Mini-invasive Interventions Research Articles

IMPROVEMENT OF THE METHOD OF MINI-INVASIVE TREATMENT OF PATIENTS WITH ACUTE PANCREATITIS

One of the manifestations of purulent-septic complications in acute pancreatitis is the development of pancreatic and peripancreatic infected necrosis, while the prevalence and location of involved areas of fiber in different patients varies greatly [1]. For a long time in the literature there was an opinion that regardless of the form of acute pancreatitis, the timing of the disease, and the quality of preoperative topical diagnosis of complications, the best is the upper-middle laparotomy, and only after revision of the abdomen, extrahepatic bile ducts, omental sac, pancreas and retroperitoneal cell space can be performed drainage in areas depending on the specific situation [2]. However, with limited abscesses, the use of laparotomy threatens the spread of infection in the abdominal cavity with the development of bacterial-toxic shock and increase the mortality rate [3]. Therefore, in recent years, preference is given to mini-invasive interventions, which are mainly carried out under local anesthesia.

The role of miniinvasive surgery in the treatment of early thyroid cancer

Minimally invasive thyroid surgery is a relatively new branch that has begun to develop since the 1990s, it comes in response to an increasing incidence in recent decades of thyroid tumors such as cancers and adenomas. Thin minimally invasive thyroid surgery has 2 main directions: with and without approach in the neck region, and those with approach at the neck are divided into endoscopic and non-endoscopic. Miniinvasive interventions have a number of advantages over the classic ones such as reduction of postoperative pain syndrome and analgesic consumption, respectively, shorter residence time and much better cosmetic results. Not all patients with thyroid tumors can be operated minimally invasively, there are a number of selection criteria: early stage of primary thyroid cancer or adenomas smaller than 3.5 cm in diameter, without capsule penetration or metastases, the volume of the gland should not exceed 50 -60 ml are not allowed overweight patients, patients with severe chronic morbidity, patients with a history of surgery on the neck, patients as short as possible, children and the elderly are not allowed too

Step-up mini invasive surgical treatment of patients with different morphological forms of acute necrotizing pancreatitis

Introduction: Despite significant progress in the treatment strategy of acute necrotizing pancreatitis (ANP), mortality in cases of its severe form remains high. There is no single point of view concerning the indications for the use of mini invasive interventions depending on the nature, extension and localization of the pathological foci of ANP. Material: We performed a prospective observational cohort study of efficacy of elaborated algorithmic mini invasive step-up approach of surgical treatment of 317 patients with different morphological forms of ANP. The following parameters were collected for each episode: length of hospital stay, mortality, occurrence of organ failure and local complications. Results: Transcutaneous punction/drainages were applied as the first step in 37 patients with acute necrotic collections (ANC). In the presence of walled-off pancreatic necrosis (WOPN) EUS procedures were preferred in case their close localization to the stomach or duodenum in 65 observations. Initial surgical treatment wasn't effective in 18.8% and video-assisted retroperitoneal debridement (VARD) in patients with ANC or necrosectomies under EUS control in cases of WOPN were applied. Necessary for laparotomic necrosectomies occurred in 14.5% of patients and was the final step of proposed algorithmic approach. During postoperative period complications occurred in 28.3% of patients. They included 7 new episodes of organ failure, 4 cases of arosive hemorrhage, and 5 observations of pancreatic and duodenal fistulas. Overall mortality rate was 3.3%, after interventional treatment - 6.5%. Conclusion: Surgical treatment in patients with ANP based on elaborated algorithmic step-up approach is followed by acceptable complication and mortality level.

Minimally invasive surgical interventions in the treatment and prevention of bleeding from varicose veins of the esophagus and stomach

Treatment and prevention of complications of portal hypertension today is a complex and unsolved problem of hepatosurgery. Mortality from esophageal-gastric bleeding (ESH) of portal genesis ranges from 22 to 100%. The aim of the study is to improve the results of the treatment and prevention of digestive haemorrhage in portal hypertension by optimize using of miniinvasive interventions. A retrospective analysis of the treatment results of 128 patients with cirrhosis of the liver, in which the predominant complication of portal hypertension resulted in bleeding from varicose veins of the esophagus and the stomach, and a high risk of its occurrence or recidivism have been carried out. Gastric laparoscopic devascularization with endoscopic ligation reduces the lethality from esophageal-gastric bleeding, compared to only ligation, for six months after the operation by 21.8% (2 = 2.61; p = 0.106), 25.5% within a year (2 = 2.75; p = 0.091), for two years after the 25.4% operation (2 = 1.47; p = 0.225), for three years 25.5% (2 = 0.43; p = 0.051). There is a statistically reliable lack of differences in the groups of patients after the traditional and endovideoxyric operations of the portocal bypass in terms of the reduction of the degree of VDEV (84.3 and 86.7%), which indicates the equivalent effect of the performed operations. A comparative study of selective portocaval anastomoses and TIPS found no reliable difference in the frequency of recurrent bleeding. Post-shunt encephalopathy, thrombosis, and stenosis of the shunt were more common in the transjugular intrahepatic portosistame shunt (p 0.001), and survival in the group of surgical anastomosis was superior to that of TIPS. The above data indicate that the use of endoscopic, endovascular, endovision and endovision surgery, extracorporeal miniinvasive techniques is an integral part of the complex surgical treatment of patients with portal hypertension. Miniinvasive surgical treatments are required depending on the current clinical situation and the degree of liver-cell failure. Flexible and selective tactics make it possible to improve the results of treatment of patients with cirrhosis of the liver, complicated by portal hypertension (6 figs, bibliography: 14 refs).

Prognostication of complications in patients with diseases of gallbladder after laparoscopic cholecystectomy

Objective. To elaborate a prognostic classification of possibilities for occurrence of іntra- and postoperative complications, basing on determination of a premorbid state and the risk factors, concerning operative intervention in patients, suffering surgical diseases of gallbladder.
 Маterials and methods. Retrospective analysis of treatment of 911 patients, suffering cholelithiasis disease, оperated by the laparoscopic cholecystectomy procedure, was conducted, and factors of possibility of occurrence for іntra- and postoperative complications were determined with further establishment of their criteria.
 Results. The factors of risk for the complications occurrence after laparoscopic cholecystectomy in patients with diseases of gallbladder (n=911) were investigated. Prognostication pattern of the complications occurrence was built, taking into account the results of correlation-regression analysis conducted, and on its base the clinic-epidemiological groups of the complications risk were formatted with determination of their frequency of confidence intervals.
 Conclusion. Theoretical substantiation and scientific-practical decision of the task was presented, concerning raising of efficacy of miniinvasive operative interventions in patients with diseases of gallbladder, using elaborated methods of prophylaxis and surgical treatment of complications.

The contact ureterolithotripsy in treatment of ureterolythiasis

Objective. Аnalysis of the treatment results in patients, suffering ureteric calculi, using the contact ureterolithotripsy procedure.
 Маterials and methods. In 104 patients with ureteric calculi, in whom ureteroscopy with further laser contact ureterolithotripsy was conducted, symptoms of the disease were analyzed, as well as the diagnostic methods value, peculiarities and efficacy of surgical treatment.
 Results. In all the patients endoscopic extraction of calculi have been succeeded. Calculus does not cause significant macroscopic changes in ureter, if symptoms, characteristic for ureterolithiasis, persists up to one week. Local edema is formed, if a calculus persists in ureter longer than a week. Long-term (more than two months) local ureteric persistence of calculi enhances the risk of its intramucosal intraureteric «ingrowth» greatly.
 Conclusion. The contact ureterolithotripsy constitutes a highly effective and miniinvasive method of surgical intervention in ureterolithiasis, guaranteeing high level of postoperative “stone free rate”. Prolongation of the calculi ureteric insertion time without a process of a stone discharge causes the ureteric wall changes, complicating performance of miniinvasive interventions (the contact ureterolithotripsy and a distant shock-wave lithotripsy).

TRANSCUTANEOUS MINI INVASIVE INTERVENTIONS IN TREATMENT OF PURULENT SEPTIC COMPLICATIONS OF ACUTE NECROTIZING PANCREATITIS

Aim. To estimate efficacy of mini invasive transcutaneous interventions in treatment of purulent septic complications of acute necrotizing pancreatitis. Material and methods. We analyzed results of treatment of 85 patients with purulent septic complications of acute necrotizing pancreatitis in whom mini invasive transcutaneous interventions were applied during 2014-2019. New onset of organ failure after operation, duration of intensive care treatment, postoperative complications and mortality rates have been studied. Results and discussion. Transcutaneous punctions and drainages were definitive methods of treatment at 74.1 % of patients with infectioned pathological lesions, at 25.9 % of patients – as a stage for preparation for open necrosequestrectomy that promoted to reduce postoperative mortality to 4.5 %. Conclusion. Transcutaneous mini invasive interventions are effective methods of step-up treatment of purulent septic complications of acute necrotizing pancreatitis, reduce necessary for wide laparotomic necrosectomies and reduce level of postoperative mortality.

Порівняльний аналіз відкритої та лапароскопічної апендектомії у дітей

Laparoscopic appendectomy step-by-step widely introduced in the practice of pediatric surgeons. Besides of the well-known advantages of mini-invasive interventions, the expediency of laparoscopic appendectomy in children still debated. Aim of the work was to compare the results of open (OA) and laparoscopic appendectomy (LA) based on the own experience. Materials and Methods. This study based on the results of surgical treatment of 3171 children with acute appendicitis, which were operated in 1st surgical department of Lviv regional clinical hospital «OXMATDYT» during 2009-2018 years. OA was applied in 2879 (90.8%) and LA – in 292 (9.2%) of patients. We analyzed the following data: accuracy of intraoperative diagnosis, duration of surgery, antibiotics therapy at the postoperative period and postoperative ileus; complications in the early postoperative period. Besides that, the results at the remote period were evaluated in 1032 (32.5%) of patients. Results. The accuracy of the intraoperative diagnostic of the form of appendicitis was higher in case of LA compared with OA – 68.8% and 59.3%, respectively. Duration of LA was longer than OA, however this difference statistically was insignificant (р>0.05). The restoration of the gut motility was faster after LA vs. OA – at 21.52±1.39 and 29.5±0.68 hours, respectively. It’s determined the earlier starting of the enteral nutrition – at 1.22±0.57 and 2.32±0.72 days, respectively. The complications’ frequency in the early postoperative period had no statistical difference in cases of LA and OA, by that LA associated with the decreasing of the negative consequences and complications at the remote period. Conclusions. LA accompanied by the faster restoration of the gut function that promoted for the earlier start of enteral nutrition and abolishing of antibacterial therapy. According to the frequency of complications both methods had no significant differences at the early postoperative period, however in LA these complications are less. At the follow-up, LA associated with the significant decrease of the quantity of negative consequences and complications. 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 institution. The informed consent of the patient was obtained for conducting the studies.

Possibilities of performance of nonstandard operative interventions in patients, suffering early gastric cancer

Objective. To study a possibility of performance of nonstandard organ-preserving operations in patients, suffering early gastric cancer, using application of the sentinel lymph nodes visualization procedures and the lymph node dissection procedure.
 Materials and methods. There were performed operative interventions in 35 patients, suffering early gastric cancer (Stages T1 and T2). For identification of sentinel lymph nodes a procedure of luminescence, using green indocyan, was applied.
 Results. In all the patients early gastric cancer was diagnosed (T1,T2). Possibility for performance of organ-preserving operations in early gastric cancer was shown. Miniinvasive interventions in a patient with severe concurrent diseases have appeared sufficiently effective and radical. The patients’ quality of life after laparoscopic pylorus-preserving and organ-preserving operations was significantly better, than quality of life in patients, to whom gastric resection with extended D2 lymph node dissection was done.
 Conclusion. There was established, that intraoperative lymphography constitutes he informative method, which helps to estimate the disease Stage in gastric cancer and to apply the adequate scheme of combined and complex treatment. More sensitive is a procedure of luminescence, using green indocyan. Determination of the affection degree of «sentinel lymph nodes» in gastric cancer may serve as an argument for change of the selection tactics while changing the tactics for the operative intervention volume choice.

The structure of ambulatory operative interventions and application of international experience while making a reform of surgical service in Ukraine

Objective. To study the operative interventions structure in ambulatory conditions, possibility of their widening and reformation of ambulatory surgical service using international experience.
 Materials and methods. There was conducted calculation and a characteristic given of ambulatory operative interventions, performed in polyclinic in 1999 - 2017 yrs, and possible ways of reforming of surgical service, including the ambulatory one, were determined. There were observed 1863 operated patients - women and men ageing 31 - 86 years old. Average duration of disability was 12,6 days.
 Results. Miniinvasive operative interventions performance make it possible to reduce the stationary stay, i. e. to enhance the hospital bed turnover.
 Conclusion. Taking into account, that the hospitals’ consulting-diagnostic centres and stationaries, which have occurred as a result of reforming in branch of the health care in Ukraine, constitutes a secondary chain of medical help. Clinically and economically it is expedient to include them into the hospitals, what was mentioned by The Order of Ministry of Health of Ukraine, dated by 05.10.2011 yr. № 646. The presence of departments of miniinvasive surgery in the hospitals structure give possibility to use the hospital beds fund more rationally, to reduce the administrative apparatus, shortening by this way the state economic expanses significantly.

Прицільні візуально контрольовані мініінвазивні втручання в онкохірургії грудної залози (огляд наукової літератури й аналіз власного досвіду)

Прицільні візуально контрольовані мініінвазивні втручання в онкохірургії грудної залози (огляд наукової літератури й аналіз власного досвіду)

Coccygeal cysts in children (clinic, diagnostic and surgical treatment)

The problem of surgical treatment of children with a pilonidal cyst is presented. The history of studying and evolution of theories clarifying etiology and pathogenesis of this pathology by Russian and foreign scientists is covered. The diagnostics of a coccygeal cyst is described. The classification of a disease is presented; it determines the treatment tactics depending on the stage of the disease. Criteria of an ideal surgery are defined. Types of surgical treatment and their use depending on the complexity of fistulas are found. Modern mini-invasive interventions and their advantages in the treatment of pilonidal cysts are described in detail.

Mini-invasive interventions in acute cholangitis malignant and benign etiology

Mini-invasive interventions in acute cholangitis malignant and benign etiology

Resources and Indicators of Activity of the Urological Service of the Ivano-Frankivsk Region in Dynamics for 2008-2017

According to the national system of medical-statistical accounting and reporting, data on human resources supply, network, staffing, structure, logistics and indicators of the activity of the urological service in Ukraine and Ivano-Frankivsk region were analyzed.
 It is shown that the urological service of the Ivano-Frankivsk region is characterized by the sufficient provision of qualified personnel, a wide infrastructure in health care institutions of different forms of ownership, the equipment of which allows performing modern mini-invasive interventions only in certain public medical institutions of the secondary level, in еhe Regional Clinical Hospital and in some private health care institutions.
 It has been determined that despite the performance of the network optimization over the past decade and the reduction of urological beds, their average use continues to decrease, and the average duration of patients’ treatment remains high, indicating irrational use and excessiveness of inpatient urological care.

Результати хірургічного лікування парадуоденального (groove) панкреатиту

Мета. Покращити результати хірургічного лікування пацієнтів з парадуоденальним панкреатитом шляхом розробки та впровадження нових методик оперативних втручань та застосування диференційованої тактики лікування хворих.
 Матеріали і методи. Проаналізовано результати лікування 1261 пацієнта з хронічним панкреатитом в Інституті за період з 2014 по 2018 р., 106 із них, у яких діагностовано парадуоденальний панкреатит, включено до дослідження.
 Результати. Консервативне лікування проведено 34 (32,1%) пацієнтам. Мініінвазивні втручання під контролем ендоскопічної ультрасонографії виконані 25 (23,6%) пацієнтам. Відкрите хірургічне втручання виконано 47 (44,3%) пацієнтам: дуоденозберігаючу резекцію підшлункової залози - 40 (37,8%), панкреатодуоденектомію - 7 (6,6%).
 Висновки. У разі застосування мініінвазивних методів лікування та органозберігаючих операцій скорочується тривалість перебування хворих у стаціонарі з (18,4 ± 2,6) (95% довірчий інтервал - ДІ) до (14,2 ± 5,5) (95% ДІ) дня та знижується частота розвитку післяопераційних ускладнень з 42,9 до 4 - 12,5%.

Sympathetic nervous system in age-related cardiovascular dysfunction: Pathophysiology and therapeutic perspective.

Cardiovascular diseases such as heart failure and metabolic syndrome have high prevalence in the elderly population and are leading causes of death, disability, hospitalization, driving high healthcare costs worldwide. To reduce this social and economic burden there is urgency to find effective therapeutic targets. Several studies have linked the dysfunction of the Sympathetic Nervous System and β-adrenergic receptor signaling with the pathogenesis of age-related cardiovascular diseases. Therapeutic treatments that restore their functions have been shown to be effective in subjects with cardiovascular comorbidities. In fact, lifestyle interventions (such as exercise training and diet) as well as pharmacologic treatments (e.g. β-blockers or moxonidine) and mini-invasive interventions (renal sympathetic denervation) have beneficial effects on age-related cardiovascular diseases. In the current "Medicine in focus" article we will discuss the pathogenic role of the Sympathetic Nervous System in age-related cardiovascular diseases as well as current and new therapeutic approaches.

Miniinvasive interventions at malignant diseases of the hepatopancreatoduodenal zone, complicated with an obstructive jaundice

Background: 225 patients with malignant diseases of the hepatopancreatoduodenal zone organs, complicated with an obstructive jaundice were cured in 2010-2015 in Orel regional clinical Hospital. Methods: The reasons of obstructive jaundice were: pancreatic head cancer - 60.9%, cholangiocarcinoma of common bile duct - 14.7%, cholangiocarcinoma of proximal bile ducts - 6.2%, gallbladder cancer - 5.8%, cancer of the major duodenal papilla - 2.6%, regional metastases - 9.8%. Results: 305 miniinvasive interventions were conducted: external cholangiostomy - 63%; antegrade endobiliary stenting - 22.3%; external-internal drainage of ducts - 11.8%; antegrade balloon plastic -0.6%; transcutaneous-transhepaticc micro holetsistostomiya - 2,3%. Complication were in 50 cases, and were mediated by dislocation of holangiostomic drainage in 24 patients (10.7%); by acute cholecystitis in 9 cases (4%); by acute pancreatitis in 5 cases (2.2%); by hydrothorax in 8 patients (3.6%). Lethal outcome appeared in 14 patients, and was due to the progression of the main disease. Conclusion: Thus, miniinvasive intervention at malignant diseases of the hepatopancreatoduodenal zone organs, complicated with obstructive jaundice, allow timely and effectively to determine the level of the biliary tract obstruction, to stop biliary hypertension, to improve the general condition of the patients and to determine further treatment strategy.

Miniinvasive interventions at malignant diseases of the hepatopancreatoduodenal zone, complicated with an obstructive jaundice

Miniinvasive interventions at malignant diseases of the hepatopancreatoduodenal zone, complicated with an obstructive jaundice

Surgical treatment of complicated pseudocyst of pancreas

Background: Total mortality of complicated pancreatic pseudocyst is 14%, postoperative - 11%, while complications such as sepsis, bleeding, perforation of the abdominal cavity, it is 40 - 60%. Methods: The work is based on retrospective and prospective analysis of the results of surgical treatment of 505 patients with pancreatic pseudocyst complicated, divided according to the classification D'Egidio A. and Schein M.(1991). With type I were 81, with type II were 247 and with type III were 177 patients. Used tactics Step-up approach for the treatment of all patients. Results: At the I type in 77.1% of patients used a percutaneous drainage under ultrasound and laparoscopy.In 32.9% performed open surgery. In the treatment of patients with type II in 119 (48.2%) completed mini-invasive surgery: ultrasound - percutaneous puncture and drainage under the ultrasound, endoscopic transgastric and transduodenum anastomosis. As the first stage 15 (6.07%) patients, complicated by bleeding in their cavity performed Х-ray occlusion of the vessel. Open surgery in patients with type II performed in 128 (51.8%). Were made external drainage (17.1%), internal drainage (76%) and resection methods (6.9%). In the treatment of type III mini-invasive interventions used in 36 (20.3%) patients. Internal drainage performed in 84 (47.4%), external drainage in 8 (4.5%), resection surgery in 46 (26%) patients. Total mortality was 0.79%. Conclusion: Our results indicate that the preferred treatment strategy is a minimally invasive Step-up approach.

ЛОЖНАЯ АНЕВРИЗМА ЛУЧЕВОЙ АРТЕРИИ: КРАТКИЙ ЛИТЕРАТУРНЫЙ ОБЗОР И ОПИСАНИЕ КЛИНИЧЕСКОГО СЛУЧАЯ

The article describes a case of successful treatment of pseudoaneurysm of the radial artery (PRA). The peculiarity of the described case is that as a result of injury in the lower third of the forearm there was damage to the lateral wall of the radial artery; against the background of the pressure bandage, the artery defect temporarily clotted, and there were no signs of bleeding. In this regard, in the initial surgical treatment of the wound, the surgeon did not pay attention to the condition of the artery wall and put stitches on the skin. Subsequently, due to the resumption of bleeding, a pulsatile hematoma was spread in its further transformation into a false aneurysm. PRA can lead to the development of dangerous complications – rupture, bleeding, infection, compression of nerve trunks of the forearm. In order to avoid their development, it is necessary in all cases to eliminate the PRA. Currently, proposed mini-invasive interventions: endovascular aneurysm embolization, stent-grafting of vascular defect, compression method, as well as puncture technique by injecting thrombin into the cavity of the PRA under X-ray control. However, the experience of their application shows that, despite all their advantages, open operations continue to be the «gold standard» in the treatment of PRA. The authors of the article also adhered to this tactic, which allowed them to achieve a good result. Keywords: False aneurysm, radial artery, diagnosis, surgical treatment.