Background: Sleeve gastrectomy (SG) has become the predominant bariatric surgery, leading to significant weight loss and reductions in obesity-related complications. However, postoperative gastrointestinal symptoms such as constipation and bloating are common. This study aims to evaluate the impact of probiotic supplementation on postoperative gastrointestinal symptoms in patients undergoing SG. The secondary aim is to analyze laboratory and stool test results. Materials and methods: This prospective, placebo-controlled study included patients undergoing SG at a single center. Participants were adults without specific gastrointestinal diseases. They were randomly assigned to either the Probiotics or Controls group. Gastrointestinal symptoms and laboratory and stool tests were assessed before surgery and one month after. Results: Thirty-one patients participated, with 15 in the Probiotics group and 16 in the Controls group. Probiotic supplementation significantly increased the number of stools per week (p = 0.027) and reduced constipation incidence (p = 0.002). Patients in the Probiotics group reported easier defecation and greater bowel movement completeness (p = 0.015, p = 0.004). No significant differences in weight loss or laboratory tests were observed between the groups. Stool microbiota analysis showed a return to normal levels of Enterococcus faecalis, Enterococcus faecium, and Clostridium perfringens in the Probiotics group and an increase in the Controls group. Conclusions: Probiotic supplementation after SG significantly reduces constipation without adverse effects. These findings suggest that incorporating probiotics into postoperative care protocols can enhance patient comfort and recovery.

Introduction: The course of the branches of the thyrocervical trunk (TT) such as the inferior thyroid artery (ITA), suprascapular artery (SSA), transverse cervical artery (TCA) and ascending cervical artery (ACA) has a range of anatomical variations. The available literature distinguishes between 4 to 9 types of TT variation and its branches. Aim: The following paper presents an anatomical variation that was not included in any known classifications. Case study: During routine dissection of a body of a 84-year-old woman located in the Department of Anatomy of the University of Warmia and Mazury in Olsztyn, a following course of TT was observed. In the described case the SSA derives directly from the subclavian artery (SA), while the TT gives away ITA, ACA and TCA, which further bifurcates into two dorsal scapular arteries (DSA). Results and discussion: The analysis of the described cadaver showed that this anatomical variation of TT cannot be included in any known classification. This indicates, that it is a very rare anatomical variation of the TT. Conclusions: Knowledge of the course of the branches of TT has some significant clinical importance, inter alia during endovascular procedures, during which any mistakes may result in serious consequences for the operated patient. The most accurate understanding of the course of TT vessels and the dissemination of knowledge on this subject may reduce the risk of complications after the treatment.

DOI: 10.20452/wiitm.2025.17968, Published online: June 04, 2025, Authors: Dominika Mysiorska¹, Natalia Mazek¹, Julia Młyńska¹, Ewelina Sosnowska-Turek², Paweł Lech¹, Natalia Dowgiałło-Gornowicz¹

Introduction: Postoperative bleeding is a relevant complication after sleeve gastrectomy (SG). Perioperative blood pressure may influence the detection of bleeding during surgery, but the relationship between haemodynamic patterns and postoperative haemorrhage remains unclear.Aim: To evaluate the association between perioperative blood pressure patterns and major postoperative intra-abdominal bleeding after SG, and to identify factors associated with intraoperative systolic blood pressure (SBP) changes >20% from baseline.Materials and Methods: This retrospective single-centre cohort study included 463 consecutive patients who underwent primary SG between 2024 and 2025. Demographic, clinical and perioperative haemodynamic variables were analysed. Major postoperative bleeding was defined as bleeding requiring reoperation or blood transfusion. Univariable logistic regression was used to assess factors associated with bleeding, while uni- and multivariable logistic regression analyses were performed for predictors of an intraoperative SBP decrease >20%.Results: Postoperative bleeding occurred in 8 patients (1.7%), all of whom required transfusion and relaparoscopy. Patients with bleeding had higher mean arterial pressure (MAP) at admission than those without bleeding (110.2 vs 105.7 mmHg; p=0.046), although this association was not significant in univariable regression (OR 1.06, 95% CI 1.00–1.14; p=0.056). Intraoperative MAP range and SBP deviations >20% were not associated with postoperative bleeding. In multivariable analysis, only age independently predicted an intraoperative SBP decrease >20% (OR 1.03, 95% CI 1.01–1.05; p=0.003).Conclusions: No single perioperative blood pressure parameter reliably predicted postoperative bleeding after SG. Higher MAP at admission to hospital may warrant further investigation, while advanced age appears to be associated with greater intraoperative SBP reductions.

Introduction: Alopecia areata (AA) is a condition in which the immune system attacks the hair follicles, resulting in hair loss. A deeper understanding of AA’s underlying mechanisms has contributed to the development of new therapies, such as JAK inhibitors. There are only two EMA-approved medications for AA. Upadacitinib shows much potential, but there are few reports on its effectiveness. Case Report: The clinical presentation of AA is variable. We report two cases of AA to highlight the varied clinical presentations and diagnostic challenges in our setting and encourage consideration of using upadacitinib as a treatment, which has yielded satisfactory results, with visible regrowth of vellus hair within 3– 6 months. In one case, we have a classical form of AA universalis, and in the other one, we have the coexistence of AA with sarcoidosis. Conclusion: The early inclusion of effective treatment for AA with JAK inhibitors contributes to an improvement in the patient’s quality of life, both physically and psychologically, without further aggravating the skin lesions of sarcoidosis.