Aim: Classification of hiatal hernias should include the main parameters for intraoperative selection of the surgical treatment method. Abbreviated descriptions of hiatal hernias, such as HH I-IV are not complete and need further development. Methods: We have perfected a classification of hiatal hernias and used it in clinical practice to classify hernias in 75 patients who underwent surgical treatment. Four recognized types of hiatal hernias (HH) were used. Type I (sliding) hernias have the gastroesophageal (GE) junction above the level of the diaphragmatic hiatus. Type II (rolling) hernias have a normally positioned GE junction, but a portion of the fundus is above the hiatus. Type III hernias have displacement of the GE junction and fundus above the hiatus and type IV hernias are characterized by the presence of other viscera within the hernia sac. The width (W) defect between the right and left diaphragmatic crura is the most important size measurement that determines the difficulty of successfully repairing the hiatal hernia, with W1 < 3 cm; W2, 3-5 cm; W3, 5-8 cm; and W4 > 8 cm. The length (L) of the hernia defect was defined as the vertical distance in cm between the high and low point of hiatal orifice with L1 < 5 cm; L2, 5-8 cm; and L3 ≥ 8 cm. Measurement of the GEJ position was done immediately after hiatal opening to evaluate the grade of short esophagus (SE), with SE0, no shortening; SE1, shortening by ≤ 4 cm; and SE2, shortening by > 4 cm. We considered that hiatal hernia recurrence (R) after previous repair should be included in the classification with R0, no recurrence and R (n), the number of previous hernia repairs.Results: Our perfected classification was in the format: HH I-IV; W1-4; L1-3; SE 0-2; R 0-n. According to our data, the parameters of hiatal hernia were formulated in most cases (49/75) as HH I; W 2; L 2; SE 0; R 0, which represented the prevalence of patients with sliding hernia with secondary width and length of the esophageal orifice, without shortening esophagus or recurrence.Conclusions: Our classification allows abbreviated description of the main intraoperative parameters of hiatal hernia, which facilitates the choice of the surgical treatment method.
Многопрофильная областная больница № 2, Нур-СултанЦель исследования -изучить опыт успешного лечения больной коронавирусной инфекцией (беременность сроком в 29 недель), одномоментно оперированной по поводу острого панкреонекроза и кесарева сечения. Материалы и методы исследования: история болезни, лабораторные (биохимические, бактериологические, гистологические) данные, заключения УЗИ, компьютерной томографии, наркозная карта и т.д. Результаты исследования: молодая женщина С., 28 лет, поступила в хирургическое отделение в экстренном порядке с острым панкреатитом. Консервативное лечение в течение суток неэффективное. Status praesens objectivus: выраженный болевой синдром, интоксикация, нарастание механической желтухи, появление признаков панкреонекроза, перитонита, прогрессирование гипоксии плода. Выполнено оперативное вмешательство: 1) классическое кесарево сечение (новорожденный мальчик, диагноз: недоношенность 28 недель 5 дней, синдром дыхательного расстройства новорожденного, анемия недоношенных, врожденная пневмония; выхаживание ребенка -в условиях couveuse); 2) холецистэктомия, дренирование холедоха по Пиковскому, санация и дренирование сальниковой сумки, брюшной полости, забрюшинного пространства. После операции комплексная интенсивная терапия. С целью улучшения микроциркуляции: спазмолитики, антикоагулянты (клексан), дезагреганты, обезболивающие, антигипоксант и антиоксидант (мексидол по 200 мг×3 раза в день в/в капельно). На 34-е и 36-е сутки от момента операции пациентка и новорожденный выписаны в удовлетворительном состоянии. Данный клинический случай представляется для ознакомления и обсуждения тактики лечения хирургических осложнений у беременных с COVID-19.
To evaluate the results of hemorrhoidectomy using thermal suturing technology. We used an electrosurgical device made by «FOTEK». The unit has a “THERMAL SUTURING” mode. In contrast to traditional bipolar coagulation in the “THERMAL SUTURING” when the power supply to tissue under automatic control while compression the vascular wall proteins formed a solid homogeneous absorbable seals (collagenate). We analyzed the results of the 100 cases of the hemorrhoidectomy. In 70 cases, was used thermal suturing (group 1), and in 30 cases – the traditional Milligan‐Morgan's method (group 2). The mean operative time in the first group was 19,7 ± 3,7 minutes, in the second group ‐ 32,9 ± 5,4 minutes. The level of postoperative pain (at 3, 6, 12, 24 and 72 hours after the operation) was significantly lower in the first group. No one case of urinary retention and the problems with the first defecation of patients of the first group. Average duration of hospitalization in the first group was 5,7 ± 0,7 days, in the second group ‐ 5,7 ± 0,7 days.1. Features of the thermal suturing provide quality hemostasis, absence of suture material in the wound, minimal pain and faster healing. 2. The cases of using thermal suturing marked decrease in the average duration of the operation (by 1.6 times), and reduce the length of hospital stay.
The objective of the study was to determine whether results of open and laparoscopic operations for esophageal achalasia are comparable. All patients (n = 53) were divided into two groups according to the used method of oesophagocardiomyotomia: first ‐ basic (laparoscopic) group (n = 29), in which a laparoscopic approach has been used, the second ‐ control (open) group (n = 24), in which open (laparotomy) oesophagocardiomyotomia was used.Blockade was completely (100%) eliminated in cardioesophageal transition using the improved method of oesophagocardiomyotomia year after operation in comparison with a standard method, which had the current indicator in 79.2% of the value of all clinical cases. We observed endoscopically full antireflux effect in 96.6% operated in the first group versus 75% in the comparison group. Endoscopically positive GER was detected in 1 (3.4%) patient of the main and in 6 (25%) patients of the control group ( ƒÔ2=4,9; „Q=0,025). An improved method of laparoscopic oesophagocardiomyotomia is characterized by a more pronounced antireflux effect than laparotomy (96.6% versus 75% respectively) and by 100% removal of the disturbed patency of cardioesophageal transition versus 79.2% of the control group.
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