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1
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Pancreatic cysts: etiology, diagnosis and management

100%
Jabłońska B.
Open Medicine
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2014
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vol. 9
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issue 1
92-107
EN
Pancreatic cysts involve a wide spectrum of pathologies from post-inflammatory cysts to malignant neoplasms. Pancreatic pseudocysts, serous cystadenomas, mucinous cystadenomas, intraductal papillary mucinous neoplasms (IPMNs) and solid pseudopapillary tumors occur most frequently. Differential diagnosis involves the following imaging investigations: transabdominal ultrasonography (TUS), contrast enhanced ultrasonography (CEUS) and endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance (MR) and magnetic resonance cholangiopancretography (MRCP), endoscopic retrograde cholangiopancretography (ERCP). The cyst fluid cytology is performed in difficult differential diagnosis between pseudocysts and benign and potentially malignant or malignant tumors. Most frequently, viscosity, amylase, CEA and CA 19-9 levels are determined. Imaging findings should be correlated with cytology. The management depends on the cyst type and size. Small asymptomatic pseudocysts, serous cystadenomas and branchduct IPMNs should be carefully observed, whereas symptomatic large or uncertain serous cystadenomas and cystadenocarcinomas, mucinous cystadenomas and cystadenocarcinomas, main-duct IPMNs and large branch-duct IPMNs with malignant features, serous and mucinous cystadenocarcinomas, and solid pseudopapillary tumors require surgery. Pseudocysts are usually drained. Percutaneous / EUS-guided or surgical cyst drainage can be performed. Complicated and uncertain pseudocysts and cystic tumors need surgical resection. The type of surgery depends on cyst location and size and includes proximal, central, distal, total pancreatectomies and enucleation.
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The Arterial Blood Supply of the Extrahepatic Biliary Tract - Surgical Aspects

100%
Jabłońska B.
Polish Journal of Surgery
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2008
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vol. 80
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issue 6
336-342
3
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Long-Term Results in the Surgical Treatment of Iatrogenic Bile Duct Injuries

51%
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

45%
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.
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Influence of Location and Mitotic Index on Prognosis in Patients with Gastrointestinal Stromal Tumors

45%
Mrowiec S., Jabłońska B., Leidgens M., Pająk J., Lampe P.
Polish Journal of Surgery
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2008
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vol. 80
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issue 6
321-330
EN
Gastrointestinal stroma tumors (GIST) arise from the pacemaker, the interstitial Wells of Cajal. These tumors constitute 1 to 3% of gastrointestinal neoplasms, and may occur in each portion of the gastrointestinal tract. The most useful prognostic factors are tumor size, mitotic index, cell structure and location within the gastrointestinal tract.The aim of the study was to assess the chosen prognostic factors (location in the gastrointestinal tract and mitotic index) in patients with GIST.Material and methods. Between 1989 and 2002, 74 patients (37 men and 37 women) with an average age of 54.9 years (range from 13 to 89 years) were operated for GIST in the Department of Gastrointestinal Surgery. Two- and five-year survival rates during observation were analyzed, as well as the location within the gastrointestinal tract and mitotic index. Based on the intraoperative and postoperative investigations, the tumor size, presence of metastases and histological type of predominant cells were estimated in each patent. Results were subjected to statistics, where p≤0.05 was considered to be significant.Results. Of the 74 patients included in the study, 3 patients (4%) had a primary tumor located in the lower oesophagus, 42 patients (56.8%) in the stomach, 4 patients (5.4%) in the duodenum, and 13 patients (17.6%) had tumors originated from the small intestine. In an additional 12 patients (16.2%), the tumor originated from the large intestine. The most frequent (51%) mitotic index was 2, and 9/50 hpf was considered an intermediate malignant potential risk. Two-year survival was common in patients with GIST located in the oesophagus, stomach, and duodenum, totalling 34 (79%) patients. A lower than two-year survival rate was noted in patients with GIST arising from the small intestine: 7 (63.6%) patients had tumors arising from the colon and 4 (36.3%) patients had rectal tumors. Five-year survival was also the most frequent in patients with GIST located in the upper part of gastrointestinal tract (37.2%), in the median part of gastrointestinal tract (36.3%), and in the lower part of the gastrointestinal tract (27.7%). Correlation between location, mitotic index and survival of patients was assessed. The correlation studies showed a statistically significant influence of tumor location in the gastrointestinal tract (p=0.0264) and mitotic index (p=0.0003) with the survival of patients operated for GIST. Thus, the lower location and higher mitotic index of GIST are associated with shorter survival of patients.Conclusions. The mitotic index and location in the gastrointestinal tract are essential prognostic factors in analyzed patients with GIST. In the analyzed group, the lower locations and higher mitotic indices of GIST were associated with shorter survival of patients.
6
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Middle Pancreatectomy - Own Experience

45%
Jabłońska B., Żaworonkow D., Dranka-Bojarowska D., Musialski P., Lampe P.
Polish Journal of Surgery
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2011
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vol. 83
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issue 5
237-243
EN
The aim of the study was to analyse early results after middle pancreatectomy based on our experience.Material and methods. During the period between 2008 and 2009, 154 pancreatic resections were performed at the Department of Gastrointestinal Surgery, Silesian Medical University in Katowice. The following procedures were performed: 109 (70.78%) pancreatoduodenectomies, 32 (20.78%) distal pancreatectomies, 9 (5.84%) middle pancreatectomies, 3 (1.94%) total pancreatic resections, and 1 (0.65%) subtotal pancreatic resection. Early results in case of nine middle pancreatectomies were subject to analysis.Results. Average hospitalization period amounted to 24.28 days (ranging between 8 and 57 days). Mean hospitalization period after surgery amounted to 20.71 days (ranging between 6 and 54 days). Average duration of the surgical procedure amounted to 3.6 hours (ranging between 2.25 and 4 hours). Wirsung's duct required drainage in 4 (44.4%) patients. Pancreatoenterostomy was performed in 5 (55.5%) patients. Early postoperative complications were observed in three (33.3%) patients. The most common complications included wound suppuration and intra-abdominal abscess development observed in two (22.2%) patients. Pancreatic fistula development during the postoperative period was observed in case of one (11.1%) patient. Other early postoperative complications included peritoneal cavity hemorrhage (1-11.1%) and pancreatic necrosis (1-11.1%). Two (2.22%) reoperations were required. Early postoperative mortality amounted to 0%.Conclusions. Middle pancreatectomy operations performed in experienced centers are considered as safe procedures with a low rate of complications. The most common indication for middle pancreatectomy is the diagnosis of a benign pancreatic tumor.
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Surgical Treatment of Pancreatic Neuroendocrine Tumours - Clinical Experience

45%
Jabłońska B., Dranka-Bojarowska D., Palacz H., Lewiński A., Lampe P.
Polish Journal of Surgery
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2011
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vol. 83
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issue 4
216-222
EN
The aim of the work was the clinical characteristics and analysis of preliminary results for surgical treatment of pancreatic neuroendocrine tumors (PNETs), based on own material.Material and methods. In the period from 2005 to 2009, in the Department of Gastrointestinal Surgery, Silesian Medical University in Katowice, there were 27 patients (15 males and 12 females) treated surgically for pancreatic neuroendocrine tumours, constituting 65.86% (27/41) of all gastroenteropancreatic neuroendocrine tumours. Prior to the surgery, the following diagnostic examinationswere performed: laboratory tests and imaging examinations (abdominal ultrasound and CT scan). The following tumour localisation was established: head of the pancreas - 14, body of the pancreas - 4, tail of the pancreas - 5, body and tail of the pancreas - 1, retroperitoneal space - 4. There were found 24 (88.89%) primary tumours and 3 (11.11%) recurrences. The following methods of surgical treatment were applied: pancreatoduodenectomy - 11, distal pancreatic resection with splenectomy - 6, middle segment resection with anastomosis between the pancreatic tail and jejunal loop: Roux-Y procedure - 1, pancreatic resection by Beger procedure - 1, pancreatic head and body resection with splenectomy - 1, tumour enucleation or local excision - 4, exploratory laparotomy with specimen collection - 3.Results. The mean hospitalisation period was 25 days (4-78 days). The mean procedure duration was 4.2 hours (1.15-9.15 hours). Early post-operative complications were observed in 10 patients (37.04%). The following early complications were observed: intra-abdominal abscess - 2, wound suppuration - 2, pancreatic fistula - 1, acute pancreatitis - 1, pancreaticojejunal anastomosis leak - 1, peritoneal cavity haemorrhage - 1, acute cholangitis - 1, adhesion obstruction - 1, subobstruction - 1, portal vein thrombosis - 1, sepsis - 1, fluid in pleural cavity - 1, acute heart failure - 1. There were performed 2 (7.41%) repeat surgeries: one due to adhesion obstruction and one due to peritoneal cavity haemorrhage. Death of 1 patient (3.71%) was recorded in the post-operative period due to acute heart failure.Conclusions. Pancreatic neuroendocrine tumours constituted the majority of gastroenteropancreatic neuroendocrine tumours in the analysed patient group. Most commonly, PNETs were localised in the head of the pancreas. In the presented material, the mortality rate does not exceed 4%, similarly as in other renowned centres.
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The Association of Polish Surgeons on Pancreatic Fistulas

39%
Jabłońska B., Lampe P., Dziki A., Matyja A., Śledziński Z., Wallner G.
Polish Journal of Surgery
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2015
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vol. 86
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issue 5
244-247
9
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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

39%
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.
10
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Distal Pancreatectomy - OWN Experience

33%
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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