Лапароскопія у лікуванні пацієнтів з ускладненою дивертикулярною хворобою товстої кишки

Abstract

SummaryPurpose – to study the results of treatment of colon diverticular disease bylaparoscopy.Materials and methods. During 2004–2020 the treatment of 221 patients hospitalized inthe Department of Abdominal, Emergency Surgery and Coloproctology Clinic of the MilitaryMedical Clinical Center of the Southern Region of Odessa was analysed. Patients underwent263 surgeries for diverticular colon disease (DCD) and its complications. There were 118 men(53.4%) and 103 women (46.6%). Complicated forms of DCD were diagnosed in 186 (84.5%)patients. 164 (62.4%) operations were performed as an emergency, of which 102 (61.7%) wereperformed using video endoscopic equipment.Results and discussion. 49 patients were treated in 2 stages. At the first stage,during the hospitalization of patients with urgent indications with a clinical picture ofacute abdomen, radical surgery was not performed. The purpose of this stage was tosave live and stabilize the patient’s condition. Preference was given to minimallyinvasive operations (diagnostic laparoscopy, laparoscopic peritoneal lavage,sigmostomy). In the second stage, radical interventions were performed in the intervalsfrom 9 days to 6 months after the first operation including left hemicolectomy orsigmoidectomy. In 19 patients, radical operations of the second stage were performedwithout discharge from the hospital after first stage treatment.Conclusions. 1. Surgical treatment of patients with complicated DCD is better tocarry out using video endoscopic equipment, as evidenced by the shorter duration of theoperation (73.4±6.2) minutes compared with open surgery – (118.4±7.3) minutes andless bed-day – (6.1± 0.7) days compared to open transactions – (11.3±1.2) days.2. Repeated planned radical operations on DCD is better to perform laparoscopically, as evidenced by fewer complications (6.7% compared to open operations –10.1%)3. Two-stage treatment of complicated DCD is considered the best approach if thesecond stage (left hemicolectomy) is performed routinely within 10 days to 6 monthsafter surgery for urgent indications.