The objectiveis to study the results of different methods of surgical treatment of patients with infected pancreonecrosis and to conduct a comparative analysis of minimally invasive and traditional surgical interventions.Material and methods.The results of treatment of 206 patients with infected pancreonecrosis were analyzed. In accordance with the used method of surgical treatment, the patients were divided into 2 groups: 105 (51.0%) patients with “traditional” open interventions were included in the first group (comparison), and 101 (49.0%) patients treated with various miniinvasive technologies, or a combination of minimally invasive and “open” interventions were included in the second group.Results.It was found that the mortality rate in the second group was less than in the first group by 12.8% (p<0.05).Conclusion.Minimally invasive surgical techniques are the method of choice for delimited pancreatogenic ulcers. The use of combined surgical interventions leads to a significant reduction of postoperative mortality and duration of inpatient treatment.
INTRODUCTION. The choice of a treatment method in patients with stages 3–4 of the esophageal achalasia remains an actual topic.The OBJECTIVE was to evaluate the long-term results of Heller esophagocardiomyotomy with Dor hemiesophagofundoplication at stages 3–4 of the esophageal achalasia by comparing the results of patient survey with data of instrumental methods of diagnosis of esophageal function.METHODS AND MATERIALS. The results of the operation were analyzed in 67 patients, including 35 patients with stage 3 and 32 patients with stage 4 of the disease. The period of postoperative follow-up was 1–5 years. The results of X-ray examination of the esophagus and stomach, esophageal manometry, 24-hour pH-metry and the data of the Eckardt and GIGLI scale questionnaires were evaluated.RESULTS. The data of X-ray examination of the esophagus and stomach, in the long-term period, showed a complete restoration of the esophagus evacuation function in all patients (p=0.001), according to manometric data, a significant decrease in the tone of the lower esophageal sphincter in all patients to normal values (p=0,001) was revealed, esophageal atony was noted in three patients with stage 4 of the disease. Pathological gastroesophageal reflux before and after surgery was not registered by pH-metry, the De Meester index was within the normal range in all groups (less than 14.72). Dysphagia in the long-term period decreased in all patients. Long-term results on the Eckardt scale in patients with stage 3 improved by 83.5 %, with stage 4 by 78.3 % (p=0.001), according to the GIGLI questionnaire, patients with stage 3 scored 83.5 %, with stage 4 by 78.3 % more than before surgery.CONCLUSION. Laparoscopic Heller esophagocardiomyotomy with Dor fundoplication reduces symptoms of the disease in patients with stages 3–4 of the esophageal achalasia, increases the gastrointestinal index of quality of life, which makes it advisable to perform organ-preserving surgery at stage 4 of the disease.
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