Two-millimeter minisite mini-laparoscopy for rescue of dysfunctional continuous ambulatory peritoneal dialysis catheters.

In addition to peritonitis, mechanical outflow obstruction is the most common complication of continuous ambulatory peritoneal dialysis. If conservative methods are unsuccessful, the insufficient catheter must be placed in the right position or freed surgically. Currently, laparoscopy appears to be the method of choice in these cases. "Standard" laparoscopy using 10- and 5-mm ports can lead to dialysate wound leakage. Two-mm mini-laparoscopy was employed in three cases with good results. In two patients, catheters are still patent (after 19 and 23 months), and in one patient, the catheter had to be replaced after 5 weeks. No postoperative complications occurred. In some cases of catheter dislodgement or wrapping, mini-laparoscopy using a 2-mm MiniSite device can replace open surgery and even "standard" laparoscopy.

[Prospective evaluation of treatment results while using surgical esophageal devascularization and transection for esophageal varices]. / Prospektywna ocena wyników leczenia zylaków przelyku przy zastosowaniu operacji dewaskularyzacyjnych i transekcji przelyku.

During the years 1979-1996 over 300 patients aged 2-71, with esophageal varices had been treated in our Clinic. In 104 cases extended gastroesophageal devascularization and esophageal transection combined with splenectomy was performed. According to Child-Pugh's classification 60 patients (58%) were qualified to group A and B, 44 (42%)-to group C. In 61 cases (59%) the operations were carried out electively, in 30 (29%)-as an emergency and in the remaining 13 (12%)-prophylacticly. In all cases the operation was successful in controlling preoperative variceal bleeding. Postoperative mortality amounted in 20 cases (19%): in Child's group A and B-10% and in group C-32%. The highest mortality rate was noted in group C patients operated emergently (38%). The main cause of death was developing hepatic failure (18 cases) and esophageal fistula in the remaining 2. Recurrence of esophageal varices was observed in 4 patients (4%) and the recurrence of variceal bleeding in 3 of them (3%). In other 3 cases recurrent bleeding was caused by acute mucosal lesions in the stomach. No cases of postoperative encephalopathy have been observed. Follow-up period ranged from 2 months to 15 years (mean 6.5 years) and actuarial survival-67 patients (64%). In our opinion esophageal transection with extended gastroesophageal devascularization is an effective method of controlling variceal hemorrhage, with very low recurrence rate and allows to avoid postoperative encephalopathy.

[Evaluation of esophageal motility after its resection and extensive devascularization]. / Ocena motoryki przelyku po jego transekcji polaczonej z rozlegla dewaskularyzacja.

UNLABELLED: Almost complete lack of information concerning esophageal motility after non-shunt operations due to bleeding esophageal varices was the main stimulus of this study. Thirty seven patients from 112 treated for bleeding esophageal varices in our Clinic in the years 1993-1997, were studied. To evaluate esophageal parameters the Autronic GmbH D-7500 pH-meter, and from 1995, the Microdigitrapper 2 MB (Synectics) System were used. The latter enables 24-hour, simultaneous pH and pressure measurements. In patients before operation, and those who did not undergo surgery (24 measurements), reflux occurred in 14 (58%). In 10, the varices were qualified to gr. III and IV according to Paquet's classification. Five cases of mixed (supine/upright) reflux was observed. Among 9 patients subjected to previous sclerotherapy, 4 had reflux. Ph parameters in 14 patients examined before and after operation did not differ significantly. 24-hour pressure monitoring was performed in 24 patients. Eight were examined before and after operation. All pre and postoperative results were compared. No statistic differences were found. CONCLUSION: 1. Gastroesophageal reflux is frequent in cirrhotic patients with varices, and concerns over 50% of them. 2. No significant differences between pre and postoperative results, suggest that extensive devascularisation and esophageal transection do not affect esophageal motility significantly. 3. 24-hour combined pH and manometry is an extremely helpful method of obtaining objective motility data.

[Changes in portal circulation after esophageal transection]. / Zmiany w krazeniu wrotnym po transekcji przelyku.

UNLABELLED: 104 patients with hepatic cirrhosis and esophageal varices were treated between 1979 and 1996 using the modified Sugiura (Hirashima) procedure. In 60 cases (18 F, 42 M) portal hemodynamics (portal blood velocity (PBV) and portal blood flow (PBF)) were investigated using Doppler-USG method. In 40 cases a prospective study before operation, 2 weeks, 3 months after operation and then in 6-month intervals was completed. In 20 patients the study was done 18 months to 7 years after operation only. The control group comprised 20 healthy volunteers. Mean PBV before operation was 17.5 +/- 1.2 cm/s, 2 weeks after surgery-14.2 +/- 1.0 and 3 months after operation 15.1 +/- 0.9 cm/s, mean PBF: 1211 +/- 124 ccm/min, 987 +/- 97 ccm/min and 1179 +/- 92 ccm/min respectively. The observed decrease of PBV and PBF was not significant. In the late postoperative period mean PBV was 14.0 +/- 1.2 cm/s and PBF 1077 +/- 99 ccm/min. We observed portal vein thrombosis in 4 cases before the operation and 7 new cases after operation. In 3 of them the recanalization of portal vein trunk was noted in further investigations. CONCLUSION: Extended gastroesophageal devascularization, splenectomy and esophageal transection (Hirashima procedure) does not result in significant decrease of portal blood velocity and portal blood flow. The hemodynamic effect of this operation is stabile in the observation period 1.5 to 7 years.

[Diagnosis of pancreatic neoplasm--possibilities and limitations]. / Diagnostyka raka trzustki--mozliwosci i ograniczenia.

75 consecutive patients treated for pancreatic cancer were submitted to prospective trial. 1 to 12 weeks passed from the onset of symptoms before diagnosis was established. 61 (81%) patients were admitted due to symptoms and 14 (19%)--due to USG findings. Sensitivity and selectivity of imaging techniques was as follows: USG-87% and 73%, ERCP-72% and 72%, CT-100% and 82% respectively. Staging of the lesions estimated by CT (AJCC/TNM scale) 34 patients qualified as stage I, 15 as stage II, 14 as III and 12 as stage IV. Surgery was undertaken in 71 patients and resective procedures in 32 of them (43%). The final diagnosis was established by one biopsy in 21 patients, and in the further 8 cases 2-3 biopsies were necessary. In 3 cases cancer cells were found only during histological examination of the whole resected specimen. The follow up in resected group was 1-30 months. One year survival was 72%, actuarial survival is 38%.

[Results of reconstructive surgery for bile duct injury]. / Wyniki operacji naprawczych w kalectwie dróg zólciowych.

The results of the treatment of 51 patients operated on for iatrogenic bile duct injuries are presented. 65 reconstructive operations were performed. In 92% of the cases the injury was causes during cholecystectomy, in 8% - it happened during gastric resection. According to Bismuth's classification, 2 patient demonstrated type I injury, 13 - type II, 21 - type III, 10 - type IV, and 3 - type V. The choice of reconstructive method depended on the type of injury and the local situation. Consequently 37 hepatic-jejunostomies were performed (classic method - 17x, the mucosal-graft - 18x, Allen's method modified by Galperin - 1x, Hepp-Couinaud's - 1x), 8 hepatic-duodenostomies, 2 - Longmire-Sanford method, 4 choledocho-duodenostomies. Recurrence of structure in anastomosis place were noted after 11 procedures, but no one were observed after mucosal-graft reconstruction.

[Repeated laparotomy for acute necrotizing pancreatitis]. / Powtarzana laparostomia w zakazonej martwicy trzustki.

In the period of 1984-1996, 569 patients were treated for acute pancreatitis and 37 of them (6.5%) developed infected pancreatic necrosis (IPN). All these patients were submitted to repeated laparotomies according to Bradley's procedure. The IPN was caused by: bile duct stones--in 11 cases, alcohol abuse-14, ERCP-6, trauma-1, in 6 cases the etiology was cryptogenic. The accuracy of imaging tests was: USG-62%, CT-100%. Sepsis was present in all cases, and multiorgan insufficiency-in 25 patients. Hospital mortality was 30% (11 patients). The most frequent reason of death was multiorgan insufficiency. The actuarial survival was 26 patients (70%).

[Development of renal transplantation in the Gdansk center]. / Rozwój transplantacji nerek w osrodku Gdanskim.

The kidney transplantation is one of the renal replacement therapy methods, which prolongs live of the patients with the end stage renal disease for many years. Moreover, this method is well known, safe and not so expensive as dialysotherapy. Our purpose was to present the 15-year activity of the transplantation center in Gdansk. The first renal transplantation took place on the 31st of March 1980 and there have been 137 renal transplantations in Gdansk until now. We can divide the time between the 31st of March 1980 and the end of 1994 into two periods: I from 31.03.80 to 31.12.89 and II from 1991 to 1994. During the first were 46, and during the second were 91 renal transplantations performed. It means that since the second half of 1991 the activity of the center in Gdansk has increased. The graft function was noted in 29 patients (63%) during the first period and in 75 (82%) during the second. The acute graft failure was observed in the most of the cases mentioned above. The 5-year living of the transplanted patients and the dialysed patients is comparable and amounts to 90%. Infections were the main reason of death during the first period, and cardiovascular complications during the second. The 5-year graft's functioning is 60%. Nowadays the results of the kidney transplantation center in Gdansk are good and comparable with the results of other centers in Poland and Europe. Our center, as similar ones in Poland is prepared to extend the kidney transplantation activity. So it is necessary to intensify an effort to gain more organs for transplantations.