Preliminary results of Polish national multicenter study on colostomy reversal - LICO (Liquidation of Colostomy) study.

Introduction: Creation of colostomy is still a commonly performed procedure in emergency settings, when intestinal anastomosis cannot be performed safely. Reversing a stoma has been linked with high rates of morbidity and also mortality. Aim: The primary goal of the study was to identify the risk of postoperative complications in patients undergoing colostomy liquidation. The secondary goal was to assess perioperative care parameters. Material and methods: The LIquidation of COlostomy (LICO) study is an open multicenter prospective cohort study that began in October 2022 and will continue until December 2023. Data from 20 Polish surgical departments were collected. Overall 45 patients were reported over the initial 3 months; based on that group we performed a preliminary analysis. Results: Mean operative time was 163 min. Patients were operated on by specialists in 93.3% of cases. Complications occurred in 15 (33.3%) patients. Wound infection was the most common complication (17.8%). In 3 (6.7%) cases anastomotic leakage was diagnosed, and in 2 of those cases reoperation was required. The overall mortality rate was 2.2%. The mean length of hospital stay was 10.1 days. Preoperative fasting was used in 53.3% of patients, and the mechanical bowel preparation rate was 75.6%. Only in 8.9% of cases was laparoscopic access used for stoma reversal, and only in 1 out of 45 cases was mesh used for incisional peristomal hernia prophylactics. The stoma site was closed by single sutures in 73.3%, and negative pressure assisted closure was performed in 6.7% of patients. Conclusions: Colostomy liquidation is associated with significant morbidity and minor mortality in the Polish population. Standardized perioperative care should be established for stoma reversal surgery.

The usefulness of biliopancreatic diversion/Scopinaro operation in treatment of patients with Prader-Willi syndrome.

Prader-Willi syndrome (PWS) is the most common form of obesity with a genetic basis. The short expected survival time due to numerous accompanying diseases and their complications is the reason for research on the maximally efficient method of treatment of obesity in this syndrome. Undertaken attempts of conservative treatment, for example with somatostatin, are ineffective. It seems that the only effective treatment of obesity in this syndrome may be surgical. In this article we present 2 cases of patients with PWS who underwent surgery consisting of biliopancreatic diversion (BPD)/Scopinaro procedure. The BPD/Scopinaro operation in selected cases of disciplined patients with a co-operative family, which we find of key importance, can be considered as one option of treatment of this syndrome in patients with prior neglect of conservative treatment.

Endoscopic treatment of the choledocholithiasis--effectiveness, safety and limitations of the method.

UNLABELLED: Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is accepted referred method of treatment of the choledocholithiasis. THE AIM OF THE STUDY: Evaluation of efficacy and safety of the endoscopic treatment of the biliary tract stones. MATERIAL AND METHODS: Results of 3309 Endoscopic Retrograde Cholangio-Pancreatography (ERCP) carried out in Division of Endoscopy of the General Surgery Department in the period 2000 - 2010. The retrospective analysis of the indications, process, findings and final results of 1698 ERCP and Endoscopic Sphincterotomy (ES) was performed with intention to treat of the biliary tract stones. RESULTS: The 883 (52%)patients with coexisted gall-bladder and biliary tract stones were the principal group. The second group included 580 (34.2%) patients with residual choledocholithiasis after cholecystectomy and biliary tract surgery. Moreover ERCP, ES and endoscopic evacuation of biliary stones have been urgently carried out in 159 (9.4%) cases with acute biliary pancreatitis. Lastly ERCP with re-sphincterotomy and removal of the stones was performed in 75 (4.4%) patients with recurrent choledocholithiasis. The procedure was effective in 1561 (92%) patients. When removal of the stones was not possible, decompression of the biliary tract by implantation of the plastic stent was done in 63 (3.7%) cases. Ineffective procedure was noted in 74 (4.3%) patients. The most commonly observed complication was acute pancreatitis. Because of: post ES bleeding, acute haemmorhagic and necrotic pancreatitis, impacted Dormia basket and peripapillary duodenal perforation 10 patients (0.5%) had to be operated. Two patients (0.1%) died. CONCLUSIONS: 1. Endoscopic treatment of choledocholithiasis is highly effective but risk factors of complications with urgency an intensive conservative management and surgical intervention have to be considered. 2. After ES, if surgical evacuation of the stones have to be carry out, post operative biliary tract drainage (by T tube) is not necessary.

Colonoscopic polypectomy--evaluation of the effectiveness and safety (single center experience).

UNLABELLED: Colonoscopy is currently accepted as the golden standard in the detection of pre-malignant lesions, and reduction of the incidence of colorectal cancer in patients with adenomatous polyps. THE AIM OF THE STUDY: was to determine the diagnostic value of colonoscopy in case of patients with clinical symptoms suggesting the possibility of colorectal pathology, as well as evaluate the technical aspects and results of colonoscopic polypectomies, considering the efficacy and safety of the above-mentioned procedures. MATERIAL AND METHODS: Retrospective analysis of the course and results of the polypectomies performed during 3638 colonoscopies was undertaken, considering patients with suspicion of colorectal pathology. RESULTS: Complete colonoscopy with cecal intubation was performed in 3310 (91%) cases. Colonoscopic polypectomies were performed during 806 (22.1%) examinations. Single polyps were detected in 459 (56.9%) cases, while multiple lesions in 347 (43.1%) cases. The total number of removed polyps amounted to 1184. There were 882 (74.6%) adenomas of which 225 (25.5%) were considered as an advanced pathology. Moreover, the pathologist detected 4 malignant polyps with features of adenocar-carcinoma. In case of 30 examinations, adenomas coexisted with colorectal cancer and were removed preoperatively. Post-polypectomy bleeding was observed after 15 (1.7%) polypectomies, although only two patients required surgery. Moreover, amongst the 343 rectal polyps, 19 (6%) non-pedunculated lesions were surgically removed (18 of them by means of the trans-anal approach). CONCLUSIONS: The method proved effective and the polyps were detected and removed in more than 22% of the colonoscopic examinations. In two (0.28%) cases surgical intervention was required, in order to stop post- polypectomy bleeding from the polyp's peduncle. Some of the rectal polyps (6%) had to be surgically removed. Preoperative endoscopic "clearance" of large bowel polyps, facilitated the adjustment of the resection margin in subsequent colorectal cancer surgery.