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Obesity, at present, seems to be a very serious health problem all over the world. The surgery is said to be the most successful treatment of obesity. With the increase in the quantity of conducted bariatric procedures, the number of revision treatments increases as well. The aim of the study was to analyze the indications, results and complications after repeated bariatric surgeries. Material and methods. The repeated bariatric procedures performed in 2009-2015 have been retrospectively analyzed. The endpoint of the study was the evaluation of early surgical treatment results-up to 30th day after repeated surgery. Results. Overall, amongs 103 obese patients with a BMI over 35 kg / m2, qualified for bariatric treatment 7 revision surgeries were conducted (6.8%). Two operations were carried out by laporotomy, other by laparoscopy. In the study group, neither any deaths were noted in perioperative period nor life-threatening complications. The frequency of complications-Surgical site infection and bleeding from the staple lines of stapler in the study group appeared to be 28.6%. Conclusions. Qualification for repeated bariatric surgeries should be based on a thorough analysis of the condition of the patient, previous outcome of the bariatric treatment: evaluation of weight loss as well as possible complications of the original surgery. [ABSTRACT FROM AUTHOR]

Endoscopic retrograde cholangiopancreatography (ERCP) is the most important non-surgical procedure in serious pancreatic and biliary diseases, still burdened with the risk of severe complications. The objective of the study was to distinguish factors which could increase the risk of occurrence of ERCP complication in the form of pancreatitis. Material and methods. The study included 452 patients who had undergone ERCP. Patients' records were retrospectively analyzed from the aspect of demographic data, indications for the procedure, type and course of the procedure, type and severity of complications, width of the common bile duct (CBD), concomitant diseases and administered medicines which might increase the risk of complications. Results. In 35 patients (7.7%) a complication occurred in the form of pancreatitis (AP). A severe course was confirmed in 11 patients (31%). Cholelithiasis constituted approximately 2/3 of indications for ERCP. AP after ERCP was significantly more often observed in the group of patients aged under 40 (22.9% vs 8.6%; p<0.05). Narrow biliary ducts (3-8 mm) were the factor increasing the frequency of development of AP (25.9% vs 45%; p<0.05). Death occurred in 5 patients (1.1%), including 4 patients (0.96%) in the group without complications, and in 1 patient (2.85%) with complicated AP. Conclusions. ERCP is a very valuable procedure in clinical treatment; however, it is burdened with the risk of complications, such as AP, bleeding, or duodenal perforation. A group especially exposed to the risk of complications in the form of AP are young patients aged under 40 with a narrow CBD. [ABSTRACT FROM AUTHOR]

Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures in surgical wards. Iatrogenic bile duct injuries (IBDI) incurred during the procedures are among postoperative complications that are most difficult to treat. The risk of bile duct injury is 0.2-0.4%, and their consequences are unpleasant both for the surgeon and for the patient. The aim of the study was analysis of iatrogenic bile duct injuries and methods of their repair,taking into consideration the circumstances, under which the injuries occur. Material and methods. The study group consisted of 16 patients who had suffered IBDI during surgery. The analysed parameters included sex, age, indications for surgery, the setting of the surgical procedure and the type of bile duct injury. Additionally, the time of injury diagnosis, type of repair and treatment outcome were assessed. The IBDI analysis used the EAES classification of injuries. The time of IBDI repair was defined as immediate, early or late,depending on the time that had passed from the injury. The analysis included complications seen after bile duct repair. Results. The study group consisted of 10 women and 6 men, aged 29-84. Patients underwent 6 classic cholecystectomies, 8 laparoscopic cholecystectomies, one gastrotomy to remove oesophageal prosthesis and one laparotomy due to peptic ulcer. IBDI was diagnosed intraoperatively in 4 patients. In 12 patients IBDI was diagnosed within 1-7 days. The diagnosis was based on endoscopic retrograde cholangiopancreatography and the results of biochemistry tests. According to the EAES classification, the injuries were of type 1 (4 patients), type 2 (8 patients), type 5 (3 patients) and type 6 (1 patients). Reconstruction procedures were performed during the same anaesthesia session in 3 patients, and in the early period in 13 patients. The main procedure was Roux-en-Y anastomosis (12 patients), with the remaining including bile-duct suturing over a T-tube (3 patients) and underpinning of an accessory bile duct in the pocket left after gallbladder removal (1 patient). The most common reconstruction complications included bile leak (3 patients), recurrent cholangitis (3 patients) and bile duct stricture (2 patients). Mortality in the study group was 12.5%. Conclusions. The procedures of laparoscopic and classic cholecystectomy are associated with a risk of IBDI, especially in the presence of inflammatory state of the gall-bladder. IBDI is a complex complication: its treatment poses a challenge for the operating surgeon, and even the most careful treatment adversely affects the patient's lifedue to complications. [ABSTRACT FROM AUTHOR]

Introduction: Pancreatic resections belong to the most difficult surgical procedures and are still burdened with a high percentage of complications. Aim of the research: To analyse both the medical records of patients qualified for surgical treatment and the postoperative course after procedures of radical resection of the pancreas, with consideration of the most severe complications. Material and methods: Postoperative courses were analysed in 100 patients who had undergone pancreatic resection. Results: The most frequent indications for pancreatic resection were: cancer of the ampulla of Vater (30), pancreatic cancer (24), inflammatory tumours (16), and benign cystic tumours (12). In 8 cases, pancreatic resection (distal) was an element of the surgery due to advanced gastric cancer, while the remaining were: lymphoma (2), neuroendocrine tumour (2), adenoma with high-grade dysplasia involving the ampulla of Vater (2), GIST (1), IPMN (1), fibromatosis (1), and injury (1). The most frequently performed surgery was partial resection of the organ (73: proximal resection – 35, distal resection – 38). Total pancreatectomy was performed in 20 patients, and in 3 patients the surgery was limited to resection of the tumour. The dominant postoperative complications were pancreatic fistulas (9%) and haemorrhages (5%). Only one case of fistula was surgically treated. Surgical intervention was necessary in all cases of haemorrhagic complications (in 2 patients – several times). During the postoperative period 5 deaths were registered (5%). Conclusions: Pancreatic surgery remains a very difficult discipline, which requires not only excellent surgical technique, but also skill in the management of postoperative complications. [ABSTRACT FROM AUTHOR]