[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.