RESUMEN
Among all patients with gastric cancer, 40% admit to the hospitals due to cancer-related complications. The most common complications of gastric cancer are bleeding (22-80%), malignant gastric outlet obstruction (26-60%), and perforation (less than 5%). The main treatment methods for gastric cancer complicated by bleeding are various forms of endoscopic hemostasis, transarterial embolization and external beam radiotherapy. Surgical treatment is possible in case of ineffective management. However, surgical algorithm is not standardized. Malignant gastric outlet stenosis requires decompression: endoscopic stenting, palliative gastroenterostomy. Surgical treatment is also possible (gastrectomy, proximal or distal resection of the stomach). The main problem for patients with complicated gastric cancer is the lack of standardized algorithms and abundance of potential surgical techniques. The aim of our review is to systematize available data on the treatment of complicated gastric cancer and to standardize existing methods.
Asunto(s)
Obstrucción de la Salida Gástrica , Estenosis Pilórica , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/cirugía , Gastroenterostomía/efectos adversos , Obstrucción de la Salida Gástrica/complicaciones , Obstrucción de la Salida Gástrica/cirugía , Estenosis Pilórica/cirugía , Constricción Patológica/cirugía , Stents/efectos adversos , Cuidados Paliativos/métodosRESUMEN
The authors summarize the world experience in the management of patients with penetrating abdominal wounds. A gradual transition from the concept of «mandatory laparotomy¼ to selective management and active-expectant approach in appropriate cases is described.
Asunto(s)
Abdomen , Heridas Penetrantes , Humanos , Laparotomía , Heridas Penetrantes/diagnóstico , Heridas Penetrantes/cirugíaRESUMEN
OBJECTIVE: To analyze the capabilities of laparoscopy in the diagnosis and treatment of atypical diseases. MATERIAL AND METHODS: Laparoscopy was performed in 5188 patients with established, suspected and unclear diagnosis of acute surgical diseases for the period from 2008 to 2018. Rare atypical diseases were diagnosed in 114 (2.2%) patients. These diseases simulated established and suspected clinical diagnoses in 100 (87.7%) cases, and the diagnosis was unclear in 5 (4.4%) cases. In 9 (7.9%) patients, atypical diseases were concomitant. In 7 cases, atypical diseases competed with the underlying disease and required emergency surgery. Conservative treatment was required in 2 cases. Seventy (61.4%) patients with atypical diseases needed emergency surgery, and 44 (38.6%) patients required conservative treatment. Laparoscopic operations were performed in 61 (87.1%) patients including simultaneous procedures in 8 cases and video-assisted interventions in 2 (2.9%) patients. Laparotomy was applied in 7 (10.0%) patients. RESULTS: Histological examination confirmed laparoscopic diagnosis in 66 out of 68 specimens. Cells of mucus-forming adenocarcinoma were detected in one resected epiploic appendix, carcinomatosis - in one segment of resected omentum. CONCLUSION: Video-assisted laparoscopy was valuable to establish a diagnosis and determine surgical strategy, detect competing and concomitant diseases, perform operations including simultaneous procedures.
Asunto(s)
Laparoscopía , Enfermedades Raras/diagnóstico , Enfermedades Raras/cirugía , Neoplasias Abdominales/cirugía , Apéndice/cirugía , Tratamiento Conservador , Urgencias Médicas , Humanos , Laparotomía , Epiplón/cirugía , Cirugía Asistida por VideoRESUMEN
OBJECTIVE: To evaluate the possibility and safety of modified endoscopic stent in the treatment of benign intestinal fistulas. MATERIAL AND METHODS: Analysis of the experience of Sklifosovsky Research Institute for Emergency Care and recent numerous foreign reports confirms that staged treatment followed by delayed radical surgery is the most perspective approach. Modified endoscopic treatment of intestinal fistulas successfully used in 10 patients is reported in the article. RESULTS: Endoscopic stenting of various parts of gastrointestinal tract is a minimally invasive treatment of this pathology and not followed by complications and mortality. An important advantage is early closure of fistula that reduces duration of treatment and improves further social and labor rehabilitation of patients.
Asunto(s)
Fístula Intestinal/cirugía , Endoscopía , Humanos , Fístula Intestinal/etiología , Implantación de Prótesis , Stents , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the possibilities of laparoscopy in the diagnosis and treatment of acute abdominal surgical diseases. MATERIAL AND METHODS: A retrospective analysis of laparoscopic procedures in 4655 patients with confirmed or suspected acute abdominal surgical diseases for the period 2008-2017 was performed. Laparoscopy was applied to confirm or to determine unclear diagnosis. RESULTS: Diagnosis was established and confirmed in 4526 (97.2%) patients. Advisability of laparoscopic surgery was confirmed in 3091 (68.3%) patients, laparotomy - in 491 (10.8%) patients. Surgical treatment was not required in 944 (20.9%) patients. Laparoscopic procedures were performed in 3050 (98.7%) patients, 41 (1.3%) patients required conversion to laparotomy. Laparoscopic approach failed to define diagnosis in 129 (2.8%) patients that required conversion to diagnostic laparotomy. CONCLUSION: Laparoscopic was valuable to establish the diagnosis and determine surgical strategy, diagnose concomitant diseases, perform operations including simultaneous ones.
Asunto(s)
Abdomen Agudo/diagnóstico , Abdomen Agudo/cirugía , Abdomen/cirugía , Laparoscopía , Enfermedad Aguda , Conversión a Cirugía Abierta , Urgencias Médicas , Humanos , Laparotomía , Estudios RetrospectivosRESUMEN
AIM: To present treatment of patients with ileocecal intussusception. MATERIAL AND METHODS: There were 3 patients with ileocecal intussusception for the period from June 2016 to August 2017. CONCLUSION: Abdominal sonography is main diagnostic method for intestinal intussusception. X-ray examination including contrast-enhanced irrigography gives more complete information about suspected intussusception. It is necessary to differentiate intestinal intussusception from other diseases accompanied by abdominal pain, vomiting, bloody discharge from rectum, abdominal neoplasm. Minimally invasive laparoscopic approach is advisable for diagnosis and treatment of intestinal intussusception.
Asunto(s)
Enfermedades del Íleon/diagnóstico por imagen , Válvula Ileocecal/diagnóstico por imagen , Intususcepción/diagnóstico por imagen , Medios de Contraste , Humanos , Enfermedades del Íleon/cirugía , Válvula Ileocecal/cirugía , Intususcepción/cirugía , Laparoscopía , UltrasonografíaRESUMEN
AIM: To develop medical algorithms for reduction of morbidity and mortality in rare forms of mechanical intestinal obstruction. MATERIAL AND METHODS: 17 patients with mechanical intestinal obstruction have been operated in Sklifosovsky Research Institute for Emergency Care for the period 2010 - 2016. There were 13 women and 4 men aged 56 (44,5-74,5) years on the average. Phytobezoar was detected in 7 patients (41.2%), tumor in 7 patients (41.2%) and gallstone ileus in 3 patients (17.6%). RESULTS: There were no complications in group 1. In group 2 postoperative complications occurred in 3 patients: gastrocnemius vein thrombosis followed by successful medication (Clavien-Dindo type II), abdominal abscess drained under ultrasonic control (Clavien-Dindo type IIIa) and 1 (8.3%) death (Clavien-Dindo type V). Postoperative mortality in group 2 was 8.3%. CONCLUSION: Despite small sample size and no statistically reliable results the advantages of minimally invasive access are obvious. However, further trials are required to ensure the reliability of the results.
Asunto(s)
Obstrucción Intestinal/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos , Adulto , Anciano , Algoritmos , Femenino , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/mortalidad , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Reproducibilidad de los ResultadosRESUMEN
It was analyzed the results of surgical treatment of 118 patients with stomach cancer. Lymphadenectomy and gastrectomy were done in all cases. All patients were divided into two groups. Gastrectomy and splenectomy were performed in the first group, gastrectomy with preservation of spleen was done in the second group. It was revealed that splenectomy is not an independent prognostic factor influencing on prolonged survival of patients with stomach cancer. Preservation of spleen permits to reduce the number of early postoperative complications.