A retrospective case-controlled study of video-assisted versus open minimally invasive parathyroidectomy

INTRODUCTION: Minimally invasive parathyroidectomy (MIP) with intraoperative parathyroid hormone assay (IOPTH) has successfully replaced conventional neck exploration in most patients with primary hyperparathyroidism (pHPT) and preoperatively localized parathyroid adenoma. AIM: To compare outcomes of video-assisted MIP (MIVAP) to open MIP (OMIP). MATERIAL AND METHODS: A retrospective case-controlled study of 455 patients with sporadic pHPT undergoing MIP with IOPTH at our institution in 2003–2012 was undertaken. The primary outcome measure was postoperative pain. Secondary outcome measures were: duration of surgery, recurrent laryngeal nerve (RLN) identification rate, conversion rate, length of hospital stay, cure rate, patients’ satisfaction with cosmetic outcome, morbidity, costs, and diagnostic accuracy of IOPTH. RESULTS: Of 455 patients with pHPT and a solitary parathyroid adenoma on preoperative imaging, 151 underwent MIVAP and 304 had OMIP. The following outcomes were favourable for MIVAP vs. OMIP: lower pain intensity during 24 h postoperatively (p < 0.001), lower analgesia request rate (p < 0.001), lower analgesics consumption (p < 0.001), higher recurrent laryngeal nerve identification rate (p < 0.001), shorter scar length (p < 0.001), and better cosmetic satisfaction at 1 month (p = 0.013) and at 6 months (p = 0.024) after surgery. However, MIVAP vs. OMIP had longer duration of surgery (p < 0.001), and was more expensive (p < 0.001). No differences were noted in the conversion rate, length of hospital stay, and morbidity. CONCLUSIONS: Both MIVAP and OMIP approaches were equally safe and effective. However, the outcomes of MIVAP operations were superior to OMIP in terms of lesser postoperative pain, lower analgesics consumption, and better cosmetic satisfaction resulting from a smaller scar

Utility of the laparoscopic approach to surgical treatment of acute appendicitis in a single surgical unit

INTRODUCTION: Acute appendicitis (AA) is one of the most common reasons for emergency surgery within the abdominal cavity in Poland. AIM: To compare outcomes of surgical treatment of AA using both classical (OA) and laparoscopic methods (LA). MATERIAL AND METHODS: Retrospective analysis of 299 patients (157 men and 142 women) operated on in 2008–2011 due to AA. The following comparisons between LA and OA were done: mean operative time, mean hospital stay after surgery, conversion rate, proportion of LA to OA in successive years. RESULTS: Laparoscopic appendectomy was performed in 170 (56.9%) patients (74 men and 96 women), whereas OA was done in 89 (29.8%) patients (44 men and 45 women). In 13.4% of patients (24 men and 16 women) conversion from LA to OA was done. Mean operating time was 53.4 ±16.1 min (range: 25–100 min) for LA, and 55.4 ±20.2 min (range: 20–140 min) for OA; p = 0.64. Mean hospital stay after LA was 4.0 ±1.2 days (range: 2–9 days), while it was 6.0 ±4.2 days (range: 2–28 days) after OA; p < 0.001. Laparoscopic appendectomy was 24.1% of all appendectomies performed in the year 2008, 54.1% in the year 2009, and in consecutive years 71.7% in 2010 and 65.6% in 2011. CONCLUSIONS: Laparoscopic appendectomy method did not require longer surgery times and entailed shorter hospital stays as compared with OA. In our opinion, LA should be the preferred approach in surgical treatment of AA in adults

Endovascular treatment of nutcracker syndrome : a case report

Background: The "nutcracker" syndrome is most commonly caused by arterial compression of the left renal vein between the superior mesenteric artery and the aorta. As a consequence venous blood pressure increases within the renal pelvis, ureter and gonadal veins. This compression syndrome may be treated by endovascular stent implantation into the left renal vein. Case report: A 20 year old female patient was referred to us, suffering from pain in her left side, gross proteinuria and the suspicion of "nutcracker" syndrome. Symptoms were present for the last 3 years. Angio MRI was performed and confirmed compression of the left renal vein between the aorta and the superior mesenteric artery. The patient was qualified for endovascular treatment. A self expandable metallic stent, diameter 16 x 40 mm was implanted into the left renal vein. Control venography confirmed good placement of the stent and a good immediate hemodynamic effect of the procedure. The patient remains symptom free in a 14 month follow up period. Conclusions: At present, endovascular stenting seems to be the method of choice for the treatment of the nutcracker syndrome

The incidence of major, nontraumatic lower amputations in patients without diabetes mellitus in Poland during 2009–2012, based on Polish National Health Found data

Duże amputacje kończyn dolnych wykonywane są głównie ze wskazań naczyniowych i jako powikłania zespołu stopy cukrzycowej. W niewielkim odsetku są konsekwencją urazu, nowotworów i wad wrodzonych. Autorzy na podstawie danych pochodzących z całej Polski, zawartych w rejestrach Narodowego Funduszu Zdrowia, obliczyli liczbę chorych, u których wykonano dużą nieurazową amputację kończyny dolnej oraz wskaźnik liczby dużych amputacji kończyn dolnych u chorych bez cukrzycy na 100 000 mieszkańców. Autorzy zaobserwowali istotne obniżenie się średniego wskaźnika z 11,23 ± 1,65 do 9,73 ± 1,22 (p &lt; 0,05) na przestrzeni lat 2009–2012 w Polsce. Main of major amputations are related to the angiopathy of various origin and diabetic foot. The rest of amputations are consequence of injures, neoplasm’s and congenital malformation. An electronic search for entire was performed using Polish National Health Found database from 2009 until 2012 for incidence of non-traumatic major lower extremity was presented as a number of amputations per 100 000 individuals in populations. The authors presents that the mean rates of major amputations in people without diabetes mellitus diminished from 11.23 ± 1.65 to 9.73 ± 1.22 (p &lt; 0.05) during 2009–2012 years in Poland.

Peritoneal Adhesions as a Cause of Mechanical Small Bowel Obstruction Based on Own Experience

Bowel obstruction is a condition which has been known for many years. As time goes by, the problem is still often encountered at surgical emergency rooms. More than 20% of emergency surgical interventions are performed because of symptoms of digestive tract obstruction with the disease mostly situated in the small bowel. Rates of causative factors of the disease have changed over recent years and there have been increasingly more cases of small bowel obstruction caused by peritoneal adhesions, i.e., adhesive small bowel obstruction (ASBO). The aim of the study to analyse the reasons and incidence of adhesive small bowel obstruction during two periods of time (1990-1995 and 2005-2010). Material and methods. We performed a retrospective analysis of medical records of patients hospitalized at the 1st Department of General Surgery and Surgical Oncology of the Provincial Polyclinic Hospital in Płock between 1990 and 1995. The outcomes were compared with another period of 2005-2010. Results. We found that the incidence of adhesive small bowel obstruction increased from 58 cases in the first period to 215 cases in the second one, and the outcomes improved. The proportion of patients who underwent surgery diminished from 38% to 13%. The mean hospitalization time shortened and was 11.3 days and 6.95 days during 1990-1995 and 2005-2010 periods of time, respectively. In the first group, patients who had a surgery were hospitalized for 17.8 days and those who were treated conservatively for 8.08 days. In the second group, the mean hospital stay decreased to 15.6 days and 5.7 days in the case of surgical and conservative treatment, respectively. The age of onset declined from 56.63 years in the first period to 52.54 years in the other one. Conclusions. Analysed data show an increasing number of patients with adhesive small bowel obstruction. The highest risk of the disease was associated with operations on the large bowel and gynaecological procedures

Total thyroidectomy is associated with increased prevalence of permanent hypoparathyroidism

BACKGROUND: Thyroid disorders are very common in adults. Despite advances in conservative management, surgery remains a treatment modality of choice in many cases. The mortality and morbidity of thyroidectomy are low, but long-term postoperative hypoparathyroidism (HPT) remains a prominent complication of the procedure. The aim of this study was to assess the incidence of permanent HPT and identify the risk factors for this complication in a cohort of post-thyroidectomy patients followed at a District Endocrine Clinic. MATERIAL/METHODS: This was a retrospective analysis of 401 patients followed up at a Regional/District Endocrine Clinic, who had undergone thyroid surgery in the years 1993–2011. The percentage of patients with permanent (>12 months) HPT was the primary endpoint of the study. The statistically analyzed data of patients with permanent HPT versus the remaining patients free from postoperative complications included their demographic data, indications for surgical treatment of their thyroid disorder, and extent of the thyroid resection. The risk factors for postoperative hypoparathyroidism were assessed using logistic regression analysis. RESULTS: Permanent HPT following surgery on the thyroid gland occurred in 8.5% of the patients. It was more frequent following total thyroidectomy (20.2%) than near-total thyroidectomy (6.7%) or subtotal thyroidectomy (4.2%); p<0.0001. A multivariate statistical regression analysis demonstrated that primary total thyroidectomy was a significant risk factor for permanent HPT (OR 6.5; 95% CI: 2.9–14.4; p<0.0001). CONCLUSIONS: Total thyroidectomy was associated with increased prevalence of permanent hypoparathyroidism when compared to less extensive thyroid resection modes in patients with benign thyroid diseases