scholarly journals Abdominal adhesions: Surgical treatment and prevention (literature review)

2021 ◽  
Vol 16 (1) ◽  
pp. 43-49
Author(s):  
Dmitry Kluiko ◽  
◽  
Vladimir Korik ◽  
Alexey Sivets ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Intestinal Obstruction ◽  
Abdominal Cavity ◽  
Adhesion Formation ◽  
Recurrent Abdominal Pain ◽  
Early Postoperative Period ◽  
Pulmonary Complications ◽  
Important Place ◽  
Treatment And Prevention ◽  
Significant Difference

The ongoing discussion on the diagnosis and tactics of surgical treatment of painful forms of adhesions of the abdominal cavity and adhesive intestinal obstruction testifies to the persistent urgency of this problem. The presence of a postoperative scar and recurrent abdominal pain are interpreted by surgeons and gastroenterologists as adhesive disease, with the appointment of the same type of treatment. At the same time, patients have a reduced critical attitude to their condition, which leads them to late seeking medical help. For the occurrence of the adhesion process, a long-term effect of a complex of factors is necessary, an important place among which is blood supply, oxygen access to tissues and peristalsis in the early postoperative period. The most effective methods of treatment and prevention of intestinal obstruction are low-traumatic surgical technologies. There was no statistically significant difference between open and laparoscopic adhesiolysis in the number of intraoperative intestinal injuries, wound infections and mortality. Laparoscopic operations have fewer general and pulmonary complications than open ones. Reducing fibroblast proliferation, minimizing hypoxia and inflammation are a new preventive solution to the problem of adhesion formation.

Comparison of the Effectiveness of Mitomycin-C and Viscoat on Delayed Adjustable Strabismus Surgery in Rabbits

2005 ◽  
Vol 15 (5) ◽  
pp. 530-535 ◽  
Author(s):  
Y. Cengiz ◽  
Ö. Altintas ◽  
G. Manav Ay ◽  
Y. Çaglar
Keyword(s):  
Mitomycin C ◽  
Chondroitin Sulphate ◽  
Adhesion Formation ◽  
Sodium Hyaluronate ◽  
Rectus Muscle ◽  
Strabismus Surgery ◽  
Early Postoperative Period ◽  
Group V ◽  
Significant Difference ◽  
Group 6

Purpose To determine a way to prevent the formation of adhesions and delay the time of suture adjustment in the course of adjustable strabismus surgery, an animal study was performed to assess and compare the effects of mitomycin C (Mit-C) and viscoelastic material Viscoat (sodium hyaluronate 3% and chondroitin sulphate 4%, Alcon, Fort Worth, TX). Methods Right eyes of 47 rabbits were divided into three groups. After recession of the superior rectus muscle (SRM), Mit-C was administered beneath and over the SRM in Group M (16 eyes), Viscoat was administered beneath and over SRM in Group V (16 eyes), and ringer lactate was administered in Group C (15 eyes). SRM then recessed 5 mm with adjustable strabismus surgery technique. Animals in each group were subdivided into 1 and 2, where 1 = adjustment 1 week postoperatively and 2 = adjustment 3 weeks postoperatively. Delayed adjustment was performed in M1 group (6 eyes), V1 group (6 eyes), and C1 group (7 eyes) after 1 week; in M2 group (6 eyes), V2 group (6 eyes), and C2 group (6 eyes) after 3 weeks. Histopathologic examinations were performed for the remaining 10 eyes without suture adjustment at the end of first and third weeks after adjustable strabismus surgery. The possible length and the necessary force to adjust and the degree of adhesions were recorded. Results When length and strength of the adjustment, adhesions between muscle and sclera, and adhesions between muscle and conjunctiva were taken into consideration, there was no statistically significant difference among M, V, and C groups at postoperative weeks 1 and 3. The force needed for adjustment in M1 group was statistically lower than M2 group. Conclusions The intraoperative use of Mit-C (0.4 mg/mL) may decrease adhesion formation in the early postoperative period, especially in the first week. The intraoperative use of Viscoat was not effective in reducing postoperative adhesions and delaying adjustment.

scholarly journals The role of bacteriophages in the complex treatment of peritonitis of appendicular origin (experimental study)

2017 ◽  
Vol 10 (4) ◽  
pp. 265-268
Author(s):  
Evgeny Mikhailovich Mokhov ◽  
Artem Mikhailovich Morozov ◽  
Victor Alekseevich Kadykov ◽  
Elshad Magomedovich Askerov ◽  
Nina Evgenievna Serova
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Acute Appendicitis ◽  
Intraperitoneal Injection ◽  
Abdominal Cavity ◽  
Experimental Studies ◽  
Morphological Data ◽  
White Rats ◽  
Single Intraperitoneal Injection ◽  
Significant Difference

Relevance: with the management of laparoscopic methods of surgical treatment of acute appendicitis, the problem of the occurrence of early postoperative complications has not changed at present, which makes it necessary to carry out preventive measures. Objective: to study the possibility of improving the results of surgical treatment of peritonitis, the most frequent complication of acute appendicitis, by reducing the number of postoperative complications of infectious genesis. Methods: Studies were performed on 47 non-linear white rats weighing 200-250 grams by modelling peritonitis using the biological model as an example, followed by antibiotic therapy and combination therapy using bacteriophages. To model peritonitis, the infection of the abdominal cavity with the E. coli strain 25922 was used. The laboratory animals were divided into 3 groups: the first group was control group, the second group received treatment in the form of a single intraperitoneal injection of Cefipime, the third group received treatment as a single intraperitoneal injection of the Sextapage. Results: the evaluation of the methods was carried out on the basis of the study of the clinical picture of the course of peritonitis in experimental animals, the data of pathomorphological and histological examination of the sectional peritoneum. As a result of experimental studies, there was no significant difference in the methods of perioperative prevention of complications of acute appendicitis, which makes it possible to perform monotherapy with bacteriophages. Phages in comparison with antibiotics have no less therapeutic efficacy. Conclusions: Thus, our experimental studies revealed completely satisfactory results of monotherapy of experimental peritonitis with a bacteriophage. According to the morphological data, the inflammatory process in the abdominal cavity is stopped by the phage fast enough and there is a tendency for a faster fading of the inflammation than in the treatment with antibiotics.

scholarly journals DIAGNOSTICS AND COMPLEX TREATMENT OF ADGHESIVE INTESTINAL OBSTRUCTION

2019 ◽  
pp. 59-62
Author(s):  
V. B. Bоrisenko ◽  
А. М. Kovalev
Keyword(s):  
Polyethylene Glycol ◽  
Surgical Treatment ◽  
Intestinal Obstruction ◽  
Clinical Laboratory ◽  
Hypotonic Solution ◽  
Polyethylene Glycol 4000 ◽  
Treatment And Prevention ◽  
Ultrasound Diagnostics ◽  
Adhesive Intestinal Obstruction ◽  
Adhesive Obstruction

Summary: Develop a comprehensive program for the diagnosis, treatment and prevention of intestinal adhesive obstruction.  Analyzed the results of diagnosis and treatment of 60 patients with acute adhesive intestinal obstruction. The diagnostic program included clinical, laboratory, X-ray and ultrasound diagnostics. Local barrier prevention of peritoneal adhesive disease was performed with a solution of polyethylene glycol 4000 according to the method developed by us. Conservative therapy was effective in 19 (31.7%) cases. 41 (68.3%) patients with a progression of adhesive ileus were operated. Laparoscopic adheolysis was performed in 4 (9.8%) patients. In 37 (90.2%) cases, surgical treatment was performed in the traditional method. The proposed diagnostic and treatment program with priority use of ultrasound diagnostics allows in a short time to establish a detailed diagnosis of adhesive intestinal obstruction and to determine the indications for surgical treatment. Intraoperative use of hypotonic solution polyethylene glycol 4000 allows to reliably prevent the development of peritoneal adhesive disease and adhesive obstruction.

scholarly journals COMPARISON OF DIAGNOSTIC METHODS AND TREATMENT OF ENDOMETRIOSIS OF ATYPICAL LOCATION

2018 ◽  
Vol 5 (3) ◽  
pp. 157-163
Author(s):  
D. D Shlyk ◽  
Yury E. Kitsenko ◽  
D. R Markaryan ◽  
V. I Lanchinskiy ◽  
I. A Tulina ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Malignant Neoplasm ◽  
Early Postoperative Period ◽  
Diagnostic Methods ◽  
Reproductive Age ◽  
Treatment Technique ◽  
Intravenous Contrast ◽  
Preoperative Stage ◽  
Extragenital Endometriosis

Surgical treatment and subsequent management of women of reproductive age with endometriosis of extragenital localization involving intestine, whose frequency is up to 37%, currently do not have a detailed and clearly described protocol, which may be caused by the complexity of diagnosis at the preoperative stage. In most cases, extragenital localization is an intraoperative finding. The purpose of the article is to evaluate the complexity of diagnosing the atypical location of extragenital endometriosis, systematize the diagnostic protocol and present the chosen treatment tactics. Material and methods. In the clinic of coloproctology and minimally invasive surgery, 4 observations of extragenital endometriosis with intestinal lesions were noted. According to the results of diagnostic studies (multispiral computed tomography - MSCT of the abdominal cavity with intravenous contrast, irrigoscopy with double contrasting, colonoscopy with biopsy), endometriosis was confirmed in 2 patients at the preoperative stage. All patients underwent surgical interventions in the volume of resection of the affected segment of the intestine within the unchanged tissues. Results. According to the intraoperative revision, in all patients there was noted the presence of additional extragenital foci of different localization, which were destroyed by diathermocoagulation. Patients with unverified endometriosis also underwent lymphadenectomy in D2 volume due to the inability to exclude malignant neoplasm. In the early postoperative period, no complications were noted. Only 1 patient decided to take hormonal therapy for 6 months after the operation. At present, none of the relapses have been observed, the mean follow-up time is 17.3 ± 13.6 months (4-33 months). In all patients there was recovered the menstrual cycle, menstruation moderately painful, previous abdominal pains before menstruation and spotting discharges from the rectum stopped. Conclusion. Surgical treatment of extragenital endometriosis of intestinal localization in the volume of resection of the affected intestine within the unchanged tissues is the optimal treatment technique and is not accompanied by significant complications. However, in cases of unverified histologically endometriosis, principles of oncological radicalism should be kept. To select the optimal volume of surgical intervention and access, a multidisciplinary consultation with the coloproctologist, gynecologist and with the obligatory consideration of the patient’s opinion is required.

scholarly journals BIOMATERIALS BASED ON CHITOSAN AND ITS DERIVATIVES TO PREVENT ADHESION FORMATION

2021 ◽  
Vol 26 ◽  
pp. 11-22
Author(s):  
Mariya Konovalova ◽  
◽  
Daria Tsaregorodtseva ◽  
Elena Svirshchevskaya ◽  
Keyword(s):  
Quality Of Life ◽  
Intestinal Obstruction ◽  
Abdominal Cavity ◽  
Adhesion Formation ◽  
Reproductive Function ◽  
Postoperative Adhesions ◽  
Surgical Interventions ◽  
Adhesion Process ◽  
Mechanisms Of Adhesion

An increase in the number and volume of surgical interventions leads to an increase in the frequency of postoperative adhesions. The development of the adhesion process in the abdominal cavity causes pain, a decrease in the quality of life of patients, a violation of the reproductive function of women as well as acute adhesion intestinal obstruction. Recently, polymer biomaterials, including those based on chitosan, have been widely used for the prevention of adhesions. Due to their biocompatibility and biodegradation ability, they do not require repeated operations to extract the material. It is believed that these materials act as barriers, physically separating the damaged surfaces. The molecular mechanism of their action is still poorly understood. In this review, the main mechanisms of adhesion formation, as well as ways to prevent them with the help of materials based on chitosan and its derivatives, are discussed.

scholarly journals Laparoscopic dissection in children with celiac artery compression syndrome

2021 ◽  
Vol 11 (2) ◽  
pp. 131-140
Author(s):  
Razhab A. Zainulabidov ◽  
Alexander Y. Razumovsky ◽  
Zorikto B. Mitupov ◽  
Galina Y. Chumakova
Keyword(s):  
Abdominal Pain ◽  
Surgical Treatment ◽  
Clinical Symptoms ◽  
Abdominal Cavity ◽  
Treatment Success ◽  
Celiac Trunk ◽  
Early Postoperative Period ◽  
Median Arcuate Ligament ◽  
Flow Measurements ◽  
Arcuate Ligament

BACKGROUND: A cause of abdominal pain in children may be compression stenosis of the celiac trunk (Dunbars syndrome). This disease occurs when the median arcuate ligament of the diaphragm compresses the celiac trunk, thereby creating compression stenosis, causing the arterial hemodynamics in the artery to suffer and provide adequate blood circulation to the abdominal cavity organs. Medical statistics indicate that 10% to 15% of children and adolescents suffering from chronic abdominal pain have compression stenosis of the celiac trunk. AIM: This study aims to improve the diagnostic results and identify the indications for the surgical treatment of children with compression stenosis of the celiac trunk. MATERIALS AND METHODS: From 2015 to 2020 at the N.F. Filatov Childrens Hospital, 64 patients, aged 4 to 17 years underwent surgical treatment for compression stenosis of the celiac trunk. There are 42 boys (66%) and 22 girls (34%). The leading clinical manifestation in all patients was abdominal pain. Associated surgical pathology was observed in 34 of them. The diagnosis was based on anamnesis, examination, ultrasound examination with Doppler and celiac trunk blood flow measurements, multispiral computed tomography, and angiography. RESULTS: After completing the examination, 61 patients underwent laparoscopic decompression of the celiac trunk, and three children were operated on using the laparotomic approach. In all cases, the leading cause of compression stenosis of the celiac trunk was the median arcuate ligament of the diaphragm combined with the neurofibrous tissue of the celiac plexus. The average duration of the operation was 50 minutes. Intraoperative blood loss did not exceed 530 ml. One conversion completed. There were no postoperative complications in the early postoperative period. The patients were discharged in satisfactory condition. The control examination was conducted in the period from six months to three years. In 97% of patients, clinical symptoms of abdominal ischemia were not detected. CONCLUSION: Our experience indicates the possibility of diagnosing compression stenosis of the celiac trunk in children at early disease stages and laparoscopic treatment success of patients with this disease.

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

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.

scholarly journals Bile leak syndrome after laparoscopic cholecystectomy

2019 ◽  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Treatment ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Minimally Invasive ◽  
Abdominal Cavity ◽  
Bile Leak ◽  
Bile Leakage ◽  
Early Postoperative Period ◽  
Type I

Aim of the study was the assasement of surgical treatment results of patients with cholelithiasis, who had external or internal bile leakage (BL), for the optimization and improvement of diagnostic programme and surgical tactic of minimally invasive techniques usage. Materials and methods. Results of surgical treatment during the early postoperative period of patients with cholelithiasis, who underwent laparoscopic cholecystectomy (LC) were analysed. Results. In early post-operative period 67 (0,6%) patients, mean aged 56,9 ± 7,4 had BL. 54 (81,0%) of them were women, 13 (19,0%) were men. 21 (31,3%) patients underwent LC due to chronic cholecystitis, 46 (68,7%) patients had acute cholecystitis. In 54 (81,0%) cases there was drainage bile leakage, in 13 (19,0%) cases bile collection in abdominal cavity was identified several days after drains ejection, due to clinical manifestation and ultrasonography data. 23 (34,3%) patients were treated conservatively. Minimally invasive endoscopic manipulations, ultrasonography controlled percutaneous drainage and relaparotomy were effective in 35 (52,2%) patients, 9 (13,4%) patients underwent laparotomy with following surgical correction of BL. These patients had dense perivesical infiltrates, Mirizzi’s syndrome type I. 6 (9,0%) patients underwent laparotomy, abdominal cavity sanation and drainage. In 1 (1,5%) case partial right bile duct injury was identified, defect suturing and Vishnevsky common bile duct drainage. In 2 (3,0%) cases the cause of BL was more than 2/3 diameter injury of common bile duct. These patients underwent Roux-en-Y hepaticojejunostomy. Conclusion. Installation of drainage into the hepatic space and the right flank provide early diagnosis of postoperative complications, one of which is bile flow syndrome. Ultrasound examination of abdominal organs and endoscopic retrograde cholangiopancretography are performed to determine the cause and localization of the syndrome of the BL syndrome, depending on the volume of the BL. Repeated laparoscopy is indicated for the phenomena of bile peritonitis, significant accumulation of bile in the abdominal cavity. The complex usage of relaparoscopy, transduodenal endoscopic interventions and puncture techniques can significantly reduce the number of laparotomy operations to correct complications.

scholarly journals A CLINICAL CASE OF SURGICAL TREATMENT OF PEPTIC ULCER OF GASTROENTEROANASTOMOSIS

2021 ◽  
Vol 9 (1) ◽  
pp. 101-106
Author(s):  
S.V. Leonchenko ◽  
◽  
V.N. Petyushkin ◽  
A.P. Motin ◽  
A.A. Dyomin ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Surgical Treatment ◽  
Clinical Case ◽  
Abdominal Cavity ◽  
Decisive Role ◽  
Pain Syndrome ◽  
Gastric Surgery ◽  
Early Postoperative Period ◽  
Actual Problem ◽  
Long Time

In the article a clinical case of surgical treatment of peptic ulcer of gastroenteroanastomosis complicated with perforation and gastrointestinal bleeding, is described. The patient was observed with the diagnosis: cholelithiasis, chronic calculous cholecystitis, for which planned laparoscopic cholecystectomy with draining of the abdominal cavity was performed. According to the discharge record, the operation ran without peculiarities. Later the patient was rehospitalized with complaints of weakness, nausea, vomiting, pain in the upper parts of the abdomen; he was diagnosed with ulcer of gastroenteroanastomosis and continuing bleeding that were indications for the surgical intervention for life-saving indications. From the patient words, a part of the stomach was resected more than 20 years before for gastric ulcer. Until the latest time, the patient felt satisfactory, but within 6 months pain in the abdomen reappeared, however, on examination cholelithiasis was identified, and the pain syndrome was attributed to this pathology. Assumably, after the first operation performed in 1995, a complication developed in the early postoperative period in the form of obstruction of gastroenteroanastomosis (anastomositis?), and additional gastroenteroanastomosis was applied. Conclusion. Peptic ulcer of anastomosis is an actual problem of the gastric surgery which may not only appear long time after the operation, but may give the same complications as «essential» peptic ulcer, and really threaten the life of patients. It should be noted that in some cases the intraoperative picture, experience and sensations of a surgeon play a decisive role in the diagnosis of surgical pathology even if they differ from the data of additional methods of examination.

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