SUCCESSFUL TREATMENT OF SEVERE PURULENT PERITONITIS WITH INTRAABDOMINAL HYPERTENSION COMPLICATIONS (CLINICAL CASE)

The widely used traditional method of surgical treatment of patients with widespread purulent peritonitis failed to establish itself as universal and has a large number of disadvantages, which prompts the use of new methods of managing patients in the postoperative period in surgical practice. The case described in the work illustrates the possibilities of a successful integrated approach in the treatment of diffuse purulent peritonitis against the background of Abdominal Compartment Syndrome, which includes the «Open abdomen» and «VAC-therapy» techniques, the use of which leads to a persistent decrease in both IАP and relief of the phenomena of purulent inflammation in the abdominal cavity. Conclusions. The use of VAC-therapy in combination with the «Open abdomen» technique leads to a persistent decrease in both ICP and relief of the phenomena of purulent inflammation in the abdominal cavity.

SIZE AND STRUCTURE OF SANITARY LOSSES IN WARS OF MODERN LOCAL ARMED CONFLICTS IN GUNSHOT INJURIES OF THE ABDOMEN WITH DAMAGE TO THE COLON

The purpose of the study is to analyze the sources of domestic and world literature with the study of the magnitude and structure of sanitary losses in wars and modern local armed conflicts with gunshot wounds to the abdomen with damage to the colon. To investigate sanitary losses at gunshot wounds of a colon. Conclusions. Sanitary losses in wars of local armed conflicts with gunshot wounds to the abdomen with damage to the colon remain high worldwide, despite individual means of protecting the torso. In this regard, it is notable to further study the anatomical and clinical features of gunshot wounds of the colon in the experience of the antiterrorist operation in eastern Ukraine.

EXPERIMENTAL STUDY OF CLINICAL INDICATORS OF INTRATISSUE PRESSURE IN DEEP CIRCULAR BURNS AND ITS DYNAMICS DEPENDING ON THE NATURE AND VOLUME OF SURGERY

The purpose of research. To improve in the experiment the optimal variants of surgical tactics to eliminate the phenomena of compartment syndrome in circular deep burns on the basis of studying the dynamics of intratissue pressure. Materials and methods. An experiment to study the effectiveness of treatment of deep circular burns of III degree, accompanied by compartment-syndrome with objectification of intra-tissue pressure was performed on 18 male WAG rats weighing 190.0-200.0 g, which were divided into three groups depending from the nature and scope of surgery. Research results and their discussion. Based on the assessment of the dependence of the level of intratissue pressure in the tissues on the timing of modeling of deep circular burns in the experiment and tactics and volume of surgical treatment, a clear dependence of indicators in all groups of experimental animals. The primary necrectomy performed in the III main group due to the radical surgical intervention allowed to completely normalize the intratissue pressure within 24 hours. Conclusions. 1. Clinical indicators of intratissue pressure at deep circular burns depending on time of modeling of a thermal trauma and character and volume of surgical intervention are defined in experiment. 2. It is established that primary necrectomy due to radical excision of necrotized tissues and rapid decompression contributes to the nor malization of intratissue pressure.

SURGICAL TREATMENT OF PATIENTS WITH EXTRAORGANIC TUMORS OF THE PELVIC LOCALIZATION WITH INVASION OF THE ILIAC VESSELS

The aim of our study was to determine the indications for expanding the scope of operations in patients with pelvic extraorgan local formations. Materials and methods. The results of surgical treatment of 7 patients with nonorgan tumors of the pelvic localization, who underwent resection on the main vessels in connection with their involvement in the tumor process, are presented. Results and discussion. A total of 7 interventions were performed on the iliac arteries — 2 resections with an end-to-end anastomosis and 5 prostheses (one case — the aorta resection with reconstruction with a bifurcation prosthesis). Patients with pelvic extraorgan tumors are a special cohort of patients, due to the presence of several organs in a narrow space, which inevitably causes them to fit snugly to the tumor. Locally advanced tumor process in extraorganic tumors involving the main vessels of the pelvis and adjacent organs is not a reason to refuse surgery, and despite the complications, repeated recurrences and previous operations, are well tolerated by patients. This is especially important due to the lack of a real alternative to surgical treatment of this group of patients. Conclusions. Surgical intervention in the treatment of pelvic inorganic tumors involving the main vessels is the only radical method of treatment. Invasion of the main arterial and venous vessels is not a contraindication to surgery in patients with pelvic tumors. Combined angioplastic interventions allow to achieve a long without recurrent period even after cytoreductive operations.

THE ROLE OF THE INSTUMENTAL EXAMINATIONS IN DIAGNOSTICS AND STAGING OF LOCALY DISTRIBUTED STOMACH CANCER

Objective. Improvement of algorithm of diagnostics of patients with complicated stomach cancer. Materials and methods. It was shown the analysis of results of surgical treatment of 418 patients with complicated stomach cancer, which got the hospital treatment at GI “V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine “ from 2010 till 2019, aged 29 till 76. Results. Patiens were examinated with using of combination of instrumental methods. Goal is total detal examination of pathologic process. SCT has precission of 95-97 % at detecting of cancer, definition of stage – 77-80 %. Endoscopy allows to define the location, spreading of process, to find a pathologic process at starting and precancer stages. There no any ideal oncomarker. Diagnostic precission of CA 72-4 is 28-80 % (40-46 % on the average). According to international guides [7], all patients were performed the diagnostic laparoscopy with researching of washout liquids of abdomen in uncertain cases. Conclusion. Only complex examination of patients with stomach cancer with using combination of SCT of abdomen, FEGDS with biopsy, laparoscopy can provide total volum of examination, staging and surgical aid.

FEATURES OF SURGICAL TREATMENT OF GALLSTONE DISEASE AND PREVENTION OF ITS COMPLICATIONS

The aim. To analyze the results of surgical treatment of gallstone disease (GD), methods of prevention of complications. Materials and methods. To analyze the results of surgical treatment of gallstone disease (GD), methods of preventing complications. Results and discussion. The data of 204 patients with GD who underwent laparoscopic cholecystectomy (LC) at the Kiev City Hospital No. 6 and the Medical Center “Universal Clinic Oberig” for 2018 were analyzed. Conclusions. The only radical method of treatment of CD is LC. To reduce the complications of LC, it is necessary to conduct the correct selection of patients and apply bail-out strategies to overcome complex LHE.

SELECTION OF SURGICAL TACTICS FOR TREATMENT OF NON-APHENIC VARICOSIS ON THE RESULTS OF US-DIAGNOSTICS OF THE VENES OF THE LOWER LIMBS

Purpose of research. Determination of variants of the anatomical structure of non-saaphenic veins and pathological anastomoses in varicose enlargement of atypical venous basins with ultrasound Doppler of the veins of the lower extremities, including as sources of pathological venous reflux, as well as the importance of insolvent veins — perforants and non-saaphenic veins — in the formation of venous insufficiency to clarify the treatment protocol. Materials and methods. The venous system was studied in 2348 pa tients, including both patients with various pathologies of the venous system, including those with varicose veins, and those in whom the pathology of the veins was not detected by Doppler ultrasound. Research results and discussion. Surgical treatment for non-safenic varicose veins includes phlebectomy, sclerotherapy and Muller-Vara di minifblektomy, depending on the diameter of the affected nonsafenic vein. Conclusions. The specialists’ understanding of the variants of nonsafenic varicose veins, as well as adherence to the full research protocol for ultrasound Doppler ultrasound of the veins, allows us to provide detailed information in order to determine the most effective treatment tactics and prevention of relapses and complications of the disease.

THE USE OF ANTEGRADE ENDOBILIARY INTERVENTIONS IN BENIGN DISEASES OF THE BILIARY TRACT COMPLICATED BY MECHANICAL JAUNDICE

Introduction. One of the most common manifestations of diseases of the biliary tract are strictures or stenoses. They can have malignant, inflammatory and traumatic etiology, as well as be accompanied by mechanical jaundice syndrome. Aim. To study the results of the use of antegrade endobiliary interventions in benign diseases of the biliary tract complicated by mechanical jaundice. Materials and methods. An analysis of surgical treatment of 34 patients with benign diseases of the biliary tract complicated by mechanical jaundice (MJ) in the SI “V.T. Zatsev IGUS NAMSU». Choledocholithiasis was the cause of MF in 21 (61.8 %) cases, stricture of the LV in 6 (17.6 %) and stricture of the biliodigestive anastomosis (BDA) in 7 (20.6 %) patients. BDA strictures developed after the following operations: biliobiliostomy — 1 (14.3 %), hepaticojejunostomy — 3 (42.9 %), choledochoduodenoanastomosis — 2 (28.5 %) and hepaticoduodenostomy — 1 (14.3 %) %). Research results. External percutaneous transhepatic cholangiodrainage was performed in 7 (46.7 %) patients, external-internal percutaneous transhepatic cholangiodrainage was performed in 6 (40 %), percutaneous transhepatic cholecystostomy was performed in 2 (13.4 %) patients. With slightly dilated intrahepatic ducts (<5 mm) cholangiodrainage was established in 3 (20 %) patients. Of these, in 3 (20.0 %) cases, a separate percutaneous transhepatic cholangiodrainage of the right and left lobular ducts of the liver was performed. Performing percutaneous transhepatic cholangiography and percutaneous transhepatic cholangiodrainage allows to determine the level and nature of biliary block in a minimally invasive way, to perform biliary decompression and prevention of complications after an unsuccessful attempt at endoscopic treatment. Conclusions. By using antegrade endobiliary interventions, we were able to reduce the risk of biliary decompression complications compared with patients who had unsuccessful attempts at endoscopic treatment from 15 (78.9 %) to 1 (6.67 %), and to reduce the number of complications after reconstructive rehabilitation. operations from 10 (52.6 %) to 1 (6.67 %) and the mortality rate from 2 (10.5 %) to 1 (6.67 %).

FEATURES OF THE DYNAMIC OF ACUTE C-REACTIVE PROTEIN AND INDICATORS OF THE BODY’S IMMUNE SYSTEM AND THEIR RELATIONSHIP WITH THE CLINICAL PICTURE IN ELDERLY PATIENTS WITH ULCERATIVE GASTROINTESTINAL BLEEDING

The aim. Improve the effectiveness of treatment of elderly patients with ulcerative gastrointestinal bleeding by studying the dynamics of the level of C-reactive protein (CRP) and immune system parameters, their relationship with the clinical picture. Materials and methods. 35 elderly patients in the period from 2019 to 2021 (according to the WHO classification — 61-90 years) with ulcerative gastrointestinal bleeding complicated by cardiovascular pathology. The gender distribution is as follows: men — 19 (54%), women — 16 (46%). The average age of the patients was 76.3 years. This category of patients was divided according to the methods of treatment of concomitant cardiovascular pathology: group A — patients who received therapy according to the standard scheme (n = 20), B — double (n = 15). As a control category of patients (n = 50) was selected. There are relatively healthy (donors), who were similar to the study group in terms of age, gender, and the method for determining indicators. Results. The state of local endoscopic hemostasis in group “A” was investigated: Forrest II was detected in 14 (70%) patients, Forrest III — in 6 (30%) patients; in group “B”: Forrest I — in 7 (47%) patients, Forrest II — in 8 (53%) patients. These results indicate that using of dual therapy leads to a change in the rheological properties of blood, which, in turn, leads to a decrease in the stability of local endoscopic hemostasis and an increased risk of recurrent bleeding compared with standard antihypertensive therapy (the studied groups are represented, respectively, 100% each). Conclusions. We have analyzed the C-reactive protein, interleukin-6 and interleukin-4. The main result of the study was the identification of the dynamics of markers in groups A and B. On the seventh day, normalization of these indicators was not revealed (in group B, it was especially pronounced). But the state of the latter was influenced by the therapy of concomitant pathology in patients with cardiovascular pathology. The clinical significance of immune indicators has been proven in many clinical examples and can be one of the objective criteria for assessing the patient’s condition, predicting the disease and correcting the treatment started.

RARE COMPLICATION OF CROHN’S DISEASE WITH LOCALIZATION IN THE INFLAMMATORY INTESTINE IN THE F0ORM OF THE SPREAD OF INFLAMMATORY OF THE PROCESS ON THE ANTERIOR ABDOMINAL WALL WITH FORMATION ABSCESS AND ITS DISCLOSURE IN THE NAVEL

The purpose of the study. Show a rare variant of the clinical course of complications of Crohn’s disease (СD). To analyze the anamnestic data, symptoms, clinical manifestations, preoperative diagnosis, features of surgery, postoperative period and the results of histological examination in a patient with CD who had complications in the form of transition of inflammation from the ileal wall to the anterior abdominal wall with abscess formation, opening it in the navel and the formation of a fistula. Material and methods. An analysis of the case of a complicated course of CD, manifested by the transition of inflammation from the ileum to the anterior abdominal wall, the formation of an abscess, its breakthrough into the navel and the formation of a fistula in the umbilical region. This complication was detected only after urgent computed tomography of the abdominal cavity and small pelvis (CTACSP). Results. The patient, despite the history of complaints, performed appendectomy, in which the removed appendix did not fully correspond to the clinical manifestations and data of CTACSP, in which CD was suspected, did not complete the examination, was not consulted by gastroenterologists and proctologists. He was urgently hospitalized with a clinic similar to acute purulent omphalitis. Only careful collection of the anamnesis and performance of urgent CTACSP allowed to suspect existence at the patient of the complicated course of CD. This allowed us to predict the course of surgery, perform a right hemicolectomy with excision of the altered tissues of the anterior abdominal wall and suturing the wound in the form of a laparostomy. The patient’s condition improved, he was discharged from the hospital. Conclusions. Patients with suspected CD should be monitored and treated by gastroenterologists and proctologists. Careful collection of anamnesis in patients of this group and the implementation of emergency CTACSP allowed to establish a correct diagnosis in the preoperative period.