ONE OF THE METHODS OF PREVENTING THE OCCURRENCE OF POSTOPERATIVE VENTRAL HERNIAS

Снижение количества коллагена первого типа, существенно влияет на развитие ПВГ. Снизить частоту развития послеоперационных вентральных грыж можно вследствие раннего диагностирования факторов риска снижения коллагена на амбулаторном этапе подготовки к лапаротомии. Чем раньше сделана операция, тем меньше выражены изменения в тканях и органах, а само хирургическое вмешательство является менее сложным и более эффективным. При гладком течении и заживлении после первой операции можно оперировать послеоперационную грыжу спустя 6-8-10 месяцев в зависимости от вида и обширности первого вмешательства, общего состояния больного, величины и динамики роста грыжевого выпячивания. При склонности к ущемлению, а также при развивающемся синдроме спаечной непроходимости следует оперировать в возможно ранние сроки. Если в анамнезе есть указания на тяжело протекавший послеоперационный период в связи с обширным нагноением в ране, длительной тампонадой брюшной полости, тяжелой интоксикацией, перитонитом либо весьма длительным пребыванием в стационаре по поводу релапаротомии, следует выждать больший срок, примерно 12-18 месяцев. На это время надо назначить больному определенный режим, принять меры к улучшению общего состояния, уменьшению страданий в связи с развитием спаечного процесса в грыжевом мешке и в брюшной полости. По показаниям следует рекомендовать ношение хорошо прилаженного бандажа. Тhe decrease in the amount of collagen of the first type significantly affects the development of PVG. It is possible to reduce the incidence of postoperative ventral hernias due to early diagnosis of risk factors for collagen loss at the outpatient stage of preparation for laparotomy. The earlier the operation, the less pronounced changes in tissues and organs, and the surgery itself is less complex and more effective. When you smooth over and heal after the first operation can be operated incisional hernia after 6-8-10 months depending on the type and extensiveness of the first intervention, the patient's General condition, size and growth of hernial protrusion. With a tendency to infringement, as well as with the developing syndrome of adhesive obstruction, it is necessary to operate as early as possible. If in the history there are indications of a difficult postoperative period due to extensive suppuration in the wound, prolonged tamponade of the abdominal cavity, severe intoxication, peritonitis or a very long stay in the hospital for relaparotomy, you should wait a longer period, about 12-18 months. At this time, it is necessary to assign the patient a certain regime, take measures to improve the General condition, reduce suffering in connection with the development of adhesions in the hernia SAC and in the abdominal cavity. According to the indications, it should be recommended to wear a well-adjusted bandage.

Epidemiology of intra-abdominal infiltrates and abscesses in patients with concomitant diseases and diabetes mellitus

The purpose ofthe work — to study the epidemiological factors in the development of primary and secondary intra-abdominal infiltrates, abscesses and fluid formations in patients with concomitant diseases and diabetes. Material and methods. In the clinic of the Department of Surgical Diseases No. 1, on the basis of the Center of Surgery of the Kiev City Clinical Hospital No. 1 from 2006 to 2019,218patients 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 male patients (49.08 %), 111 female patients (50.92 %). X-ray examination was performed in 112 (51.38 %) patients, computed tomography (CT) in 25 (11.48 %),ultrasound examination of the abdominal organs for 105 (4816 %) patients. Anterior abdominal wall thermometry was performed in 76 (34.86 %) patients. Resultsand discussion. Depending on the cause of the development of intra-abdominal infiltrates, abscesses and fluid formations, the patients were divided into 4 groups. Patients of the first, second and third groups had primary intra-abdominal complications, and in the fourth group patients had secondary postoperative complications. The first group included 74 (33.94 %) patients suffering from a complicated course of destructive appendicitis. The second group included 48 (22.02 %) patients suffering from perforated gastric ulcer and 12 duodenal ulcer. The third group included 69 (31.65 %) patients suffering from cholecystitis and various types of complications. The fourth group included 27 (12.39 %) patients who underwent urgent surgery due to strangulated hernias, adhesive obstruction. The study of the scales showed that: in 87 (39.91 %) the weight was within normal limits, and in 131 (60.09 %) patients were overweight and obese. It was found that 126 (57.80 %) patients wore glasses. Diseases of the cardiovascular system and arterial pressure disorders according to the data of case histories and anamnesis had 123 (56.42 %) patients. Diabetes was diagnosed in 38 (17.43 %) patients. Diseases of the musculoskeletal system were diagnosed in 27 (12.38 %) patients, and 48 (22.02 %) patients suffered from flat feet of various stages. Primary intra-abdominal complications(infiltrates and abscesses) were diagnosed in 191 (3.48 %) patients out of 5483 urgent hospitalizations and operations, of which 74 (1.35 %) with appendicitis, 69 (1.26 %), perforated gastric ulcer and 12 duodenal ulcer in 48 (0.87 %) patients. Secondary postoperative infiltrates, abscesses and fluid formations were found in 27 (18.12 %) of 149 patients who had undergone urgent abdominal surgery (adhesive obstruction, incarcerated and postoperative hernias, etc.), and in 29 (15.18 %) of 191 patients who underwent surgery for primary intra-abdominal complications of the underlying disease and urgent surgery. Diabetes mellitus was diagnosed in 38 (17.4 3%) patients, and therefore all patients who are hospitalized in an urgent and planned manner must undergo a comprehensive clinical and laboratory examination with the determination of blood sugar. The presence of established diabetes mellitus requires the consultation of an endocrinologist, and during the operation it is advisable and necessary to correct glycemic and volemic disorders, which continues until the restoration of vital functions and stabilization of the general condition of the patient. Intra-abdominal complications occurred on the background of concomitant diseases: overweight in 28.44 %, visual impairment in 57.80 %, diseases of the cardiovascular system and arterial pressure disorders in 56.42 %, diseases of the musculoskeletal system in 12.38 %, which indicates the need for an individual approach in the treatment of each patient.

Congenital Incomplete Rotation of the Colon With Adhesive Obstruction in an Adult

Intestinal obstruction is an entity commonly encountered by general and colorectal surgeons. Anatomic abnormalities account for only a small fraction of cases of complete or partial obstruction. This case report focuses on a 51-year-old female presenting with acute on chronic large bowel obstruction. Workup revealed an exceedingly rare anatomic abnormality: a medialized descending colon, traveling adjacent to the abdominal aorta, with a transition point and dense bands just distal to the splenic flexure. She underwent exploratory laparotomy with division of the constrictive bands and subsequently experienced near-complete resolution of her chronic obstructive symptoms.

ASSESSMENT AND MANAGEMENT OF INTESTINAL OBSTRUCTION IN PATIENTS ATTENDING TERTIARY CARE INSTITUTE

Background and Aim: Bowel obstruction is the most common intra-abdominal problem faced by general surgeons in their practice. Therefore better understanding of pathophysiology, improvement in diagnostic techniques, fluid and electrolyte correction, much potent antibiotics and knowledge of intensive care is required. present study was undertaken to study the management and post-operative complications of intestinal obstruction. Material and Methods: This is a prospective study of 97 cases presenting with symptoms and signs suggestive of acute intestinal obstruction. All patients are subjected to required preoperative biochemical investigations. Patients who showed reduction in abdominal distention and improvement in general condition especially in individuals with postoperative adhesions, a chance of conservative management was taken (by extending the supportive treatment) for further 12 to 24 hours; those who showed improvement by moving bowels, reduction in pain and tenderness was decided for conservative treatment, such individuals were excluded in this study. Results: The occurrence of acute intestinal obstruction was common in male in comparison with female. The commonest presenting symptom was abdominal pain (100%) followed by vomiting (92.7%), distention of abdomen (87.6%) and absolute constipation (53.6%). In this study, Adhesive obstruction (56.7%) was the commonest cause of acute intestinal obstruction. Release of adhesions and bands was done in 43 cases. Resection and end-to-end anastomosis was done in 25 cases, which included cases of intussusceptions, adhesions, stricture, ileocaecal growth, colonic growth. Conclusion: Most common etiological factor for intestinal obstruction is postoperative adhesions. Obstructed Inguinal Hernia is second most common cause of intestinal obstruction. Clinic radiological and operative findings put together can bring about the best and accurate diagnosis of intestinal obstruction. Key Words: Abdominal pain, Adhesions, Bands, Bowel obstruction, Inguinal Hernia,

Outcomes of surgical treatment of neonates with intestinal stomas in a regional perinatal center

Introduction. Emergency intestinal surgeries in neonates can lead to stoma formation. Indications for stoming, associated complications and ways to prevent them are being actively discussed. The aim of this study was to analyze results of surgical treatment of neonates with intestinal stomas in a perinatal center for the last 10 years.Material and methods. 81 children with intestinal obstruction (32), necrotizing enterocolitis (27), meconium ileus (14) and others abdominal pathologies (8) were included into the study. Statistical processing was carried out using the SPSS v.26 package; differences were significant at p-value ≤0.05. Complications were assessed with the Clavien-Dindo Сlassification (CDC).Results. There were 59 premature infants (72.8%); 32 had body weight below 1000 grams (54.2%). Initially performed: 15 (18.5%) colostomies, 49 (60.5%) enterostomies, 17 (21%) T-anastomoses. A compression clip was put in six children with double-barreled ileostomies. Complications were the following: prolapse (12.3%), skin excoriation (43.2%), bleeding (19.8%), large losses of intestinal chyme (17.3%), liver failure (19.8%), sepsis (17.3%), wound dehiscence (6.2%), adhesive obstruction (16%), necrosis (9.9%) and stenosis (7.4%). 16 (19.7%) patients had no complications. 28 (43%) patients had complications by CDC of grade <III, and 37 (57%) - by CDC of grade ≥III. Stomas were closed in 32 children (39.5%) after 35 days, on average (6-126 days). Mortality was 28.4%, mainly in children weighing less than 1000 gramm (p = 0.03).Conclusion. If a neonate patient has contraindications to primary anastomosing, double-barreled enterostomy with a compression clip is a safe alternative to it. The enterostomy technique in premature newborns does not increase the rate of complications and mortality. Skin excoriation, increased bleeding from the stoma, and liver failure are most common in neonates with enterostomy.

Management and post operative complication of acute intestinal obstruction

Background: Intestinal obstruction remains one of the most common intra-abdominal problems faced by general surgeons in their practice. Its early recognition and aggressive treatment in patients of all ages, including neonates, can prevent irreversible ischemia and transmural necrosis, thereby decreasing mortality and long-term morbidity. Objective of the study was to study the etiological factors, various modes of clinical presentation and management of intestinal obstruction.Methods: Study was conducted by selection of consecutive 50 cases presenting with symptoms and signs suggestive of acute intestinal obstruction from Chigateri General Hospital and Bapuji Hospital attached to J.J.M.Medical College, Davangere during the period from June 2009 to May 2011.Results: In our series, the maximum incidence is in the age group of 41-50 years. The occurrence of acute intestinal obstruction was common in male compared to female. Small bowel obstruction is more common. The commonest presenting symptom was abdominal pain followed by vomiting, distention of abdomen and absolute constipation. Adhesive obstruction (56%) was the commonest cause of acute intestinal obstruction, followed by Obstructed Hernia (18%), Malignancy (6%), Volvulus (4%), Intussusceptions (6%) and TB stricture (6%). Release of adhesions and bands was done in 22 cases. Resection and end-to-end anastomosis was done in 16 cases, which included cases of intussusception, adhesions, stricture, Ileo-caecal growth, colonic growth.Conclusions: Most common etiological factor for intestinal obstruction is postoperative adhesions. Release of adhesions and bands was the most common surgery done.

Short-Term Clinical Outcomes after Using Novel Deeper Intubation Technique (DIT) of Ileus Tube for Acute Bowel Obstruction Patients

Background. The ileus tube has been widely used for the treatment of acute small bowel obstruction. However, it is difficult to get the tube sufficiently adjacent to the obstruction site due to various reasons. Methods. We developed a novel intubation technique, named Deeper Intubation Technique (DIT), by using the Zebra Urological Guidewire and digital gastrointestinal fluoroscopy, where we deepened the catheter intubation, and further compared the effects of DIT with the Traditional Intubation Technique (TIT) on the short-term clinical outcomes of 183 patients. Results. The average intubation depth of DIT apparently exceeds that of TIT (213.89±31.11 vs. 134.67±18.22 cm, P<0.001). Compared with patients in the TIT group, patients in the DIT group got a lower pain score (P<0.001), shorter recovery time for anal exhaust defecation (2.87±1.50 vs. 3.37±1.52 d, P=0.040), higher recovery rate in anal exhaust defecation (24 h, 16.8% vs. 5.7%, P=0.021; 48 h, 46.3% vs. 27.3%, P=0.009), better symptomatic remission rate and imaging relief rate (P<0.05), and increased drainage volume (1006.88±583.45 vs. 821.02±358.73 ml, P=0.009). Importantly, the emergency surgery rate in the DIT group was lower than that in the TIT group (3.2% vs. 13.6%, P=0.014). In addition, the DIT procedure was effective for patients with adhesive obstruction but not for cancerous and stercoral bowel obstruction. Conclusion. Compared to TIT, DIT produced better short-term clinical outcomes, indicating that DIT is a safe and feasible technique for the treatment of adhesive intestinal obstruction.

MODERN TRENDS IN THE TREATMENT OF ACUTE ADHESION IN INTESTINAL OBSTRUCTION

Summary. Aim. To perform the modern tactics of acute adhesive obstruction (AAO) treatment. Materials and methods. The basis of the work is the analysis of the results of treatment of 38 patients hospitalized in an urgent order to the surgical department with the clinic AAO. Results. 20 (52.6 %) patients with the background of conservative therapy, the phenomenon of intestinal obstruction was regressed. Repeated hospitalization during the year with the hospital was required by AAO 2 (5.3 %) patients. Laparoscopic adhesion was performed 4 (10.5 %) patients whose average intestinal restoration time was (1.8±1.2) days, and the duration of postoperative inpatient treatment was (5.1±1.3) days. Open surgical interventions were performed 14 (36.8 %) patients, in whom the period of restoration of the intestine function was (3.8±1.5) days, and the duration of postoperative treatment was (10.1±1.2) days. Conclusion. Conservative therapy is effective in 52.6 % of patients. Laparoscopic adhesion is indicated in the absence of peritoneal symptoms, if ≤ 2 laparotomies were noted in the history, with a peritoneal index of adhesion ≤ 9 points.

DIAGNOSTICS AND COMPLEX TREATMENT OF ADGHESIVE INTESTINAL OBSTRUCTION

Summary: Develop a comprehensive program for the diagnosis, treatment and prevention of intestinal adhesive obstruction. Analyzed the results of diagnosis and treatment of 60 patients with acute adhesive intestinal obstruction. The diagnostic program included clinical, laboratory, X-ray and ultrasound diagnostics. Local barrier prevention of peritoneal adhesive disease was performed with a solution of polyethylene glycol 4000 according to the method developed by us. Conservative therapy was effective in 19 (31.7%) cases. 41 (68.3%) patients with a progression of adhesive ileus were operated. Laparoscopic adheolysis was performed in 4 (9.8%) patients. In 37 (90.2%) cases, surgical treatment was performed in the traditional method. The proposed diagnostic and treatment program with priority use of ultrasound diagnostics allows in a short time to establish a detailed diagnosis of adhesive intestinal obstruction and to determine the indications for surgical treatment. Intraoperative use of hypotonic solution polyethylene glycol 4000 allows to reliably prevent the development of peritoneal adhesive disease and adhesive obstruction.