Surgical correction of the chronic liver purulent-septic lesions

Purpose of the study. The purpose of the study is to improve the results of surgical treatment of patients with purulent-septic lesion of the liver substantiating the indication for resection method use. Material and methods. The work is based on a comparative analysis of the results of examination and treatment of 64 patients aged 10 to 81 years old, with chronic liver abscesses in the department of surgery and liver transplantation during the 1995–2016 periods. According to the tasks of the study patients are divided into two groups. In 30 (46,8%) patients (the study group), various types of anatomical resection of the liver with a purulent lesion were performed without its dissection during the operation; in 34 (53,2%) patients (group of comparison) they performed the disclosure, sanation, drainage of purulent cavity. The majority of patients with chronic liver abscesses treated the abscess with a puncture or drainage method under the control of ultrasound in other medical institutions of Ukraine. Results. The results of diagnosis and treatment of 64 patients for chronic liver abscesses from 1995 to 2016 are analyzed. In the study group, the patients performed anatomical resection of the liver, in the comparison group – standard surgical interventions – the disclosure and drainage of the abscess of the liver. The duration of antibiotic therapy after surgery in the comparison group is significantly higher than in the study group, respectively, 22 ± 3,4 and 5,75 ± 1,6 days; p < 0,001. Second-line antibacterial drugs after draining operations were used more often (p < 0,001) than after resection interventions, respectively, in 94,1 and 6,6% of cases. The duration of treatment of patients in the hospital after surgery in the study group was less than in the comparison group, according to 15,1 ± 0,7 and 27,3 ± 3,05 days; total 25,9 ± 1,4 and 45,7 ± 3,45 days (p < 0,001). After drainage operations, drainages from the abdominal cavity were removed later than after resection interventions, respectively, 17,1 ± 2,8 and 6,35 ± 1,1 days (p < 0,001), through. Conclusion. Resection for chronic purulentseptic lesions of the liver is the priority methods of surgical treatment. The analysis of the obtained results allows us to conclude that resection technologies contribute to the rapid normalization of physical and social rehabilitation of patients with septic liver damage. Keywords: liver abscess, liver resection, chronic, purulent-septic.

Download Full-text

Evolution of diagnosis and surgical treatment of intra-abdominal infiltrates, abscesses of primary and postoperative origin in patients

Paediatric Surgery Ukraine ◽

10.15574/ps.2021.72.15 ◽

2021 ◽

pp. 15-29

Author(s):

V.V. Skyba ◽

◽

V.F. Rybalchenko ◽

A.V. Ivanko ◽

R.М. Borys ◽

...

Keyword(s):

Duodenal Ulcer ◽

Gastric Ulcer ◽

Surgical Treatment ◽

Abdominal Cavity ◽

Postoperative Mortality ◽

Multiple Organ ◽

Long Term Results ◽

Control Group ◽

Study Group ◽

Perforated Gastric Ulcer

Purpose – to improve the results of surgical treatment of patients with intra-abdominal infiltrates and abscesses through the introduction of the latest imaging methods and surgical technologies. Materials and methods. In the clinic of the Department of Surgical Diseases No 1, on the basis of the Surgery Center of the Kyiv City Clinical Hospital No. 1 from 2006 to 2019 218 patients with primary and secondary intra-abdominal infiltrates, abscesses and fluid formations were treated. The patients’ age ranged from 16 to 85 years. There were 107 (49.08%) male patients, 111 (50.92%) female patients. Depending on the time of hospitalization (by years), the patients were divided into two groups: the control group (CG) (2006–2012) 117 (53.67%) patients and the study group (SG) (2013–2019) 101 (46.33%) patients. The SG used the latest imaging technologies and improved methods of surgical treatment. Results. The patients were divided into two groups: primary in 191 (87.61%) and secondary postoperative infiltrates and abscesses in 27 (12.39%). The causes of primary infiltrates and abscesses were: complicated forms of appendicitis in 74 (33.94%), perforated stomach and duodenal ulcer in 48 (22.02%), complicated forms of cholecystitis in 69 (31.65%). Postoperative infiltrates and abscesses were observed in 27 (12.39%) patients who underwent urgent surgery: adgeolysis of adhesive ileus in 14 (6.42%) and complicated hernias of various localization in 13 (5.97%). Postoperative complications were diagnosed in 43 (19.72%) patients, of whom 34 (15.59%) from the surgical wound and 29 (15.18%) of the abdominal cavity, who required relaparotomy or laparoscopy, with destructive appendicitis in 10 (13.51%), perforated gastric ulcer and 12 duodenal ulcer in 6 (12.5%), destructive cholecystitis in 9 (13.04%), adhesive intestinal obstruction in 13 (19.12%) and with strangulated and complicated hernias in 14 (17.28%) of the examined patients. During relaparotomy, incompetence of the intestinal wall and intestinal sutures was established in 11 out of 32 patients, an ileostomy was imposed in 7, and cecostomy in 1 patient. Actually, in the control group, 8 (6.84%) patients died on the background of ongoing peritonitis, thrombosis of mesenteric vessels and multiple organ failure and concomitant ailments and in the study group 4 (3.96%) patients died. Conclusions. Surgical treatment is individualized depending on the disease, so with destructive appendicitis from 74 (38.74%) laparotomic in 42 (21.99%), laparoscopic in 32 (16.75%), and in 12 (6.28%) with conversion; perforated gastric ulcer and duodenal ulcer in 48 (25.13%) open laparotomy; with cholecystitis of 69 (36.13%) patients, 48 (25.13%) had laparotomy and 21 (11.00%) had laparoscopic examination. The use of the latest imaging and treatment technologies: Doppler ultrasonography, hydrojet scalpel and laparoscopy in 64 (33.51%), allowed to have better near and long-term results and to reduce postoperative mortality from 6.84% to 3.96%, with an average of 5.5%. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: destructive appendicitis, cholecystitis, perforated gastric ulcer and 12-duodenal ulcer, adhesive leakage, strangulated hernias, diagnosis and treatment.

Download Full-text

Surgical tactics for victims of gunshot wounds of the diaphragm specialized stage of medical care in conditions of a modern armed conflict

Photobiology and Photomedicine ◽

10.26565/2076-0612-2019-27-02 ◽

2019 ◽

Keyword(s):

Surgical Treatment ◽

Medical Care ◽

Comparison Group ◽

Care Delivery ◽

Abdominal Cavity ◽

Surgical Care ◽

Gunshot Wounds ◽

Main Group ◽

Lung Capacity ◽

Combat Injuries

Introduction. The diaphragm gunshot wounds are serious combat injuries. The main functions of the diaphragm are to change the intra-abdominal pressure and the outflow of lymph and blood from the abdominal cavity due to the constant contraction and relaxation. Therefore, when it is injured at the same time with a powerful painful impulse, cardiopulmonary disorders quickly arise. Purpose: To improve the results of surgical treatment of patients with gunshot wounds through the introduction of new video endoscopic technologies at the stage of specialized surgical care. Materials and methods. The article analyzes the features of specialized surgical care in 64 patients with gunshot wounds who were treated at the surgical clinic of the Military Medical Clinical Center of the Northern Region (III level of medical care). New minimally invasive methods are proposed to improve the outcomes of surgical treatment of victims with diaphragm gunshot wounds at level III of health care delivery. Results. Thus, the use of video thoracoscopic technique in the surgical treatment of the diaphragm wound and its suturing in the proposed method allowed to improve the results of treatment by increasing the average value of diaphragmatic excursion in deep breath in the main group to 3.73 ± 0.31 cm, whereas in the comparison group 2.21 ± 0.38 cm. The severity of the pain syndrome on the of Visual Аnalogue Scale 5 days after surgical treatment was 5.2 ± 2.3 points in the injured main group, 6.7 ± 2.1 points in the comparison group. The ratio of vital lung capacity to the required vital lung capacity in the main group was 75.3 ± 2.2%, in the comparison group 64.1 ± 1.7%. Conclusions. The use of video thoracoscopy increases the efficiency of the diagnosis of gunshot wounds of the diaphragm. The use of laser imaging and fluorescence diagnosis of diaphragm wounds ensure the adequacy of the removal of paravulary necrotic tissues. The suturing of the wounds in accordance with the anatomical and functional structure of the diaphragm with the use of plaques improves the immediate postoperative results of surgical treatment.

Download Full-text

Choice of tactics of surgical treatment of acute cholecystitis and its complications

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2018-22(3)-08 ◽

2018 ◽

Vol 22 (3) ◽

pp. 442-445

Author(s):

B.S. Zaporozhchenko ◽

K.V. Kravets ◽

I.E. Borodaev ◽

D.A. Bondarets ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Average Duration ◽

Abdominal Cavity ◽

Age Groups ◽

Total Duration ◽

Duration Of Treatment ◽

Surgical Interventions ◽

Emergency Operations ◽

Surgical Tactics

Acute cholecystitis ranks second in the incidence of urgent surgical diseases in hospitals in Ukraine. Despite a marked improvement in the treatment results, the lethality after emergency operations (9,4-37%) for acute cholecystitis complicated by peritonitis remains several times higher than with routine surgical interventions. Objectives — development of rational surgical tactics and evaluation of the effectiveness of treatment of acute cholecystitis and its complications in patients of different age groups, with different pathomorphological forms of acute cholecystitis. The result of treatment of 203 patients was presented: 75 (37,5%) were operated on an emergency basis, 73 (36,5%) urgently, and 52 (26%) in a deferred period. 173 (86.5%) patients were operated using laparoscopic technologies. Intraoperative cholangiography was performed in 16 (9,3%) patients during laparoscopic interventions. In 17 (8,5%) patients, “open” operations were performed. All patients underwent drainage of the abdominal cavity with one or more drains in view of the presence of peritonitis. The average duration of the preoperative period was 1.5 days, the total duration of treatment with LC was 4.5 days, and the total duration of treatment with OC was 10.8 days. So, in the early stages of the development of acute cholecystitis, laparoscopic cholecystectomy is effective. The use of lifting systems for laparoscopic cholecystectomy is advisable in elderly and senile patients, with concomitant diseases of the heart and lungs.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Uterine fibroids, laparoscopic surgery and morcellation. Literature review

GYNECOLOGY ◽

10.26442/20795696.2019.3.190518 ◽

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.

Download Full-text

ANTITUMOR CHEMOTHERAPY IN COMBINED TREATMENT OF PATIENTS WITH CANCER OF THE LARYNX AND HYPOPHARYNX

Problems in oncology ◽

10.37469/0507-3758-2018-64-5-607-611 ◽

2018 ◽

Vol 64 (5) ◽

pp. 607-611

Author(s):

Yuliya Belevich ◽

Yelena Simolina ◽

Vitalina Vysotskaya ◽

Nataliya Popova ◽

Denis Kulbakin ◽

...

Keyword(s):

Surgical Treatment ◽

Neoadjuvant Chemotherapy ◽

Comparison Group ◽

Combined Treatment ◽

Study Group ◽

Complete Regression ◽

Partial Regression ◽

Patients With Cancer ◽

Carcinoma Of The Larynx ◽

Antitumor Chemotherapy

Preliminary results of the evaluation of the effectiveness of combined treatment of 116 patients with morphologically verified squamous cell carcinoma of the larynx and hypopharynx II-IV (T2-4N0-2M0) stages of the tumor process for the period from 2006 to 2017 are presented in the article. Patients of the study group (n=20) underwent 2 courses neoadjuvant chemotherapy according to the scheme: docetaxel + cisplatin, followed by radiotherapy in the mode of multifraction of a dose of 1,3 Gy 2 times a day and surgical treatment (according to indications). Patients included in the comparison group (n=96) underwent 2 courses of neoadjuvant chemotherapy according to the scheme: paclitaxel + carboplatin, followed by radiotherapy in the mode of multifractionation of a dose of 1,3 Gy 2 times a day and surgical treatment (according to indications). The overall effectiveness of the treatment in the study group was 90,3 ± 3,1% (complete regression - 49,4 ± 4,0%, partial regression - 40,9 ± 5,2%), in the comparison group - 81,3 ± 4,0% (complete regression - 34,4 ± 4,8%, partial regression - 46,9 ± 5,1%). Differences between groups are statistically significant (p = 0,001).

Download Full-text

RESULTS OF SURGICAL TREATMENT OF NON-PARASITIC SPLENIC CYSTS IN CHILDREN

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2018-22-1-32-35 ◽

2018 ◽

Vol 22 (1) ◽

pp. 32-35

Author(s):

A. V. Myzin ◽

Vasily G. Kuleshov ◽

A. E. Stepanov ◽

N. V. Gerasimova ◽

K. Yu. Ashmanov

Keyword(s):

Surgical Treatment ◽

High Efficiency ◽

Clinical Symptoms ◽

Abdominal Cavity ◽

Long Term Results ◽

Surgical Interventions ◽

Results Of Treatment ◽

Splenic Cysts ◽

Good Cosmetic

Introduction. Currently, there are different views on the treatment of non-parasitic spleen cysts in children. The choice of method of treatment is under discussion. The aim of our study was to evaluate and analyze the immediate and long-term results of surgical interventions performed on nonparasitic spleen cysts in children. Material and methods. There are presented results of surgical treatment of the 21 patient, who was on treatment at the Department of Abdominal Surgery of the Russian Children Clinical Hospital over the period from 2013 to 2016. Patients were examined by means of ultrasound of the abdominal cavity, CT, MRI. All patients have been operated. 22 surgical interventions were performed by using laparoscopic access, out of which 2 partial resections of the spleen, 1 splenectomy, 19 fenestrations of spleen cysts.Results. During the course of the operation and in the immediate postoperative period there were no complications. Patients were observed for the period of from 1 year to 3 years. Good results of treatment were obtained in 20 (95.2%) children. In a long-term period a relapse occurred in the one patient one year after the operation. The patient was reoperated, splenectomy was performed. Conclusion. The surgical treatment of spleen cysts is the basic one. It is indicated for cysts sized larger than 5 cm and cysts with clinical symptoms. Minimally invasive interventions in children are optimal because of their low traumatism and good cosmetic effect. Our study showed a high efficiency of laparoscopic operations in children suffered from non-parasitic spleen cysts with good long-term results.

Download Full-text

Rationale for use of osteoplastic material Bio Ost in surgical dentistry clinic

Medical alphabet ◽

10.33667/2078-5631-2019-2-11(386)-11-14 ◽

2019 ◽

Vol 2 (11) ◽

pp. 11-14

Author(s):

E. Yu. Efimova ◽

D. V. Stomatov ◽

Yu. V. Efimov ◽

A. V. Stomatov ◽

D. V. Smolentsev ◽

...

Keyword(s):

Surgical Treatment ◽

Bone Defect ◽

Comparative Evaluation ◽

Comparison Group ◽

Study Group ◽

Osteoplastic Material

A comparative evaluation of the effectiveness of surgical treatment of 63 patients with periapical cysts of the jaws with the filling of a bone defect with osteoplastic material Osteo Biol (the comparison group) and Bio Ost (the study group) was carried out. The results obtained in patients of the study group indicate a predominance of the rate of osteogenesis processes over the rate of resorption processes, which characterizes the osteo-substituting material Bio-Ost as meeting modern requirements for such materials.

Download Full-text

Surgical treatment of patients with descending purulent mediastinitis

Medicni perspektivi (Medical perspectives) ◽

10.26641/2307-0404.2021.4.248192 ◽

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.

Download Full-text