Acute appendicitis still predominates among surgical diseases. Despite the improvement in the technique of surgical intervention and treatment, the frequency of its complications ranges from 2 to 14%, which requires improvement of measures to prevent complications during operations and in the postoperative period. The aim of our work was to evaluate the effectiveness of the use of regional lymphatic stimulation and ozonized solutions in the prevention of complications after appendectomy with an atypical location of the appendix. Material and methods. The analysis included 45 patients with an atypical location of the appendix. Retrocecal was found in 25, retroperitoneal – in 12, and mesoceacal – in 8 patients. To assess the preventive measures used, 2 groups were identified. The comparison group consisted of 21 patients who received traditional treatment after surgery (to prevent complications antibiotics – ampicillin 1.0 g 4 times or gentamicin 80 mg 2 times a day for 4–5 days), pain relievers and infusion therapy. The main group included 24 patients who received regional lymphatic stimulation of the transitional fold of the peritoneum of the ileocecal region and the mesentery of the ileum, irrigation of the bed of the removed process and the surgical wound before suturing with ozonized sodium chloride solution with an ozone concentration of 8–10 μg/ml. In the diagnosis of appendicitis, clinical, laboratory (leukocyte count, leukocyte intoxication index) signs of the disease, and ultrasound were used. Results. In the comparison group, after surgery, suppuration appeared in 4 patients, wound infiltration was in 3 cases, early adhesive intestinal obstruction emerged once. Relaparatomy was performed with a favorable outcome. In the main group, one case of suppuration and infiltration of a postoperative wound was observed. By the time of discharge, all complications have been cured. There were no lethal outcomes. The hospital stay in the comparison group was 8.1 ± 0.37 bed-days, in the main group – 6.6 ± 0.12. Conclusions. The use of regional lymphatic stimulation can reduce the incidence of complications and shorten the length of hospital stay.
The OBJECTIVE was to evaluate the results of the developed measures for the prevention of the residual cavity in liver echinococcectomy.METODS AND MATERIALS. The patients were operated on in the surgical departments of the City Clinical Hospital ¹ 1 in Bishkek in 2017–2018. The article presents the results of observation of 95 patients operated on for liver echinococcosis without complications of biliary fistulas. The developed measures for the prevention of complications were used in the work. There were 2 groups (control and main). In the control group (63 people), organ-preserving operations were performed using traditional methods to eliminate the cavity of the fibrous capsule. In the main group (32 people), the same elimination methods were performed, but supplemented with the use of a hemostatic collagen sponge to prevent the occurrence of a residual cavity, and they also affected the area of the surgical wound with infrared irradiation to prevent inflammatory complications.RESULTS. In the control group, when performing capitonage and invagination, the residual cavity was detected in 5 patients, of which 3 developed suppuration. During pericystectomy, residual cavity and bile leakage occurred in 1 case, reactive pleurisy – in 4 cases. In the control group, the residual cavity required puncture, and in 3 patients, a second operation was performed – open drainage of the festering cavity. Thus, the occurrence of residual cavity was 9.5 %, other complications – 7.9 %. In the main group, with the use of preventive measures of capitonage and invagination, the residual cavity was detected in 2 (6.3 %) cases of small size, without the presence of exudative-inflammatory phenomena, and during pericystectomy, the occurrence of a cavity and wound complications were not detected.CONCLUSION. The application of the developed measures to prevent the occurrence of a residual cavity and inflammatory complications with the use of a hemostatic collagen sponge during capitonage and invagination made it possible to reduce the number of complications by 1.5 times. There were no complications associated with pericystectomy.
Objective. To evaluate the results and effectiveness of simultaneous operations for echinococcosis of the liver. Methods. Surgical diseases requiring surgical treatment (cholelithiasis: calculus cholecystitis, choledocholithiasis, nodular goiter, ventral postoperative hernia) were detected in 38 patients with echinococcosis of the liver. 23 patients underwent organ-preserving operations for echinococcosis, and 15 patients underwent radical operations, all operations were perfomed in combined with cholecystectomy, choledocholitotomy, thyroidectomy, and herniotomy (coating of a polypropylenemesh for hernia gate).Immediate and remote results were studied. Patients were reexamined 6 months after surgery within a 3-year period. The examination included the checkup, general blood test, liver and kidney tests, an ultrasound examination of the abdominal organs, and a chest x-ray once a year. Results. During theimmediate postoperative period 4 patients out of 38 (10.5%) had complications. After simultaneous operations using organ-preserving methods of echinococcectomy, 2 patients out of 23 (8.7%) had complications (pleuritis, wound suppuration), and 2 - out of 15 had radical operations (bile leakage, pleuritis). All complications had been cured by the time of discharge. The remote results were studied over a period of 6 months to 3 years. 34 patients were examined up to 1 year, 31 - from 1 to 2 years, 26 - from 2 to 3 years. Within the examination and follow-up periods no recurrence of echinoccosis was observed. Conclusion. During simultaneous operations and the echinococcectomy of the liver it is necessary to observe accurately the rules of aparasiticity and antiparasiticity.Simultaneous operations for the liver echinococcosis should be performed according to strict indications and by a highlyexperiencedandqualified surgeon. Patients who have undergone simultaneous operations was asked toundergoa medicalcontrol examination at least once a year. What this paper adds The possibility of performing simultaneous operations for echinococcosis of the liver has been defined. The sequence of operations for echinococcosis in combination with other pathologies requiring surgical treatment has been justified.
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