[Diagnosis and treatment of post-operative peritonitis and intra-abdominal abscess].

Early diagnosis of post-operative infectious complications was established based on semiotic evaluation, SAPS-based analysis of severity of the disease, and results of ultrasound studies. SAPS analysis of functional disorders proved a reliable tool for diagnosis of peritonitis but less accurate for diagnosis of intra-abdominal abscess. Ultrasound revealed meaningful symptoms of infectious complications, such as the presence of free and confined fluids in the abdominal cavity, increased small intestine diameter, disturbed peristalsis. High diagnostic efficiency of laparoscopy permits it to be used to verify or turn down complication and thereby avoid repeated surgical intervention. The proposed approach made it possible to significantly accelerate diagnosis.

[Surgical aspects of the treatment of generalized peritonitis].

Advantages and disadvantages of different methods of surgery termination at generalized peritonitis are discussed. Drainage of abdominal cavity can not guarantee adequate sanation. Disadvantages of peritoneal lavage exceed the clinical value of this method. Active influence on infectious process during postoperative period can be realized with laparostomy, programmed revisions and sanations of abdominal cavity. These methods lead to recovery of more 80% patients with generalized peritonitis. Laparoscopic sanation is effective when bacterial contamination of peritoneal exudation doesn't exceed 10(5) mb/g.

[Diagnosis and treatment of postoperative intraabdominal complications]. / Diagnostika i lechenie posleoperatsionnykh vnutribriushnykh oslozhnenii.

Postoperative complications after 8168 reoperations were seen in 143 (1.8%) patients. Clinical symptoms, laboratory tests, results of x-ray and ultrasound examinations were taken into account in diagnosis of the complications. Differential diagnosis of postoperative peritonitis, stable paralytic intestinal obstruction, early adhesive obstruction and intraabdominal bleeding based only on clinical data is difficult in many cases. Ultrasonic examination and laparoscopy permitted to reduce number of unjustified relaparotomies. In the majority of cases relaparotomy was considered as a method of choice in treatment of these complications. Mini-invasive surgeries may be performed only in mild complications. Lethality in the treatment of postoperative complications after relaparotomy was 39.4%, after laparoscopic surgeries--8.8%, after US-assisted drainage--0. General lethality was 29.4%.

[Postoperative complications in patients with peritonitis]. / Posleoperatsionnye oslozhneniia u bol'nykh s peritonitom.

One thousand three hundred and ten patients with peritonitis have undergone surgery: local limited peritonitis was in 230 patients, local unlimited--in 342, general--in 738 patients. After surgery suppuration of the wound was seen in 92 (7.1%) patients, phlegmons of the abdominal wall--in 16 (1.3%), progressive peritonitis--in 40 (3.1%), abscesses of abdominal cavity--in 13 (1.0%), eventration--in 19 (1.5%), adhesive intestinal obstruction--in 17 (1.3%). Laparoscopy was used for diagnosis of intraabdominal complications in 47 patients. This allowed to avoid unjustified laparotomies in 20 patients. Application of laparoscopy is limited by degree of bacterial contamination of peritoneal exudates. Early adhesive intestinal obstruction in 7 patients was treated with endoscopic procedure. Sonography is effective in diagnosis of intraabdominal complications, detection of site of safe puncture before postoperative laparoscopy and drainage of abscesses.

[Results and prospects of treatment of general forms of peritonitis]. / Rezul'taty i perspektivy lecheniia rasprostranennykh form peritonita.

956 patients with general peritonitis were operated: 596 patients--for diffuse peritonitis, 360--for general peritonitis. The causes of peritonitis were: perforating gastroduodenal ulcers (454), acute destructive appendicitis (190), acute destructive cholecystitis (82), perforation of small intestine and colon (96), postoperative peritonitis (80), other diseases (54). In low degree of bacterial contamination of abdominal cavity (not more Ig 5 CFU/g) operations were completed without abdominal drainage, laparoscopic variant of the operation being optimal. In postoperative period, out of 691 patients with low degree of bacterial contamination wound infection was in 7.9%, intraabdominal infection--in 2.5%, polyorganic insufficiency--in 1.0%; lethality was 5.9%. In high degree of bacterial contamination (more Ig 5 CFU/g) and massive unremovable fibrinous patch on the peritoneum the programmed revisions and sanations of abdominal cavity were performed, sometimes--control laparoscopic revisions. In postoperative period of 256 patients with high degree of bacterial contamination wound infection arose in 6.0%, intraabdominal infection--in 4.2%, polyorganic insufficiency [symbol: see text] in 42.6%; lethality was 18.1%.

[Can perforated ulcer be not sutured?]. / Mozhno li ne ushivat' perforativnuiu iazvu?

Experiments in 5 pigs and 18 mongrel dogs have shown the possibility to close perforating ulcers with plates of biopolymer "Tachocomb". The method is proposed as an alternative to suturing perforations in the zone of pylorus in order to prevent stenosis of the pyloric part of the stomach. The experimental data obtained have confirmed good adhesive and stimulating properties of the fibrin-collagen substance. Successful results of using the method were demonstrated in 2 patients with perforating ulcers.

[Intraabdominal cholerrhea after cholecystectomy]. / Vnutribriushnoe zhelcheistechenie posle kholetsistéktomii.

Cholecystectomy (CE) was performed in 2303 patients with cholelithiasis and its complications. Cholerrhea (CR) after operation was in 31 (1.34%) patients: after laparoscopic CE (1425 patients)--in 18 (1.26%), after open CE (878 patients)--in 13 (1.48%). Source of CR was not found in 21 patients, CR from gall bladder bed was revealed in 7, from cystic duct stump--in 2, from hepaticojejunoanastomosis--in 1 patient. Ultrasonic examination, endoscopic retrograde pancreatocholangiography, laparoscopy were used for diagnosis of this complication. CR stopped spontaneously in 19, after endoscopic papillosphincterotomy--in 4 patients. Spread of bile in abdominal cavity was revealed in 6 patients, 4 of them underwent laparoscopic operations, 2--open operations. Infrahepatic encapsulated bile clumps were in 2 patients, they underwent ultrasonic-assisted drainage.

[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.

[Technical aspects of nasointestinal intubation]. / Tekhnicheskie aspekty nazointestinal'noi intubatsii.

According to the authors' opinion nasointestinal intubation have some advantages over "open" methods of decompression of the small bowel in paralytic intestinal obstruction resulted from peritonitis and mechanical obstruction of the small bowel. The authors' experience with more than 500 their own cases indicates, that application of nasointestinal intubation is not only necessary, but safe as well if keeping strictly to the established technique. Technical aspects of the method, possible errors which could occur during the performance of nasointestinal intubation and introduction of the probe are described. Complications which made up 2.6% are analysed.

[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.

[The efficacy of different antimicrobial preparations in treating patients with disseminated peritonitis]. / Izuchenie éffektivnosti razlichnykh antimikrobnykh preparatov pri lechenii bol'nykh s rasprostranennym peritonitom.

The results of our investigations revealed that in 68% of cases the treatment of patients with diffuse peritonitis with ampiox, gentamicin and metronidazole led to arresting the infectious process and to a considerable decrease in microbial contamination of the abdominal cavity. The use of cephalosporins and metronidazole proved to be effective in 85% of cases. In this treatment a considerable decrease in the amount of aerobic and anaerobic bacteria in peritoneal exudate was registered. In the process of treatment with cyprophloxacin positive clinical and microbiological dynamics were observed in all patients.

[The microflora of the peritoneal exudate in patients with disseminated peritonitis]. / Izuchenie mikroflory peritoneal'nogo ékssudata u bol'nykh s rasprostranennym peritonitom.

In 11 patients with diffuse peritonitis and 39 patients with general peritonitis the microflora of peritoneal exudate and the sensitivity of isolated microorganisms to antimicrobial preparations were studied. The study revealed that in the total number of microorganisms isolated from peritoneal exudate enterobacteria prevailed in patients with diffuse peritonitis and bacteroids, in patients with general peritonitis. Enterobacteria were most sensitive to ciprofloxacin and claforan, while bacteroids, to ciprofloxacin; at the same time 15.4% of the bacteroid strains under study were resistant to ciprofloxacin.