Мета. Порівняти результати й ефективність ретроперитонеальної і трансабдомінальної лапароскопічної андреналектомії з визначенням показань до їх застосування. Матеріали і методи. Дослідження виконане на базі Одеської обласної клінічної лікарні. Обстежено 78 пацієнтів, яким виконали трансабдомінальну (n=44) або ретроперитонеальну (n=34) лапароскопічну адреналектомію. Результати. Показано, що задній ретроперитонеальний доступ має значні переваги над трансабдомінальним доступом у разі виконання лапароскопічної адреналектомії: істотне скорочення тривалості та зниження травматичності операції, зменшення крововтрати, больового синдрому, отримання хорошого косметичного результату, скорочення строків перебування пацієнтів у стаціонарі. Висновки. Задній ретроперитонеальний доступ є методом вибору у хворих, яким раніше були виконані оперативні втручання на органах черевної порожнини.
The aim of the study was to study the indications for the use of mesh implants in patients with large hiatal hernias, depending on the tension of the crura. Materials and methods. Using a Walcom Fm-204-50k digital force gauge, we measured the force of crural tension during laparoscopic cruroraphy in 115 patients who met the inclusion criteria for participation in the study. All patients underwent intraoperative measurement of the tension force of the crura during the crura repair. All patients, whose tensile strength during measurement was > 4 N (n=69), were randomly divided into two groups. The first group included 30 patients who underwent hiatal hernia repair using a collagen-coated Parietex mesh implant. The second group included 39 patients who underwent simple suturing of the crura (cruroraphy). Results. The main and control groups did not differ significantly in terms of age, gender, quality indicator and the area of hiatal surface (p>0.05). According to the results of measuring the tension of the sutures during cruroraphy, the average tensile force of the suture closest to the esophagus was 5.2 (from 4.0 to 8.2 N). When performing anterior cruroraphy, the tensile force of the seams averaged 3.5 N (from 2.4 to 4.7 N). Over an average follow-up period of 48 months, anatomical relapses were revealed in 1 patient of group I and in 6 patients of group II (p=0.004). Patient satisfaction was significantly higher in the mesh implant group (p=0.004). The mesh group showed a greater improvement in GERD-HRQL (p<0.0001) compared to the non-mesh group. Conclusion. Laparoscopic repair of large hiatal hernias using a collagen-coated Parietex mesh implant in patients with a cruraraphy suture pull force > 4 N is safe and can prevent anatomical recurrence. Key words: hernia of the esophageal orifice of the diaphragm, laparoscopic cruroraphy, measuring the tension of the seams of the cruroraphy.
Objective. To study the efficacy of miniinvasive video-assisted interventions on the thyroid and parathyroid glands. Materials and methods. In a frame of the investigation accomplished in 2012-2018 yrs 50 patients were operated for nodular goiter (40) and primary hyperparathyrosis with solitary adenoma of a parathyroid gland (10). In all the patients miniinvasive video-assisted interventions were performed in accordance to procedure, proposed by P. Miccoli. Results. A pain syndrome was minimal in all the patients. Stable paresis of nn. Recurrens and parathyrosis were not observed. Transitory paresis of n. Recurrens have occurred in 2 patients. The wound infection was absent. In all the patients with primary hyperparathyrosis the calcium content have lowered down to normal or subnormal value. Stationary stay after miniinvasive operations have been reduced down to (2.2 ± 0.3) bed-days, while after open operations they constituted (5/7 ± 1.2) bed-days. While further follow-up of the patients during one year the disease recurrence was not registered. Excellent cosmetic result was obtained in majority of the patients. In 3 of them only keloid cicatrices have formatted, causing a cosmetic effect lowering. Conclusion. The procedure for miniinvasive video-assisted interventions on thyroid gland was proposed by P. Miccoli, and is still actual. It may be applied also in patients with primary parathyrosis and solitary adenoma of parathyroidal gland. But the patients must be thoroughly selected for this operative interventions.
Objective. Studying of velocity of prevalence of luminescent dye indocyanine green along lymphatic vessels in the large bowel surgery. Materials and methods. Estimation of procedure for coloring of tumoral substrate and lymphatic vessels while performance of oncological operations was conducted. We performed laparoscopic resection of sigmoid colon in 7 patients, suffering tumors, and anterior rectal resection in 5 patients, having tumors of upper ampullary part of rectum, using indocyanine green dye. Results. In Group I, consisting of 7 patients, surgical technique of no touch manipulations on the tumor before transection of feeding vessels (NTIT–operations) was applied, and in Group II, consisting of 5 patients, the tumor mobilization was done primarily. Application of indocyanine green dye helped a lot to establish localization and prevalence of the process in rectum. Conclusion. Application of fluorescent dye indocyanine green on tumoral substrate before doing ligation of feeding vessels raises possibility of the complication occurrence, consisting of the cancer cells dissemination in abdominal cavity. While performing laparoscopic procedures in resection of the large bowel tumors it is expedient to ligate the feeding vessels primarily, with secondary manipulation– to dissect and mobilize the tumoral substrate.
Objective. To analyze the results of treatment of patients with retrosternal goiter. Materials and methods. During the period from 2010 to 2019, 62 patients with thoracic goiter were operated on, which was 6.2% of all patients operated in relation to goiter. There were 48 women (77.4%) and 14 men (22.6%). Age of patients varied from 21 to 87 years (average age - 47 years). Computed tomography was mandatory in terms of research. The size of the sternal goiter and the degree of operative risk were determined by G. Mercante (2011). Results. In 39 patients (1st group) the operation was performed by cervicotomy according to standard techniques. Video endoscopic support was used in 23 patients, thanks to which in 15 patients (group 2) it was able to cross all blood vessels with the help of an electro coagulator and isolate nerve structures and parathyroid glands. In 8 patients (group 3) there was a massive bleeding after attempts of finger dissection. They underwent tamponade and temporarily stopped bleeding. After that, a video endoscope was inserted into the wound and hemostasis was performed with the help of an electrocoagulation. Bleeding from the surgical wound, which required revision, was not observed. Temporary tracheostomy in the postoperative period was imposed in 3 patients, later it was closed. Hypocalcemia occurred in 12 (19.3%) patients (in 11 it was transient). Transient paresis of the recurrent nerves was observed in 3 patients of the 1st, 2 of the 2nd and 2 of the 3rd groups. Permanent paresis of the recurrent nerve occurred in only 1 patient of the 3rd group. According to histological examination, 21 patients were diagnosed with cancer (19 - papillary, 2 - follicular). They subsequently underwent standard treatment for highly differentiated thyroid cancer. Conclusions. The use of cervical access with video endoscopic support during surgery for thoracic goiter avoids performing a sternotomy, reduces blood loss and operational trauma, improves the nerve structures and parathyroid glands identification, and reduces the duration of surgery. The use of modern methods of electrocoagulation significantly expands the capabilities of endoscopic techniques.
The aim of the work: to determine the optimal method of reoperation for recurrent inguinal hernias after laparoscopic hernioplasty. Materials and Methods. The research was conducted on the basis of the Regional Clinical Hospital (Odesa). During the period from 2012 to 2021, 36 patients with relapses after previous laparoscopic interventions for inguinal hernias were operated on in our clinic. Among these patients, there were 29 men and 7 women. Bilateral inguinal hernias were observed in 9 patients. Relapse occurred on one side in 6 patients, bilateral recurrence was in 3 patients. The results were evaluated according to the following criteria: the severity of postoperative pain, the number of postoperative complications, the length of stay in the hospital, recovery time after surgery and the patient's return to work. Results and Discussion. The duration of repeated laparoscopic interventions was (82±10) min and significantly exceeded the duration of open operations (p<0.05). The severity of pain in 12 patients after repeated operations that could be performed laparoscopically was significantly lower than in open interventions (VAS 4.8 vs 8.7, p < 0.05). Severe seromas in the area of the installed mesh were observed in 5 patients operated on by the laparoscopic method and in 4 patients operated on using the Liechtenstein method. Suppuration of the postoperative wound was observed in 3 patients, two of them underwent conversion. Patients started work after laparoscopic operations in 14–18 days, after open operations in 19–27 days (p>0.05). The choice of the method of repeated interventions for recurrent inguinal hernias depends on many factors. The main method of repeated interventions should be considered an open operation according to the Lichtenstein method. Under certain conditions, a second laparoscopic hernioplasty can be performed.