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1.
Khirurgiia (Mosk) ; (5): 14-20, 2024.
Artículo en Ruso | MEDLINE | ID: mdl-38785234

RESUMEN

OBJECTIVE: To study the possibilities of minimally invasive methods for removing intra-abdominal calculi after laparoscopic cholecystectomy. MATERIAL AND METHODS: There were 5 patients with abdominal abscesses associated with infected calculi after previous laparoscopic cholecystectomy at the Sklifosovsky Research Institute for Emergency Care between 2020 and 2023. Mean age of patients was 55±12 years. There were 3 (60%) women and 2 (40%) men. All patients underwent minimally invasive treatment. RESULTS: Four patients (80%) underwent percutaneous drainage of abscess with subsequent replacement by larger drains and removal of calculi with endoscopic assistance. Event-free period after cholecystectomy was 44±32 months. One patient developed subhepatic abscess in 72 months after laparoscopic cholecystectomy. This patient underwent transluminal removal of calculus through the duodenal wall. There was 1 calculus in 3 (60%) patients, 2 calculi in 1 (20%) patient and 3 calculi in 1 (20%) patient. CONCLUSION: The above-mentioned cases demonstrate successful minimally invasive interventions for symptomatic abdominal calculi after laparoscopic cholecystectomy. Minimally invasive treatment can reduce surgical aggression and accelerate rehabilitation.


Asunto(s)
Absceso Abdominal , Colecistectomía Laparoscópica , Procedimientos Quirúrgicos Mínimamente Invasivos , Humanos , Masculino , Colecistectomía Laparoscópica/efectos adversos , Colecistectomía Laparoscópica/métodos , Femenino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Absceso Abdominal/etiología , Absceso Abdominal/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Drenaje/métodos , Anciano , Adulto , Resultado del Tratamiento , Cálculos Biliares/cirugía
2.
Khirurgiia (Mosk) ; (9): 57-65, 2024.
Artículo en Ruso | MEDLINE | ID: mdl-39268737

RESUMEN

Currently, severe combined abdominal trauma ranks third among all causes of mortality In Russia, second only to cardiovascular and oncologic diseases. In the period from 2019 to 2020 in our country, a slight decrease in traumatism is noted due to a decrease in the number of traffic accidents as the main cause of combined and multiple trauma. The number of abdominal injuries from the total number of injuries In Russian regions ranges from 1.5 to 36.5% and is accompanied by a high level of disability (25-80% in combined trauma and 5-8% in isolated trauma). Despite modern medical advances, lethality in combined trauma of abdominal organs varies from 10.7 to 69.7%, with closed abdominal trauma accounting for up to 6% of fatal outcomes. OBJECTIVE: Improving treatment outcomes in patients with closed abdominal trauma through comprehensive diagnosis of SCN and optimization of enteral therapy in patients with closed abdominal trauma. MATERIAL AND METHODS: The study included 40 patients (29 (72.5%) men and 11 (27.5%) women), who underwent examination and treatment at the State Budgetary Institution "Research Institute of SP. Im. N.V. Sklifosovsky Research Institute of St. Petersburg State Medical Center with the diagnosis: Closed abdominal trauma. The age of the patients varied from 25 to 81 years (Mean age was 49.6±13.1). To evaluate the effectiveness of intensive therapy, the patients were divided into 2 groups: the comparison group (n=26) included patients who were treated with complex conservative therapy. Patients of the main group (n=14) conservative therapy was supplemented with the use of ER to restore the functional activity of the intestine under the control of ultrasound and assessment of the degree of intra-abdominal hypertension, as well as with Intestamine to stimulate the intestinal trauma. RESULTS: In the course of the study it was found that, as a result of complex enteral therapy in the patients of the main group, starting from the 7th day of stay in the ORIT, positive dynamics was observed, consisting in a statistically significant decrease in the levels of lactate, ALT, AST, LDH, and CRP. By the 14th day there was also a statistically significant decrease in leukocyte and PCT levels. The lethality in the main group amounted to 7.2%, n=1. At the same time, in patients of the comparison group only by the 7th day there was a decrease in concentration of CRP (p=0.065), by the 10th day - ALT (<0.001) and by the 14th day there was a decrease in leukocytes level (p=0.038). Lethality in this group amounted to 23.1%, n=6. CONCLUSION: Timely initiation of pathogenetic enteral therapy contributes to faster normalization of clinical and laboratory parameters, protection of intestinal barrier function, prevention of complications associated with bacterial translocation and bacterial overgrowth syndrome, increase in immunoresistance of the organism.


Asunto(s)
Traumatismos Abdominales , Heridas no Penetrantes , Humanos , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/terapia , Masculino , Femenino , Persona de Mediana Edad , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/terapia , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/fisiopatología , Federación de Rusia/epidemiología , Traumatismo Múltiple/complicaciones , Traumatismo Múltiple/diagnóstico , Traumatismo Múltiple/terapia , Traumatismo Múltiple/mortalidad , Adulto , Nutrición Enteral/métodos , Nutrición Enteral/estadística & datos numéricos , Síndrome , Enfermedades Intestinales/diagnóstico , Enfermedades Intestinales/terapia
3.
Khirurgiia (Mosk) ; (2): 84-89, 2024.
Artículo en Ruso | MEDLINE | ID: mdl-38344964

RESUMEN

Malignant lesions of tracheal bifurcation usually lead to respiratory failure and risk of mortality. Airway stenting is the only minimally invasive method for these patients. The authors present a patient with T4N3M0 left-sided lung cancer (inoperable stage IIIc) complicated by respiratory failure due to tracheal bifurcation obstruction. Bilateral stenting by self-expanding stents with perforated coatings was effective for airway recanalization and provided subsequent chemotherapy.


Asunto(s)
Obstrucción de las Vías Aéreas , Enfermedades Bronquiales , Insuficiencia Respiratoria , Estenosis Traqueal , Humanos , Constricción Patológica/complicaciones , Estenosis Traqueal/diagnóstico , Estenosis Traqueal/etiología , Estenosis Traqueal/cirugía , Enfermedades Bronquiales/complicaciones , Obstrucción de las Vías Aéreas/complicaciones , Stents/efectos adversos
4.
Khirurgiia (Mosk) ; (1): 29-33, 2024.
Artículo en Ruso | MEDLINE | ID: mdl-38258685

RESUMEN

OBJECTIVE: To improve the outcomes in patients with malignant obstructive jaundice using intraluminal stenting. MATERIAL AND METHODS: The present study included 62 patients with clinical symptoms of malignant obstructive jaundice. In the main group, we performed biliary stenting with self-expanding multi-perforated stents (Hanarostent Multi-hole Biliary). Microscopic perforations of these stents prevent migration and reduce the risk of blocking the cystic and main pancreatic ducts. In the control group, stenting was performed with fully and partially covered self-expanding stents. RESULTS: Lower incidence of obstructive cholecystitis and acute pancreatitis in the main group was associated with multiperforated stents reducing the risk of blocking the main pancreatic and cystic ducts. CONCLUSION: In our study, multiperforated stents excluded migration and reduced the incidence of complications (acute cholecystitis from 11.5 to 3.8%, acute pancreatitis from 15.3 to 7.7%).


Asunto(s)
Ictericia Obstructiva , Pancreatitis , Humanos , Enfermedad Aguda , Constricción Patológica , Ictericia Obstructiva/diagnóstico , Ictericia Obstructiva/etiología , Ictericia Obstructiva/cirugía , Pancreatitis/complicaciones , Pancreatitis/diagnóstico , Stents/efectos adversos
6.
Khirurgiia (Mosk) ; (8): 13-19, 2023.
Artículo en Inglés, Ruso | MEDLINE | ID: mdl-37530766

RESUMEN

OBJECTIVE: To improve the outcomes after orthotopic liver transplantation (OLT) followed by early biliary complications via endoscopic bilioduodenal stenting. MATERIAL AND METHODS: The study enrolled 41 patients with early biliary complications within 90 days after OLT. All patients underwent endoscopic treatment between 2001 and 2021. There were 34 (82.9%) men and 7 (17.1%) women aged 48.5±12.5 years. Strictures and failure of biliary anastomosis occurred in 33 (80.5%) and 8 (19.5%) patients, respectively. RESULTS: After endoscopic treatment, serum bilirubin normalized in 3.3±0.86 days in patients with strictures (23.7 (16.4; 34.5) mmol/l, p<0.001). Diameter of lobar ducts as a criterion of biliary hypertension was normalized after 4 (2.5; 5.5) days (p<0.001). Bile leakage after stenting with a covered self-expanding stent regressed in all 7 patients after 3 (2; 5) days. In 1 patient, bile output through the drainage stopped in 8 days after bilioduodenal stenting with a plastic stent. CONCLUSION: Endoscopic bilioduodenal stenting is always effective and minimally invasive treatment after liver transplantation followed by early biliary complications (failure or stricture of anastomosis). This approach minimizes postoperative complications (9.8%) that do not require surgical intervention (Clavien-Dindo grade I).


Asunto(s)
Enfermedades de las Vías Biliares , Trasplante de Hígado , Masculino , Humanos , Femenino , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Resultado del Tratamiento , Trasplante de Hígado/efectos adversos , Constricción Patológica/diagnóstico , Constricción Patológica/etiología , Constricción Patológica/cirugía , Enfermedades de las Vías Biliares/diagnóstico , Enfermedades de las Vías Biliares/etiología , Enfermedades de las Vías Biliares/cirugía , Stents/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos
7.
Khirurgiia (Mosk) ; (2): 92-95, 2023.
Artículo en Ruso | MEDLINE | ID: mdl-36748875

RESUMEN

Cholelithiasis complicated by cholecystoduodenal fistula and small bowel biliary obstruction is an absolute indication for surgical treatment. Modern possibilities of intraluminal endoscopy (electrohydraulic lithotripsy) made it possible to avoid intra-abdominal access (laparotomy, laparoscopy) and postoperative complications. Finally, rapid rehabilitation was noted.


Asunto(s)
Fístula Biliar , Colelitiasis , Colestasis , Obstrucción Duodenal , Fístula Intestinal , Litotricia , Humanos , Obstrucción Duodenal/diagnóstico , Obstrucción Duodenal/etiología , Obstrucción Duodenal/cirugía , Colelitiasis/complicaciones , Colelitiasis/diagnóstico , Colelitiasis/cirugía , Endoscopía/efectos adversos , Endoscopía Gastrointestinal/efectos adversos , Litotricia/efectos adversos , Fístula Intestinal/diagnóstico , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Fístula Biliar/diagnóstico , Fístula Biliar/etiología , Fístula Biliar/cirugía
8.
Khirurgiia (Mosk) ; (5): 22-30, 2023.
Artículo en Inglés, Ruso | MEDLINE | ID: mdl-37186647

RESUMEN

OBJECTIVE: To develop an effective method for percutaneous endoscopic gastrostomy using gastropexy technology. MATERIAL AND METHODS: We retrospectively analyzed 260 ICU patients with dysphagia associated with neurological disorders between 2010 and 2020. All patients were divided into two groups: the main group (n=50) - percutaneous endoscopic gastrostomy with gastropexy, control group (n=210) - surgery without fixing the anterior wall of the stomach to the abdominal wall. RESULTS. G: Astropexy significantly reduced the incidence of postoperative complications (p=0.045) and severe complications (grade IIIa and higher) (χ2=3.701, p=0.055). Early postoperative complications occurred in 20 (7.7%) patients. Surgery and subsequent treatment were associated with normalization of leukocyte count (p=0.041), C-reactive protein (p=0.024) and serum albumin (p=0.0012). Mortality was similar in both groups. Overall 30-day mortality rate in both groups was 20.8% that was associated with clinical severity of patients. Percutaneous endoscopic gastrostomy was not the direct cause of death in any case. However, complications of endoscopic gastrostomy aggravated the underlying disease in 2.9% of cases. CONCLUSION: Percutaneous endoscopic gastrostomy with gastropexy reduces the incidence of postoperative complications.


Asunto(s)
Trastornos de Deglución , Enfermedades del Sistema Nervioso , Humanos , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/epidemiología , Trastornos de Deglución/etiología , Estudios Retrospectivos , Estómago/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedades del Sistema Nervioso/etiología
9.
Khirurgiia (Mosk) ; (4): 55-60, 2023.
Artículo en Ruso | MEDLINE | ID: mdl-37850895

RESUMEN

OBJECTIVE: To improve treatment outcomes in patients with Klatskin tumor and obstructive jaundice by using of endoscopic bilioduodenal stenting. MATERIAL AND METHODS: There were 1904 transpapillary interventions between August 2017 and February 2022. Endoscopic bilioduodenal stenting was performed in 250 patients including 25 (10%) ones with Klatskin tumor. RESULTS: Bilioduodenal plastic and self-expanding stents were installed in 19 (76%) and 6 (24%) patients, respectively. In Klatskin tumor type I, 11 patients (44%) underwent bilioduodenal stenting of common hepatic duct with plastic stent; 5 (20%) patients with Klatskin tumor type II received self-expanding stents. In case of tumor type IIIA, 3 (12%) patients underwent stenting of the right lobar duct with plastic stent. Four (16%) patients with Klatskin tumor type III B underwent stenting of the left lobar duct. Two 2 (8%) patients with Klatskin tumor type IV underwent bilateral bilioduodenal stenting with plastic and bifurcation self-expanding stents. Peroral cholangioscopy using the SpyGlass DS system was performed in 4 (16%) patients. No intraoperative complications were identified. One (4%) patient developed gastrointestinal bleeding in 2 postoperative days after retrograde intervention that did not require surgery. Moreover, 1 (4%) patient with distal dislocation of plastic bilioduodenal stent required redo bilioduodenal stenting. Three (12%) patients died from multiple organ failure despite adequate biliary decompression, and 22 (88%) patients were discharged in 8±5 days after retrograde intervention. CONCLUSION: Bilioduodenal stenting as minimally invasive and physiological method was highly effective for obstructive jaundice in patients with Klatskin tumor. Peroral cholangioscopy using the SpyGlass system provides effective and safe direct visualization of the biliary tract, as well as biopsy for morphological verification and prescription of chemotherapy in patients with intraductal growth of tumor.


Asunto(s)
Neoplasias de los Conductos Biliares , Colestasis , Ictericia Obstructiva , Tumor de Klatskin , Humanos , Ictericia Obstructiva/diagnóstico , Ictericia Obstructiva/etiología , Ictericia Obstructiva/cirugía , Tumor de Klatskin/complicaciones , Tumor de Klatskin/diagnóstico , Tumor de Klatskin/cirugía , Neoplasias de los Conductos Biliares/complicaciones , Neoplasias de los Conductos Biliares/diagnóstico , Neoplasias de los Conductos Biliares/cirugía , Estudios Retrospectivos , Endoscopía/efectos adversos , Stents/efectos adversos , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colestasis/etiología
10.
Khirurgiia (Mosk) ; (7): 106-112, 2023.
Artículo en Ruso | MEDLINE | ID: mdl-37379413

RESUMEN

The authors present ultrasonography-assisted endoscopic diagnosis of chemical burn of the esophagus. This method early predicted decompensated cicatricial stenosis of the esophagus that was valuable to determine treatment strategy. Preventive mini-invasive endoscopic percutaneous gastrostomy provided adequate enteral nutrition in a patient with decompensated esophageal stenosis before reconstructive surgery.


Asunto(s)
Quemaduras Químicas , Quemaduras , Estenosis Esofágica , Humanos , Quemaduras Químicas/complicaciones , Quemaduras Químicas/diagnóstico , Endosonografía , Estenosis Esofágica/diagnóstico por imagen , Estenosis Esofágica/etiología , Gastrostomía
11.
Khirurgiia (Mosk) ; (11): 63-71, 2023.
Artículo en Inglés, Ruso | MEDLINE | ID: mdl-38010019

RESUMEN

OBJECTIVE: To improve the outcomes in ICU patients with blunt abdominal trauma via enteral therapy by saline enteral solution. MATERIAL AND METHODS: A retrospective and prospective study included 24 patients (18 (75%) men and 6 (25%) women) with blunt abdominal trauma who underwent examination and treatment at the Sklifosovsky Research Institute for Emergency Care. Age of patients ranged from 38 to 81 years (mean 50.1±13.6). RESULTS: Enteral therapy was followed by normalization of serum lactate, alanine aminotransferase and aspartate aminotransferase after 3 days. There were significant differences in decrease of lactate dehydrogenase, alanine aminotransferase and C-reactive protein. In the control group, these parameters decreased only by the 10th day. CONCLUSION: Inclusion of saline enteral solution into the complex therapy contributes to earlier recovery of gastrointestinal function and prevents compartment syndrome. These aspects reduced the number of patients with multiple organ failure.


Asunto(s)
Traumatismos Abdominales , Heridas no Penetrantes , Masculino , Humanos , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Estudios Prospectivos , Estudios Retrospectivos , Alanina Transaminasa , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/terapia , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/terapia
12.
Khirurgiia (Mosk) ; (10): 28-34, 2022.
Artículo en Ruso | MEDLINE | ID: mdl-36223147

RESUMEN

OBJECTIVE: To improve the results of treatment of obstructive jaundice by using of oral cholangioscopy. MATERIAL AND METHODS: There were 321 patients with obstructive jaundice between October 2020 and November 2021. Of these, cholangioscopy (SpyGlass video system) was used in 18 patients. Patients were divided into two groups: group 1 (n=9) - malignant biliary strictures; group 2 (n=9) - choledocholithiasis with large calculi (≥1.2 cm). At admission, all patients underwent laboratory and instrumental examination. In the first group, bilioduodenal stenting with plastic stents 7 and 10 Fr in diameter, 7 to 12 cm long or self-expanding nitinol stents 0.8-1.0 cm in diameter, 6 to 10 cm long was carried out. Patients with large calculi underwent targeted laser lithotripsy under endoscopic control until formation of 1-cm fragments. These fragments were removed using a lithoextraction balloon and Dormia basket. RESULTS: Cholangioscopy (SpyGlass system) was performed within 2 days after admission. In group 1, tumor tissue overgrowths were found during cholangioscopy. Five out of 9 (55.6%) patients underwent bilioduodenal stenting for adequate biliary drainage. Of these, 4 (44.5%) patients developed acute edematous pancreatitis on the first postoperative day. This complication regressed after 3-4 days under therapy. Four (44.5%) patients died from cancer-related multiple organ failure. In group 2, cholangioscopy effectively visualized the calculus and ensured its destruction by laser contact lithotripsy. Intraoperative and postoperative complications were not revealed in both groups. CONCLUSION: SpyGlass system is effective and safe for diagnosis and treatment in 100% of patients with extrahepatic biliary strictures and/or large calculi.


Asunto(s)
Sistema Biliar , Cálculos , Colestasis , Enfermedades del Sistema Digestivo , Ictericia Obstructiva , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Constricción Patológica , Endoscopía del Sistema Digestivo/efectos adversos , Endoscopía del Sistema Digestivo/métodos , Humanos , Ictericia Obstructiva/diagnóstico , Ictericia Obstructiva/etiología , Ictericia Obstructiva/cirugía , Plásticos
13.
Khirurgiia (Mosk) ; (8): 31-37, 2022.
Artículo en Inglés, Ruso | MEDLINE | ID: mdl-35920220

RESUMEN

OBJECTIVE: To improve treatment outcomes in patients with acute pancreatitis through a differentiated approach to transluminal drainage. MATERIAL AND METHODS: There were 1074 patients with acute pancreatitis between January 2018 and December 2021 at the Sklifosovsky Research Institute for Emergency Care. EUS was used as a final diagnostic method to determine localization, dimensions, shape and contours of fluid collections. We also assessed content, presence or absence of a capsule and connection with pancreatic ductal system, possibility of intraluminal drainage under EUS control. A plastic stent with rounded ends was installed if homogeneous hypo- and anechoic cavity with clear even contours was detected. The same measure was applied in case of aspiration of serous or serous-hemorrhagic fluid. The indication for installation of covered self-expanding endoprosthesis was inhomogeneous anechoic fluid collection with hyperechoic inclusions (sequesters) and cloudy purulent content. Patients with necrotic forms underwent insertion of a cystonasal drainage tube 7Fr for sanitation of the cavity with 0.05% aqueous chlorhexidine solution. Endoscopic sequestrectomy was performed every 24-48 hours. Stent was removed in 6 (for encapsulated peripancreatic fluid collections) or 1 month (for other types of fluid collections) after discharge. RESULTS: According to the EUS data, endoscopic TLD was performed in 63 (46%) out of 136 patients with fluid collections. Among 63 patients with TLD, connection with pancreatic ductal system was found in 5 (7.9%) patients. These ones underwent pancreaticoduodenal stenting. Twenty-two patients underwent elective sequestrectomy after stenting of necrotic types of fluid collections with fully covered self-expanding stents. Additional percutaneous drainage was required in 11 (45.8%) of 24 patients. Complicated postoperative period was observed in 4 (6.3%) patients with acute necrotic fluid collections (bleeding from the area of pancreatogenic destruction). Four (6.3%) patients died. Autopsy revealed resolution of purulent-inflammatory process in all patients. CONCLUSION: Intraluminal surgery is possible not only for homogeneous delimited fluid collections, but also for advanced lesions including infected destructions. This approach allows us to consider endoscopic intraluminal drainage as the final minimally invasive method of surgical treatment of pancreatic necrosis. Its effectiveness is up to 45.8%.


Asunto(s)
Drenaje , Pancreatitis Aguda Necrotizante , Enfermedad Aguda , Drenaje/métodos , Endoscopía/métodos , Endoscopía Gastrointestinal , Endosonografía/métodos , Humanos , Necrosis/cirugía , Pancreatitis Aguda Necrotizante/etiología , Stents , Resultado del Tratamiento
14.
Khirurgiia (Mosk) ; (6): 18-26, 2022.
Artículo en Ruso | MEDLINE | ID: mdl-35658132

RESUMEN

OBJECTIVE: To evaluate the efficacy of endoscopic retrograde stenting of the pancreatic duct for acute severe pancreatitis. MATERIAL AND METHODS: We analyzed 94 patients with acute severe pancreatitis who underwent surgery (n=87, 92.6%) and endoscopic retrograde pancreatic stenting (n=28, 29.8%). The first group included 15 patients (16%) after pancreatic duct stenting in aseptic phase of acute pancreatitis. The second group enrolled 13 patients (13.8%) who underwent pancreatic duct stenting in the phase of sequestration and infection. The third group consisted of 66 patients (70.2%) after open surgery without pancreatic duct stenting. RESULTS: In the 1st group, we recanalized the necrosis zone up to distal pancreas via stenting. Infection was detected in 14 out of 15 patients. Surgical treatment was performed in 13 patients (13.8%). In the second group, pancreatic duct stenting was carried out in the phase of infected pancreatitis. We applied stenting to block the area of duct destruction or restore outflow in case of distal defect. No infection was observed in 1 out of 13 patients. Pancreatic duct stenting was not performed in 66 patients of the third group. Surgical treatment was performed in 59 patients (62.8%). In general, 11 of 94 patients (11.7%) were free from infection. CONCLUSION: Better postoperative outcomes were observed in patients with damage to pancreatic duct, pancreatic drainage through percutaneous drains installed at the first stage of treatment. Early pancreatic duct stenting did not lead to significant improvement in treatment outcomes.


Asunto(s)
Pancreatitis , Enfermedad Aguda , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Drenaje/efectos adversos , Humanos , Páncreas , Conductos Pancreáticos/cirugía , Pancreatitis/diagnóstico , Pancreatitis/etiología , Pancreatitis/cirugía , Stents , Resultado del Tratamiento
15.
Khirurgiia (Mosk) ; (7): 19-23, 2022.
Artículo en Inglés, Ruso | MEDLINE | ID: mdl-35775841

RESUMEN

OBJECTIVE: To improve the outcomes after pancreas transplantation complicated by pancreatitis using percutaneous drainage and endoscopic stenting of the main pancreatic duct. MATERIAL AND METHODS: There were 64 transplantations of the pancreatoduodenal complex between January 1, 2012 and December 31, 2021 at the Sklifosovsky Research Institute for Emergency Care. In 11 (17.2%) cases, early postoperative period was complicated by acute pancreatitis and parapancreatic fluid accumulations. Of these, 7 patients underwent ultrasound-guided percutaneous drainage of focal destructions. This procedure was effective and did not require additional treatment. In 4 patients, debridement and drainage were ineffective and required additional endoscopic stenting of the main pancreatic duct. RESULTS: All patients underwent percutaneous drainage of peripancreatic fluid collections and subsequent fistulography. All patients had inhomogeneous cavities with irregular shape and volume of 19.6±1.8 cm3. In 3 (75%) out of 4 patients, there was a passage of contrast agent into the main pancreatic duct of the graft and donor duodenal stump. We did not find contrast enhancement of ductal system in 1 (25%) patient since filling of the cavity with a contrast agent was not tight. Sensitivity of this method for detecting pancreatic ductal defects was 75%. Indications for stenting of the main pancreatic duct were established in 22.5±9.6 days after transplantation. Drainage and debridement were ineffective in 2 (50%) patients. In other 2 (50%) patients, peripancreatic fluid collections enlarged. All patients underwent endoscopic stenting of the main pancreatic duct. CONCLUSION: Endoscopic stenting of the main pancreatic duct of the donor pancreas combined with percutaneous drainage of peripancreatic fluid accumulations is a highly effective and minimally invasive approach for fluid collections after transplantation of the pancreatoduodenal complex. This method also minimizes the incidence of postoperative complications. Thanks to this method, we avoided redo open surgeries in all cases.


Asunto(s)
Trasplante de Páncreas , Enfermedades Pancreáticas , Pancreatitis , Enfermedad Aguda , Colangiopancreatografia Retrógrada Endoscópica , Humanos , Trasplante de Páncreas/efectos adversos
16.
Khirurgiia (Mosk) ; (2): 17-23, 2022.
Artículo en Inglés, Ruso | MEDLINE | ID: mdl-35146995

RESUMEN

OBJECTIVE: To evaluate the effectiveness of intraluminal drainage of acute fluid accumulations for infected pancreatic necrosis. MATERIAL AND METHODS: There were 848 patients with acute pancreatitis between January 2018 and December 2020 at the Sklifosovsky Research Institute for Emergency Care. Necrotizing pancreatitis was detected in 232 (27.4%) patients. Among necrotic forms, pancreatic parenchymal necrosis was detected in 56 (24.1%) patients, its combination with peripancreatic necrosis - in 176 (75.9%) patients. All patients underwent transabdominal ultrasound, CT of the abdomen and retroperitoneal space, esophagogastroduodenoscopy, endo-ultrasonography of pancreatobiliary zone. Dimensions and localization of acute necrotic accumulations were established using ultrasound and CT data. Endoscopic transluminal drainage was performed in 22 patients with necrotizing pancreatitis and fluid accumulations attached to the stomach or duodenum. There were 12 men (55%) and 10 women (45%) aged 48.5 [39; 56] (35; 88) years. Effectiveness of endoscopic treatment was assessed considering clinical, endoscopic data and reduction of fluid accumulations confirmed by ultrasound and CT data. RESULTS: Among 22 patients, connection with pancreatic ductal system was detected in 3 patients (13.6%) that required pancreaticoduodenal stenting. Early postoperative period was complicated by bleeding from the area of pancreatogenic destruction in 4 patients (18.1%). Therefore, angiography and endovascular embolization of a. gastroduodenalis were required in 2 (9.1%) cases. In 1 (4.5%) case, we performed endoscopic hemostasis using Hemoblock hemostatic solution (4 ml). Combination of both methods was used in 1 (4.5%) patient. In 11 (50%) patients, endoscopic drainage was the final method of surgical treatment of necrotizing pancreatitis. Four patients (18.1%) died. Multiple organ failure caused mortality in 3 patients (13.6%). One (4.5%) patient died from severe nosocomial pneumonia developed in 32 days after drainage. Spurs not drained into the stomach with US-confirmed suspension and sequestration were observed in 11 (50%) out of 22 patients. These accumulations required additional ultrasound-assisted percutaneous drainage. CONCLUSION: Endoscopic transluminal drainage is a perspective minimally invasive method for necrotizing pancreatitis.


Asunto(s)
Pancreatitis Aguda Necrotizante , Enfermedad Aguda , Drenaje , Endoscopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Necrosis/etiología , Necrosis/cirugía , Pancreatitis Aguda Necrotizante/diagnóstico , Pancreatitis Aguda Necrotizante/cirugía , Resultado del Tratamiento
17.
Khirurgiia (Mosk) ; (7): 49-56, 2021.
Artículo en Inglés, Ruso | MEDLINE | ID: mdl-34270194

RESUMEN

OBJECTIVE: To develop the indications and assess an effectiveness of treatment of patients with ampullary tumors followed by mechanical jaundice. MATERIAL AND METHODS: There were 26 patients with major duodenal papilla neoplasms for the period 2015-2020 at the Sklifosovsky Research Institute for Emergency Care. RESULTS: Twenty patients underwent transpapillary interventions: papillosphincterotomy followed by lithoextraction and bilio-duodenal stenting in 4 (15.3%) patients, bilio-duodenal stenting in 12 (46.1%) patients, nasobiliary drainage in 2 (7.6%) patients, pancreaticoduodenal stenting in 2 (7.6%) patients. Percutaneous transhepatic microcholecystostomy was performed in 6 (23.4%) patients. In all cases, laboratory values decreased in 5-7 days after drainage. Eight (30.7%) patients refused further surgical treatment and were discharged in satisfactory condition. Another 8 (44.5%) patients underwent endoscopic submucosal papillectomy. There were no postoperative complications. Patients were discharged after 5-7 days. Four (22.2%) patients underwent tumor resection via laparotomy. One of these patients required redo laparotomy in postoperative period due to acute perforated duodenal ulcer. Six (33.3%) patients underwent palliative bilio-duodenal stenting. CONCLUSION: Invasion of muscle layer or distal parts of the common bile duct, as well as abnormal vascularization are indications for open surgery or palliative endoscopic treatment. Tumor location within mucous and muscle layers without invasion of distal third of the common bile duct and no abnormal vascularization of tumor justify endoscopic papillectomy. Endoscopic approach can be considered as a final minimally invasive method with minimal risk of postoperative complications in case of benign ampullary tumor.


Asunto(s)
Ampolla Hepatopancreática , Neoplasias del Conducto Colédoco , Neoplasias Duodenales , Ictericia Obstructiva , Ampolla Hepatopancreática/cirugía , Neoplasias del Conducto Colédoco/complicaciones , Neoplasias del Conducto Colédoco/diagnóstico , Neoplasias del Conducto Colédoco/cirugía , Neoplasias Duodenales/complicaciones , Neoplasias Duodenales/diagnóstico , Neoplasias Duodenales/cirugía , Humanos , Ictericia Obstructiva/diagnóstico , Ictericia Obstructiva/etiología , Ictericia Obstructiva/cirugía , Resultado del Tratamiento
18.
Khirurgiia (Mosk) ; (3): 20-25, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33710822

RESUMEN

OBJECTIVE: To report initial experience of endoscopic transluminal drainage of infected pancreatic necrosis. MATERIAL AND METHODS: There were 8 patients with acute severe pancreatitis and large-focal pancreatic necrosis who underwent transluminal drainage of destruction zones for the period from December 2018 to October 2019. RESULTS: Transluminal drainage of pancreatogenic destruction zones in acute severe pancreatitis can be considered as the only surgical approach in 50% of cases that is comparable with literature data.


Asunto(s)
Endoscopía , Pancreatitis Aguda Necrotizante , Drenaje , Endoscopía/métodos , Humanos , Necrosis/etiología , Necrosis/cirugía , Páncreas/patología , Páncreas/cirugía , Pancreatitis Aguda Necrotizante/diagnóstico , Pancreatitis Aguda Necrotizante/cirugía , Resultado del Tratamiento
19.
Khirurgiia (Mosk) ; (11): 32-36, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-33210505

RESUMEN

OBJECTIVE: To evaluate an efficacy of surgical treatment of patients with benign tumors of the major duodenal papilla. MATERIAL AND METHODS: For the period from January 2015 to January 2020, sixteenth patients with benign tumors of the major duodenal papilla were treated at the Sklifosovsky Research Institute for Emergency Care. There were 7 men (43.7%) and 9 women (56.3%). Tumor dimension ranged from 1.0 to 4.0 cm (mean 2.5 cm). RESULTS AND DISCUSSION: Tumor resection through laparotomy was performed in 4 (25%) patients. Six (37.5%) patients underwent endoscopic submucosal papillectomy. Other 6 (37.5%) patients refused surgical treatment due to regression of symptoms. Postoperative re-laparotomy was performed in 1 patient (10%) with acute perforated duodenal ulcer. There were no complications after endoscopic papillectomy. Control endoscopic examination identified no signs of tumor recurrence in all patients after 3 and 6 months. In our opinion, endoscopic papillectomy is preferable for adenoma of the major duodenal papilla due to reduced surgical trauma. We assume that stenting of the bile ducts and the major pancreatic duct prevented acute pancreatitis and obstructive jaundice. CONCLUSION: Endoscopic papillectomy is an effective minimally invasive treatment of tumors of the major duodenal papilla. Despite a considerable number of complications, most of them can be resolved by conservative treatment or endoscopic procedures. Thus, endoscopic papillectomy may be considered as preferable method in the treatment of patients with benign tumors of the major duodenal papilla.


Asunto(s)
Ampolla Hepatopancreática , Neoplasias del Conducto Colédoco , Pancreatitis , Enfermedad Aguda , Ampolla Hepatopancreática/cirugía , Neoplasias del Conducto Colédoco/diagnóstico , Neoplasias del Conducto Colédoco/cirugía , Duodenoscopía , Femenino , Humanos , Masculino , Pancreatitis/etiología , Pancreatitis/prevención & control , Reoperación , Resultado del Tratamiento
20.
Khirurgiia (Mosk) ; (4): 61-64, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32352670

RESUMEN

A 93-year-old patient underwent endoscopic treatment of perforated duodenal ulcer after previous laparoscopic suturing complicated by failure of sutured defect. A self-expanding nitinol stent with partial polyurethane coating was used. Positive effect of the treatment was noted. Further study of this method and its clinical introduction in case of favorable results can significantly reduce the incidence of complications and mortality in patients with perforated gastroduodenal ulcers.


Asunto(s)
Úlcera Duodenal/cirugía , Úlcera Péptica Perforada/cirugía , Anciano de 80 o más Años , Aleaciones , Materiales Biocompatibles Revestidos , Duodenoscopía , Gastroscopía , Humanos , Laparoscopía/efectos adversos , Poliuretanos , Implantación de Prótesis , Reoperación , Stents Metálicos Autoexpandibles , Técnicas de Sutura/efectos adversos
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