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 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.

scholarly journals VIDEOTRACOSCOPIC INTERFERENCE WITH BULLOUS EMPHYSEMA COMPLICATED BY SPONTANEOUS PNEUMOTHORAX

2019 ◽  
pp. 59-63
Author(s):  
V. V. Boyko ◽  
K. L. Gaft ◽  
E. V. Nakonechny ◽  
M. V. Shilina
Keyword(s):  
Surgical Treatment ◽  
Spontaneous Pneumothorax ◽  
Comparison Group ◽  
Pulmonary Tissue ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Integral Component ◽  
Surgical Tactics ◽  
Definition Of

Objective. To study the factors of a large number of relapses of spontaneous pneumothorax in bullous emphysema (BE) of the lungs and to improve the results of treatment of patients with various forms of BE with the help of developed methods. Methods. The study is based on the study of the results of surgical treatment of 423 patients with different forms of BE, which used traditional and developed surgical tactics using patented methods for determining the elastic capacity of pulmonary tissue and autohemoplévoidosis as an integral component of radical surgical interventions. Results. The use of developed surgical tactics using videotrakaskopicheskoy biopsy to further determine the destructive index in patients with different forms of BE has reduced the overall number of relapses from 18.8% in the comparison group to 5.1%. Conclusion. Videotracoscopic biopsy with the definition of a destructive index allows to more objectively distribute FE in forms that allows to choose optimal surgical tactics.

scholarly journals The choice of surgical treatment in patients with infected pancreonecrosis

2018 ◽  
Vol 177 (6) ◽  
pp. 20-26
Author(s):  
E. A. Tseimakh ◽  
V. A. Bombizo ◽  
P. N. Buldakov ◽  
A. A. Averkina ◽  
D. N. Ustinov ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Surgical Treatment ◽  
Minimally Invasive ◽  
Inpatient Treatment ◽  
Surgical Techniques ◽  
Postoperative Mortality ◽  
Group Comparison ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Minimally Invasive Surgical

The objectiveis to study the results of different methods of surgical treatment of patients with infected pancreonecrosis and to conduct a comparative analysis of minimally invasive and traditional surgical interventions.Material and methods.The results of treatment of 206 patients with infected pancreonecrosis were analyzed. In accordance with the used method of surgical treatment, the patients were divided into 2 groups: 105 (51.0%) patients with “traditional” open interventions were included in the first group (comparison), and 101 (49.0%) patients treated with various miniinvasive technologies, or a combination of minimally invasive and “open” interventions were included in the second group.Results.It was found that the mortality rate in the second group was less than in the first group by 12.8% (p<0.05).Conclusion.Minimally invasive surgical techniques are the method of choice for delimited pancreatogenic ulcers. The use of combined surgical interventions leads to a significant reduction of postoperative mortality and duration of inpatient treatment.

scholarly journals Surgical treatment of patients with osteoarthritis of the ankle joint

2012 ◽  
Vol 93 (1) ◽  
pp. 38-43
Author(s):  
Yu A Plakseychuk ◽  
R Z Salikhov ◽  
V V Soloviev
Keyword(s):  
Surgical Treatment ◽  
Ankle Joint ◽  
Bone Grafting ◽  
Comparison Group ◽  
Functional Results ◽  
Main Group ◽  
Radiographic Evaluation ◽  
Results Of Treatment ◽  
Ilizarov Apparatus

Aim. To evaluate the results of treatment using the authors’ proposed method of arthrodesis of the ankle and subtalar joints, based on the combination of bone grafting with compression in the Ilizarov apparatus. Methods. Conducted was a clinical and radiographic evaluation of the results of arthrodesis in the Ilizarov apparatus in 286 patients with osteoarthritis of the ankle and subtalar joints (during the last 15 years). 36 (12.6%) patients (the main group) were operated on using the authors’ proposed technique. Results. Bone adhesion as a result of arthrodesis was achieved in all patients of the main group. Excellent functional results were achieved in 11 out of 36 patients (30.5%), good results - in 22 (61.1%) patients, satisfactory results - in 3 (8.4%) patients. Bone adhesion as a result of arthrodesis in 250 patients of the comparison group was achieved in 243 patients (97.2%). In this group excellent functional results were achieved in 76 out of 250 patients (30.4%), good results - in 145 (58%) patients, satisfactory results - in 21 (8.4%) patients, poor results - in 8 (3.2%) patients. Conclusion. The proposed method of biarticular arthrodesis makes it possible to improve the trophism of the arthrodesis zone, to conduct the correction of posttraumatic deformities in the region of the ankle and subtalar joints, provides a durable and solid bone ankylosis of the ankle and subtalar joints, and makes it possible to achieve adhesion even in severe forms of osteoarthritis of the ankle and subtalar joints.

scholarly journals Standard open operative interventions in surgical treatment of patients, suffering an acute complicated pancreatitis

2018 ◽  
Vol 85 (7) ◽  
pp. 27-29
Author(s):  
V. P. Аndriushchenko ◽  
D. V. Аndriushchenko ◽  
Yu. S. Lysiuk
Keyword(s):  
Surgical Treatment ◽  
Comparison Group ◽  
Surgical Intervention ◽  
Main Group ◽  
Control Group ◽  
Treatment Results ◽  
Surgical Interventions ◽  
Second Stage ◽  
Standard Operations

Objective. To determine the character and optimal volume of standard open surgical interventions in an acute complicated pancreatitis (ACP) with elaboration of the main technical elements of the operations. Маterials and methods. There were operated 96 patients, suffering ACP. The main group consisted of 47 patients, in whom open interventions were performed primarily in 19, and as the second-stage procedure after application of miniinvasive interventional technologies (МIТ) – in 28. The comparison group consisted of 49 patients, in whom standard operations were done only. Results. Application of MIТ have promoted the indications narrowing for performance of primary open operations more than twice. In the main group the arcuate-like subcostal access was applied predominantly - in 26 (55%) observations (χ²=14.287; р=002), while in a control one – a median upper laparotomy – in 37 (76%) observations (χ²=38.43, р < 0.001). The method of closed draining in accordance to procedure of Beger was used predominantly in the main group of patients – in 43% of observations, comparing with a control group - 9% of observations (χ²=12.965; р=0.003). In 23% patients of the main group and in 26% patients of a control one (χ²=0.0013; р=0.05), when the extended purulent-necrotic inflammation process have presented, a staged sanation was applied, using programmed relaparotomies. Some technical elements of the surgical intervention were improved. Conclusion. Application of standard open operations in accordance to elaborated principle is accompanied by improvement of the treatment results in patients, suffering ACP.

scholarly journals Carbuncle - the actual problem of modern surgery (Literature review)

2019 ◽  
Vol 21 (4) ◽  
pp. 19-24
Author(s):  
K V Lipatov ◽  
Yu E Cherkasov ◽  
V I Khrupkin ◽  
M V Lysenko ◽  
E I Dekhissi
Keyword(s):  
Surgical Treatment ◽  
Literature Review ◽  
Plastic Surgery ◽  
Pathological Process ◽  
Tissue Viability ◽  
Actual Problem ◽  
Surgical Interventions ◽  
Timely Diagnosis ◽  
Results Of Treatment ◽  
Surgical Tactics

Analyzed the features of the surgical treatment of carbuncles. The severity of the purulent-necrotic process was assessed, the significance of the timely diagnosis of the inflammatory stage and the choice of the timing of surgical treatment is shown. The features of the options of surgical tactics - from gentle to radical surgical interventions, methods of intraoperative assessment of tissue viability in the inflammatory focus are described. The necessity of a differentiated approach to the treatment of carbuncles depending on the stage of the disease, the prevalence of the pathological process and its localization is substantiated. The significance of restorative skin-plastic surgery in the replacement of postnecrectomy defects of epithelial tissues in the treatment of extensive carbuncles is shown. Ways of improving the results of treatment of patients with carbuncles are outlined, including timely diagnosis, a differentiated approach to surgical treatment, rational antibacterial therapy, and adequate general treatment.

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 An acute complicated pancreatitis: principles of surgical tactics, using miniinvasive technologies and standard operations

2018 ◽  
Vol 85 (6) ◽  
pp. 10-12 ◽  
Author(s):  
V. P. Andriushchenko ◽  
O. T. Girniak ◽  
D. V. Andriushchenko
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Main Group ◽  
Surgical Interventions ◽  
Combined Application ◽  
Closed Drainage ◽  
Comparative Group ◽  
Surgical Tactics ◽  
Complications Rate ◽  
Standard Operations

Objective. To elaborate a surgical tactics for patients, suffering  an acute complicated pancreatitis (ACP), using miniinvasive technologies (МІТ) and standard surgical interventions. Маterials and methods. There were operated 170 patients, suffering ACP. In the main group (109 patients) a МІТ was applied, and in a comparative one (61 patients) the standard operations were used. Results. МІТ as the «definite» were applied in 62 (57%), «staged» - in 16 (15%) and «the patient’s state stabilizing» - in 12 (11%) patients. The part of operative interventions in the main group have constituted 26%, and in a comparative one - 12% (χ2=4.002; р=0.04). Primary laparotomic operations were performed in 41 (67%) patients of a comparative group and 19 (17%) patients of the main group (χ2=40.291; р<0.0001). Standard operations, mainly consisted of necrosequestrectomies (NSE) with the closed drainage in accordance to Berger procedure were performed in 26 (55%) patients of the main and in15 (31%) patients of comparative group (χ2=5.018; р=0.02). The NSE quantity with further staged sanations, which were conducted in patients, suffering extended purulent-necrotic affections, was comparable in both groups: 11 (23%) - in the main and 13 (26%) - in a comparative group (χ2=0.0013; р > 0.05). Conclusion. Application of elaborated tactics of surgical treatment of an ACP with a separate or combined application of МІТ and standard operations was accompanied by reduction of postoperative complications rate from 13.1 tо 8.3% and lethality - from 14.8 tо 9.2%.

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 Surgical Aspects of the Treatment of Patients With Generalized Peritonitis

2021 ◽  
Vol 10 (1) ◽  
pp. 58-65
Author(s):  
B. V. Sigua ◽  
V. P. Zemlyanoy ◽  
S. V. Petrov ◽  
V. A. Ignatenko ◽  
P. A. Kotkov
Keyword(s):  
Statistical Significance ◽  
Abdominal Cavity ◽  
Postoperative Mortality ◽  
Abdominal Sepsis ◽  
Secondary Peritonitis ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Generalized Peritonitis ◽  
Surgical Tactics ◽  
Planned Relaparotomy

BACKGROUND Much attention is currently given to the issues of surgical treatment of common forms of secondary peritonitis, which is associated with unsuccessful results of treatment of this group of patients and the lack of a unified approach to surgical tactics among patients requiring repeated surgical interventions for adequate sanitation of the abdominal cavity.AIM OF STUDY Improvement of the immediate results of treatment of patients with generalized secondary peritonitis by determining the approaches to choosing the optimal surgical tactics.MATERIAl AND METHODS We analyzed the results of treatment of 220 patients with common forms of secondary peritonitis who were treated at the Elizavetinskaya hospital of St. Petersburg in the period from 2013 to 2019. The indicated patients were divided into two groups, comparable in terms of the main features, including the depth pathomorphological changes in the abdominal cavity, assessed by calculating abdominal cavity index (ACI) and the Mannheim peritonitis Index (MPI). The main group consisted of 109 patients, where developed algorithm was used, which supposed planned sanitation relaparotomies within up to 2 days in patients with high values of ACI and MPI. The comparison group included 111 patients who underwent sanitation interventions “on demand”, that is, in the presence of signs of persistence of the infectious process in the abdominal cavity. The results of treatment were compared by assessing the level and structure of postoperative mortality, the frequency of complications, and the length of stay in intensive care units and hospital. Mathematical-statistical dataprocessing, calculations of intensive and extensive coefficients of features, assessment of the statistical significance of differences in features for the studied groups were carried out.RESUlTS The use of a differentiated approach to performing planned relaparotomy in patients with generalized peritonitis made it possible to reduce the overall mortality 1.7-fold (from 51.3 to 30.2%) (p=0.001) due to a decrease in the proportion of abdominal sepsis as a cause of unfavorable the outcome. No significant effect of the use of this algorithm on the frequency and structure of complications, as well as the duration of multiple organ failure, was found.FINDINGS The use of planned relaparotomy among the selected patients helps to reduce postoperative mortality without significantly negatively affecting other treatment results.

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