Laparoscopic Repair of Perforated Gastric Ulcer by Forming a “Covered Perforation”

Performing video endoscopic operations on patients with emergency surgical pathology in order to increase the efficiency and reduce the duration of surgical intervention, as well as to prevent postoperative complications, stimulates the continuous development and implementation of new minimally invasive technologies in emergency surgery. The aim of the study was to develop a new method for laparoscopic suturing of a perforated gastric ulcer (PGU) with the formation of a “covered perforation.” The proposed method uses a fold-duplicator from the anterior wall of the stomach to close the perforation of the stomach wall, thus expanding the possibilities of using minimally invasive technologies for PGU.

DIVERTICULAR DISEASE: FROM TRADITION TO INNOVATION

This article presents current data from the world medical literature and a five-year study of surgical clinic on the effect of perioperative intestinal decontamination in patients with acute complicated diverticulitis on the frequency of postoperative complications after elective resection of the sigmoid colon and the formation of primary colorectal anastomosis. The possibility of selective perioperative intestinal decontamination in patients with acute sigmoid diverticulitis complicated by covered perforation, the number of postoperative surgical and general complications was observed. The used scheme of topical antibacterial sanitation, along with orthograde intestinal cleansing with osmolar solutions, significantly reduced the frequency of insufficiency of colectal anastomoses, surgical (abdominal) and the total number of postoperative complications.

SELECTIVE INTESTINAL DECONTAMINATION IN PATIENTS WITH ACUTE DIVERTICULITIS COMPLICATED BY COVERED PERFORATION AS A WAY TO REDUCE THE NUMBER OF POSTOPERATIVE COMPLICATIONS

The effect of selective perioperative intestinal decontamination in patients with acute sigmoid diverticulitis complicated by covered perforation on the number of postoperative complications was described. A prospective and partially retrospective study of the results of complex treatment of 196 patients with acute diverticulitis localized in the sigmoid colon, complicated by covered perforation, divided into group А – 66 patients with perioperative selective intestinal decontamination and group B – 130 patients without decontamination. Rectal resection by open, laparoscopic and robot-assisted methods with the formation of primary colorectal anastomoses was performed in all cases. Of the 196 patients included in our study, 122 (62,2 %) underwent surgery without complications. Abdominal postoperative complications directly caused by surgical interventions and related, according to the classification of Сlavien-Dindo surgical complications (C-D) to grades I, IIIb and IV, were noted in 9 (13,6 %) patients of group A and 36 (27,6 %) patients of group B, and extraabdominal (C-D I, IV), which included: pneumonia, acute renal failure, pyelonephritis, urosepsis, postoperative delirium and transient ischemic attack – in 8 (12,1 %) and 21 (16,1 %) patients of the corresponding groups. In group A, there was a significantly lower number of general abdominal and wound complications, as well as the total number of all postoperative complications (p = 0,03, p = 0,04 and p = 0,0111 respectively). There were no fatalities. The used scheme of oral antibiotic therapy, along with orthograde intestinal sanitation with osmolar solutions, significantly reduced the frequency of surgical and non-surgical complications.

Impact of Cement Dust Pollution on the Surface of Sound-Absorbing Panels on Their Acoustic Properties

The publication presents a comparison of the sound absorption test results of a perforated wall cassette filled with mineral wool for various degree of cement dust pollution. Cement dust should be understood here as dust created during the production of cement and during the milling and dispatch of finished products. If the partitions in production plants are made of sound-absorbing cassettes or additional sound-absorbing elements made of perforated cassettes are applied, we must know how dust can change sound-absorbing properties of the cassettes. Thus, one has to consider whether the use of sound-absorbing perforated cassettes is appropriate if sound-absorbing parameters change over time due to dust. To determine the impact of dust-covered perforation on sound-absorbing parameters, tests were performed for four variants having different level of pollution. The tests involved ‘clean’ and then dust-covered cassettes, each time increasing the amount of cement dust on the perforations. Sound absorption parameters of the cassettes were tested in the reverberation chamber for individual variants. Test results indicate the loss of sound absorption of the cassettes only when they are heavily polluted. Then the reduction of the single-number sound absorption index αw is 50%. Using computer simulation, we analyzed how the change of sound-absorbing parameters of the cassettes would influence the change of noise reduction in the production hall. The results of the analysis demonstrate a very effective reduction of noise level of 14 dB by the application of clean cassettes. The reduction value for the dirtiest cassettes was 6 dB.