[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 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.