Suppuration Of Postoperative Wound Research Articles

Experience in early minimally invasive fixation of pubic symphysis disruption with a system of transpedicular screws in patients with combined pelvic trauma (pilot study)

Introduction Challenges of treating the injuries of pubic symphysis in patients with combined pelvic injury require developing new techniques for stable minimally invasive osteosynthesis in the acute period of trauma.Purpose of the work was to assess the application of low invasive fixation of the pubic symphysis with a system of transpedicular screws in the patients with combined unstable pelvic injuries in the acute period of the traumatic disease.Materials and methods The results of treatment of 12 patients with polytrauma with unstable pelvic injury with rupture of the pubic symphysis who were treated at Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, in the period from 2017 to 2023, were analyzed. All the patients underwent final minimally invasive fixation of the pubic symphysis with a system of transpedicular screws in the early period of the traumatic disease.Results The overall assessment of the results in 12 patients found no complications or technical errors during the installation of transpedicular screws. Control CT scans of the pelvis showed that osteosynthesis was stable in all patients, and the position of metal was correct in all. One patient from the study group died in the clinic from massive pulmonary embolism. The long-term results in 11 patients in the period from 6 months to 3 years after trauma were evaluated as excellent and good anatomical and functional results in 10 patients, one case had fair outcome.Discussion The use of bone plates to fix ruptures of the symphysis pubis leads to disruption of its physiological mobility, and the patient’s activity in the postoperative period can cause an implant fracture. Original dynamic plates and wire cerclage help avoid this complication; however, all these techniques involve significant surgical trauma and blood loss, as well as the risk of postoperative wound suppuration. Minimally invasive methods of fixation using cannulated screws, systems such as Endobutton, Tight Rope can reduce intraoperative trauma and the risk of complications (blood loss, suppuration); however, the procedure for their installation is quite complex and lengthy, and for greater stability, external fixation of the pelvic ring is often required. The proposed minimally invasive fixation of the pubic symphysis with a system of transpedicular screws avoids a lot of shortcomings and is sufficiently stable.Conclusion The method of minimally invasive fixation of the pubic symphysis with a system of transpedicular screws meets current requirements in the treatment of patients with polytrauma and unstable pelvic injury, and it may be successfully used in the acute period of trauma.

Prevention of purulent and inflammatory complications of the soft tissues of the abdominal wall in patients with peritonitis

Objective. To learn about measures to prevent purulent and inflammatory complications of the soft tissues of the abdominal wall in patients with peritonitis.
 Materials and methods. Based on the purpose of the study, 2 groups of patients were formed. The main group included 23 patients in whom a variable–height polyurethane wound dilator in combination with an application sorbent was used intraoperatively to prevent surgical wound suppuration. The control group included 27 patients who were treated with polyurethane wound dilator alone.
 Results. Suppuration of the surgical wound occurred in 2 (8.7%) patients of the main and 6 (22.2%) patients of the control group, seroma – in 1 (4.3%) and 2 (7.4%) patients, respectively, haematoma – in 1 (3.7%) patient of the control group, inflammatory infiltration – in 2 (8.7%) patients of the main and 3 (11.1%) patients of the control group.
 Conclusions. The use of a polyurethane wound dilator in combination with an application sorbent for the prevention of postoperative wound suppuration in patients with spilled and general peritonitis in the toxic and terminal stages allowed to reduce the number of purulent and inflammatory complications of the soft tissues of the abdominal wall in the main group by 2 times compared to the corresponding indicator in the control group.

Compression-distraction devices in the treatment of congenital disorders in children. Case series

Relevance. In many cases, Pierre Robin sequence and congenital micrognathia lead to respiratory failure, obstructive sleep apnea, and aspiration of food due to swallowing problems. Compression-distraction osteogenesis method allowed for the effective achievement of a stable clinical result with the minimum losses for the child's body.Purpose. The study aimed to conduct a retrospective analysis of various types of compression-distraction devices based on the Department of Maxillofacial Surgery of the Republican Children's Clinical Hospital.Material and Methods. Since 2010, 36 children aged three months to 13 years have been operated, 20 boys and 16 girls. Four children were operated using an multi-vector external compression-distraction device. Two children with Pierre Robin sequence had surgery with a Conmet intraoral compression-distraction device, 27 children – with a KLS Martin bone-borne compression-distraction device, of which 15 had Pierre Robin sequence, and 12 had congenital lower micrognathia. Seven children had tracheostomy, which had been placed due to permanent sleep apnea.Results. Three (8.33%) children were operated using external compression-distraction devices. From three months to one year. A patient with Pierre Robin sequence, tracheostomy, and cannula. A tracheostomy was installed at the age of 15 days due to persistent apnea. At three months of age, bilateral osteotomy of the mandible with the installation of an external compression-distraction device was performed. Compression was for three days; then, they began distraction of one mm/day for 15 days. Five months later, the child began to breathe freely through the natural respiratory tract; under mask anesthesia, the compression-distraction device was removed. Four children (11.11%) aged 8 to 12 months were operated using multi-vector external compression-distraction device. A patient aged one year with Pierre Robin sequence, tracheostomy, and cannula. The external compression-distraction device was installed at the age of eight months. The distraction period was 12 days. The consolidation period was three months. The treatment result was independent breathing through the natural respiratory tract. The tracheostomy cannula was removed. Twenty-nine children 2 (5.56%) were operated using intraoral bone-borne compressiondistraction devices. A child aged 14 months, diagnosed with Pierre Robin sequence, complained of periodic sleep apnea with signs of acrocyanosis. Moderate to severe obstructive sleep apnea was detected. A bilateral osteotomy of the mandible was performed, and a bone-borne compression-distraction device was installed. Compression was for three days, then the distraction of 0.5 mm twice a day – for 14 days. Distraction was performed at 14 mm. After five months, the bone-borne CDD was removed, and polysomnography was repeated. The apnea-hypopnea index (AHI) was <5. Respiratory function was fully restored.Conclusion. Thus, 24 children showed successful results with the use of compression-distraction device (an orthognathic occlusion was formed, glossoptosis was eliminated, natural breathing and feeding were restored); 11 children did not have a satisfactory result (due to distraction interruption, it was not possible to achieve a physiological bite, there was postoperative wound suppuration with wound dehiscence). There was one negative result due to trauma: the child fell on his chin at home during the consolidation period, and the compression-distraction device broke, which resulted in disocclusion.

Wound complications after prosthetics of hernial defects of the anterior
 abdominal wall: causes and methods of prevention (literature review).

Goal. To review the literature data on wound complications after prosthetic repair of hernial defects of the anterior abdominal wall, causes and methods of prevention.Results. An analysis of the literature has shown that the problem of wound complications during endoprosthetics for external abdominal hernias has not been completely solved. Among all postoperative complications after such hernias, seroma, infiltration and prolonged exudation are most common, less often ligature fistula, subcutaneous fat infarction, postoperative wound suppuration, cyst, granuloma, rejection of the prosthesis. The effectiveness of various methods of preventing wound complications during abdominal wall prosthetics is ambiguous. Conclusions. It is necessary to improve the known and develop new endoprostheses that would cause a minimal reaction of the body with good integration into tissues and high strength (to exclude relapses).

Simultaneous treatment for anal fissure and hemorrhoids

When using surgical approach to treatment for combined anal fissure and hemorrhoids doctor always faces the question of whether to divide the procedure into two sequential stages or to perform a simultaneous surgical intervention, and in which cases one or the other should be done. Purpose - to improve the results of treatment for patients with anal fissure in combination with chronic hemorrhoids by combining fissurectomy with transanal hemorrhoidal dearterialization (THD). Materials and methods. 177 patients with combination of anal fissure and hemorrhoids were studied. The Group I (GI) - fissure excision and hemorrhoidectomy, 60 patients. The Group II (GII) - anal fissure excision without surgery for hemorrhoids, 60 patients. The Group III (GIII) - proposed method used, 57 patients. Laser Doppler flowmetry was performed to assess blood flow intensity in fissure area. The assessment of treatment outcomes in patients was based on the following criteria: pain intensity, urinary retention in early postoperative period, postoperative wound suppuration, disease recurrence, iatrogenic incontinence, duration of postoperative hospital stay. Qualitative parameters are presented as the absolute number of cases (n) and their percentage (%). Comparison of these parameters between groups was performed using the Pearson’s χ2 test and the Fisher’s exact test. Statistical analysis was conducted by STATA 12.1 statistical package. Results. Pain intensity: GI - 8±1, GII - 6±2, GIII - 4±1. Urinary retention: GI - 19 (31.6%), GII - 8 (13%), GIII - 6 (10.5%). Wound suppuration: GI - 5 (8.3%), GII - 1 (1.7%), GIII - 1 (1.7%). Hospital stay (days): GI - 6±1.2, GII - 4±1.3, GIII - 3±1.1. Fissure recurrences: GI - 5 (8.3%), GII - 2 (3.3%), GIII - 1 (1.7%). Hemorrhoid recurrence: GI - 6 (10%), GIII - 2 (3.5%). Iatrogenic incontinence: GI - 4 (6.7%), GII - 1 (1.7%), GIII - 0. Significant decrease in relative risk of complications (by 88%) in GIII compared with GI - OR=0.12 (0.04-0.29), p=0.0001, and a tendency to reduction of complication risk by 15% compared with GII - OR=0.85 (0.29-2.4), p=0.734 was observed. Blood flow intensity (flowmetry results) in GII and GIII was comparable. Conclusions. Simultaneous anal fissure excision and THD can improve treatment outcomes. This method does not impair blood flow in the area of anal fissure. Proposed method is both radical and minimally invasive. 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.

ORNIDAZOL-BASED APPLICATION SORBENT WITH NANO SILICA AND ITS ANTIMICROBIAL ACTIVITY.

The aim: To investigate the effect of application sorbent based on ornidazole with nanosilicon in experiment and clinic. Materials and methods: In order to study the effectiveness of the Ornidasil application sorbent for the treatment of purulent wounds, we conducted an experimental study in rats. Also, we studied the effectiveness of the Ornidasil in the clinic for the treatment of patients with diabetic foot syndrome and to prevent the suppuration of postoperative wounds in patients with purulent peritonitis in toxic and terminal stages. Results: The formation of active substance complexes with hydroxylated matrices is due to hydrogen bonds between the oxygen atom of the silanol group of the silica surface and the hydrogen atom of the alcohol group of the ornidazole molecule. This promotes the gradual release of ornidazole from the surface of such a matrix into the wound exudate. Thus, on day 13, 9 experimental rats of group I healed completely, 11 rats had a small wound surface, complete healing occurred on day 15. We also investigated the effectiveness Ornidasil in the clinic. In the comparison group, postoperative wound suppuration occurred in 6 patients (31.6%), and in the main group - in 3 patients (12.5%). Conclusions: A study of the effectiveness Ornidasil in the complex treatment of Diabetic foot syndrome showed that in the experimental groups, wound healing occurred 1.6 -1.9 times faster. The use of polyurethane wound protector in combination with Ornidasil reduced the suppuration of postoperative wounds in patients of the main group by 2.5 times relative to patients in the comparison group.

Surgical treatment of pilonidal disease with the use of «closed» techniques

The OBJECTIVE was to evaluate long-term results of the use of «closed» techniques of surgical treatment of pilonidal disease.METHODS AND MATERIALS. The study included 147 patients who underwent excision of the pilonidal sinuses according to Karydakis – 28 and excision of the pilonidal sinuses with mobilization of the gluteal fascia – 89, laser obliteration using Filac Fistula Probe – 30 patients. To assess the long-term results, a questionnaire survey of patients, a face-to-face examination and ultrasound of the soft tissues of the postoperative scar area, statistical data processing were carried out.RESULTS. By primary intention, wounds healed in 91.4 % of patients. Complications were observed in 10 (8.5 %) patients: postoperative wound seromas – 8, wound hematoma – 1, postoperative wound suppuration – 1. After mobilization of the gluteal fascia, recurrence of the disease was established in 4 (4.4 %) patients, after obliteration with the use of laser energy and Filac Fistula Probe – in 4 (13.3 %) patients. No relapse was diagnosed after Karydakis procedure.CONCLUSIONS. Operations using «closed» techniques are effective methods of surgical treatment of pilonidal disease. At the same time, there is a low percentage of complications, relapses of the disease and a short period of rehabilitation.

Different methods of femoropopliteal bypass grafting with autologous vein: propensity score matching analysis

To analyze immediate and long-term results of various methods of femoropopliteal bypass grafting with autologous vein using propensity score matching. A retrospective single-center open study included 464 patients who underwent femoropopliteal bypass grafting with an autologous vein between January 10, 2016 and December 25, 2019 at the Research Institute - Ochapovsky Regional Clinical Hospital No. 1. The following types of autovenous conduits were used: n=266 - reversed autologous vein (group 1); n=59 - in situ autologous vein (group 2); n=73 - upper limb autologous vein (group 3); n=66 - ex situ autologous vein (group 4). The long-term period was 16.6±10.3 months. We used propensity score matching analysis because patients were not comparable for some indicators. Groups 2-4 included small samples of patients, and their number was reduced to less than 10. This did not allow us to draw reliable conclusions about treatment outcomes. In this situation, we decided to allocate two groups: group 1 - ex situ femoropopliteal bypass grafting; group 2 - other variants of femoropopliteal bypass grafting with autologous vein. Propensity score matching allocated 299 people in group 1 and 46 patients in group 2. There were significant differences in early postoperative incidence of autologous vein thrombosis (group 1: n=3 (6.5%), group 2: n=79 (26.4%), p=0.003; OR= 0.19; 95% CI 0.05-0.64) and postoperative wound suppuration (group 1: n=2 (4.3%), group 2: n=52 (17.4%); p=0.02; OR=0.21; 95% CI 0.05-0.91). In long-term postoperative period, significant differences were obtained in the incidence of limb amputation (group 1: n=6 (13%), group 2: n=85 (28.4%); p=0.02; OR=0.37; 95% CI 0.15-0.92) and myocardial infarction (group 1: n=1 (2.2%), group 2: n=43 (14.4%); p=0.02; OR 0.13; 95% CI 0.01-0.98). Femoropopliteal bypass grafting ex situ is characterized by lower incidence of graft thrombosis, amputations of the limb, mild decrease in the incidence of infectious complications and all adverse cardiovascular events in early and late postoperative period compared to conventional surgery (reversed autologous vein, in situ autologous vein, upper limb autologous vein).

Прогнозування ризику розвитку післяопераційної злукової кишкової непрохідності в дітей

Прогнозування ризику розвитку післяопераційної злукової кишкової непрохідності в дітей

OPTIMIZATION OF THE CHOICE OF LAPAROSCOPIC AND OPEN ALLOPLASTICS IN CASE OF INCISIONAL VENTRAL HERNIAS

The aim of the work – to increase the effectiveness of surgical treatment of incisionalventral hernias (IVH) by optimizing the choice of laparoscopic and open allohernioplasty.Material and methods. The analysis of surgical treatment of 508 patients with IVH from2009 to 2020 was conducted. According to the Europenian Herniology Association(EGA) classification (Ghent, Belgium, 2008) IVH was distributed as follows: MW1-2R0 was diagnosed in 217 (42,7%), MW3R0 – in 291 (57,3%) patients. Diastasis of therectus abdominis muscles up to 5 cm was present in 217 (42,7%) patients, diastasis5-10 cm – in 127 (25%), diastasis greater than 10 cm – in 164 (32.3%) patients.Depending on the size of the hernia and the width of diastasis of the rectus abdominis,patients were divided into 3 groups.In group I, laparoscopic allohernioplasty was performed in 109 (21,5%) patients withsmall and medium-sized IVH with diastasis of up to 5 cm, in particular the developedlaparoscopic preperitoneal in 63 patiens and laparoscopuc retromuscular alloplastiesin 46 patients. The comparison group IIa consisted of 108 (15,1%) patients whounderwent open retromuscular allohernioplasty.In group II, 64 (12,6%) patients with large IVH and diastasis of the rectus abdominis5-10 cm underwent open allohernioplasty by «sublay» technique. The comparison groupIIa consisted of 63 (12,4%) patients who were performed the open method «onlay».In group III, in 82 (16,1%) patients with giant IVH and diastasis more than 10 cm ananterior component separation technique of the abdominal wall in combination withalloplasty with intra-abdominal placement of a mesh implant with anti-adhesive coatingwas performed according to the developed method. Comparison group IIIa consistedof 82 (16,1%) patients who underwent anterior component separation technique of theabdominal wall in combination with alloplasty «onlay».Results. For small and medium-sized IVH and diastasis of the rectus abdominis musclesup to 5 cm, laparoscopic allohernioplasty with preperitoneal and retromuscularplacement of a mesh implant and elimination of diastasis is optimal in comparisonwith open retromuscular allohernioplasty, contributes to a significant decrease in theincidence of seroma from 35,2% to 3,7 %, postoperative wound suppuration – from6,5% to 0%, inflammatory infiltrate – from 4,6% to 0%, chronic postoperative pain –from 6,4% to 2,6%, hernia recurrence – from 6,4% up to 0%.The optimal method of allohernioplasty for large IVH and diastasis of the rectusabdominis muscles from 5 to 10 cm is the open «sublay» technique in comparison withthe open «onlay» technique, reduces the incidence of seroma from 23,8% to 6,3%,postoperative wound suppuration – from 4,8% to 1,6%, chronic postoperative pain –from 4,8% to 1,6%, hernia recurrence – from 7,9% to 3,1%.In case of gigantic IVH, contracture of the rectus abdominis muscles and diastasisof more than 10 cm the anterior component separation technique of the anatomicalcomponents of the abdominal wall in combination with intra-abdominal alloplasty isoptimal in comparison with the use of an anterior component separation techniqueof an abdominal wall combined with «onlay» significant improvement in treatmentoutcomes, namely, reduction of seroma frequency from 25,6% to 7,3%, postoperativewound suppuration – from 4,9% to 2,4%, postoperative wound infiltrate – from 13,4%to 2,4 %, chronic postoperative pain – from 8,1% to 1,6%, recurrence of IVH – from6,5% to 1,6%.Conclusion. Optimization of the choice of laparoscopic and open allohernioplastyenables to increase significantly ventral hernias and to decrease the quantity of thepost-operative complications.

Immediate and postponed results of surgery of tuberculosis in patients with HIV infection

The objective: to evaluate immediate and postponed results of surgical treatment of tuberculosis (TB) in patients with TB/HIV co-infection.Subjects and methods. 106 patients underwent surgery: 64 patients suffering from pulmonary tuberculosis (81.2% had resections, and 18.8% – thoracoplasty), 36 patients – tuberculous spondylitis (vertebral body resection in combination with anterior spondylodesis), and 6 patients – cerebral TB (removal of tuberculous lesions under neuronavigation). Development of complications in the postoperative period and tuberculosis relapses in the long-term period was assessed.Results. No severe and suppurative complications were observed in the postoperative period in patients with HIV/pulmonary TB and HIV/cerebral TB. In patients with HIV/TB spondylitis, complications were registered in 4/36 (11.1%) cases: in 2/4 – postoperative wound suppuration and in 2/4 – ligature fistulas. No relapse of tuberculosis was reported after lung resection in 45 out of 45 patients availabe for follow-up, after thoracoplasty in 10 out of 12 patients, after surgery due to tuberculous spondylitis – in 25 out of 27 patients, and cerebral tuberculosis – in 5 out of 6.

Efficiency assessment of laparoscopic vs open alloplasty for incisional ventral hernias

Materials and methods. During the period from 2009 to 2020 in the clinic of the Department of Surgery and Proctology of the Shupyk National Healthcare University of Ukraine, the surgical treatment of 217 patients with IVH was analysed.The choice of laparoscopic hernioplasty or open allohernioplasty was made taking into account the size of the abdominal wall defect and the width of the rectus diastasis. By intraoperatively conducting a study during a surgery for IVH with an abdominal rectus diastasis involving approximation of the rectus muscles and measurement of IAP, it was found that with an abdominal rectus diastasis measuring up to 5 cm IAP increases to 5.6 ± 1.3 mm Hg and the abdominal wall defect is closed without an undue tension of the supporting tissues.Depending on the method of surgical treatment, patients were divided into 2 groups.In group I, 109 (21.5%) patients with small and medium-sized IVH with a diastasis of up to 5 cm underwent laparoscopic allohernioplasty, in particular, 63 patients underwent laparoscopic preperitoneal alloplasty and 46 underwent laparoscopic retromuscular alloplasty.Conclusions. For small and medium-sized IVH with an abdominal rectus diastasis of up to 5 cm, laparoscopic allohernioplasty with preperitoneal and retromuscular placement of the mesh implant and elimination of the diastasis is optimal. In comparison with open retromuscular allohernioplasty, it contributes to a significant reduction in the incidence of seroma (from 35.2% to 3.7%), postoperative wound suppuration (from 6.5% to 0%), inflammatory infiltrate (from 4.6% to 0%), chronic postoperative pain (from 6.4% to 2.6%), and recurrence of hernia (from 6.4% to 0%).

METHODS OF ILEO-TRANSVERSE AND COLON INVAGINATIONAL ANASTOMOSES CREATING

Summary. The aim of the study. To improve the results of patients with tumors and non-neoplastic diseases of the colon treatment, to introduce into clinical practice the original surgical technique and methods of creating of colon anastomoses, which were tested in experiment.
 Materials and methods. Original methods of invaginational ileo-transverse and colon anastomoses creating were developed in the experiment on rabbits. Taking into account the obtained positive results, the methods of anastomoses formation were transferred to the surgical clinic and patents of Ukraine were obtained.
 In 2020, ileo-transverse and colonic anastomoses were formed in 134 patients on the basis of Transcarpathian Antitumor Center: one-row invaginational anastomosis according to the developed method in 22 patients (16.4 %), two-row manual — in 58 (43.3 %), circular stapler — in 36 (26.9 %), linear stapler anastomosis — in 4 (3 %), laparoscopic (linear stapler) — in 14 (10.4 %).
 Results and discussion. The most of complications occurred in the group with manual two-row anastomosis (16), in two cases the anastomotic leakage was recorded. When using a circular stapler suture, anastomotic leakage was observed in 1 patient, and anastomositis — in 4. When using linear stapler anastomoses, postoperative wound suppuration was observed in 1 patient.
 Conclusions. The most of early postoperative complications was observed after using a two-row manual colonic anastomosis (27.5 %). When using a circular stapler suture, the number of early postoperative complications was less than with a two-row manual anastomosis (22.2 % vs. 27.5 %, respectively). The least number of complications was recorded after the creation of a one-row invaginational anastomosis in the proposed original technique.

EXCISION OF PILONIDAL FISTULA AND PILONIDAL CYST. NEW APPROACH TO POSTOPERATIVE DEFECT REPAIR

We have developed and implemented a new approach to postoperative defect repair in patients with pilonidal fistula (PF) and pilonidal cyst (PC). We analyzed different variants of subcutaneous fat and skin suturing, as well as the avoidance of drains in the area of intervention. The new approach reduced the incidence of postoperative wound suppuration and wound dehiscence.

Treatment strategy for complicated pancreatic pseudocysts

To analyze an effectiveness of various surgical approaches for complicated pancreatic pseudocysts. The results of surgical treatment were analyzed in 188 patients with complicated pancreatic pseudocysts. The study included patients with one of complications of pseudocyst (infection, bleeding, compression of adjacent organs, perforation). Depending on surgical treatment, patients were divided into 2 groups: the 1st group (76 patients) - laparotomy followed by certain open surgery, the 2nd group (112 patients) - various minimally invasive treatments without further open operations. Effectiveness of surgical treatment was analyzed considering incidence of complications (postoperative wound suppuration, pneumonia, sepsis, multiple organ failure) and mortality. In the 1st group, postoperative wound suppuration - 22 (29%) patients, pneumonia - 17 (22.4%), sepsis - 14 (18.4%) patients, multiple organ failure - 14 (18.4%), 15 (19.8%) patients died. In the 2nd group, these values significantly differed: postoperative wound suppuration - 9 (8%), pneumonia - 5 (4.3%), sepsis - 1 (0.9%), multiple organ failure - 4 (3.5%), 1 (0.9%) patient died. Minimally invasive measures are the most optimal for any complication of pancreatic pseudocyst. Laparotomy is indicated if minimally invasive intervention is impossible for certain reason. It is advisable to concentrate these patients in specialized centers.

EXPERIENCE OF USING PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN THE TREATMENT OF PATIENTS WITH DYSPHAGIA AND SIGNIFICANT DISTURBANCE OF TROPHIC STATUS

Treatment of patients with various origins of dysphagia is a difficult task, especially in the presence of severe enteral insufficiency. Purpose of the study: to improve the results of treatment of patients with various origins of dysphagia at the City Clinical Hospital named after N.I. Pirogov (Orenburg, Russian Federation) in order to correct significant violations of the trophic status by imposing a percutaneous endoscopic gastrostomy. Clinical studies included 23 patients with various origins of dysphagia from November 2018 to September 2020. Percutaneous endoscopic gastrostomy was performed for all patients. The duration of the surgery averaged 13 minutes. In all the cases the installation process was normal and smooth. Later in 2 patients the postoperative period had been complicated by postoperative wound suppuration. The abscess was opened and drained. The prolapse of the gastrostomy tube occurred in one patient due to a violation of its care. It was required repeated endoscopic intervention. There were not any fatal outcomes. The maximum o bservation period for patients was seven days. There were no restrictions on the duration of feeding and the location of the gastrostomy tube. We have noted the following advantages of percutaneous endoscopic gastrostomy: the possibility of performing technique in patients with a high risk of sugery, minimally invasiveness, the simplicity of performance, the using a local anesthesia, the possibility of perfomance this method in the room of endoscopy and intensive care unit. The introduction of endoscopic gastrostomy method into clinical practice provides a better and more reliable enteral support for patients, improves treatment results and quality of life, and minimizes all possible complications.

Risk factors for surgical site infection in thoracic and lumbosacral spine surgery: retrospective study results

Objective. To specify risk factors for the development of surgical site infection in patients operated on for injuries and degenerative diseases of the thoracic and lumbosacral spine through the posterior median approach. Material and Methods. The study included formalized case histories of 415 patients (207 men, 208 women) who were operated on for degenerative diseases (n = 385) or unstable injuries (n = 30) of the spine. The average age of patients was 47 ± 18 years. Out of them, 230 patients had concomitant chronic diseases requiring constant drug treatment. Before statistical processing, the data obtained in the study were classified according to a generally accepted method to determine the possibility of using different statistical methods when comparing groups. The patients were divided into two groups: Group I included patients with pyoinflammatory complications, and Group II – without pyoinflammatory complications. Results. It was revealed that the following factors significantly affect the development of postoperative wound suppuration: the use of metal fixation, external drainage of the wound for more than four days, the use of monocoagulation from the level of subcutaneous fat, the installation of a retractor for a period of more than 1 hour, blood loss of more than 300 ml, leaving absorbable hemostatic materials in the wound, suturing of muscles in the area of laminectomy, and applying intradermal (cosmetic) sutures. Patient age, preoperative bed day number, skin isolation technique (or lack thereof), duration of surgery, and surgeon experience do not affect the risk of the surgical site infection. Conclusion. Despite the fact that most of the identified risk factors for postoperative wound suppuration are reduced to more complex and prolonged intervention which is more difficult for a patient to tolerate, some of the identified risk factors are potentially removable.

Botkin Hospital Transplant Program: 100 solid organ transplantations

Objective : to evaluate the first results of the Botkin Hospital transplant program. Materials and methods . From June 2018 to October 2019, 100 solid organ transplants were performed at the Botkin City Clinical Hospital. Out of the 100 transplantations, 72 were kidney transplants (average age of recipients was 45.65 ± 11.35 years, HLA match averaged 2.09 ± 1.03) and 28 were liver transplants (average age of recipients was 50.14 ± 7.62 years, average MELD was 17.78 ± 3.28 (14–34). Results . After transplantation, there was no 30-day mortality. Postoperative complications following kidney transplantation were established in 11 patients (15.2%). In 3 patients (4.3%) – suppuration of postoperative wound, in 2 patients (2.8%) – hematomas in the area of the postoperative suture during hemodialysis, in 5 patients (6.9%) – retroperitoneal lymphocele, in 1 patient (1.4%) – urosepsis. There were 4 cases (5.5%) of acute rejection, 3 cases (4.2%) of humoral rejection, and 1 case (1.3%) of cellular rejection. Early postoperative complications following liver transplantation were detected in 2 patients (7.2%). In one patient – hematoma under the right lobe of the liver on the 1st day after surgery, the diaphragm was the source of bleeding, in one patient – ascites leakage through postoperative sutures, which required relaparotomy. In 2 patients (7.2%), postoperative complications were found in the separated postoperative period. In one case, of choledochocholedochal anastomotic stricture – stricture stenting was performed with coated nitinol stent. In another case, acute adhesive intestinal obstruction, which required laparotomy, adhesiolysis. Conclusion . Implementation of the transplantation program in multidisciplinary hospitals can boost transplant care in a district and improve the treatment results of patients with terminal organ damage.

ФАКТОРЫ, СПОСОБСТВУЮЩИЕ РАСПРОСТРАНЕНИЮ ВНУТРИБОЛЬНИЧНОЙ ИНФЕКЦИИ МОЧЕВЫВОДЯЩИХ ПУТЕЙ

Objective: Exploring the factors which contributes the spreading the nosocomial urinary tract infection (NUTI). Methods: Random sampling method analyzed 248 medical cards of patients with benign prostatic hyperplasia for 2016-2018. 154 of them were underwent open adenomectomy, and 94 – transurethral resection of the prostate (TURP). The prevalence of NUTI was studied depending on the patient’s age, duration of surgery, duration preoperative period and duration of bladder catheterization. Results: In 31 cases, the NUTI was identified, which amounted to 12.5%. After the open adenomectomy, the NUTI had 21 observations (13.6%), and after the TURP – in 10 cases (10.6%). The most typical manifestations of NUTI were: urethritis – 32.2%, postoperative wound suppuration – 25.8%, cystitis – 19.3%. It has been found that the frequency of development of NUTI is influenced by the duration of the preoperative period. Thus, among patients who had no more than 2 days of preoperative surgery, the NUTI was 5 times less common than patients with a longer preoperative period, with a frequency of 5.0% and 26.1%, respectively (р<0.001). Statistically significant differences in the frequency of NUTI was found, depending on the duration of catheterization of the bladder: at the terms of catheterization up to 6 days and more than 6 days frequency of NUTI was 6.5% and 22.6% respectively (р<0.001). Conclusion: The most frequent clinical manifestations of NUTI were the suppuration of postoperative wound and urethritis. The main factors influencing the spread of NUTI are the duration of the preoperative period and the duration of bladder catheterization. Keywords: Benign prostatic hyperplasia, open adenomectomy, transurethral resection of the prostate, urinary infection tract, nosocomial infection.

Реконструктивные аспекты хирургического лечения новообразований кожи наружного носа

The unsatisfactory results of treatment of external nose skin neoplasms is a serious social problem. The nose is the central and most visible part of the face, therefore, the patients are very sensitive even to minor defects in this area. The social significance of the location of skin tumors on the face is the predominant factor of the choice of a treatment method. Radiation therapy, cryodestruction and laser excision of malignant skin tumors provide equally favorable results at stages I–II of the process. However, with these types of treatment, the percentage of tumor recurrences is rather high. In most cases, the cause of recurrence is the inadequate excision of the tumor due to the desire of simultaneous replacement of the defect with local tissues. The more radical the treatment is and the earlier it is carried out, the lower is the probability of recurrence. The objective of study: to improve the oncological and functional results of surgical treatment of external nose skin neoplasms. The authors have analyzed the results of surgical treatment of external nose skin neoplasms in 93 patients, including 45 men and 48 women. The operation included wide excision of neoplasm with simultaneous closure of the formed defect with the help of some kind of plastics. The average age of patients was 70.5 years. According to the histological structure, 62 patients had basal cell carcinoma of the nasal skin, 21 had squamous cell carcinoma, 5 had metatypical cancer, 4 had melanoma, and 1 patient had ganglioneuroblastoma. The distribution of patients according to TNM system was as follows: T1 – 50 patients; T2 – 29; T3 – 3; T4 – 11. The reconstruction of external nose defects was performed using various types of flaps. The wound healing by primary intention was observed in 75 of 93 patients, which accounted for 80.6%. Complicated wound healing was observed in 18 patients (19.4%): trophic disorders were observed in 3 patients (3.2%), postoperative wound suppuration – in 4 (4.3%); partial flap necrosis – in 11 (11.8%). The suggested new method of external nose plastics provides safe healing of postoperative wounds and good cosmetic results.