Advanced age is not a serious limitation in choice of laparoscopic access in both elective and emergency surgery in patients with colorectal cancer.
Short bowel syndrome is a pathological symptom complex that occurs after removal (resection) of the small intestine (more than 25% of its length), or when there is a signifi cant violation of its function. The most common cause of short bowel syndrome is adhesions of the small intestine that occur after surgical interventions on the abdominal organs. A description of the clinical observation of short bowel syndrome with severe manifestations of enteric insufficiency in a 41-year old patient is given. The patient was admitted to the surgical Department of FGBUZ Central clinical of the hospital Russian Academy of Sciences with com-plaints of General weakness, pain, spastic nature in the abdomen without clear localization, pain in the area of operational wound (for 4 months had 4 surgery for adhesive intestinal obstruction), abdominal distention, thirst, dry mouth, semiliquid chair 3–4 times a day, weight loss for the last 7 months before the hospitalization at 22 kg, the body mass index was 17.3 kg/m2. After the last surgical intervention, ileostomy of the ascending colon was applied using the Brooke method in connection with adhesive small bowel obstruction. The functioning segment of the jejunum was anastomosed with the ascending colon and was 22 cm long. At admission, the state of moderate severity, moderately emaciated, dehydrated. Liquid stool up to 6 times a day, without pathological impurities. MSCT of abdominal organs from 03.05.2018 with contrast: in meso — and hypogastria (mainly on the left), expanded loops of the small intestine (up to a maximum of 37–38 mm) fi lled with liquid content were visualized, the contrast preparation in the above described loops of the small intestine was not visualized. Additionally, non-expanded loops of the small intestine were visualized in the hypogastria and did not contain contrast. Non-functional loops of the small intestine in the meso — and hypogastrium. Liver, biliary system, pancreas, spleen — without features. On the background of complex therapy, the stabilization of clinical and laboratory indicators was achieved, which allowed to plan surgical treatment-laparotomy, closure of ileostomy, imposition of small intestine anastomosis in the large intestine. A laparotomy was performed with the right pararectal access. Continuous viscero-visceral and of viscero-peritoneal splices were found in the abdominal cavity. With technical difficulties caused by fi brous-calcifi ed splices, it was possible to separate the ascending colon and the part of the jejunum that goes to the anterior abdominal wall to the site of the bred jejunostomy. The intersection of the jejunum stoma was performed in close contact with the anterior abdominal wall. A double-row “end-to-side” anastomosis was formed with the middle third of the ascending colon. When performing laparotomy with left pararectal access under conditions of a pronounced adhesive process, it was possible to isolate a section of the sigmoid colon and a loop of the small intestine that was previously disabled (during the previous operation). Ileosigmoidostomy formed a double row “side to side”. The preserved portion of the small intestine was 85 cm. In the postoperative period, there were signs of endogenous intoxication. Against the background of intestinal paresis and severe intoxication, there was an increase in the markers of infl amemation and pancytopenia. Complex therapy with parenteral mixtures, prebiotics and antimicrobial drugs stopped the symptoms of intoxication, the activity of infl ammation, and improved laboratory parameters, which allowed us to gradually switch to oral food intake. Semi-formed stool 1–2 times a day. She was discharged on the 10th day after the operation for outpatient treatment under the supervision of a surgeon and gastroenterologist. One-year rehabilitation period with a positive effect, which indicates the uniqueness of this clinical observation.
1 Кафедра госпитальной хирургии с курсом детской хирургии ФГПОУ ВО РУДН, ЦКБ РАН, Москва, Россия; 2 Центральная больница г. Баку, Баку, Республика Азербайджан Данная статья представляет результаты лапароскопического лечения больных раком ободочной кишки. По результатам исследования оценено влияние на возможность применения лапароскопического метода у этих больных таких клинических параметров, как возраст, гендерная принадлежность, наличие сопутствующих заболеваний, локализация и стадия опухоли, а также наличие осложнений опухоли. Выявлено, что на эффективность лапароскопических операций у больных раком ободочной кишки оказывают влияние стадия опухоли и наличие опухолевых осложнений.Ключевые слова: колоректальный рак, лапароскопические операции, лапароскопическая гемиколэктомия, лапароскопическая резекция сигмовидной кишки.This paper was designed to report the results of the laparoscopic treatment of the patients presenting with the malignant colonic neoplasm. The study has demonstrated the influence of such characteristics of the patients as the age, sex, clinical manifestations, concomitant diseases, the stage and localization of the tumour as well as its complications on the possibility of the application of the laparoscopic techniques. It was shown that the effectiveness of the laparoscopic interventions in the patients with malignant colonic neoplasm depends on the stage of the tumour and the presence of its complications.
Background: According to experimental studies, mesh implants may reduce in size up to 50.8% during their integration into soft tissues. This results in impaired mobility of the anterior abdominal wall and hernia recurrences, as well as affects patients' quality of life. Due to unsatisfactory radiographic contrast of polymeric mesh implants, changes in their size can be rarely confirmed using imaging methods. Medical devices made of metal alloys have the best radiographic contrast. Objective: The purpose of this study was to evaluate the radiographic contrast of mesh implants made of titanium filaments and to determine the sizes and locations of the implants after the anterior abdominal wall hernia repair. Materials & Methods: The study included 40 patients with inguinal, umbilical, and postoperative ventral hernias. Surgical hernia repair was performed using a mash implant made of titanium filaments, "titanium silk". Multislice spiral computed tomography (MSCT) was performed on Days 3 and 90 after surgery, followed by an assessment of the size and location of the mesh implant.Results: 90 days after the anterior abdominal wall hernia repair, the locations of the titanium silk mesh implants in the tissues corresponded to their intraoperative setting. There were no statistically significant changes in the sizes of mesh implants on Day 90, compared with Day 3. Conclusion:The titanium silk mesh implants have satisfactory radiographic contrast, which allows imaging of their location and size in the tissues using MSCT and comprehensive evaluation of hernia repair outcomes using instrumental methods of examination. K E Y W O R D S3D reconstruction, multislice spiral computed tomography, polymeric mesh implants, radiographic contrast, soft tissues, titanium mesh
Objective: to assess the percentage of mesh “titanium silk” implant shrinkage after inguinal hernia repair surgery in the late postoperative period using multi-slice computed tomography (MSCT). Material and methods. The comparative assessment of the long-term results of treatment in 90 patients with inguinal hernias was performed using MSCT. In 36 (40%) patients of Group 1 the titanium implant was used in Lichtenstein hernia repair surgery. In Group 2, 54 (60%) patients were operated by laparoscopic hernia repair surgery. On day 3 and 3 months after surgery every patient underwent MSCT with subsequent determination of the implant square. Results. The percent of mesh “titanium silk” implant shrinkage 3 months after surgery according to MSCT was 4.4% in Lichtenstein hernia repair group, and 8.3% in laparoscopic hernia repair group. According to Kruskal-Wallis test, there were no statistic differences of this indicator between two groups (p = 0,185). Conclusion. The analysis of long-term results of inguinal hernia repair surgery with titanium mesh implants using MSCT showed that implant square significantly decreases 3 months after surgery. There were no significant differences in implants shrinkage regarding the type of surgery. MSCT is an effective method for evaluating the size of mesh titanium implants after hernia repair surgery.
Severe comorbidities do not impose serious restrictions on the choice of endoscopic approach in colorectal cancer patients.
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