Inguinal hernias (IH) are widespread in the human population and occur in 27–43 % of men and 3–6 % of women. Many risk factors for IH have been overestimated in the last decade: male gender is considered the leading factor (the ratio between men and women is approximately 1:7), less significant factors are heredity (most significant for women), physical activity (more significant for men), age (peak prevalence of IH occurs at 5 years and 70–80 years), congenital or acquired connective tissue dysplasia, history of prostatectomy, low body mass index.Hernioplasty with the use of synthetic mesh prostheses remains the most popular technique for surgical correction of IH. Performing non-prosthetic hernioplasty is only recommended if mesh prostheses are not available, for example in poor countries. In open hernioplasty using mesh prostheses, different methods are used today: Plug & Patch, Prolene Hernia System, Parietene Progrip, sutureless plastic according to Trabucco, Stoppa, preperitoneal techniques TIPP (trans-inguinal pre-peritoneal), TREPP (transrectus pre-peritoneal), TEP (total extraperitoneal), however, none of them showed significant advantages over the gold standard of open hernioplasty – tensionfree repair according to Liechtenstein.Laparoscopic IH correction is represented by the TAPP (transabdominal preperitoneal) technique, performed through the abdominal cavity, and TEP (total extraperitoneal) – extraperitoneal prosthetic hernioplasty. None of them has a significant advantage in the treatment of IH; therefore, when choosing a treatment method, the surgeon should be guided by the cost of the operation and the level of proficiency in one or another hernioplasty technique.
Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most informative and often in-demand methods for the detection and treatment of pathology of the biliary tract, its diagnostic value is 79-98%. A significant disadvantage of the method are side effects and various complications (acute pancreatitis, bleeding, retroduodenal perforation, cholangitis, acute cholecystitis, etc.). Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common and severe complication of intraluminal endoscopic operations on the large duodenal papilla, its etiology is multifactorial, and the pathophysiology has not yet been fully studied. According to many randomized, controlled studies, the incidence of PEP ranges from 2.7 to 37%. Despite all the possibilities of modern medicine and the introduction of new methods, mortality with the development of PEP remains at a very high level: it reaches 7-15%, and with the development of destructive forms - 40-70%. The problems of prevention of PEP are still the subject of discussions and numerous studies by leading clinics around the world. In this paper, we conducted a review of the literature over the past decade using the sources of major medical libraries Medline, eLibrary, PubMed. The article discusses current modern pathogenetic mechanisms and the main risk factors for the development of PEP, related to both the characteristics of the patient and the procedure being performed, technical options for performing ERCP. The article also presents currently used and recommended by most authors methods of drug prevention of PEP and various technical solutions related to this complication. Thus, the not entirely satisfactory results of the proposed methods of prevention of PEP force the authors to search for safer and more effective solutions to this urgent problem at the present time.
Целью исследования явилась оптимизация технических условий выполнения селективной проксимальной ваготомии у больных с перфоративными пилородуоденальными язвами путем применения метода химической денервации.В качестве метода исследования применялся диффузионный способ, сопряженный с исследованием протеолиза верхних отделов пищеварительного тракта по методу В.А. Горшкова (1988).Представлены результаты лечения 88 (контрольная группа) и 82 (основная группа) больных с перфоративными пилородуоденальными язвами за период 1990-2002 гг., которым в сочетании с ушиванием перфоративного отверстия выполнялась селективная проксимальная ваготомия методом скелетирования малой кривизны желудка и методом химической денервации. Проанализированы результаты лечения в ближайшем послеоперационном периоде и в отдаленные сроки до пяти лет.Установлено стойкое снижение кислотно-протеолитической активности (протеолиз -(419,0 23,2) г/м 2 24 -1 , концентрация соляной кислоты -(18,4 2,14) ммоль/л) тела желудка в обеих группах больных, выявлен низкий процент рецидива язвенной болезни двенадцатиперстной кишки, который недостоверно выше в основной группе (4,3 и 7,3% соответственно).Простота и доступность метода химической денервации и его эффективность позволяют рекомендовать его для широкого применения.Ключевые слова: дуоденальная язва, селективная проксимальная ваготомия, химическая денервация.The aim of the study was to optimize the technical conditions of the selective proximal vagotomy in patients with perforating pyloroduodenal ulcers by the chemical denervation method.The diffusion method was applied, which includes the study of the proteolys of the top parts of a digestive tract by the Gorshkovs' method (Gorshkov V.A., 1988).The results of treatment of 88 (the control group) and 82 (the basic group) patients with perforating pyloroduodenal ulcers (PPDU) for the period 1990-2002 are presented. The patients were subjected to the combination of suture plication and selective proximal vagotomy (SPV) by the method of skeleting of small curvature of stomach and the method of the chemical denervation. The results of treatment in the nearest postoperative period and in the long terms up to five years are analyzed.The stable decrease of the acidic and proteolytical activity (APA) (proteolys (419,0 23,2) g/m 2 24 -1 , concentration of the hydrochloric acid (18,4 2,4) mmol/l) of the stomach body in the both groups of patients was established, accompanied by the low percentage of relapse of a duodenal ulcer, which was uncertainly higher in the basic group (4,3 and 7,3% respectively).Simplicity and availability of the chemical denervation method and its efficiency allow it to be recommended for the wide application.
A clinical case of successful radical multi-stage surgical treatment of a patient with bilobar parasitic lesion of the liver with echinococcosis complicated by infection of one of the cysts is presented. The patient was admitted to the clinic with volumetric lesions in both lobes of the liver. At the stage of differential diagnosis, on the basis of process verification by puncture biopsy under ultrasound control, the ethiology of mass lesions was reliably established. At the primary stationary stage, infection of one of the echinococcal cysts was diagnosed, for which the cyst was drained under ultrasound control. After that, the patient was discharged to the outpatient care for compensation, correction of the general level of health and nutritional status. At the next stage of the inpatient examination, the patient was determined to have an insufficient level of functional reserves of the liver to perform a radical operation. For this reason, laparoscopic ligation of the right branch of the portal vein was performed in order to develop vicarious hypertrophy of the contralateral lobe. After 30 days, the increased level of functional reserves of the liver made it possible to plan radical surgical treatment with an acceptable risk for the patient. The operation was performed in the amount of right-sided extended hemihepatectomy with marginal resection of the 3rd segment of the liver. The symptoms of liver failure in the postoperative period according to the ISGLS scale were regarded as Grade A. The patient was discharged from the hospital in a satisfactory condition on day 10 after the operation. In the postoperative period, courses of therapy with albendazole were prescribed according to the standard scheme. The patient is under observation for more than a year after treatment. The condition is satisfactory. No recurrence of the disease was noted.
Introduction. Echinococcosis of the liver with subtotal organ damage remains an urgent surgical problem. The development of surgical technologies does not stand still. In the modern scientific community, more and more publications appear that speak of good treatment results with the staged application of various surgical technologies and their combination in various options. The purpose of the study is to present and evaluate the results of treatment of operated patients with liver echinococcosis using a new diagnostic and treatment protocol for surgical treatment. Materials and methods. The results of treatment of 10 patients [4 men (40%), 6 women (60%)] with widespread parasitic lesions of the liver, who underwent 26 surgical interventions for liver echinococcosis in the surgical department No. 2 on the basis of the M.A. Podgorbunsky” in the period from 2017 to 2022. The difference in the number of operations performed and actual patients is explained by the use of a staged method of surgical treatment. Criteria for inclusion in the study group: the absence of an initial sufficient safe level of liver functional reserves to perform a one-stage extensive liver resection based on the results of a comprehensive assessment of clinical, laboratory and instrumental tests in conjunction with the use of a statistical prognostic model. Results. All patients (10/100%) from the study group underwent laparoscopic vascular isolation of the portal blood flow of the right lobe of the liver in order to create vicarious hypertrophy of the contralateral lobe and increase the reserve capacity of the liver. After objective confirmation of the effectiveness of the above surgical stage of treatment, assessment of the perioperative risk using a statistical model, all underwent extensive liver resections as the next stage. In the postoperative period, 8/80% of patients had post-resection hepatic insufficiency of class A (n = 4) and B (n = 4) according to the ISGLS classification. In two patients, the clinical picture and the absence of liver dysfunctions (synthetic, secretory, detoxification) made it possible to judge the absence of liver failure in the postoperative period. Against the background of conservative therapy, the phenomena of liver failure regressed. All patients were discharged in a satisfactory condition. Findings. Staged laparoscopic vascular isolation of portal blood flow is effective and safe. The use of a modern diagnostic algorithm for perioperative examination in combination with staged surgical techniques makes it possible to achieve good treatment results in a specialized surgical center/
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