RESUMEN
The COVID-19 pandemic has a serious impact on surgical service, emergency and especially elective surgical care. Many hospitals were re-designated as COVID hospitals due to resource constraints and large number of COVID-19 patients requiring hospitalization. This led to cancellation or postponement of scheduled surgeries. In addition, restrictions in elective surgery were associated with the risk of infection in surgical patients. Various protocols and guidelines recommended non-surgical or outpatient treatment if possible. During the pandemic, postoperative morbidity and mortality in emergency surgery increased significantly. The same is true for elective surgeries in 7-8 weeks after previous coronavirus infection. The authors analyze the issues of organization, priorities for restoration of elective surgery and criteria for patient selection.
Asunto(s)
COVID-19 , Humanos , Pandemias , SARS-CoV-2 , Hospitalización , Hospitales , Procedimientos Quirúrgicos Electivos/métodosRESUMEN
OBJECTIVE: Systematic review and metaanalysis of the effectiveness of open and minimally invasive laparoscopic suturing of perforated peptic ulcer. MATERIAL AND METHODS: Searching for Russian and English language reports included Scientific Electronic Library, Cochrane Collaboration Library and PubMed databases. We have analyzed contents of specialized journals, reviews and their references. Unpublished data were obtained via communication with chiefs of national surgical hospitals. RevMan 5.3 software was used for metaanalysis. RESULTS: We found no international randomized trials in available literature. Metaanalysis was based on national non-randomized studies. Total sample was 1177 cases. Laparoscopic minimally invasive surgery was performed in 43% of cases (n=503), open suturing - in 57% (n=674) of patients. Choice of these procedures is not currently not standardized. Minimally invasive procedures are shorter in time (mean difference -8.02, 95% CI -11.26 - -4.77, p<0.00001) and ensure less hospital-stay (mean difference -1.93, 95% CI -2.97 - -0.88, p=0.0003). Complications were less common (OR 0.14, 95% CI 0.07-0.27, p<0.00001) after minimally invasive operations (2.4%, 12/503) compared to laparotomy (11.4%, 77/674). Incidence of suture failure was similar (OR 0.4, 95% CI 0.1-1.6, p=0.2) (0.4% (2/503) vs. 0.7% (5/674)). Postoperative mortality was higher (OR 0.14, 95% CI 0.05-0.37, p<0.0001) after laparotomy (8%, 54/674) compared to laparoscopy (0.8%, 4/503). CONCLUSION: A metaanalysis indicates the advantage of laparoscopy-assisted suturing of perforated ulcer via minimally invasive approach over laparotomy. The absence of a standardized approach in choosing of minimally invasive laparotomy and conventional approach is a limitation of these results.
Asunto(s)
Laparoscopía , Laparotomía , Úlcera Péptica Perforada , Humanos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Laparotomía/efectos adversos , Laparotomía/métodos , Tiempo de Internación , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Úlcera Péptica Perforada/diagnóstico , Úlcera Péptica Perforada/cirugía , Resultado del TratamientoRESUMEN
The article provides a review of foreign literature for 2020 on existing methods of drug treatment of coronavirus disease COVID-19. To date, in the treatment of COVID-19 in different countries, a little more than 10 drugs are used. The largest number of studies on the testing of these drugs is carried out by scientists from China, the USA, and European countries. It should be noted that among these drugs there is not a single new drug developed specifically for the treatment of COVID-19, the recommended and used drugs have previously been used to treat, as a rule, diseases of the viral etiology, less often another pathology. These suggestions are often based on analogy, the hypothesis of their supposed effectiveness for COVID-19. It can be assumed that a brake on the development of a drug specific for coronavirus disease is a poor knowledge of the pathogenesis of virus invasion in the body's adhesives and the development of complications. The review provides detailed literature data on drugs such as hydroxychloroquine / chloroquine, lopinavir/natinavir, remdesivir, ACE inhibitors and angiotensin converting enzyme receptor blockers, tissue plasminogen activator, as well as plasma transfusion transfusions.
Asunto(s)
Infecciones por Coronavirus/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Alanina/análogos & derivados , Alanina/uso terapéutico , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Betacoronavirus , COVID-19 , Cloroquina/uso terapéutico , Infecciones por Coronavirus/terapia , Combinación de Medicamentos , Humanos , Hidroxicloroquina/uso terapéutico , Inmunización Pasiva , Lopinavir/uso terapéutico , Pandemias , Ritonavir/uso terapéutico , SARS-CoV-2 , Activador de Tejido Plasminógeno/uso terapéutico , Tratamiento Farmacológico de COVID-19 , Sueroterapia para COVID-19RESUMEN
AIM: To develop classification of surgical complications. MATERIAL AND METHODS: The most common and recently proposed classifications of surgical complications (Clavien-Dindo, Occordion, R. Satava, et al., A. Kazaryan, et al.) were analyzed. Postoperative complications in 25 556 patients were retrospectively assessed. Incidence and severity of complications, methods of their correction, effect of complications on length of hospital-stay were analyzed. RESULTS: As a result of comprehensive analysis, new classification of surgical complications was proposed. 5 grades of complications were identified. Classification is based on anatomical features, type of complications (within surgical access, organ or cavity), correction depending on this type, severity of complications. Causal relationship of complication with type of repair and increased length of hospital-stay was considered. CONCLUSION: Classification proposed is anatomically justified, considers causal relationship of complications and their repair, as well as length of hospital-stay.
Asunto(s)
Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/epidemiología , Humanos , Incidencia , Tiempo de Internación , Estudios RetrospectivosRESUMEN
AIM: To study the results of simultaneous abdominal and retroperitoneal interventions. MATERIAL AND METHODS: The article presents analysis of 856 simultaneous operations whose proportion was 3.49% of total number of operations. Most of them was performed via videolaparoscopic approach (697, 81.4%), open access and mini-laparotomy were used rarer (111, 12.9%) and 48 (6,7%) respectively). Severity of great number of interventions corresponded to degree I and II of D. Lochlein and R. Pichlmayer classification. Modern diagnostic methods including sonography, computed tomography, magnetic resonance imaging, angiography, endoscopy and laboratory data were used to define diagnosis. RESULTS: Simultaneous approach increases duration of surgery 30.3% on the average that is significant risk factor in case of surgery of severity degree III and videolaparoscopic interventions. Simultaneous surgery does not significantly increase ICU-stay and incidence of postoperative complications.
Asunto(s)
Laparotomía , Peritoneo/cirugía , Complicaciones Posoperatorias , Espacio Retroperitoneal/cirugía , Angiografía/métodos , Endoscopía/métodos , Femenino , Humanos , Laparotomía/efectos adversos , Laparotomía/métodos , Imagen por Resonancia Magnética/métodos , Masculino , Peritoneo/patología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Espacio Retroperitoneal/patología , Resultado del Tratamiento , Ultrasonografía/métodos , Cirugía Asistida por Video/métodosRESUMEN
An analysis of application results of complex research methods of diagnostics of intraorganic hepatic and splenic hematomas was made. At the same time, options of these methods were used for determination of prescription of injury. The ultrasound, CT, MR-imaging, videolaparoscopy, angiography, Doppler ultrasonics, impedometry, biochemical, laboratory and cytological study of punctate sample from hematomas were applied for this purpose in 33 patients. According to authors, an evolution of hematomas happened in 3 stages, each of this stage was characterized by specified data associated with investigation results. The staging procedure of hematomas or their evolution allowed setting the prescription of injury.
Asunto(s)
Traumatismos Abdominales/complicaciones , Hematoma/etiología , Hígado/lesiones , Bazo/lesiones , Rotura del Bazo/complicaciones , Heridas no Penetrantes/complicaciones , Traumatismos Abdominales/diagnóstico , Angiografía , Hematoma/diagnóstico , Humanos , Laparoscopía , Imagen por Resonancia Magnética , Rotura , Rotura del Bazo/diagnóstico , Tomografía Computarizada por Rayos X , Heridas no Penetrantes/diagnósticoRESUMEN
AIM: To present the algorithm of management of victims using modern technologies including CT, laparoscopy, angiography, intraabdominal pressure monitoring, etc. MATERIAL AND METHODS: Treatment of 395 victims with traumatic retroperitoneal hemorrhage was analyzed. RESULTS: It was shown that the use of developed algorithm decreases mortality rate from 10.5 to 4.5% and postoperative complications incidence from 23 to 14.1% in reviewed patients.
RESUMEN
This article presents results of surgical treatment of 2963 patients with cholelithiasis. The majority of them (71.8%) had an elective surgery, though 28.2% of patients underwent an emergency operation. A comparative assessment of obligate treatment criteria was made in 2 groups. A first group consisted of 803 patients and it was before introduction of Roman selection criteria used for surgical treatment of patients. A second group included 2963 patients in the period after introduction of selection criteria. Preoperative planning of surgery with evaluation of technical complexity of all stages of intervention with prognosis for possible complications should be the base of reasonable choice of surgical method of treatment of cholelithiasis and safety protection of surgery. The study completed and results obtained allowed decrease of the rate of postoperative complications to 1.4% and lethality--to 0.3%, respectively.
Asunto(s)
Colecistectomía Laparoscópica , Colelitiasis , Procedimientos Quirúrgicos Mínimamente Invasivos , Complicaciones Posoperatorias , Colecistectomía Laparoscópica/efectos adversos , Colecistectomía Laparoscópica/métodos , Colecistectomía Laparoscópica/estadística & datos numéricos , Colelitiasis/diagnóstico , Colelitiasis/etiología , Colelitiasis/mortalidad , Colelitiasis/cirugía , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/estadística & datos numéricos , Selección de Paciente , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Periodo Preoperatorio , Ajuste de Riesgo , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
The authors' opinion about conservative treatment of acute appendicitis is presented in the article. Conservative treatment of acute appendicitiswas proposed by K. Varadhan, etc. (2009). It was presented the examination results of 7216 patients who werehospitalized with suspected acute appendicitis. Also it was analyzed the results of appendectomy, which were performed in 5172 patients. Validity of diagnostic laparoscopy, informational content of ultrasonic scanning and Alvarado scale were discussed in the article. The authors propose that wide application of conservative treatment of acute appendicitis is premature in Russian Federation. Technique approbation is necessary on base of several medical organizations with discussion of its results within the Russian Society of Surgeons.
Asunto(s)
Apendicectomía , Apendicitis , Política Organizacional , Apendicectomía/métodos , Apendicectomía/estadística & datos numéricos , Apendicitis/diagnóstico por imagen , Apendicitis/epidemiología , Apendicitis/cirugía , Necesidades y Demandas de Servicios de Salud , Humanos , Laparoscopía/métodos , Laparoscopía/estadística & datos numéricos , Selección de Paciente , Federación de Rusia , UltrasonografíaAsunto(s)
Hipertensión Intraabdominal/complicaciones , Daño por Reperfusión/diagnóstico , Adulto , Anciano , Animales , Femenino , Humanos , Hipertensión Intraabdominal/fisiopatología , Riñón/patología , Hígado/patología , Pulmón/patología , Masculino , Persona de Mediana Edad , Daño por Reperfusión/fisiopatología , PorcinosRESUMEN
An analysis of the condition of emergency surgery for the patients with acute abdominal diseases was made in the period of 1972-2012. The dynamics of surgical beds provision and surgical personnel were taken into account. The authors investigated the rate of general and postoperative lethality, tendencies and regular occurrences and leading reasons of negative results in given diseases. Reserves of further decrease of the lethality were considered and it was associated with shortening of hospitalization part later than 24 hours. The future improvement of intensive therapy and resuscitation, more wide application of minimally traumatic techniques of surgical treatment could give better results in this group of patients.
Asunto(s)
Abdomen/cirugía , Urgencias Médicas/epidemiología , Procedimientos Quirúrgicos Operativos , Abdomen/patología , Enfermedad Aguda , Urgencias Médicas/economía , Cirugía General/economía , Cirugía General/estadística & datos numéricos , Cirugía General/tendencias , Encuestas de Atención de la Salud , Hospitalización/estadística & datos numéricos , Humanos , Evaluación de Resultado en la Atención de Salud , Federación de Rusia , Procedimientos Quirúrgicos Operativos/métodos , Procedimientos Quirúrgicos Operativos/mortalidad , Análisis de SupervivenciaRESUMEN
Ethiology, pathogenesis, treatment and prevention of reperfusion disorders in emergency abdominal surgery are highlighted in the article. The thorough analysis of reperfusional disorders' pathogenesis by the abdominal compartment syndrome was carried out.
Asunto(s)
Cavidad Abdominal , Descompresión Quirúrgica/métodos , Hipertensión Intraabdominal , Laparoscopía/métodos , Daño por Reperfusión , Ultrasonografía Doppler Dúplex/métodos , Cavidad Abdominal/irrigación sanguínea , Cavidad Abdominal/cirugía , Adulto , Algoritmos , Animales , Terapia Combinada , Descompresión Quirúrgica/efectos adversos , Femenino , Humanos , Hipertensión Intraabdominal/sangre , Hipertensión Intraabdominal/diagnóstico , Hipertensión Intraabdominal/etiología , Hipertensión Intraabdominal/terapia , Ácido Láctico/sangre , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/prevención & control , Neumoperitoneo Artificial/efectos adversos , Neumoperitoneo Artificial/métodos , Daño por Reperfusión/diagnóstico , Daño por Reperfusión/etiología , Daño por Reperfusión/prevención & control , Circulación Esplácnica , Porcinos , Resultado del TratamientoRESUMEN
The presented method of hernioplasty was used in 1242 patients with different types of inguinal hernias. In 428 patients plasty of the inguinal canal was performed by the classical method of Lichtenstein, in 814 patients the method was modified. The method modified by the authors is described in detail. Improved results of treatment are associated by the authors with reduced ischemization of the sutured tissues with reticulate endoprosthesis. Recurrent hernias were noted in 0.2% in the main group, and 1.8% in the control group.
Asunto(s)
Pared Abdominal/cirugía , Hernia Inguinal/cirugía , Herniorrafia , Conducto Inguinal/cirugía , Isquemia/prevención & control , Microvasos/fisiopatología , Pared Abdominal/irrigación sanguínea , Pared Abdominal/fisiopatología , Adulto , Femenino , Hernia Inguinal/patología , Hernia Inguinal/fisiopatología , Herniorrafia/efectos adversos , Herniorrafia/métodos , Herniorrafia/normas , Humanos , Conducto Inguinal/fisiopatología , Isquemia/etiología , Isquemia/fisiopatología , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina/normas , Mejoramiento de la Calidad , Prevención Secundaria , Técnicas de Sutura/efectos adversos , Técnicas de Sutura/normas , Resultado del TratamientoRESUMEN
Results of surgical treatment of 197 patients with acute colonic obstruction complicated by intraabdominal hypertension were analyzed. Monitoring of intraabdominal pressure was made in 101 patients at the pre- and postoperative periods. Compensated, sub- and decompensated forms of obstruction depending on the data of intraabdominal pressure were determined. The level and dynamics of the intraabdominal pressure are taken as criteria of severity of acute colonic obstruction, decision on the time and volume of surgical procedures. The medico-diagnostic algorithm of management of such patients is proposed. Lethality turned out to be decreased to 15.8% as compared with a control group (24%) due to the monitoring of intraabdominal pressure and improved surgical strategy.
Asunto(s)
Enfermedades del Colon/complicaciones , Síndromes Compartimentales/clasificación , Síndromes Compartimentales/diagnóstico , Obstrucción Intestinal/complicaciones , Manometría/métodos , Presión/efectos adversos , Cavidad Abdominal/fisiopatología , Cavidad Abdominal/cirugía , Enfermedad Aguda , Colon/patología , Enfermedades del Colon/fisiopatología , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Descompresión Quirúrgica/métodos , Humanos , Obstrucción Intestinal/fisiopatología , Manometría/normas , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/normas , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/mortalidad , Selección de Paciente , Periodo Posoperatorio , Periodo Preoperatorio , Índice de Severidad de la EnfermedadRESUMEN
The authors present results of examination and treatment of 698 patients with erosive-ulcerative lesions in the mucous membrane of the upper digestive tract that accounted for 39.49% of all subjects with gastrointestinal hemorrhage. These lesions were diagnosed in 73.8% of the patients in critical conditions. The leading role in their pathogenesis is played by ischemic-perfusion syndrome, gastric acid hypersecretion resulting in microcirculatory disorders, hypoxia, and activation of free radicals in gastric and duodenal mucosa. It is concluded that preventive and conservative therapy of the above lesions must be focused on the correction of ischemia and after-effects of reperfusion to achieve long-standing hypoacidic state (pH < 4) with the help of up-to-date antisecretory agents.
Asunto(s)
Antagonistas de los Receptores H2 de la Histamina/administración & dosificación , Úlcera Péptica Hemorrágica , Úlcera Péptica , Inhibidores de la Bomba de Protones/administración & dosificación , Daño por Reperfusión , Tracto Gastrointestinal Superior , Aclorhidria/inducido químicamente , Animales , Perros , Ácido Gástrico/metabolismo , Técnicas Hemostáticas , Antagonistas de los Receptores H2 de la Histamina/efectos adversos , Humanos , Modelos Animales , Membrana Mucosa/metabolismo , Membrana Mucosa/fisiopatología , Úlcera Péptica/tratamiento farmacológico , Úlcera Péptica/etiología , Úlcera Péptica/metabolismo , Úlcera Péptica/fisiopatología , Úlcera Péptica Hemorrágica/etiología , Úlcera Péptica Hemorrágica/fisiopatología , Úlcera Péptica Hemorrágica/terapia , Inhibidores de la Bomba de Protones/efectos adversos , Daño por Reperfusión/complicaciones , Daño por Reperfusión/metabolismo , Daño por Reperfusión/fisiopatología , Factores de Riesgo , Resultado del Tratamiento , Tracto Gastrointestinal Superior/metabolismo , Tracto Gastrointestinal Superior/fisiopatologíaRESUMEN
Retrospective analysis of treatment results was carried out in patients with acute bleedings from upper digestive tract according to efficacy evaluation of hemostatic methods. All methods of hemostasis were divided into 7 groups: resectional, local treatment of the bleeding source with or without vagotomy, angiosurgical, local surgical hemostasis, hemostasis along the length, endoscopic hemostasis and conservative modes. Indications for hemostatic methods were estimated depending on severity, intensity, character of the bleeding basing on the J. Forrest classification and severity of patient's condition (severity of blood loss). Prophylactic measures for prevention of recurrent bleedings after primary hemostasis are proposed. Differential approach to hemostasis in acute gastrointestinal bleedings allows achieving 96-97% efficacy.
Asunto(s)
Hemorragia Gastrointestinal/cirugía , Hemostasis Endoscópica/métodos , Vagotomía/métodos , Enfermedad Aguda , Humanos , Estudios Retrospectivos , Prevención Secundaria , Resultado del TratamientoRESUMEN
Results of treatment of 345 patients with Mallory-Weiss syndrome were analyzed. Classification of the disease with a glance on stages and bleeding activity was given. Methods of hemostasis and indications for the surgical interference were discussed. The importance of consideration and respective treatment of the concomitant gastrointestinal diseases or alcohol intoxication was stressed.