Biomedical subjects
Publications and source records attributed to V V Strizheletskiĭ.
The authors made an analysis of using endovideosurgery in diagnosing and treatment of Meckel's diverticulum and its complications in 18 patients. They describe signs and diagnostic criteria of the disease. Adequate treatment was proved to be possible by laparoscopy.
On the basis of an experience with 1800 operations of endovideosurgical hernioplasty in patients with inguinal and femoral hernias, the authors analyze the frequency and character of complications after such operations. Complications were noted in 37 (2.05%) patients. The most frequent complication was injury of the vessels. It could be liquidated in all the cases using laparoscopic technology. In three cases hollow organs were injured. In these cases laparotomy was used. The laparoscopic hernioplasty, if all details are fulfilled thoroughly, is a minimally invasive and effective method of treatment of inguinal and femoral hernias. The frequency of recurrences after these interventions is considerably less than that after traditional operations.
The authors present the results of surgical treatment of 106 elderly and senile patients. In 30 patients admitted in a extremely severe condition the acute intestinal obstruction was combined with peritonitis. Postoperative mortality in this group of patients was 86.7% in spite of intensive treatment. In 28 patients generalization of the process was detected and they were given palliative interventions for liquidation of acute intestinal obstruction. Postoperative mortality in this group was 39.2%. Conventional radical operations were fulfilled on 48 patients. Postoperative mortality in this group was 20.8%. Later on the intestinal patency was reestablished in 15 patients. The data obtained show the possibility to widen the indications to radical operative interventions and to improve results of treatment of such patients.
Laparoscopic operations in patients who have undergone earlier "open" operations on abdominal organs are described. Before 1994 open laparoscopy by Hassan was used for penetration into the abdominal cavity. There were 46 such manipulations (2.14% of all 9100 endosurgical operations), in 5 cases of them the conversion to open operation was necessary. From 1994 the optic trocar "Visiport" was used permitting to image tissues in its passage through anterior abdominal wall. 195 operations with optical trocar were performed. All the patients had been operated earlier. Trocar was introduced without damages of abdominal organs in all the cases. Trocar was introduced in the left iliac area, where the comissures were found in 4 cases only. In 147 patients during revision unions of intestinal loops and great omentum with anterior abdominal wall were revealed. In one patient significant comissural process was revealed, so conversion to laparotomy was necessary. In 2 other patients laparotomy was performed because of damage of ileum and ceclim during endoscopic operation. Main criterion of rejection laparoscopic operation in patients operated earlier on abdominal organs is the results of laparoscopy with trocar.
Laparoscopy was used in differential diagnostics of acute appendicitis in 524 female patients. Acute gynecological diseases were diagnosed in 123-of them, inflammatory processes in appendages being most frequent. The laparoscopic technology allowed not only to avoid diagnostic errors in all the cases, but also to take all necessary surgical measures. The effectiveness of laparoscopic operations for acute gynecological diseases was confirmed by the absence of complications and recovery within short terms.
In 1992-1994 laparoscopic hernioplasty was performed in 403 patients with inguinal (371) and femoral (32) hernias. Mean duration of hospital-stay 2.3 days, period of incapacity 9.7 days. Complication were encountered in 25 (3.7%) patients, including perforation of the small intestine and commissural ileus for which laparotomy had to be performed. Recurrent hernias occurred in 7 (1.7%) patients in periods of 2 weeks to 1.5 month due to poor fixation of the implant and choice of an inadequate operative method.
Laparoscopic technology was applied as diagnostic method in 608 patients, 50 patients have undergone laparoscopic appendectomy. There were no diagnostic errors in laparoscopy application. Laparoscopic technology allowed to perform appendectomy quite safely and without any complications. This method permitted considerably reduce terms of treatment of the acute appendicitis patients and quickly restore their ability to work.
The first experience with using laparoscopic extraperitoneal hernioplasty with implant Prolene" in 300 patients since November 1992 is analyzed. The analysis of the original method of laparoscopic extraperitoneal hernioplasty has shown its efficiency and safety for patients with inguinal hernias (recurrences were noted in 2,3%).
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