RESUMO
Intra-abdominal hypertension during laparoscopic operations increased the risk of complications from cardiovascular and respiratory systems. An application of laparolifting systems allowed doctors to avoid changes of pneumoperitoneum, although it was associated with technical difficulties in operation performance. The authors used a test in order to determine cardiorespiratory reserve in preoperative period. The reserve was characterized by decrease of stroke volume of the heart against the background of intra-abdominal hypertension. There was noted a reliable increase of complication rate in these patients in case of application of standard laparoscopic operation compared with operation using lifting systems.
Assuntos
Cirurgia Bariátrica , Doenças Cardiovasculares , Pneumoperitônio Artificial , Doenças Respiratórias , Risco Ajustado/métodos , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/prevenção & controle , Colecistite/cirurgia , Neoplasias do Colo/cirurgia , Feminino , Reserva Fracionada de Fluxo Miocárdico , Humanos , Volume de Reserva Inspiratória , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumoperitônio Artificial/efeitos adversos , Pneumoperitônio Artificial/métodos , Doenças Respiratórias/etiologia , Doenças Respiratórias/fisiopatologia , Doenças Respiratórias/prevenção & controleRESUMO
The article made a comparative assessment of traumatic injury of open hand-assisted laparoscopic anterior resection of the rectum in lateral and spinal positions. The presented technique of hand-assisted laparoscopic colon and rectal surgery is simple. There are advantages in case of obesity presence (IMT more than 30 kg/m2), in significant shortening of the mesocolon and mesentery, high fixation of splenic flexure and intimate fixation of the spleen, in case of bad preparation of the bowels in partial intestinal obstruction or in case of emergency operation, big cancer size, expressed perifocal inflammation. A comparative analysis of dynamics of hormone stress content and metabolism (cortisol, adrenaline, thyrothrophic hormone) showed their expressed increase in blood during operation after traditional surgery. Less stressed reaction was noted after hand-assisted surgery, especially in overweight patients. An application of low invasive method allowed reduction of hemorrhage, pain syndrome, terms of patient's activation and restoration of intestinal motility after operation.
Assuntos
Colectomia , Neoplasias do Colo , Obstrução Intestinal/cirurgia , Laparoscopia , Complicações Pós-Operatórias , Neoplasias Retais , Adulto , Idoso , Idoso de 80 Anos ou mais , Colectomia/efeitos adversos , Colectomia/métodos , Colectomia/estatística & dados numéricos , Colo/patologia , Colo/cirurgia , Neoplasias do Colo/complicações , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Pesquisa Comparativa da Efetividade , Feminino , Humanos , Obstrução Intestinal/etiologia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Neoplasias Retais/complicações , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Reto/patologia , Reto/cirurgia , Resultado do TratamentoRESUMO
The main cause of lethal outcomes after operations on the oesophagus and cardia remains failure of esophageal anastomosis. The lack of substantial positive changes in prophylaxis and especially in treatment of this complication is explained by etiological approach to this problem. Pathogenesis of the failure is determined by the only trigger--penetration of infection into the tissues of anastomotic area. The authors have developed and introduced into practice the method and the device to influence the basic link of the pathogenesis. The application of the method of permanent irrigation and sealing of the esophageal anastomosis line in treatment of 917 patients made it possible to cut down lethal outcomes from insufficiency of esophageal anastomosis to 0.1%.