Comparison of the results of laparoscopic appendectomies with application of different techniques for closure of the appendicular stump

BACKGROUND: Nowadays laparoscopy is used frequently not only in elective surgery but also in abdominal emergencies, including acute appendicitis. There are several techniques used to close the appendicular stump during laparoscopic appendectomy. The aim of the study was to present and compare the results of minimally invasive appendectomies performed with the use of endoscopic staplers (group A), titanium endoclips (group B) and invaginating sutures (group C). METHODS: Three hundred seven patients (mean age = 35.6; SD = 15.9; 178 males,129 females) operated on laparoscopically for acute appendicitis from January 2010 to December 2014 at our department were included in the study. We reviewed retrospectively patients’ data including: age, sex, duration of the surgical procedure and hospital stay, mortality, intraoperative and postoperative complication rates in all analyzed groups. RESULTS: There were 102 patients in group A (mean age = 35.8;SD = 15.4; 57 males, 45 females). The average hospital stay in this group was 4.3 days (SD = 1.7), average operation time was 62.0 min (SD = 15), postoperative complication rate was 5.9 %. There were 160 patients in group B (mean age = 35.0; SD = 16.3; 96 males, 64 females). The average hospital stay in this group was 3.6 days (SD = 1.4), average operation time was 62.9 min (SD = 13.5), postoperative complication rate was 5.6 %. There were 45 patients in group C (mean age =37.3; SD = 15.8; 25 males, 20 females). The average hospital stay in this group was 4.6 days (SD = 2.0), average operation time was 73.9 min (SD = 20.8), postoperative complication rate was 6.7 %. There were no intraoperative complications and no mortality in all compared groups of patients operated on laparoscopically for acute appendicitis. CONCLUSIONS: Laparoscopic appendectomies with application of different techniques for closure of the appendicular stump are useful and safe. In our study the shortest hospital stay and lowest complication rate were observed in patients operated with the use of titanium endoclips. The longest hospital stay and operation time and the highest complication rate was associated with the use of invaginating sutures

How to improve the adenoma detection rate in colorectal cancer screening? Clinical factors and technological advancements

Introduction: Colonoscopy has been widely regarded as the gold standard in colorectal cancer (CRC) screening. Within recent years different endoscopic imaging techniques have been introduced to improve the quality of colonoscopy. The adenoma detection rate (ADR) is the single most important quality indicator for colonoscopy. The aim of this study was to evaluate the quality of CRC screening expressed by ADR in two different eras of endoscopic technology advancement. Material and methods: We conducted a dual-center study that enrolled 24 055 patients, who underwent colonoscopy as part of a national screening program. Patients were sorted into two groups according to the advancement of endoscopic equipment used for colonoscopic examination: group I - 10 405 patients examined between 2004 and 2008 (standard electronic endoscopes); group II - 13 650 patients examined between 2009 and 2014 (modern endoscopes). The ADR in two different eras and the impact of endoscopic novelties were determined. Results: The ADR in group I was 29.14%, in group II 31.73% (p < 0.001). The overall ADR was 30.88% - 38.80% and 25.95% (p < 0.001) for the male and female patients, respectively. The mean adenoma number per colonoscopy was 0.366 (95% CI: 0.357-0.375; p < 0.001), 0.337 (0.321-0.352) and 0.380 (0.369-0.392) for patients in group I and group II, respectively. Conclusions: Our study shows that technological innovation, novel endoscopy devices and diagnostic techniques improve the quality in CRC screening by increasing the ADR. However, we need to determine which of the technologies are supreme to achieve excellence in colorectal cancer screening

Acute appendicitis during pregnancy

W latach 2000–2006 w II Klinice Chirurgii Ogólnej CMUJ w Krakowie leczono z powodu ostrego zapalenia wyrostka robaczkowego 4 ciężarne — wszystkie metodą laparoskopową. Omówiono trudności diagnostyczne oraz wynikające z tego różnice w poszczególnych trymestrach ciąży. Przedstawiono własne doświadczenia i możliwości zastosowania appendektomii laparoskopowej. Oceniono również wpływ leczenia operacyjnego na dalszy przebieg ciąży oraz rozwój płodu. Nie stwierdzono powikłań wynikających z zastosowanej metody leczenia. Wszystkie ciąże zostały zakończone o czasie: 3 siłami natury, 1 przez cięcie cesarskie z przyczyny położniczej. Wycięcie zmienionego zapalnie wyrostka robaczkowego metodą laparoskopową u kobiet w każdym trymestrze ciąży jest metodą bezpieczną zarówno dla matki, jak i dla płodu.Between 2000–2006, in the 2nd Department of Surgery at the Medical College of the Jagiellonian University, we performed 4 laparoscopic appendectomies in pregnant patients with acute appendicitis. Diagnostic difficulties in relation to the progression of pregnancy are discussed. Our own experience and the use of laparoscopic technique are also presented. We have evaluated the possible influence of operative management on the further development of the fetus. There were no complications related to the operative procedure. All pregnancies developed normally until delivery, which were either natural (3 patients) or cesarean (1 patient, due to obstetrical indications). We conclude, therefore, that laparoscopic appendectomy seems to be a safe approach both for mother and baby during any trimester of pregnancy

Colonoscopy for colorectal cancer screening : is it effective in the hands of a general surgery resident?

INTRODUCTION: Colonoscopy is considered to be a gold standard for colorectal cancer (CRC) screening. Endoscopy training is an essential component of general surgery training program. Patients should receive care at the highest level possible, nevertheless residents need to gain experience. The aim of our study was to evaluate the effectiveness of colonoscopy performed by general surgery residents by comparing quality indicators between surgical trainees and consultants. MATERIALS AND METHODS: The analysis included 6384 patients aged 40–65 who underwent screening colonoscopy between October 2014 and February 2018. The patients were divided into two groups: group I – patients examined by residents, group II - patients examined by board-certified general surgeons. Quality indicators such as cecal intubation rate, adenoma detection rate and patient tolerance scale were compared between the two groups. RESULTS: Group I comprised 2268 (35.53%) and group II 4116 (64.47%) patients. The overall cecal intubation rate (CIR) was 95.99%, equal for both groups (p = 0.994). There was no statistically significant difference in adenoma detection rate: 29.30% among residents and 27.66% among consultants (p = 0.203). Patient tolerance of the examination was very good (4-point scale) in consultants group in 78.98% of cases and in 75.18% cases among residents (p < 0.001). CONCLUSION: In a proper learning environment general surgery residents are able to perform high-quality and effective screening colonoscopy. However, residents need to continue the progress in their technique to improve patient tolerance in order to reach the proficiency of a consultant

Acute appendicitis during pregnancy

W latach 2000&#8211;2006 w II Klinice Chirurgii Ogólnej CMUJ w Krakowie leczono z powodu ostrego zapalenia wyrostka robaczkowego 4 ciężarne - wszystkie metodą laparoskopową. Omówiono trudności diagnostyczne oraz wynikające z tego różnice w poszczególnych trymestrach ciąży. Przedstawiono własne doświadczenia i możliwości zastosowania appendektomii laparoskopowej. Oceniono również wpływ leczenia operacyjnego na dalszy przebieg ciąży oraz rozwój płodu. Nie stwierdzono powikłań wynikających z zastosowanej metody leczenia. Wszystkie ciąże zostały zakończone o czasie: 3 siłami natury, 1 przez cięcie cesarskie z przyczyny położniczej. Wycięcie zmienionego zapalnie wyrostka robaczkowego metodą laparoskopową u kobiet w każdym trymestrze ciąży jest metodą bezpieczną zarówno dla matki, jak i dla płodu.Between 2000-2006, in the 2nd, Department of Surgery at the Medical College of the Jagiellonian University, we performed 4 laparoscopic appendectomies in pregnant patients with acute appendicitis. Diagnostic difficulties in relation to the progression of pregnancy are discussed. Our own experience and the use of laparoscopic technique are also presented. We have evaluated the possible influence of operative management on the further development of the fetus. There were no complications related to the operative procedure. All pregnancies developed normally until delivery, which were either natural (3 patients) or cesarean (1 patient, due to obstetrical indications). We conclude, therefore, that laparoscopic appendectomy seems to be a safe approach both for mother and baby during any trimester of pregnancy

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