Fifteen-year experience of using the integral scale “Abdominal cavity index” in establishing indications for staged surgical treatment of generalized peritonitis

2021 ◽  
pp. 39-43
Author(s):  
V.V. Saveliev ◽  
M.M. Vinokurov ◽  
V.V. Frantsuzskaya
Keyword(s):  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Integral Scale ◽  
Generalized Peritonitis

scholarly journals Evolution of diagnosis and surgical treatment of intra-abdominal infiltrates, abscesses of primary and postoperative origin in patients

2021 ◽  
pp. 15-29
Author(s):  
V.V. Skyba ◽  
◽  
V.F. Rybalchenko ◽  
A.V. Ivanko ◽  
R.М. Borys ◽  
...  
Keyword(s):  
Duodenal Ulcer ◽  
Gastric Ulcer ◽  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Postoperative Mortality ◽  
Multiple Organ ◽  
Long Term Results ◽  
Control Group ◽  
Study Group ◽  
Perforated Gastric Ulcer

Purpose – to improve the results of surgical treatment of patients with intra-abdominal infiltrates and abscesses through the introduction of the latest imaging methods and surgical technologies. Materials and methods. In the clinic of the Department of Surgical Diseases No 1, on the basis of the Surgery Center of the Kyiv City Clinical Hospital No. 1 from 2006 to 2019 218 patients with primary and secondary intra-abdominal infiltrates, abscesses and fluid formations were treated. The patients’ age ranged from 16 to 85 years. There were 107 (49.08%) male patients, 111 (50.92%) female patients. Depending on the time of hospitalization (by years), the patients were divided into two groups: the control group (CG) (2006–2012) 117 (53.67%) patients and the study group (SG) (2013–2019) 101 (46.33%) patients. The SG used the latest imaging technologies and improved methods of surgical treatment. Results. The patients were divided into two groups: primary in 191 (87.61%) and secondary postoperative infiltrates and abscesses in 27 (12.39%). The causes of primary infiltrates and abscesses were: complicated forms of appendicitis in 74 (33.94%), perforated stomach and duodenal ulcer in 48 (22.02%), complicated forms of cholecystitis in 69 (31.65%). Postoperative infiltrates and abscesses were observed in 27 (12.39%) patients who underwent urgent surgery: adgeolysis of adhesive ileus in 14 (6.42%) and complicated hernias of various localization in 13 (5.97%). Postoperative complications were diagnosed in 43 (19.72%) patients, of whom 34 (15.59%) from the surgical wound and 29 (15.18%) of the abdominal cavity, who required relaparotomy or laparoscopy, with destructive appendicitis in 10 (13.51%), perforated gastric ulcer and 12 duodenal ulcer in 6 (12.5%), destructive cholecystitis in 9 (13.04%), adhesive intestinal obstruction in 13 (19.12%) and with strangulated and complicated hernias in 14 (17.28%) of the examined patients. During relaparotomy, incompetence of the intestinal wall and intestinal sutures was established in 11 out of 32 patients, an ileostomy was imposed in 7, and cecostomy in 1 patient. Actually, in the control group, 8 (6.84%) patients died on the background of ongoing peritonitis, thrombosis of mesenteric vessels and multiple organ failure and concomitant ailments and in the study group 4 (3.96%) patients died. Conclusions. Surgical treatment is individualized depending on the disease, so with destructive appendicitis from 74 (38.74%) laparotomic in 42 (21.99%), laparoscopic in 32 (16.75%), and in 12 (6.28%) with conversion; perforated gastric ulcer and duodenal ulcer in 48 (25.13%) open laparotomy; with cholecystitis of 69 (36.13%) patients, 48 (25.13%) had laparotomy and 21 (11.00%) had laparoscopic examination. The use of the latest imaging and treatment technologies: Doppler ultrasonography, hydrojet scalpel and laparoscopy in 64 (33.51%), allowed to have better near and long-term results and to reduce postoperative mortality from 6.84% to 3.96%, with an average of 5.5%. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: destructive appendicitis, cholecystitis, perforated gastric ulcer and 12-duodenal ulcer, adhesive leakage, strangulated hernias, diagnosis and treatment.

scholarly journals Intraoperative Tactics of Local Surgical Hemostasis in Injuries and Planned Operations on the Parenchymal Organs of the Abdominal Cavity

2020 ◽  
Vol 13 (3) ◽  
pp. 268-278
Author(s):  
Dmitriy Andreevich Severinov ◽  
Gennady Alekseevich Bondarev ◽  
Vyacheslav Alexandrovich Lipatov ◽  
Araik Rubenovich Saakyan
Keyword(s):  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Structural Features ◽  
Main Indication ◽  
Anatomical Features ◽  
Abdominal Bleeding ◽  
Adhesive Compositions ◽  
Liver Injuries ◽  
Operation Techniques ◽  
Manual Skills

Currently, mortality rate in the liver and spleen injuries remains high, despite the present-day level of advances in the diagnosis and treatment of surgical diseases. Damage to parenchymal organs leads to the development of intra-abdominal bleeding. The severity of bleeding depends on the anatomical features of the blood supply to the damaged organ and the massiveness of the lesion, the type of traumatic agent. Intraoperative provision of reliable hemostasis is a significant problem in liver and spleen injuries. This paper summarizes the experience of Russian and foreign experts on surgical treatment of various types of parenchymal organ injuries. Stitching, adhesive compositions, biological and synthetic films, non-contact methods are used to achieve the final intraoperative hemostasis for parenchymal organ injuries; electrocoagulation is also very popular. Currently, the issues of surgical treatment tactics of spleen and liver injuries are not fully resolved. The search for optimal options, as well as technical advancement of organ-preserving operation techniques involving parenchymal organs, remains relevant. This depends on the structural features of these organs, availability of the methods of local hemostasis listed in this paper and surgeon's knowledge and manual skills. Moreover, at present, hemostatic application agents are widely introduced into clinical practice, parenchymal bleeding caused by superficial planar injuries of parenchymal organs being the main indication for the use of these agents.

scholarly journals To casuistry, opening the abdominal cavity with intraligamentous parovarial cysts

2020 ◽  
Vol 5 (10) ◽  
pp. 831-834
Author(s):  
A. F. Khelminsky
Keyword(s):  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Considerable Difficulty

With the comparative rarity of intra-ligamentous cysts and, in some cases, considerable difficulty in the clinical recognition of their various types, on which the choice of one or another method of surgical treatment depends, a description of each well-traced case is desirable.

scholarly journals Method of spleen reduction in laparoscopic splenectomy in children with hereditary autoimmune hemolytic anemia

2020 ◽  
Vol 10 (4) ◽  
pp. 429-433
Author(s):  
Vyacheslav G. Svarich ◽  
Ilya M. Kagantsov ◽  
Violetta A. Svarich
Keyword(s):  
Surgical Treatment ◽  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Laparoscopic Splenectomy ◽  
Surgical Intervention ◽  
Abdominal Cavity ◽  
Operation Time ◽  
Spleen Tissue ◽  
Surgical Department ◽  
Large Size

Purpose. This study aimed to improve the results of surgical treatment of children with hereditary autoimmune hemolytic anemia by laparoscopic splenectomy. Materials and methods. In the period from 1991 to 2020, a total 47 patients with hereditary autoimmune hemolytic anemia were treated in the surgical department of the Republican Childrens Clinical Hospital of Syktyvkar. Splenectomy was performed by the open method in 25 children, and laparoscopic method in 22 patients. Since 2019, the method of spleen reduction during laparoscopic splenectomy has been used in 3 patients when the large size of the mobilized spleen does not correspond to the size of the endoscopic container. Results. On average, surgical intervention using the above-described method of spleen reduction lasted for 19 2 min lesser than with laparoscopic splenectomy without the above method, due to the possibility of removing a significantly smaller volume of spleen tissue from the endoscopic sac outside the abdominal cavity. However, the most important achievement was the almost complete elimination of the risk of getting free fragments of a pathologically altered spleen with its possible replantation and recurrence of the clinic of autoimmune hemolytic anemia. The postoperative period was smooth, and all patients were discharged at their place of residence 7 days after the laparoscopic splenectomy. Intra-abdominal complications and relapses of the disease associated with the above-described method of operation did not occur in any patient within 612 months postoperative. Conclusion. The proposed method of spleen reduction during laparoscopic splenectomy made it possible to avoid relapses of the disease, reduce the operation time, as a result, improved the results of surgical treatment in children with hereditary autoimmune hemolytic anemia.

scholarly journals MIGRATION OF THE INTRAUTERINE DEVICE TO THE ABDOMINAL CAVITY

2017 ◽  
Vol 25 (2) ◽  
pp. 247-262
Author(s):  
D. A. Rahmonov ◽  
F. Sh. Rashidov ◽  
E. L. Kalmykov ◽  
M. M. Marizoeva ◽  
O. B. Bobdjonova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Intrauterine Device ◽  
Abdominal Cavity ◽  
Clinical Signs ◽  
Uterine Cavity ◽  
Pain Syndrome ◽  
Pregnant Patient ◽  
Pelvic Cavity ◽  
And Migration ◽  
Laparoscopic Removal

The aim: demonstration of our experience of surgical treatment of patients with migrated intrauterine device (IUD) into the abdominal cavity. The results of surgical treatment of migrated IUDs in the pelvic cavity are summarized in 17 women. The average age of the patients was 33,23,4 years. The timing of implantation of the IUDs varied from 10 days to 24 months. In all cases, the intra operational finding was T-shaped a copper device. The reason behind the women's consultation was an increase in pain syndrome in the lesser pelvis (n=15), dysuric phenomenon (n=1) and the onset of pregnancy (n=1). Perforation of the uterus and migration of the spiral occurred from 10 days to 2 years after its implantation. All patients were operated laparoscopicaly. The average duration of operations was 45,510,5 minutes. In the postoperative period there were no complications from the pelvic organs and postoperative wounds. The period of hospitalization of patients was 3,50,7 days. In all cases there was a regression of clinical signs and recovery. In one pregnant patient (gestation period 5-6 weeks) the pregnancy proceeded without particular pathological abnormalities and resulted in the birth of a full-term child. Laparoscopic removal of the IUD migrating from the uterine cavity to the abdominal cavity is the method of choice in the treatment of this group of patients, avoiding development of intra- and postoperative complications and a shorter length of stay in the hospital. The effectiveness of the procedure reaches 100%. The most common cause of complication of the IUD is the perforation of the uterus during its implantation.

Survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

2020 ◽  
Vol 21 (4) ◽  
pp. 127-130
Author(s):  
V. U. Rayn ◽  
◽  
A. A. Chernov ◽  
S. O. Zabotkin ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Soft Tissues ◽  
Abdominal Cavity ◽  
Survival Rates ◽  
Pancreatic Head ◽  
Ductal Adenocarcinoma ◽  
En Bloc ◽  
Free Survival ◽  
Pancreatic Head Cancer

Aim. To access overall and event-free survival rates in patients after surgical treatment of localized and locally spread pancreatic head cancer. Materials and methods. A single center observational trial was conducted at a low-volume pancreatic surgery center in Khanty-Mansiysk. Data were collected retrospectively from 2007 to 2019. Patients with resectable tumors were included into the study whose final histology showed pancreatic ductal adenocarcinoma and en-bloc resection. According to the technical facilities and actual clinical protocols all patients received surgical treatment only and were then monitored. Data on progression patterns and survival rates were collected and calculated using Kaplan-Meier survival analysis. Results. Median overall survival (OS) after R0 pancreaticoduodenectomy was 16,8 months (IQR 10,9-23,5). Median progression-free survival was 10,6 mo. (IQR 8,0-20,7). OS in jaundiced patients was 4,9 mo. shorter than in patients without jaundice at the diagnosis (р = 0,011). Patients with serum bilirubin level < 100 μmol/l lived on average 7.2 months longer (p = 0.014). Most frequent sites of primary progression were liver and peritoneum, lungs, bones, lymph nodes of the abdominal cavity / retroperitoneal space, less often metastases were found in the skin and soft tissues. In 21.4% of cases metastases were found in several organs simultaneously with most frequent combination of liver and peritoneum, liver and lungs, lungs and bones. The median survival after progression was 7.1 ± 4.8 months Conclusion. Pancreatic duct adenocarcinoma has a high potential for progression and has therefore poor prognosis. To improve long-term outcomes, it is advisable to apply additional therapeutic options perioperatively.

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

2019 ◽  
Keyword(s):  
Surgical Treatment ◽  
Medical Care ◽  
Comparison Group ◽  
Care Delivery ◽  
Abdominal Cavity ◽  
Surgical Care ◽  
Gunshot Wounds ◽  
Main Group ◽  
Lung Capacity ◽  
Combat Injuries

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

scholarly journals Experimental Validation of the Use of Immobilized Form of Miramistin in the Treatment of Advanced Peritonitis

2021 ◽  
Vol 14 (1) ◽  
pp. 53-60
Author(s):  
Boris Semenovich Sukovatykh ◽  
Maria Alekseevna Zatolokina ◽  
Anastasiya Viktorovna Mosolova
Keyword(s):  
Aqueous Solution ◽  
Inflammatory Process ◽  
Comparison Group ◽  
Abdominal Cavity ◽  
Inflammatory Activity ◽  
Sodium Carboxymethylcellulose ◽  
Generalized Peritonitis ◽  
Fecal Suspension ◽  
Anti Inflammatory ◽  
Experimental Group

Introduction. Mortality in generalized peritonitis ranges from 16% to 30%.The aim of research was to experimentally study the effect of the immobilized form of 0.01% miramistin on the basis of sodium salt of carboxymethylcellulose on the course of the inflammatory process in generalized purulent peritonitis.Materials and methods. The experimental study included 288 male Wistar rats, divided into 3 groups, 96 animals each. Animals of the 1st group (control) were exposed to laparotomy and lavage of the abdominal cavity with saline under aseptic conditions 24 hours after the introduction of fecal suspension into the abdominal cavity. Simultaneously, animals of the 2nd group (comparison) underwent a thorough sanitation of the abdominal cavity with saline with removal of purulent effusion and fibrin films at the first stage, and at the second stage, they were injected 5 ml of an aqueous solution of 0.01% miramistin. In animals of the 3rd (experimental) group, 5 ml of 0.01% miramistin gel was evenly distributed over the entire surface of the peritoneum after laparotomy and sanitation of the abdominal cavity with saline solution. The anti-inflammatory activity of the dosage forms was assessed by the dynamics of leukocytosis and the leukocyte index of intoxication, and the anti-inflammatory activity was assessed by the dynamics of the number of microorganisms in the abdominal exudate. The lethality of animals in each group was estimated. The following areas were taken for histological examination: small and large intestine, parietal peritoneum, pancreas, liver.Results. The anti-inflammatory activity of the immobilized form of 0.01% miramistin on the basis of sodium carboxymethylcellulose was superior to the aqueous solution of miramistin 0.01% on the 1st day - 1.3 times, on the 3rd day - 1.6 times, on the 7th day - 1.5 times. Antimicrobial activity in animals of the experimental group was 1.3 times higher on the 1st day, 1.9 times higher on the 3rd day, and 1.7 times higher on the 7th day than in the comparison group. The mortality rate in animals of the experimental group was 1.5 times lower on the 1st day, and 1.4 times lower on the 3rd and 7th days than in animals of the comparison group. On the first day, the morphological picture of peritonitis in animals of the experimental and comparison groups had no significant differences. On the 3rd day in animals of the comparison group, the inflammatory process in the abdominal cavity was pronounced, and in the experimental group, the intensity of peritonitis began to decrease, and by the 7th day it was completely eliminated.Conclusion. The results of the study allow recommending the use of the immobilized form of 0.01% miramistin based on sodium carboxymethylcellulose in the treatment of generalized peritonitis.

scholarly journals The option of surgery for gastric stump cancer in patients who have previously undergone pancreaticoduodenectomy

2021 ◽  
Vol 102 (1) ◽  
pp. 100-103
Author(s):  
F Sh Akhmetzyanov ◽  
N A Valiev ◽  
V I Egorov ◽  
M I Shaymardanov
Keyword(s):  
Surgical Treatment ◽  
Digestive Tract ◽  
Stomach Cancer ◽  
Professional Training ◽  
Abdominal Cavity ◽  
Benign Disease ◽  
Gastric Stump ◽  
Previous Surgery ◽  
Gastric Stump Cancer ◽  
Abdominal Organs

Gastric stump cancer is a carcinoma which forms no earlier than 5years after surgery for benign disease. The incidence ranges from 2.4 to 5% among patients with stomach cancer. Previous operations lead to the emergence of an adhesive process in the abdominal cavity, changes in the anatomy and topography of the abdominal organs, as well as the development of new ways of lymph outflow. These factors lead to the re-surgery becomes technically more complicated and requires high professional training from the surgeon. Of particular surgical interest is the issue of restoration of the digestive tract, which directly depends on the nature and volume of the previous surgery. In this paper, the authors describe cases of surgical treatment of gastric stump cancer in two patients, who had previously undergone pancreaticoduodenectomy.

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