scholarly journals Optimization of surgical treatment of abdominal hernias in patients with obesity

2021 ◽  
Vol 180 (1) ◽  
pp. 73-80
Author(s):  
V. I. Belokonev ◽  
V. P. Zakharov ◽  
D. B. Grachev ◽  
S. Y. Pushkin ◽  
Z. V. Kovaleva ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Abdominal Wall ◽  
Clinical Manifestations ◽  
Side Surface ◽  
Negative Consequences ◽  
Systemic Complications ◽  
Mathematical Algorithm ◽  
Results Of Treatment ◽  
Clinical Observations

Introduction. Among patients with primary and postoperative ventral hernias, obesity of various degrees is observed in more than 50 % of patients. A severe complication of obesity is the development of panniculus – a skin-subcutaneous apron of varying severity. The hernia surgeon often performs a panniculectomy, which requires justification, taking into account both the positive and negative consequences.The objective was to improve the results of treatment of patients with hernias who are obese by developing a mathematical algorithm of indications for removing the skin-subcutaneous apron.Methods and materials. The analysis of surgical treatment of 253 obese patients with hernia aged 20 to 90 years was performed. There were 44 males (17.4 %) and 209 females (82.6 %). There are 2 groups: the first (comparison group) included 129 patients whom the hernia excision was performed without removing the skin-subcutaneous apron; the second (main group) – 124 patients who had the excision of the skin-subcutaneous apron during surgery. Indications for panniculus removal were based on the proposed mathematical algorithm, which took into account the size, clinical manifestations, associated complications, and possible consequences after surgeries while preserving it.Results. When considering the abdomen in patients with hernias and obesity from the side surface, the hanging apron in relation to the abdominal wall forms a truncated cone, or two conjugated cones that form significantly different moments of forces acting on the abdominal wall at different stages of development of the panniculus, and, therefore, can serve as the basis for the development of classification. Based on this mathematical model, the following classification of changes in the anterior abdominal wall in hernias and obesity is proposed: saggy belly; cutaneoussubcutaneous apron I, II, III degrees, which are based on calculated mathematical indicators and clinical manifestations of the disease. When treating patients with hernias and obesity during operations, the following tactical algorithms were followed: with a saggy stomach and panniculus of the 1st degree, the removal of the skin-subcutaneous apron can be refused; with the 2nd and 3rd degrees, its preservation contributes to the recurrence of the hernia due to the action of moments of forces that shift and pull the abdominal wall down.Conclusions. Clinical observations of patients with hernias and obesity have shown that the removal of the skinsubcutaneous apron did not lead to an increase in the frequency of wound and systemic complications, and therefore it should be considered a necessary stage of surgery.

scholarly journals SURGICAL TREATMENT OF ANOMALIES OF FIXATION OF THE COLON IN CHILDREN

2020 ◽  
Vol 19 (4) ◽  
pp. 32-36
Author(s):  
O. Bodnar
Keyword(s):  
Congenital Anomaly ◽  
Surgical Treatment ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Results Of Treatment ◽  
Left Diaphragm ◽  
Comparative Group ◽  
The Right ◽  
Paroxysmal Pain ◽  
Over Time

Pyrrhic disease is a congenital anomaly that occurs during embryogenesis due to the fixation of the splenic angle of the colon by a short and highly located left transverse-diaphragmatic ligament, creating a sharp bend and forming a "wellbore". In this case the passage of feces on a cross colon becomes difficult, there is also its sagging to a small pelvis. This pathology is characterized by paroxysmal pain (aggravated by exercise and after eating) and prolonged constipation, which progresses over time. Hilaiditis syndrome is a rather rare pathology in which there is an interposition of the hepatic angle of the colon between the liver and the diaphragm. There are permanent and intermittent localizations. The work generalizes the experience of evaluation of clinical manifestations and remote results of treatment of children with chronic colostasis caused by fixation abnormalities of the colon. 58 children were detected to have Payre’s disease, with Cyilaiditi’s syndrome – 3 children. 24 patients with Payre’s disease and 2 Cyilaiditi’s syndrome were operated on. To assess the effectiveness of surgery, children were divided into two groups: I group – comparative and II group - experienced. In I group (n=12 children) – the analysis of surgical treatment was performed traditionally. In II group (n=14 children) – the analysis of surgical treatment was conducted by means of the methods proposed. Traditional surgical treatment of Payre’s disease in children was followed by relapse of chronic constipation in 45,45%, pain in 50%, flatulence in 33,33% and failure of the ileocoecal closing apparatus in 100% of children. Unsatisfactory outcomes of surgical treatment of Cyilaiditi’s syndrome was observed in a child from the comparative group. Relapse of clinical symptoms to a lesser degree than before the surgery was found in 1 child from the experienced group. To treat Payre’s disease the following operation is proposed: intersection of the left diaphragm-colon ligament, resection of transverse colon and colofixation of the left bending of the colon. To treat Cyilaiditi’s syndrome (in case of dolichoascendocolon) the following operation is suggested: hepatopexy, resection of the right bending of the colon with ascending transversal anastomosis “end to end”, fixing of right bending of the colon. Their reasonability is being proved.

scholarly journals Dilated cardiomyopathy: reconceptualization of the problem

2019 ◽  
pp. 35-47
Author(s):  
T. G. Vaykhanskaya ◽  
L. N. Sivitskaya ◽  
T. V. Kurushko ◽  
O. D. Levdansky ◽  
N. G. Danilenko
Keyword(s):  
Dilated Cardiomyopathy ◽  
Contractile Function ◽  
Clinical Manifestations ◽  
Epidemiological Data ◽  
Genetic Determinants ◽  
Clinical Observations ◽  
Intermediate Phenotypes ◽  
European Working ◽  
Definition Of

Dilated cardiomyopathy (DCM) is a complex, etiologically heterogeneous myocardial disease, which is one of the main causes of heart failure and heart transplantation. In 2016, experts from the European working group proposed a new definition of cardiomyopathy, which includes intermediate variants with a change in phenotype in carriers of mutations from subclinical form to the full manifestations of the disease. The classification of DCM was supplemented with intermediate phenotypes with the inclusion of a hypokinetic form with reduced contractile function without ventricular dilatation and variants with predominant dilation or arrhythmogenicity. Pathological architectonics of DCM consists of many genetic determinants that interact with numerous environmental factors. Clinical manifestations depend not only on the malignancy and penetrance of the gene mutation, but also on a number of other causes — epigenomic factors, age, toxic effects, environmental aggressiveness, pregnancy, and the effects of other acquired diseases. The article summarizes the current epidemiological data and ideas about specific molecular changes with an unfavorable prognosis. For clarity, we present clinical observations of familial DCM with mutations in the RBM20 and LMNA genes.

scholarly journals SIMULTANEOUS INTERVENTIONS IN PATIENTS WITH COMPLICATED FORMS OF POSTOPERATIVE VENTRAL HERNIA AND ANTERIOR ABDOMINAL WALL DEFORMATIONS

2019 ◽  
Vol 26 (1) ◽  
pp. 88-93
Author(s):  
Oksana Yu. Gerbali ◽  
Aleksandr V. Kosenko
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Treatment ◽  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Female Ratio ◽  
Male Female Ratio ◽  
Wall Deformation ◽  
Ventral Hernias ◽  
Postoperative Intestinal Obstruction

The aim is to optimize the treatment of patients with postoperative ventral hernias, anterior abdominal wall deformations and cholelithiasis.Materials and methods. 36 patients with complicated forms of postoperative ventral hernias, anterior abdominal wall deformation and cholelithiasis aged 36–74 years, under the 12:24 male/ female ratio were studied. According to the classification of Toskin — Zhebrovsky, smallsized, medium-sized, extensive and gigantic hernias were observed in 3 (8.3%), 12 (33.3%), 15 (41.7%) and 6 (16.7%) patients, respectively. According to the SWR-classification, the hernia of the median, lateral and combined localization was observed in 14 (38.9%), 7 (19.4%) and 15 (41.7%) patients, respectively. All patients were operated. Both autoplastic and prosthetic techniques of operations were used. Various forms of the anterior abdominal wall deformation were eliminated with the help of abdominoplasty. Laparoscopic cholecystectomy was performed simultaneously in all patients.Results. Postoperative complications occurred in 11 (30.5%) patients, with persistent seroma prevailing (6–54.5% of patients). In 3 (27.2%) patients wound suppuration was observed, in 1 (9.1%) — early postoperative intestinal obstruction. Postoperative pneumonia was observed in one patient.Conclusion. Success in the surgical treatment of such patients is determined by whether an individualized differentiated approach was used in choosing the method of surgery and the management of patients in the postoperative period.

scholarly journals Immediate results of surgical treatment of peripheral hepatic cholangiocarcinoma in elderly and senile patients

2020 ◽  
Vol 87 (9-10) ◽  
pp. 48-53
Author(s):  
O. Yu. Usenko ◽  
O. V. Hrynenko ◽  
A. І. Zhylenko ◽  
O. O. Popov ◽  
A. V. Husiev
Keyword(s):  
Surgical Treatment ◽  
International Study ◽  
Main Group ◽  
Control Group ◽  
Results Of Treatment ◽  
Peripheral Cholangiocarcinoma ◽  
Acute Pulmonary Thromboembolism ◽  
Clinically Significant ◽  
Selection Of

Objective. To estimate immediate results of surgical treatment of peripheral cholangiocarcinoma in elderly and senile patients. Materials and methods. In 2004-2018 yrs period in the Department of Transplantation and Surgery of the Liver of the Shalimov National Institute of Surgery and Transplantology 84 patients, suffering peripheral cholangiocarcinoma, were radically operated: 31 (36.9%) patients older than 60 yrs (the main Group), and 53 (63.1%) patients, younger than 60 yrs (control Group). Results. Postoperative clinically significant (IIIa-IV degree in accordance to classification of Clavien-Dindo) complications during 90-days of postoperative period were noted in 29.1% patients of the main Group and in 32.1% patients of a control Group (p=0.262), postoperative hepatic insufficiency, in accordance to The International Study Group of Liver Surgery criteria, - in 16.1 and 22.6% accordingly (p=0.473); reoperation was performed in 9.6 and 9.4% patients, accordingly (p=0.973). The causes of postoperative lethality in 2 patients of the main Group were an acute myocardial infarction (1) and an acute pulmonary thromboembolism (1). Conclusion. Hepatic resection is characterized by satisfactory immediate results of treatment of peripheral cholangiocarcinoma in elderly and senile patients, if performed in highly-specialized multidisciplinary centre and thorough selection of patients.

scholarly journals FEATURES OF DIAGNOSTICS AND SURGICAL TREATMENT OF PATIENTS WITH NEUROENDOCRINE TUMORS OF THE SMALL INTESTINE

2020 ◽  
Vol 23 (2) ◽  
pp. 100-109
Author(s):  
M.V. Lysanyuk ◽  
P. N. Romashchenko ◽  
N.A. Maistrenko
Keyword(s):  
Small Intestine ◽  
Surgical Treatment ◽  
Clinical Manifestations ◽  
Laboratory Diagnostics ◽  
Morphological Examination ◽  
Results Of Treatment ◽  
Pet Ct ◽  
Oncological Results ◽  
Generalized Net ◽  
Diagnostic Capabilities

The aim of the study of the study is to evaluate the current diagnostic capabilities and improve the method of surgical treatment of patients with NET of the small intestine. Materials and methods: The results of treatment of 68 patients with NET of the small intestine (SI) were studied. Localized tumors were diagnosed in 5,9% of patients, locally spread – 22%, generalized – in 72,1%. Diagnostics of SI-NET included: assessment of clinical manifestations of the disease; laboratory diagnostics (CgA, serotonin, 5-HIAA), instrumental examination (US, CT, MRI, PET-CT 68Ga-DOTA-TATE); morphological examination (histological, immunohistochemical) of the tumor. Results: Late diagnosis of SI-NET is due to an asymptomatic course of the disease in 27,9% of patients, and non-specific clinical manifestations in 29,4%. The sensitivity of CgA, serotonin, 5-HIAA in the diagnosis of localized and locally distributed tumors is 11,1%, 45,5%, 20%, generalized – 59,3%, 86,2% and 50% respectively. The main method for diagnosing neo of the small intestine is CT, which is informative in detecting a tumor of 20%, and mesentery conglomerate – 94.5%. Surgical treatment was performed in 75% of patients. Cytoreduction or removal of the primary tumor increases the life expectancy of patients with generalized NET by 2 times. The developed method of surgical treatment of patients with SI-NET with extensive local distribution, which provides radical surgical intervention. Conclusion: Difficulties in diagnosing SI-NET are due to the peculiarities of the clinical course of the disease. The surgical method is the main one in the treatment of patients at all stages of the oncological process. The proposed techniques of surgery allow performing resection of the small intestine and removing the tumor conglomerate of the mesentery without compromising the functional and oncological results of treatment of patients.

scholarly journals Hydatid cysts in the outpatient practice of a surgeon

2021 ◽  
pp. 135-139
Author(s):  
D. V. Pakhnov ◽  
G. D. Odishelashvili ◽  
L. G. Odishelashvili
Keyword(s):  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Pathological Process ◽  
Main Method ◽  
Results Of Treatment ◽  
Clinical Observations ◽  
Before And After ◽  
Diagnostic Difficulties ◽  
Standard Set ◽  
Outpatient Practice

Introduction. The hydatid form of echinococcal disease of EB is a rather urgent problem and over time the degree of its significance does not decrease. The main target organ is the liver, according to various authors, it accounts for up to 84% of all clinical observations. The probability of lung tissue involvement in the pathological process is 15%. Echinococcosis of other organs and tissues, as well as a combined lesion occurs in 25% of cases. Lesion of echinococcosis of muscle tissue is observed in 0.7–0.9% of all cases. The main method of treatment at present is surgery with its various options such as echinococcectomy, pericystectomy, resection.Objective. To demonstrate on the available clinical example the feasibility of using surgical treatment of EB of rare localization in the area on the anterior abdominal wall.Materials and methods. The result of treatment of a patient with echinococcosis of rare localization on the anterior abdominal wall is presented. The diagnosis is established in accordance with the available clinical recommendations. The examination was carried out using a standard set of clinical metols, and included: collection, analysis of complaints, as well as an anamnesis of life and disease. Standard clinical and biochemical studies were performed.Results. The hydatid form of echinococcosis with localization on the anterior abdominal wall is a rather rare pathology. However, treatment issues and diagnostic difficulties are quite relevant for doctors of various specialties. As a result of this clinical observation and the treatment, the patient recovered; after 17 months there was no data for a relapse of the disease.Conclusion. 1. Timely diagnosis of hydatid echinococcosis of any localization is fundamental in improving the results of treatment of this category of patients. 2. A multidisciplinary approach in the selection of therapeutic tactics, namely the appointment of chemotherapeutic effects before and after surgery, an active surgical one, allows to achieve a good therapeutic result.

scholarly journals COMPLICATIONS OF SURGICAL TREATMENT OF LUMBAR STENOSIS IN THE EARLY POSTOPERATIVE PERIOD

2018 ◽  
Vol 17 (3) ◽  
pp. 185-187
Author(s):  
Igor Vadimovich Basankin ◽  
Vladimir Alexeevich Porkhanov ◽  
Asker Alievich Afaunov ◽  
Alexander Veniaminovich Kuzmenko ◽  
Vladimir Konstantinovich Shapovalov
Keyword(s):  
Surgical Treatment ◽  
Postoperative Period ◽  
Intraoperative Complications ◽  
Clinical Manifestations ◽  
Early Postoperative Period ◽  
Lower Limbs ◽  
Wound Complications ◽  
Lumbar Stenosis ◽  
Results Of Treatment ◽  
Acute Radiculopathy

ABSTRACT Objective: To analyze the structure of degenerative lumbar stenosis surgical treatment complications and to analyze their effect on the results and indications for revision operations. Methods: Between 2009 and 2013, 513 patients with lumbar stenosis of degenerative etiology were surgically treated. There were 205 men, 308 women, aged 23 to 74 years. The main clinical manifestations were persistent compression radiculopathy, chronic pain in the back and lower limbs, and difficulty walking. The intensity of the pain was assessed by the VAS. At the time of hospitalization, VAS was 55-90 points. Results: Of the 513 operated patients, 65 (12.67%) had complications in the early postoperative period (up to three months after the operation); intraoperative complications occurred in 26 (5.1%) patients; intraoperative dura mater injury occurred in 24 (4.67%); pulmonary embolism (PE) occurred in 2 (0.39%) patients; 39 patients had early postoperative complications; acute radiculopathy occurred in 22 patients (4.28%); and 17 patients (3.31%) had surgical wound complications. Conclusions: Liquorrhea, postoperative hematomas and acute radiculopathy had no negative effect on the results of treatment in any of the cases. In the early postoperative period, 4 (0.77%) deaths were recorded intraoperatively and in 2 (0.39%) cases, intraoperative PE occurred. Two cases (0.39%) resulted in sepsis and multiple organ failure. In eight (1.55%) patients, the results of the treatment were unsatisfactory: in 4 (0.77%) cases due to death, and in a further 4 (0.77%) due to elimination of the system by the spinal column as a result of suppuration. Level of Evidence IV; Therapeutic studies - Investing the results of treatment.

scholarly journals Combination of autoplasty with autodermoplasty in the treatment of lateral abdominal hernias

2012 ◽  
Vol 93 (2) ◽  
pp. 250-255
Author(s):  
A A Botezatu ◽  
I N Nurmeev
Keyword(s):  
Surgical Treatment ◽  
Abdominal Wall ◽  
State Institution ◽  
Case Histories ◽  
Treatment Results ◽  
Surgical Department ◽  
Lateral Abdominal Wall ◽  
New Methods ◽  
Abdominal Hernias

Aim. To improve the outcomes of treatment in patients with lateral abdominal hernias by combining autoplastic methods with autodermoplasty. Methods. 42 case histories of patients with lateral abdominal wall hernias, operated in the first surgical department of the State Institution «Republican Clinical Hospital», Tiraspol city, from 2001 to 2011 were subjected to retrospective analysis. In all of the cases surgical treatment was performed. Combined methods of hernioplasty, which combine autoplasty with autodermoplasty, were applied. The authors’ personal patented method of hernioplasty was also used among others. Results. According to the classification of Chevrel-Rath (2000) 23 (54.7%) of the patients had inferolateral hernias, 5 (11.9%) patients - supra-lateral hernias, 8 (19%) patients - lumbar hernias, there were also 2 (4.8%) patients each with transrectal, pararectal and paracolostomy hernias. Despite their small number in the total amount of postoperative hernias (17.5%), 26 (65%) patients had large and giant lateral hernias, while recurrences were present in 7 (16.7%) cases. Treatment results were satisfactory. Complications and recurrence occurred in 1 (2.9%) patient each. Conclusion. The combination of autoplasty with autodermoplasty is an effective method of treatment for inferolateral, supra-lateral, pararectal, transrectal, paracolostomy and lateral hernias; during lumbar hernias autodermoplasty even with two autodermal grafts was not as effective, and therefore justified is the search for new methods of hernioplasty.

Spinal lumbar stenosis (analysis of the literature and own results)

2021 ◽  
pp. 594-613
Author(s):  
Anton Viktorovich Yarikov ◽  
Maksim Vladimirovich Shpagin ◽  
Amir Muratovich Meredzhi ◽  
Olga Aleksandrovna Perlmutter ◽  
Aleksandr Petrovich Fraerman
Keyword(s):  
Surgical Treatment ◽  
Lumbar Spine ◽  
Spinal Stenosis ◽  
Clinical Manifestations ◽  
Long Term Results ◽  
Lumbar Stenosis ◽  
Detailed Classification ◽  
Surgical Methods

The article is devoted to the issues of etiology, pathophysiology and clinical manifestations of spinal stenosis of the lumbar spine. The possibilities of modern instrumental diagnostics of the disease are described, the differential clinical diagnosis of lumbar stenosis is presented. The paper presents a detailed classification of spinal stenosis. The modern therapeutic tactics of the disease are described, indications for the surgical treatment of the disease are given. Modern methods of surgical treatment of stenosis are briefly and schematically described: decompression (microsurgical and endoscopic), interspinous fixation, stabilization (dorsal and ventral) and epidural stimulation of the spinal cord. The data on the immediate and long-term results of surgical methods of treatment are presented. The authors also presented their experience in the treatment of spinal stenosis of the lumbar spine. The use of differentiated surgical treatment tactics in 85–90 % of cases provides good and excellent results in the treatment of lumbar stenosis.

scholarly journals ANOMALIES OF THE PROSTATE GLAND AND SEMINAL TUBERCLE IN CHILDREN

2019 ◽  
Vol 23 (1) ◽  
pp. 31-34
Author(s):  
Anatoly E. Solovev
Keyword(s):  
Surgical Treatment ◽  
Positive Result ◽  
Rare Diseases ◽  
Prostate Gland ◽  
Diagnostic Methods ◽  
Urogenital System ◽  
Genitourinary System ◽  
Clinical Observations ◽  
Modern Methods

Aim of the study. To investigate the embryology, clinic, diagnosis, and treatment of prostate anomalies and seminal tubercle in children. Material and Methods. A total of 1.5 thousand children with pathology of the urogenital system were examined. In 36 children, abnormalities of the prostate gland and seminal tubercle were found. Ultrasound, ureteroscopy, CT, MRI, as well as general clinical diagnostic methods were used in the diagnosis. A description of 2 clinical observations of prostate anomalies is presented. Results and discussion: A classification of prostate and seminal tubercle anomalies has been developed. 3 types of anomalies were selected according to the number, position, structure. The congenital nature of the process, the clinical features of the prostate anomalies and the seminal tubercle make it difficult to recognize rare diseases of the genitourinary system in children. Modern methods of diagnosis and surgical treatment can get a positive result.

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