In conclusion, this study confirms that laparoscopic repair of large hiatal hernias is effective and durable over a long period of time. Reinforcement of crura repair with ProGrip™ mesh is safe and can prevent anatomical recurrences.
Мета. Покращити діагностику та результати лікування хворих з пухлинами прямої кишки шляхом застосування тран- санальної ендоскопічної мікрохірургії і вивчення «сторожових» лімфатичних вузлів. Матеріали і методи. За період з 2009 по 2017 р. у клініці трансанальні ендоскопічні операції виконані 115 хворим у віці від 29 до 82 років. У 92 пацієнтів була тубуловорсинчата аденома прямої кишки, із них у 26 гістологічним дослі- дженням видалених пухлин виявлено малігнізацію (TisN0M0). У 23 пацієнтів до операції виявлено ранній рак прямої кишки Т1–2N0M0. Результати. У строки спостереження від 12 до 60 міс рецидив виявили у 2 (2,2%) хворих з аденомою і у 3 (13%) з раком прямої кишки. Рецидив раку виник у хворих, які відмовилися від хіміотерапії та променевої терапії. Висновки. Ідентифікація і прицільне дослідження «сторожових» лімфатичних вузлів при раку прямої кишки умож- ливлює вірогідну (чутливість=0,89, специфічність=0,99) оцінку стадії захворювання і застосування адекватної схеми комбінованого і комплексного лікування пацієнтів.
Intraoperative diagnosis of «sentinel lymph nodes» with objective to select the surgical procedure in gastric and uterus cancers
Objective. Studying of possibility of application of a self-fixing mesh ProGrip™ while plasty performing for large hiatal hernias (HH).Маterials and methods. In the investigation 144 patients, ageing 30 – 78 yrs old, owing HH with square 10 - 20 сm2, took part. The patients were divided into two groups. Group I consisted of 71 patients, to whom crurorhaphy with additional strengthening of the sutures, using a self-fixing mesh ProGrip™ was peformed. Group II consisted of 73 patients, in whom sutures of crurorhaphy were not strengthened by the mesh implant. Dynamical follow-up in patients was conducted in 3, 6, 12, 24, 36, 48 and 60 mo after the surgical treatment.Results. Average duration of the operation in patients of Group i and Group II did not differ essentially – (94 ± 12) and (92 ± 15) min, accordingly (p > 0.1). In late terms of follow-up the HH recurrence have occurred in 3.2% in the Group I patients and in 21.5% - in the Group II patients. The quality of life index in patients of Group I, in accordance to questionnaire SF-36, was trustworthily better, than in patients of Group II (p < 0.05).Conclusion. The mesh ProGrip™ application while doing plasty of large HH permits to lower the recurrence rate significantly and to improve the operative interventions results essentially.
Introduction: Laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis is a popular option in many surgical institutes. Decompression of biliary system via T-tube post supraduodenal choledochotomy has been the traditional surgical practice. Primary closure of common bile duct (CBD) has been shown to reduce hospital stay but bears a risk of bile leak. We conducted a prospective randomized trial to compare complications and length of stay in patients undergoing biliary stent insertion versus T-tube drainage following LCBDE via choledochotomy. Methods and Procedures: The study involves 52 patients with choledocholithiasis who underwent LCBDE and decompression of the biliary system by either antegrade biliary stent or T-tube insertion. A 7 French biliary stent (9 "10 cm long) have been placed in 27 patients (group I), T-tube insertion have been used for 25 patients (group II). The length of hospital stay and complications were recorded. All transcystic explorations were excluded. Results: There were no significant differences between groups with respect to age, sex, comorbidities, number and size of CBD stones. Postoperative complications have been observed in 4 patients (16%) in the T-tube group (one patient needed reoperation for dislocation of T-tube),
Objective. Intraoperative determination of the threads tension force while performance of laparoscopic cruroraphy. Materials and methods. Using a numerical dynamometer Walcom FM-204-50K the threads tension force was measured while performance of laparoscopic cruroraphy in 62 patients, suffering large hiatal hernias. The measured results have included a middle value of the tension force of every stitch for secure approximation of diaphragmatic crura and presence of any dehiscence in diaphragmatic crura while doing cruroraphy. Results. The middle tension force of the first suture while performing of posterior cruroraphy have constituted 2.1 N, while a second one – 3.2 N and the third – 4.2 N. Positive correlational dependence was revealed between the threads tension force while doing cruroraphy and the hiatus square, as well as with a patient’s age. The correlation link between the threads tension force, while doing cruroraphy, and the patient’s body mass index was not revealed. The diaphragmatic crura muscles dehiscence was observed in the threads tension force, exceeding 4 N. Conclusion. The sutures tension force while cruroraphy conduction, as our data demonstrate, exceeding 4,5 - 5 N, constitutes indication for the net implants application.
Background: Different techniques of wrap fixation in laparoscopic Nissen fundoplication (LNF) have been proposed with of the aim to reduce the complications, but the optimal technique is yet to be determined. The aim of our prospective study was to evaluate several techniques of wrap fixation and determine whether the application of a combined approach to perform wrap fixation reduces the failure rate in short-term and long-term follow-up.Materials and Methods: One hundred two patients with sliding or paraesophageal hiatal hernia (type I or type II), who underwent antireflux surgery were randomized into 2 groups. In group I, LNF was supplemented with suturing the wrap to the diaphragmatic crura (35 patients) or to the body of stomach (16 patients). This was dependent on the strength of the crura (defined as weak or strong). The control group (51 patients) underwent LNF without wrap fixation. All patients were assessed using a validated symptom and quality of life (gastroesophageal reflux disease-Health Related Quality of Life) questionnaire, 24-hour impedance-pH monitoring, and barium swallow.Results: At the 48-month follow-up, the overall rate of complications was not significantly different between the 2 groups; however, there was a tendency toward a lower frequency of reoperations in the first group (P = 0.059). Fixation of the fundoplication of wrap was noted to lead to significantly lower rates of postoperative dysphagia (P < 0.05). These patients (group I) were also found to have significant improvement in gastroesophageal reflux disease-Health Related Quality of Life score (from 19.3 ± 13.2 to 4.3 ± 3.9 vs. from 18.7 ± 11.9 to 9.3 ± 7.7). Conclusion:Fixation of the Nissen fundoplication wrap has been shown to have a positive impact on the reduction of postoperative dysphagia and leads to an improvement in disease-specific quality of life.
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