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1
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Treatment of Iatrogenic Anal Stricture

100%
Kościński T.
Polish Journal of Surgery
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2007
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vol. 79
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issue 4
280-285
EN
Anal stenosis is an abnormal narrowing deformation of the anal canal. The anal canal become unable to extend during defecation, due to tissue cicatrization and loss of elasticityThe aim of the study. 1. Careful selection of different anoplasty techniques according to the size and shape of the stenosis. 2. Describing the results of anoplasty operations after 3 months.Material and methods. The study includes 7 patients operated on for critical anal stricture during a 10-year period, with ages ranging from 22 to 76. Anal stenoses were complications of prior anorectal surgery. Seven reconstructive operations were performed. Five conservative excisions of scar tissue using the Y-V anoplasty for covering the tissue defect. In one case of cicatrization after improperly performed Whitehead hemorrhoidectomy, two S-shaped rotational flaps were used. Another patient was treated by radial incision of the stricture and internal sphincterotomy.Results. In all but one patient, durable anal dilatation was achieved. One patient developed late recurrent anal stricture. She was successfully reoperated after 6 years using internal sphincterotomy and a mucosal advancement flap.Conclusions. Various surgical techniques, such as the incision of the scar and internal anal sphincter, removal of scar tissue and covering the defects with well vascularized skin flaps, are available for management of anal stenosis. Early complications like visible wound dehiscence in the donor site or translocated flaps and local infection may occur. In most cases, they are amenable to medical management and do not affect functional results.
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Surgical Treatment of Rectocele as the Most Common Cause of Rectal Voiding Disturbances. Own Experience with the Use of Prosthetic Material

64%
Kościński T., Stadnik H.
Polish Journal of Surgery
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2010
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vol. 82
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issue 10
556-563
EN
The aim of the study was to present different methods of reconstruction in case of rectovaginal septum defects, considering female patients with impaired colorectal voiding.Material and methods. During the period between 2001 and 2010, 39 female patients, aged between 42 and 75 years (mean age-58 years) were subject to surgical intervention. Patients complained of voiding disturbances, sensation of a "mass" in the pelvis (64.1%), dyspareunia (30.8%), anal sphincter insufficiency (17.9%) and urinary incontinence (10.3%).Defecography and MRI examinations confirmed rectocele (100%), enterocele (46.6%), pelvic floor prolapse (35.9%), vaginal prolapse (30.8%), and rectal prolapse (25.6%).Considering the surgical treatment of rectocele the following prosthetic material was used: polypropylene mesh and collagen implants (Pelvicol ®). In case of 19 patients with low rectocele the transvaginal approach was used. In case of high rectocele and coexisting pelvic organ prolapse the mesh was implanted by means of laparotomy (12 pts) or the abdomino-vaginal approach (8 pts).Results. Permanent reconstruction of the rectovaginal septum and withdrawal of voiding disturbances was observed in all patients operated by means of the transvaginal approach. Dyschesia symptoms were present in 16.6% of patients after mesh implantation by means of laparotomy, and in 12.5% of patients after the abdomino-vaginal approach. 10.3% of patients complained of pelvic pain and rectal tenesmus. All the above-mentioned symptoms were observed after polypropylene mesh implantation. The percentage of reoperations, due to complications amounted to 17.9%. Insignificant erosion of the prosthetic material was diagnosed in 7.7% of patients. 94.6% of patients were satisfied with the proposed treatment.Conclusions. The use of prosthetic material in the treatment of pelvic floor anatomical defects is an effective and safe method, considering patients with colorectal voiding disturbances.
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Surgical Treatment of Rectovaginal Fistulas

64%
Kościński T., Sękowska M.
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EN
Rectovaginal fistulas account for less than 5% of all anorectal fistulas. They may occur as a result of obstetrical injuries, inflammatory bowel diseases, or pelvic cancer irradiation.The aim of the study was to describe the results of different methods of surgical treatment according to the etiology and localization of rectovaginal fistulas.Material and methods. The study included 23 female patients who underwent operations for rectovaginal fistulas within the period of 1995 to 2006. The age of patients ranged from 18 to 64 years, with an average age of 41 years.14 patients received radical treatment according to the etiology and localization of the fistulas: four were treated with abdominal approach, six with a local excision of the rectovaginal fistula involving layer closure of rectal and vaginal openings and interposition of musculomucosal flaps, and four with a simple fistulectomy involving the removal of inflamed tissue and the reconstruction of the perineal body, anal sphincters, and all layers of the rectal and vaginal walls.In nine cases, patients received a palliative surgical treatment to address extensive tissue destruction resulting from radiotherapy for uterine cervix cancer or advanced rectal cancer.Results. Complete recovery occurred in patients who underwent laparotomy for rectovaginal fistulas following inflammatory bowel disease or complicating anterior resection of the rectum. Patients operated on using rectal and vaginal approaches displayed positive results, as did those who underwent. fistulectomy with perineal body and anal sphincter reconstruction.Conclusions. Various surgical techniques are available for the management of rectovaginal fistulas depending on their etiology, size, and location. The best results of low rectovaginal fistula treatment occurred using fistulectomy with layer closure and both-sided covering of the tissue defect with advancement vaginal and rectal flaps.
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The Effect of Surgical Treatment on Anal Sphincter Function in Patients with Rectal Prolapse

64%
Kościński T., Stadnik H.
Polish Journal of Surgery
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2008
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vol. 80
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issue 2
75-80
EN
The aim of the study was analysis of an anal sphincter function in patients before and after surgery for rectal prolapse.Material and methods. Between 1987 and 2005, 49 patients underwent operations for rectal prolapse. The anal sphincter function was analyzed in 17 of these patients. Abdominal approach surgery was performed in 13 patients; this involved rectopexy in 11 and sigmorectal resection in two others. A transanal approach was chosen in four patients, with the Mikulicz technique in two cases, the Delorme procedure in one, and the Altmeier procedure in the remaining case.Results. In all patients who were operated using the transanal approach, we observed some regression in anal sphincter insufficiency. Among the patients operated using the abdominal approach, first degree incontinence persisted in three cases, second degree in five cases, and third degree persisted in four cases. As a result of the surgical treatment of rectal prolapse by rectopexy and transanal approach, we observed a statistically significant increase in the resting anal sphincter pressure; this increase on average reached 58.8 mm Hg. A statistically significant increase in the average maximum squeeze anal sphincter pressure (95.9 mm Hg) was attained after the surgical procedures were performed on patients with rectal prolapse.Conclusion. The results suggest that the improvement of anal function in the control of stool and flatus after surgical treatment for rectal prolapse appears to be the result of an increase in the rest and maximal squeeze pressures of the anal sphincters.
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Abdominal Rectopexy with Absorbable and Non-Absorbable Materials in the Treatment for Rectal Prolapse

51%
Kościński T., Meissner W., Stadnik H.
Polish Journal of Surgery
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2011
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vol. 83
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issue 12
668-671
EN
The aim of the study was to present and compare own results of abdominal rectopexy performed with absorbable and nonabsorbable materials used in surgical repair of rectal prolapse.Material and methods. In the years 1991-2009, 50 patients were operated on for rectal prolapse. The first 8 patients (group I) were operated using absorbale polyglycolic acid mesh. The next 42 patients were operated using non-absorbable polypropylene mesh (group II). 12 patients with chronic, incurable constipation had sigmoidectomy and rectopexy performed at the same operation. Rectopexy was performed with the mesh and fixed to the pelvic fascia and periosteum and mesorectum, leaving the anterior one third of the rectum free. 6 months after surgery functional outcomes were evaluated. Statistic analysis with the level of statistical significance p<0,005 was applied to obtained functional results.Results. On the follow up visits, there were no symptoms of the recurrence of rectal prolapse in 5 patients (62.5%) from group I and in 25 patients (92.6%) from group II. Patients relapsing were reoperated 24 to 98 months after primary surgery. In all patients from group I (absorbable mesh), prosthetic material was not found at reoperation. In redo surgery only non-absorbable mesh was used.Conclusions. The effectiveness of rectal fixation depends on the on the durability of the prosthetic material. In the studied group polypropylene mesh was superior in rectopexy to absorbable mesh.
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Treatment of the Hemorrhoids and Anal Mucosal Prolapse Using Elastic Band Ligature - Early and Long Term Results

45%
Sękowska M., Kościński T., Wierzbicki T., Hermann J., Drews M.
Polish Journal of Surgery
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2011
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vol. 83
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issue 12
654-661
EN
The aim of the study was to evaluate the results of the treatment of internal hemorrhoids and anal mucosal prolapse using elastic band ligation and to compare this method to chosen surgical procedures.Material and methods. The study included 648 patients (363 males and 285 females). 474 patients were treated using an elastic band ligature and 174 patients underwent surgical hemorrhoidectomy. The average age of the patients in both groups was similar - 49 years.The treatment tolerance was evaluated in the prospective study group. The intensity and duration of pain was assessed on the first and second postoperative day using a Verbal Rating Scale.Results. 86.5% of the patients were cured using Barron's procedure, success rate for second-degree hemorrhoids was 89% and for third degree - 85.2%. Surgical hemorrhoidectomy was effective in 92% of patients. Early failure of elastic ligature was noted in 2.5% of patients. The recurrences of hemorrhoidal symptoms were observed in 11% of Barron's group and in 8% after hemorrhoidectomy. The intensity of pain was much higher among patients after surgical hemorrhoidectomy. The average of the pain score in the 4th hour was 0.3 for the elastic band ligation and 1.4 for the surgical treatment. In the 24th hour - 0.2 and 1.7 respectively. Mean postoperative stay was 3.8 days.Conclusions. Rubber band ligation is highly effective and well tolerated. Relatively minor pain following this procedure is found in only 9.5% of patients. The disadvantages of surgical hemorrhoidectomy are: important postoperative pain and long time of wound healing that impair the recovery to professional activity.
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Płaskonabłonkowy rak pochwy u pacjentki z całkowitym wypadaniem narządów płciowych – opis przypadku

45%
Moszyński R., Kościński T., Burchardt B., Szubert S., Sajdak S.
Current Gynecologic Oncology
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2014
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vol. 12
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issue 3
233-238
EN
Vaginal cancer is one of the least common reproductive tumors in women; in Poland it constitutes only 1–4% of them. It is found primarily in elderly patients with the mean age at diagnosis of approximately 70 years. Because of a similar clinical presentation and histological structure, vaginal cancer can be mistaken in its early stages for infiltrating cervical cancer. The incidence of vaginal cancer has been increasing at an alarming pace in recent years, due to the aging of the surveyed populations. In this article we analyzed the comorbidity of squamous cell vaginal cancer and complete pelvic organ prolapse. In order to employ proper cancer treatment, we had to restore the normal anatomy of the reproductive organs prior to brachytherapy. Following unsuccessful attempts to reduce the prolapse using a conservative approach, a two-stage surgical treatment was performed to enable brachytherapy. Initially, we excised the uterus with its adnexa and removed (with a rim of healthy tissue) the tumor in the pouch of Douglas. Subsequently, in collaboration with a surgical team, we reconstructed the vaginal ligaments with the use of a U-shaped polypropylene mesh, which was fixed to the sacral bone. Simultaneously, we reconstructed the rectovaginal septum. In connection with this case report we reviewed the current methods of surgical and systemic treatment of vaginal cancer.
PL
Rak pochwy to jeden z najrzadszych nowotworów kobiecych narządów płciowych; w Polsce stanowi jedynie 1–4% przypadków nowotworów z tej grupy. Dotyczy przede wszystkim pacjentek w wieku podeszłym: średnia wieku w chwili rozpoznania to około 70 lat. W początkowych stadiach choroba może być mylona z naciekającym pochwę rakiem szyki macicy – ze względu na podobną symptomatologię i wygląd histopatologiczny. W ostatnich latach zaobserwowano niepokojącą tendencję wzrostową występowania raka pochwy, co ma związek ze starzeniem się społeczeństwa. Praca porusza problem współwystępowania dwóch patologii w obrębie miednicy mniejszej: raka płaskonabłonkowego pochwy i całkowitego wypadania narządów płciowych. Aby umożliwić prawidłowe leczenie przeciwnowotworowe, przed rozpoczęciem brachyterapii należało przywrócić prawidłowe stosunki anatomiczne narządów płciowych. Po nieudanych próbach zachowawczego odprowadzenia wynicowanych narządów płciowych zdecydowano się na leczenie operacyjne, przeprowadzone dwuetapowo, co pozwoliło na wdrożenie brachyterapii. Po usunięciu – w pierwszym etapie – macicy z przydatkami oraz resekcji (w granicach zdrowych tkanek) guza zlokalizowanego w zatoce Douglasa we współpracy z zespołem chirurgicznym wykonano rekonstrukcję aparatu więzadłowego pochwy za pomocą U-kształtnej siatki polipropylenowej, ufiksowanej do kości krzyżowej, z jednoczesnym odtworzeniem przegrody odbytniczo-pochwowej. Na podstawie opisu przypadku przedstawiono i przeanalizowano współczesne metody zabiegowego i systemowego leczenia raka pochwy.
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Trace elements and rat pouchitis

39%
Drzymała-Czyż S., Banasiewicz T., Walas S., Kościński T., Wenska-Chyży E., Drews M., Walkowiak J.
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EN
The procedure of restorative proctocolectomy is associated with a complete removal of the colon and slight reduction of ileum length, which together can lead to systemic shortages of trace elements. Inflammatory changes in the pouch mucosa may also have some impact. However, there is no data on trace elements in pouchitis. Therefore, in the present study we aimed to assess the effect of acute pouchitis on the status of selected trace elements in rats. Restorative proctocolectomy with the construction of intestinal J-pouch was performed in twenty-four Wistar rats. Three weeks after the surgery, pouchitis was induced. Eight untreated rats created the control group. Liver concentrations of selected micronutrients (Zn, Cu, Co, Mn, Se) were measured in both groups six weeks later, using inductively coupled plasma mass spectrometry. Liver concentrations of trace elements did not differ between the study and the control groups. However, copper, cobalt and selenium concentrations [μg/g] were statistically lower (p<0.02, p<0.05 and p<0.04, respectively) in rats with severe pouchitis (n=9) as compared with rats with mild pouchitis (n=7) [median (range): Cu - 7.05 (3.02-14.57) vs 10.47 (5.16-14.97); Co - 0.55 (0.37-0.96) vs 0.61 (0.52-0.86); Se - 1.17 (0.69-1.54) vs 1.18 (0.29-1.91)]. In conclusion, it seems that acute pouchitis can lead to a significant deficiency of trace elements.
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Iatrogenic Bile Duct Injury. A Significant Surgical Problem. Assessment of Treatment Outcomes in the Department's Own Material

39%
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.
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Migration of biomaterials used in gastroenterological surgery

39%
Ratajczak A., Kościński T., Banasiewicz T., Lange-Ratajczak M., Hermann J., Bobkiewicz A., Drews M.
Polish Journal of Surgery
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2013
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vol. 85
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issue 7
377-380
EN
Mesh biomaterials have become the standard in the treatment of hernias, regardless the location. In addition to the obvious advantages of the methods based on implantable biomaterials, one should be aware of the possible complications, such as their migration to the abdominal organs. Material and methods. The study group comprised patients operated at the Department of General, Gastroenterological Oncology, and Plastic Surgery during the period between 2008 and 2011, due to hernia surgery with mesh implantation. We also analysed the number of patients operated, due to complications of mesh migration during the same period. Results. 368 patients were subject to mesh implantation, due to hernias during the period between 2008 and 2011. Three patients underwent surgery because of symptomatic migration of the mesh (ileus, fistula). Conclusions. The frequency of mesh migration is difficult to determine because of the different criteria of migration, observation period, and other factors. In patients after mesh implantation the potential migration of the biomaterial should be considered in case of unclear or acute abdominal symptoms.
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Inulin supplementation in rat model of pouchitis

33%
Drzymała-Czyż S., Banasiewicz T., Tubacka M., Majewski P., Biczysko M., Kościński T., Drews M., Walkowiak J.
Acta Biochimica Polonica
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2011
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vol. 58
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issue 3
381-384
EN
Available data indicates potential effectiveness of prebiotic therapy in alleviating inflammation and prolonging the remission in inflammatory bowel disease. Documented successes of such therapies were the basis for this study. So far, there is no data related to the effectiveness of inulin application in symptomatic or severe pouchitis in humans or in animal model. The aim of the study was to determine the effect of inulin supplementation on the expression of intestinal inflammation and feeding efficiency in rats with induced pouchitis. Twenty-four Wistar rats were operated. After induction of pouchitis animals were randomly divided into control and supplementation groups receiving, respectively, semi-synthetic diet with or without inulin (in a lower (LD) or higher (HD) dose: 2.5 % or 5 % of total dietary content of mass) for a period of 6 weeks. Selected nutritional parameters were assessed throughout the study. Histopathological and immunohistochemical analysis of pouch mucosa specimens was also performed. The energy intake, weight gain, feeding efficiency, quality of stools were comparable in all studied groups. The intensity of inflammation (Moskovitz scale) and adaptive changes (Laumonier scale) did not differ between compared groups. The tissue expression of pro- and anti-inflammatory interleukins (IL-1α, IL-6, IL-10 and IL-12) was not different either. Inulin supplementation does not improve the quality of stools or the expression of intestinal inflammation in rats with induced pouchitis. It has no impact on the intensity of pouch adaptation or on feeding efficiency.
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