Preperitoneal Blockade in the Treatment of Patients with Perforated Gastroduodenal Ulcers and Peritonitis

Чарышкин, А. Л.; Yakovlev, S V; Демин, В. П.

doi:10.21103/article6(2)_oa4

Cited by 3 publications

(2 citation statements)

References 19 publications

(27 reference statements)

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“…В результате роста числа пациентов, которым прово дили предоперационную визуализацию, с 30 до 93 % и применения лапароскопической АЭ необоснованные аппендэктомии сократились с 7,5-10 до 1,7 % [30]. Существует мнение, что АЭ при простом аппендици те -диагностическая и тактическая ошибка [3,31]. Необоснованные, так называемые «напрасные» АЭ связаны, как правило, с диагностическими ошибками.…”

Section: Discussionunclassified

Acute Appendicitis: How Often is Appendectomy Negative?

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Fedorov

et al. 2023

Kreativnaâ hirurgiâ i onkologiâ

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Introduction. At present, medical practice lacks a unifi ed approach to the choice of therapeutic tactics for acute catarrhal appendicitis and therefore lacks understanding of negative appendectomy. Aim. To study the incidence of negative appendectomy in acute appendicitis. Materials and methods. The methodology involved a retrospective analysis of the results of 1590 appendectomies performed from 2003 to 2005 and a prospective non-randomized study of 1112 patientsfor the period from 2018 to 2019. During the first observation period, the examination included physical and laboratory examinations, and in the second period, Alvaro scoring, ultrasound scan, and videolaparoscopy. Results and discussion. In the first period, catarrhal forms of appendicitis were reported in 7.82 % of cases, while in the second period — in 3.04 %. The diagnoses were confi rmed pathohistologically in all cases. Conclusion. No cases of performing negative appendectomy were reported, based on the results of clinical, endoscopic and pathomorphological examinations. However, the ambiguous interpretation of acute catarrhal appendicitis in the national clinical practice guidelines for acute appendicitis does not allow for unambiguous conclusions from the study.

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Section: Discussionunclassified

Acute Appendicitis: How Often is Appendectomy Negative?

Тимербулатов

Fedorov

et al. 2023

Kreativnaâ hirurgiâ i onkologiâ

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“…[ 47 ] When closure is difficult, alternatively, the preperitoneal tunneled catheter technique can be used. [ 48 ]…”

Section: Discussionmentioning

confidence: 99%

Preperitoneal postcesarean section bupivacaine analgesia: Comparison between dexamethasone and dexmedetomidine as adjuvants

2018

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Background:The peritoneal wound is frequently neglected during laparotomy. The preperitoneal local anesthetics and many adjuvants were effective for postcesarean analgesia. Analgesia may involve somatic and autonomic components. The preperitoneal bupivacaine and the promising adjuvants dexamethasone or dexmedetomidine were compared in this study.Patients and Methods:Sixty patients subjected to a cesarean section (CS) under general anesthesia divided into two groups using a bolus of preperitoneal bupivacaine 0.7 mg/kg with either 1ug/kg dexmedetomidine (Group P) or 8 mg dexamethasone (Group D). The time to the first analgesic request was the primary outcome.Results:There was a significantly prolonged time to the first analgesic request in the Group P than the Group D and less required preperitoneal injections in the Group P, also pain assessed by Numerical Rating Scale (NRS) was lower in the Group P than the Group D after 6 h postoperatively up to 24 h.Conclusions:Dexmedetomidine provided better analgesia than dexamethasone as an adjuvant to preperitoneal bupivacaine post-CS.

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A New Method of Treatment for Appendiceal Stump

Чарышкин

Ярцев

2018

Neotložnaâ med. pomoŝʹ

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Background.In 30% of acute destructive appendicitis, the disease is accompanied by typhlitis, which makes it difficult to perform classical methods of appendiceal stump treatment.Aim of study.To improve the way of appendiceal stump treatment in the destructive form of acute appendicitis complicated by significant typhlitis.Material and methods.We studied 57 cases of acute destructive appendicitis complicated by typhlitis, which were divided into two groups depending on the method of treatment. The first group (comparison group) consisted of 30 patients who underwent a standard method for treating the appendiceal stump after appendectomy, such as ligation at the base and putting the stump into the cupula of the cecum and fixing it with interrupted serous-muscular sutures or with a purse and Z-shaped sutures. The second (main) group included 27 patients, who were treated by the method we proposed. The essence of the method is successive U-shaped stitching of the stump. After that, the stump curls in the form of a cochlea, peritonizes, reaching the necessary tightness without going into the cupula of the cecum. In this case, the abdominal cavity of patients in both groups was adequately sanitized and drained.Results.In the first group of patients there were technical difficulties associated with immersion of the appendiceal stump, which caused the serous damage, hematoma of the cupula of the cecum in 7 (23.3%) patients. In the second group of patients, due to the developed method of forming the appendiceal stump, technical difficulties did not arise, there were no complications. The duration of appendectomy in the first group of patients with standart treatment (interrupted serous-muscular sutures or purse and Z-shaped stiches) was 28.7±5.4 minutes, and in the second group of patients appendectomy with stump management with the suggested method lasted 20.3±6.1 minutes, p <0.05, which reduced the operation time by 8 minutes on the average. Purulent-inflammatory wound complications in the first group were detected in 7 patients (23.3%), and in 1 (3.7%) patient of the second group, which is significantly less by 19.6%.Conclusion.The proposed method is technically simple, as peritonization of the stump is performed without putting it into the cupula of the cecum. The use of this method is indicated in destructive forms of acute appendicitis complicated by severe typhlitis, which significantly reduces the operation trauma and contributes to reduction in the number of postoperative wound purulent-inflammatory complications by 19.6%. Findings The proposed method for treating the appendiceal stump during appendectomy for acute destructive appendicitis complicated by typhlitis is simple enough, reliable, characterized by low traumatism and shortens the duration of surgery by 8 minutes on the average (p <0.05).

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Preperitoneal Blockade in the Treatment of Patients with Perforated Gastroduodenal Ulcers and Peritonitis

Cited by 3 publications

References 19 publications

Acute Appendicitis: How Often is Appendectomy Negative?

Acute Appendicitis: How Often is Appendectomy Negative?

Preperitoneal postcesarean section bupivacaine analgesia: Comparison between dexamethasone and dexmedetomidine as adjuvants

A New Method of Treatment for Appendiceal Stump

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