Experience in treating gastrointestinal tract perforations in newborns in the Republic of Uzbekistan

Introduction. Despite of the fact that necrotic enterocolitis (NEC) is a common surgical disease in newborns, a significant breakthrough in its treatment has not been made yet.Purpose. To analyze outcomes of surgical treatment at the NEC surgical stage in newborns.Material and methods. Outcomes after surgical treatment of 71 newborns with necrotic enterocolitis at its surgical stage, who were admitted to the hospital in 2015-2020, have been analyzed.Results and discussion. Diagnostic laparoscopy (DL) was prescribed if the surgical stage of the disease was not complicated with pneumoperitonitis. 37 patients had DL; of them 11 (29.7%) had conversion to laparotomy. In 26 (70.3%) patients, diagnostic laparoscopy was ended with therapeutic laparoscopy and video-assisted mini-laparotomy; among them there were 7 (26.9%) patients in whom gastric perforation was sutured. Resection of the necrotic part of the intestine with followed end-to-end anastomosis was made in 8 (30.7%) patients; in 11 (42.3%) patients, an intestinal stoma was created. In 45 newborns with the NEC surgical stage, surgeons chose the traditional surgical tactics. 34 (75.5%) patients with diagnosed pneumoperitoneum had laparocentesis to achieve decompression; 8 (17.7%) patients out of them died. 37 (82.2%) patients had laparotomy; in 5 (11.1%) out of them stomach perforations were sutured. In 32 (71.1%) patients, intestinal stomas were created. If to compare the obtained results after video-assisted laparoscopic surgeries, the mortality rate was as follows: 6 (23.1%) patients after laparoscopic interventions and 64.4% after traditional ones.Conclusion. Diagnostic laparoscopy at the surgical stage of necrotizing enterocolitis allows to select tactics for radical surgical treatment, to transfer surgical treatment into non-surgical one, thus minimizing surgical trauma what impacts positively the postoperative survival of patients.

A COMPREHENSIVE STUDY ON THE ROLE OF LAPAROSCOPY IN ABDOMINAL TRAUMA

Explorative laparotomy has been the mainstay of management in patients with blunt abdominal trauma . The advantage of laparoscopy is that it can provide both diagnostic and therapeutic interventions for those hemodynamically stable abdominal trauma patients. Methods: 30 patients of blunt trauma abdomen were retrospectively studied for whom laparoscopic intervention was done. Results: In our study 30 patients with abdominal trauma were included of which 22 (76%) had penetrating trauma and 8 had blunt trauma (24%). Among penetrating trauma, seven patients (31.8%) underwent therapeutic laparoscopy whereas diagnostic laparoscopy was done for 10 patients (45.5%). Conclusions: Laparoscopy can be safely performed in haemodynamically stable patients of abdominal trauma for both diagnostic and therapeutic purposes and can help in avoiding the negative laparotomies.

One Bullet Causing Five Holes, Laparoscopic Exploration with Repair: A Case Report and Review of the Literature

Introduction. The proper treatment of penetrating abdominal wounds has been a controversial topic, and the preferred regimen has evolved over time. In recent years, many trauma centers have started using diagnostic laparoscopy in stable trauma patients in an effort to reduce the incidence of nontherapeutic laparotomy. This is more commonly seen in solid organ injuries, and its role is less clearly defined for hollow visceral injuries. Case Presentation. A 19-year-old male presented with a gunshot wound (GSW) to the abdomen with mild peritoneal signs and computed tomography (CT) findings. Diagnostic laparoscopy was performed with the repair of five lacerations to intra-abdominal organs including the sigmoid colon, rectum, bladder, and small bowel. Discussion. To our knowledge, this is the first case report in the literature detailing such a GSW repair. Abdominal GSWs have been repaired laparoscopically in the past, but none have elaborated on the repair of multiple defects of bowel and/or bladder. Conclusion. Therapeutic laparoscopy can be considered in selected cases of penetrating abdominal trauma. Laparoscopy offers several advantages over laparotomy including decreased mortality, complication rate, and length of stay.

The role of laparoscopy in patients with abdominal trauma

Background: Use of laparoscopy in penetrating trauma has been well established; however, its application in blunt trauma is gaining popularity as a useful diagnostic tool to avoid unnecessary laparotomies where there is diagnostic dilemma. Even though recent case reports seem to suggest that these patients can be managed using laparoscopy, the practice is not yet wildly adopted.Methods: All adult patients who presented with abdominal trauma laparoscopic surgery was considered in patients who were deemed fit for the same in the Department of General Surgery, MMIMSR, Mullana, Ambala during a period of 18 months starting from January 1st 2015 to June 30th 2016. Data was analysed using descriptive statistics.Results: A total of 53 patients with either blunt or penetrating abdominal trauma that required surgery were included in the study. Exploratory laparotomy was performed in 45 patients (84.91%) and laparoscopy was performed in 8 patients (15.09%). Overall mesenteric injury (45.28%) was the most common intra-abdominal injury noted. The most common organ involved in blunt trauma was the spleen (68.97%). The mean operating time of laparoscopy was lesser by 57 minutes as compared to exploratory laparotomy. The use of laparoscopy avoided negative and non-therapeutic laparotomy in 2 patients (25%). Therapeutic laparoscopy was performed in 3 patients with repair of bowel and mesenteric injuries. There was no documented procedure‑related morbidity and mortality.Conclusions: The positive outcomes from the study suggest that laparoscopy can be safe and feasible in both diagnostic and therapeutic interventions in carefully selected blunt abdominal trauma patients.

Laparoscopy for blunt abdominal trauma: a challenging endeavor

Background and Aims: Laparoscopy in blunt abdominal trauma is challenging because of multiple associated injuries, higher trauma score values and higher morbidity and mortality, as compared with patients with penetrating abdominal trauma. The aim of this study was to investigate the role of laparoscopy in the management of blunt abdominal trauma patients and to highlight related challenges. Material and Methods: Over a 4-year period, patients managed laparoscopically for blunt abdominal trauma were retrospectively analyzed. Perioperative details, indications for laparoscopy and conversion, complications, and length of hospital stay were discussed. Results: A total of 35 stable patients underwent laparoscopy. The mean Injury Severity Score was 12 (4–38). Therapeutic laparoscopy was performed in 15 (56%) and diagnostic in 12 (44%) patients. Eight (23%) patients were converted to therapeutic laparotomy. Intraoperative bleeding, complex injuries, visualization problem, and equipment failure necessitated conversion. Three (30%) patients with negative computed tomography scan had therapeutic laparoscopy for mesenteric injuries. There were no missed injuries. The mean length of hospital stay was 11 days in both groups. Conclusion: Laparoscopy for stable patients is feasible and safe. Multiple injuries make laparoscopy more difficult, and advanced laparoscopic skills are required. The conversion rate is high; however, the non-therapeutic laparotomies were completely eliminated in this study.

Diagnostic and therapeutic laparoscopy in the management of endometriosis

Background: Endometriosis associated with a variety of symptoms, primarily produces dysmenorrhea and infertility. Three classes of techniques have been used to diagnose women with endometriosis beside the history and the clinical picture: biochemical markers, radiological imaging and laparoscopic examination of peritoneal cavity.Methods: All 52 patients were evaluated clinically, biochemically, and radiologically and laparascopically to find out the abnormalities.Results: Most common complaint in a patient with endometriosis is dysmenorrhea affecting 67.6% population in this study group. 20% patients presented with infertility. Diagnostic laparoscopy of the patients in the study group show ovarian endometrioma in 67.3% population. Stage II endometriosis was seen in maximum number of cases in the study group comprising 46.2% patients. Ovarian cystectomy was the most common therapeutic procedure done in 51.9% of patients, out of which 40.4% cases treated with unilateral cystectomy and rest by bilateral cystectomy.Conclusions: This study concludes that endometriosis predominantly affects the women of reproductive age group and causes dysmenorrhea and infertility in majority of the patients. A laparoscopic finding marks as a standard tool in diagnosis and treatment of endometriosis.