Aim. To present the experience in performing posterior separation plasty according to Yu. Novitskiy, to evaluate the efficacy and safety of the technique. Methods. The results of treatment of 22 patients with giant middle postoperative ventral hernias, treated in the surgical department №1 of Kazan City clinical hospital №7 in 2013-2016, were analyzed. 9 patients had open posterior separation plasty of the abdominal wall in Yu. Novitskiy’s modification performed (study group). Comparison group included 13 patients who had standard tension-free inlay-plasty. Results. The average duration of surgery in the study group was 143.9±10.7 min, in comparison group - 136.6±12.1 min. In the study group there were no serious complications in the immediate postoperative period. In 3 cases at control ultrasound examination clinically insignificant seromas were found which did not require additional treatment and self-resolved within the period of 3 weeks. In one case there was lymphorrhea from the wound for 9 days. Healing of a surgical wound in all cases was by primary intention. Average hospital stay was 10.2±0.6 days. There were no lethal outcomes. Recurrence of the disease in the observed period was not registered. Conclusion. Posterior separation plasty of the abdominal wall in Yu. Novitskiy’s modification is a safe and effective technique that allows recommending this surgery to the surgeons operating patients with giant postoperative ventral hernias.
Aim. To assess the condition of hepatopancreatobiliary system and quality of life in patients in the remote period after cholecystectomy.Methods. 88 patients with cholelithiasis who undergone cholecystectomy in 2008-2010 were examined 5 years after the surgery. Common blood count, blood biochemistry test were performed, fasting blood glucose level was measured, esophagogastroduodenoscopy, ultrasonic examination of abdominal organs, fractional duodenal intubation, fecal elastase test (ELISA, «BioServ Diagnostics», Germany) were performed. Patients filled out questionnaires to assess the quality of life: MOS SF-36 (Medical Outcomes Study Short Form), GIQLI (Gastrointestinal Quality of Life Index) before, 1 and 5 years after cholecystectomy.Results. According to the esophagogastroduodenoscopy, 56 (63.6%) patients had duodenal reflux, 21 (23.8%) - duodenal diverticula, 9 (10.2%) - reflux esophagitis. Reduced fecal pancreatic elastase-1 was detected in 37 (42%) of patients. According to the fractional duodenal intubation, hypersecretory type was the most prevalent, 40 (45.5%) patients had hypotonic sphincter of Oddi, 48 (54.5%) - hypertonic sphincter of Oddi. All patients had crystals of calcium bilirubinate, leukocytes and bacteria in bile, microliths were identified in 76 (86%) of patients. After emergency surgery, quality of life increased by all indicators, after planned cholecystectomy for asymptomatic cholelithiasis the quality of life decreased 1 and 5 years after cholecystectomy. After planned cholecystectomy for symptomatic cholelithiasis, the surgery improved quality of life, but after 5 years indicators for quality of life returned to preoperative levels.Conclusion. Various changes in hepatopancreatobiliary system organs are detected in patients after cholecystectomy, like disorders of bile formation and biliary excretion, sphincter of Oddi dysfunction, decreased function of the pancreas, which reduce the quality of life.
The article presents a case of an occasional extraperitoneal suppurative complication of acute appendicitis due to atypical clinical manifestation and diagnostic complexity. A 56-year-old male was hospitalized to the urological emergency department of Emergency Hospital №2 in December, 2014, with low back pain suggestive of renal colic. Renal ultrasound revealed cavitary lesion with liquid content in right lumbar region. Pus was drawn off by tapping. Further on, the abcess was opened 6 times during 2 following years. X-ray computed tomography of abdomen showed that the apex of appendix was located in lumbar (Petit) hernia and communicated with purulent cavity. Planned appendectomy was performed on January, 10, 2017. Convalescence. Histological finding (11.01.2017) was simple appendicitis. The reported case is of clinical interest as a rare compication of acute appendicitis developed in appendix located in lumbar (Petit) hernia; X-ray computed tomography of the abdomen is the most informative instrumental method for the diagnosis of acute appendicitis and its complications.
Aim. To evaluate the effectiveness of regional prolonged irrigation with ropivacaine ozonated solution at large and giant postoperative ventral hernia prosthetic hernioplasty. Methods. 77 patients who underwent a planned surgery for large and giant postoperative ventral hernia from 2010 to 2012 were examined. All patients were distributed to two groups. The main group included 26 patients in whom a polyvinyl chloride catheter was installed in periprosthetic tissue for the wound irrigation using anesthetic (ropivacaine) ozonated solution for regional prolonged anesthesia and wound complications prevention as well as for preoperative preparation and intra-abdominal pressure monitoring for abdominal compression syndrome prevention using the technique developed by authors. The comparison group consisted of 51 patients in whom prevention of wound complications was carried out conventionally, and who received narcotic analgesics. Ultrasonography of postoperative wound area was used for local inflammation intensity assessment. Pain was assessed using numeric visual analogue scale in both groups. Results. 4 (15.4%) patients of the main group developed subcutaneous tissue seroma at the 5-6th day. In comparison group wound complications were registered in 15 (29.4%) patients, including 11 cases of seromas, 2 cases of suppurative inflammation, 1 case of ischemic necrosis of the wound edges, and also an isolated case of limphorrhea which occurred on the first day. The observations showed that the average pain level among patients of the main group was 3.8±0.4 points, compared to the control group - 5.3±0.4 points. Conclusion. Periprosthetic irrigation with ropivacaine ozonated solution provides adequate anesthesia, reduces the number of wound complications and promotes early rehabilitation.
Aim. To study the efficacy and pancreatic and biliodigestive bypass surgeries combined with or without resection of the pancreatic head in the surgical treatment of biliary hypertension syndrome in chronic pancreatitis.Methods. The analysis of surgical treatment of 87 patients with chronic pancreatitis complicated with biliary tract obstruction was performed. In 78 patients the strictures were tubular and had a length of 2-4 cm, 9 patients had «rat’s tail» shaped strictures and a length of 5-7 cm.Results. In 37 patients various biliodigestive anastomoses without intervention on the pancreas were performed. Unsatisfactory results of choledochoduodenal anastomosis in chronic pancreatitis in long-term follow-up were reported in 3 of 8 interviewed patients. The optimal variant of biliodigestive bypass in chronic pancreatitis with biliary hypertension syndrome is hepaticojejunal anastomosis. In 13 patients different interventions on biliary tract in combination with resection of pancreatic head by Frey were performed. In 13 patients with obstructive forms of chronic pancreatitis with severe pancreatic hypertension pancreaticojejunostomy without resection of the pancreatic head was performed. In the long-term follow up after these surgeries in 7 out of 10 patients the signs of biliary hypertension did not completely resolve. The best results were obtained by using draining pancreatic duct interventions with pancreatic head resection by Frey.Conclusion. In tubular pancreatogenic strictures of the common bile duct when the symptoms of biliary hypertension are severe, the method of choice is hepaticojejunal anastomosis; duodenum preserving resection of pancreatic head in chronic pancreatitis complicated with biliary hypertension should be combined with bile duct draining operations.
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