Surgical and intervention treatment
of secondary pancreatic infections

Introduction. Many experimental and clinical studies have improved our understanding of the pathophysiology of acute pancreatitis. Today, there are no disagreements over the timing and basic indications for surgery in this disease, but there are still various surgical approaches. Methods. A retrospective and prospective twocenter controlled study was conducted in 582 patients with acute pancreatitis treated in 2004–2018. Age of patients was 53 ± 12,5 years. The classification of the disease was used according to the recommendations of the International Consensus 2012. Patients included in the study were treated in accordance with the IAP/APA (2013) recommendations adapted to local resources and procedures. Of 582 patients, 387 (66,5%) patients with mild to moderate heaviness performed complex treatment, including 89 patients undergoing surgery. According to the goals and objectives of the study, other patients were divided into two groups: the main group – 103 patients with secondary pancreatic infection, who used the tactic of treatment «step-up approach»; а comparison group – 92 patients with open surgical intervention. Results. In the comparison group were used open necrosectomy and drainage. Postoperative complications have arisen in 52 (56,2%) patients. After surgery died 26 patients (28,3%), 19 had a 30-day mortality and 7 had a 90-daymortalityof them. In the main group 62 (60,2%) patients were treated by percutaneous controlled ultrasound intervention, 26 (25,2%) by videolaparoscopic necrosectomy and drainage and at 5 (4,9%) drainage through the wall of the stomach or duodenum. In 10 (9,7%) open operations were performed (minilumbotomy, upper medial, left or right-winged minilaparotomy with formation of mini-bursostomy) with pancreatic necrosectomy, including at 5 decompressive VAC-laparostomy local access. Postoperative complications have arisen in 33 (32%) patients. After surgery died 15 patients (14,6%), 6 had a 30-day mortality and 9 had a 90-day mortality of them. When comparing the two strategies of the treatment-tactical approach, the number of postoperative complications and mortality were lower than in the group of patients who performed only open surgical interventions (x2 = 6,976, p = 0,011). Conclusion. The our research showed that an individualized approach to patients with secondary pancreatic infection using the step-up approach provides a reduction in the number of laparotomic pancreatic necrosectomies and allows postponing «open» surgical interventions for a period after the 4th week from the onset of the disease and reducing the number of postoperative complications and mortality (x2 = 6,976, р = 0,031). Keywords: acute pancreatitis, secondary pancreatic infection, diagnostics, tactics «step-up approach», surgical treatment.

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INDICATIONS AND CONTRAINDICATIONS FOR REMOVAL OF FOREIGN BODIES OF LUNGS OF FLAMMABLE ORIGIN

Kharkiv Surgical School ◽

10.37699/2308-7005.3.2021.09 ◽

2021 ◽

pp. 43-47

Author(s):

V. Kupriyanchuk ◽

Y. Bunin ◽

R. Mikhailusov ◽

V. Negoduyko ◽

E. Khoroshun ◽

...

Keyword(s):

Postoperative Complications ◽

Foreign Bodies ◽

Comparison Group ◽

Gunshot Wounds ◽

Northern Region ◽

Main Group ◽

Surgical Instruments ◽

Surgical Trauma ◽

Surgical Interventions ◽

Surgical Department

Summary. The purpose of the study is to establish the indications and contraindications for the removal of foreign bodies of lungs of gunshot origin. Materials and methods. In the surgical department of the surgical clinic of the Military Medical Clinical Center of the Northern Region, 207 wounded who received gunshot wounds penetrating the chest were examined. The wounded were divided into 2 groups depending on the operational tactics used. The main group of 97 wounded who were treated using modern video endoscopic technology and magnetic surgical instruments. The comparison group consisted of 110 wounded who received traditional treatment. Results and their discussion. Using video endoscopic technologies and magnetic surgical instruments during surgery, 42 (54.5%) in the main group were removed, in the comparison group — 23 (27.4%) foreign bodies. The amount of surgery should not exceed the amount of damage that minimizes surgical trauma. The article presents indications and contraindications to the removal of foreign bodies of pulmonary origin. The differential approach allows to determine the surgical tactics depending on the location of the foreign body, its size and the fit of foreign bodies to the vessels, bronchi, mediastinum. Adherence to the rules of removal of foreign bodies of the lung, depending on the location of its location and size leads to a decrease in inappropriate surgical interventions and postoperative complications. Conclusions. 1. The distribution of foreign bodies by location and size allows you to clearly determine the tactics of treatment and avoid postoperative complications. 2. Surgical interventions to remove foreign bodies should be performed in the first days after stabilization of the patient’s condition using minimally invasive technologies.

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Modern approaches to treatment of echinococcal diseases

Clinical Medicine (Russian Journal) ◽

10.30629/0023-2149-2021-99-5-6-333-338 ◽

2021 ◽

Vol 99 (5-6) ◽

pp. 333-338

Author(s):

R. S. Sultanova ◽

R. T. Mejidov ◽

S. M. Magomedova

Keyword(s):

Liver Disease ◽

Postoperative Complications ◽

Comparison Group ◽

Length Of Hospital Stay ◽

Disease Recurrence ◽

Main Group ◽

Long Term Results ◽

High Tech ◽

Disease Treatment ◽

Surgical Interventions

Purpose. To evaluate the results of treatment of echinococcal liver disease, to determine the most effective method of echinococcectomy and its role in the prevention of of the disease recurrence. Material and methods. The analysis of 1072 cases (1358 cysts) of echinococcal liver disease was carried out. Radical (closed) echinococcectomy with the use of high-tech resection devices was performed in 258 patients, including the use of ultrasonic dissectors and aspirators in 105 patients (main group), other resection devices (LigaSure, argon plasmic scalpel) — in 153 patients (comparison group). Results.Length of hospital stay in the main group was 9.4 ± 2.1 bed-days, in the comparison group — 11.6 ± 1.7. Postoperative complications in the main group were recorded in 4.6% of cases, in the comparison group — in 11.0% respectively. Recurrence of the disease in the comparison group was noted in 2.3% of cases, in the main group there was no secondary echinococcusinduced liver injury. The quality of life of patients in the main group was 73.5 ± 1.8 points, in the comparison group — 72.8 ± 1.7 points. There were no deaths among patients who underwent echinococcectomy with the use of resection technologies.Conclusion. The most effective way of echinococcal liver disease treatment is radical echinococcectomy: cystpericystectomy, liver resection. Ultrasound resection technologies are the most optimal for radical surgical interventions, they reduce intraand postoperative complications and improve the immediate and long-term results echinococcal liver disease treatment .

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CURRENT ASPECTS OF DIAGNOSTICS AND TREATMENT OF ACUTE BILLARIAN PANCREATITIS

Medical Science of Ukraine (MSU) ◽

10.32345/2664-4738.3-4.2018.10 ◽

2018 ◽

Vol 14 (3-4) ◽

pp. 74-79

Author(s):

I.V. Kolosovych ◽

B.H. Bezrodnyi ◽

I.V. Hanol

Keyword(s):

Acute Pancreatitis ◽

Length Of Stay ◽

Comparison Group ◽

Abdominal Cavity ◽

Main Group ◽

Duct System ◽

Results Of Treatment ◽

Positive Clinical Effect ◽

Number Of Patients ◽

Comparative Group

Relevance. The article is devoted to the problem of diagnosis and treatment of acute biliary pancreatitis, which remains one of the most common surgical diseases of the abdominal cavity and accounts for 33.2% of the total number of patients with acute pancreatitis. Objective of the work is to improve the diagnosis and results of surgical treatment of patients with acute pancreatitis of biliary etiology. Materials and methods. The results of treatment of 264 patients with acute pancreatitis of biliary etiology are analyzed. Operative treatment was applied in 92 (34,8 %) patients: endoscopic operations were performed in 44 patients (16,7 %). Thus, in 10 (3,8 %) patients, endoscopic papilloprotectomy was performed with the auditory of the duct system and the extraction of concrements. In other cases, organo-preserving intervention was performed without disturbing the morphofunctional integrity of the sphincter apparatus of the duct system: the cannulation in 6 (2,3%) patients, mechanical (balloon) in 5 (1,9 %) cases, pharmacological (myogenic antispasmodic) dilatation of distal duct and a large duodenal papilla in 11 (4,2 %) patients. In residual choledocholithiasis, a technique of papillotomy under the control of choledochoscopy was proposed – 12 (4,54 %) patients. A comparative analysis of the effectiveness of the treatment of patients who used the "open" (comparative group) and noninvasive endoscopic interventions in the early disease (the main group) was performed. Results. So in the main group the length of stay in the hospital was 12±3,2 days, respectively, in the comparison group – 26±4,3 days. In 42 (95,4 %) patients who had undergone endoscopic surgery, a positive clinical effect, a rapid regress of the symptoms of acute pancreatitis was achieved. In two (4,5 %) patients in the main group, the course was complicated by the development of the abscess of the stuffing box, and puncture under ultrasound control was performed. In patients of the comparison group complications arose in 5 (41,6 %) patients, it is noteworthy that all of them had undergone operative interventions, which were limited only to the rehabilitation and drainage of the abdominal cavity, a stuffing box bag. The mortality rate among unopposed was 1,2 % (2 patients), and among the operated – 11,9 % (11 patients). Among prooperated patients who died, 81,8 % (9 people) were elderly patients. Conclusions. The use of minimally invasive endoscopic interventions in the early phase of the disease reduces the length of stay of patients in the hospital from 26±4,3 days (comparison group) to 12 3,2 days (main group) and the number of complications occurring by 37,1 % (P <0, 05). Application of the proposed method of papillotomy under the control of choledochoscopy makes it possible to reduce the risk of perforation of the wall of the duodenum with the development of peritonitis or retroperitoneal phlegmon by 1,2 % (P <0,05).

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Original method of esophagojejunal anastomosis after gastrectomy for stomach cancer, allowing post-operative complications prevention

Kazan medical journal ◽

10.17816/kmj1831 ◽

2014 ◽

Vol 95 (4) ◽

pp. 505-510

Author(s):

F Sh Akhmetzyanov ◽

V P Borisov ◽

F F Akhmetzyanova ◽

S V Borisov

Keyword(s):

Comparison Group ◽

Intestinal Anastomosis ◽

Original Method ◽

Main Group ◽

Double Row ◽

Esophagojejunal Anastomosis ◽

Single Row ◽

Operative Complications ◽

Complications And Mortality ◽

Post Operative Complications

Aim. To perform the comparative assessment of postoperative complications and mortality rate associated with two types of cuff esophagojejunal anastomosis after gastrectomy. Methods. Follow-up data of short-term post-operative complications rate in two groups of patients who underwent gastrectomy for gastric cancer, are described. Comparative results are presented on after gastrectomy in two groups of patients with gastric cancer: 193 patients were operated using the original method - single-row esophageal-intestinal anastomosis (main group), and 164 patients - using a double-row anastomosis (comparison group). Results. Among the patients who underwent an operation, 229 (64.1%) were older 60 years of age. Post-operative complications were observed in 25.4% of cases in the main group and in 36.6% of cases - in comparison group, including complications leading to unfavorable outcome - in 8.3 and 16.5% of cases, respectively. Post-surgical mortality in non-combined interventions was 5.1% in the main group and 13.7% in comparison group. After combined gastrectomy, post-surgical mortality was assessed as 10.5 and 17.7%, respectively. Early post-operative complications were subdivided into 2 groups: (1) associated with the method of anastomosis and (2) not associated with the method of anastomosis. The first group consisted of anastomosis suture failure, esophagojejunal anastomosis afferent loop obstruction syndrome, pancreatitits. Those complications were combined in one group because of pathogenesis unity. The number of such complications was lower by 2.2 times in the main group, including those with fatal outcome - by 3.2 times. Conclusion. Early post-surgical complications and mortality rate in patients who underwent gastrectomy with original method of single-row esophageal-intestinal anastomosis (main group) was significantly lower compared to patients who underwent gastrectomy with double-row anastomosis. Good reliability of the method of single-row esophageal-intestinal anastomosis allows to recommend its wide use in daily practice by surgeons and oncologists.

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SPEAKING OF PREVENTION OF ACUTE PANCREATITIS AFTER ENDOSCOPIC CHOLANGIOPANCREATO-GRAPHY

Kharkiv Surgical School ◽

10.37699/2308-7005.2.2020.09 ◽

2020 ◽

pp. 45-48

Author(s):

V. I. Lupaltsov ◽

N. N. Skalii ◽

A. I. Yagnyuk ◽

V. S. Kotovshchіkov

Keyword(s):

Acute Pancreatitis ◽

Clinical Practice ◽

Pancreatic Necrosis ◽

Preventive Measures ◽

Comparison Group ◽

Main Group ◽

Pancreatic Ducts ◽

Terminal Part ◽

Highly Effective ◽

The Common

Summary. Purpose. To study the manometric control of pressure in the pancreatic ducts when performing ERCP and to determine its capabilities in the early diagnosis of postmanipulative pancreatitis. Materials and methods. The study was conducted to identify postmanipulative pancreatitis in 122 patients with impaired patency of the terminal part of the common bile duct who underwent ERCP. Patients were divided into two groups: the main – 58 patients and the comparison group – 64 patients. In 58 patients of the main group, the pressure in the pancreatic duct was studied by the device we developed. One makes it possible to register early signs of acute postmanipulative pancreatitis with conducting timely preventive measures for its development. Results. Using the proposed device that records the pressure in the pancreatic ducts, acute postmanipulative pancreatitis was diagnosed in 6.9 % of patients in the main group, while in the comparison group it developed in 21.9 % of cases. Mild forms of APMP in the comparison group were noted in 11 patients and in 4 patients in the main group. Severe APMP caused by focal pancreatic necrosis occurred in three cases of the comparison group. Conclusions. 1. ERCP is a highly effective method for diagnosing diseases of the pancreatobiliary zone, at the same time, sometimes fraught with the danger of developing serious complications, one of which is acute postmanipulative pancreatitis. 2. Monometric control during ERCP is a highly effective method for the diagnosis of early forms of acute postmanipulative pancreatitis, which can be recommended in the clinical practice of endoscopic surgeries.

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Peculiarities of early diagnosis and tactics of treatment in an acute pancreatitis in pregnant women

Klinicheskaia khirurgiia ◽

10.26779/2522-1396.2018.06.13 ◽

2018 ◽

Vol 85 (6) ◽

pp. 13-17

Author(s):

Ya. P. Feleshtynskyi ◽

О. V. Golyanovskyi ◽

Т. P. Pavliv

Keyword(s):

Acute Pancreatitis ◽

Early Diagnosis ◽

Pregnant Women ◽

Comparison Group ◽

Early Stage ◽

Treatment Algorithm ◽

Main Group ◽

Diagnosis And Treatment ◽

Treatment Results ◽

Standard Methods

Objective. Improvement of the treatment results of an acute pancreatitis in pregnant women, using enhanced early diagnosis and tactics of treatment. Маterials and methods. Analysis of the diagnosis and treatment results was conducted in 123 pregnant women, suffering an acute pancreatitis. In the main group (61 pregnant women) the elaborated algorithm of diagnosis and treatment for an acute pancreatitis in the period 2012 - 2018 yrs was applied, while in a comparison group (62 pregnant women) - the standard methods of diagnosis and treatment in an acute pancreatitis for the period of 2006 - 2012 yrs. Results. In the main group in 100% of the patients an acute pancreatitis was revealed on early stage. This have had guaranteed the effect obtaining from the conservative therapy in 27 (44.3%) pregnant women, using miniinvasive surgical interventions - in 31 (50.8%) and to prevent postoperative lethality. In a comparison group in 26 (41.9%) patients an acute pancreatitis diagnosis was established in (8 ± 2.1) days after the disease beginning. In a comparison group the conservative treatment effect was observed in 21 (33.9%) patients only. Two (3.2%) pregnant women died. Conclusion. Application of the diagnostic-treatment algorithm, comparing with standard methods, permits to diagnose an acute pancreatitis in pregnant women on early stage, to reduce the complications and lethality rate.

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The choice of surgical treatment method of patients with bacterial liver abscesses

Kazan medical journal ◽

10.17816/kmj2304 ◽

2012 ◽

Vol 93 (2) ◽

pp. 265-269 ◽

Cited By ~ 1

Author(s):

A P Tolstikov

Keyword(s):

Postoperative Complications ◽

Ultrasound Guidance ◽

Comparison Group ◽

Average Duration ◽

Abdominal Cavity ◽

Bile Leakage ◽

Main Group ◽

Early Postoperative Complications ◽

Liver Abscesses ◽

Bed Days

Aim. To improve the results of surgical treatment of patients with bacterial abscesses of the liver. Methods. During the period from 2000 to 2010 treated were 118 patients with bacterial liver abscesses, 75 men and 43 women aged from 18 to 80 years (mean age 52.1 years). Management of the patients was based on the developed algorithm of diagnosis and treatment of liver abscesses. Two groups of patients were formed: the main group (treatment consisted of percutaneous puncture and drainage of the abscesses under ultrasound guidance) - 94 patients, the comparison group - 24 patients. In the comparison group surgical interventions were performed using the transabdominal access: laparotomy, opening and drainage of the abscess (18 patients), hepatic resection (3 patients), left-sided hemihepatectomy (2 patients), right-sided hemihepatectomy (1 patient). Results. In the patients of the comparison group the following early postoperative complications developed: wound infection - 4, intra-abdominal hemorrhage - 1, bile leakage - 1, abscesses of the abdominal cavity - 2, exudative pleuritis - 2, pneumonia - 3 cases. The average duration of patient hospitalization was 19.5±1.6 bed-days. In the main group the average duration of patient hospitalization was 9.2±±0.6 bed-days. Early postoperative complications in patients of the main group included: intra-abdominal hemorrhage - 1, bile leakage - 1, abscesses of the abdominal cavity - 1, exudative pleuritis - 2, pneumonia - 2 cases. There were no deaths in either of the groups. Conclusion. Puncture and drainage of bacterial liver abscesses under ultrasound guidance is an effective method of treatment that makes it possible to reduce the number of abdominal operations, reduce the number of postoperative complications and shorten the hospital stay.

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

Klinicheskaia khirurgiia ◽

10.26779/2522-1396.2018.07.27 ◽

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.

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A Meta-Analysis of Enteral Nutrition and Total Parenteral Nutrition in Patients with Acute Pancreatitis

Gastroenterology Research and Practice ◽

10.1155/2011/698248 ◽

2011 ◽

Vol 2011 ◽

pp. 1-9 ◽

Cited By ~ 19

Author(s):

Heming Quan ◽

Xingpeng Wang ◽

Chuanyong Guo

Keyword(s):

Acute Pancreatitis ◽

Enteral Nutrition ◽

Parenteral Nutrition ◽

Total Parenteral Nutrition ◽

Meta Analysis ◽

Controlled Trials ◽

Feeding Method ◽

Surgical Interventions ◽

Pancreatic Infection ◽

Randomized Controlled

Objective. To analyze the effect of total parenteral nutrition (TPN) and enteral nutrition (EN) in patients with acute pancreatitis.Methods. Randomized controlled trials of TPN and EN in patients with acute pancreatitis were searched in NCBI and CBM databases and The Cochrane Controlled Trials Register. Six studies were enrolled into the analysis, and the details about the trial designs, characters of the subjects, results of the studies were reviewed by two independent authors and analyzed by STATA 11.0 software.Results. Compared with TPN, EN was associated with a significantly lower incidence of pancreatic infection complications (RR=0.556, 95% CI 0.436∼0.709,P=.000), MOF (RR=0.395, 95% CI 0.272∼0.573,P=.003), surgical interventions (RR=0.556, 95% CI 0.436∼0.709,P=.000), and mortality (RR=0.426, 95% CI 0.238∼0.764,P=.167). There was no statistic significance in non-pancreatitis-related complications (RR=0.853, 95% CI 0.490∼1.483,P=.017). However, EN had a significantly higher incidence of non-infection-related complications (RR=2.697, 95% CI 1.947∼3.735,P=.994).Conclusion. EN could be the preferred nutrition feeding method in patients with acute pancreatitis.

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THE POSSIBILITIES OF APPLICATION OF DECIMETER-WAVE THERAPY IN DESTRUCTIVE APPENDICITIS CHILDREN

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2019-23-1-4-8 ◽

2019 ◽

Vol 23 (1) ◽

pp. 4-8

Author(s):

Ekaterina R. Soloveva ◽

O. V. Karaseva ◽

M. F. Vasileva ◽

S. V. Petrichuk

Keyword(s):

Postoperative Complications ◽

Postoperative Period ◽

Comparison Group ◽

Abdominal Ultrasound ◽

Main Group ◽

Inpatient Stay ◽

Decimetric Wave ◽

Insufficiency Syndrome ◽

Common Laboratory ◽

Inflammatory Effect

Introduction. The article presents a comparative study of the postoperative period after laparoscopic appendectomy for destructive appendicitis in children with and without application of decimetric-wave therapy (DMWT). Material and methods. The study included 299 children aged from 3 to 17 years, the average age of children accounted for 10.7 ± 3.3 years. Patients were operated on for various forms of destructive appendicitis. The patients observed included 201 boys (67.3%) and 98 girls (32.7%), Destructive appendicitis (DA) was diagnosed in 129 (43.1%) children, appendicular peritonitis (AP) - in (56.9%). Patients of the main group received DMWT, starting from the 1st day after surgery. Patients in the comparison group did not receive physiotherapy. To assess the effectiveness of the use of UHF-therapy in the postoperative period, the following groups were taken into account: 1) intestinal insufficiency syndrome (ISS) and systemic inflammatory response syndrome (SSRS); 2) postoperative complications; 3) abdominal ultrasound data; 4) the dynamics of common laboratory indices 4) the duration of the inpatient stay. Results. In DA cases without peritonitis, ISS and SSRS in the main group were observed by 15.7 and 12.8 times less than in the comparison group, with the duration of ISS decreased by 2.13 times, SSRS by 3.3 times. In AP patients the frequency of ISS decreased by 1.68 times, SSRS - by 1.97 times. By the 5th day of the postoperative period in the main group, both in DA and AP cases, there was a significant increase in the incidence of patients with both leukocytes and lymphocytes count normal for the age, LII, CRP. The inpatient stay in the main group decreased by 1.0±0.7 days in DA patients, in AP cases - by 3.3±0.7 days. Conclusion. Evaluation of the postoperative period, as well as traditional laboratory indices, confirm the effectiveness of DMWTin the postoperative period in DA cases YES, in that the local and systemic anti-inflammatory effect is more pronounced in with AP patients.

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