THE TECHNIQUE OF LAPAROSCOPIC VENTRAL/INCISIONAL HERNIA REPAIR
E. G. RUSTAMOV
Tusi Memorial Clinic, Baku, AZERBAIJAN
Despite of increase of the popularity of laparoscopic incisional and ventral hernia repair surgical technique is not standardized Meanwhile, in most cases the frequency of relapse after surgery depends on a guaranteed fixed of mesh, which prevents the protrusion in the postoperative period. The aim of this study was to improve and standardize the laparoscopic mesh fixation technique in ventral/incisional hernia.
Materials. Since April 2006 to November 2010, 73 patients were performed laparoscopic ventral/incisional hernia repair. All patients were operated in elective. The average age of patients was 53 years old (19-76 old years). 30 patients had primary hernias, the 43 had incisional hernias.
Surgical technique. In all cases in fixation the mesh were used transfascial sutures without of any herniotackers. At the first polypropylene mesh introduced into the abdominal cavity (Galmesh) previously imposed with two suture seam clockwise 12.00 and 18.00 and fixed transabdominally. Then, transfascial sutures are placed with the thread, introduced through the Veress (without mandren) into the abdominal cavity (transabdominally) with a capture of a synthetic plastic material.
Results. The results of operations controlled directly and in late periods after 2 years of surgery. Mean operative time averaged 42 minutes. In 4 patients at 10-14 days after surgery were reported seroma, which have been emptied by a thin puncture needle. Due to the severe adhesive process one patient has conversion. The average BMI (Body Mass Index) was> 35kg/m². The average stay of hospital - a 1,7 days. In one patient developed recurrent hernia.
Conclusion. The fixation of the mesh during laparoscopic ventral hernia with transabdominal sutures without additional tacks is a safe, efficient, reliable and simple procedure and can be widely applied in clinical practices.
SOME ASPECTS OF THE ESTIMATION OF RESPIRATORY INSUFFICIENCY AT PATIENTS WITH THE ACUTE PERITONITIS AT STAGES OF SURGICAL TREATMENT
City hospital ¹ 6 of A.D.Melikov, Baku,AZERBAIJAN
Despite the appreciable reached successes in complex treatment of an acute diffuse peritonitis, a mortality from this pathology remains enough high (25 % - 80 %). Among the reasons burdening the current of a peritonitis and leading to a lethal outcome, is noted by disturbances of respiratory system. The purpose of the given work was – to define criteria of various forms of respiratory insufficiency and correction of the given pathology in the course of surgical treatment. For achievement of an object in view we had been surveyed 50 patients with the diagnosis «acute peritonitis», received the radical surgical help. All patients have been parted on two groups. The first group of patients (control) – this group included 20 patients with the acute peritonitis, received surgical and anesthesiology – reanimation help by the standard technique. The second group included 30 patients, at which else in before operation period was available in parallel with an acute peritonitis also respiratory insufficiency. In this group correction of indicators acid – alkaline balance (AAB) in the preoperative period has been spent. Various parametres of a hyperventilating regimen during operation and in the postoperative period before full restoration of normal spontaneous breath have been applied. Along with clinical indicators, have been investigated and gas structure of arterial, venous and capillary blood by micromethod Astrup and a continuous manual oximetry. The analysis of the spent researches in the first group has shown, that AAB at various stages of surgical treatment of peritonitis at 8 sick (40 %) respiratory insufficiency took place. The mortality in this group has made 30 % (6 patients). In the second group of patients from the moment of an establishment of signs of respiratory insufficiency, there has been begun correction of the given pathology by various ways (from inhalation of the wetted oxygen before carrying out full the pulmonary ventilation by various regimens). The mortality in this group has considerably decreased and has made 16,6 % (5 patients). Thus, adequate correction of respiratory insufficiency in the second group of patients has convincingly shown advantages of the given approach.
FEATURES PREOPERATIVE PREPARATION IN HYDATID PULMONARY DISEASE IN YOUNGER CHILDREN
Sh.T.SALIMOV, Kh.S.USMANOV, R.A. HASHIMOV
Rep. Scientific and Practical Center of Miniinvasive and Endovisual Surgery in children
The results of thoracoscopic operations of 17 children (9 boys and 8 girls) aged between 3 - 7 years were analyzed for the period within 2005 – 2010 at the Republican Scientific and Practical Center of minimally invasive and endovisual surgery.
In our studies we used the classification of A.V. Melnikov (1935). Among the 17 patients with hydatid pulmonary disease, 8 had different complications, 6 suppuration without perforation of a chitinous membrane, 2 - break into the pleural cavity. Clinical management of patients with respiratory distress syndrome depends on the etiology of respiratory distress syndrome. General aspects of treatment of respiratory distress syndrome: ensuring of adequate breathing, oxygen therapy, aerosol therapy, fight with disorders of the cardiovascular system, fight with edemas, prevention of hypoglycemia, correction of adrenal insufficiency, improvement of oxidative processes in tissues, stimulation of protective forces.
Antibiotic therapy is the most important direction in the treatment of complicated forms of hydatid pulmonary disease. In this case, we prescribed broad-spectrum antibiotics - III generation cephalosporins for younger children 20-50 mg/kg of body weight per day. Antihistamine drugs are administered after the restoration of hemodynamic indicators, as they may have a hypotensive effect. They can be injected intramusculary and intravenously: 1% solution of dimedrol (or 2.5% pipolphen solution, 2% suprastin solution, 2.5% diprasin solution) in an amount of 2 ml. Corticosteroid drugs (30-60 mg of prednisolone or 125 mg of hydrocortisone) are injected subcutaneously, in severe cases, intravenously by stream – with 10 ml of 40% glucose solution or a in a dropper with 300 ml of 5% glucose solution. Vitamin therapy – Ñ, Â1, Â2, À vitamins are administered orally to children from first days at therapeutic doses of vitamins C, B1, B2 and A.
During the break of hydatid cysts into the pleural cavity there was performed pleural puncture for the elimination of restrictive acute respiratory failure.
Conclusion: Thus, preoperative preparation in complex hydatid pulmonary disease is carried out for the elimination of acute respiratory failure, hypovolemia, endotoxicosis, and fluid deficiency, and leads to a relief of symptoms, normalization of temperature, with a reduction of the severity of respiratory failure, and desensitization of the organism of younger children.