Khirurgiia (Mosk)

[Iatrogenic injuries of bile ducts during cholecystectomy]

Year 1998
Gal'perin EI. Kuzovlev NF.
No information.
Having analyzed case histories 266 patients with cicatrical strictures of bile ducts, due to iatrogenic trauma in cholecystectomy who were admitted to clinic for reconstructive operation, the authors established that in 53% of patients the injury of bile ducts was not revealed during the operation. In missed bile ducts injury there were 5 varieties of clinical manifestations in the early postoperative period: 1) mechanical jaundice (72 patients); 2) exterior bile leakage (33 patients); 3) diffuse biliary peritonitis (23 patients); 4) mechanical jaundice and exterior bile leakage (5 patients); 5) mechanical jaundice and subhepatic abscess formation (6 patients). From 117 patients in whom iatrogenic trauma of the biliary tract was revealed in cholecystectomy, in 55 biliobiliary anastomosis was carried out, in 40--biliodigestive anastomosis in 22-external drainage procedure of biliary tract was accomplished. In the recent iatrogenic trauma of biliary ducts the authors have operated on urgently 12 patients, in 5 of which reconstructive operations were carried out (in 2--with removal transhepatic drainage, in 3--with T-shaped drainage) and in 7 patients--precisional biliointestinal anastomosis without framed drainage. In all the patients after reconstructive operation with T-shaped drainage in long-term period cicatricial stricture of hepaticocholedochus has developed. Favourable result was observed in patients after reconstructive operation with changeable transhepatic drainage and in patients with precisional biliointestinal anastomosis. The last variant of correction of the iatrogenic bile ducts T injuries is the most preferable. The external drainage procedure of bile ducts should be used when there are no suitable conditions for accomplishment of reconstructive surgery.

[Surgical treatment of chronic calculous cholecystitis and its complications]

Year 1998
Movchun AA. Koloss OE. Oppel' TA. Abdullaeva UA.
No information.
Introduction of endoscopic and laparoscopic methods in surgical treatment of chronic calculous cholecystitis and its complications has changed not only the character of surgical interventions, but the surgical policy as well. The operation of choice in uncomplicated calculous cholecystitis is laparoscopic cholecystectomy, which whenever indicated, is advisable to be combined with other surgical interventions allowing the recovery from the concomitant surgical diseases. In complicated calculous cholecystitis in dependence on the character of bile ducts disorder and patient's condition, 3 versions of surgical interventions are possible: one stage radical correction of all pathologic changes of the biliary tract and surgical treatment, including 2-3 separate, less traumatic and more tolerable procedure. The choice of optimal policy of treatment reduces the risk of operation, decreases postoperation mortality rate and complications.

[Application of wound coat Tachocomb in surgical interventions on liver and pancreas]

Year 1998
Skipenko OG. Shatverian GA. Movchun AA. Eramishantsev AK.
No information.
From May 1994 to December 1996 the wound coat "Takhocomb" was used in surgical procedures in 23 patients with various diseases of the and the pancreas. "Takhocomb" was mostly applied in various anatomical resections of the liver. Initial hemostasis of the hepatic stump was carried out by careful suturing of bleeding vessels. "Takhocomb" was used in 3 patients during pancreatoduodenal resection for chronic pancreatitis, adenocarcinoma of papilla Vateri and adenocarcinoma of the pancreatic head. The application of the wound coat "Takhocomb" in various resections (12) an hepatic ruptures (2), as well as in echinococcectomies (3) and removal of hepatic hemangioma (1) contributed to favourable hemostatic effect in all the patients. In 2 cases formation of external biliary fistulas due to technical errors in liver resection was detected in postoperative period. The fluid accumulation at subhepatic space or at the bed of resected liver after rightsided liver resections was considered as the tissue fluid production frown retroperitoneal fat.

[Anaerobic-aerobic infection in acute appendicitis]

Year 1998
Mamchich VI. Ulitovskii IV. Savich EI. Znamenskii VA. Beliaeva OA.
No information.
362 patients with acute appendicitis (AA) were examined. For microbiological diagnosis of aerobic and anaerobic nonclostridial microflora we used complex accelerated methods (including evaluation of gram-negative microorganisms in comparison with tinctorial-fermentative method of differential staining according to oxygen sensitivity of catalasopositive together with aerobic and cathalasonegative anaerobic microorganisms) as well as complete bacteriologic examination with determination of sensitivity of the above microorganism to antimicrobial remedies. High rate of aerobic-anaerobic microbial associations and substantial identity of microflora from appendicis and exudate from abdominal cavity was revealed, which evidenced the leading role of endogenous microorganisms in etiology and pathogenesis of AA and peritonitis i. e. autoinfection. In patients with destructive forms of AA, complicated by peritonitis it is recommended to use the accelerated method of examination of pathologic material as well as the complete scheme of examination with the identification of the isolated microorganisms and the correction of antibiotic treatment.

[Weak-flow membrane blood oxygenation in treatment of patients with peritonitis]

Year 1998
Lobakov AI. Vatazin AV. Vasin IuV. Drozdova GA.
No information.
The application of the level of molecules with medium molecular mass (MM) and wave length E254 and 280 nm was tried in 30 patients, operated on for various diseases of the organs of abdominal cavity and their purulent complications. Besides routine treatment weak flow membrane blood oxygenation was carried out. As a result of the study it was established that the level of medium molecular peptides appears to be a criteria of effectiveness of the weak-flow membrane blood oxygenation and determines duration of the procedure. The initial concentration of MM from 1,0 relative units and more duration of the blood oxygenation period should be limited by 2 hours. This method can be regarded, as independent mode od detoxication.

[Stomach resection through minimal approach with use of EndoGIA apparatus]

Year 1998
Egiev VN.
No information.
Our small experience of the use of the stomach resection technique through mini-approach with additional introduction of the apparatus Endo GIA through the separate puncture applied in 2 patients showed that according to its results in postoperative period, this method approximates laparoscopic resection, and in the same time it is less time consuming and cheaper. There was neither insufficiency of the anastomosis, nor pneumonias, wound complications. The patients were active since the first day after the operation, were discharged from clinic on the 7-th day pos/top and returned to normal home regime after 1,5--2 weeks.

[Proximal colostomy in multistage treatment of complicated colonic diverticulosis]

Year 1998
Salamov KN. Achkasov SI. Soltanov BTs.
No information.
On the basis of experience in surgical treatment of 128 patients with colonic diverticulosis who had a proximal colostoma which was formed earlier for acute complications of the process, it is shown that colostomy is inadequate as an independent method for the management of complicated diverticulosis. Resection or exteriorization of the involved segment of the large intestine is necessary in such cases. The formation of entero-enterostomy is hazardous and inexpedient in that event.

[Antipyrine test in evaluation of patients hepatic failure in early postoperative period]

Year 1998
Nemchenko NS. Vagner VK. Erashev ON.
No information.
In victims of severe combined trauma in early postoperative period there are disorders in the system of monooxygenase detoxication of hepatocytes--the duration of antipyrine semiexcretion period in the blood was 2.5 times longer than in healthy people. In 40% of injured parallelism in changes of values of the antipyrine test and general blood bilirubin are detected; in 18% of cases hyperbilirubinemia is revealed in antipyrine clearence being normal, and in 42% a sharp decrease of antipyrine clearence at the background of normal bilirubin content is detected. Hypoproteinemia, hypoalbuminuria, and activation of ALT and AST was revealed, which evidenced of the reaction of urgent adaptation. Under conditions of development of the postoperative stress-reaction the examination of monooxygenaze system of hepatocytes' detoxication is the most specific test of revealing early hepatic insufficiency. A sharp decrease or increase of antipyrine clearence is a sign of irreversibility of hepatic insufficiency.

[Aortoiliopelvic lymphadenectomy in surgical treatment of rectal cancer]

Year 1998
Vorob'ev GI. Odariuk TS. Tsar'kov PV. Eropkin PV.
No information.
The results of aortoiliopelvic lymphadenectomy in macroscopic changes in lymphatic nodes being revealed intraoperatively in 73 patients with locally spread rectal cancer, are represented. Morphological examination of the removed tissues made it possible to reveal metastatic involvement of paraaortal and iliac lymphatic nodes in 57.3% of patients. In 36.9% of cases combined radical operations were performed. There were no lethal outcomes. Postoperative complications were detected in 37.9% of cases, among them atony of the urine bladder in 30.1% and inflammatory processes in pelvic cavity--in 8.2%. And in 9 men with normal sexual potency before the operation it resulted in impotency after surgery. 5-year survival made up 27.4% including cases with metastatic involvement of lymphatic nodes--19.3%, and without it--35.7%.

[Duodeno-gastric reflux and its consequences after resection of stomach by Billroth II and Roux methods]

Year 1998
Petrov VP. Badurov BSh. Khaburzaniia AK.
No information.
The severity of the duodenogastral reflux (DGR) and its deteriorative effect on the mucous membrane of gastric stump with the help of dynamic scintigraphy of the liver, fibrogastroscopy, morphological and morphometrical methods in patients, who underwent stomach resection by Billroth-2 and Roux methods, were studied. It was established, that after resection of the stomach by Billroth-2, extensive DGR appeared, vachiny 14.8%. At the same time extensive inflammatory, atrophyc and methaplastic changes are developed in the mucous membrane of the gastric stump disregeneration and prolipherative processes were progressing. The optimal gastroenteroanastomosis, preventing reflux of duodenal contents into gastric stump lumen and development of its extensive morphological changes, is considered to be Roux type anastomosis with distal (efferent) loop 40 cm of length (DGR made up 0.9%).

[Possibilities of recanalization of cicatricial strictures of esophagus]

Year 1998
Oskretkov VI. Shel' AI. Trott VF.
No information.
Long-term results of recanalization of the esophagus by orthograde bouginage through the guide and by endoprosthesis post-burn strictures were evaluated in 105 patients. The application of these methods enabled in 81% of patients to achieve steadfast restoration of esophageal continuity, sufficient enough for adequate feeding. Orthograde bouginage of the esophagus through the guide showed to be effective in 45.5% patients with strictures up to 100 mm length and over 6 mm in diameter, the end of the bouge being not more than 1.5 kg. Endoprosthetic procedure provided to achieve restoration of esophageal continuity in 95% of patients.

[Diagnosis of chronic duodenal obstruction]

Year 1998
Alibegov RA. Kasum'ian SA.
No information.
The results of examination of 111 patients with chronic duodenal obstruction (CDO) were analyzed. CDO makes up 3.8% in the whole structure of the diseases of the organs of gastro-intestinal tract, and in the structure of the diseases of pancreato-duodenal area--6.1%. Mechanical form of CDO was revealed in 43.6% of patients, functional--in 51.4%; the disease in compensated stage was detected in 38.7% of patients, in subcompensated stage--in 52.3% and in decompensated stage--in 9.0%. Clinical manifestations of the disease are characterized by diversity of symptoms, which necessitates the use of the complex of instrumental examinations. For establishment of the causes of CDO, besides the routine methods USE and computed tomography were used. In simultaneous contrast of the duodenum, the aorta and superior mesenteric artery computed tomography in comparison with other methods makes it possible to make more precise diagnosis of mechanical CDO caused by arteriomesenterial compression.

[Peritoneal dialysis in treatment of diffuse purulent peritonitis]

Year 1998
Karimov ShI. Ergashev UIu.
No information.
Peritoneal dialysis (PD) as a method of sanitation of the abdominal cavity was used in treatment of 221 patients (140 males and 81 females aged 17-89 years) with extended purulent peritonitis. In all patients toxic (138) of terminal (83) stage of purulent peritonitis was diagnosed. PD was carried dut in flow-fractional regimen with the use of 10-15 l of isotonic physiologic solution with the addition of antibiotics and heparin 4 times per day during 4-6 days. Carrying out PD in patients with purulent diffuse peritonitis resulted in improvement of general condition of the patients, normalization of hemodynamics, diuresis, and in lessening the paresis of gastro-intestinal tract as well as decrease of intoxication. Thus, in the group of patients in whom PD was not used the mortality rate was high--36%, and including PD in the complex of treatment contributed to the decrease of lethality to 23%.

[Sucking effect of diaphragm and its significance in drainage of abdominal cavity during hepatic surgery]

Year 1998
Al'perovich BI. Kazantsev NI. Avdeev SV.
No information.
Investigation of the value of the sucking effect of the diaphragm in 44 patients was carried out. The first group consisted of 28 patients who have not undergone hepatic resection. The second group included patients after hepatic resections of various volume in local pathology. The balloon method in modification of this clinic was used for measurement of the value of the sucking effect. In patients of the first group the value of sucking effect was almost two times more under the right cupula of the diaphragm (130.33 + 4.78 mm of water column) in comparison with the left infradiaphragmatic space. It is responsible for presence of the slot between the right half of the liver and the diaphragm, which aggravates the sucking effect. In the second group of patients the value of the sucking effect under the right diaphragmatic cupula was practically the same as in patients of the first group. After right-sided hemihepatectomy the value of the sucking effect under right cupula of the diaphragm has significantly diminished. After resection of the right lobe of the liver as well as after left-sided hemihepatectomy, or without them, the value of sucking effect under left cupula of the diaphragm did not significantly differ. The investigations showed that vacuum-aspiration with vacuum of not less than 150 mm water column should be used for effective drainage of infradiaphragmatic space.

[Peculiarities of clinical features and surgical treatment policy in old patients with acute cholecystitis]

Year 1998
Aliev SA.
No information.
The results of treatment of 138 patients with acute cholecystitis aged from 75 to 89 years are analyzed. Calculous cholecystitis was revealed in 126 patients, acalculous cholecystitis--in 12 patients. Cholelythiasis was revealed in 63 (45.6%), stricture of the large duodenal papilla (LDP)--in 13 (9.4%), combination of choledocholithiasis and stricture of LDP--in 16 (11.6%). Mechanical jaundice was revealed in 54 (39.1%) patients, purulent cholangitis--in 18 (13%). From 138 patients 113 (81.8%) underwent surgery. Urgent operations were carried out in 35 (30.9%), early operations--in 54 (47.8%), delayed operation--in 24 (21.2%) patients. Cholecystectomy was performed in 99 patients, it was supplemented with choledocholithotomy and various types of external drainage of the duct (n = 28), choledochoduodenostomy (in 40), transduodenal papillosphincterotomy (n = 6) and endoscopic papillosphincterotomy (n = 7). Cholecystostomy was carried out in 14 patients (including laparoscopic cholecystostomy, n = 5). Repeated operations were performed in 29 patients. Postoperative complications appeared in 28 (24.7%) patients. 16 patients (14.1%) died after the operation. The causes of death were hepatic functional deficiency (6), peritonitis (2), pancreatic necrosis (1), acute cardio-vascular failure (4), pulmonary artery thrombo-embolism (2), acute cerebro-vascular failure (1).

[One-stage elimination of bilateral inguinal and femoral hernias]

Year 1998
Kabanov AN. Rozhkov MS. Ostroukhov NF.
No information.
The method of preperitoneal hernioplasty for simultaneous elimination of inguinal and femoral hernias was developed, which consists in that semi-oval cross-section of the skin is performed 3-4 cm above inguinal ligament. The approach through the aponeurosis of superficial oblique (abdominal) muscle is made above the inguinal channel, the muscles are retracted by blunt manner, and through the incision in transversal fascia they penetrate into preperitoneal space. When doing plastics the posterior wall of inguinal channel is strengthened. The tendon of internal oblique and transversal muscles are sutured together as well as lateral margin of the vagina of rectal muscle with pectineal ligament. Transverse fascia is sutured as duplication by the second row of nodular and the interior orifice of inguinal channel is reconstructed.