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    Wyświetlanie 1-9 z 9
    Tytuł:
    Cystic Adrenal Lesions - Analysis of Indications and Results of Treatment
    Autorzy:
    Major, Piotr
    Pędziwiatr, Michał
    Matłok, Maciej
    Ostachowski, Mateusz
    Winiarski, Marek
    Rembiasz, Kazimierz
    Budzyński, Andrzej
    Powiązania:
    https://bibliotekanauki.pl/articles/1396728.pdf
    Data publikacji:
    2012-04-01
    Wydawca:
    Index Copernicus International
    Tematy:
    cystic adrenal lesions
    laparoscopic adrenalectomy
    endocrinological surgery
    minimally invasive surgery
    adrenal gland surgery
    indications for surgery
    Opis:
    Cysts are a rare pathology of adrenal glands. As the development of new diagnostic techniques takes place, the occurrence of adrenal cystic lesions has been rapidly increasing. The majority of them are solid adrenal lesions, but localized fluid collections are also more frequently diagnosed. In case of solid adrenal lesions, there are straight indications for surgery, but on the other hand there are no clear guidelines and recommendations in case of adrenal cysts.The aim of the study was to analyze surgical methods and evaluate treatment effects in patients who were qualified for laparoscopic adrenalectomy due to adrenal cystic lesions.Metarial and methods. Identical criteria were used to qualify patients with solid and cystic lesions of the adrenal gland for surgery. Out of the whole number of 345 patients who underwent laparoscopic surgery for adrenal tumors, 28 had adrenal cysts. 16 of them (57%) were women and 12 (43%) men. The average age of the studied group was 46.4 years (25-62 years). The average cyst diameter in CT was 5.32 cm (1.1-10 cm). Most of the lesions were hormonally inactive (22 patients), but in 6 cases increased level of adrenal hormones was observed.Results. Pathological analysis revealed 4 (14%) pheochromocytomas and 2 (7%) dermoid cysts. In case of 22 (79%) patients, the postoperative material was profiled by pathologists as insignificant according to potential neoplasmatic transformation risk: 5 (17.5%) - endothelial vascular cysts, 3 (11%) endothelial lymphatic cysts, 7 (25.5%) pseudocysts, 3 (11%) simple cysts, 2 (7%) bronchogenic cysts, 1 (3.5%) - cortical adenoma and 1 (3.5%) cyst was of myelolipoma type.Conclusions. Based on the performed research and previous experience in treating patients with adrenal lesions we can conclude that application of the same evaluating algorithm for both cystic and solid lesions is valid.
    Źródło:
    Polish Journal of Surgery; 2012, 84, 4; 184-189
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    The use of the enhanced recovery after surgery (ERAS) protocol in patients undergoing laparoscopic surgery for colorectal cancer – a comparative analysis of patients aged above 80 and below 55
    Autorzy:
    Pędziwiatr, Michał
    Pisarska, Magdalena
    Wierdak, Mateusz
    Major, Piotr
    Rubinkiewicz, Mateusz
    Kisielewski, Michał
    Matyja, Maciej
    Lasek, Anna
    Budzyński, Andrzej
    Powiązania:
    https://bibliotekanauki.pl/articles/1394301.pdf
    Data publikacji:
    2015
    Wydawca:
    Index Copernicus International
    Tematy:
    ERAS protocol
    fast track protocol
    postoperative care
    colorectal cancer
    colorectal surgery
    advanced age
    laparoscopic surgery
    Opis:
    Age is one of the principal risk factors for colorectal adenocarcinoma. To date, older patients were believed to achieve worse treatment results in comparison with younger patients due to reduced vital capacity. However, papers have emerged in recent years which confirm that the combination of laparoscopy and postoperative care based on the ERAS protocol improves treatment results and may be particularly beneficial also for elderly patients. The aim of the study was to compare the outcomes of laparoscopic surgery for colorectal cancer in combination with the ERAS protocol in patients aged above 80 and below 55. Material and methods. The analysis included patients aged above 80 and below 55 undergoing elective laparoscopic colorectal resection for cancer at the 2nd Department of General Surgery of the Jagiellonian University. They were divided into two groups according to their age: ≥80 years of age (group 1) and ≤55 years of age (group 2). Both groups were compared with regard to the outcome of surgery: length hospital stay, complications, hospital readmissions, degree of compliance with the ERAS protocol, and recovery parameters (tolerance of oral nutrition, mobilisation, need for opioids, restored gastrointestinal function). Results. Group 1 comprised 34 patients and group 2, 43 patients. No differences were found between both groups in terms of gender, BMI, tumour progression or surgical parameters. Older patients typically had higher ASA scores. No statistically significant differences were found with regard to the length hospital stay following surgery (5.4 vs 7 days, p=0.446481), the occurrence of complications (23.5% vs 37.2%, p=0.14579) or hospital readmissions (2.9% vs 2.4%). The degree of compliance with the ERAS protocol in group 1 and 2 was 85.2% and 83.0%, respectively (p=0.482558). Additionally, recovery parameters such as tolerance of oral nutrition (82.4% vs 72.1%, p=0.28628) and mobilisation (94.1% vs 83.7%, p=0.14510) within 24 hours of surgery did not differ among the groups. However, a smaller proportion of older patients required opioids in comparison with younger patients (26.5% vs 55.8%, p=0.00891). Conclusions. Similar levels of compliance with the ERAS protocol may be achieved among patients aged ≥80 and younger patients. When laparoscopy is combined with the ERAS protocol, age does not seem to be a significant factor that could account for worse utcomes. Therefore, older patients should not be excluded from perioperative care based on ERAS principles.
    Źródło:
    Polish Journal of Surgery; 2015, 87, 11; 565-572
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Impact of bariatric surgery on non-alcoholic fatty liver disease
    Autorzy:
    Major, Piotr
    Pędziwiatr, Michał
    Rubinkiewicz, Mateusz
    Stanek, Maciej
    Głuszewska, Anna
    Pisarska, Magdalena
    Małczak, Piotr
    Budzyński, Andrzej
    Budzyński, Piotr
    Powiązania:
    https://bibliotekanauki.pl/articles/1393188.pdf
    Data publikacji:
    2017
    Wydawca:
    Index Copernicus International
    Tematy:
    non-alcoholic fatty liver disease
    bariatric surgery
    morbid obesity
    Opis:
    Introduction; p to 300 million people have the body mass index (BMI) greater than 30 kg/m2. Obesity is the cause of many serious diseases, such as type 2 diabetes, hypertension, and non-alcoholic fatty liver disease (NAFLD). Bariatric surgery is the only effective method of achieving weight loss in patients with morbid obesity. Objectives: The aim of the study was to assess the impact of bariatric surgery on non-alcoholic fatty liver disease in patients operated on due to morbid obesity. Material and Methods: We included 20 patients who were qualified for bariatric procedures based on BMI > 40 kg/ m2 or BMI > 35kg/m2 with the presence of comorbidities. The average body weight in the group was 143.85kg, with an average BMI of 49.16kg/m2. Before the procedure, we evaluated the severity of non-alcoholic fatty liver disease in each patient using the Sheriff-Saadeh ultrasound scale. We also evaluated the levels of liver enzymes. Follow-up evaluation was performed twelve months after surgery. Results: Twelve months after surgery, the average weight was 102.34 kg. The mean %WL was 33.01%, %EWL was 58.8%, and %EBMIL was 61.37%. All patients showed remission of fatty liver disease. Liver damage, evaluated with ultrasound imaging, decreased from an average of 1.85 on the Sheriff-Saadeh scale, before surgery, to 0.15 twelve months after surgery (p < 0.001). As regards liver enzymes, the level of alanine aminotransferase decreased from 64.5 (U/l) to 27.95 (U/l) (p < 0.001), and the level of aspartate aminotransferase decreased from 54.4 (U/l) to 27.2 (U/l). Conclusions: Bariatric procedures not only lead to a significant and lasting weight loss, but they also contribute to the reduction of fatty liver disease and improve liver function.
    Źródło:
    Polish Journal of Surgery; 2017, 89, 2; 1-4
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Effects of bariatric surgery on cardiovascular risk factors among morbidly obese patients
    Autorzy:
    Major, Piotr
    Kowalczuk, Aleksandra
    Wysocki, Michał
    Osadnik, Sonia
    Pędziwiatr, Michał
    Głuszewska, Anna
    Pisarska, Magdalena
    Małczak, Piotr
    Lasek, Anna
    Kisielewski, Michał
    Budzyński, Andrzej
    Powiązania:
    https://bibliotekanauki.pl/articles/1393464.pdf
    Data publikacji:
    2017
    Wydawca:
    Index Copernicus International
    Tematy:
    morbid obesity
    bariatric surgery
    laparoscopic sleeve gastrectomy
    laparoscopic Roux-en-Y Gastric Bypass cardiovascular risk factors
    SCORE
    Framingham
    Opis:
    Aim of the study: The aim of this study was to evaluate the influence of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric by-pass on risk factors of cardiovascular diseases. Material and methods: We analyzed prospectively collected data of patients operated for morbid obesity who were qualified for laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric by-pass (LRYGB). Risk factors for wyłączecardiovascular diseases were assessed with the SCORE scale and both full and hard Framingham cardiovascular risk scores (FCRs). The data were collected on admission and one year after the procedures. We enrolled 264 patients (119 females, 116 males, 40.2±9.9 years old), of whom 117 underwent LRYGB and 118 LSG, respectively. Results: Preoperatively, 12% of patients were in the high-risk category of the SCORE scale, 65% were in the moderate risk category, and 24% were in the low-risk category. The median score of the SCORE scale was 1 (1-2). Lipid-based full FCR was 34.5% (24%-68%) and the hard FCR was 17.5% (10%-52%), while the respective BMI-based FCRs were 59% (31%-84%) and 37% (15%-67%). One year after the procedures, the mean %EBMIL (62.88%±20.02%) and %EWL (53.18%±15.87) were comparable between both procedures. Hypertension treatment was not necessary in 33 patients after LSG and in 55 after LRYGB. Diabetes mellitus remitted in 9 and 29 patients, respectively. Both procedures significantly reduced high and moderate risk prevalence in the SCORE scale in favor of the low risk category. Surgical interventions resulted in significant reductions of FCRs 1 year after surgery ( p<0.001). Conclusions: Both LSG and LRYGB lead to a significant and comparable body mass reduction. Both procedures significantly decrease of the risk of cardiovascular diseases, based on SCORE and Framingham scales.
    Źródło:
    Polish Journal of Surgery; 2017, 89, 1; 41-49
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Endoscopic Insertion Of A Self-Expandable Stent Combined With Laparoscopic Rinsing Of Peritoneal Cavity As A Method For Staple Line Leaks Treatment In Patients Post Laparoscopic Sleeve Gastrectomy
    Autorzy:
    Matłok, Maciej
    Major, Piotr
    Pędziwiatr, Michał
    Winiarski, Marek
    Budzyński, Piotr
    Małczak, Piotr
    Hynnekleiv, Leif
    Budzyński, Andrzej
    Powiązania:
    https://bibliotekanauki.pl/articles/1395616.pdf
    Data publikacji:
    2015-05-01
    Wydawca:
    Index Copernicus International
    Tematy:
    bariatric surgery
    laparoscopic sleeve gastrectomy
    post-bariatric surgery complications
    staple line leaks
    Opis:
    Currently, laparoscopic sleeve gastrectomy is one of bariatric surgeries most commonly performed in the world. The most frequent complications of surgeries of this type, with the highest mortality rate, include bleeding into the GI tract and peritoneal cavity, and sleeve staple line leaks. These severe complications prolong the hospital stay, and often are a cause of patient’s death. While in a case of bleeding the procedure appears to be obvious, so far no uniform and standard guidelines have been established for the group of patients with staple line leaks. The aim of the study was to report results of treatment for staple line leaks following laparoscopic sleeve gastrectomy with a laparoscopic procedure and simultaneous endoscopic insertion of a self-expandable stent. Material and methods. 152 laparoscopic sleeve gastrectomies were performed from April 2009 to December 2014. The BMI median was 46.9, and the age median was 42 years. Staple line leaks developed in 3 out of 152 people (1.97%). All patients who developed this complication were included in the study. The treatment involved laparoscopic revision surgery with simultaneous endoscopic insertion of a self-expandable stent (Boston Scientific, Wallflex Easophageal Stent, 150×23 mm) into the gastric stump during gastroscopy. Results. Leaks following laparoscopic sleeve gastrectomy were diagnosed on day 5 after the procedure, on average. Intervention consisting of laparoscopy and endoscopic insertion of a self-expandable stent was initiated within 14 hours of diagnosing the leak, on average. The mean time for which the stent was kept was 5 weeks (4–6 weeks). Stenting proved to be fully effective in all patients, where after discharging home, a cutaneous fistula, periodically (every 2-3 weeks) discharging several millilitres of matter, persisted in one patient. The mean time for the leak healing in 2 patients, in whom the described method was successful in treatment of this complication, was 37 days. No patient died in the perioperative or follow-up period. Conclusions. The proposed method for treatment of staple line leaks following laparoscopic sleeve gastrectomy by combined laparoscopic rinsing and draining of the peritoneal cavity and endoscopic insertion of a self-expandable stent is an interesting and worth recommending method for treatment of this complication.
    Źródło:
    Polish Journal of Surgery; 2015, 87, 5; 238-244
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Preoperative pancreatic duct stenting in patients undergoing laparoscopic pancreatic surgery – a preliminary report
    Autorzy:
    Rubinkiewicz, Mateusz
    Migaczewski, Marcin
    Pędziwiatr, Michał
    Matłok, Maciej
    Dembiński, Marcin
    Budzyński, Andrzej
    Powiązania:
    https://bibliotekanauki.pl/articles/1395645.pdf
    Data publikacji:
    2015-06-01
    Wydawca:
    Index Copernicus International
    Tematy:
    laparoscopic pancreatectomy
    minimally invasive techniques
    pancreatoduodenectomy
    pancreatic tumor
    Opis:
    Laparoscopic surgery is becoming an approved technique in pancreatic surgery. It offers some advantages over an open approach due to shorter hospital stay and decreased complication rate. Regardless the technique the most significant problem of pancreatic surgery is postoperative pancreatic fistula. There are numerous methods attempted at reduction of its incidence. One of the possibilities is preoperative pancreatic duct stenting. It aims at decreasing the pressure in the pancreatic duct, which is supposed to facilitate pancreatic juice flow to the duodenum. The aim of the study was to determine the role of preoperative pancreatic duct stenting in pancreatic surgery. Material and methods. Nineteen patients undergoing laparoscopic pancreatic resection were enrolled into the study. Prior to the surgery, all of the patients were submitted for the Endoscopic Retrograde Choleangiopancreatography (ERCP) with pancreatic duct stenting. Following the subsequent laparoscopic pancreatic resection, all patients were monitored to detect the pancreatic fistula appearance. The pancreatic stent was removed 6‑8 weeks after the surgery. Results. With an exception of two patients, all other patients underwent successful ERCP with pancreatic duct stenting before the surgery. In one case the placement of the prosthesis failed due to a tortuous pancreatic duct. Five patients had an episode of acute pancreatitis including two severe courses as a complication of preoperative ERCP. One of the patient died due to severe GI bleeding 2 weeks after stenting. Among the procedures there were 15 distal pancreatectomies, two enucleations of the tumor localized in the uncinate process and in the body of the pancreas and one central pancreatectomy. The median time of surgery duration was 186 minutes (90‑300; ±56). No conversions to an open approach were necessary. Likewise, there was neither any major complications reported in a postoperative course nor incidence of pancreatic fistula in any of the patients undergoing surgery. Conclusions. Preoperative pancreatic duct stenting can decrease the incidence of pancreatic fistula. However, a number of serious complications exceed the potential benefit of this method.
    Źródło:
    Polish Journal of Surgery; 2015, 87, 6; 307-311
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Colonoscopy for colorectal cancer screening - is it effective in the hands of a general surgery resident?
    Autorzy:
    Matyja, Maciej
    Pasternak, Artur
    Wysocki, Michał
    Pędziwiatr, Michał
    Szura, Mirosław
    Rembiasz, Kazimierz
    Powiązania:
    https://bibliotekanauki.pl/articles/1392891.pdf
    Data publikacji:
    2018
    Wydawca:
    Index Copernicus International
    Tematy:
    colorectal
    cancer
    screening
    colonoscopy
    residents
    quality
    Opis:
    INTRODUCTION: Colonoscopy is considered to be a gold standard for colorectal cancer (CRC) screening. Endoscopy training is an essential component of general surgery training program. Patients should receive care at the highest level possible, nevertheless residents need to gain experience. The aim of our study was to evaluate the effectiveness of colonoscopy performed by general surgery residents by comparing quality indicators between surgical trainees and consultants. MATERIALS AND METHODS: The analysis included 6384 patients aged 40–65 who underwent screening colonoscopy between October 2014 and February 2018. The patients were divided into two groups: group I – patients examined by residents, group II - patients examined by board-certified general surgeons. Quality indicators such as cecal intubation rate, adenoma detection rate and patient tolerance scale were compared between the two groups. RESULTS: Group I comprised 2268 (35.53%) and group II 4116 (64.47%) patients. The overall cecal intubation rate (CIR) was 95.99%, equal for both groups (p = 0.994). There was no statistically significant difference in adenoma detection rate: 29.30% among residents and 27.66% among consultants (p = 0.203). Patient tolerance of the examination was very good (4-point scale) in consultants group in 78.98% of cases and in 75.18% cases among residents (p < 0.001). CONCLUSION: In a proper learning environment general surgery residents are able to perform high-quality and effective screening colonoscopy. However, residents need to continue the progress in their technique to improve patient tolerance in order to reach the proficiency of a consultant.
    Źródło:
    Polish Journal of Surgery; 2018, 90, 5; 6-12
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    A periampullary duodenal diverticula in patient with choledocholithiasis – single endoscopic center experience
    Autorzy:
    Major, Piotr
    Dembiński, Marcin
    Winiarski, Marek
    Pędziwiatr, Michał
    Rubinkiewicz, Mateusz
    Stanek, Maciej
    Dworak, Jadwiga
    Pisarska, Magdalena
    Rembiasz, Kazimierz
    Budzyński, Andrzej
    Powiązania:
    https://bibliotekanauki.pl/articles/1393717.pdf
    Data publikacji:
    2016
    Wydawca:
    Index Copernicus International
    Tematy:
    choledocholithiasis
    digestive system endoscopic surgery
    diverticulum
    endoscopic retrograde cholangiopancreatography
    prevalence
    Opis:
    The reported prevalence of periampullary duodenal diverticula varies between 9 and 32.8%. The aim of the study was to evaluate the prevalence of periampullary diverticula in the studied population and establish whether their presence influence the risk of choledocholithiasis and the risk of Endoscopic Retrograde Cholangio Pancreatography (ERCP) related complications. Material and methods. The study group of 3788 patients who underwent ERCP between 1996 and 2016at the 2nd Department of General Surgery Jagiellonian University Medical College in Kraków were analyzed. The group comprised of 2464 women (mean age 61.7 years) and 1324 men (mean age 61.8 years). The patients were divided into two groups. Group A included patients in whom there were no periampullary diverticula detected. Group B included patients in whom the opening of the bile duct was in the vicinity of a duodenal diverticulum. Results. There were 3332 patients included in group A (2154 women and 1178 men) and 456 patients in group B (310 women and 146 men). The prevalence of periampullary duodenal diverticula in the analyzed group was 12.8%. The presence of stones or biliary sludge was diagnosed in 1542 patients (47.6%) in group A and 290 patients (68.1%) in group B. Recurrence of choledocholithiasis occurred in 4.5% of patients (70/1542) in group A and 10.3% of patients (30/290) in group B. Complications occurred in a total of 76 patients in group A (2.3%) and 22 patients in group B (4.8%). Conclusions. The presence of choledocholithiasis and the risk of ERCP related complications are significantly higher in the group with duodenal diverticula.
    Źródło:
    Polish Journal of Surgery; 2016, 88, 6; 576-586
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Guidelines for the management of surgical departments in non-uniform hospitals during the COVID-19 pandemic
    Autorzy:
    Mitura, Kryspin
    Myśliwiec, Piotr
    Rogula, Wojciech
    Solecki, Michał
    Furtak, Jarosław Piotr
    Kazanowski, Michał
    Kłęk, Stanisław
    Nowakowski, Michał
    Pędziwiatr, Michał
    Zawadzki, Marek
    Wallner, Grzegorz
    Sobocki, Jacek
    Powiązania:
    https://bibliotekanauki.pl/articles/1391784.pdf
    Data publikacji:
    2020
    Wydawca:
    Index Copernicus International
    Tematy:
    COVID-19
    SARS-CoV-2
    pandemic
    epidemic
    surgical care
    personal protective equipment
    FFP3 masks
    surgery
    hospital
    virus
    guidelines
    recommendations
    Opis:
    In the last several weeks we have been witnessing the exponentially progressing pandemic SARS-CoV-2 coronavirus. As the number of people infected with SARS-CoV2 escalates, the problem of surgical management of patients requiring urgent surgery is increasing. Patients infected with SARS-CoV2 virus but with negative test results will appear in general hospitals and may pose a risk to other patients and hospital staff. Health care workers constitutes nearly 17% of infected population in Poland, therefore early identification of infected people becomes a priority to protect human resources and to ensure continuity of the access to a surgical care. Both surgical operations, and endoscopic procedures are considered as interventions with an increased risk of infection. Therefore, determining the algorithm becomes crucial for qualifying patients for surgical treatment, but also to stratify the risk of personnel being infected during surgery and to adequately protect staff. Each hospital should be logistically prepared for the need to perform urgent surgery on a patient with suspected or confirmed infection, including personal protective equipment. Limited availability of the equipment, working under pressure and staff shortages in addition to a highly contagious pathogen necessitate a pragmatic management of human resources in health care. Instant synchronized action is needed, and clear uniform guidelines are essential for the healthcare system to provide citizens with the necessary surgical care while protecting both patients, and staff. This document presents current recommendations regarding surgery during the COVID-19 pandemic in Poland.
    Źródło:
    Polish Journal of Surgery; 2020, 92, 2; 42-53
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
      Wyświetlanie 1-9 z 9

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