ABSTRACT
AIM: To evaluate technology, indications and time of minimally invasive semi-closed and laparotomic sanations for infected pancreatic necrosis (IP). MATERIAL AND METHODS: Initially it was used sonography-assisted minimally invasive semi-closed drainage of IP with gradual augmentation of catheters' diameter. In 462 patients with IP liquid pus prevailed over sequesters in epigastric localized pancreatonecrotic phlegmon (ELPF) and pancreatonecrotic abscesses. So, minimally invasive approach may be definitive. Epigastric advanced pancreatonecrotic phlegmon with predominant sequesters is often followed by conversion to transverse omentobursopancreatostomy (OBPS) to open all purulent accumulations. RESULTS: Surgical treatment immediately after parapancreatic infiltrate suppuration (i.e. within 3-4 weeks after onset of the disease) is associated with reduced mortality. Absent result of minimally invasive drainage is followed by mortality from the 11th day and maximum in 14 days after treatment onset. Therefore, focal IP resistant to minimally invasive drainage requires conversion to transverse OBPS or video-assisted sequestrectomy after 10-13 days. The lowest mortality (14.8±2.5%) was observed in patients who underwent minimally invasive drainage or transverse OBPS within 10-13 days. Ineffective prolonged minimally invasive drainage was accompanied by high mortality rate (60.7±3.2%, p<0.001). CONCLUSION: Conversion to transverse OBPS or video-assisted sequestrectomy are required if minimally invasive drainage of IP is ineffective after 10-13 days. Clear understanding of indications for closed and open drainage of PI helps to avoid tactical and technological errors.
Subject(s)
Abdominal Abscess/surgery , Intraabdominal Infections/surgery , Pancreatitis, Acute Necrotizing/surgery , Suppuration/surgery , Abdominal Abscess/etiology , Cellulitis/etiology , Cellulitis/surgery , Conversion to Open Surgery , Drainage/methods , Humans , Intraabdominal Infections/etiology , Minimally Invasive Surgical Procedures , Pancreatitis, Acute Necrotizing/complications , Suppuration/therapy , Time Factors , Treatment OutcomeABSTRACT
AIM: to improve the results of advanced peritonitis management. MATERIAL AND METHODS: 743 patients with advanced peritonitis were studied. Patients were divided into 2 groups depending on treatment strategy. RESULTS: Programmed relaparotomy combined with removable draining musculoaponeurotic seams during laparotomy closure decreased mortality from 47.8±2.7% to 24.1±2.3% (p<0.001) and provided 4-fold reduction of postoperative suppuration incidence (p<0.001). Refusal from removable draining musculoaponeurotic seams and use of only cutaneous seams in persistent abdominal hypertension were associated with further decrease of mortality to 15.8±2.7% (p<0.05). CONCLUSION: Programmed relaparotomy combined with removable draining musculoaponeurotic seams are advisable for advanced peritonitis management. Laparotomy closure with only cutaneous seams is indicated in case of persistent abdominal hypertension. Large eventration always requires abdominal wall repair. APACHE-III scale scores have significant prognostic value in patients with advanced peritonitis.
Subject(s)
Abdominal Wound Closure Techniques/standards , Laparotomy , Multiple Organ Failure , Peritoneal Lavage , Peritonitis/surgery , Postoperative Complications , Reoperation , Sepsis , Adult , Aged , Female , Humans , Laparotomy/adverse effects , Laparotomy/methods , Male , Middle Aged , Multiple Organ Failure/etiology , Multiple Organ Failure/mortality , Multiple Organ Failure/prevention & control , Outcome and Process Assessment, Health Care , Peritoneal Lavage/adverse effects , Peritoneal Lavage/methods , Peritonitis/diagnosis , Peritonitis/mortality , Peritonitis/physiopathology , Postoperative Complications/mortality , Postoperative Complications/prevention & control , Prognosis , Reoperation/adverse effects , Reoperation/methods , Reoperation/mortality , Retrospective Studies , Russia/epidemiology , Sepsis/etiology , Sepsis/mortality , Sepsis/prevention & controlABSTRACT
The article presents the follow-up study of 254 onco-proctologic patients after reconstructive abdominoperitoneal resections. Patients were divided into 4 statistically homogeneous groups (2 main and 2 control groups). A comparative analysis of middle and lateral laparotomy wounds healing was made. Laparotomy wounds were stitched up using conventional method (in layers, tightly) and using other method of prolonged flow-aspiration drainage of hypodermic tissue. Postoperative wound infections were noted in 11.4% patients in case of conventional means. The prolonged flow-aspiration drainage in laparotomy wounds causes only 1.5% of complications.
Subject(s)
Abdominal Wound Closure Techniques/adverse effects , Colonic Diseases/surgery , Drainage/methods , Surgical Wound Infection/prevention & control , Colostomy/methods , Comparative Effectiveness Research , Female , Humans , Laparotomy/methods , Male , Middle Aged , Prospective Studies , Russia , Suction/methods , Treatment OutcomeABSTRACT
In oncologic coloproctologic patients the comparative cytological analysis of wound secretion in healing midline laparotomy wounds was implemented. The wounds were taken in common way (layer-by-layer tightly) and with prolonged flow aspiration drainage of subcutaneous cellular tissue. It is proved that application of prolonged flow aspiration drainage effects positively on regeneration process and objectively reflects more benevolent course of healing of laparotomy wounds. In the end, this mode decreases number of festering from 7.3% in control group to 1.6% in main group (p < 0.05).
Subject(s)
Drainage/methods , Neoplasms/surgery , Postoperative Care , Wound Healing , Aged , Body Fluids/metabolism , Female , Humans , Laparotomy/adverse effects , Male , Middle Aged , Neoplasms/complications , Neoplasms/pathology , Postoperative Complications/therapy , Wounds and Injuries/pathologyABSTRACT
One of frequent postoperative complications of cylindrical extralevatory extirpation of the rectum is suppuration of a perineal wound. It is possible to reduce to a minimum or to prevent completely this complication by application of the passive prolonged drainage of a perineal wound.
Subject(s)
Digestive System Surgical Procedures/methods , Drainage , Rectal Neoplasms/surgery , Rectum/surgery , Surgical Wound Infection/prevention & control , Adult , Aged , Female , Humans , Male , Middle Aged , Perineum , Russia , Surgical Wound Infection/microbiology , Surgical Wound Infection/therapy , Suture Techniques , Time Factors , Treatment Outcome , Wound HealingABSTRACT
In two statistically uniform groups of observation of oncocoloproctological patients a comparative analysis was made of healing median laparotomy wounds sutured traditionally (layerwise, hermetically) and with irrigating prolonged drainage of the subcutaneous fat. Traditional suturing of the wounds was followed by suppuration in 66%, while in laparotomy wounds where irrigating prolonged drainage was used there were no cases of suppuration.
Subject(s)
Colectomy/adverse effects , Colorectal Neoplasms/surgery , Drainage/methods , Laparotomy/adverse effects , Surgical Wound Infection/therapy , Therapeutic Irrigation/methods , Wound Healing , Female , Humans , Male , Middle Aged , Treatment OutcomeSubject(s)
Aprotinin/therapeutic use , Fibrinogen/therapeutic use , Lymph Node Excision/adverse effects , Lymph Node Excision/methods , Lymphatic Vessels/injuries , Postoperative Complications/prevention & control , Rectal Neoplasms/surgery , Thrombin/therapeutic use , Abdominal Cavity , Collagen/therapeutic use , Drug Combinations , Hemostasis, Surgical/methods , Humans , Lymph , Postoperative Complications/etiology , Prospective Studies , Rectal Neoplasms/pathology , Tissue Adhesives/therapeutic use , Treatment OutcomeABSTRACT
Clinico-instrumental investigations and experimental studying of the regeneration of laparotomy wounds sutured by removable draining aponeurotic and muscular-aponeurotic sutures have shown less pronounced course of aseptic inflammation in the wounds. It has been established that the removable aponeurotic sutures substantially decrease the frequency of postoperative suppurations of laparotomy wounds in patients operated on the colon mainly for colorectal carcinoma. The original authors' sutures provide the formation of a cicatrix of the laparotomy wound by the 20th day of the postoperative period and completely prevent the appearance of ligature fistulas.
