[Palliative bypass surgery]. / Bypasschirurgie zur Palliation.

Impaired intestinal passage considerably reduces quality of life irrespective of the underlying condition. Limited life expectancy and increased operative risk of advanced malignant disease add particular weight to this issue. The indication for operative therapy results from carefully weighing individual incapacity and potential gain vs operative risk and life expectancy. Exactly because life expectancy is quite limited, selection of an effective, low-risk procedure is of utmost importance to benefit the patient.

[The modified laparostomy with the use of ultrasound dissector and garamycin sponge in the treatment of complicated acute pancreatitis]. / Zmodyfikowana laparostomia z zastosowaniem dyssektora ultradzwiekowego i gabki garamycynowej w leczeniu powiklan ostrego zapalenia trzustki.

In the report a new modified technique of complicated pancreatitis treatment by laparostomy was showed. In included the use of ultrasound dissector for removing necrotic tissues and locating of garamycin sponge which should protect against secondary infection. Between January and May 1998 12 patients were treated using this method. In 8 cases (66%) we obtained rapid improvement of patients' general condition. One patient died and in 6 cases postoperative complications occurred. The use of ultrasound dissector shortens time of necrotic demarcation in pancreas and peripancreatic tissues. Garamycin sponge is effective protection from late infections concerning laparostomic wound. Modified laparostomy decreases about 50% number of secondary re-laparostomies, period of hospitalization and cost of complications treatment in acute pancreatitis in comparison with conventional method.

Gastrectomy in the rat using two modifications of esophagojejunal anastomosis. general status, local histological changes and relationships to bone density.

Gastrectomy (GX) was carried out in the male rat according to the Longmire and the Roux-en-Y procedure. The focus of the postoperative investigations was to evaluate the influence of post-GX morphological changes occurring at the site of two types of end-to-end esophagojejunal anastomosis (with and without invagination), in particular food intake, body weight gain, food efficiency, hematocrit and bone density. GX failed to alter food intake, fasting blood glucose, alpha-amino nitrogen, or free fatty acids, but led to uniformly decreased body weight, food efficiency and serum gastrin, and increased serum osteocalcin, indicating high turnover osteopenia. However, irrespective of the type of (digestive tract) reconstruction (Longmire or Roux-en-Y), the invagination anastomosis was associated with lower mortality, fewer complications, less early postoperative weight loss, less intensive tissue changes at the anastomotic site, and improvement of bone density and hematocrit. Bivariate and multivariate regression analysis revealed that bone density was negatively influenced by epithelial hyperplasia of the anastomotic tissue, while hematocrit was positively influenced by bone density. In contrast, food intake appeared to have no influence. It was concluded that (1) the histological status of the esophagointestinal anastomosis varies depending on the surgical technique applied and (2) the type of anatomical reconstruction of the digestive tract (Longmire vs. Roux-en-Y) and food intake may be of minor importance for the bone and hematological status of GX rats. Future investigations are justified to clarify whether esophagojejunal proinflammatory tissue factors may contribute to the GX-mediated damage of bone mineral and bone marrow, thereby leading to low body weight.

Gastrectomy osteopenia in the rat: the role of vitamin B12 deficiency and the type of reconstruction of the digestive tract.

1. The mechanisms underlying gastrectomy osteopenia are not yet clear. The gastrectomy-associated cobalamin (vitamin B12) deficiency may favour osteopenia and skeletal fractures. Also, the exclusion of the duodenum from the food passage may contribute to gastrectomy osteopenia. To investigate this, rats were gastrectomized and the passage of nutrients restored either with the duodenum excluded (Roux Y) or included (Longmire). Sham-operated rats served as controls. In half of the rats in each gastrectomy group the serum B12 levels were normalized by parenteral administration of B12.2. Four months post operation, both gastrectomy groups showed a similar degree of osteopenia. There was normal bone mineralization; serum levels of parathyroid hormone were normal, but decreased for 25-hydroxyvitamin D, and elevated for 1,25-dihydroxyvitamin D; in urine there was decreased pH and excessive hyperphosphaturia.3.B12 therapy had no influence on any of the essential bone and mineral metabolic parameters.4. We conclude that osteopenia in the gastrectomized rat (i) is not due to B12 or folic acid deficiency, calcium deficiency or secondary hyperparathyroidism; (ii) is independent of the type of anatomic reconstruction of the digestive tract; (iii) appears to be related to disturbed vitamin D, phosphorus and acid-base metabolism.

[Comparison of early results for pancreato-jejunal and pancreato-gastric anastomosis after pancreatoduodenectomy]. / Porównanie wczesnych wyników zespolenia trzustkowo-jelitowego i trzustkowo-zoladkowego po wycieciu glowy trzustki wraz z dwunastnica.

The aim of the study was to compare two types of anastomosis of the pancreatic stump with the digestive tract after pancreatoduodenectomy. 64 patients have been studied. Eighteen of them underwent pancreatoduodenectomy followed by the anastomosis of the pancreatic stump with the posterior wall of the stomach, in 46 patients pancreato-jejunal anastomosis has been done. Short term results of those two types of anastomosis did not differ significantly. Pancreato-gastric anastomosis seems to be technically easier, can be endoscopically controlled and does not impair recovery of gastric motility.

[Total gastrectomy using Longmire's and Roux method. Evaluation of the invagination technique for esophageal-jejunal anastomosis]. / Calkowite wyciecie zoladka sposobem Longmire'a i Roux. Ocena inwaginacyjnej techniki zespolenia przelykowo-jelitowego.

582 patients were gastrectomized between 1976 and 1996 in the Department for Gastrointestinal Surgery in Katowice/Poland for gastric cancer. Before 1985 esophago-jejunal anastomosis have been accomplished using a simple end-to-end or special end-to-side (Schreiber-Eichfuss) method with jejunoplication. Thereafter we used an end-to-end invagination method with 4-5 cm deep intussusception of the first raw of sutures into jejunum. Comparison of the occurrence of short and long term complications at the site of esophago-jejunal anastomosis showed that invagination technique is safer that the previous one. It is associated with the lower rate of short and long term complications (dehiscence, stenosis, oesophagitis). Details of the surgical procedure facilitating the accomplishment of the tight and safe anastomosis are presented.

[Surgical course in patients with diabetes]. / Zabieg operacyjny u chorych na cukrzyce.

A retrospective analysis is presented of 388 patients with diabetes mellitus treated in a gastrointestinal surgery department in the years 1975-1988. In the patients 473 diseases were diagnosed which could be the basis for surgical treatment. Our of 388 patients, 254 were treated surgically and 375 operations were performed in them; 46 patients had multiple operations. The highest per cent of deaths was found in the group of patients with diabetic gangrene of the lower limbs which reached 10.4%, while in all patients the mortality was 4.3%. Finally it is suggested that only the approach to the diabetic patients as to high-risk patients enables obtaining of a satisfactory result of surgical treatment.

Postprandial gallbladder emptying in patients after pancreatoduodenectomy. A preliminary report.

The study was undertaken to establish the pattern of gallbladder emptying in patients after pancreato-duodenectomy with the gallbladder preserved. 14 patients were examined. The preliminary examination revealed pathologic changes of the gallbladder in 5 patients, they were excluded from further investigations. The mean initial gallbladder volume, and the mean gallbladder maximum ejection fraction in patients after pancreatoduodenectomy were significantly lower as compared with controls. The pattern of gallbladder emptying was markedly flattened in the majority of patients, accompanied by alternate emptying and refilling of the gallbladder. On the basis of the above-mentioned observations we confirm the necessity to remove the gallbladder during pancreatoduodenectomy.

[Closing of an extensive abdominal wall defect with an implant of preserved dura mater in animal experiments. Mechanical and morphological studies]. / Verschluss eines ausgedehnten Bauchwanddefektes mit einem Implantat konservierter Dura mater im Tierversuch. Mechanische und morphologische Untersuchungen.

An extensive muscle-fascia-peritoneum defect of the abdominal wall was closed by means of an implant of preserved human dura mater in rats. The behaviour of the implant was tested by macroscopic, microscopic, and mechanical examination until the 60th week after the operation. Microscopic investigations showed a predominance of absorption to the 12th week later the ingrowing of collagenous fibres. Mechanical investigations demonstrated a considerable reduction of the tensile strength until the 12th week and a slight increase afterwards. An advanced protrusion of the abdominal wall formed in reach of the implant after the 30th week. The implant transformed itself to a scarlike connective-tissue membrane of poor quality in the end. The mechanical function as abdominal wall was not accomplished effectively.