.
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Damage Control

62%
Brongel L., Lorkowski J., Hładki W., Jarzynowski W., Kuliś M., Budzyński P.
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issue 11
569-575
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The 2+2 Rule in the Management of Long Bone Fractures in Patients with Severe Multiple Trauma

62%
Brongel L., Jarzynowski W., Budzyński P., Hładki W., Lorkowski J., Kuliś M.
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issue 11
526-531
EN
The aim of the study was to estimate the efficacy of surgically stabilizing long bone fractures within 48 hours in patients with severe multiple injuries following life-saving procedures and compensating for circulatory-respiratory parameters.Material and methods. The study comprised 364 patients with multiple injuries scoring 7 or more LSO points, who were admitted and treated university department during 1992-2000. Upon admission patients were documented on the basis of computer case histories of diseases and the standard calculation sheets. The assumption was that all long bone fractures in patients with multiple trauma would be stabilized within 48 hours. Parameters for operating were set so that the duration time of the operative procedure could not exceed 2 hours, and the amount of blood transfused could not exceed 2 units.Results. From among 364 patients with multiple traumas scoring 7 or more LSO points, 192 patients sustained long bone fractures that required surgical attention. One-third of the patients were female, the average age of the patients was nearly 45 years, and the average injure severity was 10.28 LSO points. 146 patients underwent 226 orthopaedic operations, out of which 127 were carried out in the first 24 hours, and 23 in the next 24 hours of the hospital stay. The mortality was 13.5%.Conclusions. Stabilization of the long bone fractures within the first 48 hours in patients with multiple traumas, after compensating circulatory parameters, is a life-saving treatment.
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The usefulness of the Mannheim Peritonitis index score in assessing the condition of patients treated for peritonitis

52%
Budzyński P., Dworak J., Natkaniec M., Pędziwiatr M., Major P., Migaczewski M., Matłok M., Budzyński A.
Polish Journal of Surgery
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2015
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vol. 87
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issue 6
301-306
EN
The aim of the study was to verify the Mannheim Peritonitis Index (MPI) suitability to determine the probability of death among patients in Polish population operated due to peritonitis and to assess the possibility of using the Index to determine the risk of postoperative complications, relaparotomy and need for postoperative hospitalization in intensive care unit. Material and methods. Retrospective analysis covered 168 patients (M: F = 83: 85, mean age = 48.45 years, SD ± 22.2) treated for peritonitis. The MPI score was calculated for each patient. According to MPI results, patients were divided to the appropriate groups (<21, 21‑29, > 29) and within analyzed. The statistical analysis used Chi-square, Mann Withney U and Kolmogorov-Smirnov test. The best cut-off point for MPI was calculated on the basis of ROC analisys. Results. Mortality in the study group was 13.1%. In groups <21, 21‑29 and > 29 points according to MPI mortality was 1.75%, 28.13% and 50% respectively, the difference was statistically significant (p = 0.0124). Significant differences were observed in mortality depending on the diagnosis. Based on the ROC curve the cut-off point was identified as 32 with an accuracy of 85.9% and AUC = 81%. There has been a significant correlation between the MPI count and and the occurrence of: cardio-respiratory failure, acidosis, electrolyte imbalance, surgical wound complications, the need for treatment in the intensive care unit after surgery. Conclusions. The MPI is a simple and effective predictor of death among patients operated due to peritonitis. It can also provide assistance in assessing the risk of postoperative complications and the need for treatment in the intensive care unit.
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Endoscopic Insertion Of A Self-Expandable Stent Combined With Laparoscopic Rinsing Of Peritoneal Cavity As A Method For Staple Line Leaks Treatment In Patients Post Laparoscopic Sleeve Gastrectomy

52%
Matłok M., Major P., Pędziwiatr M., Winiarski M., Budzyński P., Małczak P., Hynnekleiv L., Budzyński A.
Polish Journal of Surgery
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2015
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vol. 87
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issue 5
238-244
EN
Currently, laparoscopic sleeve gastrectomy is one of bariatric surgeries most commonly performed in the world. The most frequent complications of surgeries of this type, with the highest mortality rate, include bleeding into the GI tract and peritoneal cavity, and sleeve staple line leaks. These severe complications prolong the hospital stay, and often are a cause of patient’s death. While in a case of bleeding the procedure appears to be obvious, so far no uniform and standard guidelines have been established for the group of patients with staple line leaks. The aim of the study was to report results of treatment for staple line leaks following laparoscopic sleeve gastrectomy with a laparoscopic procedure and simultaneous endoscopic insertion of a self-expandable stent. Material and methods. 152 laparoscopic sleeve gastrectomies were performed from April 2009 to December 2014. The BMI median was 46.9, and the age median was 42 years. Staple line leaks developed in 3 out of 152 people (1.97%). All patients who developed this complication were included in the study. The treatment involved laparoscopic revision surgery with simultaneous endoscopic insertion of a self-expandable stent (Boston Scientific, Wallflex Easophageal Stent, 150×23 mm) into the gastric stump during gastroscopy. Results. Leaks following laparoscopic sleeve gastrectomy were diagnosed on day 5 after the procedure, on average. Intervention consisting of laparoscopy and endoscopic insertion of a self-expandable stent was initiated within 14 hours of diagnosing the leak, on average. The mean time for which the stent was kept was 5 weeks (4–6 weeks). Stenting proved to be fully effective in all patients, where after discharging home, a cutaneous fistula, periodically (every 2-3 weeks) discharging several millilitres of matter, persisted in one patient. The mean time for the leak healing in 2 patients, in whom the described method was successful in treatment of this complication, was 37 days. No patient died in the perioperative or follow-up period. Conclusions. The proposed method for treatment of staple line leaks following laparoscopic sleeve gastrectomy by combined laparoscopic rinsing and draining of the peritoneal cavity and endoscopic insertion of a self-expandable stent is an interesting and worth recommending method for treatment of this complication.
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Trauma in the Aged

52%
Brongel L., Hładki W., Grodzicki T., Friedlein J., Nazimek R., Lorkowski J., Kuliś M., Budzyński P.
Polish Journal of Surgery
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2007
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vol. 79
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issue 2
106-112
EN
After accidents, elderly patients (aged 75 years and older) have been demonstrated to have increased mortality rates after trauma, however, the prognosis of those patients surviving their hospitalization is unknown. We hypothesized that surviving elderly patients would also have decreased functional outcomes.The aim of the study. This study examined the outcome of elderly patients exposed to varying trauma relative to all trauma patients.Material and methods. This was a retrospective study of 5046 patients with trauma in 2001-2005 treated. 972 of these patients were aged 75 or more. Data included demographics, risks factors, cause of trauma, operative or conservative management and result of treatment.Results. Mechanisms of injury were falls (almost 90%), motor vehicle collisions (8%) and other. Statistical differences in the mechanisms of trauma between the studied and younger groups were observed. The mortality rate was doubled in the older group. Almost 2/3 of the patients underwent surgery. The strategy of management and treatment of elderly trauma patients has not been studied in the literature. This group may require special management and monitoring, and if possible, noninvasive modes of treatment. There are big advantages by aggressive, operative treatment of oldest patients, but is the "thin red line" in profits and loss in this group.Conclusions. In our opinion, it is necessity to operate on all elderly patients in good overall condition who were mobile and of good mental status prior to the accident, status, but we do not recommend operations in low-risk patients or those with bad prognosis for successful rehabilitation.
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Laparoscopic cholecystectomy in the treatment of gallbladder polypoid lesions – 15 years of experience

52%
Matłok M., Migaczewski M., Major P., Pędziwiatr M., Budzyński P., Winiarski M., Ostachowski M., Budzyński A., Rembiasz K.
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vol. 85
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issue 11
625-629
EN
Due to the constant increase of public health awareness and widespread “cancerophobia”, the progressively larger number of incidentally diagnosed gall-bladder polyps became the source of anxiety, which leads patients and physicians to undertake therapeutic decisions, despite the absence of symptoms. The majority of gall-bladder polyps are benign. It is estimated that only 3 to 5% of polyps are malignant. Currently, there is lack of randomized control trials based on which the clear-cut criteria of qualification of patients with gall-bladder polyps for surgical procedure can be created. The aim of the study was to analyze gall-bladder polyps in patients who underwent laparoscopic cholecystectomy in the 2nd Department of General Surgery, Jagiellonian University Collegium Medicum. Material and methods. The retrospective study was conducted on 5369 patients who underwent laparoscopic cholecystectomy in the 2nd Department of General Surgery, Jagiellonian University Collegium Medicum with special attention to 152 (2.8%) patients in whom gall-bladder polyps were diagnosed preoperatively. Qualification criteria for surgery, surgical treatment results, and histopathological examination results were also analyzed. Results. Amongst the 5369 patients qualified for laparoscopic cholecystectomy, 152 (2.8%) were diagnosed with gall-bladder polyps during the preoperative ultrasound examinations. Postoperative histopathological examinations of 41 (27%) patients confirmed the presence of gall-bladder polyps. In 102 (67%) patients, only gall-stones were diagnosed without previously described polyps during the ultrasound examination. Analysis of the histopathological examination results revealed the presence of benign lesions in 35 (23.35%) patients. In 5 (3%) patients the presence of an adenoma, and in one (0.65%) the presence of adenocarcinoma were confirmed. Conclusions. Based on the conducted study and previous personal experience in the treatment of patients with gall-bladder polyps, we believe that due to the potential risk of neoplastic transformation, patients with polyps larger than 10 mm in diameter and polyps of proven rapid growth should be qualified for laparoscopic cholecystectomy. Indications for surgical treatment also seem reasonable in case of patients with present polyps and coexisting right upper quadrant pain, even though the above-mentioned is connected with gall-bladder deposits.
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Selected Aspects in Abdominal Trauma Management

52%
Kuliś M., Brongel L., Budzyński P., Hładki W., Lorkowski J., Nazimek R., Jarzynowski W., Magiera J.
Polish Journal of Surgery
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2007
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vol. 79
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issue 5
353-361
EN
The aim of the study was analysis of diagnostic techniques relative to the type of trauma sustained (blunt versus penetrating), the patients' haemodynamic status (stable versus in shock), the character of injuries (isolated versus multiple) and the type of treatment employed (conservative versus operative) in patients with suspected abdominal injuries.Material and methods. The study included 1406 trauma victims hospitalized in the 2nd Department of Surgery in Cracow from 1995 to 2004 who were diagnosed with or underwent surgery for suspected abdominal organ injury. In addition to the clinical examination performed in each case, the ultrasonographic examination according to FAST procedure was used in 1373 patients, diagnostic peritoneal lavage (DPL) in 46, computed tomography (CT) in 27, laparoscopy in 45 and contrast studies of the urinary tract in 45 patients. Data concerning treatment process were obtained retrospectively from the computer databases entitled "Kopernik" and "Pacjenci". The efficiency of diagnostics provided in our clinic was estimated on the basis of the percentage of exploratory laparotomies and the number of missed injuries.Results. Of 218 patients with abdominal organ injuries, 72% underwent surgery and the remaining 28% were treated conservatively. Regardless of the type of trauma, the patients in shock received surgical treatment more often. In the group of patients suffering from blunt injuries, exploratory laparotomies were performed in 5.9% of haemodynamically stable patients and in 12.3% of patients admitted in shock. In the group of penetrating injuries the percentage of exploratory laparotomies reached 23.5 and 6.25% respectively. In six patients with blunt abdominal trauma who were treated conservatively the abdominal injuries were missed. One out of every ten patients was qualified for laparotomy solely on the basis of clinical examination. Most of these patients suffered from abdominal wounds. In the vast majority of remaining patients, FAST was used as the only diagnostic technique or (more often) in combination with additional diagnostic techniques. Except for FAST, additional diagnostic techniques were used in every tenth patient with isolated abdominal injury and in every fourth with multiple injuries. In the most abundant group of patients operated on due to bleeding, FAST was supplemented by additional techniques in half of the patients.Conclusions. FAST played a crucial role in diagnosing patients with injuries of the torso. CT or laparoscopy was additionally recommended for patients with suspected intra-abdominal organ injury, especially in cases of multiple injuries. Peritoneal penetration of the wound without symptoms of intra-abdominal organ injury should not constitute an indication for laparotomy. Qualification for laparotomy on the basis of clinical examination only is permissible only in haemodynamically unstable patients with abdominal wounds.
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Evaluation of Long Term Therapy Outcomes for Achilles Tendon Ruptures

52%
Lorkowski J., Brongel L., Hładki W., Budzyński P., Żeglin M., Kuliś M., Nazimek R., Guzik P.
Polish Journal of Surgery
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2007
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vol. 79
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issue 6
410-417
EN
The aim of the study was to assess the results of treatment for partial and complete Achilles tendon ruptures.Material and methods. We evaluated 94 patients suffering from the injury (61 males and 33 females) with an average age of 43.8.Results. The most common mechanism of injury was sport-related (57 participants) or walking-related overstraining (32 participants). 81 patients underwent surgical procedures. In 77 patients, Kessler's suture was used and in 12 patients, transplantation of iliotibial tract was performed. A group of 13 patients underwent a conservative therapy. Plantar flexion immobilization was used for 3 months (constant immobilization for 6 weeks) in all groups. Every patient underwent rehabilitation following surgery. The follow up period was 2.5 years. 85 patients fully recovered lower limb function. In 9 patients, complications were noted: 4 had flexor contractions in the ankle joint requiring further treatment, 2 patients suffered from reoccurrence of tears, and 2 had thrombophlebitis. One patient developed diffuse necrosis of the posterior region of the distal leg, which required amputation.Conclusions. An appropriate approach to the treatment of Achilles tendon injuries is surgery followed by intensive physiotherapy. During the surgical procedure, it is essential to properly realign the anatomic structures including the fibers rotating within the tendon.
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