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Ileal-Pouch-Anal Anastomosis After Restorative Proctocolectomy in Patients With Ulcerative Colitis or Familial Adenomatous Polyposis - 11 Years of Experience

100%
Bednarz W., Olewiński R., Woldan J.
Polish Journal of Surgery
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2007
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vol. 79
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issue 5
362-367
EN
Restorative proctocolectomy is the "gold standard" in surgical treatment for ulcerative colitis and familial adenomatous polyposis. The two alternative techniques of ileal-pouch-anal anastomosis include handmade and double line stapled suture.The aim of the study was to analyze postoperative complications and functional results of the two types of anastomosis.Material and methods. The study group consisted of 108 patients operated between 1994 and 2005 for ulcerative colitis (n=97) or familial adenomatous polyposis (n=11). Stapled anastomosis was performed in 88 (81.5%) cases and hand-made suture was performed in 20 (18.5%) cases.Results. No significant differences between the two anastomotic techniques were found in terms of postoperative complications and late functional results.Conclusions. The low rate of complications and well-accepted functional outcomes prove that restorative proctocolectomy is a safe surgical procedure that can be offered to patients with ulcerative colitis or familial adenomatous polyposis. Double line stapled suture should be the preferred method of ilealpouch-anal anastomosis, however, the hand-made suture remains its valuable alternative and may be considered in selected cases.
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Influence of Total Thyroidectomy on Orbital Opthalmopathy and Levels of Antithyroid Antibodies in Patients with Graves' Disease

64%
Domosławski P., Łukieńczuk T., Forkasiewicz Z., Balcerzak W., Bednarz W., Dawiskiba J., Krawczyk Z., Wojtczak B., Olewiński R., Podhorska-Okołów M.
Polish Journal of Surgery
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2007
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vol. 79
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issue 3
167-172
EN
Graves' disease is an autoimmune disease. One of the most severe complications of Graves' disease is orbitopathy.The aim of the study was to estimate the influence of total thyroidectomy on the postoperative course of exophthalmus and determine the levels of thyroid antibodies after surgery.Material and methods. During the period between 2002 and 2005, 1514 strumectomies were performed at the I Chair and Department of General, Gastroenterological and Endocrine Surgery, Medical University in Wroclaw. The study included 69 (4.5%) patients, who were operated on because of Graves' disease. Forty-two (60%) of these patients had progressive opthalmopathy and were subjected to total thyroidectomy (35 women and 7 men, mean age was 31 years). The diagnosis of Graves' disease was established on the basis of the clinical evaluation, fT3, fT4 and TSH values, as well as the determination of serum thyroid antibody levels. Every patient was subjected to an opthalmological examination, with measurements of the degree of exopthalmus, as compared to the ATA (American Thyroid Association) scale. Above-mentioned parameters were measured before surgery and 6, 12 and 18 months after total thyroidectomy.Results. Considering patients after total thyroidectomy, exophthalmus did not proceed. In 17 (40%) patients, 2- 3 mm of eyeball retraction was noted, mainly during the initial six months. After surgery, a statistically significant reduction of TSH-receptor and anti-TPO antibody values were observed.Conclusions. Total thyroidectomy in patients with Graves' disease and orbital opthalmopathy significantly reduced the progression of orbitopathy. It also leads to the normalization of serum anti-recepor (TRAb) and anti-peroxidase (anti-TPO) antibody levels.Total thyroidectomy is a quick and effective procedure in the hands of an experienced surgeon and should be performed in secondary or tertiary care centers.
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