COMPARISON OF HARTMANN'S PROCEDURE VERSUS RESECTION WITH PRIMARY ANASTOMOSIS IN MANAGEMENT OF LEFT SIDED COLON CANCER OBSTRUCTION: A PROSPECTIVE COHORT STUDY.

The aim of our prospective study is to compare and analyze the results of two treatment methods of left-sided malignant colon obstruction: Hartmann's procedure (HP) and Resection with primary anastomosis (RPA). 90 Patients with diagnosis of left-sided malignant colon obstructions were enrolled in this study. The patients were assigned into two groups: Hartmann's procedure (HP) group and Resection and Primary anastomosis group (RPA). Several clinical characteristics were determined and compared between the groups: hospital stay days, duration of the surgery, postoperative complications (during 30 days after surgery) and mortality was assessed. 37 patients were enrolled in the Hartmann's procedure (HP) group and 53 patients were enrolled in the Primary anastomosis (RPA) group and had undergone different types of colon resections with primary anastomosis. There was 1mortality in HP group and 1 in RPA group. In RPA group, there were 7 complications (13.2%). 1 intraabdominal abscess after colorectal anastomosis, which was cured with antibiotic therapy and percutaneous drainage; 5 cases of wound infections, 1- leak of colorectal anastomosis and in Hartmann's procedure group there were 8 (21.6%) complications (7 - wound infections, 1-necrosis of colostomy). But this difference is not statistically reliable (p=0.110). In stenting RPA stay were - 6 days and in HP group, it was 8 days. This difference is statistically reliable (P=0.02). In case of left-sided malignant colon obstructions, Primary anastomosis intervention should be preferred, rather than Hartmann's procedure. In the future it's needed to perform the randomized trials, which will study the long-term outcomes (recurrence of cancer, survival rate) of this treatment method.

COMPARISON OF THE PATIENT-CONTROLLED EPIDURAL AND INTRAVENOUS ANALGESIA AFTER OPEN COLORECTAL SURGERY: A RANDOMIZED CONTROLLED TRIAL.

The goal of this study was to evaluate the efficacy of two common analgesic techniques: patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (IVPCA) in patients undergoing open colorectal surgeries. 130 patients were randomized in two groups: group I - n=65 (27 males, 38 females, age range 23-75) - whose postoperative period and pain was managed with PCEA; group II - n=65 (31 male, 34 female, age range 23-75) - whose postoperative period and pain was managed with IVPCA. There were no significant differences by demographic and preoperative factors between the groups. The study demonstrates, that both analgesia techniques in colorectal surgery patients, IVPCA and PCEA, resulted in high levels of satisfaction (as reflected by a median score of 4 on the 1-5 scale), and provided effective management of postoperative pain. There were no differences in the pain scores on the postoperative visual analogue scales, analgesic requirements and satisfaction score between groups. This indicates that IVPCA and Epidural PCA are equally effective to control the postoperative pain after open colorectal surgery.

ENHANCED RECOVERY AFTER SURGERY VS TRADITIONAL CARE IN ELECTIVE COLORECTAL SURGERY: A RETROSPECTIVE COHORT STUDY.

The objective and the goal of this study was to determine how ERAS guidelines affected on hospital stay days and other complications rates in case of elective colorectal surgery in our clinic, compared to traditional care methods. First of all, all team members including surgeons, anesthetists, nurses were being trained in ERAS guidelines principals during two months and we started active implementation process after this. 87 patients, who were needed to be done colorectal surgery treatment, were actively treated according to ERAS guidelines and these patients were gathered in experimental group. At the same time, we started to collect data retrospectively from last 2 years elective colorectal surgery cases and sorted them according to preoperative, intraoperative surgical and anesthesia data, postoperative analgesia, all type of complications. 120 patients were placed in traditional care group (control group). In traditional care group open colorectal surgery was associated with long length of stay 8-10 days. High rates of surgical site infection-24.2%, readmission rate during 30 days-30.8%, PONV-44.2%, respiratory complication-6.7%, deep vein thrombosis-3.3%, urinary retention-2.5%, prolonged postoperative ileus 16.7%. We included 87 patients in ERAS care group during 2 years. In this group our study showed big reduction of hospital stay days and it was average 5 days. Compared to traditional care group incidence of respiratory complications was 0, postoperative PONV- 6.9%, postoperative ileus-5.7%, deep vein thrombosis-0, urinary retention-0, readmission rate-0, surgical site infection-3.4%.

Comparison of intravenous pantoprazole with intravenous ranitidine in peptic ulcer bleeding.

Following successful endoscopic therapy in patients with peptic ulcer bleeding, rebleeding occurs in 4% to 30% of cases. Rebleeding remains the most important determinant of poor prognosis. The aim of our study is to compare the efficacy of intravenous pantoprazole and ranitidine for prevention of rebleeding of peptic ulcers following initial endoscopic hemostasis. In our study patients who had gastric or duodenal ulcers with bleeding received combined endoscopy therapy with injection of epinephrine and thermocoagulation. Patients with initial hemostasis were randomly assigned to two groups. One group (45 patients) was treated with intravenous pantoprazole, with an initial dose of 40 mg and subsequently with 40 mg every twelve hours during the first three days, followed by 40 mg a day orally. The other group (44 patients) was treated with intravenous ranitidine, with an initial dose of 50 mg and subsequently every eight hours during the first three days, followed by 150 mg ranitidine every 12 h. In all case of rebleeding repeated endoscopy was performed. One patient (2,2%) had rebleeding in pantoprazole group. Bleeding could not be blocked by repeated endoscopic intervention, thus the patient underwent emergency surgery. 6 patients (13,6%) from ranitidine group had recurrence of bleeding. Repeated endoscopy was performed in all these patients: bleeding was stopped in 3 cases endoscopically, other 3 patients were surgically treated urgently as endoscopic hemostasis was not successful. None of the patients died of uncontrolled rebleeding. The frequency of rebleeding was significantly low in the group of pantoprazole compared to ranitidine group (2,2% vs 13,6% P=0,046). There were no statistically significant differences between the groups with regard to need for emergency surgery (2,2% vs 6,8%), the length of hospital stay (6,7±3,3 vs 7,4±4,3 d) and mortality (0%vs 0%). After endoscopic treatment of bleeding peptic ulcers, intravenous pantoprazole is more effective than ranitidine for the prevention of rebleeding.

[The biliary intestinal obstruction].

The successful experience of treatment of 3 patients with biliary intestinal obstruction is depicted. The most informative means of diagnostics was the multispiral computed tomography. Authors state, that the volume of the operation should include only the liquidation of the intestinal obstruction. The simultaneous biliodigestive fistulae closure should be performed only in rare situations.

Comparison of Lichtenstein and laparoscopic transabdominal preperitoneal repair of recurrent inguinal hernias.

The aim of our study was the comparative analysis of the results of two surgical methods: tension-free repair by the Lichtenstein technique and laparoscopic transabdominal preperitoneal (TAPP) repair. In total 52 patients with recurrent inguinal hernia were randomly assigned to the two groups: Lichtenstein (28 patients) and TAPP (24 patients). Comparisons between these groups were done by several preoperative, intraoperative, and postoperative factors. For postoperative factors both short-term and long-term results were considered. Average operation time for Lichtenstein group was 59.6 +/- 9.9 minutes, compared with 64.4 +/- 8.4 minutes for TAPP patients (P = 0.068). In TAPP patients there was less pain in the postoperative period (P = 0.002) and fewer sick-leave days (13.4 +/- 1.7 versus 17.5 +/- 2.6 days; P < 0.001) and, correspondingly, faster recovery. In the Lichtenstein group a total of 4 postoperative complications (infection, hematoma, seroma, urinary retention) were observed, compared with 8 in the TAPP group (P = 0.19). Statistically significant difference was only by urinary retention (0 for Lichtenstein, 4 for TAPP; P = 0.039). There were no cases of hernia recurrence observed during the followup. Chronic pain developed in 5 patients from the Lichtenstein group (17.9%) and 2 patients from the TAPP group (8.3%; P = 0.28) more than 1 year after the operation; 4 Lichtenstein patients (14.3%) and 1 TAPP patient (4.2%; P = 0.23) more than 2 years after the operation; and 3 Lichtenstein patients (10.7%) and 1 TAPP patient (4.2%; P = 0.36) more than 3 years after the operation. For the treatment of recurrent inguinal hernias, which are developed after use of conventional (nonmesh) methods, the first choice should be given to the laparoscopic method, especially for young, physically active, nonobese patients, and if there are any contraindications for the laparoscopy, the Lichtenstein approach should be recommended.

[Comparative evaluate of methods of placement of polypropylene meshes in alloplastic of incisional hernias].

Treatment results in 107 patients with incisional hernias were analyzed. All patients undergoing abdominal wall grafting with use of cellular polypropylene implant. Patients were divided into 2 groups. 57 patients operated according alloplastic method sublay formed the first group, 50 patients operated by method onlay formed the second group. Frequency of local wound postoperative complications and hernia relapses were taken into account for comparative evaluation of surgical treatment results. Hernia relapses investigated in 51 patients from the first group and in 44 patients from the second group. Basing on the authors' data method sublay are accompanied by local wound complications (infiltration, suppuration, seroma, haematoma) in 12,3% of observations, method onlay - in 28% (x(2)=4,17, p=0,04). In the first group hernia relapse developed in 1 patient (2%), in the second group - in 3 patients (6,8%) (x(2)=1,43, p=0,23). Authors consider that treating median incisional hernias by using diverse alloplastic methods preference should be given to sublay method.

[Experience in treatment of postoperative ventral hernias].

Treatment results in 193 patients with medium and large postoperative ventral hernias were analyzed. All patients were divided into 2 groups. 66 patients operated according to autoplastic methods formed the control group. 127 patients undergoing abdominal wall grafting with use of cellular polypropylene implant formed the main group. Sublay method was used in 48 patients, onlay--in 38 patients, Rives-Stoppa method--in 41 patients. Frequency of local wound postoperative complications and hernia relapses were taken into account for comparative evaluation of surgical treatment results. Hernia relapses developed in 56 patients from the control group and in 115 patients from the main group. Basing on the authors' data autoplastic methods are accompanied by local wound complications (infiltration, suppuration, seroma, haematoma) in 7.9% of observations, alloplastic methods--in 22.8% (chi2 = 6.36, p<0.05). In the control group hernia relapse developed in 18 patients (32.1%), in the main group--in 6 patients (5.2%) (chi2 = 22.63, p<0.001). Hernia relapse was revealed when using onlay method in 8.6% of observations, Rives-Stoppa--in 5.4%, sublay--in 2.3% of observations (chi2 = 1.53, p>0.05). Authors consider that it is necessary to use diverse alloplasic methods treating median postoperative hernias of medium and big sizes. Preference should be given to sublay method.

[Application of lectin for studying of the erythrocytes membranes changes in an acute mechanical intestinal obstruction].

Osmoresistance and the erythrocytes membranes deformity were studied in 62 patients, suffering an acute mechanical ileus, using lectin LPM. The lowering of indices, comparing with such in normal conditions, was established. While applying lectin, in tumoral ileus, in difference with nontumoral affection, the reduction of the erythrocytes membranes deformity was trustworthy (P < 0.01). In favourable course of postoperative period osmoresistance and deformity had approximated to normal values; in purulent complications occurrence the indices values had become poorer, these changes were strictly revealed using lectin. The method may be used for estimation of the treatment efficacy and the disease course prognosis.

Erratum to: The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections.

[This corrects the article DOI: 10.1186/s13017-017-0141-6.].

[HLA antigens and the process of operative wound healing].

Association of HLA antigens with wound healing process was investigated in Georgian patients. Based on the peculiarities of the wound healing process dynamics, two groups of patients have been distinguished. The first group included 22 patients with primary intention of the operative wounds, while the second group included 30 patients with complicated course of the wound healing process. Control group was comprised by 492 healthy persons. Our study showed that the distribution of HLA antigens is different in these groups. The genetically determined risk of development of wound complications was significantly higher in individuals with HLA-DR1 having the relative risk 3,56.

[Use of lectin for detection of changes of erythrocytic osmotic resistance and deformity in acute advanced peritonitis]. / Primenenie lektina dlia vyiavleniia izmenenii osmorezistentnosti i stepeni deformatsii éritrotsitov pri ostrom rasprostranennom peritonite.

Thirty-one patients with acute general peritonitis were studied. Lectin (LPM) demonstrated an additional peak on kinetic curves of erythrocytic osmolysis in patients with acute general peritonitis. Deformity of erythrocytes had a tendency to decrease (p > 0.05), but in the presence of LPM this difference increased sharply (p < 0.001). On day 7 after surgery in case of a favorable outcome the peak decreased or disappeared, deformity of erythrocytes also disappeared. It is important for diagnosis and prognosis.