scholarly journals Staged treatment strategy in patients with acute abdomen

2015 ◽  
Vol 96 (1) ◽  
pp. 22-27
Author(s):  
P V Polenok
Keyword(s):  
Surgical Treatment ◽  
Treatment Strategy ◽  
Abdominal Cavity ◽  
Intervention Group ◽  
Postoperative Mortality ◽  
Control Group ◽  
Early Total Care ◽  
Abdominal Organs ◽  
Total Care ◽  
Staged Treatment

Aim. To reason the strategy of staged surgical treatment in patients with acute abdomen.Methods. The study included 72 patients, of them 32 were included in the main group, in which the staged surgical treatment strategy was implemented. To assess the effect of such approach, control group including 40 patients who were treated using the early total care strategy, was formed retrospectively. The decision on the certain strategy use (early total care strategy or staged treatment strategy («aborted operation») was made in every included patient by operating surgeon during the operation.Results. The modern method of surgical treatment («aborted operation» strategy) was introduced into the clinical practice for treating acute surgical abdominal diseases. A new method for patient’s condition severity assessment and operative risk prognosis based on the physical signs, as well as the scale of the indications for the «aborted operation» approach were developed. An original method for laparotomy wound closure was proposed. Device for laparostomy consists of two details - frame, which is stitched to the edges of surgical wound, and replaceable cap, which can be fixed to the frame. The device is made of soft elastic organic material, which is transparent and non-reactive. The key advantage of the device is the transparency of the cap material, allowing to review the condition of abdominal organs at any moment after the surgery without additional analgesia. The device act as a «viewport», allowing to clearly visualize the changes of abdominal organs, to diagnose the possible complications and to timely recognize the indications for programmed abdominal cavity debridement. The mortality in the control group was 100%, in the intervention group - 59%.Conclusion. Staged treatment strategy may significantly reduce the postoperative mortality, being an alternative to standard tactical and technical approaches used in emergency abdominal surgery.

scholarly journals Evolution of diagnosis and surgical treatment of intra-abdominal infiltrates, abscesses of primary and postoperative origin in patients

2021 ◽  
pp. 15-29
Author(s):  
V.V. Skyba ◽  
◽  
V.F. Rybalchenko ◽  
A.V. Ivanko ◽  
R.М. Borys ◽  
...  
Keyword(s):  
Duodenal Ulcer ◽  
Gastric Ulcer ◽  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Postoperative Mortality ◽  
Multiple Organ ◽  
Long Term Results ◽  
Control Group ◽  
Study Group ◽  
Perforated Gastric Ulcer

Purpose – to improve the results of surgical treatment of patients with intra-abdominal infiltrates and abscesses through the introduction of the latest imaging methods and surgical technologies. Materials and methods. In the clinic of the Department of Surgical Diseases No 1, on the basis of the Surgery Center of the Kyiv City Clinical Hospital No. 1 from 2006 to 2019 218 patients with primary and secondary intra-abdominal infiltrates, abscesses and fluid formations were treated. The patients’ age ranged from 16 to 85 years. There were 107 (49.08%) male patients, 111 (50.92%) female patients. Depending on the time of hospitalization (by years), the patients were divided into two groups: the control group (CG) (2006–2012) 117 (53.67%) patients and the study group (SG) (2013–2019) 101 (46.33%) patients. The SG used the latest imaging technologies and improved methods of surgical treatment. Results. The patients were divided into two groups: primary in 191 (87.61%) and secondary postoperative infiltrates and abscesses in 27 (12.39%). The causes of primary infiltrates and abscesses were: complicated forms of appendicitis in 74 (33.94%), perforated stomach and duodenal ulcer in 48 (22.02%), complicated forms of cholecystitis in 69 (31.65%). Postoperative infiltrates and abscesses were observed in 27 (12.39%) patients who underwent urgent surgery: adgeolysis of adhesive ileus in 14 (6.42%) and complicated hernias of various localization in 13 (5.97%). Postoperative complications were diagnosed in 43 (19.72%) patients, of whom 34 (15.59%) from the surgical wound and 29 (15.18%) of the abdominal cavity, who required relaparotomy or laparoscopy, with destructive appendicitis in 10 (13.51%), perforated gastric ulcer and 12 duodenal ulcer in 6 (12.5%), destructive cholecystitis in 9 (13.04%), adhesive intestinal obstruction in 13 (19.12%) and with strangulated and complicated hernias in 14 (17.28%) of the examined patients. During relaparotomy, incompetence of the intestinal wall and intestinal sutures was established in 11 out of 32 patients, an ileostomy was imposed in 7, and cecostomy in 1 patient. Actually, in the control group, 8 (6.84%) patients died on the background of ongoing peritonitis, thrombosis of mesenteric vessels and multiple organ failure and concomitant ailments and in the study group 4 (3.96%) patients died. Conclusions. Surgical treatment is individualized depending on the disease, so with destructive appendicitis from 74 (38.74%) laparotomic in 42 (21.99%), laparoscopic in 32 (16.75%), and in 12 (6.28%) with conversion; perforated gastric ulcer and duodenal ulcer in 48 (25.13%) open laparotomy; with cholecystitis of 69 (36.13%) patients, 48 (25.13%) had laparotomy and 21 (11.00%) had laparoscopic examination. The use of the latest imaging and treatment technologies: Doppler ultrasonography, hydrojet scalpel and laparoscopy in 64 (33.51%), allowed to have better near and long-term results and to reduce postoperative mortality from 6.84% to 3.96%, with an average of 5.5%. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: destructive appendicitis, cholecystitis, perforated gastric ulcer and 12-duodenal ulcer, adhesive leakage, strangulated hernias, diagnosis and treatment.

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.

scholarly journals The option of surgery for gastric stump cancer in patients who have previously undergone pancreaticoduodenectomy

2021 ◽  
Vol 102 (1) ◽  
pp. 100-103
Author(s):  
F Sh Akhmetzyanov ◽  
N A Valiev ◽  
V I Egorov ◽  
M I Shaymardanov
Keyword(s):  
Surgical Treatment ◽  
Digestive Tract ◽  
Stomach Cancer ◽  
Professional Training ◽  
Abdominal Cavity ◽  
Benign Disease ◽  
Gastric Stump ◽  
Previous Surgery ◽  
Gastric Stump Cancer ◽  
Abdominal Organs

Gastric stump cancer is a carcinoma which forms no earlier than 5years after surgery for benign disease. The incidence ranges from 2.4 to 5% among patients with stomach cancer. Previous operations lead to the emergence of an adhesive process in the abdominal cavity, changes in the anatomy and topography of the abdominal organs, as well as the development of new ways of lymph outflow. These factors lead to the re-surgery becomes technically more complicated and requires high professional training from the surgeon. Of particular surgical interest is the issue of restoration of the digestive tract, which directly depends on the nature and volume of the previous surgery. In this paper, the authors describe cases of surgical treatment of gastric stump cancer in two patients, who had previously undergone pancreaticoduodenectomy.

scholarly journals THE RESULTS OF SURGICAL TREATMENT IN PATIENTS WITH DIFFUSE POSTOPERATIVE PERITONITIS COMPLICATED WITH SEVERE ABDOMINAL SEPSIS

2015 ◽  
Vol 1 (1) ◽  
pp. 28-32
Author(s):  
F. V. Galimzyanov ◽  
T. M. Bogomyagkova ◽  
M. I. Prudkov ◽  
M. A. Lazareva
Keyword(s):  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Treatment Algorithm ◽  
Abdominal Sepsis ◽  
Postoperative Peritonitis ◽  
Control Group ◽  
Complex Treatment ◽  
Results Of Treatment ◽  
Clinical Indications ◽  
Surgical Methods

Aim of investigation: improvement the results of treatment in patients with diffuse postoperative peritonitis complicated with severe abdominal sepsis. Materials and methods. The present investigation is performed in 132 patients. According to the way of treatment the patients were divided into 2 groups: the first (control) group included 56 patients with diffuse postoperative peritonitis, severe abdominal sepsis who got complex treatment, sanations and abdominal cavity drainage according to “clinical indications”. The second (main) group included 76 patients with diffuse postoperative peritonitis, severe abdominal sepsis who got complex treatment and a surgical treatment algorithm which we have worked out. The patients were in severe condition with marked multiple organ failure, with equal risk of lethality in both groups. Surgical methods included laparotomy, relaparotomy, sanations, abdominal cavity drainage, mini-laparotomy. Results: application of the elaborated algorithm for surgical treatment of patients with diffuse postoperative peritonitis and severe abdominal sepsis made it possible to improve the results of treatment. Intensive ward stay was 1.4 times less accordingly, 10.0 ± 1.4 days and 14.0 ± 1.9 days (p < 0.1). Hospital stay was 3.3 days less accordingly, 29.0 ± 0.9 days and 32.3 ± 1.2 days (p < 0.05). Lethality was 2.5 times less as compared with abdominal cavity sanations according to “clinical indications”, accordingly 21.1 and 51.8 % (p < 0.01).

Effectiveness of pre-surgical neuromuscular electrical stimulation on the recovery time of diaphyseal femoral fractures

2020 ◽  
Vol 27 (8) ◽  
pp. 1-15
Author(s):  
María C Bustos ◽  
María S Lo Presti
Keyword(s):  
Electrical Stimulation ◽  
Surgical Treatment ◽  
Recovery Time ◽  
Treatment Time ◽  
Waiting Times ◽  
Intervention Group ◽  
Neuromuscular Electrical Stimulation ◽  
Femoral Fractures ◽  
Control Group ◽  
Men And Women

Background/aims: Quadriceps pathology is common in patients who have suffered diaphyseal femoral fractures because of the long waiting times before surgery, during which they remain immobilised. The aim of this study was to evaluate the effectiveness of neuromuscular electrical stimulation applied in the pre-surgical period on the recovery time of the patients. Methods Before surgical treatment, patients with closed diaphyseal femoral fractures were systematically distributed alternatively into an intervention group and a control group. The intervention group (n=22) received pre-surgical neuromuscular electrical stimulation and the control group (n=25) received conventional physiokinetic treatment. Results Age, gender proportions and time between admission and surgery were similar in both groups. Average treatment time was 14.14 ± 9.7 days. Recovery time (from surgery to medical discharge) was 111 ± 15.65 days for participants in the intervention group, and 139.36 ± 23.05 days for participants in the control group (P<0.0001). No differences were found between men and women nor between the fractured femur (right vs left). Conclusions The results highlight the value of neuromuscular electrical stimulation in the pre-surgical period for patients with diaphyseal femoral fractures, optimising their rehabilitation and facilitating a quicker return to their everyday lives.

scholarly journals COMPARATIVE RESULTS OF RECOVERY STAGE IN TWO-STEP TREATMENT OF MALIGNANT COLONIC OBSTRUCTION

2017 ◽  
Vol 176 (1) ◽  
pp. 70-75
Author(s):  
V. I. Pomazkin
Keyword(s):  
Colonic Obstruction ◽  
Abdominal Cavity ◽  
Postoperative Mortality ◽  
Main Group ◽  
Control Group ◽  
Recovery Stage ◽  
Malignant Colonic Obstruction ◽  
Analysis Of Results ◽  
Comparative Results ◽  
Adhesion Process

The aim of the study was a comparative analysis of results of different approaches to two-stage treatment of malignant colonic obstruction on the stage of recovery of the integrity of intestinal tract. The main group included 260 patients. A double-barreled colostomy was formed at the first stage, than resection of the colon with tumor removing and stoma excision were performed. The control group consisted of 192 patients. An obstructive resection of the colon was made at the first stage with following reconstructive operation. Intraoperative damage of the small intestine was observed in 6,9% patients of the main group and 18,2% patients of the control group. Postoperative mortality consisted of 1,2% in the main group and it was 1,5% in the control group. The early postoperative complications numbered 9,2% and 17,7%, respectively. The main risk factor of complication development was an expressed adhesion process of the abdominal cavity in the control group of patients. CONCLUSIONS. The method, which included the colostomy formation at the first stage with following radical surgery at the second stage, had advantages in case of elimination of malignant colonic obstruction.

scholarly journals Shoulder Tip Pain in Laparoscopic Cholecystectomy with Active vs Passive Evacuation of Pneumoperitoneum

Esculapio ◽  
2021 ◽  
Vol 16 (4 (oct 2020 - dec 2020)) ◽  
Author(s):  
Anum Arif ◽  
Sabih Nofal ◽  
Muhammad Atif Khan ◽  
Abdul Waheed Khan ◽  
Ahsin M Bhatti ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Cavity ◽  
Intervention Group ◽  
University Hospital ◽  
Control Group ◽  
Key Words Laparoscopic Cholecystectomy ◽  
Pain Scores ◽  
Study Results ◽  
Surgery Department ◽  
Negative Suction

Objective: The objective of the study was to compare the frequency of severity of shoulder tip pain after active (gas suctioning) and passive removal of pneumoperitoneum among patient undergoing laparoscopic cholecystectomy. Methods: This Observational comparative study was directed in general surgery department of DOW university hospital beginning from February 2016 to February 2017. Two hundred and six patients undergoing standard 4 port laparoscopic cholecystectomy were enrolled equally in either groups. The surgeon evacuated the abdomen by using a multiporous suction tube limiting the negative suction pressure to - 40 mmHg for 2-5 minutes under direct vision in active aspiration group, while in control group, CO2 was removed passively. Pain scores were recorded using visual analog score at 16 hours post-operatively by residents of surgery blinded to the study. Results: Mean VAS pain score at 16 hours in intervention group was much inferior than control group 1.00 ±2.09 vs. 3.06 ± 2.58 ( p < 0.001). Conclusion: Active aspiration of CO2 is an effective method that removes most if not all gas from the abdominal cavity. This will cause statistically significant decrease post-operative discomfort, pain and decrease need of rescue analgesics. Key Words: Laparoscopic cholecystectomy, Pneumoperitoneum, Active Aspiration, shoulder tip pain, post- laproscopic cholecystectomy pain How to Cite: Arif A, Nofal S, Khan MA, Khan AW, Bhatti AM, Ishaq SH. Shoulder tip pain in laparoscopic cholecystectomy with active vs passive evacuation of pneumoperitoneum. Esculapio. 2020;16(04):116-119.

scholarly journals Polypropylene endoprostheses in the surgical treatment of strangulated postoperative ventral hernias

2012 ◽  
Vol 93 (3) ◽  
pp. 541-544
Author(s):  
I M Fatkhutdinov
Keyword(s):  
Surgical Treatment ◽  
Abdominal Wall ◽  
Abdominal Wall Defect ◽  
Subcutaneous Tissue ◽  
Abdominal Cavity ◽  
Subcutaneous Fat ◽  
Postoperative Mortality ◽  
Early Postoperative Period ◽  
Mesh Endoprostheses ◽  
Ventral Hernias

Aim. To determine and implement the best ways to position mesh endoprostheses in the anterior abdominal wall during strangulated postoperative ventral hernias; to introduce methods of non-stretch hernioplasty into emergency surgery of giant hernias. Methods. 115 patients (27 males and 88 females) with strangulated postoperative ventral hernias aged 30-73 years were under observation. Depending on the size of the hernia and on the intraoperative findings different methods of implantation of the mesh endoprostheses were used, which prevented the mesh contact with subcutaneous fat and abdominal organs. For small and medium-sized hernias the mesh was placed under or over the abdominal membrane, it was fixed to the abdominal wall, the aponeurosis was sewn together in an «edge to edge» fashion. In cases with giant hernias non-stretch hernioplasty was performed. During the operation of non-stretch hernioplasty, dissection and excision of the hernial sac was performed in such a way that made it possible to use it to cover the abdominal wall defect. Results. In the early postoperative period in 17 (14.8%) patients seromas had formed in the wound, which were treated by needle puncture under ultrasound guidance. Postoperative mortality was 5.2% (6 people). In 5 cases the deaths were due to myocardial infarction and pulmonary embolism. One patient developed peritonitis due to suture insufficiency of the enteric anastomosis. Of all patients with lethal outcomes five patients were admitted after more than 6 hours from the start of the strangulation, one patient was admitted after 3 hours. Conclusion. The usage of techniques that delimit the mesh prosthesis from the abdominal cavity and subcutaneous tissue, and the introduction of non-stretch methods for giant hernias in the surgical treatment of strangulated postoperative ventral hernia contribute to improved outcomes of treatment in this group of patients.

scholarly journals Impact of Modified Transesophageal Echocardiography on Mortality and Stroke after Cardiac Surgery: A Large Cohort Study

2017 ◽  
Vol 2017 ◽  
pp. 1-8
Author(s):  
Wouter W. Jansen Klomp ◽  
Carl G. M. Moons ◽  
Arno P. Nierich ◽  
George J. Brandon Bravo Bruinsma ◽  
Arnoud W. J. van’t Hof ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Transesophageal Echocardiography ◽  
Intervention Group ◽  
Postoperative Mortality ◽  
Control Group ◽  
Aortic Atherosclerosis ◽  
Stroke Incidence ◽  
Relative Risks ◽  
Large Cohort Study ◽  
The Impact

The aim of this study was to investigate the impact of perioperative screening with modified transesophageal echocardiography (A-View method). We compared, in consecutive patients who underwent cardiac surgery between 2006 and 2014, 30-day mortality and in-hospital stroke incidence, operated either with perioperative modified TEE screening (intervention group) or only with conventional TEE screening (control group). Of the 8,605 study patients, modified TEE was applied in 1,391 patients (16.2%). Patients in the intervention group were on average older (71 versus 68 years, p<0.001) and more often females (31.0% versus 28.0%, p<0.001) and had a higher predicted mortality (EuroSCORE I: 5.9% versus 4.0%, p<0.001). The observed 30-day mortality was 2.2% and 2.5% in both groups, respectively, with multivariable and propensity-score adjusted relative risks (RRs) of 0.70 (95% CI: 0.50–1.00, p=0.05) and 0.67 (95% CI: 0.45–0.98, p=0.04). In-hospital stroke was 2.9% and 2.1% in both groups, respectively, with adjusted RRs of 1.03 (95% CI: 0.73–1.45) and 1.01 (95% CI: 0.71–1.43). In patients undergoing cardiac surgery, use of perioperative screening for aortic atherosclerosis with modified TEE was associated with lower postoperative mortality, but not stroke, as compared to patients operated on without such screening.

scholarly journals DIAGNOSTIC AND TREATMENT OF COMBINED DAMAGES OF LARGE BONES OF THE LIMBS AND ORGANS OF THE ABDOMINAL CAVITY IN CHILDREN

2019 ◽  
Vol 22 (1) ◽  
pp. 33-37
Author(s):  
Y. M. Yahyaev ◽  
M. I. Izrailov ◽  
I. A. Aliyev ◽  
M. -A. Magomedov ◽  
A. M. Aliskandiev
Keyword(s):  
Traffic Accident ◽  
Abdominal Cavity ◽  
Economic Effect ◽  
Lower Extremities ◽  
Upper Extremities ◽  
Lower Limbs ◽  
Diagnosis And Treatment ◽  
Multiple Injuries ◽  
Control Group ◽  
Abdominal Organs

The experience of the management of 141 victim cases aged from 1 year to 15 years with fractures of the large bones of the extremities associated with injuries of the abdominal organs is presented. The cause of injury in 56% of cases was a traffic accident with boys to prevalent to suffer. In 141 victims, 184 injuries of the abdominal organs were diagnosed with predominant damage in isolated injuries of the spleen (40%), in case of multiple injuries, a combination of damage to the spleen and liver (41.9%). In 47.6% of patients, fractures of the lower limbs were observed, fractures of the bones of the upper extremities were found in 41.8%, with predominant damage to the bones of the lower extremities with open fractures (65%). The use of the developed algorithm for diagnosis and treatment, providing for a differentiated approach to diagnosis and treatment at different periods of combined trauma, allowed obtaining more beneficial results in the main group (97.4%) compared with the control group (93.9%) with an economic effect of 28%.

Sign in / Sign up

Export Citation Format

Share Document