CORRECCIÓN DEL DESPLAZAMIENTO ABOMASAL IZQUIERDO POR VIDEOLAPAROSCOPÍA

Correction of left abomasal displacement by video laparoscopy. This article reviews the benefits of the laparoscopic abomasopexy used for correction and fixation of the left abomasal displacement in dairy cows. The first steps are similar to the conventional technique, with sedation, analgesia and antisepsis. Two small flank incisions were made, the first one is about 10 centimeters ventral to the lumbar transverse processes in the cranial aspect of the left paralumbar fossa, and the second one, more cranial than the other and is located 7 cm ventral to the transverse processes of the lumbar vertebrae in the left 11th intercostal space, these two are the entry points of instruments and optics. This technique allows us to shorten the surgical time, reducing the tissue exposure time, the possibility of intra and post-surgical infections and iatrogenic injuries. Therefore, we saw that the recovery time was shorter; and a quick return to production is guaranteed due to the low use of antibiotics.

Video laparoscopic diagnostics and surgical tactics for acute diseases of abdominal organs

The article presents the results of video laparoscopy (VLS) performed in 2008–2019 in 5,599 patients in order to diagnose acute diseases of the abdominal organs requiring emergency surgery, identify competing and concomitant diseases, and determine treatment tactics. 2,442 (43.6 %) of them made up group I, with no doubt; 2,656 (47.4 %) – II group, with presumptive reliability; and 501 (9.0 %) – group III, with an unclear clinical diagnosis of the disease. In 2,326 (95.2 %) patients of group I with VLS, the clinical diagnosis was confirmed, in 100 (4.1 %) other diseases were revealed, and in 16 (0.7 %) the diagnosis was not established. Competing diseases were found in 8 patients and concomitant diseases in 4. In 1,641 (61.8 %) patients of group II, VLS made it possible to clarify and differentiate the clinical diagnosis of diseases, in 929 (35.0 %) – to identify other diseases, and in 86 (3.2 %) the diagnosis was not possible. When performing differential diagnosis, 126 other diseases were identified more than the number of patients. Competing diseases were found in 6 patients and concomitant diseases in 6 patients. 356 (71.0 %) patients of group III with VLS were diagnosed with major diseases, 75 (15.0 %) had other diseases, and 70 (14.0 %) were not diagnosed. In 4 patients, competing diseases were found, and in 1 – concomitant disease. Of the 5,427 (96.9 %) patients with the definitive diagnosis of the disease established with VLS, 3,828 (70.5 %) were found to be able to perform VLS operations, in 10 (0.3 %) of them – simultaneous with competing diseases.

Spontaneous subcapsular and perirenal haemorrhage with retroperitoneal haematoma in a patient with ovarian melanoma metastases

A 47-year-old woman was admitted to our clinic for intensive pain in the left flank region. The transvaginal ultrasound showed a left adnexal solid mass with ascites. She had undergone surgical removal of skin melanoma in 2008, but in September 2019, intracardiac metastasis resulting from it had been discovered. CT performed in March 2020 had been negative for other metastases. A full abdomen ultrasound was not performed. During the night, the patient began to show signs and symptoms of hypovolaemic shock. The patient was urgently transferred to the operating room for a video laparoscopy. A vast left retroperitoneal haematoma was diagnosed along with voluminous enlargement of the left ovary. We proceeded with a left adnexectomy and blood transfusion. Subsequent contrast-enhanced CT revealed a left subcapsular, perirenal haematoma and a voluminous retroperitoneal haematoma. Kidney metastasis was also seen. The final histological diagnosis was metastatic amelanotic malignant melanoma of the ovary.

Experience and possibilities of video laparoscopy in emergency abdominal surgery

Objective. To evaluate the effectiveness and improve treatment outcomes for patients with acute abdominal pathologies using video laparoscopy. Materials and methods. The paper is based upon a ten-year experience of using video laparoscopy in emergency abdominal surgery. Within a decade (2008 2018), 23127 patients had been admitted to the surgical department of City Emergency Hospital in the city of Rostov-on-Don; among them 19748 patients were operated on. Video laparoscopic surgeries for acute appendicitis, acute cholecystitis, acute intestinal obstruction, perforated gastric and duodenal ulcers, and other acute abdominal surgical pathologies were performed in 15124 patients; the share of these interventions was 76.6 % of all cases. Results. Initially, when laparoscopy was introduced in emergency abdominal surgery, diagnostic laparoscopy was used in more than a half of the performed surgeries, mainly for acute appendicitis and abdominal injuries. Today, video endoscopic surgery is widely used for acute cholecystitis, acute pancreatitis, perforated ulcers, strangulated hernias, torsions of epiploic appendages of the colon and of the greater omentum. An effective use of video laparoscopy for therapeutic purposes allows increasing the number of laparoscopic operations performed in patients with emergency surgical pathology of abdominal organs. Conclusions. Video laparoscopy in urgent surgery allows establishing a diagnosis in time, performing dynamic video laparoscopy, eliminating concomitant pathology, diagnosing and, in some cases, preventing postoperative complications. Video laparoscopic surgery is easier for patients to tolerate; it reduces the number of complications, the period of staying at the hospital and the rehabilitation period, and opens up new possibilities for helping patients with emergency surgical conditions.

Successful treatment of patient with thoracoabdominal injury with heart and esophageal trauma (clinical case).

The article presents a case of treating the patient with extrapleural thoracoabdominal injury with heart and esophageal trauma. Examination of the patient in a shock trauma operating room, the use of minimally invasive technologies (thoracoscopy, laparoscopy) allowed to choose the right treatment tactics, timely identify all injuries and eliminate them. The presented clinical observation demonstrates the feasibility of using video thoracoscopy and video laparoscopy in hemodynamically stable patients with penetrating thoracoabdominal wounds to detect damage to the heart and esophagus.

TACTICS OF SURGICAL TREATMENT FOR ISOLATED DUODENAL INJURY

Currently the diagnosis and surgical treatment of isolated duodenal injury is one of the most rare and, consequently, a complicated and completely unsolved problem in emergency surgery. In order to analyze the results of surgical treatment and to justify the optimal amount of intervention in the patients with isolated duodenal injury we have performed a study, wherein the cases of an open injury of the cut−stab character, the effects of a blow on the anterior abdominal wall have been considered. The admission time of patients generally made 6 hours. Examination radiography of abdominal organs with DeBakey − Henelt test, phagogastroduodenoscopy was performed. In cases of unexplained clinical picture the diagnostic video laparoscopy was urgently used. The factors, affecting an outcome of treating the isolated duodenal injury were as follows: the time of hospitalization of patients, size and localization of the bowel defect, timely diagnosis and choice of the surgery volume as well as the post−surgery complications. A thorough revision of a retroperitoneal space, being the one of the symptoms of the Winiwarter−Laffite triad, was accomplished. In injuries of the first and second degree, duration of an injury of no longer than 6 hours, it is necessary to close the defect of the duodenum by two−row sutures with a nasogastroduodenal intubation. At admission of the patients at later terms or with the injuries of the third degree it is expedient to exclude a passage of food on a gut by imposing a gastroenteroanastomosis with Brownian complicity and a decompression of bilious ways. On the basis of our findings the diagnostic and surgical algorithms, depending on admission time of patients to a hospital, size and localization of duodenum wall defect were designed. Key words: duodenal injury, tactics of surgical treatment, results of surgical treatment.