Introduction: Esophageal perforation has been considered a catastrophic and often life-threatening event.Aim of the research: To show the results and difficulties in the management of esophageal perforation based on the experience of our department of thoracic surgery as well as data obtained from other hospitals. Material and methods: We performed a retrospective analysis of the management of 103 patients (mean age: 49.4 ±3.1) treated during the period of 1997-2011. Open surgery historical control group (94 patients) was compared with patients (9 cases) who had undergone video-assisted thoracoscopic surgery nonresection procedure in our hospital. Results: Data analysis has revealed that 32 (31%) of all patients were not recognized as a "thoracic esophageal injury" at the first examination. Despite the fact that more than 80% of patients were hospitalized on the first day, in 42 cases (40.8%), surgical treatment was applied after 24 h (52.1 ±7.8). Sixty-percent patients of control group were complicated by postoperative morbidity resulted in higher (p < 0.05) mortality rate (35.1%) and hospital stay time (41.2 ±6.1 days), then VATS management of patients who had 11.1% postoperative mortality and 26.5 ±5.6 days of hospital stay. Conclusions: Esophageal perforations are rare pathology and due to the rarity of this condition and its often nonspecific presentation, the surgical treatment of it is delayed in more than 40% of patients, which leads to death of every third patient. Video-assisted thoracoscopic surgery with adequate drain perforation has had advantages in comparison with standard open surgical techniques in treatment of patients with delayed perforation and severe inflammatory reaction.
Background: In traditionally performed fundoplications during the treatment of sliding diaphragmatic hernias, the improvement of surgical techniques to restore acute angle of His remains topical. Aim: To develop a method of surgical treatment of hiatus hernias to restore acute angle of His. Material and methods: Patients (n = 74) were divided into two groups: the main group (I) (n = 45), in which the developed operation method was applied and the control group (II) (n = 29), in which Toupet method was applied to 26 patients, Nissen method-to 3 patients. GERD-Q and GERD-HRQL questionnaires were applied to all patients of the first group before the operation, during discharge from hospital and 6-12 12-18 18-24 months after surgical intervention. Patients of the second group were surveyed 6-12 months after the operation. Results: According to the results of the survey after 6-12 months statistically significant differences were not revealed in the groups: GERD-Q, p<0,386; GERD-HRQL, p<0,1089. In the main group there was a tendency to decrease the points in the GERD-Q survey when compared before and after surgery, p <0.0001. Out of 16 (55%) patients of the second group hospitalized after the operation the relapse was revealed in 9 patients, 7 of them were re-operated. 20(43,3%) patients of group I underwent inpatient examination, 2 relapsed and no one was re-operated. Conclusion: The efficiency of the suggested operation technique is comparable to Toupet method in the early stages, although when assessing the remote results there are a less number of relapses.
Introduction: Renal transplantation has progressively increased, and it is the best management of end-stage renal disease. Aim of the research: To evaluate the outcome of renal transplantation from deceased donors to adults living in a region with a population of about one and a half million. Material and methods: A retrospective analysis of the outcomes of 126 recipients of allografts in the period 2011-2014 was performed. The mean age of the recipients was 44.5 ±13.4 years; 71 were male and 55 were female. Kaplan-Meier survival curves were used to assess the graft and recipient survival rates. Results: The overall mortality rate in our study was 4.7% (6 patients), and the mortality of patients with a functioning kidney graft was 3.9% (5 patients). All of them died due to multiple organ failure caused by septic complications of different aetiologies. The data of in our study show that 1-year and 3-year cumulative patient survival after transplantation was 96% and 93.5%, respectively, and the survival rate of kidney grafts was 93% and 68%, respectively. Mean time spent on the renal transplant waiting list had been 31.6 ±7.9 years before the start of the Regional Department of Transplantation, and that was 21.4 ±10.3 (1-141) months in 2014. Conclusions: Three-years of transplant activity in the Brest region resulted in a significant increase in the availability of deceased donor transplantations since every third of the patients with chronic renal failure had kidney allograft transplantation. The 3-year patient survival after transplantation was over 90% owing to up-to-date immunosuppressive regimens and management of postoperative complications.
Introduction: Thoracoscopic plication is an effective treatment for diaphragmatic eventration, but the procedure has some disadvantages such as inadvertent abdominal organ injuries or superficial sutures that are not strong enough. Aim of the research: In this study, we devised and tested the method of diaphragm plication through simultaneous laparoscopic-and thoracoscopic-assisted left mini-thoracotomy. Material and methods: During the period between October 2012 and March 2014 there were four patients operated on for left-sided diaphragmatic paralysis. The average age was 52.3 ±17.8 years. The preoperative examination included a routine laboratory study, spirometry, plain chest radiograph, and computed tomographic scan of the chest. The initial part of the surgery was a two-port laparoscopy to remove the adhesions between the abdominal viscera and the abdominal segment of the diaphragm using bipolar electrocautery. After that, video-assisted thoracoscopic surgery plication of the diaphragm was performed via anterior mini thoracotomy. Results: The mean operation time was 58 ±11 min, and the mean hospital stay was 9.0 ±2.1 days. All of the patients demonstrated good postoperative recovery. The descending distance of the diaphragm after the surgery ranged from two to four intercostal spaces, which was confirmed with plain chest X-ray. The follow-up ranged from 20 to 38 months and showed no recurrence of diaphragm elevation symptoms. Conclusions: Simultaneous thoraco-and laparoscopic assisted mini-thoracotomy surgery for diaphragm plication is a safe procedure with strong positive clinical effect, and it can serve as an alternative to conventional thoracoscopic approaches especially in patients with high risk of inadvertent abdominal organ injuries.
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