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

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

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