Rami N Abu Shamsiya MD,Phd .Hojouj Mohammad MD,MSo,.Aldababsah Islam MD,Phd

 

Advantages and disadvantages of laparoscopic interventions in emergency abdominal surgery

مزايا وعيوب التدخلات بالمنظار في جراحة البطن في حالات الطوارئ

Department of Surgery №1 National Medical University OOBohomolets .Kiev. Ukraine.

Rami N Abu Shamsiya

+380674441848

doc_rami@yahoo.com

 

Modern possibilities of laparoscopic surgery to minimize the duration of treatment with minimal economic costs, to obtain the highest possible performance and provide high quality treatment, can eliminate the intermediate stages of treatment, reducing the overall time of treatment and rehabilitation, to achieve in the near and distant term quality of life of operated patients [1-4].

The purpose of the work – improve treatment outcomes in patients with acute diseases of the abdominal cavity by using endovideohirurhichnyh developed and improved technologies.

Materials and methods. A retrospective analysis of 442 video laparoscopic surgery for acute surgical diseases of the abdominal cavity in 207 (46.8%) men and 235 (53.2%) of women aged 17-84 (57 ± 19,8) years at the Department of Surgery number 1 National Medical University OA Bohomoltsia for the period from 2010 to 2015. Structure of patients and the number of operations are presented in Table 1.

The vast number of video laparoscopic interventions (71.7%) were performed for acute destructive cholecystitis. The choice was determined by the volume of intervention, depending on the severity of the patient caused by manifestations of both basic and comorbidity. In patients with a high degree of operational risk, two-step method was applied. The first stage was performed under ultrasound guidance percutaneous through liver cholecystostomy, allowed to prevent an acute attack of disease, achieve subsided acute inflammation, to compensate for the patient’s condition, inspect it thoroughly and prepare for radical surgery in the most favorable conditions.

 

 

 

table 1.Structure of patients and the number of operations

disease number of operations
number %
Acute cholecystitis destructive 317 71,7
Acute pancreatitis 16 3,6
Acute appendicitis 76 17,1
Perforative ulcer and 12 duodenal ulcer 13 2,9
The acute intestinal obstruction adhesive 7 1,5
abdominal trauma 13 2,9
Total 442 100

Micro-choletsystostomy performed using ultrasound navigation under local anesthesia. A dynamic ultrasound to assess changes in the gallbladder, pancreas, biliary tract patency.

Video laparoscopy on acute pancreatitis was performed in 16 (3.6%) patients.    Video laparoscopic operations in acute appendicitis were made in 76 (17.1%) patients, including endo-surgical appendectomy – 61 (80.3%). In other cases, the diagnosis of appendicitis was excluded.

When perforative gastric or duodenal ulcer 12 in 13 (2.9%) patients underwent laparoscopic intervention, one of (1.8%) had suturing of the ulcer and drainage of the abdominal cavity, 5 (1.1%) exhibited observations impressions to conversion.

Expanding indications for video laparoscopic operations on acute adhesive intestinal obstruction highlighted the security issues of these interventions. “non-invasive application technologies limited in acute dilatation of loops of small intestine and as a result, small free space in the abdomen that predicted a high risk of intraoperative complications. In such circumstances the intervention presents technical difficulties even for experienced surgeons.

In 4 patients after the elimination of adhesive small bowel obstruction, video laparoscopic adhesolysis was performed. To establish a laparoscope used to access Hasan. Complications and mortality after endo-surgical adhesolysis were observed.

Video laparoscopy was incorporated in medical diagnostic algorithm in 13 (2.9%) patients with closed abdominal trauma. Laparoscopy is used as a diagnostic in – 9 (2.03%) patients, and therapeutic purposes – in 4 (0.9%). To assess the depth of damage of parenchymal organs intraoperative ultrasound was used. In 4 (0.9%) observable indications for laparotomy were: haemoperitoneum 500 ml, peritonitis, injury of hollow organs, deep (3 or more degree by Moore) parenchymal damage of active bleeding.

The results of the study and discussion.

Of the 317 patients operated on for acute cholecystitis complications were observed in 43 (13.5%). In patients with cardiovascular failure after creating carboxyperitoneum gas at a pressure of 14 mm Hg. Art. Occurred deterioration that was manifested in cardiac weakness of varying severity. In the context of drug support and reducing intra-abdominal pressure of 6-8 mm Hg. c., all patients failed scheduled amount of interference. From local complications should allocate bleeding from the cystic artery and its branches – in 11 (3.4%) of the anterior abdominal wall wounds – in 9 (2.8%), gallbladder bed – in 18 (5.8%), with adhesions – in 12 (3.7%), thermal burn of serous membrane duodenal ulcer – in 3 (0.9%), damage hepaticocholedochus – in 1 (0.3%). Intraoperative complications persist without applying conversion. Postoperative complications were found in 5 patients (1.5%) festering wound through which removed the gallbladder – in 3 (0.9%), postoperative pancreatitis – 1 (0.3%), obstructive abscess – 1 (0, 3).

Our experience has shown that laparoscopic surgery for acute diseases and injuries of the abdomen allow to verify the diagnosis, reduce the number of unnecessary interventions, especially in the diagnosis of acute appendicitis in women of reproductive age. This increases the accuracy of diagnostic surgical pathology, allowing you to choose the optimal amount of interference. In the postoperative period patients experience less pain syndrome, it is possible to activation  them in the first hours after the operation.

Of the 16 patients who had surgery for acute pancreatitis curative and diagnostic video laparoscopy was effective in 9 (2.03%), in 2 (0.45%) separate liquid formed separated fluid accumulation with the subsequent formation of pseudocysts that have been sanitized by puncture under ultrasound.

Contraindications to laparoscopic method operations are infiltrative-inflammatory tissue changes that makes it difficult anatomical-orientation wise for the surgeon and sharply increases bleeding. Patients with common adhesive process, sharp abdominal intestinal loops can also be operated laparoscopically, given the danger of injury and lack of adequate opportunities of examination of the abdominal cavity.

Patients stay in the hospital after laparoscopic surgery lasted 3 to 10 days. Over 5 days stayed the patients with peritonitis or perforation of gastric ulcers.

CONCLUSIONS:

  1. Surgeries using endo-video-surgical technology are effective, safe, pathogenetically proved method of diagnosis and treatment of acute surgical diseases of the abdominal cavity through a combination of diagnostic and therapeutic procedures.
  2. Wide application of endo-video-surgical technologies in emergency surgery reduces the time of the diagnostic phase and reduces operating trauma that promotes rapid postoperative rehabilitation of patients and reduces the number of complications.

LITERATURE.

  1. Ермолов А.С. Лапароскопия в неотложной абдоминальной хирургии. / Ермолов А.С., Гуляев А.А., Ярцев П.А. и др. // Хирургия. – 2007;7 : С. 57–9.
  2. Мальчиков А.Я. Стандартизированный подход к диагностике острого аппендицита. / Мальчиков А.Я., Крюков А.Н., Стеньшин А.С. // Труды конгресса «Новые технологии в хирургии», 5-7 октября 2005 г., Ростов-на-Дону. – С. 223–224.
  3. Шаваев Х.Б. Причины наиболее частых осложнений послеоперационного периода после лапароскопической аппендэктомии. // Труды конгресса «Новые технологии в хирургии», 5-7 октября 2005 г., Ростов-на-Дону. – С. 256–256.
  4. Денисенко В. Л., Кубышкин, В. А., Трансанальные эндоскопические операции в комплексном лечении осложненного колоректального рака/ В. Л. Денисенко. 2014, С. 67-68.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Rami N Abu Shamsiya MD,Phd .Hojouj Mohammad MD,MSo

 

Advantages and disadvantages of laparoscopic interventions in emergency abdominal surgery

مزايا وعيوب التدخلات بالمنظار في جراحة البطن في حالات الطوارئ

Department of Surgery №1 National Medical University OOBohomolets .Kiev. Ukraine.

Rami N Abu Shamsiya

+380674441848  doc_rami@yahoo.com

The aim- to improve the results of treatment of patients with acute abdominal diseases, through the use of developed and improved laparoscopic technologies.

Materials and methods. A retrospective analysis of 442 videolaparoscopic surgery for acute surgical abdominal diseases in 207 (46.8%) men and 235 (53.2%) of women aged 17 – 84 (57 ± 19,8) years at the Department of Surgery number 1 of the National Medical University named after AA Bogomolets, for the period from 2010 to 2015.

Results and discussion. 317 patients operated on for acute cholecystitis complications were observed in 43 (13.5%). In patients with cardiovascular. Of local complications should be allocated bleeding from the cystic artery and its branches – in 11 (3.4%) of the anterior abdominal wall – in 9 (2.8%), gallbladder – in 18 (5.8%), of adhesions – 12 (3.7%), thermal burns serosa duodenum – 3 (0.9%), injury hepaticocholedochus – y 1 (0.3%). Intraoperative complications persists without applying conversion. Postoperative complications were observed in 5 patients (1.5%): surgical wound fester through which removed the gallbladder – in 3 (0.9%), postoperative pancreatitis – 1 (0.3%), abscess – 1 (0, 3). the 16 patients operated on for acute pancreatitis remedial diagnostic videolaparoscopic was effective in 9 (2.03%), 2 patients (0.45%) were formed circumscribed fluid accumulation with subsequent formation of pseudocysts that have been sanitized by ultrasound.

Conclusions. 1. laparoscopic interventions technology is an effective, safe, pathogenetically substantiated method of diagnosis and treatment of acute surgical diseases of the abdominal cavity, because of a combination of diagnostic and therapeutic procedures. 2. The widespread introduction of videolaparoscopic technologies in emergency surgery allows for reducing the time the diagnostic phase and reducing surgical trauma that promotes rapid postoperative rehabilitation of patients and reduce the number of complications.

Key words: laparoscopic cholecystostomy, diagnostic  videolaparoscopy.