Adam Bobkiewicz’s research while affiliated with Poznan University of Medical Sciences and other places

Negative Pressure Wound Therapy (NPWT) has been widely adopted in wound healing strategies due to its multimodal mechanism of action. While NPWT’s positive impression on wound healing is well-established, its effect on bacterial load reduction remains equivocal. This study investigates NPWT’s efficacy in reducing bioburden using an in vitro porcine skin model, focusing on the impact of Staphylococcus aureus and Staphylococcus epidermidis. Custom-made negative pressure chambers were employed to apply varying negative pressures. Porcine skin was cut into 5 × 5 cm squares and three standardized wounds of 6 mm each were created using a biopsy punch. Then, wounds were infected with S. aureus and S. epidermidis bacterial suspensions diluted 1:10,000 to obtain a final concentration of 1.5 × 10⁴ CFU/ml and were placed in negative pressure chambers. After incubation, bacterial counts were expressed as colony-forming units (CFU) per ml. For S. aureus at 120 hours, the median CFU, mean area per colony, and total growth area were notably lower at −80 mmHg when compared to −250 mmHg and −50 mmHg, suggesting an optimal negative pressure for the pressure-dependent inhibition of the bacterial proliferation. While analyzing S. epidermidis at 120 hours, the response to the negative pressure was similar but less clear, with the minor CFU at −100 mmHg. The influence of intermittent negative pressure on the S. epidermidis growth showed notably lower median CFU with the interval therapy every hour compared to the S. aureus control group. This study contributes valuable insights into NPWT’s influence on the bacterial load, emphasizing the need for further research to reformulate its role in managing contaminated wounds.

br>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).</br

b>Introduction: Loop ileostomy reversal (LIR) procedure is associated still with relatively high risk of complications. Surgical site infection (SSI) is the most common complication in this group of patients. As a result of SSI, it leads to prolonged hospital stay, delay the adjuvant therapy and increase the hospital costs. Aim of the study: The aim of the study was to analyze the risk factors for SSI in patients following loop ileostomy reversal procedure. Material and methods: A single-centre retrospective analysis was conducted in a tertiary reference center. Finally, sixty five patients following loop ileostomy reversal procedure performed between 2018 and 2022 were enrolled into the study. Data were collected retrospectively based on the available medical charts. The study group comprised of 23 women (35%) and 42 men (65%) with the mean age 48.914.5 years and the mean body mass index 24.34.9 kg/m2. The most common indication for index surgery was ulcerative colitis (33%) and colorectal cancer (29%). Preferably, handsewn anastomosis was performed (n=42; 64.6%). Results: The most important parameter evaluated in the above study was the diagnosis of surgical site infection, which was important, among others, in during hospitalization after surgery, the need for antibiotic therapy or CRP values. 9 patients (13.8%) were diagnosed with SSI during their hospital stay (more than 86% without SSI). In the group with SSI it was over 13 days compared to almost 6 days in the group without SSI (p=0.00009). The time of the procedure had a statistically significant correlation with antibiotic therapy introduction (p=0.01). The type of intestinal anastomosis had a significant impact on the operative time (p=0.0011) and the time of hospital stay after surgery (p=0.04). Conclusions: Most of the analyzed clinical factors were directly related to the impact on the duration of postoperative hospitalization. The duration of hospitalization is an independent and undeniable factor of increasing the risk of other postoperative complications and significantly increases the cost of hospitalization. Another factor that has a large clinical impact on postoperative treatment is the presence of comorbidities, which made patients more likely to develop SSI, CRP increase or the need for antibiotic therapy. An important factor was the level of CRP, the elevated value of which may be a predictor of many negative aspects in postoperative treatment.</br

Choroba Leśniowskiego-Crohna jest czynnikiem ryzyka występowania zakażenia miejsca operowanego. W pracy przedstawiono przypadek 62-letniej pacjentki z powikłaną chorobą Leśniowskiego-Crohna. Z powodu ostrego rzutu choroby, miejscowego zaawansowania choroby, obecności przetok i ropni okołostomijnych, a także przepukliny okołostomijnej u pacjentki wystąpiło głębokie zakażenie miejsca operowanego, wymagające trzykrotnej reoperacji. W przypadku licznych, dużych ran obejmujących znaczną powierzchnię powłok brzusznych z obecnością stomii zastosowanie terapii podciśnieniowej z płukaniem pozwala na optymalizację procesu leczenia i gojenia rany. Odseparowanie skażonego środowiska stomii od łożysk ran wydaje się kluczowym elementem powodzenia leczenia. Odpowiedni dobór płynu płuczącego umożliwia intensyfikację leczenia zakażenia w pierwszej fazie wystąpienia zakażenia miejsca operowanego oraz sprzyja dalszemu postępowi gojenia ran.

Introduction Although introduction of the laparoscopic approach for adrenal gland surgery revolutionized the strategy in management of adrenal gland tumors, open surgery is still a method of choice in some clinical scenarios. Moreover, laparoscopy may have limitations resulting in conversion. Aim To assess risk factors predisposing for conversion based on our own material, including 256 laparoscopic adrenalectomies performed in 2009–2016. Material and methods A retrospective analysis of patients who underwent adrenalectomies between 2009 and 2016 was conducted. Patients were analyzed for sex, body mass index (BMI), size of the adrenal gland lesion, final histopathological diagnosis and operated side of the adrenal gland, its impact on conversion rate. Results A total of 256 patients underwent laparoscopic adrenalectomy. The reported study comprised of 94 (36.7%) men and 162 (63.3%) women. The most common indication for adrenalectomy were adrenal cortex adenoma (n = 149; 58.2%) and pheochromocytoma (n = 48; 18.75%). The conversion rate was 3.91% (n = 10 patients). Mean BMI of patients without conversion was 27.6 kg/m², whereas in the group of patients with conversion, BMI was 29.7 kg/m² (p > 0.05). The conversion rate was precisely the same when comparing the right (5/126; 3.9%) and left (5/126; 3.9%) adrenal gland. There was no correlation between the size of the adrenal lesion and the risk of conversion. Conclusions The laparoscopic approach remains an efficient and safe procedure for adrenal gland tumors. Based on our study, obese patients and those with pheochromocytoma are associated with a higher risk of conversion but without any statistical significance. There was no difference in the conversion rate when analyzing the size of the adrenal gland tumor. No difference was also revealed in the conversion rate when comparing both sides of laparoscopic adrenalectomy.

b> Introduction: In some clinical scenarios, a stoma site may be located close to the edge of the abdominal wound, impeding optimal wound management and stoma care. We present a novel strategy of using NPWT to manage both abdominal wound and stoma simultaneously. Material and methods: A retrospective analysis of 17 patients treated with a novel wound care strategy was conducted. The application of NPWT within the wound bed, around the stoma site, and the skin between helps in 1) separating the wound from the stoma site, 2) maintaining an optimal environment for wound healing, 3) protecting the peristomal skin, and 4) facilitating the application of ostomy appliances. Results: The study group was comprised of 12 women (70.6%) and 5 men (29.4%) with a mean age of 49.1 18.4 years. The most common underlying pathology was Crohn’s disease (n = 5; 29.4%). After the implementation of NPWT, patients underwent from 1 to 13 surgeries. Thirteen patients (76.5%) required admission to the intensive care unit. The mean time of hospital stay was 65.3 28.6 days (range: 36–134). The mean number of NPWT sessions was 10.8 5.2 (range: 5–24) per patient. The negative pressure ranged from –80 to –125 mmHg. Progress in wound healing was achieved in all patients, resulting in granulated tissue formation, minimal wound retraction, and thus reduction of the wound area. As a result of NPWT, the wounds were granulated entirely, tertiary intension closure was achieved, or patients were qualified for reconstructive surgery. Discussion: NPWT is a safe and useful therapy for complicated abdominal wounds with the presence of a stoma close to the wound’s edge. A novel care strategy allows for simultaneous technical opportunity to separate the stoma from the wound bed and facilitate wound healing. In this study, we described a novel combined technique for complicated abdominal wounds with a stoma close to the wound’s margins. We emphasize some tricks and tips that might be important from a practical point of view to optimize holistic management.

b> Introduction: The restoration of bowel continuity is associated with significant postoperative morbidity. Aim: The aim of the study was to report the outcomes of restoring intestinal continuity in a large patient cohort. Material and methods: A retrospective analysis was conducted on 91 patients with terminal stoma who were qualified for restoration of GI tract continuity between January 2015 and March 2020. The following demographic and clinical characteristics were analyzed: age, gender, BMI, comorbidities, indication for stoma creation, operative time, the need for blood replacement, the site and type of the anastomosis, and complication and mortality rates. Results: The study group was comprised of 40 women (44%) and 51 men (56%). The mean BMI was 26.8 4.9 kg/m2 . Only 29.7% of the patients (n = 27) were at normal weight (BMI: 18.5–24.9) and only 11% (n = 10) did not suffer from any comorbidities. The most common indications for index surgery were complicated diverticulitis (37.4%) and colorectal cancer (21.9%). The stapled technique was used in the majority of patients (n = 79, 87%). The mean operative time was 191.7 71.4 min. Nine patients (9.9%) required blood replacement peri- or postoperatively, whereas 3 patients (3.3%) required intensive care unit admission. The overall surgical complication rate was 36.2% (n = 33) and the mortality rate was 1.1% (n = 1). Discussion: Restoration of bowel continuity is quite a demanding and complex procedure and thus should be performed by an experienced surgical team. In the majority of patients, the complication rate represents only minor complications. The morbidity and mortality rates are acceptable and comparable to other publications.</br