SOCIAL AND ECONOMIC EFFECTIVENESS OF THE INTRODUCTION OF COMBINED SINGLE-STAGE SURGICAL INTERVENTIONS

2021 ◽  
Vol 1 (15) ◽  
pp. 66-72
Author(s):  
N.Y. Kondratyuk ◽  
O. O. Litvak
Keyword(s):  
Surgical Treatment ◽  
Economic Effect ◽  
Economic Cost ◽  
Economic Feasibility ◽  
Single Stage ◽  
Uterine Myoma ◽  
Surgical Interventions ◽  
One Stage ◽  
Number Of Patients ◽  
Study Results

In gynecological practice, due attention is paid to increasing the efficiency of institutions and organizations for surgical treatment of patients, in particular, rational use of hospital beds, reducing the economic cost of operations and rehabilitation of patients, reducing the time of hospitalization and incapacity for work, besides the above, the expediency of expanding the scope of surgical intervention is also increasing. The aim of the study is to prove the economic feasibility of combined single-stage surgical interventions in gynecological patients.Materials and Methods. The study was based on a retrospective analysis of the immediate results of surgical treatment of 50 women with uterine myoma operated on using combined (hystero-, laparo-) access and intracorporeal continuous suturing of the node bed (an innovative proposal) in the Scientific and Research Center SIS RPCPCM SAD. The results were in comparison with the same number of patients who underwent isolated operations of laparoscopy and hysteroscopy. Study results and discussion. As a result of the calculations, it was established that the total economic effect of the treatment using a combined one-stage operation was 8765.37 hryvnias per patient. This confirms the economic feasibility of this type of surgery compared to the two isolated ones. Conclusions. The results of the study indicate the economic feasibility of performing a combined one-stage hysteroscopy and laparoscopy for uterine myoma.

Problems of surgical treatment of the anterior pelvic ring chronic injuries

2021 ◽  
Vol 19 (3) ◽  
pp. 47-54
Author(s):  
A. F. LAZAREV ◽  
◽  
E. I. SOLOD ◽  
YA. G. GUDUSHAURI ◽  
E. I. KALININ ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pelvic Ring ◽  
Metal Structure ◽  
Complex Problem ◽  
Long Term Results ◽  
Fixation Method ◽  
Surgical Interventions ◽  
Anterior Section ◽  
Pelvic Injuries ◽  
Study Results

A surgical treatment of the joints of the pelvic ring, especially the pubic joint is a separate and complex problem. When using standard plates, which are applied in the treatment of patients with fresh injuries to stabilize old injuries of the pelvic ring, problems arise with fatigue fracture of plates, destabilization of the metal structure and the need for repeated surgical interventions. Therefore, in the case of old injuries, during surgical treatment, it is necessary to use other tactical approaches to fixing pelvic injuries and to search for adapted structures for such cases. The purpose — to study the features of fixation of old injuries of the pelvic ring and to determine the results of different methods of the anterior pelvis fixation in old cases. Materials and methods. A retrospective analysis of the performed surgical treatment was carried out. In 2000-2015, in the first department of National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorov, 117 patients underwent surgical treatment of old injuries of the anterior pelvic ring under our supervision using standard reconstructive plates applied in the surgical treatment of new injuries of the pelvic ring. Results. Of the 65 patients who underwent fixation of an old injury of the anterior semiring with AO reconstructive plates and AO pelvic plates, installed in a standard manner as in new injuries, 12 patients (10,2%) experienced migration or fracture of structures within 2 to 6 months from the operation. In 52 patients, fixation of the anterior section with two AO plates was applied, one of which was located in a standard way along the upper edge of the pubic bones, the second was implanted additionally along the anterior surface of the pelvic ring perpendicular to the first one. In this group, migration and destabilization of the structures was observed in 7 patients (13,4%) within a period from 2 weeks to 2 months from the date of the operation. Conclusion. The analysis of the study results suggests that surgical treatment of old injuries of the anterior pelvic ring requires a special approach to the choice of the surgical fixation method, which differs from the treatment of new injuries. Over time, in the absence of treatment for injuries and ruptures of the pelvic ring, cicatricial-fibrous adhesions of the pelvic ring occur, which does not always ensure the stability of the pelvic ring, but leads to rigid post-traumatic deformity of the pelvis. Taking into account the cases of destabilization in groups 1 — 10,2% and 2 — 13,4%, as well as the assessment of the long-term results according to the Majeed scale, the use of standard methods for fixing the anterior pelvic semiring can be considered ineffective in old pelvic injuries.

Uterine fibroids, laparoscopic surgery and morcellation. Literature review

GYNECOLOGY ◽  
2019 ◽  
Vol 21 (3) ◽  
pp. 22-25
Author(s):  
Alexander A Seregin ◽  
Anastasiia B Nadezhdenskaya ◽  
Aleksandra V Asaturova ◽  
Dmitry L Ovodenko
Keyword(s):  
Laparoscopic Surgery ◽  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Uterine Fibroids ◽  
Extraction Process ◽  
Uterine Myoma ◽  
Historical Aspect ◽  
Surgical Interventions ◽  
Oncological Safety ◽  
High Level

Aim. To analyze the literature data on modern approaches to morcellation of myomatous nodes in laparoscopic surgery and to highlight this area in a historical aspect. To form an idea of the main difficulties associated with morcellation, which contributed to and contribute to the improvement of the technique of this manipulation. Materials and methods. The review includes data from foreign articles published in the elibrary.ru and PubMed databases on this topic. Results. It describes both modern trends in the surgical treatment of patients with uterine myoma, and historical aspects of improving methods aimed at reducing risks, reducing the time of surgical intervention and improving its safety. Analyzed data on the use of electromorcellation, carried out both with the use of plastic containers, and without them. Conclusion. High requirements for surgical interventions contributed to the emergence of such a method of intracorporeal fragmentation of drugs, such as morcellation, which led to a significant reduction in the proportion of laparotomic operations in the treatment of patients with my uterus. The introduction of laparoscopy in the surgical treatment of uterine myoma allowed to achieve a fundamentally new high level of rehabilitation of patients. Removing removed drugs from the abdominal cavity is associated with a certain risk. Despite the significant number of proposed methods and devices for morcellation, they all require further improvement, since it is necessary to completely exclude contact of the myoma node tissue with abdominal organs in the extraction process. Currently, active research continues on ways to realize all the benefits of minimally invasive technologies in compliance with the rules of oncological safety.

scholarly journals RECURRENT PERINEAL HERNIA — LAPAROSCOPIC SURGICAL TREATMENT: CLINICAL CASE

2020 ◽  
pp. 59-64
Author(s):  
E. A. Galliamov ◽  
M. A. Agapov ◽  
D. R. Markaryan ◽  
V. V. Kakotkin ◽  
E. A. Kazachenko ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Case ◽  
Randomized Clinical Trials ◽  
Rare Complication ◽  
Perineal Hernia ◽  
Permanent Colostomy ◽  
Surgical Interventions ◽  
Number Of Patients ◽  
Wide Range ◽  
Mesh Implant

Background: Recurrent postoperative perineal hernia is a rare complication of such operation as posterior pelvic evisceration. This condition can reduce the quality of life in the postoperative period and requires surgical restoration of the impaired pelvic anatomy.Clinical case: A 54-year old female patient applied to the MSU University clinic in July 2020 with the protrusion in the perineal area. She was diagnosed with recurrent perineal postoperative hernia. She was diagnosed with rectal cancer T4N1M0 and uterine dysplasia in 2017, 6 courses of neoadjuvant polychemoradiation therapy were performed; she underwent extralevator abdominal-perineal resection with uterine extirpation and the permanent colostomy formation in 2018. A perineal postoperative hernia was diagnosed in March 2020, perineal transabdominal plastic surgery was performed with a mesh implant. A recurrent perineal hernia was diagnosed in April 2020, the patient underwent laparoscopic alloplasty with a composite mesh implant. On the 9th postoperative day, she was discharged in a satisfactory condition without any complaints.Conclusion: Postoperative perineal hernia is a fairly rare complication in surgical practice. The recurrent rate is quite high. The insufficient number of patients, the short follow-up period and the wide range of surgical treatment methods do not allow evaluating the results adequately. It is necessary to conduct large randomized clinical trials to assess the efficacy of surgical interventions and to determine the indications for certain procedures.

scholarly journals ECONOMIC INDICATORS OF SURGICAL TREATMENT OF ATHEROSCLEROSIS OF THE FEMORAL-POPLITEAL SEGMENT IN PATIENTS FOR CRITICAL LIMB ISHEMIA

2021 ◽  
Vol 4 (18) ◽  
pp. 51-57
Author(s):  
O.A. Holyachenko ◽  
Y.M. Gupalo ◽  
O.I. Nabolotnuy ◽  
B.L. Kulikovskuy ◽  
A.V. Shamrai-Sas ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Lower Extremity ◽  
Bypass Surgery ◽  
Transluminal Angioplasty ◽  
Economic Indicators ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Number Of Patients ◽  
Patients With Diabetes ◽  
Average Patient

Introduction: is to analyze the economic indicators of different types of surgical treatment of atherosclerosis of the femoral-popliteal segment of the lower extremity in patients for сritacal limb ishemia. Materials and methods. were analyzed 173 cases of atherosclerosis of the femoral-popliteal segment of the lower extremity in patients for сritacal limb ishemia, of which 93 underwent arterial percutaneous transluminal angioplasty and 80 bypass surgery of the affected vessels. For this an original model of determining the value of medical care was used. It included the determination of costs that was given as a payment for medical workers, material and technical costs, the surgical interventions costs, the drugs that were used, additional examinations, and etc. Results. Economic analysis of costs per average patient that underwent PTA was UAH 5025.85, and bypass surgery UAH 4351.1. However,analyzing the results of treatment showed that there are small differences between the two methods, in particular a larger number of patients with diabetes. Conclusions. Both methods of treatment gave almost the same result in terms of the cost of treatment, which requires consideration of other factors, especially the clinical course of the disease.

scholarly journals FEATURES OF SURGICAL TACTICS IN ACUTE CHOLANGITIS DEPENDING FROM THE MECHANISM OF ITS DEVELOPMENT

2019 ◽  
Vol 42 (3) ◽  
pp. 46-49
Author(s):  
Vovk V. A.
Keyword(s):  
Acute Pancreatitis ◽  
Surgical Treatment ◽  
Cause Of Death ◽  
Acute Cholangitis ◽  
Surgical Interventions ◽  
One Stage ◽  
Liver Abscesses ◽  
Three Stages ◽  
Surgical Tactics

Purpose of the study. Improvement of acute cholangitis treatment by improving surgical tactics, depending on the mechanisms of acute cholangitis development. Materials and methods. Analysis of 135 patients with gallstone origin acute cholangitis. In 18 (13,3%) of these patients, acute cholangitis was accompanied by acute destructive cholecystitis; in 7 (5,2%) cholangitis was complicated by liver abscesses formation. Endoscopic transpapillary intervention was performed on 132 (97,8%) patients, and laparoscopic operations – 105 (7,8%). Totally, among 135 patients were 248 stages of surgical treatment. One-stage treatment for cholangitis was performed in 33 patients, 2 stage – 91 patients, and three stages – 11 patients. Results. Complications after endoscopic and laparoscopic interferences occurred in 17 (12,6%) patients. Complications after endoscopic interventions were bleeding from papilla – 4, acute pancreatitis – 3; after laparoscopic interventions – inflammatory complications of postoperative wounds – 6, conversion – 5. Died 2 (1,5%) patients, the cause of death in both cases was sepsis. Conclusion. The ascending and bladder mechanisms of acute cholangitis development with cholelithiasis require a different sequence of stages of endoscopic transpapillary and laparoscopic surgical interventions. Differentiated tactics, depending on the cause of acute cholangitis, contribute to reducing the trauma of surgical treatment and improving its results. Keywords: acute cholangitis, cholelithiasis, mechanical jaundice, laparoscopy, endoscopy.

scholarly journals Pulmonary Echinococcosis Surgery

2021 ◽  
Vol 03 (04) ◽  
pp. 68-75
Author(s):  
Zafar Isrаfulovich Murtazaev ◽  
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Single Stage ◽  
Minimally Invasive Techniques ◽  
Surgical Interventions ◽  
Anterolateral Thoracotomy ◽  
Echinococcal Cyst ◽  
Residual Cavity ◽  
Invasive Techniques ◽  
Pulmonary Echinococcosis

We present an analysis of the results of surgical treatment of 182 patients with pulmonary echinococcosis (126 patients with uncomplicated and 56 with complicated pulmonary echinococcosis). Of these, only in 23 patients out of 25 planned, it was possible to carry out echinococcectomy purely thoracoscopically through trocar punctures. In 134 cases, videothoracoscopic echinococectomy was performed using a mini-access. In case of bilateral localization of cysts, stage-by-stage operations were performed in 7 patients, and in 3 (36.36%) cases - single-stage echinococcectomy. Echinococcectomy from the lung was performed in 25 patients using a wide thoracotomy approach. In 134 cases, videothoracoscopic echinococectomy was performed using a mini-access. In case of bilateral localization of cysts, stage-by-stage operations were performed in 7 patients, and in 3 (36.36%) cases - single-stage echinococcectomy. Echinococcectomy from the lung was performed in 25 patients using a wide thoracotomy approach. All patients underwent anterolateral thoracotomy. Basically (97.67%) performed organ-preserving operations with the elimination of the residual cavity in the light suture plastics in various modifications. In 2 patients with marginal location and pneumocirrhosis, marginal resection of the lung with an echinococcal cyst was performed.With combined echinococcosis of the lungs and liver, 10 patients were operated on. 6 patients underwent surgical interventions on the lungs and liver through separate approaches at the same time. The use of minimally invasive techniques for pulmonary echinococcosis is possible in more than 2/3 of patients.

Quality of life after anti-reflux surgical interventions: possible solutions to the problem

2020 ◽  
pp. 3-25
Author(s):  
D. Lukanin ◽  
G. Rodoman ◽  
M. Klimenko ◽  
A. Sokolov ◽  
A. Sokolov
Keyword(s):  
Quality Of Life ◽  
Hiatal Hernia ◽  
Antireflux Surgery ◽  
Nissen Fundoplication ◽  
Laparoscopic Nissen Fundoplication ◽  
Partial Fundoplication ◽  
Surgical Interventions ◽  
Number Of Patients ◽  
Laparoscopic Nissen

The article presents the results of a prospective controlled parallel clinical study of a new modification of laparoscopic antireflux surgery in the treatment of gastroesophageal reflux disease in combination with a hiatal hernia compared with laparoscopic Nissen fundoplication in terms of assessing quality of life after surgery. Clinical and instrumental examination of patients was carried out a year after surgical interventions. In accordance with the results of instrumental examination after surgery, the proposed modification of laparoscopic partial fundoplication is not inferior to laparoscopic Nissen fundoplication both, in terms of relief of reflux esophagitis symptoms and in relation to the recurrence of hiatal hernia. Clinical monitoring indicates a significantly higher quality of life for patients after the modified antireflux surgery, which is associated with a number of factors. The implementation of this fundoplication led to a decrease in the number of patients with complaints of dysphagia, the development of which is directly related to the surgery performance, as well as to a statistically significant reduction of bloating in the upper abdomen. Another advantage of the modified surgery is a significantly smaller number of cases of gas-bloat syndrome. In addition, the disorders developing in the framework of the gas bloat syndrome after laparoscopic Nissen fundoplication are more severe.

scholarly journals Epidemiology of Secondary Warm Autoimmune Haemolytic Anaemia—A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (6) ◽  
pp. 1244
Author(s):  
Stinne Tranekær ◽  
Dennis Lund Hansen ◽  
Henrik Frederiksen
Keyword(s):  
Haemolytic Anaemia ◽  
Lupus Erythematosus ◽  
Meta Analysis ◽  
Underlying Disease ◽  
Age At Diagnosis ◽  
Autoimmune Haemolytic Anaemia ◽  
Sex Distribution ◽  
Number Of Patients ◽  
Study Results ◽  
Full Text Review

Background: Warm autoimmune haemolytic anaemia (wAIHA) is a haemolytic disorder, most commonly seen among adults and is classified as either primary or secondary to an underlying disease. We describe the age and sex distribution and the proportion of secondary wAIHA. Method: We retrieved 2635 published articles, screened abstracts and titles, and identified 27 articles eligible for full-text review. From these studies, we extracted data regarding number of patients, sex distribution, age at diagnosis, number of patients with secondary wAIHA, and whether the patients were diagnosed through local or referral centres. All data were weighted according to the number of included patients in each study. Results: 27 studies including a total of 4311 patients with wAIHA, of which 66% were females, were included. The median age at diagnosis was 68.7 years, however, wAIHA affected all ages. The mean proportion of secondary wAIHA was 49%, most frequently secondary to systemic lupus erythematosus. The proportions of secondary wAIHA reported from primary vs. referral centres were 35% vs. 59%, respectively. Conclusion: This review consolidates previously reported gender distribution. The higher proportion of secondary wAIHA in referral centres suggests that the most severely affected patients are disproportionally more frequent in such facilities.

scholarly journals Assessment of Lacrimal Duct Patency in Patients Undergoing Endoscopic Medial Maxillectomy

2021 ◽  
Vol 10 (2) ◽  
pp. 245
Author(s):  
Andrzej Sieśkiewicz ◽  
Tomasz Łysoń ◽  
Marek Rogowski ◽  
Marek Bielecki ◽  
Ewa Gindzienska-Sieskiewicz ◽  
...  
Keyword(s):  
Assessment Method ◽  
Test Results ◽  
Functional Disorders ◽  
Lacrimal Duct ◽  
Assessment Tests ◽  
Number Of Patients ◽  
Study Results ◽  
Assessment Techniques ◽  
Medial Maxillectomy ◽  
Comparison Of The Results

Purpose: The risk of epiphora after medial maxillectomy with lacrimal duct transection is difficult to assess. The data available in the literature are inconclusive due to various operating techniques used by the authors of medical publications, different additional procedures aimed at improving tear drainage after maxillectomy, and a variety of lacrimal duct patency assessment techniques. The aim of our work was to assess the anatomical and functional patency of lacrimal ducts after medial maxillectomy without performing additional procedures to improve tear drainage as well as comparison of the results obtained with different assessment tests. Materials and methods: 21 patients who underwent medial maxillectomy in the years 2016–2019 were assessed for discomfort and epiphora based on patients’ own reports and basic clinical examination, lacrimal duct rinse test, the Munk score, and a modified endoscopic Jones I test. Results: Gradually increasing the sensitivity of the assessment method resulted in an increase in the number of patients with potential tear drainage disorders, starting from 0% in the rinsing test, 4.8% self-reported tearing complaints, 14.3% Munk score, and 19% modified endoscopic Jones I test. Conclusions: The study results revealed that a small fraction of patients tend to report epiphora as a consequence of medial maxillectomy themselves. Subtle functional disorders, which are not particularly bothersome to patients, are more common. More sensitive lacrimal duct patency tests reveal more cases of tear drainage disorders. The results of studies assessing the incidence of epiphora after medial maxillectomy appear to depend on the type of test used.

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