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Long term results of the use of compression anastomosis clips (CAC) in gastrointestinal surgery – the first report

100%
Kuśnierz K., Lampe P.
Polish Journal of Surgery
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2015
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vol. 87
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issue 6
295-300
EN
The aim of the study was to present the first long-term results on the clinical use of compression anastomosis clips (CAC) in upper and lower gastrointestinal tract anastomoses. Material and methods. The study included 50 patients who underwent anastomosis of the upper (n = 32) or lower GI tract (n = 18) with the use of CAC. In the period of 6‑7 months after the surgery, patients underwent endoscopic examination and computed tomography evaluation of the anastomosis. Each anastomosis was evaluated macro and microscopically. The width of anastomoses was evaluated using a 4-point-scale for grading stenosis. Results. Of the 50 patients who underwent anastomosis with compression anastomosis clip, 28 (56%) patients reported to the follow-up examination within 190‑209 days of the execution of the anastomosis. Among the 22 patients who did not report to the study, 18 (36%) patients died within 91‑154 days from the execution of the anastomosis (mean 122 days), 4 (8%) patients were impossible to contact after discharge from hospital. Two mild stenoses (I0) were diagnosed; 1 of them was found in the gastroenterostomy and 1 in Braun enteroenterostomy. Microscopic changes were diagnosed in 4 anastomoses (3 gastroenterostomies, 1 Braun enteroenterostomy). Anastomoses were well-formed and wide, scars in the line of anastomoses were thin. Conclusions. During the period of 6 months after the anastomoses performed using CAC have been formed, they were evaluated as unobstructed and functioning properly; therefore, they can be safely performed within the upper and lower gastrointestinal tract.
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Anatomia Kliniczna Okolicy Odbytowo-Odbytniczej

100%
Stefański L., Lampe P.
Polish Journal of Surgery
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2012
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vol. 84
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issue 5
267-269
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Pancreatic Tail Cysts

100%
Stefański L., Lampe P.
Polish Journal of Surgery
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2008
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vol. 80
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issue 6
310-314
EN
The aim of the study was to determine the optimal surgical strategy in patients with pancreatic tail cysts infiltrating the spleen, stomach, left diaphragmatic dome, or transverse colon mesentery.Material and methods. From 1997 through 2004, 184 patients with pancreatic pseudocysts were evaluated and treated in our Department. In 63 of those cases (34.2%), the lesion was located in the tail of the pancreas, and was classified as type II or III according to D. Egidio and Schein.Results. Combined pancreatic tail and splenic resection was performed in 32 subjects (51%), 13 (20%) underwent external drainage / marsupialisation, 11 (18%) had a Roux-en-Y pancreaticocystojejunostomy, and one patient underwent a Duval operation. Endoscopic drainage to the stomach (pancreatocysto-gastrostomy) was used in one subject; another five patients who had previously undergone external drainage / marsupialisation and developed a recurrent cyst within four months after the primary procedure were selected for pancreaticocystojejunostomy. Thus, internal drainage was performed in a total of 18 patients (28%).Conclusions. Based on our experience, we prefer pancreatic tail resection (with splenectomy) in those patients who present to the hospital with involvement of the neighbouring organs.
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Comments on the Selected Problems in Surgery of the Pancreas

100%
Lampe P., Kuśnierz K.
Polish Journal of Surgery
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2008
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vol. 80
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issue 6
295-298
5
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Somatostatinoma of the Pancreas; Difficulties in Preoperative Diagnostic Approaches - A Case Report

81%
Dranka-Bojarowska D., Olakowski M., Lampe P.
Polish Journal of Surgery
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2007
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vol. 79
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issue 2
129-133
EN
Somatostatinoma is the rarest neuroendocrine tumor of the digestive tract. About 60% of somatostatinomas arise in the pancreas. This study presents a case of a 51-year-old male patient with tumor of the pancreas. Despite wide preoperative diagnostic examinations, it was impossible to determine the histological type of the tumor preoperatively. The patient was qualified for surgical procedure, during which the tumor was enucleated. The tumor was classified as somatostatinoma through immunohistochemical examination. The postoperative course was complicated by a small fluid collection, which arose in area of enucleation; the cistern was absorbed spontaneously. Currently, the patient is under surgical ambulatory care and is in general, in good condition.
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Primary Adenocarcinoma in an Oesophageal Gastric Graft – Case Report

81%
Dranka-Bojarowska D., Lewiński A., Grabarczyk A., Lampe P.
Polish Journal of Surgery
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2015
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vol. 87
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issue 2
97-101
EN
Primary adenocarcinoma in the esophageal gastric graft is a rare complication diagnosed in patients with long-term survival. Most data concerning the diagnosis and treatment of patients with metachronic cancer in esophageal grafts is derived from Japan and South Korea. The diagnosis of cancer in esophageal gastric grafts in the European countries is rare. The study presented a case of a 66-year old male patient who, 30 months after an esophageal squamous cell cancer resection, was diagnosed with adenocarcinoma of the esophageal gastric graft. Despite control follow-up after the esophagectomy, cancer in the esophageal graft was detected during the stage that prevented performing radical surgery. The study presented the recommended diagnostic procedures and treatment options for esophageal gastric graft cancer, as well as review of available literature data
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Video-Assisted Transhiatal Esophagectomy in the Treatment of Esophageal Cancer

81%
Lampe P., Olakowski M., Lekstan A.
Polish Journal of Surgery
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2008
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vol. 80
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issue 6
315-320
EN
The aim of the study was the analysis of sugical treatment of esophageal cancer using the video-assisted transhiatal esophagectomy (VTE).Material and methods. Between May 1994 and December 2001 a total of 115 patients with esophageal cancer underwent VTE. The study group included 102 men (89%) and 13 women (11%). Eighty - six (75%) had squamous cell carcinoma and 29 (25%) had adenocarcinoma.Results. The mean operative time was 4.5±1 h. Short-term complications occurred in 70 patients (60%), where the most common were pulmonary complications (27%, n=31), recurrent laryngeal nerve injury (17.4%, n=20), anastomotic stricture (14%, n=16) and anastomotic leak (10.4%, n=12). Early re-laparotomy was performed in 7 patients (6%). The hospital mortality rate was 9%. Follow-up included 86 patients. Long-term complications were present in 28 patients (33%). The most common complication was anastomotic stricture in 18 patients (21%). There was no statistical difference observed in survival betweeen patients operated on for squamous cell carcinoma or adenocarcinoma. Median postoperative survival was 10 months for squamous cell carcinoma and 16 months for adenocarcinoma. The 1-, 3- and 5-year survival rates were 42%, 10% and 5%, respectively, for squamous cell carcinoma and 63%, 16% and 0%, respectively, for adenocarcinoma.Conclusions. Video-assisted transhiatal esophagectomy is a useful method for esophageal cancer treatement. The use of this technique did not improve short- or long-term results of esophageal cancer management.
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Use of Compression Clips Made of Shape Memory Material in the Gastrointestinal Surgery - A Preliminary Report

81%
Lampe P., Kuśnierz K., Zhavoronkov D., Morawiec H.
Polish Journal of Surgery
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2008
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vol. 80
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issue 6
306-309
EN
The aim of the study was to present a clinical use of compression clip (CC) implants made of shape memory materials, i.e., superelastic nickel titanium alloys (NiTi). This report represents the first experience with these materials in gastrointestinal surgery in Poland.Material and methods. Nine anastomoses were performed in 8 patients using CC: Two anastomoses of the small intestine with the large intestine, 3 anastomoses of the small intestine with the small intestine, 3 anastomoses of the stomach with the small intestine, and 1 anastomosis between the transverse colon and the duodenum.Results. No complications related to this method were observed. Delayed clip excretion was found in one patient. (On day 61 after the surgery, radiological imaging showed that the clip was located in the rectum.)Conclusions. A preliminary study investigating the use of compression clips made of shape memory TiNi alloys in gastrointestinal anastomoses demonstrated that they led to safe anastomoses. Because only a small number of anastomoses have been performed by us to date, this procedure requires further study.
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Long-Term Results in the Surgical Treatment of Iatrogenic Bile Duct Injuries

81%
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

71%
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

71%
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.
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Quality of Life of Patients Following Pylorus-Sparing Pancreatoduodenectomy

71%
Musiewicz M., Lampe P., Mrowiec S., Ciosek J., Grabarczyk A.
Polish Journal of Surgery
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2008
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vol. 80
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issue 7
351-363
EN
Quality of life after pancreatoduodenectomy (PD) for cancer of the head of the pancreas depends on multiple factors. Handling of the pancreatic remnant is a decisive factor for the success of the operation. The aim of the study is to assess quality of life of patients with cancer of the head of the pancreas undergoing pylorus-sparing PD and reconstruction with pancreaticojejunostomy (PJ) versus pancreaticogastrostomy (PG).Material and methods. An analysis was performed for 115 patients with malignancy of the head of the pancreas who underwent surgical treatment in the Department of Gastrointestinal Surgery Medical Academy of Silesia between 2004 and 2006. Quality of life was assessed with the EORTC QLQ-C30 and QLQ-PAN26 forms. These questionnaires were mailed to 34 patients at least 6 months after PD. The 20 patients who returned correctly completed questionnaires were divided into two groups. Group I included 14 patients after PD with (Traverso or Imanaga) PJ. Group II included six patients after PD with Flautner PG.Results. The study groups were homogeneous with respect to age, gender, preoperative and intraoperative factors, and complications. Better quality of life was observed in group I with respect to the cognitive functions, general fatigue, and insomnia scales., Group II exhibited better quality of life with respect to the physical functioning, social functioning, life activity, general health, dyspeptic symptoms, nausea and vomiting, diarrhea, respiratory disturbances, lack of satisfaction with own appearance, taste changes, liver symptoms, decreased muscle strength, indigestion, dry mouth and treatment of emergent side-effects scales.Conclusions. Patients in the study group following PD and Flautner PG exhibit markedly better quality of life.
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Middle Pancreatectomy - Own Experience

71%
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

71%
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

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
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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

62%
Lekstan A., Olakowski M., Jabłońska B., Łabuzek K., Olakowska E., Filip I., Lampe P.
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|
vol. 85
|
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.
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Gastric Emptying in Esophageal Substitutes

62%
Mrowiec S., Dobija M., Nalewajka-Kołodziejczak J., Kasicka-Jonderko A., Jonderko K., Nowak S., Lampe P.
Polish Journal of Surgery
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2008
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vol. 80
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issue 7
343-350
EN
For patients undergoing esophagectomy, the stomach is the organ that is most commonly used to restore continuity in the gastrointestinal tract. As a consequence of changes in stomach shape and location, patients in the postoperative period usually experience disturbed motility of the upper gastrointestinal tract of variable intensity.The aim of the study was to assess the motility of esophageal substitutes and the emptying rate of a narrowed stomach (in particular its prepyloric portion) using scintigraphy in patients undergoing esophageal resection compared to those in healthy controls.Material and methods. Between 2000 and 2006, 297 patients (105 women, 192 men) underwent surgical treatment for esophageal cancer in the Clinic of Gastrointestinal Surgery. Ten patients (average age 59; range 54 to 67 years) who underwent an attempted curative esophageal resection were selected into the study group. Patients from this group underwent scintigraphic assessment of gastric emptying between three to 11 months after the surgical procedure (an average 7 months). Furthermore, ten healthy volunteers (average age 28; range 19 to 43 years) constituted the control group.Results. The average radiotracer retention after two hours was 44.7±6.5% in the study group and 51.1±7.4% (p>0.2) in the control group. Frequency of contractions of the whole prepyloric segment, as well as its distal fragment, in the subsequent periods of examination was comparable in both groups. Correlation among the frequency of contractions, contraction duration and duration of relaxation of the whole prepyloric segment and its distal fragment was high for the control group (correlation coefficients 0.71 p<0.001; 0.71 p=0; and 0.63 p=0, respectively). In the study group, correlation between the frequency of contractions and contraction duration was poor (coefficients of correlation 0.03 p>0.8 and -0.02 p>0.9), while correlation between duration of relaxation of the whole prepyloric segment and its distal fragment was moderate (coefficient of correlation 0.34 p>0.06).Conclusions. Formation of a gastric substitute after its narrowing and denervation (truncal vagotomy) does not abolish gastric contractility. Frequency, amplitude, duration of contraction, and relaxation duration of the prepyloric portion of the ectopic substitute do not differ significantly from the patterns of motility of the upper gastrointestinal tract in healthy volunteers.
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Recommendations of Association of Polish Surgeons and Polish Society of Oncological Surgery Gastrointestinal Fistulae in Patients Treated for Malignancy - Diagnostics and Treatment

52%
Szawłowski A., Pertkiewicz M., Drews M., Dziki A., Krasnodębski I., Kulig J., Lampe P., Stojcev Z., Wallner G., Zegarski W.
Polish Journal of Surgery
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2008
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vol. 80
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issue 12
694-711
EN
Postoperative gastrointestinal fistulae occur more often in patients undergoing surgical treatment for oncological reasons than non-oncological reasons. Fistula is associated with a number of serious sequelae and complications: fluid and electrolyte abnormalities, acid-base abnormalities, local and systemic infection and progressive cachexia that increase morbidity, treatment duration and mortality. Development of fistula additionally delays or prevents specific treatment in oncology. For a patient, a fistula is associated with both physical and mental suffering resulting from concern over further therapy.Although the introduction of advanced surgical techniques, intensive postoperative care, total parenteral nutrition and modern enteral nutrition, resulted in decreased postoperative mortality, however the number of patients with gastrointestinal fistulae hospitalized in the departments of surgery is not decreasing. This may result from the fact that many patients still present for treatment in the advanced phase of their malignancy (clinical stage III/IV according to International Union Against Cancer - UICC) and consequently in worse general status, which poses a high risk of postoperative complications and requires more extensive procedures in progressively older patients. Thus gastrointestinal fistulae still remain a serious clinical problem. Main components of treatment of fistulae include: adequate draining, fighting of infections, artificial nutrition and drugs that decrease gastrointestinal secretion (e.g. somatostatin) that are intended to create conditions for spontaneous fistula healing. Some cases may require an early or late surgical intervention.
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Practical Aproach to Variceal Gastrointestinal Bleeding – Association of Polish Surgeons Guidelines

52%
Wallner G., Solecki M., Dąbrowski A., Ćwik G., Dąbrowski A., Matyja A., Lampe P., Dziki A.
Polish Journal of Surgery
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2015
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vol. 86
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issue 5
248-256
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Distal Pancreatectomy - OWN Experience

52%
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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