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Cwaliński J, Cwalińska A, Kuczyńska B, Zasada W, Cholerzyńska H, Banasiewicz T, Paszkowski J. Prevention of Postoperative Malnutrition with Oral Nutritional Supplements in Patients Undergoing Gastrointestinal Surgery. J Med Food 2024; 27:250-256. [PMID: 38394188 DOI: 10.1089/jmf.2023.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Oral nutritional supplements (ONSs) offer support for the nutritional needs of surgical patients. However, their efficacy is contingent upon the nutrient composition, absorption efficiency, and postingestion tolerance. Our study included a cohort of 84 patients who underwent elective open surgery involving at least one intestine anastomosis. To mitigate the risk of malnutrition, 2 groups of 28 patients each received either a high-protein low-osmotic ONS (Group I) or a high-calorie high-osmotic ONS (Group II). A standard diet was used in the control group (Group III). The metabolic effects were evaluated by measuring body weight and relative change in body weight (Δkg) from 24 h (-1 day) presurgery to 28 days postprocedure. Subjective tolerance following ONS consumption on the second postoperative day was also assessed. Our findings showed that, across all groups, the average body weight decreased during the initial 2 weeks postsurgery, subsequently stabilizing or returning to baseline levels by the third and fourth week of observation. Patients receiving ONS demonstrated greater weight gain between days 14 and 28, with Group I exhibiting the highest rate of gain. Low-osmotic ONS displayed superior tolerance and elicited fewer patient complaints postconsumption. Postoperative hospitalization duration did not differ significantly among the nutritional strategies. In conclusion, early administration of ONS supplies essential nutrients and facilitates refeeding, thereby reducing the risk of malnutrition. Low-osmotic preparations are better tolerated and contribute more effectively to the restoration of preoperative body weight, despite their lower caloric content.
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Affiliation(s)
- Jarosław Cwaliński
- Department of General, Endocrinological Surgery and Gastroenterological Oncology and Poznan University of Medical Sciences, Poznan, Poland
| | - Agnieszka Cwalińska
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Barbara Kuczyńska
- Department of General, Endocrinological Surgery and Gastroenterological Oncology and Poznan University of Medical Sciences, Poznan, Poland
| | - Wiktoria Zasada
- Department of General, Endocrinological Surgery and Gastroenterological Oncology and Poznan University of Medical Sciences, Poznan, Poland
| | - Hanna Cholerzyńska
- Department of General, Endocrinological Surgery and Gastroenterological Oncology and Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Banasiewicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology and Poznan University of Medical Sciences, Poznan, Poland
| | - Jacek Paszkowski
- Department of General, Endocrinological Surgery and Gastroenterological Oncology and Poznan University of Medical Sciences, Poznan, Poland
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Banasiewicz T, Machała W, Borejsza Wysocki M, Lesiak M, Krych S, Lange M, Hogendorf P, Durczyński A, Cwaliński J, Bartkowiak T, Dziki A, Kielan W, Kłęk S, Krokowicz Ł, Kusza K, Myśliwiec P, Pędziwiatr M, Richter P, Sobocki J, Szczepkowski M, Tarnowski W, Zegarski W, Zembala M, Zieniewicz K, Wallner G. Principles of minimize bleeding and the transfusion of blood and its components in operated patients - surgical aspects. Pol Przegl Chir 2023; 95:14-39. [PMID: 38084044 DOI: 10.5604/01.3001.0053.8966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
One of the target of perioperative tratment in surgery is decreasing intraoperative bleeding, which increases the number of perioperative procedures, mortality and treatment costs, and also causes the risk of transfusion of blood and its components. Trying to minimize the blood loss(mainly during the operation) as well as the need to transfuse blood and its components (broadly understood perioperative period) should be standard treatment for a patient undergoing a procedure. In the case of this method, the following steps should be taken: 1) in the preoperative period: identyfication of risk groups as quickly as possible, detecting and treating anemia, applying prehabilitation, modyfying anticoagulant treatment, considering donating one's own blood in some patients and in selected cases erythropoietin preparations; 2) in the perioperative period: aim for normothermia, normovolemia and normoglycemia, use of surgical methods that reduce bleeding, such as minimally invasive surgery, high-energy coagulation, local hemostatics, prevention of surgical site infection, proper transfusion of blood and its components if it occurs; 3) in the postoperative period: monitor the condition of patients, primarily for the detection of bleeding, rapid reoperation if required, suplementation (oral administration preferred) nutrition with microelements (iron) and vitamins, updating its general condition. All these activities, comprehensively and in surgical cooperation with the anesthesiologist, should reduce the blood loss and transfusion of blood and its components.
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Affiliation(s)
- Tomasz Banasiewicz
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Waldemar Machała
- Klinika Anestezjologii i Intensywnej Terapii - Uniwersytecki Szpital Kliniczny im. Wojskowej Akademii Medycznej - Centralny Szpital Weteranów, Łódź
| | - Maciej Borejsza Wysocki
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Maciej Lesiak
- Katedra i Klinika Kardiologii Uniwersytetu Medycznego im. K. Marcinkowskiego w Poznaniu
| | - Sebastian Krych
- Katedra i Klinika Kardiochirurgii, Transplantologii, Chirurgii Naczyniowej i Endowaskularnej SUM. Studenckie Koło Naukowe Kardiochirurgii Dorosłych. Śląski Uniwersytet Medyczny w Katowicach
| | - Małgorzata Lange
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Piotr Hogendorf
- Klinika Chirurgii Ogólnej i Transplantacyjnej, Uniwersytet Medyczny w Łodzi
| | - Adam Durczyński
- Klinika Chirurgii Ogólnej i Transplantacyjnej, Uniwersytet Medyczny w Łodzi
| | - Jarosław Cwaliński
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Tomasz Bartkowiak
- Oddział Kliniczny Anestezjologii, Intensywnej Terapii i Leczenia Bólu, Uniwersytet Medyczny im. K. Marcinkowskiego w Poznaniu
| | - Adam Dziki
- Klinika Chirurgii Ogólnej i Kolorektalnej Uniwersytetu Medycznego w Łodzi
| | - Wojciech Kielan
- II Katedra i Klinika Chirurgii Ogólnej i Chirurgii Onkologicznej, Uniwersytet Medyczny we Wrocławiu
| | - Stanisław Kłęk
- Klinika Chirurgii Onkologicznej, Narodowy Instytut Onkologii - Państwowy Instytut Badawczy im. Marii Skłodowskiej-Curie, Oddział w Krakowie, Kraków
| | - Łukasz Krokowicz
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Krzysztof Kusza
- Katedra i Klinika Anestezjologii i Intensywnej Terapii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Piotr Myśliwiec
- I Klinika Chirurgii Ogólnej i Endokrynologicznej, Uniwersytet Medyczny w Białymstoku
| | - Michał Pędziwiatr
- Katedra Chirurgii Ogólnej, Wydział Lekarski, Uniwersytet Jagielloński - Collegium Medicum, Kraków
| | - Piotr Richter
- Oddział Kliniczny Chirurgii Ogólnej, Onkologicznej i Gastroenterologicznej Szpital Uniwersytecki w Krakowie
| | - Jacek Sobocki
- Katedra i Klinika Chirurgii Ogólnej i Żywienia Klinicznego, Centrum Medyczne Kształcenia Podyplomowego, Warszawski Uniwersytet Medyczny, Warszawa
| | - Marek Szczepkowski
- Klinika Chirurgii Kolorektalnej, Ogólnej i Onkologicznej, Centrum Medyczne Kształcenia Podyplomowego, Szpital Bielański, Warszawa
| | - Wiesław Tarnowski
- Klinika Chirurgii Ogólnej, Onkologicznej i Bariatrycznej CMKP, Szpital im. Prof. W. Orłowskiego, Warszawa
| | | | - Michał Zembala
- Wydział Medyczny, Katolicki Uniwersytet Lubelski Jana Pawła II w Lublinie
| | - Krzysztof Zieniewicz
- Katedra i Klinika Chirurgii Ogólnej, Transplantacyjnej i Wątroby, Warszawski Uniwersytet Medyczny, Warszawa
| | - Grzegorz Wallner
- II Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego, Uniwersytet Medyczny w Lublinie
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Banasiewicz T, Kobiela J, Cwaliński J, Spychalski P, Przybylska P, Kornacka K, Bogdanowska-Charkiewicz D, Leyk-Kolańczak M, Borejsza-Wysocki M, Batycka-Stachnik D, Drwiła R. Recommendations on the use of prehabilitation, i.e. comprehensive preparation of the patient for surgery. Pol Przegl Chir 2023; 95:62-91. [PMID: 38348849 DOI: 10.5604/01.3001.0053.8854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Prehabilitation is a comprehensive preparation of a patient for primarily surgical treatments. Its aim is to improve the patient'sgeneral condition so as to reduce the risk of complications and ensure the fastest possible recovery to full health. Thebasic components of prehabilitation include: improvement of nutritional status, appropriate exercises to improve functioning,psychological support, and help in eliminating addictions. Other important aspects of prehabilitation are: increasinghemoglobin levels in patients with anemia, achieving good glycemic control in patients with diabetes, treatment or stabilizationof any concurrent disorders, or specialist treatment associated with a specific procedure (endoprostheses, ostomyprocedure). This article organizes and outlines the indications for prehabilitation, its scope, duration, and the method to conductit. Experts of various specialties related to prehabilitation agree that it should be an element of surgery preparationwhenever possible, especially in patients with co-existing medical conditions who have been qualified for major procedures.Prehabilitation should be carried out by interdisciplinary teams, including family physicians and various specialists in thetreatment of comorbidities. Prehabilitation requires urgent systemic and reimbursement solutions.
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Affiliation(s)
- Tomasz Banasiewicz
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Jarosław Kobiela
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Transplantacyjnej, Gdański Uniwersytet Medyczny
| | - Jarosław Cwaliński
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Piotr Spychalski
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Transplantacyjnej, Gdański Uniwersytet Medyczny
| | - Patrycja Przybylska
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Karolina Kornacka
- Oddział Chirurgii Ogólnej, Onkologicznej i Kolorektalnej, Wielospecjalistyczny Szpital Miejski im. J. Strusia, Poznań
| | | | - Magdalena Leyk-Kolańczak
- Zakład Pielęgniarstwa Chirurgicznego, Klinika Chirurgii Ogólnej, Endokrynologicznej i Transplantacyjnej, Gdański Uniwersytet Medyczny
| | - Maciej Borejsza-Wysocki
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Dominika Batycka-Stachnik
- Oddział Kliniczny Chirurgii Serca, Naczyń i Transplantologii, Krakowski Szpital Specjalistyczny im. Św. Jana Pawła II, Kraków
| | - Rafał Drwiła
- Katedra i Zakład Anestezjologii i Intensywnej Terapii, Collegium Medicum Uniwersytet Jagielloński, Kraków
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Cwaliński J, Hermann J, Banasiewicz T. Healing Peristomal Wounds Around Retracted Stomas with Negative-Pressure Wound Therapy: A Case Series. Adv Skin Wound Care 2023; 36:435-440. [PMID: 37471448 DOI: 10.1097/asw.0000000000000006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
ABSTRACT One method for treating a retracted stoma is a vacuum dressing that cleans the wound and protects against intestinal leakage. This case series describes the use of an integrated, single-use negative-pressure wound therapy (NPWT) dressing to treat retracted stomas as an alternative to other noninvasive remedies. The report includes seven patients who were hospitalized in the authors' surgical department from 2019 to 2020. All patients developed severe peristomal infection that failed to respond to local treatment with proper ostomy appliances or specialist dressings. After cleaning each wound and removing necrotic lesions, the authors applied a single-use hydrofiber NPWT dressing to each patient. The dressing was changed every 2 to 5 days, depending on the effects of the therapy. The stoma orifice was covered with a bag with two-piece ostomy systems. The peristomal wound healed in all cases, and leakage was eliminated. The mean time of treatment was 14 days (range, 10-21 days), and the vacuum dressings were changed an average of four times (range, 3-7 times). None of the patients required a stoma translocation or other additional surgery. Three patients received systemic IV antibiotic therapy to treat general infection. Single-use NPWT dressings protect peristomal wounds from bowel leakage and do not hinder the application of stoma bags. This system, similar to standard NPWT devices, effectively protects infected stomas from retraction.
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Affiliation(s)
- Jarosław Cwaliński
- In the Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland, Jaroslaw Cwalinski, MD, PhD, and Jacek Hermann, MD, PhD, are Senior Assistants and Tomasz Banasiewicz, MD, PhD, is Professor and Head of Clinic. The authors have disclosed no financial relationships related to this article. Submitted February 16, 2022; accepted in revised form April 29, 2022
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Cwaliński J, Hermann J, Paszkowski J, Banasiewicz T. Minimally Invasive Treatment of Recurrent Anal Fistulas with Autologous Platelet-Rich Plasma Combined With Internal Orifice Closure. Surg Innov 2023; 30:28-35. [PMID: 35430904 DOI: 10.1177/15533506221086778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Minimally invasive procedures for the treatment of anal fistulas are gaining more and more popularity. For this purpose, Platelet-Rich Plasma (PRP) are administered to accelerate the healing process of various difficult wounds or lesions. The aim of this study was to evaluate preliminary results of PRP injection into the tissues adjacent to anal fistulas. PATIENTS AND METHODS A cohort of 42 patients with recurrent anal fistula, who underwent at least one cutting procedure previously, were enrolled into this preliminary and prospective trial. Closure of internal orifice was performed in all investigated patients, however, in 22 patients from group I, that procedure was combined with topical injection of PRP. In the postoperative period, the PRP administration could be repeated in case of incomplete fistula closure. Follow-up consisted of out-patient visits in a fortnight, 1, 2, and 12 months. RESULTS Complete closure of anal fistulas was achieved in 16 (75%) patients from group I and 10 (45,5%) patients from group II. The fistulas were healed in 9 patients from group I after single application of PRP. In the next 9 patients with incomplete fistula closure, the injection was repeated 2 to 4 times every fortnight leading finally to complete recovery in 6 of them. CONCLUSIONS Surgical fistula closure with local PRP application spares the anal sphincter and gives the opportunity to repeat the procedure several times if necessary. Treatment of recurrent anal fistulas with PRP can be considered as last resort therapy.
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Affiliation(s)
- Jarosław Cwaliński
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, 37807Poznan University of Medical Sciences, Poznań, Poland
| | - Jacek Hermann
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, 37807Poznan University of Medical Sciences, Poznań, Poland
| | - Jacek Paszkowski
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, 37807Poznan University of Medical Sciences, Poznań, Poland
| | - Tomasz Banasiewicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, 37807Poznan University of Medical Sciences, Poznań, Poland
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Hermann J, Cwaliński J, Banasiewicz T, Kołodziejczak B. Comparison between application of platelet rich plasma and mucosal advancement flap in patients with high transsphincteric anal fistulas: a randomized control trial. ANZ J Surg 2022; 92:1137-1141. [DOI: 10.1111/ans.17656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/27/2022] [Accepted: 03/06/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Jacek Hermann
- Department of General, and Endocrine Surgery, and Gastroenterologic Oncology Poznań University of Medical Sciences Poznań Poland
| | - Jarosław Cwaliński
- Department of General, and Endocrine Surgery, and Gastroenterologic Oncology Poznań University of Medical Sciences Poznań Poland
| | - Tomasz Banasiewicz
- Department of General, and Endocrine Surgery, and Gastroenterologic Oncology Poznań University of Medical Sciences Poznań Poland
| | - Barbara Kołodziejczak
- Faculty of Mathematics and Computer Science Adam Mickiewicz University Poznań Poland
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Cwaliński J, Hermann J, Paszkowski J, Banasiewicz T. ASSESSMENT OF RECURRENT ANAL FISTULAS TREATMENT WITH PLATELET-RICH PLASMA. Arq Gastroenterol 2021; 58:185-189. [PMID: 34287530 DOI: 10.1590/s0004-2803.202100000-32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/11/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Surgical treatment of recurrent anal fistulas can lead to numerous complications, including fecal incontinence. Therefore, sphincter preserving techniques are gaining more popularity. OBJECTIVE The aim of the study was to assess effectiveness of platelet-rich plasma (PRP) therapy in the patients with recurrent cryptoglandular anal fistulas. METHODS A cohort of 18 patients with anal fistulas was enrolled into a preliminary and prospective trial. They were divided into two groups consisting of eight and ten patients respectively. PRP was injected locally in all patients, however in the group II it was applied after 7 days drainage of fistulas with polyurethane foam or negative pressure wound therapy. On average, three doses of PRP were administered, but with the opportunity to double the number of applications if it was clinically justified. The patients were evaluated in an out-patient department after fortnight and then in 1, 6, and 12 months following the last PRP application. RESULTS Anal fistulas were closed in 4 (50%) patients from the group I and in 7 (70%) patients form the group II. Although, the difference between both groups was not statistically significant, PRP therapy should be preceded with fistulous tract drainage in all patients. Summarizing, that successful result was achieved in 11 (60%) patients from the entire group of 18 participants. CONCLUSION The rate of recurrent cryptoglandular anal fistulas closure reaching 60%, after topical treatment with PRP, exceeds the results of other sphincter-saving methods of treatment. Therefore, it might become a novel method of anal fistulas therapy.
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Affiliation(s)
- Jarosław Cwaliński
- Poznan University of Medical Sciences, Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznań, Poland
| | - Jacek Hermann
- Poznan University of Medical Sciences, Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznań, Poland
| | - Jacek Paszkowski
- Poznan University of Medical Sciences, Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznań, Poland
| | - Tomasz Banasiewicz
- Poznan University of Medical Sciences, Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznań, Poland
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Hermann J, Cwaliński J, Banasiewicz T. Application of platelet-rich plasma in rectovaginal fistulas in the patients with ulcerative colitis. Langenbecks Arch Surg 2021; 407:429-433. [PMID: 34155543 PMCID: PMC8847300 DOI: 10.1007/s00423-021-02232-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/06/2021] [Indexed: 10/28/2022]
Abstract
BACKGROUND There is a need for other than surgical methods of therapy for small and low rectovaginal fistulas (RVF) in the course of inflammatory bowel diseases (IBD), such as application of fibrin sealants, stem cells, biological therapy, or platelet-rich plasma. The aim of this study was to evaluate the results of the treatment after local application of PRP in aforementioned fistulas, exclusively in the patients with ulcerative colitis (UC). PATIENTS AND METHODS Medical records of 13 patients with small and low-lying, active RVF in the course of UC, and after restorative proctocolectomy for UC were evaluated. Curettage of fistulous tracts was performed with the following application of PRP in all patients. RESULTS Complete closure of RVF was achieved after the first injection in 4 patients, 3 women healed their fistulas following the second application, and two of them closed RVF after 3 injections. To sum up, the complete closure of RVF was achieved in 9 (69%) patients. Fistulas remained closed from 6 to 12 months. CONCLUSIONS The application of PRP in small, low, and recurrent IBD anal fistulas is effective, simple, and safe with an acceptable rate of healing. This therapy might also precede any further, surgical methods of treatment.
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Affiliation(s)
- Jacek Hermann
- Department of General, and Endocrynologic Surgery, and Gastroenterologic Oncology, Poznań University of Medical Sciences, 49 Przybyszewski Str., 60-355, Poznań, Poland.
| | - Jarosław Cwaliński
- Department of General, and Endocrynologic Surgery, and Gastroenterologic Oncology, Poznań University of Medical Sciences, 49 Przybyszewski Str., 60-355, Poznań, Poland
| | - Tomasz Banasiewicz
- Department of General, and Endocrynologic Surgery, and Gastroenterologic Oncology, Poznań University of Medical Sciences, 49 Przybyszewski Str., 60-355, Poznań, Poland
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Cwaliński J, Hermann J, Kasprzyk M, Banasiewicz T. Endoscopic vacuum assisted closure of esophagogastric anastomosis dehiscence: A case report. World J Gastrointest Endosc 2020; 12:42-48. [PMID: 31942233 PMCID: PMC6939118 DOI: 10.4253/wjge.v12.i1.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/19/2019] [Accepted: 11/07/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophagogastric leakage is one of the most severe postoperative complications. Partial disruption of the anastomosis, can be successfully treated with an endoscopic vacuum assisted closure (E-VAC). The advantage of that method of treatment is the ability to adjust a vacuum dressing individually to the size of the dehiscence and thus to reduce the risk of a secondary fistula or abscess. The authors present two patients with postoperative gastroesophageal leakage treated successfully with E-VAC.
CASE SUMMARY Two male patients developed a potentially life threatening esophagogastric leakage. Patient A underwent resection of the distal half of the esophagus and upper part of the stomach due to Siewert type II adenocarcinoma of the gastroesophageal junction. Proximal resection of the stomach was performed in the patient B after massive bleeding from Mallory-Weiss tears. Both patients were treated successfully with an individually adapted E-VAC with concomitant correction of fluid and electrolyte disturbances, and treatment of sepsis with appropriate antibiotics.
CONCLUSION Endoscopic vacuum closure is an effective alternative to endoscopic stenting or relaparotomy. Through individual approach it allows a more accurate assessment of healing.
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Affiliation(s)
- Jarosław Cwaliński
- Department of General and Endocrynologic Surgery and Gastroenterologic Oncology, Poznan University of Medical Sciences, Poznan 60-355, Poland
| | - Jacek Hermann
- Department of General and Endocrynologic Surgery and Gastroenterologic Oncology, Poznan University of Medical Sciences, Poznan 60-355, Poland
| | - Mariusz Kasprzyk
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan 60-355, Poland
| | - Tomasz Banasiewicz
- Department of General and Endocrynologic Surgery and Gastroenterologic Oncology, Poznan University of Medical Sciences, Poznan 60-355, Poland
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Cwaliński J, Hermann J, Banasiewicz T, Paszkowski J. Atypical and Life-threatening Crohn’s Disease Following Colectomy: A Case Report. Wound Manag Prev 2019. [DOI: 10.25270/wmp.2019.7.3640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Hard-to-heal wounds continue to be a challenge in the everyday surgical practice. Their treatment is time-consuming, expensive and in many cases requires interdisciplinary assessment. Therapy option include properly selected surgical procedures and dressings combined with systemic antibiotherapy. Application of vacuum assisted closure (VAC) facilitates the evacuation of pathological discharge, reduces tissue oedema and eliminates bacterial biofilm. Complementary administration of antibiotics to control chronic infection relies today in most cases on vancomycin, ciprofloxacin or piperacillin with tazobactam, with good clinical effect.
An alternative to antibiotics against MRSA, administered at hospitals might be dalbavancin, a new generation lipoglycopeptide, which belongs to the same class as vancomycin. Introduction of dalbavancin and VAC might be an alternative to traditional methods of therapy.
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Cwaliński J, Bręborowicz A, Połubińska A. The Impact of 0.9% NaCl on Mesothelial Cells After Intraperitoneal Lavage During Surgical Procedures. ADV CLIN EXP MED 2016; 25:1193-1198. [PMID: 28028973 DOI: 10.17219/acem/44381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 04/30/2015] [Accepted: 06/08/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Normal saline gained wide popularity in abdominal surgery as a basic compound used in intraoperative drainage of the peritoneal cavity. However, recent studies have revealed that saline solution is not quite biocompatible with the intraperitoneal enviroment and may promote peritoneal adhesions. OBJECTIVES The aim of the study was to evaluate the function and viability of human mesothelial cells cultured in vitro in 0.9% NaCl solution from intraperitoneal lavage carried out during laparoscopic cholecytectomies. MATERIAL AND METHODS The study included 40 consecutive patients suffering from gallstones who underwent laparoscopic cholecystectomy. Fluid was collected after intraperitoneal lavage during the surgical procedures. The samples obtained were used as a medium for in vitro incubation of primary human mesothelial cells. After 24 h the synthesis of interleukin 6 (IL-6), plasminogen activator inhibitor (PAI) and tissue plasminogen activator (tPA), as well as the index of cell proliferation were assessed in all the experimental groups. RESULTS All the mesothelium cell cultures treated with fluid samples obtained ex vivo were characterized by elevated levels of IL-6. The highest concentrations of PAI-1 were found in groups of cells exposed to fluid with bile; similarly, tPA synthesis was extremely elevated in groups treaded with fluid containing bile and small amounts of hemolyzed blood. In contrast, cell proliferation was exceedingly high in 2 groups of cells placed in a standard culture medium and in 0.9% NaCl solution. CONCLUSIONS Normal saline introduced into the abdominal cavity modifies the biological and physicochemical conditions of the intraperitoneal environment. The impact of 0.9% NaCl on mesothelial cells is manifested in destabilized tissue regeneration, which supposedly initiates adhesion formation.
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Affiliation(s)
- Jarosław Cwaliński
- Department of Pathophysiology, Poznan University of Medical Sciences, Poland
- Heliodor Swiecicki Clinic Hospital, Poznan University of Medical Sciences, Poland
- Department of General, Gastroenterological and Endocrine Surgery, Poznan University of Medical Sciences, Poland
| | - Andrzej Bręborowicz
- Department of Pathophysiology, Poznan University of Medical Sciences, Poland
| | - Alicja Połubińska
- Department of Pathophysiology, Poznan University of Medical Sciences, Poland
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Ciesielczyk B, Cwaliński J, Janusz P. [Robotic surgery and NOTES--Natural Orifice Translumenal Endoscopic Surgery in treatment of cholelithiasis--revolution or failed conception]. Pol Merkur Lekarski 2008; 25:380-385. [PMID: 19145941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
At the beginning of 90th years of the last century a laparoscopy technique initiated a new chapter in surgical treatment becoming the realistic alternative of classical laparotomies. Nowadays, after 20. years from first laparoscopic cholecystectomy new treatment methods such as Natural Orifice Translumenal Endoscopic Surgery (NOTES) and robotic surgery are gaining more and more great interest. The first robots created in the middle of 90 years were used only for keeping a camera and they were steered with voice, however with the development of technology was possible constructing precise machines, which were able to carry complicated procedures out (fundoplication, gastrectomy or colectomy), also from a long distance. At present two types of robots are being applied in the medical practice: da Vinci and Zeus. NOTES is a method that make possible to perform operations trough natural orifice of the body with an endoscope and appropriate instrumentation. Actually three fundamental ways of reaching the peritoneum are being used: through the stomach, through the rectum and through the vagina. Some authors tried also to use transbladder approach. The main advantage of the NOTES technique is a possibility of performing the procedure without necessity of cutting the abdominal wall, what decreases postoperative pain, eliminates the problem of an infecting wound, minimizes risk of postoperative hernias and reduces amount of postoperative adhesions. Problems related to the NOTES technique are mostly need of inventing new and better equipment, assurance tightness of the surgical access, development of an efficient antiseptic prophylaxis and also standardize learning methods. Dynamic development of the NOTES method allows overcoming some of these limitations by using innovative technical solutions and new systems e.g. TULA, NOTUS, ShapeLock, ViaCath, MAGS and many others. The aim of this study is a deep analysis of the recent technical solutions, rules of the therapy and schedules of management valid in the NOTES method and the robotic surgery suggested by the leading clinics. The article is also an attempt to answer the question if this new surgical procedures become as great revolution as laparoscopy.
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