Laparostomia: History of Development and Technical Aspects of Implementation

Баранов, Андрей Игоревич; Leschishin, Ya.M.; Atamanov, K.V.; Martynov, A. A.; Потехин, Константин Владимирович; dispensary, Novokuznetsk clinical oncological

doi:10.20333/2500136-2018-3-34-42

SMR

2018

DOI: 10.20333/2500136-2018-3-34-42

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Laparostomia: History of Development and Technical Aspects of Implementation

Андрей Игоревич Баранов¹,

Ya.M. Leschishin²,

K.V. Atamanov³

et al.

Abstract: Новокузнецкая городская клиническая больница № 22, Новокузнецк 654034, Российская Федерация. Резюме. В обзоре представлены основные исторические моменты развития лапаростомии, как одного из самых активных методов лечения распространенного гнойного перитонита и тяжелой абдоминальной травмы. В статье представлены существующие на сегодняшний момент способы её формирования и их отличительные особенности. Приводится опыт использования данного метода лечения, как в России, так и за рубежом. В обзоре приводится сравн… Show more

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Cited by 4 publications

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Drainage methods in patients with unformed intestinal fistulas during the preparation to the surgical treatment

Akhtanin,

Markov,

Goev

et al. 2024

Journal of Clinical Practice

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ABSTRACT Background. To analyze the data of modern foreign and domestic literature on intestinal fistulas, including high unformed small intestinal fistulas, their classification, treatment methods, drainage methods, their types and effectiveness. Research methods. The basis of this work includes an analysis of modern literature (domestic and foreign) on the general information of intestinal fistulas, their classification and treatment methods. Research method: analysis of modern domestic and foreign literature on the treatment of high unformed small intestinal fistulas, performed on the database of the scientific library elibrary, CyberLeninka and The National Center of medicine. Results. Intestinal fistulas, often found in surgical practice, are a consequence of a number of reasons (errors in surgical technique and conservative treatment, tactical errors, the presence of severe concomitant diseases, etc.) and a high risk factor for death. Clinically, intestinal fistulas can be different depending on the localization, etiology, morphology, function, complications, etc., causing a number of difficulties in choosing a treatment method and reducing its success. Special attention is paid to high unformed small intestinal fistulas, which are accompanied by a pronounced violation of the body's homeostasis system, on the one hand, and the need for multi-stage treatment, on the other. The treatment regimen for high unformed small intestinal fistulas includes conservative and surgical treatment. The conservative method of treatment includes intensive infusion therapy, control of the source of infectious complications, reduction of irretrievable losses, nutritional therapy, and local treatment, which consists in protecting tissues from aggressive intestinal contents and various methods of adequate drainage of the wound. The drainage methods used for intestinal fistulas are different – depending on the principle of their operation, the material of the drains, the configuration of the wound, the morphology of the fistula, the number of fistulas, etc. Active and vacuum methods seem to be the most used and effective methods in the local treatment of high unformed small intestinal fistulas.

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Drainage methods in patients with unformed intestinal fistulas during the preparation to the surgical treatment

Akhtanin,

Markov,

Goev

et al. 2024

Journal of Clinical Practice

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Efficacy and safety of negative wound pressure in the treatment of surgical complications after radical cystectomy: a retrospective cohort study

Berkut,

Belyaev,

Krotov

et al. 2024

Almanac of Clinical Medicine

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Background: Negative pressure wound treatment (NPWT) is a relatively new, but promising method for management of surgical site infection (SSI). The literature data on the use of NPWT for complications in oncology surgery, and after radical cystectomy (RC) in particular, is scarce. Aim: To evaluate the short-term results of NPWT dressings in the management of SSI after RC. Materials and methods: We retrospectively analyzed data from 446 patients who had RC with various uroderivation types in the Department of Oncourology of the N. N. Petrov National Medical Research Center of Oncology from January 2012 to December 2021. A total of 62 cases of SSI emerging up to day 30 after RC were identified with complete data. Thirty six (36) cases of SSI were managed according to standard procedures, and 26 patients with SSI were treated with NPWT (VivanoTec® S 042) at constant negative pressure mode. The physical condition of the patients before RC was assessed according to the American Society of Anesthesiology (ASA) classification, and the severity of the patient's condition at SSI diagnosis within APACHE II scale. The following parameters were also analyzed: body mass index, median number of days in the hospital, number of program wound sanitations (surgical debridement) or frequency of changing NPWT dressings, changes over time in C-reactive protein and leukocyte index of intoxication, and events of clinical interest (intestinal fistulas and lateralization of the median wound margins, hernias). Results: Most cases of post-RC SSIs were identified in men (57/62, 91.93%). The standard management and NPWT study groups were well balanced for age, body mass index, and ASA physical status. The median time from the first surgical debridement of the wound to its closure was significantly shorter in the standard surgical management group: 4 days (0; 8.75) versus 8.5 days (3.25; 12.0) in the NPWT group (p = 0.026). However, this did not negatively affect the length of hospitalization (28.08 ± 12.80 and 30.03 ± 16.27 days, respectively, p = 0.599). The 30-day mortality rates were not significantly different between the groups (p = 0.137). In our series with NPWT dressings, there were no cases of intestinal fistulas in the early and late postoperative periods. Conclusion: Negative pressure wound treatment is a safe and effective method of SSI management. It is not inferior to the generally accepted treatment standard with surgical wound debridement, staged sanitations or dressings. NPWT dressings allow for early primary muscular-fascial closure of the abdominal cavity and does not increase the duration of hospital stay, postoperative death rates and the risk of intestinal fistulas.

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Surgical Aspects of the Treatment of Patients With Generalized Peritonitis

Сигуа

Земляной

Петров

et al. 2021

Neotložnaâ med. pomoŝʹ

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BACKGROUND Much attention is currently given to the issues of surgical treatment of common forms of secondary peritonitis, which is associated with unsuccessful results of treatment of this group of patients and the lack of a unified approach to surgical tactics among patients requiring repeated surgical interventions for adequate sanitation of the abdominal cavity.AIM OF STUDY Improvement of the immediate results of treatment of patients with generalized secondary peritonitis by determining the approaches to choosing the optimal surgical tactics.MATERIAl AND METHODS We analyzed the results of treatment of 220 patients with common forms of secondary peritonitis who were treated at the Elizavetinskaya hospital of St. Petersburg in the period from 2013 to 2019. The indicated patients were divided into two groups, comparable in terms of the main features, including the depth pathomorphological changes in the abdominal cavity, assessed by calculating abdominal cavity index (ACI) and the Mannheim peritonitis Index (MPI). The main group consisted of 109 patients, where developed algorithm was used, which supposed planned sanitation relaparotomies within up to 2 days in patients with high values of ACI and MPI. The comparison group included 111 patients who underwent sanitation interventions “on demand”, that is, in the presence of signs of persistence of the infectious process in the abdominal cavity. The results of treatment were compared by assessing the level and structure of postoperative mortality, the frequency of complications, and the length of stay in intensive care units and hospital. Mathematical-statistical dataprocessing, calculations of intensive and extensive coefficients of features, assessment of the statistical significance of differences in features for the studied groups were carried out.RESUlTS The use of a differentiated approach to performing planned relaparotomy in patients with generalized peritonitis made it possible to reduce the overall mortality 1.7-fold (from 51.3 to 30.2%) (p=0.001) due to a decrease in the proportion of abdominal sepsis as a cause of unfavorable the outcome. No significant effect of the use of this algorithm on the frequency and structure of complications, as well as the duration of multiple organ failure, was found.FINDINGS The use of planned relaparotomy among the selected patients helps to reduce postoperative mortality without significantly negatively affecting other treatment results.

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Laparostomia: History of Development and Technical Aspects of Implementation

Cited by 4 publications

References 13 publications

Drainage methods in patients with unformed intestinal fistulas during the preparation to the surgical treatment

Drainage methods in patients with unformed intestinal fistulas during the preparation to the surgical treatment

Efficacy and safety of negative wound pressure in the treatment of surgical complications after radical cystectomy: a retrospective cohort study

Surgical Aspects of the Treatment of Patients With Generalized Peritonitis

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