Andrzej Lekstan

Hepaticojejunostomy vs. End-to-end Biliary Reconstructions in the Treatment of Iatrogenic Bile Duct Injuries

BackgroundRetrospective comparison of short- and long-term results and quality of life in patients treated for iatrogenic bile duct injuries (IBDI) with Roux-Y hepaticojejunostomy (HJ) or end-to-end ductal anastomosis (EE).MethodsBetween January 1990 and March 2005, 94 patients underwent reconstructive surgery for IBDI: 49, Roux-Y HJ, and 45, EE.ResultsEarly postoperative complications were observed in 12 (24.5%) patients undergoing HJ and three (6.7%) undergoing EE (p = 0.0239). Reoperations in the early postoperative period were performed in four (8%) patients after HJ and in zero patients after EE. Following HJ, one (2%) hospital death occurred due to acute circulatory insufficiency. Long-term results were evaluated in 69 (72%) patients. Postoperative mean weight gain was significantly higher after EE than HJ (p = 0.0191). Recurrent stricture was observed in two (5.3%) patients after HJ and three (9.6%) after EE (p = 0.6509). Terblanche long-term results were comparable in both groups (p = 0.3173). Good Karnofsky quality of life was comparable in both groups (p = 0.8377).ConclusionsMore early complications occurred after HJ than after EE. Long-term results were comparable after both reconstructive methods. After EE, patients achieved a higher weight gain than after HJ. Quality of life in both groups was comparable.

Clinical Value of Serum Neopterin, Tissue Polypeptide-Specific Antigen and CA19-9 Levels in Differential Diagnosis between Pancreatic Cancer and Chronic Pancreatitis

Background: Neopterin and tissue polypeptide-specific antigen (TPS) have been suggested to be useful in differential diagnosis between pancreatic adenocarcinoma (PA) and chronic pancreatitis (CP). The aim of our study was to compare the clinical usefulness of CA19-9, neopterin and TPS serum levels in patients with PA and CP. Methods: The study included 85 patients with PA, 72 with CP and 50 healthy controls. The serum concentrations of neopterin, TPS and CA19-9 were measured (DRG International, USA). The associations of the analyzed markers and clinical data at diagnosis have been evaluated. Results: Serum levels of neopterin, TPS and CA19-9 were higher in PA patients compared to CP (p < 0.001). TPS and CA19-9 levels were also elevated in patients with CP compared to the control group (p < 0.001). In contrast, there was no difference between neopterin serum levels in CP patients and the control group (p > 0.05). Neopterin showed the best sensitivity and specificity (91.8 and 87.5%) in PA diagnosis compared to CA19-9 (respectively 83.5 and 75%) and TPS (75.3 and 65.3%). Conclusion: Our results indicate that neopterin may be potentially useful in differential diagnosis between PA and CP. Assessment of TPS probably adds no significant information to that obtained with CA19-9 and neopterin.

Concentration of gelatinases and their tissue inhibitors in pancreatic inflammatory and neoplastic tumors and their influence on the early postoperative course.

UNLABELLED Pancreatic cancer (PC) is the fourth leading cause of death in the world, due to neoplastic disease. Chronic pancreatitis (CP) is a progressive disease leading towards pancreatic fibrosis. The aim of the study was to assess the impact of matrix metalloproteinases 2 and 9 (MMP2 and 9) and their tissue inhibitor (TIMP 1 and 2) concentrations in case of PC and CP tissue homogenates on early treatment results of patients subject to pancreatic resections. MATERIAL AND METHODS The study group comprised 63 patients, including 25 (39.68%) female and 38 (60.32%) male patients. Group 1 (CP) consisted of 31 patients with CP (F: M = 10/21). Group 2 (PC) consisted of 32 patients with PC (F: M = 15:17). The pancreatic tumor samples were collected from the resected pancreas, being subject to electrophoresis and immunoenzymatic studies. After confirming their activity, MMP2, MMP9, TIMP1, TIMP2 concentrations were determined. Correlation analysis of MMPs and TIMPs concentrations was performed in relation to the following: tumor diameter, age, BMI, hospitalization, duration of symptoms and surgery, blood loss, incidence of perioperative complications. RESULTS Group differences were presented in terms of: age, BMI, ASA, duration of symptoms, jaundice, tumor diameter, time of operation. There were no differences considering weight loss, blood loss, extent of resection, and hospitalization. Significant MMPs and TIMPs concentration differences between groups were demonstrated. CONCLUSIONS Comparison of PC to CP tissue samples showed significantly higher levels of metalloproteinases and TIMPs in the former. Positive correlations of MMP1, TIMP1 and 2 with tumor diameter (CP) were observed, and MMP2 with the duration of surgery and blood loss (PC). There was no MMPs and TIMPs concentration levels influence on the incidence of postoperative complications.

Distal Pancreatectomy - OWN Experience

THE AIM OF THE STUDY was the retrospective analysis of early results after distal pancreatectomy (DP). MATERIAL AND METHODS During the period between January, 2000 and December, 2010 distal pancreatectomy was performed in 73 patients, including 32 (43.83%) male, and 41 (56.16%) female patients. Average patient age amounted to 53.92 ± 14.37 years. Surgery was performed by means of laparoscopy or the classical method. RESULTS The mean duration of the procedure amounted to 179.79 ± 59.90 minutes. Fifty-nine (80.82%) patients were subject to splenectomy. After the resection the pancreatic stump was hand-sewn in 69 patients. Pancreatoenterostomy was performed in 4 (5.47%) patients. Early postoperative complications occurred in 11 (15%) patients. Reoperation was required in two (2.7 %) patients. The postoperative mortality rate amounted to 2.7%. The average hospitalization period after surgery amounted to 12.72 ± 9.8 (1- 66) days. CONCLUSIONS Distal pancreatectomy performed in a center experienced in pancreatic surgery is a safe procedure characterized by a low rate of complications and mortality.

Hemorrhage from the inferior epigastric artery malformation into the external intestinal fistula as an atypical complication of Crohn's disease

Dear Sir, Severe lower gastrointestinal bleeding is a rare complication of Crohns disease, occurring in 0.9% to 6% of cases. Most bleeding episodes originate from colonic ulcers or ulcerated areas within the mucosa.1 In most cases, hemorrhage from the inferior epigastric artery is into the abdominal wall or retroperitoneal space.2,3 Only two cases of bleeding into the intestine and life-threatening hemorrhage due to injury to the inferior epigastric artery following ileostomy construction appearing as massive bloody diarrhea have been reported in the literature.4,5 One case of intraperitoneal hemorrhage from IEA has been reported.5 We present the unique case of life-threatening spontaneous hemorrhage into the external intestinal fistula from the …

Complications following Video-Assisted Transhiatal Esophagectomy for Esophageal Cancer

Background: The aim of the study was to evaluate the clinical safety and usefulness of esophageal dissection under laparoscopic monitoring during transhiatal esophagectomy for esophageal cancer. Patients and Methods: The study group of 115 patients included 102 men and 13 women. The mean age was 57 (range 32-79) years. Tumor histology showed a squamous cell carcinoma in 75% and an adenocarcinoma in 25% of cases. According to the American Joint Committee on Cancer classification, 3 patients were classified as stage I, 19 as stage IIA, 24 as stage IIB, 64 as stage III, and 5 as stage IVA. Mean operating time was 4.5 ± 1 h. Results: Ten significant intraoperative complications were observed (9 hemorrhages, 1 death). The mean blood loss was 900 (range 300-2,100) ml. Postoperative complications occurred in 61% of the patients; the most frequent were pulmonary complications (27%), recurrent laryngeal nerve injury (17.4%), anastomotic stricture (14%), and anastomotic leak (10.4%). Early re-laparotomy was performed in 6% of the patients. Hospital mortality rate was 9%. Mean hospital stay was 34 (range 5-64) days. Conclusion: Video-assisted transhiatal esophagectomy is a useful method, but does not allow a vision-guided removal of the upper esophagus. The method does not prevent or diminish the number of intra- and postoperative complications of esophageal resection.