No abstract

Meckel’s diverticulum (MD) is relatively rare, although frequent anomaly of the digestive tract, as a rule, in the event of complications or incidentally at laparotomy, laparoscopy, contrast study of the bowel. Aim - to examine the results of diagnosis and treatment of complicated forms of MD. Material and methods. It was a prospective non-randomized study of 77 patients with complicated forms of MD, including 30 adults and 47 children. The ratio of males and females in adult patients were 2,3:1, and 8,4:1 in children. The incidence of complicated forms in adults was 0,61 per 100,000 adult, 6,6 per 100,000 child population. The study was used clinical, laparotomy methods, ultrasound examination, CT, endoscopy, laparoscopy. Results. Diagnostic methods can identify complications (often diverticulitis, intestinal obstruction, peritonitis), and source-cause of complications is established by laparoscopy or laparotomy. Videolaparoscopic operations (diverticulectomy) made of 35%, the option of surgical intervention depended on the size of the diverticulum, the severity of degradation and prevalence of the inflammatory process in the wall ileum. Postoperative complications were 6,49% of patients, there were no cases mortality.

По данным ВОЗ, ежегодно в мире выполняют 234 млн обширных оперативных вмешательств, серьезные осложнения развиваются в 3-16% случаев, показатели стойкой нетрудоспособности или смертности составляют 0,4-0,8%, а в развивающихся странах-5-10% [1]. В специальной отечественной литературе отсутствует общепринятая классификация хирургических осложнений, как, впрочем, и упорядоченная, систематизированная форма учета этих осложнений в системе здравоохранения. Существует несколько классификаций послеоперационных осложнений в специальностях «кардиохирургия» [2], «легочная хирургия» [3], а также при абдоминальной травме [4]. Недавно А.М. Казарян и А.Л. Акопов [5] предложили российскую редакцию классификации осложнений в хирургии, представляющую собой комбинацию двух систем оценки: классификации интраоперационных неблагоприятных инцидентов по R. Satava [6] и модификации классификации послеоперационных осложнений Occordion [7, 8]. Для достоверной оценки качества лечения, возможности сравнения результатов, полученных в раз

No abstract

Aim. To conduct a detailed analysis of the causes of development of late stomal complications, to determine the indications for surgical correction, to evaluate the effectiveness of new methods of surgical treatment. Methods. Conducted was an analysis of the causes of late stomal complications in 141 patients with a stoma of the colon. Results. A parastomal hernia was diagnosed in 44 (31.2%), prolapse - in 29 (20.6%), stricture - in 9 (6.4%) patients. Introduced into practice were new methods of surgical correction of complicated stomas. Parastomal hernia was detected in 44 (31.2%) patients - 26 (59.1%) females and 18 (40.9%) males, all patients with this complication were older than 50 years, the age group 71-80 years included 43.5% of patients. Since 2005 performed were 17 reconstructive operations for parastomal hernias (Russian Federation patent №2406454 and №2395238). Stoma prolapse was observed in 29 (20.6%) patients, 10 cases - in patients aged 71 to 80 years. Most often this complication developed in patients with double-barreled transverse stomas - in 10 (76.9%) of 13 patients. 4 patients underwent surgery due to prolapse. Stoma stricture was diagnosed in 9 (6.4%) patients. In 7 patients with a stoma stricture in the early postoperative period registered was festering of the parastomal wound (4 cases), marginal necrosis of the stoma (2 cases), and stoma retraction (1 case). Correction with the use of stents for the prevention of recurrence (Russian Federation patent №2357681) was conducted in all cases. The so-called «lock-stoma» was diagnosed in 16.3% of cases (23 patients). Although this condition does not belong to stomal complications in its pure form, however in most cases it causes the inability to use the incontinence bag, reducing the quality of life. Conclusion. Despite the inevitability of the development of parastomal complications, provided proper surgical techniques can either prevent or delay their appearance; reconstructive operations for complicated stomas, conducted by moving the stoma to a new place with retroperitoneal conduction makes it possible to obtain satisfactory results, significantly improve the quality of life that promotes full social adaptation of stomal patients.