scholarly journals Methods of diagnosis and choice of the method of surgical treatment of Mirizzi syndrome

2018 ◽  
Vol 22 (3) ◽  
pp. 538-542
Author(s):  
B.S. Zaporozhchenko ◽  
D.A. Bondarets ◽  
I.E. Borodaev ◽  
V.N. Kachanov ◽  
I.V. Sharapov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Bile Duct ◽  
Open Cholecystectomy ◽  
Acute Attack ◽  
Mirizzi Syndrome ◽  
Diagnostic Methods ◽  
Chronic Obstructive ◽  
Type I ◽  
Type Ii ◽  
Surgical Interventions

The purpose of the study is to improve the results of preoperative diagnosis and treatment of patients with Mirizzi syndrome. The work is based on the analysis of the case histories and clinical observations of 85 patients with chronic obstructive pulmonary disease with a complicated Mirizzi syndrome in the Surgery Clinic No. 2 ONMEDU from 2006 to 2018. There were 63 women (74%) and 22 men (26%). The age of patients ranged from 24 to 97 years. Among the patients studied elderly patients prevailed — 50 (69.3%) and senile age — 28 (3%). All patients 85 (100%) went to the hospital at different stages of development of calculous cholecystitis. In 53 (62%) patients, an acute attack of the disease was noted for the first time. Periodically repeated episodes were noted more often in patients in 32 (38%) patients. The clinical picture of the disease consisted of symptoms characteristic of acute and chronic cholecystitis with the development of mechanical jaundice. The most characteristic and frequently occurring symptoms were dull pain in the upper right quadrant of the abdomen — 58 (68.2%), jaundice and symptoms of cholangitis (chills, fever) — 42 (49.4%). In 41 (48.2%) patients type I CS was diagnosed, in — 29 (34.1%) type II, in 8 (9.4%) — type III, in — 7 (8.2%) patients with type IV CS. In type I, the choice method was laparoscopic cholecystectomy (LCE) in 36 (42.3%), LCE with drainage of choledochus in 10 (11.7%) patients. There were no iatrogenic bile duct lesions and no conversion in this group. The leading role in the treatment of patients with CS was given to open surgical interventions in 39 (45.8%). In type II, the main types of surgical intervention were: "open" cholecystectomy with plastic of the common bile duct on the Kehr's T-tube (in the presence of a defect of not more than 1/3 of the bile duct circumference) in 25 (29.4%); hepaticojejunostomy (in the presence of a defect of more than 1/3 of the circumference of the bile duct) in 14 (16.4%) patients. The main surgical operations with CS III-IV types do not differ in principle from the above operations. So, the use of highly sensitive diagnostic methods and a combination of endoscopic and surgical treatment can significantly improve the results of treatment of patients with Mirizzi syndrome.

scholarly journals CURRENT APPROACHES TO DIAGNOSIS AND SURGICAL TREATMENT OF MIRIZZI SYNDROME (OWN CLINICAL OBSERVATIONS WITH LITERATURE REVIEW)

2018 ◽  
Vol 17 (2) ◽  
pp. 65-70
Author(s):  
I. O. Kozak ◽  
S. R. Mykytyuk ◽  
V. P. Mosiychuk ◽  
L. I. Kozak
Keyword(s):  
Surgical Treatment ◽  
Rare Complication ◽  
Open Cholecystectomy ◽  
Clinical Signs ◽  
Mirizzi Syndrome ◽  
Type I ◽  
Type Ii ◽  
Leading Role ◽  
Type Iv ◽  
Clinical Observations

The article presents the review of the literature and own clinical observations on the diagnosis and surgical treatment of Mirizzi syndrome – a rare complication of gallstones. The clinical features of the disease has no specific symptoms. The main clinical signs of MS are periodic jaundice (84%), pain in the right hypochondrium (75%) and cholangitis (56%), the phenomenon of acute cholecystitis and pancreatitis. The most informative method of preoperative diagnosis is magnetic resonance imaging, which, unfortunately, not readily available for public use. The diagnostic sensitivity of MRI with MS is 97,6%, intraoperative cholangiography – 94%, ERCP – 86%, PTC – 5%, fibrocholangioscopy – 77%, ultrasound – 46%. The most common type of MS (10,5-51%), less often type II (15-41%), even more rare types III (3-44%), IV (7,4%) and V (2,9% ). The leading role in the treatment of syndrome belongs to open surgery. Laparoscopic cholecystectomy can only be shown to individual MS and type I patients. Conversion with this occurs in 31-100%, complications – 60%, damage to common bile duct – 22%. Open cholecystectomy remains the standard. For Type II and III types of MS, they perform cholecystectomy while retaining part of the Hartmann pocket with the subsequent plastics of CBD at the Kehr drainage. At type IV of the MS it is shown a hepaticojejunostomy. Reorder phases of operation including cholangiography before cholecystectomy made it possible to diagnose and set the type of Mirizzi syndrome, to determine the optimal surgery approach and to prevent intra– and postoperative complications.

scholarly journals Modern aspects of surgical treatment of patients with adhesive small bowel obstruction

2021 ◽  
Vol 12 (4) ◽  
pp. 47-54
Author(s):  
Badri V. Sigua ◽  
Vyacheslav P. Zemlyanoy ◽  
Sergey V. Petrov ◽  
Diyora H. Qalandarova
Keyword(s):  
Small Intestine ◽  
Surgical Treatment ◽  
Small Bowel ◽  
Mortality Rate ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Diagnostic Algorithm ◽  
Diagnostic Methods ◽  
Adhesive Small Bowel Obstruction ◽  
Surgical Interventions

Despite the ongoing preventive measures aimed at reducing the formation of adhesions in the abdominal cavity with an increase in the number of surgical interventions on the abdominal organs, the number of patients admitted to surgical hospitals with adhesions of the small intestine is also increasing. It should be noted that annually about 12% of previously operated patients undergo treatment in surgical departments while the exceptional fact is that 5070% are patients with acute adhesive ileus of the small intestine and the mortality rate in this group ranges from 13 to 55%. In recent years the literature has been actively discussing the advantages of minimally invasive technologies in the treatment of adhesive small bowel obstruction since the use of traditional methods often leads to the development of complications with repeated (in 60% of cases) surgical interventions. The purpose of this study was the development and implementation of an improved therapeutic and diagnostic algorithm in patients with adhesive small bowel obstruction which made it possible to improve the results of treatment. A comparative analysis of 338 patients with adhesive small bowel obstruction who were treated in the surgical departments of the St. Elizabeth Hospital in St. Petersburg in the period from 2016-2019 was carried out. All the patients were divided into 2 groups: the main (I) group (2018-2019), which consisted of 198 patients who received the improved diagnostic and treatment algorithm as well as the comparison group (II) (2016-2017) which included 140 cases these are patients examined according to the standard protocol and operated on in the traditional way. Moreover, in 98 cases, it was possible to resolve acute adhesive small intestinal obstruction in a conservative way, and 240 patients underwent surgical treatment. The developed diagnostic algorithm is based on the consistent application of the most informative diagnostic methods. At the same time the indications and the sequence of their application were established which ultimately made it possible to shorten the preoperative time interval as well as to determine the optimal treatment strategy with the choice of the type of surgical treatment (laparotomy or laparoscopy). The proposed treatment and diagnostic algorithm allowed to reduce the complication rate from 46.5% (53) to 22.2% (28) (р 0,001), and the mortality rate from 14.9% (17) to 3.9% (5) (p 0,01).

Surgical treatment of the radial head is crucial for the outcome in terrible triad injuries of the elbow

2020 ◽  
Vol 102-B (12) ◽  
pp. 1620-1628
Author(s):  
Alexander Klug ◽  
Angela Nagy ◽  
Yves Gramlich ◽  
Reinhard Hoffmann
Keyword(s):  
Surgical Treatment ◽  
Radial Head ◽  
Independent Effect ◽  
Type I ◽  
Dash Score ◽  
Type Ii ◽  
Terrible Triad ◽  
Radial Head Fractures ◽  
Type Iii

Aims To evaluate the outcomes of terrible triad injuries (TTIs) in mid-term follow-up and determine whether surgical treatment of the radial head influences clinical and radiological outcomes. Methods Follow-up assessment of 88 patients with TTI (48 women, 40 men; mean age 57 years (18 to 82)) was performed after a mean of 4.5 years (2.0 to 9.4). The Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and Disabilities of the Arm, Shoulder and Hand (DASH) score were evaluated. Radiographs of all patients were analyzed. Fracture types included 13 Mason type I, 16 type II, and 59 type III. Surgical treatment consisted of open reduction and internal fixation (ORIF) in all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) was performed if reconstruction was not possible. Results At follow-up the mean MEPS was 87.1 (20 to 100); mean OES, 36.9 (6 to 48); and mean DASH score, 18.6 (0 to 90). Mean movement was 118° (30° to 150°) for extension to flexion and 162° (90° to 180°) for pronation to supination. The overall reoperation rate was 24%, with nine ORIF, ten RHA, and two patients without treatment to the radial head needing surgical revision. When treated with RHA, Mason type III fractures exhibited significantly inferior outcomes. Suboptimal results were also identified in patients with degenerative or heterotopic changes on their latest radiograph. In contrast, more favourable outcomes were detected in patients with successful radial head reconstruction after Mason type III fractures. Conclusion Using a standardized protocol, sufficient elbow stability and good outcomes can be achieved in most TTIs. Although some bias in treatment allocation, with more severe injuries assigned to RHA, cannot be completely omitted, treatment of radial head fractures may have an independent effect on outcome, as patients subjected to RHA showed significantly inferior results compared to those subjected to reconstruction, in terms of elbow function, incidence of arthrosis, and postoperative complications. As RHA showed no apparent advantage in Mason type III injuries between the two treatment groups, we recommend reconstruction, providing stable fixation can be achieved. Cite this article: Bone Joint J 2020;102-B(12):1620–1628.

Surgical treatment of the radial head is critical to the outcome of Monteggia-like lesions

2019 ◽  
Vol 101-B (12) ◽  
pp. 1512-1519 ◽  
Author(s):  
Alexander Klug ◽  
Felix Konrad ◽  
Yves Gramlich ◽  
Reinhard Hoffmann ◽  
Kay Schmidt-Horlohé
Keyword(s):  
Surgical Treatment ◽  
Radial Head ◽  
Type I ◽  
Dash Score ◽  
Type Ii ◽  
Coronoid Fracture ◽  
Radial Head Arthroplasty ◽  
Type Iii ◽  
Clinical And Radiological Results

Aims The aim of this study was to evaluate the outcome of Monteggia-like lesions at midterm follow-up and to determine whether the surgical treatment of the radial head influences the clinical and radiological results. Patients and Methods A total of 78 patients with a Monteggia-like lesion, including 44 women and 34 men with a mean age of 54.7 years (19 to 80), were available for assessment after a mean 4.6 years (2 to 9.2). The outcome was assessed using the Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), Mayo Modified Wrist Score (MMWS), and The Disabilities of the Arm, Shoulder and Hand (DASH) score. Radiographs were analyzed for all patients. A total of 12 Mason type I, 16 type II, and 36 type III fractures were included. Surgical treatment consisted of screw fixation for all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) or excision was performed if reconstruction was not possible. Results The mean MEPS was 88.9 (40 to 100), mean OES was 40.1 (25 to 48), mean MMWS was 88.1 (50 to 100), mean DASH score was 14.7 (0 to 60.2), and mean movement was 114° (sd 27) in extension/flexion and 155° (sd 37) in pronation/supination. Mason III fractures, particularly those with an associated coronoid fracture treated with RHA, had a significantly poorer outcome. Suboptimal results were also identified in patients who had degenerative changes or heterotopic ossification on their latest radiograph. In contrast, all patients with successful radial head reconstruction or excision had a good outcome. Conclusion Good outcomes can be achieved in Monteggia-like lesions with Mason II and III fractures, when reconstruction is possible. Otherwise, RHA is a reliable option with satisfactory outcomes, especially in patients with ligamenteous instability. Whether the radial head should be excised remains debatable, although good results were achieved in patients with ligamentous stability and in those with complications after RHA. Cite this article: Bone Joint J 2019;101-B:1512–1519

scholarly journals TREATMENT OF COMMON BILE DUCT DISEASES COMPLICATED BY OBSTRUCTIVE JAUNDICE (review)

2018 ◽  
Vol 5 (2) ◽  
pp. 84-92
Author(s):  
A. Sochnieva
Keyword(s):  
Surgical Treatment ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Obstructive Jaundice ◽  
Hepatic Impairment ◽  
Life Quality ◽  
Biliary Tree ◽  
Biliary Decompression ◽  
Surgical Interventions ◽  
Bile Duct Diseases

TREATMENT OF COMMON BILE DUCT DISEASES COMPLICATED BY OBSTRUCTIVE JAUNDICE (review)Sochneva A.L.The article presents the up-to-date data concerning the treatment of common bile duct diseases complicated by obstructive jaundice. Nowadays, specialized clinics widely use mini-invasive interventions to treat this complicated pathology. Biliary tree decompression is the main objective of operative treatment. It is reasonable to perform antegrade and retrograde endobiliary interventions as preparatory and final stages of surgical treatment and in order to improve the patients’ life quality and avoid hepatic impairment progression. Reconstructive-reparative operations following prior biliary decompression yield significantly better results as compared to surgical interventions without it.Key words: common bile duct diseases, obstructive jaundice, antegrade interventions, retrograde interventions, reconstructive-reparative operations. ЛІКУВАННЯ ЗАХВОРЮВАНЬ ГЕПАТИКОХОЛЕДОХА, УСКЛАДНЕНИХ МЕХАНІЧНОЮ ЖОВТЯНИЦЕЮ (огляд літератури)Сочнева А.Л.У статті висвітлені сучасні дані по лікуванню захворювань гепатикохоледоха, ускладнених механічною жовтяницею. В даний час в спеціалізованих клініках широко застосовуються мініінвазивні втручання в лікуванні такої складної патології. Декомпресія біліарного дерева є основною метою при виконанні оперативних втручань. Антеградний і ретроградні ендобіліарні втручання доцільно застосовувати в якості як підготовчого, так і завершального етапів хірургічного лікування, а також поліпшити якість життя хворих і уникнути прогресування печінкової недостатності. Виконання реконструктивно-відновлювальні операцій після попередньої біліарної декомпресії демонструє значно кращі результати в порівнянні з оперативними втручаннями, виконаними без неї.Ключові слова: захворювання гепатикохоледоха, механічна жовтяниця, антеградний втручання, ретроградні втручання, реконструктивно-відновлювальні операції. Лечение заболеваний гепатикохоледоха, осложненных механической желтухой: обзор литературы ЛЕЧЕНИЕ ЗАБОЛЕВАНИЙ ГЕПАТИКОХОЛЕДОХА, ОСЛОЖНЕННЫХ МЕХАНИЧЕСКОЙ ЖЕЛТУХОЙ (обзор литературы)Сочнева А.Л.В статье освещены современные данные по лечению заболеваний гепатикохоледоха, осложненных механической желтухой. В настоящее время в специализированных клиниках широко применяются миниинвазивные вмешательства в лечении столь сложной патологии. Декомпрессия билиарного дерева является основной целью при выполнении оперативных вмешательств. Антеградные и ретроградные эндобилиарные вмешательства целесообразно применять в качестве как подготовительного, так и завершающего этапов хирургического лечения, а также улучшить качество жизни больных и избежать прогрессирования печеночной недостаточности. Выполнение реконструктивно-восстановительные операций после предварительной билиарной декомпрессии демонстрирует значительно лучшие результаты в сравнении с оперативными вмешательствами, выполненными без нее.Ключевые слова: заболевания гепатикохоледоха, механическая желтуха, антеградные вмешательства, ретроградные вмешательства, реконструктивно-восстановительные операции.

scholarly journals Gallbladder perforation: management in a tertiary care centre

2018 ◽  
Vol 5 (10) ◽  
pp. 3346
Author(s):  
Prashant Tubachi ◽  
K. Sphurti Kamath ◽  
Mallikarjun Desai ◽  
Harsha Kodliwadmath
Keyword(s):  
Surgical Treatment ◽  
Acute Cholecystitis ◽  
Computerized Tomography ◽  
Open Cholecystectomy ◽  
Tertiary Care ◽  
Diagnostic Procedures ◽  
Gallbladder Perforation ◽  
Type I ◽  
Tertiary Care Centre ◽  
Intravenous Antibiotics

Background: Retrospective study in the management of perforated gallbladder and clinical outcome in a tertiary care centre.Methods: Total of 583 patients underwent laparoscopic or open cholecystectomy between 2015 to 2017. Out of these eleven patients had perforated gallbladder (1.9%). Niemeier’ classification used for gallbladder perforation. Both Ultrasonography and Abdominal computerized tomography was used in this study. The parameters like age, gender, method of management, diagnostic procedures, time between date of admission to time of surgery, surgical treatment, duration of hospital stay and post-operative morbidity were evaluated.Results: Out of the eleven cases, eight patients were male and three were female. Nine patients were above the age of fifty years. According to Niemer classification, seven patients had type I perforation, three patients had type II perforation and one had type one perforation. Out of the eleven cases, eight were clinically diagnosed to be acute cholecystitis and three were clinically diagnosed to have peritonitis. The cases diagnosed to have peritonitis- underwent immediate intervention. The remaining eight cases were initially managed conservatively with intravenous antibiotics, imaging and workup was done, following which intervention was done.Conclusions: Early diagnosis and emergency surgical treatment of gallbladder perforation with peritonitis is of crucial importance. If the patient is stable then intervention after optimising has better outcome. Abdominal computerized tomography for acute cholecystitis patients may contribute to the preoperative diagnosis of gallbladder perforation. 

scholarly journals Diagnosis and classification of Mirizzi syndrome

2020 ◽  
Vol 87 (3-4) ◽  
pp. 26-30
Author(s):  
I. N. Mamontov
Keyword(s):  
Treatment Method ◽  
Mirizzi Syndrome ◽  
Diagnostic Process ◽  
Type I ◽  
Type Ii ◽  
Results Of Treatment ◽  
Diagnosis And Classification ◽  
Definite Kind ◽  
Variant Anatomy

Objective. To determine the factors, predisposing to development of Mirizzi syndrome; to improve diagnosis and classification of it, taking into account of these factors and possibilities to apply a definite kind of endoscopic or operative treatment. Materials and methods. Retrospective analysis was done for results of treatment of 21 patients with Mirizzi syndrome: Type I in accordance to classification of McSherry (1982) was present in 7 patients, while a Type II - in 14. Results. There was established, that atypia (the variant anatomy) of the ductus cysticus localization predisposes for contact between hepaticocholedochus and a gallbladder of with ductus cysticus, leading to development of Mirizzi syndrome Types I and II. Squeezing (Type I) or fistula (Type II) are observed on any level of hepaticocholedochus. In syndrome of Mirizzi Type II the duct distal to fistula may be not dilated (Subtype IIA) or dilated (Subtype IIB). Conclusion. Atypia (the variant anatomy) of the ductus cysticus duct constitute a factor, promoting development of Mirizzi syndrome. While diagnostic process for Mirizzi syndrome it is necessary to take into account a localization of squeezing of hepaticocholedochus or of fistula, presence of atypia of the ductus cysticus and its stump localization, character of the gallbladder inflammation, quantity and size of calculi. Proposition to include the Types IIA and IIB II in Mirizzi syndrome, depending on the dilation degree present in hepaticocholedochus distally, to the fistula, constitutes a substantiated principle, because it takes into account a possibility to perform endoscopic lithoextraction and to impact the choice of the surgical treatment method.

scholarly journals Type A aortic aneurysm dissection: causes of development, diagnostic methods and treatment results

2019 ◽  
pp. 43-47
Author(s):  
I. M. Kravchenko ◽  
V. I. Kravchenko ◽  
I. I. Zhekov ◽  
I. A. Osadovska ◽  
I.I. Zinovchyk ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Aortic Aneurysm ◽  
Hospital Mortality ◽  
Type A ◽  
Diagnostic Methods ◽  
Moderate Hypothermia ◽  
Type I ◽  
Treatment Results ◽  
Initial Stage ◽  
Aneurysm Dissection

Surgical treatment of Type A aortic aneurysm dissection remains one of the most complicated problems in car-diac surgery. The whole surgical treatment experience of such aneurysms by one team is presented in the article. Factors that could have caused the aortic aneurysm (dissection) development are provided. It is shown that experience accumulation, methods improvement of surgical treatment, brain, heart and internal organs protection have allowed to reach the hospital mortality rate of 4.5% over the last 5 years. Data on severe baseline of the operated patients are presented in the paper. It is represented that in the Institute’s experience type A aneurysm dissection accounts for 28.9% of all aneurysms. The vast majority (79.6%) of patients were operated on for acute or subacute type A dissection; 69.2% of patients had type I dissec-tion. All operations were performed under conditions of bypass, moderate hypothermia (30–32 °C) and during the aortic arch replacement (42.4%) – under conditions of deep hypothermia (13–20 °C) and retrograde cerebral perfusion. Surgical correction methods are presented with valve-saving surgeries performed in 63.7% of patients. The surgical treatment results have been shown to be highly dependent on the time of the surgery. Thus, at the initial stage of surgical experience, hospital mortality was 24.1% with a decrease to 16.1% and with a decrease to 4.6% over the last 8 years.

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