IntroductionFormation of adhesions after laparoscopic hernia repair using the intra-peritoneal onlay mesh (IPOM) procedure can lead to intestinal obstruction or mesh erosion into intestinal lumen. The aims of this study included: measurement of adhesion formation with Dynamesh IPOM after laparoscopic intraperitoneal implantation, and assessment of the occurrence of isolated adhesions at the fastening sites of slowly absorbable sutures.Material and methodsTwelve healthy pigs underwent laparoscopic implantation of 2 Dynamesh IPOM mesh fragments each, one was fastened with PDSII, and the other with Maxon sutures. An assessment of adhesion formation was carried out after 6 weeks and included an evaluation of surface area, hardness according to the Zhulke scale, and index values. The occurrence of isolated adhesions at slowly absorbable suture fixation points was also analyzed.ResultsAdhesions were noted in 83.3% of Dynamesh IPOM meshes. Adhesions covered on average 37.7% of the mesh surface with mean hardness 1.46 and index value 78.8. In groups fixed with PDS in comparison to Maxon sutures adhesions covered mean 31.6% vs. 42.5% (p = 0.62) of the mesh surface, mean hardness was 1.67 vs.1.25 (p = 0.34) and index 85.42 vs. 72.02 (p = 0.95).ConclusionsThe Dynamesh IPOM mesh, in spite of its anti-adhesive layer of PVDF, does not prevent the formation of adhesions. Adhesion hardness, surface area, and index values of the Dynamesh IPOM mesh are close to the mean values of these parameters for other commercially available 2-layer meshes. Slowly absorbable sutures used for fastening did not increase the risk of adhesion formation.

PCS and PNK do not differ in terms of efficacy or complication rates, but PNK is more often associated with the necessity for a two-step procedure.

Post-endoscopic pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Depending on the presence of risk factors, PEP can occur in 4,1% to about 43% of patients. According to the European Society of Gastrointestinal Endoscopy (ESGE) guidelines, only three to patient-associated risk factors have been identified: suspected sphincter of Oddi dysfunction (SOD) (OR 4.09), female gender (OR 2.23), and previous pancreatitis (OR 2.46). Another three procedure-associated factors include cannulation attempt duration > 10 minutes (OR 1.76), more than one pancreatic guidewire passage (OR 2.77, CI: 1.79 - 4.30), and pancreatic injection (OR 2.2, CI: 1.60 - 3.01). Importantly, analyses of cumulative risk due to coexistence of several factors emphasize the importance of female sex, difficult cannulation, CBD diameter <5 mm, young age, and many other factors. Unfortunately, studies performed to date have included only small numbers of patients with several co-existing risk factors. Therefore, further analysis of other risk factors and the cumulative risk related to their co-occurrence is necessary. Based on current evidence, special care must be given to patients with several risk factors. Also, care should be given to proper qualification of patients, use of guidewires, early pre-cut incision, protective Wirsung's duct stenting, and rectal NSAID administration.

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Introduction: Detection of post-endoscopic pancreatitis (PEP) in the first hours after endoscopic retrograde cholangiopancreatography (ERCP) can limit its consequences, while excluding it can provide safe discharge of the patient. Therefore, a simple, clinically available test is needed for this purpose.Aim: The assessment of the risk of PEP development based on serum and urine amylase levels and parameters included in blood counts 4 h after ERCP.Material and methods: The study included 398 patients after therapeutic ERCP. Four hours after the procedure was completed, serum and urine amylase levels and blood count parameters were analysed.Results: The optimal serum amylase level for PEP detection was 516 UI/l, with ACC = 0.94, sens. 77.8%, spec. 0.95; positive predictive value (PPV) 0.412, negative predictive value (NPV) 0.98, positive likelihood factor (LR+) 14.93, and negative likelihood factor (LR-) 0.23. The serum amylase level for exclusion of PEP was 184 UI/l with ACC 0.79, sens. 0.83, spec. 0.79, PPV 0.16, NPV 0.99, and LR-0.21. The optimal urine amylase level for detection and exclusion (based on Youden index) was 575 UI/l, sens. 83.33%, spec. 81.3%, PPV 0.172, NPV 0.99, LR+ 4.44, and LR-0.20.Conclusions: Serum amylase levels above 516 UI/l at 4 h after ERCP should be an indication for further observation in hospital, and levels below 184 UI/l may justify safe discharge of the patient. Additional determinations of urine amylase levels and parameters included in blood counts do not improve the diagnostic capacity for the detection or exclusion of PEP risk.

We present the case of 60-year-old man (twin) with ileus cause by intussusception of the caecum adenocarcinoma and coexistence of intestinal malrotation (IM) and agenesis of one kidney. Intestinal malrotation with colon carcinoma is very rare in adult patients (only 14 cases have been described in the literature). Ileus cause by tumour intussusception has been previously reported in only one patient and the additional coexistence of agenesis of one kidney has not been reported in the available medical literature. However, coexistence of other anomalies was observed in 46 per cent of patients with IM. Therefore, in patients with ileus and coexisting congenital anomalies in other organs, the existence of intestinal malrotation should be considered. Furthermore, because of the unusual anatomy of the mesenteric vessels, right colon resection in patients with IM should be performed with special caution and the preoperative work-up should be extended to include visceral angiography.

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