Sarcoidosis of the spleen : rare indications for splenectomy : own experience

The article presents two patients who underwent laparoscopic splenectomy because of splenic sarcoidosis. In onepatient sarcoidosis was diagnosed based on the chest X-ray and computed tomography (CT) scans. Further imagingallowed for the diagnosis of systemic spread of the disease with bone marrow and splenic involvement. The latterlocation was confirmed by pathological examination after the operation. The indication for splenectomy was hypersplenismwith concurrent thrombocytopenia. In the second patient, an abdominal ultrasound scan (US) showed suspiciousfocal lesions in the spleen. Histological examination proved it to be a rare isolated splenic form of sarcoidosis

Short- and long-term outcomes of incarcerated inguinal hernias repaired by Lichtenstein technique

INTRODUCTION: The use of tension-free inguinal hernia repair techniques using commercially available implants is now rather common. However, it is widely accepted that the use of biomaterials should be limited to non-infected surgical fields. As such, most current studies pertain to the application of various implants during the surgical repair of uncomplicated hernias. AIM: To compare the short- and long-term outcomes of incarcerated inguinal hernia repair using the Lichtenstein or Bassini technique. MATERIAL AND METHODS: Between 1997 and 2012, 107 patients were operated on an emergency basis due to the incarceration of inguinal hernias – 105 subjects were included for further analysis in our study. RESULTS: Postoperative complications were observed in 13 out of the 84 (15.5%) patients subjected to Lichtenstein repair. In 9 of these patients (10.7%), morbidity was associated with the surgical wound. In 2 cases (2.4%), a small inflammatory infiltration was observed and resolved within a few days. Serous fluid accumulation within the wound was observed in 3 patients (3.6%), but the fluid was successfully drained by puncture. Finally, hematoma formed in 4 cases (4.8%). In total, 4 complications (19%) were recorded in the group of 21 patients who were operated on with the Bassini technique. In 3 of these cases (14.3%), the complications were related to suppuration of the surgical wound. CONCLUSIONS: Polypropylene mesh may be safely implanted during the repair of incarcerated hernia and this approach is reflected by satisfactory long-term outcomes

Laparoscopic Nissen fundoplication in the treatment of Barrett's esophagus : 10 years of experience

INTRODUCTION: Barrett's esophagus (BE) is a state in which the distal portion of esophageal mucosa becomes lined with cylindrical epithelium as a result of adaptive remodeling. It is widely accepted that the metaplastic lesions result from chronic irritation with gastric and/or duodenal contents in the course of reflux disease. For many years, research centered on the risk factors of BE and resulting adenocarcinoma. Anti-reflux operations are the only procedures which offer the possibility of treating the cause by restoring the anatomic barrier responsible for guarding against irritating effects of gastroduodenal content on the distal esophagus. Total (i.e. 360°) laparoscopic Nissen fundoplication (LNF) is considered the most effective amongst these procedures. Still, controversies related to the indications for anti-reflux surgery are frequently encountered. AIM: Retrospective analysis of long-term treatment outcomes in patients with BE subjected to laparoscopic Nissen fundoplication. MATERIAL AND METHODS: The group included 42 BE patients, amongst them 30 men and 12 women. Initially, all the patients were treated conservatively for at least 1 year. The subgroup with dysplasia was subjected to preoperative argon plasma coagulation (APC). From 1 year after surgery (laparoscopic Nissen fundoplication), control biopsy specimens were obtained from the gastroesophageal junction of all the patients. RESULTS: None of the patients showed the development of esophageal adenocarcinoma during the follow-up period. Furthermore, no cases of dysplasia progression or de novo development of dysplasia were observed in the analyzed group. In the initial 12-24 months after surgery, complete regression of metaplasia was documented in 7 (31.8%) patients from group A, and a reduction in the area of Barrett's metaplasia was observed in another 7 patients (31.8%). Throughout the period of this study, persistent planoepithelial re-epithelialization was observed in 14 (70%) group B patients, i.e. in individuals with baseline dysplasia subjected to preoperative argon plasma ablation. In the remaining patients of this group, the developed changes of BE character were less advanced than at baseline. CONCLUSIONS: Our opinion is that laparoscopic Nissen fundoplication, as a result of high effectiveness, represents the method of choice in the treatment of BE in the case of patients who were qualified for surgery

Laparoscopic treatment of type III and IV hiatal hernia : authors' experience

INTRODUCTION: There are four types of hiatal hernias, and diagnosis is established on the basis of gastroscopy in the majority of cases. Type III represents a mixed type in which the abdominal esophagus as well as the gastric cardia and fundus protrude into the thorax through the pathologically widened esophageal hiatus. Type IV, the so-called upside down stomach, can be considered an evolutionary form of type III, and refers to herniation of nearly the whole stomach (except for the cardia and pylorus) into the thorax. Types III and IV of hiatal hernias represent a group of rare diaphragmatic defects; thus, most centers do not possess considerable experience in their treatment. Frequently, laparoscopic treatment is implemented, although, according to some authors, conversion to laparotomy, thoracotomy, or thoracolaparotomy is necessary in selected cases. AIM: To analyze the outcomes of laparoscopic treatment of the largest hiatal hernias, i.e. type III and IV hernias. MATERIAL AND METHODS: A total of 25 patients diagnosed with type III and IV hiatal hernia were included in further analysis. RESULTS: As many as 19 out of 25 patients (76%) assessed the outcome of the surgery as evidently positive and reported marked improvement in the quality of life. CONCLUSIONS: The laparoscopic technique constitutes an excellent and safe method of repair of even the most complex defects in the esophageal hiatus. Therefore, the minimally invasive technique combined with an anti-reflux procedure should be the method of choice in patients with type III and IV hernia

Analysis of complications of laparoscopic management of abdominal diseases related to extended indications

Introduction: The introduction of minimally invasive procedures has changed the pattern of surgical complications.Some were only incidentally described in open surgery. Others significantly changed in character or incidence.Aim: We present the incidence, character and dynamics of important complications of laparoscopic procedures withinthe entire period of application of this technique.Material and methods: Patients operated on laparoscopically in the 2nd Department of General Surgery of theJagiellonian University between 1992 and 2009 (n = 8732) were included in the study. In order to follow the dynamicsof complication rates the study period was divided into 3 sub-periods: 1) 1992-1997, 2) 1998-2003, 3) 2004-2009.There were 2343 laparoscopic procedures performed in the 1st period, 3310 in the 2nd and 3079 in the 3rd.Results: The proportion of procedures other than cholecystectomy gradually increased: 1) –22.79%, 2) –31.81%,3) –40.05%. Overall conversion rate was 2.91%; in the 1st period it was 3.97%, in the 2nd 1.81%, and in the 3rd 3.28%.Complication-driven conversion rates were 0.60%, 0.27%, and 0.26%, respectively. Bleeding and biliary tree injurieswere the most common causes. Complications requiring reoperations occurred in 0.48% of patients, and theirincidence remained constant. Haemorrhage and intra-abdominal abscesses were observed most often. Use oflaparoscopic technique in their management increased in consecutive periods from 20% in the 1st, 45.83% in the 2nd,to 53.57% in the 3rd time period.Conclusions: The introduction of new advanced procedures did not increase overall complication rate. Change in theirnature and more common use of laparoscopic technique in their management were noted

Tools for Road Infrastructure Safety Management – Polish Experiences

AbstractThe objective of road safety infrastructure management is to ensure that when roads are planned, designed, built and used road risks can be systematically identified, assessed, removed and mitigated. There are a number of approaches to road safety management. European Union Directive 2008/96/EC requires EU member states to use four basic tools of road safety infrastructure management. An overview of the methods in these countries shows a variety of approaches to how these tools are used in practice. The paper presents a systematics of these tools and a concept of how they could be developed in Poland. It looks at the life cycle of a road structure and the requirements of risk management processes. The paper focuses on elements of scientific support to help build the necessary tools. To help with assessing the impact of a road project on the safety of related roads, a method was developed for long-term forecasts of accidents and accident victims and accident cost estimation as well as a risk classification to identify risks that are not acceptable risks. With regard to road safety audits and road safety inspection, a set of principles was developed to identify risks and the basic classification of errors and omissions. In the case of road network safety management, measures of individual and societal risk were selected. A method for classifying dangerous road sections was developed as well. An estimation is given of the consequences and effects of applying the tools of road safety management on the network of national roads in Poland until 2020

Quality of life after bariatric surgery

INTRODUCTION AND PURPOSE: Morbid obesity together with obesity-related diseases has a negative impact on the quality of life. The aim of the study was to assess the quality of life amongst patients with morbid obesity as well as the impact of bariatric treatment on body weight and obesity-related diseases in addition to conducting an analysis of changes in the quality of life after surgical treatments, in the context of the surgical procedure type and degree of body weight loss. MATERIAL AND METHODS: Sixty-five patients were treated for morbid obesity. The sample group consisted of 34 patients treated with laparoscopic sleeve gastrectomy (LSG) and 31 persons qualified for laparoscopic Roux-en-Y gastric bypass (LRYGB). The average body weight before the procedure was 146.2 kg. In the sample group, 89 % of persons qualified for the surgical treatments were diagnosed with hypertension and 52 % persons that were operated on were diagnosed with diabetes type 2 before the surgical procedure. Before commencement of the surgical treatment, the quality of life was assessed, which in both groups qualified for given types of bariatric procedures was considerably low. RESULTS AND CONCLUSIONS: Percentage excessive weight loss (%EWL) was 58.8 %. No significant differences in body weight loss were noted between the two types of procedures. Improvement was observed in the treatment of obesity-related diseases. Also, the quality of life was enhanced significantly. No differences were noted in terms of the quality of life improvement between particular types of surgical procedures. No significant differences were observed during the analysis of body weight loss impact on the quality of life improvement

Enhanced recovery (ERAS) protocol in patients undergoing laparoscopic total gastrectomy

INTRODUCTION: Laparoscopic technique combined with the ERAS (Enhanced Recovery after Surgery) protocol enables a shorter hospital stay and a lower complication rate. Although it has been widely used in many patients undergoing elective abdominal surgery, especially in patients with colorectal cancer, there are only a few papers describing laparoscopic total gastrectomy and the enhanced recovery protocol in patients with gastric cancer. Minimally invasive gastrectomy is still an uncommon procedure, mostly because of its difficulty. AIM: To present the preliminary results of treatment of patients with gastric neoplasms who underwent laparoscopic gastrectomy D2 with perioperative care according to ERAS principles. MATERIAL AND METHODS: Eleven patients (5 male and 6 female, age 52–77 years) underwent laparoscopic D2 gastrectomy with intracorporeal esophagojejunal anastomosis. In all patients the ERAS protocol was implemented. We analyzed operation time, complications and hospital stay. Additionally we focused on operative technique as well as the perioperative care protocol. RESULTS: The mean duration of the procedure was 245 min. There was 1 conversion due to unclear tumor infiltration. Mean hospital stay was 4.6 days. One postoperative complication (central venous catheter sepsis) was reported. Histological analysis confirmed the tentative diagnosis (R0 resection) in 10/11 patients. There were no readmissions. CONCLUSIONS: Laparoscopic gastrectomy is a valuable alternative to the classical approach and combined with the ERAS protocol can result in reduced hospital stay. However, due to the small group of patients it is difficult to adequately assess the incidence of early and late complications of the laparoscopic procedures; therefore further research is needed