Background/Aims: Reports about perforated gastric ulcer are scarce and thus it is difficult to settle for a uniform model of operative management. The purpose of the study was to review our experience with perforated gastric ulcer and evaluate the results of gastric resection vs. oversewing of the perforation. Methods: Within 36 years 77 patients with peritonitis caused by histologically confirmed perforated gastric ulcer were operated. Furthermore, in another 7 microscopic examination revealed that perforation occurred within the gastric cancer. There were twice as many male as female patients. Results: Recently, the overall postoperative mortality (20.8%) tended to decrease markedly. 32 patients (mean age 49.9 years) were submitted to gastric resection and this procedure was associated with 2.9% mortality. All 3 subjects in whom vagotomy, pyloroplasty and wedge resection of the ulcer had been performed survived. In 40 patients (mean age 61.5 years) only a suture of the ulcer was performed. This procedure was associated with high mortality (1/3 of patients died). Selection criteria included poor general medical status, age, comorbidities, and substantial progression of the inflammatory process. Conclusion: Authors believe that emergency gastrectomy is a safe procedure; however, it might be performed without excessive operative risk in only half of the patients.

To emphasize the importance of the experience of the operating team, we compared the two largest materials in the total extraperitoneal (TEP) and the transabdominal preperitoneal (TAPP) procedures in Poland. We performed 1225 procedures on 1110 patients (368 TEP and 809 TAPP). The experience of the operating teams measured by the mean number of procedures/surgeon was comparable. The mean operating time and hospitalization duration did not differ markedly. There was no procedure-related mortality. Intraoperative complications were infrequent. The ratio of early local complication (neuralgia, hematoma, and seroma) was slightly higher in the TEP group. We observed a higher recurrence rate following the TAPP procedure (2.84% vs 1.92%). However, after excluding the learning period this dropped markedly to much lower, comparable values (TEP: 0.98%; TAPP: 1.14%). In laparoscopic hernia repair the experience of the operating team seems to be more important than choice of technique (TEP vs TAPP).

Biliary stones are the most common etiology of acute pancretitis (AP). Pathomechanism of this etiology is based on common channel theory of Opie. Material and methods. 113 patients with ABP were included in the study -91 with mild and 22 with severe form of ABP. 17 patients with cholelithiasis and choledocholithiasis without ABP served as controls. All the patients were submitted to the same model of treatment. Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sfi ncterotomy (ES) were performed in the day of admission and laparoscopic cholecystectomy within the next 24 hours. Bile specimens were taken from main bile duct (MBD) during ERCP and from gall-bladder (GB) during laparoscopic cholecystectomy. Bacteriological cultures, bile acids (BA) concentration and total and secretory form of IgA concentration were assessed in particular groups of patients. Results. No signifi cant statistical differences of bile infection in MBD and GB were found between the analyzed groups of patients. Furthermore, the bile among the patients with severe ABP was more frequently infected, particularly when obtained from gall-bladder. Most common pathogens found in cultures were Gram negative bacteria. Interestingly, Gram positive cultures and fungi were also signifi cant. The number of species of pathogens was of no signifi cance for infection concerning both: source of bile and groups of patients. Mean concentrations of total BA were different between study groups of patients in MBD and in GB. It is worth mentioning, that the fraction of hydrophobic, secondary BA which are potentially more toxic, was increased in total concentration of BA in MBD particularly in patients with severe form of AP. Among patients with mild AP and controls these values were lower and similar. Conclusions. It seems that BA play as an aggressive factor during AP while in physiologic condition have a protective, antibacterial meaning.

2Opiekunowie Koła: dr n. med. M. Winiarski, dr n. med. M. MatłokThe aim of the study was to analyse patients in whom upper gastroinentestinal bleeding appeared during hospitalization in the surgical clinic. Material and methods. The study group consisted on 61 patients. 35 were women and 26 were men. The mean age of women was 76 and men 64.8 years. The mean age of the whole group was 72.3 years. 30 patients (49%) were hospitalized in general surgery ward, 16 (26%) in trauma unit and 15 patients (25%) in intensive care unit. Results. The reasons of hospitalisation in general surgery ward were: acute cholecystitis, acute pancrtatitis, peritonitis, lower extremity ischemia with foot necrosis, large bowel cancer and cancer of the gall-bladder. Patients were admitted to trauma unit because of hip and pelvic fractures. Patients were hospitalized in intensive care unit because of polytrauma, diffuse peritonitis, isolated head trauma and necrotising pancreatitis. The main source of bleeding were duodenal and gastric ulcers. It appeared in 28 (45.9%) and 18 (29.5%) patients respectively. The other reasons of bleeding were: erosive gastritis (9 patients) and Mallory-Weiss syndrome (6 patients). Bleeding recurrence was found in 21 patients (34.4%). This group of patients was characterised by high mortality rate 43%. The highest was among patients in intensive care unit. It reached 60%. Conclusions. Based on the performed analysis we come to the following conclusions: 1. Upper gastrointestinal bleeding is serious complication during hospitalisation in surgical clinic; 2. Usually it affects older patients; 3. This complication is associated with high rate of rebleeding and high mortality rate.