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1
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Internal Pancreatic Fistulae - Management Review

100%
Hać S., Śledziński Z.
Polish Journal of Surgery
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2008
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vol. 80
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issue 5
281-287
2
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Early Results of Roux-en-Y Gastric By-Pass on Regulation of Diabetes Type 2 in Patients with BMI Above and Below 35 Kg/m2

81%
Proczko-Markuszewska M., Stefaniak T., Kaska Ł., Śledziński Z.
Polish Journal of Surgery
|
2011
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vol. 83
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issue 2
81-86
EN
The idea of surgical treatment of type 2 diabetes was established in the U.S. and was based on observation of patients after bariatric operations. Performed in cases of morbid obesity exclusion of the duodenum and anastomose the stomach with the central part of the intestines cause shortened absorbtion of nutrients, what showed a beneficial effect on weight loss, resolution of comorbidities and reduce the risk of developing cardiovascular diseases and cancer. Analysis of the results of surgical treatment of obese patients with type 2 diabetes confirmed the usefulness of surgical methods.The aim of the study was to evaluate the impact of Roux-en-Y gastric by-pass (RYGB) on diabetes in patients with BMI below and above 35 kg/m2.Material and methods. The study comprised 66 patients with DM2, who underwent Roux-en-Y gastric bypass due to morbid obesity (BMI above 35 kg/m2) and three patients with DM2 and BMI below 35 kg/m2. In patients with DM2 and BMI < 35 kg/m2 criteria for inclusion in the operational treatment were: DM2 difficult to be regulated pharmacologically lasting less than 10 years and BMI at the qualification about 35 kg/m2. Indications have been determined on the basis of three consecutive measurements of HbA1c values above 7%, and measurements of blood glucose (frequent fluctuations in blood glucose levels on the value of hypoglycemia to hyperglycemia).Results. The criteria for diagnosing resolution of DM2 included the level of HbA1c < 6% and glucose fasting level below 100 mg/ dl. In a group of 66 patients with DM2 and obesity, regression of DM2 was observed in 48 patients (73%) as early as during the hospitalization. In 11 patients (16.7%) glycaemia and HBA1c were stabilized within 8 weeks after surgery. In 7 (10.6%) cases of patients with difficult to control DM2, there was still need for antidiabetic medication, but glycemic control was much more effective. After one year remission was observed in 89% of patients. In all three patients with DM2 and BMI < 35 kg/m2 total glycemic resolution of DM2 was observed during hospitalization. In this group there has been no postoperative complications. In the group of 66 obese patients with DM2 postoperative complications were found in 7 cases, they were related to infection and prolonged healing of surgical wound. One patient had an intraabdominal abscess located in the left subphrenic region, it was punctured under ultrasound guidance.Conclusions. The ultimate evaluation of this method demands several years of meticulous clinical studies. Despite of that, considering high cost of life-long conservative therapy of DM2 and its complications, severe impact on quality of life and serious consequences of the disease, the surgical metabolic intervention may become the most resonable solution in many cases.
3
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Portal Vein Resection During Pancreatectomy for Pancreatic Head Adenocarcinoma. Scope of Current Opinions and own Experiences

81%
Łaski D., Hać S., Śledziński Z.
Polish Journal of Surgery
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2015
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vol. 86
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issue 7
345-349
4
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Infections in Notes

81%
Kobiela J., Naumiuk Ł., Łaski D., Śledziński Z.
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vol. 85
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issue 10
619-624
5
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Introduction of new technique of single-port transgastric access for repeated debridement of infected pancreatic necrosis

81%
Kobiela J., Hać S., Śledziński Z.
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vol. 85
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issue 4
228-233
EN
In this article we introduce a novel technique of repeated single-port transgastric debritment of walledoff pancreatic necrosis using TriPort ™ Access System. The presented technique seems an appealing and innovative approach to the treatment of walled-off pancreatic necrosis in acute pancreatitis patients. Studies proving feasibility, safety and efficiency are necessary to elucidate real value of the technique
6
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Enteral Nutrition Without the Use of An Endoscope in Patients with Severe Acute Pancreatitis

81%
Czerepko M., Hać S., Sawicka W., Śledziński Z.
Polish Journal of Surgery
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2011
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vol. 83
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issue 11
630-633
EN
One of the main elements of acute pancreatitis therapy is nutritional treatment, which should ensure the implementation of the patients' energetic needs, limit the exocrine activity of the pancreas, and maintain the gastrointestinal passage. The most important argument in favor of the above-mentioned is the fact that enteral nutrition in case of severe acute pancreatitis prevents infectious complications. The most effective method is enteral nutrition. The unavailability of bedside endoscopy, and thus the need to transport the patient in order to obtain access, considerably complicates the procedure. Literature data described various bedside techniques consisting in the blind introduction of the feeding tube, which are rarely used, despite the fact that they are cheaper and as effective as endoscopy.
7
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Complex Interventional Treatment of Extensive Consequences of Necrotizing Pancreatitis - Case Report

71%
Jagielski M., Smoczyński M., Studniarek M., Śledziński Z., Adrych K.
Polish Journal of Surgery
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2015
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vol. 87
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issue 1
39-42
EN
The paper presents description of the effective treatment of patients with extensive consequences of necrotizing pancreatitis. The strategy of treatment was to extend access to necrotic areas („step-up approach”). Applied endoscopic transmural access (transgastric), percutaneous access (transperitoneal) and surgical access. The cooperation endoscopist, surgeon and interventional radiologist gave very beneficial clinical effects in patients with extensive complications of acute pancreatitis.
8
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Training in classic and laparoscopic surgery – needs and remedies

71%
Stefaniak T. J., Łaski D., Patrzyk M., Bigda J., Śledziński Z.
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vol. 85
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issue 7
412-418
9
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Kinetic properties of AMP deaminase in acute experimental pancreatitis

71%
Kossowska E., Purzycka-Preis J., Woźniak M., Żydowo M., Śledziński Z.
Acta Biochimica Polonica
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1994
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vol. 41
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issue 2
158-160
10
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Surgical Treatment of Neuroendocrine Tumors of the Pancreas

71%
Dobrowolski S., Śledziński Z., Sworczak K., Hellmann M., Babińska A.
Polish Journal of Surgery
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2010
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vol. 82
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issue 7
417-421
EN
Management of patients with neuroendocrine tumors (NETs) of the pancreas causes considerable controversy because rarity of this neoplasm.The aim of the study was to present our results of treatment of patients with NETs and to sum up our experience in surgical management.Material and methods. Thirty four patients with neuroendocrine tumors of the pancreas were treated in Department of General, Endocrine and Transplant Surgery of Medical University in Gdańsk (24 inulinomas and 10 nonfunctioning neuroendocrine tumors). Insulinoma was present in the head of the pancreas in 3 cases, in the body in 8 cases, and 10 patients had lesion situated within the tail.Results. Localization of the tumor in patients with organic hyperinsulinism was possible in 21 out of 24 operated patients (17 patients with use of preoperative imaging studies, 4 patients with Intraoperative ultrasonography). In 3 remaining patients the localization of the pathologic mass was impossible with use of pre- and intraoperative techniques.Conclusions. Treatment of choice of patients with neuroendocrine tumors of the pancreas is surgery. Management of patients with islet cells adenomatosis is still difficult clinical problem.
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Postoperative PTH Measurement as a Predictor of Hypocalcaemia After Thyroidectomy

71%
Proczko-Markuszewska M., Kobiela J., Stefaniak T., Łachiński A., Śledziński Z.
Polish Journal of Surgery
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2010
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vol. 82
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issue 1
24-28
EN
Hypocalcemia after thyroidectomy is the most common postoperative complication with reported incidence from 0.5% to even half of the operated patients. Hypoparathyroidism could be a result of careless or inadequate preparation during the surgical procedure. There is a variety of proposed options for prediction of the incidence of hypocalcemia. The most effective of them are the perioperative and intraoperative measurements of PTH level.The aim of the study was to assess the potential correlation between the iPTH levels after the operation and development of hypocalcaemia. The possible prediction value of postoperative iPTH levels was to be evaluated assessed.Material and methods. A prospective study was performed on 100 patients who underwent total thyroidectomy from January 2007 to June 2009. The total calcium level and intact human PTH (iPTH) levels were measured 24 hours before, 1 and 24 hours after the surgery.Results. We have presented a significant correlation between early iPTH measurement and risk of hypocalcaemia. Moreover a significant correlation between the iPTH level 1 hour after operation with the calcium level 24 hours after the operation was demonstrated.Conclusions. Early postoperative assessment of iPTH levels can be used to identify the group of patients at risk of hypocalcaemia after thyroidectomy. Pre-emptive calcium supplementation can lead to avoidance of complications causing prolonged hospital stay and most importantly to prevent severe hypocalcemia.
12
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Percutaneus Thermoablation in Patients with Primary and Secondary Liver Cancer - Early Results

62%
Zadrożny D., Śledziński Z., Studniarek M., Dobrowolski S., Gorycki T., Adamonis W., Bury K.
Polish Journal of Surgery
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2008
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vol. 80
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issue 8
387-393
EN
Liver is common place where the cancer occurs primary as well as secondary. Liver resection as a potentially healing method can be performed only in about 20% of patients. Prognosis in group of patients treated non-invasively is bad. Using high frequency thermal ablation which damages the neoplastic tissue in liver may lead to prolongation of life expectancy.The aim of the study was to assess the early results of using the high frequency thermal ablation in patients with primary or secondary cancer.Material and methods. During years of 2001-2007 371 patients underwent the 520 procedures of percutaneous RF thermal ablation under US control. Mean age of patients was 62.47 (19-85 ± 11.63). 175 women and 196 men were treated using this method.Results. There were 10 early complications after thermal ablation (1.92% of procedures, 2.7% of patients). Two of them ended fatal (0.38% of procedures, 0.54% of patients). In seven cases absces formation were observed, one of them was the cause of death due to Clostridium perfingens infection. Cholerrhagia from damaged bile duct in cirrhotic liver caused the peritonitis and subsequent death of patient. Two patients suffered from sub-capsular hematoma of liver. 14 patients also suffered from long lasting pain (more than 14 days).Conclusions. Percutaneous thermal ablation in primary or secondary liver tumors is safe and efficient procedure. Long term follow up will give the knowledge about the real value of the procedure.
13
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Content available

Sources of medical information of patients referred to colorectal surgery outpatient clinic for hemorrhoidal disease

62%
Spychalski P., Perdyan A., Łaski D., Kobiela J., Błażyńska-Spychalska A., Łachiński A., Śledziński Z.
|
2019
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vol. 2
|
issue 1
36-43
EN
Background We surveyed patients with hemorrhoids about their behavior regarding searching for information about that disease and confronted it with data obtained from Google Trends website and Google searches. We aimed to determine sources of information on hemorrhoids used by patients. Secondary aim was to assess the quality of information provided by Internet in particular. Material and methods We collected 78 surveys from patients of the outpatient surgical clinic at Medical University of Gdańsk, in which we asked about sources of information about hemorrhoids. We used Google Trends to analyze most often used search queries associated with that topic. In result, we analyzed the content of top 10 Google search results of that queries in order to verify reliability. Results Over 80% of surveyed patients looked for information about that disease online, 50% of whom were satisfied with the quality of information obtained. Our Google Trends analysis showed that term hemorrhoids has overwhelming prevalence in comparison to remaining terms. Analysis of top 10 Google search results showed that 7 in 10 organic links lead to websites with professional information about hemorrhoids. Conclusions Patients use the Internet as a source of knowledge about hemorrhoids and find it satisfactory. Moreover, our research indicates that this information is reliable.
14
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The Association of Polish Surgeons on Pancreatic Fistulas

62%
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
15
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Factors Influencing Frequency of Conversion During Laparoscopic Cholecystectomy

62%
Skonieczny B., Pytka M., Stefaniak T., Skonieczny W., Grzybowski Z., Śledziński Z.
Polish Journal of Surgery
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2008
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vol. 80
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issue 2
62-68
EN
The aim of the study was to evaluate factors influencing the frequency of conversion during laparoscopic cholecystectomy; to observe dynamic trends concerning frequency of classic versus laparoscopic cholecystectomies; and to evaluate correlations between the experience of a surgeon and conversion incidence.Material and methods. A retrospective study was performed, reviewing the records of 3337 patients operated on for gallbladder stones from January 2000 to December 2005 in three hospitals in the Pomeranian Region of Poland: Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk; Department of Surgery, 110th Military Hospital in Elbląg and Department of Surgery, Hospital in Słupsk.The main issues evaluated were: dynamic changes in frequency of laparoscopic versus classic cholecystectomies; frequency of conversions, reasons for conversion; correlation between experience of a surgeon and conversion incidence; and demographic data.Results. Out of 3337 patients, there were 2390 (71.62%) females and 947 (28.3%) males. For these patients, 1493 procedures (45.2%) were performed as classical, 1804 (54.06%) as laparoscopic, and 176 (9.7%) as converted from laparoscopy to open procedure. Sex distribution in the laparoscopic group was 1352:452 (F:M 74.9%:25.05%) and in the converted group was 107:69 (60.8%:39.2%).The main problems relating to conversion during laparoscopic cholecystectomy were: adhesions - 108 (61.36%), gall-bladder perforations - 8 (4.5%), tumors - 10 (5.6%), technical problems - 28 (15.9%), hemostasis problems - 11 (6.25%), unrecognizable anatomical structures - 24 (13.6%), complications of ‘e fundo’ cholecystectomy - 24 (13.6%) and equipment problems - 4 (2.27%).It was also observed that SHO's and surgeons with greater experience are performing more conversions during laparoscopic procedures.Conclusions. Laparoscopic cholecystectomy is a safe procedure recommended as a gold standard for gallbladder stone treatment. Frequency of this procedure is rising in centers in the Pomeranian region.The highest incidence of conversions is associated with adhesions after previous open operations.Consultants perform earlier conversion due to greater experience and better estimation of risk factors.
16
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Bariatric surgery in morbidly obese patients with chronic renal failure, prepared for kidney transplantation – case reports

62%
Proczko M., Kaska Ł., Kobiela J., Stefaniak T., Zadrożny D., Śledziński Z.
|
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vol. 85
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issue 7
407-411
EN
Recent years, obesity is a growing health problem also in patients with chronic renal failure and end it’s end stage. This situation has a negative impact both on the extension of the waiting period for transplantation, and the survival rate of the transplanted organ and the recipient. Weight loss through lifestyle modification before transplantation is ambiguous. Its well known fact of rapid body mass gain after transplantation, and finnaly the results of transplantation are not better than those of patients who have not reduced body weight. The paper presents preliminary experience associated with bariatric operations of three chronic dialysed patients with morbid obesity BMI> 35 kg/m2, all patients had been treated by Roux-en-Y gastric by-pass (RYGB). All operated patients were classified as potential recipients were listed by Poltransplant. One of them three months after RYGB surgery underwent without complications a renal transplantation. Preliminary experiences based on operating these three caese confirmed the complete safety of this type of approach in patients with end-stage chronic kidney disease (CKD).
17
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Human Serum Paraoxonase Activity Decreases After Vertical Banded Gastroplasty*

62%
Goyke B., Goyke E., Śledziński T., Adrych K., Raczyńska S., Śledziński Z., Świerczyński J.
Polish Journal of Surgery
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2007
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vol. 79
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issue 6
436-444
EN
The aim of the study. Investigation of the effect of vertical banded gastroplasty (VBG), which is an effective method of treating patients with morbid obesity on serum paraoxonase (PON) activity.Material and methods. Serum PON activity was measured in twenty eight morbidly obese patients 6 and 12 months after surgery. PON activity was also measured in the serum and liver of rats maintained on a restricted diet for one month.Results. We found that VBG-induced significant reduction in body weight and serum PON activity at 6 and 12 months after surgery. Similar patterns of decreases in serum paraoxonase activity in obese patients after VBG were observed in A, AB and B paraoxonase/esterase phenotypes. After VBG, several clinically relevant events occurred: a) a decrease of serum triacylglycerol concentration was observed; b) no significant changes in total serum cholesterol and LDL-cholesterol concentrations were found; c) serum HDL-cholesterol concentration increased slightly.Paraoxonase activity in the serum of rats maintained on a restricted diet, which induced approximately 30% and 50% of rat body weight and fat mass loss, respectively, was lower than in control animals.Conclusions. This study indicates that after VBG significant decreases in serum paraoxonase activity occur in obese subjects. It is likely that less food ingestion and possibly a different type of food consumed by the obese subjects after VBG (compared to type of food consumed before surgery) may contribute to decreases in serum PON activity.
18
Publication available in full text mode
Content available

Sources of medical information of patients referred to colorectal surgery outpatient clinic for hemorrhoidal disease

62%
Spychalski P., Perdyan A., Łaski D., Kobiela J., Błażyńska-Spychalska A., Łachiński A., Śledziński Z.
European Journal of Translational and Clinical Medicine
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2019
|
vol. 2
|
issue 1
36-43
EN
Background: We surveyed patients with hemorrhoids about their behavior regarding searching for information about that disease and confronted it with data obtained from Google Trends website and Google searches. We aimed to determine sources of information on hemorrhoids used by patients. Secondary aim was to assess the quality of information provided by Internet in particular. Material and methods: We collected 78 surveys from patients of the outpatient surgical clinic at Medical University of Gdańsk, in which we asked about sources of information about hemorrhoids. We used Google Trends to analyze most often used search queries associated with that topic. In result, we analyzed the content of top 10 Google search results of that queries in order to verify reliability. Results: Over 80% of surveyed patients looked for information about that disease online, 50% of whom were satisfied with the quality of information obtained. Our Google Trends analysis showed that term hemorrhoids has overwhelming prevalence in comparison to remaining terms. Analysis of top 10 Google search results showed that 7 in 10 organic links lead to websites with professional information about hemorrhoids. Conclusions: Patients use the Internet as a source of knowledge about hemorrhoids and find it satisfactory. Moreover, our research indicates that this information is reliable.
19
Publication available in full text mode
Content available

Interdisciplinary treatment of large adrenocortical carcinoma infiltrating inferior vena cava

52%
Dobrzycka M., Spychalski P., Rusek U., Brzeziński M., Kobiela J., Kłosowski P., Berendt-Obołończyk M., Łachiński A., Sworczak K., Śledziński Z.
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2019
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vol. 2
|
issue 2
38-42
EN
Adrenal tumors are common neoplasms and majority of them are small, benign, hormonally inactive adrenocortical adenomas. Whereas adrenal cancer (ACC) is a rarely occurring (5% of adrenal tumors) but highly aggressive neoplasm. The early diagnosis and complete surgical resection is the only effective treatment option. Laparoscopic adrenalectomy is the gold standard for small and medium tumors. Whereas for large tumors classic adrenalectomy is considered a procedure of choice with a proven better oncological outcome. We herein report a case of a 57-year-old female diagnosed with a large, advanced left adrenal tumor with invasion of vena cava. It was diagnosed in CT and proven in core biopsy. Open adrenalectomy with thoracotomy was conducted to completely resect the tumor by an interdisciplinary team.
20
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Preliminary Results of the First Quality Assurance Project in Rectal Cancer in Poland

52%
Mroczkowski P., Hać S., Mik M., Berut M., Dziki Ł., Kube R., Śledziński Z., Lippert H., Dziki A.
Polish Journal of Surgery
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2011
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vol. 83
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issue 3
144-149
EN
When compared with other EU countries, Poland is in the last place in terms of efficacy of rectal cancer treatment. In order to remedy this situation, in 2008 Polish centres were given the opportunity to participate in an international programme for evaluating the treatment efficacy.The aim of the study was to present the results obtained during the first two years of research.Material and methods. The study protocol covered 71 questions concerning demographic data, diagnostics, risk factors, peri- and post-operative complications, histopathology, and treatment plan at discharge. The patient and unit data were kept confidential.Results. From 1 January 2008 to 30 December 2009, there were 709 patients recorded, of which 55.9% were males. At least one risk factor was found in approx. 3/4 of patients, while approx. 1/3 of patients were classified to group 3 and 4 according to ASA. The mean distance of the tumour from the anal margin was 8.5 cm; approx. 70% of patients were in the clinical stages cT3 and cT4; metastases were observed in 18.8%. Transrectal endoscopic ultrasonography (TREUS) was performed in 23.7% of patients, magnetic resonance imaging (MRI) in 2.5% and computed tomography (CT) scan - in 48.1%. In close to half of the patients, anterior or low anterior resection of the rectum was performed, and abdominoperineal resection in 1/4 of the patients. Anastomotic leakage was seen in 3.8% of patients, while 1.8% died during hospitalisation.Conclusions. It should be strived after that all the centres undertaking the treatment of rectal cancer should participate in the quality assurance programme. This should enable the achievement of good therapeutic results in patients with rectal cancer treated in Polish centres.
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