Publications by authors named "Maciej Bobowicz"

28 Publications

  • Page 1 of 1

Author Correction: Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy - results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study.

Sci Rep 2019 Dec 6;9(1):18479. Epub 2019 Dec 6.

2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-019-54993-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6897885PMC
December 2019

Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy - results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study.

Sci Rep 2019 10 15;9(1):14793. Epub 2019 Oct 15.

2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.

Laparoscopic appendectomy (LA) for treatment of acute appendicitis has gained acceptance with its considerable benefits over open appendectomy. LA, however, can involve some adverse outcomes: morbidity, prolonged length of hospital stay (LOS) and hospital readmission. Identification of predictive factors may help to identify and tailor treatment for patients with higher risk of these adverse events. Our aim was to identify risk factors for serious morbidity, prolonged LOS and hospital readmission after LA. A database compiled information of patients admitted for acute appendicitis from eighteen Polish and German surgical centers. It included factors related to the patient characteristics, peri- and postoperative period. Univariate and multivariate logistic regression models were used to identify risk factors for serious perioperative complications, prolonged LOS, and hospital readmissions in acute appendicitis cases. 4618 laparoscopic appendectomy patients were included. First, although several risk factors for serious perioperative complications (C-D III-V) were found in the univariate analysis, in the multivariate model only the presence of intraoperative adverse events (OR 4.09, 95% CI 1.32-12.65, p = 0.014) and complicated appendicitis (OR 3.63, 95% CI 1.74-7.61, p = 0.001) was statistically significant. Second, prolonged LOS was associated with the presence of complicated appendicitis (OR 2.8, 95% CI: 1.53-5.12, p = 0.001), postoperative morbidity (OR 5.01, 95% CI: 2.33-10.75, p < 0.001), conversions (OR 6.48, 95% CI: 3.48-12.08, p < 0.001) and reinterventions after primary procedure (OR 8.79, 95% CI: 3.2-24.14, p < 0.001) in the multivariate model. Third, although several risk factors for hospital readmissions were found in univariate analysis, in the multivariate model only the presence of postoperative complications (OR 10.33, 95% CI: 4.27-25.00), reintervention after primary procedure (OR 5.62, 95% CI: 2.17-14.54), and LA performed by resident (OR 1.96, 95% CI: 1.03-3.70) remained significant. Laparoscopic appendectomy is a safe procedure associated with low rates of complications, prolonged LOS, and readmissions. Risk factors for these adverse events include complicated appendicitis, postoperative morbidity, conversion, and re-intervention after the primary procedure. Any occurrence of these factors during treatment should alert the healthcare team to identify the patients that require more customized treatment to minimize the risk for adverse outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-019-51172-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794313PMC
October 2019

Complicated appendicitis: Risk factors and outcomes of laparoscopic appendectomy - Polish laparoscopic appendectomy results from a multicenter, large-cohort study.

Ulus Travma Acil Cerrahi Derg 2019 Mar;25(2):129-136

Polish Laparoscopic Appendectomy Collaborative Study Group.

Background: Preoperative classification of complicated and uncomplicated appendicitis (AA) is challenging. However, the differences in surgical outcomes necessitate the establishment of risk factors in developing, complicated AA. This study was an analysis of the clinical outcomes of laparoscopic appendectomies (LA), as well as preoperative risk factors for the development of complicated AA.

Methods: The data of 618 patients who underwent LA in 18 surgical units across Poland and Germany were collected in an online web-based database created by the Polish Videosurgery Society. The surgical outcomes of patients with complicated and uncomplicated appendicitis were compared. Uni- and multivariate logistic regression models were used to establish risk factors for the development of complicated appendicitis.

Results: In all, 1269 (27.5%) patients underwent LA for complicated appendicitis (Group 1) and 3349 (72.5%) for uncomplicated appendicitis (Group 2). The conversion rate, number of intra-operative adverse events, re-intervention rate, postoperative complications, and readmission rate was greater in Group 1. The preoperative risk factors associated with complicated appendicitis were: female sex (Odds ratio [OR]: 1.58), obesity (OR: 1.51), age >50 years (OR: 1.51), symptoms >48 hours (OR: 2.18), high Alvarado score (OR: 1.29 with every point), and C-reactive protein level >100 mg/L (OR: 3.92).

Conclusion: Several demographic and clinical risk factors for complicated AA were identified. LA for complicated appendicitis was associated with poorer outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5505/tjtes.2018.80103DOI Listing
March 2019

Risk factors for intraabdominal abscess formation after laparoscopic appendectomy - results from the Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study.

Wideochir Inne Tech Maloinwazyjne 2019 Jan 24;14(1):70-78. Epub 2018 Jul 24.

2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.

Introduction: According to meta-analyses laparoscopic appendectomy is associated with many benefits. However, in comparison to open surgery an increased rate of intraabdominal abscesses (IAA) has been reported. Identification of predictive factors for this complication may help to identify patients with higher risk of IAA.

Aim: To identify potential risk factors for intraabdominal abscess after laparoscopic appendectomy (LA).

Material And Methods: Eighteen surgical units in Poland and Germany submitted data of patients undergoing LA to the online web-based database created by the Polish Videosurgery Society of the Association of Polish Surgeons. It comprised 31 elements related to the pre-, intra- and postoperative period. Surgical outcomes were compared among the groups according to occurrence of IAA. Univariate and multivariate logistic regression models were used to identify potential risk factors for IAA.

Results: 4618 patients were included in the analysis. IAA were found in 51 (1.10%) cases. Although several risk factors were found in univariate analysis, in the multivariate model, only the presence of complicated appendicitis was statistically significant (OR = 2.98, 95% CI: 1.11-8.04). Moreover, IAA has a significant influence on postoperative reintervention rate (OR = 126.95, 95% CI: 67.98-237.06), prolonged length of stay > 8 days (OR = 41.32, 95% CI: 22.86-74.72) and readmission rate (OR = 33.89, 95% CI: 18.60-34.73).

Conclusions: Intraabdominal abscesses occurs relatively rarely after LA. It is strongly associated with complicated appendicitis. Occurrence of this complication has a great influence on the postoperative period and due to the nature of its treatment is associated with the need for reintervention, prolonged length of stay and by extension possible readmission.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/wiitm.2018.77272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372867PMC
January 2019

Comparison of stump closure techniques during laparoscopic appendectomies for complicated appendicitis - results from Pol-LA (Polish laparoscopic appendectomy) multicenter large cohort study.

Acta Chir Belg 2020 Apr 12;120(2):116-123. Epub 2019 Feb 12.

2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.

In general, the three main options for stump closure in laparoscopic appendectomy are clips, endoscopic staplers and endoloops. However, there is no gold standard, especially regarding complicated acute appendicitis which is generally associated with worse outcomes. We aimed to assess the outcomes of different stump closure techniques during laparoscopic appendectomies for complicated appendicitis Our multicenter observational study of 18 surgical units assessed the outcomes of 1269 laparoscopic appendectomies for complicated appendicitis that used the three main stump closure techniques: clips, staplers and endoloops. Groups were compared in terms of peri- and postoperative outcomes. Staplers were superior in terms of overall morbidity (9.79 vs. 3.29% vs. 7.41%,  = .017) and length of stay (4 vs. 3 vs. 4 days,  < .001) respectively for clips, staplers and endoloops. However, no differences in major complication rates, postoperative intraabdominal abscess formation, reintervention rates and readmission rates were found. Although our results show some clinical benefits of staplers for appendix stump closure, they are based on a non-randomized group of patients and are therefore prone to selection bias. Further well-designed trials taking into consideration not only the clinical benefits, but also, the economic aspects of the surgical treatment of complicated acute appendicitis are needed to confirm our results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/00015458.2019.1573527DOI Listing
April 2020

The significant impact of age on the clinical outcomes of laparoscopic appendectomy: Results from the Polish Laparoscopic Appendectomy multicenter large cohort study.

Medicine (Baltimore) 2018 Dec;97(50):e13621

Faculty of Health Sciences, Powiślańska School in Kwidzyn, Kwidzyn.

Acute appendicitis (AA) is the most common surgical emergency and can occur at any age. Nearly all of the studies comparing outcomes of appendectomy between younger and older patients set cut-off point at 65 years. In this multicenter observational study, we aimed to compare laparoscopic appendectomy for AA in various groups of patients with particular interest in the elderly and very elderly in comparison to younger adults.Our multicenter observational study of 18 surgical units assessed the outcomes of 4618 laparoscopic appendectomies for AA. Patients were divided in 4 groups according to their age: Group 1-<40 years old; Group 2-between 40 and 64 years old; Group 3-between 65 and 74 years old; and Group 4-75 years old or older. Groups were compared in terms of peri- and postoperative outcomes.The ratio of complicated appendicitis grew with age (20.97% vs 37.50% vs 43.97% vs 56.84%, P < .001). Similarly, elderly patients more frequently suffered from perioperative complications (5.06% vs 9.3% vs 10.88% vs 13.68%, P < .001) and had the longest median length of stay (3 [Interquartile Range (IQR) 2-4] vs 3 [IQR 3-5], vs 4 [IQR 3-5], vs 5 [IQR 3-6], P < .001) as well as the rate of patients with prolonged length of hospital stay (LOS) >8 days. Logistic regression models comparing perioperative results of each of the 3 oldest groups compared with the youngest one showed significant differences in odds ratios of symptoms lasting >48 hours, presence of complicated appendicitis, perioperative morbidity, conversion rate, prolonged LOS (>8 days).The findings of this study confirm that the outcomes of laparoscopic approach to AA in different age groups are not the same regarding outcomes and the clinical picture. Older patients are at high risk both in the preoperative, intraoperative, and postoperative period. The differences are visible already at the age of 40 years old. Since delayed diagnosis and postponed surgery result in the development of complicated appendicitis, more effort should be placed in improving treatment patterns for the elderly and their clinical outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MD.0000000000013621DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6320074PMC
December 2018

Patient with metastatic breast cancer presenting as acute cholecystitis with one-year survival on hormonotherapy.

Pol Przegl Chir 2017 Aug;89(4):46-49

Department of Oncological Surgery Medical University in Gdańsk.

Breast cancer has high metastatic potential with distant metastases involving mainly lungs, liver and bones. Less frequently it gives distant spread to other organs. Herein we would like to present a very rare case of an acute cholecystitis which turned out to be a metastatic breast cancer in previously healthy woman. A female patient, 64-years old, presented to the emergency department with symptoms of biliary colic and acute abdomen. During the emergency cholecystectomy, we diagnosed the gallbladder empyema with thickened wall. There were also multiple metastatic nodules in the peritoneal cavity and an excessive amount of free fluid. The emergency physicians diagnosing female patient with the acute abdominal symptoms and a breast cancer history might suspect malignant spread into abdominal organs including gallbladder. On the other hand, acute cholecystitis symptoms might be the first symptoms of metastatic process in the gallbladder from the unknown primary source, which may be breast.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5604/01.3001.0010.4063DOI Listing
August 2017

Keratin 7 expression in lymph node metastases but not in the primary tumour correlates with distant metastases and poor prognosis in colon carcinoma.

Pol J Pathol 2016;67(3):228-234

Department of Pathomorphology, Medical University of Gdańsk, Gdańsk, Poland.

Colorectal carcinoma (CRC) is one of the leading causes of cancer-related deaths worldwide. Alterations in keratin expression, including keratin 7 (K7), are frequent findings in multiple cancers, and they constitute a prognostic factor. The aim of our study was to evaluate the prognostic significance of K7 in the primary tumour and lymph node metastases in two separate cohorts of patients: the first one with lymph node involvement (LN+, 129 cases) and the second one free of LN metastases (LN-, 85 cases). Keratin 7 expression in CRC was analysed on tissue microarrays with immunohistochemistry and evaluated using the h-score. In the LN+ group K7 positivity was identified in 7/129 (5.4%) of primary tumours (PT) and lymph node metastases (LNM); concordance between them was 94% ( 0.396). Keratin 7 was expressed in 8/85 cases (9.4%) in the LN- group. K7 expression in LNM of the LN+ cohort correlated with shorter overall survival (OS) (p = 0.047) and presence of distant metastases at diagnosis (p = 0.005). Expression of K7 in the primary tumour in both cohorts did not correlate with survival. We conclude that the status of K7 expression in metastatic lymph nodes from CRC is a poor prognostic factor.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/pjp.2016.63774DOI Listing
June 2017

Antibiotic prophylaxis in open inguinal hernia repair: a literature review and summary of current knowledge.

Wideochir Inne Tech Maloinwazyjne 2016 5;11(3):127-136. Epub 2016 Oct 5.

Department of General Surgery, Hospital, Puck, Poland; 2 Department of Radiology, Medical University of Gdansk, Gdansk, Poland.

More than 1 million inguinal hernia repairs are performed in Europe and the US annually. Although antibiotic prophylaxis is not required in clean, elective procedures, the routine use of implants (90% of inguinal hernia repairs are performed with mesh) makes the topic controversial. The European Hernia Society does not recommend routine antibiotic prophylaxis for elective inguinal hernia repairs. However, the latest randomized controlled trial, published by Mazaki et al., indicates that the use of prophylaxis is effective for the prevention of surgical site infection. Unnecessary prophylaxis contributes to the development of bacterial resistance and significantly increases healthcare costs. This review documents clinical trials on inguinal hernia repairs with mesh and summarizes the current knowledge. It also tries to solve certain problems, namely: what constitutes a real risk factor, late-onset infection, and how the "surgical environment" impacts on the need to use antibiotic prophylaxis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/wiitm.2016.62800DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5095278PMC
October 2016

Prognostic value of 5-microRNA based signature in T2-T3N0 colon cancer.

Clin Exp Metastasis 2016 12 2;33(8):765-773. Epub 2016 Aug 2.

Department of Oncology and Radiotherapy, Medical University of Gdansk, 7 Dębinki St., 80-211, Gdańsk, Poland.

The role of adjuvant chemotherapy in stage T2-T3N0 colon cancer (CC) is controversial and there are currently no reliable factors allowing for individual selection of patients with high risk of relapse for such therapy. We searched for microRNA-based signature with prognostic significance in this group. We assessed by qRT-PCR expression of 754 microRNAs (miRNAs) in tumour samples from 85 stage pT2-3N0 CC patients treated with surgery alone. MiRNA expression was compared between two groups of patients: 40 and 45 patients who did and did not develop distant metastases after resection, respectively. Additionally, miRNA expression was compared between CC and normal colon mucosa samples and between the mismatch repair (MMR) competent and deficient tumours. Low expression of miR-1300 and miR-939 was significantly correlated with shorter distant metastasis-free survival (DMFS) in Cox univariate analysis (p.adjusted = 0.049). The expression signature of five miRNAs (miR-1296, miR-135b, miR-539, miR-572 and miR-185) was found to be prognostic [p = 1.28E-07, HR 8.4 (95 % CI: 3.81-18.52)] for DMFS and cross-validated in a leave-one-out analysis, with the sensitivity and specificity of 74 and 78 %, respectively. The expression of miR-592 was significantly associated with the MMR status (p.adjusted <0.01). The expression of several novel miRNAs were found to be tumour specific, e.g. miR-888, miR-523, miR-18b, miR-302a, miR-423-5p, miR-582-3p (p < 0.05). We developed a miRNA expression signature that may be predictive for the risk of distant relapse in early stage CC and confirmed previously reported association between miR-592 expression and MMR status.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10585-016-9810-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5110606PMC
December 2016

A numerical scale to assess the outcomes of metabolic/bariatric surgery (NOMS).

Wideochir Inne Tech Maloinwazyjne 2015 Sep 14;10(3):359-62. Epub 2015 Sep 14.

Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.

Introduction: Absent today is a simple numerical system of outcomes assessment that recognizes that bariatric surgery is metabolic surgery and incorporates weight loss, hypertension control, and type 2 diabetes control.

Aim: To introduce a simple, new Numerical Scale to Assess the Outcomes of Metabolic Surgery (NOMS).

Material And Methods: For the stratification of weight outcomes, we used the percentage excess weight loss (%EWL); for hypertension, the systolic blood pressure (SBP) and diastolic blood pressure (DBP) combined with medication usage; and for type 2 diabetes, the hemoglobin A1c (HbA1c) value combined with medication usage.

Results: Utilizing the guidelines of the American Diabetes Association, the Working Group of the European Society of Hypertension, the European Society of Cardiology, and the American College of Cardiology/American Heart Association, we propose for %EWL: W1 ≥ 50, W2 > 25 and < 50, and W3 ≤ 25; for hypertension H1 SBP/DPB < 140/90 mm Hg on no medication, H2 SBP/DBP ≥ 140/90 mm Hg with improvement of SBP or possible reduction of antihypertensive medication, and H3 no change or SBP higher than before surgery; for diabetes mellitus D1 HbA1c ≤ 7% and no medication, D2 HbA1c > 7% with a decrease of the HbA1c level or possible reduction of medication, D3 no change in HbA1c or HbA1c higher than before surgery. Designations of H0 and D0 are given if hypertension or diabetes was not present before surgery. Patient examples for numerical scores are provided.

Conclusions: The introduction of our numerical scale (NOMS) can be of benefit in metabolic/bariatric outcomes assessment; communications among metabolic/bariatric surgery centers, physicians, and patients; and for more precise reporting in the evidence-based literature.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/wiitm.2015.54085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653263PMC
September 2015

Extracorporeal staple technique: an alternative approach to the treatment of critical colostomy stenosis.

Wideochir Inne Tech Maloinwazyjne 2015 Jul 22;10(2):316-9. Epub 2015 Jun 22.

Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, USA.

We describe an extracorporeal staple technique used to treat severe colostomy stenosis under analgo-sedation, thus avoiding relaparotomy. The surgery is performed under short-term sedation. The orifice of the stoma is widened and overgrowing skin is excised. The volume and diameter of the stoma are assessed. The anvil of a circular stapler device is inserted into the lumen of the colostomy. First bowel layers and then skin are closed with purse-string sutures. One firing of the stapler is used to reshape the stoma. The procedure takes around 20-30 min. One circular stapler is used. The patient can be discharged the same day or a day after surgery. No complications were noted in operated patients. At 6- and 12-month follow-ups, a slight narrowing of the colostomy was visible, but no recurrence of the stricture was noted. The described technique is an interesting, easy and safe alternative to previous methods of treatment for stenosed end-colostomy. Importantly, it is an extra-abdominal procedure and may be offered to patients with a history of multiple abdominal operations or with serious coexisting medical conditions in the one-day surgery setting.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/wiitm.2015.52474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520851PMC
July 2015

The treatment of chronic pleural empyema with laparoscopic omentoplasty. Initial report.

Wideochir Inne Tech Maloinwazyjne 2014 Dec 5;9(4):548-53. Epub 2014 Sep 5.

Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland.

Introduction: Pleural empyema is the most serious, life-threatening postoperative complication of pneumonectomy, observed after 1-12% of all pneumonectomies, with bronchopleural fistula being its main cause.

Aim: The aim of this publication is to present early outcomes of minimally invasive surgical management of pleural empyema. Patients were subjected to a single, complex procedure, consisting of the laparoscopic mobilization of the greater omentum and its transposition via the diaphragm into the pleural cavity to fill in the empyema cavity with the consecutive pleuro-cutaneous fistuloplasty (thoracoplasty).

Material And Methods: Between May 2011 and April 2013, 8 patients were qualified to undergo the procedure. The mean age was 61 years (range: 46-77 years). Presence of bronchopleural fistula was confirmed in 3 cases. The median time of treatment with thoracostomy was 14.5 months.

Results: The mean operative time was 125 min. The mean duration of post-operative hospital stay was 13.5 days (range: 7-31 days). In 6 patients (75%) the objective of permanent resolution of pleural empyema was achieved. In total, 4 patients had complications: pleural empyema recurrence (2 patients), splenic injury, hiatal hernia, gastrointestinal bleed. Two patients with empyema recurrence had Staphylococcus aureus infections prior to surgery. They were successfully managed both with prolonged thoracic drainage and antibiotics.

Conclusions: Use of the greater omentum that was laparoscopically mobilized and transpositioned into the pleural cavity allows simultaneous management of the pleural empyema cavity and thoracostomy. The procedure is safe, with few direct complications. It is well tolerated and has at least a satisfactory cosmetic effect. The minimally invasive approach allows faster recovery and return to daily activities in comparison to the fully open technique.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/wiitm.2014.45129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4280418PMC
December 2014

Comparison of percentage excess weight loss after laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding.

Wideochir Inne Tech Maloinwazyjne 2014 Sep 23;9(3):351-6. Epub 2014 Jul 23.

General and Vascular Surgery Department, Ceynowa Hospital, Wejherowo, Poland ; Department of General and Minimally Invasive Surgery, University of Warmia and Mazury, Olsztyn, Poland.

Introduction: Laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) are acceptable options for primary bariatric procedures in patients with body mass index (BMI) 35-55 kg/m(2).

Aim: The aim of this study is to compare the effects of these two bariatric procedures 6, 12 and 24 months after surgery.

Material And Methods: Two hundred and two patients were included 72 LSG and 130 LAGB patients. The average age was 38.8 ±11.9 and 39.4 ±10.4 years in LSG and LAGB groups, with initial BMI of 44.1 kg/m(2) and 45.2 kg/m(2), p = NS.

Results: The mean percentage of excess weight loss (%EWL) at 6 months for LSG vs. LAGB was 36.3% vs. 30.1% (p = 0.01) and at 12 months was 43.8% vs. 34.6% (p = 0.005). The greatest difference in the mean %EWL at 12 months was observed in patients with initial BMI of 40-49.9 kg/m(2) in favor of LSG (47.5% vs. 35.6%; p = 0.01). Two years after surgery there was no advantage of LSG and in the subgroup of patients with BMI 50-55 kg/m(2) there was a trend in favor of LAGB (57.2% vs. 30%; p = 0.07). The multiple regression model of independent variables (age, gender, initial BMI and the presence of comorbidities) proved insignificant in prediction of the best outcome in means of %EWL for either operative modality. None of these factors in the logistic regression model could determine the type of surgery that should be used in particular patients.

Conclusions: During the first 2 years after surgery, the best results were obtained in women with lower BMI undergoing LSG surgery. The LSG provides greater %EWL after a shorter period of time though the difference decreases in time.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/wiitm.2014.44257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4198654PMC
September 2014

Preoperative nutritional support in cancer patients with no clinical signs of malnutrition--prospective randomized controlled trial.

Support Care Cancer 2015 Feb 6;23(2):365-70. Epub 2014 Aug 6.

Department of Surgical Oncology, Medical University of Gdańsk, Smoluchowskiego 17, 80-952, Gdańsk, Poland,

Purpose: Preoperative nutrition is beneficial for malnourished cancer patients. Yet, there is little evidence whether or not it should be given to nonmalnourished patients. The aim of this study was to assess the need to introduce preoperative nutritional support in patients without malnutrition at qualification for surgery.

Methods: This was a prospective, two-arm, randomized, controlled, open-label study. Patients in interventional group received nutritional supplementation for 14 days before surgery, while control group kept on to their everyday diet. Each patient's nutritional status was assessed twice--at qualification (weight loss in 6 months, laboratory parameters: albumin, total protein, transferrin, and total lymphocyte count) and 1 day before surgery (change in body weight and laboratory parameters). After surgery, all patients were followed up for 30 days for postoperative complications.

Results: Fifty-four patients in interventional and 48 in control group were analyzed. In postoperative period, patients in control group suffered from significantly higher (p < 0.001) number of serious complications compared with patients receiving nutritional supplementation. Moreover, levels of all laboratory parameters declined significantly (p < 0.001) in these patients, while in interventional arm were stable (albumin and total protein) or raised (transferrin and total lymphocyte count).

Conclusions: Preoperative nutritional support should be introduced for nonmalnourished patients as it helps to maintain proper nutritional status and reduce number and severity of postoperative complications compared with patients without such support.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00520-014-2363-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4289010PMC
February 2015

Long-term outcomes of stapled hemorrhoidopexy.

Wideochir Inne Tech Maloinwazyjne 2014 Mar 26;9(1):18-23. Epub 2013 Nov 26.

Department of General and Vascular Surgery, Ceynowa Hospital, Wejherowo, Poland.

Introduction: Hemorrhoidal disease is one of the commonest anorectal disorders worldwide. Stapled hemorrhoidopexy (SH) is a treatment modality associated with low postoperative pain and early mobilization.

Aim: To assess long-term outcomes after SH.

Material And Methods: All 326 patients who underwent SH in 1999-2003 were invited by mail to participate. For each patient we analyzed their medical records, and conducted a questionnaire survey and a digital rectal examination.

Results: Only 91 patients attended the final examination and the mean ± SD follow-up time was 8.7 ±1.2 years. Recurrences were diagnosed in one third of the 91 subjects. There were correlations between recurrences and: the duration of disease (p = 0.047); female gender (p = 0.037); and childbirth (vaginal delivery) (p = 0.026). Sixty-seven patients (73.6%) were satisfied with the outcomes. In the group of dissatisfied patients symptoms such as pain (p = 0.0001), burning (p = 0.0002) and itching (p = 0.014) were most common. Long-term outcomes were good with 75% and 88% reductions in pain sensation and severe and moderate hemorrhoidal bleeding. Pruritus, burning and discomfort resolved in more than 50% of patients. Flatus incontinence, fecal incontinence, or soiling occurred in 21%, 11%, and 32% of patients.

Conclusions: Long-term results of stapled hemorrhoidopexy are satisfactory in most patients. The 36% recurrence rate correlates with the degree of hemorrhoidal prolapse before the operation, duration of the disease, female gender, and previous vaginal delivery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/wiitm.2011.35784DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3983538PMC
March 2014

Endoscopic submucosal dissection of gastric ectopic pancreas.

Wideochir Inne Tech Maloinwazyjne 2013 Sep 5;8(3):249-52. Epub 2013 Mar 5.

Department of Oncological Surgery, University Clinical Center, Medical University of Gdansk, Poland.

Patients with gastric tumors usually present with symptoms of discomfort or pain in the epigastrium, regurgitations, nausea, vomiting or melena. Treatment options include open and laparoscopic total or partial gastrectomy and recently endoscopic mucosal resection. A case of successful endoscopic submucosal dissection is described with the unusual pathological finding of heterotopic pancreatic tissue forming a gastric tumor. The 67-year-old male patient was operated on due to the initial diagnosis of gastro-intestinal stromal tumor of the gastric trunk. Two intra-operative biopsies were negative for cancer cells. Submucosal endoscopic dissection was performed with IT and Hook knives (Olympus). A literature review was performed. The operative time was 180 min with hospital stay of 6 days. During the injection of the carmine dye and the air insufflation pneumoperitoneum occurred and remained clinically silent during the observation period. The pathology result showed a heterotopic pancreatic tissue type 2 according to Heinrich's classification with microfoci of intestinal metaplasia. Preoperative diagnostics of gastric masses might be misleading and such tumors not necessarily should be excised. There are several surgical options with endoscopic submucosal dissection being probably the safest one and a non-disabling approach. Patients tolerate that kind of surgery well with good postoperative functional outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/wiitm.2011.33709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3796718PMC
September 2013

Single incision laparoscopic surgery - is it time for laboratory skills training?

Wideochir Inne Tech Maloinwazyjne 2013 Sep 12;8(3):216-20. Epub 2013 Mar 12.

Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Poland.

Introduction: With the introduction of new surgical equipment, there is always the need for new, more advanced training. The authors try to answer whether the use of the newest generation tools has an impact on achieving better results in single incision laparoscopic surgery (SILS) technique during the exercises in the surgical skills laboratory.

Material And Methods: There were 51 participants in the study: 44 'novices' and 7 'experts'. All subjects performed the 'advanced grasping' exercise according to the FLS programme manual using four types of laparoscopic approach including two SILS ports and SILS-dedicated instruments. The outcome measures involved task completion time and the number of errors.

Results: Tasks using straight laparoscopic instruments set together with classic three-port access as well as SILS access ports were finished significantly faster when compared with SILS-dedicated instruments (p < 0.05). There were no significant differences in performance times between the two setups with straight instruments (p < 0.05) and both setups with SILS-dedicated instruments, irrespective of the use of curved or dynamic articulated tools. Students with no previous laparoscopic experience had significantly worse task completion times in all tasks in comparison to students with laparoscopic laboratory training and the 'experts' group.

Conclusions: The use of the straight instruments in the SILS technique remain similar to its performance in full triangulation. SILS-dedicated instruments paradoxically increase the task completion time irrespective of possessed skills. The study showed the necessity of a SILS-dedicated tools training programme.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/wiitm.2011.33811DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3796722PMC
September 2013

Morbidity, mortality and survival after stomach resection with or without splenectomy--the single centre observations.

Pol Przegl Chir 2013 Aug;85(8):433-7

Unlabelled: Over the last decade, gastric cancer treatment has changed from extensive multiorgan resections towards less invasive approaches with limited resections and a more selective lymphadenectomy. Despite all available trials, the conclusions on the extent of necessary resections still remain debatable. The aim of the study was to assess the short term outcomes (morbidity and mortality) of a total gastrectomy depending on the simultaneous splenectomy status.

Material And Methods: We performed a retrospective analysis of the records of all patients treated with a curative intent using a total gastrectomy for gastric cancer between 1997 and 2003. 49 patients fulfilled the inclusion criteria. Patients were divided into two groups: S(+) gastrectomy with splenectomy group (29 patients) and S(-) total gastrectomy with spleen preservation (20 patients).

Results: Survival analysis at one year showed that there was no difference in survival between the two groups (p=0.84). There were six recurrences, one in the group S(+) and five in group S(-) (p>0.05). Dissemination was observed in three patients in group S(-) (p>0.05). Other complications including infectious complications, exenteration, subileus, cardiovascular insufficiency, multiorgan failure were more frequent in the S(+) group (31% v 15%) although the difference was not significant (p=0.17).

Conclusions: Splenectomy during gastrectomy for cancer has no statistically significant impact on short-term morbidity and mortality. Even though it does not show benefit in terms of 5-year overall survival rates it might be performed when needed in more advanced cases in properly selected patients (e.g. upper gastric T3/4 gastric cancer).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2478/pjs.2013.85.8.433DOI Listing
August 2013

Laparoscopic cholecystectomy in a patient with total situs inversus - case report.

Pol Przegl Chir 2013 Mar;85(3):141-4

For many years, laparoscopic cholecystectomy remains the method of choice for both the treatment of symptomatic cholelithiasis, and chronic and acute cholecystitis (1). The experience of the surgeon grows with each laparoscopic procedure, which enables to operate in case of difficult anatomical conditions and associated anatomical variants. The aim of the study was to present a case of a 47-year old male patient with total situs inversus and several months history of recurrent left epigastric pain, radiating to the left scapula, being accompanied by nausea and vomiting. The study presented the operative technique of laparoscopic cholecystectomy and postoperative period data. In conclusion, laparoscopic cholecystectomy in a patient with total situs inversus is possible and safe, providing relevant precautions. The main issues certainly include a good and feasible plan of the operation, discussion concerning the possible intraoperative and postoperative complications, a good plan considering the localization of the trocars, as well as an experienced surgical team. One should also not forget that early conversion to classical cholecystectomy is not considered as failure, but might prevent accidental damage of the biliary ducts and long-term complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2478/pjs-2013-0025DOI Listing
March 2013

Transumbilical laparoendoscopic single-site total mesorectal excision for rectal carcinoma.

Wideochir Inne Tech Maloinwazyjne 2012 Jun 26;7(2):118-21. Epub 2012 Jan 26.

Department of General and Vascular Surgery, Ceynowa Hospital, Wejherowo, Poland.

In recent years, multiple studies have proved laparoscopic total mesorectal excision (TME) to be as safe and as effective in rectal cancer treatment as open surgery, with the undeniable benefit of perioperative trauma reduction. Decreasing the number of incisions and performing single-port surgery could have further reduced the trauma. A new access device, QuadPort™ Olympus, enables operations from just one small transumbilical incision, leaving a barely visible scar afterwards. This is one of the first reports of transumbilical laparoendoscopic single-site TME for rectal carcinoma. A 73-year-old woman presented with tubulo-villous adenoma with high-grade dysplasia and focal adenocarcinoma in situ at 7 cm from the anal verge. She had TME performed via a QuadPort™, Olympus, in line with principles of laparoscopic TME. The operating time was 80 min. There were no adverse events during the procedure. Total blood loss was less than 100 ml. There were no complications in the postoperative period. The patient required only non-opioid analgesia, during the first 2 days. The patient was discharged on the 3(rd) postoperative day with standard recommendations. Feasibility and safety of the proposed transumbilical laparoendoscopic single site TME for rectal carcinoma was proved. It is a technically demanding procedure, requiring appropriate laparoscopic skills. The QuadPort provided good oncological protection of the wound and easy specimen extraction. Reduced operative trauma resulted in no opioid administration in the perioperative period. Hospital stay was comparable with laparoscopic TME but the cosmetic effect was much better.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/wiitm.2011.26756DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3516973PMC
June 2012

Band misplacement: a rare complication of laparoscopic adjustable gastric banding.

Wideochir Inne Tech Maloinwazyjne 2012 Mar 27;7(1):40-4. Epub 2011 Nov 27.

Department of General and Vascular Surgery, Ceynowa Hospital, Wejherowo, Poland.

Introduction: Laparoscopic adjustable gastric banding (LAGB) is considered to be a very effective minimally invasive procedure for treating morbidly obese patients. Nevertheless, there are numerous complications that a good surgeon should be aware of. Most of them have been widely presented in the literature.

Aim: In this study we would like to focus on the rare but important complication which is ante-gastric positioning of the band.

Material And Methods: Between January 2005 and May 2008, 122 patients (88 female and 34 male) with mean body mass index (BMI) of 48.5 kg/m(2) (range 35-80 kg/m(2)) underwent LAGB procedure. The average time of hospitalization was 2.47 days. The first radiological control with band calibration was performed 6 weeks after the operation. Consecutive follow-up depended on the percent excess weight loss (EWL%).

Results: Of the 122 patients, 4 (3.3%) presented herein had a band misplaced in the ante-gastric position. There were three out of five surgeons who faced complications of this type. The most and the least experienced team members avoided misplacing the band. Two physicians encountered it at the beginning of their learning curve, and for one it was not related to the process of education. Among other postoperative complications there were two incidents of band slippage, 2 patients had their port localization corrected and in one case drain disconnection occurred. There were no mortalities.

Conclusions: Ante-gastric positioning of the band was the most common cause of obesity surgery failure in our group of patients. It was very difficult to recognize during the typical postoperative checkups; hence there arose a question whether it has been disregarded in other studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/wiitm.2011.25930DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3516960PMC
March 2012

Totally laparoscopic feeding jejunostomy - a technique modification.

Wideochir Inne Tech Maloinwazyjne 2011 Dec 20;6(4):256-60. Epub 2011 Dec 20.

Department of Oncological Surgery, Hospital of Medical University of Gdansk, Poland.

In oncological patients with upper gastrointestinal tract tumours, dysphagia and cachexy necessitate gastrostomy or jejunostomy as the only options of enteral access for long-term feeding. In this article the authors describe a modified technique of laparoscopic feeding jejunostomy applied during the staging laparoscopy. A 48-year-old male patient with gastroesophageal junction tumour and a 68-year-old male patient with oesophageal tumour were operated on using the described technique. Exploratory laparoscopy was performed. Then the feeding jejunostomy was made using a Cystofix(®) TUR catheter. The jejunum was fixed to the abdominal wall with four 2.0 Novafil™ transabdominal stitches. Two additional sutures were placed caudally about 4 cm and 8 cm from the jejunostomy, aiming at prevention of jejunal torsion. Total operating time was 45 min. There was no blood loss. There were no intraoperative complications. The only adverse event was one jejunostomy wound infection that responded well to oral antibiotics. There were no mortalities. The described technique has most of the benefits of laparoscopic feeding jejunostomy with some steps added from the open operation making the procedure easier to perform as part of a staging operation with a relatively short additional operating time. The proposed transabdominal stitches make the technique easier to apply. Two additional 'anti-torsion sutures' prevent postoperative volvulus. Use of the Cystofix catheter allows easy introduction of the catheter into the peritoneal cavity and the jejunal lumen, providing a good seal at the same time. Further studies on larger groups of patients are required to assess long-term outcomes of the proposed modified technique.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/wiitm.2011.26262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3516942PMC
December 2011

Paraesophageal hernia repair followed by cardiac tamponade caused by ProTacks.

Ann Thorac Surg 2012 Oct;94(4):e87-9

Department of Oncological Surgery, Academic Clinical Center, Medical University of Gdansk, Gdansk, Poland.

We describe a case of cardiac tamponade caused by ProTacks Autosuture used for mesh fixation during a laparoscopic Nissen operation with giant paraesophageal hernia repair. Perforations of the posterior descendent artery and epicardial vein of the right ventricle were caused by ProTacks used for Parietex Composite Mesh fixation. Protruding ProTacks were secured from inside the pericardiac sac with a synthetic vascular patch during emergency sternotomy. Quick and multidisciplinary cooperation ended with emergency cardiothoracic procedure saving the patient's life and preventing further damage to the heart muscle and its vessels.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.athoracsur.2012.03.107DOI Listing
October 2012

Transanal endoscopic microsurgery via TriPort Access System with no general anesthesia and without sphincter damage.

Surg Laparosc Endosc Percutan Tech 2011 Dec;21(6):e308-10

General and Vascular Surgery Department, Ceynowa Hospital, Wejherowo, Poland.

The aim of this study was to develop a less-invasive transanal endoscopic microsurgery (TEM) operative technique that could be applied in severely ill patients. Modified technique of TEM operation with use of the TriPort Access System in place of the operative rectoscope was designed. Harmonic scalpel and regular laparoscopic instruments were used. Resection of the rectal stump tumor was performed. A 71-year-old male patient with recurrent adenocarcinoma T2N0M0 in rectal stump and ASA 4 was operated using presented technique with good outcome. Total operating time was 25 minutes. There were no adverse events during or after the procedure. Patient was fully mobilized directly after the procedure. Proposed technique can be performed in severely ill patients as it avoids anal sphincter divulsion and therefore general anesthesia. Standard laparoscopic instruments can be used at no extra cost and no need for additional skills.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SLE.0b013e31823cd06bDOI Listing
December 2011

A 5-year experience with laparoscopic adjustable gastric banding--focus on outcomes, complications, and their management.

Obes Surg 2011 Nov;21(11):1682-6

General and Vascular Surgery Department, Ceynowa Hospital, Jagalskiego 10, Wejherowo, 84-200, Poland.

Background: Laparoscopic adjustable gastric banding (LAGB) remains the most popular surgical modality for obesity management in Europe. The aim of this publication is to present a 5-year experience in obesity treatment with LAGB operation with the assessment of outcomes, frequency of complications, and their management. Management of the band-related complications is crucial for continuous obesity treatments, despite the fact of initial failure, allowing further excess weight loss in patients with morbid obesity.

Methods: One hundred sixty patients underwent the LAGB procedure with standard pars flaccida technique during the years 2005-2009. A retrospective analysis of the data was performed; chi-squared test and Student's t test at the level of significance of p < 0.05 were used. Information on reoperations was gathered from hospital case notes.

Results: In the presented group, the mean body mass index (BMI) was 48.13 kg/m(2) (33.46-83.04 kg/m(2); standard deviation [SD] ±8.45). Of the patients, 36.2% had super morbid obesity with BMI >50 kg/m(2). The mean observation period reached 549 days (31-2,026 days; SD ±390.1), with the mean number of control visits of 4.2 (1-12). The mean percentage of excess weight loss during the observation period was 34% (from -9.9% to 85.1%; SD ±20.6), with the mean body mass reduction of 24.4 kg. Complications appeared in 30 patients (20.1%). Twenty-four patients (16.1%) required reoperation. There were no mortalities recorded.

Conclusions: The mean operative time of 59 min was relatively short. Morbidity and mortality rates were comparable to many published series. Failure or complications of LAGB did not stop the obesity treatment. Most of the band-related complications occurred late and could be provided for laparoscopically.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11695-011-0453-7DOI Listing
November 2011

Preliminary outcomes 1 year after laparoscopic sleeve gastrectomy based on Bariatric Analysis and Reporting Outcome System (BAROS).

Obes Surg 2011 Dec;21(12):1843-8

General and Vascular Surgery Department, Ceynowa Hospital, Jagalskiego 10, Wejherowo 84-200, Poland.

Background: The aim of this study was to assess outcomes of laparoscopic sleeve gastrectomy (LSG) as a stand-alone bariatric operation according to the Bariatric Analysis and Reporting Outcome System (BAROS).

Methods: Out of 112 patients included and operated on initially, 84 patients (F/M, 63:21) were followed up for 14-56 months (mean 22 ± 6.75). Patients lost to follow-up did not attend scheduled follow-up visits or they have withdrawn their consent. Mean age was 39 years (range 17-67; SD ± 12.09) with mean initial BMI 44.62 kg/m(2) (range 29.39-82.8; SD ± 8.17). Statistical significance was established at the p < 0.05 level.

Results: Mean operative time was 61 min (30-140 min) with mean hospital stay of 1.37 days (0-4; SD ± 0.77). Excellent global BAROS outcome was achieved in 13% of patients, very good in 30%, good in 34.5%, fair 9.5% and failure in 13% patients 12 months after surgery. Females achieved significantly better outcomes than males with the mean 46.5% of excess weight loss (EWL) versus 35.3% of EWL at 12 months (p = 0.02). The mean percentage of excess weight loss (%EWL) was 43.6% at 12 months and 46.6% at 24 months. Major surgical complication rate was 7.1%; minor surgical complication rate 8.3%. There was one conversion (1.2%) due to the massive bleeding. Comorbidities improved or resolved in numerous patients: arterial hypertension in 62%, diabetes mellitus in 68.3%, respectively.

Conclusions: Presented LSG series shows that the LSG as a stand-alone procedure provides acceptable %EWL and good global BAROS outcomes. It significantly improves comorbidities as well.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11695-011-0403-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217142PMC
December 2011

The first report on hybrid NOTES adjustable gastric banding in human.

Obes Surg 2011 Apr;21(4):524-7

General and Vascular Surgery Department, Ceynowa Hospital, Jagalskiego 10, Wejherowo, 84-200, Poland.

Background: Despite their current limitations, metabolic surgery and natural orifice transluminal endoscopic surgery (NOTES), set new horizons. In this article, the first three cases of adjustable gastric banding (AGB) through transvaginal access in obese women are described.

Methods: In the General and Vascular Surgery Department, Ceynowa Hospital, Poland, three cases of AGB through the transvaginal access in hybrid, laparoscopically assisted NOTES technique were performed. All patients were female with BMI range 35-37. A dual-channel endoscope and regular laparoscopic instruments were used.

Results: The mean operating time was 110 min. Indometacin was given intravenously PRN for postoperative pain. None of the patients required more than 3 g of indometacin and for longer than 24 h postoperatively. None required opioids either. There was one major complication of iatrogenic damage to the ureter, which required subsequent hospitalisation and laparoscopic repair. Hospitalisation time was 2 days. During 2 months follow up, the mean weight loss was 15 kg. There were no malpositions of the band. There was no early mortality in the study group.

Conclusion: Feasibility of the proposed hybrid laparoscopically assisted NOTES adjustable gastric banding was proved. It is a technically demanding procedure, requiring appropriate endoscopic and laparoscopic skills. To avoid ureteric damage one should acquire safe colpotomy skills before commencing transvaginal NOTES operations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11695-010-0130-2DOI Listing
April 2011