[Complications after Hartman's operation].

Results of treatment of 145 patients with acute diseases of colon's right half are analyzed. Hartman's operation was performed at all the patients: original Hartman's operation -- at 83 patients, left-sided hemicolectomy like Hartman's operation -- at 42, and combined Hartman's operation -- at 20. Various complications were seen at 51% cases; insufficiency of rectum distal stump and paracolostoma complications were the main of them. Postoperative lethality was 6,9% (10 of 145 operated patients died). All the complications were classified on laparotomic wound, paracolostomic, intraabdominal and extraabdominal complications.

[The method of choice for surgical treatment of intestinal obstruction in colon cancer]. / Vybor metoda khirurgicheskogo lecheniia obturatsionnoi neprokhodimosti pri opukholiakh obodochnoi kishki.

The authors present the results of surgical treatment of 326 patients with cancer of the colon complicated by occlusive intestinal obstruction. Three degrees of colon passage disorders were distinguished. Surgical policy depended on location of the tumor, degree of the obstruction, severity of general state and concomitant diseases. General postoperative lethality was 13% (43 of 326 operated patients died). Resection of the colon and subtotal colectomy with one-stage intestinal reconstruction may be recommended for patients with compensated stage of intestinal obstruction and stable general state.

[Undeveloped high intestinal fistulas as an urgent problem of modern surgery]. / Nesformirovavshiesia vysokie kishechnye svishchi kak aktual'naia problema sovremennoi khirurgii.

Eighty-two cases of un formed high intestinal fistulas are analyzed. Degree of non-formation and volume of chymus loss are the main criteria determining treatment policy. Early surgery (one or two-sided switching of fistulas zone) is indicated in intestinal loss more then 600-700 ml per day or in complete fistula. Mezonnes surgery was un effective in the majority of cases. Special policy including trunk vagotomy, antrumectomy and plastic repair of the duodenal bulb permitted in the last years to avoid duodenal fistulas in the treatment of ulcer disease.

[Diagnosis and treatment in polypous lesions of the gallbladder]. / Diagnostika i lechenie pri polipovidnykh obrazovaniiakh zhelchnogo puzyria.

Experience in observation and treatment of 193 patients with polypous lesions of the gallbladder (PLGB) was analyzed. The patients were divided into 2 groups: group 1 consisted of 102 operated patients including ones with polypous cholesterosis (59), hyperplastic polyps (21), adenomatous polyps (19), polyform cancer (3). Group 2 consisted of 91 non-operated patients. The structure of the disease was studied. Clinical and morphological classification of PLGB, indications for surgery and follow-up were developed. Proposed algorithm of diagnostic and treatment policy permits to reduce surgical activity in PLGB by 68.6% without detriment for diagnosis and treatment of polyform cancer of the gallbladder.

[The treatment of epithelial coccygeal cyst]. / Lechenie épitelial'nogo kopchikovogo khoda.

The dissection of coccygeal duct and closing the wound with a through perforated bathing drainage under modified epidural-sacral anaesthesia has been clinically approved. The operation was performed 3-4 days after two-step opening and cleaning of the abscess. The epithelial duct that doesn't have abscess symptoms should be dissected in one step operation. 68 patients underwent one-step surgery and in 125 cases two-step surgery has been done. The average time of staying in hospital was 15.3 days and 19.1 days, respectively. The double-step surgery of epithelial coccygeal duct decreases the level of postoperative septic complications and improves the functional and cosmetic results of the treatment.

[Methods of treatment of external fistula of gastrointestinal tract]. / Taktika lecheniia naruzhnykh svishchei zheludochno-kishechnogo tracta.

Experience in the treatment of external gastrointestinal fistulas in 1970-1988 consisted of 127 patients with 158 fistulas; 11 patients had a gastric fistula; 14, a duodenal fistula, 42, a fistula of the small intestine; 38, a fistula of the large intestine, and 22 patients had mixed fistulas. Operation for acute appendicitis was the main cause of fistula formation (20.3%). In undeveloped fistulas with considerable and uncontrolled loss of the intestinal contents, treatment consisted in early operation for vital indications for disconnection of the fistula, with preference given to complete bilateral disconnection. In developed fistulas most operations for their closure were carried out through an intraabdominal approach. Total mortality was 25.2%; in most of the fatal cases (90.6%) the fistulas were undeveloped.

[Surgical treatment of patients with cholelithiasis]. / Khirurgicheskoe lechenie bol'nykh zhelchekamennoi bolezn'iu.

The article analyses the results of treatment of 1,506 patients with cholelithiasis in the period between 1977 and 1986. On the grounds of the results four groups of risk were set apart. The lethality rate was 6.6% in the group of patient over 60 years of age. Performance of the operation in jaundice worsens the results 3.5 times, while conduction of choledochotomy in calculous cholecystitis leads to 3-4 fold increase in lethality depending on the patient's age. Diagnostic endoscopic retrograde cholangiopancreatography in patients with complicated forms of the disease helps in identifying the cause of jaundice before the operation. It is shown that the use of endoscopic papillosphincterotomy, both as the first and, in some cases, as the final stage of the treatment of the most severe patients with choledocholithiasis is promising.

[Selection of the method of treatment of complicated hemorrhoids]. / Vybor metoda khirurgicheskogo lecheniia oslozhnennogo gemorroia.

The authors make a comparative analysis of the immediate complications after hemorrhoidectomy conducted by various methods in 504 patients engaged in heavy physical work. Group 1 consisted of 172 patients with hemorrhoidectomy performed by the ligature method. Group 2 was made up of 151 patients who had been operated on by A. N. Ryzhikh's modification of Martynov's method. Group 3 included 145 patients treated by the Milligan-Morgan operation involving the restoration of the anal mucosa. Group 4 consisted of 36 patients who had undergone ligation of the terminal branches of the superior rectal artery with economical excision of the hemorrhoids. In appraisal of the results of operative treatment of hemorrhoids, the least number of complications were found in patients of groups 3 and 4.

[Surgical choices in the treatment of lung gangrene]. / Khirurgicheskaia taktika v lechenii gangreny legkogo.

Patients with gangrene of the lung should be treated at a specialized thoracic department. Nonoperative treatment is justified only as preoperative management applied for no more than 2 weeks. Pneumonectomy is the operation of choice in gangrene of the lung. Pneumotomy may be conducted in patients who are in a very grave condition with respiratory and hemodynamic disorders.

[Social aspects in patients with temporary colostomy]. / Sotsial'nye aspekty u bol'nykh s vremennoi kolostomoi.

Some aspects of the social life and trend of work were studied in 188 patients with temporary colostomy formed after radical operation for various diseases and injury of the colon. In the group of 188 patients examined after surgery, 160 were declared invalids (group I--6 persons, group II--72, group III--82 persons). Diminished social activity, development of an asthenic personality and of familiar and social conflicts were noted in many cases. With the object of rehabilitation, patients with temporary colostomy should be trained in the methods of irrigation of the large intestine while they are still in the hospital and the question of restoration of natural continuity of the intestine should be contemplated in time.