scholarly journals SURGICAL STRATEGY OF TREATMENT OF PATIENTS WITH STOMACH CANCER COMPLICATED WITH PERFORATION

2020 ◽  
pp. 4-7
Author(s):  
V. V. Boyko ◽  
V. A. Lazirskiy ◽  
N. N. Farzullayev
Keyword(s):  
Stomach Cancer ◽  
Postoperative Mortality ◽  
Hospital Treatment ◽  
Basic Group ◽  
Results Of Treatment ◽  
Urgent Surgery ◽  
Analysis Of Results ◽  
The Common ◽  
Surgical Tactics ◽  
Objective Improvement

Summary. Objective. Improvement of results of treatment of patients with stomach cancer complicated with perforation. Materials and methods. It was shown the analysis of results of surgical treatment of 19 patients with stomach cancer complicated with perforation, which got the hospital treatment at GI «V. T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine» from 2011 till 2020, aged 18 till 85. All patients randomly divided on 2 groups: the group of control — 9 patients (got the hospital treatment from 2011 till 2015), and the basic group — 10 patients (from 2016 till 2020). Results. The common surgical tactics and operations were used at the group of control. The two-staged active-idividualized surgical tactic, that consist of closure by interrupted sutures at first stage and reconstructive operation at second, was used at the basic group. Radical surgery was performed in 10 (52,6 %) cases; in 9 (47,4 %) cases – palliative and symptomatic. Postoperative complications occurred in 5 patients (26.3 %) and postoperative mortality in 26.3 % (5 patients) cases. Conclusion. There is the rational of using the two-staged surgical tactic. Using of this tactic leads to increasing of quantity of radical operations from 4(21,0 %) at the group of control till 6(31,6 %) at the basic group and leads to decreasing post-operative deaths from 15,8 % till 10,5 % respectively.

scholarly journals SURGICAL STRATEGY OF TREATMENT OF PATIENTS WITH STOMACH CANCER COMPLICATED WITH ACUTE GASTRIC BLEEDING

2020 ◽  
pp. 4-8
Author(s):  
V.V. Boyko ◽  
V. A. Lazirskiy ◽  
N. N. Farzullayev
Keyword(s):  
Stomach Cancer ◽  
Postoperative Mortality ◽  
Invasive Procedure ◽  
Hospital Treatment ◽  
Gastric Bleeding ◽  
Basic Group ◽  
Results Of Treatment ◽  
Urgent Surgery ◽  
Analysis Of Results ◽  
Surgical Tactics

Summary. Objective. Improvement of results of treatment of patients with stomach cancer complicated with acute gastric bleeding. Materials and methods. It was shown the analysis of results of surgical treatment of 252 patients with stomach cancer complicated with acute gastric bleeding, which got the hospital treatment at GI “V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine “ from 2010 till 2019, aged 29 till 76. All patients randomly divided on 2 groups: the group of control - 129 patients (got the hospital treatment from 2010 till 2014), and the basic group - 123 patients (from 2015 till 2019). Results. The common surgical tactics and operations were used at the group of control. The two-staged active-idividualized surgical tactic was used at the basic group. Radical surgery was performed in 120 (47.6 %) cases; in 132 (52,4 %) cases – palliative and symptomatic (the 121(48,0 %) cases of it was major abdominal surgery). Postoperative complications occurred in 79 patients (31.1 %) and postoperative mortality in 7.9 % (20 patients) cases. Conclusion. There is the rational of using the two-staged surgical tactic with wide using of minimally invasive procedure for the treatment of patients with stomach cancer complicated with acute gastric bleeding. Using of this tactic leads to increasing of quantity of radical operations from 38(29,2 %) at the group of control till 82(72,8 %) at the basic group and leads to decreasing post-operative deaths from 8,5 % till 7,2 % respectively.

SURGICAL STRATEGY OF PATIENTS WITH STOMACH CANCER COMPLICATED WITH ACUTE GASTRIC BLEEDING

2021 ◽  
pp. 4-7
Author(s):  
V. V. Boiko ◽  
V. A. Lazirskiy ◽  
I. V. Krivorotko
Keyword(s):  
Stomach Cancer ◽  
Postoperative Mortality ◽  
Invasive Procedure ◽  
Hospital Treatment ◽  
Gastric Bleeding ◽  
Basic Group ◽  
Results Of Treatment ◽  
Urgent Surgery ◽  
Analysis Of Results ◽  
Surgical Tactics

Summary. Objective. Improvement of results of treatment of patients with stomach cancer complicated with acute gastric bleeding. Materials and methods. It was shown the analysis of results of surgical treatment of 252 patients with stomach cancer complicated with acute gastric bleeding, which got the hospital treatment at GI “V. T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine“ from 2010 till 2019, aged 29 till 76. All patients randomly divided on 2 groups: the group of control — 129 patients (got the hospital treatment from 2010 till 2014), and the basic group — 123 patients (from 2015 till 2019). Results. The common surgical tactics and operations were used at the group of control. The two-staged active-idividualized surgical tactic was used at the basic group. Radical surgery was performed in 120 (47.6%) cases; in 132 (52,4%) cases – palliative and symptomatic(the 121(48,0%) cases of it was major abdominal surgery). Postoperative complications occurred in 79 patients (31.1%) and postoperative mortality in 7.9% (20 patients) cases. Conclusion. There is the rational of using the two-staged surgical tactic with wide using of minimally invasive procedure for the treatment of patients with stomach cancer complicated with acute gastric bleeding. Using of this tactic leads to increasing of quantity of radical operations from 38(29,2%) at the group of control till 82(72,8%) at the basic group and leads to decreasing post-operative deaths from 8,5 % till 7,2 % respectively.

scholarly journals THE ROLE OF THE INSTUMENTAL EXAMINATIONS IN DIAGNOSTICS AND STAGING OF LOCALY DISTRIBUTED STOMACH CANCER

2021 ◽  
pp. 13-17
Author(s):  
V. A. Lazirskiy ◽  
N. N. Farzullayev
Keyword(s):  
Stomach Cancer ◽  
Diagnostic Laparoscopy ◽  
Hospital Treatment ◽  
Pathologic Process ◽  
Urgent Surgery ◽  
Analysis Of Results ◽  
Definition Of ◽  
Instrumental Methods ◽  
Objective Improvement

Objective. Improvement of algorithm of diagnostics of patients with complicated stomach cancer. Materials and methods. It was shown the analysis of results of surgical treatment of 418 patients with complicated stomach cancer, which got the hospital treatment at GI “V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine “ from 2010 till 2019, aged 29 till 76. Results. Patiens were examinated with using of combination of instrumental methods. Goal is total detal examination of pathologic process. SCT has precission of 95-97 % at detecting of cancer, definition of stage – 77-80 %. Endoscopy allows to define the location, spreading of process, to find a pathologic process at starting and precancer stages. There no any ideal oncomarker. Diagnostic precission of CA 72-4 is 28-80 % (40-46 % on the average). According to international guides [7], all patients were performed the diagnostic laparoscopy with researching of washout liquids of abdomen in uncertain cases. Conclusion. Only complex examination of patients with stomach cancer with using combination of SCT of abdomen, FEGDS with biopsy, laparoscopy can provide total volum of examination, staging and surgical aid.

scholarly journals Analysis of surgical treatment of duodenal ulcers with multiple combined complications

2021 ◽  
pp. 10-12
Author(s):  
Pavlo Ivanchev ◽  
Maxim Bilyachenko ◽  
Anton Kurbanov ◽  
Oleksii Lissov
Keyword(s):  
Surgical Treatment ◽  
Postoperative Mortality ◽  
Bleeding Complications ◽  
Duodenal Ulcers ◽  
The Third ◽  
Number Of Patients ◽  
Group A ◽  
Analysis Of Results ◽  
Surgical Tactics ◽  
Group B

The aim of the research. Analysis of results and development of surgical tactics for the treatment of DU with multiple combined complications. Materials and methods. The results of the analysis of surgical treatment of duodenal ulcers with multiple combined complications (3 and 4 combined complications) for 3 periods are presented: 1st (1983–1995) (group A) – 77 patients, 2nd (2000–2007) years (group B) – 30 patients and 3rd (2008–2020) (group C) – 46 patients. Results. 153 patients (100 %) underwent surgery for complicated duodenal ulcer (DU), of which 130 patients (84.9 %) had a combination of three complications and 23 (15.1 %) had four complications. Bleeding complications were noted in 139 of 153 patients, accounting for 90.8 %, and ulcer perforation in 69 patients, accounting for 45.1 % of all other complications. Based on the obtained data of the analysis, there is a steady tendency to increase the proportion of organ-preserving operations (OPO) by 1.5 times (from 50.7 % to 76.2 %), reducing the number of gastrectomy (GR) by 3 times (from 14.5 % to 4.8 %) and palliative operations (PAL) 3.3 times (from 15.8 % to 4.8 %) with a relatively stable number of performed organ-saving operations (OSO): in group A – 17 (24.6 %) interventions, in group B – 4 (21.1 %), group C – 6 (14.3 %). Conclusions. The use of modern measures of endoscopic hemostasis allowed to operate on patients in the delayed period, and their share from the second period to the third increased 2.8 times. The number of patients who underwent emergency surgery with perforation of the ulcer as one of the complications decreased in the third period compared to the second by 2.6 times, due to the widespread use of PPIs in the conservative treatment of DU. According to the results of the analysis it became known that the chosen active-individualized tactics and developed algorithms for choosing the type of surgery allowed to achieve a stable level of postoperative mortality at 8.3 %.

scholarly journals Modern approaches to the diagnosis and treatment of femoral neck fractures.

2018 ◽  
Vol 96 (7) ◽  
pp. 663-666
Author(s):  
S. G. Parfeev ◽  
M. M. Rankov ◽  
L. K. Brizhan ◽  
D. V. Davydov ◽  
B. P. Buryachenko ◽  
...  
Keyword(s):  
Selection Criteria ◽  
Femoral Neck Fractures ◽  
Actual Problem ◽  
Femur Neck ◽  
Results Of Treatment ◽  
Analysis Of Results ◽  
Surgical Tactics ◽  
Femur Neck Fractures ◽  
Statistical Results

Choice of surgical tactics in femur neckfractures is the actual problem of modern traumatology and orthopedics. The analysis of results of treatment of patients with femur neck fractures is carried out. It is taped that femur neck fractures happened in the place of the formed solitary cyst. Diagnostics of cysts of a femur neck is complicated, however at their detection, performance of an osteosynthesis of a femur neck can lead to development of a nearthrosis. Selection criteria ofpatients which were established the osteosynthesis of a neck of a femur or endoprosthesis replacement of a hip joint is shown. The received clinical and statistical results demonstrate that use of these criteria promotes decrease of quantity of auditing interventions and improvement of quality of life ofpatients.

scholarly journals Surgical treatment of patients with descending purulent mediastinitis

2021 ◽  
Vol 26 (4) ◽  
pp. 118-123
Author(s):  
I.M. Shevchuk ◽  
S.S. Snizhko
Keyword(s):  
Surgical Treatment ◽  
Pleural Cavity ◽  
Comparison Group ◽  
Postoperative Mortality ◽  
Complete Removal ◽  
Main Group ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Minimally Invasive Surgical ◽  
Surgical Tactics

The aim of the study was to improve the results of treatment of patients with descending purulent mediastinitis by means of individualized surgical tactics with the priority use of minimally invasive surgical interventions and developed methods of drainage of the mediastinum and pleural cavity. Examination and treatment of 73 patients with descending purulent mediastinitis receiving treatment in the department of thoracic surgery of Ivano-Frankivsk regional clinical hospital was carried out. Treatment of patients in the main group included intramediastinal administration of antibiotics, the use of the developed method of cascade drainage of the mediastinum and pleural cavity, the priority use of video-assisted thoracoscopy and surgical tactics aimed at anticipating the spread of the purulent process in the mediastinum. The rapid and reliable decrease in the indices of endogenous intoxication in the main group confirms the effectiveness of the developed tactics of surgical treatment of patients with mediastinitis, adequate sanation of purulent mediastinatis, complete removal of the purulent substrate from the mediastinum and pleural cavity. The developed tactics of surgical treatment of purulent mediastinitis allowed reducing the overall postoperative mortality from 26.3% in the comparison group to 11.4% in the main group of patients.

scholarly journals Surgical Aspects of the Treatment of Patients With Generalized Peritonitis

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

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

scholarly journals Combined Surgical Tactics with Step-up Approach in the Treatment of Infected Acute Pancreatitis

2020 ◽  
Vol 87 (3-4) ◽  
pp. 3-9
Author(s):  
I. A. Kryvoruchko ◽  
V. V. Boyko ◽  
K. Yu. Parkhomenko ◽  
A. G. Drozdova ◽  
S. A. Andreieshchev
Keyword(s):  
Acute Pancreatitis ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Open Surgery ◽  
Postoperative Mortality ◽  
Multiple Organ ◽  
Percutaneous Catheter Drainage ◽  
Results Of Treatment ◽  
Surgical Tactics ◽  
Open Necrosectomy

Objective. To evaluate the results of treatment using minimally invasive interventions and open necrectomy in patients with infected acute pancreatitis. Materials and methods. A retrospective cohort two-centered analysis was performed in 211 patients with infected acute pancreatitis who divided into two groups: the first included 101 patients, in the treatment of which used open surgery; the second included 110 patients, in the treatment of which used treatment tactic step-up approach. Results. In the first group used open necrosectomy with drainage for postoperative lavage (75 patients, 74.3%), including open packing with planned re-laparotomy (8 patients, 7.9%), and omentobursostomy for necrosectomy after surgery (18 patients, 17.8%). Postoperative complications occurred in 58 (57.4%), after the surgery 34 (33.7%) patients was died: 30 had a thirty-day mortality, and 4 had a ninety-day mortality. In the second group group, 72 (65.5%) patients were treated by percutaneous catheter drainage, 6 (5.5%) by video-assisted retroperitoneal debridement and drainage, 5 (4.5%) by through the wall of the stomach or duodenum in the infected pseudocyst and open necrosectomy was performed on 27 (24.5%) patients. Postoperative complications occurred in 37 (33.6%) patients, after the surgery 19 (17.3%) was died: 15 had a thirty -day mortality and 4 had a ninety-day mortality. In the regression analysis, only the presence of multiple organ dysfunction before (AUC = 0.867) and after surgery (AUC = 0.930) significantly affected postoperative mortality, but the effect of the prevalence of pancreatic necrosis (AUC = 0.693) on mortality was limited. Differences were likely between groups (χ2=7.282, p=0.026). Conclusion. The surgical treatment should be initiated with a minimally invasive procedures and combination these operations with open surgery was able to reduce complications and mortality in the patients with infected acute pancreatitis.

scholarly journals TREATMENT OF PATIENTS WITH GASTRIC CANCER COMPLICATED BY PERFORATION

2021 ◽  
pp. 23-26
Author(s):  
V. V. Boyko ◽  
I. V. Krivorotko ◽  
V. A. Lazirskiy
Keyword(s):  
Gastric Cancer ◽  
Comparison Group ◽  
Postoperative Mortality ◽  
Main Group ◽  
Diffuse Peritonitis ◽  
Two Stage ◽  
Surgical Interventions ◽  
Perforation Hole ◽  
Results Of Treatment ◽  
Surgical Tactics

Abstract. Introduction. Despite the declining incidence of gastric cancer, the problem of treatment of complicated forms of the disease remains one of the most complex and relevant. The aim of the study was to improve the results of treatment of patients with complicated gastric cancer. Materials and methods. The study is based on the analysis of the results of treatment of 19 patients with gastric cancer complicated by perforation, who were treated at the “State Institution «Zaitsev V.T. Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine” from 2011 to 2020 aged 18 to 85. All patients were divided into two groups: comparison — 9 (47.3 %) patients (were treated from 2011 to 2015), the main — 10 (52.7 %) patients (treatment period from 2016 to 2020). Results and discussion. In the comparison group, conventional surgical tactics and operations were used. The main group used active-individualized two-stage surgical tactics, which involve suturing a perforation hole in the first stage and combined and reconstructive surgery in the second. Radical operations were performed in 10 (52.6 %) patients; in 9 (47.4 %) — palliative and symptomatic. Postoperative complications occurred in 5 patients (26.3 %), postoperative mortality was 26.3 % (5 patients). Conclusions. In patients with gastric cancer complicated by perforation, in a serious condition of the patient and the presence of diffuse peritonitis, we consider it appropriate to use two-stage surgical tactics. The introduction of the proposed surgical tactics and new surgical interventions helped to increase the number of radical operations from 4 (21.0 %) in the comparison group to 6 (31.6 %) in the main group and reduce postoperative mortality from 15.8 % to 10.5 %, respectively.

scholarly journals 606 Mortality and Pulmonary Complications in Patients Undergoing Upper Extremity Surgery at The Peak of the SARS-Cov-2 Pandemic in the UK: A National Cohort Study Presented on Behalf of The Corona Hands Collaborative

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
B Dean ◽  
J Duncan
Keyword(s):  
Cohort Study ◽  
Upper Limb ◽  
Complication Rate ◽  
Postoperative Mortality ◽  
Primary Outcome Measure ◽  
Pulmonary Complications ◽  
Related Complication ◽  
Urgent Surgery ◽  
Upper Limb Surgery ◽  
The Uk

Abstract Introduction This study reports the 30-day mortality, SARS-CoV-2 complication rate and SARS-CoV-2 related hospital processes at the peak of the first wave of the pandemic in the UK. Method This national, multicentre, cohort study at 74 centres in the UK included all patients undergoing any surgery below the elbow at the peak of the UK pandemic. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. Results This analysis includes 1093 patients who underwent upper limb surgery from the 1st to the 14th of April 2020. The overall 30-day mortality was 0.09% and the mortality of day case surgery was zero. The SARS-CoV-2 complication rate was 0.18% (2 pneumonias) and the overall complication rate 6.6% (72 patients). Both SARS-CoV-2 related complications occurred in patients who had been hospitalised for a prolonged period before their surgery and a total of 19 patients (1.7%) were SARS-CoV-2 positive. Conclusions The SARS-CoV-2 related complication rate for upper limb surgery even at the peak of the UK pandemic was low at 0.18% and the mortality was zero for patients admitted on the day of surgery. Urgent surgery should not be delayed pending the results of SARS-CoV-2 testing.

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