Reoperations of the thyroid gland are challenging to any surgeon. Such procedures are technically difficult and involve higher risk of complications than primary procedures. Recurrent laryngeal nerve (RLN) palsy is one of such complications The aim of the study was to evaluate the effectiveness of intraoperative neuromonitoring (IONM) in preventing RLN palsy during recurrent goiter operations. Material and methods. We retrospectively analyzed the results of thyroid reoperation performed at the Department of Endocrine, General and Vascular Surgery of Medical University of Lodz in the period from January 2014 to June 2016. The study included 80 patients, who were divided into 2 groups: group A consisted of 27 patients, who had undergone surgery with the use of IONM, while group B included 53 patients, in whom RLN was identified visually. During statistical analysis we took into account the number of nerves at risk, not the number of patients. There were 47 nerves at risk In group A and 86 in group B. We analyzed whether application of IONM had any effect on the frequency of RLN palsy and procedure duration. Results. The frequency of RLN palsy was 10.64% (5/47) in group A and 15.12% (13/86) in group B (no statistical significance, p=0,47). Mean operation time was shorter in group B 71.29 ± 17.125 minutes vs. 75.75 ± 17.94 minutes in group A (no statistical significance, p=0,377). Conclusion. Use of IONM did not significantly reduce the occurrence of RLN palsy and procedure duration.

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THE AIM OF THE STUDY was comparison of inflammatory response intensity through estimation of CRP, IL-6 and WBC concentration in blood serum in patients before and after inguinal hernia operations with Stoppa and TEP method. MATERIAL AND METHODS. The study involoved 117 patients operated on inguinal hernia between 2006-2008. The patients were divided into two groups. In the first group (group I - 56) Stopp'a method was used, in the second (group II - 61) TEP method. The patients selection was coincidental. All examined patients were men between 25-75 years old (mean age 54.3). Moreover, the operation's time, state of postoperative wound, the average hospitalization time and intensity of pain were estimated. The observations were directed over two weeks after operation. RESULTS. The inflammatory response estimated with CRP, IL-6 concentration in blood serum was considerably higher in patients operated with Stoppa method. There wasn't observed a relevant difference in increase of white blood cells' concentration in both groups. Moreover, the patients operated on with TEP method experienced lower pain. In group, operated on with Stoppa method, 3 cases of wound healing complications were observed. The operation's time was considerably shorter in the first group. The hospitalization time, was considerably shorter in patients operated on with videoscopic method. CONCLUSIONS. The operation of inguinal hernia with TEP technique in comparison with Stopp'a method is connected with considerably lower inflammatory response of organism, what directly involve with postoperative pain abridgment and reduction of hospitalization time. Moreover it may have influence on frequency of postoperative complications related with wound healing.

Słowa kluczowe: guz neuroendokrynny, trzustka, wyrostek robaczkowy.

An adrenal tumors are a clinical problem encountered by all health care providers go into endocrinological surgery. Nowadays the videoscopic adrenalectomy gains mounting acceptance. In the adrenal operations two kinds of operative access are used: an itraperitoneal and an extraperitoneal. The aim of the study was to analyse its own material and literature in purpose to find the answer if extraperitoneal access may be acknowledged as widely used method in adrenal tumor operations. Material and methods. 68 videoscopic adrenalectomy with extraperitoneal access were made in the Surgery Department of MSWiA Hospital in Łódź, between 2005 to 2007. The time of the operation, the time of the hospitalization, intraoperative blod loose, probability of complications, number and reasons of the conversies were taken into account. Results. In all the patients was performed complete tumor resection with adrenal gland.The diameter of removed tumors was between 4-14 cm. In 23 cases (33.8%), intraoperatively, during tumor preparation, the continuity of the peritoneum was broken however it didn't have any influence for the operation's proceedings and postoperative condition of the patients. Three conversions were made (4.4%). The average time of hospitalization was about 3.1 days. There weren't observed, in the postoperative period any wound suppurations or postoperative hernias. Conclusions. The own observations in confrontation with literature let find an extraperitoneal videoscopy as method with wide application in various size and origination in adrenal tumor operations.