scholarly journals Complications of Acute Acetabular Fractures Surgical Treatment: Systematic Review

2021 ◽  
Vol 27 (2) ◽  
pp. 144-155
Author(s):  
A. I. Kolesnik ◽  
N. V. Zagorodniy ◽  
A. A. Ochkurenko ◽  
A. F. Lazarev ◽  
E. I. Solod ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Femoral Head ◽  
Sciatic Nerve ◽  
Intraoperative Complications ◽  
Surgical Approaches ◽  
Acetabular Fractures ◽  
Aseptic Necrosis ◽  
Superior Gluteal Artery ◽  
Duration Of Surgery

Background.The combination of classical anterior and posterior approaches, as well as their modifications, is recognized as the most effective in acetabular fractures surgical treatment. The use of classical and modified approaches is accompanied by  serious  intra-  and  postoperative  complications  associated  primarily  with  the  duration  of  surgery,  significant  blood loss, tissue trauma, surgical site infection. The aim of review — to determine the main and most frequent complications associated with surgical approaches to the acetabulum. material and methods. Access to literature sources is carried out in the information systems and databases PubMed/Medline, Embase, Scopus, Сochran Library, eLibrary, Wiley Online Library. Keywords: acetabular fractures, surgical treatment, approach to the acetabulum, total hip replacement.Results. The most common intraoperative complications are incorrect fragments reduction, sciatic nerve injury, less often — intraarticular implant position, damage to the superior gluteal artery and other vessels, among the early postoperative complications - wound infection, both superficial and deep, less often — venous thrombosis. Late postoperative complications are mainly represented  by  the  development  of  heterotopic  ossification,  post-traumatic  coxarthrosis,  less  often  revealed  aseptic necrosis of the femoral head, residual protrusion and secondary femoral head lesion. Conclusion. The main approach to the acetabulum are the ileo-inguinal and the Kocher-Langenbeck approach, as well as their combination.Complications were more common using two approaches, especially in cases of simultaneous use. The main intraoperative complications are the sciatic nerve and the superior gluteal artery injury with posterior approaches, the femoral lateral cutaneous nerve with expanded ilio-femoral approach, and the obturator nerve with anterior approaches.

Potentialities of Surgical Treatment for Acetabular Fractures Using Low-Invasive Techniques

2009 ◽  
Vol 16 (2) ◽  
pp. 3-9
Author(s):  
Eduard Ivanovich Solod ◽  
A F Lazarev ◽  
A A Lazarev ◽  
Ya G Gudushauri ◽  
M G Kakabadze ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Femoral Head ◽  
Invasive Surgery ◽  
Surgical Approach ◽  
Acetabular Fractures ◽  
Aseptic Necrosis ◽  
Social Rehabilitation ◽  
Bone Fragments ◽  
Invasive Techniques ◽  
Percutaneous Osteosynthesis

Original technique of percutaneous osteosynthesis was applied for the treatment of 24 patients with acetabular columns fractures. The achieved results were compared to the results of osteosynthesis performed using open direct reposition of bone fragments (39 patients). The efficacy of low-invasive surgery in acetabular column fractures with regard to provision of fragments consolidation, prevention of femoral head aseptic necrosis development and achievement of early medical and social rehabilitation of patients was showed. Maintenance of fragments blood supply, use of minimal surgical approach and closed reposition are considered to be the progressive direction of internal osteosynthesis development.

Determination of Indications to Surgical Treatment and Choice of Surgical Approaches in Complicated Complex Acetabular Fractures

2010 ◽  
Vol 17 (4) ◽  
pp. 30-37
Author(s):  
A V Beletskiy ◽  
A I Voronovich ◽  
Aleksandr Eduardovich Murzich ◽  
A V Beletskiy ◽  
A I Voronovich ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Internal Fixation ◽  
Surgical Approaches ◽  
Acetabular Fractures ◽  
Treatment Results ◽  
Complex Fractures ◽  
Comminuted Fractures ◽  
Simultaneous Use

Experience in surgical treatment of 65 patients with complex fractures of the acetabulum is presented. All patients underwent open reposition with internal fixation of fragments by reconstructive plates. Basic moments of the performance of portals to acetabulum, steps of reposition and fixation in multi-segment comminuted fractures are described. Algorithm for determination of indications to surgical treatment of complex acetabular fractures was determined. Clinical and roentgenologic results were studied at terms from 1 to 9 years. Excellent results were established in 39.5%, good and satisfactory in 34.9%, poor in 25.6% of patients. It was shown that in complex bi-columned fractures the technique of open osteosynthesis was the most effective when used within the first 3 weeks after injury. Simultaneous use of anterior and posterior accesses considerably facilitated the performance of reposition and stabilization of multi-segment comminuted fractures and enabled to achieve favorable treatment results.

scholarly journals INCREASING SAFETY OF SURGICAL INTERVENTIONS IN PATIENTS WITH VENTRAL AND INCISIONAL HERNIA UNDER COMORBIDITY CONDITIONS WHEN PERFORMING DIFFERENT TYPES OF OPEN HERNIOPLASTY

2020 ◽  
pp. 135-139
Author(s):  
V. I. Piatnochka ◽  
I. Ya. Dziubanovskyi ◽  
A. M. Prodan
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Abdominal Wall ◽  
Ventral Hernia ◽  
Polypropylene Mesh ◽  
Immunosuppressive Agents ◽  
Technical Improvement ◽  
Surgical Interventions ◽  
Duration Of Surgery ◽  
Ventral Hernias

Abstract. In the period from 2001 to 2017, 1419 patients with ventral and postoperative ventral hernia were operated on. The unsatisfactory results of the surgical treatment of this pathology were due to a number of disadvantages: the choice of an inadequate method of hernioplasty in a specific clinical situation, an incomplete revision of the muscle-aponeurotic layer of the anterior abdominal wall, especially in patients with postoperative veterinary hernias, concomitant syndrome of undifferentiated connective tissue dysplasia and obesity, and weak points, the wrong choice of the type of mesh implant (“light” or “heavy” polypropylene mesh) and its size, the choice of an inappropriate type of suture material, as well as the high invasiveness of surgical intervention. Based on the given causes of complications in the operated patients with a high risk of their development, we have made a technical improvement of the existing methods of hernioplasty and development of new ones, which significantly reduced the number of postoperative complications and increased the safety of performing surgical interventions in patients with ventral and postoperative ventral hernia. Purpose. Based on the results of the analysis of surgical treatment of patients with comorbid conditions for primary and incisional ventral hernias to develop technical prerequisites for improving the safety of surgical interventions in this category of patients. Methods. Іn the period from 2001 to 2017, an in-depth comprehensive clinical-instrumental and laboratory examination of 1419 patients with primary ventral hernia (PVH) and postoperative ventral hernia (PVH) was conducted. The patients were divided into groups according to the periods of surgical treatment of patients. For this purpose, two periods were formed: from 2001 to 2009 and from 2010 to 2017. At the first period, 597 (42.07%) patients were examined and operated on. These patients formed a comparison group. The main group corresponding to patients who were treated in the period from 2010 to 2017 was 822 (57.93%) people. Results. Developed techniques for performing retromuscular allogernioplasty, which were based on controlled visualization of suturing when fixing polypropylene mesh to the posterior leaf of the vagina of the rectus muscle, allowed us to reliably and safely place and secure the implant in the retromuscular space, significantly reduce the trauma and duration of surgery. Kind of treatment using the mesh allograft with a liposomal complex with included antibacterial and immunosuppressive agents during the operation on the "onlay" method significantly reduced the number of local infectious complications. The location of the PRF membrane over the polypropylene mesh during retromuscular allogernioplasty improved neoangiogenesis at the mesh implantation site, increased fibroblast activity and the formation of collagen fibers around the mesh material, which provided maximum integration of the "light" abdominal wall with polypropylene tissue. Conclusion. These features of the dynamics of the used methods of surgical interventions and types of polypropylene nets with an individualized approach to each patient were reflected in a significant reduction in the number of both early local and general late postoperative complications, which improved the effectiveness of surgical treatment of patients with primary postoperative ventral hernias.

scholarly journals Surgical treatment of liver echinococcosis

2021 ◽  
Vol 38 (3) ◽  
pp. 32-40
Author(s):  
M. F. Zarivchatskiy ◽  
I. N. Mugatarov ◽  
E. D. Kamenskikh ◽  
M. V. Kolyvanova ◽  
N. S. Teplykh
Keyword(s):  
Surgical Treatment ◽  
Liver Resection ◽  
Postoperative Complications ◽  
Hospital Stay ◽  
Average Length ◽  
Enzyme Linked Immunosorbent Assay ◽  
Percutaneous Puncture ◽  
Echinococcal Cyst ◽  
Duration Of Surgery ◽  
Methods Of Treatment

Objective. To improve the results of treatment of patients with liver echinococcosis and carry out a comparative assessment of techniques of surgical treatment depending on the nature of postoperative complications, hospital stay and antirecurrent efficacy. Materials and methods. The experience of complex examination and treatment of 65 patients with liver echinococcosis for the period of 1999-2019 was analyzed. Open echinococectomy was performed in 21 patients, atypical liver resection in 18 patients, anatomical liver resection in 14 patients, pericystectomy in 10, laparoscopic echinococectomy in 1, percutaneous puncture of an echinococcal cyst under ultrasound control in 1 patient. Results. The time of inpatient treatment of patients after open echinococectomy was 23.5 4.3 days, after pericystectomy 19.8 1.4 days, after liver resection 14.4 2.7 days, after laparoscopic echinococcectomy 6, after percutaneous puncture echinococcal cyst 7 days. Postoperative complications were observed in 52.4 % of patients who underwent open echinococectomy, in 20 % of patients after pericystectomy, and in 15.6 % after liver resection. There were no relapses of liver echinococcosis in all the groups. Mortality was 1.5 % and was recorded after open echinococectomy. Conclusions. The most effective techniques for preventing postoperative complications are pericystectomy and liver resection. The duration of surgery and the average length of hospital stay with minimally invasive methods of treatment are shorter. However, the use of these methods of treatment remains controversial due to the possibility of intra-abdominal spread of the parasite. Patients with parasitic liver cysts after surgical treatment are subjected to dynamic follow-up observation (ultrasound examination of the liver, enzyme-linked immunosorbent assay, computed tomography of the abdominal organs) after 3-6 months for at least 5 years.

Perioperative and Long-term Outcomes of Laparoscopic, Open Abdominal, and Vaginal Surgery for Endometrial Cancer in Patients Aged 80 Years or Older

2014 ◽  
Vol 24 (5) ◽  
pp. 894-900 ◽  
Author(s):  
Giorgio Bogani ◽  
Antonella Cromi ◽  
Stefano Uccella ◽  
Maurizio Serati ◽  
Jvan Casarin ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Postoperative Complications ◽  
Intraoperative Complications ◽  
Vaginal Surgery ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Rank Test ◽  
Term Survival ◽  
Log Rank Test

ObjectiveThis study was undertaken to evaluate the safety, feasibility, and the long-term effectiveness of laparoscopy in endometrial cancer patients aged 80 years or older.MethodsData of consecutive patients aged 80 years and older undergoing laparoscopic, open abdominal, and vaginal approaches were compared. Postoperative complications were graded per the Accordion Severity Classification. Survival outcomes within the first 5 years were analyzed using the Kaplan-Meier method.ResultsAmong 726 patients, 63 (9%) were aged 80 years and older. Laparoscopic, open abdominal, and vaginal surgery were performed in 22 (35%), 25 (40%), and 16 (25%) cases, respectively. All laparoscopic procedures were completed laparoscopically, whereas a conversion from vaginal to open procedure occurred (0% vs 6%; P = 0.42). Patients undergoing laparoscopy experienced similar operative time (P > 0.05), lower blood loss (P < 0.05), and shorter hospital stay (P < 0.05) than patients undergoing open and vaginal surgery. No intraoperative complications were recorded. Laparoscopy is related to a lower rate of postoperative complications (P = 0.09) and Accordion grade greater than or equal to 2 complications (P = 0.05) in comparison to open abdominal and vaginal surgery. The route of surgical approaches did not influence the 5-year disease-free (P = 0.97, log-rank test) and overall (P = 0.94, log-rank test) survivals.ConclusionsLaparoscopy seems to represent a safe and effective treatment of endometrial cancer in women aged 80 years or older. Our data suggest that in elderly women, laparoscopic surgery improves perioperative outcomes compared with open and vaginal approaches without compromising long-term survival.

scholarly journals Safety and efficacy of manual vacuum suction compared with conventional dilatation and sharp curettage and electric vacuum aspiration in surgical treatment of miscarriage: a randomized controlled trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Toshiyuki Kakinuma ◽  
Kaoru Kakinuma ◽  
Yuuka Sakamoto ◽  
Yoshimasa Kawarai ◽  
Koyomi Saito ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Controlled Trial ◽  
World Health ◽  
Vacuum Suction ◽  
Safety And Efficacy ◽  
Vacuum Aspiration ◽  
Incomplete Abortion ◽  
Duration Of Surgery ◽  
Electric Vacuum

Abstract Background The World Health Organization does not recommend dilatation and sharp curettage (D&C) for the surgical treatment of miscarriage during the first trimester because this may cause Asherman’s syndrome due to endometrial damage; therefore, suction remains the primary treatment option. While manual vacuum aspiration (MVA) has been widely used since the 1990s outside Japan, the use of an MVA device (Women’s MVA system) was approved in Japan in October 2015. Here, we examined the efficacy of the MVA kit in women surgically treated for miscarriage. Methods This retrospective cohort study was conducted between 2014 and 2018 at the International University of Health and Welfare Hospital in Japan. Women who underwent surgical treatment for miscarriage within 12 weeks of pregnancy were identified and enrolled in the study. A total of 404 women were included who underwent the following procedures: 121 D&C, 123 electric vacuum aspiration (EVA), and 160 MVA. For each participant, the duration of surgery, amount of bleeding, amount of anesthetic used, incomplete abortion requiring repeat procedures, and intraoperative/postoperative complications were evaluated. Results The duration of surgery was 13.7 ± 7.2, 11.2 ± 4.2, and 6.9 ± 4.3 min in the D&C, EVA, and MVA groups, respectively (p = 1.00). The amount of anesthetic used was not significantly different among all groups. Bleeding of ≥ 100 mL was confirmed in three (2.4%), one (0.8%), and one (0.6%) patient(s) in the D&C, EVA, and MVA groups, respectively (p = 0.50). Incomplete abortion was identified in three (2.4%), two (1.6%), and one (0.6%) patient(s) in the D&C, EVA, and MVA groups, respectively (p = 0.61). However, severe intraoperative/postoperative complications were not observed in any group. Conclusions Surgical treatment for miscarriage performed using the MVA kit has safety and efficacy similar to those of conventional methods, such as D&C and EVA.

scholarly journals Surgical approaches in the treatment of patients with acute acetabular fractures

2021 ◽  
Vol 27 (5) ◽  
pp. 610-619
Author(s):  
N.V. Zagorodny ◽  
◽  
A.I. Kolesnik ◽  
A.F. Lazarev ◽  
E.I. Solod ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Open Reduction ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Surgical Approaches ◽  
Acetabular Fractures ◽  
Online Library

Abstract. Introduction According to the overwhelming majority of Russian and foreign authors, orthopedic traumatologists have been striving to improve the results of surgical treatment of acetabular (AC) fractures over the past decades. First of all, this is due to an increase in the number and severity of this injury, persisting complications and dissatisfaction of researchers with their own results of surgical treatment. Purpose Study of the rationale used by traumatologists for certain surgical approaches in the treatment of acute acetabular fractures. Materials and methods Literature sources were searched for information in the systems and databases Pubmed, Embase, Scopus, Medline, Cochran Library, eLibrary, Wiley Online Library using the keywords: acetabular fractures, surgical treatment, acetabular approach, open reduction and fixation of acetabular fractures, duration and blood loss, hip arthroplasty. Results The incidence of AC fractures, according to different authors, ranges from 2 to 23.4 %. The cause of this injury is road traffic accidents in up to 83 % of all cases. A significant increase in the number of AC fractures was noted. AC fractures in the vast majority of cases are classified according to AO/ASIF. Displaced AC fractures and multiplanar fractures are subject to surgical treatment. Open reduction and internal fixation still remain the standard treatment for AC fractures. The choice of the surgical approach is carried out more often taking into account the classification of AC fractures, and the type of fracture dictates the choice of approach to the acetabulum. It was found that the authors are forced to use surgical approaches taking into account the fractures of the AC columns. Discussion Adherence of traumatologists to the standards regarding indications for the choice of surgical approaches for complex AC fractures was noted. Surgical approaches for the treatment of two-column acetabular fractures are still often extended and traumatic, prolonged and accompanied by blood loss. Conclusion In the surgical treatment of pelvic and AC fractures, most authors adhere to standards in the choice of approach and fixation of columns and AC fragments. There is unanimity in the recognition of the trauma and "expansion" of the approaches used, accompanied by blood loss reaching up to 2000 ml and more, and the duration of the operation is on average 3 hours 50 minutes. For the surgical treatment of acute AC fractures, the researchers used both classical and modified anterior and posterior surgical approaches with the obligatory consideration of the classification of AC fractures. The rationale for choosing an operative approach, as a rule, was the determination of the type of AC fracture according to the AO/ASIF classification. The most effective approach in the surgical treatment of AC fractures is the combined anterior and posterior approach.

scholarly journals Dializuojamų ligonių šlapimo takų ligų chirurginis gydymas

2005 ◽  
Vol 3 (4) ◽  
pp. 0-0
Author(s):  
Henrikas Ramonas ◽  
Asta Kantaravičienė ◽  
Audrius Rimas
Keyword(s):  
Renal Failure ◽  
Urinary Tract ◽  
Surgical Treatment ◽  
High Risk ◽  
Postoperative Complications ◽  
Obstructive Uropathy ◽  
Intraoperative Complications ◽  
Postoperative Bleeding ◽  
Dialysis Access ◽  
Infravesical Obstruction

Henrikas Ramonas, Asta Kantaravičienė, Audrius RimasVilniaus universiteto, Gastroenterologijos, nefrologijos,urologijos ir pilvo chirurgijos klinika,Vilniaus universiteto ligoninės Santariškių klinikosNefrologijos ir urologijos centras, 1 nefrourologijos skyrius,Santariškių g. 2, LT-08661, VilniusEl paštas: [email protected] Tikslas Nustatyti šlapimo takų ligų chirurginio gydymo rezultatus ligoniams, kuriems atliekamos hemodializės, ir operacinio gydymo įtaką hemodializės procedūroms. Ligoniai ir metodai Išanalizuoti chirurginio gydymo rezultatai 69 ligonių, kurie nuo 1999 iki 2004 metų operuoti ir gydyti hemodializėmis nuo ūminio inkstų nepakankamumo ir esant galutinei nepakankamumo stadijai. Vidutinis amžius – 57,07 ± 1,9 metų. Operuota dėl šių priežasčių: inkstų akmenligės – 26 (37,7%) ligoniai, inkstų policistozės – 7 (10,2%), obstrukcinės uropatijos – 13 (18,8%), infravezikinės obstrukcijos – 10 (14,5%), inksto vėžio – 5 (7,2%), dėl kitų priežasčių – 8 (11,6%) ligoniai. Dažniausiai atlikta nefrektomija – 46 (66,7%) pacientams, abipusė nefrektomija – vienuolikai. Rezultatai Intraoperacinių komplikacijų ir operavimo sunkumų buvo 21 (31,43%) pacientui. Pooperacinės komplikacijos diagnozuotos 14 (20,9%) ligonių. Pagrindinė komplikacija – pooperacinis kraujavimas. Mirė 5 (7,25%) ligoniai, trys iš jų – po abipusės nefrektomijos, pagrindinė mirties priežastis buvo pooperacinis kraujavimas. Analizuojant šiuos atvejus įsitikinta, kad operuojant per laparotominį pjūvį ir negalint gerai apriboti nefrektomijos zonos, komplikuotų operacijų atvejais sunkiai kontroliuojamas kraujavimas buvo pagrindinė mirties priežastis. Skubiosios hemodializės sėkmingiausiai integruotos su obstrukcinės uropatijos chirurginiu gydymu. Hemodializės procedūros komplikavosi 13 (18,84%) ligonių. Dažniausia komplikacija – arterinės-veninės jungties trombozė. Išvados Šlapimo takų ligų chirurginis gydymas ligoniams, kuriems lygia greta atliekamos hemodializės, susijęs su didele intraoperacinių, pooperacinių ir arterinių-veninių jungčių komplikacijų, dažniausiai okliuzinių, rizika. Jei šlapimo takų ligos komplikuotos, abipusės nefrektomijos nerekomenduojamos dėl didelės, sunkiai kontroliuojamo pooperacinio kraujavimo rizikos. Reikšminiai žodžiai: hemodializė, inkstų nepakankamumas, nefrektomija, obstrukcinė uropatija, infravezikinė obstrukcija Surgical treatment of urinary tract in haemodialysed patients Henrikas Ramonas, Asta Kantaravičienė, Audrius RimasVilnius University, Clinic of Gastroenterology, Urology andAbdominal Surgery, Center of Nephrology and Urology,Vilnius University Hospital "Santariškių klinikos",Vilnius, Santariškių str. 2, LT-08661, LithuaniaE-mail: [email protected] Background / objective To evaluate outcomes of urinary tract surgery in haemodialysed patients and determine the influence of surgery on haemodialysis procedures. Patients and methods We analysed results of urinary tract surgery in 69 patients with end stage renal impairment and acute renal failure in the period from 1999 till 2004. The mean age of patients was 57.07 ± 1.9 years. Operations were performed due to nephrolithiasis in 26 (37.7%) cases, polycystic kidneys in 7 (10.2%), obstructive uropathy in 13 (18.8%), infravesical obstruction 10 (14.5%), renal carcinoma 5 (7.2%), other causes in 8 (11.6%) cases. More frequently nephrectomy was done (in 46, or 66.67% of patients), and bilateral nephrectomy was performed in 11 cases. Results Intraoperative complications and surgery difficulties were defined in 21 (30.43%) patients. Postoperative complications were diagnosed in 14 (20,29%) cases, and the main complication was postoperative bleeding. Five (7.25%) patients died. Three patients died after bilateral nephrectomies, and the main cause of death was postoperative bleeding. Analysis of these cases showed that the laparotomic aproach and absence of the posibillity to isolate the renal area during complicated nephrectomies was the main cause of poorely controlled bleeding after operation. The urgent heamodialysis procedures were more successfully integrated with the surgical treatment of obstructive uropathy. Haemodialysis procedures were complicated in 13 (18.84%) patients. The common complication was thrombosis of arteriovenal dialysis access. Conclusions Urinary tract surgery in haemodialysis patients influences the high risk of intraoperative and postoperative complications, arteriovenal occlusive complications. Bilateral nephrectomies in complicated urinary tract diseases are not recommended due to a high risk of poorely controlled postoperative bleeding. Keywords: haemodialysis, renal failure, nephrectomy, obstructive uropathy, infravesical obstruction

scholarly journals Results of surgical treatment of aseptic necrosis of the femoral head at early stages

2013 ◽  
Vol 0 (1) ◽  
pp. 5
Author(s):  
Volodymyr Filipenko ◽  
Gennadiy Olinichenko ◽  
Zoya Miteleva ◽  
Nataliya Poletaeva
Keyword(s):  
Surgical Treatment ◽  
Femoral Head ◽  
Aseptic Necrosis ◽  
Early Stages
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