Laparoscopic Appendectomy as an Alternative to Conventional Procedure – Results in our own Material

Appendectomies are the most common surgical procedures performed in the emergency surgery setting. Since more than one decade laparoscopic appendectomy appeared as an alternative procedure to commonly used conventional appendectomy as a recognized method of treatment of acute appendicitis. Despite multiple papers and studies comparing these techniques, still no clear indications and eligibility criteria exist for either of them. The aim of the study was to evaluate results of treatment of acute appendicitis using the laparoscopic method versus the conventional appendectomy, basing on parameters affecting treatment results and costs, such as duration of hospitalization, complications, use of medications. Material and methods. The analysis included patients who underwent surgical treatment for acute appendicitis at the Department of Surgery of 4th Military Clinical Hospital in Wrocław between 2006 and 2012. Since 2006, 128 laparoscopic appendectomies (group 1) were performed, while 189 patients underwent conventional procedure during this time (including 11 who underwent a diagnostic laparoscopy - group 2). The study was based on retrospective analysis of medical records of patients. Treatment results were evaluated basing on the following parameters: duration of hospitalization, amount of used analgesics, duration and type of antibiotic therapy, peri- and postoperative complications. Results and conclusions. Results obtained at our Clinic, similar to results obtained at other sites, warrant use of laparoscopic appendectomy. Use of minimally invasive techniques provides better treatment results, mainly with regard to shorter duration of hospitalization, lower use of antibiotics and analgesics, which also contributes to lower overall treatment costs

Rusults of Classical Crawford and Hybrid Operations in Thoracic-Abdominal Aorta Aneursysms Treatment - Comperative Assesment

Thoracic-abdominal aortic aneurysms (TAAA) are still serious medical problem. Classical procedure requires two cavities approach and implantation of vascular prosthetic in the place of aneurysm - Crawford's procedure. Significant progress was made during last years by using endovascular procedures (stentgrafts). Alternative is hybrid procedure - prosthetic appliance of visceral and kidney arteries and then stentgraft implantation in whole thoracic-abdominal aorta.The aim of the study was comparative analysis of classical and hybrid procedures in thoracic-abdominal aneurysms treatment.Material and methods. Between 1989-2011 in Department of Vascular, General and Transplantological Surgery Medical University in Wrocław and Surgical Department of 4th Military Clinical Hospital in Wrocław 53 patients were operated due to thoracic-abdominal aortic aneurysms. Classical Crawford's procedure was performed in 41 patients (group I) and hybrid procedure was performed in 12 patients (group II). Additionally 7 patients required aortic arc branches reconstruction due to achieve optimal conditions to stentgraft amplantation. Procedures were performed at one or two stages.Results. Mortality in patients treated classically (group I) depended on type of aneurysm in Crawford's classification. In type I-II mortality rate was 54% ((7 deaths/12 patients), in type III do V 17% (5 deaths/ 29 patients). In the group after hybrid procedure (group II) mortality rate was 28% (2 deaths/ 7 patients) in type I-II and 20% (1 death/5 patients) in type III to V. Observed serious perioperative complications.Conclusions. 1. Endovascular procedures development enabled introducing of new methods in thoracic-abdominal aortic aneurysms treatment (hybrid procedures) and allowed to get better results. 2. Clear advantage of hybrid procedures above classical Crawford's procedure is observed in type I and II of TAAA. 3. Mortality and morbidity rates recommend hybrid procedure in type I and II of TAAA. 4. Surgical results of classical and hybrid procedures in type III-V TAAA treatment are comparative, with indication on classical approach

Own Clinical Observations of Treatment Outcome in Acute Type B Aortic Dissection

The aim of the study was to analyse early results of treatment of acute type B aortic dissection.Material and methods. 59 patients, treated between 1998 and 2011, were divided into four groups. Group I comprised ten patients in whom hybrid procedures were performed: extra-anatomical by-pass graft from the brachio-cephalic trunk to the left carotid artery in six patients, transposition of the left carotid artery to the right one in two patients, and reversed Y prosthesis from the brachio-cephalic trunk to both carotids in the remaining 2 patients, to facilitate stent-grafting. Group II comprised 13 patientsin whom endovascular procedures were performed (stent-grafting). Group III comprised 21 patients in whom conventional surgery was done. Group IV comprised 15 patients who were treated conservatively.Results. In group I, a very good clinical outcome, without complications, was achieved in six patients (60% of cases). The total mortality rate was 40%. One patient died on the operation table, following stent-grafting, due to the rupture of the aortic arch. Two patients died as a result of brain damage (cerebral aneurysm rupture in one, and ischemic stroke in the other). In one patient, an aorto-oesophageal fistula developed. In group II, one patient died during endovascular procedure. Another patient suffered from type 1 endoleak, requiring repeated endovascular surgery. In group III, 15 patients (72%) died. Moreover, four patients required acorrective cardiac surgery (Bentall procedure)which in three patients resulted in death. Thus, the total mortality rate in this group was as high as 85%. In group IV, the mortality rate was 13%.Conclusions. We noticed a clear superiority of endovascular procedures over conventional surgeries-for acute type B aortic dissection. Hybrid procedures for acute, complicated type B aortic dissection evidently reduce mortality and postoperative morbidity. Uncomplicated acute type B aortic dissections should be treated conservatively at intensivecare units

Laparoscopic Treatment of Abdominal Hernia – 5 Years of Experience

Laparoscopic surgery has become a well approved method of abdominal hernias treatment in recent years. Due to the advancement of laparoscopy and the use of improved synthetic materials laparoscopic surgery is characterized not only by low complication but also by a short period of recovery after surgery. The aim of the study was a retrospective analysis of the results of laparoscopic abdominal hernia surgeries (IPOM). Material and methods. Between year 2007 and 2012, 65 patients aged between 29 to 76 underwent laproscopic abdominal hernia surgeries due to either primary or postoperative abdominal hernias. All patients were examined in perioperative period, after 12 and 24 months after surgery in search of complications, pain and reccurence. Recovery period was also estimated. Results. In most cases postoperative pain was estimated from 1 to 4 on VAS scale. The most frequent complications were seromas that occured in 3 patients. The other complications were pneumothorax, wound hematoma and wound infection that occured once each. One patient required reoperation due to wound hematoma. Chronic postoperative pain was diagnosed in 3 patients and 4 recurrences were stated. Conclusions. Laparoscopic therapy of abdominal hernias is a safe operative method characterized by low recurrence and complication rates as well as short hospital stay and quick recovery. This technique is restricted by high material costs and the lack of full refund for the procedure

The Use of Radioisotopic Tests for Diagnosing Lower Limb Venous Thrombosis – Own Research

Inflammatory mediators play an important role in thrombosis etiopathology. Diagnostic radioisotopic tests can be used to assess the activity of thrombo-inflammatory process. The aim of the study was to assess the suitability of Tc-99m HMPAO labelled leukocyte scintigraphy in the diagnostics of deep vein thrombosis. Material and methods. The study covered 45 patients with lower limb deep vein thrombosis treated in 2009 at the Department of Vascular, General and Transplantological Surgery of the Wrocław Medical University. Scintigraphic test were performed during the first few days after the onset of symptoms and 8 weeks later. Results. All patients with active deep vein thrombosis had higher levels of TC-99m-HMPAO markers in sick limbs. After 8 weeks, 93% of patients still had elevated levels of radioisotope in limbs with an active thrombosis process. However, the levels of markers were clearly lower than in the acute phase of thrombosis. Conclusions. 1. In the chronic phase of thrombosis, 93% of patients still have higher levels of radioisotopic markers, which indicates an active inflammatory process. 2. Tc-99m HMPAO labelled leukocyte scintigraphy demonstrates high sensitivity in the diagnostics of deep vein thrombosis

Wyniki lecznia operacyjnego pękniętych tętniaków aorty brzusznej (PTAB) w materiale własnym

Background. Pęknięty tętniak aorty jest definiowany jako krwawienie poza przydankę poszerzonej ściany aorty. Częstość występowania pękniętego tętniaka aorty brzusznej (PTAB) waha się pomiędzy 5.6 a 17.5 na 100.000 mieszkańców w ciągu roku i wydaje się maleć w ciągu ostatnich dwóch dekad. Celem pracy była ocena wyników leczenia pacjentów z pękniętym tętniakiem aorty brzusznej Materiał i metoda: Do analizy włączono pacjentów operowanych z powodu pękniętego tętniaka aorty brzusznej w Klinice Chirurgicznej 4 Wojskowego Szpitala Klinicznego z Polikliniką we Wrocławiu w latach 2011-2017. Z powodu pękniętego tętniaka aorty brzusznej operowano łącznie 140 pacjentów. Ocenę wyników leczenia przeprowadzono na podstawie retrospektywnej analizy dokumentacji medycznej pacjentów, oceniającej wyniki leczenia w oparciu o następujące parametry: śmiertelność około- i pooperacyjna, poważne powikłania około- i pooperacyjne (ostry zespół wieńcowy, niedokrwienie jelit, niewydolność nerek, niewydolność oddechowa, niedokrwienie kończyn dolnych). Wyniki Uzyskane wyniki potwierdzają, pomimo ciągłego postępu, wysoką śmiertelność oko-ło-i pooperacyjną z powodu pękniętego tętniaka aorty brzusznej. Dalszy rozwój techniki operacyjnej z leczeniem wewnątrznaczyniowym (EVAR), postępowania anestezjologicznego, może pozwolić na uzyskanie lepszych wyników leczenia. Wymaga to jednak dużego wysiłku organizacyjnego z zapewnieniem całodobowej dostępności wielospecjalistycznego zespołu (chirurg naczyniowy, anestezjolog, technik radiolog, personel pielęgniarski), z możliwością wykonywania procedur wewnątrznaczyniowych. Wnioski Leczenie operacyjne pacjentów z pękniętym tętniakiem aorty brzusznej nadal wiąże się z wysokimi wskaźnikami śmiertelności i znaczną ilością powikłań pooperacyjnych

Own Clinical Observations of Treatment Outcome in Acute Type B Aortic Dissection

The aim of the study was to analyse early results of treatment of acute type B aortic dissection.Material and methods. 59 patients, treated between 1998 and 2011, were divided into four groups. Group I comprised ten patients in whom hybrid procedures were performed: extra-anatomical by-pass graft from the brachio-cephalic trunk to the left carotid artery in six patients, transposition of the left carotid artery to the right one in two patients, and reversed Y prosthesis from the brachio-cephalic trunk to both carotids in the remaining 2 patients, to facilitate stent-grafting. Group II comprised 13 patientsin whom endovascular procedures were performed (stent-grafting). Group III comprised 21 patients in whom conventional surgery was done. Group IV comprised 15 patients who were treated conservatively.Results. In group I, a very good clinical outcome, without complications, was achieved in six patients (60% of cases). The total mortality rate was 40%. One patient died on the operation table, following stent-grafting, due to the rupture of the aortic arch. Two patients died as a result of brain damage (cerebral aneurysm rupture in one, and ischemic stroke in the other). In one patient, an aorto-oesophageal fistula developed. In group II, one patient died during endovascular procedure. Another patient suffered from type 1 endoleak, requiring repeated endovascular surgery. In group III, 15 patients (72%) died. Moreover, four patients required acorrective cardiac surgery (Bentall procedure)which in three patients resulted in death. Thus, the total mortality rate in this group was as high as 85%. In group IV, the mortality rate was 13%.Conclusions. We noticed a clear superiority of endovascular procedures over conventional surgeries-for acute type B aortic dissection. Hybrid procedures for acute, complicated type B aortic dissection evidently reduce mortality and postoperative morbidity. Uncomplicated acute type B aortic dissections should be treated conservatively at intensivecare units