[Non-surgical treatment of staple-line suture leakage after redo sleeve gastrectomy]. / Endoskopicheskoe klipirovanie nesostoyatel'nosti linii steplernogo shva posle povtornoi prodol'noi rezektsii zheludka.

Redo bariatric procedures are common. However, redo sleeve gastrectomy is not a frequent case of repeated bariatric surgery and can be performed rather as a necessary measure in difficult intraoperative conditions. We report a patient who underwent laparoscopic adjustable gastric band placement, its blockage and surgical removal, sleeve gastrectomy and redo sleeve gastrectomy. After that, staple-line suture failure developed that required endoscopic clipping.

Using local hemostatic to prevent seromas in patients with large incisional hernias randomized controlled trial.

PURPOSE: The purpose of the study is to compare the results of single-blind a randomized controlled trial on the use of the local hemostatic agent Haemoblock and ultrasound monitoring of postoperative wounds in patients after the large incisional hernias repair. METHODS: The study represented a single-blind randomized controlled trial. The total number of patients was 66. Group with Haemoblock (A) and the Group without Haemoblock (B) included 33 patients each. Operation-sublay retromuscular repair with mesh prolene implant. We applied Haemoblock 15 ml retromuscularly and 15 ml subcutaneousely in group A. Wounds were drained by vacuum suction drainage. Postoperatively - ultrasound monitoring of postoperative wounds. RESULTS: Median of follow-up was 33 days. Significant differences were obtained in the duration of wound draining, 2.6 ± 0.6 days in group A versus 4.1 ± 0.9 days in group B (p = 0.002). In group A, the levels of C-reactive protein and albumin were less in the separated discharge, as well as its total amount. During the first 12 days, a significantly lower volume of fluid collections was detected in patients of group A than in patients of group B. We noted a more rapid subsidence of exudative processes in postoperative wounds in patients from group A. The number of punctures was significantly higher in group B (0.8 ± 1.0 vs. 0.2 ± 0.4, respectively, p = 0.003). The total number of puncture interventions in group A was six in six patients, versus 27 in 14 patients in group B (p = 0.000). CONCLUSION: The use of the local hemostatic agent Haemoblock can reduce the duration of the postoperative wound draining, shorten the period of inflammatory exudative processes in the postoperative wound, significantly reduce the number of puncture interventions for the postoperative wound, reduce the risk of the seromas formation and surgical site infections (SSI) associated with seroma, reduce the severity of pain and the need for analgesics.

[Complete ileal substitution of the obliterated ureter].

The article presents the experience of successful surgical treatment of a patient with complete ureteral obliteration after transurethral endoscopic pyelolithotripsy in the left renal pelvis with lithoextraction and stenting. Two months later the patient developed stent obstruction and underwent repeat stenting and insertion of a left nephrostomy tube. After another 1.5 months, he was found to have complete obliteration of the left ureter. Ileal substitution of the left ureter was performed with the formation of a pyelo-ileal anastomosis and antireflux ileo-cysto-anastomosis. Contrast-enhanced MRI-urography performed on the 21st day ascertained the complete patency of the anastomosis. The patient was discharged in a satisfactory condition. At a follow-up examination five months after hospital discharge, the patient was in satisfactory condition with no complaints. Renal ultrasound and MRI showed no signs of obstruction of the ileal autograft.