Search results

1

Cholecystectomy - When and Why?

100%

Sośnik H., Sośnik K., Noga L.

Polish Journal of Surgery

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2007

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vol. 79

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issue 10

649-655

EN

The number of cholecystectomies is continuously increasing. However, the most beneficial period to perform surgery for gall-bladder pathologies has not been documented.The aim of the study. Based on pathomorphological changes in the gall-bladder wall, the aim of the study was to determine the optimal patient age for cholecystectomy.Material and methods. The study was comprised of 6356 surgically removed gall-bladders. Based on the analysis of microscopic specimens stained with hematoxylin and eosin, nine types of pathomorphological lesions were distinguished. These lesions were characterized from minimal changes to malignant neoplasms. Additionally, 2662 gall-bladders were examined to estimate the frequency of dysplasia and were classified from stage one to three. The occurrence of particular types of dysplasia correlated with patient age and gender. The results were subjected to statistical analysis. p≤0.05 was considered statistically significant.Results. The female patients were subjected to surgical intervention 3.2 times more frequent than male patients. The average female patient age was significantly lower (53.3±14.2 years) relative to male subjects (57.3±13.3 years) (p=0.001). For men, the lowest average age for patients with minimal gall-bladder wall lesions that were significantly different from the mean patient age with exacerbation of chronic (p=0.001) and gangrenous cholecystitis was 54.41±13 years (p=0.001). For female patients, the lowest mean age of patients with minimal changes that were significantly different from the average age of the remaining pathomorphological lesion subgroups was 50.11±14.12 years. The mean age of male patients with gall-bladder carcinoma exceeded that of patients with minimal lesions by ten years (p=0.002) and female patients by 18 years (p=0.001).68% of operated women were aged between 41 and 70 years. Most cases (76.9%) concerned subjects with minimal lesions (36.4%), chronic cholecystitis (24.9%), and exacerbation of chronic cholecystitis (13.5%). Gall-bladder dysplasia was observed in 36.7% of cases: first degree - 25.9%, second degree - 9.4%, and third degree - 1.43%. The occurrence of the above-mentioned pathologies significantly correlated with the age of operated patients. Dysplasia was diagnosed in 22.8% of cases under the age of thirty. Gender had no significant influence on the occurrence of dysplasia.The late occurrence of exacerbated chronic and gangrenous cholecystitis (51-70 years), and early occurrence of mucous membrane dysplasia, especially third degree, implicates the need for surgical intervention in the management of cholelithiasis.Conclusion. Based on the examination of pathomorphological lesions and the literature, the most beneficial period to perform surgery, especially by means of laparoscopy is during the fifth decade of life.

2

Abnormal right hepatic artery injury resulting in right hepatic atrophy: diagnosed by laparoscopic cholecystectomy

80%

Martino V., Ferrarese A., Bindi M., Marola S., Gentile V., Rivelli M., Ferrara Y., Enrico S., Berti S., Solej M.

Open Medicine

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2014

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vol. 10

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issue 1

EN

An intact hepatic artery is the gateway to successful hepato-biliary surgery. Introduction of laproscopic cholecystectomy (LC) has stimulated a renewed interest in the anatomy of hepatic artery. In this case report we have highlighted importance of variations of right hepatic artery in terms of origin and course We present a rare asymptomatic case of liver atrophy due to an intraoperative lesion of right hepatic artery. We also performed a literature review about surgical vascular lesions and tried to confirm the right concept behind “non trivial procedure” of the LC.

3

Need Assessment for Gastroscopy in Patients with Gall-Stones

80%

Bartosz K., Głuszek S.

Polish Journal of Surgery

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2010

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vol. 82

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issue 8

469-478

EN

Cholelithiasis (gall-stones) occurs in 13% of the Polish population. Patients affected with gall-stones notify non-specific symptoms caused by pathology of the upper segment of the digestive track which coexists with gall-stones.The aim of the study was to analyze the risk of occurrence of pathological changes, within the part of the digestive track in patients affected with gall-stones, to assess the correlation between data of medical histories of patients and results of gastroscopy based diagnosis; to devise tactics of alterations to the planned measures in case a clinically significant disease has been diagnosed.Material and methods. The study group comprised 615 patients, qualified for cholecystectomy, with symptomatic gall-stones, verified by an ultrasound diagnosis. After being interviewed and examined, all the patients were subjected to gastroscopy, and when necessary biopsy was performed. The statistical analysis was performed using an multifactorial analysis (Pearson's correlation coefficient for categorical variables).Results. Among 615 patients, the subjects in the study, we found 183 ones (29.7%) with a normal upper digestive tract, we found pathology of the upper digestive system in 70.3% cases (432 patients). Serious pathology resulting in changing the planned treatment was found in 83 patients (13.5%): among those four ones had gastric carcinoma, sixty-three ones suffering from chronic peptic ulcer disease (gastric or/and duodenal), twelve patients were affected with hemorrhagic gastritis, four patients had GERD C and D. In a group of 83 patients cholocystectomy was postponed and the diagnosed disease was treated. Four patients were operated on because of gastric cancer, with intention of cure.Conclusions. 1. Routine gastroscopy performed before cholecystectomy is justified. The percentage of abnormalities diagnosed during gastroscopy proved the above mentioned thesis. 2. Medical histories and an object examination do not allow to state explicitly that there is another disease of the upper part of the digestive system which coexists with gall-stones. In case of diagnosing the other pathology it is necessary to take into consideration an alteration of tactics of management: to delay an operation and treat the other disease which has been diagnosed.

4

Iatrogenic bile duct injuries – clinical problems

80%

Głuszek S., Kot M., Bałchanowski N., Matykiewicz J., Kuchinka J., Kozieł D., Wawrzycka I.

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vol. 86

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issue 1

17-25

EN

Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures in surgical wards. Iatrogenic bile duct injuries (IBDI) incurred during the procedures are among postoperative complications that are most difficult to treat. The risk of bile duct injury is 0.2-0.4%, and their consequences are unpleasant both for the surgeon and for the patient. The aim of the study was analysis of iatrogenic bile duct injuries and methods of their repair,taking into consideration the circumstances, under which the injuries occur. Material and methods. The study group consisted of 16 patients who had suffered IBDI during surgery. The analysed parameters included sex, age, indications for surgery, the setting of the surgical procedure and the type of bile duct injury. Additionally, the time of injury diagnosis, type of repair and treatment outcome were assessed. The IBDI analysis used the EAES classification of injuries. The time of IBDI repair was defined as immediate, early or late,depending on the time that had passed from the injury. The analysis included complications seen after bile duct repair. Results. The study group consisted of 10 women and 6 men, aged 29-84. Patients underwent 6 classic cholecystectomies, 8 laparoscopic cholecystectomies, one gastrotomy to remove oesophageal prosthesis and one laparotomy due to peptic ulcer. IBDI was diagnosed intraoperatively in 4 patients. In 12 patients IBDI was diagnosed within 1-7 days. The diagnosis was based on endoscopic retrograde cholangiopancreatography and the results of biochemistry tests. According to the EAES classification, the injuries were of type 1 (4 patients), type 2 (8 patients), type 5 (3 patients) and type 6 (1 patients). Reconstruction procedures were performed during the same anaesthesia session in 3 patients, and in the early period in 13 patients. The main procedure was Roux-en-Y anastomosis (12 patients), with the remaining including bile-duct suturing over a T-tube (3 patients) and underpinning of an accessory bile duct in the pocket left after gallbladder removal (1 patient). The most common reconstruction complications included bile leak (3 patients), recurrent cholangitis (3 patients) and bile duct stricture (2 patients). Mortality in the study group was 12.5%. Conclusions. The procedures of laparoscopic and classic cholecystectomy are associated with a risk of IBDI, especially in the presence of inflammatory state of the gall-bladder. IBDI is a complex complication: its treatment poses a challenge for the operating surgeon, and even the most careful treatment adversely affects the patient’s lifedue to complications.

5

Gall-Bladder Duplication - Case Report

80%

Koszman B.

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vol. 86

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issue 9

433-435

EN

Gall-bladder duplication is a rare anatomical variation, which can affect safe performance of cholecystectomy and be a cause of persistent symptoms and a need for reoperation in case of accessory gall-bladder omission. A case of successfully performed elective laparoscopic cholecystectomy in a patient with duplicated gall-bladder accidentally intraoperatively disclosed is presented. The identified anomaly was classified according to the Harlaftis Classification of Multiple Gall-bladders. Attention was drawn to the uneffectivenes of ultrasound scanning in multiple gall-bladders preoperative detecting, and presence of other non-biliary anatomical variation in the same individual as well.

6

Cholelithiasis in Home Parenteral Nutrition (Hpn) Patients – Complications of the Clinical Nutrition: Diagnosis, Treatment, Prevention

80%

Ławiński M., Jachnis A., Ukleja A., Pertkiewicz M.

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vol. 86

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issue 3

111-115

EN

Long-term home parenteral nutrition (HPN) is an important factor for cholelithiasis. An individualized nutrition program, trophic enteral nutrition and ultrasound bile ducts monitoring is a necessity in those patients. The aim of the study was to evaluate the usefulness of prophylactic cholecystectomy in patients with asymptomatic cholelithiasis requiring HPN. Material and methods. 292 chronic HPN patients were analyzed in the period from 2005 to 2012. Patients were divided into four groups: A - without cholelithiasis, B - with asymptomatic cholelithiasis, C - urgent cholecystectomy because of cholecystisis caused by gallstones, D - cholecystectomy in patients without cholelithiasis performed during an operation to restore the continuity of the digestive tract. The patients were additionally divided depending on the extent of resection of the small intestine and colon. Results. 36.9% of chronic HPN patients had cholelithiasis confirmed using ultrasonographic examination. Cholecystectomy due to acute cholecystitis symptoms was performed in 14.4% of the patients. The remaining 22.6% patients had asymptomatic cholelithiasis. Prophylactic cholecystectomy was performed in 5.5% patients with no signs of cholelcystisis during the planned operation to restore the continuity of the digestive tract. Conclusions. Cholelithiasis in chronic HPN patients is a frequent phenomenon. It seems useful to perform prophylactic cholecystectomy during primary subtotal resection of the small intestine, because the risk of cholelithiasis in this group of patients is very high.

7

Is the Age of Patients with Iatrogenic Bile Duct Injuries Increasing?

80%

Stankiewicz R., Najnigier B., Krawczyk M.

Polish Journal of Surgery

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2015

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vol. 87

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issue 3

129-133

EN

Resection of the gall-bladder is still the most common surgical procedure performed at general surgery departments. The laparoscopic method used in the majority of cases offers considerable benefits but at the same time is associated with an increased rate of bile duct complications. So far, a slim female aged 25-50 years was a typical patient with a iatrogenic bile duct injury. The aim of the study was to identify the age of patients with iatrogenic bile duct injuries as well as the clinical course observed in recent years. Material and methods. Gender and age structure of patients admitted to the Department of General, Transplant and Liver Surgery between the beginning of 2011 and June 2014 and treated for iatrogenic bile duct injuries, complications of laparoscopic cholecystectomy, were analysed. The patients were referred to the department as a reference centre. Results. In the group of 186 patients, females predominated (69.4%) and the mean age was 52 years. A considerable increase in the mean age of patients treated in 2014 as compared with previous years was seen. This was related to an increased rate of bile duct injuries in patients aged over 70 years, who accounted for about 25% of the group. In previous years, bile duct injuries in patients of such an advanced age happened considerably less frequently. Conclusions. A iatrogenic bile duct injury in an elderly person may prove a fatal complication. A repair surgery, i.e. the biliary-enteric anastomosis, is a major and burdensome procedure, particularly in the case of patients aged over 70 years. Special caution during laparoscopic cholecystectomy is advised in this population, and the slightest doubts should lead to conversion.

8

Iatrogenic Bile Duct Injury. A Significant Surgical Problem. Assessment of Treatment Outcomes in the Department's Own Material

80%

Bobkiewicz A., Krokowicz ł., Banasiewicz T., Kościński T., Borejsza-Wysocki M., Ledwosiński W., Drews M.

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vol. 86

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issue 12

576-583

EN

Iatrogenic bile duct injuries (BDI) are still a challenging diagnostic and therapeutic problem. With the introduction of the laparoscopic technique for the treatment of cholecystolithiasis, the incidence of iatrogenic BDI increased. The aim of the study was a retrospective analysis of 69 patients treated at the department due to iatrogenic BDI in the years 2004-2014. Material and methods. In this paper, we presented the results of a retrospective analysis of 69 patients treated at the Department due to iatrogenic BDI in the years 2004-2014. The data were analysed in terms of age, sex, type of biliary injury, clinical symptoms, the type of repair surgery, the time between the primary surgery and the BDI management, postoperative complications and duration of hospital stay. Results. 82.6% of BDI occurred during laparoscopic cholecystectomy, 8.7% occurred during open cholecystectomy, whereas 6 cases of BDI resulted from surgeries conducted for other indications. In order to assess the degree of BDI, Bismuth and Neuhaus classifications were used (for open and laparoscopic cholecystectomy respectively). 84.1% of patients with confirmed BDI, were transferred to the Department from other hospitals. The average time between the primary surgery and reoperation was 6.2 days (SD 4). The most common clinical symptom was biliary fistula observed in 78.3% of patients. In 28 patients, unsuccessful attempts to manage BDI were made prior to the admission to the Department in other centres. The repair procedure was mainly conducted by laparotomy (82.6%) and by the endoscopic approach (15.9%). Hepaticojejunostomy was the most common type of reconstruction following BDI (34.7%). Conclusions. The increase in the rate of iatrogenic bile duct injury remains a challenging surgical problem. The management of BDI should be multidisciplinary treatment. Referring patients with both suspected and confirmed iatrogenic BDI to tertiary centres allows more effective treatment to be implemented.

9

Multicenter Analysis of 74 000 Cholecystectomies Age Dependent Morbidity and Transfusion Rate

80%

Wente M., Hecker R., Schulze-Raestrup U., Kozianka J., Waleczek H.

Polish Journal of Surgery

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2007

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vol. 79

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issue 2

92-97

EN

The aim of the study multicenter analysis of risc factors during 74 000 cholecystectomies to establish age dependent morbidity and transfusion rate.Material and methods. Between 1th January 1993 and 31th December 1997, 74 049 patients overall in 178 surgical departments with the diagnoses of cholecystolithiasis or cholecystitis were included into a prospective database.Results. The most frequently used method of cholecystectomy was the laparoscopic technique in patients up to 70 years of age. With increasing age, the proportion of laparotomy to laparoscopy procedures inverts; in patients over 70 years of age, open cholecystectomy was the most common method used. In the group of patients older than 90 years, 67.6% of patients were operated by laparotomy and 21.9% laparoscopically (conversion rate 3%).In the age group of 41-50 years, less than 5% of cholecystectomies were performed as emergency cases. This proportion was increased with age continuously up to 46.2% in patients over 90 years of age. After elective cholecystectomy, the postoperative morbidity rate increased continuously from 5.3% to 21.7% in relationship to the patient age. In cases of emergency cholecystectomy, the morbidity rates were higher in all age groups ranging from 12.7% in patients between 31 and 40 years to 34.6% in patients over 90 years of age.Mortality rates also increased continuously from 0.1% to 3.5% after elective cholecystectomy and from 2.9% up to 12.5% after emergency cholecystectomy depending on the age of the patient. The transfusion rate was 0% to 16.6%, increased with age from 0.8 to 5.5% in the cases of elective operations and from 3.8% to 16.6% in the cases of emargancy operations in erderly patients.Conclusions. 1. The number of complication after elective cholecystectomies were low, increase it the case of emergency. 2. In the group of elderly patients laparotomy was done more frequently then laparoscopy. 3. The number of emergency operations increased in elderly patients. 4. The postoperative morbidity, mortality and transfusion rate increase in relationship to the patient age

10

Laparoscopic cholecystectomy in a patient with total situs inversus – case report

80%

Stojcev Z., Duszewski M., Bobowicz M., Galla W., Maliszewski D.

Polish Journal of Surgery

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2013

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vol. 85

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issue 3

141-144

EN

For many years, laparoscopic cholecystectomy remains the method of choice for both the treatment of symptomatic cholelithiasis, and chronic and acute cholecystitis (1). The experience of the surgeon grows with each laparoscopic procedure, which enables to operate in case of difficult anatomical conditions and associated anatomical variants. The aim of the study was to present a case of a 47-year old male patient with total situs inversus and several months history of recurrent left epigastric pain, radiating to the left scapula, being accompanied by nausea and vomiting. The study presented the operative technique of laparoscopic cholecystectomy and postoperative period data. In conclusion, laparoscopic cholecystectomy in a patient with total situs inversus is possible and safe, providing relevant precautions. The main issues certainly include a good and feasible plan of the operation, discussion concerning the possible intraoperative and postoperative complications, a good plan considering the localization of the trocars, as well as an experienced surgical team. One should also not forget that early conversion to classical cholecystectomy is not considered as failure, but might prevent accidental damage of the biliary ducts and long-term complications.

11

Gall-Bladder and Hepatoduodenal Ligament Lymphangioma – Case Report and Literature Review

80%

Nazarewski Ł., Patkowski W., Pacho R., Marczewska M., Krawczyk M.

Polish Journal of Surgery

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2013

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vol. 85

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issue 1

39-43

EN

Lymphangiomas are rare benign lesions of the lymphatic vessels that are most commonly diagnosed in childhood. Intraperitoneal localization is unusual as, typically, they are located in the head and neck areas. In general, abdominal lymphangiomas seem to be asymptomatic, however, patients may occasionally suffer from acute abdominal symptoms, due to intestinal obstruction or peritonitis. The study presented a case of a 41-year-old female patient, clinically asymptomatic, who was accidentally diagnosed with a multiseptated cystic lesion of the right liver lobe surrounding the gall-bladder fossa in a routine ultrasound examination. Further examinations including computed tomography and magnetic resonance (MR) aroused suspicion of a polycystic lesion of the gall-bladder and hepatoduodenal ligament. The cystic lesion of the gall-bladder and hepatoduodenal ligament filled with lymphatic fluid was diagnosed intraoperatively. Simultaneous cholecystectomy and radical resection of the cystic lesion was undertaken. The histopathological examination revealed the presence of a lymphangioma. Additionally, the authors of the study reviewed literature data concerning gall-bladder lymphangiomas.

12

Spinal Anaesthesia For Surgery Upper Part of Abdomen Cavity - Case Report

80%

Dyaczyński M., Chanek I., Jałowiecki P.

Polish Journal of Surgery

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2008

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vol. 80

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issue 11

627-629

EN

Surgery procedures in the upper part of the abdomen cavity are performed routinely in general anaesthesia. High risk group patients, namely those with circulatory insufficiency, respiratory failure and with metabolic disorders pose a problem. In this group surgical treatment is applied for life indications and in emergency cases. Regional anaesthesia as an alternative for general anaesthesia makes planned surgical treatment possible for this group of patients.The study presents the case of a 63-year-old female afflicted with chronic obstructive pulmonary disease, ischaemic heart disease, cor pulmonale and arterial hypertension who underwent operation under spinal anaesthesia as planned.

13

Comparison of the Quality of Patients' Life After the Classical and Laparoscopic Cholecystectomies

80%

Gembal P., Zubilewicz T.

Polish Journal of Surgery

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2008

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vol. 80

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issue 11

585-593

EN

In Poland cholecystolithiasis is the most frequent cause of surgical treatment and a significant growth in the number of cholecystectomies has been observed since the laparoscopic method was introduced. Recently there has been noted an increased interest in such issues as the quality of life connected with health and the impact of particular therapeutic methods on the quality of patients' lives.In order to measure the quality of life, the instruments (forms) - or so-called health profiles are used. In respect of this quality of life, one of the forms mostly acknowledged in the world is the questionnaire SF36, which is also applied in the field of the gall-bladder surgery.The aim of the study was to compare the quality of patients' lives before and after the surgical treatment of cholecystolithiasis with the use of the classical and the laparoscopic methods by means of the SF36 form.Material and methods. The research was conducted among patients treated in the Surgery Department of the Hospital in Mielec from June 2005 to June 2006.The patients were divided into two groups: A - 42 people are the patients treated by the classical method of cholecystecomy, B - 46 people are the patients subjected to the laparoscopic method of cholecystecomy. Both groups of patients fulfilled the questionnaire twice: first, before the surgical procedure, and then three months after the operation. Additionally, during the second survey, the patients estimated subjective alteration of the quality of life three months after the surgery.Results. A statistically significant increase in the physical and mental components as well as in a total quality of life was stated in both groups. A higher increase in the general quality of life was estimated in the group of patients treated by the laparoscopic method. In the subjective estimation of the alteration of the quality of life three months after surgery, there was also recognized the growth of it in both groups of patients.Conclusions. An increase in the life quality of the patients with diagnosed cholecystolithiasis has been observed after both methods of cholecystectomy respectively. A greater increase of this quality analyzed by means of the questionnaire SF36® has been noticed in case of the laparoscopic method especially in the physical component.

14

Management of Giant Hepatic Hemangioma in Atypical Localization; Report of a Case and Literature Review

70%

Stankiewicz R., Kobryń K., Patkowski W., Krawczyk M.

Polish Journal of Surgery

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2015

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vol. 87

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issue 3

139-142

EN

Hemangiomas are the most common benign primary hepatic neoplasms, often being incidentally discovered. In most of the cases they are small and asymptomatic. It is widely accepted that clinical intervention is indicated only for symptomatic hemangiomas. We present a case of an asymptomatic giant hemangioma managed by enucleation due to its atypical localization. The hemangioma, originally located in segment 5, was now described in Computer Tomography (CT) Imaging as separating the gallbladder from the liver parenchyma. A careful evaluation of images revealed proximity to the portal vein (PV), right hepatic artery (RHA), right hepatic duct (RHD) and right branch of the portal vein (RBPV). Thus, in the case of an emergent operation, surgical maneuvers in the area of the altered hepatic anatomy and proximity to the hemangioma itself, would in fact increase the risk endangering the patient’s life. After patient’s consent, a surgical enucleation en block with the gall-bladder was performed. It is of great importance that specifically selected, asymptomatic patients diagnosed with a giant hemangioma, with the above mentioned or similar localization should be considered for surgical treatment.

15

Gender as a predictive factor in cholecystectomy — is it true or false?

61%

Osuch C., Dolecki M., Rogula W. P., Łapiak A., Matyja M., Czerwińska A., Rubinkiewicz M., Matyja A., Osuch C., Dolecki M., Rogula W. P., Łapiak A., Matyja M., Czerwińska A., Rubinkiewicz M., Matyja A.

Folia Medica Cracoviensia

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2020

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vol. 60

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issue 2

16

REPRINTED WITH PERMISSION OF EDITOR-IN-CHIEF OF ANNALS OF SURGERY: Annals of Surgery: Vol. 266, nr 5, November 2017; 703 - 705: Modern Surgeons: Still Masters of Their Trade or Just Operators of Medical Equipment?

61%

Krawczyk M.

Polish Journal of Surgery

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2018

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vol. 90(2)

1-4

EN

My surgical education began at a time when Poland formed part of the communist bloc and was isolated from the world, or in today’s Terms – it remained behind the Iron Curtain. This was true of all areas of life, including medicine. When after 40 years of work, I look back at my professional career; I wonder whether I owe my proficiency in surgery to my experience and dexterity or, like many others, to technological progress. Two of the great Polish surgeons were my mentors and teachers. Professor Zdzisław Łapiński was the one I met first. He was a manual genius and an unusual operational strategist. Granted, he had one character defect, but nobody’s perfect after all. In 1975, I defended my dissertation. I was convinced that I should continue my education at a center abroad, preferably within a postdoctoral scholarship. Professor Łapiński wanted me to learn everything about surgery from him. I decided otherwise, and in 1978 with his tacit agreement, I obtained a Humboldt Fellowship and went to Heidelberg, to the department headed by none other than Professor Fritz Linder.1 I started my research for the habilitation thesis at the Experimentelle Chirurgie Abteilung of his Department.

17

Perioperative Antibiotic Prophylaxis in Clinical

61%

Jawień M., Bulanda M.

Polish Journal of Surgery

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2010

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vol. 82

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issue 4

219-225

EN

The aim of the study was to determine the efficiency of perioperative antibiotic prophylaxis in surgical patients.Material and methods. During the period between January and December, 2005, eight surgical Departments were subject to investigation, considering surgical wound infections following selected procedures: 3 orthopedic departments, 3 general surgery departments, and two vascular surgery departments. Based on obtained results the following parameters concerning perioperative antibiotic prophylaxis were evaluated: was the procedure performed with antibiotic prophylaxis?; type of chemotherapeutic agent used, and duration of prophylaxis.Results. Inguinal hernia repair procedures were most often performed without antibiotic (33% of procedures). The statistically significant higher incidence index of surgical wound infections was confirmed in case of cholecystectomy without (18.8 vs 2%). In case of vascular procedures cefuroxime was used in 8 doses. In case of hip or knee joint endoprosthesis surgery cefazolin was administered in five doses. In 70% of cholecystectomy and hernial repair procedures one dose of cefazolin was used. Considering colorectal operations the following antibiotics were used: 6 doses of cefazolin in 36% of cases, and 8 doses of amoxicillin with clavulanic acid. Twenty-five percent of colorectal procedures required the administration of amoxicillin with clavulanic acid and metronidazolConclusions. Analysis demonstrated that in spite of the many guidelines elaborated by scientific associations concerning perioperative antibiotic prophylaxis, the above-mentioned are rarely administered according to clinical practice.

18

Niedrożność brodawki Vatera i żółtaczka mechaniczna spowodowana przez ognisko ektopowej trzustki

51%

Ciesielski K., Ciesielski W., Rogowski-Tylman A.

Pediatria i Medycyna Rodzinna

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2015

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vol. 11

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issue 2

227-230

EN

Ectopic pancreas is defined as the presence of normotypic pancreatic tissue lying outside its anatomical location and lacking nervous or vascular connections with the pancreas. Ectopic pancreas in the stomach and duodenum represent locations that most often result in clinical symptoms. So far, 22 cases of such locations have been described, including 16 patients with lesions located in the major duodenal papilla and 6 patients with lesions located in the common bile duct. The severity of jaundice depends on the size of ectopic lesion. Treatment is initiated only in the case of the occurrence of clinical symptoms or ectopic tumour, and the choice of therapeutic method depends on the size and location of the lesion. The prognosis is favourable, even in the case of late sequelae. This article presents a case of a 54-year-old male with focal ectopic pancreas in the vicinity of the ampulla of Vater resulting in the obstruction of the opening of the common bile duct into the duodenum and, consequently, mechanical jaundice.

PL

Trzustka ektopowa definiowana jest jako obecność normotypowego utkania trzustki poza jej anatomicznym położeniem bez jakiegokolwiek nerwowego lub naczyniowego połączenia z właściwym narządem. Żołądek i dwunastnica to lokalizacje ektopowej trzustki najczęściej dające objawy kliniczne. Dotychczas opisano 22 przypadki takiej lokalizacji, z czego u 16 pacjentów zmiana znajdowała się w brodawce większej dwunastnicy, a u 6 w przewodzie żółciowym wspólnym. Nasilenie żółtaczki zależy od rozmiaru ogniska ektopowego. Leczenie podejmuje się jedynie w przypadku występowania objawów klinicznych lub stwierdzenia nowotworu w ektopii, a wybór metody leczenia zależy od wielkości i lokalizacji zmiany. Rokowanie jest pomyślne, nawet w przypadku wystąpienia następstw odległych. Artykuł prezentuje przypadek 54-letniego mężczyzny, u którego ognisko ektopowej trzustki w okolicy brodawki Vatera stało się przyczyną niedrożności ujścia przewodu żółciowego wspólnego do dwunastnicy, a w efekcie żółtaczki mechanicznej.

19

Zanik powłok brzusznych po zabiegach operacyjnych

41%

Smereczyński A., Kołaczyk K., Lubiński J., Bojko S., Gałdyńska M., Bernatowicz E.

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2012

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vol. 12

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issue 50

262-268

EN

The aim of the study was to analyze clinical material concerning postoperative atrophy of abdominal integument. Material and methods: The evaluated group consisted of 29 patients with sonographically revealed atrophy of the abdominal wall. Those changes were observed after various surgical procedures: mainly after long, anterolateral laparotomies or several classical operations. Ultrasound examinations up to the year 2000 were performed with analog apparatus, in the latter years only with digital apparatus with linear transducers (7–12 MHz) and sometimes convex type conducers (3–5 MHz). The location, size and intestine stratified wall structure were evaluated. In each case the integument thickness was measured in millimeters in the site of the greatest atrophy and it was compared with the integument thickness from the side that had not been operated which enabled the calculation of the percentage reduction of integument in the area of the scar. Results: In 3 patients who underwent several laparotomies there was a total reduction of muscular mass in the operated area. In these cases we stated only skin and slightly echogenic subcutaneous strand; probably corresponding to fibrous tissue – the thickness of integument in this area was in the range from 3 to 8 mm. In the remaining 26 patients the integument atrophy on the scar level included muscles in a greater extent and covered an extensive area after classical urological procedures on the upper urinary tract: after nephrectomy and even ureter stone evacuation or kidney cyst excision by means of classical anterolateral approach with the integument incision on the length of almost 20 cm. Reduction in the integument thickness was observed on the smaller area after classical cholecystectomies, appendectomies and other surgical procedures with the incision across the integument. The integument atrophy in the operated sites expressed in absolute numbers was in the range of 7–20 mm (average 14 mm). These values are markedly lower than the comparative integument thickness on the not operated side: 17–52 mm (average 25.4 mm). The percentage value of the integument thickness reduction oscillated in the range of 32–67% (average 44.2%). In most cases the atrophy involved all layers of the abdominal wall, what demonstrated as regional prominence of the integument, mimicking the presence of hernia. Conclusions: Ultrasonography allows precise evaluation of the size and extent of atrophy as well as depiction of other lesions simulating that effect. Establishing the correct diagnosis should prevent the unnecessary reconstructions of the abdominal integument.

PL

Celem pracy była analiza materiału klinicznego dotyczącego zaniku powłok brzusznych po zabiegach operacyjnych. Materiał i metoda: Zgromadzono grupę 29 chorych z wykazanym ultrasonograficznym zanikiem powłok brzusznych. Zmiany te obserwowano po różnych procedurach operacyjnych, najczęściej po długich nacięciach laparotomijnych przednio‑bocznych lub kilkukrotnych operacjach klasycznych. Badania ultrasonograficzne wykonano do 2000 roku na aparatach analogowych, a w następnych latach wyłącznie aparatami cyfrowymi, z głowicami linowymi (7–12 MHz) i niekiedy głowicami typu konweks (3–5 MHz). Określano lokalizację, rozległość, warstwową budowę ściany jelita. W każdym przypadku mierzono grubość powłok w milimetrach w miejscu największego zaniku i porównywano ją z grubością powłok po stronie nieoperowanej, co pozwalało na obliczenie procentowej redukcji powłok w okolicy blizny. Wyniki: U 3 pacjentów po kilku laparotomiach doszło do całkowitej redukcji masy mięśniowej w miejscu operacji. W tych przypadkach stwierdzano jedynie skórę i lekko echogeniczne pasmo podskórne, prawdopodobnie odpowiadające zwłókniałym tkankom – grubość powłok w tym miejscu wahała się od 3 do 8 mm. U pozostałych 26 pacjentów zanik powłok na poziomie blizny pooperacyjnej dotyczył w największym stopniu mięśni i obejmował rozległy obszar po klasycznych zabiegach urologicznych na górnych drogach moczowych: po usunięciu nerki, a nawet po ewakuacji złogu z moczowodu lub wycięciu torbieli nerki z dostępu klasycznego przednio‑bocznego z nacięciem powłok na długości prawie 20 cm. Na mniejszym obszarze obserwowano redukcję grubości powłok po klasycznych cholecystektomiach, appendektomiach i innych operacjach z nacięciem powłok na całej grubości. Zanik powłok w miejscach operacji wyrażał się w liczbach bezwzględnych w zakresie 7–20 mm (średnio 14 mm). Wartości te są wyraźnie mniejsze od porównawczej grubości powłok po stronie nieoperowanej: 17–52 mm (średnio 25,4 mm). Procentowa wielkość redukcji grubości powłok wahała się w granicach 32–67% (średnio 44,2%). W większości przypadków zanik obejmował wszystkie warstwy ściany brzucha, co manifestowało się uwypukleniem powłok w tym rejonie pozorującym istnienie przepukliny. Wnioski: Ultrasonografia pozwala z dużą precyzją określić stopień zaniku, jego rozległość oraz zmiany, które mogą pozorować taki efekt. Ustalenie właściwego rozpoznania powinno zapobiec zbędnej rekonstrukcji powłok brzusznych.

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