[Foreign body of abdominal cavity as a cause of the complications occurrence].
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Biomedical subjects
Publications and source records attributed to N N Volobuev.
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Experience of surgical treatment of 48 patients with postburn cicatricial gastric stenosis was presented. In 28 of them the combined gastric and esophageal stricture were reveal. Gastric resection according to Billroth-I was performed in 26 patients, gastroduodenostomy according to Finney--in 4, gastric resection according to Hoffmeister-Finsterer--in 5, gastroenterostomy according to Belfler-Brown--in 10 and other operations--in 3. One patient died. For the treatment of combined stricture esophageal passability was restored using bougienage, optimally--along the ring-like thread-guide, conducted, while performing gastric operation, through the mouth, esophagus, stomach and brought out via microgastrostomy.
In clinic there were treated 554 patients for postresectional syndrome of alimentary dystrophy (SAD), including functional one--230 (41.5%), organic--228 (41.1%), combined--96 (17.4%). In 91% of patients prominent disorders of digestion up to severe alimentary dystrophy were noted. Three patients died because of cachexia during preoperative preparation, 1--on the first day after it. Reduodenization operation is the surgical treatment method of choice for the treatment of functional and combined postresectional SAD. Excellent result was noted in 30%, good--in 47%, the digestion processes improvement was noted in 87% of observations.
There were treated 554 patients for functional, organic and combined forms of postresectional syndrome. Reconstructive jejunogastroplasty was applied as the method of choice of the operative treatment. Intraoperative and postoperative complications have occurred in 112 (20.2%) of patients.
An original variant of minimally invasive gastrostomy is described which is recommended for use in cases of a necessary temporary exclusion of the esophagus passage in patients with lesions of the esophagus in combination with a severe concomitant pathology.
While performing forceful esophageal bougienage for postburn cicatricial stricture its wall perforation have occurred in 9 of 57 patients. All the patients were operated on. For perforation of thoracic esophagus transabdominal transdiaphragmatic mediastinal drainage was performed and for subdiaphragmatic perforation--closure of the defect with Nissen fundoplication, gastrostomy with temporary conduction of ring--like guide fishing-line. One patient died.
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For the 1970-1997 yrs. period 1357 patients were operated on for an ulcer disease using vagotomy, in 361 (26%) simultant operations were carried out, including in 340--for the abdominal cavity organs diseases and in 21--for intraoperative complications.
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Intraoperative complications occurred in 28 (2.8%) and early postoperative complications in 157 (15.7%) out of 1,000 operations for vagotomy in duodenal ulcer (109 truncal, 64 selective, 445 isolated SPV, and 372 SPV combined with draining operations). Postoperative lethality was 1.3%. Controllable types of complications were encountered in 2.6%, prognostic in 9.6%, and non-prognostic in 5.7% of cases. The first two groups of complications accounted for two thirds of the total number and determined the lethal outcome in 0.7% of the fatal cases. Thus, mastering of the operative techniques and realization of the complex of preventive measures allows the postoperative results of vagotomy to be considerably improved.
Results of treatment of 92 patients with nonpremeditated iatrogenic injuries of the circulatory vessels were analyzed. As a rule, the cause of injury were operative-technical mistakes. Classification of iatrogenic injuries of vessels is presented, several clinical observations are depicted in detail. By the authors opinion, the conduction of training of general surgeons for the issues of emergent angiosurgery is necessary.
Primary tuberculosis of the intestines was revealed in four patients. The process was localized in the cecum in three and in the descending colon in one patient. The true diagnosis was suspected before the operation in one patient, determined during the operation in two patients and after pathohistological study in one patient. The course of the disease was complicated by intestinal obstruction in three cases by anemia in one case. The differential diagnosis was made with intestinal tumors. Three patients underwent right hemicolectomy and one patient left hemicolectomy. Specific therapy was prescribed after recognition of the tuberculous process. All patients recovered.
A modified method for hernioplasty consisting in performance of multi-layer reconstruction of the abdominal wall with transfer and implantation of one of the cuspids of the hernial sac tissues beyond the contralateral musculus rectus abdominis has been suggested. Operated on were 20 patients with extensive, or giant abdominal hernia. Within 2 years after the operation, no hernia recurrence was noted.
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