Improving the management of morbidly obese patients with postoperative bleeding undergoing Roux-en-Y gastric bypass.

OBJECTIVE: Aim: To improve the management of morbidly obese patients who undergo gastric bypass surgery to reduce the number of postoperative complications, in particular, bleeding. PATIENTS AND METHODS: Materials and Methods: From 2011 to 2022, a total of 348 patients with morbid obesity (MO) underwent laparoscopic gastric bypass treatment at the clinical base of the Department of General Surgery №2 of Bogomolets National Medical University. The retrospective group included 178 patients who received treatment between 2011 and 2019. 170 patients were enrolled in the prospective group for the period from 2019 to 2022. RESULTS: Results: Retrospective group had 8 episodes of postoperative bleeding, representing a rate of 4.49%, prospective group - 3 episodes of postoperative bleeding, representing a rate of 1.76% Four factor characteristics associated with the probability of bleeding were identified: "number of comorbid conditions", "arterial hypertension", "chronic liver diseases" and "chronic obstructive pulmonary disease". CONCLUSION: Conclusions: The factors responsible for the occurrence of postoperative bleeding in morbidly obese patients after laparoscopic gastric bypass surgery were the number of comorbid conditions, the presence of arterial hypertension, the presence of chronic liver diseases, and chronic obstructive pulmonary disease. A new strategy for the management of morbidly obese patients after laparoscopic gastric bypass was developed. This strategy involves changing cassettes to create gastroentero- and enteroenteroanastomoses, reducing the period of use of the nasogastric tube, drains, and urinary catheter from 3-4 days to 1 day, and resuming the drinking regimen 6 hours after extubation.

APPLICATION OF PROBIOTIC ANTISEPSIS FOR PURULENT COMPLICATIONS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS.

OBJECTIVE: The aim: To improve the results of surgical treatment of patients with type 2 diabetes and purulent-necrotic wounds by using probiotic antiseptics. PATIENTS AND METHODS: Materials and methods: 66 patients with type 2 diabetes and purulent-necrotic complications took part in this study. Probiotic antiseptics were used for local treatment in the experimental group (n=31), and traditional antiseptics were used in the control group (n=35). The levels of pro-inflammatory markers in the blood (IL-6, TNF-a, CRP) were studied; microscopic material was taken to study the type of cytogram during bandaging, before wound treatment with antiseptics or debridement on admission to the hospital (1st day), on the 3rd day and on the 7th day. RESULTS: Results: Analysis of dynamic changes in pro-inflammatory markers between the first and seventh days proved that only in the experimental group there was a statistically significant difference (IL-6 (Р=0.004), TNF-a (Р=0.001), CRP (Р=0.018)). Detection of regenerative-inflammatory and regenerative cytogram types on the 7th day in the experimental group had a statistically significant difference compared to the control group (p=0.002 and p<0.001, respectively). CONCLUSION: Conclusions: the use of probiotic antisepsis accelerates wound healing in patients with type 2 diabetes and purulent-necrotic complications.

SURGICAL ISCHEMIC ASPECTS OF COVID-19: MANAGEMENT OF PATIENTS WITH COVID TOES AND FINGERS.

OBJECTIVE: The aim: Study of clinical manifestations and management of patients with COVID toes and fingers. PATIENTS AND METHODS: Materials and methods: 1,841 patients with laboratory-confirmed SARS-CoV-2 infection were hospitalized. All patients were divided into two groups: without surgical pathology - 1,693 (91.96%) and with surgical pathology (patients with COVID toes and fingers and abdominal syndrome) - 148 (8.04%). The diagnosis of COVID-19 was made on the basis of clinical data, laboratory test results (PCR test for SARS-CoV-2) and computed tomography of the chest. On admission, in addition to the general laboratory tests, mandatory special methods of examination included determination of D-dimer, procalcitonin (PCT), C-reactive protein, and interleukin-6 (IL-6). RESULTS: Results: Surgical ischemic manifestations were observed in 8.04% of all patients with COVID-19, of which 86.48% presented with ischemic abdominal syndrome and 13.52% with COVID toes and fingers. C-reactive protein and procalcitonin are the markers that may indicate the development of ischemic surgical problems. A direct statistically significant linear correlation was found between the severity of the underlying disease and the mean D-dimer (r = 0.815; p = 0.01). CONCLUSION: Conclusions: The confirmed phenomenon of COVID toes and fingers does not require active surgical tactics. It is necessary to conduct pathogenetic treatment of COVID-19 and dynamic monitoring of its clinical course.