Biomedical subjects
Publications and source records attributed to V P Sazhin.
Laparoscopic technologies have been used for the treatment of 184 patients with cancer of colon. Use of electrosurgical and suturing mechanical devices with linear and circular sutures is the essential part of laparoscopic and laparoscopy-assisted operations. Laparoscopic lymphadenectomy at patients with cancer of colon permits to perform required radical surgery that guarantees positive short- and long-term results of treatment.
Laparoscopic resection of the stomach by Billroth-I technique is described. Previously different variants of laparoscopic Billroth-II resection and laparoscopy-assisted Billroth-I resection have been performed a complete variant of laparoscopic Billroth-I resection of the stomach the authors reported on Symposium of Endo-surgeons in 2004.
Method of treatment of postinjection abscesses and phlegmons was developed. This method includes endovideoscopy of purulent focus with creation of permanent liquid medium, visual revision of purulent cavity with evacuation of pus, controlled radical surgical treatment and introduction of perforated drainages for flowing drainage. Hand endoscopic instruments or special shaver were used for surgical necrectomy. Flowing-aspiration drainage of formed cavity was performed after surgery. This technique was used in 12 patients. It permitted to improve significantly results of treatment, reduce period of temporary disability and achieve good cosmetic effect.
Based on experience in the treatment of 156 patients with chronic haemorrhoids, a comparative study of clinical efficiency of electrosurgical techniques in hemorrhoidectomy was carried out. Device-controlled bipolar electrocoagulation is characterized by less invasiveness compared with electrosurgical closed hemorrhoidectomy. Device-controlled bipolar electrocoagulation provides better repair and treatment of wound inflammation, shorter wound healing. Long-term results of device-controlled bipolar electrocoagulation were followed-up for 12 months; a high level of life quality was achieved.
Results of treatment of 3372 patients with acute pancreatitis for the period from 1990 to 2002 are analyzed. The authors have developed a medico-diagnostic algorithm for acute pancreatitis. The introduction of it into clinics allowed the general lethality from acute pancreatitis to be reduced to 2.9% for 11 years.
Long-term results of laparoscopic resections of the stomach were studied, a comparative analysis with similar open surgeries was carried out. The comparative analysis was based on the results of ultrasonic examination (USE) of the gastric stump (GS) and gastroenteroanastomosis (GEA). Basing on ultrasonic parameters of GS, digital parameters of GEA in mild, moderate and severe degree of dumping-syndrome were determined. Ultrasonic examinations of the gastric stump permitted to study its function in dumping-syndrome of different degree, to reveal sizes of GEA in relaxation and contraction stage, and based on these data to determine its gradients of contractility. Ultrasonic method in long-term period after resection of the stomach has advantages compared with gastroscopic and X-ray methods.
Based on experience in treating 64 patients with chronic hemorrhoid a comparative clinical evaluation of efficiency of electrosurgical methods is carried out hemorrhoidectomy. Compared with traditional Milligan-Morgan surgery, electrosurgical method demonstrates the absence of intraoperative blood loss, a reduction in the algetic syndrome after surgery, a decrease in postoperative complications rates by 4.8 times. Physiological and physical activity, stool are also recovered by electrosurgery.
The authors performed 1389 laparoscopic surgeries in one-day hospital of outpatient clinic. The majority of surgeries were carried out for cholelithiasis and inguinal hernia. Conditions for laparoscopic surgeries in outpatient clinics, indications and contraindications for this procedures were developed. Combination of laparoscopic technologies with non-hospital forms of surgical care organization permitted to achieve medical, social and economic effects.
Use of Liga Sure and Auto Sonix devices in laparoscopic surgery on the stomach, colon and rectum for gastric, duodenal ulcers and colorectal cancer was analyzed. These devices make easier surgery and improved postoperative period. In test group of patients time of surgery, blood loss, smoke in surgical field were less, scope of laparoscopic stage increased.
Minimally-invasive operations were used in 156 patients with acute appendicitis. Laparoscopic appendectomy with ligature method by F. Gotz was performed in 64 (41%) patients (group 1), combined appendectomy--in 32 (20.5%) patients (group 2), laparoscopic operation with ligature method in the authors modification in combination with developed prophylactic complex--in 60 (38.5%) patients (group 3). Conversion to open operation was necessary in 6 (3.8%) patients. Intraoperative complications were seen in 5.1% operated patients, postoperative--in 6.4%, however rate of complications in each group ranged from 10.9 to 1.7%. Results of bacterial examination during different stages of laparoscopic appendectomy are provided. Programme of postoperative complications prophylaxis is described. Algorithm of differential approach to various methods of laparoscopic or minimally-invasive appendectomy in presented.
Results of diagnostic laparoscopy in acute appendicitis suspects are presented. Laparoscopy allowed examination of the appendix in 96.5% cases, to make final diagnosis in 92.5% and to avoid surgery in 31.2% cases. Larger application of diagnostic laparoscopy in patients suspected of acute appendicitis will reduce significantly rate of diagnostic mistakes, complications and unwarranted appendectomies.
Results of reformation of ambulatory and hospital surgical service were analyzed. It is demonstrated that organization of ambulatory surgical care permits one to reduce 9.2 times cost of treatment and to find financial reserves for development of modern surgical technologies.
Laparoscopy and pancreatoscopy were performed in 2091 (62% of all hospitalized) patients with acute pancreatitis. High informative value of laparoscopy and pancreatoscopy in diagnosis of different morphologic forms of acute pancreatitis is demonstrated. Original fistula for pancreatoscopy was developed. It permits one to evaluate visually the dynamics of repair in the pancreas and surrounding tissues and to correct treatment policy.
Comparative assessment of treatment results in 618 patients with gastroduodenal ulcer (GDU) was carried out. 3 groups of patients were compared. Different combinations of drugs were used in 384 patients, 234 patients have undergone open resections of the stomach or organsaving operations, 83 patients--analogous laparoscopic operations. Immediate and long-term results of the treatment were studied. After drug therapy, including antihelicobacter drugs, healing of ulcers was achieved in 96.9-97.9% cases. 1 year after drug therapy the recurrence of CDU is revealed in 16.2-20.3% patients, rate of the recurrence increases with years. After surgical treatment of CDU (more often in complicated course of the disease) rate of recurrences is 2-3 times lower (6.5-7.4% cases). Laparoscopic resections of the stomach and organsaving operations are atraumatic, accompanied by physiologic course of postoperative period and reduction of postoperative complication rate.
One-stage operations in pancreatic injuries are characterized by high rate of complications (acute traumatic pancreatitis, peritonitis, sepsis, bleeding, etc.) and high mortality rate. The method of repeated sanations of omental bursa and sequestre-necrectomy of the pancreas through the fistulas used in 61 patients provided a considerable decrease of the rate of complications and mortality in injuries of the pancreas and acute traumatic pancreatitis.
The results of investigations the hepato-pancreatico-duodenal organs are analysed. High diagnostic effectiveness of the ultrasound examination in acute cholecystitis (95.5%) is demonstrated. In chronic calculous cholecystitis and in choledocholithiasis the ultrasound examination appeared to be accurate in 97.0% and 84.2% of cases respectively. Retrograde cholangiopancreatography was the most informative method for detection of the concrements in choledochus (effective in 94.4% of the cases). The diagnostic effectiveness of the ultrasound examination and laparoscopy in detection of mechanical jaundice and acute pancreatitis are considered to be equal. Ultrasound examination, retrograde cholangiopancreatography, laparoscopy appeared to be the most accurate and informative methods in diagnosis of the diseases of the organs of hepato-pancreatico-duodenal zone. The role of the X-ray examination decreased. At the same time the significance and reliability of intraoperative cholangiography has been stressed.
The results of 44 patients treatment with neck wounds are analysed. Isolated wounds of the neck were shown to be in 77.3%, combined trauma was determined in 22.7% of examination. Cervical organ's injury had been revealed in 51 patients (84.1%). Postsurgical complications have developed in 6. The main reasons for complications occurred to be primary surgical wound treatment from little operative approach and noncomplete revision of the wound canal.
A comparative analysis of the performance of 51 operations for resection of various parts of the colon, among which were 24 operations conducted by laparoscopy, was undertaken. Certain advantages of laparoscopic resection of the colon, as well as the possibility of lymph dissection, which meets the principles of oncological surgery, were revealed.