scholarly journals Staged surgical treatment of cholangiogenic abscesses of the liver

2020 ◽  
pp. 20-23
Author(s):  
V. V. Boyko ◽  
V. M. Lykhman ◽  
D. A. Miroshnichenko ◽  
A. A. Merkulov ◽  
S. V. Tkach ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Postoperative Mortality ◽  
Treatment Method ◽  
Stage Ii ◽  
Abscess Cavity ◽  
Controlled Drainage ◽  
Results Of Treatment ◽  
Liver Abscesses ◽  
Single Lumen

The aim of the work: to improve the results of treatment of patients with cholangiogenic liver abscesses by means of staged treatment methods using minimally invasive interventions. Materials and Methods. 82 patients with cholangiogenic liver abscesses aged 21 to 80 years who underwent 130 operations were examined and treated. The main group consisted of 40 (48.4 %) patients who underwent ultrasound-controlled drainage of abscess cavities (stage I), followed by removal of the source of cholangiogenic abscesses (stage II). The comparison group consisted of 42 (51.6 %) patients who underwent rehabilitation and drainage only with laparotomy access. Results and Discussion. Minimally invasive methods of surgical treatment included ultrasound-controlled drainage with simultaneous rehabilitation of abscess cavities. The dimensions of the cavities averaged (150±23.3) cm³. One drainage was used to drain the liver abscess with a diameter of up to 10.0 cm. When the diameter of the abscess was more than 5.0 cm, drainage was carried out by two single-lumen tubes followed by suction-flow washing of the abscess cavity. Monitoring the standing of the drainage and reducing the cavity of abscesses was carried out on 3, 7, 14 days after setting. The drainage tube was removed after the disappearance of the cavity according to ultrasound and control fistulography, which coincided with the normalization of the general condition and body temperature, the disappearance of signs of purulent intoxication. Duration of drainage averaged from 7 to 30 days (an average of 15.2). The proposed treatment method is not very traumatic, the ability to control the effectiveness of the treatment, and most importantly – positive results in 87 % of patients. Second stage in 38 (95 %) was performed laparoscopic cholecystectomy of technical features. The optimal duration of stage II was considered (13±3) days after extraction of the drainage. In the diagnosis and treatment of cholangiogenic liver abscesses, it is necessary to use puncture ultrasound-controlled drainage methods. The stage-by-stage treatment of cholangiogenic liver abscesses with rehabilitation of the abscess cavity made it possible to reduce the incidence of sepsis from 9.5 to 2.5 %, reduce postoperative mortality in extremely severe patients to 2.4 %, and develop complications by 7.3 %.

scholarly journals COMBINED SURGICAL TREATMENT LIVER ABCESSES IN EXPERIMENT

2019 ◽  
Vol 21 (1) ◽  
pp. 21-25
Author(s):  
V V Alipov ◽  
M S Lebedev ◽  
G A Avanesyan ◽  
A G Musaelyan ◽  
D R Mustafaeva ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Laser Irradiation ◽  
Liver Abscess ◽  
Copper Nanoparticles ◽  
Abscess Cavity ◽  
Fourth Group ◽  
Low Intensity ◽  
Results Of Treatment ◽  
Liver Abscesses ◽  
Intensity Laser

The results of surgical antibacterial rehabilitation and drainage of liver abscess largely depend on the effectiveness of local action of drugs. A promising direction in experimental liver abscess surgery is the local application of laser and nanotechnology. - The goal is to experimentally substantiate the effectiveness of the combined use of low-intensity laser radiation and copper nanoparticles in the surgical treatment of liver abscesses. Material and methods. In an experiment on 80 laboratory rabbits, a classic liver abscess was modeled. According to the variant of local two-week treatment, the animals were divided into 4 groups of 20 each. Animals of the first group were given daily standard sanitation of the cavity with an antiseptic solution; in the second group, low-intensity laser irradiation was locally administered; animals of the third group, the cavity of the abscess was washed with a suspension of copper nanoparticles; in the fourth group of animals, treatment with a suspension of copper nanoparticles in combination with low-intensity laser irradiation was applied. Clinical, planimetric, microbiological, morphological and instrumental research methods were used to evaluate the results of treatment. Results and discussion. The best clinical indicators of general condition by the 9th day were observed in the treatment of animals of the fourth group. Due to the active stimulation of reparative processes, by the 7th day of treatment of animals of this group, no aspirate cultures from the growth abscess cavity were given, which made it possible to speed up the closure of the purulent cavity, which by the 21st day according to ultrasound planimetry, the abscess cavity of the liver was completely obliterated. Conclusion. Used clinical and instrumental methods of research are effective ways to assess the results of treatment of simulated purulent cavity of the liver. The combined surgical treatment of simulated liver abscesses with topical application of uniformly scattered LLLT and copper nanoparticles provides accelerated cleansing of the abscess cavity causative agent and complete obliteration of the abscess cavity.

scholarly journals The choice of surgical treatment in patients with infected pancreonecrosis

2018 ◽  
Vol 177 (6) ◽  
pp. 20-26
Author(s):  
E. A. Tseimakh ◽  
V. A. Bombizo ◽  
P. N. Buldakov ◽  
A. A. Averkina ◽  
D. N. Ustinov ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Surgical Treatment ◽  
Minimally Invasive ◽  
Inpatient Treatment ◽  
Surgical Techniques ◽  
Postoperative Mortality ◽  
Group Comparison ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Minimally Invasive Surgical

The objectiveis to study the results of different methods of surgical treatment of patients with infected pancreonecrosis and to conduct a comparative analysis of minimally invasive and traditional surgical interventions.Material and methods.The results of treatment of 206 patients with infected pancreonecrosis were analyzed. In accordance with the used method of surgical treatment, the patients were divided into 2 groups: 105 (51.0%) patients with “traditional” open interventions were included in the first group (comparison), and 101 (49.0%) patients treated with various miniinvasive technologies, or a combination of minimally invasive and “open” interventions were included in the second group.Results.It was found that the mortality rate in the second group was less than in the first group by 12.8% (p<0.05).Conclusion.Minimally invasive surgical techniques are the method of choice for delimited pancreatogenic ulcers. The use of combined surgical interventions leads to a significant reduction of postoperative mortality and duration of inpatient treatment.

scholarly journals Result of using a minimally invasive method of surgical treatment of purulent-necrotic complications in a patient with diabetic foot syndrome

2020 ◽  
Vol 39 (3) ◽  
pp. 60-64
Author(s):  
Sergey Y. Ivanusa ◽  
Boris V. Risman ◽  
Andrey V. Yanishevskiy
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Diabetic Foot ◽  
Pain Syndrome ◽  
Diabetic Foot Syndrome ◽  
Military Medical Academy ◽  
Results Of Treatment ◽  
Medical Academy ◽  
Invasive Method ◽  
Short Time

The article presents an analysis of the results of treatment of a patient with purulent-necrotic complications of diabetic foot syndrome, who, in the framework of surgical treatment, used a minimally invasive method of treatment of purulent-necrotic complications of diabetic foot syndrome, developed at the departments of general surgery and normal anatomy of the S.M. Kirov Military Medical Academy. The effectiveness of the developed method has been demonstrated, which makes it possible to sanitize the purulent cavity in a short time, stop pain syndrome and restore the support ability of the foot (4 figs, 1 table, bibliography: 7 refs).

scholarly journals Efficiency of minimally invasive surgery for liver echinococcosis and its complications

2021 ◽  
Vol 26 (1) ◽  
pp. 84-91
Author(s):  
Z. A. Azizzoda ◽  
K. M. Kurbonov ◽  
K. R. Ruziboyzoda ◽  
S. G. Ali-Zade
Keyword(s):  
Minimally Invasive Surgery ◽  
Comparative Analysis ◽  
Surgical Treatment ◽  
Liver Resection ◽  
Minimally Invasive ◽  
Postoperative Mortality ◽  
Main Group ◽  
Control Group ◽  
Surgical Methods ◽  
Access Surgery

Aim. Improving outcomes of diagnosis and treatment of patients with liver echinococcosis and its complications. Materials and methods. A comparative analysis of the results of surgical treatment of liver echinococcosis and its complications with traditional laparotomy access surgery (control group) and minimally invasive interventions (main group) was performed.Results. The study included 300 patients (170 in the control and 130 in the main group). In the main group, 37 (28.4%) cases performed open echinococcectomy from various mini-accesses, and 27 (20.7%) performed twostage operations using minimally invasive technology. Laparoscopic echinococcectomy was performed in 23 (17.7%) patients, laparoscopic pericystectomy 12 (9.2%) and laparoscopic liver resection in 10 (7.7%) patients. The frequency of postoperative complications in the main group was 17.7%, in the control 51.8%, postoperative mortality decreased from 2.3% to 0.8%.Conclusion. Minimally invasive technologies in the surgical treatment of liver echinococcosis show the better immediate results compared to traditional open surgical methods.

Safety in parathyroid surgery: innovation in diagnostic and minimally invasive operations

2021 ◽  
Vol 23 (3) ◽  
pp. 29-34
Author(s):  
Pavel N. Romashchenko ◽  
Nikolaj A. Maistrenko ◽  
Dmitry O. Vshivtsev ◽  
Denis S. Krivolapov ◽  
Andrey S. Pryadko
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Traditional Approach ◽  
Treatment Method ◽  
Intraoperative Neuromonitoring ◽  
Parathyroid Glands ◽  
Safety Level ◽  
Tertiary Hyperparathyroidism ◽  
Surgical Interventions ◽  
Comprehensive Examination

The main treatment method of primary and tertiary hyperparathyroidism is surgery. However, surgical interventions on the parathyroid glands can lead to formidable complications such as laryngeal paresis and hypocalcemia. With this background, a comprehensive study examined the effectiveness of modern methods of diagnosis and surgical treatment of hyperparathyroidism to increase the safety level in surgery of the thyroid gland. The results of a comprehensive examination and treatment of 53 patients with hyperparathyroidism who underwent surgery using three methods were analyzed: traditional (n = 18/34); minimally invasive endoscopically assisted (n = 32/60), and endoscopic (transoral) (n = 3/6). Intraoperative neuromonitoring was also performed in all surgical interventions. Parathyroidectomy was performed under parathyroid monitoring for intraoperative topical diagnosis of parathyroid tumors in nine patients. The use of minimally invasive endoscopically assisted access to the parathyroid glands, as an alternative to the traditional approach, indicated that the preoperative potential in the diagnosis of parathyroid disorders. Moreover, intraoperative neuromonitoring and parathyroid monitoring demonstrated efficiency based on the decline in the incidence of specific postoperative complications with a tolerable increase in operative time, maintenance of the average duration of stationary treatment after surgery, and increased safety level of surgical treatment of hyperparathyroidism.

COMBINATION OF ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL FISTULA AND DUODENAL ATRESIA: TREATMENT ANALYSIS OF FIFTEEN PATIENTS

2021 ◽  
Vol 100 (6) ◽  
pp. 45-53
Author(s):  
I.N. Khvorostov ◽  
◽  
N.K. Barova ◽  
S.V. Minaev ◽  
M.A. Akselrov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Esophageal Atresia ◽  
Gestational Age ◽  
Tracheoesophageal Fistula ◽  
Postoperative Mortality ◽  
Duodenal Atresia ◽  
Two Stage ◽  
Results Of Treatment ◽  
Esophageal Anastomosis ◽  
Overall Mortality

The combination of duodenal atresia (DA) with esophageal atresia with tracheoesophageal fistula (EA-TEF) is a rare pathology, the frequency of which ranges from 1% to 6% of all cases of EA. Surgical treatment of the DA+EA-TEF combination always causes significant difficulties, primarily in determining the timing and stages of surgical correction. Objective of the study: to evaluate the results of treatment with a combination of DA+EA-TEF to determine the effective tactics of surgical treatment. Materials and methods of research: a retrospective, nonrandomized, uncontrolled, multicenter study was carried out. The work is based on the results of treatment of 15 newborns – 6 (40%) boys, 9 (60%) girls with a combination of DA+EA-TEF, who were treated in clinics of 6 university centers for pediatric surgery in the Russian Federation in 2015–2021. Simultaneous operations (SIMOPs) were performed in 10 (60%) patients, two-stage operations (TO) – in 5 (40%) newborns. The following criteria were taken into account: the period of antenatal (weeks) and postnatal (days) of establishing the diagnosis of obstruction of the gastrointestinal tract (GIT), gestational age (weeks), birth weight (g), weight at the time of surgery (g), type of concomitant pathology , sequence and methods of surgical treatment, terms of complete enteral feeding (days), outcomes of operations and reasons for unsatisfactory outcomes. The average gestational age of children who underwent SIMOPs was 35.1 weeks. (Q1 – 31.5, Q3 – 39; Me – 37; SD – 5.1; min/max – 25–40; 95% CI: 31.1–39.0) versus 29.8 weeks. at DO (Q1 – 29, Q3 – 30.5; Me – 30; SD – 1.0; min/max – 28–31; 95% CI: 28.4–31.6) did not differ statistically significantly (р=0.083). The mean body mass values did not have statistically significant differences (p=0.081) and amounted to 2224 g (Q1 – 1410, Q3 – 2930; Me – 2665; SD – 890.8; min/max – 760–3260; 95% CI: 1556–2926) for SIMOPs, versus 1322 g (Q1 – 1165, Q3 – 1450; Me – 1380; SD – 196; min/max – 980–1450; 95% CI: 1078.4–16565) in the TO group. Results: the average duration of SIMOPs was on average 144.4 min (Q1 – 125, Q3 – 155; Me – 147.5; SD – 22; min/max – 120–190; 95% CI: 1321–159.3), TO – 147.0 (Q1 – 125, Q3 – 172; Me – 140; SD – 33.4; min/max – 120–205; 95% CI: 126–178.6). The sequence of surgical correction of defects in SIMOPs in 8 (53%) patients consisted of thoracotomy, ligation of the TEF, direct anastomosis of the esophagus and the imposition of duodeno-duodenoanstomosis (DDA). In one case, DDA was selected as the first operation, which was supplemented with Kader gastrostomy followed by thoracotomy, ligation of the TEF and anastomosis of the esophagus after elongation according to I. Livaditis. In one patient, after thoracotomy and ligation of the TEF in connection with an insurmountable diastasis of the esophagus, a cervical esophagostomy (CE), duodenojejunoanastomosis (DEA) and a gastrostomy according to Kader were applied. In a two-stage correction (TO), the first operation in 3 patients was DDA (20%), supplemented in one case (7%) with Kader gastrostomy, and the second stage after 2 days performed thoracotomy with the elimination of TEF and EA. In 2 (13%) newborns, the first stage was thoracotomy, elimination of TEF and EA, followed by imposition of DDA 2 days later. In one case, due to an insurmountable diastasis of the esophagus after thoracotomy and ligation of the TEF, intrathoracic elongation of the esophagus according to Foker with delayed anastomosis of the esophagus (on the 7th day) and laparoscopic fundoplication according to Nissen (at 5 months) were performed. The duration of hospitalization did not statistically significantly depend on the chosen method for correcting the combination of DA+EA-TEF (p=0.79) and averaged 28.4 days for SIMOPs (Q1 – 16, Q3 –34.5; Me – 26; SD – 21.4; min/max – 5.0–79; 95% CI: 17.6–42.4), and for TOs – 27,2 days (Q1 – 21, Q3 – 33; Me – 28; SD – 7.1; min/max – 19–38; 95% CI: 27.2–33). In the group of patients with SIMOPs, 2 deaths (13%) were recorded on the 5th and 7th days after surgery due to progressive multiple organ failure and intractable pulmonary hypertension. In one case (7%), a lethal outcome was recorded 8 months after primary surgery due to progressive cardiovascular failure. Early postoperative mortality after SIMOPs was 20%, overall mortality was 30%. In the TO group, 3 (20%) deaths were recorded: 2 in the early postoperative period (on day 3 and day 19) and one at the age of 3 months of life. Early postoperative mortality after TO was 40%, overall mortality – 60%. Conclusion: it is preferable to choose the ligation of the TEF as the first operation and, if the child's condition allows, to impose an esophageal anastomosis and restore duodenal patency, followed by a nasogastric tube through the esophageal anastomosis into the stomach. If, after ligation of the TEF, the patient's cardiorespiratory status does not stabilize, it is possible to restore the patency of the esophagus and pass the probe into the stomach without imposing a gastrostomy, which will allow the patient to be further treated as an isolated DA, and the operation to restore the patency of the duodenum is delayed. In the presence of insurmountable diastasis, the use of esophageal elongation technology with subsequent delayed EA is justified.

scholarly journals Features of Surgical Treatment of Malignant Tumors of the Heart and Ways to Improve Immediate Results

2021 ◽  
pp. 50-55
Author(s):  
Andrii R. Vitovskyi ◽  
Volodymyr V. Isaіenko ◽  
Valentyna M. Ryabytza ◽  
Rostyslav M. Vitovskyi
Keyword(s):  
Surgical Treatment ◽  
Hospital Mortality ◽  
Malignant Tumors ◽  
Mechanical Damage ◽  
Postoperative Mortality ◽  
Cardiac Tumors ◽  
Artificial Circulation ◽  
Results Of Treatment ◽  
Adequate Surgery ◽  
Cardiac Surgeons

To date, the issues of surgical treatment of malignant cardiac tumors (MCT) remain relevant and are of particular interest to cardiac surgeons. Hospital mortality of this group of patients is extremely high (20–30%). Finding ways to reduce early postoperative mortality remains an extremely important task of oncocardiac surgery. The aim. To analyze the causes of early postoperative mortality based on the data of many years of experience in the surgical treatment of MCT and to propose methods for the prevention of early postoperative complications with the improvement of the immediate results of operations. Materials and methods. From 1970 to 01.01.2021, National Amosov Institute of Cardiovascular Surgery has provided surgical treatment of 67 patients with malignant tumors of the heart which amounted to 7.1% of the total number of observed patients with cardiac tumors (949). Of the 67 patients with MCT, 57 (84.9%) were operated using artificial circulation, three operations (4.6%) were emergency. Hospital mortality was 19.4% (13 patients). Results. Microscopic examination of the removed tumors revealed the presence of necrosis zones, their mechanical damage leads to significant intoxication of the patient. To prevent tumor intoxication (cause of postoperative mortality) in the operative and postoperative periods, new methods of combating such a factor of hospital mortality were used, which helped to improve the results of treatment of MCT. Hospital mortality reduced from 33.3% (1970–2001) to 5.5% (last 10 years), as a result of use these measures. Conclusions. Destruction of the tumor during surgery with artificial circulation leads to the entry of a significant number of tumor cells and toxins into the bloodstream, causing tumor intoxication. Improvement of the immediate results of surgical treatment of MCT depends on their timely diagnosis, which allows for adequate surgery with radical removal of the tumor and the use of detoxification measures, significantly reducing surgical mortality.

scholarly journals Experience of application of interventional sonography in treatment of patients with bacterial hepatic abscesses

2020 ◽  
Vol 87 (3-4) ◽  
pp. 31-34
Author(s):  
M. V. Bezruchko ◽  
S. I. Panasenko ◽  
O. S. Osipov ◽  
V. S. Drabovskyi ◽  
Ya. V. Rybalka
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Bile Leakage ◽  
Complex Configuration ◽  
Abscess Cavity ◽  
Hepatic Parenchyma ◽  
Sonographic Guidance ◽  
Results Of Treatment ◽  
Bed Days ◽  
Dynamical Control

Objective. To analyze the possibilities and efficacy of application of the intervention sonography in complex surgical treatment of patients with bacterial hepatic abscesses. Materials and methods. Results of treatment of 39 patients with hepatic abscesses in Department of Surgery № 3 through period from 2012 till June 2019 yr was presented. The patients were treated, using the puncture aspiration or drainage of abscesses under sonographic guidance. In hepatic abscesses with diameter up to 40 mm a puncture sanation was applied. In all the patients transcutaneous drainage was performed, not depending from the abscesses dimensions and localization. Results. Treatment and application of the intervention sonography was effective in 37 (94.9%) patients. Postoperative complications have occurred in 4 (10.3%) patients: hemorrhage inside the abscess cavity (in 2), durable bile leakage via the drain (in 1), migration of the drain from the abscess cavity (in 1). Average stationary stay of the patients was (19,2 ± 1,6) bed-days. Conclusion. Application of the puncture-draining procedures under sonographic control in treatment of patients, suffering hepatic abscesses constitutes a method of choice, what is caused by their small traumaticity, availability of dynamical control and efficacy in 94.9% patients. But these procedures owe some limitations, connected by the abscesses quantity, their localization, as well as complex configuration and big possibility of presence of large sequesters of necrotized hepatic parenchyma.

scholarly journals Surgical treatment of patients with descending purulent mediastinitis

2021 ◽  
Vol 26 (4) ◽  
pp. 118-123
Author(s):  
I.M. Shevchuk ◽  
S.S. Snizhko
Keyword(s):  
Surgical Treatment ◽  
Pleural Cavity ◽  
Comparison Group ◽  
Postoperative Mortality ◽  
Complete Removal ◽  
Main Group ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Minimally Invasive Surgical ◽  
Surgical Tactics

The aim of the study was to improve the results of treatment of patients with descending purulent mediastinitis by means of individualized surgical tactics with the priority use of minimally invasive surgical interventions and developed methods of drainage of the mediastinum and pleural cavity. Examination and treatment of 73 patients with descending purulent mediastinitis receiving treatment in the department of thoracic surgery of Ivano-Frankivsk regional clinical hospital was carried out. Treatment of patients in the main group included intramediastinal administration of antibiotics, the use of the developed method of cascade drainage of the mediastinum and pleural cavity, the priority use of video-assisted thoracoscopy and surgical tactics aimed at anticipating the spread of the purulent process in the mediastinum. The rapid and reliable decrease in the indices of endogenous intoxication in the main group confirms the effectiveness of the developed tactics of surgical treatment of patients with mediastinitis, adequate sanation of purulent mediastinatis, complete removal of the purulent substrate from the mediastinum and pleural cavity. The developed tactics of surgical treatment of purulent mediastinitis allowed reducing the overall postoperative mortality from 26.3% in the comparison group to 11.4% in the main group of patients.

Treatment of fractures of the shin bones with extrafocal uniplanar osteosynthesis

2020 ◽  
Vol 3-4 (213-214) ◽  
pp. 40-45
Author(s):  
Askar Bukatov ◽  
◽  
Akhmetkali Dyussupov ◽  
Sabyrbek Dzhumabekov ◽  
Olga Van ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Bone Fractures ◽  
Treatment Method ◽  
Ilizarov Method ◽  
Permanent Disability ◽  
Treatment Methods ◽  
Recommended Treatment ◽  
Results Of Treatment ◽  
Inflammatory Processes ◽  
First Time

Fractures of the lower limb not only lead to temporary disability, they can also be the cause of a patient's permanent disability. Despite numerous treatment methods, there is currently no precise definite technique. The requirement for all fracture treatment methods is minimally invasive and minimal complications. One of such methods for treatment shin bone fractures is extrafocal uniplanar osteosynthesis. Purpose. To evaluate the effectiveness of the treatment of extrafocal uniplanar transosseous osteosynthesis in case of fractures of the shin bones. Material and methods. The results of the treatment of 98 patients with a shin bone fracture treated with the new technique, developed and tested by uniplanar transosseous osteosynthesis in the Emergency Hospital, Department of Polytrauma and Orthosurgery, are shown for the first time. Patients were divided into two groups, in the 1st group of the research (GR) we used the proposed technique, in the 2nd group of the comparison (GC) was used the G.A. Ilizarov method. Results and discussion. In group patients with GR, the duration of inpatient treatment was halved, the positive results of treatment increased by 1.4 times, and the terms of outpatient treatment were also significantly reduced. Negative treatment results were reduced by 2.6 times, peri-spoke inflammatory processes were reduced by 4.2%. Conclusion. The recommended treatment method, in contrast to the traditional one, showed the most positive result. Due to the simplified version of the apparatus and a small number of components, it is less traumatic thereby reducing the number of complications. Keywords: fractures, extra focal osteosynthesis, minimally invasive, knitting needles with persistent pads.

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