[Thoracic sympathectomy performed by videothoracoscopic technique]. / Zabiegi sympatektomii piersiowej wykonywane metoda wideotorakoskopowa.

UNLABELLED: Thoracic sympathectomy is a method for a segmental elimination of functions of the sympathetic system by the excision of its Th2-Th3 ganglia. The procedure can be performed both using open and videoscopic technique. OBJECTIVE: The purpose of the study was the evaluation of efficacy of videoscopic thoracic sympathectomy. MATERIAL AND METHOD: From 1993 to 2003 we performed 53 videoscopic thoracic sympathectomies in patients with Raynaud's syndrome and upper limb hyperhidrosis. RESULTS: In all patients that underwent thoracic sympathectomy we obtained a positive reaction to a segmental excision of the sympathetic trunk. Patients with Raynaud's showed a significant improvement in symptoms in 76% of cases after a 4-year observation while patients with hyperhidrosis in 100%. The time of hospitalisation was 3.5 days in average. Postoperative complications were observed in two patients (3.7%). Videoscopic thoracic sympathectomy provides good therapeutic and cosmetic results and deserves more common use compared with open technique.

[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.

[CD11b and CD62L receptors expression on neutrophils after laparoscopic versus open cholecystectomy]. / Ekspresja receptorów CD11b i CD62L na powierzchni neutrofilów obojetnochlonnych po cholecystektomii laparoskopowej w porównaniu z cholecystektomia klasyczna.

UNLABELLED: The development of immunology correlated with surgery enables close recognition of multiple mechanisms responsible for more frequent complications observed after open surgical procedures than after minimally invasive operations. OBJECTIVE: Evaluation of selected elements of non-specific immunity in patients undergoing open cholecystectomy (OC) versus laparoscopic cholecystectomy (LC). MATERIAL AND METHODS: 30 postmenopausal females with non-complicated cholecystolithiasis were analysed. Both OC and LC was performed in 15 cases. Blood samples for an analysis were collected 24 hours before surgery and 24 and 72 hours postoperatively. Qualitative changes of neutrophils measured by the expression of CD11b and CD62L receptors on their surface without or with formyl-methionyl-leucyl-phenylalanine (fMLP) stimulation were evaluated. RESULTS: The expression of CD11b and CD62L receptors show no significant changes in patients that underwent LC while patients that underwent OC had significant changes 24 hours postoperatively compared both with their preoperative values and values observed in patients after LC. CONCLUSION: The activation of neutrophils measured by changes of the expression of CD11b and CD62L receptors on their surface is connected with the magnitude of trauma and is only observed in patients after OC.

[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.