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Intraoperative Difficulties and the Reasons for Conversion in Patients Treated with Laparoscopic Colorectal Tumors

100%
Tarnowski W., Uryszek M., Grous A., Dib N.
Polish Journal of Surgery
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2012
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vol. 84
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issue 7
352-357
EN
The aim of the study was an evaluation of conversion causes and intraoperative difficulties in patients treated with laparoscopic surgery due to colorectal tumours on the basis of authors' own material.Material and methods. in the period 2009-2012 160 patients were operated on because of large bowel cancer, 79 women and 81 men. Average age of patients was 66 years. The conversion was recognized as desuflation of peritoneal cavity, trocars removal and making laparotomy.Results. The conversion was made in 22 cases (13,7%). More in men (16.1%) than in women. The conversion was made twice as likely in T3 and T4 tumors than in T1 and T2.Conclusions. The main cause of conversion in laparoscopic operations of colorectal cancer is local tumor progression.
2
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Laparoscopic Abdominoperineal Resection Of The Rectum – How Is It Done; Initial Results

88%
Grous A., Uryszek M., Ciesielski A., Dib N., Tarnowski W.
Polish Journal of Surgery
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2013
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vol. 85
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issue 10
569-575
EN
The abdominoperineal resection of the rectum is a classical operation performed in case of patients diagnosed with rectal cancer. The development of laparoscopic techniques in recent years, introduced yet another method of treatment, considering patients with rectal cancer- laparoscopic abdominoperineal resection of the rectum. The aim of the study was to present initial treatment results considering the above-mentioned patients. Material and methods. The study group comprised 25 patients (16 male and 9 female) diagnosed with low-rectal cancer, subjected to surgery by means of the above-mentioned method. Mean patient age amounted to 66 years. Three (12%) patients required conversion to classical surgery (laparotomy), while one patient required reoperation, due to presacral vascular bleeding. Complications were observed in 10 (40%) patients. Average hospitalization was 7 days. In case of all patients the radial margin was negative, and mean number of removed lymph nodes amounted to 9.6. Mortality was not observed during the perioperative period. Due to the initial character of the study analysis (mean observation period in case of 68% of patients was shorter than 2 years), oncological results were not subject to evaluation. Conclusions. Laparoscopic abdominoperineal resections are considered as technically difficult operations, requiring significant experience of the operating team. However, they enable the patient to take advantage of the many assets of minimally invasive surgery, with comparable rates of postoperative complications.
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Results of the Inguinal Hernia Repair With The Use of Mesh. Analysis of the Operation Technique Influence on Post-Operative Complications

76%
Łebkowski Ł., Białek P., Uryszek M., Polańska M., Proczka R., Polański J.
Polish Journal of Surgery
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2008
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vol. 80
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issue 12
653-658
EN
The aim of the study was to demonstrate the relation between the operation technique and the early and late complications after the primary and secondary inguinal hernia repairs with the use of artificial material.Material and methods. There were 103 patients qualified for the research from among 140 patients operated within the period of 2003 - 2005. In all patients the same kind of mesh was used (100% Prolene). The operators were asked to fill in a special, original questionnaire. In all patients hernia type was classified during the repair with the use of Nyhus classification, seven key technical details of the treatment were described, subsequently the most frequent post-operative complications and inexpedient symptoms were evaluated - just after the operation and in 18 months time. Statistic one-dimension analysis of X2 method was applied or Fisher's exact test. After indication of the links, multidimensional analysis of logistic regression was used.Results. Based on the multidimensional analysis of logistic regression the links between technical details of the treatment and complications were evaluated. The analysis shows that only high tension has a significant influence on complications' emergence (p<0.0001). Precision of the model amounts to 71%. Additionally each particular complication was analyzed separately.Conclusions. Based on above mentioned results the operation technique algorithm was created with the smallest number of complications. From among analyzed technical details of the operation the special attention should be put at those which are directly and indirectly connected to the mesh binding. The lack of its tension is assumed to be the key factor of the whole procedure that minimizes one of the most serious post-operative complication which is the chronic pain.
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