Prevention of paracolostomal complications following abdominoperineal extirpation of the rectum

Aim. To find an optimal way of end colostoma formation in patients with colorectal cancer following abdominoperineal extirpation of the rectum. Methods. Results of surgical treatment (rectum extirpation ended with sigmoidostomy) of 142 patients with malignant tumors of lower part of rectal ampulla treated from 2005 to 2012 are presented. Data of 101 patients (comparison group) were retrospectively analyzed, in whom the same approach of choosing the colostomy technique was applied. The main group consisted of 41 patients in whom the efficacy of authors-introduced technique of colostomy with alloplasty for colostomal wound consolidation from the abdominal cavity side was prospectively defined. Results. The prevalence of early post-operative stomal complications was 18,8% (in 19 out of 109 patients) in comparison group. Ileum volvulus around the stoma causing bowel obstruction was diagnosed in 2 cases, necrosis of stoma wall - in 2 patients, evisceration around stoma site - in 3 patients, perforation of sigmoid stoma - in 1 patient, stoma retraction - in 1 patient, bleeding at stoma site - in 3 patients, paracolostomal mass - in 1 patient. 14 patients from comparison group developed late post-operative stomal complications, including parastomal hernia - 8 patients, stoma prolapse - 3 patients, colostomal fistula - 1 patient, stomal stenosis - 2 patients. Treatment results in the patients from the main group were satisfactory. Early complications included 1 case of bleeding from stoma site, 1 case of partial necrosis of stoma wall. No late complications were registered. The gained data allows to provide successful rehabilitation to patients who underwent colorectal cancer surgery. The described technique is contraindicated in case of infected peritoneal effusion. Conclusion. The use of the method proposed by authors not only significantly improves colostomy results, but significantly decreases the rate of both early and late post-operative complications of stomas compared to standard methods.

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CURRENT ASPECTS OF DIAGNOSTICS AND TREATMENT OF ACUTE BILLARIAN PANCREATITIS

Medical Science of Ukraine (MSU) ◽

10.32345/2664-4738.3-4.2018.10 ◽

2018 ◽

Vol 14 (3-4) ◽

pp. 74-79

Author(s):

I.V. Kolosovych ◽

B.H. Bezrodnyi ◽

I.V. Hanol

Keyword(s):

Acute Pancreatitis ◽

Length Of Stay ◽

Comparison Group ◽

Abdominal Cavity ◽

Main Group ◽

Duct System ◽

Results Of Treatment ◽

Positive Clinical Effect ◽

Number Of Patients ◽

Comparative Group

Relevance. The article is devoted to the problem of diagnosis and treatment of acute biliary pancreatitis, which remains one of the most common surgical diseases of the abdominal cavity and accounts for 33.2% of the total number of patients with acute pancreatitis. Objective of the work is to improve the diagnosis and results of surgical treatment of patients with acute pancreatitis of biliary etiology. Materials and methods. The results of treatment of 264 patients with acute pancreatitis of biliary etiology are analyzed. Operative treatment was applied in 92 (34,8 %) patients: endoscopic operations were performed in 44 patients (16,7 %). Thus, in 10 (3,8 %) patients, endoscopic papilloprotectomy was performed with the auditory of the duct system and the extraction of concrements. In other cases, organo-preserving intervention was performed without disturbing the morphofunctional integrity of the sphincter apparatus of the duct system: the cannulation in 6 (2,3%) patients, mechanical (balloon) in 5 (1,9 %) cases, pharmacological (myogenic antispasmodic) dilatation of distal duct and a large duodenal papilla in 11 (4,2 %) patients. In residual choledocholithiasis, a technique of papillotomy under the control of choledochoscopy was proposed – 12 (4,54 %) patients. A comparative analysis of the effectiveness of the treatment of patients who used the "open" (comparative group) and noninvasive endoscopic interventions in the early disease (the main group) was performed. Results. So in the main group the length of stay in the hospital was 12±3,2 days, respectively, in the comparison group – 26±4,3 days. In 42 (95,4 %) patients who had undergone endoscopic surgery, a positive clinical effect, a rapid regress of the symptoms of acute pancreatitis was achieved. In two (4,5 %) patients in the main group, the course was complicated by the development of the abscess of the stuffing box, and puncture under ultrasound control was performed. In patients of the comparison group complications arose in 5 (41,6 %) patients, it is noteworthy that all of them had undergone operative interventions, which were limited only to the rehabilitation and drainage of the abdominal cavity, a stuffing box bag. The mortality rate among unopposed was 1,2 % (2 patients), and among the operated – 11,9 % (11 patients). Among prooperated patients who died, 81,8 % (9 people) were elderly patients. Conclusions. The use of minimally invasive endoscopic interventions in the early phase of the disease reduces the length of stay of patients in the hospital from 26±4,3 days (comparison group) to 12 3,2 days (main group) and the number of complications occurring by 37,1 % (P <0, 05). Application of the proposed method of papillotomy under the control of choledochoscopy makes it possible to reduce the risk of perforation of the wall of the duodenum with the development of peritonitis or retroperitoneal phlegmon by 1,2 % (P <0,05).

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Surgical tactics for victims of gunshot wounds of the diaphragm specialized stage of medical care in conditions of a modern armed conflict

Photobiology and Photomedicine ◽

10.26565/2076-0612-2019-27-02 ◽

2019 ◽

Keyword(s):

Surgical Treatment ◽

Medical Care ◽

Comparison Group ◽

Care Delivery ◽

Abdominal Cavity ◽

Surgical Care ◽

Gunshot Wounds ◽

Main Group ◽

Lung Capacity ◽

Combat Injuries

Introduction. The diaphragm gunshot wounds are serious combat injuries. The main functions of the diaphragm are to change the intra-abdominal pressure and the outflow of lymph and blood from the abdominal cavity due to the constant contraction and relaxation. Therefore, when it is injured at the same time with a powerful painful impulse, cardiopulmonary disorders quickly arise. Purpose: To improve the results of surgical treatment of patients with gunshot wounds through the introduction of new video endoscopic technologies at the stage of specialized surgical care. Materials and methods. The article analyzes the features of specialized surgical care in 64 patients with gunshot wounds who were treated at the surgical clinic of the Military Medical Clinical Center of the Northern Region (III level of medical care). New minimally invasive methods are proposed to improve the outcomes of surgical treatment of victims with diaphragm gunshot wounds at level III of health care delivery. Results. Thus, the use of video thoracoscopic technique in the surgical treatment of the diaphragm wound and its suturing in the proposed method allowed to improve the results of treatment by increasing the average value of diaphragmatic excursion in deep breath in the main group to 3.73 ± 0.31 cm, whereas in the comparison group 2.21 ± 0.38 cm. The severity of the pain syndrome on the of Visual Аnalogue Scale 5 days after surgical treatment was 5.2 ± 2.3 points in the injured main group, 6.7 ± 2.1 points in the comparison group. The ratio of vital lung capacity to the required vital lung capacity in the main group was 75.3 ± 2.2%, in the comparison group 64.1 ± 1.7%. Conclusions. The use of video thoracoscopy increases the efficiency of the diagnosis of gunshot wounds of the diaphragm. The use of laser imaging and fluorescence diagnosis of diaphragm wounds ensure the adequacy of the removal of paravulary necrotic tissues. The suturing of the wounds in accordance with the anatomical and functional structure of the diaphragm with the use of plaques improves the immediate postoperative results of surgical treatment.

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The choice of surgical treatment method of patients with bacterial liver abscesses

Kazan medical journal ◽

10.17816/kmj2304 ◽

2012 ◽

Vol 93 (2) ◽

pp. 265-269 ◽

Cited By ~ 1

Author(s):

A P Tolstikov

Keyword(s):

Postoperative Complications ◽

Ultrasound Guidance ◽

Comparison Group ◽

Average Duration ◽

Abdominal Cavity ◽

Bile Leakage ◽

Main Group ◽

Early Postoperative Complications ◽

Liver Abscesses ◽

Bed Days

Aim. To improve the results of surgical treatment of patients with bacterial abscesses of the liver. Methods. During the period from 2000 to 2010 treated were 118 patients with bacterial liver abscesses, 75 men and 43 women aged from 18 to 80 years (mean age 52.1 years). Management of the patients was based on the developed algorithm of diagnosis and treatment of liver abscesses. Two groups of patients were formed: the main group (treatment consisted of percutaneous puncture and drainage of the abscesses under ultrasound guidance) - 94 patients, the comparison group - 24 patients. In the comparison group surgical interventions were performed using the transabdominal access: laparotomy, opening and drainage of the abscess (18 patients), hepatic resection (3 patients), left-sided hemihepatectomy (2 patients), right-sided hemihepatectomy (1 patient). Results. In the patients of the comparison group the following early postoperative complications developed: wound infection - 4, intra-abdominal hemorrhage - 1, bile leakage - 1, abscesses of the abdominal cavity - 2, exudative pleuritis - 2, pneumonia - 3 cases. The average duration of patient hospitalization was 19.5±1.6 bed-days. In the main group the average duration of patient hospitalization was 9.2±±0.6 bed-days. Early postoperative complications in patients of the main group included: intra-abdominal hemorrhage - 1, bile leakage - 1, abscesses of the abdominal cavity - 1, exudative pleuritis - 2, pneumonia - 2 cases. There were no deaths in either of the groups. Conclusion. Puncture and drainage of bacterial liver abscesses under ultrasound guidance is an effective method of treatment that makes it possible to reduce the number of abdominal operations, reduce the number of postoperative complications and shorten the hospital stay.

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Does Intraperitoneal Chemotherapy Increase the Incidence of Anastomotic Leakage after Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis

Gastroenterology Research and Practice ◽

10.1155/2021/9204373 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Yu Yang ◽

Yuxuan Li ◽

Xiaohui Du

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Anastomotic Leakage ◽

Incidence Rate ◽

Intraperitoneal Chemotherapy ◽

Meta Analysis ◽

Abdominal Cavity ◽

Cancer Surgery ◽

Colorectal Cancer Surgery ◽

Increased Risk

Purpose. To identify and evaluate the influence of intraperitoneal chemotherapy without hyperthermia (ICwh) to the incidence of anastomotic leakage (AL) after colorectal cancer surgery. Methods. A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses in order to review all studies investigating the relationship between ICwh and AL in patients undergoing colorectal surgery. The primary outcome was overall incidence rate of anastomotic leakage. Results. Four studies were included in the final review. ICwh was associated with an overall increased risk of anastomotic leakage [OR 2.05 (1.06, 3.98), P = 0.03 ]. But there was no significant increased incidence rate when fluorouracil was implanted into the abdominal cavity for ICwh [OR 2.48 (0.55, 11.10), P = 0.24 ]. Conclusions. This meta-analysis provides some evidence to suggest ICwh may increase the incidence of postoperative AL in colorectal cancer. However, fluorouracil implantation for ICwh does not increase the risk of AL, which seems to be a relatively safe method of ICwh.

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Risk stratification of postoperative complications in jaundiced patients with focal diseases of the biliopancreatoduodenal zone

Journal of Education, Health and Sport ◽

10.12775/jehs.2021.11.06.034 ◽

2021 ◽

Vol 11 (6) ◽

pp. 309-319

Author(s):

P. Muraviov ◽

B. Zaporozhchenko ◽

I. Borodaev ◽

V. Shevchenko ◽

M. Zaporozhchenko ◽

...

Keyword(s):

Mathematical Modeling ◽

Risk Stratification ◽

Genetic Factors ◽

Comparison Group ◽

Radical Surgery ◽

Malignant Tumors ◽

Main Group ◽

Decompression Surgery ◽

Preoperative Preparation ◽

Comparison Groups

The risk stratification was performed by mathematical modeling taking into account genetic factors and the results of instrumental research as ultrasonic elastography. The results of 272 jaundiced patients’ surgical treatment as pancreaticoduodenal resection (PDR) for malignant tumors of biliopancreatoduodenal area (218 patients) and chronic pseudotumoral pancreatitis (54 patients) were analyzed. In the main group (n=112) the optimized algorithm of preoperative preparation and risk stratification was used and in the comparison group (n=160) preparation for PDR was carried out conservatively according to generally accepted standards. radical surgery is defined as inexpedient and too risky, while shunt decompression surgery is performed as a first step for pancreatoduodenal resection. Thanks to the preoperative preparation according to our algorithm, mental status evaluation in the main group compared to the comparison one was significantly better. By MoCA scale before surgery it was 24.9 ± 3.2 and 22.8 ± 2.4 points, and by the DSST test - 40.2 ± 3.8 and 23.6 ± 2.6 points in the main and comparison groups respectively. The level of bilirubinemia in patients of the main group on the day before PDR was 112.3±2.7 μmol/l, while in the comparison one it was 198.3±3.3 μmol/l (p <0.05). On the eve of the PDR, the activity of alkaline phosphatase was in the main group 104.8 ± 1.3 U / l, and in the comparison group - 270.8 ± 1.9 U / l (p <0.05). Before PDR, γ-glutamiltransferase activity significantly decreased to 529 ± 29 U / l in the comparison group and to 485 ± 33 U / l in the main group (p <0.05).

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Application of adaptive tools in relaparotomy wound surgery

Kazan medical journal ◽

10.17816/kmj2019-351 ◽

2019 ◽

Vol 100 (2) ◽

pp. 351-357

Author(s):

S G Izmaylov ◽

M G Ryabkov ◽

A E Leont’ev ◽

V V Beschastnov ◽

A G Izmaylov ◽

...

Keyword(s):

Postoperative Complications ◽

Wound Closure ◽

Comparison Group ◽

Abdominal Cavity ◽

Clinical Effectiveness ◽

Main Group ◽

Wound Surface ◽

Severity Grade ◽

Mechanical Methods ◽

Complicated Course

Aim. To evaluate the clinical effectiveness of the developed adaptive tools for mechanical treatment of wound surface and suturing of relaparotomy wounds. Methods. 55 patients aged 43 to 79 years after relaparotomy operated on for various acute surgical diseases of the abdominal cavity were treated. In the main group (n=22. average age 63.5±4.75 years) in uncomplicated and complicated course of the wound process after relaparotomy for treatment of the wound surface and wound closure, adaptive tools were used as proposed by the authors. In the comparison group (n=33, average age 62±6 years; p=0.98) traditional mechanical methods of wound defect sanation and wound suturing (simple nodal, 8-shaped and U-shaped sutures) were used. Monitoring of relaparotomy wound healing was performed using an ultrasound method. The analysis of postoperative local complications in the discussed groups of patients was carried out according to Clavien-Dindo classification. Results. In patients of the main group, the multiplicity of wound surface treatment decreased by 1.8 times compared to the comparison group. There were no cases of damage to the underlying tissues of the wound edges. Wound postoperative complications corresponded to severity grade I, II, and IIIa according to Clavien-Dindo classification: in the main group - 27.3% and in the comparison group - 54.5%. Suppuration occurred respectively in 9.1 and 33.3% of patients (p=0.049). Conclusion. The developed adaptive tools are safe and effective mechanical means of prevention of wound postoperative complications after relaparotomy.

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Clinical justification of the device for the prevention of post-operating eventration

Clinical anatomy and operative surgery ◽

10.24061/1727-0847.19.1.2020.13 ◽

2020 ◽

Vol 19 (1) ◽

pp. 78-83

Author(s):

I. K. Morar

Keyword(s):

Postoperative Complications ◽

Postoperative Period ◽

Malignant Tumors ◽

Abdominal Cavity ◽

Surgical Techniques ◽

Early Postoperative Period ◽

Main Group ◽

Abdominal Pressure ◽

Non Invasive ◽

Significant Difference

Postoperative surgery is one of the most dangerous complications, especially in patients with malignant tumors of the abdominal cavity, where secondary immunodeficiency, cachexia, anemia, etc. occur. Today, there are many ways to prevent postoperative surgery in patients at high risk for this complication, but all of them, along with their advantages, have a number of disadvantages that greatly limit their use. Developing an effective, non-invasive device for preventing postoperative surgery may to some extent solve this problem. The purpose of the study is to substantiate the effectiveness of the device for the prevention of postoperative events, by studying the frequency of development of postoperative complications in patients with malignant tumors of the abdominal organs. Material and methods. We have proposed a device for the prevention of postoperative surgery, the use of which does not require additional surgical techniques during surgery, and also allows the use of the latter in the event of the incomplete (subcutaneous) event (patent No. 120209 from 25.10.2017). The device consists of 5 soft plates lined with soft cloth and connected to each other by the widest parts. The central plate is adjustable depending on the width of the back surface of the patient's torso. The two side plates at the free edges have 11 lacing loops. To substantiate the effectiveness of the use of this device, we investigated 107 operated patients with malignant tumors of the abdominal cavity. The comparison group consisted of 60 people who did not use the proposed device. The main group consisted of 47 patients who used the above device in the early postoperative period. Results of the study and their discussion. The results obtained indicate a significant predominance of the incidence of postoperative events in patients in the main group. It should be noted that there is no significant difference in the frequency of development of "systemic" and other "local" postoperative complications between the two study groups of patients, which indicates the representativeness of the sample since "local" postoperative complications lead to the development of eventration. Patients in the main group, starting from day 2 after surgery, had a markedly lower intra-abdominal pressure during the first 12 days of the early postoperative period. Conclusion. The use of the proposed device for the prevention of postoperative surgery allows a non-invasive way to prevent the development of the latter, as well as the occurrence of the incomplete event to prevent the development of full, without significantly affecting the level of intra-abdominal pressure, compared with conventional use of the bandage.

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Diagnosis and treatment of anterior abdominal wall ligature fistulas

Kazan medical journal ◽

10.17750/kmj2016-204 ◽

2016 ◽

Vol 97 (2) ◽

pp. 204-207 ◽

Cited By ~ 1

Author(s):

A G Izmaylov ◽

S V Dobrokvashin ◽

D E Volkov ◽

V A Pyrkov ◽

R F Zakirov ◽

...

Keyword(s):

Abdominal Wall ◽

Comparison Group ◽

Anterior Abdominal Wall ◽

Abdominal Cavity ◽

Main Group ◽

Wound Complications ◽

Control Group ◽

Absorbable Suture ◽

Wound Debridement ◽

Complications Rate

AIM. To improve treatment results of patients with ligature fistulas of the anterior abdominal wall by the development of pyo-inflammatory wound complications diagnosis and prevention methods.METHODS. During the period from the beginning of 2001 to June, 2015, 34 patients with a ligature fistulas of the anterior abdominal wall were admitted to the Department of Surgery of Hospital for War Veterans, Kazan. Terms of ligature fistula occurrence ranged from 3 months to 5.5 years after surgery. 7 (20.6%) patients previously underwent herniotomy, 20 (58.8%) - laparotomy for various acute surgical diseases of the abdominal cavity, 2 (5.9%) - appendectomy, 5 (14.7%) - pelvic organs surgery. The patients mean age was 59±4.5 years. Patients were divided into two groups: the first - the comparison group, 23 (67.6%) patients. In this group suturing was performed with polypropylene or absorbable suture filaments, wound debridement was performed by the conventional technique using different antiseptics types: 0.5% chlorhexidine (chlorhexidine bigluconate) and 3% hydrogen peroxide solutions. The second group - the main one, included 11 (32.4%) patients. In this group polyglycolide-co-lactide (purple), USP 2/0 (3 Matric) 75 cm with the atraumatic tip suture materials were used and the wound debridement was performed with 10% aqueous hydroxyethyldimethyldihydropyrimidin (xymedon) solution using a device developed by us.RESULTS. The postoperative pyo-inflammatory complications rate in the control group was 17.4% (4 cases), in the main group - 9.1% (1 case); thereby infiltrates were registered in 3 patients of comparison group and in 1 patient of main group, seroma - in 1 patient of comparison group. Monoculture was isolated in microbiological assay of material from the surgical wounds in 86% of patients. Staphylococci, enterobacteria and non-fermentative Gram-negative bacteria were detected most often. Our results of microbiological assays point to the need for perioperative antibiotic prophylaxis.CONCLUSION. The infectious wound complications rate when using conventional methods of anterior abdominal wall ligature fistulas prevention and treatment is 17.4%, which makes it relevant to search for new methods of treatment and wound surface debridement; the author’s technique offered by us allowed to significantly reduce the wound complications rate.

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METHOD OF STOMA FORMATION IN PATIENTS WITH ACUTE INTESTINAL OBSTRUCTION

Ulyanovsk Medico-biological Journal ◽

10.34014/2227-1848-2021-1-98-104 ◽

2021 ◽

pp. 98-104

Author(s):

A.L. Charyshkin ◽

E.A. Keshyan

Keyword(s):

Intestinal Obstruction ◽

Postoperative Period ◽

Comparison Group ◽

Abdominal Cavity ◽

Early Postoperative Period ◽

Main Group ◽

Acute Intestinal Obstruction ◽

Control Group ◽

Drain Tube ◽

Stoma Formation

Surgery is the main method to treat obstructive intestinal obstruction. Stoma formation is desirable in emergency colon surgery. The aim of the study was to compare the results of the newly developed and traditional stoma formation techniques according to the number of wound purulent-inflammatory complications in the early postoperative period in patients with acute intestinal obstruction. Materials and Methods. The authors examined 62 patients with acute intestinal obstruction. The patients were divided into two groups according to the method of stoma formation. The comparison group consisted of 30 patients, who underwent traditional colostomy after obstructive resection of the sigmoid colon (rectosigmoid part of the colon). The main group included 32 patients in whom a stoma was formed using a newly developed method (patent No. 2704477). In patients of the main group, the paracolostomy space was isolated from the abdominal cavity, the preperitoneal and subgaleurotic zones of the paracolostomy space were drained. During the postoperative period local anesthetics and antibacterial drugs were administered through the drain tube. Results. Patients of the comparison group demonstrated more purulent-inflammatory complications of the median postoperative and paracolostomy wounds than those of the control group, 20.2 % (p=0.047) and 23.6 % (p=0.024), respectively. Conclusion. The proposed method of stoma formation helps to reduce wound purulent-inflammatory complications and can be used in the surgical treatment of patients with intestinal obstruction. Keywords: colon cancer, acute intestinal obstruction, postoperative complications, new method of stoma formation. Основным методом лечения обтурационной кишечной непроходимости является оперативное вмешательство. В экстренной хирургии толстого кишечника показано формирование колостомы. Цель исследования – сравнение результатов применения разработанной и традиционной методик наложения колостомы по количеству раневых гнойно-воспалительных осложнений в раннем послеоперационном периоде у больных с острой обтурационной кишечной непроходимостью. Материалы и методы. Клинический материал составили 62 пациента с острой обтурационной кишечной непроходимостью, которые в зависимости от способа формирования колостомы были разделены на две группы. Группу сравнения составили 30 больных, у которых после обструктивной резекции сигмовидной кишки (ректосигмоидного отдела ободочной кишки) выполняли традиционное наложение колостомы. В основную группу были включены 32 пациента, у которых колостома наложена разработанным способом (патент № 2704477). Суть способа состоит в изоляции от брюшной полости параколостомического пространства, дренировании предбрюшинной и подапоневротической зоны параколостомического пространства, введении местных анестетиков, антибактериальных препаратов по дренажу в послеоперационном периоде. Результаты. В группе сравнения гнойно-воспалительных осложнений срединной послеоперационной и параколостомической ран было больше, чем в контрольной группе, на 20,2 % (р=0,047) и 23,6 % (р=0,024) соответственно. Выводы. Предложенный способ формирования колостомы способствует снижению раневых гнойно-воспалительных осложнений и может быть использован в хирургическом лечении больных с обтурационной кишечной непроходимостью. Ключевые слова: рак ободочной кишки, острая обтурационная кишечная непроходимость, послеоперационные осложнения, оригинальный способ формирования колостомы.

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