LARGE INTESTINES COMPLICATED DIVERTICULITIS MODERN TREATMENT TACTICS USING VIDEOENDOSCOPIC EQUIPMENT

Abstract

Abstract. Colonic diverticular disease (CDD) is an important problem in abdominal surgery for the majority countries of the world. The incidence of CDD is, unfortunately, progressing. The CDD relevance is determined by medical and economic aspects taking into account the disease frequent cases in working age persons. The tactics of CDD treatment is considered to be traditional and is determined according to the generally accepted modifi ed disease classifi cation according to E. J. Hinchey. Using daily the tactics of a personalized approach to patients we agree with the opinion of our colleagues and consider the choice of sigmoid colon acute diverticulitis and its complications optimal method of diagnosis and surgical treatment to be still arguing. Having considerable experience and treating patients with CDD for a long time, we try to use mostly the laparoscopic approach in surgical tactics the eff ectiveness of which we intend to summarize.The purpose. To determine the eff ectiveness of the laparoscopic method of surgical treatment of patients with CDD complicated clinical manifestation. Research material and methods. The treatment of 221 patients with 263 surgical interventions due to CDD and its complications was analyzed. CDD complicated forms were diagnosed in 186 (84.5 %) patients. 164 (62.4 %) operations were performed urgently, 102 (61.7 %) of which were performed using videoendoscopic equipment, 62 (38.3 %) were performed using the traditional open method. Open operations performed under urgent indications. Special attention was attracted to patients with bleeding as CDD complication. 9 patients (in 6 with initial intestinal bleeding and in 3 with CDD complicated by profuse bleeding) underwent operative treatment. All patients were treated in one stage.Results and their discussion. According to planned indications, 26 laparoscopic and 31 open resections of the large intestine were performed due to CDD. The source of infl ammation was localized in the sigmoid colon in all patients. Infl ammation of one diverticulum occurred in 56 (98.4 %) cases, two diverticulies – in 1 (1.6 %) observation. 49 patients were treated in 2 stages. Perforation of the diverticulum wall was detected in 79 (51.6 %) patients. The duration of operative treatment of patients with complicated CDD using videoendoscopic equipment was 73.4±6.2 min. The index of bed days duration with laparoscopic operations was 6.1±0.7. The patients’ stay in the hospital after scheduled videoendoscopic operations was 6.3±1.6 days. From 9 patients with bleeding in the absence of conservative therapy effi cacy and under the condition of the patient’s stable condition, 4 patients underwent laparoscopic left-sided hemicolectomy. Open surgical interventions were performed in 5 patients, mostly elderly and with severe concomitant pathology.Conclusions. In case of patients with a CDD complicated course treatment we consider a two-stage treatment preferable, when the second stage (left-sided hemicolectomy) is performed in a planned manner within 9 days to 6 months after the operation for urgent indications. Patients with complicated CDD operative treatment is better to be performed with the use of videoendoscopic equipment. It is better to perform repeated planned radical operations for CDD laparoscopically, which is evidenced by a lower number of complications. The use of laparoscopic technologies in case of colonic bleeding treatment as CDD complication is a promising direction in abdominal surgery and requires its e ffi ciency further study.