Laparoscopic repair of a posttraumatic left-sided diaphragmatic hernia complicated by strangulation and colon obstruction.

BACKGROUND: Posttraumatic diaphragmatic hernias (PDH) are serious complications of blunt and penetrating abdominal or thoracic trauma. Traditional thoracic or abdominal operations are usually performed in these cases. METHODS: We present 2 cases of posttraumatic left-sided diaphragmatic hernia complicated by strangulation and colon obstruction. Both cases were successfully treated with laparoscopy. RESULTS: We found that laparoscopy is a safe, successful, and gentle procedure not only for diagnosis but also for treatment of complicated PDH. Strangulation and colon obstruction were not contraindications to performing laparoscopic procedures. The postoperative course and long-term follow-up (range, 12 to 30 months) were uneventful and short. We expect the same good long-term results after laparoscopic repair as after open conventional surgery. CONCLUSION: We recommend the use a minimally invasive approach to treat posttraumatic diaphragmatic hernia complicated by strangulation and colon obstruction in hemodynamically stable patients.

[Laparoscopic restoration of the colon continuity after Hartmann procedure].

Literature data and personal experience with laparoscopic restoration of the continuity of the colon after Hartmann's procedure in 19 patients allowed the authors to conclude that minimally traumatic procedures had a number of advantages over operations of wide laparotomy such as less blood loss, rapid restoration of the intestinal motility, early activation of the patients, shorter postoperative stay at hospital. They are also thought to be effective methods of treatment and prophylactics of peritoneal commissures and their complications.

[Endoscopic endoprosthesis in inoperable cancer of the esophagus].

The author describes technical characteristics and results of endoprosthesing in 24 patients with inoperable cancer of the esophagus or cardioesophageal zone which can be used for substantiation of indications, contraindications and risk of complications. Based on his positive experiences with endoprosthesis of the esophagus the author makes a conclusion that this operation is minimally traumatic, allows the reestablishment of enteral nutrition and avoidance of gastrostomy.

[Laparoscopic splenectomy through a lateral access]. / Laparoskopicheskaia splenéktomiia iz lateral'nogo dostupa.

The investigation included 35 patients with diseases of blood and spleen pathology (30) and wounds and traumas of the abdomen with injuries of that organ (5), treated by laparoscopic splenectomy through a lateral access. The technique and stages of the operation and advantages of the lateral access are described. The laparoscopic splenectomy was shown to be possible in 90% of cases if patients were selected with special reference to the main disease, size and degree of pathological alterations in the spleen. An adequate approach to selections of patients with injuries of the organ allowed to make operations in more than a third of the patients and casualties. When using the lateral access laparoscopic splenectomy is thought to be more convenient, gives better visualization of the anatomical structures and reduces risk of injury of adjacent organs, thus resulting in less frequency of complications and conversions.

[Physical methods of dissection and coagulation in surgery]. / Fizicheskie sposoby dissektsii i koaguliatsii v khirurgii.

The paper presents 20-year experience in using various devices for tissue dissection and coagulation of such as electrosurgical ones EN-57M, Efa-0201 (Russia), Karl Storz-endoscope (Germany), Force-300, Force-FX, LigaSure ("Valley-lab", USA), Erbotom ICC 350 ("Erbe"), Argo-3000 ("Soring", Germany), a Surgitrone radioknife ("Ellman", USA), ultrasonic Auto Sonix devices ("Auto Suture", USA), a harmonic Ultracision scalpel ("Ethicon Endo-Surgery", USA), laser Scalpel-1 and Romashka-1 devices (Russia), plasma Fakel-01 and Prometey devices (Russia). The results of 424 experimental studies and clinical application of different energies in 1683 patients are analyzed. The influence of different types of energy on tissue and reparative processes were revealed, morphological changes were studied. Advantages and shortcomings of each type of energy are demonstrated, recommendations for their optimum application are formulated.

[Diagnosis and surgical treatment of mediastinal neoplasms]. / Diagnostika i khirurgicheskoe lechenie pri novoobrazovaniiakh sredosteniia.

The authors share their experiences with examination and surgical treatment of 163 patients with various neoplasms of the mediastinum. The first place among the neoplasms is occupied by tumors of the lymphatic apparatus (33%), the second--by tumors of the thymus (21%). The video-thoracoscopic technique was used in 17 of 131 operations performed. Complications after the operations took place in 6 patients (4.5%), two patients died (1.5%). A conclusion is made that the patients of this category must be treated not only by thoracic surgeons but also by hematologists, neurologists, neurosurgeons and specialists in radiation therapy.

[Laparoscopic surgery in colorectal tumors]. / Laparoskopicheskaia khirurgiia pri opukholiakh priamoi i obodochnoi kishki.

The authors describe their first experience with using less invasive laparoscopic methods in patients with tumors of the rectum and the colon. Twelve operative interventions were performed. The method and technique of endovideosurgical operations on the colon are described. The intraoperative and postoperative complications are analyzed. The authors not rich experience with performing laparoscopic interventions on the colon shows the necessity of stepwise and thorough mastering the method and of using strictly individual indications for such operations.

[The combined endoscopic surgery of gallstones complicated by diseases of the terminal common bile duct]. / Kombinirovannaia éndoskopicheskaia khirurgiia zhelchnokamennoi bolezni, oslozhnennoi zabolevaniiami terminal'nogo otdela obshchego zhelchnogo protoka.

The article deals with combined endoscopic treatment of cholelithiasis complicated by pathological changes of the terminal part of the common bile duct in 104 patients: in 81 of them there was choledocholithiasis (5 of them had the Mirizzi syndrome). 15 patients had choledocholithiasis and papillostenosis, 8 patients had papillostenosis. Papillosphincterotomy with laparoscopic cholecystectomy was performed in 50 patients, in 4 senile patients only papillosphincterotomy was performed. Laparoscopic cholecystectomy and interventions on the common bile duct were fulfilled in 46 patients; in 27 cases the duct was drained by the method of Holsted-Pikovskii, in 13 cases--after Kehr, in 3--after Vishnevskii. In 2 cases the concrements were removed through the cystic duct, the common bile duct was not drained. The supraduodenal choledochoduodenoanastomosis was made in one patient. The open operation was performed in 4 cases (3.9%). One patient died (1%). The experience shows that the modern endoscopic technique allows the whole program of intraoperative revision and sanitation of the hepaticocholedochus and its drainage to be realized. Advantages of the combined endoscopic treatment of the cholelithic disease complicated by a lesion of the terminal part of the common bile duct as compared with traditional surgery are evident. They are: decreased postoperative pain syndrome, less amount of complications, good cosmetic affect, shorter period of reconvalescence, high economic effect.

[Endoscopic interventions in cicatricial strictures of esophageal anastomoses]. / Endoskopicheskie vmeshatel'stva pri rubtsovykh strikturakh pishchevodnykh anastomozov.

Endoscopic balloon hydrodilation was conducted in 39 patients with cicatricial stenoses of esophageal anastomoses, in 12 patients it was combined with electrodissection of the esophageal anastomosis, in 3 with bougienage, and in 10 with temporary endoprosthetics. The anastomosis was dilated adequately (to 2.0-2.5 cm) in 38 patients. In one case endoscopic treatment was ineffective; another surgical intervention was performed. In another case endoprosthetics was complicated by decubitus of the cervical esophagus (favorable outcome). In late-term period of 2 months to 4 years restenosis occurred in 6 of 38 patients; the course of dilation was repeated in 4 patients, 2 patients underwent a reconstructive operation. The authors believe that in development of cicatricial stenosis of the esophageal anastomosis modern methods of therapeutic endoscopy should be resorted to in the first place, and only if they prove ineffective should the question of repeated surgical intervention be discussed. Balloon hydrodilation is the principal method of operative endoscopy in cicatricial stenoses of esophageal anastomoses, which in some cases should be combined with other endoscopic interventions (electroincision and temporary endoprosthetics).

[Current possibilities of diagnostic and surgical endoscopy in cicatricial esophageal stenosis]. / Sovremennye vozmozhnosti diagnosticheskoi i operativnoi éndoskopii pri rubtsovykh strikturakh pishchevoda.

Endoscopic methods of examination have been employed in 153 cases of burn and peptic strictures of the esophagus. The experience has shown that the use of small-diameter (including ultrathin) fiber endoscopes provides maximum information of the status of the esophagus along its whole length as well as of the stomach and duodenum, which is of importance in the choice of therapeutic tactics in this category of patients. Eighty one patients with cicatricial stenosis of the esophagus and esophageal anastomoses were subjected to various endoscopic interventions: balloon hydrodilation, bougienage, electrocision, and endoprosthesis . Balloon hydrodilatation was the major technique and in many cases was combined with other modes of therapeutic endoscopy. The authors' experience suggest that endoscopy adds to the available treatments for cicatricial strictures of the esophagus and esophageal anastomoses.

Endoscopic balloon hydrodilatation and endoprosthetic treatment of esophageal and esophageal anastomotic strictures.

In 37 patients with benign stenosis of the esophagus and esophageal anastomoses, the method of dilatation using special balloon catheters under endoscopic control was employed, and adequate dilatation of the stenotic region accomplished. In comparison with balloon dilators, bougies exert forces along the radial axis, and no tension is applied to the esophagus along the longitudinal axis. To obtain prolonged remission and decrease the number of "supporting" dilatations of esophageal benign stenosis and esophageal anastomoses, temporary intubation of the esophagus with a silicone prosthesis was performed in 7 patients. Further clinical application, and a study of the long-term results of endoscopic balloon hydro-dilatation and endoprosthesis for treating esophageal and anastomotic esophageal strictures, will help to elaborate more precise indications for the combined use of these methods.