O. Kravets, V. Yekhalov, V. Gorbuntsov, D. Stanin, D. Krishtafor
Nowadays, rewarming of the affected tissues is the primary method of treatment for patients with cold injuries. But the warming manipulation has its own characteristics and limitations, depending on specific circumstances. Untimely and incorrectly performed rewarming can lead to a significant increase in the level of dangerous complications, mortality, and disability. The rewarming strategy is implemented according to one of the two scenarios. If there is a risk of freezing again, the injured area is not actively rewarmed; it is just immobilized, and thermo‑insulating bandages are applied. Slow warming with body heat is also acceptable. If the frozen area can be warmed and kept warm without refreezing until the evacuation is completed, a quick warming with warm water or special heating blankets is preferable. Recommendations on the ideal water temperature significantly differ among authors and include a wide range between 37 °C and 43 °C. The extent of damage to the tissues becomes obvious only after thawing. The traditional classification system of local cold injuries distinguishes four degrees of frostbite. First‑degree frostbite presents with superficial damage to the skin; second‑degree frostbite involves deep skin damage; third‑degree frostbite results in full‑thickness skin damage, including the subcutaneous and surrounding tissues; and fourth‑degree frostbite causes deep necrosis of the subcutaneous structures. Depending on the extent of damage, patients may experience constant and severe pain during rewarming, so analgesics should be prescribed to relieve it. It is recommended to use topical agents (creams, gels, and ointments) to improve circulation and prevent and treat infection. Tissue necrosis with severe frostbite requires surgical treatment of wounds. The authors hope that the provided information will be useful to doctors‑of‑first‑ contact and in hospital conditions in order to optimize the treatment of local cold injuries.
如今，重新加热受影响的组织是治疗冷伤患者的主要方法。但是，根据具体情况，复温操作有其自身的特点和局限性。不及时和不正确的复温操作会导致危险并发症、死亡率和残疾程度显著增加。复温策略根据两种情况之一实施。如果有再次受冻的风险，则不主动对受伤部位进行复温，而只是将其固定，并缠上隔热绷带。用体温缓慢加温也是可以接受的。如果受冻部位在撤离前可以加温和保温而不会再次结冰，则最好用温水或专用加热毯快速加温。不同作者对理想水温的建议大相径庭，包括 37 °C 至 43 °C 之间的广泛范围。组织受损的程度只有在解冻后才能显现出来。传统的局部冷伤分类系统将冻伤分为四级。一级冻伤表现为皮肤表层损伤；二级冻伤涉及皮肤深层损伤；三级冻伤导致皮肤全层损伤，包括皮下和周围组织；四级冻伤导致皮下结构深层坏死。根据损伤程度，患者在复温过程中可能会持续感到剧烈疼痛，因此应使用止痛药来缓解疼痛。建议使用外用药物（药膏、凝胶和软膏）来改善血液循环，预防和治疗感染。严重冻伤导致的组织坏死需要对伤口进行手术治疗。作者希望所提供的信息能对首诊医生和医院医生有所帮助，以优化局部冷伤的治疗。
{"title":"Methods and pathophysiology of rewarming in case of local cold injury. Literature review","authors":"O. Kravets, V. Yekhalov, V. Gorbuntsov, D. Stanin, D. Krishtafor","doi":"10.30978/gs-2023-2-90","DOIUrl":"https://doi.org/10.30978/gs-2023-2-90","url":null,"abstract":"Nowadays, rewarming of the affected tissues is the primary method of treatment for patients with cold injuries. But the warming manipulation has its own characteristics and limitations, depending on specific circumstances. Untimely and incorrectly performed rewarming can lead to a significant increase in the level of dangerous complications, mortality, and disability. The rewarming strategy is implemented according to one of the two scenarios. If there is a risk of freezing again, the injured area is not actively rewarmed; it is just immobilized, and thermo‑insulating bandages are applied. Slow warming with body heat is also acceptable. If the frozen area can be warmed and kept warm without refreezing until the evacuation is completed, a quick warming with warm water or special heating blankets is preferable. Recommendations on the ideal water temperature significantly differ among authors and include a wide range between 37 °C and 43 °C. The extent of damage to the tissues becomes obvious only after thawing. The traditional classification system of local cold injuries distinguishes four degrees of frostbite. First‑degree frostbite presents with superficial damage to the skin; second‑degree frostbite involves deep skin damage; third‑degree frostbite results in full‑thickness skin damage, including the subcutaneous and surrounding tissues; and fourth‑degree frostbite causes deep necrosis of the subcutaneous structures. Depending on the extent of damage, patients may experience constant and severe pain during rewarming, so analgesics should be prescribed to relieve it. It is recommended to use topical agents (creams, gels, and ointments) to improve circulation and prevent and treat infection. Tissue necrosis with severe frostbite requires surgical treatment of wounds. The authors hope that the provided information will be useful to doctors‑of‑first‑ contact and in hospital conditions in order to optimize the treatment of local cold injuries.","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"35 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139275902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Kopchak, L. Pererva, V. Kropelnytskyi, V. Khanenko, P. Azadov, Z. Y. Holobor
Objective — to design and implement a preventive approach aimed at reducing the incidence of postoperative pancreatic fistulas and other complications following pancreatoduodenectomy in patients diagnosed with cancer of the pancreatic head and periampullary region. Materials and methods. The present study involved the analysis of treatment outcomes for a cohort of 370 patients diagnosed with cancer of the pancreatic head and periampullary region who underwent pancreatoduodenectomy during the years 2015—2021. Between November 2018 and December 2021, a total of 141 patients were operated on using our modified pancreatic fistula risk score, an evaluation of preoperative sarcopenia status, and our risk mitigation strategies aimed at minimising postoperative complications. These patients made up the main group. The comparison group included a total of 229 patients. The surgical procedures were conducted between January 2015 and October 2018, employing generally accepted methods. However, the risk evaluation of potential pancreatic fistulas, the presence of sarcopenia, and the implementation of suggested prevention strategies were not taken into account. Results. The incidence of postoperative complications was significantly higher in the comparison group, with complications occurring in 94 (41.0%) patients, while in the main group, complications occurred in 43 (30.5%) patients (χ2=4.1; p=0.04). In the main group, a total of 16 (11.3%) patients experienced a clinically relevant grade B postoperative pancreatic fistula, which was significantly lower than in the comparison group, where the grade B or grade C fistula occurred in 64 (27.9%) patients (χ2=14.2; p=0.0002). In the main group, 2 patients died; the mortality rate was 1.4%. In the comparison group, 5 patients died, and the mortality rate was 2.2%. This rate was shown to be higher (χ2=0.27; p=0.6) when compared to the main group. Conclusions. The implemented approach demonstrated a substantial reduction in the incidence of postoperative pancreatic fistulas from 27.9% to 11.3%, the number of postoperative complications from 41.0% to 30.5%, and mortality from 2.2% to 1.4%.
{"title":"Prevention strategies for reducing the incidence of postoperative pancreatic fistulas in patients following pancreatoduodenectomy","authors":"V. Kopchak, L. Pererva, V. Kropelnytskyi, V. Khanenko, P. Azadov, Z. Y. Holobor","doi":"10.30978/gs-2023-2-8","DOIUrl":"https://doi.org/10.30978/gs-2023-2-8","url":null,"abstract":"Objective — to design and implement a preventive approach aimed at reducing the incidence of postoperative pancreatic fistulas and other complications following pancreatoduodenectomy in patients diagnosed with cancer of the pancreatic head and periampullary region. Materials and methods. The present study involved the analysis of treatment outcomes for a cohort of 370 patients diagnosed with cancer of the pancreatic head and periampullary region who underwent pancreatoduodenectomy during the years 2015—2021. Between November 2018 and December 2021, a total of 141 patients were operated on using our modified pancreatic fistula risk score, an evaluation of preoperative sarcopenia status, and our risk mitigation strategies aimed at minimising postoperative complications. These patients made up the main group. The comparison group included a total of 229 patients. The surgical procedures were conducted between January 2015 and October 2018, employing generally accepted methods. However, the risk evaluation of potential pancreatic fistulas, the presence of sarcopenia, and the implementation of suggested prevention strategies were not taken into account. Results. The incidence of postoperative complications was significantly higher in the comparison group, with complications occurring in 94 (41.0%) patients, while in the main group, complications occurred in 43 (30.5%) patients (χ2=4.1; p=0.04). In the main group, a total of 16 (11.3%) patients experienced a clinically relevant grade B postoperative pancreatic fistula, which was significantly lower than in the comparison group, where the grade B or grade C fistula occurred in 64 (27.9%) patients (χ2=14.2; p=0.0002). In the main group, 2 patients died; the mortality rate was 1.4%. In the comparison group, 5 patients died, and the mortality rate was 2.2%. This rate was shown to be higher (χ2=0.27; p=0.6) when compared to the main group. Conclusions. The implemented approach demonstrated a substantial reduction in the incidence of postoperative pancreatic fistulas from 27.9% to 11.3%, the number of postoperative complications from 41.0% to 30.5%, and mortality from 2.2% to 1.4%.","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"45 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139274790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective — to use cryosurgery in combination with simultaneous peritumoral and intratumoral tracer injections of blue dye for further lymphatic mapping in the treatment of primary breast tumors. The effectiveness of intraoperative cryoprobe‑assisted injection of blue dye and cytotoxic‑tracer mixture for locoregional drug targeting in the VX2 tumor model as well as its translational significance for cryo‑assisted breast tumor surgery with blue dye alone were evaluated. Sentinel lymph node mapping, pathological determination of the tumor, and resection margins were achievable. Materials and methods. Thirty‑nine patients with primary breast cancer in stages I to IV, aged 52,4 (±19) years (mean, standard deviation (SD) years), were randomly selected, treated at the Rudolfinerhaus Private Clinic in Vienna, Austria, and included in this preliminary clinical study. Under computed tomography guidance, we injected 2 ml of cytotoxic‑tracer mixture in five aliquots into the margins of 16 frozen or normothermic VX2 tumors. We evaluated the intraoperative and post‑operative drug targeting and therapeutic efficacy at the tumor‑host interface by means of computer tomography, gross examination, and histopathology. In thirty‑four T1 to T4 primary breast cancers, we performed an ultrasound‑guided cryoprobe‑assisted tumor freezing‑thawing cycle, blue dye‑guided lymphatic mapping, and surgery. We examined an intraoperative and freshly resected specimen and the blue dye distribution pattern in the tumor‑host interface, lymph node(s), breast parenchyma, and resection cavity. Results. 29 of the 38 patients had localized primary breast cancer, which was estimated to be resectable without neoadjuvant chemotherapy. 87% of patients had one to twelve stained axillary lymph nodes, while 72% of patients had another quadrant and resection cavity stained. Fluid‑impervious frozen VX2 or breast tumors transported drug(s) in an arc‑like pattern at the tumor‑host interface regardless of freeze dose, number of freeze‑thaw cycles, drug dose fractionation, tumor characteristics, or tumor dimensions. During melting, the cytotoxic‑tracer mixture spread within 50% of the VX2 tumor and mirrored that of the tumor‑host interface; it was massive in normothermia. In VX2, the CT gap corresponded to 20% of the focal margin necrosis in pathology. In both studies, blue dye dose‑staining spread linearly in the tumor‑host interface and tumor. Conclusions. The study paves the way for intraoperative cryo‑assisted cure options for primary breast cancer. We have shown that our cryosurgical technique of repeatedly freezing deep tumors for en bloc resection or for in situ ablation of primary breast cancer, facilitated by IOUS monitoring, can be coupled with the simultaneous injection of dye tracers during conventional surgery, which then allows for lymphatic mapping. Intraoperative freezing‑assisted drug delivery and targeting techniques during cryoablation of the VX2 tumor translate successfully
{"title":"Cryo-assisted resection of primary breast cancer en bloc and tumor cryoablation connected with local drug delivery and targeting of tumor fluids. Experimental and clinical studies","authors":"M. M. Korpan, Yueyong Xiao, Xiao-Ou He, O. Dronov","doi":"10.30978/gs-2023-1-7","DOIUrl":"https://doi.org/10.30978/gs-2023-1-7","url":null,"abstract":"Objective — to use cryosurgery in combination with simultaneous peritumoral and intratumoral tracer injections of blue dye for further lymphatic mapping in the treatment of primary breast tumors. The effectiveness of intraoperative cryoprobe‑assisted injection of blue dye and cytotoxic‑tracer mixture for locoregional drug targeting in the VX2 tumor model as well as its translational significance for cryo‑assisted breast tumor surgery with blue dye alone were evaluated. Sentinel lymph node mapping, pathological determination of the tumor, and resection margins were achievable. \u0000Materials and methods. Thirty‑nine patients with primary breast cancer in stages I to IV, aged 52,4 (±19) years (mean, standard deviation (SD) years), were randomly selected, treated at the Rudolfinerhaus Private Clinic in Vienna, Austria, and included in this preliminary clinical study. Under computed tomography guidance, we injected 2 ml of cytotoxic‑tracer mixture in five aliquots into the margins of 16 frozen or normothermic VX2 tumors. We evaluated the intraoperative and post‑operative drug targeting and therapeutic efficacy at the tumor‑host interface by means of computer tomography, gross examination, and histopathology. In thirty‑four T1 to T4 primary breast cancers, we performed an ultrasound‑guided cryoprobe‑assisted tumor freezing‑thawing cycle, blue dye‑guided lymphatic mapping, and surgery. We examined an intraoperative and freshly resected specimen and the blue dye distribution pattern in the tumor‑host interface, lymph node(s), breast parenchyma, and resection cavity. \u0000Results. 29 of the 38 patients had localized primary breast cancer, which was estimated to be resectable without neoadjuvant chemotherapy. 87% of patients had one to twelve stained axillary lymph nodes, while 72% of patients had another quadrant and resection cavity stained. Fluid‑impervious frozen VX2 or breast tumors transported drug(s) in an arc‑like pattern at the tumor‑host interface regardless of freeze dose, number of freeze‑thaw cycles, drug dose fractionation, tumor characteristics, or tumor dimensions. During melting, the cytotoxic‑tracer mixture spread within 50% of the VX2 tumor and mirrored that of the tumor‑host interface; it was massive in normothermia. In VX2, the CT gap corresponded to 20% of the focal margin necrosis in pathology. In both studies, blue dye dose‑staining spread linearly in the tumor‑host interface and tumor. \u0000Conclusions. The study paves the way for intraoperative cryo‑assisted cure options for primary breast cancer. We have shown that our cryosurgical technique of repeatedly freezing deep tumors for en bloc resection or for in situ ablation of primary breast cancer, facilitated by IOUS monitoring, can be coupled with the simultaneous injection of dye tracers during conventional surgery, which then allows for lymphatic mapping. Intraoperative freezing‑assisted drug delivery and targeting techniques during cryoablation of the VX2 tumor translate successfully","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"149 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81722325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Susak, M. Maksimenko, L. Markulan, R. Honza, I. I. Tiuliukin, V. V. Volkovetskii
The management of difficult choledocholithiasis, which accounts for 10—15% of all cases of bile duct stones, has not yet been definitively defined. One of the treatment options for difficult choledocholithiasis is laparoscopic choledocholithoextraction combined with choledochoscopy. Objective — to evaluate the experience of a single centre in the treatment of difficult choledocholithiasis using laparoscopic choledocholithoextraction and choledochoscopy. Materials and methods. A total of 47 patients, including 16 (34%) men and 31 (66%) women with difficult choledocholithiasis, were enrolled in the study and received treatment at our centre. All patients were operated on using laparoscopic choledocholithoextraction combined with choledochoscopy. Thereafter, the results of treatment were analysed for the cohort of patients. In the study, we identified the causes of difficult choledocholithiasis and evaluated the achievement of complete bile duct clearance, the surgery duration, total and postoperative bed days, complications, and mortality. Results. All patients underwent laparoscopic choledocholithoextraction combined with choledochoscopy. The causes of difficult choledocholithiasis were as follows: characteristics of bile duct stones — 27 (57.4%), altered anatomy of the organs of the hepatopancreatobiliary zone — 11 (23.6%), specific location of bile duct stones — 9 (19.1%). After laparoscopic choledocholitoextraction combined with choledochoscopy, complete bile duct clearance was achieved in 95.7% of cases. The average duration of the operation was 130.0±14.7 min. The length of hospital stay after surgery was, on average, 14.3±1.7 days. 4 (8.5%) patients had complications corresponding to classes II (2 (4.2%)) and III (2 (4.2%)) according to the standardized Clavien‑Dindo classification (2009). Conclusions. Laparoscopic choledocholithoextraction combined with choledochoscopy can be used as one of the technologies for the treatment of difficult choledocholithiasis.
{"title":"Results of laparoscopic choledocholithoextraction and choledochoscopy for difficult choledocholithiasis: a single centre experience","authors":"Y. Susak, M. Maksimenko, L. Markulan, R. Honza, I. I. Tiuliukin, V. V. Volkovetskii","doi":"10.30978/gs-2023-1-28","DOIUrl":"https://doi.org/10.30978/gs-2023-1-28","url":null,"abstract":"The management of difficult choledocholithiasis, which accounts for 10—15% of all cases of bile duct stones, has not yet been definitively defined. One of the treatment options for difficult choledocholithiasis is laparoscopic choledocholithoextraction combined with choledochoscopy. \u0000Objective — to evaluate the experience of a single centre in the treatment of difficult choledocholithiasis using laparoscopic choledocholithoextraction and choledochoscopy. \u0000Materials and methods. A total of 47 patients, including 16 (34%) men and 31 (66%) women with difficult choledocholithiasis, were enrolled in the study and received treatment at our centre. All patients were operated on using laparoscopic choledocholithoextraction combined with choledochoscopy. Thereafter, the results of treatment were analysed for the cohort of patients. In the study, we identified the causes of difficult choledocholithiasis and evaluated the achievement of complete bile duct clearance, the surgery duration, total and postoperative bed days, complications, and mortality. \u0000Results. All patients underwent laparoscopic choledocholithoextraction combined with choledochoscopy. The causes of difficult choledocholithiasis were as follows: characteristics of bile duct stones — 27 (57.4%), altered anatomy of the organs of the hepatopancreatobiliary zone — 11 (23.6%), specific location of bile duct stones — 9 (19.1%). After laparoscopic choledocholitoextraction combined with choledochoscopy, complete bile duct clearance was achieved in 95.7% of cases. The average duration of the operation was 130.0±14.7 min. The length of hospital stay after surgery was, on average, 14.3±1.7 days. 4 (8.5%) patients had complications corresponding to classes II (2 (4.2%)) and III (2 (4.2%)) according to the standardized Clavien‑Dindo classification (2009). \u0000Conclusions. Laparoscopic choledocholithoextraction combined with choledochoscopy can be used as one of the technologies for the treatment of difficult choledocholithiasis. \u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90284496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Sliesarenko, P. Badiul, O. Rudenko, M. I. Romanshuk
In the conditions of warfare in Ukraine, the question of providing medical services to injured civilian and military is especially relevant and severe. In plastic surgeons` professional activities, the task is to restore extensive and deep wound defects in a short term and with a high degree of damaged organ`s restoration, especially supporting function. In this article the authors describe their experience with local keystone perforator island flaps, which are used to reconstruct skin and soft tissue defects of the lower limbs caused by combat injuries. Patients and methods. The authors conducted a retrospective review of 49 keystone perforator flaps for 28 patients (26 men and 2 women) who received treatment in the clinic for bullet, shrapnel, and mine‑explosive injuries between 2014 and 2022. Results. In all cases, extensive wound defects were completely closed during a single‑stage surgical procedure, and the patients were discharged after recovery. Non‑critical complications required secondary sutures in two cases (4%), extending the duration of treatment by 6 days. The time spent in the operating room on the transposition of one flap ranged from 40 to 95 min (mean: 67 min). Conclusions. The findings of the study show that local keystone perforator island flaps are highly effective in the successful reconstruction of lower limb defects caused by combat wounds. The keystone perforator island flap technique requires basic preoperative preparation of the patient, is easy‑to‑use, and exhibits a fairly high level of reliability at the same time. In most cases, keystone perforator island flaps provide primary and single‑stage closure of a large defect in the thigh, in the area of the knee joint, and in the lower leg in the absence of secondary defects that are common at donor sites when alternative techniques are chosen.
{"title":"Keystone perforator island flaps in the reconstruction of lower limb defects resulting from shrapnel and mine-explosive combat injuries. Case series","authors":"S. Sliesarenko, P. Badiul, O. Rudenko, M. I. Romanshuk","doi":"10.30978/gs-2023-1-48","DOIUrl":"https://doi.org/10.30978/gs-2023-1-48","url":null,"abstract":"In the conditions of warfare in Ukraine, the question of providing medical services to injured civilian and military is especially relevant and severe. In plastic surgeons` professional activities, the task is to restore extensive and deep wound defects in a short term and with a high degree of damaged organ`s restoration, especially supporting function. In this article the authors describe their experience with local keystone perforator island flaps, which are used to reconstruct skin and soft tissue defects of the lower limbs caused by combat injuries. \u0000Patients and methods. The authors conducted a retrospective review of 49 keystone perforator flaps for 28 patients (26 men and 2 women) who received treatment in the clinic for bullet, shrapnel, and mine‑explosive injuries between 2014 and 2022. \u0000Results. In all cases, extensive wound defects were completely closed during a single‑stage surgical procedure, and the patients were discharged after recovery. Non‑critical complications required secondary sutures in two cases (4%), extending the duration of treatment by 6 days. The time spent in the operating room on the transposition of one flap ranged from 40 to 95 min (mean: 67 min). \u0000Conclusions. The findings of the study show that local keystone perforator island flaps are highly effective in the successful reconstruction of lower limb defects caused by combat wounds. The keystone perforator island flap technique requires basic preoperative preparation of the patient, is easy‑to‑use, and exhibits a fairly high level of reliability at the same time. In most cases, keystone perforator island flaps provide primary and single‑stage closure of a large defect in the thigh, in the area of the knee joint, and in the lower leg in the absence of secondary defects that are common at donor sites when alternative techniques are chosen.","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"96 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85849468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The literature review discusses contentious issues and challenges that arise in the surgical treatment of anterior abdominal wall hernias. The author identified the causes of hernia formation and examined the dynamics of change in the pattern of hernia incidence. An analysis of the factors that contribute to the development of incisional ventral hernias was given special consideration. The causes of hernia recurrence were also studied. The entire spectrum of existing classifications of primary and incisional ventral hernias was reviewed, along with their advantages and disadvantages. Evaluation of current recommendations regarding the use of additional imaging methods for the examination of patients with ventral hernias was carried out. In the study, considerable attention was paid to surgical methods for hernia treatment. The advantages and disadvantages of “open” and minimally invasive laparoscopic hernioplasty techniques were critically evaluated. The difficulties in selecting an intervention method for certain types of hernias, including large ones, were highlighted, as was the importance of preventing hernia recurrence. It has been established that there are still many unsolved problems in the surgical treatment of anterior abdominal wall hernias. The author justified the need for a standardized approach to determining the characteristics of anterior abdominal wall hernias and their further classification. It is necessary to study the effectiveness of using imaging methods (ultrasound, computed tomography) for ventral hernias, depending on their size and location. There is a need for wider implementation of laparoscopic hernioplasty techniques, and the degree of the hernial defect should be taken into account when determining the indications for surgical intervention. The possibility of using laparoscopic hernioplasty for large hernias, as well as for hernias associated with rectus abdominis diastasis, requires further investigation. Improving management strategies for patients with anterior abdominal wall hernias is critical in order to reduce the risk of hernia recurrence and complications.
{"title":"Issues and challenges in the surgical treatment of anterior abdominal wall hernias. Review","authors":"T. Tarasiuk","doi":"10.30978/gs-2023-1-58","DOIUrl":"https://doi.org/10.30978/gs-2023-1-58","url":null,"abstract":"The literature review discusses contentious issues and challenges that arise in the surgical treatment of anterior abdominal wall hernias. The author identified the causes of hernia formation and examined the dynamics of change in the pattern of hernia incidence. An analysis of the factors that contribute to the development of incisional ventral hernias was given special consideration. The causes of hernia recurrence were also studied. The entire spectrum of existing classifications of primary and incisional ventral hernias was reviewed, along with their advantages and disadvantages. Evaluation of current recommendations regarding the use of additional imaging methods for the examination of patients with ventral hernias was carried out. In the study, considerable attention was paid to surgical methods for hernia treatment. The advantages and disadvantages of “open” and minimally invasive laparoscopic hernioplasty techniques were critically evaluated. The difficulties in selecting an intervention method for certain types of hernias, including large ones, were highlighted, as was the importance of preventing hernia recurrence. \u0000It has been established that there are still many unsolved problems in the surgical treatment of anterior abdominal wall hernias. The author justified the need for a standardized approach to determining the characteristics of anterior abdominal wall hernias and their further classification. It is necessary to study the effectiveness of using imaging methods (ultrasound, computed tomography) for ventral hernias, depending on their size and location. There is a need for wider implementation of laparoscopic hernioplasty techniques, and the degree of the hernial defect should be taken into account when determining the indications for surgical intervention. The possibility of using laparoscopic hernioplasty for large hernias, as well as for hernias associated with rectus abdominis diastasis, requires further investigation. Improving management strategies for patients with anterior abdominal wall hernias is critical in order to reduce the risk of hernia recurrence and complications.","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75076680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The American Cancer Society estimated that 68,820,000 men and 61,360,000 women in the United States of America would die from lung and bronchial cancer in 2022, which is equal to 21% of all cancer deaths. Patients who undergo thoracotomy have a higher risk of postoperative complications due to the severe pain syndrome that typically develops after surgery. Even though there has been extensive research on the advantages and disadvantages of various perioperative analgesia techniques, the search for the best and safest still continues. Objective — to improve the results of perioperative anesthesia in patients undergoing thoracotomy by choosing the optimal method of analgesia. Materials and methods. A total of 59 patients with lung cancer who underwent thoracotomy at the communal non‑profit enterprise «Kyiv City Clinical Hospital No 17» from 2018 to 2020 were included in an open‑label noncommercial randomized controlled clinical trial. Patients were divided into 2 groups: the multimodal analgesia (MA) group (32 patients) and the epidural analgesia (EA) group (27 patients). According to the concept of preemptive analgesia, patients in the MA group received 1000 mg of paracetamol and 50 mg of dexketoprofen intravenously 1 hour before surgery. In the postoperative period, dexketoprofen and paracetamol were administered every 8 hours in combination with epidural analgesia. During postoperative epidural analgesia, patients received 40 mg of a 2% lidocaine solution through a catheter inserted into the epidural space (Th5—Th6) and a ropivacaine 2 mg/mL (3—14 mL/h) infusion. Patients in the EA group received only epidural analgesia in the postoperative period. After placement of an epidural catheter in the epidural space (Th5—Th6), they had an injection of 40 mg of a 2% lidocaine solution and an epidural infusion of ropivacaine 2 mg/ml (3—14 mL/h). Results. The study groups did not demonstrate a statistically significant difference in terms of age, hight, weight, a grade of anesthesiological risk (ASA), blood loss, surgery duration, and surgical volume (р >0,05). The level of analgesia was assessed using the numerological rating scale (NRS) after 3, 6, 24, and 32 hours after surgery. Every research stage revealed a significant difference in the level of pain syndrome between the study groups (p<0.05). Patients in the EA group experienced more severe pain syndrome than those in the MA group. Consequently, 7 patients (26%) in the EA group were anesthetized with morphine 10 mg intramuscularly compared to 3 patients (9%) in the MA group. Conclusions. In patients undergoing thoracic surgery, a multimodal analgesic approach, which includes the use of COX‑2 and COX‑3 inhibitors in combination with epidural analgesia, has been shown to produce better analgesia compared to epidural anesthesia alone. The beneficial effect of multimodal analgesia was seen in a significant difference (p<0.05) in the intensity of pain syndrome between the study groups in the early p
{"title":"Multimodal approach to pain management in thoracic surgery","authors":"H. Poniatovska, S. Dubrov","doi":"10.30978/gs-2023-1-21","DOIUrl":"https://doi.org/10.30978/gs-2023-1-21","url":null,"abstract":"The American Cancer Society estimated that 68,820,000 men and 61,360,000 women in the United States of America would die from lung and bronchial cancer in 2022, which is equal to 21% of all cancer deaths. Patients who undergo thoracotomy have a higher risk of postoperative complications due to the severe pain syndrome that typically develops after surgery. Even though there has been extensive research on the advantages and disadvantages of various perioperative analgesia techniques, the search for the best and safest still continues. \u0000Objective — to improve the results of perioperative anesthesia in patients undergoing thoracotomy by choosing the optimal method of analgesia. \u0000Materials and methods. A total of 59 patients with lung cancer who underwent thoracotomy at the communal non‑profit enterprise «Kyiv City Clinical Hospital No 17» from 2018 to 2020 were included in an open‑label noncommercial randomized controlled clinical trial. Patients were divided into 2 groups: the multimodal analgesia (MA) group (32 patients) and the epidural analgesia (EA) group (27 patients). According to the concept of preemptive analgesia, patients in the MA group received 1000 mg of paracetamol and 50 mg of dexketoprofen intravenously 1 hour before surgery. In the postoperative period, dexketoprofen and paracetamol were administered every 8 hours in combination with epidural analgesia. During postoperative epidural analgesia, patients received 40 mg of a 2% lidocaine solution through a catheter inserted into the epidural space (Th5—Th6) and a ropivacaine 2 mg/mL (3—14 mL/h) infusion. Patients in the EA group received only epidural analgesia in the postoperative period. After placement of an epidural catheter in the epidural space (Th5—Th6), they had an injection of 40 mg of a 2% lidocaine solution and an epidural infusion of ropivacaine 2 mg/ml (3—14 mL/h). \u0000Results. The study groups did not demonstrate a statistically significant difference in terms of age, hight, weight, a grade of anesthesiological risk (ASA), blood loss, surgery duration, and surgical volume (р >0,05). The level of analgesia was assessed using the numerological rating scale (NRS) after 3, 6, 24, and 32 hours after surgery. Every research stage revealed a significant difference in the level of pain syndrome between the study groups (p<0.05). Patients in the EA group experienced more severe pain syndrome than those in the MA group. Consequently, 7 patients (26%) in the EA group were anesthetized with morphine 10 mg intramuscularly compared to 3 patients (9%) in the MA group. \u0000Conclusions. In patients undergoing thoracic surgery, a multimodal analgesic approach, which includes the use of COX‑2 and COX‑3 inhibitors in combination with epidural analgesia, has been shown to produce better analgesia compared to epidural anesthesia alone. The beneficial effect of multimodal analgesia was seen in a significant difference (p<0.05) in the intensity of pain syndrome between the study groups in the early p","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82265825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. P. Lytvynenko, O. Holik, L. Zavernyĭ, M. Kryvopustov, Y. Tsiura, T. Tarasiuk
The article focuses on the professional and scientific path of Professor Ivan Mykolayovych Ishchenko. He was a leading Ukrainian surgeon, a renowned scientist, an accomplished teacher, and a great humanist who formed the ideology of surgical science. Professor Ishchenko defined and developed promising directions for scientific research in the fields of military field surgery, urology, traumatology, neuro‑ and thoracic surgery, and tissue transplantation. His scientific interests included the surgical treatment of diseases of the biliary tract, liver, and stomach as well as theoretical and practical issues of anesthesia administration.
{"title":"Professor Ivan Mykolayovych Ishchenko — Heracles of Ukrainian medicine","authors":"N. P. Lytvynenko, O. Holik, L. Zavernyĭ, M. Kryvopustov, Y. Tsiura, T. Tarasiuk","doi":"10.30978/gs-2023-1-4","DOIUrl":"https://doi.org/10.30978/gs-2023-1-4","url":null,"abstract":"The article focuses on the professional and scientific path of Professor Ivan Mykolayovych Ishchenko. He was a leading Ukrainian surgeon, a renowned scientist, an accomplished teacher, and a great humanist who formed the ideology of surgical science. Professor Ishchenko defined and developed promising directions for scientific research in the fields of military field surgery, urology, traumatology, neuro‑ and thoracic surgery, and tissue transplantation. His scientific interests included the surgical treatment of diseases of the biliary tract, liver, and stomach as well as theoretical and practical issues of anesthesia administration.","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87801820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Prytula, Y. Rudenko, O. Gorbatiuk, A. Nakonechnyi, Y. Susak
The term «lymphatic malformations» (LMs) refers to a wide spectrum of disorders with clinical manifestations that can vary from asymptomatic to life‑threatening. Objective — to analyze the factors and pathological conditions that necessitate the use of emergency surgical procedures in patients with thoracic and abdominal LMs. Materials and methods. The retrospective study of medical charts of patients with LMs was performed for a period from 2012 to 2021. Among 240 patients with LMs, 55 (22.9%) were diagnosed with lesions of the abdominal or thoracic cavity. 5 (9.1%) required an emergency surgical procedure. Results. Among 38 patients with abdominal LMs, only one (2.6%) required emergency surgery. This patient underwent laparotomy and subtotal bowel resection for total mesenteric thrombosis. The postoperative period was complicated by short bowel syndrome. Mediastinal LMs were diagnosed in 17 patients, 14 (73.7%) of whom had neck LM extension. In 4 cases, mediastinal LMs were complicated by intrathoracic tension syndrome. It was caused by a lymphatic leak into the pleural cavity in 1 case and by sudden enlargement of LMs, resulting from intracystic hemorrhage, in 3 other cases. A pleural drain with subsequent sclerotherapy was used in a patient with chylothorax. Patients with intracystic hemorrhage underwent thoracotomy and partial LM resection. They also received an injection of a sclerosing agent into the residual cysts. In uncomplicated cases, minimally invasive methods were preferred, with laparoscopic resections of abdominal LMs in 22 (78.6%) patients and sclerotherapy under ultrasound guidance in 7 (36.8%) patients with mediastinal LMs. Conclusions. Intrathoracic tension syndrome and thrombotic complications are potentially dangerous and life‑threatening conditions that pose a risk to patients with visceral LMs and require emergency interventions. Minimally invasive technologies were preferred in uncomplicated cases of thoracic and abdominal LMs, whereas open surgeries were the method of choice in complicated cases.
{"title":"Life-threatening complications in patients with thoracic and abdominal lymphatic malformations","authors":"V. Prytula, Y. Rudenko, O. Gorbatiuk, A. Nakonechnyi, Y. Susak","doi":"10.30978/gs-2023-1-36","DOIUrl":"https://doi.org/10.30978/gs-2023-1-36","url":null,"abstract":"The term «lymphatic malformations» (LMs) refers to a wide spectrum of disorders with clinical manifestations that can vary from asymptomatic to life‑threatening. \u0000Objective — to analyze the factors and pathological conditions that necessitate the use of emergency surgical procedures in patients with thoracic and abdominal LMs. \u0000Materials and methods. The retrospective study of medical charts of patients with LMs was performed for a period from 2012 to 2021. Among 240 patients with LMs, 55 (22.9%) were diagnosed with lesions of the abdominal or thoracic cavity. 5 (9.1%) required an emergency surgical procedure. \u0000Results. Among 38 patients with abdominal LMs, only one (2.6%) required emergency surgery. This patient underwent laparotomy and subtotal bowel resection for total mesenteric thrombosis. The postoperative period was complicated by short bowel syndrome. Mediastinal LMs were diagnosed in 17 patients, 14 (73.7%) of whom had neck LM extension. In 4 cases, mediastinal LMs were complicated by intrathoracic tension syndrome. It was caused by a lymphatic leak into the pleural cavity in 1 case and by sudden enlargement of LMs, resulting from intracystic hemorrhage, in 3 other cases. A pleural drain with subsequent sclerotherapy was used in a patient with chylothorax. Patients with intracystic hemorrhage underwent thoracotomy and partial LM resection. They also received an injection of a sclerosing agent into the residual cysts. In uncomplicated cases, minimally invasive methods were preferred, with laparoscopic resections of abdominal LMs in 22 (78.6%) patients and sclerotherapy under ultrasound guidance in 7 (36.8%) patients with mediastinal LMs. \u0000Conclusions. Intrathoracic tension syndrome and thrombotic complications are potentially dangerous and life‑threatening conditions that pose a risk to patients with visceral LMs and require emergency interventions. Minimally invasive technologies were preferred in uncomplicated cases of thoracic and abdominal LMs, whereas open surgeries were the method of choice in complicated cases.","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79149790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the general structure of the disease, severe acute pancreatitis occurs in 20% of cases, requires treatment in the intensive care unit, and is accompanied by a high risk of complications (up to 50%) and death (40—70%). In turn, early use of enteral nutrition in patients with severe acute pancreatitis significantly improves the condition of the intestinal wall and the course of the disease as a whole, reducing the number of complications and mortality. Objective — to determine the timeframe for the restoration of intestinal absorptive function as one of the main criteria for the start of enteral nutrition in patients with severe acute pancreatitis and to improve the results of comprehensive treatment of patients by preventing its complications. Materials and methods. The results of the evaluation and treatment of 67 patients with severe acute pancreatitis served as the basis for the study. Patients were divided into two groups depending on the specifics of the selected treatment strategies: a comparison group of 33 patients receiving standard enteral nutrition and a main group of 34 patients receiving standard enteral nutrition with the inclusion of antiflatulants in the mixture. Before the start of tube feeding, a test using unmetabolized disaccharides (lactulose/mannitol) and a sample containing a 3% potassium iodide solution was conducted to determine the timeframe for the restoration of intestinal absorptive function. Results. Іn 70.6% of patients in the main group and 69.7% of patients in the comparison group, the restoration of intestinal absorptive function was registered only after 48 hours from the beginning of treatment. After 7 and 14 days of enteral nutrition, a significant difference was obtained between total protein, albumin, cholesterol and serum K+ (p<0.05). Аfter 7 days of treatment, there was a significantly lower incidence of intestinal complications in patients of the main group by 21.5% (χ2=4.88, 95% CI 2.3—39.5, p=0.03). Conclusions. The method, which uses a 3% potassium iodide solution, is quick and informative for determining the restoration of intestinal absorptive function in patients with severe acute pancreatitis. The inclusion of antiflatulants in the composition for enteral nutrition improved the laboratory parameters of blood serum and reduced the incidence of intestinal complications by 7 days and the duration of multiorgan failure from 11.5±1.8 days to 10.5±1.9 days (p=0.04).
在该疾病的一般结构中，20%的病例发生严重急性胰腺炎，需要在重症监护病房进行治疗，并伴有并发症(高达50%)和死亡(40-70%)的高风险。反过来，重症急性胰腺炎患者早期使用肠内营养可显著改善肠壁状况和整个病程，减少并发症数量和死亡率。目的-确定肠吸收功能恢复时间作为重症急性胰腺炎患者肠内营养开始的主要标准之一，通过预防其并发症提高患者综合治疗的效果。材料和方法。对67例重症急性胰腺炎患者的评价和治疗结果作为本研究的依据。根据所选治疗策略的具体情况，将患者分为两组:对照组33名患者接受标准肠内营养，主要组34名患者接受标准肠内营养，并在混合物中加入抗胀气剂。在开始管饲之前，使用未代谢的双糖(乳果糖/甘露醇)和含有3%碘化钾溶液的样品进行试验，以确定肠道吸收功能恢复的时间。结果。Іn主组70.6%的患者和对照组69.7%的患者在治疗开始48小时后才登记到肠道吸收功能的恢复。肠内营养7和14 d后，总蛋白、白蛋白、胆固醇和血清K+差异有统计学意义(p<0.05)。Аfter治疗7 d时，主组患者肠道并发症发生率显著降低21.5% (χ2=4.88, 95% CI 2.3 ~ 39.5, p=0.03)。结论。该方法使用3%碘化钾溶液，可快速测定重症急性胰腺炎患者肠道吸收功能的恢复情况。在肠内营养组合物中加入抗胀药可改善血清实验室参数，使肠道并发症发生率减少7 d，多器官功能衰竭持续时间由11.5±1.8 d减少到10.5±1.9 d (p=0.04)。
{"title":"Peculiarities of the use of enteral nutrition in patients with severe acute pancreatitis","authors":"I. Kolosovуch, I. Hanol","doi":"10.30978/gs-2023-1-41","DOIUrl":"https://doi.org/10.30978/gs-2023-1-41","url":null,"abstract":"In the general structure of the disease, severe acute pancreatitis occurs in 20% of cases, requires treatment in the intensive care unit, and is accompanied by a high risk of complications (up to 50%) and death (40—70%). In turn, early use of enteral nutrition in patients with severe acute pancreatitis significantly improves the condition of the intestinal wall and the course of the disease as a whole, reducing the number of complications and mortality. \u0000Objective — to determine the timeframe for the restoration of intestinal absorptive function as one of the main criteria for the start of enteral nutrition in patients with severe acute pancreatitis and to improve the results of comprehensive treatment of patients by preventing its complications. \u0000Materials and methods. The results of the evaluation and treatment of 67 patients with severe acute pancreatitis served as the basis for the study. Patients were divided into two groups depending on the specifics of the selected treatment strategies: a comparison group of 33 patients receiving standard enteral nutrition and a main group of 34 patients receiving standard enteral nutrition with the inclusion of antiflatulants in the mixture. Before the start of tube feeding, a test using unmetabolized disaccharides (lactulose/mannitol) and a sample containing a 3% potassium iodide solution was conducted to determine the timeframe for the restoration of intestinal absorptive function. \u0000Results. Іn 70.6% of patients in the main group and 69.7% of patients in the comparison group, the restoration of intestinal absorptive function was registered only after 48 hours from the beginning of treatment. After 7 and 14 days of enteral nutrition, a significant difference was obtained between total protein, albumin, cholesterol and serum K+ (p<0.05). Аfter 7 days of treatment, there was a significantly lower incidence of intestinal complications in patients of the main group by 21.5% (χ2=4.88, 95% CI 2.3—39.5, p=0.03). \u0000Conclusions. The method, which uses a 3% potassium iodide solution, is quick and informative for determining the restoration of intestinal absorptive function in patients with severe acute pancreatitis. The inclusion of antiflatulants in the composition for enteral nutrition improved the laboratory parameters of blood serum and reduced the incidence of intestinal complications by 7 days and the duration of multiorgan failure from 11.5±1.8 days to 10.5±1.9 days (p=0.04).","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75532288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：