[Enteral protection in patients with diffuse peritonitis]. / Enteroprotektsiya v povyshenii effektivnosti lecheniya patsientov s rasprostranennym peritonitom.

OBJECTIVE: To improve treatment outcomes in patients with diffuse peritonitis via enteral protection using intestinal lavage with ozonized solution through an original tube. MATERIAL AND METHODS: We analyzed 78 patients with advanced peritonitis. The control group included 39 patients who underwent standard measures after surgery for peritonitis. The main group consisted of 39 patients who underwent early postoperative intestinal lavage with ozonized solutions through original tube for 3 days. RESULTS: Clinical and laboratory parameters, as well as ultrasound data indicated better correction of enteral insufficiency in the main group. Morbidity in the main group was lower by 33.3%, length of hospital-stay - by 3.5 days. CONCLUSION: Early postoperative intestinal lavage with ozonized solutions through original tube accelerates recovery intestinal function and improves treatment outcomes in patients with widespread peritonitis.

[Optimization of early postoperative period in intestinal resection surgery for acute intestinal obstruction complicated by peritonitis]. / Optimizatsiya rannego posleoperatsionnogo perioda v rezektsionnoi khirurgii kishechnika pri ostroi kishechnoi neprokhodimosti, oslozhnennoi peritonitom.

OBJECTIVE: To establish the effectiveness of complex therapy with Remaxol in optimizing the early postoperative period and increasing the reparative ability of intestinal tissues in acute intestinal obstruction complicated by peritonitis. MATERIAL AND METHODS: We analyzed treatment outcomes in 37 patients with acute intestinal obstruction complicated by peritonitis. The control group included 19 patients who underwent standard therapeutic measures after resolving intestinal obstruction and resection of small or large intestine. The main group consisted of 18 patients who underwent intraoperative intestinal lavage with Remaxol through a probe and early postoperative intravenous infusions (800 ml within 2 days and 400 ml for subsequent 3 days). RESULTS: The main group was characterized by positive dynamics of clinical and laboratory parameters, in particular, relief of endogenous intoxication syndrome, reduction of oxidative stress and phospholipase activity, general hypoxia. Postoperative morbidity in the main group decreased by 61.7% (χ2=3.897, p<0.05). Better tissue healing in the area of intestinal anastomosis and laparotomy under Remaxol therapy was demonstrated. CONCLUSION: Inclusion of Remaxol in complex therapy of acute intestinal obstruction complicated by peritonitis can significantly improve treatment outcomes, reduce the number of complications and increase reparative potential of tissues. Positive effect of this drug is based on less oxidative stress, phospholipase activity and hypoxia.

[Possible ways to approach the effectiveness of open abdominal interventions to laparoscopic]. / Vozmozhnye puti priblizheniya rezul'tativnosti otkrytykh abdominal'nykh vmeshatel'stv k laparoskopicheskim.

THE PURPOSE OF THE WORK: Based on the determination of the mechanisms of negative manifestations of surgical aggression in open interventions, compared with laparoscopic, to determine ways to optimize the early postoperative period when using them. MATERIAL AND METHODS: The work is based on clinical and laboratory analysis of 147 patients with acute appendicitis complicated by acute peritonitis. In the first group (n=58), patients were operated with traditional laparotomy access. In the second group (n=47) - laparoscopic interventions were used. In the first and second groups, traditional therapy was carried out according to clinical recommendations. In the third group (n=42), patients were operated with traditional laparotomy access, and in the early postoperative period, their therapy included remaxol (intravenous injections of 800.0 ml of the drug in the first two days, then within three days - 400.0 ml). Laboratory and instrumental studies were carried out in patients, including the level of hydrophilic and hydrophobic toxins in the blood, the intensity of peroxidation of membrane lipids and antioxidant enzyme potential, the activity of phospholipase A2. The functional status of the intestine and liver was assessed. RESULTS: It was found that the most important manifestation of the reduction of surgical aggression in the early stages after surgery, which is characteristic of laparoscopic operations, are significantly low phenomena of endogenous intoxication against the background of a significant decrease in the activity of peroxidation of membrane lipids and phospholipase systems - triggers of catabolic phenomena and lesions of various organs and systems, including the intestine and liver. The inclusion of remaxol in complex therapy for patients who have undergone open surgical operations leads to a number of positive clinical and laboratory effects. The most important of them is the reduction of endogenous intoxication. This beneficial effect is associated with the restoration of the functional status of the intestine and liver, as well as a decrease in the severity of catabolic phenomena. The effectiveness of complex therapy with remaxol was marked by reducing the number of postoperative complications and the length of the patient's stay in the hospital. CONCLUSION: The use of remaxol in patients with acute peritonitis complicated by peritonitis who have undergone open surgical interventions, due to the relatively rapid restoration of the functional status of the intestine and liver, reduction of catabolic phenomena, reduces the severity of endogenous intoxication syndrome, which was the basis for a significant improvement in the course of the early postoperative period, bringing it closer to that when using laparoscopic technology.

[The variants of enteral distress syndrome correction with peritonitis]. / Puti korrektsii enteral'nogo distress-sindroma pri rasprostranennom peritonite.

OBJECTIVE: To determine the effectiveness of a new treatment regimen for patients with widespread peritonitis with an accent on enteroprotection based on the use of a drug of the metabolic type of action of remaxol and physiotherapy. MATERIAL AND METHODS: Clinical and laboratory studies of 82 patients with widespread peritonitis, mainly with grade 2 severity according to the Mannheim peritonitis Index, severe form - according to the ARASNE II scale. In the 1st group (28) patients underwent intraoperative intestinal intubation in the traditional way; in the 2nd (22) - intestinal intubation according to the original method; in the 3rd (32) - intestinal intubation according to the original method and combined use of remaxol (parenterally, enterally and intraperitoneally). An intestinal tube of an original design was used, which allows electrical stimulation of the duodenum in the postoperative period. The study evaluates clinical data, the results of instrumental and laboratory studies: ultrasound examination of the abdominal cavity, assessment of the functional state of the small intestine, a number of indicators of homeostasis. RESULTS: It was shown that in patients with acute widespread peritonitis who underwent intestinal intubation according to the original method (group 2), as well as in combination with remaxol (group 3), the postoperative period was relatively more favorable. One of the factors optimizing the course of the disease was the relatively rapid restoration of the structural and functional state of the small intestine due to its electrical stimulation. The clinical and laboratory positive effect was especially significant in the 3rd group of patients, in which the use of remaxol, which has a membrane-stabilizing effect, played a special role in the enteroprotective effect. Timely correction of enteral distress syndrome resulted in a significant decrease in the severity of the syndrome of endogenous intoxication and oxidative stress, which was important in significantly improving the results of treatment of patients. CONCLUSION: The use of technical innovations in the form of an original nasointestinal tube, which allows to quickly restore intestinal motility due to electrical stimulation, as well as the use of remaxol (parenterally, enterally and intraperitoneally) significantly optimize the course of the early postoperative period of patients with acute widespread peritonitis.

[Membrane protection of intestine and liver cells in the effectiveness of minimally invasive surgery for acute peritonitis]. / Otsenka effektivnosti mini-invazivnykh vmeshatel'stv pri ostrom peritonite na osnovanii izucheniya funktsional'nogo sostoyaniya pecheni i kishechnika.

OBJECTIVE: To determine the value of membrane protective effect in intestine and liver cells for the effectiveness of minimally invasive surgery for acute peritonitis. MATERIAL AND METHODS: Patients with acute peritonitis undergoing laparoscopic (n=60) and open (n=50) surgery are analyzed. Functional characteristics of liver and bowel, disorders of homeostasis were evaluated in early postoperative period. RESULTS: Reduced negative impact of surgical aggression on the state of liver and intestine is essential to improve treatment outcomes in patients with acute peritonitis undergoing minimally invasive surgery. Fast recovery of intestine inevitably results reduced release of endotoxins while restoration of liver function is associated with rapid elimination of these toxins. These processes prevent severe intoxication and facilitate accelerated recovery. Functional restoration of liver and bowel is associated with reduced oxidative stress during laparoscopic operations. It is also important because peritonitis causes activation of free-radical processes per se. Therefore, an additional source of oxidative phenomena is extremely undesirable in these cases. CONCLUSION: Laparoscopic surgery for acute peritonitis minimizes surgical aggression and is associated with more favorable recovery of liver and bowel function. Undoubtedly, these findings should be considered to choose surgical approach in this severe category of patients.

[Homeostasis correcting therapy in optimizing the early postoperative period of patients with peritonitis]. / Gomeostazkorrigiruiushchaia terapiia v optimizatsii rannego posleoperatsionnogo perioda bol'nykh peritonitom.

The aim - of the study was to study the effectiveness of Remaxol in the correction of homeostasis disorders in patients with acute peritonitis after laparotomic surgery intervention.

[Prognostic criteria of efficacy of programmed laparoscopic sanitation of the abdominal cavity in peritonitis]. / Prognosticheskie kriterii éffektivnosti laparoskopicheskoi programmirovannoi sanatsii briushnoi polosti pri peritonite.

AIM: To define prognostic criteria of efficacy of programmed laparoscopic sanitation of the abdominal cavity in peritonitis. MATERIAL AND METHODS: There were 32 patients after programmed laparoscopic sanitation of abdominal cavity for peritonitis due to different acute surgical diseases. Subsequently 12 of them required relaparotomy due to poor effectiveness of laparoscopic sanitation. Comprehensive clinical examination and laboratory assessment of some indexes of homeostasis and oxidative status were conducted. RESULTS: Prognostic clinical and laboratory criteria of efficacy of laparoscopic abdominal sanitation were suggested after analysis of intraoperative data during primary surgery and laboratory values in the 1st postoperative day. CONCLUSION: The offered prognostic criteria allow to define further management of peritonitis patients after primary laparotomy.

[Closed management of pancreatic necrosis complicated by diffuse peritonitis]. / Lechenie pankreonekroza, oslozhnennogo rasprostranennym peritonitom.

AIM: To assess an efficiency of closed management of pancreatic necrosis complicated by widespread peritonitis by using of elective laparoscopic sanations with ultrasonic processing of an abdominal cavity and retroperitoneal space. MATERIAL AND METHODS: Treatment of 111 patients with pancreatic necrosis complicated by diffuse peritonitis was analyzed. Closed management was used in 41 patients (main group). Among them there were 12 patients who underwent laparoscopic sanation with ultrasonic cavitation of abdominal cavity, laparoscopic drainage of omental bag, US-assisted puncture drainage of retroperitoneal space and 29 patients after laparotomy followed by laparoscopic lavage and low-frequency ultrasound through retroperitoneal drains which were deployed during lumbotomy or under US control. Control group included 70 patients in whom open treatment of diffuse peritonitis was used (laparotomy, lumbotomy, omentobursostomy). Monitoring of hepatonephric dysfunction, endogenic intoxication was carried out. RESULTS: It was concluded that developed technique is associated with better clinical and laboratory data due to less surgical trauma and ultrasonic cavitation in early postoperative period. Rapid recovery of liver function, decrease of endogenic intoxication and mortality rate were observed. So, this method may be recommended for patients with pancreatic necrosis complicated by diffuse peritonitis.