Katedra i Klinika Chirurgii Ogólnej, Transplantacyjnej i Wątroby Warszawskiego Uniwersytetu Medycznego w Warszawie
Surgical Intensive Care Unit (S-ICU)
The Surgical Intensive Care Unit, was established in 2001 and is functioning to this day under the Department of General, Transplant and Liver Surgery. It is comprised of 8 well-equipped intensive care stations.
This unit admits patients in their first days following liver transplantation and other extensive procedures carried out in the Department.
Patients with acute liver failure qualified for urgent transplantation are also managed here in order to monitor their health state and treat until surgery. Equipment of all stations provide the ability to monitor vital activities, provide replacement ventilation, dialysis, including albumin dialysis, and the use of precision dosing drugs in continuous infusions.
Nursing care is interdisciplinary and includes collaboration with other specialists: transplant, hepatology, nephrology, cardiology, hematology and neurology. Early Rehabilitation is implemented on routine basis.
Approximately 1,200 patients are admitted to the Department each year. Care is provided by a specialized team of nurses and work in the Unit is managed by Dr. Wojciech Figiel - specialist in anesthesia and intensive care.
Cooperation with the Department of Hepatology:
The essential elements concerning medical activities of the Department of Hepatology and Internal Diseases, which is headed by Prof. Piotr Milkiewicz are:
Qualification of patients with acute and chronic hepatic insufficiency, complications of chronic liver and biliary tract diseases and primary liver tumors (mainly hepatocellular carcinoma - HCC) for liver transplantation;
Management and medical care of liver transplant recipients following 1 week post surgery and throughout the ongoing period in the outpatient clinic;
Comprehensive diagnosis and treatment of a wide spectrum of liver diseases, with particular emphasis on autoimmune diseases of the liver and bile ducts (PBC, PSC, AIH);
Histological biopsies of the liver and of focal hepatic lesions under ultrasound control;
Non-invasive diagnostics of liver fibrosis (Fibroscan, transverse elastography of SWE);
Implementation of the Ministry of Health programs for antiviral treatment of chronic hepatitis B and C, in particular using modern noninterferon therapy (DAA);
The Department of Hepatology and Internal Diseases of the Medical University of Warsaw also conducts numerous scientific studies on autoimmune / cholecystic diseases of the liver and bile ducts and many issues related to liver transplantation. These studies are conducted in close collaboration with the largest hepatological centers in the world (in the United Kingdom, USA, Canada, Norway, Germany, Greece).
Endoscopic Unit of the Department of General, Transplant and Liver Surgery
The Endoscopic Unit performs approximately 2500 different types of endoscopic procedures and diagnostic tests each year.
Full-time physicians - surgeons are: Dr Sławomir Kozieł and Dr Jan Pertkiewicz. In addition, there are 4 attending physicians. The Unit is maintained under 24h on-call emergency duty.
This Unit specializes in the treatment of patients with biliary tract diseases and portal hypertension. Every year there is more than 700 Endoscopic Retrograde Cholangio Pancreatography (ERCP) procedures carried out and about 1000 procedures treating esophageal and stomach varices.
In addition, the laboratory offers a full range of endoscopy of the gastrointestinal tract, including the expansion and stenting of stenosis of benign and malignancies of the esophagus, duodenum, colon, gastrointestinal polyps removal using the EMR and ESD technique. Furthermore treatment of achalasia of the esophagus by balloon expansion and via the POEM technology POEM is performed. Endoscopic treatment of pseudocysts and endoscopic drainage is conducted as well as other post-inflammatory peri-pancreatic vessels, endoscopic treatment of postoperative gastrointestinal fistulas, the treatment of gastrointestinal hemorrhage, ERCP. In recent years the usage of an enteroscope for obliteration of gastric varices under EUS control has become more frequent.
The Unit has 24 hour endoscopic on-call emergency duties, and life-saving treatments can be performed in 24/7 mode. Most procedures are performed under general anesthesia or intravenous sedation, conducted by anesthetists. The vast majority of patients are hospitalized and prepared for surgery in a hospital ward.
Important: Patients treated in a single-day hospitalization mode, having previously made the appointment, should present themselves on the day of the procedure with a referral note, medical history and personal ID.
Patients should be fasting and prepare for surgery at home, according to the instructions given on the day of registration. After the procedure, the patient returns to the recovery room for short observation and if everything checks out well are discharged home after a few hours of observation.
Patients treated on a one-day basis in sedation must be accompanied after discharge by an adult for assistance.
In case of disturbing symptoms after discharge (e.g.: bloody vomiting or bowel movements, severe abdominal pain with accompanying bloating and gas retention), patients should report immediately to hospital.
Department of Interventional Radiology
The Department of General, Transplant and Liver Surgery cooperates with the II Department of Radiology (Head - Prof. Olgierd Rowiński), not only in the field of diagnostics but also concerning therapeutic procedures performed in the Interventional Radiology Unit:
- transarterial chemoembolization (TACE)
- radiofrequency ablation (RFA)
- portal vein embolization (PVE)
- Transcutaneous percutaneous cholangiography (PTC)
Chemoembolization of liver tumors through arterial access - TACE
The Department of General, Transplant and Liver Surgery is the leading center in Poland for the treatment of hepatocellular carcinoma (HCC) of the liver. Approximately 350 TACE procedures are performed here every year. This is a locoregional treatment designed for patients who cannot be treated surgically at the time or at all in some cases.
Patients qualified for intra-articular chemoembolization are admitted to the Department on the day preceding the procedure. The treatment is performed under local anesthesia. A catheter is inserted in the groin through which the radiologist gives the chemotherapeutic.
After surgery, patients are hospitalized 1-2 days. Pain and / or fever can occur up to two weeks after the procedure. If they occur, patients are to follow the instructions in the information sheet issued during the discharge.
As a standard, patients undergo chemoembolization twice, with pause between the procedures of 4-5 weeks. Six weeks following the second procedure, a three-phase CT scan and blood serum alpha-fetoprotein are performed. The results are discussed at multidisciplinary meetings where further treatment is planned.
Percutaneous ablation of the liver tumors – pRFA
Another method of locoregional treatment of liver tumors is percutaneous thermoablation using a radiofrequency ablating device and needle. The course of hospitalization is similar to that described above. The procedure itself is performed under general anesthesia. Under the control of ultrasound and computed tomography in the vicinity of the liver tumors are inserted needles (electrodes), the effect of which causes thermal damage to the tumor tissue. The effects of treatment are evaluated in the computed tomography of the liver or magnetic resonance imaging of the liver min. 6 weeks after the procedure.
Portal Vein Embolization - PVE
The treatment involves partial closure of blood flow to the liver, which results in increased hepatic mass with preserved flow. This method is used to prepare patients with borderline residual liver tumors. Increased liver weight, which remains after removal of liver tumors, enhances the safety of surgery by reducing the risk of post-operative liver failure. The treatment is performed under general anesthesia for min. 6 weeks before planned liver resection.
Percutaneous transcutaneous cholangiography of bile ducts is performed for patients in whom an endoscopic retrograde cholangiopancreatography is not possible. In addition to diagnostic capabilities, it allows percutaneous drainage of bile ducts in patients with cholestatic jaundice, which once again cannot be executed by endoscopic means. The treatment is performed under general anesthesia.
Leading physician (radiologist): Dr. Robert Lechowicz.
A dedicated room to abdominal ultrasonography on the spot in the Department is an undeniable tool which allows for preoperative work-up, post-operative follow-up and surgical interventions. Detailed imaging of the abdominal organs are performed, with vascular analysis in color doppler ultrasound. Dr. Lechowicz is a recognized authority among radiologists and surgeons in the field of abdominal ultrasonography, in particular the liver and bile ducts.
Liver transplant recipients have routine ultrasound check-up according to protocol.
Department of General, Transplant and Liver Surgery
Medical University of Warsaw