scholarly journals Acute Appendicitis: Approaches to Complex Surgical Treatment in Accordance with the Principles of Multimodal Surgical Strategy (Fast-Track Surgery)

2018 ◽  
Vol 25 (2) ◽  
Author(s):  
Adrian Kvit ◽  
Olexiy Kushniruk
Keyword(s):  
Surgical Treatment ◽  
Acute Appendicitis ◽  
Hospital Stay ◽  
Laparoscopic Appendectomy ◽  
Fast Track ◽  
Pain Syndrome ◽  
Surgical Trauma ◽  
Fast Track Surgery ◽  
Duration Of Hospital Stay ◽  
Response To Stress

The objective of the research was to develop approaches to complex surgical treatment of patients with acute appendicitis taking into consideration the type of surgical approach, perioperative antibiotic therapy, adequate pain relief, duration of inpatient treatment.         Materials and methods. The analysis of complex surgical treatment of the group of patients (31) with acute appendicitis, treated in the surgical departments of Lviv Emergency Hospital during 2017 was performed. The age of patients ranged from 18 to 77 years. There were 13 (41.9%) males and 18 (58.1%) females. Duration of hospital stay from the moment of hospitalization varied from 2 to 13 days. The level of pain sensation in patients was assessed on a 10-point visual analog scale of pain 6, 12 and 24 hours after surgery (with four-step stratification of the received data - absent (0-2), weak (3-4), moderate (5-8), strong (9-10 points). All the patients were divided into two groups using blind envelope technique: Group A included 18 patients, who underwent conventional appendectomy, and Group B comprised 13 patients who underwent diagnostic laparoscopy with the transition to laparoscopic appendectomy if the diagnosis of acute appendicitis was confirmed, or laparoscopic appendectomy was initially performed. The analysis of treatment efficacy was performed taking into account the dynamics of pain relief and the duration of inpatient treatment.         Results and discussion. As a result of the conducted research it was stated that among all the patients examined, catarrhal acute appendicitis was found in 1 (3.2%) case, acute phlegmonous appendicitis was detected in 20 (64.5%) cases, acute gangrenous appendicitis was seen in 7 (22.6%) cases, acute gangrenous appendicitis with perforation and local peritonitis was diagnosed in 3 (9.7%) cases. Conventional appendectomy was performed in 18 cases; laparoscopic appendectomy was used in 13 cases. All the patients received anti-bacterial treatment in the early perioperative period. According to the prospective analysis, pain syndrome at the site of postoperative wounds was found to be present in patients of both groups. The intensity of pain syndrome was significantly lower in patients who underwent laparoscopic appendectomy. The analysis of treating patients with acute appendicitis allows confirming that the introduction of laparoscopic appendectomy into the complex of surgical treatment of patients with acute appendicitis can significantly reduce the body’s response to stress from surgical trauma and pain, speed up recovery due to early activation of the patient and maximally reduce the duration of hospital stay, which definitely corresponds to the modern principles of fast-track surgery.         Conclusions. The use of laparoscopic appendectomy makes it possible to significantly reduce the body’s response to stress from pain and surgical trauma and is an important part of the formation of the patient’s general condition. Complex surgical treatment of patients with acute appendicitis using non-invasive techniques allows shortening the duration of hospital stay (4.62 ± 0.77 days) and reducing the period of disablement. The method of minimally invasive surgical interventions can be considered a “gold standard” for providing medical care to the patients with urgent surgical diseases of the abdominal cavity, which provides an optimal approach to surgical treatment.

BIOCHEMICAL AND PSYCHOSOCIAL ASPECTS OF FAST TRACK SURGERY IN SURGICAL PATIENTS WITH COMORBID METABOLIC SYNDROME IN GYNECOLOGICAL PRACTICE

2020 ◽  
pp. 70-81
Author(s):  
L.N. Gumenyuk ◽  
Z.Z. Khayretdinova ◽  
G.A. Puchkina
Keyword(s):  
Quality Of Life ◽  
Metabolic Syndrome ◽  
Surgical Treatment ◽  
Fast Track ◽  
Complete Recovery ◽  
Surgical Patients ◽  
Controlled Study ◽  
Surgical Trauma ◽  
Fast Track Surgery

The aim of the paper was to study the influence of the Fast Track surgery on the perioperative dynamics of biochemical and psychosocial indicators in surgical patients with comorbid metabolic syndrome in gynecological practice. Materials and Methods. The authors conducted a prospective controlled study of 158 patients aged 18–45 with gynecological pathology requiring surgery and comorbid metabolic syndrome. All the patients underwent surgical treatment. All the patients were divided into two clinical groups according to perioperative management: Group 1 consisted of 82 patients who underwent laparoscopic operations with components of Fast Track surgery; Group 2 contained 76 patients who underwent laparoscopic operations according to the traditional management protocol. The examination of the patients included general surgical, clinical laboratory and psychometric methods. Results. The combined use of laparoscy and the basic methods of Fast Trak surgery helped to reduce the intensity of the endocrine-metabolic response to surgical trauma and the severity of psychoemotional distress, significantly increased the efficiency of surgical treatment and provided an earlier and more complete recovery of physical and psychological components of the quality of life of gynecological patients with comorbid metabolic syndrome. Conclusion. Fast Traсk surgery in laparoscopy in gynecological patients with comorbid metabolic syndrome contributed to an earlier recovery of biochemical markers of surgical stress, inflammatory-immune profile, and endothelium functional state. The psychosocial efficacy of Fast Trak surgery was confirmed by a reduction in hospital stay, earlier and complete recovery of physical and psychological components of patients’ quality of life. Keywords: surgical treatment, gynecological pathology, metabolic syndrome, Fast-Track surgery, neuro-immune-endocrine indicators, quality of life. Цель. Изучение влияния концепции Fast Track surgery на периоперационную динамику биохимических и психосоциальных показателей у пациенток хирургического профиля с коморбидным метаболическим синдромом в гинекологической практике. Материалы и методы. Выполнено проспективное контролируемое исследование 158 пациенток в возрасте от 18 до 45 лет с гинекологической патологией, требующей оперативного вмешательства, и коморбидным метаболическим синдромом, которым проведено хирургическое лечение. В зависимости от тактики периоперационного ведения больные были разделены на две клинические группы: 1-ю составили 82 пациентки, которым выполнены лапароскопические операции с применением компонентов концепции Fast Track surgery; 2-ю – 76 пациенток, которым выполнены лапароскопические операции с применением традиционного протокола ведения. Обследование пациенток включало общехирургический, клинико-лабораторный и психометрический методы. Результаты. Комбинированное применение лапароскопических операций и базовых компонентов мультимодальной концепции Fast Traсk surgery способствует снижению интенсивности эндокринно-метаболического ответа на операционную травму и выраженности психоэмоционального дистресса, значительно повышает эффективность хирургического лечения и обеспечивает более раннее и полноценное восстановление физического и психологического компонентов качества жизни гинекологических больных с коморбидным метаболическим синдромом. Выводы. Применение мультимодальной концепции Fast Traсk surgery при выполнении лапароскопических оперативных вмешательств у гинекологических больных с коморбидным метаболическим синдромом способствуют более раннему восстановлению уровня биохимических маркеров операционного стресса, воспалительно-иммунного профиля и функционального состояния эндотелия. Психосоциальная эффективность мультимодальной концепции Fast Traсk surgery подтверждается сокращением длительности пребывания в стационаре, более ранним и максимально полноценным восстановлением физического и психологического компонентов качества жизни пациенток. Ключевые слова: хирургическое лечение, гинекологическая патология, метаболический синдром, концепция Fast-Track surgery, нейро-иммунно-эндокринные показатели, качество жизни.

scholarly journals Early enteral nutrition in surgical treatment of an acute complicated pancreatitis

2018 ◽  
Vol 85 (9) ◽  
pp. 8-10
Author(s):  
V. P. Andriushchenko ◽  
D. V. Andriushchenko ◽  
V. V. Kunovskyi ◽  
Yu. S. Lysiuk
Keyword(s):  
Surgical Treatment ◽  
Small Bowel ◽  
Enteral Nutrition ◽  
Fast Track ◽  
Early Enteral Nutrition ◽  
Fast Track Surgery ◽  
Blood Leukocytes ◽  
Necrotic Focus ◽  
Rapid Restoration ◽  
Effective Component

Objective. To estimate the efficacy of early enteral nutrition (EEN) in patients with an acute complicated pancreatitis, after determining of its content  and improving the realization methods. Маterials and methods. There were studied the results of EEN in 82 patients, suffering an acute complicated pancreatitis. Two groups of patients were delineated - the main (n=58), in which EEN was included into the complex of treatment in preoperative and postoperative periods, and a comparative one (n=24). For conduction of EEN the probe was put during fibrogastroscopy into jejunum (in 25 patients), while suboperative nasogastrointestinal intubation was performed (in 12), and a jejunostomy in accordance to Witzel procedure was formatted (in 21), what have appeared the most effective procedure and served for realization of the Fast track surgery principles. Results. Nutritious food blends were applied in combination with probiotics and the metabolism correctors. Application of EEN in the patients іn an acute complicated pancreatitis have promoted more rapid restoration of a motor-evacuation function of a small bowel, normalization of levels of the blood leukocytes and proteins, weakening of microstructural changes in mucosa and «clearance» of purulent-necrotic focus. Conclusion. EEN in the patients, suffering an acute complicated pancreatitis constitutes an effective component of surgical treatment in preoperative and postoperative periods.

Treatment of the pilonidal sinus in children using laser radiation

2021 ◽  
Vol 24 (4) ◽  
pp. 32-36
Author(s):  
D. S. Zolotukhin ◽  
I. V. Krochek ◽  
S. V. Sergiyko
Keyword(s):  
Comparative Analysis ◽  
Surgical Treatment ◽  
Hospital Stay ◽  
Pain Syndrome ◽  
Surgical Excision ◽  
Duration Of Surgery ◽  
Invasive Method ◽  
Open Excision ◽  
Interstitial Thermotherapy ◽  
Late Postoperative Period

The work carried out a comparative analysis of the results of surgical treatment of the epithelial-coccygeal course of ECC in 133 children aged 3 to 17 years, using laser-induced interstitial thermotherapy (LIT) and open excision. Comparative analysis was carried out according to the following criteria: duration of surgery, average time of hospital stay, duration of pain syndrome on a 10-point scale (VAS), the presence of complications in the early and late postoperative period. In the main group, the average time of hospital stay was 4.9 ± 0.3; the duration of surgical treatment was 17.2 ± 2.8 minutes. The duration of the pain syndrome was 5.3 ± 2.1 hours, and its severity was 2.7 ± 0.8 points. Average terms of epithelialization of fistulas are 3.1 ± 2.8 days. Recurrence of ECC was observed in 7 patients (11.7%), which required re-intervention. In 3 (5.0%) patients, LIT was used, and in 4 (6.7%), excision using plastics according to the Bascom method. In the comparison group, the duration of surgical treatment was 32.6 ± 5.4 minutes. The duration of inpatient treatment is 16.7 ± 1.4 days. Pain syndrome averaged 71.8 ± 11.9 hours, severity 6.5 ± 2.3 points. The number of relapses was 9 (12.3%), of which 5 (6.8%) children underwent laser treatment, and 4 (5.5%) repeated surgical excision with Bascom with recovery. This technique is an effective and minimally invasive method for treating ECC, which makes it possible to recommend this method for use in pediatric surgical practice.

Changes in Incidence and Management of Acute Appendicitis in Children—A Population-Based Study in the Period 2000–2015

2020 ◽  
Author(s):  
Grith Laerkholm Hansen ◽  
Jakob Kleif ◽  
Christian Jakobsen ◽  
Anders Paerregaard
Keyword(s):  
Acute Appendicitis ◽  
Hospital Stay ◽  
Laparoscopic Appendectomy ◽  
Pediatric Population ◽  
Open Appendectomy ◽  
Postoperative Mortality ◽  
Population Based ◽  
Postoperative Hospital Stay ◽  
Population Based Study ◽  
Registration System

Abstract Introduction Recent studies suggest that the epidemiology and management of appendicitis have changed during the last decades. The purpose of this population-based study was to examine this in the pediatric population in Denmark. Materials and Methods Data were retrieved from the Danish National Patient Registry, the Danish Civil Registration System, and the Statbank Denmark. Patients aged 0 to 17 years diagnosed with appendicitis and appendectomized during the period 2000 to 2015 were included. The primary outcome was the annual incidences of appendicitis. Secondary outcomes were the annual percent of patients with appendicitis having a laparoscopic appendectomy, delay from admission to surgery, length of postoperative hospital stay, and 30-day postoperative mortality. Results A total of 24,046 pediatric cases of appendicitis were identified. The annual incidence steadily declined until 2008 (–29%, all ages) and then remained stable. The surgical approach of choice changed from being open appendectomy in 2000 (97%) to laparoscopic appendectomy in 2015 (94%). Simultaneously, the duration of postoperative hospital stay declined from 41 hours (median) to 17 hours. Delay from admission until surgery did not change during the period. Only one child died within the 30-day postoperative period. Conclusion In accordance with other recent studies from Western countries, we found significant changes in the incidence of acute appendicitis including a decline in all age groups except those below 5 years of age, a shift toward laparoscopic appendectomy, and decreasing time spent in the hospital during the years 2000 to 2015.

scholarly journals A retrospective study on laparoscopic appendectomy versus open appendectomy

2019 ◽  
Vol 6 (4) ◽  
pp. 1144
Author(s):  
P. Senthil Kumar ◽  
S. Edwin Kin’s Raj ◽  
Saranya Nagalingam
Keyword(s):  
Retrospective Study ◽  
Acute Appendicitis ◽  
Hospital Stay ◽  
Laparoscopic Appendectomy ◽  
Operative Time ◽  
Open Appendectomy ◽  
Laparoscopic Approach ◽  
Laparoscopic Group ◽  
Daily Activities ◽  
Early Return

Background: Appendectomy is the most common surgical procedure performed in emergency surgery. Open appendectomy is the “gold standard” for the treatment of acute appendicitis. Laparoscopic appendectomy though widely practiced has not gained universal approval. Our aim is to compare the safety and benefits of laparoscopic versus open appendectomy in a retrospective study.Methods: The study was done as a retrospective study among 387 patients diagnosed with appendicitis for a period of 18 months in the Dept of General Surgery. All patients included were 16 years and above and followed up for 3 weeks. In this study, 130 patients diagnosed as acute appendicitis - underwent open appendectomy and 257 patients diagnosed as sub-acute cases of appendicitis - underwent laparoscopic appendectomy. These two groups (open & laparoscopic) were compared for operative time, length of hospital stay, postoperative pain, complication rate, early return to normal activity.Results: Laparoscopic appendectomy was associated with a shorter hospital stay (around 4.5 days), with a less need for analgesia and with an early return to daily activities (around 11.5 days). Operative time was significantly shorter in the open group (35 mins), when compared with laparoscopic group (around 59 mins). Total number of complications was less in the Laparoscopic group with a significantly lower incidence of post-op pain and complications.Conclusions: The laparoscopic approach is a safe and efficient operative procedure and it provides clinically beneficial advantages over open appendectomy (including shorter hospital stay, an early return to daily activities and less post-op complications).

scholarly journals Foundations for Molecular and Enzymatic Functional Surgery

2018 ◽  
Author(s):  
Ilya Klabukov
Keyword(s):  
Clinical Trials ◽  
Surgical Treatment ◽  
Medical Ethics ◽  
Fast Track ◽  
Modern Concept ◽  
Fast Track Surgery ◽  
Surgical Interventions ◽  
Personalized Approach ◽  
Functional Surgery ◽  
Further Development

This paper presents an approach of molecular and enzymatic surgery for treatment of human diseases, including opportunity for use of systemic biology methods in planning of surgical interventions, possible biological components of a “molecular scalpel”, and problems of standardization, medical ethics and clinical trials of the new pharma-surgical toolbox. In conclusions is proposed to consider of molecular and enzymatic surgery methods as realization of the principles of “functional surgery” and also further development of fast track surgery with attaining the modern concept of a personalized approach to surgical treatment of the patient.

scholarly journals LAPAROSCOPIC APPENDECTOMY;

2019 ◽  
Vol 26 (01) ◽  
Author(s):  
Sajid Malik ◽  
Kamran Zaib Khan ◽  
Iftikhar Ahmad
Keyword(s):  
Hospital Stay ◽  
Laparoscopic Appendectomy ◽  
Operative Time ◽  
Standard Procedure ◽  
Minimal Invasive ◽  
Time Duration ◽  
Duration Of Hospital Stay ◽  
Post Operative Pain ◽  
Scar Mark ◽  
Almost All

Background: Minimal invasive surgery (MIS) is a modern and safe improvement in field of laparoscopic surgery. Single incision laparoscopic appendectomy (SILA) is a major breakthrough in MIS and has become standard procedure for acute appendicitis in place of conventional three port laparoscopic appendectomy (CTLA). Objectives: To see the potential advantages in terms of operative time, duration of hospital stay, post-operative pain and cosmetic results in SILA and CTLA groups. Study Design: Randomized control study. Setting: Department of General Surgery in Allama Iqbal Medical College/ Jinnah Hospital Lahore. Period: July 2016 to June 2017. Materials and Methods: 48 patients were divided in two groups; group SILA (cases) and CTLA (control). Each group comprised 24 patients. All cases were performed by consultant who were competent enough and trained in MIS. Results: We found that there was statistically no difference in operative time (p>0.05) and post-operative pain (p>0.05) of both procedures but statistically significant outcome was observed in duration of hospital stay (p<0.005) and cosmetic result (p< 0.005). Post-operative analgesia usage was same in both groups with similar outcome of control. Surgical wound healed in all patients of both groups without complication but noticeably had shown no scar mark on three months follow up in patients of SILA group. Almost all patients in SILA group were discharged on same day on oral diet. Conclusion: This study showed that results of SILA are better in terms of cosmoses and less duration of hospital stay in the presence of non-significant operative time of two procedures. Staying with promise of minimizing in MIS to SILA, cosmetic satisfaction and minimal hospital stay are its comprehensible advantages.

scholarly journals Acute Appendicitis in Pregnant Women: Our Clinical Experience

2016 ◽  
Vol 39 (6) ◽  
pp. 159 ◽  
Author(s):  
Ahmet Türkan ◽  
Metin Yalaza ◽  
Mehmet Tolga Kafadar ◽  
Gürka Değirmencioğlu
Keyword(s):  
Abdominal Pain ◽  
Surgical Treatment ◽  
Acute Appendicitis ◽  
Pregnant Women ◽  
Laparoscopic Appendectomy ◽  
Open Appendectomy ◽  
Fetal Loss ◽  
University Research ◽  
Lower Quadrant ◽  
Right Lower Quadrant

Purpose: The purpose of this study was to analyse 13 patients who were treated in our clinic due to acute appendicitis during pregnancy. Methods: Records of the patients who received appendectomy with appendicitis diagnosis in our Turgut Özal University Research and Application Hospital between January 2007 and December 2015 have been analyzed retrospectively. Results: Appendectomies were performed on 13 pregnant patients with an acute appendicitis diagnosis. Average age of the patients was 27.69 years (between 22-37 years). Most frequent complaint of the patients was abdominal pain and most frequent examination finding was tenderness at right lower quadrant. Ultrasonography was used in all cases for diagnosis. Surgery was decided with clinical diagnosis for five cases (38.5%) where appendix had not been identified with ultrasonography. While laparoscopic appendectomy was applied in one case (7.7%) and open appendectomy was applied using a McBurney incision in 12 cases (92.3%). Average hospitalization duration was 1.69 days. All patients were tracked together through the Gynaecology Department for two weeks after they had been discharged from the hospital. Preterm delivery, maternal and fetal loss did not occur. Conclusion: It is considered appropriate to apply ultrasonography routinely to all pregnant patients in whom acute appendicitis is suspected. Concern for maternal or fetal complication that may occur in consequence of an unnecessary surgery should not be at a level that will delay surgical treatment needed by the patient.

scholarly journals Study of laparoscopic appendectomy: advantages, disadvantages and reasons for conversion of laparoscopic to open appendectomy

2017 ◽  
Vol 4 (3) ◽  
pp. 993
Author(s):  
Sujan Narayan Agrawal ◽  
Sunita Meshram ◽  
Kamlesh Dhruv
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Laparoscopic Appendectomy ◽  
Open Appendectomy ◽  
Laparoscopic Approach ◽  
Normal Activity ◽  
Organ Injury ◽  
Cross Sectional ◽  
Duration Of Hospital Stay ◽  
Duration Of Surgery

Background:Good outcome has been reported with the laparoscopic approach in uncomplicated appendicitis, but a higher incidence of postoperative intraabdominal abscesses has been reported after laparoscopic appendectomy in complicated appendicitis. Objective was to study the efficacy of laparoscopic appendectomy.Methods: A Hospital based cross sectional study was carried out among of 302 patients. The study duration was from June 2004 to December 2006. Institutional Ethics Committee permission was obtained. Informed individual consent was taken. Out of 302 subjects, 236 underwent open appendectomy and 66 underwent laparoscopic appendectomy.Results:It was observed that in both the groups majority patients had retrocecal position of the appendix. The amount of blood loss, adjacent organ injury and duration of surgery were similar in both the groups. The difference in the incidence of wound infection in both groups was not found to be statistically significant. But the antibiotic use was significantly less in the LA group compared to OA group. It was found that time to resumptions of oral fees, duration of hospital stay and time to return to normal duties were significantly lesser in LA group compared to OA group. (p < 0.001). As per the cosmetic end result, majorities were satisfied in LA group and rated the surgery as excellent as compared to patients in OA group.Conclusions:Laparoscopic appendectomy was better than open appendectomy with respect to wound infection, tackling co-existing pathology, duration of hospital stay, earlier return to normal activity, excellent cosmetic end result, lesser use of antibiotics and earlier resumption of oral feeds.

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