scholarly journals The standardisation of minimally invasive methods approaches in treatment of post-laparoscopic cholecystectomy bile leakage

2018 ◽  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Minimally Invasive ◽  
Abdominal Cavity ◽  
Bile Leakage ◽  
Early Postoperative Period ◽  
Endoscopic Retrograde ◽  
Septic Complications ◽  
Endoscopic Techniques ◽  
Results Of Treatment ◽  
Ultrasound Guided Puncture

The paper analyses the results of surgical treatment of 10243 patients with cholelithiasis who underwent laparoscopic cholecystectomy. In the early postoperative period 60 patients (0.59%) had bile leakage. Developed surgical technique based on ultrasound data and endoscopic retrograde cholangiopancreatography can improve the results of treatment and avoid septic complications and lethal outcomes. Conservative treatment, minimally invasive endoscopic techniques, ultrasound guided puncture methods and relaparoscopy were effective in 52 patients (86,7%). Postoperative bile leakage is currently one of the most frequent complications of LCE, routine drainage of the subhepatic space facilitates early diagnosis of postoperative complications. When choleo-excretion is more than 200 ml per day, endoscopic retrograde cholangiography is necessary to diagnose damage to the main bile ducts, while confirming the injury of the hepaticocholedochus, a reconstructive surgery with laparotomy is indicated. Drainage bile bleeding, accompanied by symptoms of biliary peritonitis or a significant accumulation of bile in the abdominal cavity in the absence of an injury to the hepaticocholedochus, requires a relaparoscopy for diagnostic and therapeutic purposes. Standardization of the complex application of relaparoscopy, transduodenal endoscopic interventions and puncture techniques can significantly reduce the number of laparotomic operations to correct the complications that have arisen.

scholarly journals Bile leak syndrome after laparoscopic cholecystectomy

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

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

scholarly journals Outcomes of the minimally invasive aortic valve replacement

2019 ◽  
Vol 178 (3) ◽  
pp. 16-20
Author(s):  
M. A. Snegirev ◽  
A. A. Paivin ◽  
D. O. Denisyuk ◽  
N. E. Khvan ◽  
L. B. Sichinava ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Early Postoperative Period ◽  
Red Blood Cell Transfusion ◽  
Postoperative Blood Loss ◽  
Transfusion Rate ◽  
Results Of Treatment ◽  
Risk Patients

The OBJECTIVE was to demonstrate clinical outcomes of minimally invasive aortic valve replacement (MIAVR).MATERIAL AND METHODS. We retrospectively analyzed surgical results of treatment of patients underwent isolated AVR in our Institution between 2006 and 2018. Overall number of operations was 122; 56 of patient were operated via upper ministernotomy approach. Preoperative characteristics were similar in both groups.RESULTS. In our series MIAVR procedures had prolonged CPB and aortic cross clamping time, what significantly contributed to the increase in manifestations of heart failure in the early postoperative period, but didn’t affect the perioperative mortality and major morbidity rates. MIAVR led to reduction in postoperative blood loss and perioperative red blood cell transfusion rate. Most severe complications occurred in frail patients older than 75 years, and in those with extensive aortic annular calcification.CONCLUSION. MIAVR was the safe and reproducible surgical intervention and rarely led to significant complications in low-risk patients. Prolonged CPB time adversely affected the frequency of significant complications, especially in elderly patients. Although, selected high risk patients might benefit with MIAVR.

scholarly journals MINI-INVASIVE PERCUTANEOUS USP-CONTROLLED DRAINING OF PSEUDOCYSTS OF THE PANCREAS, SUPPLEMENTED WITH LASER VAPORIZATION

2020 ◽  
pp. 32-36
Author(s):  
Ya. V. Naboychenko ◽  
R. S. Shevchenko
Keyword(s):  
Minimally Invasive ◽  
Research Methods ◽  
Surgical Intervention ◽  
Average Length ◽  
Abdominal Cavity ◽  
Surgical Techniques ◽  
Early Postoperative Period ◽  
Laser Vaporization ◽  
Pancreatic Pseudocysts ◽  
Surgical Methods

Summary. Aim. The aim of this study was to evaluate the results of percutaneous minimally invasive ultrasound-controlled drainage of pancreatic pseudocysts, supplemented by laser vaporization, compared with classical surgical methods of treatment. Materials and research methods. This work is based on the results of examination and surgical treatment of 51 patients with PCPD, which were divided into two clinical groups. To optimize the choice of the method of surgical intervention, instrumental research methods were used: ultrasound (PHILIPS HD 11 XE apparatus (Austria), EGDS, ERCP, CT of the pancreas, ECG, X-ray examination of the chest and abdominal cavity, laparoscopy. Research results. The paper establishes options for choosing a puncture point for a pancreatic pseudocyst with minimal traumatic effect, as a result of which damage to neighboring organs is excluded. Selected the most effective methods of intraoperative use of laser radiation, depending on the formation of the pseudocyst wall and the type of complication. The main surgical techniques for intraoperative use of percutaneous puncture laser vaporization of the pseudocyst wall, with external and internal drainage, are presented. Conclusions. When comparing minimally invasive methods of surgical intervention with laparotomic ones, the effectiveness of the former is evidence-based, while the proportion of complications in the early postoperative period and the average length of hospital stay when using minimally invasive interventions are much less. The use of laser irradiation for the purpose of debridement and vaporization (for percutaneous minimally invasive interventions) made it possible to reduce the number of external drainage operations to 41.0 %, and to increase the number of internal digestive drainage operations to 48.7 %. In the long-term period, there was a decrease in the recurrence of pseudocysts to 12.5 %. The proposed method of treating patients with PCPD can be used as an operation of choice in the presence of clinical conditions and technical support.

scholarly journals Results of surgical treatment of extrahepatic bile duct injuries

2020 ◽  
Vol 37 (1) ◽  
pp. 63-72
Author(s):  
L. P. Kotelnikova ◽  
I. G. Burnyshev ◽  
O. V. Bazhenova ◽  
D. V. Trushnikov
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Treatment ◽  
Bile Duct ◽  
Bile Ducts ◽  
Bile Leakage ◽  
Biliary Reconstruction ◽  
Long Term Outcomes ◽  
Endoscopic Retrograde ◽  
Extrahepatic Bile Ducts

Aim. To evaluate the short-and long-term outcomes after surgical repair of iatrogenic lesions of extrahepatic bile ducts depending on the timing of diagnosis in conditions of specialized clinic. Materials and methods. Our study involved a retrospective analysis of 159 patients who were treated for iatrogenic lesions of extrahepatic bile ducts during 1987-2017. These patients were divided into two groups depending on the timing of surgical treatments: early biliary reconstruction ( 5 days after bile duct transection) and late biliary reconstruction ( 5 days post-transection). These groups were compared on the basis of postoperative morbidity and long-term outcomes. Results. Following laparoscopic cholecystectomy, 2 patients received endoscopic retrograde stents due to bile leakage from the cystic ducts, and 14 patients underwent hepaticocholedochostomy using Ker drainage. The incidence of bile leakage was observed in 14. 3 % of cases during the early post-operative period, strictures appeared in 28.6 % of cases. Hepaticojejunostomy was performed in 91 cases: in 62 with stents and in 29 without stents. Bile leakage was observed in 17.6 % of cases, and strictures in 19.8 % of cases. Our statistical analyses revealed no significant differences between the two groups (i.e., early and late timing of surgical treatment) in the rates of bile leakage and strictures. The extent of surgeons experience in bile surgery significantly correlated with positive outcomes. Conclusions. Endoscopic retrograde stent proved to be an effective and fast solution in cases of bile leakage from cystic ducts following laparoscopic cholecystectomy. Although it is preferable to perform reconstructive surgeries within the first five days after bile duct injury, our results indicated that in the presence of external bile fistula without peritonitis and severe cholangitis, reconstructive surgery can be performed in specialized surgical departments later than 5 days with satisfactory results.

DAMAGE TO THE BILE DUCTS AFTER LAPAROSCOPIC CHOLECYSTECTOMY. REVIEW.

2021 ◽  
pp. 17-25
Author(s):  
Maxat Doskhanov
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Ducts ◽  
Gallstone Disease ◽  
Abdominal Cavity ◽  
Bile Leakage ◽  
Treatment And Prevention ◽  
Technical Errors ◽  
Bile Duct Injuries ◽  
Good Cosmetic

This article provides a review of the literature on bile duct injuries after laparoscopic cholecystectomy. Laparascopy is considered the gold standard in the treatment of gallstone disease. This technique has a number of positive advantages: minimally invasiveness, quick rehabilitation, a shorter hospital stay, a good cosmetic effect, and a low lethal outcome. Along with these advantages, the number of complications also increased: damage to the bile ducts, hepatic vessels, bile leakage, formation of strictures, defects in drainage of the biliary tract and improper treatment of the cystic duct, insufficient drainage of the abdominal cavity. Today, many aspects of surgical treatment and prevention of bile duct injuries remain controversial and are still considered relevant. The main reasons for this complication are: lack of experience of the surgeon, inattention, ignorance of the main options and possible anomalies of important anatomical structures in the area of the hepatic hilum and hepato-duodenal ligament, technical errors.

scholarly journals Endoscopic cystic duct stent as primary treatment for intrahepatic gallbladder perforation with abscess formation

2017 ◽  
Vol 99 (4) ◽  
pp. e128-e130 ◽  
Author(s):  
P Williams ◽  
R French ◽  
B Paranandi ◽  
C Wilson ◽  
R Charnley
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Minimally Invasive ◽  
Open Cholecystectomy ◽  
Primary Treatment ◽  
Abscess Formation ◽  
Gallbladder Perforation ◽  
Biliary Disease ◽  
Invasive Treatment ◽  
Endoscopic Retrograde ◽  
Uncommon Presentation

Intrahepatic gallbladder perforation with abscess formation is an uncommon presentation of biliary disease. There is no consensus on how to treat this condition, with strategies varying from percutaneous drainage to open cholecystectomy and washout. We present a case of a novel, minimally invasive treatment, using endoscopic retrograde cholangiopancreatography to place a transcystic drain as a bridge to laparoscopic cholecystectomy.

scholarly journals First results of using a bidirectional U-shaped sternal suture in patients who have suffered a deep sternal infection

2021 ◽  
Vol 180 (4) ◽  
pp. 51-56
Author(s):  
A. L. Charyshkin ◽  
A. A. Guryanov
Keyword(s):  
Mechanical Damage ◽  
Early Postoperative Period ◽  
Septic Complications ◽  
Static State ◽  
Native Bone ◽  
Sternal Infection ◽  
Results Of Treatment ◽  
Heart Operation ◽  
First Results ◽  
Suture Failure

Introduction. Sternomediastinitis in patients undergoing open heart operation remains a formidable complication. Treatment of a sternal infection is a complex and multi-component process. Closing of the sternal wound is one of the decisive steps in the treatment of sternomediastinitis. This is due to the fact that an insufficiently static state of the sternum in itself leads to a relapse of purulent-septic complications. At the same time, we have to work with non-native bone that has undergone inflammatory and destructive changes and multiple mechanical damage.The objective of the study was to evaluate the results of using the developed bidirectional U-shaped sternal suture for reosteosynthesis of the sternum in patients after postoperative mediastinitis.Methods and materials. The results of treatment of 16 patients with deep sternal infection in the early postoperative period were analyzed. All patients were divided into two groups according to the type of used sternal sutures. The first group consisted of 8 patients in whom a developed bidirectional U-shaped sternal suture was used for sternum reosteosynthesis. In the second group, in 8 patients, the sternal cusps were brought together using classic sternal figure-of-8 suture. A two-stage tactics of treatment was used both in the first and in the second groups of patients. Surgical debridement of the wound with removal of the primary sternal sutures was performed in the first stage. Subsequently, vacuum-assisted therapy was carried out using antiseptics. The second stage was the closure of the sternal wound after cleaning and decontamination of the wound.Results. Signs of sternal suture failure were not observed in the first group. Three patients underwent repeated plasty of the sternum due to the incompetence of the sternal sutures in the second group. One patient had relapse of wound infection.Conclusion. The developed bi-directional U-shaped sternal suture in patients after postoperative sternomediastinitis provides the prevention of inconsistency of sternum.

scholarly journals A forgotten biliary stent for 17 years: Presented with perforated gallbladder and stentolith

2014 ◽  
Vol 05 (01) ◽  
pp. 022-023 ◽  
Author(s):  
Tejas J. Patel ◽  
Sanjay Rajput ◽  
K. S. Patel ◽  
Sanjiv P. Haribhakti
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Minimally Invasive ◽  
Stent Placement ◽  
Unusual Case ◽  
Biliary Stent ◽  
Endoscopic Retrograde ◽  
The Past ◽  
Gangrenous Cholecystitis ◽  
Biliary Diseases

AbstractEndoscopic biliary stent placement is a well-established, safe, and minimally invasive modality for the treatment of choledocholithiasis and other biliary diseases. Over the past decade, there has been an increase in its prevalence and use. We present an unusual case of forgotten biliary stent for 17 years who presented now with gangrenous cholecystitis and sealed the perforation. A large stentolith had also developed which was cleared with endoscopic retrograde cholengiography and re-stenting followed by laparoscopic cholecystectomy.

scholarly journals The case of the multistage treatment of acute pancreatitis using a variety of minimally invasive techniques

2020 ◽  
Vol 39 (3) ◽  
pp. 40-49
Author(s):  
Sergey Y. Ivanusa ◽  
Maksim Lazutkin ◽  
Dmitriy Shershen ◽  
Anton Chebotar
Keyword(s):  
Acute Pancreatitis ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Surgical Procedures ◽  
Infectious Complications ◽  
Minimally Invasive Techniques ◽  
Septic Complications ◽  
Results Of Treatment ◽  
Invasive Techniques ◽  
Surgical Injury

Treatment of acute pancreatitis and infectious complications is a complex multidisciplinary task. The use of traditional surgical procedures for the rehabilitation of foci of pancreatogenic infection often aggravates the course of the disease, leads to the development of postoperative complications, does not improve the results of treatment. On the contrary, the use of minimally invasive techniques avoids additional surgical injury. The case of stage treatment of acute pancreatitis and its purulent-septic complications with the use of minimally invasive technologies is presented to the readers.

scholarly journals Results of Colostomy Use in Children with Anorectal Malformation

2021 ◽  
Vol 11 (2) ◽  
pp. 17-28
Author(s):  
Temur T. Narbaev ◽  
Mahmud M. Aliev ◽  
Shovkat T. Bozorov ◽  
Jasmin T. Turaeva ◽  
Muzaffar A. Yuldashev ◽  
...  
Keyword(s):  
Anorectal Malformation ◽  
Abdominal Cavity ◽  
Anorectal Malformations ◽  
Excretory Urography ◽  
Early Postoperative Period ◽  
Social Adaptation ◽  
Screening Tests ◽  
Medical Institute ◽  
Results Of Treatment ◽  
Technical Errors

Introduction. Anorectal malformations in children are still one of the most challenging problems in pediatric coloproctology. The incidence of anorectal malformations in recent years has no tendency to decrease and, according to various authors, ranges from 1 in 4000-5000 live births. Most pediatric surgeons continue to adhere to the opinion about the advisability of preliminary colostomy and delayed proctoplasty at the age of 6-18 months or when the child reaches a certain body weight (8-10 kg.). They are motivating this tactic with the possibility of creating an optimal condition for performing a complex intervention, reducing anesthetic risk, avoiding technical errors. Objective is to improve treatment outcomes for anorectal malformations in children with prior colostomy. Materials and methods. The work is based on the results of treatment of 154 children with anorectal malformation, with preliminary colostomy in the clinic of the Tashkent Pediatric Medical Institute for the period from 2000 to 2020. Along with routine and general clinical examination methods, all children underwent: X-ray of the abdominal cavity, colostography, fistuloirrigography, excretory urography, cystography, ultrasound of the perineum (small pelvis), neurosonography (NSG) screening tests. Results. 154 (10*0%) children had colostomy as a palliative stage of treatment. Of these 117 (76%) children developed colostomy on the first day of life, with the development of intestinal obstruction. In 37 (24%) children, the formation of a colostomy was performed directly by us. 9 (5.8%) children as the first stage before primary radical correction with a high form of the defect and 10 (6.5%) children previously operated on and requiring re-corrective operations, 5 (3.2%) patients underwent colostomy after the development of complications in the early postoperative period. In 13 (8.5%) cases, colostomies were formed with identified concomitant anomalies and defects that clinically "dominated" over anorectal malformation. In 2 (5.4%), a double sigmastoma was imposed, in 2 (5.4%) a distal single-barreled sigmastoma, in 5 (13.5%) the Hartmann type terminal sigmastoma. Conclusion. The use of colostomy in children with anorectal malformation made it possible to carry out the necessary surgical tactics in a timely and differentiated manner. To reduce the frequency, nature of complications and early disability, to improve the quality of life and social adaptation of patients.

Sign in / Sign up

Export Citation Format

Share Document