CAPABILITIES OF MINIMALLY INVASIVE INTERVENTIONS IN THE TREATMENT OF POSTOPERATIVE ABDOMINAL ABSCESSES

A.M. HAJIBAEV, Kh.Kh. ASOMOV, U.R. RISKIYEV, M.A. MIRSIDIKOV

Republican scientific center for emergency medical care, Tashkent, UZBEKISTAN

Purpose – improvement of the results of diagnosis and surgical treatment of patients with intraabdominal complications by using early postoperative miniinvasive interventions. 464 patients with postoperative intraabdominal complications were examined within the period from 2003 to 2010. Total number of men - 286 (61.6%), women - 178 (38.4%), aged between - 16-86 years, Average age - 49.00 years. Of them, postoperative abdominal abscesses (POAA) were revealed in 51 (11.0%) patients. The main reasons of POAA were pancreatic 18 (35.3%), appendectomy 12 (23.5%), laparoscopic cholecystectomy 7 (13.7%), open traditional cholecystectomy 5 (9.8%), resection/suture of a hollow organ 5 (9.8%), intra-abdominal bleeding 4 (7.9%). The localization of abscesses: in the omental bursa constituted 18 (35.3%) in the subhepatic area 13 (25.5%), in the pelvis 9 (17.6%), between intestinal loops 8 (15.7%), under the diaphragm 3 (5.9%). In POAA there were used three variants of surgical treatment: open surgery, drainage of abscess under ultrasound or CT control, laparoscopic incision and drainage. In an open surgical intervention, surgical access was carried out in accordance with the localization of the process. In the use of miniinvasive interventions (drainage under ultrasound or CT control ) in all cases there was observed a favorable outcome. The worst results of the treatment of abscesses of the abdominal cavity were observed during operation from a laparotomic access. The overall mortality in abdominal abscesses in patients with the use of miniinvasive interventions was 2.8%. In the open method of treatment it constituted 16.9%. Laparoscopic lancing and drainage of abscesses was accompanied by a mortality in 2.2% of cases.

Thus, the determining factor influencing the results of treatment of patients with postoperative abscesses, is a form of surgical intervention. The best results were obtained in patients who were performed closed surgery - drainage of abscesses under ultrasound or CT control. This allows to consider this variant of operation and method of choice in case of the mentioned intraperitoneal complications. In the absence of conditions for the use of these methods laparoscopic intervention, which is an alternative to relaparotomy is preferred.

Date: 2014-12-28; view: 1066