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1
Content available remote Minimally Invasive Subtotal Esophagectomy
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EN
In the study a subtotal videothoracoscopic and laparoscopic esophageal resection with cervical anastomosis was presented with discussion concerning the new surgical problems and positions (classical and prone) of videothoracoscopic and laparoscopic approaches. The technique of esophageal elevation during mediastinal preparation, ligation and dissection of the azygos vein, pharmacological elongation of the graft using Glucagon as well as tips regarding easier identification of the esophagus at the outlet level was described. The usefulness of the harmonic scalpel and endostaplers was stressed. Additionally, findings and outcomes were discussed.
EN
The aim of the study was to compare surgical treatment results in cases of recurrent spontaneous pneumothorax following video-assisted thoracoscopic surgery (VATS) and thoracotomy. We assessed the recurrence rate after the procedures and postoperative complications, considering two patient groups.Material and methods. The study group was comprised of 127 patients subjected to surgical treatment due to recurrent spontaneous pneumothorax during the period between 1996 and 2005. The group of 43 women and 84 men was between 15 and 79 years of age (mean age: 37 years). Video-assisted thoracoscopic surgery was performed in 67 cases, while the remaining 60 patients underwent thoracotomy. We performed the excision of the emphysematous blebs or apex of the lungs in 96 patients, partial pleurectomy with mechanical pleurodesis in 73 patients, subtotal pleurectomy in 33 cases, decortication of the lung in 30 cases, and chemical pleurodesis in 13 patients.Results. Pneumothorax recurrence was significantly more frequent in the group of patients following the minimally-invasive approach (28% vs 8%). We observed no statistically significant differences considering patient gender in both groups. However, the VATS approach had a tendency to be performed in younger patients (average 33 yrs. in VATS vs 42 yrs. in the thoracotomy group). We performed partial pleurectomy and mechanical pleurodesis more often during VATS, while subtotal pleurectomy and lung decortication were performed more frequently during thoracotomy. The percentage of resections, considering emphysematous blebs or lung apexes was similar in both patient groups. We observed no differences considering the duration and amount of postoperative drainage, hospitalization period, or percentage of postoperative complications (pleural hematoma, prolonged air leak, residual pneumothorax) between both groups.Conclusions. Apart from the excision of emphysematous blebs, subtotal pleurectomy should be considered in cases of patients subjected to video-assisted thoracoscopy. Subtotal pleurectomy could decrease the risk of recurrent pneumothorax, while having comparable percentages of postoperative complications as those following mechanical pleurodesis.
3
Content available remote Treatment of Recurrent Primary Spontaneous Pneumothorax – Own Experience
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EN
Primary spontaneous pneumothorax could be a serious therapeutic problem in case of recurrence. Lack of therapeutic standards sometimes leads to delay in definitive surgical treatment and could cause respiratory complications. The aim of the studywas the evaluation of treatment results in patients with recurrence of primary spontaneous pneumothorax and looking for optimal therapeutic method after first recurrence (surgical treatment vs. pleural drainage). Material and methods.Between 01.01.2009 and 31.07.2010 fifty four patients with recurrent primary spontaneous pneumothorax was hospitalized in Wrocław Thoracic Surgery Centre (24.3% of all patients with pneumothorax). The recurrence was treated surgically in 24 cases, in 30 pleural drainage was performed: simple drainage (n=14) or drainage with chemical pleurodesis (n=16). Mean age of patients treated without surgery was higher than surgically treated (p=0,012). Results.In surgery group no recurrence was found, in drainage group 11 recurrences occurred (p=0.0009). In group of 11 patients with second recurrence, pleurodesis was performed four times (36%) vs. 12 times (63%) in 19 patients without a recurrence of the disease. 70% of non-surgically treated patients vs. 50% of surgically treated were afraid of recurrence (p=0.01). Among 11 patients in drainage group, nine underwent surgery at the second episode of recurrence. Conclusions.The optimal treatment method in case of first recurrence of primary spontaneous pneumothorax is surgical treatment. When it is not possible chemical pleurodesis should be performed during pleural drainage. Most of the patients after second recurrence are treated surgically anyway. The surgical treatment significantly reduces patient’s fears for future recurrence of the disease. Younger patients are most often surgically treated.
EN
The treatment of cancer neuralgia is considered to be one of the most difficult elements of paliative care. Currently there is no single universally accepted treatment method. In this paper the authors define pain pain and present current standards of treatment, paying special attention to videoscopic splanchicectomy, a minimally invasive technique introduced in 1993. Indications, preoperative management, technique and the risk of anaesthesia are briefly described. Videothoracoscopic splanchicectomy allows more traumatatic interventions, such as thoracotomy or laparotomy, to be avoided. It is a safe, minimally invasive and effective form of paliative treatment and is considered to be the method of choice for patients for whom other treatment techniques for cancer neuralgia have proved to be insufficient. The authors emphasize that this method of treatment is gaining popularity among patients, physicians and economists.
PL
Leczenie bólu nowotworowego należy do najtrudniejszych elementów leczenia paliatywnego. Obecnie nie ma idealnej metody zmniejszającej odczuwanie bólu. W artykule przedstawiono definicję bólu nowotworowego i aktualne standardy leczenia, ze szczególnym uwzględnieniem wprowadzonej do praktyki klinicznej w 1993 roku techniki leczenia bólu nowotworowego nadbrzusza – splanchnicektomii wideotorakoskopowej. W pracy przedstawiono wskazania, przygotowanie do zabiegu, technikę operacji i ryzyko znieczulenia. Splanchnicektomia wideotorakoskopowa pozwala uniknąć traumatyzującej torakotomii lub laparotomii. Jest paliatywną, małoinwazyjną, bezpieczną oraz skuteczną techniką operacyjną. Polecana jest jako metoda z wyboru, w sytuacji gdy inne sposoby leczenia bólu przewlekłego okazują się mało skuteczne. Ten sposób leczenia zyskuje coraz więcej zwolenników wśród pacjentów, lekarzy i ekonomistów.
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