This document presents a comprehensive overview of the management of postinflammatory pancreatic and peripancreatic fluid collections, with a particular emphasis on endoscopic treatment, developed by a team of experts based on the latest clinical and scientific evidence. The guidelines present a detailed scheme of treatment of patients with local complications of acute pancreatitis in the form of postinflammatory pancreatic and peripancreatic fluid collections.

BACKGROUND The following guidelines were developed at the initiative of the Association of Polish Surgeons. In preparing this paper, the authors conduct- ed a thorough analysis of the current literature on the management of acute surgical conditions. A summary was drawn up following a compre- hensive review of studies from the past sever- al years. The main object of the summary was to dissect current knowledge on the approaches to optimize the management of severe acute pan- creatitis (AP).

Introduction: Computer-based interactive techniques are becoming an important tool in medical education. One of the important benefits of the use of telemedicine in surgical training is the reduction of the number of people in the operating room. As shown in the studies, this can lead i.e. to the reduction in the risk of surgical site infections. Aim: The objective of this survey as held among fifth-year medical students at three academic centers was to assess the usefulness and effectiveness of telemedicine as a surgery-teaching tool. Material and methods: A transmission of a surgical procedure was carried out by each of the three participating centers according to a previously prepared schedule. Each transmission was preceded by the diagnostics, indications, and the course of the surgical procedure being discussed by the facilitator physician who also coordinated the transmission throughout the procedure. After the class, students received anonymous surveys consisting of fourteen questions as per the attached protocol so as to evaluate the class using the rating scale of 1 (the lowest rating) through 5 (the highest rating). The survey assessed the educational value (the knowledge acquired from the class), the form (interactivity, facilitator complicity), and the usefulness of the class for overall surgical education. Results: The survey was completed by 232 students, with 95% of respondents rating the usefulness of telemedicine classes in surgical education as very good or good. As many as 97% of students declared that the transmission had been a good or a very good tool in terms of delivery or adding to their knowledge of topographical anatomy and basic aspects of surgical technique. Higher ratings were given to the usefulness of comments and remarks by the facilitating physician (96% of very good or good ratings) who had been watching the procedure along with the students as compared to those provided by the operating physician (81%). Discussion: The use of telemedicine-based teaching models in surgical education facilitates a better view of the operating field for the students, greater accessibility of educational content delivered simultaneously to multiple groups of students, increased safety of the surgical procedure by reducing the number of people in the operating room as well as reduced burden on the operating physician (thanks to the introduction of class facilitator).

Introduction: Over the past three decades, almost every type of abdominal surgery has been performed and re-fined using the laparoscopic technique. Surgeons are applying it for more procedures, which not so long ago were performed only in the classical way. The position of laparoscopic surgery is therefore well established, and in many operations it is currently the recommended and dominant method. Aim: The aim of the preparation of these guidelines was to concisely summarize the current knowledge on laparos-copy in acute abdominal diseases for the purposes of the continuous training of surgeons and to create a reference for opinions. Material and methods: The development of these recommendations is based on a review of the available literature from the PubMed, Medline, EMBASE and Cochrane Library databases from 1985 to 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. Recommendations were for-mulated in a directive form and evaluated by a group of experts using the Delphi method. Results and conclusions: There are 63 recommendations divided into 12 sections: diagnostic laparoscopy, perforat-ed ulcer, acute pancreatitis, incarcerated hernia, acute cholecystitis, acute appendicitis, acute mesenteric ischemia, abdominal trauma, bowel obstruction, diverticulitis, laparoscopy in pregnancy, and postoperative complications re-quiring emergency surgery. Each recommendation was supported by scientific evidence and supplemented with expert comments. The guidelines were created on the initiative of the Videosurgery Chapter of the Association of Polish Surgeons and are recommended by the national consultant in the field of general surgery. The first part of the guidelines covers 5 sections and the following challenges for surgical practice: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia and acute cholecystitis. Contraindications for laparoscopy and the ERAS program are discussed.

One of the target of perioperative tratment in surgery is decreasing intraoperative bleeding, which increases the number of perioperative procedures, mortality and treatment costs, and also causes the risk of transfusion of blood and its components. Trying to minimize the blood loss(mainly during the operation) as well as the need to transfuse blood and its components (broadly understood perioperative period) should be standard treatment for a patient undergoing a procedure. In the case of this method, the following steps should be taken: 1) in the preoperative period: identyfication of risk groups as quickly as possible, detecting and treating anemia, applying prehabilitation, modyfying anticoagulant treatment, considering donating one's own blood in some patients and in selected cases erythropoietin preparations; 2) in the perioperative period: aim for normothermia, normovolemia and normoglycemia, use of surgical methods that reduce bleeding, such as minimally invasive surgery, high-energy coagulation, local hemostatics, prevention of surgical site infection, proper transfusion of blood and its components if it occurs; 3) in the postoperative period: monitor the condition of patients, primarily for the detection of bleeding, rapid reoperation if required, suplementation (oral administration preferred) nutrition with microelements (iron) and vitamins, updating its general condition. All these activities, comprehensively and in surgical cooperation with the anesthesiologist, should reduce the blood loss and transfusion of blood and its components.

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Purpose: Multimodal treatment is the standard of care in patients with locally advanced gastric cancer. Unfor-tunately, the response rate after neoadjuvant treatment remains limited. The ability to predict the response has a potential to improve patient outcomes by promoting a more individualized approach. We sought to describe the current state of research in pre-treatment molecular biomarkers of response to neo-adjuvant therapy in gastric adenocarcinoma available for testing before the initiation of treatment and to perform a systematic review and meta-analysis in order to summarize and evaluate the potential methods.Methods: A systematic MEDLINE, EMBASE and CENTRAL literature search was conducted to extract articles on potentially predictive molecular biomarkers of pathological response to neoadjuvant therapy in patients with gastric-and esophago-gastric junction adenocarcinoma. Fixed and random effects models were used to undertake the meta-analysis when appropriate.Results: Data on predictive biomarkers was reported in 38 studies. These articles described 47 biomarkers showing statistical significance. After evaluation of all reported biomarkers, 3 of them met the inclusion criteria for meta -analysis. The meta-analysis results indicate that >5 ng/mL pre-therapeutic serum concentration of carcinoem-bryonic antigen (CEA; norm <5 ng/mL) is significantly associated with tumor response (RR = 5.13, 95% CI 2.53-10.43, P = 0.026).Conclusion: Previous studies describe a large number of candidate biomarkers. Our meta-analysis indicated pre -therapeutic serum concentration of CEA >5 ng/mL as a potential and easy-accessible biomarker available for use before initiation of treatment. However, it could be only an additional tool for complex qualification for neoadjuvant therapy.

Prehabilitation is a comprehensive preparation of a patient for primarily surgical treatments. Its aim is to improve the patient'sgeneral condition so as to reduce the risk of complications and ensure the fastest possible recovery to full health. Thebasic components of prehabilitation include: improvement of nutritional status, appropriate exercises to improve functioning,psychological support, and help in eliminating addictions. Other important aspects of prehabilitation are: increasinghemoglobin levels in patients with anemia, achieving good glycemic control in patients with diabetes, treatment or stabilizationof any concurrent disorders, or specialist treatment associated with a specific procedure (endoprostheses, ostomyprocedure). This article organizes and outlines the indications for prehabilitation, its scope, duration, and the method to conductit. Experts of various specialties related to prehabilitation agree that it should be an element of surgery preparationwhenever possible, especially in patients with co-existing medical conditions who have been qualified for major procedures.Prehabilitation should be carried out by interdisciplinary teams, including family physicians and various specialists in thetreatment of comorbidities. Prehabilitation requires urgent systemic and reimbursement solutions.

Surgical procedures are extremely burdensome for patients, as in addition to complications directly related to the intervention, they expose the patient to further complications resulting from the disturbance of key functions of homeostasis in the body’s systems, particularly the circulatory, respiratory, and nervous systems. Furthermore, they may contribute to the exacerbation of symptoms of underlying chronic diseases. This paper focuses on the most common possible neurological complications that may occur after surgical procedures and includes topics such as stroke, chronic pain, neuropathy, and delirium. The risk factors for neurological deficits, their known or possible etiology, the most characteristic symptoms, and potential preventive actions are discussed. The paper analyzes articles from the PubMed, ResearchGate, and Scopus databases. A surge0on’s knowledge of possible complications that may occur in the perioperative period enables early recognition and effective reduction of their negative impact on the patient’s functioning and quality of life after surgery, contributing to better overall treatment outcomes.

Colorectal cancer (CRC) is the second most common cause of cancer-related death globally. Because of a tendency to be an asymptomatic primary tumor and therefore resulting in late detection, most CRC patients are diagnosed in the advanced stage. Several miRNAs have the potential to become novel noninvasive biomarkers measured as diagnostic and prognostic indicators of CRC to guide surgical therapies and promote the understanding of the carcinogenesis of CRC. Since the change of miR-3613-3p was associated with several types of cancer other than colorectal cancer, there is a lack of functional evidence and the results are inconsistent. We conducted a pilot microarray study in which we noted a decreased expression of miR-3613-3p in colorectal cancer cells, then we confirmed the expression of miR-3613-3p by qPCR on a group of 83 patients, including 65 patients with colorectal cancer, 5 with a benign tumor and 13 from the control group. We noted that in both malignant and benign tumors, miR-3613-3p is downgraded relative to the surrounding tissue. As a result of the study, we also observed colorectal tumor tissue and surrounding tissue in patients with colorectal cancer who received radiotherapy before surgery, which showed a significantly higher expression of miR-3613-3p compared to patients who did not receive radiotherapy. In addition, we noted that the tissue surrounding the tumor in patients with distant metastases showed a significantly higher expression of miR-3613-3p compared to patients without distant metastases. The increased expression of miR-3613-3p in patients after radiotherapy suggests the possibility of using this miR as a therapeutic target for CRC, but this requires confirmation in further studies.

Introduction: Neoadjuvant chemotherapy (NAC) is a part of the current standard of care in a locally advanced gastric adenocarcinoma (GA) and esophagogastric junction adenocarcinoma (EGJA), but only patients with good pathomorphological response (pR) to NAC benefit from prolonged overall survival. Aim: The study aims to evaluate ApoA-I and ApoB as candidate pre-treatment biomarkers of pR to NAC in patients with GA and EGJA. Materials and methods: Serum samples were collected from 18 patients with GA and 9 with EGJA before the initiation of NAC to determine the ApoA-I and ApoB levels. After NAC tumor regression grade (TRG) was evaluated in resected specimens according to the Mandard’s tumor regression grading system and correlated with pre-treatment ApoA-I and ApoB serum concentration, and ApoB-to-ApoA-I serum concentration ratio. Results: We found a positive correlation of ApoA-I level and pR (95% CI: –0.863 to –0.467; P < 0.0001), a negative correlation of ApoB level and pR (95% CI: 0.445 to 0.857; P < 0.0001), a negative correlation of ApoB-to-ApoA-I ratio and pR (95% CI: 0.835 to 0.964; P < 0.0001). Conclusions: ApoA-I and ApoB levels, and ApoB-to-ApoA-I ratio are candidate pre-treatment predictors of pR to NAC in GA and may help to guide personalized therapy.Our work fits into the dynamically developing trend of personalized treatment. It describes a potentially important rationale for further evaluation of apolipoprotein A-I and apolipoprotein B as predictors of cancer response to neoadjuvant therapy.

Introduction: Correct surgical technique and perioperative care are the two factors which can reduce the number of complications, improve treatment outcomes and decrease hospital length of stay. Implementation of enhanced recovery protocols has changed the approach to patient care in some clinical centers. However, significant differences among clinical centers can still be observed and the standard of care has remained unchanged in some of them. Aim: The goal of the expert group was to develop recommendations for modern perioperative care in accordance with the current state of medical knowledge, in order to reduce the number of complications associated with surgical treatment. An additional goal was to optimize and standardize perioperative care among Polish healthcare facilities. Materials and methods: Recommendations presented in this document are based on a comprehensive review of available literature from the PubMed, Medline, and Cochrane Library databases, published from January 1, 1985, to March 31, 2022, with a particular focus on systematic reviews and clinical recommendations of widely recognized scientific associations. The recommendations were formulated in a directive form and assessed using the Delphi method. Results and conclusions: A total number of 34 recommendations for perioperative care were developed. The recommendations cover various aspects of pre-, intra-, and postoperative care. Implementation of guidelines presented in this document allows to improve the outcomes of surgical treatment.

The COVID-19 (coronavirus disease 2019) pandemic has markedly affected the life of people worldwide. In Poland, one of its consequences consisted in new laws being put into force to regulate the provision of healthcare services. This gave rise to much anxiety and concern within the healthcare community, particularly among the specialists in interventional medicine. Taking into account all signals received by the National Consultant, Voivodeship Consultants, as well as the Association of Polish Surgeons and the Polish Chamber of Physicians and Dentists, the new regulations negatively affect the performance of healthcare professionals, e.g. in the context of diagnostic and therapeutic decision-making or activities potentially beneficial for patients not being undertaken. The authors of the article have analyzed the regulations in force in an attempt to bring their interpretation into line with their substance and their objective, as well as to provide comprehensive answers to questions and concerns as raised by interventional surgeons.

The paper was prepared by an expert group appointed by the Polish Society of Gastroenterology with an aim to update and systematize the knowledge about diagnosis and treatment of gastroesophageal reflux disease (GERD). Based on the previously published guidelines of international societies, expert consensuses, and recently published good quality data, we formulated 74 statements regarding the definition, diagnosis and treatment of GERD and assessed the level of acceptance of these statements and the reliability of the data. We discussed in details the possibilities and limitations of the available diagnostic methods and therapies, with particular emphasis on the diversity of gastroesophageal reflux symptoms and complications including Barrett's esophagus. Practical principles regarding interpretation of the diagnostic tests are presented. In addition, we discussed the indications for surgical treatment as well as the situations in which surgical treatment is not indicated with emphasis on the importance of preoperative diagnostics. The role of add-on therapy and indications for maintenance treatment are defined.

This document - "Polish Consensus on Gastric Cancer Diagnosis and Treatment - Update 2022" - represents an expert consensus following a year's worth of dedicated effort by a team of specialists throughout 2021, put forward in a conference in December 2021 in Krakow, and finalized below for publication in 2022. The effective date of this document is June 14th 2022. The work that went into updating this consensus was made under auspices of the Polish Society of Surgical Oncology and the Association of Polish Surgeons.

Background The American Joint Committee on Cancer (AJCC) staging system has limited accuracy in predicting survival of gastric cancer patients with inadequate counts of evaluated lymph nodes (LNs). We therefore aimed to develop a prognostic nomogram suitable for clinical applications in such cases. Methods A total of 1511 noncardia gastric cancer patients treated between 1990 and 2010 in the academic surgical center were reviewed to compare the 7(th) and 8(th) editions of the AJCC staging system. A nomogram was developed for the prediction of 5-year survival in patients with less than 16 LNs evaluated (n = 546). External validation was performed using datasets derived from the Polish Gastric Cancer Study Group (n = 668) and the SEER database (n = 11,225). Results The 8th edition of AJCC staging showed better overall discriminatory power compared to the previous version, but no improvement was found for patients with < 16 evaluated LNs. The developed nomogram had better concordance index (0.695) than the former (0.682) or latest (0.680) staging editions, including patients subject to neoadjuvant treatment, and calibration curves showed excellent agreement between the nomogram-predicted and actual survival. High discriminatory power was also demonstrated for both validation cohorts. Subsequently, the nomogram showed the best accuracy for the prediction of 5-year survival through the time-dependent ROC curve analysis in the training and validation cohorts. Conclusions A clinically relevant nomogram was built for the prediction of 5-year survival in patients with inadequate numbers of LNs evaluated in surgical specimens. The predictive accuracy of the nomogram was validated in two Western populations.

Podręcznik przybliża w kompletny oraz nowoczesny sposób najnowszą wiedzę i aktualne trendy postępowania diagnostyczno-terapeutycznego w chirurgii. W czterech tomach zawarto najświeższe informacje wzbogacone doświadczeniem własnym Autorów – uznanych ekspertów reprezentujących praktycznie wszystkie chirurgiczne dyscypliny zabiegowe. Bogaty materiał graficzny – prawie 1200 rycin – doskonale ilustruje omawiane zagadnienia. W książce przedstawiono wiadomości z zakresu chirurgii ogólnej, chirurgii stanów nagłych, podstaw chirurgii i skojarzonego leczenia nowotworów, wybranych dziedzin chirurgii, a także zasad kompleksowego, wielospecjalistycznego postępowania diagnostyczno-terapeutycznego. Najbardziej rozbudowaną częścią publikacji są rozdziały poświęcone chirurgii układów narządów z uwzględnieniem zasad tzw. chirurgii wielonarządowej i chirurgii wisceralnej. Nowością w polskim piśmiennictwie jest poruszenie problemów przywództwa czy nabywania tzw. umiejętności nietechnicznych, w tym umiejętności kierowania zespołami chirurgów, współpracy wielodyscyplinarnej czy krytycznego postępowania diagnostyczno-terapeutycznego opartego na zasadach EBM i GCP. Autorzy dołożyli starań, aby podręcznik dobrze spełniał swoją funkcję edukacyjną w szkoleniu podyplomowym absolwentów kierunku lekarskiego oraz rezydentów realizujących szkolenie specjalizacyjne w chirurgii i jednocześnie był pomocny w codziennej praktyce klinicznej. * Fragment (epub) * Fragment (mobi)

1 Theodor-Billroth-Academy , Germany, USA 2 INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Academy , Germany, USA Department of Surgery, Carl-Thiem-Klinikum, Cottbus, Germany Neurogenetics, Institute of Zoology, University of Regensburg, Regensburg, Germany Department 4, Genetic Engineering and other Biotechnological Processes, Federal Office of Consumer Protection and Food Safety,

Over the years, the rise in the obesity epidemic has led to an increasing demand for bariatric surgery. Considering the rapidly growing number of bariatric surgery procedures performed, intensive development of postoperative care and surveillance programs should be expected. However, the effectiveness of follow-up after bariatric surgery appears to be surprisingly low. The purpose of this review is to draw attention to the quality of follow-up programs and to encourage health care providers to make efforts to ensure adequate post-operative data collection. Awareness should be raised about inadequate data collection to strengthen the credibility and authenticity of treatment results, thus providing a clearer picture of treatment efficacy.