[Complications of endoscopic retrograde cholangiopancreatography during preparation of patient for pancreatoduodenal resection].
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Adenocarcinoma↗
Biomedical subjects
A G Kriger
Publications and source records attributed to A G Kriger.
[Treatment of pancreonecrosis with lesion of retroperitoneal adipose tissue].
The results of treatment of 122 patients with pancreonecrosis (PN) with lesion of retroperitoneal fat tissue (RFT) were analyzed. Twenty-four patients underwent emergency and urgent surgery, drainage of RFT through lumbotomy was performed. Nine (37,5%) patients died. Sixty-six patients with aseptic PN were treated conservatively, 7 (10,6%) of them died. Thirty-two patients treated conservatively with infection of RFT underwent surgery with minimally invasive methods - retroperitoneoscopy with sequestrectomy, minilumbotomy, sequestrectomy. 5 (15,6%) patients died. In sterile PN conservative treatment should be carried out. Recent fluid formations in RFT are indications for thin-needle puncture, their drainage is contraindicated. Prognosis of the disease is favorable when 1-3 regions of RFT are affected, more advanced process is prognostically unfavorable. Infected PN should be treated surgically. Ultrasound-assisted drainage of purulent cavities must be performed as the first stage. Flow aspiration drainage may be a final procedure when 1-2 (rarely 3) regions of RFT are affected and large RFT sequesters are absent. Formation of large RFT sequesters requires removing with retroperitoneoscopy or through mini-approach.
Adipose Tissue↗
[Diagnosis and treatment of postoperative intraabdominal complications].
Postoperative complications after 8168 reoperations were seen in 143 (1.8%) patients. Clinical symptoms, laboratory tests, results of x-ray and ultrasound examinations were taken into account in diagnosis of the complications. Differential diagnosis of postoperative peritonitis, stable paralytic intestinal obstruction, early adhesive obstruction and intraabdominal bleeding based only on clinical data is difficult in many cases. Ultrasonic examination and laparoscopy permitted to reduce number of unjustified relaparotomies. In the majority of cases relaparotomy was considered as a method of choice in treatment of these complications. Mini-invasive surgeries may be performed only in mild complications. Lethality in the treatment of postoperative complications after relaparotomy was 39.4%, after laparoscopic surgeries--8.8%, after US-assisted drainage--0. General lethality was 29.4%.
Abdomen↗
[Occlusive intestinal obstruction due to gallstones].
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Cholelithiasis↗
[Perforation of nonspecific ulcers of the small intestine].
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Female↗
[Diagnosis and treatment of acute adhesive small intestine obstruction].
Experience of treatment of 162 patients with acute adhesive intestinal obstruction (AAIO) is described. These patients had most often (23.3%) appendectomy in anamnesis. Conservative treatment was effective in 23 (14.2%) patients only. Surgical treatment was performed in 139 (85.8%) patients including traditional open operation in 79 (56.8%) patients, laparoscopic and laparoscopy-assisted in 60 (43.2%). Advanced adhesive process with formation of single intestinal conglomerate, neglected forms of AAIO with paralytic ileus were indications to open operations; lethality in these operations was 17.7%. Laparoscopic operation was indicated in AAIO due to isolated commissure as well as in early adhesive obstruction; lethality was 1.7%. If diagnostic laparoscopy showed that AAIO is caused by intestinal deformation in small intestinal conglomerate or intestinal resection is required, laparoscopy-assisted operations were performed.
Acute Disease↗
[Results and prospects of treatment of general forms of peritonitis].
956 patients with general peritonitis were operated: 596 patients--for diffuse peritonitis, 360--for general peritonitis. The causes of peritonitis were: perforating gastroduodenal ulcers (454), acute destructive appendicitis (190), acute destructive cholecystitis (82), perforation of small intestine and colon (96), postoperative peritonitis (80), other diseases (54). In low degree of bacterial contamination of abdominal cavity (not more Ig 5 CFU/g) operations were completed without abdominal drainage, laparoscopic variant of the operation being optimal. In postoperative period, out of 691 patients with low degree of bacterial contamination wound infection was in 7.9%, intraabdominal infection--in 2.5%, polyorganic insufficiency--in 1.0%; lethality was 5.9%. In high degree of bacterial contamination (more Ig 5 CFU/g) and massive unremovable fibrinous patch on the peritoneum the programmed revisions and sanations of abdominal cavity were performed, sometimes--control laparoscopic revisions. In postoperative period of 256 patients with high degree of bacterial contamination wound infection arose in 6.0%, intraabdominal infection--in 4.2%, polyorganic insufficiency [symbol: see text] in 42.6%; lethality was 18.1%.
Adult↗
[Intraabdominal cholerrhea after cholecystectomy].
Cholecystectomy (CE) was performed in 2303 patients with cholelithiasis and its complications. Cholerrhea (CR) after operation was in 31 (1.34%) patients: after laparoscopic CE (1425 patients)--in 18 (1.26%), after open CE (878 patients)--in 13 (1.48%). Source of CR was not found in 21 patients, CR from gall bladder bed was revealed in 7, from cystic duct stump--in 2, from hepaticojejunoanastomosis--in 1 patient. Ultrasonic examination, endoscopic retrograde pancreatocholangiography, laparoscopy were used for diagnosis of this complication. CR stopped spontaneously in 19, after endoscopic papillosphincterotomy--in 4 patients. Spread of bile in abdominal cavity was revealed in 6 patients, 4 of them underwent laparoscopic operations, 2--open operations. Infrahepatic encapsulated bile clumps were in 2 patients, they underwent ultrasonic-assisted drainage.
Cholecystectomy↗
[Complications of laparascopic cholecystectomy].
1389 laparoscopic operations were fulfilled for chronic and acute cholecystitis. In 41 patients (3%) it was necessary to pass on to laparotomy. Injury of hepaticocholedochus was made in 6 patients (0.5%), bleedings appeared in 9 (0.7%), bile leakage at the postoperative period--in 9 (0.5%). Subhepatic abscess was formed in 2 patients. Wound complication sat at the postoperative period developed in 33 patients (2.5%), pulmonary complications--in 7 patients. One patients died of myocardial infarction. The most frequent causes of intraoperative injuries of the vascular and duct structures of the hepatoduodenal ligament and the bile bladder bed were found to be cicatricial and inflammatory alterations of the areas mentioned and non-typical variants of the anatomical situs of the vessels and bile ducts. The detailed examination of the patients at the preoperative period, knowledge of the anatomical variants of the disposition of bile and vascular structures in the operation zone allow to prevent their intraoperative injury.
Cholecystectomy, Laparoscopic↗
[Up-to=date view on medical documentation in surgical clinic].
Computer variants of the fragments of clinical records were developed. They represent the parts: "Title-page", "Examination of surgical patient in the admission department", "Protocol of laparoscopic cholecystectomy". During modelling of the intellectual contents of the modules the principle of the formalized protocol was used, which has been realized with use of a context-depending menu. According to the authors opinion, newly developed programs provide objective and correct reflection of any clinical and surgical situation, use of standardized terminology and classifications, save the surgeons the trouble of "scribbling" and decrease time-consuming registration of medical records, provide specialized information, prevent possible diagnostic and technical errors, and give physicians, legal defence.
Documentation↗
[Mode of surgery completion in peritonitis].
1310 patients with various forms of peritonitis were operated during 1989-1998. The tactics of the treatment was determined depending on bacterial contamination of the abdominal cavity. In abscesses of the abdominal cavity with massive bacterial contamination (6-7 CFU/g) drainage procedure was used. Mortality rate made up 4.8%. In local extended and diffuse peritonitis with a slight bacterial contamination of the abdominal cavity (3-5 CFU/g) and in absence of fibrinous deposition fixed on peritoneum, the drainage of the abdominal cavity was not used, and laparoscopy was performed in postoperative period for the control of the course of infectious process. Mortality rate was 0.6%. In extended peritonitis with massive bacterial contamination (6-8 CFU/g) the method of repeated explorations and sanitations of the abdominal cavity was used, mortality rate being 17.8%. The overall lethality made up 7.8%. Postoperative wound infection occurred in 6.7%, intraabdominal infection as abscesses or progressing peritonitis--in 2.1% of cases.
Humans↗
[Laparoscopy in the diagnosis of acute appendicitis].
The results of diagnosis of acute appendicitis (AA) were retrospectively analyzed in 2403 patients, in 336 of them diagnostic laparoscopy (DLS) was performed. Acute appendicitis was diagnosed in 132 (39.3%) patients, other surgical diseases were found in 102 (20.35%) and acute surgical abdominal diseases of were excluded in 102 (20.35%) patients. AA was also diagnosed in 17 patients suspected for other surgical diseases of the abdomen. This is DLS showed AA in 149 (42.2%) patients and its absence in 204 (57.8%) cases DLS revealed cathartic AA was in 3 (2%) patients, in of 2 of them there was a diagnostic error during morphologic control (no inflammation). The diagnostic error rate was 96% in the group of 163 patients undergone appendectomy for cathartic AA without previous DLS. At DLS destructive AA forms were diagnosed in 111 patients, diagnostic errors were made in 0.9%. In the group of patients undergone appendectomy for destructive AA without previous DLS, the diagnostic errors rate was 1.1%. In 35 cases (23.4%) when the appendix could not be visualized at DLS (including patients with appendiceal infiltrate), the diagnosis was based on indirect criteria, errors being made in 3 cases. There were neither direct nor indirect data on the appendiceal status in 3 (0.9%) DLS. In these cases, the policy was based on clinical manifestations.
Acute Disease↗
[Technical aspects of nasointestinal intubation].
According to the authors' opinion nasointestinal intubation have some advantages over "open" methods of decompression of the small bowel in paralytic intestinal obstruction resulted from peritonitis and mechanical obstruction of the small bowel. The authors' experience with more than 500 their own cases indicates, that application of nasointestinal intubation is not only necessary, but safe as well if keeping strictly to the established technique. Technical aspects of the method, possible errors which could occur during the performance of nasointestinal intubation and introduction of the probe are described. Complications which made up 2.6% are analysed.
Gastrointestinal Diseases↗
[Laparoscopic operations in emergency surgery].
582 laparoscopic operations for various urgent diseases of the organs of abdominal cavity were made. 190 of them were performed for acute appendicitis, 266--for acute cholecystitis and its complications, 33--for pancreonecrosis, 39--for perforated gastro-duodenal ulcers, 32--for acute bowel obstruction and 22--for other pathological conditions. The necessity of conversion to conventional open surgery has arose in 41 (7.0%) patients. Intraoperative complications were detected in 7 (1.3%) patients. Postoperative complications developed in 18 (3.3%) patients. 2 patients (0.4%) died. The obtained results of treatment made it possible to recommend laparoscopic operations in acute abdominal diseases.
Abdomen↗
[Laparoscopic surgery in the treatment of perforating gastroduodenal ulcers].
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Costs and Cost Analysis↗
[Laparoscopy in perforated gastroduodenal ulcers].
The authors have performed operations on 32 patients with perforated ulcers of the duodenum and 7 patients with perforated ulcers of the stomach. The diameter of the perforations was 2-8 mm. In 10 of the 39 patients the perforation defects could not be sutured by the laparoscopic method. The authors consider that of great significance for the decision to make laparoscopic operations was the diagnosis of peritonitis, size and localization of the perforation, the surgeon's experience with endoscopic operating. The technique of laparoscopic suturing the perforations is described. Special attention is paid to the special disposition of the surgeon and his assistant at the operating table.
Duodenal Ulcer↗
[Ciprofloxacin and other antimicrobial drugs in the treatment of disseminated peritonitis].
Forty two patients with general peritonitis were treated with ciprofloxacin and combinations of various antimicrobial drugs. Ciprofloxacin had the highest effect on aerobic and anaerobic microbes in the peritoneal cavity which defined the favourable clinical results in all the patients. Moreover, there were observed no disorders in the composition of the normal intestinal microflora which in the end promoted a decrease in the number of the patients with suppuration of the surgical wound.
Adolescent↗