Hemorrhagic Cysts in the Pancreas: Risk Factors, Treatment, and Outcomes - Insights from a Single-Center Study.

BACKGROUND Hemorrhagic cysts are rarely discussed subtypes of pancreatic pseudocysts that occur in about 10% of these cases. They are caused by erosion of the walls of neighboring vessels by extravasated proteolytic pancreatic enzymes. A retrospective analysis was performed to clinically characterize risk factors, treatment, and outcome in patients with hemorrhagic cysts of the pancreas. MATERIAL AND METHODS The retrospective study included patients from the Department of Digestive Tract Surgery in Katowice, Poland, who were treated surgically for a pancreatic hemorrhagic cyst from January 2016 to November 2022. We gathered and assessed data on cyst etiology, symptoms, imaging examinations, risk factors, time, type, and complications of surgery. RESULTS The main symptom was abdominal pain, noted in 5 (62.5%) patients. The most common etiology of cyst was acute pancreatitis, which occurred in 5 patients (62.5%). The most common localization was the tail of pancreas, found in 3 patients (36.5%). The largest dimension of the cyst was 98±68 (30-200) mm. Every patient needed surgical intervention. Patients underwent distal pancreatectomy (n=3) or marsupialization (n=5). One (12.5%) postoperative complication was observed, while mortality was 0%. CONCLUSIONS Hemorrhagic cyst is a life-threatening complication of pancreatitis requiring immediate treatment. In most cases, open surgery is the treatment of choice. Despite the continuous development of minimally invasive techniques, surgical treatment remains the only effective treatment method. Depending on the cyst localization and technical possibilities, pancreatectomy or marsupialization can be applied, and both of them have low complication and mortality rates.

Combination of modified FOLFIRINOX with stereotactic body radiotherapy as an induction therapy for locally advanced pancreatic adenocarcinoma - a prospective single-arm study.

Introduction: Radical resection is the only potentially curative treatment for pancreatic adenocarcinoma; however, only a minor fraction of patients are eligible for resection. Induction therapy may be offered to patients, but the response rate in cases with significant vascular involvement is limited. This study aimed to evaluate the efficacy and safety of modified of FOLFIRINOX chemotherapy (mFFX) + stereotactic body radiotherapy (SBRT) in combination as induction therapy for locally advanced pancreatic carcinoma. The primary endpoints were the resection rate and one-year overall survival (OS). The secondary endpoints were progression-free survival (PFS), toxicity, and quality of live (QoL). Material and methods: Thirty patients with locally advanced pancreatic adenocarcinoma were treated with 6 cycles of mFFX, followed by SBRT and additional 3 cycles of mFFX. The response was measured prior to SBRT and after regimen completion. In the absence of disease progression, the patients were referred for surgery. The patients were requested to complete quality of life questionnaires (QLQ)-C30 and QLQ-PAN26 questionnaires biweekly. Results: On the first evaluation, disease control was noted in 26 (86.7%) patients. Stereotactic body radiotherapy was performed in 20 patients. Twelve patients underwent laparotomy, with radical resection possible in 3 cases. The one-year OS rate was 63.3%. Overall, 11 grade ≥ 3 adverse events were noted. No deterioration in the overall QoL was observed. The median PFS was 7.53 months. Conclusions: The expected resection rate of ≥ 30% was not achieved. However, the combination was associated with good local control, low adverse event rate, and good QoL, which advocate its further investigation in this clinical situation.

Comparison of Postoperative Outcomes of Hand-Sewn Versus Stapled Esophago-jejunal Anastomosis During Total Gastrectomy for Gastric Cancer in 72 Patients: A Retrospective, Single-Center Study in Poland.

BACKGROUND Mechanical stapling is a commonly used alternative to hand-sewn technique for esophago-jejunal anastomosis in total gastrectomy (TG). Some studies report reduction in postoperative complications in the stapler group. This retrospective study aimed to compare short- and long-term surgical outcomes between the groups with stapled and hand-sewn esophago-jejunal anastomosis (EJA) during open TG for gastric cancer. MATERIAL AND METHODS The study included 72 adult patients with gastric cancer who underwent TG in the Department of Digestive Tract Surgery in Katowice between May 2018 and December 2021. The patients were divided into 2 groups according to the technique of EJA: stapled (44 cases) or hand-sewn (28 cases). We compared the groups in terms of the duration of the surgery, length of hospital stay, and occurrence of complications (focusing on anastomotic leakage, stricture and abdominal abscess). RESULTS There were no significant differences in duration of the surgery (P=0.6), blood loss (P=0.7), or length of postoperative hospital stay (P=0.2) among the groups. Early postoperative complications rates were 9.1% (4/44) in the stapler group and 17.9% (5/28) in the hand-sewn group (P=0.27). The most frequent complication was anastomotic leakage, with 2 cases in each group (P=0.76). The mean follow-up time was 1.8±0.9 (0.3-3.6) years. During this period the anastomotic stricture occurred in 7 (15.9%) cases with stapled anastomosis and in 5 (17.9%) cases with hand-sewn anastomosis (P=0.52). CONCLUSIONS In this study there were no significant differences in mortality, morbidity, and surgery duration between stapled and hand-sewn esophago-jejunal anastomosis in total gastrectomy.

Surgical Outcomes in 62 Patients with Ulcerative Colitis: A Retrospective, Single-Center Study from Poland.

BACKGROUND Surgery continues to play an important role in the treatment of ulcerative colitis (UC), which is one of the most common inflammatory diseases of the colon and rectum. This retrospective study from a single center in Poland aimed to evaluate surgical outcomes in 62 patients with ulcerative colitis. MATERIAL AND METHODS The study enrolled 62 patients (36 men [58.1%], 26 women [41.9%]), mean age 52.69±16.84 (range, 19-96) years who underwent surgical treatment of UC during the period 2001-2020. The mandatory inclusion criteria were patients with UC, who underwent total intra-abdominal colectomy (n=22, 46.8%), proctocolectomy (n=25, 53.2%), or left-sided hemicolectomy (n=8, 12.9%). The primary endpoint was postoperative death, and secondary endpoints were long hospitalization (>15 days), complications, and relaparotomy. RESULTS Postoperative mortality was observed in 8 (12.9%) patients. Older age and low albumin level were associated with longer hospitalization time (P=0.004 and P<0.001, respectively). High C-reactive protein (CRP) level (P=0.003), high CRP/albumin ratio (P=0.023), and malnourishment (P=0.026) were risk factors for complications. Malnutrition (P=0.026), older age (P=0.031), high CRP level (p<0.001), high CRP/albumin ratio (P=0.014), arterial hypertension (P=0.012), and urgent surgeries (P=0.021) were associated with higher risk of postoperative death. Patients who had undergone previous surgeries were more likely to need relaparotomy (P=0.022). CONCLUSIONS Preoperative nutritional status was an important factor associated with postoperative outcomes in patients with ulcerative colitis. Correction of malnutrition seems to be a vital part of preoperative preparation.

Intraoperative Hypotension and Its Association with Postoperative Acute Kidney Injury in Patients Undergoing Pancreaticoduodenectomy: A 5-Year, Single-Center, Retrospective Cohort Study.

BACKGROUND Intraoperative hypotension (IOH) is a common phenomenon in high-risk surgery and is often linked to postoperative acute kidney injury (AKI). Pancreaticoduodenectomy (PD), or Whipple's procedure, is a lengthy and complex surgical procedure to remove the head of the pancreas, gallbladder and bile duct, and the first part of the duodenum. This retrospective 5-year study from a single center in Poland included 303 patients who underwent PD and evaluated IOH as a factor associated with AKI. MATERIAL AND METHODS We analyzed perioperative data to assess how various IOH thresholds can predict AKI (according to KDIGO criteria). Several IOH definitions were applied, including absolute and relative thresholds, based on the mean arterial pressure (MAP). Statistically significant IOH thresholds were inserted into multivariable logistic regression models with previously established independent variables. RESULTS We included 303 patients over a 5-year period (2016-2021). There were 58 (19.1%) cases of postoperative AKI. MAP <55 mmHg and a maximal% drop from preinduction MAP were the only IOH definitions associated with AKI. Multivariable analysis revealed that max% drop from preinduction MAP (per 10%, OR=1.65; AUROC=0.70) was the IOH definition best suited for AKI prediction in patients undergoing PD. CONCLUSIONS In patients undergoing PD, it is important to prevent excessive blood pressure drops in regards to preinduction blood pressure values. In this cohort, relative IOH thresholds were better suited for prediction of AKI than the absolute IOH thresholds.

A chronicle of the pancreatoduodenectomy technique development - from the surgeon's hand to the robotic arm.

BACKGROUND: Pancreatoduodenectomy (PD) remains one of the most challenging abdominal surgical procedures. METHODS: A review of the literature regarding the history of PD, starting from the pioneers, Walter Kausch and Alan Whipple, through the great surgeons of the last century, up to the present day. RESULTS: The greatest development of the PD technique took place at the end of the twentieth century. Over the last 40 years, there have been huge technological advances in medicine, which have resulted in the introduction of laparoscopic and robotic techniques for abdominal surgery. However, it turns out that PD is still performed as it used to be "by the surgeon's hand" via laparotomy rather than using the most modern robot or laparoscope and is currently recommended by experts for treatment of pancreatic head cancer (PHC). This is mainly caused by not many data comparing these three PD methods. Moreover, increasingly the results achieved by surgeons advanced in minimally invasive pancreatic resections are comparable to or even better than those achieved by the open method in reference centres. Robot-assisted PD appears to be gaining an advantage over laparoscopic technique in the efficacy of PHC treatment. The obstacles most inhibiting the use of surgical robotics are the high cost of the device and procedure, and the long learning curve. A bright future lies ahead for both methods, with the robotic technique in the forefront. CONCLUSIONS: Despite significant advances in access and surgical technique, PD remains a challenging surgical procedure requiring a big surgeon's experience.

Pancreatic Cystic Tumors: A Single-Center Observational Study.

Background and Objectives: The aim of the study was to analyze the prevalence and characteristics of pancreatic cystic tumors (PCTs). Material and Methods: A retrospective analysis of the medical records of 124 patients, 102 (69%) women and 46 (31%) men, who had undergone surgery for pancreatic cystic tumors in 2014-2018. Among 148 pancreatic cysts, 24 (16%) were non-neoplasmatic and 124 (84%) were neoplasmatic. The neoplasmatic cysts (n = 124) were included in our analysis. There were five main types of PCTs: IPMN (intraductal papillary mucinous neoplasm) (n = 45), MCN (mucinous cystic neoplasm) (n = 30), SCN (serous cystic neoplasm) (n = 28), SPN (solid pseudopapillary neoplasm) (n = 8), and CPEN (cystic pancreatic endocrine neoplasm) (n = 8), as well as mixed-type tumors (n = 5). Results: A statistically significant dependency between PCT type and age was proven (p= 0.0001): IPMNs were observed in the older group of patients with an average age of 66.12 (40-79) years while SPNs were noted in the youngest group of patients with an average age of 36.22 (22-55) years. A statistically significant association between PCT type and gender (p = 0.0001) was found: IPMNs occurred among 24 (53.33%) men and 21 (46.6%) women. In the MCN and SPN groups, all patients were female (100%). Among the SCN group, the majority were women (27 (96.43%)), and there was only 1 (3.57%) man. A statistically significant dependency between PCT type and size was proven (p = 0.0007). The mean size of IPMNs was the smallest 2.95 (0.6-10 cm) and the mean size of MCNs was the largest 6.78 (1.5-19 cm). A statistically significant dependency between PCT type and tumor location was proven (p = 0.000238). The most frequent location of IPMN was the pancreatic head: 27 (60%). MCN was most frequently located in the pancreatic tail (18 (60%)). Most (10/28) SCNs were found in the pancreatic tail (10 (35.71%)). CPENs were most frequently located in the pancreatic tail (three (37.5%)) and pancreatic body and tail (three (37.5%)). SPNs were located commonly in the pancreatic head (five (62.5%)). The type of surgery depended on the tumor location. The most frequent surgery for IPMNs was pancreatoduodenectomy (44.4%), while for MCNs and SCNs, it was distal pancreatectomy (81%). The postoperative morbidity and mortality were 34.68% and 1.61%, respectively. Postoperative pancreatic fistula (POPF) was the most frequent (29%) complication. Conclusions: IPMN was the most frequent resected PCT in our material. A statistically significant association between the type of cyst and location within the pancreas, size, local lymph node involvement, and patient's age and sex was proved. POPF was the most frequent postoperative complication. In patients with PCTs, due to substantial postoperative morbidity, adequate patient selection, considering both the surgical risk as well as the long-term risk of malignant transformation, is very important during qualification for surgery.

Retrospective Study of Surgical Outcomes in 60 Patients with Crohn Disease from a Single Center in Poland.

BACKGROUND In Crohn disease (CD), pharmacotherapy with nutritional support is the treatment of choice. However, complications and a lack of response to drugs are indications for surgery. The aim of this study was to present indications for surgery and methods of surgical treatment of CD and to analyze the postoperative morbidity and mortality risk factors. MATERIAL AND METHODS This was a retrospective analysis of adult patients who underwent surgery for CD between January 2015 and January 2019. Sixty of 457 patients (13%) hospitalized for CD required surgical treatment. The parameters age, sex, body mass index, duration, behavior and location of the disease, pharmacotherapy, indications for surgery, type and duration of surgery, perioperative complications, and laboratory tests results were analyzed. RESULTS Most procedures (90%) were elective. The most common indications for surgery were fistulae and strictures. The most frequently performed procedure was right hemicolectomy (60%). Thirty-two percent of patients had postoperative complications. Perianal disease (P=0.002) and penetrating behavior (P=0.01) were associated with more surgeries. Stricturing and penetrating behavior was more frequent in patients with ileal/ileocecal involvement than in those with CD affecting the colon (P=0.039). Patients with smoking history had a significantly lower age at first surgery (P=0.02). The use of anti-TNF medications appeared to extend time between diagnosis and first surgery (P=0.014). CONCLUSIONS Although the analysis did not reveal any risk factors for perioperative complications, perianal manifestations, penetrating disease type, ileal/ileocecal involvement, and smoking may be associated with risk of earlier surgery or multiple surgeries.

A Single-Center Retrospective Study of Selected Clinical Parameters and Intraoperative Fluid Management of Patients Undergoing Pancreatoduodenectomy.

BACKGROUND Pancreatoduodenectomy is an extensive procedure with a very high risk of complications. Appropriate intraoperative fluid therapy is a subject of ongoing debate. The aim of this retrospective study was to analyze the relationship between selected preoperative parameters, intraoperative fluid therapy, and catecholamines administration during pancreatoduodenectomy. MATERIAL AND METHODS From 2011 through 2017, among pancreatoduodenectomies performed at a single university hospital, 192 patients met the inclusion criteria of the study: 105 (54.7%) males and 87 (45.3%) females with a mean age of 60.06 (±11.63) years. Correlations were assessed between sex, age, body mass index (BMI), selected comorbidities, surgery duration, American Society of Anesthesiologists (ASA) Physical Status (PS) scale, preoperative endoscopic retrograde cholangiopancreatography (ERCP) and intraoperative catecholamine administration, intraoperative fluid supply, red blood cell (RBC) concentrate and fresh frozen plasma (FFP) supply, blood loss, and diuresis. RESULTS A need for catecholamines has been shown to be more frequent in smokers (P=0.01), patients with cardiovascular comorbidities (P=0.037), high ASA PS scores (P=0.003), and preoperative ERCP (P=0.011). The need for intraoperative transfusion of RBC concentrate was more frequent in smokers (P=0.005). Surgical time was significantly longer in males (P=0.014). Among females, liberal intraoperative fluid therapy (>7.9 ml/kg/h) was more frequent in patients with thyroid comorbidities (P=0.003). CONCLUSIONS The findings of this retrospective study demonstrate the influence of comorbidities, ASA PS class, and catecholamine use on fluid therapy during pancreatoduodenectomy.

A Retrospective Study of Postoperative Outcomes in 98 Patients Diagnosed with Gastrointestinal Stromal Tumor (GIST) of the Upper, Middle, and Lower Gastrointestinal Tract Between 2009 and 2019 at a Single Center in Poland.

BACKGROUND Gastrointestinal stromal tumors (GISTs) arise in the smooth muscle pacemaker interstitial cells of Cajal, or similar cells. The aim of this retrospective study between 2009 and 2019 from a single center in Poland was to assess the selected prognostic factors (location, tumor size, mitotic index, body mass index (BMI), length of hospital stay, age, sex, and coexistent neoplasm) and to investigate postoperative outcomes in 98 patients with GIST of the upper, middle, and lower gastrointestinal tract. MATERIAL AND METHODS Between 2009 and 2019, 98 patients (50 women and 48 men) with an average age of 63.8 years (range from 38 to 90 years) were operated on for GIST in the Department of Gastrointestinal Surgery in Katowice, Poland. Based on the intraoperative and postoperative investigations, the tumor size and mitotic index were determined in each case. RESULTS A statistically significant correlation between age and mitotic index (MI) was found (p=0.02). The higher the MI, the younger the age of the patients. However, regardless of sex, younger patients had a tendency to survive longer. A >60-year-old male patient's probability of survival was around 65% after 40 months. Higher mitotic index was also associated with larger tumor size (p<0.0001). Female patients had a tendency to survive longer than males. CONCLUSIONS The findings from this small retrospective study support the importance of preoperative evaluation and frequent postoperative follow-up for patients with GIST of the gastrointestinal tract, particularly in older male patients, and patients with malignant comorbidities, which are associated with increased mortality.

Fluid Therapy in Patients Undergoing Abdominal Surgery: A Bumpy Road Towards Individualized Management.

Prudent intraoperative fluid replacement therapy, inotropes, and vasoactive drugs should be guided by adequate hemodynamic monitoring. The study aimed to evaluate the single-centre practice on intraoperative fluid therapy in abdominal surgery (AS). The evaluation, based on a review of medical files, included 235 patients (103 men), aged 60 ± 15 years who underwent AS between September and November 2017. Fluid therapy was analyzed in terms of quality and quantity. There were 124 high-risk patients according to the American Society of Anaesthesiologists Classification (ASA Class 3+) and 89 high-risk procedures performed. The median duration of procedures was 175 (IQR 106-284) min. Eleven patients died post-operatively. The median fluids volume was 10.4 mL/kg/h of anaesthesia, including 9.1 mL/kg/h of crystalloids and 2.7 mL/kg/h of synthetic colloids. Patients undergoing longer than the median procedures received significantly fewer fluids than those who underwent shorter procedures. The volume of fluids in the longer procedures depended on the procedural risk classification and was significantly greater in high-risk patients undergoing high-risk surgery. Patients who died received significantly more fluids than survivors. In all patients, a non-invasive blood pressure monitoring was used and only six patients had therapy guided by metabolic equilibrium. The fluid therapy used was liberal but complied with the recommendations regarding the type of fluid and risk-adjusted dosing. Hemodynamic monitoring was suboptimal and requires modifications. In conclusion, the optimization of intraoperative fluid therapy requires a balanced and standardized approach consistent with treatment procedures.

Absence of the celiac trunk and anomalous very low origin of the common hepatic artery arising independently from the abdominal aorta just above aortic bifurcation in patient undergoing radical pancreaticoduodenectomy.

PURPOSE: Knowledge of anomalies of the celiac trunk is very important during various surgical procedures (such as pancreatic and gastric resections including Appleby operation, liver resections and liver transplantations) and as well as radiologic procedures (such as chemoembolization of pancreatic and hepatic tumors). METHODS: A 77-years-old woman was admitted to our department for surgical treatment of ampullary adenocarcinoma G2 confirmed in endoscopic retrograde cholangiopancreatography (ERCP) with papillotomy and ampullary biopsy. In the contrast-enhanced computed tomography, the ampullary tumor was not visible, but the main pancreatic duct within pancreatic head and isthmus was dilated (indirect radiological tumor signs). An absence of the celiac trunk (CT) was established via computed tomography. Therefore, computed tomography-based angiography (angio-CT) of the abdominal aorta (AA) was performed before operation. RESULTS: Angio-CT confirmed an extremely rare vascular anomaly: an absence of CT. The left gastric (LGA), splenic (SA), and common hepatic (CHA) arteries connected above origin of the superior mesenteric artery (SMA) from the AA. Pylorus-preserving pancreaticoduodenectomy (PD) was performed. This anomaly was also confirmed intraoperatively. The postoperative course was uneventful and the patient was discharged on postoperative day 10. There were no signs of recurrence of the tumor during the 6 months follow-up. CONCLUSION: The proper preoperative identification of anomalies within major abdominal vessels and its relationship to the tumor is very important to avoid intraoperative vascular injury and major postoperative complications.

Small Intestinal Intussusception Due to Complicated Giant Jejunal Diverticulosis.

Background: Jejunal diverticulosis and jejunal lipomatosis are uncommon conditions. Usually asymptomatic, they may cause severe complications in some cases. Intussusception is unusual in adults, but when diagnosed swiftly it can be treated surgically, usually with good outcome. Case presentation: We present a 60-year-old female patient with a history of chronic malnutrition and anemia, complaining of acute abdominal pain, vomiting and diarrhea. Contrast-enhanced abdominal computed tomography (CT) showed intussusception, multiple giant jejunal diverticula and multiple lipomas. The patient underwent urgent surgery, but radical treatment was not possible due to the extent of the diseases. One month later, another surgery was needed due to ileostomy obstruction caused by lipomas. The patient's condition deteriorated due to malnutrition and concomitant metabolic disorders, which eventually led to her demise. Conclusions: Radical treatment is not always possible in an extensive jejunal disease. Prolonged malnutrition impairs postoperative healing, and therefore surgical or nutritional treatment should be considered in jejunal diverticulosis before the onset of severe complications requiring urgent surgical intervention.

Pancreaticojejunostomy-a review of modern techniques.

BACKGROUND: Pancreaticojejunal anastomosis is one of the most demanding procedures in surgery. Up to now, no technique has been proven to reduce the incidence of POPF when compared to the other methods. PURPOSE: The aim of this review was to provide a concise and illustrated description of the most recent methods of pancreaticojejunostomy. Their development was directly related to the still ongoing search by surgeons for such a technique of anastomosis that would eliminate the problem of POPF. CONCLUSIONS: Knowledge of various techniques of anastomosis may help the surgeon to find the most suitable and optimal method of pancreatic-intestinal anastomosis for the patient.

Results of surgical management of renal cell carcinoma metastatic to the pancreas.

AIM OF THE STUDY: Metastases from renal cell carcinoma represent between 0.25% and 3.00% of all resected pancreatic tumours. The aim of this study was to review 13 patients with renal cell carcinoma metastatic to the pancreas. MATERIAL AND METHODS: Clinical data, time from initial presentation, operative outcome, long-term survival, tumour size, presence of lymphatic invasion, and surgical margin status were evaluated. RESULTS: The median age of the patients was 62 years (mean 60.9). The median time for appearance of metastatic disease following resection of the primary tumour was 9 years (mean 8.38). Pancreatic metastases were located in the head of the pancreas in four patients, in the body in three, in the tail in two patients, and four patients had multiple pancreatic localisations. Four (30.7%) pancreatoduodenectomies, 5 (38.5%) distal resections, 2 (15.3%) total pancreatectomies, 1 (7.6%) enucleation, and 1 (7.6%) Roux duodenojejunostomy were performed. Two patients (15.3%) had postoperative complications. Operative mortality was 0%. Surgical margins were microscopically positive in 1 (8.3%) patient, and lymph nodes were positive in 2 (16.6%) patients. In our group of 7 deceased patients the mean survival was 19 months (median 16 months). CONCLUSIONS: Renal cell carcinoma metastatic to the pancreas can occur several years after nephrectomy. In our series a large number of patients with occurrence of symptoms, advancement of tumours, metastases to lymph node, and positive margin were connected with short survival period. Early detection of primary tumour, long and thorough patient care, and radical resections give patients a chance for a prolonged life.

A nickel-titanium memory-shape device for gastrojejunostomy: comparison of the compression anastomosis clip and a hand-sewn anastomosis.

BACKGROUND: The aim of this study was to evaluate the efficacy of a compression anastomosis clip (CAC) for gastrojejunostomy and comparison of a novel technique with a hand-sewn anastomosis. METHODS: Sixty-six patients underwent gastrojejunostomy with the CAC or hand-sewn anastomosis. The time of bowel function recovery, the duration of nasogastric drainage, the time of initiation of oral feeding, the duration of postoperative hospital stay, the time needed to expel the clip, and the observation of any complications were recorded. RESULTS: Neither group had anastomotic complications such as leakage or obstruction. Anastomosis time was shorter in the CAC group than in the control group (P < 0.01). The mean time of clip expulsion was 15.1 ± 6.04 d. There was no statistical difference in postoperative results between the two groups. There was a moderate positive correlation between the day of first bowel movement and the day of clip expulsion (r = 0.536) and a strong correlation between the duration of nasogastric drainage and the day of clip expulsion (r = 0.881). CONCLUSIONS: The method of using a CAC appeared to be safe, easy, inexpensive, and less time consuming. It should be taken into consideration that intra-abdominal complications may cause delayed CAC expulsion.

Nutritional Status and Its Detection in Patients with Inflammatory Bowel Diseases.

Malnutrition is an important issue in patients with inflammatory bowel diseases (IBDs) including Crohn's disease (CD) and ulcerative colitis (UC). It is caused by altered digestion and absorption within the small bowel, inadequate food intake, and drug-nutrient interactions in patients. Malnutrition is an essential problem because it is related to an increased risk of infections and poor prognosis in patients. It is known that malnutrition is also related to an increased risk of postsurgery complications in IBD patients. Basic nutritional screening involves anthropometric parameters with body mass index (BMI) and others (fat mass, waist-to-hip ratio, muscle strength), medical history concerning weight loss, and biochemical parameters (including the Prognostic Nutritional Index). Besides standard nutritional screening tools, including the Subjective Global Assessment (SGA), Nutritional Risk Score 2002 (NRS 2002), and Malnutrition Universal Screening Tool (MUST), specific nutritional screening tools are used in IBD patients, such as the Saskatchewan Inflammatory Bowel Disease-Nutrition Risk Tool (SaskIBD-NR Tool and IBD-specific Nutritional Screening Tool). There is a higher risk of nutrient deficiencies (including iron, zinc, magnesium) and vitamin deficiencies (including folic acid, vitamin B12 and D) in IBD patients. Therefore, regular evaluation of nutritional status is important in IBD patients because many of them are undernourished. An association between plasma ghrelin and leptin and nutritional status in IBD patients has been observed. According to some authors, anti-tumor necrosis factor (anti-TNFα) therapy (infliximab) can improve nutritional status in IBD patients. On the other hand, improvement in nutritional status may increase the response rate to infliximab therapy in CD patients. Optimization of nutritional parameters is necessary to improve results of conservative and surgical treatment and to prevent postoperative complications in patients with IBDs. This review presents basic nutritional screening tools, anthropometric and laboratory parameters, dietary risk factors for IBDs, common nutrient deficiencies, associations between anti-TNFα therapy and nutritional status, selected features regarding the influence of nutritional status, and surgical outcome in IBD patients.

Gastrointestinal Disease: New Diagnostic and Therapeutic Approaches.

Gastrointestinal diseases (GIDs) involve various benign and malignant pathologies of the digestive tract, as well as the liver, biliary tract, and pancreas [...].

Pancreatectomy and Pancreatic Surgery.

Pancreatectomy, including pancreaticoduodenectomy (PD), as well as central pancreatectomy (CP), distal pancreatectomy (DP) and total/subtotal pancreatectomy, is a major, complex and difficult surgical procedure performed for various benign and malignant pancreatic diseases: from chronic pancreatitis, through benign cystic tumors and neuroendocrine neoplasms to malignant neoplasms, including pancreatic ductal adenocarcinoma (PDAC) [...].

Risk Factors of Postoperative Acute Pancreatitis and Its Impact on the Postoperative Course after Pancreaticoduodenectomy-10 Years of Single-Center Experience.

BACKGROUND: Clinically relevant acute postoperative pancreatitis (CR-PPAP) after pancreaticoduodenectomy (PD) is a complication that may lead to the development of local and systemic consequences. The study aimed to identify risk factors for CR-PPAP and assess the impact of CR-PPAP on the postoperative course after PD. METHODS: The study retrospectively analyzed data from 428 consecutive patients who underwent PD at a single center between January 2013 and December 2022. The presence of increased amylase activity in plasma, above the upper limit of normal 48 h after surgery, was checked. CR-PPAP was diagnosed when accompanied by disturbing radiological features and/or symptoms requiring treatment. We investigated the relationship between the occurrence of CR-PPAP and the development of postoperative complications after PD, and possible predictors of CR-PPAP. RESULTS: The postoperative follow-up period was 90 days. Of the 428 patients, 18.2% (n = 78) had CR-PPAP. It was associated with increased rates of CR-POPF, delayed gastric emptying, occurrence of intra-abdominal collections, postoperative hemorrhage, peritonitis, and septic shock. Patients who developed CR-PPAP were more often reoperated (37.17% vs. 6.9%, p < 0.0001)) and had increased postoperative mortality (14.1% vs. 5.74%, p < 0.0001). Soft pancreatic parenchyma, intraoperative blood loss, small diameter of the pancreatic duct, and diagnosis of adenocarcinoma papillae Vateri were independent risk factors for CR-PPAP and showed the best performance in predicting CR-PPAP. CONCLUSIONS: CR-PPAP is associated with an increased incidence of postoperative complications after PD, worse treatment outcomes, and an increased risk of reoperation and mortality. Pancreatic consistency, intraoperative blood loss, width of the duct of Wirsung, and histopathological diagnosis can be used to assess the risk of CR-PPAP. Amylase activity 48 h after surgery > 161 U/L is highly specific in the diagnosis of CR-PPAP.