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Laparoscopic gastric resections with per oral specimen extraction in treatment of intramural gastric tumors

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Stanek M., Major P., Wierdak M., Pędziwiatr M., Radkowiak D., Zychowicz A., Budzyński A.
Polish Journal of Surgery
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2017
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vol. 89(1)
16-21
EN
Aim: The goal of this work was to present our experiences and results of treatment of gastric tumors using the per oral specimen extraction (POSE) technique. Material and methods: A retrospective analysis a group of patients treated with laparoscopic stomach wedge resection of gastrointestinal stromal tumor (GIST). During that time 50 patients underwent laparoscopy due to the suspicion of GIST. In 12 patients resected material was removed endoscopically per os (POSE). In the remaining 38 subjects it was evacuated through minilaparotomy. Mean age of patients treated using POSE technique was 65.6 years (48-81 years). There were 9 women and 3 men in this group Results: Mean time of the POSE procedure was 92.5 min (40-160 min). Size of removed tumors ranged from 14 mm to 40 mm (mean: 25 mm). The mean length of hospital stay was 3.2 days (2 to 8 days) for patients treated with POSE. One patient (8.3%) required longer hospitalization (8 days) due to the presence of a fluid collection at the site of gastric suture. This patient was treated conservatively. One patient (8.3%) was diagnosed with surgical site infection (navel wound after an optical trocar). Histopathological examination confirmed radical excision in all of our patients (R0). Conclusions: It seems that the POSE technique is the next stage of development of minimally invasive surgery and may constitute a link in evolution of natural orifice translumenal surgery techniques. Removal of excised material through oral cavity is an attractive, effective, and safe method despite its many limitations.
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Laparoskopowe resekcje żołądka z usunięciem preparatu przez usta w leczeniu guzów śródściennych żołądka

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Stanek M., Major P., Wierdak M., Pędziwiatr M., Radkowiak D., Zychowicz A., Budzyński A.
Polish Journal of Surgery
|
2017
|
vol. 89(1)
16-21
PL
Cel: Celem pracy jest przedstawienie doświadczeń i wczesnych wyników leczenia guzów żołądka z zastosowaniem techniki usunięcia preparatu operacyjnego przez usta (POSE - per oral specimen extraction).. Materiał i Metodyka: Przeprowadzono retrospektywną analizę leczenia chorych, u których wykonano klinową resekcję żołądka techniką laparoskopową z powodu podejrzenia nowotworu podścieliskowego przewodu pokarmowego (GIST). W okresie tym operowano sposobem laparoskopowym 50 chorych z powodu podejrzenia GIST żołądka. U 12 chorych materiał pooperacyjny usunięto przez usta przy pomocy endoskopu (POSE). U pozostałych 38 chorych preparat usunięto przez minilaparotomię. Średni wiek chorych leczonych techniką POSE wyniósł 65,6 lat (48 – 81 lat). W grupie tej znalazło się 9 kobiet oraz 3 mężczyzn. Wyniki: Średni czas zabiegu z użyciem techniki POSE wyniósł 92,5 min (40 – 160). Wielkość usuniętych zmian wahała się od 14 mm do 40 mm (średnio 25 mm). Czas pobytu po zabiegu w oddziale chirurgicznym chorych leczonych techniką POSE wyniósł średnio 3,2 dnia (od 2 do 8 dni). Jeden chory (8,3%) wymagał dłuższego pobytu (hospitalizacja 8-dniowa) ze względu na obecność zbiornika płynowego w okolicy miejsca szycia ściany żołądka. Chorego tego leczono zachowawczo. U jednego chorego (8,3%) stwierdzono infekcję rany pooperacyjnej (rany w pępku po trokarze optycznym). U wszystkich chorych w naszej grupie ocena histopatologiczna potwierdziła radykalność zabiegu (R0). Wnioski: Wydaje się, że technika POSE jest kolejnym etapem rozwoju chirurgii małoinwazyjnej, który może stanowić pośrednie ogniwo w rozwoju technik operacyjnych przez naturalne otwory ciała. Usuwanie preparatu przez usta jest efektowną, skuteczną i bezpieczną metodą, posiadającą jednak wiele ograniczeń.
3
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Randomized Clinical Trial to Compare the Effects of Preoperative Oral Carbohydrate Loading versus Placebo on Insulin Resistance and Cortisol Level after Laparoscopic Cholecystectomy

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Pędziwiatr M., Pisarska M., Matłok M., Major P., Kisielewski M., Wierdak M., Natkaniec M., Budzyński P., Rubinkiewicz M., Budzyński A.
Polish Journal of Surgery
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2015
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vol. 87(8)
402-408
EN
Postoperative insulin resistance, used as a marker of stress response, is clearly an adverse event. It may induce postoperative hyperglycemia, which according to some authors can increase the risk of postoperative complications. One of the elements of modern perioperative care is preoperative administration of oral carbohydrate loading (CHO-loading), which shortens preoperative fasting and reduces insulin resistance. The aim of the study is to establish the influence of CHO-loading on the level of insulin resistance and cortisol in patients undergoing elective laparoscopic cholecystectomy. Material and methods. Patients were randomly allocated to one of 2 groups. The intervention group included 20 patients who received CHO-loading (400 ml Nutricia pre-op®) 2 hours prior surgery. The control group received a placebo (clear water). In every patient blood samples were taken 2 hours prior to surgery, immediately after surgery, and on the 1st postoperative day. Levels and changes in glucose, cortisol and insulin resistance were analyzed in both groups. Results. Although there were differences in the levels of cortisol, insulin, and insulin resistance, no statistically significant differences were observed between groups in every measurement. The length of stay and postoperative complications were comparable in both groups. Conclusions. We believe that CHO-loading is not clinically justified in case of laparoscopic cholecystectomy. No effect on the levels of glucose, insulin resistance and cortisol was observed. Even though such procedure is safe, in our opinion there is no clinical benefit from CHO-loading prior to laparoscopic cholecystectomy.
4
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The use of the enhanced recovery after surgery (ERAS) protocol in patients undergoing laparoscopic surgery for colorectal cancer – a comparative analysis of patients aged above 80 and below 55

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Pędziwiatr M., Pisarska M., Wierdak M., Major P., Rubinkiewicz M., Kisielewski M., Matyja M., Lasek A., Budzyński A.
Polish Journal of Surgery
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2015
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vol. 87(11)
565-572
EN
Age is one of the principal risk factors for colorectal adenocarcinoma. To date, older patients were believed to achieve worse treatment results in comparison with younger patients due to reduced vital capacity. However, papers have emerged in recent years which confirm that the combination of laparoscopy and postoperative care based on the ERAS protocol improves treatment results and may be particularly beneficial also for elderly patients. The aim of the study was to compare the outcomes of laparoscopic surgery for colorectal cancer in combination with the ERAS protocol in patients aged above 80 and below 55. Material and methods. The analysis included patients aged above 80 and below 55 undergoing elective laparoscopic colorectal resection for cancer at the 2nd Department of General Surgery of the Jagiellonian University. They were divided into two groups according to their age: ≥80 years of age (group 1) and ≤55 years of age (group 2). Both groups were compared with regard to the outcome of surgery: length hospital stay, complications, hospital readmissions, degree of compliance with the ERAS protocol, and recovery parameters (tolerance of oral nutrition, mobilisation, need for opioids, restored gastrointestinal function). Results. Group 1 comprised 34 patients and group 2, 43 patients. No differences were found between both groups in terms of gender, BMI, tumour progression or surgical parameters. Older patients typically had higher ASA scores. No statistically significant differences were found with regard to the length hospital stay following surgery (5.4 vs 7 days, p=0.446481), the occurrence of complications (23.5% vs 37.2%, p=0.14579) or hospital readmissions (2.9% vs 2.4%). The degree of compliance with the ERAS protocol in group 1 and 2 was 85.2% and 83.0%, respectively (p=0.482558). Additionally, recovery parameters such as tolerance of oral nutrition (82.4% vs 72.1%, p=0.28628) and mobilisation (94.1% vs 83.7%, p=0.14510) within 24 hours of surgery did not differ among the groups. However, a smaller proportion of older patients required opioids in comparison with younger patients (26.5% vs 55.8%, p=0.00891). Conclusions. Similar levels of compliance with the ERAS protocol may be achieved among patients aged ≥80 and younger patients. When laparoscopy is combined with the ERAS protocol, age does not seem to be a significant factor that could account for worse utcomes. Therefore, older patients should not be excluded from perioperative care based on ERAS principles.
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