scholarly journals ELECTROSURGICAL AND ULTRASOUND DISSECTION AND COAGULATION TISSUE EFFECT FEATURES DURING OPERATIONS ON STOMACH AND INTESTINES

2018 ◽  
Keyword(s):  
Gastrointestinal Tract ◽  
Postoperative Complications ◽  
Blood Vessels ◽  
Postoperative Mortality ◽  
Main Group ◽  
Ultrasound Scanning ◽  
Results Of Treatment ◽  
Tissue Effect ◽  
Ultrasound Dissection

The work is devoted to the problem of reducing intra- and postoperative complications in patients with surgical gastrointestinal tract pathology. The aim of the study is to comprehensively investigate electrosurgical and ultrasound dissection and coagulation features to prevent intra- and postoperative complications, improve the results of treatment of patients with surgical gastrointestinal tract pathology. The study included experimental and clinical parts. The use of ultrasound scanning in the main group of patients revealed significant advantages of this method compared to MES. This device allowed not only to carry out the dissection of the gastrointestinal tract organs, but also to mobilize them, thereby simplifying and speeding up the operation. Intersection of vessels of both omenta, small and large intestines mesentery vessels was carried out with alternating regimes of coagulation and cutting, while ligating only large blood vessels. The study showed that thanks to the use of ultrasound scanning it was possible to reduce the number of postoperative complications from 16.2% to 6.7%, postoperative mortality decreased from 6.11% to 1.55%, and postoperative bed-day decreased from an average of 17.5+ 3.75 to 12.5 + 2.58, which in the complex allowed to improve the parameters of treatment and rehabilitation of patients.

scholarly journals PREVENTION OF EARLY POSTOPERATIVE COMPLICATIONS OF INTESTINAL SURGERY USING IMMUNOMODULATING THERAPY

2020 ◽  
pp. 37-45
Author(s):  
M. Tymchenko
Keyword(s):  
Small Intestine ◽  
Postoperative Complications ◽  
Lipoic Acid ◽  
Comparison Group ◽  
Intestinal Anastomosis ◽  
Interleukin 2 ◽  
Postoperative Mortality ◽  
Main Group ◽  
Immunomodulating Therapy ◽  
Results Of Treatment

Summary. The aim of the study is to develop a method of immunocorrection, which improves the results of treatment of patients with developed peritonitis against the background of the small intestine anastomosis leakege by stopping the cascade of SIRS and MOF. Materials and methods. The work was clinical in nature, was performed in the clinic of the SI «ZIGUS NAMSU» in the period from 2016 to 2019. We examined 58 patients with various diseases of the abdominal organs complicated by peritonitis, in which sections of the small intestine were resected. The Comparison Group included patients who received traditional therapy, patients of the Main Group, the complex of drug therapy included recombinant interleukin-2, galavit and α-lipoic acid. The results of surgical treatment were evaluated according to the classification of D. Dindo, N. Demartinesta, P.-A. Clavien (2004). Statistical analysis was removed from the Statistica 6.0 software (StatSoft, Inc. 2001) and SPSS 7.5 on Apple PC. Results and Discussion. Thus, the results of the use of a comprehensive immunomodulation scheme using IL-2, galavit and α-lipoic acid in the complex treatment of patients with widespread peritonitis against the background of intestinal anastomosis failure suggest that the developed scheme has a targeted immunoregulatory effect and prevents the excess production of inflammatory mediators in the early postoperative the period of the disease, helps to eliminate the cytokine imbalance and prevents the development of secondary immune deficiency. A comparative analysis of the incidence of complications revealed that in patients of the Main Group the average number of complications per patient was 0.53, while in the Comparison Group this indicator was 1.36. Conclusions. The use of a combination of IL-2, galavit and α-lipoic acid in the complex of treatment of common peritonitis helps to reduce the level of systemic and local postoperative complications, as well as the level of postoperative mortality.

scholarly journals PREVENTION OF SECONDARY INFECTION OF WOUNDS IN PATIENTS WITH HEMODIALYSIS

2019 ◽  
Vol 18 (4) ◽  
pp. 90-93
Author(s):  
O. Ya. Popadyuk
Keyword(s):  
Polymer Film ◽  
Biodegradable Polymer ◽  
Secondary Infection ◽  
Postoperative Mortality ◽  
Main Group ◽  
Purulent Discharge ◽  
Control Group ◽  
Results Of Treatment ◽  
Tissue Edema ◽  
Student’S T

According to the literature, postoperative complications and associated purulent-inflammatory processes occur in 35-60 % of patients, which increases the rates of postoperative mortality to 25 %. The main purpose of our work was to evaluate the effectiveness of the application of the polymeric film «biodep-nano» in the prevention of secondary infection of wounds in patients with hemodialysis. Methods. The results of treatment of 36 patients divided into two groups were analyzed: the main group (18 patients) with applied traditional gauze dressings and the experimental group (18 patients) with additionally applied biodep-nano polymer films (Pat. No. 110594 Ukraine, MPK 2016.01, biodegradable polymer film «biodep-nano» is produced as «Hygienic and prophylactic. Biodegradable polymer film «Biodep-nano» of 50 g according to TU U 20.4-2950221612-001: 2017». Statistical data processing was performed using Student's t-test, 5 % (p≤0.05). Results. The results obtained showed that the temperature of the study area in the main group came to normal on the 3rd day (2.8±0.2 days), and in the group where traditional methods were used – on the 5-7th (5.9±0.4) day, (p<0.05). Reduction of tissue edema by an average of 3.8±1.2 days, and in the control group by an average of 6.1±1.7 days, (p<0.05). With regard to hyperemia, it gradually decreased and in the main group was up to 3.9±2.1 days on an average, and in the control group by 6.0±1.9 days (p<0.05). In the main group, the appearance of purulent discharge was observed in 1 patient, in the control group in 4 cases. The statistical calculations showed a significant statistical difference in the reduction of inflammatory process in both groups. Conclusions. The use of new methods and means of preventing secondary infections after surgery in patients with hemodialysis will enable to carry out dialysis of patients, shorten their stay in the clinic and save lives.

scholarly journals Surgical treatment of patients with descending purulent mediastinitis

2021 ◽  
Vol 26 (4) ◽  
pp. 118-123
Author(s):  
I.M. Shevchuk ◽  
S.S. Snizhko
Keyword(s):  
Surgical Treatment ◽  
Pleural Cavity ◽  
Comparison Group ◽  
Postoperative Mortality ◽  
Complete Removal ◽  
Main Group ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Minimally Invasive Surgical ◽  
Surgical Tactics

The aim of the study was to improve the results of treatment of patients with descending purulent mediastinitis by means of individualized surgical tactics with the priority use of minimally invasive surgical interventions and developed methods of drainage of the mediastinum and pleural cavity. Examination and treatment of 73 patients with descending purulent mediastinitis receiving treatment in the department of thoracic surgery of Ivano-Frankivsk regional clinical hospital was carried out. Treatment of patients in the main group included intramediastinal administration of antibiotics, the use of the developed method of cascade drainage of the mediastinum and pleural cavity, the priority use of video-assisted thoracoscopy and surgical tactics aimed at anticipating the spread of the purulent process in the mediastinum. The rapid and reliable decrease in the indices of endogenous intoxication in the main group confirms the effectiveness of the developed tactics of surgical treatment of patients with mediastinitis, adequate sanation of purulent mediastinatis, complete removal of the purulent substrate from the mediastinum and pleural cavity. The developed tactics of surgical treatment of purulent mediastinitis allowed reducing the overall postoperative mortality from 26.3% in the comparison group to 11.4% in the main group of patients.

scholarly journals Goal-directed fluid therapy in urgent GAstrointestinal Surgery—study protocol for A Randomised multicentre Trial: The GAS-ART trial

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e022651
Author(s):  
Anders Winther Voldby ◽  
Anne Albers Aaen ◽  
Ann Merete Møller ◽  
Birgitte Brandstrup
Keyword(s):  
Mechanical Ventilation ◽  
Gastrointestinal Tract ◽  
Postoperative Complications ◽  
Fluid Therapy ◽  
Bowel Disease ◽  
Gastrointestinal Surgery ◽  
Postoperative Mortality ◽  
Bleeding Complications ◽  
Standard Group ◽  
Goal Directed Fluid Therapy

IntroductionIntravenous fluid therapy during gastrointestinal surgery is a life-saving part of the perioperative care. Too little fluid may lead to hypovolaemia, decreased organ perfusion and circulatory shock. Excessive fluid administration increases postoperative complications, worsens pulmonary and cardiac function as well as the healing of surgical wounds. Intraoperative individualised goal-directed fluid therapy (GDT) and zero-balance therapy (weight adjusted) has shown to reduce postoperative complications in elective surgery, but studies in urgent gastrointestinal surgery are sparse. The aim of the trial is to test whether zero-balance GDT reduces postoperative mortality and major complications following urgent surgery for obstructive bowel disease or perforation of the gastrointestinal tract compared with a protocolled standard of care.Methods/analysisThis study is a multicentre, randomised controlled trial with planned inclusion of 310 patients. The randomisation procedure is stratified by hospital and by obstructive bowel disease and perforation of the gastrointestinal tract. Patients are allocated into either ‘the standard group’ or ‘the zero-balance GDT group’. The latter receive intraoperative GDT (guided by a stroke volume algorithm) and postoperative zero-balance fluid therapy based on body weight and fluid charts. The protocolled treatment continues until free oral intake or the seventh postoperative day.The primary composite outcome is death, unplanned reoperations, life-threatening thromboembolic and bleeding complications, a need for mechanical ventilation or dialysis. Secondary outcomes are additional complications, length of hospital stay, length of stay in the intensive care unit, length of mechanical ventilation, readmissions and time to death. Follow-up is 90 days.We plan intention-to-treat analysis of the primary outcome.Ethics and disseminationThe Danish Scientific Ethics Committee approved the GAS-ART trial before patient enrolment (J: SJ-436). Enrolment of patients began in August 2015 and is proceeding. We expect to publish the GAS-ART results in Summer 2019.Trial registration numberEudraCT 2015-000563-14.

scholarly journals COMPLICATED DIVERTICULITIS: MANAGEMENT, DIAGNOSIS, TREATMENT

2018 ◽  
pp. 68-72
Author(s):  
O. Yu. Karpukhin ◽  
Yu. S. Pankratova ◽  
M. I. Cherkashina ◽  
A. F. Shakurov ◽  
M. I. Ziganshin
Keyword(s):  
Postoperative Complications ◽  
Diverticular Disease ◽  
Bowel Resection ◽  
Wide Spectrum ◽  
Postoperative Mortality ◽  
Complicated Diverticulitis ◽  
Intestinal Tube ◽  
Results Of Treatment ◽  
Secondary Resection ◽  
Colostomy Reversal

AIM. To analyze the results of treatment of patients with diverticular disease in Coloproctology Department. MATERIALS AND METHODS. During the periodfrom 2001 to 2017, 223 patients with diverticular colon disease were treated in the hospital. RESULTS. 191 (85,7%) were treated conservatively, 32 (14,3%) patients were operated on. One-stage procedure was performed in 21 (67,7%) patients, in 10 (32,3%) bowel resection has been completed by stoma. Postoperative complications developed in 25% of cases. Postoperative mortality was 3,1%. Operations reconstructive the length of the intestinal tube were performed in 24 previously operated patients. Colostomy reversal was combined with secondary resection in 9 (37,5%) patients CONCLUSION. Diverticular disease of the colon is a widespread condition with a wide spectrum of severe complications requiring surgical correction. In work with this pathology it is necessary to strictly observe uniform standards of diagnostics and treatment.

scholarly journals Differentiated approach to radical surgical treatment of elderly patients with tumor diseases of the pancreatoduodenal zone

2021 ◽  
Vol 13 (2) ◽  
pp. 49-56
Author(s):  
Badri V. Sigua ◽  
Vyacheslav P. Zemlyanoy ◽  
Alexey V. Gulyaev ◽  
Malkhaz Yu. Tsikoridze ◽  
Evgeny A. Zakharov
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Comparison Group ◽  
Main Group ◽  
Control Group ◽  
Study Group ◽  
Tumor Diseases ◽  
Results Of Treatment ◽  
Repeated Surgery ◽  
Pancreatic Fistulas

BACKGROUND: In recent years, there has been a widespread increase in the incidence of tumors of the pancreatoduodenal zone, especially noticeable in the older age group. A decrease in the incidence of postoperative complications and mortality after pancreatoduodenal resection made it possible to expand the indications for surgical treatment of elderly and senile patients. AIM: Improvement of the immediate results of pancreatoduodenal resection in the treatment of elderly and senile patients suffering from tumor diseases of the pancreatoduodenal zone. MATERIALS AND METHODS: Pancreatoduodenal resection was performed in 61 elderly and senile patients with tumors of the pancreatoduodenal zone. The main group consisted of 32 patients, whose treatment was carried out in accordance with the developed algorithm for choosing a method for forming a pancreatodigestive anastomosis based on a scale for assessing the risk of developing pancreatic fistulas. The comparison group consisted of 29 patients in whom the method of forming a pancreatodigestive anastomosis was carried out in accordance with the preferences of the operator without taking into account the risk of developing a pancreatic fistula. RESULTS: In the main group, compared with the control group, pylorus-saving interventions were performed significantly more often 27 (84.4%) and 14 (48.3%) (p 0.01). There was also a decrease in the frequency of performing pancreaticojejunostomy 16 (50%) and 22 (75.9%) (p 0.05), due to the use of reservoir terminolateral pancreatojejunostomy 8 (25%) and 0, respectively (p 0.01). Postoperative complications were observed in 14 (43.8%) of the study group and in 21 (72.4%) patients of the comparison group (p 0.05). There was also a decrease in the incidence of postoperative pancreatic fistulas from 8 (27.6%) to 2 (6.2%) (p 0.05) in the study group. Repeated surgery was required in 5 (15.6%) patients of the main group and 11 (37.9%) in the comparison group (p 0.05). The lethal outcome was recorded in 3 (9.4%) patients of the main group and in 7 (24.1%) in the comparison group (p 0.05). CONCLUSIONS: The results of performing pancreatoduodenal resection in the treatment of elderly and senile patients can be comparable with the results of treatment of the general population. The use of the developed algorithm made it possible to reliably reduce the incidence of complications from 72.4 to 43.8% (p 0.05), postoperative pancreatic fistulas from 27.6 to 6.2% (p 0.05), as well as the frequency of repeated interventions. from 37.9 to 15.6 % (p 0.05). In addition, a downward trend in mortality was achieved from 24.1% to 9.4%.

scholarly journals The methods of prophylaxis of the morbidity occurrence after pancreatico-duodenal resection

2019 ◽  
Vol 86 (5) ◽  
pp. 3-7
Author(s):  
V. М. Коpchak ◽  
L. О. Pererva ◽  
О. V. Duvalko ◽  
V. V. Khanenko ◽  
S. V. Аndronik ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Pancreatic Fistula ◽  
Comparison Group ◽  
Main Group ◽  
Postoperative Pancreatic Fistula ◽  
Occurrence Rate ◽  
Results Of Treatment ◽  
Comparative Group ◽  
Clinically Significant ◽  
Duodenal Resection

Objective. To elaborate the system of measures with objective of lowering of the occurrence rate for pancreatic fistula and severe complications after pancreaticoduodenal resection (PDR). Маterials and methods. Results of treatment was analyzed for 143 patients, to whom pancreaticoduodenal resection performed. In accordance to the scheme proposed, using elaborated scale of the risk for occurrence of postoperative pancreatic fistula, were operated 56 patients in 2017 - 2018 yrs (the main group). Comparative group consisted of 87 patients, operated in the clinic in 2015 - 2016 yrs without estimation of the risk for postoperative pancreatic fistula occurrence and sarcopenia presence, and formation of pancreaticojejunoanastomosis have depended upon decision of a surgeon-operator. Results. The rate of occurrence of the postoperative complications was trustworthily higher in the comparison group (c2 = 5.8, p=0.01). In the main group a clinically significant pancreatic fistula of Grade В was observed in 1 of 7 patients with postoperative complications. In the comparison group pancreatic fistulas of Grades В or С were diagnosed in 15 of 26 patients with postoperative complications, which are trustworthily higher, than in the main group (c2 = 4.16, p=0.04). Conclusion. The system of measures elaborated gave the possibility to reduce the occurrence rate for pancreatic fistula significantly - from 17.2 tо 1.8% and severe postoperative morbidity - from 29.9 tо 12.5%.

scholarly journals Combined Surgical Tactics with Step-up Approach in the Treatment of Infected Acute Pancreatitis

2020 ◽  
Vol 87 (3-4) ◽  
pp. 3-9
Author(s):  
I. A. Kryvoruchko ◽  
V. V. Boyko ◽  
K. Yu. Parkhomenko ◽  
A. G. Drozdova ◽  
S. A. Andreieshchev
Keyword(s):  
Acute Pancreatitis ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Open Surgery ◽  
Postoperative Mortality ◽  
Multiple Organ ◽  
Percutaneous Catheter Drainage ◽  
Results Of Treatment ◽  
Surgical Tactics ◽  
Open Necrosectomy

Objective. To evaluate the results of treatment using minimally invasive interventions and open necrectomy in patients with infected acute pancreatitis. Materials and methods. A retrospective cohort two-centered analysis was performed in 211 patients with infected acute pancreatitis who divided into two groups: the first included 101 patients, in the treatment of which used open surgery; the second included 110 patients, in the treatment of which used treatment tactic step-up approach. Results. In the first group used open necrosectomy with drainage for postoperative lavage (75 patients, 74.3%), including open packing with planned re-laparotomy (8 patients, 7.9%), and omentobursostomy for necrosectomy after surgery (18 patients, 17.8%). Postoperative complications occurred in 58 (57.4%), after the surgery 34 (33.7%) patients was died: 30 had a thirty-day mortality, and 4 had a ninety-day mortality. In the second group group, 72 (65.5%) patients were treated by percutaneous catheter drainage, 6 (5.5%) by video-assisted retroperitoneal debridement and drainage, 5 (4.5%) by through the wall of the stomach or duodenum in the infected pseudocyst and open necrosectomy was performed on 27 (24.5%) patients. Postoperative complications occurred in 37 (33.6%) patients, after the surgery 19 (17.3%) was died: 15 had a thirty -day mortality and 4 had a ninety-day mortality. In the regression analysis, only the presence of multiple organ dysfunction before (AUC = 0.867) and after surgery (AUC = 0.930) significantly affected postoperative mortality, but the effect of the prevalence of pancreatic necrosis (AUC = 0.693) on mortality was limited. Differences were likely between groups (χ2=7.282, p=0.026). Conclusion. The surgical treatment should be initiated with a minimally invasive procedures and combination these operations with open surgery was able to reduce complications and mortality in the patients with infected acute pancreatitis.

scholarly journals TREATMENT OF PATIENTS WITH GASTRIC CANCER COMPLICATED BY PERFORATION

2021 ◽  
pp. 23-26
Author(s):  
V. V. Boyko ◽  
I. V. Krivorotko ◽  
V. A. Lazirskiy
Keyword(s):  
Gastric Cancer ◽  
Comparison Group ◽  
Postoperative Mortality ◽  
Main Group ◽  
Diffuse Peritonitis ◽  
Two Stage ◽  
Surgical Interventions ◽  
Perforation Hole ◽  
Results Of Treatment ◽  
Surgical Tactics

Abstract. Introduction. Despite the declining incidence of gastric cancer, the problem of treatment of complicated forms of the disease remains one of the most complex and relevant. The aim of the study was to improve the results of treatment of patients with complicated gastric cancer. Materials and methods. The study is based on the analysis of the results of treatment of 19 patients with gastric cancer complicated by perforation, who were treated at the “State Institution «Zaitsev V.T. Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine” from 2011 to 2020 aged 18 to 85. All patients were divided into two groups: comparison — 9 (47.3 %) patients (were treated from 2011 to 2015), the main — 10 (52.7 %) patients (treatment period from 2016 to 2020). Results and discussion. In the comparison group, conventional surgical tactics and operations were used. The main group used active-individualized two-stage surgical tactics, which involve suturing a perforation hole in the first stage and combined and reconstructive surgery in the second. Radical operations were performed in 10 (52.6 %) patients; in 9 (47.4 %) — palliative and symptomatic. Postoperative complications occurred in 5 patients (26.3 %), postoperative mortality was 26.3 % (5 patients). Conclusions. In patients with gastric cancer complicated by perforation, in a serious condition of the patient and the presence of diffuse peritonitis, we consider it appropriate to use two-stage surgical tactics. The introduction of the proposed surgical tactics and new surgical interventions helped to increase the number of radical operations from 4 (21.0 %) in the comparison group to 6 (31.6 %) in the main group and reduce postoperative mortality from 15.8 % to 10.5 %, respectively.

Outcomes of Surgical and Nonsurgical Treatment for Colorectal Cancer in Nonagenarian Patients

2021 ◽  
pp. 000313482199506
Author(s):  
Youngbae Jeon ◽  
Kyoung-Won Han ◽  
Won-Suk Lee ◽  
Jeong-Heum Baek
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Surgical Treatment ◽  
Postoperative Complications ◽  
Postoperative Mortality ◽  
Nonsurgical Treatment ◽  
Perioperative Outcomes ◽  
Rank Test ◽  
Kaplan Meier ◽  
Number Of Patients

Purpose This study is aimed to evaluate the clinical outcomes of surgical treatment for nonagenarian patients with colorectal cancer. Methods This retrospective single-center study included patients diagnosed with colorectal cancer at the age of ≥90 years between 2004 and 2018. Patient demographics were compared between the operation and nonoperation groups (NOG). Perioperative outcomes, histopathological outcomes, and postoperative complications were evaluated. Overall survival was analyzed using Kaplan-Meier methods and log-rank test. Results A total of 31 patients were included (16 men and 15 women), and the median age was 91 (range: 90‐96) years. The number of patients who underwent surgery and who received nonoperative management was 20 and 11, respectively. No statistical differences in baseline demographics were observed between both groups. None of these patients were treated with perioperative chemotherapy or radiotherapy. Surgery comprised 18 (90.0%) colectomies and 2 (10.0%) transanal excisions. Short-term (≤30 days) and long-term (31‐90 days) postoperative complications occurred in 7 (35.0%) and 4 (20.0%) patients, respectively. No complications needed reoperation, such as anastomosis leakage or bleeding. No postoperative mortality occurred within 30 days: 90-day postoperative mortality occurred in two patients (10.0%), respectively. The median overall survival of the operation group was 31.6 (95% confidence interval: 26.7‐36.5) and that of NOG was 12.5 months (95% CI: 2.4‐22.6) ( P = 0.012). Conclusion Surgical treatment can be considered in carefully selected nonagenarian patients with colorectal cancer in terms of acceptable postoperative morbidity, with better overall survival than the nonsurgical treatment.

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