Analysis of the influence of selected protein markers as markers of nutritional status and inflammation on the occurrence of eventration after laparotomy.

<b><br>Introduction:</b> Eventration is a fairly rare complication after laparotomy, which consists of postoperative wound dehiscence and protrusion of the viscera outside the abdominal cavity. This complication is associated with a higher mortality rate. The known risk factors for this condition include malnutrition and the coexistence of inflammation or cancer.</br> <b><br>Aim:</b> The main aim of the study was to investigate the relationship between the occurrence of eventration after laparotomy and the patient's nutritional status with the intensity of inflammatory processes, expressed using selected protein markers.</br> <b><br>Material and method:</b> The study was based on the analysis of patients treated at our own center from January 2014 to December 2020. It included a group of patients who underwent laparotomy and who experienced eventration, as well as a control group of patients who underwent laparotomy but did not experience eventration after the procedure.</br> <b><br>Results:</b> The analysis showed that a lower serum albumin concentration is associated with a greater risk of eventration in patients who have undergone laparotomy due to acute abdominal disease. The study group and the control group differed significantly in the levels of: Hgb, serum total protein, CRP, lymphocytes, albumin, PCT, NRS.</br>.

Repair of postpneumonectomy bronchopleural fistula using pedicled pericardial flap supported by fibrin glue.

Effective closure of the postpneumonectomy bronchopleural fistula (PBF) with the use of different techniques still remains a challenge for thoracic surgeons. The aim of this study was to evaluate the efficacy of modified method of PBF closure using pedicled pericardial flap (PPF) supported by fibrin glue (FG). The efficacy of the late PBF closure with the use of two surgical methods was compared. In 10 patients, the edges of the PBF were covered with FG and PPF. In the second group of nine patients, myoplasty was used to close the bronchial fistula. Postsurgical follow-up was for 1 year. In the first group, the healing of the fistula was achieved in 100% of the cases, whereas in the second, myoplasty group, healing was achieved in only 66·67% of the cases. The number of complications was similar in both groups. Pericardial flap supported by fibrin glue can be an effective method adjunctive to the treatment of PBF in selected patients.

Pericardial flap: an effective method of surgical repair of late post-pneumonectomy fistula.

BACKGROUND: We report our experience with the surgical closure of late post-pneumonectomy bronchopleural fistula (PBF) using our own method of coverage of the bronchial stump: Pedicled pericardial flap in combination with fibrin glue. METHODS: We reviewed the surgical results of 33 patients who underwent surgical closure of PBF by thoracotomy access using three methods: Myoplasty (MYO)-12, omentoplasty (OMT)-10, and pedicled pericardial flap (PPF) with fibrin glue-11. Post-operative follow up was six months. RESULTS: The patients' demography was comparable among the groups. The diameter of the fistulas ranged from 5 mm to total dehiscence. The mean time of the fistula manifestation (in weeks) was 21.5 in the MYO group, 19.50 in the OMT, and 20.1 in the PPF group. The shortest period of hospital drainage of the pleural space was noted in the PPF group. Healing of the fistula was obtained in 66.67% in the MYO group, 80% in the OMT, and 100% in the PPF group. The number of complications was similar in all groups. The hospitalization time was significantly shorter in the PPF group (13.00 d) versus the MYO group (19.58 d) and the OMT (20.01 d). Overall mortality rate was 18.18%; 33.33% of the patients in the MYO group and 20% in the OMT group died. There were no hospital deaths in the PPF group. CONCLUSION: Pericardial flap supported by fibrin glue can be an effective method adjunctive to the treatment of postpneumonectomy PBF in selected patients. Compared with other methods of bronchial stump coverage (omentopasty and myoplasty), this one showed a higher percentage of healing of the fistulas and shorter duration of hospital drainage and hospitalization.

[Analysis of complications after laparoscopic cholecystectomy on the basis of our thirteen-years experience]. / Analiza powiklan cholecystektomii laparoskopowej na podstawie trzynastoletnich doswiadczen wlasnych.

UNLABELLED: The objective of study is to present and discuss complications observed in our patients after laparoscopic cholecystectomy throughout nine years of using this technique. MATERIAL AND METHODS: Between 1992 and 2003, 3146 laparoscopic cholecystectomies were performed in our clinic for symptomatic or complicated cholecystolithiasis. The number of laparoscopic cholecystectomies (LC) increases constantly compared to open cholecystectomies (OC). At the beginning the ratio of LC to OC was 1:20, then 1:1, for a short time, and it is 10:1 presently. Approximately 280 LC and merely 30 OC are carried out in our clinic annually. RESULTS: The most common complications of LC in our material were suppuration of a infraumbilical wound (23) and umbilica hernia (14). A common bile duct injury was observed in nine cases and intraoperative haemorrhage in 11 patients. Infrahepatic abscess (2), bile peritonitis (2), digestive tract injury (1) and abdominal wall haemorrhage (1) appeared rarely. Conversion into an open technique had to be done in 91 cases (2.89%) but only in 34 cases due to intraoperative complications. No deaths connected with LC were observed. CONCLUSIONS: The number of complications after laparoscopic cholecystectomy is not higher than after open cholecystectomy. Laparoscopic cholecystectomy is a save operative technique in the hands of an experienced surgeon.

[The assessment of hepatic portal flow using Doppler's technique in patients after laparoscopic cholecystectomy]. / Ocena watrobowego przeplywu wrotnego metoda Dopplera u chorych po cholecystektomii laparoskopowej.

UNLABELLED: A decrease in hepatic portal flow was observed within two days after open cholecystectomy but such an analysis was not done for laparoscopic cholecystectomy. OBJECTIVE: To answer the following problems: 1. Is there any difference between the volume of hepatic portal flow in patients with cholecystolithiasis and without it. 2. Does hepatic portal flow change within two days after laparoscopic cholecystectomy compared with its preoperative value. MATERIAL AND METHODS: 30 patients without hepatic parenchyma diseases were qualified for the study (21 cases of cholecystolithiasis and 9 cases without cholecystolithiasis). In the group of patients with cholecystolithiasis a maximal portal velocity (Vmax) was measured by Doppler's technique and the diameter of the portal vein (D) before laparoscopic cholecystectomy and 1 and 2 days postoperatively. In the group without cholecystolithiasis these values were measured once. On the basis of Vmax a mean velocity (Vmean = 0.57 x Vmax) of portal flow was calculated. Using Vmean and D values a volume of portal flow was calculated. RESULTS: A mean hepatic portal flow volume in patients with cholecystolithiasis was 725+/-187 ml/min and without it 792+/-229 ml/min. The difference between these values was not statistically significant. No statistically significant differences were also found between values of preoperative and postoperative hepatic portal flow volume. CONCLUSIONS: No statistically significant difference was found between hepatic portal flow volume in patients with and without cholecystolithiasis. Hepatic portal flow does not change significantly within 2 days after laparoscopic cholecystectomy.

[The results of treatment of acute haemorrhagic necrotizing pancreatitis in the own material]. / Wyniki leczenia martwiczo-krwotocznej postaci ostrego zapalenia trzustki w materiale wlasnym.

AIM OF WORK: The retrospective estimation of surgical procedure and the results of treatment of haemorrhagic necrotizing pancreatitis in the own material. MATERIAL AND METHODS: The estimated group consist of 161 patients from the clinic treated for heavy grade of acute pancreatitis. Characteristics which qualified patients to the chosen group were: aggravating general condition, biochemical parameters of disease's progression, results of radiological investigations (USG, CT of abdomen) and bacteriological culture from peritoneal cavity. RESULTS: 142 patients (88.2%) were surgically treated in different duration periods of illness (from 0 to 53 day of illness). Firstly, they were intensively treated with conservative treatment. After about 9.6 days they were operated on (from 0 to 51 day of treatment). Clinical symptoms such as: rapid aggravating general condition of patients, septic shock, as well as infected necrosis in radiological and bacteriological investigations, were indication to surgical intervention. The methods of surgical treatments were: laparotomy and flow drainage 73 patients, closed drainage 31 patients, repeated relaparotomy 25, Bradley's method 13. Mortality in the group of operated patients was 5.9%. The most common causes of death were: respiratory insufficiency 29.4%, multiorgan insufficiency 21.6%, circulatory insufficiency 13.8%, insufficiency of kidneys 9.8% CONCLUSIONS: The authors suggest that the most important in deciding about necessity and time of surgical intervention of haemorrhagic necrotizing acute pancreatitis are individual clinical characteristics of patients. The lowest mortality was in the group of operated patients in later period of illness and who did not required reoperation.