New materials, techniques of tendon suture and methods of post-operative rehabilitation offer surgeons perspective of effective repair and excellent outcomes. Results of experimental studies show that multistrand tendon suture provides better mechanical properties than two-strand technique, however, clinical use in only 4 studies did not confirm its definitive superiority to traditional method of the repair.The aim of the study was the assessment of the outcomes of the treatment of flexor tendon repair by a modified, four-strand Stickland technique.Material and methods. Flexor tendons lacerations in 60 patients, all in Verdan's zone II, without associated bone fractures and impaired blood supply were repaired by a modified, four-strand Stickland technique. An active flexion and extension of the fingers in the range restricted by a splint was recommended immediately after operation. Early results were evaluated in 51 patients, 41 men and 10 women, in a mean age of 31 years, in whom 69 tendons were repaired in 69 digits. Follow-up at 2 and 6 weeks included examination of total active range of motion (AROM) of involved fingers, rupture rate and complications.Results. Failure of the repair occurred in 3 cases (6%), including one thumb, index and little finger, all between 2nd and 6th week after the operation. A mean AROM at 2 and 6 weeks was 38% and 58% of the normal value (270° for the finger and for 170° the thumb), respectively. In 13 digits (28%) AROM at 6 weeks was excellent, greater than 80%, but in 5 digits was poor, less than 20% of the normal value. The main cause of reduced AROM was incomplete extension of the digits, due to splint employment up to 6 weeks post-operatively.Conclusions. Early results obtained in the study fail to confirm greater endurance of four-strand repair over two-strand, what suggest rupture rate closed to given in the literature. An active range of motion achieved in the group was poorer than obtained after two-strand repair in other studies, but one can expect its improvement in the longer perspective.
In this case report, the treatment history of a woman with congenital esophageal atresia is presented. She underwent thoracotomy immediately after birth, but the distance between two atresic parts of the esophagus (7cm) did not allow for a primary anastomosis. Gastric and salivary fistulas were constructed. A salivary fistula was made in the cervical part of the esophagus. For 21 years, the patient received nutrition only by gastrostomy. Her physical and mental conditions were normal. She underwent esophageal reconstruction of the last segment of the ileum, coecum, and ascending colon and began oral feeding when she was 21 years old.
Vascular prosthesis infection in aorto-femoral position presents a life-threatening complication. Two operative modalities are utilized in the authors center: own superficial femoral veins (SFVR) and silver salts bonded anatomic reconstruction (AgR).The aim of the study was comparison of the two treatment methods in terms of early and distant clinical resultsMaterial and methods. 35 patients were qualified for infected aorto-femoral graft removal. In years 2000-2004 SFVR was conducted in 19 patients and in years 2005-2007 16 patients had AgR done. These groups were compared in terms of demographic, co-morbidity, vascular reconstructions history, infection symptoms and bacterial contamination. Then treatment results analysis was performed including: operation course, mortality, postoperative morbidity, amputation rate and further observation results.Results. There were no differences in demographic and co-morbidity between the groups. First operation/clinical symptoms onset interval was significantly longer for AgR patients (8 vs 3.3 years, p=0.001). Purulent inguinal sinus was dominating infection manifestation in both groups. Swab results were similar for both groups (Gram+ species dominated in both). Analysis of course and results of operative treatment revealed that AgR operation time was shorter than SFVR (195 vs 317, p<0.001), intraoperative blood requirement was also lower for AgPR (1.6 vs 3.1, p<0.05). Postoperative death, postoperative bleeding, reinterventions and amputation rate were higher for SFVR than AgR, however differences were not significant. During follow-up no infection recurrence was observed.Conclusions. We believe that AgPR is superior comparing with SFVR for patients with infected vascular prosthesis in the aorto-femoral prosthesis. Further investigations are mandatory to confirm our results.
In this case report, we describe a rare event: acute inflammation of the true cecal diverticulum. Emergency surgery enabled proper diagnosis and management of this condition. Diagnostic approaches and the management of this disease are described in detail and based on literature review. In conclusion, pathologies of cecal diverticula should be considered in differential diagnosis of pain in the right iliac fossa.
The aim of the study was to determine whether detailed preoperative Doppler ultrasonographic examination of saphenofemoral complex can improve the results of the lower limb varicose veins surgery.Two groups of patients (30 people each) were operated due to lower limbs primary varicose veins caused by saphenous vein insufficiency. All patients had a routine duplex examination performed. Group B had additional ultrasound examination before the operation to evaluate the number, diameter, and localization of the tributary vessels in the area of saphenofemoral junction. 30 days after the operation, in both groups control duplex examination was performed to evaluate the sparingness of the surgical procedure. The control ultrasonography showed 8 and 2 tributary vessels overlooked in groups A and B, respectively. The differences were statistically significant. The conformity of the preoperative ultrasound and the scene found during the operation in group B was 83.3%. The chance of overlooking peripheral vessels in group A increased 5.1 times.Preoperative Doppler ultrasound estimates localization of tributary vessels within the saphenofemoral junction, which makes detecting vessels during the operation much easier. It allows to minimize the number of technical mistakes and improve the lower limb varicose veins surgery results.
The authors present a case report of a 46-year-old man with a tumor of the posterior pharyngeal wall. Based on clinical examination and magnetic resonance imaging, the patient was qualified for surgical treatment. The patient underwent tumor resection under general anesthesia. Histopathological examination of resected tumor revealed the diagnosis of ancient schwannoma.
In Polish society Stereotypes about the surgeons are deeply rooted, which could really affect their relationship with the patient and the entire treatment process. The aim of the study was to evaluate the results of an opinion survey on the image of the surgeon and operative treatment. Material and methods. Between 1 January and 30 October 2012, 1000 patients were examined by use of a original questionnaire containing 25 questions. Results were analyzed statistically by STATISTICA test. Differences between groups were tested using Chi-square test (X²) with Yates modification, adopting the significance level α = 0.05. Results. The study group consisted of 1000 patients, including 56% of women (n = 560) and 44% of men (n = 440). The media image of Polish surgeon was identified as positive by 78% of respondents. A majority of patients (74%) considered that the Polish surgeons had equal level of competence and skills as foreign specialists. The greatest trust of the respondents (n = 537) had surgeons in middle age (40‑60 years). For the majority of patients (n = 649) a sex of the surgeon had no significance. Respondents clearly stated that a surgeon performing the operation should not have additional financial rewards. Almost all respondents in medical emergencies without hesitation declared their agreement to surgery (n = 974). Conclusions. Present knowledge of Polish patients about surgeons and surgical treatment is high. The surgeon has a high social prestige, respect and appreciation, and his image in the opinion of the vast majority of respondents is positive.
The 30-day mortality is one of the factors reflecting the quality of treatment. All these efforts focused on decreasing 30-day mortality will directly improve quality of care. The aim of the study was to identify risk factors of 30-day postoperative mortality in a cohort of patients operated on for colorectal cancer in one tertiary colorectal centre. Material and methods. Patients operated on due to colorectal cancer (CRC) between 2008 and 2014 were included in the study. 30-day mortality was assessed as an endpoint of the retrospective study. All records were collected from prospective database. Results. 1744 patients were operated on due to CRC. The 30-day mortality was noted in 65 patients (3.5%). In multivariable analyses we revealed that spread disease and poor general condition at admission were risk factors of 30-day mortality: OR 2.35; 2.01‑2.57 95%CI, p=0.03 and OR 2.18; 1.95‑2.41 95% CI; p=0.01, respectively. Emergency surgery significantly increased the risk of 30-day mortality: OR 2.64; 2.45‑2.87 95%CI; p=0.009. Low serum albumin concentration level and diabetes mellitus were additional risk factors for 30-day mortality, OR 1.65; 1.52‑1.78 95%CI; p=0.01 and OR 1.67; 1.41‑1.82 95%CI; p=0.03, respectively. Mortality was significantly higher after resection procedures than after only palliative operations: 4.21% vs 1.57%; p=0.002. Conclusions. Emergent patients, patients with advanced disease and in poor general state have to be assessed by multidisciplinary team to prepare them to operation. Additionally to reduce the risk of 30-day mortality decision of extend of surgery should be made by experienced surgeons.
The obese patient constitute the group with high perioperative risk due to more respiratory and cardiovascular disorders. The respiratory disorders deepen during postoperative period.The aim of the study was an assessment of changes in ventilation lung activity after classic and laparoscopic bariatric operations.Material and methods. For the lung activity assessment the measurement of pick expiratory flow was used before operation, in the first and third twenty-four hours after operation. Moreover, before and in the first twenty-four hours after operation a spirometry was performed. The forced vital capacity (FVC), 1 second forced expiratory volume (FEV1) and Tiffenau index (FEV1/FVC) were estimated in the study. 54 persons were included in batriatric operations. The first group was formed by the patients after vertical banded gastroplasty (VBG), the second after laparoscopic vertical banded gastroplasty (LVBG), the third one after laparoscopic adjustable gastric banding (LABG).Results. The following average results were gained: first group-PEF before operation 399 liter per minute, in the first twenty-four hours after operation 195 liter per minute and in the third twenty-four hours 282 liter per minute. FEV1 before operation 2.6 liter, in the first twenty-four hours 1.5 liter, FVC before 3.5 liter and after operation 2liter. Tiffenau index before 86%, after 85%. The second group PEF before operation 446 liter per minute, in the first twenty-four hours 326 liter per minute in the third twenty-four hours 409 liter per minute, FEV1 before 3.6 liter, after 2.6 liter, FVC before 3.9 liter, after 2.7 liter, Tiffenau index before 92%, after 96%. The third group PEF before 460 liter per minute, in the first twenty-four hours 340 liter per minute, in the third twenty-four hours 430 liter per minute, FEV1 before 3.2 liter, after 3.1 liter, FVC before 4.5 liter, after 3.6 liter, Tiffenau index before 90%, after 90%.Conclusions. The bariatric operations reduce ventilation lung activity. After classic bariatric surgery respiratory disorders are longer and become more intense. Independently of bariatric operation's method all respiratory disorders have a restrict type.
Optimal management of asymptomatic generalized rectal cancer is still the matter of debate.The aim of the study was to review stage IV rectal cancer patients who were treated in our clinic since 2000 till 2008 in order to evaluate the effectiveness of surgery.Material and methods. Fifty-two generalized rectal cancer patients treated with elective resection of primary tumor were identified. Patients' age, sex, duration of hospital stay, modality of surgery, complications, postoperative mortality rate and survival rate were assessed.Results. Median survival was 16.3 months. Postoperative complications occurred in 29% patients. Postoperative mortality rate was 1.9%.Conclusions. In properly selected group of patients elective resection of primary tumor may cause low mortality rate and acceptable morbidity rate. This surgical modality allows to avoid potential complications of tumor local growth.
The aim of this study was to assess short-term outcomes of surgical treatment of pancreatic cystic tumors (PCTs). Material and methods: We retrospectively reviewed medical records of 46 patients (31 women and 15 men) who had undergone surgery for pancreatic cystic tumors in our department. Results: Pancreatic cystic tumors were located within the pancreatic head (21), body (11), tail (13), and whole pancreas (1). The following surgical procedures were performed: pancreatoduodenectomy (20), central pancreatectomy (9), distal pancreatectomy (3), distal pancreatectomy with splenectomy (3), distal extended pancreatectomy with splenectomy (2), total pancreatectomy (1), duodenum preserving pancreatic head resection (1), local tumor resection (4), and other procedures (2). Histopathological tumor types were as follows: serous cystadenoma (14), intraductal papillary mucinous adenoma (5), intraductal papillary mucinous carcinoma (5), solid pseudopapillary tumor (5), mucinous cystadenoma (5), mucinous cystadenoma with border malignancy (1), mucinous cystadenocarcinoma (2), adenocarcinoma (4), and other tumors (5). Early postoperative complications were observed in 14 (30.43%) patients. Reoperations were performed in 9 (19.56%) patients. The perioperative mortality rate was 6.52%. Conclusions: Serous cystadenoma was the most common pancreatic cystic tumor in the analyzed group. PCTs were most frequently located within the pancreatic head. Pancreatic resection was possible in most patients, and pancreatoduodenectomy was the most common pancreatic resection type.
Insulinomas are rare tumors, accounting for 1-2% of all neoplasms of the pancreas. Usually their treatment is not associated with any problems; however there is a small subset of problematic clinical cases. The authors present their own clinical experience with surgical treatment of insulinomas of the pancreas. The aim of the study was to conduct a retrospective analysis of patients with insulinomas of the pancreas who underwent surgical treatment at Department of General and Transplant Surgery Medical University in Łódź. Material and methods. The study included all patients who underwent surgical treatment at the Department between 2007 and 2013 for the tumor of the pancreas. Further retrospective analysis included all patients with tumors of the insulinoma type. The data was obtained from medical records, surgical protocols and histopathology reports. Results. The analysis included 530 patients who underwent surgical treatment for the tumor of the pancreas. Insulinoma was found in 10 (1.88%) patients (8 females, 2 males). An average age of patients who underwent surgical treatment was 47.5±13.8 years. An average size of the tumor was 1.6±0.5 cm. Six patients underwent extirpation of the insulinoma, while the other patients underwent distal resection of the pancreas. All patients underwent “an open surgical procedure”. The average duration of the surgical procedure was 55±45 minutes. Duration of the hospitalization in the analyzed group of patients was 7±5 days. Incidence of postoperative pancreatic fistulas was 10%. All insulinomas were benign. Conclusions. Insulinomas were rare among patients who underwent surgical treatment at the Department. They were benign and their treatment was unproblematic. However, there is a small group of cases that can be associated with problematic clinical situations. Thus treatment of patients with insulinomas should be conducted at specialist centers. Correct diagnostic and therapeutic management, involving close cooperation between multiple medical specialists, results in complete curing of majority of patients.
We present a case of a 53-year old male patient who underwent elective surgery due to a giant abdominal cystic mass. Prior to the surgery, he complained of abdominal distention, growing abdominal mass and increasing nourishment problems. CT and ultrasonographic examinations revealed a giant abdominal cyst but failed to indicate the point of its origin. Intraoperatively a giant abdominal cyst was found, approximately 30x30x25 cm in size. The cyst was free-lying in the peritoneal cavity, except small area adherent to the stomach wall. Partial resection of the stomach wall was performed and the cyst was completely removed.The postoperative course was uncomplicated. The pathological examination did not give an unequivocal answer as to the origin of the cyst, suggesting differentiation between a tumor of vascular origin and of stromal origin.
Introduction: Congenital factor VIII deficiency is a rare hemorrhagic disorder inherited in an autosomal recessive pattern. Surgical treatment with insufficient diathesis correction is burdened with a high risk of bleeding complications. The aim of the study was to evaluate the surgical outcome in patients with congenital factor VII deficiency and assessment of the efficacy and safety of recombinant activated factor VII (rFVIIa) used for perioperative hemostatic coverage in our two schemas of substitutive therapy. Material and methods: In the years 2002-2017 a total of 22 patients with congenital factor VII deficiency were subjected to surgery. Substitution therapy relied on rFVIIa used in two schemas. One involved 15 patients with factor VII activity of <10% of normal value who were injected rFVIIa at a dose of 30 μg/kg b.w. every 12 hours on surgery day, 15 μg/kg b.w. every 12 hours on the first postoperative day and 15 μg/kg b.w. every 24 hours on the following days. The second schema involved 7 patients with factor VII activity of 10-25% of normal value who were given rFVIIa at a dose of 15 μg/kg b.w. every 12 hours on surgery day and the first postoperative day; then the same dose was administered every 24 hours on consecutive days. The treatment continued for 4-10 days. Results: In 22 patients a total of 26 surgeries were performed; 17 surgeries in 15 patients with factor VII <10% of normal and 9 in 7 patients with factor VII deficiency of 10-25% of normal. The surgeries included: 9 cholecystectomies (8 laparoscopic, 1 open), 7 thyroidectomy procedures, 2 exploratory laparotomies, 1 left hemicolectomy, 1 total proctocolectomy, 3 inguinal hernia repairs and 3 excisions of varicose veins. One patient with factor VII activity of 9% required an additional dose of rFVIIa in the intraoperative period due to diathesis bleeding. Intraoperative hemostasis was normal for all other patients; no postoperative hemorrhagic complications were reported. In patients with FVII activity <10% average daily dose of rFVIIa was 31.3 (range 20-56) μg/kg b.w., total daily dose 186 (136-303) µg/kg b.w., total dose of rFVIIa - 15.2 (12-112) mg. In patients with FVII activity 10-25% the doses were 21.2 (15-31), 117 (46-271) µg/kg b.w. and 9.1 (6-17) mg respectively.
Endoscopic polypectomy of colorectal polyps is a common procedure. However, endoscopic treatment of large polyps (those with a diameter exceeding 2 cm) remains questionable. There is a serious risk of colorectal carcinoma presence inside these lesions, which eventually would require surgical intervention. Apart from this fact endoscopic polypectomy of large polyps is connected with substantial risk of complications, such as perforation and bleeding. Many patients with large colorectal polyps are qualified for surgical intervention.The aim of the study was to determine the efficacy and safety of polypectomy of large colorectal polyps.Material and methods. The study presented results of endoscopic treatment in case of patients with large colorectal polyps at the Department of General and Colorectal Surgery, Medical University in Łódź. Patients were admitted to the hospital during the period between January, 2008 and January, 2010. The following parameters were analysed: location of polyps, percentage of high grade dysplasia, complete excision rate, and complications connected with polypectomy procedures.Results. During the analyzed period of time 488 endoscopic polypectomies were performed. Forty-three large colorectal polyps were removed (8.8%). Seven (16.3%) of them were classified as flat polyps. Out of 488 removed polyps, 39 were classified as adenomas with high grade dysplasia (7.9%), while 16 were large-exceeding 2 cm (37.2%). Considering the group of large polyps no invasive carcinoma case was detected. The radical excision rate for large pedunculated polyps was obtained in 88.8% (32/36) of cases. In case of flat adenomas the above-mentioned parameter was lower - 57.1% (4/7). During polypectomy of large colorectal polyps one perforation was observed during the excision of a flat cecal polyp. In two cases immediate bleeding occurred (2/43). In both cases endoscopic treatment of bleeding proved sufficient.Conclusions. Endoscopic polypectomy of large pedunculated polyps is a safe and efficient method, which makes it a rationale alternative for surgery. Polypectomy of flat adenomas is connected with a lower radical excision rate and higher risk of perforation.
Introduction: There are different complications related to the submandibular gland resection, like damage to the mandibular branch of the facial nerve, lingual or hypoglossal nerve. Moreover, subjective complaints like dry mouth, altered sensation around the scar and taste alterations were described. Patients and methods: A prospective, non-randomized study was performed including 20 patients treated with submandibular gland resection. Results: The most common etiology was sialolithiasis affecting 9 (45%) patients. One (5%) patient presented a lingual nerve paresis, 2 (10%) patients presented a transient marginal mandibular branch paresis and no hypoglossal nerve alteration was observed. Factors like the size of the lithiasis (P = 0.293), size of the tumor (P = 0.445) or type of pathology (P = 0.694) were not related with neurological complications. Altered sensation in the skin around a scar was the most severely weighted problem (55% and 33.3%), and xerostomia was the second one (33% and 27.3%) at one month and at six months after surgery, respectively. Conclusion: The submandibular gland resection remains to be a safe technique with a low rate of surgical and neurological complications. However, patients should be informed about sequelae like xerostomia, altered sensation in the skin or pain around the scar, which may be discomforting. The cosmetic result can be satisfactory, but a surgical scar can be avoided with another approach. Although rare, the risk of MBFN, lingual and hypoglossal nerve damage should always be included in the preoperative information on surgical risks.
Mesenteric fibromatosis is a part of the clinical-pathologic spectrum of deep fibromatoses. We report this rare case of primary mesenteric tumor that was diagnosed to be a mesenteric fibromatosis on histopathological examination. In majority of patients it may remain asymptomatic and the management of these tumors depends on histopathological examination. Postoperatively, patient was well and subsequent follow up showed normal recovery.
The purpose of this study was to evaluate the effect of physical exercise on limited locomotion in the hands of patients who underwent surgery to correct Dupuytren's contracture. We studied the hands of 84 patients with Dupuytren's contracture aged from 30 to 84 years. In all patients, the contracture was removed by performing a partial fasciectomy. Physical exercises were carried out a week prior to surgery and during the postoperative period. Patients were divided into group I, in which the exercise was carried out under the supervision of the authors of this study and group II, in which exercises were performed sporadically and without professional supervision. Measurements were performed on all patients one week before surgery (A), 1 week after surgery (B) and 6 weeks after (C). The range of movement of fingers was measured using a goniometer. The average total loss of finger extension was evaluated, taking due account of the extension loss in the MCP, PIP and DIP joints of all fingers of the treated hand. Rehabilitation treatment included active and passive exercises; in more severe cases the treatment of choice was massage and special equipment to help bear flexion contracture. Test results were statistically analyzed. In all patients, there was an increase in mobility of the fingers. Patients taking part in physical exercise had significantly greater range of finger movement.
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