Publications by authors named "Tomasz Banasiewicz"

97 Publications

Statement of the polish expert group on the current practice and prospects for the treatment of complex perianal fistulas in Crohn's disease. Update 2021.

Pol Przegl Chir 2021 Aug;93(4):70-79

Klinika Chirurgii Ogólnej i Kolorektalnej, Uniwersytet Medyczny w Łodzi.

Perianal fistulas in Crohn's disease (CD) are a major problem. In majority of patient, inflammation involves the rectum. Perianal fistulas in CD pose a diagnostic and therapeutic challenge due to severe symptoms and worse prognosis compared to cryptogenic fistulas. The accurate diagnosis is crucial for an effective treatment of CD-related perianal fistulas, and the following should be determined: anatomy of the fistula, possible strictures and inflammation of the alimentary tract, including the rectum and the anal canal. Treatment of fistulas might be challenging and requires cooperation between the colorectal surgeon and the gastroenterologist. The combination of surgical and pharmacological therapy is more effective than surgical or pharmacological therapy alone. In conservative treatment, aminosalicylates or steroids have little significance. In everyday practice, antibacterial chemotherapeutics, antibiotics and thiopurines are applied. The most effective are TNF-neutralizing antibodies, i.e. infliximab (IFX), adalimumab (ADA) and certolizumab (CER). Surgical management can be urgent including drainage. Elective procedures include dissection of the fistula (simple fistula) or more complex interventions such as mucosal flap or ligation of the intersphincteric portion of the fistula. Surgical interventions can be enhanced using the video-assisted anal fistula treatment (VAAFT) or negative-pressure therapy. In extreme cases, creation of a stoma may be necessary. Also, tissue glues or so-called plugs may be applied in managing perianal fistulas. The use of stem cells seems promising, i.e. application of multipotent non-hematopoietic stem cells around the fistula in order to induce immunomodulation and wound healing.
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http://dx.doi.org/10.5604/01.3001.0015.2335DOI Listing
August 2021

Clinical guidelines for the management of gastrointestinal fistula - developed by experts of the Polish Surgical Society.

Pol Przegl Chir 2021 Aug;93(4):57-69

I Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego, Uniwersytet Medyczny w Lublinie.

Background: Gastrointestinal fistula is one of the most difficult problems in gastrointestinal surgery. It is associated with high morbidity and mortality, numerous complications, prolonged hospitalization, and high cost of treatment.

Aim: This project aimed to develop recommendations for the treatment of gastrointestinal fistulas, based on evidence-based medicine and best clinical practice to reduce treatment-related mortality and morbidity.

Material And Methods: The preparation of these recommendations is based on a review of the literature from the PubMed, Medline, and Cochrane Library databases from 1.01.2010 to 31.12.2020, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. Recommendations in the form of a directive were formulated and assessed using the Delphi method.

Results And Conclusions: Nine recommendations were presented along with a discussion and comments of experts. Treatment should be managed by a multidisciplinary team (surgeon, anesthetist, clinical nutritionist/dietician, nurse, pharmacist, endoscopist).
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August 2021

Crohn's Disease Susceptibility and Onset Are Strongly Related to Three Gene Haplotypes.

J Clin Med 2021 Aug 24;10(17). Epub 2021 Aug 24.

Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland.

The genetic background and the determinants influencing the disease form, course, and onset of inflammatory bowel disease (IBD) remain unresolved. We aimed to determine the gene haplotypes and their relationship with IBD occurrence, clinical presentation, and onset, analyzing a cohort of 578 patients with IBD, including children, and 888 controls. Imaging or endoscopy with a histopathological confirmation was used to diagnose IBD. Genotyping was performed to assess the differences in genotypic and allelic frequencies. Linkage disequilibrium was analyzed, and associations between haplotypes and clinical data were evaluated. We emphasized the prevalence of risk alleles in all analyzed loci in patients with Crohn disease (CD). Interestingly, c.2722G>C and c.3019_3020insC alleles were also overrepresented in ulcerative colitis (UC). T-C-G-C-insC, T-C-G-T-insC, and T-T-G-T-wt haplotypes were correlated with the late-onset form of CD (OR = 23.01, 5.09, and 17.71, respectively), while T-T-G-T-wt and C-C-G-T-wt were prevalent only in CD children (OR = 29.36, and 12.93, respectively; -value = 0.001). In conclusion, the presence of c.3019_3020insC along with c.802C>T occurred as the most fundamental contributing diplotype in late-onset CD form, while in CD children, the mutual allele in all predisposing haplotypes was the c.2798 + 158T. Identifying the unique, high-impact haplotypes supports further studies of the gene, including haplotypic backgrounds.
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http://dx.doi.org/10.3390/jcm10173777DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432186PMC
August 2021

ASSESSMENT OF RECURRENT ANAL FISTULAS TREATMENT WITH PLATELET-RICH PLASMA.

Arq Gastroenterol 2021 Apr-Jun;58(2):185-189

Poznan University of Medical Sciences, Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznań, Poland.

Background: Surgical treatment of recurrent anal fistulas can lead to numerous complications, including fecal incontinence. Therefore, sphincter preserving techniques are gaining more popularity.

Objective: The aim of the study was to assess effectiveness of platelet-rich plasma (PRP) therapy in the patients with recurrent cryptoglandular anal fistulas.

Methods: A cohort of 18 patients with anal fistulas was enrolled into a preliminary and prospective trial. They were divided into two groups consisting of eight and ten patients respectively. PRP was injected locally in all patients, however in the group II it was applied after 7 days drainage of fistulas with polyurethane foam or negative pressure wound therapy. On average, three doses of PRP were administered, but with the opportunity to double the number of applications if it was clinically justified. The patients were evaluated in an out-patient department after fortnight and then in 1, 6, and 12 months following the last PRP application.

Results: Anal fistulas were closed in 4 (50%) patients from the group I and in 7 (70%) patients form the group II. Although, the difference between both groups was not statistically significant, PRP therapy should be preceded with fistulous tract drainage in all patients. Summarizing, that successful result was achieved in 11 (60%) patients from the entire group of 18 participants.

Conclusion: The rate of recurrent cryptoglandular anal fistulas closure reaching 60%, after topical treatment with PRP, exceeds the results of other sphincter-saving methods of treatment. Therefore, it might become a novel method of anal fistulas therapy.
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http://dx.doi.org/10.1590/S0004-2803.202100000-32DOI Listing
August 2021

Application of platelet-rich plasma in rectovaginal fistulas in the patients with ulcerative colitis.

Langenbecks Arch Surg 2021 Jun 21. Epub 2021 Jun 21.

Department of General, and Endocrynologic Surgery, and Gastroenterologic Oncology, Poznań University of Medical Sciences, 49 Przybyszewski Str., 60-355, Poznań, Poland.

Background: There is a need for other than surgical methods of therapy for small and low rectovaginal fistulas (RVF) in the course of inflammatory bowel diseases (IBD), such as application of fibrin sealants, stem cells, biological therapy, or platelet-rich plasma. The aim of this study was to evaluate the results of the treatment after local application of PRP in aforementioned fistulas, exclusively in the patients with ulcerative colitis (UC).

Patients And Methods: Medical records of 13 patients with small and low-lying, active RVF in the course of UC, and after restorative proctocolectomy for UC were evaluated. Curettage of fistulous tracts was performed with the following application of PRP in all patients.

Results: Complete closure of RVF was achieved after the first injection in 4 patients, 3 women healed their fistulas following the second application, and two of them closed RVF after 3 injections. To sum up, the complete closure of RVF was achieved in 9 (69%) patients. Fistulas remained closed from 6 to 12 months.

Conclusions: The application of PRP in small, low, and recurrent IBD anal fistulas is effective, simple, and safe with an acceptable rate of healing. This therapy might also precede any further, surgical methods of treatment.
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http://dx.doi.org/10.1007/s00423-021-02232-7DOI Listing
June 2021

Apolipoprotein E variants correlate with the clinical presentation of paediatric inflammatory bowel disease: A cross-sectional study.

World J Gastroenterol 2021 Apr;27(14):1483-1496

Department of Pediatric Gastroenterology and Metabolic Diseases, Poznań University of Medical Sciences, Poznań 60-572, Poland.

Background: It has been suggested that apolipoprotein E ( polymorphisms are associated with the risk of developing inflammatory bowel disease (IBD) and the early age of disease onset. However, there are no reports regarding the relationship with clinical characteristics and disease severity.

Aim: To summarise that APOE polymorphisms are associated with the risk of developing IBD and the early age of disease onset.

Methods: In total, 406 patients aged 3-18 with IBD (192 had ulcerative colitis and 214 had Crohn's disease) were genotyped using the TaqMan hydrolysis probe assay. Clinical expression was described at diagnosis and the worst flare by disease activity scales, albumin and C-reactive protein levels, localisation and behaviour (Paris classification). Systemic steroid intake with the total number of courses, immunosuppressive, biological, and surgical treatment with the time and age of the first intervention were determined. The total number of exacerbation-caused hospitalisations, the number of days spent in hospital due to exacerbation, the number of relapses, and severe relapses were also estimated.

Results: Ulcerative colitis patients with the allele had lower C-reactive protein values at diagnosis ( = 0.0435) and the worst flare ( = 0.0013) compared to patients with the allele and genotype . Crohn's disease patients with the allele scored lower on the Pediatric Crohn's Disease Activity Index at diagnosis ( = 0.0204). IBD patients with allele spent fewer days in the hospital due to relapse ( = 0.0440).

Conclusion: polymorphisms are associated with the risk of developing IBD and the clinical expression of IBD. However, the clinical relevance of the differences identified is rather modest.
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http://dx.doi.org/10.3748/wjg.v27.i14.1483DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8047531PMC
April 2021

Pancreaticopleural Fistula as a Rare Cause of Both-Sided Pleural Effusion.

Case Rep Surg 2021 2;2021:6615612. Epub 2021 Mar 2.

Department of General, Endocrinological and Gastroenterological Surgery, Poznań University of Medical Sciences, Poland.

A pancreaticopleural fistula is a rare cause of pleural effusion. It is a complication of chronic or acute pancreatitis. It is rarely formed to the right or both pleural cavities. Diagnosis and proper treatment often turn out to be difficult and require the cooperation of a multidisciplinary team. The authors present the case of a 59-year-old patient treated for recurrent pleural effusion of unknown origin, first to the left and then to the right pleural cavity. After many months of treatment, the diagnosis of a pancreaticopleural fistula was made. The patient underwent surgery, which finally led to a successful complete recovery. Pancreaticopleural fistula should always be considered in patients with pleural effusion of unknown origin.
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http://dx.doi.org/10.1155/2021/6615612DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7946485PMC
March 2021

Subjective Psychophysical Experiences in the Course of Inflammatory Bowel Disease-A Comparative Analysis Based on the Polish Pediatric Crohn's and Colitis Cohort (POCOCO).

Int J Environ Res Public Health 2021 01 18;18(2). Epub 2021 Jan 18.

Department of Pediatric Gastroenterology and Metabolic Diseases, Poznań University of Medical Sciences, 60-572 Poznan, Poland.

No gold standard is available to evaluate subjective psychophysical experiences in pediatric inflammatory bowel disease (IBD). We aimed to assess pain, anxiety, and limitations in social activities at diagnosis and the worst flare of the disease in relation to clinical expression, treatment and IBD severity. A total of 376 children completed the survey (Crohn's disease (CD) n = 196; ulcerative colitis (UC) n = 180). The questionnaire included 12 questions regarding pain, anxiety, and social activity, all assessed at recruitment and retrospectively at diagnosis and worst flare using a numeric rating scale. Patients that had ever been treated with systemic glucocorticosteroids scored higher in pain ( < 0.001), anxiety ( = 0.015), and social activity domains ( < 0.016) at worst flare, and the answers correlated with the number of steroid courses ( < 0.0392). The perception of social activity limitations also correlated independently with the number of immunosuppressants ( < 0.0433) and biological agents ( < 0.0494). There was no difference in retrospective perception of pain, anxiety and social activity limitations between CD and UC patients at diagnosis and the worst flare. The level of limitations in social activity correlated with hospitalisations due to relapse, days spent in the hospital, number of relapses, and severe relapses with the strongest association of rho = 0.39 ( = 0.0004). Subjective and retrospective perception of pain, anxiety, and limitations in social activity differs depending on therapy, correlates with treatment modalities, and severity measures such as hospitalisations.
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http://dx.doi.org/10.3390/ijerph18020784DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831504PMC
January 2021

Insolation and Disease Severity in Paediatric Inflammatory Bowel Disease-A Multi-Centre Cross-Sectional Study.

J Clin Med 2020 Dec 7;9(12). Epub 2020 Dec 7.

Department of Pediatric Gastroenterology and Metabolic Diseases, Poznań University of Medical Sciences, 60-572 Poznan, Poland.

This study was to investigate whether the clinical course of inflammatory bowel disease (IBD) in a Polish paediatric cohort fits a seasonal pattern and depends on insolation. Two hundred and fourteen patients diagnosed with Crohn's disease (CD) and 192 with ulcerative colitis (UC) aged from 3 to 18 years, were recruited in seven centres of similar latitude. The seasons were defined as winter (December-February), spring (March-May), summer (June-August), autumn (September-November). The year was also divided depending on insolation threshold (3.0 kWh/m/day). Patients diagnosed with IBD when the isolation was >3 kWh/m/day had poorer nutritional status than those diagnosed while insolation was below threshold (lower standardised BMI at diagnosis (-0.81 ([-1.34]-[-0.03]) vs. -0.52 ([-1.15]-0.15); = 0.0320) and worst flare (-0.93 ([-1.37]-[-0.05]) vs. -0.66 ([-1.23]-0.17); = 0.0344), with the need for more frequent biological treatment (45.5% vs. 32.7%, = 0.0100). Patients diagnosed in winter were significantly younger at diagnosis (11.4 vs. 13.0; = 0.0180) and first immunosuppressive treatment (11.3 vs. 13.3; = 0.0109) than those diagnosed in other seasons. CD patients diagnosed in months with higher insolation spent more days in hospital than those diagnosed in months with lower insolation [4.6 (1.8-11.8) vs. 2.9 (1.3-6.2); = 0.0482]. CD patients diagnosed in summer had significantly more concomitant diseases. In patients with CD, the occurrence of the worst flare was more frequent in autumn. Furthermore, the season of birth was associated with Pediatric Crohn's Disease Activity Index at worst flare and earlier surgery. In conclusion, several clinical parameters are associated with insolation, the season of diagnosis and season of birth in the clinical course of Crohn's disease.
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http://dx.doi.org/10.3390/jcm9123957DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7762204PMC
December 2020

Endoscopic vacuum therapy with instillation (iEVT) - a novel endoscopic concept for colorectal anastomotic leak and perianal complications.

Wideochir Inne Tech Maloinwazyjne 2020 Dec 24;15(4):560-566. Epub 2020 Feb 24.

Department of General, Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland.

Introduction: Anastomotic leaks remain the most fearful complications.

Aim: We present a novel endoscopic salvage therapy known as endoscopic vacuum therapy with instillation (iEVT) as a combination of standard endoscopic vacuum therapy (EVT) and negative pressure wound therapy with instillation (iNPWT).

Material And Methods: A case series of 6 consecutive patients treated with iEVT is presented. A Redon drain and a central venous catheter were introduced within polyurethane foam used as a self- made device for iEVT and antimicrobial solution was instilled.

Results: A total of 6 patients with the mean age of 29.5 ±8.9 were treated with iEVT. The mean number of iEVT sessions was 5.8 ±2.3. The mean time of iEVT management was 20.7 ±8.8 days. Locally, a reduction in purulent discharge and defect's dimension with contraction were revealed confirmed with imaging studies.

Conclusions: iEVT is a very encouraging, novel method for complicated perianal diseases and anastomotic leak.
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http://dx.doi.org/10.5114/wiitm.2020.93204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7687668PMC
December 2020

Postoperative supplementation of propionate and silicon dioxide in patients after total gastrectomy - preliminary report.

Prz Gastroenterol 2020 19;15(3):253-257. Epub 2020 Sep 19.

Department of General, Endocrine Surgery and Gastroenterological Oncology, Poznan University of Medical Science, Poznan, Poland.

Introduction: Post-operative impairment of gastrointestinal tract function and metabolic consequences occur in patients after gastrectomy by Roux-en-Y method. Short-chain fatty acids and silicon dioxide may prove beneficial in the treatment of these conditions.

Aim: To evaluate a preparation containing propionic acid and silicon dioxide on the body weight, number of stools and their consistency (the Bristol scale), and pain and a feeling of gastric fullness after a meal, in patients after gastrectomy by Roux-en-Y method.

Material And Methods: Measurements were performed at the beginning of the study, on day 7 and 14 of application (Colostop; Miralex, 2 × 15 g/day).

Results And Conclusions: Initially the average daily number of movements was 10/day, after the therapy it was 3.8/day. At the beginning of the study, 3 patients described their faeces as type 6 and two as type 7 on the Bristol scale. After supplementation, 3 patients described stool consistency as type 5, and two as type 4. Initially, patients rated their pain at 3.4/10 on average, the stomach fullness as 4.6/10. At the end of the study, 3 patients did not feel any pain, while others reported pain at 1/10. Four patients described their feeling of gastric fullness as 1/10, and 1 no longer observed this feeling. Patients disclaimed any adverse effects, and satisfaction after therapy reached 9-10/10 points. Patients' body weight did not change significantly. An improvement in standard diet tolerance was observed. Despite the limited study group, clinical benefits of the supplementation were observed.
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http://dx.doi.org/10.5114/pg.2020.99040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509898PMC
September 2020

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

Pol Przegl Chir 2019 Oct;92(4):58-62

Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Uniwersytet Medyczny w Poznaniu.

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 stoma.
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http://dx.doi.org/10.5604/01.3001.0013.5357DOI Listing
October 2019

S-Detect Software vs. EU-TIRADS Classification: A Dual-Center Validation of Diagnostic Performance in Differentiation of Thyroid Nodules.

J Clin Med 2020 Aug 3;9(8). Epub 2020 Aug 3.

Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland.

Computer-aided diagnosis (CAD) and other risk stratification systems may improve ultrasound image interpretation. This prospective study aimed to compare the diagnostic performance of CAD and the European Thyroid Imaging Reporting and Data System (EU-TIRADS) classification applied by physicians with S-Detect 2 software CAD based on Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and combinations of both methods (MODELs 1 to 5). In all, 133 nodules from 88 patients referred to thyroidectomy with available histopathology or with unambiguous results of cytology were included. The S-Detect system, EU-TIRADS, and mixed MODELs 1-5 for the diagnosis of thyroid cancer showed a sensitivity of 89.4%, 90.9%, 84.9%, 95.5%, 93.9%, 78.9% and 93.9%; a specificity of 80.6%, 61.2%, 88.1%, 53.7%, 73.1%, 89.6% and 80.6%; a positive predictive value of 81.9%, 69.8%, 87.5%, 67%, 77.5%, 88.1% and 82.7%; a negative predictive value of 88.5%, 87.2%, 85.5%, 92.3%, 92.5%, 81.1% and 93.1%; and an accuracy of 85%, 75.9%, 86.5%, 74.4%, 83.5%, 84.2%, and 87.2%, respectively. Comparison showed superiority of the similar MODELs 1 and 5 over other mixed models as well as EU-TIRADS and S-Detect used alone (-value < 0.05). S-Detect software is characterized with high sensitivity and good specificity, whereas EU-TIRADS has high sensitivity, but rather low specificity. The best diagnostic performance in malignant thyroid nodule (TN) risk stratification was obtained for the combined model of S-Detect ("possibly malignant" nodule) and simultaneously obtaining 4 or 5 points (MODEL 1) or exactly 5 points (MODEL 5) on the EU-TIRADS scale.
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http://dx.doi.org/10.3390/jcm9082495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7464710PMC
August 2020

Determination of butyric acid dosage based on clinical and experimental studies - a literature review.

Prz Gastroenterol 2020 8;15(2):119-125. Epub 2020 Jun 8.

Clinic of Internal Diseases and Gastroenterology, Central Teaching Hospital of the Ministry of Interior and Administration (MSWiA), Warsaw, Poland.

Short-chain fatty acids produced by bacteria living in the large intestine are the main energy substrate for the colonocytes. Butyric acid is used for the treatment and prevention of exacerbations of various gastrointestinal diseases: diarrhoea, intestinal inflammations, functional disorders, dysbiosis, and post-surgery or post-chemotherapy conditions. The current standard doses of butyric acid (150-300 mg) range between 1.5-3% and 15-30% of the reported daily demand. Increased metabolism of the colonocytes in conditions involving intestine damage or inflammation, increased energy expenditure during a disease, stimulation of intestine growth in 'stress' conditions with accelerated intestinal passage and increased intestinal excretion, and decreased production of endogenous butyrate due to changes in bacterial flora in different pathological conditions require a significant increase of the supply of this acid. Physiological high demand for butyrate and known mechanisms of pathological conditions indicate that current supplementation doses do not cover the demand and their increase should be considered.
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http://dx.doi.org/10.5114/pg.2020.95556DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294979PMC
June 2020

Combined therapy: rifaximin-α and arabinogalactan with lactoferrin combination effectively prevents recurrences of symptomatic uncomplicated diverticular disease.

Pol Przegl Chir 2020 Apr;92(2):22-28

Klinika Chirurgii Kolorektalnej, Ogólnej i Onkologicznej, Centrum Medyczne Kształcenia Podyplomowego w Warszawie.

Introduction: Background: Diverticulosis is the most common finding in the GI tract. Nearly half of the people with diverticula experience symptomatic uncomplicated diverticular disease (SUDD).

Aims: The primary endpoints of our study were to assess the effectiveness of combined therapy with rifaximin-α and arabinogalactan-lactoferrin in symptom reduction and normalization of bowel movements. The secondary endpoints were an assessment of efficacy in SUDD recurrence prevention and patients' compliance to the combined therapy.

Methods: A retrospective observational survey study was performed in 2019 among physicians experienced in diverticular disease (DD) treatment in Poland. Patients with previous episodes of recurrences treated with combined therapy (cyclic rifaximin-α at least 400 mg b.i.d/7 days/every month and continuous arabinogalactan-lactoferrin supplementation 1 sachet daily) were assessed after 3 and 6 months regarding symptoms' resolution in the three-point scale. The patients' SUDD history, diagnostic methods, treatment, and results, as well as patients' compliance were evaluated.

Results: 281 patients met inclusion criteria, and were further evaluated (67.6% women, median age 65 years). After 6 months of combined treatment, there was a statistically significant reduction in the total severity score (median from 1.7 [max 3 points] to 0.26; P < 0.0001; sum from 8.5 [max 15 points] to 1.28; P < 0.0001) and improvement in each symptom score. Stool frequency statistically normalized in every group. As many as 31.7% had complete symptom resolution. Patients' compliance with the therapy was very good and good in 92.9% of cases. C onclusions and discussion: Combination therapy with cyclic rifaximin-α and continuous arabinogalactan combined with lactoferrin are effective in SUDD treatment in terms of symptom resolution, bowel movement normalization, prevention of recurrences with very good patient's compliance.
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http://dx.doi.org/10.5604/01.3001.0014.0946DOI Listing
April 2020

LapVac - a laparoscopic approach for negative pressure wound therapy application in open abdomen management: a porcine animal model.

Wideochir Inne Tech Maloinwazyjne 2020 Mar 22;15(1):112-116. Epub 2019 Jul 22.

Department of General, Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland.

Introduction: Negative pressure wound therapy (NPWT) in the open abdomen (OA) is recognized as a gold standard management method. Currently minimally invasive procedures are implemented in many clinical scenarios.

Aim: To demonstrate the feasibility of using negative pressure wound therapy in a laparoscopic approach for OA management in a porcine model termed as a laparoscopic vacuum (LapVac).

Material And Methods: An adult female swine underwent a laparoscopic procedure. Briefly, a small incision was made and secured with a wound protector, pneumoperitoneum was created and two additional ports were placed. Then, a non-adhesive layer was precisely placed within the abdominal cavity.

Results: Finally, polyurethane foam and adhesive drape were applied. A volume of 200 ml of saline solution was instilled and drained completely within 30 min. We did not observe any technical problems with NPWT application.

Conclusions: This study confirmed the technical feasibility of NPWT application in the laparoscopic approach. LapVac seems to be a promising technique which may minimize the trauma and lead to better outcomes.
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http://dx.doi.org/10.5114/wiitm.2019.86829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7020723PMC
March 2020

Endoscopic vacuum assisted closure of esophagogastric anastomosis dehiscence: A case report.

World J Gastrointest Endosc 2020 Jan;12(1):42-48

Department of General and Endocrynologic Surgery and Gastroenterologic Oncology, Poznan University of Medical Sciences, Poznan 60-355, Poland.

Background: Esophagogastric leakage is one of the most severe postoperative complications. Partial disruption of the anastomosis, can be successfully treated with an endoscopic vacuum assisted closure (E-VAC). The advantage of that method of treatment is the ability to adjust a vacuum dressing individually to the size of the dehiscence and thus to reduce the risk of a secondary fistula or abscess. The authors present two patients with postoperative gastroesophageal leakage treated successfully with E-VAC.

Case Summary: Two male patients developed a potentially life threatening esophagogastric leakage. Patient A underwent resection of the distal half of the esophagus and upper part of the stomach due to Siewert type II adenocarcinoma of the gastroesophageal junction. Proximal resection of the stomach was performed in the patient B after massive bleeding from Mallory-Weiss tears. Both patients were treated successfully with an individually adapted E-VAC with concomitant correction of fluid and electrolyte disturbances, and treatment of sepsis with appropriate antibiotics.

Conclusion: Endoscopic vacuum closure is an effective alternative to endoscopic stenting or relaparotomy. Through individual approach it allows a more accurate assessment of healing.
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http://dx.doi.org/10.4253/wjge.v12.i1.42DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939118PMC
January 2020

Efficacy of combined prophylactic therapy (rifaximine alpha + prebiotic arabinogalactan with lactofferin) on GUT function in patients with diagnosed symptomatic uncomplicated diverticular disease.

Pol Przegl Chir 2019 Aug;91(4):1-8

Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health.

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http://dx.doi.org/10.5604/01.3001.0013.4115DOI Listing
August 2019

Atypical and Life-threatening Crohn's Disease Following Colectomy: A Case Report.

Wound Manag Prev 2019 07;65(7):36-40

Poznan University of Medical Sciences, Poznan, Poland.

Although Crohn's Disease (CD) usually occurs between the second and third decade of life, it also may develop in older adults. Treating elderly patients may be challenging due to other comorbidities, including diverticular disease or intestinal ischemia.

Purpose: The purpose of this case study was to describe successful treatment of atypical and life-threatening CD due to enterocutaneous fistulas with short-bowel syndrome and multiorgan failure after partial colectomy.

Case Report: After an urgent colectomy for an inflammatory colon tumor, a 64-year-old woman with a history of CD and multiple comorbidities developed acute small bowel ischemia. Following an extended bowel resection, she developed a severe surgical site infection, entero- and gastrocutaneous fistulas, multiorgan failure, and short bowel syndrome. Her care included intensive medical and nutritional treatment as well as negative pressure wound therapy (NPWT) using continuous negative pressure of -80 mm Hg. She not only survived, but she also achieved complete wound closure and restoration of digestive tract continuity and metabolic control. She was discharged with a central venous catheter on total parenteral nutrition.

Conclusion: In this case study, a good outcome was observed using intensive medical treatment, nutritional therapy, and conservative surgical treatment that included NPWT for a patient with CD and major comorbidities who developed postoperative complications.
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July 2019

Lactose intolerance, lactose malabsorption and genetic predisposition to adult-type hypolactasia in patients after restorative proctocolectomy.

Acta Biochim Pol 2019 May;66(2):173-175

Poznań University of Medical Sciences, Department of Paediatric Gastroenterology and Metabolic Diseases, Poznań, Poland.

This study provides up-to-date findings on lactose malabsorption, lactose intolerance and genetic predisposition to adult-type hypolactasia in 72 patients after restorative proctocolectomy (RPC). The lactose malabsorption was assessed by hydrogen-methane breath test. Genetic predisposition to adult-type hypolactasia was assessed by detecting -13910T/C polymorphism in the lactase gene. Lactose intolerance was more frequent in UC (ulcerative colitis) patients than FAP (familial adenomatous polyposis) patients (77.5% vs. 55.2%; p=0.01). The C/C genotype of the lactase gene was observed in 39.1% subjects with no significant difference between UC and FAP patients. Lactose malabsorption occurred in 10.1% of subjects and almost only in patients with genetic predisposition, with the same frequency in UC and FAP patients.
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http://dx.doi.org/10.18388/abp.2018_2730DOI Listing
May 2019

Cyclic rifaximin therapy effectively prevents the recurrence of symptoms after exacerbation of symptomatic uncomplicated diverticular disease: a retrospective study.

Prz Gastroenterol 2019 12;14(1):69-78. Epub 2019 Mar 12.

Department of Oncological Gastroenterology, Maria Sklodowska-Curie Memorial Cancer Centre, Institute of Oncology, Warsaw, Poland.

Introduction: Symptomatic uncomplicated diverticular disease (SUDD) is the most common manifestation of diverticulosis. Data concerning the optimal treatment after SUDD exacerbation are inconsistent.

Aim: To assess the effectiveness and necessity of cyclic rifaximin treatment for recurrent SUDD symptoms and for preventing exacerbations in patients who responded to the initial treatment.

Material And Methods: A retrospective observational study was performed in 2017. Physicians responded to a survey on patients with recurrent SUDD during the observation period, who were cyclically treated with rifaximin 400 mg for 7 days per month. The patients' SUDD history, diagnostic methods, treatment, and results were evaluated.

Results: In total 294 patients were included in this study (67% women, median age: 65 years (26-87)). The mean duration of diverticular disease (DD) was 4.5 years (1-20), and 88% had at least one repeated episode of SUDD exacerbation before rifaximin. A total of 267 patients were treated with rifaximin. Changes in the severity of pain, abdominal tenderness, diarrhoea, constipation, and bloating were assessed every 2 months. After 6 months of rifaximin treatment there was a statistically significant reduction in the total severity score (median from 1.8 (max. 3 points) to 0.2; < 0.0001; sum from 9.37 (max. 18 points) to 1.35; < 0.0001) and an improvement in individual symptom score.

Conclusions: Cyclical rifaximin is effective in treating exacerbation of SUDD. This regimen leads to a gradual cessation of symptoms over a 6-month period. In patients who responded to the initial treatment, cyclic rifaximin therapy is needed to maintain remission.
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http://dx.doi.org/10.5114/pg.2019.83428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6444108PMC
March 2019

Treatment of Crohn's anal fistulas guided by magnetic resonance imaging.

Prz Gastroenterol 2019 12;14(1):55-61. Epub 2019 Mar 12.

Department of General and Endocrinological Surgery, and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland.

Introduction: Clinical evaluation of the Crohn's anal fistulas (CF) closure is inadequate to some extent due to earlier closure of cutaneous openings compared to fistulous tracts. There is a need for a more accurate method of assessment.

Aim: To compare clinical signs of CF with radiological findings, before and after treatment, to follow complete closure.

Material And Methods: It was a retrospective study of 23 patients suffering from CF admitted to a single specialist centre, who were treated with a combination of surgical and biological therapy. Fistula healing was evaluated with fistula drainage assessment classification (FDA), perianal disease activity index (PDAI), and van Assche magnetic resonance imaging score (MRI) before and 3 months after surgery and induction of the biological treatment.

Results: Clinical response occurred in 13 (57%) patients 3 months after induction treatment. Complete clinical response was achieved in 8 (35%) patients, whereas partial response occurred in 5 (22%) patients. Persistence of a fistula tract was visualised on MRI in 4 (50%) patients with clinical closure.

Conclusions: The healing process of CF should be monitored by MRI due to the discrepancy between premature closure of external openings and fistulous tracts. Prolonged biological therapy until complete healing of anal fistulas confirmed on MRI might improve the results of treatment.
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http://dx.doi.org/10.5114/pg.2019.83426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6444106PMC
March 2019

Statement of the expert group on the current practice and prospects for the treatment of complex perirectal fistulas in the course of Crohn's disease.

Pol Przegl Chir 2019 Feb;91(1):38-46

II Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego, Uniwersytet Medyczny w Lublinie.

Perirectal fistulas in the course of Crohn's disease (CD) constitute an important problem in this group of patients. They are observed in a vast majority of patients with involvement through colorectal inflammation. Perirectal fistulas in CD present a great diagnostic and therapeutic challenge due to the intensified clinical symptoms and worse prognosis than in the case of crypt originating fistulas. The condition for implementation of effective treatment of perirectal fistulas in the course of CD is the correct diagnosis, defining the anatomy of fistulas, presence of potential stenoses and inflammation in the gastrointestinal tract. Treatment of these fistulas is difficult and requires close cooperation between the colorectal surgeon and the gastroenterologist. The combination of surgical and pharmacological treatment has higher efficacy compared to surgical treatment or pharmacotherapy alone. In conservative treatment, aminosalicylates and steroids are of minor importance, while chemotherapeutics, antibiotics, and thiopurines find application in daily clinical practice. TNF-α neutralizing antibodies such as infliximab (IFX), adalimumab (ADA) or certolizumab (CER) prove to be the most effective. Surgical treatment may be provided as ad hoc; in this case, drainage procedures are recommended, usually with leaving a loose seton. Planned procedures consist in the excision of fistulas (simple fistulas) or performing more complex procedures, such as advancement flaps or ligation of the intersphincteric fistula tract Surgical measures can be complemented by the use of video technology (video-assisted anal fistula treatment VAAFT) or vacuum therapy. In extreme cases, it may be necessary to create the stoma. Treatment of perirectal fistulas includes adhesives or so-called plugs. High hopes may be associated with the introduction of stem cells into clinical practice, which is the administration of non-hematopoietic multipotent cells to the fistulas to induce the phenomenon of immunomodulation and tissue healing.
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http://dx.doi.org/10.5604/01.3001.0013.0593DOI Listing
February 2019

Role of Vacuum-Assisted Closure in the Management of Crohn Anal Fistulas.

Adv Skin Wound Care 2019 Jan;32(1):35-40

At the Poznań University of Medical Sciences in Poznań, Poland, Jacek Hermann, PhD, is Chair, Department of General and Endocrine Surgery and Gastroenterologic Oncology; Tomasz Banasiewicz is Chair, Department of General and Endocrine Surgery and Gastroenterologic Oncology; and Barbara Kołodziejczak, PhD, is Chair, Department of Computer Science and Statistics. The authors have disclosed no financial relationships related to this article. Submitted January 28, 2018; accepted in revised form May 25, 2018.

Background: Patients with Crohn disease-related anal fistulas are treated with debridement of fistulous tracts and the placement of noncutting setons (NCSs). However, to reduce the high recurrence rate, there is still a need to develop more effective treatment methods.

Objective: To compare NCS with vacuum-assisted closure (VAC) treatment.

Methods: Medical records of 47 patients with Crohn anal fistulas were retrospectively evaluated. They were divided into two groups (I, VAC; II, NCS), consisting of 24 and 23 patients, respectively. The fistulas in the former group were applied with VAC, whereas NCSs were placed in the latter group. Fistula healing was evaluated with the Fistula Drainage Assessment classification, Perianal Disease Activity Index, and the van Assche MRI-Based Score.

Results: There was a significant difference (P = .006) between the groups; closure of all fistulas at 6 months after treatment was achieved in 18 patients (75%) from group 1, compared with 8 patients (35%) from group 2. Partial response occurred in five patients (21%) from group 1 and in five patients (22%) from group 2. Closure of fistulous tracts was visualized via MRI in nine patients (37.50%) from group 1, more than twice as many patients as from group 2.

Conclusions: Because preliminary results of the study showed a high rate of closure after application of VAC to Crohn anal fistulas, this method might be considered a novel sphincter-saving procedure.
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http://dx.doi.org/10.1097/01.ASW.0000547411.16017.58DOI Listing
January 2019

One-shot dalbavancin infusion combined with vacuum-assisted closure of Crohn's anal fistulas.

Turk J Gastroenterol 2019 01;30(1):114-115

Department of General, and Endocrynologic Surgery, and Gastroenterologic Oncology, Poznań University of Medical Sciences, Poznań, Poland.

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http://dx.doi.org/10.5152/tjg.2018.17829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6389299PMC
January 2019

The course and delivery of a pregnancy in a patient with autoimmune hepatitis complicated by cirrhosis of the liver.

Ginekol Pol 2018 ;89(6):339-340

Division of Reproduction, Department of Obstetrics, Gynaecology and Gynaecological Oncology, Poznan University of Medical Sciences, Poland, Polna 33 St., 60-535 Poznan, Poland.

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http://dx.doi.org/10.5603/GP.a2018.0058DOI Listing
November 2018

Checklist in colorectal surgery - proposal of experts of the Polish Club of Coloproctology and National Consultant in general surgery.

Pol Przegl Chir 2017 12;89(6):44-49

Second Department of General, Gastroenterological and Digestive System Tumor Surgery, Medical University of Lublin, Lublin, Poland.

A checklist is a collection of information that helps reduce the risk of failure due to limitations in human memory and attention. In surgery, the first Surgical Safety Checklist (SSC), created under the supervision of WHO (World Health Organization), was established in 2007 and covers three stages related to the patient's stay in the operating theater and operation: 1. Prior to initiation (induction) of anesthesia; 2. before cutting the skin; 3. before the patient leaves the operating room Colorectal surgery is particularly at high risk for complications and relatively high mortality. Elimination or, more likely, reducing the risk of complications by standardizing perioperative procedures may be particularly important in this group. The introduction of "dedicated" colorectal checklist surgery seems to be justified. The checklist proposed by the authors in colorectal surgery is divided into four stages, in which conscientious completion of checklists is intended to reduce the potential risk of complications due to hospitalization and surgical treatment. The presented checklist is obviously not closed, as a new publications or recommendations appear, some points may be modified, new issues may be added to the checklist. At present, however, it is a tool considering the well-known and confirmed elements of intraoperative procedures, the compliance of which may significantly reduce the rate of adverse events or surgical complications.
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http://dx.doi.org/10.5604/01.3001.0010.6755DOI Listing
December 2017

A novel model of acellular dermal matrix plug for anal fistula treatment. Report of a case and surgical consideration based on first utility in Poland.

Pol Przegl Chir 2017 Aug;89(4):52-55

Department of General, Gastroenterological and Endocrinological Surgery, Poznan University of Medical Sciences, Poznan, Poland.

Anal fistula (AF) is a pathological connection between anus and skin in its surroundings. The main reason for the formation of anal fistula is a bacterial infection of the glands within the anal crypts. One of the modern techniques for the treatment of fistulas that do not interfere with the sphincters consists in implantation of a plug made from collagen material. We are presenting the first Polish experience with a new model of biomaterial plug for the treatment of anal fistula. We also point out key elements of the procedure (both preoperative and intraoperative) associated with this method. In the authors' opinion, the method is simple, safe and reproducible. Innovative shape of the plug minimizes the risk of its migration and rotation. It also perfectly blends with and adapts to the course and shape of the fistula canal, allowing it to become incorporated and overgrown with tissue in the fistula canal. The relatively short operation time, minor postoperative pain and faster convalescence are with no doubt additional advantages of the method. Long-term observation involving more patients is essential for evaluation of the efficacy of the treatment of fistulas with the new type of plug.
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http://dx.doi.org/10.5604/01.3001.0010.3912DOI Listing
August 2017

Butyric acid - a well-known molecule revisited.

Prz Gastroenterol 2017 13;12(2):83-89. Epub 2017 Jun 13.

Department of Internal Medicine and Gastroenterology, Division of Inflammatory Bowel Diseases, Central Clinical Hospital of Ministry of Internal Affairs and Administration, Warsaw, Poland.

The properties of butyric acid, and the role it plays in the gastrointestinal tract, have been known for many years. However, the newest research shows that butyric acid still remains a molecule with a potential that has not as yet been fully exploited. The article provides an outline of relevant up-to-date knowledge about butyric acid, and presents the expert position on the clinical benefits of using butyric acid products in the therapy of gastrointestinal diseases.
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http://dx.doi.org/10.5114/pg.2017.68342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497138PMC
June 2017
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