Open necrosectomy, the standard surgical treatment of infected pancreatic necrosis (IPN), presents a high rate of postoperative complications and an associated mortality of 20–60%. In the last decade various minimally invasive approaches (MIA) have been proposed for the treatment of IPN and the results seem to improve on those reported with open necrosectomy. These MIA include: percutaneous, retroperitoneal, endoscopic (endoluminal) and laparoscopic (transperitoneal). The adoption of the step-up approach in the management of severe acute pancreatitis (SAP) facilitates the implementation of MIA as the surgical treatment of choice in most cases. Since MIA require the expertise of radiologists, endoscopists and surgeons, patients suffering SAP should be treated by multidisciplinary teams in referral centers. We describe the MIA currently available and discuss their advantages, disadvantages, and results.
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Varicocele has been regarded a curable cause of infertility for dozens of years. The impact of varicocele treatment in terms of increase in pregnancy rates is a debated issue. We evaluate data from a 10-year cohort of results from laparoscopic operative treatment of varicocele patients according to pregnancy rate, complication rate, and satisfaction with varicocele repair. Ninety seven patients were treated by means of laparoscopy between 1993 and 1996. Ten years after operation questionnaires were sent to all patients. Answers were obtained from 49/97 pts. (50,5%). Details connected with marital status, pregnancy rate, addictions and scrotal pain discomfort were collected. Statistical analysis was performed using chi-square independence test and Spearman’s rank correlation coefficient. After 10 years, 75.5% who answered the questionnaire were fully satisfied with the results of treatment, 12.3% pts of patients were partially satisfied; 63.3% of patients fathered 1 to 3 children. Married patients and those who fathered children were found to be the most satisfied with the operation. We also found the statistically significant negative dependency between smoking addiction and number of children. There were no major complications intra- or postoperatively. No harmful consequences of testicular artery ligation were found. In conclusion, long-time 10 years follow-up enables better estimation of the results of laparoscopic treatment in patients with varicocele. Pregnancy rate may depend not only on varicocele repair but on smoking addiction as well. There is still no evidence of harmful consequences due to testicular artery ligation after varicocele repair
Wziernikowanie jamy otrzewnowej chorego – czyli laparoskopia jest jedną z technik chirurgicznych, która w ostatnich dwóch dekadach XX wieku odmieniła codzienną praktykę chirurgiczną na świecie. Historia laparoskopii sięga początków XIX wieku, jednak najbardziej dynamiczny jej rozwój przypada na drugą połowę XX wieku. Zawdzięczamy to zarówno pracy pionierów technik małoinwazyjnych jak i rozwojowi techniki. Początki laparoskopii w Krakowie przypadają na początek lat 90. XX wieku. Pierwsze dwa tego typu zabiegi wykonano przez polskich chirurgów przy okazji pobytu w Krakowie jednego z polskich pionierów tego typu zabiegów – E. Stanowskiego, 11.06.1992 przez A. Bobrzyńskiego w II Klinice Chirurgii Akademii Medycznej w Krakowie oraz dzień później - 12.06.1992 przez A. Cienciałę w Klinicznym Oddziale Chirurgii Ogólnej Wojskowego Szpitala Klinicznego w Krakowie. Technika ta stopniowo zyskiwała na popularności i dzisiaj jest standardowo wykorzystywana w małopolskich oddziałach chirurgicznych. Chirurdzy jednak nie przestali poszukiwać coraz to nowych technik operacyjnych, które mają zminimalizować jeszcze bardziej uraz operacyjny oraz zapewnić pacjentowi maksymalnie skuteczną i efektywną operację. Techniki te wywodzą się w dużym stopniu bądź stanowią swego rodzaju rozwinięcie klasycznej laparoskopii. Wśród nich należy wymienić SILS (Single Incision Laparoscopic Surgery), NOTES (Natural Orifi ce Translumenal Endoscopic Surgery), operacje hybrydowe oraz roboty chirurgiczne.
EN
One surgical technique that has changed every-day surgical practice in the last two decades of the 20th century is laparoscopy. This technique dates from the beginning of the 19th century, but the most dynamic development was in the second half of the 20th century. We are indebted to the work of pioneers of minimally invasive surgical techniques and the development of technology. Laparoscopy has developed especially since the early 1990s. The fi rst laparoscopic procedure was performed in Cracow by A. Bobrzyński at the Second Surgery Department of Cracow Medical University (11.06.1992), while the second was performed the next day by A. Cienciała at the Surgery Department of the Fifth Military Clinical Hospital (12.06.1992) with the assistance of E. Stanowski, a Polish pioneer of this technique. This technique became more popular and now is very common in Cracow surgery wards. Surgeons have not stopped searching for new operational techniques which could minimize surgical trauma and maximize the efficacy of operations. These techniques are derived from classic laparoscopy and the following should be mentioned: SILS (Single Incision Laparoscopic Surgery), NOTES (Natural Orifice Translumenal Endoscopic Surgery), hybrid operations and robotic surgery.
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