Cause Analysis and Diagnosis and Treatment of Intestinal Fistulas After Ultrasound-Guided Microwave Ablation of Abdominopelvic Lesions

Objective: To determine the cause and high-risk factors for the development of intestinal fistulas (IFs) after ultrasound-guided microwave ablation (MA) of abdominopelvic lesions, and to identify effective prophylactic and therapeutic actions.Methods: Clinical data were collected from patients with an IF after ultrasound-guided MA of abdominopelvic lesions in our hospital from January 1, 2010 to December 31, 2018. The cause, diagnosis, and treatment of IFs in these patients were analyzed.Results: Among 8,969 patients who underwent ultrasound-guided MA of abdominopelvic lesions, eight patients developed IF after MA, Seven patients were discharged after being cured and one died.Conclusion: Abdominopelvic lesions are close to the intestines, so histories of surgery, radiotherapy, and abdominopelvic infection are high-risk factors for IF development after MA of these lesions. Surgical treatment should be provided as soon as an IF is identified.

Compared With a Nasointestinal Route, Pre-operative Enteral Nutrition via a Nasogastric Tube Reduced the Incidence of Acalculous Acute Cholecystitis After Definitive Surgery for Small Intestinal Fistula

Purpose: This study aimed to investigate the difference in the efficacy of pre-operative enteral nutrition (EN) via a nasogastric tube (NGT) and pre-operative EN via a nasointestinal tube (NIT) in reducing the incidence of post-operative acalculous acute cholecystitis (AAC) after definitive surgery (DS) for small intestinal fistulas.Methods: Patients with a small intestinal fistula, who had a DS for the disease between January 2015 and March 2021, were enrolled in this study. They were divided into the NIT group and the NGT group based on the pre-operative routes of feeding they received. The clinical characteristics of the two groups were analyzed, and the incidences of post-operative AAC in the two groups were evaluated.Results: A total of 200 patients were enrolled in the study, 85 in the NGT group and 115 in the NIT group. Thirty-one patients developed post-operative AAC (8 in the NGT group and 23 in the NIT group). The incidence of post-operative AAC was 15.5%. EN via the NGT route was associated with a reduction in the incidence of post-operative AAC (adjusted HR = 0.359; 95% CI: 0.139–0.931; P = 0.035).Conclusion: Pre-operative EN via the NGT may reduce the incidence of post-operative AAC in patients who received a DS for small intestinal fistulas.

Nutrition in open abdomen

Open abdomen is known as a serious consequence of various intra-abdominal pathologies. Initially, patients often have a life-threatening condition, sepsis or septic shock. Severe stress related malnutrition, mineral and fluid imbalance develop as metabolic consequences. Intestinal fistulas also occur as a frequent complication in patients with open abdomen. In such patients, a comprehensive approach is needed, including rehabilitation, nutritional support using optimal formulas, and local care for the open abdomen. Our case report presents a patient with open abdomen and enterocutaneous fistulation. A complex nutritional approach in the course of the disease is described and its importance is discussed. Finally, a summary of nutritional care for open abdomen patients is provided based on current recommendations.

Negative pressure therapy for management of patients with enterocutaneous fistulas

Objective: To assess the benefits of negative pressure wound therapy (NPWT) in complex therapy of patients with enterocuta‑ neous fistulas.Methods: From 2014 to 2019 in Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, 24 patients were managed with vacuum assisted techniques. For comparison, a comparable group of 23 observations (control) was formed retrospectively based on an analysis of medical records.Results: When using NPWT, the terms of wound cleansing and the formation of a laparostomy were reduced, and conditions were created for its early closure. With a small laparostomy, the use of NPWT contributed to self-epithelialization of the wound around the fistula.Conclusions: The use of NPWT more than halves the time of formation of a laparostomy, shortens the time for cleansing the wound and creates the conditions for its closure. Surgical tactics using NPWT can more than three times reduce the number of local complications in patients with unformed intestinal fistulas and less often change the combination of antibacterial drugs.

Advanced forms of kidney tuberculosis with fistula formation: modern views

The aim of the study is to evaluate results of surgical treatment in patients with tuberculous pyonephrosis. In 2004 - 2019 12 patients underwent nephroureterectomy. The disease was complicated by involvement of nearby organs in pathological process and appearance of spontaneous external and internal fistulas in 100% of cases, it manifested with symptoms mostly not associated with kidney lesions. Reno-intestinal fistulas were found intraoperatively in 5 patients. Good long-term results of treatment were achieved mainly due to surgical debridment.

SIMULTANEOUS OPERATIONS TACTICS IN PATIENTS WITH VENTRAL HERNIAS

Objectives - to improve treatment results in patients with ventral hernia and the concurrent surgical diseases by means of the designed surgery tactics. Material and methods. The treatment of 834 patients with ventral hernia, aged from 18 up to 82 years, was analyzed. The group consisted of 196 men (23.5%) and 638 women (76.5%). According to the European Hernia Society (EHS) classification of postoperative ventral hernias the gate types were distributed in patients as follows: W1 - in 132 patients (15.8%), W2 - in 397 (47.6%), W3 - in 305 (36.6%), in 243 (29.1%) cases the hernias were recurrent. 394 (47.2%) patients had 597 simultaneous interventions. The treatment tactics for the patients with hernias and associated diseases was defined according to the designed classification. For the abdominal wall repair the 2 variants of the "tension-free" mesh repair technique were used. Results. Forced simultaneous interventions were performed in 34 patients when the intestinal loops adherent to the scar were situated in the hernia sac. In 27 cases the postoperative ventral hernia was combined to the intestinal fistulas, located out of the hernia area. 12 patients underwent herniolaparotomy conditioned by the intra-abdominal intestinal fistulas closure and small hernias size. To prevent the compartment syndrome in 3 patients with splanchnoptosis the right part of the colon was resected. 103 patients had the planned simultaneous operations including the laparoscopic cholecystectomy in 19 cases, 114 patients underwent the panniculectomy. The preventional appendectomy was performed in patients with the recurrent large hernias. In 140 cases the omentum resection was done due to the signs of the chronical strangulation and omentitis. Postoperative pulmonary artery thromboembolia was the death cause for 3 (0.4%) patients. Only 8 (0.9%) patients suffered the partial hernia recurrence. Conclusion. In patients with hernias the simultaneous operations are conditioned by the pathogenesis and do not affect the severity and frequency of wound complications in the postoperative period. A condition for the simultaneous interventions in patients with hernias is the necessary implementation of the combined techniques of the ventral tension-free mesh hernioplasty.