The issues discussed in this edition of „Postępy Nauk Medycznych” constitute recapitulation of many years´ clinical activity and scientific interests of Professor Krzysztof Bielecki, long term Head of the General and Gastrointestinal Surgery Department of CMKP, who retired by the end of August 2008, but in no case parted with the Clinic. Professor Bielecki is a consultant in our Department and still conducts scientific, didactic and medical activity.

Operations of thyroid gland belong to a group of most often performed ones in the General and Gastrointestinal Surgery Department of CMKP. In many cases total strumectomy is necessary. Indications for that type of operations have been discussed in the article of Prof. I. Kozicki. What is extremely important upon performance thereof is the so-called anatomical preparation, i.e. visualization of external and recurrent laryngal nerves and, if possible, parathyroid glands. Such technique has impact on reduction of operation-related complications. In presented material only in one case vocal cord was permanently paralyzed, which constitutes as little as 0.32%. Hypoparathyroidism is the second major complication which concerns mainly patients after thyroid carcinoma operation (5.2%)

Disorders of gastro-esophageal junction are civilization-related and presently constitute significant percentage of diseases which patients report to doctors. Majority of them will be treated conservatively, however there is still a group which requires surgical treatment. When qualifying for an operation X-ray barium meal, gastroscopy, esophagial impedance and sometimes esophageal manometry are performed. The result of surgical treatment depends on proper qualification for an operation (on the basis of clinical picture and the aforementioned examinations) and on experience of the operating surgeon. Introduction of laparoscopic techniques has significantly increased the number of performed operations and thus resulted in wider experience of surgeons and satisfactory late results of operations.

Post-operative disturbances of the digestive tract motility have been the reason of surgeons´ concern for many years. The presented paper is an attempt to give answer to the aforementioned issue. Application of various operative techniques on an animal model has allowed a statement that discontinuation of the digestive tract as well as discontinuation of the Cajal cells net connected therewith result in bigger motility disturbances than in cases when integrity of the system is maintained. Conclusions resulting from the paper are of considerable practical value in day-to-day clinical work.

Inflammatory bowel diseases (colitis ulcerosa and Leśniowski-Crohn disease) more and more often constitute indications for surgical treatment. The presented material, particularly in part concerning the Crohn disease, allows to draw a very important clinical conclusion. Early operations may have impact on decrease of the number of recurrences. This is a very significant observation as the number of recurrences in the Crohn disease is high and amounts to approx. 73% after 15 years following the operation. It is important not to extend conservative treatment, but recommend earlier operation, prior to occurrence of serious complications. Therefore, it seems that establishment of specialized centers focusing on treatment of inflammatory bowel diseases may have influence on improvement of treatment effects and patients´ lives.

Acute pancreatitis (AC) is a disease of, mostly, mild course, easily treated conservatively. Nevertheless, AC may result in pancreatic necrosis, infection, sepsis and death. Mortality in necrotic acute pancreatitis is still high and amounts to over 30%, 38.4% in presented material. The disease often leads to numerous and major complications requiring long and expensive treatment. Surgical treatment is recommended at later phases of the disease, as late as possible.

Patients with large bowel disorders constitute significant percentage of patients treated at surgical wards. Considerable part of them is treated during emergency service. Complications of large bowel diseases include: mechanical ileus, perforation and haemorrhage. In majority of cases lesions are of cancer nature, located in left part of the bowel and concern the elderly. It is the age that is one of the factors increasing the risk of post-operative complications. The other important factor having impact on post-operative mortality is the time from occurrence of complaints till implementation of proper treatment. The more intensified peritoneal inflammation the higher mortality rate.

The article entitled „Personality of a surgeon” in greater part constitutes a collection of Professor Bielecki´s considerations based on his own professional experience. Professor undertakes an attempt to specify most important and distinctive features of surgeon´s character, personality. He pays attention to significance of self-education in achieving professional skills. He also underlines the value of critical assessment of his own actions and points out to a fact that asking for assistance is neither a disgrace nor lack of education, it is a mark of maturity and professional responsibility.

Wiesław Tarnowski, M. D., Ph. D.
Head of the General and Gastrointestinal Surgery Department of CMKP