Urgent Surgical Interventions Research Articles

Quality of Recovery Following Childbirth: A Prospective, Multicenter Cohort Study

(Anaesthesia. 2023;78(9):1071–1080) The peripartum period, encompassing childbirth and its aftermath, involves the administration of anesthesia or analgesia to ∼65% of patients, a substantial portion necessitated by urgent surgical interventions. The imperative to enhance surgical recovery and ensure patient satisfaction postpartum is crucial for delivering high-quality clinical care, as it has the potential to positively influence maternal physical and psychological well-being. Despite the escalating focus on postpartum-related research, prior studies on recovery have been predominantly confined to single-center endeavors with limited sample sizes, deploying disparate outcome measures or unvalidated metrics, primarily evaluating inpatient recovery with insufficient scrutiny of outpatient recovery.

Patterns and management outcomes of intracranial extra-axial hematomas in low-resource setup: a 6-month prospective observational study at Jimma University Medical Center, Ethiopia

IntroductionIntracranial hematoma is the collection of blood in various intracranial spaces. Knowledge of patterns, origins, causes and outcomes of ICH conditions is important for decision-making for urgent surgical interventions such as craniotomy and hematoma evacuations. No prior study was conducted in our setup. Hence, this study aimed to assess the patterns and management outcomes of intracranial hematomas in low-resource setting and tailored our management approach at Jimma University Medical center.MethodsAn institution-based prospective observational study was conducted at Jimma University Medical Center, Ethiopia, for six consecutive months from June to December 2020. Different data sources and interview methods were used and analyzed using SPSS version 24. A bivariate and multivariate logistic regression was conducted to determine the association between the variables.ResultsA total of 91 eligible patients were recruited during the study period, with a mean age of 34 years. The majority of patients were males [73 (80.2%)] and more common in reproductive age groups (62.6%), from rural areas (50.5%). About 93.4% of patients reported a history of trauma, and road traffic accidents & fighting account for 63.8% of the trauma cases. Sixty-five percent of patients arrive in the hospital within 24 h. Upon presentation, there were loss of consciousness (48.4%), convulsion (11%), aspiration (9.9%) and increased ICP (12%). The majority (49.5%) of the patients had a mild head injury. The focal neurologic deficits were hemiparesis (29.7%) and hemiplegia (5.5%). Acute epidural hematoma (68.1%) was a common finding, followed by sub-acute subdural hematoma. Of the total study participants, 11% had died. All the surviving patients were accessed at 30 days after discharge and re-assessed, 66 patients had good neurologic recovery (62 upper and 4 lower good recovery), 11 patients had moderate disability (7 lower and 4 upper-moderate disabilities), two patients had a severe disability, and two patients (among those with severe disability) had died.ConclusionTrauma was invariably the cause of intracranial hematoma, and patients with low GCS, papillary abnormalities, aspiration and increased ICP had an increased risk of dying from their illness. It is good to formulate policies to enhance injury prevention and bring about health-oriented behavioral change.

Postoperative complications for complicated malignant tumours of the stomach

Objective — to determine the frequency and structure of postoperative complications for malignant tumours of the stomach accompanied by gastrointestinal bleeding. Materials and methods. The study analysed the treatment outcomes of 101 patients with a malignant tumour of the stomach complicated by bleeding (84 cases), perforation (6 cases), or stenosis (19 cases, with 8 of them having both stenosis and bleeding). These patients underwent inpatient treatment at the Kyiv City Centre for Gastrointestinal Bleeding and the Kyiv City Clinical Hospital of Emergency Medical Help between 2015 and 2020. Out of the patients, 78 (77.2%) had histologically confirmed cancer, 11 (10.9%) had GIST, and 12 (11.9%) had malignant lymphoma. Results. During the peak period of ongoing and recurrent bleeding, 5 (6%) patients required emergency surgery, including 2 (40%) radical and 3 (60%) non‑radical procedures. After proper preoperative preparation and a comprehensive follow‑up assessment, 58 (57.4%) patients underwent radical surgical interventions for stomach cancer complicated by acute gastrointestinal bleeding in the early delayed period. In the early postoperative period, 4 (15.4%) patients experienced complications after 26 radical gastrectomies combined with jejunogastroplasty. In the delayed period, early postoperative complications occurred in 9 (28.1%) patients after 32 radical gastric resections. The total postoperative mortality after emergency surgical interventions was 20.0%. The total postoperative mortality in the early‑term period was 5.7% (5 patients out of 88), which is 3.5% less compared to emergency operations (the difference is statistically significant, p ≤0.05). Conclusions. When urgent surgical interventions are carried out at the peak of ongoing and recurrent bleeding, the mortality rate from postoperative complications is 3.5 times higher than when operations are performed in the early delayed period after adequate preparation and comprehensive patient monitoring. The death rate after radical operations is 2.1 times lower than that after palliative and symptomatic operations. As the operations conducted during the peak bleeding period are associated with high postoperative mortality, we believe that they pose a high risk to patients with malignant tumours of the stomach.

Amyand’s and De Garengeot’s hernias – rare combined urgent surgical pathology

INTRODUCTION. The article describes the analysis of the Russian experience in the treatment of Amyand’s and De Garengeot’s hernias and the author’s observation of an extremely rare case of appendix incarceration in the right femoral hernia. The hybrid surgery was performed – open herniotomy for appendectomy of the distal part of the appendix and the laparoscopy to remove the remaining intraabdominal part of the appendix.The OBJECTIVE was to describe the treatment tactics for the Amyand’s and Garengeot’s hernias based on the analysis of data from the Russian literature and our own clinical experience.METHODS AND MATERIALS – review of the Russian literature and own clinical case.RESULTS. 22 cases of Amyand’s hernia and only one of Garengeot’s hernia cases in 14 articles was found. CONCLUSION. The terms «Amyand’s hernia» and “Garengeot’s hernia” mean the development of acute appendicitis in cases of the location of the appendix in the hernial sac in inguinal or femoral hernias, respectively, and are also valid in cases of incarceration of these hernias, the contents of which are a secondarily modified as a result of incarceration of the appendix. Urgent surgical interventions for Amyand’s and De Garengeot’s hernias could be performed by traditional, laparoscopic and hybrid methods, depending on the preoperative diagnosis and intraoperative features.

Bochdalek Hernia: A Comprehensive Review of Pathophysiology, Clinical Presentation, Diagnostic Modalities, and Contemporary Management Strategies

Bochdalek hernia, a rare congenital diaphragmatic anomaly, has garnered substantial attention due to its intricate pathophysiological underpinnings and multifaceted clinical implications. This article endeavors to provide an exhaustive analysis of Bochdalek hernia, encompassing its embryological origins, intricate pathophysiology involving the posterolateral diaphragmatic defect, and the subsequent herniation of abdominal contents into the thoracic cavity. A meticulous exploration of the clinical presentation underscores the considerable variation in symptomatology, ranging from asymptomatic cases incidentally detected on imaging, to severe respiratory distress and life-threatening consequences in neonates. The diagnostic armamentarium, including radiographic, ultrasonographic, and tomographic modalities, is scrutinized with a focus on their respective sensitivities and specificities in discerning this anatomical aberration. In light of contemporary advancements, the article elucidates the expanding role of three-dimensional reconstructions and minimally invasive techniques in achieving accurate diagnosis and surgical planning. Furthermore, the management landscape is delineated, encompassing conservative approaches for asymptomatic cases, urgent surgical interventions for acute presentations, and the nuanced perioperative considerations for neonates and pediatric patients. A comprehensive overview of surgical techniques, ranging from traditional open procedures to the evolving realm of robotic-assisted and laparoscopic repairs, is provided, with emphasis on individualized strategies tailored to patient-specific factors. In summation, this article offers a comprehensive and sophisticated exploration of Bochdalek hernia, amalgamating embryology, pathophysiology, clinical presentation, diagnostic modalities, and contemporary management paradigms. It is envisaged that this review will serve as a valuable resource for medical practitioners, surgeons, and researchers, fostering an enriched understanding of this intricate condition and facilitating informed decision-making in its management.

Common postbariatric surgery emergencies for the acute care surgeon: What you need to know.

The field of bariatric and metabolic surgery has changed rapidly over the past two decades, with an exponential increase in case volumes being performed because of its proven efficacy for morbid obesity and obesity-related comorbidities. Although this increased volume of procedures has been accompanied by significant decrease in postoperative complication rates, there are numerous potential complications after bariatric surgery that may require urgent or emergent surgical evaluation or interventions. Many of these risks extend well beyond the early postoperative period and can present months to years after the index procedure. Acute care surgeons are increasingly covering most or all of the emergency general surgery services at many centers and must be familiar with the numerous bariatric surgical procedures being performed and their individual complication profile to provide optimal care for these frequently challenging patients. This article provides a focused and concise review of the common bariatric procedures being performed, their early and late complication profiles, and a practical guide to the optimal diagnostic evaluations, surgical interventions, and perioperative management options. The author group includes both acute care surgeons and bariatric surgeons with significant experience in the emergency management of the complicated postbariatric surgical patient. Literature Synthesis and Expert Opinion; Level V.

Surgical Management of Congenital Lung Malformations

Congenital lung malformations (CLMs) are commonly diagnosed prenatal lesions with varied natural history. Prenatal diagnosis and monitoring help to guide fetal interventions, delivery planning, and need for urgent perinatal surgical interventions. All prenatally diagnosed CLMs should be evaluated postnatally, typically with cross-sectional imaging, because many lesions persist despite the appearance of complete 'regression' in utero. Management of CLMs in asymptomatic infants weighs the surgical and anesthetic risk of prophylactic resection against the risk of expectant management, including the possibility of infection, malignant degeneration, and more complicated surgical resection later with loss of compensatory lung growth.

WHO SAFE SURGERY CHECKLIST IMPLEMENTATION IN UKRAINE: MEDICAL PERSONNEL COMPLIENCE AND OTHER ASPECTS

Summary. WHO surgical checklist is an effective tool for human-related adverse perioperative event prevention. Although it’s implementation often accompanied by different challenges.
 The objective of the study was to evaluate the quality of implementation of the modified WHO surgical checklist and to identify the main barriers to its completion.
 Materials and methods. A retrospective analysis of 366 medical records of patients that undergoing a Cesarean section was performed during the period from 1 October 2022 to 5 January 2023 and the accompanying checklists to evaluate their completion.
 Results. The average checklist completion rate was 94.2 %. The least filled field was “specimen labelling” and “date and time” in the final section (87.9%, n = 190), the most – patient identification, informed consent to anesthesia, presence of the relevant laboratory data and obstetric history, readiness of the anesthetic equipment, known allergies (100 %, n = 216). Among the checklists’ sections, fields were most unmarked in the “end of procedure” section (91.7 % filled), followed by the “preoperative assessment” (94.5 % filled) and most rarely in the “preinduction assessment” (95.5% filled).
 Conclusion and recommendations. The results of the study indicate the average compliance of the medical staff to filling out the surgical checklist «Safe Surgery» in the Kyiv City Maternity Hospital No. 5, and the high completeness of the filled checklists. Failure to complete the checklist was most often associated with urgent surgical interventions. Analysis of compliance of medical personnel and the quality of filling out checklists is an important and mandatory component of improving the safety of surgery and anesthesia.

A clinical case of gunshot shrapnel penetrating wound of the chest with injury to the inferior vena cava with migration of a foreign body along the blood stream

Damage to the major vessels in a retroperitoneal trauma belongs to the category of the most difficult, including damage to the inferior vena cava. The aim of the work is to demonstrate the features of clinical manifestations and tactical solutions of a gunshot fragment blind wound of the inferior vena cava with the migration of a foreign body along the blood stream. Materials and methods. A case of a gunshot fragment wound of the inferior vena cava with migration of the foreign body along the blood stream was studied. An injured person underwent sCT with and without contrast, FAST protocol, general blood test, biochemical blood test, CBV was determined using the formula of Moore, hourly diuresis was measured. Results. The patient was operated on for vital signs, the condition of the injured person was stabilized. During the revision of the abdominal cavity and paranephric tissue, no foreign body was identified. In the immediate postoperative period, the injured person underwent chest and abdominal CT, according to the data of that, a metal fragment was identified, which migrated along the inferior vena cava to the point of connection with the right atrium. The injured man was operated on at another specialized facility, where the foreign body was removed using a surgical magnetic tool. Conclusions. Fire damage to the inferior vena cava is classically accompanied by a severe general condition, massive blood loss, which requires urgent surgical interventions. Multi-component preoperative preparation, a clearly established diagnostic plan, a multidisciplinary approach based on the example of our clinical case allow saving life even in the most complex cases.

Medical and social characteristics of women of reproductive age who have undergone urgent gynecological surgery

The objective: to study the medical and social characteristics of women in reproductive age who had urgent gynecological surgical operaions.Material and methods. The studied cohort consisted of 135 women in reproductive age who had urgent surgery for ovarian apoplexy (43; 31.9 %), ectopic pregnancy (57; 42.2 %), complicated ovarian tumor (35; 25.9 %). The inclusion criteria were age from 19 to 40 years; intraoperatively confirmed ovarian apoplexy, ectopic pregnancy, complicated ovarian formation; informed consent of the patient to participate in the study. Social and clinical data were registered in the developed questionnaire, which included social and household data, professional and material factors, somatic and obstetric and gynecological anamnesis. Statistical processing of the results was carried out using standard Microsoft Excel 7.0 and “Statistica 6.0” programsResults. It was determined that 26 (19.3 %) women did not visit a gynecologist at all, 18 (69.2 %) of them did not have a sexual activity, 8 (30.8 %) patients did not plan to become pregnant, so they were not considered that it is necessary to visit a doctor. Another feature of the gynecological anamnesis of patients who had urgent surgical operations was a repeated surgical intervention due to a similar gynecological pathology. Thus, 26.9 % of patients were re-hospitalized due to ovarian apoplexy, and 19.2 % had operation again. 17.3 % of women had a repeat ectopic (tubal) pregnancy, for which 13.5 % of patients had repeated surgery. Recurrence of ovarian tumor and urgent surgical intervention occurred in 25.8 % of patients.Conclusions. The lack of full coverage of patients with pathogenetically justified medical and preventive measures after urgent surgical operations leads to the recurrence of similar gynecological pathology and repeated urgent surgical interventions. The obtained results indicate the need for a multifaceted analysis of factors affecting the frequency of acute gynecological diseases and in the scientific justification of medical and diagnostic approaches with the introduction of modern organizational technologies into practice.

S195 Is There a "Golden Window" for Endoscopic Reduction of Acute Sigmoid Volvulus: A Multicenter Retrospective Study

Introduction: Colonic volvulus accounts for around 2% of all bowel obstructions in the United States. the involvement of the sigmoid colon consists of the overwhelming majority of colonic volvulus cases, possibly 60.9–80%. [1]. Per the American Society of Gastrointestinal endoscopy guidelines (ASGE), Non-operative detorsion with flexible sigmoidoscopy is considered first-line therapy in the management of sigmoid volvulus in patients without signs of peritonitis, perforation, or with recurrent or unsuccessful nonoperative decompression [2][3][4]. Despite this recommendation, the ideal timing for endoscopic intervention remains unclear. Methods: We conducted a retrospective study in adult patients admitted for acute sigmoid volvulus in 4 academic centers from January/2010-January/2020. 47 Patients were identified using ICD-9 and ICD-10 codes. Inclusion criteria included adult patients who were initially managed with endoscopic detorsion. The time interval between diagnosis and endoscopic intervention was collected. Primary outcomes included the need for subsequent urgent surgical intervention within 30 days of the endoscopic intervention. Secondary outcomes were hospital length of stay and mortality. Results: A total of 47 patients met the inclusion criteria. 33 patients were males (70.2%). The mean age of the sample was 71.0 (±16.5) years. Successful non-surgical reduction was achieved in 43 patients (91.5%). Endoscopic intervention was aborted in 4 patients for concerns of bowel ischemia or nonviable mucosa. 31 (66%) patients required urgent surgical intervention within 30 days of the endoscopic reduction, with an average interval period of 7 (±8.5) days. Surgical interventions included Hartmann’s procedure, sigmoid colectomy with primary colorectal anastomosis, and total abdominal colectomy. Early endoscopic reduction resulted in fewer subsequent urgent and emergent surgical interventions (p-value = 0.013). Using the ROC curve, a cut-off point of 8.5 hours was determined to be predic table of favorable outcomes with a sensitivity and specificity of 74.2%, and 75%, respectively. (Figure) Early endoscopic intervention was associated with shorter hospitalization (p-value = 0.001). Conclusion: Endoscopic decompressive intervention within 8.5 hours of diagnosis of acute sigmoid volvulus decreased early volvulus recurrence, bowel ischemia and subsequent need for urgent surgical interventions. This in return decreased hospital length of stay and allowed for planned prophylactic surgical resection.Figure 1

The clinical case report of Gallbladder Volvulus

Background: Gallbladder volvulus is a rare emergency surgical condition that is usually misdiagnosed as acute cholecystitis and most of the time it is diagnosed intra-operatively Purpose: to report a rare case of GBV. ase report: a forty-six years old Ethiopian male patient presented to Yirgalem General Hospital and Medical College with right upper quadrant pain, nausea, and vomiting of two days duration. Conservative treatment was devised for acalculous acute cholecystitis. Nonetheless, on the seventh day of onset of symptoms conservative treatment failed and cholecystectomy was done for gangrenous GBV. The patient improved on the ninth post-operation day and was discharged. Conclusion: Although the typical patients for GBV are elderly females and thin kyphotic, it can occur at any age. Therefore, it should be considered in the differential diagnosis of all patients presented with clinical features of acute cholecystitis. Moreover, early urgent surgical interventions will decrease mortality and morbidity.

Assessment of the prevalence of abnormal vaginal discharges in women of reproductive age who have undergone urgent gynecological surgery

The problem of restoring women’s reproductive health after emergency operations for acute gynecological pathology has been social and medical significance in recent years. This is due to both the increase in its frequency and long-term negative outcomes – a decrease fertility rate, the development of pain syndrome, changes in hormonal homeostasis, etc. One of the manifestations of postoperative dysfunction in the organism is the appearance of an excessive amount of vaginal secretions in female patients. However, the targeted studies about the state of the vaginal microbiota in women after urgent surgical interventions for acute gynecological pathology are rare, and the results are contradictory.The objective: to assess the prevalence and nature of vaginal discharge in women of reproductive age after urgent gynecological operations. Materials and methods. The studied cohort included 125 women of reproductive age. The main group included 60 women of reproductive age after urgent operations because of ovarian apoplexy, ectopic pregnancy, complicated ovarian neoplasm; the comparison group – 35 patients after planned surgery for gynecological pathology; the control group consisted of 30 healthy women. The diagnosis of the causes of vaginal secretions and infection with sexually transmitted pathogens was carried out by the method of pH-metry, bacterioscopic and molecular biological research. The examination was carried out on the 5th day after the operation. Results. Before planned surgical operations, bacterial vaginosis was diagnosed in 22.9% of women in the comparison group, vulvovaginal candidiasis – in 2.9%. The urgency of the operation because of acute gynecological pathology led to the preoperative determination of the state of the vaginal microbiota in only 56.7% of patients in the main group, with the detection of bacterial vaginosis in 26.5%, aerobic vaginitis in 17.7%. After surgery, vaginal microbiota was abnormal in 78.3% of patients in the main group and in 34.3% – in the comparison group (bacterial vaginosis – 53.3% and 31.4%, respectively). Conclusions. Dysbiosis and inflammatory diseases (aerobic vaginitis) of the lower genital organs should be considered as one of the risk factors for acute gynecological pathology. Dysbiotic processes have a tendency to progress after surgery, which makes it necessary to carry out preoperative sanitation of the vagina to reduce the risk of postoperative complications development.

INFLUENCE OF RESPIRATORY SYSTEM PROTECTION ON THE TREATMENT OF PATIENTS WITH CRANIOCEREBRAL TRAUMA

Introduction. Craniocerebral trauma (CCT) results in disorders of pharyngeal reflex, deglutition, breathing rhythm and frequency. All the mentioned conditions cause the development of respiratory complications. Whereas they become independent factors of negative therapeutic consequences in such category of patients.
 Aim of a paper. The research aims at evaluating protection/treatment possibilities of the respiratory system concerning the course of craniocerebral trauma in injured patients.
 Materials and methods. We examined 237 patients with CCT who underwent urgent surgical interventions in the form of a decompressive cranial trepanation and the removal of both subdural and epidural hematomata. All patients required prolonged mechanical ventilation of the lungs. The patients were retrospectively divided into two groups, namely: the first group (132 patients) – the patients with tracheostomy on the 5th-6th days of admission to the clinics of anesthesiology and intensive care; the second group (105 patients) – the patients with tracheostomy on the 1st-2nd days of hospitalization. Patients of both groups were not differentiated by gender, the severity of CCT and general condition. In addition to general clinical and biochemical blood markers, culturing of the secretion in the tracheostomy tube (at the moment of tracheostomy and further every 3-4 days), blood and urine were performed in all patients. Simultaneously we controlled the leucocyte count in the peripheral blood, number of immature forms, levels of CRP and procalcitonin. The evaluation of a neurological status of patients was carried out by the Glasgow and Richmond Agitation-Sedation Scale (RASS). The severity of CCT was visualized with the help of CT.
 Research results. Even at the moment of tracheostomy the frequency of colonization of tracheobronchial tree was significantly higher in the first group of patients compared to the second one. Such tendency was monitored in further stages as well. The phenomena of tracheobronchitis and pneumonia were detected more frequently in the group of patients with tracheostomy on the 5th-6th days of postoperative period in contrast to the patients with tracheostomy on the 1st-2nd days of postoperative period. Microorganisms of Enterobacteriaceae with the extended spectrum of ß-lactamase and non-fermenting Gram-negative bacteria were detected more frequently in the first group.
 Conclusion. Early tracheostomy in patients with CCT results in both the decrease in the frequency of positive culturing of secretions from the tracheobronchial tree and the reduction in a detection frequency of nosocomial pneumonia.

Reproductive disorders in women of reproductive age who have undergone urgent surgery on the reproductive organs

The objective: to analyze the long-term reproductive effects in women who after emergency gynecological surgery. Materials and methods. A retrospective analysis of the reproductive outcomes after urgent surgical operations (after 2 years) was performed in 300 gynecological patients aged 19 to 42 years. Results. A retrospective analysis showed that 69,3% of women who underwent emergency gynecological surgery had a history of gynecological diseases, but 30,7% of patients were not observed by a gynecologist. Before surgery, menstrual disorders were diagnosed in 42,0 % of patients, pathology of the lower genital tract – 19,7%, inflammatory diseases of the pelvic organs – 7,7 %. 8,2 % of women had gynecological operations before, 13,9 % – reproductive losses, and 11,1 % persons were examined and treated for infertility. The predominant method of surgical intervention in this cohort of patients was open laparotomy (59,7 %), laparoscopic intervention was performed in 40,3 % of cases. The most common indications for surgery were damage tubal pregnancy, ovarian apoplexy, complicated ovarian formation. Morphological verification of intraoperative findings showed that most often indications for operations were serous ovarian tumors (38,7 %), follicular tumors (22,4 %), complicated endometrioid and dermoid cysts (22,4 %), corpus luteum cysts with hemorrhage (9,2 %), paraovarian cysts (7,1 %). Rehabilitation postoperative therapy was performed for a limited number of patients (31,7 %), which could not but affect the state of reproductive health of women – an increase in the incidence of pain (42,0 %; p<0,05) and chronic pelvic pain (42,3%) in the absence of such before surgery, as well as infertility (from 11,1 % to 22,5 %; p<0,05). Conclusions. The lack of pathogenetically intra- and postoperative measures after urgent surgical interventions leads to increase the frequency of reproductive dysfunction, which requires the development and improvement of differentiated rehabilitation therapy and secondary prevention according to the nosology that caused urgent surgical operatrion.

ENDOSCOPIC INTERVENTIONAL MANAGEMENT USING ADRENALINE-NORMAL SALINE INJECTION FOR ACTIVELY BLEEDING PEPTIC ULCERS IN SOUTH KASHMIR, INDIA

Aim:TodeterminetheefficacyofendoscopicNormalSalineAdrenaline(NSA)injectiontherapyinactivelybleedingpepticulcerdiseasepatientsof southernKashmir. Methods: All those patients who presented with upper GI bleed (UGB) malena/hematemesis or both underwent early upper GI endoscopy after stabilization. Those patients who had actively bleeding peptic ulcers(gastric/duodenal) were enrolled in this study. They were injected 10-15ml of 1:10000 adrenaline diluted in normal saline around the 3mm of bleeding ulcer, including ulcer base. Modified Forrest classification was used for assessment and management purposes. Patients with variceal bleed were excluded from the study. Results:There were 136 actively bleedingPepticUlcerpatients (84 males,52females)intheagegroupof18-65years.96(70.58%)patients had duodenal Ulcer(DU), whereas40(29.42%) patients hadGastricUlcer(GU). Primaryhemostasis was achieved in 98.53% of patients with endoscopic injection therapy. One patient who was an elderly male withForrestIA duodenal ulcerunderwent emergency gastrojejunostomybecauseof underlyinglargevesselhemorrhage,whichcouldnotbecontrolledbythe endoscopic obliteration method. Another patient with Forrest IB, who failed with obliteration twice, responded to endoscopic clipping. Rebleeding was observed in 12 (8.82%) patients. There was no mortality in this study. Conclusion: Endoscopic injection therapy is a simple, cheap, safe, and highly effective first-line treatment for a non-variceal upper GI bleed procedure. It avoids urgent emergency surgical interventions and related complications, thus reducing these patients mortality and morbidity.

Попередження інтраопераційної ненавмисної гіпотермії у пацієнтів із політравмою

Актуальність. Ненавмисна гіпотермія розвивається спонтанно як наслідок травми, хірургічного втручання та наркозу в результаті порушення відповідності теплопродукції тепловтрат і пригнічення компенсаторної терморегуляційної відповіді. Мета: вивчити ефективність способу корекції інтраопераційної ненавмисної гіпотермії з використанням системи конвекційного обігріву в пацієнтів із політравмою. Матеріали та методи. Обстежено 20 пацієнтів із політравмою, яким проводились ургентні оперативні втручання. Пацієнти були розділені на 2 групи: I — основна група (n = 10), в якій інтраопераційно проводилося активне зігрівання системою конвекційного обігріву WarmAir 135 (CSZ) з використанням ковдр для зігрівання в умовах операційної; II — контрольна група (n = 10) без використання конвекційного зігрівання. Вивчалася температура ядра тіла (Тсо): початково, через 30, 60 хвилин і наприкінці операції. Розраховувалися наступні показники: мінімальна (Тмін.) і максимальна (Тмакс.) температура, середня температура (Тср.), температурний діапазон (Тдіап. = Tмакс. – Тмін.). Результати. У всіх пацієнтів із політравмою та проведенням ургентних хірургічних втручань відзначається розвиток клінічно значущої ненавмисної гіпотермії. На етапі 60 хвилин інтраопераційного періоду Тсо була вірогідно вище в I групі (35,38 ± 0,28 °С) порівняно з пацієнтами II групи (34,70 ± 0,39 °С) (p < 0,05). Виявлено вірогідно вищий рівень середньої Тсо в I групі (35,53 ± 0,66 °С) порівняно з II групою (34,67 ± 1,74 °С) пацієнтів (p < 0,05). Діапазон температур, який являє собою різницю максимальної та мінімальної Тсо, був вірогідно нижче в I групі пацієнтів (1,36 ± 0,74 °С) порівняно з II групою (4,55 ± 1,11 °С) (p < 0,05). Висновки. Використання в комплексі інтенсивної терапії конвекційної системи зігрівання хоча й не дозволяє досягти вихідних значень Тсо, але попереджає прогресування поглиблення гіпотермії, ефективно забезпечуючи підтримку температурного гомеостазу у критичних пацієнтів із політравмою.

Impact of the first wave of the COVID-19 pandemic on emergency surgical activities at the National Reference University Hospital of N'Djamena.

An evaluation of Covid-19 pandemic impact on emergency surgical activities at the CHU-RN in N'Djamena, Chad. A retrospective study of patients admitted to the surgical emergency room during the first wave of the pandemic (April-June 2020). The data were compared to those of patients admitted during the same period in 2019 (control group). Results: A total of 3248 patients were received: 2366 in 2019 and 882 in 2020. Respective reduction of 50% of admissions and 31% of emergency operations were observed. The average age (30 years) and male predominance remained unchanged. The average admission time went from 72 hours in 2019 to 7 days in 2020. We also noticed that digestive emergencies, such as acute generalized peritonitis (6.6% vs 14.4%, p < 0.1) and strangulated hernias (6.6% vs 15.2% p: 0.07) were more severe in 2020. COVID-19 had reduced admissions and urgent surgical interventions.

Сравнительная оценка динамики иммунологической реактивности у пациентов послеоперационными вентральными грыжами

Postoperative Ventral Hernias to this day remain one of the main pathologies of planned and urgent surgical interventions. The purpose of the study is to study the immune response in patients with postoperative ventral hernias who underwent auto and alloplastic hernioplasty methods. The study included 40 patients diagnosed with postoperative ventral hernia, including 25 men (62.25%) and 15 women (37.5%). In men, the average age was 45.6±2.3 years, and in women 57.2±3.2 years. Patients are divided into 2 groups. Group I are patients who underwent autoplastic methods and group II patients who underwent alloplastic hernioplasty methods. The complex of immunological examination included the determination of a subpopulation of lymphocytes with CD3, CD4, CD8, CD20 receptors, interleukin 6, interleukin 10 and immunoglobulins A, M, G. Immunological examination of blood parameters in patients with postoperative ventral hernias revealed the following changes. There is an upward trend in all indicators. In group I, the leukocyte level was increased by +0.2±0.01, and in group II, the indicators were within the normal range. The level of monocytes in patients who underwent alloplasty increased by +1.5±0.2. There was an increase in the concentration of T and B lymphocytes with GD3, CD4, CD8, CD20 receptors on the 7th day after surgery in patients of the first group was +1.85±0.3, +1.6±0.4, +1.6±0.1, +1.5±0.2. And in patients of the second group, the initial level of indicators was lower and increased by +1.2±0.1, +1.4±0.2, +1.67±0.65, +1.03±0.45. The level of IL6 and IL 10 in the postoperative period increased in patients of the first group by +1.55±0.2 and +1±0.9, in the second group it was IL 6 +0.9±1.2, IL 10 +0.8±1.2. The study shows that the indicators of the humoral cell type tended to increase, which shows the result. Conclusions. Patients with postoperative ventral hernias who have undergone autoplastic and alloplastic hernioplasty methods in dynamics, the immunological reactivity indicators significantly increase on the 7th day, in comparison with the initial blood parameters. Namely, in patients who have undergone autoplastic methods of hernioplasty. The use of conventional suture materials in autogernioplasty increases the risk of developing an inflammatory process in the early and long-term postoperative period, in contrast to the use of polypropylene mesh prostheses.

Correction of electrolyte balance in surgical patients with urgent surgical interventions

Annotation. Acute appendicitis is one of the most common acute pathologies of the abdominal cavity, which requires immediate surgical intervention and can lead to water-electrolyte imbalance. The aim of the study was to investigate the clinical significance of electrolyte imbalance in patients operated on for acute appendicitis and their correction. We examined 20 urgent surgical patients who were part of the control group and received “traditional” postoperative therapy and 23 patients of the study group who received oral rehydration therapy in the postoperative period to correct water-electrolyte disorders. To analyze the results of the study, profile analysis was used as a modification of multidimensional covariance analysis with repeated measurements. As can be seen from the results of testing the hypothesis of normalization of homeostasis due to the use of oral rehydration therapy schemes, the hypothesis was confirmed with a threshold significance of p=0.0642. The only significant effect of the rate of normalization of potassium concentration in blood plasma is the appointment of oral rehydration therapy with p=0.045. Also, the appointment of oral rehydration therapy is a significant effect of the rate of normalization of sodium and glucose in plasma (normalization of plasma glucose is significantly better in the dynamics of younger patients (p=0.045)). Thus, normalization of potassium and glucose, which correlates with the patient's age, was better in patients receiving oral rehydration mixture in the postoperative period than in patients receiving “traditional” postoperative therapy. Oral rehydration therapy is an acceptable alternative to infusion therapy in patients undergoing surgery for acute appendicitis in the postoperative period.