VARIANT AB, BA). ABOUT THE NECESSITY OF TRANSPLANTATION OF APPENDIX AND GALLBLADDER
Kursk State Medical University, Kursk, RUSSIA
Introduction. The treatment of five diseases of abdominal organs that have been identified as a syndrome of "stars" is of particular interest in modern gastroenterology. It is known that there are different variants of its course. The combination of diseases of the appendix and gallbladder are defined as variants of the AB and BA.
The purpose of this study was to evaluate the quality of life of patients undergoing appendectomy and cholecystectomy, and the establishment of the time between two operations, , which, as it was found, increase the risk of colorectal cancer by 5-10 times.
Materials and methods. 12 patients with gallstone disease who had a history of appendectomy (AB) and 8 patients with acute appendicitis (VA), who had cholecystectomy in the anamnesis and were treated in surgical departments of Glushkovskiy, Korenevskiy and Rila CCH for the period from January 2010 in July 2011 were examined and treated. The age of patients ranged between 20 to 74 years. There were 16 women and 4 men.
Results. In the study of patients and diagnosis there was used a set of standard clinical, instrumental and laboratory tests. Studies have shown that in patients with a variant of the course of AB average time between two operations is 17 years, and in patients with the VA variant is 15 years. In patients that underwent appendectomy, clinical signs of chronic disorders of duodenal passage appeared in the first three years after surgery. In patients underwent cholecystectomy, clinical signs of chronic disorders of duodenal passage appeared or continued in the first year after surgery.
Conclusion. The most common diseases encountered in gastroenterology and operations performed by them in the form of appendectomy and cholecystectomy do not heal the disease, but change the course of their flow. It is necessary to develop issues of conservative treatment, performance of transplantation operations, including transplantation of the appendix and gallbladder.
PROPHYLAXIS OF COMPARTMENT SYNDROME IN THE TREATMENT OF POSTOPERATIVE LARGE HERNIAS
Lugansk State Medical University, Lugansk, UKRAINE
Introduction: Compartment syndrome, being one of postoperative complications in the treatment of ventral hernias of large sizes and leading to ischemia of organs with manifestation of multiple organ failure in the future, remains an important problem of surgery until now.
Materials and methods: The study group included 64 patients at the age from 29 to 78 years, operated for large and giant postoperative hernias. Was applied non-tense alloherniaplastic Ģin lay" method. Preoperatively all patients underwent intra-abdominal pressure measurement by Kron method. It was revealed an increased intra-abdominal pressure of varying degrees - from 5 to 15 mm of water column, which corresponded to 1-2 degrees of severity of intra-abdominal hypertension and was the most important factor for a choice of the method of plastics.
Results: Were identified the most important prophylactic measures of compartment syndrome: 1) identifying of risk groups of compartment syndrome (chronic cardio-pulmonary diseases in sub- and decompensation stages, overweight, previously carried over purulent inflammative processes in abdominal cavity, etc.) 2) postoperatively applied dosed pneumocompression with bandaging in preoperatively increased intra-abdominal pressure 3) use of non-tense hernioplasty; 4) tubage of intestines with the aim of decompression; 5) respiratory support by means of extended artificial ventilation with increased positive pressure in the end of expiration, and not the respiratory volume, which, in contrast, should be reduced in a compartment syndrome.
Conclusion: Thus, the proposed measures for prophylaxis of a compartment syndrome allowed reducing its development in 2.4 times.