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    Tytuł:
    Learning curve for laparoscopic Roux-en-Y gastric bypass based on the experience of a newly created bariatric center
    Autorzy:
    Dworak, Jadwiga
    Wysocki, Michał
    Rzepa, Anna
    Pędziwiatr, Michał
    Radkowiak, Dorota
    Budzyński, Andrzej
    Major, Piotr
    Powiązania:
    https://bibliotekanauki.pl/articles/1391721.pdf
    Data publikacji:
    2020
    Wydawca:
    Index Copernicus International
    Tematy:
    bariatric center
    clinical competence
    laparoscopic Roux-en-Y gastric bypass
    learning curve
    perioperative complications
    surgical training
    Opis:
    Introduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most common treatments for morbid obesity. The learning curve for this procedure is 50–75 cases for an independent surgeon, and it is considered the most important factor in decreasing complications and mortality. We present our experience and learning curve with LRYGB for a newly established bariatric center in Poland. Material and methods: A prospectively collected database containing 285 LRYGB procedures performed in the II Department of General Surgery of the Jagiellonian University MC in Krakow between 06.2010 and 03.2019 was retrospectively reviewed. Patients were divided into groups of 30 (G1–G10) in the order of the procedures performed by each surgeon. The study analyzed the course of the operation and patient hospitalization, comparing those groups. Learning curve for the newly created bariatric center was established. Results: Operative time in G1–G3 differed significantly from G4–G10 (P < 0.0001). The stabilization point was the 90th procedure. Perioperative complications were observed in 36 (12.63%) patients. Perioperative complications, intraoperative difficulties and adverse events did not differ importantly among groups. Liberal use of “conversions of the operator” from a surgeon to a senior surgeon provides reasonable safety and prevents complications. Conclusions: The institutional learning process stabilization point for LRYGB in a newly established bariatric center is around the 90th operation. LRYGB can be a safe procedure from the very beginning in newly established bariatric centers. Specific bariatric training with active proctoring by an experienced surgeon in a bariatric centre can improve the laparoscopic gastric bypass outcome during the learning curve.
    Źródło:
    Polish Journal of Surgery; 2020, 92, 4; 23-30
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    The usefulness of the Mannheim Peritonitis index score in assessing the condition of patients treated for peritonitis
    Autorzy:
    Budzyński, Piotr
    Dworak, Jadwiga
    Natkaniec, Michał
    Pędziwiatr, Michał
    Major, Piotr
    Migaczewski, Marcin
    Matłok, Maciej
    Budzyński, Andrzej
    Powiązania:
    https://bibliotekanauki.pl/articles/1395648.pdf
    Data publikacji:
    2015-06-01
    Wydawca:
    Index Copernicus International
    Tematy:
    peritonitis
    mortality
    Mannheim Peritonitis Index (MPI)
    Opis:
    The aim of the study was to verify the Mannheim Peritonitis Index (MPI) suitability to determine the probability of death among patients in Polish population operated due to peritonitis and to assess the possibility of using the Index to determine the risk of postoperative complications, relaparotomy and need for postoperative hospitalization in intensive care unit. Material and methods. Retrospective analysis covered 168 patients (M: F = 83: 85, mean age = 48.45 years, SD ± 22.2) treated for peritonitis. The MPI score was calculated for each patient. According to MPI results, patients were divided to the appropriate groups (<21, 21‑29, > 29) and within analyzed. The statistical analysis used Chi-square, Mann Withney U and Kolmogorov-Smirnov test. The best cut-off point for MPI was calculated on the basis of ROC analisys. Results. Mortality in the study group was 13.1%. In groups <21, 21‑29 and > 29 points according to MPI mortality was 1.75%, 28.13% and 50% respectively, the difference was statistically significant (p = 0.0124). Significant differences were observed in mortality depending on the diagnosis. Based on the ROC curve the cut-off point was identified as 32 with an accuracy of 85.9% and AUC = 81%. There has been a significant correlation between the MPI count and and the occurrence of: cardio-respiratory failure, acidosis, electrolyte imbalance, surgical wound complications, the need for treatment in the intensive care unit after surgery. Conclusions. The MPI is a simple and effective predictor of death among patients operated due to peritonitis. It can also provide assistance in assessing the risk of postoperative complications and the need for treatment in the intensive care unit.
    Źródło:
    Polish Journal of Surgery; 2015, 87, 6; 301-306
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Randomized Clinical Trial to Compare the Effects of Preoperative Oral Carbohydrate Loading versus Placebo on Insulin Resistance and Cortisol Level after Laparoscopic Cholecystectomy
    Autorzy:
    Pędziwiatr, Michał
    Pisarska, Magdalena
    Matłok, Maciej
    Major, Piotr
    Kisielewski, Michał
    Wierdak, Mateusz
    Natkaniec, Michał
    Budzyński, Piotr
    Rubinkiewicz, Mateusz
    Budzyński, Andrzej
    Powiązania:
    https://bibliotekanauki.pl/articles/1394369.pdf
    Data publikacji:
    2015
    Wydawca:
    Index Copernicus International
    Tematy:
    laparoscopic cholecystectomy
    insulin resistance
    preoperative carbohydrate loading
    perioperative care
    Opis:
    Postoperative insulin resistance, used as a marker of stress response, is clearly an adverse event. It may induce postoperative hyperglycemia, which according to some authors can increase the risk of postoperative complications. One of the elements of modern perioperative care is preoperative administration of oral carbohydrate loading (CHO-loading), which shortens preoperative fasting and reduces insulin resistance. The aim of the study is to establish the influence of CHO-loading on the level of insulin resistance and cortisol in patients undergoing elective laparoscopic cholecystectomy. Material and methods. Patients were randomly allocated to one of 2 groups. The intervention group included 20 patients who received CHO-loading (400 ml Nutricia pre-op®) 2 hours prior surgery. The control group received a placebo (clear water). In every patient blood samples were taken 2 hours prior to surgery, immediately after surgery, and on the 1st postoperative day. Levels and changes in glucose, cortisol and insulin resistance were analyzed in both groups. Results. Although there were differences in the levels of cortisol, insulin, and insulin resistance, no statistically significant differences were observed between groups in every measurement. The length of stay and postoperative complications were comparable in both groups. Conclusions. We believe that CHO-loading is not clinically justified in case of laparoscopic cholecystectomy. No effect on the levels of glucose, insulin resistance and cortisol was observed. Even though such procedure is safe, in our opinion there is no clinical benefit from CHO-loading prior to laparoscopic cholecystectomy.
    Źródło:
    Polish Journal of Surgery; 2015, 87, 8; 402-408
    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:
    Elective laparoscopic cholecystectomy – is it safe in the hands of residents during training?
    Autorzy:
    Kisielewski, Michał
    Pędziwiatr, Michał
    Pisarska, Magdalena
    Major, Piotr
    Rubinkiewicz, Mateusz
    Matłok, Maciej
    Migaczewski, Marcin
    Budzyński, Piotr
    Budzyński, Andrzej
    Powiązania:
    https://bibliotekanauki.pl/articles/1394419.pdf
    Data publikacji:
    2015
    Wydawca:
    Index Copernicus International
    Tematy:
    laparoscopic cholecystectomy
    resident education
    conversion of operator
    Opis:
    The aim of the study was to assess safety of elective laparoscopic cholecystectomy (LC) performed by residents that are undergoing training in general surgery. Material and methods. A retrospective analysis was conducted on 330 patients operated electively due to cholelithiasis. Patients with acute cholecystitis, choledocholithiasis, undergoing cholecystectomy as a part of more extensive operation and patients with gall-bladder cancer were excluded. Group 1 included patients operated by resident, group 2 – by specialist. Duration of operation, mean blood loss, number of major complications, number of conversions to the open technique and conversions of the operator, reoperations and length of hospital stay were analyzed. Results. Mean operative time overall was 81 min (25 – 170, SD±28.6) and 71 min (30-210, SD±29.1) in groups 1 and 2 respectively (p=0.00009). Mean blood loss in group 1 was 45±68.2 ml and in group 2 – 41±73.4 ml (p=0.23). Six major complications has occurred (1.81%) – 2 (2%) in group 1 and 4 (1.7%) in group 2. 18 cases (15.5%) of conversion of the operator occurred in group 1, and 6 cases (2.6%) of conversion of the operator happened in group 2. Average LOS was 1.9 days in group 1 and 2.3 days in group 2 (p=0.03979). Conlcusions. Elective LC performed by a supervised resident is a safe procedure. Tactics of “conversion of operator” allowed to prevent major complications. Longer LC by residents is natural during the learning curve. Modifications of residency program in the field of laparoscopy may increase its accessibility.
    Źródło:
    Polish Journal of Surgery; 2015, 87, 9; 429-433
    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:
    Laparoscopic gastric resections with per oral specimen extraction in treatment of intramural gastric tumors
    Autorzy:
    Stanek, Maciej
    Major, Piotr
    Wierdak, Mateusz
    Pędziwiatr, Michał
    Radkowiak, Dorota
    Zychowicz, Anna
    Budzyński, Andrzej
    Powiązania:
    https://bibliotekanauki.pl/articles/1393418.pdf
    Data publikacji:
    2017
    Wydawca:
    Index Copernicus International
    Tematy:
    laparoscopy
    gastrointestinal stromal tumors
    POSE
    endoscopy
    Opis:
    Aim: The goal of this work was to present our experiences and results of treatment of gastric tumors using the per oral specimen extraction (POSE) technique. Material and methods: A retrospective analysis a group of patients treated with laparoscopic stomach wedge resection of gastrointestinal stromal tumor (GIST). During that time 50 patients underwent laparoscopy due to the suspicion of GIST. In 12 patients resected material was removed endoscopically per os (POSE). In the remaining 38 subjects it was evacuated through minilaparotomy. Mean age of patients treated using POSE technique was 65.6 years (48-81 years). There were 9 women and 3 men in this group Results: Mean time of the POSE procedure was 92.5 min (40-160 min). Size of removed tumors ranged from 14 mm to 40 mm (mean: 25 mm). The mean length of hospital stay was 3.2 days (2 to 8 days) for patients treated with POSE. One patient (8.3%) required longer hospitalization (8 days) due to the presence of a fluid collection at the site of gastric suture. This patient was treated conservatively. One patient (8.3%) was diagnosed with surgical site infection (navel wound after an optical trocar). Histopathological examination confirmed radical excision in all of our patients (R0). Conclusions: It seems that the POSE technique is the next stage of development of minimally invasive surgery and may constitute a link in evolution of natural orifice translumenal surgery techniques. Removal of excised material through oral cavity is an attractive, effective, and safe method despite its many limitations.
    Źródło:
    Polish Journal of Surgery; 2017, 89, 1; 16-21
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Early results of liver resection using laparoscopic technique
    Autorzy:
    Stranek, Maciej
    Pędziwiatr, Michał
    Radkowiak, Dorota
    Zychowicz, Anna
    Budzyński, Piotr
    Major, Piotr
    Budzyński, Andrzej
    Powiązania:
    https://bibliotekanauki.pl/articles/1394071.pdf
    Data publikacji:
    2016
    Wydawca:
    Index Copernicus International
    Tematy:
    laparoscopy
    liver resection
    liver metastases
    Opis:
    The aim of the study was to present early outcomes of liver resection using laparoscopic technique. Material and methods. Retrospective analysis of patients who underwent liver resection using laparoscopic method was conducted. The analyzed group included 23 patients (11 women and 12 men). An average patient age was 61.3 years (37 – 83 years). Metastases of the colorectal cancer to the liver were the cause for qualification to the procedure of 15 patients, metastasis of breast cancer in 1 patient and primary liver malignancy in 5 patients. The other 2 patients were qualified to the liver resection to widen the surgical margins due to gall-bladder cancer diagnosed in the pathological assessment of the specimen resected during laparoscopic cholecystectomy, initially performed for other than oncology indications. Results. Hemihepatectomy was performed in 11 patients (9 right and 2 left), while the other 12 patients underwent minor resection procedures (5 metastasectomies, 4 nonanatomical liver resections, 1 bisegmentectomy, 2 resections of the gall-bladder fossa). An average duration of the surgical procedure was 275 minutes 65 – 600). An average size of the resected tumors was 28 mm (7 – 55 mm). In three cases conversion to laparotomy occurred, caused by excessive bleeding from the liver parenchyma. Postoperative complications were found in 4 patients (17.4%). Median hospitalization duration was 6 days (2 – 130 days). One patient (4.3%) was rehospitalized due to subhepatic abscess and required reoperation. Histopathology assessment confirmed radical resection (R0) in all patients in our group. Conclusion. Laparoscopic liver resections seem to be an interesting alternative in the treatment of focal lesions in the liver.
    Źródło:
    Polish Journal of Surgery; 2016, 88, 1; 20-25
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    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:
    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:
    Gastrointestinal obstruction in patients previously treated for ma
    Autorzy:
    Budzyński, Piotr
    Pędziwiatr, Michał
    Kenig, Jakub
    Lasek, Anna
    Winiarski, Marek
    Major, Piotr
    Wałęga, Piotr
    Natkaniec, Michał
    Rubinkiewicz, Mateusz
    Rogala, Joanna
    Budzyński, Andrzej
    Powiązania:
    https://bibliotekanauki.pl/articles/1393965.pdf
    Data publikacji:
    2016
    Wydawca:
    Index Copernicus International
    Tematy:
    gastrointestinal obstruction
    adhesive bowel obstruction
    malignant bowel obstruction
    Opis:
    Bowel obstruction is a common condition in acute surgery. Among the patients, those with a history of cancer consist a particular group. Difficulties in preoperative diagnosis – whether obstruction is benign or malignant and limited treatment options in patients with reoccurrence or dissemination of the cancer are typical for this group. The aim of the study was to analyze causes of bowel obstruction in patients with history of radical treatment due to malignancy. Material and methods. Patients with symptoms of bowel obstruction and history of radical treatment for malignancy who were operated in 2nd and 3rd Department of General Surgery JUCM between 2000 and 2014 were included into the study. The patients were divided into 2 groups based on type of mechanical bowel obstruction (group 1 – adhesions, group 2 – malignant process). Results. 128 patients were included into the study – group 1: 67 (52.3%) and group 2: 61 (47.7%). In the second group bowel obstruction was caused by reoccurrence in 25 patients (40.98%) and dissemination in 36 (59.02%). The mean time between onset of the symptoms of bowel obstruction and the end of treatment for the cancer was 3.7 and 4.4 years, respectively in group 1 and 2 (p>0.05). Median time between onset of the symptoms and admission to Emergency Department was significantly longer in patients with malignant bowel obstruction compared to those with adhesions (11.6 ±17.8 days vs 5.1 ± 6.9 days, p=0.01). Considering type of surgery due to bowel obstruction, in first group in most patients (69.2%) bowel resection was not necessary and in the second group creation of jejuno-, ileo- or colostomy was the most common procedure. Morbidity was significantly higher in second group (45.9% vs 28.26%, p<0.05) but there was no difference in mortality (26% vs 24%, p>0.05). In both groups the most common localization of primary malignancy was colon. Conclusions. In analyzed group of patients frequency of bowel obstruction caused by adhesions and malignancy was similar. However, in patients with bowel obstruction caused by malignancy morbidity was significantly higher and duration of symptoms was longer. There was no diagnostic procedure which would allow to differentiate the cause of bowel obstruction preoperatively and the diagnosis was made during the operation.
    Źródło:
    Polish Journal of Surgery; 2016, 88, 2; 93-98
    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:
    Laparoscopic cholecystectomy in the treatment of gallbladder polypoid lesions – 15 years of experience
    Autorzy:
    Matłok, Maciej
    Migaczewski, Marcin
    Major, Piotr
    Pędziwiatr, Michał
    Budzyński, Piotr
    Winiarski, Marek
    Ostachowski, Mateusz
    Budzyński, Andrzej
    Rembiasz, Kazimierz
    Powiązania:
    https://bibliotekanauki.pl/articles/1396486.pdf
    Data publikacji:
    2013-11-01
    Wydawca:
    Index Copernicus International
    Tematy:
    gall-bladder polyps
    laparoscopic cholecystectomy
    gall-bladder cancer
    gall-bladder ultrasound
    Opis:
    Due to the constant increase of public health awareness and widespread “cancerophobia”, the progressively larger number of incidentally diagnosed gall-bladder polyps became the source of anxiety, which leads patients and physicians to undertake therapeutic decisions, despite the absence of symptoms. The majority of gall-bladder polyps are benign. It is estimated that only 3 to 5% of polyps are malignant. Currently, there is lack of randomized control trials based on which the clear-cut criteria of qualification of patients with gall-bladder polyps for surgical procedure can be created. The aim of the study was to analyze gall-bladder polyps in patients who underwent laparoscopic cholecystectomy in the 2nd Department of General Surgery, Jagiellonian University Collegium Medicum. Material and methods. The retrospective study was conducted on 5369 patients who underwent laparoscopic cholecystectomy in the 2nd Department of General Surgery, Jagiellonian University Collegium Medicum with special attention to 152 (2.8%) patients in whom gall-bladder polyps were diagnosed preoperatively. Qualification criteria for surgery, surgical treatment results, and histopathological examination results were also analyzed. Results. Amongst the 5369 patients qualified for laparoscopic cholecystectomy, 152 (2.8%) were diagnosed with gall-bladder polyps during the preoperative ultrasound examinations. Postoperative histopathological examinations of 41 (27%) patients confirmed the presence of gall-bladder polyps. In 102 (67%) patients, only gall-stones were diagnosed without previously described polyps during the ultrasound examination. Analysis of the histopathological examination results revealed the presence of benign lesions in 35 (23.35%) patients. In 5 (3%) patients the presence of an adenoma, and in one (0.65%) the presence of adenocarcinoma were confirmed. Conclusions. Based on the conducted study and previous personal experience in the treatment of patients with gall-bladder polyps, we believe that due to the potential risk of neoplastic transformation, patients with polyps larger than 10 mm in diameter and polyps of proven rapid growth should be qualified for laparoscopic cholecystectomy. Indications for surgical treatment also seem reasonable in case of patients with present polyps and coexisting right upper quadrant pain, even though the above-mentioned is connected with gall-bladder deposits.
    Źródło:
    Polish Journal of Surgery; 2013, 85, 11; 625-629
    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
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