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Assesment of Inflammatory Response Intensity in Early Postoperative Period in Patients After Hernioplasty Operated on with Classic Stoppa Method and Videoscopic TEP Method

100%
Libiszewski M., Drozda R., Białecki J., Wieloch M., Hedayati M., Kuzdak K., Kołomecki K.
Polish Journal of Surgery
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2011
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vol. 83
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issue 9
497-501
EN
The aim of the study was comparison of inflammatory response intensity through estimation of CRP, IL-6 and WBC concentration in blood serum in patients before and after inguinal hernia operations with Stoppa and TEP method.Material and methods. The study involoved 117 patients operated on inguinal hernia between 2006-2008. The patients were divided into two groups. In the first group (group I - 56) Stopp'a method was used, in the second (group II - 61) TEP method. The patients selection was coincidental. All examined patients were men between 25-75 years old (mean age 54.3). Moreover, the operation's time, state of postoperative wound, the average hospitalization time and intensity of pain were estimated. The observations were directed over two weeks after operation.Results. The inflammatory response estimated with CRP, IL-6 concentration in blood serum was considerably higher in patients operated with Stoppa method. There wasn't observed a relevant difference in increase of white blood cells' concentration in both groups. Moreover, the patients operated on with TEP method experienced lower pain. In group, operated on with Stoppa method, 3 cases of wound healing complications were observed. The operation's time was considerably shorter in the first group. The hospitalization time, was considerably shorter in patients operated on with videoscopic method.Conclusions. The operation of inguinal hernia with TEP technique in comparison with Stopp'a method is connected with considerably lower inflammatory response of organism, what directly involve with postoperative pain abridgment and reduction of hospitalization time. Moreover it may have influence on frequency of postoperative complications related with wound healing.
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Multicenter Study of Optimal Management Strategy in Severe Multiple Trauma

88%
Brongel L., Lasek J., Karski J., Gwoździewicz J., Hładki W., Lorkowski J.
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issue 11
518-525
EN
The aim of the study. The development of a triage system to implement proper treatment based on severity of injury.Material and methods. The study is based on material from three Polish Universities' trauma departments: Cracow, Lublin, and Gdańsk. Using trauma scales, 300 of the most severely injured multiple trauma (MT) patients from 2000-2004 have been chosen for this study. Medical documentation was carefully analysed, particularly the time and extent of the surgical procedures performed as well as their potential to influence later results.Results. There are three groups of patients:1 - critically injured, with an ISS>50, LSO>15, RTS 3 pts, two body cavity involvement, multiple long bone and/or pelvis fractures. Only damage control was allowed and the definitive treatment necessary was within 48 hours.2 - severely injured, with an unstable ISS 35-50, LSO 10-15, RTS 4-10 pts, one body cavity involvement, multiple long bone and/or pelvis fractures. Life-saving operations were possible with orthopaedic management (within 48 hours) provided using the "2+2 rule" (less than 2 hours of operation and no more than 2 units of blood transfused).3 - moderately injured, with a stable ISS<35, LSO<10, RTS>10 pts, one body cavity involvement, a long bone or pelvis fracture. Classic surgical and orthopaedic management occurred within 48 hours.Conclusions. The history and course of post-traumatic syndrome from metabolic, immune and endocrine viewpoints requires a special strategy for repairing life -threatening trauma injures at the right time, in proper sequence, and with limited surgical activity in more severe cases.
3
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The 2+2 Rule in the Management of Long Bone Fractures in Patients with Severe Multiple Trauma

88%
Brongel L., Jarzynowski W., Budzyński P., Hładki W., Lorkowski J., Kuliś M.
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issue 11
526-531
EN
The aim of the study was to estimate the efficacy of surgically stabilizing long bone fractures within 48 hours in patients with severe multiple injuries following life-saving procedures and compensating for circulatory-respiratory parameters.Material and methods. The study comprised 364 patients with multiple injuries scoring 7 or more LSO points, who were admitted and treated university department during 1992-2000. Upon admission patients were documented on the basis of computer case histories of diseases and the standard calculation sheets. The assumption was that all long bone fractures in patients with multiple trauma would be stabilized within 48 hours. Parameters for operating were set so that the duration time of the operative procedure could not exceed 2 hours, and the amount of blood transfused could not exceed 2 units.Results. From among 364 patients with multiple traumas scoring 7 or more LSO points, 192 patients sustained long bone fractures that required surgical attention. One-third of the patients were female, the average age of the patients was nearly 45 years, and the average injure severity was 10.28 LSO points. 146 patients underwent 226 orthopaedic operations, out of which 127 were carried out in the first 24 hours, and 23 in the next 24 hours of the hospital stay. The mortality was 13.5%.Conclusions. Stabilization of the long bone fractures within the first 48 hours in patients with multiple traumas, after compensating circulatory parameters, is a life-saving treatment.
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