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3 Polish Journal of Surgery

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Cholelithiasis in Home Parenteral Nutrition (Hpn) Patients – Complications of the Clinical Nutrition: Diagnosis, Treatment, Prevention

100%

Ławiński M. , Jachnis A. , Ukleja A. , Pertkiewicz M.

2015

tom 86

nr 3

111-115

Long-term home parenteral nutrition (HPN) is an important factor for cholelithiasis. An individualized nutrition program, trophic enteral nutrition and ultrasound bile ducts monitoring is a necessity in those patients. The aim of the study was to evaluate the usefulness of prophylactic cholecystectomy in patients with asymptomatic cholelithiasis requiring HPN. Material and methods. 292 chronic HPN patients were analyzed in the period from 2005 to 2012. Patients were divided into four groups: A - without cholelithiasis, B - with asymptomatic cholelithiasis, C - urgent cholecystectomy because of cholecystisis caused by gallstones, D - cholecystectomy in patients without cholelithiasis performed during an operation to restore the continuity of the digestive tract. The patients were additionally divided depending on the extent of resection of the small intestine and colon. Results. 36.9% of chronic HPN patients had cholelithiasis confirmed using ultrasonographic examination. Cholecystectomy due to acute cholecystitis symptoms was performed in 14.4% of the patients. The remaining 22.6% patients had asymptomatic cholelithiasis. Prophylactic cholecystectomy was performed in 5.5% patients with no signs of cholelcystisis during the planned operation to restore the continuity of the digestive tract. Conclusions. Cholelithiasis in chronic HPN patients is a frequent phenomenon. It seems useful to perform prophylactic cholecystectomy during primary subtotal resection of the small intestine, because the risk of cholelithiasis in this group of patients is very high.

Method of Nutrition of Patients After Major Oral and Craniofacial Surgery and its Effects on BMI Changes During a Half-Year Period of Observation

88%

Jaworska E. , Lewandowski Z. , Samolczyk-Wanyura D. , Ławiński M. , Pertkiewicz M.

2015

tom 86

nr 7

305-311

Injuries, deformations and tumours of the facial part of skull, oral cavity or neck often hamper or prevent normal food consumption. After surgery of these structures food intake may be decreased due to postoperative wounds, pain, swelling and trismus. The aim of the study was to evaluate nutritional state of patients treated surgically in the craniomaxillo- facial surgery department and determination of factors affecting body weight changes after surgery. Material and methods. The study included 83 patients operated between 2008 and 2010 in the department of cranio-maxillo-facial surgery, due to: maxillo-facial defects (30 individuals), malignant tumours (23 individuals), injuries (19 individuals), benign tumours (11 individuals). The study was prospective. A method of nutrition during the observation period and BMI (Body Mass Index) value on the first day of hospitalization and after 10, 60, 180 days after hospital admission were considered. For statistical analysis of results a general regression analysis was used. Results. Significant reduction of BMI was observed in all patients after 10 and 60 days from the start of hospitalization. A significant increase of this parameter was observed between Day 60 and Day 180 of observation, however the BMI values after 180 days were still significantly lower than the baseline. A dependency between these changes and a cause of hospitalization as well as nutrition during and after the stay at hospital has been shown. Conclusions. There is a distinct relationship between the worsening of nutritional state after craniofacial surgery and nutrition during and after hospitalization, and therefore special attention should be paid to the issue of nutrition during this period

Recommendations of Association of Polish Surgeons and Polish Society of Oncological Surgery Gastrointestinal Fistulae in Patients Treated for Malignancy - Diagnostics and Treatment

63%

Szawłowski A. , Pertkiewicz M. , Drews M. , Dziki A. , Krasnodębski I. , Kulig J. , Lampe P. , Stojcev Z. , Wallner G. , Zegarski W.

nr 12

694-711

Postoperative gastrointestinal fistulae occur more often in patients undergoing surgical treatment for oncological reasons than non-oncological reasons. Fistula is associated with a number of serious sequelae and complications: fluid and electrolyte abnormalities, acid-base abnormalities, local and systemic infection and progressive cachexia that increase morbidity, treatment duration and mortality. Development of fistula additionally delays or prevents specific treatment in oncology. For a patient, a fistula is associated with both physical and mental suffering resulting from concern over further therapy.Although the introduction of advanced surgical techniques, intensive postoperative care, total parenteral nutrition and modern enteral nutrition, resulted in decreased postoperative mortality, however the number of patients with gastrointestinal fistulae hospitalized in the departments of surgery is not decreasing. This may result from the fact that many patients still present for treatment in the advanced phase of their malignancy (clinical stage III/IV according to International Union Against Cancer - UICC) and consequently in worse general status, which poses a high risk of postoperative complications and requires more extensive procedures in progressively older patients. Thus gastrointestinal fistulae still remain a serious clinical problem. Main components of treatment of fistulae include: adequate draining, fighting of infections, artificial nutrition and drugs that decrease gastrointestinal secretion (e.g. somatostatin) that are intended to create conditions for spontaneous fistula healing. Some cases may require an early or late surgical intervention.