HOW THE TRADITIONAL OR SINGLE PORT CHOLECYSTECTOMY CAN BE JUSTIFIED IN PATIENTS WITH THE PREVIOUS SURGERY OF ABDOMINAL CAVITY

F. EZZAT, S. KAISSER, G. ROSS, R. GASPARINI,

V. KONDOBAROV, G. GOCHILAIDZE

Department of General and Abdominal Surgery of Betel Hospital, Bückeburg, GERMANY

The aim of our study is to access the risk and feasibility of traditional laparoscopy or single port cholecystectomies for the previously abdominal operated patients. In such operation, the risk of the complications doubles, since anatomical and structural changes of gallbladder and hepato-billiary region is observed.

Materials and Methods: 594 patients with symptoms of recurrent cholelithiasis and acute cholecystitis were operated between 2008 and 2010. 119 (20%) patients passed abdominal operations (gastric resection, right-sided hemicolectomy, etc.).

Patients were subdivided into two groups: Group I - previously not operated patients. Group II - operated patients with the development of abdominal complications such as adhesions in Calot triangle, shortening of Ductus Cysticus, different anatomical and structural changes. The introduction of trocars in patients of the II group depended on prior interventions. Under the optic control after separations of adhesions in abdominal wall trocars were placed in common position.

Results: Laparoscopic cholecystectomy was performed in all 119 patients. Complications were not observed. Duration of operations has made at an average 70 (± 5) minutes. Postoperative period was in an average 6 days (± 1) and did not exceed bed-days of the I group. Traditional laparoscopic or single port cholecystectomy is an adequate technique and can be performed without complications in patients with previous operations on abdominal cavity. These methods are low traumatic and do not induce such complications as postoperative hernias and suture insufficiencies.

CRITERIA OF THE INVASION OF THE TUMOR OF HEAD OF THE PANCREAS INTO THE WALL OF HIGHER MESENTERIC VEIN ACCORDING TO ULTRASOUND DATA

E.P.FISENKO, N.N. VETSHEVA

Russian Scientific Center of Surgery named after acad. B.V. Petrovsky, Moscow, RUSSIA

Development of tactics of management of patients with neoplasms of pancreatic head is mainly determined by the involvement of the superior mesenteric vein into the process.

Purpose. Determination of the ultrasound criteria for the involvement superior mesenteric vein into the neoplastic process in the cancer of the head of the pancreas.

Materials and methods. Complex ultrasound (B-mode, color mapping and spectral analysis of blood flow in tumor and in extrapancreatic vessels adjacent to the neoplasm) was performed in 52 patients with a directional diagnosis – neoplasm of the pancreatic head (men - 43 women - 9: average age 58.3±8.5 years). 9 patients there was revealed pseudotumoral pancreatitis, in 14 - cystic formation (7 - pseudocysts, 3 - mucinous cystadenoma, 4 - intraduct cystadenocarcinoma), in 29 - cancer.

Results. On the compression of the superior mesenteric vein by tumor, there was observed narrowing of the vessel without the disturbance of the integrity and character of the contours of its wall and maintenance of monophasic nature of blood flow according to the spectral analysis of blood flow. Tumor invasion of the vein wall according to the B-mode was accompanied by its thickening, the appearance of an irregular inner contour of the lumen of the vessel, narrowing of the lumen, irregular contour of the wall. With small informative value of the diagnostic method: the sensitivity was 71% and specificity - 91%, diagnostic accuracy - 87%. Additional criterion of the transition of the process to the wall of the superior mesenteric vein was obtained during spectral analysis of blood flow in the area of ​​the supposed invasion of wall: venous blood flow acquired pulsation character. The use of Doppler ultrasound allowed to increase indicators of the diagnostic information value of the identification of superior mesenteric vein, as compared to the use of only gray-scale: sensitivity up to 91%, specificity up to 97%, diagnostic accuracy up to 94%.

Conclusion. Ultrasound examination of patients with pancreatic head tumor should be performed with the use of Doppler ultrasound and spectral analysis of blood flow, which allows obtainment of additional criteria for the involvement of the superior mesenteric vein into the tumor process and improves indicators of diagnostic information value.

Date: 2014-12-28; view: 776