COLORECTAL CANCER: THERAPEUTIC OPTIONS AND OUR CLINICAL EXPERIENCE MULTIPLE STUDY
P.MAHARRAMOV , E.ZEYNALOV
Introduction: Colorectal resections are common surgical procedures all over the world.
Currently the therapeutic gold standard for medium and low rectal tumours is the laparoscopic "en-bloc" excision of the rectum and total mesorectal excision (TME) preserving the autonomous nerve plexus. In very distal tumours, complex procedures such as very low anterior resections and intersphincteric resections are used where possible. These procedures can avoid incapacitating operations such as abdominoperineal amputation.
Material and methods: From 2009 to 2010, we performed by laparoscopic procedure 105 patients and 3 inter-sphincteric resections for cancer of the low rectum . 63 of these patients involving was colon, 42 patients was rectum carsinom. 18 patients has been revealed preoperatively primary metastasis .Medium age of patients was 70 years (range 52-80 years) and male (64%)67 to female 38( 36%) gender ratio was 4/2. No laparoscopic procedure was converted to the traditional open surgery. We noted 2 anastomotic leakages of which one required re-operation. In all the cases, resection margins were free. 37 patients was performed R0 resection from rectum patients, 57 patiens R0 resections was performed from 63 patients. 3 colon patients(4,7%) from 63 was fullfilled repeatedly revision , revaled 3 anastomos insuficiency. During the rerevision 3 rectum patients(7,1%) was revealed anostomos leakage. In a mean followup of 48 months ( range 6-54 months), 1 patient developed hepatic metastasis and no local recurrence was noted. One patients had urinary retention, resolved spontaneously. At 12 months from the operation, one patient had slight incontinence for gas and liquids.
Conclusions: Under traditional perioperative treatment, laparoscopic colonic resections show clinically relevant advantages in selected patients. If the long-term oncological results of laparoscopic and conventional resection of colonic carcinoma show equivalent results, the laparoscopic approach should be preferred in patients suitable for this approach to colectomy .
We believe that total mesorectal resection, even associated with sphincter preserving procedures, such as intersphincteric resection, in case of very low rectal tumours, performed by laparoscopic approach with the same oncological and surgical principles of open surgery. Our results and the literature review clearly demonstrate that laparoscopic resection for rectal cancer is not associated with higher morbidity and mortality. Established oncological and surgical principles are respected and long-term outcomes are at least as good as those after open surgery.
PARARECTAL CONVERSION OF APPENDICEAL ACCESS IN ACUTE APPENDICITIS IN WOMEN
National Surgical Center, State Medical Academy of Kyrgyzstan, Bishkek, KYRGYZSTAN
The aim of the study: to reduce the level of surgical trauma at the stage of forced conversion of appendiceal access to laparotomy in acute appendicitis in women.
Materials and methods. In 2006-2010, 82 patients with a diagnosis of acute appendicitis were operated at the national surgical center by the offered method.
Operative approach was started with skin incision located between Volkovych-Dyakonov - Mac Burney incisions and Lennader. Just like with a typical access, in our modification, aponeurosis of the external oblique muscle is cut along the fibers, and edges are gripped by Kocher clamps, with the help of which the edges are stretched into both directions.
During the separation of the edges of the aponeurosis, fibers of the external oblique abdominal muscle, as well as the edges of the rectus sheath are found, whereas in a typical access, only the internal oblique muscle is found. In the projection of blunt separation of edges of the muscles in our method by a mouse-tooth forceps, the edge of the anterior wall rectus sheath is gripped and pulled towards the navel. At this case, after the dissection of peremesions oblique abdominal muscle is bluntly separated along the fibers. If necessary in our modification, the incision can be made along the edge of the rectus sheath, at the junction of the aponeurosis without cutting the layer of the internal oblique muscle. Moreover, a incision of any length can be extended up and down. By this method we have carried out the conversion of access in 82 patients, in whom there was made a diagnostic pitfall.
Results: The intraoperative finding in patients operated for acute appendicitis in women showed that in 34 women there was found ovarian apoplexy. Impaired tubal pregnancy was found in 8 patients. In 9 patients there were found inflammatory changes in the right uterus. In 6 patients there was found torsion, and rupture of ovarian cysts in 32.
Conclusion: During the inconsistency of changes in the appendix and the clinical picture, a surgeon must perform inspection of the abdominal cavity from the pelvis, and only after the discovery of the true cause of the disease and after its elimination, shall solve the problem of appendectomy. The proposed method allows to perform an adequate inspection and manipulation during the operation.
THE USE OF LASER TECHNOLOGY IN SURGICAL TREATMENT OF PATIENTS WITH ACUTE SUPPURATIVE INFLAMMATION OF PILONIDAL CYSTS
M.M.MAMEDOV, KH.N. MUSAYEV, N.I. MAMMADOV, G.M. GURBANOV, G. AKHMEDOV
Scientific Center of Surgery named after acad. M.A. Topchubashov, Baku,AZERBAIJAN
Objective of the investigation: to improve the results of a complex surgical treatment of patients with acute suppurative inflammation of pilonidal cysts, improve operational methods by using new laser technologies in combination with immobilized proteolytic enzymes.
Materials and methods: We analyzed the results of surgical treatment of 99 patients with acute inflammation of pilonidal cysts. Patients were divided into two groups. 63 patients of the study group underwent preventive puncture-washing enzyme sanation of suppurative focuses by using immobilized protease (imozimaza+metrogilP) + radical surgery combined with low intensity transdrainage laser radiation of the wound within 10-12minuts by “NEEDLE” device). During the treatment of 36 patients with acute suppurative inflammation of pilonidal cysts in the control group, a traditional method of wound care with a multicomponent ointment “Levomekol” on hydrophilic base was used.
Results of the investigation. Energy activity of the cell membrane increases under the influence of low-intensity transdrainage laser radiation. Regenerative processes are activated, absorption of oxygen by tissues increases with the formation of adenosine triphosphate (ATP) in mitochondria, bio-energy potential of the cells increase. Laser radiation has a direct effect on nerve endings, energy paths (meridians) and the nervous system, by enhancing metabolic processes in the organism at different levels. During the treatment by means LILR, term of healing of wounds is approximately 3 times less the term of healing of wound by means of conventional treatment methods.
Conclusion The use of associate hyaluronic acid and zinc + the use of transdrainage low-intensity laser radiation enhances complete cleansing of the wound from necrotic elements. Formation of new capillaries increased, local circulation and oxygen supply improve. The most important objective indicator of the possibility of the radical surgery is the bacteriological control of the wound. We used the most common methods of determination of the quantitative content of bacteria in 1 gram of wound tissue by C. Baxter. We calculated microbial number 10 and below that was the main criterion for the conduct of radical surgery with minimal risk of suppurative postoperative complications. The investigations were conducted, usually on 1, 3, 5-th days after lancing of abscess and start of pre-operative preparation. The developed method makes it possible to restrict the spread of infection, and prevent the accession of a secondary infection due to the correction of local immunity and suppression of pathological microflora. The use of low-intensity transdrainage laser illumination may arrest inflammation within 3-5 days. This is confirmed by both clinical presentation and bacteriological studies.