The OBJECTIVE was to increase the safety of laparoscopic decompression of the abdominal trunk.METHODS AND MATERIALS. The results of treatment of 30 patients who underwent laparoscopic decompression of the celiac trunk were analyzed. Intraoperative bleeding requiring conversion to laparotomy occurred in two (6.7%) cases.RESULTS. To prevent such a complication, a method of preventive installation of a balloon catheter into the celiac trunk was introduced, which allows creating a temporary occlusion of the vessel in case of damage. A similar approach was used in 10 (33.3%) patients. The need to cover the lumen of the vessel with a balloon arose in one observation (3.3% of all patients and 10.0% using this technique). Bleeding from the inferior phrenic artery, which originated from the celiac trunk, was stopped by laparoscopic access.CONCLUSION. The experience presented in this paper allows us to consider the installation of a balloon boat in the celiac trunk as one of the possible ways to improve the safety of its laparoscopic decompression. Further research is needed to obtain a definitive picture of the effectiveness of this approach.
The OBJECTIVE was to study the efficacy and safety of laparoscopic decompression of the celiac trunk.METHODS AND MATERIALS. A comparative analysis of the results of laparoscopic (30 patients) and conventional decompression of the celiac trunk (50 patients) was carried out. All patients were operated on between September 2018 and July 2021.RESULTS. Intraoperative bleeding during laparoscopic decompression of the celiac trunk, which required conversion of access to laparotomy and vascular suture, was noted in 2 (6.7 %) cases. With conventional access, there were no such complications. The average duration of laparoscopic decompression of the celiac trunk was 107 minutes, from conventional access – 150 minutes. The average length of hospital stay after laparoscopic intervention was 4 days, after the traditional one – 7 days. Long-term results of treatment over a period of more than 6 months were evaluated in 28 patients who underwent laparoscopic decompression of the celiac trunk and 45 people who underwent conventional decompression. Ultrasound examination in all cases stated the return of linear and velocity parameters of blood flow in the celiac trunk to normal. complete relief of the clinical manifestations of the disease was achieved in 24 (85.7 %) patients after laparoscopic and in 39 (86.7 %) after traditional intervention.CONCLUSION. Laparoscopic decompression of the celiac trunk is an effective method of surgical treatment of the syndrome of compression of the celiac trunk, but there are risks of vascular damage. The long-term results of laparoscopic and open decompression of the celiac trunk are comparable.
Introduction. Obesity is associated with a high risk of developing concomitant diseases such as: metabolic syndrome, type 2 diabetes mellitus (DM2), cardiovascular pathology. FABP4 (fatty acid binding protein) is the specific lipid chaperone and an important protein for the function of adipose tissue and is one of the adipocytokines secreted by adipose tissue.The objective of the study was to investigate the FABP4 gene expression in subcutaneous and visceral adipose tissue (SAT and VAT) in patients with obesity and DM2.Methods and materials. SAT and VAT samples were obtained during bariatric surgery (N=43, BMI>35): obese with DM2 (N=21), obese without DM2 (N=22). Samples for the control group without obesity (N=15, BMI<30) were obtained during planned operations on the abdominal cavity. FABP4 mRNA level was estimated by real-time PCR.Results. It has been demonstrated that the mRNA level of the FABP4 gene in SAT and VAT is reduced in obesity, regardless of the manifestation of DM2 (p<0.01). A negative correlation was observed between the mRNA level of the FABP4 gene in adipose tissue and the BMI index (for SAT: r=—0.327, p = 0.016; for VAT: r=—0.304, p = 0.024).Conclusion. The expression level of FABP4 gene in AT can act as a marker of AT dysfunction in obesity.
The article presents the problem of the development of complications of bariatric surgery in the early postoperative period. After the start of the use of endovideosurgical technologies in bariatric surgery, the incidence of general surgical complications in the early postoperative period dropped sharply to 2-6 %. Nevertheless, serious complications still arise, the frequency and type of which largely depends on the patient's comorbidity and the complexity of the operation. The most formidable and difficult complication in treatment is the failure of the sutures of the stomach stump (stapler line), which is more often characteristic of longitudinal resection of the stomach and occurs in 1.5-2.4 % of cases. Deep vein thrombosis is another serious complication in bariatric surgery - the incidence ranges from 2.4 to 4.5 %. Bleeding is no less serious complication of obesity surgery. The frequency of repeated interventions associated with bleeding in the early postoperative period is 11 %. Moreover, in 85 % of cases, conservative methods of stopping bleeding are successful. Considering that the permissible operational lethality of bariatric operations should not exceed 0.1 %, the issues of developing a unified concept of prevention methods to reduce the incidence of complications in patients with morbid obesity remain relevant.
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