The impact of EAES Fellowship Programme: a five-year review and evaluation.

BACKGROUND: The European Association of Endoscopic Surgery (EAES) fellowship programme was established in 2014, allowing nine surgeons annually to obtain experience and skills in minimally invasive surgery (MIS) from specialist centres across the Europe and United States. It aligns with the strategic focus of EAES Education and Training Committee on enabling Learning Mobility opportunities. To assess the impact of the programme, a survey was conducted aiming to evaluate the experience and impact of the programme and receive feedback for improvements. METHODS: A survey using a 5-point Likert scale was used to evaluate clinical, education and research experience. The impact on acquisition of new technical skills, change in clinical practice and ongoing collaboration with the host institute was assessed. The fellows selected between 2014 and 2018 were included. Ratings were analysed in percentage; thematic analysis was applied to the free-text feedbacks using qualitative analysis. RESULTS: All the fellows had good access to observing in operating theatres and 70.6% were able to assist. 91.2% participated in educational activities and 23.5% were able to contribute through teaching. 44.1% participated in research activities and 41.2% became an author/co-author of a publication from the host. 97.1% of fellows stated that their operative competency had increased, 94.3% gained new surgical skills and 85.7% was able to introduce new techniques in their hospitals. 74.29% agreed that the clinical experience led to a change in their practices. The most commonly suggested improvements were setting realistic target in clinical and research areas, increasing fellowship duration, and maximising theatre assisting opportunities. Nevertheless, 100% of fellows would recommend the fellowship to their peers. CONCLUSION: EAES fellowship programme has shown a positive impact on acquiring and adopting new MIS techniques. To further refine the programme, an individualised approach should be adopted to set achievable learning objectives in clinical skills, education and research.

Multi-organ trauma with rupture and Stanford type B dissection of thoracic aorta. Management sequence. Current possibilities of medical treatment.

A case of a 46-year-old car driver struck with great force by a tram through the driver's door is presented. The main trauma consisted in chest injury with multi-rib fracture along with rupture and dissection of the thoracic aorta. Immediate medical rescue actions consisted only in procedures necessary to support vital functions; the patient survived owing to being promptly transported to the Emergency Department to undergo thoracotomy and laparotomy with massive blood transfusion. Polytrauma angio-CT scan revealed a posttraumatic thoracic aorta lesion which in turn was treated by deployment of an endovascular thoracic stent graft. This way, the immediate risk of death was averted, and the remaining traumatic lesions and conditions could be treated. Patient was discharged to a Rehabilitation Center on the 49th day of treatment. The authors stress that trauma resulting from accidents with this particular mechanism, i.e. lateral car crash on the driver's side with the driver's door being staved in by the tram, should be managed by immediate transport of the patient to the Emergency Center. In such cases early drainage of the pleural cavity can deteriorate patient's status by increasing the bleeding from the ruptured aorta.

[Varicose veins of lower limbs is a very common medical problem in developed countries and also in Poland]. / Jakosc zycia po operacjach z powodu niepowiklanej choroby zylakowej w zaleznosci od stosowanego leczenia wspomagajacego.

UNLABELLED: Although surgery is the main therapeutic method applied for the treatment of this disease the other therapeutic modalities cannot be neglected. The aim of the study was an assessment of quality of life of patients following operative treatment of uncomplicated varicose veins with regard to applied additional therapy. The study included 100 patients of Swiebodzin district, who underwent surgery for uncomplicated varicose veins in last 6 years. These patients were visited and interviewed by trained nurse. There were four groups of patients defined. The first one received pharmacological therapy after surgery predominantly phlebotrophic agents, second one used compression therapy, third applied both methods, fourth used as controls did not get any additional therapy after surgery at all. As an investigation tool the original quality of life questionnaire CIVIQ was applied taking into account pain, psychological, physical and social aspects. Results revealed significantly better quality of life for patients using both pharmacological and compression therapy over ones applying one of these therapies alone and the group applying no therapy at all. Morbidity rate was 19%. Reintervention rate was 12% and on examinations in 72% varicose veins were seen. The majority of patients (57%) declared improvement of their health status, 10% substantial improvement 20% some improvement and 13% declared no improvement after surgery for varicose veins. CONCLUSION: Compression and phlebotrophic therapies applied together after surgery are simple an effective methods improving quality of life better than any of these methods applied separately or no additional therapy at all. Their use is still not very common in Poland.

[Some considerations about the procedure of informed consent in patients prepared for electroconvulsive treatment]. / Kilka uwag o procedurze pozyskiwania swiadomej zgody w przypadku pacjentów kwalifikowanych do zabiegów elektrowstrzasowych.

Electroconvulsive therapy (ECT) as a medical procedure of higher risk as well as a therapy evoking certain controversies requires strict obedience to the conditions of acquiring the patient's informed consent to the offered method of treatment. To acquire the patient's consent it is necessary to inform him/her about the different aspects of electroconvulsive therapy. The paper stresses that in the case of ECT therapy, the spoken information given to the patient seems insufficient. It is necessary to work out a Polish questionnaire for acquiring the patient's consent to electroconvulsive therapy and to apply it in all psychiatric institutions that carry out ECT procedures.

Parietal Strangulation Of Small Intestine In Femoral Hernia Site With Symptoms Of Intestinal Obstruction In Patient With Incidentally Found Small Intestine Tumor--A Case Report.

Richter's hernia (partial enterocele) is the strangulation/entrapment of only part of the circumference of the intestinal wall. It is relatively rare, and presents without mechanical obstruction - giving vague, non-specific symptoms and signs, and a threat of intestinal necrosis, gangrene, followed by perforation. A report of a case of entrapment of the jejunum in the femoral ring, which did not cause the gangrene, but symptoms of mechanical obstruction, is presented. Further inspection of the small bowel in this case revealed an extra-luminal tumour, which appeared to be a GIST. The entrapped part of the jejunum has been released and the tumour has been resected.

Reversed 5 pattern of diagnostic laparoscopy during laparoscopic cholecystectomy and its standardization.

An attempt at standardization of the diagnostic laparoscopy (DL) procedure during laparoscopic cholecystectomy (LC) was undertaken by establishing a simple pattern and checking its applicability in 100 consecutive LCs. DL was performed following the reversed number 5 pattern, starting from the right upper quadrant and moving to the left upper quadrant, left flank, back to the right flank along the transverse colon, down to the pelvis, along the sigmoid to the left flank, and back to the right upper quadrant inspecting small bowel. DL was incomplete in 11 patients. Inspection lasted 6-12 minutes (operation time increase, 14%). Abnormalities were discovered in 38% of patients, diagnosis elucidated in 8%, intervention undertaken in 11%, and control or further treatment proposed in 33%, without morbidity and mortality. The reversed 5 pattern of diagnostic laparoscopy is feasible and safe. It can be routinely done during LC in the general hospital setting. Standardization of diagnostic laparoscopy during laparoscopic cholecystectomy seems necessary for early disclosure of visible disorders and for medicolegal purposes.

A COMPARISON OF EFECTIVENESS, AND AN ASSESSMENT OF THE QUALITY OF LIFE OF PATIENTS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY AND ROUX-EN-Y GASTRIC BYPASS.

INTRODUCTION: Morbid obesity is nowadays one of the major problems of well developed countries. Treatment of this disease comprises many modalities, but the most successful are surgical ones. With the advent of laparoscopic operations it became clear that these are particularly useful for operation in obese patients due to their minimal invasiveness. The aim of the study was to compare the effectiveness and quality of life of patients operated on for morbid obesity by laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric by-pass (LRYGB) by one surgeon in one surgical centre. MATERIAL AND METHODS: Between 2006-2011 in the Department of General and Vascular Surgery, Szczecin-Zdunowo Specialist Hospital, 74 morbidly obese patients (54 F, 20 M) were operated on by two methods. Mean age (42.4 and 45 years), and body mass index (46.5 ± 8.9 kg/m2 for LSG and 45.1 ± 4.4 kg/m2 for LRYGB) respectively, were comparable. One surgeon in one centre performed LSG in 33 patients (24 F, 9 M) and LRYGB in 41 patients (30 F, 11 M). An independent observer evaluated patients at times of up to 6 months (37 pts), and after 7 months to 36 months (37 pts) postoperatively. Quality of life was assessed by the Gastrointestinal Quality of Life Index (GIQLI) questionnaire, with accessory questions concerning sexual, physical and other activities before and after intervention. RESULTS: There were no serious short or long term complications in either group of patients, although one patient in each group felt permanent postoperative discomfort (2.44% and 3.03%). Percentages of excess weight loss in both groups were similar and reached after 6 months 38.5% for LSG, 39.9% for LRYGB, and after 7-36 months 64.5% for LSG, 66.9% for LRYGB respectively. Quality of life assessment revealed significantly lower values in core symptoms for patients after LRYGB compared to LSG, but after LSG constipation was slightly more frequent. However, the general GIQLI score for patients after both types of surgery was statistically insignificant (110.6 for LSG versus 108.7 for LRYGB). In both groups sexual and physical activities significantly improved after operation. CONCLUSION: There were no significant differences in effectiveness and quality of life in patients after laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric by-pass.

Diffuse trauma of the right lobe of the liver successfully treated without resection. Case report.

The victim of a motorcycle frontal crash was treated in a high reference teaching hospital for disruption of the right lobe of the liver (IV grade AAST/Moore). Primary packing, secondary biloma and abscess treatment including papillotomy and biliary stent, led, after 8 months, to cicatrisation of a damaged liver parenchyma. In conclusion, the authors stress that such injuries should be treated in highest level reference centres where all modern noninvasive interventional modalities are available, and that surgical resection is not always the operation of best choice.

[Follow up and quality of life of patients after treatment at the intensive care unit. Report from the Intensive Care Unit of the Second Clinical Hospital in Szczecin]. / Dalsze losy i jakosc zycia pacjentów po odbytym leczeniu na oddziale intensywnej opieki medycznej na przykladzie Oddzialu Intensywnej Opieki Medycznej SPSK nr 2 w Szczecinie.

INTRODUCTION: Treatment of patients at the Intensive Care Unit (ICU) always requires maximal efforts of the staff and use of extended resources to save lives and restore health. Therefore, the assessment of therapeutic efficacy at the ICU is of great value. The aim of this study was to assess follow up and the quality of life of patients after treatment at the Intensive Care Unit. We chose the Department of Intensive Care and Anesthesiology with the Acute Intoxication Unit of the Second Clinical Hospital, Pomeranian Medical University in Szczecin. MATERIAL AND METHODS: Patients who stayed at the ICU for at least 14 days in 2002-2007 were qualified and cardiac surgery patients were excluded. RESULTS: Out of 1347 patients treated during this period at the Department of Intensive Care and Anesthesiology with the Acute Intoxication Unit of the Second Clinical Hospital, Pomeranian Medical University in Szczecin, 809 (60.1%) were discharged. The mean annual hospital mortality rate was 104. Eighty patients fulfilled the inclusion criteria. In this group, 32 (40%) survived until year 2010 when our study was undertaken; 26 of them (32.5%) were enrolled. The main part of the study was based on the standardized questionnaire QLQ-C30 (3.0 Polish version). Supplementary questions addressed personal data, occupation, employment status, degree of disability, and posthospital rehabilitation. An attempt was made to assess the quality of medical and nursing care at the ICU. The results were analyzed statistically with Pearson's r and Kruskal-Wallis tests for correlations and significance. Out of 26 patients (18 males and 8 females), mean age 56.4 years, mean ICU stay of 29.7 days (SD +/- 22.3 days), hospitalized for acute cardiopulmonary failure (n = 10; 38.5%), cardiac arrest (n = 9; 34.5%), multiple trauma (n = 5; 19%), and intoxication (n = 2; 8%), only 46% survived two years or more after discharge from ICU; QLQ-C30 demonstrated that their health status and quality of life was good, albeit worse than of healthy persons. CONCLUSIONS: There were no correlations between self--assessed health status and quality of life on one side and age, ICU duration, and time from ICU stay on the other. The diagnosis had no significant effect on self-assessment of health status and quality of life.

[Trauma in cycling--case report and review of the literature]. / Urazy w kolarstwie--opis przypadku i przeglad pismiennictwa.

The authors present a review of trauma in tourist and competitive cycling in Poland in comparison with reports in the literature. Groups of injuries are discussed with a focus on their frequency and threat to life and health. The authors present a case of a road cycler colliding with a car, his first aid, evacuation, and treatment at a hospital. This case, as well as accidents of other competitive cyclers, are analyzed by the authors to demonstrate ways of reducing trauma in cycling. Most importantly, competitive and tourist cyclers should always wear cycle helmets as they reduce head trauma, the main life-threatening trauma in this sport.

[Quality of life of stoma patients after colorectal surgery and possibilities of its improvement]. / Jakosc zycia pacjentów po zabiegu operacyjnym na jelicie grubym z wytworzeniem stomii i mozliwosci jej poprawy.

INTRODUCTION: It is widely known that quality of life of patients after colorectal surgery with creation of stoma substantially deteriorates. In this instance it seems interesting to assess if it is improving in time and what measures are to be undertaken to achieve such improvement. Aims to assess changes in quality of life of patients after colorectal surgery with creation of a stoma, in 3 and 6 months after intervention, and establish possibility of improvement of quality of life in these patients. MATERIALS AND METHODS: A group of 84 patients 36 men and 48 women after colorectal cancer surgery with creation of a stoma was investigated by means of a standardized questionnaire EORTC QLQ C-30 (version 2.0), filled 3 and 6 months after intervention. Questions about possibilities of improvement of their quality of life were also posed. RESULTS: Compared with representatives of general population, quality of life of investigated group 3 months after surgery was substantially inferior, in almost all items: functional domains and symptomatic ones as well. After 6 months substantial improvement in patients was revealed in functional domains such as physical functioning and fulfilling their role. However improvement of quality of life was observed in majority of items but it did not achieve the level of healthy population. Results achieved in male group which were inferior to results achieved by women after 3 months, exceeded the women' score after 6 months in many aspects. The improvement was influenced by acquaintance of patients with stoma, and by acquiring knowledge about stoma care which were considered low after 3, and after 6 months. CONCLUSIONS: Quality of life substantially lower after intervention resulting in stoma formation, improves after 6 months, however there are still deteriorations in private and social life, and financial situation. An adequate education of patients in pre- and postoperative time and active informative support is mandatory to obtain some degree of improvement of their quality of life.

[Assessment of knowledge about first aid among the teachers of chosen high schools in the Western Pomerania region]. / Ocena poziomu wiedzy nauczycieli szkól ponadgimnazjalnych w Zachodniopomorskiem na temat pierwszej pomocy medycznej.

INTRODUCTION: Increasing susceptibility to trauma among Polish society, which concerns school pupils as well, requires defining causes of the problem and establishing directions of activity in order to reduce the frequency of trauma and its unfavorable consequences. Investigation of a level of knowledge and an attitude of teachers of chosen secondary schools towards giving the first aid in the West Pomeranian voivodeship. MATERIAL AND METHODS: The survey was carried out among 100 teachers from two high schools of which one is situated in a city of Szczecin (50) and the other in a smaller town of Gryfice (50). A standardized questionnaire, which was previously applied to investigate a problem of giving the first aid among Polish society, was used as a diagnostic tool. RESULTS: Although majority of respondents took part in first aid courses while acquiring different ranks and qualifications, the survey has confirmed that the level of knowledge about giving the first aid is insufficient. The half of respondents know rules of giving first aid, and one third declares that can put these rules into the practice. A large part of respondents demonstrates rather passive attitude towards giving the first aid in case of emergency. There are no major differences in the level of knowledge about first aid between teachers from a large city and a small town. CONCLUSIONS: A systemic solutions for improvement of the knowledge of rules of giving the first aid among teachers and pupils are mandatory. The authors of this paper propose cyclical training courses for teachers led by medical professionals, and further courses for pupils led by those teachers in collaboration with students of the last year of paramedical studies.

[An investigation of the quality of life of female patients operated by laparoscopic or open way for uncomplicated cholecystolithiasis]. / Badanie jakosci zycia pacjentek operowanych sposobem laparoskopowym lub klasycznym z powodu niepowiklanej kamicy pecherzyka zólciowego.

INTRODUCTION: In many investigations concerning the results of surgical treatment of gallbladder stones, generally American or international data are cited, as national data are scarce, or even do not exist. This paper was written to complement Polish data with a comparison of patients' views about two methods of operating gallbladder stones commonly applied in our country. The purpose of the paper was to compare the quality of life of female patients operated for uncomplicated cholecystolithiasis in regional hospitals of Poland. MATERIAL AND METHODS: The study material was comprised of two groups of 100 patients each, from two regional hospitals. In one of the hospitals the patients were treated only by laparoscopic cholecystectomy alone. As in the other hospital only by open cholecystecomy. The age of the patients whom were operated by open cholecystecomy varied between 19 and 90 years, median 56, mean 54.6 SD +/- 15.4 years. Whereas, in the group treated by the laparoscopic method the age varied between 23 and 72 years, median 48, mean 49.7 SD +/- 11 years. The investigation was performed between the second and twelfth month after the operation, median 6 for both, mean 6.2 SD +/- 2 for open and mean 6.9 SD +/- 2 for the laparoscopic method. BMI of the investigated patients was between 17.7 and 33.1, median 26.3, mean 26 +/- 2.7 in the open group, and between 18.1 and 34.6, median 24.2, mean 24.7 +/- 3.2 in the laparoscopic group. As a diagnostic tool a standardized Gastrointestinal Quality of Life Questionnaire (GQLI) was used, enriched by demographic questions, self-assessment of postoperative well-being, smoking habits, and postoperative pains and complications. RESULTS: General GQLI score was within range of good quality of life in both groups. However, quality of life was significantly better in the group operated by open cholecystectomy than the one operated by the laparoscopic method (median 131 vs. 125, respectively, p < 0.022). Postoperative complications were in majority reported by patients from the open group. The possible reasons of such results are discussed in comparison with national and international results of treatment of gallbladder stones. CONCLUSIONS: There are several other factors, which besides the entire operation, can have influence on the quality of life of patients operated for uncomplicated cholecystolithiasis. These biases can significantly change the end results of quality of life of these patients, however, quality of life remains within good limits in both groups.

[Does inguinal hernia repair influence on quality of life of elderly males?]. / Czy operacja przepukliny pachwinowej u starszych mezczyzn wplywa na ich jakosc zycia?

INTRODUCTION: Inguinal hernia repair is a common surgical intervention in elderly which can affect quality of life in the future of these patients. Aim of the study is to assess the quality of life of elderly males after inguinal hernia repair compared with a similar group of male patients without any operation. MATERIAL AND METHODS: A group of 40 male patients between the age of 60-80, in time up to 2 years after Lichtenstein hernia repair was compared with the same age 50 healthy males not operated in previous 2 years by 2 questionnaires: international Gastrointestinal Quality of Life Index (GQLI) and national Gerontologic Society Investigation Questionnaire to assess possible differences in their quality of life. Both groups were comparable and operation techniques were identical. RESULTS: Hernia repair resulted in 12 complications (30%): wound infections - 3, serous exudate - 1, chronic pains - 2, inflammatory infiltration - 4, loose sutures - 2. Overall GQLI score in hernia operation group reached mean 123.5 +/- 10.3 and in control group was 121.2 +/- 8.7 (p > 0.37). Gerontologic Society Investigation Questionnaire did not reveal any significant differences between both groups, however it presented rather sad existence of elderly men in our country, who being pensioners are self-limiting their activity on all fields. However, the profile of the hernia group seemed to comprise of people, who keep better physical activity, thus are motivated to be operated for inguinal hernia to keep them in a good physical shape. Some limitations of their postoperative activity were noted, probably because of medical advice or in fear of recurrence of hernia. CONCLUSIONS: Elderly patients operated for inguinal hernia have similar long term quality of life as a healthy population of the same age. Medical prescription to restrict the physical activity after hernia repair with a mesh should be limited to short necessary time especially in elderly. Further investigations are needed to elaborate methods of increasing activity of old men in Poland to moderate medical costs for this group.

[The influence of obesity on early results and quality of life of patients after chosen operations performed by laparoscopic or open methods]. / Wplyw otylosci na wczesne wyniki i jakosc zycia pacjentów po wybranych zabiegach operacyjnych wykonanych metoda laparoskopowa lub klasyczna.

INTRODUCTION: Obesity usually depreciates early results of abdominal operations performed in an open way, but not always after laparoscopic operations. Aim of the study is to compare early results and quality of life after most common abdominal operations (cholecystectomy and appendectomy) performed on obese and non-obese patients. MATERIAL AND METHODS: 166 patients who were operated in academic teaching hospital, were analyzed in groups: cholecystectomy - laparoscopic (74) and open (30), appendectomy - laparoscopic (30) and open (32). Every group was divided into subgroups with normal body mass, obesity I obesity II and was assessed retrospectively and investigated by Gastrointestinal Quality of Life Index (GQLI) up to 5 months after intervention by registered nurse specialized in surgery. Number and gravity of complications were assessed as well as hospital stay and convalescence time. RESULTS: There were 7/19 and 4/13 complications after laparoscopic vs 8/12 and 7/19 after open cholecystectomies and appendectomies respectively in groups with normal body weight (BMI 18.5-24.9kg/m2), and 28/56 and 8/20 complications after laparoscopic vs 14/18 and 9/12 after open cholecystectomies and appendectomies respectively in obese groups (above 25 kg/m2). One conversion to open surgery occured in patient with obesity I for laparoscopic cholecystectomy and one in normal body mass patient for laparoscopic appendectomy. There was one case of common bile duct lesion in obese patient during laparoscopic intervention and two cases of intestinal obstruction after open cholecystectomy in obese patients. Mean hospital stay time was 3.2 and 3.8 days after laparoscopic operations vs 5.4 and 5.4 days after open ones respectively. Mean convalescence time was 14 and 14 days after laparoscopic operations vs 21 and 14 days after open cholecystectomy and appendectomy respectively. Quality of life was significantly better after laparoscopic than open cholecystectomy in obese patients (128.4 +/- 12.7 vs 120.6 +/- 12.2 respectively) but significantly worse after laparoscopic than open appendectomy (121 +/- 15.2 vs 133.8 +/- 12.9 respectively). In groups with normal body mass differences were not significant. CONCLUSIONS: There is the influence of obesity on number and burden of postoperative complications after laparoscopic and open operations, however laparoscopic access seems more effective. Although hospital stay time was shorter after both types of laparoscopic operations, convalescence time was shorter only after laparoscopic cholecystectomy. The choice of type of operation (open or laparoscopic) influences the quality of life of obese patients but not on those with normal body mass. Although these conclusions seem rather clear, verification of them on larger group of patients is mandatory.

[Views of students of extension nursing studies about cancer prophylaxis]. / Opinie studentów pielegniarskich studiów zaocznych na temat profilaktyki nowotworów.

INTRODUCTION: Cancer prophylaxis seems nowadays to be the more and more powerful tool in fight with these serious diseases. The aim of this work is to find out opinions of students of nursing extension studies on contemporary cancer prophylaxis. MATERIAL AND METHODS: The question about possibilities of practical efforts for prophylaxis and early detection of cancer was directed to 160 students of four consecutive years (2002-2006), at the end of the fourth year of lasting five and a half years extension nursing studies, during ending exam on subject: oncological nursing. There were 154 women and 6 men, predominantly at their third decade of life, with nursing experience approximately more than 5 years. RESULTS: Out of 160 asked students, 131 of them firstly indicated necessity of breast cancer prophylaxis, 117 mentioned lung cancer, 113 cervix cancer, 95 colorectal cancer, 33 prostate cancer. In families with cancer problems, more frequent control investigations (23 answers), and genetic tests (16) were called for. Patients should be qualified to appropriate risk groups (13) and controlled more frequently there (24). Apart from necessary wide education in media (126) personal contact with patient to discuss his or her personal problems relating to cancer is needed (91). If atypical symptoms are self-detected by patients it should alert them to not neglect and contact family physician (33). Healthy diet (62) containing fresh vegetables and fruits (73), high fibre diet (42) with less animal fat (38) and less red meat (30), containing no preservative agents (45) is recommended. Increased physical activity (84) to cease or reduce smoking (102), and alcohol intake (55), limited exposition to ultraviolet rays (49), and systematic controls of breast (105), uterus cervix (88), lungs (77), colon (55) and prostate (28) are proposed. The pollution of environment by combustion gases and smokes (34) not excluding risk factors of medical workplace (29) are mentioned as cancerogenic factors. CONCLUSIONS: In the time of increasing incidence of cancer in Poland it is necessary to elaborate a complex model of primary cancer prophylaxis and early detection of it and to implement it in practice. For better effectiveness of such systemic solution wide involvement of nursing staff is mandatory. Nurses should be, very well and consciously prepared to play their role through adequate educational efforts undertaken during nursing studies.

Splenic and parasplenic abscess as a late complication of laparoscopic nissen fundoplication--case report and review of the literature.

PURPOSE: To present a rare late complication of laparoscopic Nissen fundoplication. MATERIAL AND METHODS: Splenic and parasplenic abscess which formed in 25 year old man sixty days after laparoscopic Nissen fundoplication was not adequately detected by a double ultrasound examination but by a CT-scan, ordered when general status of the patient deteriorated. RESULTS: Operative treatment comprised splenectomy with drainage and subsequent relaparotomy for intestinal obstruction. Postoperative course afterwards was good without a relapse of the reflux syndrome. CONCLUSION: Authors stress the beneficial role of tightness control after difficult fundoplications and less value of the ultrasound than a CT-scan in detecting problems of the in upper epigastrium.