Одвічна проблема хірургії - апендицит: його ускладнення та результати лікування хворих

Abstract

Purpose - to improve the treatment of patients with appendicitis on the basis of the introduction of the latest imaging methods and surgical technologies. Materials and methods. In the clinic of the surgery center of the Kyiv City Clinical Hospital No. 1 from 2006 to 2019, 30,627 patients were treated, of which acute appendicitis with various forms of inflammation in 2697 (49.18%). The age of the patients ranged from 16 to 92 years old. Depending on the time of the hospitalization (by year), the patients were divided into two groups: the control group (2006-2012) - 1379 (51.13%) patients; the studied group (2013-2019) - 1318 (48.87%) patients. The reason for division into groups was the use of modern technologies for diagnostics (visualization) of the disease and improved methods of surgical treatment in the studied group. Results. Surgical access in 1846 (68.45%) cases was laparotomy, in 851 (31.55%) cases laparoscopic of which 69 (8.10%) cases had a conversion. Appendix location: typical in 692 (25.66%) cases, pelvic in 986 (36.56%) cases, retrocaecal in 293 (10.86%) cases, retroperitoneal in 277 (10.27%) cases, subhepatic in 228 (8.45%) cases, medial in 221 (8.19%) cases. In the postoperative period, complications from the abdominal cavity were established in 89 (3.30%) cases and wounds in 125 (4.63%) cases. 6 patients (0.22%) died, out of 1379 patients of the control group in 4 (0.29%) cases, and among 1318 patients of the study group 2 (0.15%) cases. Early adhesion obstruction in 18 (0.67%) cases, and subsequently the disease was found in 72 (2.67%) patients, which was restored surgically, as well as concomitant hernias in 45 (1.67%) cases. Conclusions. The use of modern imaging and treatment technologies has improved the results and reduced postoperative mortality from 0.29% to 0.15% with an average of 0.22%. According to the results of the study, it was found that the quality of life after laparoscopic appendectomy is statistically significantly (p<0.01) higher than in patients operated on by the open method. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: appendicitis, adults, adolescents, open appendectomy, laparoscopic appendectomy, adhesive obstruction, hernias.