Transition to Laparotomy
In patients with acute cholecystitis, 328 urgent cholecystectomies perform. At the same time, in 14 cases, a transition to laparotomy makes due to the need for revision of the common bile duct.
Use of Laparoscopic Trainer Box is a prudent choice for Training.
The transition to laparotomy was carried out in 6 (12%) patients for various reasons: due to a massive adhesive process - in 2 patients, a sharp swelling of the intestinal loops - in 3, with intestinal necrosis - in 1 patient.
The development of indications and contraindications for the use of Video-Laparoscopy in acute intestinal obstruction continues to improve. The possibility of laparoscopic intervention, prevention of complications, it is necessary to analyze the data of radiography of the abdominal organs, ultrasound scanning of visceroparietal adhesions. Insertion of the first trocar was optimal after open laparoscopy and digital exploration of the abdominal cavity, while the stylet was not used, which significantly reduced the risk of perforation of the hollow organ.
Contraindication
Contraindication for laparoscopy was intimate fusion of organs with the parietal peritoneum, the severity of the adhesive process of grade 4, with perforation and bleeding from a hollow organ against the background of AIO. For intraoperative prevention of peritoneal adhesive disease, dis-aggregants and Ream-berin solution administers at the end of the operation.
Endo-surgical method operates on 96 patients with perforated gastric and duodenal ulcers. There were 52 men and 4 women. The age of the patients ranged from 19 to 70 years. Suturing of a perforated ulcer on the anterior wall of the duodenum performs in 47 cases, stomach ulcers - in 9 cases. According to emergency indications, 36 patients were admitted to the hospital 1-6 hours after the onset of the disease, 14 patients 6-12 hours later, 6 patients 12-24 hours later.
Video-Laparoscopy
Video-Laparoscopy performs in 52 patients with acute intestinal obstruction (AIO). Adhesive obstruction detects in 31 cases, volvulus of the sigmoid colon - in 11 cases, volvulus of the small intestine - in 7 cases, incarceration of internal abdominal hernias - in 3 cases. 32 (62%) patients were operated on an emergency basis, the rest after preoperative preparation. Among patients with adhesive intestinal obstruction, 12 had a history of repeated interventions on the abdominal organs.
Video-Laparoscopy actively uses to diagnose early postoperative complications. In the immediate postoperative period, laparoscopy performs in 25 patients with suspected peritonitis or intra-abdominal bleeding. In 9 cases, widespread peritonitis was diagnosed, which served as the basis for emergency laparotomy. In 12 patients, laparoscopy revealed local peritonitis, which made it possible to perform laparoscopic sanitation and avoid relaparotomy.
Surgery Procedure
Before surgery, all patients underwent fibrogastroduodenoscopy under anesthesia to determine the size and localization of the ulcer. The dimensions of the perforation hole ranged from 2 to 5 mm. Suturing was carried out through all layers in one row with the imposition of intracorporeal interrupted sutures. In case of eruption or doubts about the tightness of the sutures, an additional z-shaped suture applies.
Then an adequate sanitation of the abdominal cavity carries out with the removal of fibrin films. The suturing of the perforated ulcer performs mainly laparoscopically. However, in case of large ulcers, the abdominal cavity sanitizes, then the ulcer defect excises using a mini-laparotomic approach and sutured with a single-row suture. Suture failure developed in 3 cases, which required laparotomy.
With the development of early adhesive intestinal obstruction, 8 patients underwent laparoscopic adhesion lysis. In 5 cases with the development of bile peritonitis after cholecystectomy, laparoscopic diathermocoagulation of the gallbladder bed was performed. 2 patients with failure of the cystic duct stump after cholecystectomy repeated.
However, clips applies, laparoscopic sanitation of the abdominal cavity performs.
Result Analysis
When analyzing the results of the use of Video-Laparoscopy, it finds that the average length of stay in the hospital for patients with acute cholecystitis was 7.6 days, acute appendicitis - 5.2 days, perforated gastric ulcer - 7.3 days, pancreonecrosis - 12.3 days.
Etiological Factors in the Development of Liver Abscesses
Liver abscesses of various origins are a group of severe, purulent, liver diseases and considers one of the complex problems of the hepatobiliary system. The article presents modern data on the causes, development and microbiological composition of pathogens of liver abscesses.
Conclusion
Video-Laparoscopy is a highly effective, safe, low-traumatic method of surgical treatment, which gives the least number of postoperative complications and contributes to earlier activation of patients.
Constant advanced training of the endosurgeon, adequate selection of patients, and careful observance of the intervention technique can minimize the risk of emergency surgical intervention.
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