Antanas Mickevicius | Lithuanian University of Health Sciences (original) (raw)
Papers by Antanas Mickevicius
World Journal of Gastroenterology, 2022
BACKGROUND Gastric cancer (GC) is one of the most frequently diagnosed tumor globally. In most ca... more BACKGROUND Gastric cancer (GC) is one of the most frequently diagnosed tumor globally. In most cases, GC develops in a stepwise manner from chronic gastritis or atrophic gastritis (AG) to cancer. One of the major issues in clinical settings of GC is diagnosis at advanced disease stages resulting in poor prognosis. MicroRNAs (miRNAs) are small noncoding molecules that play an essential role in a variety of fundamental biological processes. However, clinical potential of miRNA profiling in the gastric cancerogenesis, especially in premalignant GC cases, remains unclear. AIM To evaluate the AG and GC tissue miRNomes and identify specific miRNAs’ potential for clinical applications (e.g., non-invasive diagnostics). METHODS Study included a total of 125 subjects: Controls (CON), AG, and GC patients. All study subjects were recruited at the Departments of Surgery or Gastroenterology, Hospital of Lithuanian University of Health Sciences and divided into the profiling (n = 60) and validation (n = 65) cohorts. Total RNA isolated from tissue samples was used for preparation of small RNA sequencing libraries and profiled using next-generation sequencing (NGS). Based on NGS data, deregulated miRNAs hsa-miR-129-1-3p and hsa-miR-196a-5p were analyzed in plasma samples of independent cohort consisting of CON, AG, and GC patients. Expression level of hsa-miR-129-1-3p and hsa-miR-196a-5p was determined using the quantitative real-time polymerase chain reaction and 2-ΔΔCt method. RESULTS Results of tissue analysis revealed 20 differentially expressed miRNAs in AG group compared to CON group, 129 deregulated miRNAs in GC compared to CON, and 99 altered miRNAs comparing GC and AG groups. Only 2 miRNAs (hsa-miR-129-1-3p and hsa-miR-196a-5p) were identified to be step-wise deregulated in healthy-premalignant-malignant sequence. Area under the curve (AUC)-receiver operating characteristic analysis revealed that expression level of hsa-miR-196a-5p is significant for discrimination of CON vs AG, CON vs GC and AG vs GC and resulted in AUCs: 88.0%, 93.1% and 66.3%, respectively. Compar-ing results in tissue and plasma samples, hsa-miR-129-1-3p was significantly down-regulated in GC compared to AG (P = 0.0021 and P = 0.024, tissue and plasma, respectively). Moreover, analysis revealed that hsa-miR-215-3p/5p and hsa-miR-934 were significantly deregulated in GC based on Helicobacter pylori (H. pylori) infection status [log2 fold change (FC) = -4.52, P-adjusted = 0.02; log2FC = -4.00, P-adjusted = 0.02; log2FC = 6.09, P-adjusted = 0.02, respectively]. CONCLUSION Comprehensive miRNome study provides evidence for gradual deregulation of hsa-miR-196a-5p and hsa-miR-129-1-3p in gastric carcinogenesis and found hsa-miR-215-3p/5p and hsa-miR-934 to be significantly deregulated in H. pylori carrying GC patients.
Surgical Endoscopy, 2012
Background Long-term results in antireflux surgery may depend on fundoplication type and wrap len... more Background Long-term results in antireflux surgery may depend on fundoplication type and wrap length. We compared the outcome of two different wrap lengths among the patients undergoing partial or total fundoplications. This study is the next part of a prospective 5-year follow-up assessment. Methods A total of 153 patients were randomized to Nissen or Toupet 1.5-or 3-cm wrap laparoscopic fundoplication. The primary endpoint-treatment failure rate was defined as a recurrent GERD or persistent dysphagia. Intensity of heartburn, dysphagia, gas-bloating, presence of esophagitis were assessed as a secondary outcome at 1-year and 5-year follow-up. Results At 5-year follow-up, data were collected from 129 (85 %) patients. At 1-year follow-up, 17 (11 %) treatment failures were detected. At the end of the fifth year, the numbers reached 23 (15 %). The failures were more common in the 1.5-cm Toupet (25 %) and the 3-cm Nissen group (18.2 %). The significant difference in failure rates was found between 1.5-cm and 3-cm Toupet groups (P \ 0.05). Dysphagia remained low during the follow-up in all of the groups. The prevalence of higher scores of heartburn after 5 years was detected in Nissen 1.5-cm group (20.8 %). The lowest scores were observed in Toupet 3-cm group. Bloating symptoms were more prevalent among Nissen and Toupet 3-cm group patients at 5-year follow-up. At the end of the fifth year, the prevalence of esophagitis was lower in Nissen 1.5-cm (19.3 %) and Toupet 3-cm (13.3 %) groups. The highest prevalence of esophagitis-32.4 %-was found in Toupet 1.5-cm group. Conclusions Nissen and Toupet fundoplication achieved sufficient control of reflux with success rate of 85 % at 5-year follow-up. There were no significant differences in the postoperative dysphagia, esophagitis, and bloating rates. However, the distribution of treatment failures leads us to conclude that 1.5-cm wrap length is insufficient in cases of posterior partial fundoplication. Keywords GERD (gastro-oesophageal reflux disease) Á Antireflux surgery Á Fundoplication The antireflux surgery is a well-established treatment method for pathological gastroesophageal reflux disease (GERD). Nissen fundoplication is considered to be the standard procedure for GERD and is recommended by European and American associations of surgeons [1, 2]. Original Nissen fundoplication consisted of 6-cm-long wrap from the fundus of the stomach that had effectively increased the tone of the lower esophageal sphincter (LES) [3]. However, high rate of postoperative side effects, such as bloating, inability to belch and vomit, and dysphagia, were observed. To reduce side effects, partial fundoplications were introduced [4, 5]. After introduction, the concept of partial fundoplication was harshly criticized, and later several, randomized, controlled trials were designed to compare total and partial posterior fundoplications [6]. Most of these
Sveikatos mokslai, Mar 3, 2017
Background and objective. Inguinal hernia repair is one of the most common general surgery proced... more Background and objective. Inguinal hernia repair is one of the most common general surgery procedures. Laparoscopic repair is technically more demanding, though it has been shown to be superior in terms of pain and discomfort, however, there is no apparent difference in recurrence between laparoscopic and open mesh methods of hernia repair. Over the years we see a relatively slow increase of laparoscopic procedures and even scepticism of the patients; thus we decided to test the hypothesis that more demanding and costly laparoscopic surgery has little benefits over the open procedure. The aim of our study was to compare postoperative pain, short-and long-term outcomes after laparoscopic hernia repair and conventional open hernia repair. Results. Laparoscopic procedure was significantly more often performed for the patients, who were younger, had shorter history of disease. The mean operative time for laparoscopic inguinal hernia repair was significantly longer than for open repair (p=0.02). The pain score for laparoscopic surgery was significantly lower according to VAS on day 1, 2, 3 (overall p≤ 0.002). The patients in the laparoscopic group required significantly lower doses of narcotic analgesics on the third postoperative day; the doses of nonsteroidal anti-inflammatory drugs were also significantly lower on the second and third postoperative day in this group. The postoperative hospital stay was shorter after laparoscopic repair (p=0.01). Sixty-four patients (71.11%) completed follow-up at one year after the operation. Nine (14.06%) of them had postoperative complications and eight of them were after open hernia repair. Two patients (3.1%) were re-operated (both patients were treated by Lichtenstein hernioplasty): one for inguinal hernia recurrence, another for testicular necrosis. Conclusions. The patients from laparoscopic group had significantly shorter postoperative pain duration (p=0.019), returned to daily activity slightly earlier and had better satisfaction with the operation comparing with the patients who undergone open surgery (p=0.915, p=0.893), but the duration of the sick leave (time off from work) was similar in both hernia repair group (p=0.260). Data shows that laparoscopic hernia repair has advantages in terms of post-operative pain intensity and duration, as well as risk of complications and patient satisfaction.
Kaunas : Vitae Litera eBooks, 2013
Wideochirurgia i inne techniki mało inwazyjne = Videosurgery and other miniinvasive techniques / kwartalnik pod patronatem Sekcji Wideochirurgii TChP oraz Sekcji Chirurgii Bariatrycznej TChP, 2014
Occurrence of anastomotic leaks following Roux-en-Y gastric bypass (RYGB), arising principally fr... more Occurrence of anastomotic leaks following Roux-en-Y gastric bypass (RYGB), arising principally from the gastro-jejunal anastomosis, is associated with significant morbidity and mortality. Their early detection and treatment is essential. However, a significant number of postoperative oral contrast studies fail to identify leaks, and a negative study providing false reassurance can lead to a delay in diagnosis and treatment. Physiological features including tachycardia, increased respiratory rate and pyrexia or elevations in C-reactive protein and white cell count are seen in patients with leaks. In this study we examine physiological and laboratory parameters in patients with and without anastomotic leaks following RYGB to try and improve the detection of leaks. To evaluate clinical signs and laboratory tests in determination of the development of gastrojejunal leaks after gastric bypass surgery. The study examined 116 consecutive patients undergoing laparoscopic RYGB. Clinical sign...
Videosurgery and Other Miniinvasive Techniques, 2021
Introduction: All the bariatric procedures have evolved greatly over the past decades and laparos... more Introduction: All the bariatric procedures have evolved greatly over the past decades and laparoscopic greater curvature plication (LGCP) is one of the quite recently introduced techniques lacking systematic evaluation. Aim: To compare and summarize the current data in the literature in regard to the effect of gastric plication on obesity and diabetes mellitus type 2. Material and methods: The systematic review and meta-analysis was performed according to the PRISMA guidelines and registered at PROSPERO under the registration number CRD42018114314. The literature in English and German was searched using the MEDLINE (PubMed) and BJS databases for studies published in the last 10 years. A meta-analysis was performed focusing on the effects of this operation on weight loss, glycemia control and improvement of comorbidities. Results: Mean preoperative body mass index (BMI) ranged from 34.42 to 46.3 kg/m 2. Most of the patients were female. The operation time was in the range from 50 to 192.23 min. Mean follow-up was from one month to 12 years, with most studies having a follow-up of less than 2 years. The postoperative BMI ranged from 28.59 to 38, with reported excess weight loss (EWL%) in the range 20-70%. Glycated hemoglobin (HbA 1c) values decreased by up to 5.1% after surgery, ranging from 5.1% to 7.5%. Conclusions: Despite the quality of most of the included studies being low, the present meta-analysis revealed that, in the short term, gastric plication is an effective measure for weight loss, while the effect on diabetes mellitus type 2 is not statistically significant.
Acta chirurgica iugoslavica, 2010
THE AIM of this study was to analyze patients suffering from penetrating colon injuries managemen... more THE AIM of this study was to analyze patients suffering from penetrating colon injuries management, clinical outcomes and factors, which predict higher morbidity and complications rate. METHODS: this was a retrospective analysis of prospectively collected data from patients with injured colon from 1995 to 2008. Age, time till operation, systolic blood pressure, part of injured colon, fecal contamination, PATI were registered. Monovariate and multivariate logistic regression was performed to determine higher morbidity predictive factors. RESULTS: 61 patients had penetrating colon injuries. Major fecal contamination of the peritoneal cavity and systolic blood pressure lower than 90 mmHg are independent factors determining the fecal diversion operation. Primary repair group analysis establish that major fecal contamination and systolic blood pressure lower than 90 mmHg OR=4,2 and 0,96 were significant risk factors, which have contributed to the development of postoperative complication...
Lietuvos Bendrosios Praktikos Gydytojas, Dec 1, 2015
Hernia, 2007
The aim of this study was to compare the eVect of diVerent kinds of surgical meshes on postoperat... more The aim of this study was to compare the eVect of diVerent kinds of surgical meshes on postoperative adhesion formation. Forty-two New Zealand White rabbits were studied. The rabbits were grouped into six groups, according to the type of surgical meshes (Prolene, Mersilene, Vypro, polytetraXouroethylene (PTFE), Proceed and control group) implanted into the peritoneum cavity. Thirty days after the operation, the relaparotomies were carried out, and any adhesions observed between the implanted mesh and tissues were evaluated and graded. The mean adhesion degree was 9.2 in the Mersilene mesh group, 9.5 in the Prolene mesh group, 9.7 and in the Vypro mesh group (P > 0.05). The mean adhesion degree was 1 in the control group, 2.75 in the Proceed mesh group and 2.25 in the PTFE mesh group. There was a signiWcant diVerence in adhesion degree between the control, Proceed and PTFE groups and the Prolene, Mersilene and Vypro mesh groups. The adhesion degree was signiWcantly lower in the Proceed and PTFE mesh groups when comparing them with the Prolene, Mersilene and Vypro meshes.
Videosurgery and Other Miniinvasive Techniques
Introduction: Two types of partial wrap are commonly performed in achalasia patients after Heller... more Introduction: Two types of partial wrap are commonly performed in achalasia patients after Heller myotomy: the posterior 270° fundoplication (Toupet) and the anterior 180° fundoplication (Dor). The optimal type of fundoplication (posterior vs. anterior) is still debated. Aim: To compare the long-term rates of dysphagia, reflux symptoms and patient satisfaction with current postoperative condition between two fundoplication groups in achalasia treatment. Material and methods: Our retrospective study included 97 consecutive patients with achalasia: 37 patients underwent laparoscopic posterior Toupet (270°) fundoplication followed by Heller myotomy (group I); 60 patients underwent laparoscopic anterior partial Dor fundoplication followed by Heller myotomy (group II). Long-term follow-up results included evaluation of dysphagia symptoms, intensity of heartburn and patient satisfaction with current condition. Results: Patients in these two groups did not differ according to age, weight, height, postoperative stay or follow-up period. Laparoscopic myotomy with posterior Toupet fundoplication was effective in 89% of patients, while laparoscopic myotomy with anterior Dor was effective in 93% of patients (p > 0.05). 11% of patients after posterior Toupet fundoplication had clinically significant heartburn vs. 35% of patients after anterior Dor fundoplication (p < 0.05). Overall patient satisfaction with current condition was 88%, with no significant difference between the groups. Conclusions: According to our study results, the two laparoscopic techniques were similarly effective in reducing achalasia symptoms, but postoperative clinical manifestation of heartburn is significantly more frequent after anterior Dor fundoplication (35% vs. 11%). The majority of patients (88%) were satisfied with operation outcomes.
Medicina, Feb 1, 2003
penetrating abdominal trauma index (PATI) validity in evaluation, management of the colorectal in... more penetrating abdominal trauma index (PATI) validity in evaluation, management of the colorectal injuries and treatment results. Retrospective study of operations and treatment results of 42 patients, who had penetrating abdominal trauma with colorectal injury, was performed. Surgery performed was primary resection of injured bowel in 7 (16.7%) cases, resection with end colostomy in 5 (11.9%), stomy only in 2 (4.8%), suture of the bowel in 25 (59.5%), suture with protective enterostomy in 3 (7.1%) cases. Postoperative course was complicated in 19 (45.2%) patients, mainly as wound complication 12 (29%) and intraabdominal complication 8 (19%). Postoperative mortality was 3 (7.1%). Analysis of the complications according to penetrating abdominal trauma index has shown, that there were statistical differences below and above 15 points in PATI - 35% versus 70%. Postoperative complication rates depend on arterial blood pressure, peritoneal cavity contamination, and PATI. There is no correlation between method of operation and complications. PATI is useful in comparing extent and severity of colorectal trauma and could help in defining method of surgical repair. If PATI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;/=15 was found and contamination of peritoneal cavity is insignificant primary repair can be performed safely.
Medicina, Feb 1, 2003
penetrating abdominal trauma index (PATI) validity in evaluation, management of the colorectal in... more penetrating abdominal trauma index (PATI) validity in evaluation, management of the colorectal injuries and treatment results. Retrospective study of operations and treatment results of 42 patients, who had penetrating abdominal trauma with colorectal injury, was performed. Surgery performed was primary resection of injured bowel in 7 (16.7%) cases, resection with end colostomy in 5 (11.9%), stomy only in 2 (4.8%), suture of the bowel in 25 (59.5%), suture with protective enterostomy in 3 (7.1%) cases. Postoperative course was complicated in 19 (45.2%) patients, mainly as wound complication 12 (29%) and intraabdominal complication 8 (19%). Postoperative mortality was 3 (7.1%). Analysis of the complications according to penetrating abdominal trauma index has shown, that there were statistical differences below and above 15 points in PATI - 35% versus 70%. Postoperative complication rates depend on arterial blood pressure, peritoneal cavity contamination, and PATI. There is no correlation between method of operation and complications. PATI is useful in comparing extent and severity of colorectal trauma and could help in defining method of surgical repair. If PATI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;/=15 was found and contamination of peritoneal cavity is insignificant primary repair can be performed safely.
Medicina (Kaunas, Lithuania), 2003
penetrating abdominal trauma index (PATI) validity in evaluation, management of the colorectal in... more penetrating abdominal trauma index (PATI) validity in evaluation, management of the colorectal injuries and treatment results. Retrospective study of operations and treatment results of 42 patients, who had penetrating abdominal trauma with colorectal injury, was performed. Surgery performed was primary resection of injured bowel in 7 (16.7%) cases, resection with end colostomy in 5 (11.9%), stomy only in 2 (4.8%), suture of the bowel in 25 (59.5%), suture with protective enterostomy in 3 (7.1%) cases. Postoperative course was complicated in 19 (45.2%) patients, mainly as wound complication 12 (29%) and intraabdominal complication 8 (19%). Postoperative mortality was 3 (7.1%). Analysis of the complications according to penetrating abdominal trauma index has shown, that there were statistical differences below and above 15 points in PATI - 35% versus 70%. Postoperative complication rates depend on arterial blood pressure, peritoneal cavity contamination, and PATI. There is no correla...
BMC Surgery, 2014
Background: A steady decline in gastric cancer mortality rate over the last few decades is observ... more Background: A steady decline in gastric cancer mortality rate over the last few decades is observed in Western Europe. However it is still not clear if this trend applies to Eastern Europe where high incidence rate of gastric cancer is observed. Methods: This was a retrospective non-randomized, single center, cohort study. During the study period 557 consecutive patients diagnosed with gastric cancer in which curative operation was performed met the inclusion criteria. The study population was divided into two groups according to two equal time periods: Group II -284 patients). Primary (five-year survival rate) and secondary (postoperative complications, 30-day mortality rate and length of hospital stay) endpoints were evaluated and compared. Results: Rate of postoperative complications was similar between the groups, except for Grade III (Clavien-Dindo grading system for the classification of surgical complications) complications that were observed at significantly lower rates in Group II (26 (9.5%) vs. 11 (3.9%), p = 0.02). Length of hospital stay was significantly (p = 0.001) shorter (22.6 ± 28.9 vs. 16.2 ± 17.01 days) and 30-day mortality was significantly (p = 0.02) lower (15 (5.5%) vs. 4 (1.4%)) in Group II. Similar rates of gastric cancer related mortality were observed in both groups (92.3% vs. 90.7%). However survival analysis revealed significantly (p = 0.02) better overall 5-year survival rate in Group II (35.6%, 101 of 284) than in Group I (23.4%, 64 of 273). There was no difference in 5-year survival rate when comparing different TNM stages.
Surgical Endoscopy, 2013
Background Long-term results in antireflux surgery may depend on fundoplication type and wrap len... more Background Long-term results in antireflux surgery may depend on fundoplication type and wrap length. We compared the outcome of two different wrap lengths among the patients undergoing partial or total fundoplications. This study is the next part of a prospective 5-year follow-up assessment. Methods A total of 153 patients were randomized to Nissen or Toupet 1.5-or 3-cm wrap laparoscopic fundoplication. The primary endpoint-treatment failure rate was defined as a recurrent GERD or persistent dysphagia. Intensity of heartburn, dysphagia, gas-bloating, presence of esophagitis were assessed as a secondary outcome at 1-year and 5-year follow-up. Results At 5-year follow-up, data were collected from 129 (85 %) patients. At 1-year follow-up, 17 (11 %) treatment failures were detected. At the end of the fifth year, the numbers reached 23 (15 %). The failures were more common in the 1.5-cm Toupet (25 %) and the 3-cm Nissen group (18.2 %). The significant difference in failure rates was found between 1.5-cm and 3-cm Toupet groups (P \ 0.05). Dysphagia remained low during the follow-up in all of the groups. The prevalence of higher scores of heartburn after 5 years was detected in Nissen 1.5-cm group (20.8 %). The lowest scores were observed in Toupet 3-cm group. Bloating symptoms were more prevalent among Nissen and Toupet 3-cm group patients at 5-year follow-up. At the end of the fifth year, the prevalence of esophagitis was lower in Nissen 1.5-cm (19.3 %) and Toupet 3-cm (13.3 %) groups. The highest prevalence of esophagitis-32.4 %-was found in Toupet 1.5-cm group. Conclusions Nissen and Toupet fundoplication achieved sufficient control of reflux with success rate of 85 % at 5-year follow-up. There were no significant differences in the postoperative dysphagia, esophagitis, and bloating rates. However, the distribution of treatment failures leads us to conclude that 1.5-cm wrap length is insufficient in cases of posterior partial fundoplication.
World Journal of Gastroenterology, 2022
BACKGROUND Gastric cancer (GC) is one of the most frequently diagnosed tumor globally. In most ca... more BACKGROUND Gastric cancer (GC) is one of the most frequently diagnosed tumor globally. In most cases, GC develops in a stepwise manner from chronic gastritis or atrophic gastritis (AG) to cancer. One of the major issues in clinical settings of GC is diagnosis at advanced disease stages resulting in poor prognosis. MicroRNAs (miRNAs) are small noncoding molecules that play an essential role in a variety of fundamental biological processes. However, clinical potential of miRNA profiling in the gastric cancerogenesis, especially in premalignant GC cases, remains unclear. AIM To evaluate the AG and GC tissue miRNomes and identify specific miRNAs’ potential for clinical applications (e.g., non-invasive diagnostics). METHODS Study included a total of 125 subjects: Controls (CON), AG, and GC patients. All study subjects were recruited at the Departments of Surgery or Gastroenterology, Hospital of Lithuanian University of Health Sciences and divided into the profiling (n = 60) and validation (n = 65) cohorts. Total RNA isolated from tissue samples was used for preparation of small RNA sequencing libraries and profiled using next-generation sequencing (NGS). Based on NGS data, deregulated miRNAs hsa-miR-129-1-3p and hsa-miR-196a-5p were analyzed in plasma samples of independent cohort consisting of CON, AG, and GC patients. Expression level of hsa-miR-129-1-3p and hsa-miR-196a-5p was determined using the quantitative real-time polymerase chain reaction and 2-ΔΔCt method. RESULTS Results of tissue analysis revealed 20 differentially expressed miRNAs in AG group compared to CON group, 129 deregulated miRNAs in GC compared to CON, and 99 altered miRNAs comparing GC and AG groups. Only 2 miRNAs (hsa-miR-129-1-3p and hsa-miR-196a-5p) were identified to be step-wise deregulated in healthy-premalignant-malignant sequence. Area under the curve (AUC)-receiver operating characteristic analysis revealed that expression level of hsa-miR-196a-5p is significant for discrimination of CON vs AG, CON vs GC and AG vs GC and resulted in AUCs: 88.0%, 93.1% and 66.3%, respectively. Compar-ing results in tissue and plasma samples, hsa-miR-129-1-3p was significantly down-regulated in GC compared to AG (P = 0.0021 and P = 0.024, tissue and plasma, respectively). Moreover, analysis revealed that hsa-miR-215-3p/5p and hsa-miR-934 were significantly deregulated in GC based on Helicobacter pylori (H. pylori) infection status [log2 fold change (FC) = -4.52, P-adjusted = 0.02; log2FC = -4.00, P-adjusted = 0.02; log2FC = 6.09, P-adjusted = 0.02, respectively]. CONCLUSION Comprehensive miRNome study provides evidence for gradual deregulation of hsa-miR-196a-5p and hsa-miR-129-1-3p in gastric carcinogenesis and found hsa-miR-215-3p/5p and hsa-miR-934 to be significantly deregulated in H. pylori carrying GC patients.
Surgical Endoscopy, 2012
Background Long-term results in antireflux surgery may depend on fundoplication type and wrap len... more Background Long-term results in antireflux surgery may depend on fundoplication type and wrap length. We compared the outcome of two different wrap lengths among the patients undergoing partial or total fundoplications. This study is the next part of a prospective 5-year follow-up assessment. Methods A total of 153 patients were randomized to Nissen or Toupet 1.5-or 3-cm wrap laparoscopic fundoplication. The primary endpoint-treatment failure rate was defined as a recurrent GERD or persistent dysphagia. Intensity of heartburn, dysphagia, gas-bloating, presence of esophagitis were assessed as a secondary outcome at 1-year and 5-year follow-up. Results At 5-year follow-up, data were collected from 129 (85 %) patients. At 1-year follow-up, 17 (11 %) treatment failures were detected. At the end of the fifth year, the numbers reached 23 (15 %). The failures were more common in the 1.5-cm Toupet (25 %) and the 3-cm Nissen group (18.2 %). The significant difference in failure rates was found between 1.5-cm and 3-cm Toupet groups (P \ 0.05). Dysphagia remained low during the follow-up in all of the groups. The prevalence of higher scores of heartburn after 5 years was detected in Nissen 1.5-cm group (20.8 %). The lowest scores were observed in Toupet 3-cm group. Bloating symptoms were more prevalent among Nissen and Toupet 3-cm group patients at 5-year follow-up. At the end of the fifth year, the prevalence of esophagitis was lower in Nissen 1.5-cm (19.3 %) and Toupet 3-cm (13.3 %) groups. The highest prevalence of esophagitis-32.4 %-was found in Toupet 1.5-cm group. Conclusions Nissen and Toupet fundoplication achieved sufficient control of reflux with success rate of 85 % at 5-year follow-up. There were no significant differences in the postoperative dysphagia, esophagitis, and bloating rates. However, the distribution of treatment failures leads us to conclude that 1.5-cm wrap length is insufficient in cases of posterior partial fundoplication. Keywords GERD (gastro-oesophageal reflux disease) Á Antireflux surgery Á Fundoplication The antireflux surgery is a well-established treatment method for pathological gastroesophageal reflux disease (GERD). Nissen fundoplication is considered to be the standard procedure for GERD and is recommended by European and American associations of surgeons [1, 2]. Original Nissen fundoplication consisted of 6-cm-long wrap from the fundus of the stomach that had effectively increased the tone of the lower esophageal sphincter (LES) [3]. However, high rate of postoperative side effects, such as bloating, inability to belch and vomit, and dysphagia, were observed. To reduce side effects, partial fundoplications were introduced [4, 5]. After introduction, the concept of partial fundoplication was harshly criticized, and later several, randomized, controlled trials were designed to compare total and partial posterior fundoplications [6]. Most of these
Sveikatos mokslai, Mar 3, 2017
Background and objective. Inguinal hernia repair is one of the most common general surgery proced... more Background and objective. Inguinal hernia repair is one of the most common general surgery procedures. Laparoscopic repair is technically more demanding, though it has been shown to be superior in terms of pain and discomfort, however, there is no apparent difference in recurrence between laparoscopic and open mesh methods of hernia repair. Over the years we see a relatively slow increase of laparoscopic procedures and even scepticism of the patients; thus we decided to test the hypothesis that more demanding and costly laparoscopic surgery has little benefits over the open procedure. The aim of our study was to compare postoperative pain, short-and long-term outcomes after laparoscopic hernia repair and conventional open hernia repair. Results. Laparoscopic procedure was significantly more often performed for the patients, who were younger, had shorter history of disease. The mean operative time for laparoscopic inguinal hernia repair was significantly longer than for open repair (p=0.02). The pain score for laparoscopic surgery was significantly lower according to VAS on day 1, 2, 3 (overall p≤ 0.002). The patients in the laparoscopic group required significantly lower doses of narcotic analgesics on the third postoperative day; the doses of nonsteroidal anti-inflammatory drugs were also significantly lower on the second and third postoperative day in this group. The postoperative hospital stay was shorter after laparoscopic repair (p=0.01). Sixty-four patients (71.11%) completed follow-up at one year after the operation. Nine (14.06%) of them had postoperative complications and eight of them were after open hernia repair. Two patients (3.1%) were re-operated (both patients were treated by Lichtenstein hernioplasty): one for inguinal hernia recurrence, another for testicular necrosis. Conclusions. The patients from laparoscopic group had significantly shorter postoperative pain duration (p=0.019), returned to daily activity slightly earlier and had better satisfaction with the operation comparing with the patients who undergone open surgery (p=0.915, p=0.893), but the duration of the sick leave (time off from work) was similar in both hernia repair group (p=0.260). Data shows that laparoscopic hernia repair has advantages in terms of post-operative pain intensity and duration, as well as risk of complications and patient satisfaction.
Kaunas : Vitae Litera eBooks, 2013
Wideochirurgia i inne techniki mało inwazyjne = Videosurgery and other miniinvasive techniques / kwartalnik pod patronatem Sekcji Wideochirurgii TChP oraz Sekcji Chirurgii Bariatrycznej TChP, 2014
Occurrence of anastomotic leaks following Roux-en-Y gastric bypass (RYGB), arising principally fr... more Occurrence of anastomotic leaks following Roux-en-Y gastric bypass (RYGB), arising principally from the gastro-jejunal anastomosis, is associated with significant morbidity and mortality. Their early detection and treatment is essential. However, a significant number of postoperative oral contrast studies fail to identify leaks, and a negative study providing false reassurance can lead to a delay in diagnosis and treatment. Physiological features including tachycardia, increased respiratory rate and pyrexia or elevations in C-reactive protein and white cell count are seen in patients with leaks. In this study we examine physiological and laboratory parameters in patients with and without anastomotic leaks following RYGB to try and improve the detection of leaks. To evaluate clinical signs and laboratory tests in determination of the development of gastrojejunal leaks after gastric bypass surgery. The study examined 116 consecutive patients undergoing laparoscopic RYGB. Clinical sign...
Videosurgery and Other Miniinvasive Techniques, 2021
Introduction: All the bariatric procedures have evolved greatly over the past decades and laparos... more Introduction: All the bariatric procedures have evolved greatly over the past decades and laparoscopic greater curvature plication (LGCP) is one of the quite recently introduced techniques lacking systematic evaluation. Aim: To compare and summarize the current data in the literature in regard to the effect of gastric plication on obesity and diabetes mellitus type 2. Material and methods: The systematic review and meta-analysis was performed according to the PRISMA guidelines and registered at PROSPERO under the registration number CRD42018114314. The literature in English and German was searched using the MEDLINE (PubMed) and BJS databases for studies published in the last 10 years. A meta-analysis was performed focusing on the effects of this operation on weight loss, glycemia control and improvement of comorbidities. Results: Mean preoperative body mass index (BMI) ranged from 34.42 to 46.3 kg/m 2. Most of the patients were female. The operation time was in the range from 50 to 192.23 min. Mean follow-up was from one month to 12 years, with most studies having a follow-up of less than 2 years. The postoperative BMI ranged from 28.59 to 38, with reported excess weight loss (EWL%) in the range 20-70%. Glycated hemoglobin (HbA 1c) values decreased by up to 5.1% after surgery, ranging from 5.1% to 7.5%. Conclusions: Despite the quality of most of the included studies being low, the present meta-analysis revealed that, in the short term, gastric plication is an effective measure for weight loss, while the effect on diabetes mellitus type 2 is not statistically significant.
Acta chirurgica iugoslavica, 2010
THE AIM of this study was to analyze patients suffering from penetrating colon injuries managemen... more THE AIM of this study was to analyze patients suffering from penetrating colon injuries management, clinical outcomes and factors, which predict higher morbidity and complications rate. METHODS: this was a retrospective analysis of prospectively collected data from patients with injured colon from 1995 to 2008. Age, time till operation, systolic blood pressure, part of injured colon, fecal contamination, PATI were registered. Monovariate and multivariate logistic regression was performed to determine higher morbidity predictive factors. RESULTS: 61 patients had penetrating colon injuries. Major fecal contamination of the peritoneal cavity and systolic blood pressure lower than 90 mmHg are independent factors determining the fecal diversion operation. Primary repair group analysis establish that major fecal contamination and systolic blood pressure lower than 90 mmHg OR=4,2 and 0,96 were significant risk factors, which have contributed to the development of postoperative complication...
Lietuvos Bendrosios Praktikos Gydytojas, Dec 1, 2015
Hernia, 2007
The aim of this study was to compare the eVect of diVerent kinds of surgical meshes on postoperat... more The aim of this study was to compare the eVect of diVerent kinds of surgical meshes on postoperative adhesion formation. Forty-two New Zealand White rabbits were studied. The rabbits were grouped into six groups, according to the type of surgical meshes (Prolene, Mersilene, Vypro, polytetraXouroethylene (PTFE), Proceed and control group) implanted into the peritoneum cavity. Thirty days after the operation, the relaparotomies were carried out, and any adhesions observed between the implanted mesh and tissues were evaluated and graded. The mean adhesion degree was 9.2 in the Mersilene mesh group, 9.5 in the Prolene mesh group, 9.7 and in the Vypro mesh group (P > 0.05). The mean adhesion degree was 1 in the control group, 2.75 in the Proceed mesh group and 2.25 in the PTFE mesh group. There was a signiWcant diVerence in adhesion degree between the control, Proceed and PTFE groups and the Prolene, Mersilene and Vypro mesh groups. The adhesion degree was signiWcantly lower in the Proceed and PTFE mesh groups when comparing them with the Prolene, Mersilene and Vypro meshes.
Videosurgery and Other Miniinvasive Techniques
Introduction: Two types of partial wrap are commonly performed in achalasia patients after Heller... more Introduction: Two types of partial wrap are commonly performed in achalasia patients after Heller myotomy: the posterior 270° fundoplication (Toupet) and the anterior 180° fundoplication (Dor). The optimal type of fundoplication (posterior vs. anterior) is still debated. Aim: To compare the long-term rates of dysphagia, reflux symptoms and patient satisfaction with current postoperative condition between two fundoplication groups in achalasia treatment. Material and methods: Our retrospective study included 97 consecutive patients with achalasia: 37 patients underwent laparoscopic posterior Toupet (270°) fundoplication followed by Heller myotomy (group I); 60 patients underwent laparoscopic anterior partial Dor fundoplication followed by Heller myotomy (group II). Long-term follow-up results included evaluation of dysphagia symptoms, intensity of heartburn and patient satisfaction with current condition. Results: Patients in these two groups did not differ according to age, weight, height, postoperative stay or follow-up period. Laparoscopic myotomy with posterior Toupet fundoplication was effective in 89% of patients, while laparoscopic myotomy with anterior Dor was effective in 93% of patients (p > 0.05). 11% of patients after posterior Toupet fundoplication had clinically significant heartburn vs. 35% of patients after anterior Dor fundoplication (p < 0.05). Overall patient satisfaction with current condition was 88%, with no significant difference between the groups. Conclusions: According to our study results, the two laparoscopic techniques were similarly effective in reducing achalasia symptoms, but postoperative clinical manifestation of heartburn is significantly more frequent after anterior Dor fundoplication (35% vs. 11%). The majority of patients (88%) were satisfied with operation outcomes.
Medicina, Feb 1, 2003
penetrating abdominal trauma index (PATI) validity in evaluation, management of the colorectal in... more penetrating abdominal trauma index (PATI) validity in evaluation, management of the colorectal injuries and treatment results. Retrospective study of operations and treatment results of 42 patients, who had penetrating abdominal trauma with colorectal injury, was performed. Surgery performed was primary resection of injured bowel in 7 (16.7%) cases, resection with end colostomy in 5 (11.9%), stomy only in 2 (4.8%), suture of the bowel in 25 (59.5%), suture with protective enterostomy in 3 (7.1%) cases. Postoperative course was complicated in 19 (45.2%) patients, mainly as wound complication 12 (29%) and intraabdominal complication 8 (19%). Postoperative mortality was 3 (7.1%). Analysis of the complications according to penetrating abdominal trauma index has shown, that there were statistical differences below and above 15 points in PATI - 35% versus 70%. Postoperative complication rates depend on arterial blood pressure, peritoneal cavity contamination, and PATI. There is no correlation between method of operation and complications. PATI is useful in comparing extent and severity of colorectal trauma and could help in defining method of surgical repair. If PATI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;/=15 was found and contamination of peritoneal cavity is insignificant primary repair can be performed safely.
Medicina, Feb 1, 2003
penetrating abdominal trauma index (PATI) validity in evaluation, management of the colorectal in... more penetrating abdominal trauma index (PATI) validity in evaluation, management of the colorectal injuries and treatment results. Retrospective study of operations and treatment results of 42 patients, who had penetrating abdominal trauma with colorectal injury, was performed. Surgery performed was primary resection of injured bowel in 7 (16.7%) cases, resection with end colostomy in 5 (11.9%), stomy only in 2 (4.8%), suture of the bowel in 25 (59.5%), suture with protective enterostomy in 3 (7.1%) cases. Postoperative course was complicated in 19 (45.2%) patients, mainly as wound complication 12 (29%) and intraabdominal complication 8 (19%). Postoperative mortality was 3 (7.1%). Analysis of the complications according to penetrating abdominal trauma index has shown, that there were statistical differences below and above 15 points in PATI - 35% versus 70%. Postoperative complication rates depend on arterial blood pressure, peritoneal cavity contamination, and PATI. There is no correlation between method of operation and complications. PATI is useful in comparing extent and severity of colorectal trauma and could help in defining method of surgical repair. If PATI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;/=15 was found and contamination of peritoneal cavity is insignificant primary repair can be performed safely.
Medicina (Kaunas, Lithuania), 2003
penetrating abdominal trauma index (PATI) validity in evaluation, management of the colorectal in... more penetrating abdominal trauma index (PATI) validity in evaluation, management of the colorectal injuries and treatment results. Retrospective study of operations and treatment results of 42 patients, who had penetrating abdominal trauma with colorectal injury, was performed. Surgery performed was primary resection of injured bowel in 7 (16.7%) cases, resection with end colostomy in 5 (11.9%), stomy only in 2 (4.8%), suture of the bowel in 25 (59.5%), suture with protective enterostomy in 3 (7.1%) cases. Postoperative course was complicated in 19 (45.2%) patients, mainly as wound complication 12 (29%) and intraabdominal complication 8 (19%). Postoperative mortality was 3 (7.1%). Analysis of the complications according to penetrating abdominal trauma index has shown, that there were statistical differences below and above 15 points in PATI - 35% versus 70%. Postoperative complication rates depend on arterial blood pressure, peritoneal cavity contamination, and PATI. There is no correla...
BMC Surgery, 2014
Background: A steady decline in gastric cancer mortality rate over the last few decades is observ... more Background: A steady decline in gastric cancer mortality rate over the last few decades is observed in Western Europe. However it is still not clear if this trend applies to Eastern Europe where high incidence rate of gastric cancer is observed. Methods: This was a retrospective non-randomized, single center, cohort study. During the study period 557 consecutive patients diagnosed with gastric cancer in which curative operation was performed met the inclusion criteria. The study population was divided into two groups according to two equal time periods: Group II -284 patients). Primary (five-year survival rate) and secondary (postoperative complications, 30-day mortality rate and length of hospital stay) endpoints were evaluated and compared. Results: Rate of postoperative complications was similar between the groups, except for Grade III (Clavien-Dindo grading system for the classification of surgical complications) complications that were observed at significantly lower rates in Group II (26 (9.5%) vs. 11 (3.9%), p = 0.02). Length of hospital stay was significantly (p = 0.001) shorter (22.6 ± 28.9 vs. 16.2 ± 17.01 days) and 30-day mortality was significantly (p = 0.02) lower (15 (5.5%) vs. 4 (1.4%)) in Group II. Similar rates of gastric cancer related mortality were observed in both groups (92.3% vs. 90.7%). However survival analysis revealed significantly (p = 0.02) better overall 5-year survival rate in Group II (35.6%, 101 of 284) than in Group I (23.4%, 64 of 273). There was no difference in 5-year survival rate when comparing different TNM stages.
Surgical Endoscopy, 2013
Background Long-term results in antireflux surgery may depend on fundoplication type and wrap len... more Background Long-term results in antireflux surgery may depend on fundoplication type and wrap length. We compared the outcome of two different wrap lengths among the patients undergoing partial or total fundoplications. This study is the next part of a prospective 5-year follow-up assessment. Methods A total of 153 patients were randomized to Nissen or Toupet 1.5-or 3-cm wrap laparoscopic fundoplication. The primary endpoint-treatment failure rate was defined as a recurrent GERD or persistent dysphagia. Intensity of heartburn, dysphagia, gas-bloating, presence of esophagitis were assessed as a secondary outcome at 1-year and 5-year follow-up. Results At 5-year follow-up, data were collected from 129 (85 %) patients. At 1-year follow-up, 17 (11 %) treatment failures were detected. At the end of the fifth year, the numbers reached 23 (15 %). The failures were more common in the 1.5-cm Toupet (25 %) and the 3-cm Nissen group (18.2 %). The significant difference in failure rates was found between 1.5-cm and 3-cm Toupet groups (P \ 0.05). Dysphagia remained low during the follow-up in all of the groups. The prevalence of higher scores of heartburn after 5 years was detected in Nissen 1.5-cm group (20.8 %). The lowest scores were observed in Toupet 3-cm group. Bloating symptoms were more prevalent among Nissen and Toupet 3-cm group patients at 5-year follow-up. At the end of the fifth year, the prevalence of esophagitis was lower in Nissen 1.5-cm (19.3 %) and Toupet 3-cm (13.3 %) groups. The highest prevalence of esophagitis-32.4 %-was found in Toupet 1.5-cm group. Conclusions Nissen and Toupet fundoplication achieved sufficient control of reflux with success rate of 85 % at 5-year follow-up. There were no significant differences in the postoperative dysphagia, esophagitis, and bloating rates. However, the distribution of treatment failures leads us to conclude that 1.5-cm wrap length is insufficient in cases of posterior partial fundoplication.