A COMPARISON OF EFECTIVENESS, AND AN ASSESSMENT OF THE QUALITY OF LIFE OF PATIENTS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY AND ROUX-EN-Y GASTRIC BYPASS.

INTRODUCTION: Morbid obesity is nowadays one of the major problems of well developed countries. Treatment of this disease comprises many modalities, but the most successful are surgical ones. With the advent of laparoscopic operations it became clear that these are particularly useful for operation in obese patients due to their minimal invasiveness. The aim of the study was to compare the effectiveness and quality of life of patients operated on for morbid obesity by laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric by-pass (LRYGB) by one surgeon in one surgical centre. MATERIAL AND METHODS: Between 2006-2011 in the Department of General and Vascular Surgery, Szczecin-Zdunowo Specialist Hospital, 74 morbidly obese patients (54 F, 20 M) were operated on by two methods. Mean age (42.4 and 45 years), and body mass index (46.5 ± 8.9 kg/m2 for LSG and 45.1 ± 4.4 kg/m2 for LRYGB) respectively, were comparable. One surgeon in one centre performed LSG in 33 patients (24 F, 9 M) and LRYGB in 41 patients (30 F, 11 M). An independent observer evaluated patients at times of up to 6 months (37 pts), and after 7 months to 36 months (37 pts) postoperatively. Quality of life was assessed by the Gastrointestinal Quality of Life Index (GIQLI) questionnaire, with accessory questions concerning sexual, physical and other activities before and after intervention. RESULTS: There were no serious short or long term complications in either group of patients, although one patient in each group felt permanent postoperative discomfort (2.44% and 3.03%). Percentages of excess weight loss in both groups were similar and reached after 6 months 38.5% for LSG, 39.9% for LRYGB, and after 7-36 months 64.5% for LSG, 66.9% for LRYGB respectively. Quality of life assessment revealed significantly lower values in core symptoms for patients after LRYGB compared to LSG, but after LSG constipation was slightly more frequent. However, the general GIQLI score for patients after both types of surgery was statistically insignificant (110.6 for LSG versus 108.7 for LRYGB). In both groups sexual and physical activities significantly improved after operation. CONCLUSION: There were no significant differences in effectiveness and quality of life in patients after laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric by-pass.

Splenic and parasplenic abscess as a late complication of laparoscopic nissen fundoplication--case report and review of the literature.

PURPOSE: To present a rare late complication of laparoscopic Nissen fundoplication. MATERIAL AND METHODS: Splenic and parasplenic abscess which formed in 25 year old man sixty days after laparoscopic Nissen fundoplication was not adequately detected by a double ultrasound examination but by a CT-scan, ordered when general status of the patient deteriorated. RESULTS: Operative treatment comprised splenectomy with drainage and subsequent relaparotomy for intestinal obstruction. Postoperative course afterwards was good without a relapse of the reflux syndrome. CONCLUSION: Authors stress the beneficial role of tightness control after difficult fundoplications and less value of the ultrasound than a CT-scan in detecting problems of the in upper epigastrium.

[Assessment of knowledge about first aid among the teachers of chosen high schools in the Western Pomerania region]. / Ocena poziomu wiedzy nauczycieli szkól ponadgimnazjalnych w Zachodniopomorskiem na temat pierwszej pomocy medycznej.

INTRODUCTION: Increasing susceptibility to trauma among Polish society, which concerns school pupils as well, requires defining causes of the problem and establishing directions of activity in order to reduce the frequency of trauma and its unfavorable consequences. Investigation of a level of knowledge and an attitude of teachers of chosen secondary schools towards giving the first aid in the West Pomeranian voivodeship. MATERIAL AND METHODS: The survey was carried out among 100 teachers from two high schools of which one is situated in a city of Szczecin (50) and the other in a smaller town of Gryfice (50). A standardized questionnaire, which was previously applied to investigate a problem of giving the first aid among Polish society, was used as a diagnostic tool. RESULTS: Although majority of respondents took part in first aid courses while acquiring different ranks and qualifications, the survey has confirmed that the level of knowledge about giving the first aid is insufficient. The half of respondents know rules of giving first aid, and one third declares that can put these rules into the practice. A large part of respondents demonstrates rather passive attitude towards giving the first aid in case of emergency. There are no major differences in the level of knowledge about first aid between teachers from a large city and a small town. CONCLUSIONS: A systemic solutions for improvement of the knowledge of rules of giving the first aid among teachers and pupils are mandatory. The authors of this paper propose cyclical training courses for teachers led by medical professionals, and further courses for pupils led by those teachers in collaboration with students of the last year of paramedical studies.

[An investigation of the quality of life of female patients operated by laparoscopic or open way for uncomplicated cholecystolithiasis]. / Badanie jakosci zycia pacjentek operowanych sposobem laparoskopowym lub klasycznym z powodu niepowiklanej kamicy pecherzyka zólciowego.

INTRODUCTION: In many investigations concerning the results of surgical treatment of gallbladder stones, generally American or international data are cited, as national data are scarce, or even do not exist. This paper was written to complement Polish data with a comparison of patients' views about two methods of operating gallbladder stones commonly applied in our country. The purpose of the paper was to compare the quality of life of female patients operated for uncomplicated cholecystolithiasis in regional hospitals of Poland. MATERIAL AND METHODS: The study material was comprised of two groups of 100 patients each, from two regional hospitals. In one of the hospitals the patients were treated only by laparoscopic cholecystectomy alone. As in the other hospital only by open cholecystecomy. The age of the patients whom were operated by open cholecystecomy varied between 19 and 90 years, median 56, mean 54.6 SD +/- 15.4 years. Whereas, in the group treated by the laparoscopic method the age varied between 23 and 72 years, median 48, mean 49.7 SD +/- 11 years. The investigation was performed between the second and twelfth month after the operation, median 6 for both, mean 6.2 SD +/- 2 for open and mean 6.9 SD +/- 2 for the laparoscopic method. BMI of the investigated patients was between 17.7 and 33.1, median 26.3, mean 26 +/- 2.7 in the open group, and between 18.1 and 34.6, median 24.2, mean 24.7 +/- 3.2 in the laparoscopic group. As a diagnostic tool a standardized Gastrointestinal Quality of Life Questionnaire (GQLI) was used, enriched by demographic questions, self-assessment of postoperative well-being, smoking habits, and postoperative pains and complications. RESULTS: General GQLI score was within range of good quality of life in both groups. However, quality of life was significantly better in the group operated by open cholecystectomy than the one operated by the laparoscopic method (median 131 vs. 125, respectively, p < 0.022). Postoperative complications were in majority reported by patients from the open group. The possible reasons of such results are discussed in comparison with national and international results of treatment of gallbladder stones. CONCLUSIONS: There are several other factors, which besides the entire operation, can have influence on the quality of life of patients operated for uncomplicated cholecystolithiasis. These biases can significantly change the end results of quality of life of these patients, however, quality of life remains within good limits in both groups.

[Does inguinal hernia repair influence on quality of life of elderly males?]. / Czy operacja przepukliny pachwinowej u starszych mezczyzn wplywa na ich jakosc zycia?

INTRODUCTION: Inguinal hernia repair is a common surgical intervention in elderly which can affect quality of life in the future of these patients. Aim of the study is to assess the quality of life of elderly males after inguinal hernia repair compared with a similar group of male patients without any operation. MATERIAL AND METHODS: A group of 40 male patients between the age of 60-80, in time up to 2 years after Lichtenstein hernia repair was compared with the same age 50 healthy males not operated in previous 2 years by 2 questionnaires: international Gastrointestinal Quality of Life Index (GQLI) and national Gerontologic Society Investigation Questionnaire to assess possible differences in their quality of life. Both groups were comparable and operation techniques were identical. RESULTS: Hernia repair resulted in 12 complications (30%): wound infections - 3, serous exudate - 1, chronic pains - 2, inflammatory infiltration - 4, loose sutures - 2. Overall GQLI score in hernia operation group reached mean 123.5 +/- 10.3 and in control group was 121.2 +/- 8.7 (p > 0.37). Gerontologic Society Investigation Questionnaire did not reveal any significant differences between both groups, however it presented rather sad existence of elderly men in our country, who being pensioners are self-limiting their activity on all fields. However, the profile of the hernia group seemed to comprise of people, who keep better physical activity, thus are motivated to be operated for inguinal hernia to keep them in a good physical shape. Some limitations of their postoperative activity were noted, probably because of medical advice or in fear of recurrence of hernia. CONCLUSIONS: Elderly patients operated for inguinal hernia have similar long term quality of life as a healthy population of the same age. Medical prescription to restrict the physical activity after hernia repair with a mesh should be limited to short necessary time especially in elderly. Further investigations are needed to elaborate methods of increasing activity of old men in Poland to moderate medical costs for this group.

[The influence of obesity on early results and quality of life of patients after chosen operations performed by laparoscopic or open methods]. / Wplyw otylosci na wczesne wyniki i jakosc zycia pacjentów po wybranych zabiegach operacyjnych wykonanych metoda laparoskopowa lub klasyczna.

INTRODUCTION: Obesity usually depreciates early results of abdominal operations performed in an open way, but not always after laparoscopic operations. Aim of the study is to compare early results and quality of life after most common abdominal operations (cholecystectomy and appendectomy) performed on obese and non-obese patients. MATERIAL AND METHODS: 166 patients who were operated in academic teaching hospital, were analyzed in groups: cholecystectomy - laparoscopic (74) and open (30), appendectomy - laparoscopic (30) and open (32). Every group was divided into subgroups with normal body mass, obesity I obesity II and was assessed retrospectively and investigated by Gastrointestinal Quality of Life Index (GQLI) up to 5 months after intervention by registered nurse specialized in surgery. Number and gravity of complications were assessed as well as hospital stay and convalescence time. RESULTS: There were 7/19 and 4/13 complications after laparoscopic vs 8/12 and 7/19 after open cholecystectomies and appendectomies respectively in groups with normal body weight (BMI 18.5-24.9kg/m2), and 28/56 and 8/20 complications after laparoscopic vs 14/18 and 9/12 after open cholecystectomies and appendectomies respectively in obese groups (above 25 kg/m2). One conversion to open surgery occured in patient with obesity I for laparoscopic cholecystectomy and one in normal body mass patient for laparoscopic appendectomy. There was one case of common bile duct lesion in obese patient during laparoscopic intervention and two cases of intestinal obstruction after open cholecystectomy in obese patients. Mean hospital stay time was 3.2 and 3.8 days after laparoscopic operations vs 5.4 and 5.4 days after open ones respectively. Mean convalescence time was 14 and 14 days after laparoscopic operations vs 21 and 14 days after open cholecystectomy and appendectomy respectively. Quality of life was significantly better after laparoscopic than open cholecystectomy in obese patients (128.4 +/- 12.7 vs 120.6 +/- 12.2 respectively) but significantly worse after laparoscopic than open appendectomy (121 +/- 15.2 vs 133.8 +/- 12.9 respectively). In groups with normal body mass differences were not significant. CONCLUSIONS: There is the influence of obesity on number and burden of postoperative complications after laparoscopic and open operations, however laparoscopic access seems more effective. Although hospital stay time was shorter after both types of laparoscopic operations, convalescence time was shorter only after laparoscopic cholecystectomy. The choice of type of operation (open or laparoscopic) influences the quality of life of obese patients but not on those with normal body mass. Although these conclusions seem rather clear, verification of them on larger group of patients is mandatory.

[Views of students of extension nursing studies about cancer prophylaxis]. / Opinie studentów pielegniarskich studiów zaocznych na temat profilaktyki nowotworów.

INTRODUCTION: Cancer prophylaxis seems nowadays to be the more and more powerful tool in fight with these serious diseases. The aim of this work is to find out opinions of students of nursing extension studies on contemporary cancer prophylaxis. MATERIAL AND METHODS: The question about possibilities of practical efforts for prophylaxis and early detection of cancer was directed to 160 students of four consecutive years (2002-2006), at the end of the fourth year of lasting five and a half years extension nursing studies, during ending exam on subject: oncological nursing. There were 154 women and 6 men, predominantly at their third decade of life, with nursing experience approximately more than 5 years. RESULTS: Out of 160 asked students, 131 of them firstly indicated necessity of breast cancer prophylaxis, 117 mentioned lung cancer, 113 cervix cancer, 95 colorectal cancer, 33 prostate cancer. In families with cancer problems, more frequent control investigations (23 answers), and genetic tests (16) were called for. Patients should be qualified to appropriate risk groups (13) and controlled more frequently there (24). Apart from necessary wide education in media (126) personal contact with patient to discuss his or her personal problems relating to cancer is needed (91). If atypical symptoms are self-detected by patients it should alert them to not neglect and contact family physician (33). Healthy diet (62) containing fresh vegetables and fruits (73), high fibre diet (42) with less animal fat (38) and less red meat (30), containing no preservative agents (45) is recommended. Increased physical activity (84) to cease or reduce smoking (102), and alcohol intake (55), limited exposition to ultraviolet rays (49), and systematic controls of breast (105), uterus cervix (88), lungs (77), colon (55) and prostate (28) are proposed. The pollution of environment by combustion gases and smokes (34) not excluding risk factors of medical workplace (29) are mentioned as cancerogenic factors. CONCLUSIONS: In the time of increasing incidence of cancer in Poland it is necessary to elaborate a complex model of primary cancer prophylaxis and early detection of it and to implement it in practice. For better effectiveness of such systemic solution wide involvement of nursing staff is mandatory. Nurses should be, very well and consciously prepared to play their role through adequate educational efforts undertaken during nursing studies.

Reversed 5 pattern of diagnostic laparoscopy during laparoscopic cholecystectomy and its standardization.

An attempt at standardization of the diagnostic laparoscopy (DL) procedure during laparoscopic cholecystectomy (LC) was undertaken by establishing a simple pattern and checking its applicability in 100 consecutive LCs. DL was performed following the reversed number 5 pattern, starting from the right upper quadrant and moving to the left upper quadrant, left flank, back to the right flank along the transverse colon, down to the pelvis, along the sigmoid to the left flank, and back to the right upper quadrant inspecting small bowel. DL was incomplete in 11 patients. Inspection lasted 6-12 minutes (operation time increase, 14%). Abnormalities were discovered in 38% of patients, diagnosis elucidated in 8%, intervention undertaken in 11%, and control or further treatment proposed in 33%, without morbidity and mortality. The reversed 5 pattern of diagnostic laparoscopy is feasible and safe. It can be routinely done during LC in the general hospital setting. Standardization of diagnostic laparoscopy during laparoscopic cholecystectomy seems necessary for early disclosure of visible disorders and for medicolegal purposes.