Introduction: Traumatic abdominal wall hernias (TAWHs) are rare injuries, most often resulting from blunt trauma in motor vehicle accidents. Their diverse, uncommon, and often acute nature makes treatment planning challenging, with no consensus on the optimal approach, including the timing and type of surgery, and the role, selection, and fixation techniques of mesh. Aim: The aim of this systematic review was to synthesize the recent literature on traumatic abdominal wall hernias in adults, including their epidemiology, diagnosis, associated injuries, and management, with particular emphasis on the timing and type of repair and the use of mesh. Material and methods: We conducted a systematic review of the recent literature on TAWHs, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of the PubMed database was conducted to identify studies published between 2014 and the first half of 2024. All English-language studies documenting TAWH in adult patients were included. Results: In the literature review, 70 articles describing 721 cases were included. The main limitation was that most articles were case reports or case series. The results confirmed substantial variability in treatment selection. Conclusions: Traumatic abdominal wall hernias are rare, heterogeneous, and clinically significant conditions with no established treatment algorithm. More research is needed to help guide surgeons in the management of such hernias.
Introduction: Liver resection remains one of the fundamental treatment modalities for both malignant and benign hepatic diseases; however, it is still associated with a significant risk of intraoperative bleeding. Reducing blood loss and the need for transfusion is crucial for perioperative outcomes and long-term prognosis. The Coolingbis system, which utilizes a cooled monopolar radiofrequency electrode, represents a novel method of achieving hemostasis during hepatic parenchymal transection. Aim: The aim of this study was to evaluate the impact of the Coolingbis system on intraoperative blood loss, the need for blood product transfusions, and the perioperative course in patients undergoing liver resection. Materials and Methods: A retrospective analysis was conducted on 58 patients who underwent surgery for liver lesions between 2022 and 2024. The Coolingbis system was used in 25 patients, while conventional hemostatic techniques were applied in 33 patients. Intraoperative blood loss, operative time, transfusion rate, length of hospital stay, postoperative complications, and mortality were analyzed. Statistical analysis was performed using the Kruskal–Wallis test, the chi-square test, and Fisher’s exact test. Results: Intraoperative blood loss was significantly lower in the Coolingbis group compared with the conventional techniques group (338.0 450.1 mL vs 607.6 752.5 mL; p = 0.0062). Blood product transfusions were less frequent in the Coolingbis group (12.0% vs 24.2%; p = 0.0410). No significant differences were observed between the groups in terms of operative time or length of hospital stay. The rate of postoperative complications was lower in the Coolingbis group; however, the difference did not reach statistical significance. Age, sex, and BMI had no significant impact on intraoperative blood loss. Conclusions: The use of the Coolingbis system in liver resections is associated with a significant reduction in intraoperative blood loss and transfusion requirements, without an increased risk of complications. This technique may represent a valuable adjunct to conventional hemostatic methods in liver surgery.
Introduction: Low grade appendiceal mucinous neoplasm (LAMN) is a rare appendiceal tumor with indolent histology but clinically relevant risk of peritoneal dissemination and pseudomyxoma peritonei, creating uncertainty in surgical extent and follow-up.Aim: To synthesize evidence on surgical decision making in LAMN, including right hemicolectomy indications, TNM interpretation, perforation management, imaging limitations, CRS/HIPEC (Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy) selection, and surveillance.Materials: A targeted narrative review was conducted using biomedical sources (2000–2026), supplemented by manual reference screening and citation tracking of key guidelines, consensus statements, and cohort studies. Evidence from pathology/staging, imaging, operative strategy, intraperitoneal treatment, and surveillance was narratively synthesized into clinical decision frameworks.Results: Contemporary evidence supports de-escalation for most localized LAMN. Routine right hemicolectomy is usually overtreatment in non-perforated pTis/pT3 disease after complete appendectomy and is not routinely indicated in selected perforated cases with acellular mucin. LAMN staging differs from adenocarcinoma, including absence of T1/T2 categories and prognostic distinction between M1a and M1b disease. Perforation increases recurrence risk and supports risk-adapted surveillance, but does not alone mandate right hemicolectomy.Discussion: The evidence base remains predominantly retrospective and surveillance protocols are heterogeneous, limiting standardization.Conclusions: Risk stratified, evidence based algorithms can reduce overtreatment while preserving oncologic safety in LAMN.Significance of the study: This review integrates staging, operative strategy, and surveillance into a practical framework for standardized LAMN management and future multicenter research planning.
AbstractPurposePostoperative pancreatic fistula (POPF) remains the major source of morbidity after distal pancreatectomy (DP) for pancreatic neuroendocrine tumours (pNETs). While intraoperative risk factors are well established, the clinical relevance of discrepancies between preoperative computed tomography (CT), intraoperative, and histopathologic measurements remains unclear. This study aimed to assess the agreement between radiologic and intraoperative measurements and to explore their relationship with postoperative outcomes after DP for pNETs.MethodsThis retrospective single-centre study included 76 patients who underwent open distal pancreatectomy for histologically confirmed pNETs between 2017 and 2022. Tumour size and main pancreatic duct diameter were assessed on preoperative contrast-enhanced CT, intraoperatively, and histopathologically. Postoperative complications were graded according to the Clavien–Dindo classification, and POPF was defined according to the 2016 ISGPS criteria. The Fistula Risk Score (FRS) was calculated retrospectively. Agreement between CT, intraoperative, and histopathologic measurements was analysed using Bland–Altman plots and Spearman correlation.ResultsMedian patient age was 58 years, and 52.6% were female. Overall morbidity was 53.9%, clinically relevant POPF occurred in 19.7% of patients, and major complications (Clavien–Dindo ≥ III) were observed in 21.1%. Soft pancreatic texture (p < 0.001) and intraoperative blood loss > 700 mL (p = 0.02) were significantly associated with clinically relevant POPF and severe morbidity. FRS correlated with complication grade (τ = 0.38, p < 0.01) and hospital stay (r = 0.73, p < 0.01). CT significantly underestimated tumour size compared with intraoperative and histopathologic measurements (median bias = –0.3 cm; p = 0.01), whereas concordance between CT and intraoperative pancreatic duct diameter was weak (ρ = 0.28, p = 0.08). Neither CT-based tumour size nor duct diameter was associated with clinically relevant POPF or overall postoperative complications.ConclusionPreoperative CT underestimates tumour size and shows limited agreement with intraoperative assessment of the pancreatic duct in pNET distal pancreatectomy. In contrast, intraoperative findings, particularly pancreatic texture and blood loss, appear to be more clinically relevant in assessing the risk of postoperative complications.
Introduction: Bariatric surgery is the most effective treatment for obesity, yet obesity increases the risk of perioperative complications, including surgical site infections. Although bariatric procedures are classified as clean or clean-contaminated, current guidelines recommend antibiotic prophylaxis for all such operations, despite the lack of clear clinical evidence supporting this approach.Aim: To assess the effect of antibiotic prophylaxis on Incidence of Surgical Site infection (SSI) rate, and other postoperative outcomes after bariatric procedures.Materials and methods: A systematic search used the terms “Bariatric Surgery” and “Antibiotic Prophylaxis,” with added queries for SG, RYGB, OAGB, SADI, SASI, and AGB. Eligible designs included randomized trials, and observational studies that reported clinical outcomes such as SSI, wound complications, morbidity, or mortality. Reports without original clinical data were excluded. Data were analyzed separately for clean procedures (SG, AGB) and clean-contaminated procedures (RYGB, SADI, SASI). Results: Eight studies met criteria. Three studies directly compared prophylaxis with no prophylaxis across clean and clean-contaminated operations and found no significant reduction in SSI. In clean procedures, available evidence consistently indicated no justification for routine antibiotic use. In clean-contaminated procedures results were underpowered. Isolated studies suggested a modest benefit in selected subgroups, yet none reached statistical significance. Vancomycin was associated with increased infection risk. Ertapenem lowered infection rates compared with ceftriaxone in open gastric bypass. Alternative prophylaxis with levofloxacin and metronidazole after sleeve gastrectomy was linked to less weight loss, and clindamycin after gastric bypass to a higher rate of hypertension remission.Discussion: Current evidence does not support routine perioperative antibiotic prophylaxis in all bariatric surgery procedures. For clean operations such as SG, prophylaxis appears unnecessary. In clean-contaminated procedures, selective use may be justified for high-risk patients until adequately powered prospective trials are available. When used, prophylaxis should be weight-adjusted, timed appropriately, and repeated intraoperatively when indicated.Conclusions: Beyond infection prevention, some evidence suggests that antibiotic choice may influence non-infectious outcomes, including postoperative weight loss and hypertension remission. Future studies are needed to evaluate both infectious and metabolic endpoints to develop evidence-based, antibiotic prophylaxis strategies in bariatric surgery.
Introduction: Global obesity is increasing, affecting ~2.5 billion overweight and 1 billion obese adults (WHO, 2022). It is associated with metabolic syndrome, type 2 diabetes, cardiovascular disease, sleep disorders, and depression, forming bidirectional interactions that worsen health outcomes. Bariatric surgery is currently the most effective long-term intervention for sustained weight loss and comorbidity remission. Aim: This study evaluated associations between obesity, metabolic dysfunction, sleep disorders, and depressive symptoms, and assessed the effects of bariatric surgery on sleep quality, insomnia severity, daytime functioning, eating behavior, and mood within six months postoperatively. Material and methods: Four hundred and nineteen patients qualified for bariatric surgery were enrolled; 91 completed preand ≥6-month postoperative assessments. Participants completed validated questionnaires, including the Athens Insomnia Scale, Beck Depression Inventory (BDI) Night Eating Diagnostic Questionnaire, Difficulties in Emotion Regulation Scale, and Body Perception Questionnaire. Analyses were performed in RStudio with p < 0.05. Results: Significant postoperative weight and BMI reduction was observed. Sleep quality improved, with fewer sleep initiation difficulties, nocturnal awakenings, and snoring, as well as better sleep consolidation. Daytime sleepiness decreased, and eating patterns became more structured, including regular meals, increased breakfast intake, and reduced night eating. Depressive symptoms significantly decreased (BDI 12.19 to 8.02; p < 0.01), indicating clinically meaningful improvement in mood. Conclusions: Bariatric surgery provides multidimensional benefits beyond weight loss, improving sleep, metabolic regulation, dietary behavior, and psychological well-being. The findings highlight the interdependence of obesity, sleep disturbances, and depression, and support integrated, multidisciplinary management approaches.
Introduction: Sleeve gastrectomy (SG) has become the most frequently performed bariatric procedure worldwide. Despite its widespread adoption, early complications such as staple-line bleeding and leaks remain clinically significant. This study aimed to assess the relationship between surgical experience and key outcomes, including staple-line leaks, bleeding, and operative time. Material and methods: A retrospective analysis of 3,200 consecutive SG performed between 2013 and 2025 was conducted. Patients were divided into four chronological groups of 800 cases each. Baseline demographics, operative time, hospital stay, and 30-day complications (bleeding, leaks, mortality) were compared.Results: Over the 12-year period, operative efficiency improved markedly, with median operative time decreasing from 60 min (50–75) in Group 1 to 30 min (30–40) in Group 4 (p < 0.001). Hospital stay shortened from 3 to 2 days (p < 0.001). Major complications declined from 5.4% to 1.8% (p < 0.001), with staple-line leaks eliminated entirely (from 2.0% to 0%, p < 0.001). Bleeding incidence fell initially but increased slightly in Group 4 (from 3.0% to 1.4%, p = 0.026). Mortality remained low.Conclusions: Progressive surgical experience and adoption of modern technology improved safety and efficiency in SG, reducing major complications and operative duration. These findings underscore the value of performing metabolic bariatric surgery in high-volume, experienced centers and illustrate the combined effect of learning curve and technological advancement.
Introduction: Postoperative pancreatic fistula (POPF) is the leading cause of mortality and morbidity following pancreaticoduodenectomy (PD). Comprehensive perioperative risk analyses from African tertiary centers remain scarce. Aim: To identify independent perioperative predictors of clinically relevant POPF (CR-POPF) and to validate the Callery Fistula Risk Score (FRS) in an Upper Egyptian cohort. Material and methods: A retrospective cohort of 112 consecutive PD patients operated on at Minia University Hospital between January 2018 and October 2025 was analyzed. All procedures were carried out by a dedicated hepatopancreaticobiliary (HPB) team of three consultant surgeons at a dedicated Liver and GIT Hospital serving the Upper Egyptian referral population. CR-POPF was defined per 2016 ISGPS criteria (Grades B/C). Univariate and multivariate logistic regression identified independent predictors; the Callery FRS was calculated post-hoc for all patients. Results: CR-POPF occurred in 23.2% (26/112). Multivariate analysis identified six independent predictors: BMI ≥25 kilograms/ m (OR 6.24), soft pancreatic texture (OR 5.12), duct diameter ≤3 millimeters (OR 4.85), periampullary pathology (OR 3.47), operative time above 360 minutes (OR 3.64), and blood loss >800 milliliters (OR 2.89). CR-POPF nearly doubled hospital stay (28.4 vs. 15.3 days; p 1500 units per liter achieved AUROC of 0.93, sensitivity of 88.5%, specificity of 87.2%, PPV of 71.8%, and NPV of 95.9%. Discussion: The identified predictors align with the Callery FRS framework while highlighting BMI as an underappreciated independent risk factor in this population. Early drain amylase surpasses all preoperative scoring tools in postoperative risk stratification. Conclusions: Six perioperative predictors define a high-risk PD phenotype validated against the Callery FRS (AUROC 0.88). A POD 1 drain amylase level >1500 U/L yielded an AUROC of 0.93, enabling early clinical intervention before the fistula declares itself clinically. Significance: This study represents the first comprehensive perioperative POPF risk analysis from Upper Egypt and the first post-hoc validation of the Callery FRS in an African cohort. It provides both regional evidence and an actionable POD 1 drain-amylase threshold (>1500 U/L) that outperforms every preoperative score in this setting, offering a pragmatic early-warning marker for fast-track postoperative intervention.
Introduction: Decompressive craniectomy (DC) is an established life-saving procedure for patients with refractory intracranial hypertension. After stabilization, cranioplasty (CP) is performed to restore cranial integrity, improve cerebral hemodynamics, and protect the brain. However, CP is associated with considerable complication rates, and the optimal timing of reconstruction remains controversial. Aim: To evaluate the impact of cranioplasty timing on postoperative complications and functional outcomes following decompressive craniectomy, and to identify independent predictors of adverse events after reconstruction. Materials and methods: We conducted a retrospective single-center cohort study including 184 adult patients who underwent cranioplasty after decompressive craniectomy between January 2017 and December 2024. Patients were categorized according to the interval between DC and CP into early (≤3 months), intermediate (3–6 months), and delayed (>6 months) groups. Demographic, clinical, and surgical variables were analyzed, including age, sex, indication for DC, Charlson Comorbidity Index (CCI), cranial defect size, implant material, and ventriculoperitoneal shunt dependency. The primary outcome was the occurrence of postoperative complications. Secondary outcomes included surgical site infection, postoperative hematoma, hydrocephalus requiring CSF diversion, seizures, bone flap resorption, and reoperation. Functional outcome was assessed using the modified Rankin Scale (mRS) at six months. Kaplan–Meier analysis was used to evaluate complication-free survival, and multivariable Cox proportional hazards regression was performed to identify independent predictors of complications. Results: The cohort consisted of 184 patients with a mean age of 52.4 16.8 years; 64% were male. The most common indication for decompressive craniectomy was traumatic brain injury (55%), followed by ischemic stroke (42%) and intracerebral hemorrhage (2%). Early cranioplasty was performed in 37% of patients, intermediate in 34%, and delayed in 29%, with a median interval of 121 days between DC and CP. Autologous bone flap reimplantation was used in 86% of cases, whereas 14% received patient-specific synthetic implants. The overall postoperative complication rate was 26.6%. The most frequent complications were surgical site infection (13.0%), postoperative hematoma (8.2%), hydrocephalus (1.6%), and implant-related complications (3.8%). Complication rates did not significantly differ among timing groups (early 28%, intermediate 25%, delayed 26%; p = 0.61). Kaplan–Meier analysis demonstrated similar complication-free survival across groups (p = 0.64). Multivariate analysis identified higher comorbidity burden (CCI ≥4) as an independent predictor of postoperative complications (HR 2.1; 95% CI 1.2–3.7; p = 0.02), whereas timing of cranioplasty, cranial defect size, and implant material were not significant predictors. Conclusions: Cranioplasty after decompressive craniectomy is generally safe, with complication rates comparable to those reported in the literature. In this cohort, the timing of cranioplasty did not independently influence postoperative complication rates. Instead, patient-related factors, particularly comorbidity burden, played a more significant role in determining outcomes. These findings support an individualized approach to cranioplasty timing based on patient condition and clinical factors rather than rigid temporal thresholds.
Introduction: Elective thyroid surgery continues to be a standard treatment for benign and malignant thyroid diseases when conservative therapy is insufficient. Despite advances in surgical techniques, postoperative complications remain a concern. Aim: This study aimed to analyse postoperative complication rates in patients who underwent elective thyroidectomy, focusing on identifying predisposing and protective factors. Materials and methods: A total of 507 patients underwent elective thyroidectomy after endocrinological evaluation and, when indicated, fine-needle aspiration cytology (FNAC). Intraoperative recurrent laryngeal nerve monitoring was performed, and the resected thyroid specimens were evaluated for volume and histopathology. The postoperative outcomes included surgical complications, parathyroid dysfunction, and calcium level abnormalities. Results: The study cohort consisted of 404 women (79.7%) and 103 men (20.3%), with a mean age of 53.6 13.9 years. The mean thyroid volume was 167.9 170.7 ml, and it was larger in men than in women (209.5 192.2 vs. 157.3 163.4 ml; p = 0.0063). Overall, 400 complications were observed, with hypocalcaemia being the most common one (representing 62.3% of complications) and affecting 249 patients (49.1% of the cohort). Female sex was associated with a 2.7-fold higher risk of postoperative parathyroid dysfunction and a 3-fold higher risk of calcium level abnormalities compared with male patients. No independent predictors of complications were identified, and no mortality occurred. Conclusions: Elective thyroidectomy is safe, with no procedure-related mortality, and hypocalcaemia and parathyroid dysfunction remain the leading complications. Larger prospective studies and meta-analyses should be performed to further evaluate thyroid volume as an independent risk factor and to establish the definitions of calcium abnormalities.
<b>Introduction:</b> Crohn's disease (CD) is a chronic inflammatory bowel disease frequently necessitating surgical intervention, particularly ileocecal resection (ICR), due to complications unresponsive to medical therapy. Postoperative complications remain a significant concern, highlighting the need for reliable preoperative biomarkers to improve risk stratification.<b>Aim:</b> This study aimed to evaluate the utility of selected serologic inflammatory markers in predicting postoperative complications and their severity in CD patients undergoing ICR.<b>Materials and methods:</b> A retrospective analysis was conducted on 110 patients who underwent ICR for CD-related complications between 2015 and 2024. Preoperative blood parameters, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and C-reactive protein (CRP), were analyzed in relation to postoperative complications classified by Clavien-Dindo grading and the Comprehensive Complication Index (CCI).<b>Results:</b> Postoperative complications occurred in 46 patients (41.8%), with surgical site infection being the most common. Severe complications (Clavien-Dindo grade IV) were observed in 5 patients, with no mortality recorded. While no statistically significant associations were found between Clavien-Dindo grade and white blood cells (WBC), platelets (PLT), NLR, MPV, or CRP levels, CRP demonstrated a significant positive correlation with CCI score (p < 0.05), suggesting its potential as a predictive marker for overall complication burden.<b>Conclusions:</b> Elevated preoperative CRP levels may serve as a useful predictor of postoperative complication severity in CD patients undergoing ICR. Although other markers, such as NLR and MPV, showed trends toward association, statistical significance was not reached. Comprehensive preoperative assessment incorporating inflammatory biomarkers could enhance surgical planning and improve outcomes in this high-risk population.
<b>Introduction:</b> Achalasia is a primary esophageal motility disorder of unclear etiology. The development of third-space endoscopy has enabled the advancement of peroral endoscopic myotomy (POEM) as a promising therapeutic alternative. <br><br><b>Aim:</b> To assess the safety profile of the POEM procedure in patients with diverse clinical characteristics. <br><br><b>Material and methods:</b> A retrospective analysis of 484 consecutive POEM procedures performed between 2015 and 2024 at PCZ in Brzeziny (Brzeziny specialized medical center) was conducted. The analysis included demographic data, procedure duration, type of achalasia, as well as intraoperative and early postoperative complications. <br><br><b>Results:</b> Significant complications during or post hospitalization occurred in 26 patients (5.4%), including bleeding, mucosal perforation, pain requiring prolonged treatment, and asymptomatic elevation of inflammatory markers. Two cases of mediastinitis and 7 readmissions were recorded. All complications were successfully managed conservatively. <br><br><b>Conclusions:</b> POEM is characterized by a high safety profile in the treatment of achalasia.
Introduction: Colorectal cancer (CRC) is the second most common cancer worldwide. Much attention has recently been paid to the epigenetic features of CRC. Homologous recombination repair (HRR) is a biochemical pathway that plays a crucial role in maintaining genome integrity through the repair of double-strand breaks (DBS). RAD51 recombinase is widely considered a key enzyme in HRR. Genome-wide single nucleotide polymorphisms (SNPs) are a significant type of genetic variation. Aim: The aim of this study was to assess the association between the occurrence of individual genotypes/alleles of the RAD51 172G/T polymorphism (rs1801321) and the risk of CRC.Materials and methods: The material used for DNA isolation was peripheral blood from patients at the Department of General and Colorectal Surgery, Medical University of Lodz. The study recruited patients (n = 188) with histologically confirmed colorectal cancer. The control group consisted of undiagnosed individuals (n = 200), matched for age and gender, without a family history of cancer among first-degree relatives.Results: No statistically significant association was found between the frequency of the assessed alleles/genotypes and the presence of CRC. The analysis also showed that the 127G/T variant of the RAD51 gene was not statistically significantly associated with the development of colorectal cancer.Discussion: The 127G/T polymorphism of the RAD51 gene appears to be an unpromising marker for colorectal cancer. However, new observations regarding the variant in the distal promoter may open up prospects for future research on molecular markers.Conclusions: The study results indicate no association between the RAD51 172G/T polymorphism and the risk of CRC. Therefore, there is a need for further research in the area of selected polymorphisms in CRC.
<b>Introduction:</b> Full-thickness rectal prolapse (FTRP) is a multifactorial disease that can be treated with different surgicaltechniques. There is still no standard surgical procedure, and the selection of the surgical technique is based on the individualassessment and the experience of the surgeon. The benefits to patients should focus on repair of bowel prolapse, reduction ofconstipation, and an improvement in pelvic floor muscle insufficiency.<b>Aim:</b> Aim of this study was to evaluate clinical and functional outcomes after abdominal surgery for FTRP in a prospective single- -center observational study.<b>Materials and methods:</b> Between 2016 and 2022, a total of 94 consecutive patients (46.2 18.2 years) underwent abdominal surgery due to FTRP using an abdominal approach. They were operated on with ventral mesh rectopexy (VMR) (55 pts.) or resection and suture rectopexy - Frykman-Goldberg procedure (FG) (39 pts.). Before and after the surgery, clinical and functional outcomes were measured. The follow-up period ranged from 1 to 6 years (mean: 26 months).<b>Results:</b> At last follow-up, constipation occurred in 27.6% of VMR and 31.3% of FG patients (p = 0.754; calculated among patients with available postoperative constipation status). The Wexner incontinence score was significantly better in the VMR group (1.0 2.1 <i>vs.</i> 3.6 5.0, p = 0.009). There were no differences in the EQ5D indices between the groups (1.7 2.0 <i>vs.</i> 2.4 2.8, p = 0.257).<b>Conclusions:</b> Both surgical procedures revealed comparable rates of recurrence and complications. While QoL was similarbetween groups, VMR yielded a significantly greater improvement in the Wexner incontinence score.
<b>Introduction:</b> Necrosis of the round ligament of THE liver is an extremely rare cause of peritonitis, its nonspecific clinical signs frequently causing diagnostic difficulties. For this reason, contrast-enhanced multiphasic CT scan of the abdomen and pelvis is crucial in the diagnostic management.<b>Case report:</b> A 77-year-old male patient with epigastric pain and suspicion of acute cholecystitis was diagnosed with suspected necrosis of the round ligament of the liver on diagnostic imaging. The patient was qualified for surgical treatment. During the laparoscopic procedure, the necrosis of the round ligament of the liver was confirmed, and the necrotic ligament was subjected to laparoscopic resection. The patient was discharged home in good general condition on postoperative day 3.<b>Conclusions:</b> Necrosis of the round ligament of the liver is a rare but clinically significant entity that should be taken into consideration in the differential diagnosis of acute abdomen, particularly presenting with nonspecific symptoms. In most cases, the treatment of choice involves minimally invasive surgical treatment in the form of laparoscopic resection.
Ovarian lesions in the paediatric population are rare and may be either non-neoplastic or neoplastic in nature. Among the neoplastic lesions, the vast majority are benign, with mature teratomas being the most common subtype. This review outlines the current surgical management of ovarian lesions in paediatric patients, with particular focus on recent research findings and advances in the field. Ovary-sparing, minimally invasive surgical techniques, including robot-assisted approaches, are recommended for benign lesions. In cases where malignancy is suspected, laparotomy with complete tumour excision, oophorectomy, and staging is performed. Accurate evaluation of the lesion's nature and early diagnosis are critical to preventing complications and preserving future fertility.
<b>Introduction:</b> Visceral artery compression syndromes are rare diseases with ambiguous symptoms, varying between patients.<b>Aim:</b> The aim of the paper was to review the disease's pathology, diagnosis and treatment.<b>Methods:</b> Review based on a MEDLINE database search.<b>Results:</b> Medial arcuate ligament syndrome (MALS) is caused by celiac trunk compression by the diaphragm's medial arcuate ligament. MALS is a diagnosis of exclusion because its symptoms are not clear-cut. Diagnostic imaging is based on Doppler ultrasound and computed tomography. Invasive treatment is aimed to decompress the celiac trunk with open, laparoscopic, or robotic methods, whereas endovascular procedures do not eliminate the disease cause. Superior mesenteric artery syndrome (SMAS) is a rare disease with symptoms resulting from compression of the duodenum between the superior mesenteric artery and the abdominal aorta. Symptoms may result from other pathologies within the abdominal cavity, therefore the diagnosis is based on exclusion of other gastrointestinal causes and on tomographic criteria. Conservative treatment is usually ineffective, while the choice of surgical methods requires individual assessment. Nutcracker syndrome (NCS) is characterized by symptoms caused by compression of the left renal vein by the superior mesenteric artery. Diagnosis is made after excluding other causes, as there are no established NCS diagnostic criteria. Doppler ultrasound and computed tomography are used in syndrome diagnosis, and its treatment should be individualized.<b>Conclusions:</b> The compression syndromes are rare diseases that occur significantly more frequently in women. Their diagnosis and treatment are a clinical challenge. A better pathophysiology understanding and the use of minimally invasive treatment techniques can improve the patient's quality of life.
<b>Introduction:</b> Virtual reality (VR) simulators have gained recognition in medical education as an innovative tool for training laparoscopic skills. With the advancement of minimally invasive surgery (MIS), it is critical to evaluate the effectiveness of VR simulators in transferring motor and psychomotor skills to the operating room (OR).<b>Aim:</b> This review aims to assess the evidence on the transferability of laparoscopic skills acquired through VR simulators to the OR setting, focusing on technical proficiency and patient outcomes.<b>Materials:</b> A literature review was conducted, evaluating studies from peer-reviewed medical databases, including controlled trials and meta-analyses, to examine the impact of VR training on surgical performance.<b>Results:</b> Numerous studies have demonstrated that VR training significantly improves technical skills such as precision, time management, and error reduction. Furthermore, randomized controlled trials confirm that surgeons trained in VR perform faster and with fewer complications than those trained with traditional methods.<b>Discussion:</b> Despite the advantages of VR training, challenges remain, including the fidelity of haptic feedback and emotional stress replication. However, the continuous development of VR technology, incorporating artificial intelligence and augmented reality, promises to enhance the realism and educational value of simulators.<b>Conclusions:</b> VR simulators play an essential role in modern laparoscopic training, offering a safe, effective platform for skill acquisition. The transfer of VR-trained skills to real-life surgical procedures is well supported by current evidence, suggesting that integrating VR into standard surgical curricula will improve clinical outcomes.
<b>Introduction:</b> Pancreatic ductal adenocarcinoma (PDAC) is one of the most common causes of cancer mortality worldwide, and most patients develop local and/or distant recurrence at some point during follow-up. <br><br><b>Aim:</b> This review aims to present the follow-up protocols used in Poland and worldwide for patients undergoing surgical treatment for PDAC. <br><br><b>Material and methods:</b> The analysis included studies on oncological follow-up following surgical treatment for pancreatic adenocarcinoma. After searching PubMed, Scopus, and Google Scholar databases using the terms "pancreatic adenocarcinoma recurrence", "surveillance after pancreatic adenocarcinoma resection", "postopererative follow-up for pancreatic adenocarcinoma", 50 articles were ultimately qualified for analysis. <br><br><b>Results:</b> Currently, there are no unified international standards for postoperative follow-up for PDAC. Furthermore, standardized national guidelines do not exist in Poland; thus, the optimal modality and duration of surveillance remain undefined. Furthermore, the impact of early detection and treatment of recurrence on survival and quality of life is unknown. Early detection of recurrence potentially offers greater treatment options due to systematic improvements in the treatment of local recurrence and distant metastases (DM), but it may also be associated with increased economic burden on "the payer" (healthcare system), without clearly translating into benefits resulting from longer survival. Currently, there are no clear recommendations on this issue - it seems necessary to conduct prospective studies to assess whether increased postoperative surveillance can translate into improved survival of patients with PDAC. <br><br><b>Conclusions:</b> Multidisciplinary collaboration in developing uniform, nationwide oncological surveillance principles can enable effective supervision of patients with PDAC and bring health benefits. <br><br><b>The importance of this work for the development of the field:</b> This summary of the applicable guidelines and the proposed corrective actions proposed by the authors can translate into progress and improved treatment outcomes in this challenging therapeutic area.
<b>Introduction:</b> Hand injuries are common, accounting for between 7 and 28% of all injuries. These are both closed injuries (joint dislocations and bone fractures) and open injuries (wounds and amputations). They occur in workplaces, in agriculture, during housework, sports, and during traffic accidents. <br><br><b>Aim:</b> The aim of the paper was to review the literature and present own experiences on the mechanisms of occurrence and methods of preventing severe hand injuries. <br><br><b>Material and methods:</b> Data from the literature were obtained from the Medline and PubMed databases, using keywords such as those in this paper. In addition, data from the author's institution experience are presented. <br><br><b>Results:</b> Various mechanisms of hand injuries when operating various devices, e.g., circular saws, angle grinders, mechanical presses, agricultural machinery, and fireworks, are presented. The most common causes of injury at operating these devices are discussed. Methods to prevent injuries that are specific to each device were discussed. The number of serious accidents in factories and workplaces has decreased noticeably over the last 10 years, while their incidence in households remains unchanged. <br><br><b>Conclusions:</b> Most injuries occur when operating devices with a rotating blade: circular saw, angle saw, and manual circular grinder. The cause of these injuries is most often careless handling of tools and failure to follow the operating instructions when tinkering at home. <br><br><b>Relevance of the study to the development of the field:</b> The results of this work may contribute to increasing public attention to the observance of safety when operating mechanical equipment.
