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    Wyświetlanie 1-14 z 14
    Tytuł:
    Evaluation of patient feedback following laparoscopic cholecystectomy based on information described in the informed consent form developed by the Association of Polish Sur
    Autorzy:
    Misiak, Piotr
    Jabłoński, Sławomir
    Lazarek, Jerry
    Malinowska, Katarzyna
    Santorek-Strumiłło, Edyta
    Terlecki, Artur
    Powiązania:
    https://bibliotekanauki.pl/articles/1394302.pdf
    Data publikacji:
    2015
    Wydawca:
    Index Copernicus International
    Tematy:
    laparoscopic cholecystectomy
    informed consent
    Opis:
    The cholecystectomy procedure is the most routinely performed intervention in general surgery. The current international gold standard is via the laparoscopic approach. It is a safe, minimally-invasive procedure; however, it is associated with complications in 1% of cases. The aim of the study was to analyze patient feedback, by means of a survey, to determine how much knowledge patients possessed about their disease state and proposed surgical intervention, based primarily on information contained within the informed consent form developed by the Association of Polish Surgeons. Material and methods. This study involved the participation of 51 patients who underwent laparoscopic cholecystectomy, indicated by a diagnosis of gallstones, in the years 2014 and 2015. Results. Despite having signed the informed consent form, there was considerable variation among the responses given to the survey by the 51 patients in this study. Some patients’ responses were tangential to the questions asked; many patients did not respond to any of the sub points. Conclusions. Given that this study is based on a small sample size of patients, it must be presumed that the process by which the patient declares his or her informed consent requires further consideration with respect to the means by which it is obtained. The authors of this study thus recommend that multimedia resources be harnessed as part of the process of obtaining the informed consent of patients prior to surgical intervention.
    Źródło:
    Polish Journal of Surgery; 2015, 87, 11; 558-564
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Surgical treatment of acute cholecystitis in obese patients
    Autorzy:
    Kebkalo, Andrey
    Tkachuk, Olha
    Reyti, Andrian
    Chanturidze, Archil
    Pashunskyi, Yaroslav
    Powiązania:
    https://bibliotekanauki.pl/articles/1391898.pdf
    Data publikacji:
    2020
    Wydawca:
    Index Copernicus International
    Tematy:
    acute cholecystitis
    obesity
    laparoscopic cholecystectomy
    Opis:
    Introduction: In today’s technological climate, science and medicine have entered a new era. At the level of technological progress, we have identified millennia of “new” problems and diseases. If earlier diseases had a certain individuality then, in the third millennium, we face compliance and synergistic influence of diseases. Obesity is a problem of the third millennium. It is known that obesity is the main factor in the development of various chronic diseases [1–3]. With excess weight and obesity, bile is oversaturated with cholesterol, resulting in an increase of its lipogenicity index. As a result, frequency of gallstone disease increases; findings from this study document an increase of disease frequency as high as 50% to 60% [4]. In 20% of patients, housing concerns are combined with obesity [5]. Thus, obesity is one of the factors in the development of cholelithiasis and cholecystitis [6]. The presence of acute cholecystitis represents the most difficult situation for patients with gallstones. When obesity is also present, the patient’s risk of surgical complications increases due to altered homeostasis and reduced reserve capacity [7]. A retrospective study of this issue [8] posed a number of questions about the possibility of influencing the course of disease in the preoperative period as well as the improvement and impact of surgical technicalities in patients with acute cholecystitis and obesity. Addressing these and additional questions is the main goal of this study. Aim: The aim of the study was to study and select the optimal method of surgery in patients with acute cholecystitis and obesity. Materials and methods: In our study, a prospective analysis was used. We analyzed 67 cases with diagnosis of acute cholecystitis and obesity; all were treated at Kyiv Regional Clinical Hospital in the period from September 2018 to March 2020. Patients with acute cholecystitis and obesity received either traditional or modified laparoscopic cholecystectomy. Results: Retrospective analysis indicates traditional laparoscopic cholecystectomy is technically difficult and costly in patients with acute cholecystitis and obesity. A modified laparoscopic cholecystectomy has been proposed to improve and enhance surgery in patients with acute cholecystitis and obesity. Surgical duration was shortened by 9.01 ± 0.41 minutes (p = 0.001; αα= 0.05) when a modified laparoscopic cholecystectomy was performed. Conclusions: Performing a modified laparoscopic cholecystectomy reduced the duration of surgery by 9.01 ± 0.41 minutes (p = 0.001; α = 0.05), prevents development of metabolic acidosis pH 7.39 ± 0.03 vs 7.30 ± 0.005 = 0.001; αα= 0.05, pCO2 5.05 ± 0.36 vs 6.03 ± 0.38 (p = 0.02; αα= 0.05), reducing the risk of hypercoagulation. Modified laparoscopic cholecystectomy (LHE) is effective in II and III degrees of obesity (p = 0.001; α = 0.05).
    Źródło:
    Polish Journal of Surgery; 2020, 92, 5; 37-42
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Postcholecystectomy bile duct injuries: evolution of surgical treatment
    Autorzy:
    Šileikis, Audrius
    Žulpaitė, Rūta
    Šileikytė, Auksė
    Lukšta, Martynas
    Powiązania:
    https://bibliotekanauki.pl/articles/1392375.pdf
    Data publikacji:
    2019
    Wydawca:
    Index Copernicus International
    Tematy:
    Complications
    laparoscopic cholecystectomy
    bile duct injury
    Opis:
    Introduction: Bile duct injuries (BDIs) still occur during laparoscopic cholecystectomy. Although management of such complications is challenging, a collaboration of a multidisciplinary team and development of treatment methods and materials often lead to successful treatment. Materials and methods: Medical records of 67 patients who have experienced bile duct injuries after laparoscopic cholecystectomy were retrospectively reviewed. All injuries were classified according to the European Association for Endoscopic Surgery ATOM classification and investigated by the manifestation of the injury, surgical repair technique, early and late complications. Results: In 28 (41.8 %) patients with partial divisions, the surgical treatment of BDI was completed with endoscopic retrograde cholangiopancreatography (ERCP) and stenting while in 14 (20.1%) cases, the defect of bile duct was closed by suture. End-to-end ductal anastomosis was performed for 6 (13.4%) patients with complete division while 19 (28.3%) patients underwent hepaticojejunostomy. We followed up 58 (92.1%) of 63 patients. The mean follow-up duration was 25.7 (3 - 123) months. Twenty-three (39.7%) patients were found to have structures. Discussion: Intraoperative detection and management of BDIs are crucial to achieving good results. The routine intraoperative cholangiography and possibilities of repair by initial surgeons in peripheral hospitals remain controversial. Stenting with a covered self-expanding metal stent is promising for the patients with partial divisions of bile ducts. Initial hepaticojejunostomy is often a preferred treatment for transected bile ducts because of a lower rate of anastomosis strictures. However, an end-to-end anastomosis is more physiological, and endoscopy allows successful management of the strictures, we suggest choosing this treatment when possible Recommendation for paperwork content: Classifying bile duct injuries according to the new ATOM classification may be useful in choosing the most appropriate treatment in each case.
    Źródło:
    Polish Journal of Surgery; 2019, 91, 1; 14-21
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Retroperitoneal abscess with retained gall-stones as a late complication of laparoscopic cholecystectomy
    Autorzy:
    Kamiński, Mateusz
    Nowicki, Michał
    Powiązania:
    https://bibliotekanauki.pl/articles/1394061.pdf
    Data publikacji:
    2016
    Wydawca:
    Index Copernicus International
    Tematy:
    cholelithiasis
    laparoscopic cholecystectomy
    retroperitoneal abscess
    late complications
    Opis:
    Laparoscopic cholecystectomy is the golden standard, considering treatment of cholelithiasis. During the laparoscopic procedure one may often observe damage to the gall-bladder wall, as well as presence of gall-stones in the peritoneal cavity, as compared to classical surgery. These gall-stones may be associated with the occurrence of various complications following surgery. The study presented a rare case of a retroperitoneal abscess, as a consequence of retained gall-stones, in a female patient who was subject to laparoscopic cholecystectomy two years earlier.
    Źródło:
    Polish Journal of Surgery; 2016, 88, 1; 38-40
    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:
    Simultaneous TAPP (transabdominal pre-peritoneal technique) for inguinal hernia and cholecystectomy – a feasible and safe procedure
    Autorzy:
    Lehmann, Andrzej
    Piątkowski, Jacek
    Nowak, Mariusz
    Jackowski, Marek
    Pawlak, Maciej
    Witzling, Mieczysław
    Śmietański, Maciej
    Powiązania:
    https://bibliotekanauki.pl/articles/1395705.pdf
    Data publikacji:
    2014-02-01
    Wydawca:
    Index Copernicus International
    Tematy:
    TAPP
    transabdominal pre-peritoneal technique
    laparoscopic cholecystectomy
    simultaneous
    Opis:
    Inguinal hernia repair and cholecystectomy are amongst the most common surgical procedures performed worldwide. In the recent decades, early disease detection has notably increased due to easily accessible ultrasound. The aim of the study was to assess the safety and the possibility of performing a simultaneous hernia repair and cholecystectomy using the laparoscopic approach. Material and methods. Eight patients (M=100%) with inguinal hernia (3 with bilateral hernia) and cholelithiasis were included in the study. The presence of gallstones was confirmed by imaging. Mean age of the patients was 61.75 years (ranging from 47-72). Simultaneous laparoscopic cholecystectomy and transabdominal pre-peritoneal hernia repair was performed in all patients. Postoperative complications were analyzed to assess the safety and feasibility of the procedure. Results. Mean operating time was 55 minutes (ranging from 30-60) and average length of stay was 3.625 days (ranging from 2-7). In order to perform a cholecystectomy, 1-2 additional trocars were used. No intra-operative complications were observed. At a follow-up visit on postoperative day 7, a small hematoma (10 ml of blood was punctured) in the right groin was noted in one patient. Another patient developed fever postoperatively, treated conservatively with antibiotics. Conclusions. Simultaneous TAPP and cholecystectomy proved to be a safe and feasible procedure. Acceptable operating time and hospital stay, as well as lack of influence on the length of convalescence, may present an interesting alternative to two separate procedures
    Źródło:
    Polish Journal of Surgery; 2014, 86, 2; 73-76
    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:
    Ultrasound measurement of the gallbladder wall thickness in the assessment of the risk of conversion from elective laparoscopic cholecystectomy to open surgery — Olkusz county experience
    Autorzy:
    Kania, Dariusz
    Powiązania:
    https://bibliotekanauki.pl/articles/1393735.pdf
    Data publikacji:
    2016
    Wydawca:
    Index Copernicus International
    Tematy:
    laparoscopic cholecystectomy
    conversion
    gall-bladder wall thickness
    gall-bladder ultrasound
    Opis:
    The aim of the study was to assess the risk of intraoperative difficulties, conversion and biliaryintestinal fistula during laparoscopic cholecystectomy on the basis of an ultrasound-measured gallbladder wall thickness. Material and methods. A prospective study was conducted in 50 patients undergoing laparoscopic cholecystectomy for chronic gallstone-induced cholecystitis. To calculate the relationships between categorical variables, a chi-square (χ2 ) independence test was used, and the results were interpreted for the significance threshold of α = 0.05. Results. The relationship between the gall-bladder wall thickness and the occurrence of intraoperative difficulties in the analysed set is deterministic (AUC = 1), and the wall thickness of ≥ 5 mm allows to predict their occurrence as soon as at the stage of diagnostic evaluation (p < 0.001). In addition, the ultrasound-measured GB wall thickness is a good predictor of conversion (AUC = 0.976; 95% CI 0.444–0.975; p < 0.001) and biliary-intestinal fistula (AUC = 0.935; 95% CI 0.121–0.738; p = 0.001). Conclusions. The results allow prediction of technically difficult laparoscopic cholecystectomies in patients with CCh, and selection of the right surgical team helps to reduce the number of conversions and possible complications. In addition, bearing in mind the above results in everyday practice should facilitate planning and increase effectiveness in the operating room.
    Źródło:
    Polish Journal of Surgery; 2016, 88, 6; 587-607
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Polymeric locking clips [Hem-o-lok] versus Metallic clips in elective Laparoscopic Cholecystectomy: a retrospective study of 1496 patients
    Autorzy:
    Madhavan, Shibumon
    Pandey, Anshuman
    Masood, Shakeel
    Kumar, Suneed
    Chauhan, Smita
    Kumar, Dinesh
    Jha, Sneha
    Powiązania:
    https://bibliotekanauki.pl/articles/1391545.pdf
    Data publikacji:
    2021
    Wydawca:
    Index Copernicus International
    Tematy:
    Hem-o-lok clip
    laparoscopic cholecystectomy
    metallic clip
    wide cystic duct
    Opis:
    Background Laparoscopic cholecystectomy is one of the most commonly performed operation. Various methods for securing the cystic artery and cystic duct are described in literature. We aim to compare intra-operative and early post-operative outcomes of laparoscopic cholecystectomy using polymeric locking Hem-o-lok clips versus metallic ligaclips . Patients and Methods Retrospective study of prospectively maintained single institutional data including all consecutive patients who underwent elective laparoscopic cholecystectomy from 2013 to 2018. Patients in whom metallic ligaclips were used were grouped as Group I and those with Hem-o-Lok were grouped as Group II. The early post-operative outcomes of the two groups were compared. Results Total 1496 patients were included in the study; 836 patients in Group I and 660 in Group II. Study included 29.1% males and 70.9% females with mean age of 43.6 years. Hem-o-lok clip was better in securing wide cystic duct compared to metallic clips. Metallic clip failed to secure 8 out of 44 wide cystic duct compared to 0 out 70 with Hem-o-lok clips (p=0.002). The post-operative outcomes of both groups were comparable. There were no cystic duct leak, post- operative bleeding or major bile duct injuries in either group. Conclusion Use of Hem-o-lok clip is safe in laparoscopic cholecystectomy due to ease of application and security. Hem-o-lok is more useful in patients with thick and wide cystic duct which are difficult to secure with metallic clips with low risk of leak. Key words: Laparoscopic Cholecystectomy, Hem-o-lok clip, Metallic clip, Wide cystic duct
    Źródło:
    Polish Journal of Surgery; 2021, 93, 3; 10-16
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Patient with metastatic breast cancer presenting as acute cholecystitis with one-year survival on hormonotherapy
    Autorzy:
    Zamkowski, Mateusz
    Kąkol, Michał
    Makarewicz, Wojciech
    Ropel, Jerzy
    Bobowicz, Maciej
    Powiązania:
    https://bibliotekanauki.pl/articles/1392993.pdf
    Data publikacji:
    2017
    Wydawca:
    Index Copernicus International
    Tematy:
    breast neoplasm
    advanced cancer
    metastatic disease
    Acute cholecystitis
    gallbladder
    laparoscopic cholecystectomy
    Opis:
    Breast cancer has high metastatic potential with distant metastases involving mainly lungs, liver and bones. Less frequently it gives distant spread to other organs. Herein we would like to present a very rare case of an acute cholecystitis which turned out to be a metastatic breast cancer in previously healthy woman. A female patient, 64-years old, presented to the emergency department with symptoms of biliary colic and acute abdomen. During the emergency cholecystectomy, we diagnosed the gallbladder empyema with thickened wall. There were also multiple metastatic nodules in the peritoneal cavity and an excessive amount of free fluid. The emergency physicians diagnosing female patient with the acute abdominal symptoms and a breast cancer history might suspect malignant spread into abdominal organs including gallbladder. On the other hand, acute cholecystitis symptoms might be the first symptoms of metastatic process in the gallbladder from the unknown primary source, which may be breast.
    Źródło:
    Polish Journal of Surgery; 2017, 89, 4; 46-49
    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:
    Health risk to medical personnel of surgical smoke produced during laparoscopic surgery
    Autorzy:
    Dobrogowski, Miłosz
    Wesolowski, Wiktor
    Kucharska, Małgorzata
    Paduszyńska, Katarzyna
    Dworzyńska, Agnieszka
    Szymczak, Wiesław
    Sapota, Andrzej
    Pomorski, Lech
    Powiązania:
    https://bibliotekanauki.pl/articles/2177163.pdf
    Data publikacji:
    2015-07-29
    Wydawca:
    Instytut Medycyny Pracy im. prof. dra Jerzego Nofera w Łodzi
    Tematy:
    smoke
    exposure
    volatile organic compounds
    dioxins
    health risk
    laparoscopic cholecystectomy
    pyrolysis
    Opis:
    Objectives During laparoscopic cholecystectomy, the removal of the gall bladder, pyrolysis occurs in the peritoneal cavity. Chemical substances which are formed during this process escape into the operating room through trocars in the form of surgical smoke. The aim of this study was to identify and quantitatively measure a number of selected chemical substances found in surgical smoke and to assess the risk they carry to medical personnel. Material and Methods The study was performed at the Maria Skłodowska-Curie Memorial Provincial Specialist Hospital in Zgierz between 2011 and 2013. Air samples were collected in the operating room during laparoscopic cholecystectomy. Results A complete qualitative and quantitative analysis of the air samples showed a number of chemical substances present, such as aldehydes, benzene, toluene, ethylbenzene, xylene, ozone, dioxins and others. Conclusions The concentrations of these substances were much lower than the hygienic standards allowed by the European Union Maximum Acceptable Concentration (MAC). The calculated risk of developing cancer as a result of exposure to surgical smoke during laparoscopic cholecystectomy is negligible. Yet it should be kept in mind that repeated exposure to a cocktail of these substances increases the possibility of developing adverse effects. Many of these compounds are toxic, and may possibly be carcinogenic, mutagenic or genotoxic. Therefore, it is necessary to remove surgical smoke from the operating room in order to protect medical personnel.
    Źródło:
    International Journal of Occupational Medicine and Environmental Health; 2015, 28, 5; 831-840
    1232-1087
    1896-494X
    Pojawia się w:
    International Journal of Occupational Medicine and Environmental Health
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Znaczenie ultrasonografii przy wyborze metody leczenia ostrego zapalenia pęcherzyka żółciowego
    Significance of ultrasonography in selecting methods for the treatment of acute cholecystitis
    Autorzy:
    Ćwik, Grzegorz
    Wyroślak-Najs, Justyna
    Skoczylas, Tomasz
    Wallner, Grzegorz
    Powiązania:
    https://bibliotekanauki.pl/articles/1058344.pdf
    Data publikacji:
    2013
    Wydawca:
    Medical Communications
    Tematy:
    acute cholecystitis
    conversion
    laparoscopic cholecystectomy
    reasons of conversion
    ultrasound
    badanie ultrasonograficzne
    cholecystektomia laparoskopowa
    konwersja
    ostre zapalenie pęcherzyka żółciowego
    przyczyny konwersji
    Opis:
    Surgical removal of the gallbladder is indicated in nearly all cases of complicated acute cholecystitis. In the 1990s, laparoscopic cholecystectomy became the method of choice in the treatment of cholecystolithiasis. Due to a large inflammatory reaction in the course of acute inflammation, a laparoscopic procedure is conducted in technically difficult conditions and entails the risk of complications. The aim of this paper was: 1) to analyze ultrasound images in acute cholecystitis; 2) to specify the most common causes of conversion from the laparoscopic method to open laparotomy; 3) to determine the degree to which the necessity for such a conversion may be predicted with the help of ultrasound examinations. Material and methods: In 1993–2011, in the Second Department and Clinic of General, Gastroenterological and Oncological Surgery of the Medical University in Lublin, 5,596 cholecystectomies were performed including 4,105 laparoscopic procedures that constituted 73.4% of all cholecystectomies. Five hundred and forty-two patients (13.2%) were qualified for laparoscopic procedure despite manifesting typical symptoms of acute cholecystitis in ultrasound examination, which comprise: thickening of the gallbladder wall of > 3 mm, inflammatory infiltration in the Calot’s triangle region, gallbladder filled with stagnated or purulent contents and mural or intramural effusion. Results: In the group of operated patients, the conversion was necessary in 130 patients, i.e. in 24% of cases in comparison with 3.8% of patients with uncomplicated cholecystolithiasis (without the signs of inflammation). The conversion most frequently occurred when the assessment of the anatomical structures of the Calot’s triangle was rendered more difficult due to local inflammatory process, mural effusion and thickening of the gallbladder wall of >5 mm. The remaining changes occurred more rarely. Conclusions: Based on imaging scans, the most common causes of conversion included inflammatory infiltration in the Calot’s triangle region, mural effusion and wall thickening to > 5 mm. The classical cholecystectomy in acute cholecystitis should be performed in patients with three major local complications detected on ultrasound examination and in those, who manifest acute clinical symptoms.
    Operacyjne usunięcie pęcherzyka żółciowego jest wskazane praktycznie we wszystkich przypadkach powikłanego, ostrego zapalenia pęcherzyka żółciowego. W latach dziewięćdziesiątych metodą z wyboru w leczeniu objawowej kamicy pęcherzyka żółciowego stała się cholecystektomia laparoskopowa. Z uwagi na duży odczyn zapalny w przebiegu ostrego stanu zapalnego zabieg laparoskopowy jest przeprowadzany w trudnych technicznie warunkach i wiąże się z ryzykiem wystąpienia powikłań. Celem pracy były: 1) analiza obrazów ultrasonograficznych przypadków ostrego zapalenia pęcherzyka żółciowego; 2) ustalenie najczęstszych przyczyn konwersji z metody laparoskopowej do otwartej laparotomii; 3) określenie, w jakim stopniu za pomocą badania ultrasonograficznego można przewidzieć potrzebę konwersji. Materiał i metoda: W latach 1993–2011 w II Klinice i Katedrze Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego UM w Lublinie wykonano 5596 cholecystektomii, w tym 4105 zabiegów laparoskopowych, co stanowiło 73,4% wszystkich przeprowadzonych cholecystektomii. Pomimo typowych objawów ostrego zapalenia pęcherzyka w badaniu ultrasonograficznym, do których zaliczamy pogrubienie ściany pęcherzyka > 3 mm, naciek zapalny okolicy trójkąta Calota, wypełnienie pęcherzyka treścią zastoinową lub ropną, wysięk śródścienny lub przyścienny, 542 chorych (13,2%) zakwalifikowano do leczenia metodą laparoskopową. Wyniki: W grupie pacjentów operowanych konwersja była konieczna u 130 osób – w 24% przypadków w porównaniu z 3,8% chorych z niepowikłaną kamicą pęcherzyka żółciowego (bez cech zapalnych). Konwersji dokonywano najczęściej w przypadkach utrudnionej oceny struktur anatomicznych trójkąta Calota, wynikającej z miejscowego stanu zapalnego, wysięku przyściennego oraz pogrubienia ściany >5 mm. Pozostałe zmiany występowały rzadziej. Wnioski: Do najczęstszych przyczyn konwersji w badaniach obrazowych należały: zapalny naciek okolicy trójkąta Calota, wysięk przyścienny i pogrubienie ściany > 5 mm. Do cholecystektomii klasycznej w ostrym zapaleniu pęcherzyka żółciowego powinni być kwalifikowani pacjenci, u których w badaniu ultrasonograficznym stwierdza się trzy główne powikłania miejscowe oraz u których występują ostre objawy kliniczne.
    Źródło:
    Journal of Ultrasonography; 2013, 13, 54; 282-292
    2451-070X
    Pojawia się w:
    Journal of Ultrasonography
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Iatrogenic bile duct injuries – clinical problems
    Autorzy:
    Głuszek, Stanisław
    Kot, Marta
    Bałchanowski, Norbert
    Matykiewicz, Jarosław
    Kuchinka, Jakub
    Kozieł, Dorota
    Wawrzycka, Iwona
    Powiązania:
    https://bibliotekanauki.pl/articles/1395690.pdf
    Data publikacji:
    2014-01-01
    Wydawca:
    Index Copernicus International
    Tematy:
    laparoscopic surgery
    cholecystectomy
    iatrogenic bile duct injury
    Opis:
    Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures in surgical wards. Iatrogenic bile duct injuries (IBDI) incurred during the procedures are among postoperative complications that are most difficult to treat. The risk of bile duct injury is 0.2-0.4%, and their consequences are unpleasant both for the surgeon and for the patient. The aim of the study was analysis of iatrogenic bile duct injuries and methods of their repair,taking into consideration the circumstances, under which the injuries occur. Material and methods. The study group consisted of 16 patients who had suffered IBDI during surgery. The analysed parameters included sex, age, indications for surgery, the setting of the surgical procedure and the type of bile duct injury. Additionally, the time of injury diagnosis, type of repair and treatment outcome were assessed. The IBDI analysis used the EAES classification of injuries. The time of IBDI repair was defined as immediate, early or late,depending on the time that had passed from the injury. The analysis included complications seen after bile duct repair. Results. The study group consisted of 10 women and 6 men, aged 29-84. Patients underwent 6 classic cholecystectomies, 8 laparoscopic cholecystectomies, one gastrotomy to remove oesophageal prosthesis and one laparotomy due to peptic ulcer. IBDI was diagnosed intraoperatively in 4 patients. In 12 patients IBDI was diagnosed within 1-7 days. The diagnosis was based on endoscopic retrograde cholangiopancreatography and the results of biochemistry tests. According to the EAES classification, the injuries were of type 1 (4 patients), type 2 (8 patients), type 5 (3 patients) and type 6 (1 patients). Reconstruction procedures were performed during the same anaesthesia session in 3 patients, and in the early period in 13 patients. The main procedure was Roux-en-Y anastomosis (12 patients), with the remaining including bile-duct suturing over a T-tube (3 patients) and underpinning of an accessory bile duct in the pocket left after gallbladder removal (1 patient). The most common reconstruction complications included bile leak (3 patients), recurrent cholangitis (3 patients) and bile duct stricture (2 patients). Mortality in the study group was 12.5%. Conclusions. The procedures of laparoscopic and classic cholecystectomy are associated with a risk of IBDI, especially in the presence of inflammatory state of the gall-bladder. IBDI is a complex complication: its treatment poses a challenge for the operating surgeon, and even the most careful treatment adversely affects the patient’s lifedue to complications.
    Źródło:
    Polish Journal of Surgery; 2014, 86, 1; 17-25
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
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