Waldemar Patkowski, Krzysztof Zieniewicz, Paweł Nyckowski, Jacek Pawlak, Piotr Remiszewski, Anna Skwarek, Bartosz Cieślak, Bogdan Michałowicz, Marek Krawczyk
Department of General, Transplant and Liver Surgery, Medical University in Warsaw
Kierownik: prof. dr hab. M. Krawczyk

Alveococcosis - principles of management in the surgical department

Aim of the study was to present the experience of the Department of General, Transplant and Liver Surgery, considering the treatment of patients suffering from multilocular echinococcosis.

Material and methods.
During the period between 1990-2003, 48 patients underwent surgery due to echinococcal cystic symptoms. In case of 11 patients (2.9%) cysts developed as a result of Echinococcus multilocularis infections. All patients, prior to planned surgical intervention received 800 mg of Albendazol per day, for a minimum period of 2 weeks. All underwent surgery, the most common resection, being right-sided hemihepatectomy extended by IV-th liver segment resection. One patient underwent central liver resection, while one left-sided hemihepatectomy. The latter patient with grade four alveococcosis required orthotopic liver transplantation.

Results.
Nine patients (81.8%) in general good condition, without disease recurrence, remain under ambulatory control. Two patients (18.2%) were diagnosed with recurrence of alveococcosis in the area of left liver parenchyma, 6 months and 1.5 years after surgical intervention. The final treatment consisted in liver transplantation.

Conclusions.

  1. Alveococcosis is a zoonosis requiring combined surgical and pharmacological treatment.
  2. Liver transplantation is a safe and successful method of alveococcosis treatment.
  3. The high-percentage of recurrence and occurrence of distant metastases requires thorough, and at least ten-year long follow-up period of patients undergoing surgical treatment.




Marcin Olędzki, Zbigniew Śledziński, Maria Ignacy Pirski
Department of General, Endocrine Surgery and Transplantation, Medical University in Gdańsk
Kierownik: prof. dr hab. Z. Śledziński

Inflammatory complications after endoscopic retrograde cholangiopancreatography requiring surgical treatment

Aim of the study.
Presentation of 10 cases of significant inflammatory complications, which occurred after ERCP, and required surgical treatment.

Material and methods.
During the period between 1993 and 1998, 3293 ERCP procedures were performed. Ten (0.3%) of the above-mentioned patients were subject to surgical treatment, due to necrotizing acute pancreatitis and cholangitis. Repeated laparotomy by means of Bradley's method was most often performed. The following parameters were evaluated: indications towards ERCP, time elapsed between the examination and surgical intervention, hospitalization, postoperative complications, and final outcome. Patients were divided into two groups, depending on the type and inflammatory infiltration found during the operation.

Results.
The APACHE II prognostic scale, considering acute pancreatitis amounted to an average of 10.6 points (3-22). Indications towards surgical treatment, included deterioration of the patient's general condition and peritonitis. Total postoperative mortality amounted to 30%. Most common postoperative complications were as follows: hydrothorax, respiratory insufficiency, kidney insufficiency, jejunal fistulas. Coexistence of cholangitis worsened the prognosis.

Conclusions.
Necrotizing pancreatitis is a very rare complication occurring after ERCP. However, due to the severe course of the disease, and high mortality rate, the above-mentioned should be taken into consideration, prior to ERCP qualification. Repeated laparotomy and Intensive Care Unit management should be the treatment of choice in such cases.




Andrzej Matyja, Rafał Solecki
1st Department of General and GI Surgery, Jagiellonian University in Cracow
Kierownik: prof. dr hab. J. Kulig (do 30.09.2003 r. prof. dr hab. T. Popiela)

PHS (prolene hernia system) in the treatment of inguinal hernias

Aim of the study.
Retrospective evaluation of results obtained following inguinal hernia treatment by means of the PHS (Prolene Hernia System) method.

Material and methods.
During the period between November 1999 and December 2002, 144 patients were subject to surgical intervention using the PHS mesh, due to 164 inguinal hernias. Mean patient age amounted to 65 years (ranging between 18-95 years). Hernia repair was performed under spinal anesthesia, with additional single-dose antibiotic prophylaxis. In selected cases, such as emergency or doubtful hemostasis, Redon drainage was used.

Results.
Hernia recurrence was noted in case of one (0.6%) patient subject to bilateral hernioplasty. The patient was reoperated by means of a "plug", and the PHS mesh remained in place. Three (1.8%) patients developed wound suppuration, one (0.6%) a seroma, two (1.2%) scrotal edema persisting for one month, and two more (1.2%), inguinal neuralgia. Control examination performed after 3 months demonstrated chronic groin pain in 6 (3.6%) patients.

Conclusion.
The Prolene Hernia System (PHS) is an effective method of inguinal hernia repair with a low rate of postoperative complications and recurrences. Redon drainage in selected cases of inguinal hernia repair decreases the rate of local complications, such as hematomas and seromas.




Jerzy Paleczny1, Piotr Knapik2, Dariusz Maciejewski1, Elżbieta Łoniewska-Paleczny1, Jacek Terech3
Department of Anaesthesia and Intensive Care, Central Hospital in Bielsko-Biała1
Ordynator: dr n. med. D. Maciejewski
Department of Anesthesia and Intensive Care, Silesian Medical University in Zabrze2
Kierownik: dr hab. med. P. Knapik
Hospital of Lung Diseases in Bielsko-Biała3
Ordynator: lek. J. Terech

Comparison of percutaneous tracheostomy using Griggs' and Fantoni's technique - a retrospective clinical study

Aim of the study was to determine the duration of the procedure, complication rate and safety following percutaneous tracheostomy by means of Griggs' and Fantoni's technique.

Material and methods.
All consecutive patients requiring tracheostomy treated at the Intensive Care Unit, during a period of five years were retrospectively evaluated. All tracheostomies were performed by means of the percutaneous technique. Patients were divided into two groups: group I (n=82, Griggs' technique) and group II (n=32, Fantoni's technique).

Results.
Patients were in comparably bad condition on admission (mean APACHE II score 25,7 vs 25,5, p=ns), and there were no group differences, considering demographic data. The duration of the procedure was significantly shorter in case of group I patients (11.2±7.8 min vs 26.7±18.6 min, p<0.001). There were no deaths resulting from the procedure.

Complications during tracheostomy and the postoperative period were noted in 16 group I patients (19.5%), and 4 group II patients (12.5%) (p=ns). No differences were noted considering the hemodynamic condition during the early postoperative period. However, a temporary decrease of oxygenation was observed in group I patients.

Conclusions.
The duration of the procedure is significantly longer using Fantoni's technique. The choice of the technique has no significant influence on the early postoperative course and number of complications. Both tracheostomy echniques can be routinely used in case of intensive care unit (ICU) patients.




Krzysztof Zinkiewicz, Tomasz Skoczylas, Wit Juśkiewicz, Paweł Bury, Witold Zgodziński, Andrzej Dąbrowski, Grzegorz Wallner
2nd Department of General Surgery, Skubiszewski Medical University in Lublin
Kierownik: prof. dr hab. G. Wallner

Initial treatment results of early gastrointestinal cancer by means of endoscopic mucosal resection

Aim of the study was to present initial treatment results by means of endoscopic mucosal resection in 5 patients with early gastric cancer, and in 3 patients with superficial early colorectal cancer.

Material and methods.
Early cancer was localized in the following: gastric cardia in 3 patients, gastric body in 2 patients, rectum in 2 patients, and descending colon in one patient. The procedure was performed based on experience acquired during educational training at the Japanese National Cancer Center in Tokyo, Japan.

Results.
During the procedure, as well as thereafter no complications were observed. The endoscopic mucosal resection was finally assessed as being curative in 5 (62.5%) patients, and potentially curative in 3 (37.5%) patients. One (12.5%) patient was diagnosed with recurrent adenocarcinoma, 9 months after the endoscopic resection. The patient was subject to subtotal gastrectomy. In the remaining 7 (87.5%) patients no disease recurrence was noted during the follow-up period, ranging between 3 and 24 months. All patients (100%) continue to be alive, being under constant follow-up.

Conclusions.
Our preliminary results clearly indicate that endoscopic mucosal resection performed according to standard principles applied in Japan can also be included into the range of minimally invasive techniques used in Poland, during curative treatment of early gastrointestinal cancer.




Piotr Michał Rud, Wiesław Tarnowski, Lubomir Lembas
Department of General and Gastroenterological Surgery, Orłowski Hospital in Warsaw
Kierownik: prof. dr hab. K. Bielecki

Cutaneous melanoma metastases to the stomach as the cause of acute gastrointestinal bleeding

The study presented a case of upper gastrointestinal bleeding caused by metastatic cutaneous melanoma. Without primary histopathological diagnosis the patient was subject to endoscopic treatment, twice. Proving non-effective, surgical intervention was undertaken. Gastrectomy was performed. Diagnosis was established following the examination of the surgical specimen.





Stanisław Hać1, Tomasz Stefaniak1, Aleksander Stanek1, Robert Rzepko2
Department of General Endocrine Surgery and Transplantology, Medical University in Gdańsk1
Kierownik: prof. dr hab. Z. Śledziński
Department of Pathology, Medical University in Gdańsk2
Kierownik: prof. dr hab. K. Jaśkiewicz

Hemocholecyst caused by primary gall-bladder mucous membrane ulceration - case report

The study presented a case report of a 75 year-old patient with bleeding into the lumen of the gall-bladder, due to primary mucous membrane ulceration. Clinical symptoms lead towards the diagnosis of acute cholecystitis. The patient underwent successful cholecystectomy. The histopathological examination result was as follows: ulceration with muscular membrane necrosis. The above-mentioned is a rare case of gall-bladder pathology, requiring surgical intervention.





Jerzy Trojan1,2, Jan Kulig1, Piotr Kopiński2
1st Department of General Surgery, Collegium Medicum, Jagiellonian University in Kraków1
Kierownik: prof. dr hab. J. Kulig
Department of Gene Therapy, L. Rydygier Medical University in Bydgoszcz2
Kierownik: dr hab. J. Trojan, prof. nadzw. AMB

Anty-igf-i immunogenotherapy in the treatment of primary hepatic cancer





Grzegorz Kacprzak, Jerzy Kołodziej
Wrocław Thoracic Surgery Centre: Department of Thoracic Surgery of Lower Silesian Centre of Lung Diseases, Department of Thoracic Surgery, Medical University
Kierownik: prof. dr hab. J. Kołodziej

Funnel chest - pathomorphology, clinical symptoms, diagnostics, surgical indications





Władysław Lejman1, Włodzimierz Drożdż2
Department of the History of Medicine, Collegium Medicum, Jagellonian University in Cracow1
Kierownik: prof. dr hab. A. Śródka
2nd Department of Surgery, Collegium Medicum, Jagellonian University in Cracow2
Kierownik: prof. dr hab. D. Karcz

Laparotomy in internal intestinal obstruction







Maciej Śmietański
Department of General, Endocrine Surgery and Transplantation, Medical University in Gdańsk
Kierownik: prof. dr hab. Z. Śledziński

Inguinal hernias - does the problem of mesh implantation really exist? The future has just begun (polemics with the article by Dr Wojciech Szczęsny)