Adam Kiciak

Roux‐en‐Y or ‘uncut’ Roux procedure? Relation of intestinal migrating motor complex recovery to the preservation of the network of interstitial cells of Cajal in pigs

We designed a conscious pig model to investigate myoelectric activity and the number of interstitial cells of Cajal (ICC) in the proximal jejunum following the Roux‐en‐Y and ‘uncut’ Roux procedures in relation to clinical outcomes. Twelve male Polish White pigs (8 weeks old, 10–13 kg) underwent surgery under general anaesthesia first to implant bipolar electrodes and telemetry transmitters for continuous electromyography recordings and then, after 1 week recovery, to create Roux‐en‐Y (n= 6) and ‘uncut’ Roux loops (n= 6). Upper gut tissue specimens were studied for the expression of c‐kit staining procedure to quantitatively identify the presence of interstitial cells of Cajal. The intestinal migrating motor complex was restored within 10.5 and 37 h in ‘uncut’ Roux and Roux‐en‐Y pigs, respectively (P < 0.05). During 2 weeks, the ‘uncut’ Roux piglets increased their body weight by 18.0%, whereas the Roux‐en‐Y piglets increased their body weight by only 7.3% (P≤ 0.05). Two weeks after surgery, the number of ICC located in the region of Auerbachs plexus was higher and adhesions in the abdominal cavity lower in the ‘uncut’ Roux group. In conclusion, in the pig model, preservation of smooth muscle and ICC network continuity in the proximal jejunum may play an important role in early postsurgical recovery.

Migration of a foreign body into the colon and its autonomous excretion

Summary Background The frequency of foreign body retention in the abdominal cavity ranges from 1 in 100 to 1 in 3000 surgeries performed. Worldwide literature describes only a few cases of the migration of misplaced surgical gauze into the colon. Case Reports The first case is a 60-year-old patient following laparoscopic cholecystectomy, who excreted (on his own) a cotton sheet 30×65 cm after 26 weeks, which did not possess a radiological locator. The latter fact caused diagnostic difficulties in interpreting ultrasonography, CT-scans and abdominal X-rays. Colonoscopy after 4 months following the excretion of the sheet showed flat, stretched ulceration of the colonic wall near the hepatic turn. The second case is a 76-year-old who had undergone several abdominal surgeries, including a classical cholecystectomy and extirpation of the uterus along with related tissues, as a result of cancer and with subsequent radiotherapy. The reason for the last intervention was an occlusion, which required a resection due to abscesses inside the peritoneal cavity. Abdominal pain continued after the surgery. Uroscopy and abdominal X-rays were performed 3 months later, which confirmed the presence of foreign matter in the abdominal cavity. Conclusions Most foreign objects that have migrated into the colon will be excreted autonomously, which warrants a conservative assessment. Radiologically-tagged materials should be used, which will greatly ease identification in cases of suspected retention of surgical materials in the abdominal cavity.

The DIAMOND system in the treatment of type 2 diabetes mellitus in an obese patient

Obesity and type 2 diabetes mellitus have reached epidemic proportions worldwide. As the majority of antidiabetic medications are of limited efficacy and patient adherence to long-term therapy is one of the main limiting factors of effective blood glucose and body weight control, new therapies are still looked for. The DIAMOND system seems to be one of the most promising among them. This system recognizes natural electrical activity of the stomach and automatically applies electrical stimulation treatment during/after eating with subsequent modulation of signals transmitted to the regulatory centers in the brain in order to provoke an early response of the gut typical of a full meal. We present the case of a 47-year-old obese woman with type 2 diabetes. During treatment with this system, serum glucose and hemoglobin A1c levels significantly decreased. Body weight loss and waist circumference reduction were observed. Additionally, beneficial effect on lipid profile was found.

Purine analogues as a risk factor of postoperative complications in abdominal surgery for Crohn’s disease

Analogi puryn – azatiopryna i 6-merkaptopuryna – odgrywają coraz większą rolę w indukowaniu i podtrzymywaniu remisji u pacjentów z chorobą Leśniowskiego-Crohna. Są stosowane w coraz szerszej grupie pacjentów, często w dużych dawkach i przez dłuższy czas. Nie wszystkie jednak aspekty ich wielokierunkowego działania zostały dokładnie poznane. Coraz liczniejsze doniesienia o zwiększającej się liczbie poważnych powikłań septycznych w przebiegu pooperacyjnym u pacjentów leczonych wcześniej analogami puryn budzą niepokój chirurgów i nakazują ponownie zastanowić się nad potencjalnym wpływem tych leków na procesy gojenia i wyniki leczenia operacyjnego. Artykuł przedstawia aktualny stan wiedzy na temat mechanizmów działania analogów puryn, ich wpływu na procesy gojenia oraz potencjalnej roli w generowaniu zwiększonej częstości wystąpienia powikłań pooperacyjnych u osób z chorobą Leśniowskiego-Crohna. Abstract