MODERN FEATURES OF VATS TREATMENT OF SPONTANEOUS PNEUMOTHORAX AS A COMPLICATION OF BULLOUS LUNG EMPHYSEMA: A SYSTEMATIC LITERATURE REVIEW

The article presents a literature review on the VATS treatment of spontaneous pneumothorax as a complication of bullous lung emphysema. The review considers questions of etiology, diagnostics and therapeutic tactics in VATS treat-ment of spontaneous pneumothorax with bullous emphysema. The main target of surgeons is not only elimination of spontaneous pneumothorax, but quick exposure of lung parenchyma pathology in order to predict possible reoccurrence of spontaneous pneumothorax. Video-assisted thoracoscopy in this case is a mini-invasive, less traumatic and highly efficient method of treatment of spontaneous pneumothorax. Anti-relapsing surgical interventions with pleurodesis are unanimously considered to be necessary. An integrated and differentiated approach to the treatment of spontane-ous pneumothorax as a result of bullous emphysema helps to determine diagnostic and therapeutic tactics of VATS treatment and choice of pleurodesis induction leading to improved treatment outcomes in this category of patients.

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Surgical treatment of rectovaginal fistulas (systematic literature review)

Hirurg (Surgeon) ◽

10.33920/med-15-2104-03 ◽

2021 ◽

pp. 30-48

Author(s):

Andrei Anatolevich Mudrov ◽

Aleksandr Yur’evich Titov ◽

Mariyam Magomedovna Omarova ◽

Sergei Alekseevich Frolov ◽

Ivan Vasilevich Kostarev ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Literature Review ◽

Systematic Literature Review ◽

Meta Analysis ◽

High Recurrence Rate ◽

Surgical Interventions ◽

Rectovaginal Fistulas ◽

Surgical Treatments

Despite the large number of available surgical interventions aimed at the treatment of rectovaginal fistulas, the results of their use remain extremely disappointing, associated with the high recurrence rate of the disease reaching 80 %, as well as the lack of a single tactic to minimize the risk of anal incontinence and the need for colostomy. Objective: to conduct a systematic literature review in order to summarize information related to the rectovaginal fistulas surgery. The systematic review includes the results of an analysis of 97 clinical trials selected from 756 publications found in databases. Inclusion criteria: a full-text article, the presence of at least 5 patients in the study, as well as data on the outcome of surgery. Clinical trials with different surgical treatments were identified and classified into the following categories: elimination of the rectovaginal septal defect with a displaced flap (rectal and vaginal); Martius surgery; gracilis muscle transposition; transperineal procedure; abdominal procedure including endoscopic and laparoscopic methods; use of biological or biocompatible materials. Treatment outcomes vary significantly from 0 % to > 80 %. None of the studies were randomized. Due to the low quality of the identified studies, comparison of results and meta-analysis conduction were not possible. Conclusion: as a result of the systematic review, data for the analysis and development of any strategic and tactical algorithms for the treatment of RVF were not obtained. The most important questions still remain open: what and when surgical method to choose, is it necessary to form a disconnecting stoma?

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