ABSTRACT
AIM: To define causes of difficult situations in various forms of acute cholecystitis depending on terms of disease and clinico-morphological changes in gall bladder area and to justify differentiated application of laparoscopic surgery for acute cholecystitis. MATERIAL AND METHODS: It was reviewed 1132 medical records of patients with acute cholecystitis. It is found that morphological changes in gall bladder and surrounding tissues depend on duration of follow-up of patients with acute cholecystitis and type of inflammation. RESULTS: In acute catarrhal cholecystitis "complicated" intraoperative situations are observed in 37.5% due to "loose" tissues infiltration, in phlegmonous and gangrenous forms of inflammation - in 44.6% and 63.6% respectively due to "dense" infiltrates development. CONCLUSION: Technical variants of laparoscopic cholecystectomy for various "difficult" intraoperative situations are suggested.
Subject(s)
Cholecystectomy, Laparoscopic , Cholecystitis, Acute/surgery , Gallbladder , Intraoperative Complications , Cholecystectomy, Laparoscopic/adverse effects , Cholecystectomy, Laparoscopic/methods , Cholecystitis, Acute/pathology , Cholecystitis, Acute/physiopathology , Female , Gallbladder/pathology , Gallbladder/physiopathology , Gallbladder/surgery , Humans , Inflammation , Intraoperative Complications/diagnosis , Intraoperative Complications/etiology , Intraoperative Period , Male , Middle Aged , Outcome and Process Assessment, Health CareSubject(s)
Bezoars/complications , Bezoars/diagnosis , Stomach Ulcer/complications , Female , Humans , Peptic Ulcer Hemorrhage/etiology , Stomach , Young AdultABSTRACT
Soft tissues dynamic ultrasound investigation was applied for diagnostics of pyoinflammatory diseases. Ultrasound image correlated with intermuscular liquid formations (abscess, phlegmon) of soft tissues was revealed in 65 observations (100%). On the basis of findings 21 (32.3%) patients underwent surgical treatment of leg and gluteal region phlegmons and abscesses with application of traditional methods. Endoscopic operations on account of pyoinflammatory diseases of soft tissues were carried out in 44 (67.7%) patients. Ultrasound monitoring of traumatic process course was conducted. It is ascertained that total regress of purulent process occurs by the 14th day of postoperative period. Traumatic process regresses more rapid after endoscopic operations in comparison with traditional open methods.
Subject(s)
Cellulitis/diagnostic imaging , Drainage/methods , Endoscopy/methods , Soft Tissue Infections/diagnostic imaging , Buttocks , Cellulitis/surgery , Female , Follow-Up Studies , Humans , Middle Aged , Soft Tissue Infections/surgery , Thigh , Treatment Outcome , UltrasonographyABSTRACT
Videoendoscopic technologies were used in the treatment of postoperative complications in 289 patients. All repeated laparoscopic procedures in early postoperative period after laparoscopic and laparotomic surgeries are integrated under the term "relaparoscopy". The algorithm of choice of a surgical method during laparoscopic examination is presented, technical principles of laparoscopic surgeries, indications and contraindications are formulated. Postoperative peritonitis was diagnosed in 66 (22.7%) patients, abdominal abscesses -- in 64 (22.1%), early intestinal obstruction -- in 58 (20.1%), bile outflow -- in 53 (18.2%), postoperative bleedings -- in 26 (9.1%), local liquid accumulations -- in 17 (5.8%), abdominal foreign bodies --- in 5 (1.9%) patients. Relaparoscopy was a final method of treatment of postoperative complications in 74.5% patients. In 8.6% patients videoendoscopic procedures permitted performing some elements of surgery and to convert to minilaparotomy. In 16.9% patients indications for relaparotomy were revealed during relaparoscopy, after which dynamic relaparoscopy was used as programmed sanations.
Subject(s)
Laparoscopy/methods , Postoperative Complications/surgery , Algorithms , Humans , Reoperation , Treatment OutcomeABSTRACT
Laparoscopy and pancreatoscopy were performed in 2091 (62% of all hospitalized) patients with acute pancreatitis. High informative value of laparoscopy and pancreatoscopy in diagnosis of different morphologic forms of acute pancreatitis is demonstrated. Original fistula for pancreatoscopy was developed. It permits one to evaluate visually the dynamics of repair in the pancreas and surrounding tissues and to correct treatment policy.
Subject(s)
Laparoscopy/methods , Pancreatitis/diagnosis , Pancreatitis/surgery , Acute Disease , Endoscopy, Digestive System/methods , Humans , Pancreatitis/pathologyABSTRACT
Use of Liga Sure and Auto Sonix devices in laparoscopic surgery on the stomach, colon and rectum for gastric, duodenal ulcers and colorectal cancer was analyzed. These devices make easier surgery and improved postoperative period. In test group of patients time of surgery, blood loss, smoke in surgical field were less, scope of laparoscopic stage increased.
