scholarly journals NECROTIZING PANCREATITIS: THE WAYS OF IMPROVEMENT OF SURGICAL TREATMENT

2020 ◽  
Vol 6 (1) ◽  
pp. 43-49
Author(s):  
O.V. Rozenko
Keyword(s):  
Mortality Rate ◽  
Abdominal Cavity ◽  
Necrotizing Pancreatitis ◽  
Pathological Process ◽  
Steady Increase ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Wide Range ◽  
Surgical Tactics ◽  
Omental Bursa

Background. In connection with a steady increase of patients with destructive forms of acute pancreatitis, the proportion of which takes from 10-15 to 20-30%, despite of the wide range of treatments for non-biliary necrotizing pancreatitis, the rate of mortality reaches 80-90% in case of infected forms and needs further improvement of therapies. Objective. The purpose of this study is to improve the results of treatment of patients with nonbiliary necrotizing pancreatitis, by optimizing surgical tactics. Methods. The study examined the cases of 120 patients, whose age ranged from 22 to 83 years, including patients under the age of 50 years old who accounted for 60.0%. There were 80 males (66.7%) and 40 females (33.3%). Disease duration up to 24 hours was found in 36 (30.0%) patients, from 25 to 72 hours - in 25 (20.8%) individuals, more than 72 hours - in 49 (49.2%) patients. Results. The research claims in non-necrotizing pancreatitis, left-sided retroperitoneal phlegmon often develops in 64.2% (mortality rate 26.0%) of patients, right-sided in 24.2% (mortality rate 6.8%) of patients, and bilateral - in 11, 6% (mortality rate 64.2%) individuals. Moreover, the highest mortality was observed with a combination of retroperitoneal phlegmon cellulose and abscess of the pancreas and/or omental bursa - 39.1%. Conclusions. The use of various surgical interventions depending on the involvement in the pathological process of various sections of the abdominal cavity/ retroperitoneal space, which made it possible to reduce mortality and hospitalization time of patients in the hospital by 1.5-2 times is proposed.

scholarly journals Carbuncle - the actual problem of modern surgery (Literature review)

2019 ◽  
Vol 21 (4) ◽  
pp. 19-24
Author(s):  
K V Lipatov ◽  
Yu E Cherkasov ◽  
V I Khrupkin ◽  
M V Lysenko ◽  
E I Dekhissi
Keyword(s):  
Surgical Treatment ◽  
Literature Review ◽  
Plastic Surgery ◽  
Pathological Process ◽  
Tissue Viability ◽  
Actual Problem ◽  
Surgical Interventions ◽  
Timely Diagnosis ◽  
Results Of Treatment ◽  
Surgical Tactics

Analyzed the features of the surgical treatment of carbuncles. The severity of the purulent-necrotic process was assessed, the significance of the timely diagnosis of the inflammatory stage and the choice of the timing of surgical treatment is shown. The features of the options of surgical tactics - from gentle to radical surgical interventions, methods of intraoperative assessment of tissue viability in the inflammatory focus are described. The necessity of a differentiated approach to the treatment of carbuncles depending on the stage of the disease, the prevalence of the pathological process and its localization is substantiated. The significance of restorative skin-plastic surgery in the replacement of postnecrectomy defects of epithelial tissues in the treatment of extensive carbuncles is shown. Ways of improving the results of treatment of patients with carbuncles are outlined, including timely diagnosis, a differentiated approach to surgical treatment, rational antibacterial therapy, and adequate general treatment.

scholarly journals Surgical Aspects of the Treatment of Patients With Generalized Peritonitis

2021 ◽  
Vol 10 (1) ◽  
pp. 58-65
Author(s):  
B. V. Sigua ◽  
V. P. Zemlyanoy ◽  
S. V. Petrov ◽  
V. A. Ignatenko ◽  
P. A. Kotkov
Keyword(s):  
Statistical Significance ◽  
Abdominal Cavity ◽  
Postoperative Mortality ◽  
Abdominal Sepsis ◽  
Secondary Peritonitis ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Generalized Peritonitis ◽  
Surgical Tactics ◽  
Planned Relaparotomy

BACKGROUND Much attention is currently given to the issues of surgical treatment of common forms of secondary peritonitis, which is associated with unsuccessful results of treatment of this group of patients and the lack of a unified approach to surgical tactics among patients requiring repeated surgical interventions for adequate sanitation of the abdominal cavity.AIM OF STUDY Improvement of the immediate results of treatment of patients with generalized secondary peritonitis by determining the approaches to choosing the optimal surgical tactics.MATERIAl AND METHODS We analyzed the results of treatment of 220 patients with common forms of secondary peritonitis who were treated at the Elizavetinskaya hospital of St. Petersburg in the period from 2013 to 2019. The indicated patients were divided into two groups, comparable in terms of the main features, including the depth pathomorphological changes in the abdominal cavity, assessed by calculating abdominal cavity index (ACI) and the Mannheim peritonitis Index (MPI). The main group consisted of 109 patients, where developed algorithm was used, which supposed planned sanitation relaparotomies within up to 2 days in patients with high values of ACI and MPI. The comparison group included 111 patients who underwent sanitation interventions “on demand”, that is, in the presence of signs of persistence of the infectious process in the abdominal cavity. The results of treatment were compared by assessing the level and structure of postoperative mortality, the frequency of complications, and the length of stay in intensive care units and hospital. Mathematical-statistical dataprocessing, calculations of intensive and extensive coefficients of features, assessment of the statistical significance of differences in features for the studied groups were carried out.RESUlTS The use of a differentiated approach to performing planned relaparotomy in patients with generalized peritonitis made it possible to reduce the overall mortality 1.7-fold (from 51.3 to 30.2%) (p=0.001) due to a decrease in the proportion of abdominal sepsis as a cause of unfavorable the outcome. No significant effect of the use of this algorithm on the frequency and structure of complications, as well as the duration of multiple organ failure, was found.FINDINGS The use of planned relaparotomy among the selected patients helps to reduce postoperative mortality without significantly negatively affecting other treatment results.

scholarly journals Septic complications in patients with neck wounds

2020 ◽  
Vol 84 (3) ◽  
pp. 64-66
Author(s):  
M.Yu. Sizyi
Keyword(s):  
Head And Neck ◽  
Social Conditions ◽  
Steady Increase ◽  
Neck Trauma ◽  
Septic Complications ◽  
Traumatic Injuries ◽  
Results Of Treatment ◽  
Car Accidents ◽  
The Social ◽  
Surgical Tactics

Nowadays, we have been a steady increase in injuries as the social conditions of life and have changed. Statistically found that 54.0 % of people of car accidents have injuries to the head and neck. According to the literature, mortality in patients with neck injury which is complicating by pyoinflammatory persists up to 30.0-76.0 %. The management of neck trauma can be challenging and sometimes overwhelming, as this anatomical region contains many vital structures. These structures may pose a diagnostic and therapeutic dilemma. Our research based on the results of diagnosis and treatment of 124 patients with a purulent mediastinitis, complicating traumatic injuries of the neck organs. Among these men – 92 (74.2 %), women – 32 (25.8 %). The results of treatment depend on timely diagnosis, hospitalization in a specialized compartment and conducting active surgical tactics

scholarly journals Choice of tactics of surgical treatment of acute cholecystitis and its complications

2018 ◽  
Vol 22 (3) ◽  
pp. 442-445
Author(s):  
B.S. Zaporozhchenko ◽  
K.V. Kravets ◽  
I.E. Borodaev ◽  
D.A. Bondarets ◽  
D.A. Bondarets ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Average Duration ◽  
Abdominal Cavity ◽  
Age Groups ◽  
Total Duration ◽  
Duration Of Treatment ◽  
Surgical Interventions ◽  
Emergency Operations ◽  
Surgical Tactics

Acute cholecystitis ranks second in the incidence of urgent surgical diseases in hospitals in Ukraine. Despite a marked improvement in the treatment results, the lethality after emergency operations (9,4-37%) for acute cholecystitis complicated by peritonitis remains several times higher than with routine surgical interventions. Objectives — development of rational surgical tactics and evaluation of the effectiveness of treatment of acute cholecystitis and its complications in patients of different age groups, with different pathomorphological forms of acute cholecystitis. The result of treatment of 203 patients was presented: 75 (37,5%) were operated on an emergency basis, 73 (36,5%) urgently, and 52 (26%) in a deferred period. 173 (86.5%) patients were operated using laparoscopic technologies. Intraoperative cholangiography was performed in 16 (9,3%) patients during laparoscopic interventions. In 17 (8,5%) patients, “open” operations were performed. All patients underwent drainage of the abdominal cavity with one or more drains in view of the presence of peritonitis. The average duration of the preoperative period was 1.5 days, the total duration of treatment with LC was 4.5 days, and the total duration of treatment with OC was 10.8 days. So, in the early stages of the development of acute cholecystitis, laparoscopic cholecystectomy is effective. The use of lifting systems for laparoscopic cholecystectomy is advisable in elderly and senile patients, with concomitant diseases of the heart and lungs.

scholarly journals PUNCTIONAL DRAINAGES UNDER ULTRASOUND CONTROL IN ABDOMINAL SURGERY

2018 ◽  
Vol 14 (1-2) ◽  
pp. 49-53
Author(s):  
R.A. Sydorenko
Keyword(s):  
Abdominal Cavity ◽  
Surgical Care ◽  
Operative Management ◽  
Pathological Process ◽  
Term Treatment ◽  
Main Task ◽  
Complex Treatment ◽  
Surgical Interventions ◽  
Endogenous Factors ◽  
Abdominal Organs

Relevance. Punctic-drainage interventions under the control of ultrasound have become an effective help in complex treatment. But some technological aspects in the procedure and post-operative management of patients remain the subject of discussion. Objective: to improve the results of the use of punctional drainages under ultrasound control in abdominal and retroperitoneal pathology. Materials and methods. Echo-controlled puncture-drainage interventions are used in 89 patients: with pancreatogenic fluid concentrations in the stuffing box, parapancreatic cellular spaces (34); with intra-abdominal complications following operations on the abdominal organs (18), inflammatory processes in the gall bladder (15), tumor obstruction of the bile ducts (12), and with liver abscesses (10). Depending on the nature of the contents of the "target", its localization for puncture drainage was used by trokars of various modifications and diameters, as well as stylet-catheters of the type "PIGTAIL". Manipulation was carried out using ultrasonic devices with convection (frequency 3.5 MHz) and linear (frequency 7-12 MHz) sensors. In 68 patients, the display for intervention was infected fluid formation. In 12 – jaundice syndrome and 9 patients – sterile clusters of enzymatically active content. The main task of puncture-drainage procedures was the evacuation of the content of pathological or anatomical fluid formations to reduce intoxication and (or) their decompression. In assessing the effectiveness of minimally invasive techniques, account was taken of the effectiveness of the operation, that is, the target effect for which the intervention was performed, and the number of complications. Results. Puncture-drainage interventions have become independent and end-of-term treatment in 68 out of 85 cases (with the exception of 4 patients who, due to complications during the procedure, used other methods). The reasons for the reduced effectiveness of echo-controlled puncture-drainage interventions in 9 patients were: the predominance of the tissue component (large sequester) in the cavity, the presence of multiple isolated gates, the use of drainage structures with insufficient drainage properties. Fatal consequences in 5 patients are caused both by the above reasons, and by endogenous factors (a significant prevalence of the pathological process, decompensated background pathology, reduction of internal reserves of the organism). Conclusions. Puncture-draining interventions under ultrasound control are an alternative to open surgical interventions, especially in patients with severe concomitant pathology, severe general condition. In this case, they can be as element (stage) of complex treatment and an independent, final method of surgical care. The choice of echo-controlled interventional technologies as a method of operational correction should be carried out with understanding their capabilities. The effectiveness of such mini-invasive methods allows us to recommend their acceptance in surgical hospitals for diseases of the abdominal cavity organs and retroperitoneal space.

SURGICAL TREATMENT STRATEGY FOR COMMON PERITONITIS IN THE ELDERLY PATIENTS

2021 ◽  
pp. 1186-1192
Author(s):  
Б. В. Сигуа ◽  
В. П. Земляной ◽  
С. В. Петров ◽  
В. А. Игнатенко ◽  
П. А. Котков
Keyword(s):  
Abdominal Cavity ◽  
Treatment Algorithm ◽  
Age Groups ◽  
Postoperative Mortality ◽  
The Elderly ◽  
Abdominal Sepsis ◽  
Adverse Outcomes ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Intra Abdominal Infection

Несмотря на очевидный прогресс в изучении вопросов лечения распространенных форм вторичного перитонита, ближайшие результаты далеки от удовлетворительных, в особенности у больных старших возрастных групп. В ряде случаев однократного оперативного вмешательства оказывается недостаточно для полноценной санации источника внутрибрюшной инфекции, что побуждает к проведению повторных санационных вмешательств, порядок и сроки выполнения которых на настоящий момент не являются строго регламентированными. Изучена эффективность применения лечебного алгоритма, подразумевающего дифференцированный подход к проведению плановых хирургических санаций в краткие сроки у больных с выраженными патоморфологическими изменениями в брюшной полости. Результаты лечения больных с применением плановых санационных вмешательств продемонстрировали эффективность разработанного алгоритма, позволив снизить общую послеоперационную летальность за счет сокращения удельного веса абдоминального сепсиса в структуре неблагоприятных исходов. Despite the obvious progress in the treatment of secondary peritonitis common forms, the results are far from satisfactory, especially among patients of older age groups. In some cases, a single surgical intervention is not enough for a complete elimination of the intra-abdominal infection source, which leads to repeated sanitation interventions, the order and timing of which are currently not strictly regulated. The effectiveness of the treatment algorithm, which considers a differentiated approach to planned surgical interventions in a short time in patients with severe pathomorphological changes in the abdominal cavity, was studied. The results of treatment using planned sanitation interventions demonstrated the effectiveness of the developed algorithm, allowing to reduce the overall postoperative mortality by reducing the proportion of abdominal sepsis in the structure of adverse outcomes.

scholarly journals Laparoscopic sanitation of the abdominal cavity in complex treatment of patients with generalized peritonitis

2012 ◽  
Vol 93 (2) ◽  
pp. 287-289 ◽  
Author(s):  
I S Malkov ◽  
E K Salakhov
Keyword(s):  
Abdominal Cavity ◽  
Low Frequency ◽  
Pathological Process ◽  
Control Group ◽  
Surgical Department ◽  
Results Of Treatment ◽  
Generalized Peritonitis ◽  
Low Frequency Ultrasound ◽  
Analysis Of Results ◽  
Frequency Ultrasound

Aim. To develop a method of programmed laparoscopic sanitation in patients with generalized forms of peritonitis with the use of low-frequency ultrasound energy. Methods. Conducted was an analysis of results of treatment of 211 patients with generalized peritonitis admitted to the surgical department of the City Clinical Hospital №7 from 2000 to 2010. The main group comprised 37 patients in whom laparoscopic sanitation with the use of low-frequency ultrasound was performed. The control group included 174 patients who underwent conventional relaparotomy due to progression of the pathological process in the abdominal cavity. Results. The proposed method of laparoscopic sanitation helped to reduce mortality by 12%, and the development of postoperative complications by 8% compared with control group in patients of the II stage of severity of peritonitis according to the Mannheim peritoneal index. Conclusion. The developed method of programmed videolaparoscopic sanitations of the abdominal cavity with the use of low-frequency ultrasound in patients with generalized peritonitis has a pronounced bactericidal and bacteriostatic effect.

scholarly journals RESULTS OF SURGICAL TREATMENT OF NON-PARASITIC SPLENIC CYSTS IN CHILDREN

2018 ◽  
Vol 22 (1) ◽  
pp. 32-35
Author(s):  
A. V. Myzin ◽  
Vasily G. Kuleshov ◽  
A. E. Stepanov ◽  
N. V. Gerasimova ◽  
K. Yu. Ashmanov
Keyword(s):  
Surgical Treatment ◽  
High Efficiency ◽  
Clinical Symptoms ◽  
Abdominal Cavity ◽  
Long Term Results ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Splenic Cysts ◽  
Good Cosmetic

Introduction. Currently, there are different views on the treatment of non-parasitic spleen cysts in children. The choice of method of treatment is under discussion. The aim of our study was to evaluate and analyze the immediate and long-term results of surgical interventions performed on nonparasitic spleen cysts in children. Material and methods. There are presented results of surgical treatment of the 21 patient, who was on treatment at the Department of Abdominal Surgery of the Russian Children Clinical Hospital over the period from 2013 to 2016. Patients were examined by means of ultrasound of the abdominal cavity, CT, MRI. All patients have been operated. 22 surgical interventions were performed by using laparoscopic access, out of which 2 partial resections of the spleen, 1 splenectomy, 19 fenestrations of spleen cysts.Results. During the course of the operation and in the immediate postoperative period there were no complications. Patients were observed for the period of from 1 year to 3 years. Good results of treatment were obtained in 20 (95.2%) children. In a long-term period a relapse occurred in the one patient one year after the operation. The patient was reoperated, splenectomy was performed. Conclusion. The surgical treatment of spleen cysts is the basic one. It is indicated for cysts sized larger than 5 cm and cysts with clinical symptoms. Minimally invasive interventions in children are optimal because of their low traumatism and good cosmetic effect. Our study showed a high efficiency of laparoscopic operations in children suffered from non-parasitic spleen cysts with good long-term results.

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.

scholarly journals PUNCTIONAL DRAINAGES UNDER ULTRASOUND CONTROL IN ABDOMINAL SURGERY

2018 ◽  
Vol 14 (1-2) ◽  
pp. 49-53
Author(s):  
R.A. Sydorenko
Keyword(s):  
Abdominal Cavity ◽  
Surgical Care ◽  
Operative Management ◽  
Pathological Process ◽  
Term Treatment ◽  
Main Task ◽  
Complex Treatment ◽  
Surgical Interventions ◽  
Endogenous Factors ◽  
Abdominal Organs

Relevance. Punctic-drainage interventions under the control of ultrasound have become an effective help in complex treatment. But some technological aspects in the procedure and post-operative management of patients remain the subject of discussion. Objective: to improve the results of the use of punctional drainages under ultrasound control in abdominal and retroperitoneal pathology. Materials and methods. Echo-controlled puncture-drainage interventions are used in 89 patients: with pancreatogenic fluid concentrations in the stuffing box, parapancreatic cellular spaces (34); with intra-abdominal complications following operations on the abdominal organs (18), inflammatory processes in the gall bladder (15), tumor obstruction of the bile ducts (12), and with liver abscesses (10). Depending on the nature of the contents of the "target", its localization for puncture drainage was used by trokars of various modifications and diameters, as well as stylet-catheters of the type "PIGTAIL". Manipulation was carried out using ultrasonic devices with convection (frequency 3.5 MHz) and linear (frequency 7-12 MHz) sensors. In 68 patients, the display for intervention was infected fluid formation. In 12 – jaundice syndrome and 9 patients – sterile clusters of enzymatically active content. The main task of puncture-drainage procedures was the evacuation of the content of pathological or anatomical fluid formations to reduce intoxication and (or) their decompression. In assessing the effectiveness of minimally invasive techniques, account was taken of the effectiveness of the operation, that is, the target effect for which the intervention was performed, and the number of complications. Results. Puncture-drainage interventions have become independent and end-of-term treatment in 68 out of 85 cases (with the exception of 4 patients who, due to complications during the procedure, used other methods). The reasons for the reduced effectiveness of echo-controlled puncture-drainage interventions in 9 patients were: the predominance of the tissue component (large sequester) in the cavity, the presence of multiple isolated gates, the use of drainage structures with insufficient drainage properties. Fatal consequences in 5 patients are caused both by the above reasons, and by endogenous factors (a significant prevalence of the pathological process, decompensated background pathology, reduction of internal reserves of the organism). Conclusions. Puncture-draining interventions under ultrasound control are an alternative to open surgical interventions, especially in patients with severe concomitant pathology, severe general condition. In this case, they can be as element (stage) of complex treatment and an independent, final method of surgical care. The choice of echo-controlled interventional technologies as a method of operational correction should be carried out with understanding their capabilities. The effectiveness of such mini-invasive methods allows us to recommend their acceptance in surgical hospitals for diseases of the abdominal cavity organs and retroperitoneal space.

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