[Intraoperative use of Xefocam at laparoscopic cholecystectomy].

Xefocam was used in patients with calculous cholecystitis during laparoscopic cholecystectomy to prolong anesthesia and to reduce an inflammatory process in an area under operation. The agent was injected into the round ligament of the liver in a dose of 16 mg intraoperatively and in a dose of 8 mg postoperatively. The proposed method was applied to 52 patients operated on for acute and chronic calculous cholecystitis. Fifty patients receiving the conventional anesthesia with the narcotic analgesic promedol were examined to evaluate the efficiency of the new procedure of anesthesia; the later being effective in 96.2% of the patients. The findings indicated the high efficiency of the proposed procedure without side effects observing in the use of narcotic analgesics. Furthermore, the nonspecific anti-inflammatory activity of Xefocam promotes a reduction in the number of postoperative local inflammatory complications.

[Complications of laparascopic cholecystectomy]. / Oslozhneniia laparoskopicheskoi kholetsistéktomii.

1389 laparoscopic operations were fulfilled for chronic and acute cholecystitis. In 41 patients (3%) it was necessary to pass on to laparotomy. Injury of hepaticocholedochus was made in 6 patients (0.5%), bleedings appeared in 9 (0.7%), bile leakage at the postoperative period--in 9 (0.5%). Subhepatic abscess was formed in 2 patients. Wound complication sat at the postoperative period developed in 33 patients (2.5%), pulmonary complications--in 7 patients. One patients died of myocardial infarction. The most frequent causes of intraoperative injuries of the vascular and duct structures of the hepatoduodenal ligament and the bile bladder bed were found to be cicatricial and inflammatory alterations of the areas mentioned and non-typical variants of the anatomical situs of the vessels and bile ducts. The detailed examination of the patients at the preoperative period, knowledge of the anatomical variants of the disposition of bile and vascular structures in the operation zone allow to prevent their intraoperative injury.

[Laparoscopy in the diagnosis of acute appendicitis]. / Lapaparoskopiia v diagnostike ostrogo appenditsita.

The results of diagnosis of acute appendicitis (AA) were retrospectively analyzed in 2403 patients, in 336 of them diagnostic laparoscopy (DLS) was performed. Acute appendicitis was diagnosed in 132 (39.3%) patients, other surgical diseases were found in 102 (20.35%) and acute surgical abdominal diseases of were excluded in 102 (20.35%) patients. AA was also diagnosed in 17 patients suspected for other surgical diseases of the abdomen. This is DLS showed AA in 149 (42.2%) patients and its absence in 204 (57.8%) cases DLS revealed cathartic AA was in 3 (2%) patients, in of 2 of them there was a diagnostic error during morphologic control (no inflammation). The diagnostic error rate was 96% in the group of 163 patients undergone appendectomy for cathartic AA without previous DLS. At DLS destructive AA forms were diagnosed in 111 patients, diagnostic errors were made in 0.9%. In the group of patients undergone appendectomy for destructive AA without previous DLS, the diagnostic errors rate was 1.1%. In 35 cases (23.4%) when the appendix could not be visualized at DLS (including patients with appendiceal infiltrate), the diagnosis was based on indirect criteria, errors being made in 3 cases. There were neither direct nor indirect data on the appendiceal status in 3 (0.9%) DLS. In these cases, the policy was based on clinical manifestations.

[Mode of surgery completion in peritonitis]. / Sposoby zaversheniia operatsii pri peritonite.

1310 patients with various forms of peritonitis were operated during 1989-1998. The tactics of the treatment was determined depending on bacterial contamination of the abdominal cavity. In abscesses of the abdominal cavity with massive bacterial contamination (6-7 CFU/g) drainage procedure was used. Mortality rate made up 4.8%. In local extended and diffuse peritonitis with a slight bacterial contamination of the abdominal cavity (3-5 CFU/g) and in absence of fibrinous deposition fixed on peritoneum, the drainage of the abdominal cavity was not used, and laparoscopy was performed in postoperative period for the control of the course of infectious process. Mortality rate was 0.6%. In extended peritonitis with massive bacterial contamination (6-8 CFU/g) the method of repeated explorations and sanitations of the abdominal cavity was used, mortality rate being 17.8%. The overall lethality made up 7.8%. Postoperative wound infection occurred in 6.7%, intraabdominal infection as abscesses or progressing peritonitis--in 2.1% of cases.

[Laparoscopic operations in emergency surgery]. / Laparoskopicheskie operatsii v neotlozhnoi khirurgii.

582 laparoscopic operations for various urgent diseases of the organs of abdominal cavity were made. 190 of them were performed for acute appendicitis, 266--for acute cholecystitis and its complications, 33--for pancreonecrosis, 39--for perforated gastro-duodenal ulcers, 32--for acute bowel obstruction and 22--for other pathological conditions. The necessity of conversion to conventional open surgery has arose in 41 (7.0%) patients. Intraoperative complications were detected in 7 (1.3%) patients. Postoperative complications developed in 18 (3.3%) patients. 2 patients (0.4%) died. The obtained results of treatment made it possible to recommend laparoscopic operations in acute abdominal diseases.

[Laparoscopy in perforated gastroduodenal ulcers]. / Laparoskopiia pri perforativnykh gastroduodenal'nykh iazvakh.

The authors have performed operations on 32 patients with perforated ulcers of the duodenum and 7 patients with perforated ulcers of the stomach. The diameter of the perforations was 2-8 mm. In 10 of the 39 patients the perforation defects could not be sutured by the laparoscopic method. The authors consider that of great significance for the decision to make laparoscopic operations was the diagnosis of peritonitis, size and localization of the perforation, the surgeon's experience with endoscopic operating. The technique of laparoscopic suturing the perforations is described. Special attention is paid to the special disposition of the surgeon and his assistant at the operating table.