Prosthetic materials for treating posterior vaginal wall prolapse and rectocele — own experience

Objectives: This report describes results of posterior vaginal wall prolapse and rectocele treatment performing tension free reconstruction method with polypropylene mesh implantation.Material and methods: In years 2001 to 20015, 71 female patients in age of 42–82 years were surgically treated. Besides difficult emptying they complained of feeling of heaviness in the pelvis (38%) and dyspareunia (16.9%). Defecography and magnetic resonance proved the presence of rectocele in 84.5%, enterocele in 38%, descending perineum in 28.2%, genital organ prolapse in 23.9%, and rectal prolapse in 22.5% cases. 37 patients with defects of low location have undergone implantation of prosthetic material from vaginal approach. In cases of high location and genital organ prolapse abdominal approach was done.Results: Permanent reconstruction of the rectovaginal septum has been achieved in 70 patients (98%). Symptoms of dyschesia, pelvic plain, heavy straining were persisted in 4 patients (10.3%). 3 cases of mash erosions were diagnosed. One patient was reoperated. Among 6 other patients who needed futher surgical treatment only one was reoperated because of vaginal prolapse. 81.7% of patients was satisfied with their treatment.Conclusion: Using prosthetic materials in pelvic floor defects treatment is characterized by high efficacy and low complication percentage

Niezwykle powikłanie operacji cięcia cesarskiego u ciężarnej z nierozpoznanym zespołem Crohna

Abstract The authors have described a perforation of the colon, diagnosed during the course of cesarean section, performed as an emergency operation in 31st week of pregnancy, in a woman with undiagnosed Lesniowski-Crohn disease. The post operation course was complicated and required a partial resection of the bowel.Streszczenie Autorzy opisali perforację kątnicy, stwierdzoną w czasie cięcia cesarskiego, wykonanego w trybie nagłym w 31 tygodniu ciąży u kobiety z nierozpoznana chorobą Leśniowskiego-Crohna. Przebieg pooperacyjny był powikłany i wymagał resekcji jelita

Ileal pouch anal anastomosis leak after restorative proctocolectomy without protective stoma successfully treated with endoscopic vacuum therapy

Aim An ileal pouch anal anastomosis (IPAA) leak is one of the most severe complication after restorative proctocoletomy (RPC). We present a rare case of a successful management of IPAA leak after RPC without defunctionig stoma with the utility of endoscopic vacuum therapy. Methods A 57-year-old male with a ileal pouch anal anastomosis leak after RPC due to ulcerative colitis with presacral abscess was qualified for endoscopic vacuum therapy (EVT). The abscess of the left buttock was drained and secured with suction drain (redon drain). Due to the lack of defunctioning stoma, a system for contain and divert fecal matter was placed within afferent limb of the J-pouch and EVT was placed directly within IPAA dehiscence. EVT was changed every third day. Results The patient underwent a total of five EVT sessions. Improvement of patient’s general condition characterized with lack of pelvic pain, fever and reduction of inflammatory markers was achieved. Locally, anastomosis dehiscence was healed with prominent reduction in the defect’s dimension, contraction and revascularization. Based on imaging studies no chronic presacral sinus or any other perianal disturbances were revealed at the time of five months follow up. Conclusions EVT is a promising method for management of IPAA leak. Although, it remains extremely difficult, EVT may serve as a method of choice in early pouch-related septic complications after RPC performed without defunctioning stom

Nieszczelność zespolenia zbiornikowo-odbytniczego po proktokolektomii odtwórczej bez wyłonienia stomii protekcyjnej, skutecznie leczony endoskopową terapią podciśnieniową

Cel: Nieszczelność zespolenia zbiornikowo-odbytniczego (IPAA, ang. ileal pouch anal anastomosis) to jedno z najcięższych powikłań po odtwórczej proktokolektomii (RPC, ang. restorative proctocolectomy). W pracy przedstawiono rzadki przypadek skutecznego leczenia nieszczelności zespolenia IPAA po zabiegu RPC bez wyłonienia stomii, przy zastosowaniu endoskopowej terapii podciśnieniowej. Metody: Do zabiegu endoskopowej terapii podciśnieniowej (EVT, ang. endoscopic vacuum therapy) zakwalifikowano 57-letniego pacjenta z nieszczelnością zespolenia zbiornikowo-odbytniczego po odtwórczej proktokolektomii, wykonanej z powodu wrzodziejącego zapalenia jelita grubego oraz z ropniem w okolicy przedkrzyżowej. Wykonano drenaż ropnia lewego pośladka, pozostawiając dren ssący Redona. Z powodu braku stomii, system odpowiedzialny za magazynowanie i przemieszczanie mas kałowych umieszczono w pętli doprowadzającej zbiornika jelitowego typu „J”, zaś EVT umieszczono bezpośrednio w miejscu rozejścia się zespolenia zbiornikowo-odbytniczego. EVT zmieniano co trzeci dzień. Wyniki: U pacjenta przeprowadzono łącznie pięć sesji EVT. Uzyskano poprawę stanu ogólnego pacjenta: ból miednicy mniejszej i gorączka ustąpiły, obniżyły się markery stanu zapalnego. Miejscowo doszło do wyleczenia rozejścia się zespolenia, znacznie zmniejszyła się wielkość ubytku, obserwowano jego spłycenie i rewaskularyzację. W badaniach obrazowych nie stwierdzono przewlekłej przetoki przedkrzyżowej ani żadnej innej nieprawidłowości w okolicy okołoodbytniczej w czasie 5-miesięcznego okresu obserwacyjnego. Wnioski: Endoskopowa terapia podciśnieniowa to obiecująca metoda leczenia nieszczelności zespolenia zbiornikowo-odbytniczego. Mimo że nieszczelność IPAA jest niezwykle trudne do zaopatrzenia, EVT może stanowić metodę z wyboru we wczesnych, septycznych powikłaniach związanych ze zbiornikiem jelitowym po proktokolektomii odtwórczej bez wyłonienia stomii

Iatrogenic Bile Duct Injury. A Significant Surgical Problem. Assessment of Treatment Outcomes in the Department's Own Material

Iatrogenic bile duct injuries (BDI) are still a challenging diagnostic and therapeutic problem. With the introduction of the laparoscopic technique for the treatment of cholecystolithiasis, the incidence of iatrogenic BDI increased. The aim of the study was a retrospective analysis of 69 patients treated at the department due to iatrogenic BDI in the years 2004-2014. Material and methods. In this paper, we presented the results of a retrospective analysis of 69 patients treated at the Department due to iatrogenic BDI in the years 2004-2014. The data were analysed in terms of age, sex, type of biliary injury, clinical symptoms, the type of repair surgery, the time between the primary surgery and the BDI management, postoperative complications and duration of hospital stay. Results. 82.6% of BDI occurred during laparoscopic cholecystectomy, 8.7% occurred during open cholecystectomy, whereas 6 cases of BDI resulted from surgeries conducted for other indications. In order to assess the degree of BDI, Bismuth and Neuhaus classifications were used (for open and laparoscopic cholecystectomy respectively). 84.1% of patients with confirmed BDI, were transferred to the Department from other hospitals. The average time between the primary surgery and reoperation was 6.2 days (SD 4). The most common clinical symptom was biliary fistula observed in 78.3% of patients. In 28 patients, unsuccessful attempts to manage BDI were made prior to the admission to the Department in other centres. The repair procedure was mainly conducted by laparotomy (82.6%) and by the endoscopic approach (15.9%). Hepaticojejunostomy was the most common type of reconstruction following BDI (34.7%). Conclusions. The increase in the rate of iatrogenic bile duct injury remains a challenging surgical problem. The management of BDI should be multidisciplinary treatment. Referring patients with both suspected and confirmed iatrogenic BDI to tertiary centres allows more effective treatment to be implemented

Inulin supplementation in rat model of pouchitis

Available data indicates potential effectiveness of prebiotic therapy in alleviating inflammation and prolonging the remission in inflammatory bowel disease. Documented successes of such therapies were the basis for this study. So far, there is no data related to the effectiveness of inulin application in symptomatic or severe pouchitis in humans or in animal model. The aim of the study was to determine the effect of inulin supplementation on the expression of intestinal inflammation and feeding efficiency in rats with induced pouchitis. Twenty-four Wistar rats were operated. After induction of pouchitis animals were randomly divided into control and supplementation groups receiving, respectively, semi-synthetic diet with or without inulin (in a lower (LD) or higher (HD) dose: 2.5 % or 5 % of total dietary content of mass) for a period of 6 weeks. Selected nutritional parameters were assessed throughout the study. Histopathological and immunohistochemical analysis of pouch mucosa specimens was also performed. The energy intake, weight gain, feeding efficiency, quality of stools were comparable in all studied groups. The intensity of inflammation (Moskovitz scale) and adaptive changes (Laumonier scale) did not differ between compared groups. The tissue expression of pro- and anti-inflammatory interleukins (IL-1α, IL-6, IL-10 and IL-12) was not different either. Inulin supplementation does not improve the quality of stools or the expression of intestinal inflammation in rats with induced pouchitis. It has no impact on the intensity of pouch adaptation or on feeding efficiency

Metabolic syndrome is associated with similar long-term prognosis in non-obese and obese patients. An analysis of 45 615 patients from the nationwide LIPIDOGRAM 2004-2015 cohort studies

Aims We aimed to evaluate the association between metabolic syndrome (MetS) and long-term all-cause mortality. Methods The LIPIDOGRAM studies were carried out in the primary care in Poland in 2004, 2006 and 2015. MetS was diagnosed based on the National Cholesterol Education Program, Adult Treatment Panel III (NCEP/ATP III) and Joint Interim Statement (JIS) criteria. The cohort was divided into four groups: non-obese patients without MetS, obese patients without MetS, non-obese patients with MetS and obese patients with MetS. Differences in all-cause mortality was analyzed using Kaplan-Meier and Cox regression analyses. Results 45,615 participants were enrolled (mean age 56.3, standard deviation: 11.8 years; 61.7% female). MetS was diagnosed in 14,202 (31%) by NCEP/ATP III criteria, and 17,216 (37.7%) by JIS criteria. Follow-up was available for 44,620 (97.8%, median duration 15.3 years) patients. MetS was associated with increased mortality risk among the obese (hazard ratio, HR: 1.88 [95% CI, 1.79-1.99] and HR: 1.93 [95% CI 1.82-2.04], according to NCEP/ATP III and JIS criteria, respectively) and non-obese individuals (HR: 2.11 [95% CI 1.85-2.40] and 1.7 [95% CI, 1.56-1.85] according to NCEP/ATP III and JIS criteria respectively). Obese patients without MetS had a higher mortality risk than non-obese patients without MetS (HR: 1.16 [95% CI 1.10-1.23] and HR: 1.22 [95%CI 1.15-1.30], respectively in subgroups with NCEP/ATP III and JIS criteria applied). Conclusions MetS is associated with increased all-cause mortality risk in non-obese and obese patients. In patients without MetS obesity remains significantly associated with mortality. The concept of metabolically healthy obesity should be revised