Guidelines for treatment of esophageal atresia in the light of most recent publications.

INTRODUCTION: Esophageal atresia is a congenital anomaly well known in the community of pediatric surgeons. Nonetheless some aspects of management remain vague and societies of gastroenterologists as well as surgeons have been gathering to determine pertinent ways to handle this condition. To make ground for unification, the guidelines of some most important societies were compared and gathered in one review. MATERIALS AND METHODS: Literature review of online databases of the PubMed and the Cochrane Library with (o)esophageal atresia, guidelines and follow-up used as keywords. RESULTS: Over the course of the last few years there was a lot of effort invested in making clear and accurate guidelines for management of EA, largely with good results. In the majority of important matters, opinions of specialists were consistent or complementary to each other. Because some of them described different phases of management, gathering them together led to obtaining the wider picture, which can help pediatric surgeons in making decisions while treating the patients with EA. CONCLUSION: There is a necessity for careful following guidelines which have been changing quite fast along with new significant publications about EA. Some concerns remained debatable and their accentuation in this review was made to bring awareness to vague issues, such as postoperative antibiotic prophylaxis or duration of administering PPI. Additionally structured follow-up programs for the first 18 years and after reaching maturity should be made.

Adulthood of patients after oesophageal atresia repair- General Surgeon's Guide.

Introduction Despite proper surgical management in neonatal period, congenital oesophageal atresia [OA] may present serious source of lifelong disorders. The objective of our study is to present the most important facts about oesophageal atresia, types of treatment and possible complications which might demand surgical management in adult life. We would like to familiarize general surgeons with this matter to provide OA patients with proper medical care. Materials and Methods We made a thorough literature review of Medline database and Cochrane Library with "(o)esophageal atresia", "long gap", "surgery" and "follow-up" used as keywords. Results Long-term observation reveals that patients with OA may need help from general surgeons, however do not often look for it. Even after surgical repair in neonatal period, OA indispose to multiple concomitant disorders including gastroesophageal reflux disease, oesophagitis, strictures, epithelial metaplastic changes in the oesophagus or hiatal hernia development. Endoscopic follow-up should be systematically performed in OA patients' population in order to early detection of possible pathologies. Discussion Advancement in medicine allowed to improve survival rates and adulthood is reached more often in population of OA patients. In the face of variety of concomitant problems, systematic long-term follow-up seems to be crucial in proper medical care in these patients.

Gender as a predictive factor in cholecystectomy - is it true or false?

INTRODUCTION: Cholecystolithiasis is one of the most frequent disorders of the human digestive system in a present population. It is common to point out that male gender is one of strong risk factors for complications during cholecystectomy, however the debate about that seems to be still open. AIM OF THE STUDY: The aim of this study was to compare the values related to the course and treatment effects between gender in patients undergoing cholecystectomy, based on own material. MATERIALS AND METHODS: The study encompassed 504 patients who were admitted to General Surgery And Polytraumatic Injury Department of University Hospital in Kraków, Poland between 2013 and 2018, with the initial diagnosis of cholecystolithiasis (scheduled cases) and acute cholecystitis (emergency cases). The patients underwent surgical gallbladder removal. In this group there were 326 (64.7%) female and 178 (35.3%) male patients. RESULTS: Statistically significant differences between both genders were found containing age, type of admission, numeric rating scale of pain during admission, results in American Society of Anesthesiologists physical status classification system, outcomes in Acute Physiology And Chronic Health Evaluation II severity-of-disease classification system, percentage of conversions, mortality, period of time from admission to surgical procedure, mean duration of the procedure, blood tests and histopathological results. CONCLUSIONS: Subgroups of the cases where determining factor is gender are strongly heterogeneous. Although treatment results were different for both subgroups and these differences were partly statistically significant, it cannot be clearly determined on the basis of a study with such selection of patients, that gender is an independent risk factor for surgical gallbladder removal.

In pursuit of COVID-19 surgical risk stratification to manage a limited workforce and supplies in minimally invasive surgery.

The protective barriers used so far in surgery do not provide adequate protection against SARS-CoV-2 virus, and reinforced protective equipment is needed. The rapid increase in the number of patients and the worldwide panic associated with the increasingly low availability of protective equipment has resulted in a shortage of protective equipment in many hospitals. Appropriatepersonal protective equipment must be provided so that the surgical team proceeding to surgery is not excluded from the further struggle for patients' health, especially in MIS. Reckless and excessive use of maximum protective equipment may result in a severe shortage of these products when the number of infected persons requiring surgery increases. The use of a structured infection risk scheme for medical staff, depending on the results of reverse transcription polymerase chain reaction assays and COVID-19 symptoms, combined with the division of protection equipment into three groups, allows easy selection of an appropriate clothing scheme for the clinical setting.

Guidelines for the management of surgical departments in non-uniform hospitals during the COVID-19 pandemic.

In the last several weeks we have been witnessing the exponentially progressing pandemic SARS-CoV-2 coronavirus. As the number of people infected with SARS-CoV2 escalates, the problem of surgical management of patients requiring urgent surgery is increasing. Patients infected with SARS-CoV2 virus but with negative test results will appear in general hospitals and may pose a risk to other patients and hospital staff. Health care workers constitutes nearly 17% of infected population in Poland, therefore early identification of infected people becomes a priority to protect human resources and to ensure continuity of the access to a surgical care. Both surgical operations, and endoscopic procedures are considered as interventions with an increased risk of infection. Therefore, determining the algorithm becomes crucial for qualifying patients for surgical treatment, but also to stratify the risk of personnel being infected during surgery and to adequately protect staff. Each hospital should be logistically prepared for the need to perform urgent surgery on a patient with suspected or confirmed infection, including personal protective equipment. Limited availability of the equipment, working under pressure and staff shortages in addition to a highly contagious pathogen necessitate a pragmatic management of human resources in health care. Instant synchronized action is needed, and clear uniform guidelines are essential for the healthcare system to provide citizens with the necessary surgical care while protecting both patients, and staff. This document presents current recommendations regarding surgery during the COVID-19 pandemic in Poland.