[16-year experience with one-day surgery inguinal hernia repair]

AIM OF THE STUDY

Evaluation of inguinal hernia repair techniques and results.

MATERIAL

Study group consist of patients undergoing inguinal hernia repair between 1990-1998 326 patients (305 men, 21 women, mean age 45.5 yrs), and between 1999-2006 693 patients (662 men, 31 women, mean age 48.5 yrs).

METHOD

Inguinal hernia repair techniques and anesthesia: 1990-1998: Bassini--234 (47.7%), Girard--52 (15.9%), Shouldice--36 (11.8%), PHS--2 (0.6%); general anesthesia--140 (430%), spinal anesthesia--186 (57%), 1999-2006: Lichtestein--207 (30.0%). Robbins-Rutkow--299 (43.1%), PHS--148 (21.3%), Shouldice--39 (5.6%); general anesthesia--28 (4%), spinal anesthesia--665 (96%).

RESULTS AND CONCLUSION

1. The use of synthetic mesh significant reduces inguinal hernia recurrences. 2. Returning to normal daily activities within short time after surgery. 3. The use of lowered doses of analgesics after surgery. 3. The use of lowered doses of analgesics after surgery. 4. After the use of synthetic hernia mesh the number of wound infections, hametaomas or seromas did not increase. 5. There were no differences in the intensity of postoperative pain related to synthetic mesh used. Inguinal hernia repair-management diagram. 1. Patients operated on through one-day surgery. 2. Hospital stay--12 hours. 3. Spinal anaesthesia. 4. The administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended. 5. We prefer Lichtenstein repair ("gold standard"). 6. Patient fully ambulated 4-6 hours after surgery. 7. Returning to normal daily activities after 2 weeks.

[Cryotherapy of liver tumors]

AIM OF THE STUDY

To assess the value of cryodestruction during cytoreduction of liver tumors in the patients undergoing palliative treatment as well as evaluation of the frequency and type of complications of the method.

PATIENTS AND METHOD

Between 1990-2001, 33 cryodestruction of maligant tumors of liver were performed for primary tumor in 8 cases and for metastatic lesions in 25. Thirteen patients had single, and the remaining 20 multiple lesions in liver. In 11 cases cryotherapy supplemented resective procedures or devascularisation of liver parenchyma.

RESULTS

Mean time of follow-up was 14 months in the patients subjected to cryotherapy alone and 10 months in those subjected to cryotherapy as a supplementing modality. Postroperative complications related to cryotherapy did not exceed 9%, and overall mortality was 3%.

CONCLUSIONS

Cryoablation is valuable alternative for other methods of palliative treatment in the patients with liver tumors.

[Radiofrequency ablation of the primary and secondary liver malignancies]

For primary liver tumors and selected cases of colorectal liver metastases, surgical resection with preserved oncological margins of healthy tissue has been a method of choice. The criteria that decide about qualifying the patients to surgical resections include the number of nodules, size, localization, infiltrations to vessels or neighboring organs, liver functions, and patient's general condition. In fact, these criteria confine the number of performed resections to 5-25% of cases. These low rates encourage the search for the effective methods of primary and secondary liver tumors destruction with low complication rates. The authors review the results of radiofrequency thermal ablation (RFA) used to treat hepatocellular carcinoma and colorectal metastases in 65 patients, who underwent 178 RFA procedures (143 percutaneous and 35 during laparotomy). Positive response (regression, fibrosis or stabilized disease) to RFA was obtained from 60% of cases, and 3 (1.7%) patients developed bowel perforation. RFA is recommended as effective method with low rates of complications to be used for palliative treatment of unresectable primary and secondary liver malignancies.

[Results of kidney transplantation in Krakow in 1992-2000]

The aim of the study was an analysis of renal transplantation results in the Krakow Transplant Center during 1992-2000. The analysis concerned 94 cadaveric transplant recipients. The study group included 31 females aged 23 to 61 years (mean 40.4 years) and 63 males aged 16 to 60 years (mean 41.8 years). The time of pre-transplant renal replacement therapy ranged from 4 to 120 months (mean 32 months). The mean time of total ischaemia was 22 hours 20 minutes. The majority of the recipients had three identical antigens out of six typed. Most of the recipients were treated with three immunosuppressive drugs including: Cyclosporine A, Azathioprine and steroids. Immediately after kidney transplantation 25.6% of the patients had urine output and did not require dialysis. Acute renal failure (ARF) of the graft was observed in 73.2% recipients. The average number of hemodialysis sessions in patients presenting ARF was 10. Acute rejection was diagnosed in 41.5% of the patients. The most frequent complications were: CMV (cytomegalovirus) infection, UTI (urinary tract infection) and policytemia. In the study group 1-year survival rate of the patients was 97.8% and 1-year graft survival was 93.61%. The 5-year survival rates both in the patients and the grafts were very satisfactory (96.96% and 87.7% respectively).