Wyniki wyszukiwania - Biblioteka Nauki

1

Minimally Invasive Subtotal Esophagectomy

100%

Wójcik J. , Grodzki T. , Kaseja K.

Polish Journal of Surgery

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2007

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tom 79

|

nr 10

672-677

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.

2

Early results of liver resection using laparoscopic technique

100%

Stranek M. , Pędziwiatr M. , Radkowiak D. , Zychowicz A. , Budzyński P. , Major P. , Budzyński A.

Polish Journal of Surgery

|

2016

|

tom 88(1)

20-25

EN

The aim of the study was to present early outcomes of liver resection using laparoscopic technique. Material and methods. Retrospective analysis of patients who underwent liver resection using laparoscopic method was conducted. The analyzed group included 23 patients (11 women and 12 men). An average patient age was 61.3 years (37 – 83 years). Metastases of the colorectal cancer to the liver were the cause for qualification to the procedure of 15 patients, metastasis of breast cancer in 1 patient and primary liver malignancy in 5 patients. The other 2 patients were qualified to the liver resection to widen the surgical margins due to gall-bladder cancer diagnosed in the pathological assessment of the specimen resected during laparoscopic cholecystectomy, initially performed for other than oncology indications. Results. Hemihepatectomy was performed in 11 patients (9 right and 2 left), while the other 12 patients underwent minor resection procedures (5 metastasectomies, 4 nonanatomical liver resections, 1 bisegmentectomy, 2 resections of the gall-bladder fossa). An average duration of the surgical procedure was 275 minutes 65 – 600). An average size of the resected tumors was 28 mm (7 – 55 mm). In three cases conversion to laparotomy occurred, caused by excessive bleeding from the liver parenchyma. Postoperative complications were found in 4 patients (17.4%). Median hospitalization duration was 6 days (2 – 130 days). One patient (4.3%) was rehospitalized due to subhepatic abscess and required reoperation. Histopathology assessment confirmed radical resection (R0) in all patients in our group. Conclusion. Laparoscopic liver resections seem to be an interesting alternative in the treatment of focal lesions in the liver.

3

Laparoscopy-Assisted Total Gastrectomy with D2 Lymphadenectomy and Roux-En-Y Reconstruction - Case Report

100%

Papaj P. , Kozieł S. , Śleziński P. , Dobija-Kubica K. , Wróbel J.

Polish Journal of Surgery

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2015

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tom 87

|

nr 1

43-46

EN

We report a case of patient with stage IIIb gastric cancer qualified for laparoscopy - assisted gastrectomy and our first impressions about this procedure. Total gastrectomy with complete omentectomy and extended lymphadenectomy (D2) was performed laparoscopically. The intestinal continuity was restored in a Roux-en-Y mode extracorporeally through the abdominal access system. The orogastric tube with anvil of the circular stapler was transorally introduced into the esophagus. Subsequently, intracorporeal stapling esophagojejunostomy was performed. There were no complications after the operation and the patient was discharged in good shape. Oncological radicality was sufficient and patient has undergone chemotherapy treatment.

4

The Influence of Micropauses on Surgeons’ Precision After Short Laparoscopy Procedures

100%

Komorowski A. L. , Usero D. D. , Rodil J. R. M. H. , Topór-Mądry R.

Polish Journal of Surgery

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2015

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tom 87

|

nr 3

116-120

EN

It has recently been shown that micropauses during long surgical procedures can be beneficial for surgeons’ precision and fatigue. The aim of the study was to evaluate the impact of micropauses on surgical precision measured by a simple smartphone application. Material and methods. Two surgeons performed 40 simple laparoscopic procedures (appendectomy and cholecystectomy) with or without micropauses. After the operation the precision of surgical movements was measured by a simple smartphone application in which the number of successful trials and their mean time were used as a precision surrogate. Results. Mean number of successful trials was significantly higher for appendectomy than for cholecystectomy (5.59 vs 4; p = 0.032). There was a difference between participating surgeons both in terms of number of successful trials (5.80 vs 3.55; p = 0.01) and a mean time of all successful trials (10.03 vs 6.28; p = 0.001). No other statistically significant differences were identified. Conclusion. Micropauses had no influence on surgical precision as evaluated after short laparoscopy procedures. The only differences were surgeon-dependent and intervention-dependent.

5

Analysis of selected ergonomic problems in the use of surgical laparoscopic tools

100%

Bartnicka J. , Ziętkiewicz A. , Kowalski G.

Zeszyty Naukowe / Akademia Morska w Szczecinie

|

2013

|

tom nr 34 (106)

19--26

EN

The article demonstrates the important problematic areas associated to the ergonomics of surgical instruments during their usage. For this purpose, an analysis of cholecystectomy surgery with the use of laparoscopic instruments was conducted. There was identified the individual operations performed by surgeon, as well as the particular laparoscopic instruments. The prepared in this way study material, allowed for evaluation of design features of tools used in laparoscopic surgery from functional and ergonomic point of view and developing special research procedure for ergonomic assessment. Particularly, the critical states within the selected body postures in the system were identified: an operator (surgeon) and a surgical tool, as well as the areas of ergonomics corrective intervention in the process of using laparoscopic instruments.

6

Major vascular injury during laparoscopy

100%

Paśnik B. , Modrzejewski A.

Polish Journal of Surgery

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2019

|

tom 91(4)

36-40

EN

Major Vascular injury during laparoscopy is most deadly complication of laparoscopy. This report is review major vascular injuries based on surgeon’s relation and literature. The incidence of MVI is 0,04–0,1%. Extremely important is to learn proper technique of insuflation. According to patient’s physique surgeon should consider best technique of insuflation, take caution against slim people, and induct implements with proper angle. We should avoid excesive force during trocar and Verres’s needle insertion, we also should avoid redundant movement after Verres needle is inserted in abdomen cavity. Elevation of the anterior abdominal wall at the time of Veress or primary trocar insertion is routinely recomended. Major vascular injury is seriously underestimated problem of laparoscopic operations.

7

Single-Incision Laparoscopic Cholecystectomy - can we Afford that? Cost Comparison of Different Surgical Techniques

100%

Matyja M. , Strzałka M. , Zychowicz A. , Kołodziej D. , Rembiasz K. , Budzyń A.

Polish Journal of Surgery

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2015

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tom 86

|

nr 4

177-180

EN

One of the most commonly performed surgeries in general surgery wards with laparoscopic technique as a method of choice is gall-bladder excision. In addition to -the commonly used conventional laparoscopic cholecystectomy single incision laparoscopic cholecystectomy is getting more and more attention. Despite many works and studies comparing these methods, there is still a shortage of results assessing efficiency of this new surgical technique. The aim of the study was to evaluate cost-effectiveness of this method in Polish financial reality. We have analyzed costs of three different surgical techniques: conventional (multi- incision) laparoscopic cholecystectomy, SILC and ‘no -port’ SILC. Material and methods. We conducted a retrospective study that compared three groups of patients who underwent treatment with conventional laparoscopic cholecystectomy (n=20), SILC (n=20) and no-port SILC (n=20). These groups were matched by age, sex and BMI. Following parameters were analyzed: complication rate, operative time, operative costs, length of hospital stay, hospitalization costs. The SILC cases were performed with one of the three-trocar SILC ports available on the market. The ‘no- port’ SILC cases were performed by single skin incision in the umbilicus, insertion of one 10 mm trocar for the operating instrument, another instrument and scope were inserted directly thorough small incisions in the aponeurosis without a dedicated port Results. The average operative cost was significantly higher in the SILC group comparing to the conventional laparoscopy group and the no-port SILC group. There was no significant difference in complication rate, operative time, length of hospital stay, or hospitalization costs between the three groups Conclusions. Currently the cost of the dedicated SILC port does not allow a regular use of this procedure in Polish financial reality. According to our experience improved cosmesis is the only advantage of the single incision laparoscopy, therefore we believe that it is reasonable to consider this technique in a a very selected group of patients.

8

Laparoscopic Treatment of Abdominal Hernia – 5 Years of Experience

100%

Litarski A. , Pawełczyk J. , Majcherek J. , Janczak D. , Pawłowski L. , Rucińska Z. , Janczak D.

Polish Journal of Surgery

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2015

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tom 86

|

nr 8

353-358

EN

Laparoscopic surgery has become a well approved method of abdominal hernias treatment in recent years. Due to the advancement of laparoscopy and the use of improved synthetic materials laparoscopic surgery is characterized not only by low complication but also by a short period of recovery after surgery. The aim of the study was a retrospective analysis of the results of laparoscopic abdominal hernia surgeries (IPOM). Material and methods. Between year 2007 and 2012, 65 patients aged between 29 to 76 underwent laproscopic abdominal hernia surgeries due to either primary or postoperative abdominal hernias. All patients were examined in perioperative period, after 12 and 24 months after surgery in search of complications, pain and reccurence. Recovery period was also estimated. Results. In most cases postoperative pain was estimated from 1 to 4 on VAS scale. The most frequent complications were seromas that occured in 3 patients. The other complications were pneumothorax, wound hematoma and wound infection that occured once each. One patient required reoperation due to wound hematoma. Chronic postoperative pain was diagnosed in 3 patients and 4 recurrences were stated. Conclusions. Laparoscopic therapy of abdominal hernias is a safe operative method characterized by low recurrence and complication rates as well as short hospital stay and quick recovery. This technique is restricted by high material costs and the lack of full refund for the procedure.

9

Current treatment of the inguinal hernia — the role of the totally extraperitoneal (TEP) hernia repair

100%

Łomnicki J. , Leszko A. , Kuliś D. , Szura M.

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2018

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tom 58

|

nr 3

10

Recommendations for the standards of equipping of the Bariatric and Metabolic Surgery Center

100%

Sztuczka E. , Żukowska W. , Jackowski M. , Janik M. R. , Paśnik K. , Michalik M.

Polish Journal of Surgery

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2018

|

tom 90(5)

52-56

EN

Introduction: The prevalence of obesity in Poland and worldwide is constantly rising. High effectiveness of bariatric surgery has been proven in literature. It is recommended that bariatric procedures should be done by highly qualified surgeons with the appropriate, up-to-date medical equipment. Aim: The purpose of the study is to establish Polish recommendations and standards for the use of medical equipment for bariatric surgery centers. Materials and methods: The review of the present recommendations of the worldwide organizations and societies (including EAES, IFSO, SAGES) and guidelines was made. On the basis of current literature and authors’s clinical experience we proposed standardized protocol for bariatric surgical equipment. Conclusions: Relevant equipping of bariatric surgery centers and implementation of standardized perioperative and surgery protocols will result in significant improvements in bariatric treatment. This will ensure patients safety, a shorter length of hospital stay and considerably reduce the risk of morbidity. Moreover, it will contribute to the efficacy of the bariatric and metabolic surgery procedures, in accordance with the highest globally accepted standards.

11

Over 10 Years of Experience in the Laparoscopic Treatment of Adrenal Lesions via Lateral Transperitoneal Approach

100%

Otto M. , Dzwonkowski J. , Ciąćka T. , Jędrasik M.

Polish Journal of Surgery

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2008

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tom 80

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nr 9

478-486

EN

The aim of the study was to present own experience in the treatment of adrenal pathology using laparoscopic adrenalectomy (LA) via lateral transperitoneal approach.Material and methods. From 29.10.1997 to 30.04.2008 in the Department of General, Vascular and Transplant Surgery of Warsaw Medical University 417 LA have been performed in 405 patients. The indications were 195 (48%) non-functioning incidentaloma type tumors and 210 (52%) functioning tumors. Among them hypercortisolism in 66 (31.5%) patients (Cushing's disease - 3, Cushing's syndrome -28, subclinical Cushing's syndrome - 35), pheochromocytoma in 82 (39%), Conn's syndrome in 61 (29%) and adrenogenital syndrome in 1 (0.5%). There where 288 (71%) women and 117 (29%) men with the mean age of 51.8 years. The mean size of adrenal tumor was 41.1 mm. In 62 (15%) bilateral lesions were noted. All patients were operated laparoscopically via lateral transabdominal approach.Results. LA was successful in 393 patients (97%). We performed 393 (97%) unilateral LA, 10 (2.5%) bilateral simultaneous LA, 2 (0.5%) bilateral two-staged LA and also 2 (0.5%) sparing LA. 12 (3%) patients underwent simultaneous LA with laparoscopic cholecystectomy due to symptomatic cholecystolithiasis and 2 (0,5%) with laparoscopic umbilical hernioplasty. 12 (3%) conversions were necessary. 15 (3.7%) complications occurred, 3 (0.7%) intraoperative and 12 (3%) postoperative. There was 1 remote death on the 56th postoperative day.Conclusions. 1. LA should be recognize as the referential method in the treatment of adrenal pathology. 2. Results, as well as avoiding unnecessary complications and intraoperative difficulties is possible thanks to: close cooperation with the endocrinologist, experience gained from performing other laparoscopic operations, experience got at making open adrenalectomies.

12

Laparoscopic Live-Donor Nephrectomy With Retroperitoneoscopic Access

100%

Słojewski M. , Śluzar T. , Umiński M. , Sikorski A.

Polish Journal of Surgery

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2008

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tom 80

|

nr 8

413-416

EN

Live donation remains the single most consistent factor affecting long-term results of the transplantation. Open live donor nephrectomy is associated with high traumatization and possibility of complications due to large skin incision. The alternative is laparoscopic live donor nephrectomy (LDN) which is widely used in many countries. We present the case of LDN. The retroperitoneal approach was applied and time of operation was 210 min. The immediate function of transplanted kidney was observed. Authors hope that the offering this minimally invasive procedure to the potential donors may popularize the idea of live donation in Poland.

13

Laparoscopic nephron sparing surgery on a patient with extreme body deformation due to cerebral palsy. Is this justified when the tumor biopsy is unavailable?

100%

Łesiów M. , Borowik M. , Liss R. , Przudzik M. , Łesiów R. , Grabysa R. , Michalak M. , Roslan M.

OncoReview

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2022

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tom 12

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nr 1

16-19

EN

Abdominal surgery on patients with significant body malformation is often a challenge for an operative team. Particularly, when patient presents lesions suspected for malignancy but benign disease cannot be excluded. In the reported case the patient suffered from cerebral palsy and had extreme spinal distortion with significant displacement of internal organs. Solid renal mass was detected incidentally, but because of body deformation the biopsy to asses pathological status could not be performed. The decision to perform surgery was made and the patient underwent successful laparoscopic partial nephrectomy. Pathology examination of the specimen revealed renal cell carcinoma grade 2.

14

Outcomes of Endoscopic Totally Extraperitoneal (TEP) repair of clinically occult inguinal hernia diagnosed with ultrasonography

100%

Kebabci E. , Ozturk S. , Unver M.

Polish Journal of Surgery

|

2021

|

tom 93

|

nr 4

11-14

EN

Inguinal hernias generally present with groin lump and pain. Although inguinal hernias can be diagnosed clinically in most cases, patients without a groin lump pose a considerable diagnostic challenge. The first-line diagnostic imaging tool in these cases is ultrasound (US) and the recommended surgical procedure is laparoscopic-endoscopic repair. This retrospective study aims at evaluating postoperative results and complication rates of TEP technique in patients with occult contralateral hernias diagnosed with US in comparison to patients with clinically diagnosed hernias. A retrospective study was conducted to evaluate the outcomes of TEP procedure in patients with radiologically diagnosed occult contralateral hernias in comparison to patients with clinically diagnosed hernias. All hernias included in this study were repaired by TEP technique and secured with an extraperitoneal mesh. Demographic data, patient characteristics and perioperative information were obtained by reviewing medical records. A total number of 109 patients were enrolled in the study. The majority of patients were male and the mean age was 48.9 ± 14.6 years. In 56 cases, hernias were repaired unilaterally, while the remaining 53 were repaired bilaterally. Right-sided hernias were more common than left-sided hernias. The morbidity rate was 7.1% in unilateral repairs and 3.8% in bilateral repairs. The recurrence rate was 3.6% for unilateral repairs and 5.7% for bilateral repair. Some studies report that the incidence of clinical contralateral inguinal hernias identified after primary unilateral surgery is approximately 10%. If these contralateral hernias were diagnosed prior to the primary surgery, the risk of performing another operation could be avoided. Laparoscopic surgery enables bilateral hernia repair without any additional incisions, presenting similar morbidity rates when compared to unilateral repair. There was no significant difference between unilateral and bilateral TEP repair in terms of intraoperative and postoperative surgical complications. These results suggest that laparoscopic inguinal hernia repair is a safe and effective surgical technique for both unilateral and bilateral procedures. In order to prevent second operation, all patients with suspected inguinal hernia should undergo an US examination before surgery.

15

Impact of Menthal Representation of Disease and Wound-Related Subjective Perception of Disease on Convalescence After Surgical Treatment

100%

Stefaniak T. , Dziedziul J. , Walerzak A. , Adamczyk K. , Gill D. , Vingerhoets A. , Babinska D. , Trus M. , Lachinski A. , Śledziński Z.

Polish Journal of Surgery

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2011

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tom 83

|

nr 5

258-263

EN

Compared to open surgery, laparoscopic treatment has been shown to have several advantages, including lower levels of postoperative pain, faster recovery, and better cosmetic results. Nevertheless, the advantages of laparoscopy are being debated as possibly not being merely related to biomedical factors.Material and methods. The study consisted of two sub-studies. In the first study, 150 healthy, previously unoperated volunteers, not employed in the health services, were included. Healthy volunteers, from the latter study, were given questionnaires that presented different sizes of post-operative wounds and examined their perception of the severity of the illnesses that were treated by surgery leading to these wounds. In the second study, data was collected from 65 laparoscopic cholecystectomy patients and 35 patients treated by the open approach cholecystectomy. Patients from the second study were examined prior to operation and 1 month after surgery with a questionnaire evaluating their subjective perception of the disease.Results. Subjective perception of the severity of disease (SPSD) was similar between the laparoscopy and the open approach cholecystectomy patients before the operation (respectively, 6.25±1.7 and 6.06±2.2; ns). At the follow-up, a significant decrease of SPSD among laparoscopy patients was observed (post-op score = 3.28±0.8, p<0.05 in paired t-Student test), but not in the open approach patients (6.42±1.7, ns in paired t-Student test). The volunteers perceived that the disease of the laparoscopically treated patients was less serious than the disease of those treated with open surgery.Conclusions. The authors would like to emphasize that the study presents a new approach to the explanation of the so called "laparoscopy phenomenon", i.e. much faster and smoother recovery after relatively larger and more serious surgical procedures. We believe that the benefits observed among the videoscopy patients might be, apart from immunological and pain-related factors, attributed to the psychological influence of cognitive representations of the disease severity on pain, analgetics use, and recovery.

16

Laparoscopic colpopexy technique performed with laparoscopic supracervical hysterectomy, total laparoscopic hysterectomy, and following total abdominal hysterectomy

100%

Stangel-Wójcikiewicz K. , Wojtyś A. , Piwowar M. , Migdał M. , Popławska A. M.

Bio-Algorithms and Med-Systems

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2011

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tom Vol. 7, no. 1

43--48

EN

Study objective: Our purpose was to assess a modification of laparoscopic colpopexy technique. Design: Retrospective case analysis. Setting: University teaching hospital. Patients: A total of 28 patients with stage I, II and III organ prolapse. Interventions: The rectovaginal space was dissected at the superior aspect of the posterior vaginal fascia and a mesh was sutured to this fascia. Measurements and Main Results: 28 patients completed a 36 months follow-up. No recurrences of the vagina vault prolapse was observed. Three cases of abdominal pain at the level of the trocars placing were recorded in a first week after surgery. Two of these were found in the group of LSH and one in the group of a hysterectomy history. There was no significant difference in blood loss, length of hospital stay and surgical or postoperative complications. Conclusion: The modification of laparoscopic colpopexy, although technically challenging, may be learned quickly. It shows rapid improvement in operative time without subjecting the patient to undue risk. Further studies are required to determine the long-term tolerance and outcome of the procedure.

17

Why diagnostic laparoscopy?

100%

Firat N. , Mantoglu B. , Akin E. , Altintoprak F. , Bas E.

Polish Journal of Surgery

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2021

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tom 93

|

nr 3

22-26

EN

Introduction: Abdominal pain requires rapid diagnosis and treatment, especially in emergency circumstances. Sometimes the diagnosis of the disease cannot be accomplished with laboratory and imaging methods, and an invasive procedure such as diagnostic laparoscopy may be required to obtain a diagnosis. Although diagnostic laparoscopy can be performed for postdiagnosis treatment purposes, laparotomy is inevitable in some cases. Aim: The aim of the study is to evaluate the role of diagnostic laparoscopy in diagnosis and treatment and to retrospectively examine the factors that force the surgeon to perform a laparotomy. Material and methods: Patients over the age of 18 who underwent diagnostic laparoscopy in the general surgery clinic of Sakarya University Training and Research Hospital between January 2013 and December 2019 were retrospectively evaluated. Patients under 18 years of age and patients diagnosed before surgery were excluded. Demographic data of the patients, whether there was a conversion from laparoscopy to laparotomy, postoperative morbidity, and mortality were recorded. Results: The data of 347 patients in total were evaluated retrospectively between the specified dates. As many as 216 of the patients were previously diagnosed, with laparoscopic procedures performed for staging purposes and they were not included in the study. The remaining 131 patients were included in the study. Sixty-eight patients were women and 63 were men. In total 79.4% of the patients had diagnostic laparoscopies performed due to emergency circumstances, and 20.6% for abdominal pain evaluation. While the procedure was concluded laparoscopically in 64.9% of the patients, the operation was continued by performing laparotomy in 35.1%. Conclusion: Despite the increase in the variety and frequency of imaging modalities used, laparoscopic intervention is an essential approach in both diagnosis and treatment when the diagnosis is doubtful, especially in appropriate emergency cases.

18

Laparoscopic gastric resections with per oral specimen extraction in treatment of intramural gastric tumors

100%

Stanek M. , Major P. , Wierdak M. , Pędziwiatr M. , Radkowiak D. , Zychowicz A. , Budzyński A.

Polish Journal of Surgery

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2017

|

tom 89(1)

16-21

EN

Aim: The goal of this work was to present our experiences and results of treatment of gastric tumors using the per oral specimen extraction (POSE) technique. Material and methods: A retrospective analysis a group of patients treated with laparoscopic stomach wedge resection of gastrointestinal stromal tumor (GIST). During that time 50 patients underwent laparoscopy due to the suspicion of GIST. In 12 patients resected material was removed endoscopically per os (POSE). In the remaining 38 subjects it was evacuated through minilaparotomy. Mean age of patients treated using POSE technique was 65.6 years (48-81 years). There were 9 women and 3 men in this group Results: Mean time of the POSE procedure was 92.5 min (40-160 min). Size of removed tumors ranged from 14 mm to 40 mm (mean: 25 mm). The mean length of hospital stay was 3.2 days (2 to 8 days) for patients treated with POSE. One patient (8.3%) required longer hospitalization (8 days) due to the presence of a fluid collection at the site of gastric suture. This patient was treated conservatively. One patient (8.3%) was diagnosed with surgical site infection (navel wound after an optical trocar). Histopathological examination confirmed radical excision in all of our patients (R0). Conclusions: It seems that the POSE technique is the next stage of development of minimally invasive surgery and may constitute a link in evolution of natural orifice translumenal surgery techniques. Removal of excised material through oral cavity is an attractive, effective, and safe method despite its many limitations.

19

Laparoscopically Assisted Ileo-Colonic Resection in Patients with Crohn’s Disease – Preliminary Report

100%

Borycka-Kiciak K. , Dib N. , Janaszek Ł. , Sołtysiak Ł. , Bukowicka B. , Tarnowski W.

Polish Journal of Surgery

|

2013

|

tom 85

|

nr 9

505-510

EN

Despite increasing number of reports indicating good treatment outcomes, laparoscopic treatment of Crohn’s disease remains controversial. The aim of the study was to compare outcomes of laparoscopically assisted and open ileo-colonic resection in patients with active Crohn’s disease. Material and methods. 82 patients who underwent surgical treatment (44 laparoscopic and 38 open procedures) at the Department of General, Oncological and Gastrointestinal Surgery in Warsaw were enrolled to the study. The following perioperative parameters were compared in both these groups: duration of hospitalization and presence of postoperative complications in at least 12 months of follow‑up. Results. The conversion rate in the laparoscopy group was 29.5%. There were no statistically significant differences between the study groups with regard to duration of the surgical procedure, requirement for perioperative transfusions and total number of postoperative complications (19.3% in the laparoscopy group versus 28.9% in the open surgery group). However, amount of analgesic drugs required in the postoperative period was significantly lower (25±6 vs 43±9, p<0.01) and duration of hospitalization was significantly shorter (9.0 vs 11.3 days, p=0.021) after laparoscopic versus open procedures procedures. Most of the patients with complicated Crohn’s disease who were qualified to laparoscopic treatment, underwent successful treatment using this method. Patients in whom conversion was done, were more likely to be on long term preoperative immunosuppressive therapy versus other patients. Conclusions. Laparoscopy is a demanding procedure from the technical point of view, but provides valuable benefits to patients with Crohn’s disease, including those with a complicated disease. However, this method requires ongoing improvement of technical aspects and thorough analysis of failures to identify factors that could accurately select patients with indications and contraindications to this procedure.

20

Laparoscopic cholecystectomy in a patient with total situs inversus – case report

100%

Stojcev Z. , Duszewski M. , Bobowicz M. , Galla W. , Maliszewski D.

Polish Journal of Surgery

|

2013

|

tom 85

|

nr 3

141-144

EN

For many years, laparoscopic cholecystectomy remains the method of choice for both the treatment of symptomatic cholelithiasis, and chronic and acute cholecystitis (1). The experience of the surgeon grows with each laparoscopic procedure, which enables to operate in case of difficult anatomical conditions and associated anatomical variants. The aim of the study was to present a case of a 47-year old male patient with total situs inversus and several months history of recurrent left epigastric pain, radiating to the left scapula, being accompanied by nausea and vomiting. The study presented the operative technique of laparoscopic cholecystectomy and postoperative period data. In conclusion, laparoscopic cholecystectomy in a patient with total situs inversus is possible and safe, providing relevant precautions. The main issues certainly include a good and feasible plan of the operation, discussion concerning the possible intraoperative and postoperative complications, a good plan considering the localization of the trocars, as well as an experienced surgical team. One should also not forget that early conversion to classical cholecystectomy is not considered as failure, but might prevent accidental damage of the biliary ducts and long-term complications.