Standard open operative interventions in surgical treatment of patients, suffering an acute complicated pancreatitis
Objective. To determine the character and optimal volume of standard open surgical interventions in an acute complicated pancreatitis (ACP) with elaboration of the main technical elements of the operations.
Маterials and methods. There were operated 96 patients, suffering ACP. The main group consisted of 47 patients, in whom open interventions were performed primarily in 19, and as the second-stage procedure after application of miniinvasive interventional technologies (МIТ) – in 28. The comparison group consisted of 49 patients, in whom standard operations were done only.
Results. Application of MIТ have promoted the indications narrowing for performance of primary open operations more than twice. In the main group the arcuate-like subcostal access was applied predominantly - in 26 (55%) observations (χ²=14.287; р=002), while in a control one – a median upper laparotomy – in 37 (76%) observations (χ²=38.43, р < 0.001). The method of closed draining in accordance to procedure of Beger was used predominantly in the main group of patients – in 43% of observations, comparing with a control group - 9% of observations (χ²=12.965; р=0.003). In 23% patients of the main group and in 26% patients of a control one (χ²=0.0013; р=0.05), when the extended purulent-necrotic inflammation process have presented, a staged sanation was applied, using programmed relaparotomies. Some technical elements of the surgical intervention were improved.
Conclusion. Application of standard open operations in accordance to elaborated principle is accompanied by improvement of the treatment results in patients, suffering ACP.
2. Andriushchenko DV, Maglevanyi VA, Andriushchenko VP. Ostryi pankreatit: prioritetnye sostavliaiushchie kompleksnogo khirurgicheskogo lecheniia s pozitcii sovremennykh nauchnykh issledovanii. Mezhdunarodnyi nauchno-prakticheskii zhurnal KhirurgiiaVostochnaia Evropa. 2013;2:120-6. [In Russian].
3. Dronov AI, Kovalskaia IA, Uvarov VIu. Osobennosti patogeneticheskogo pokhoda k lecheniiu ostrogo nekroticheskogo pankreatita. Ukraїnskii zhurnal khіrurgії. 2013;3:145–9 [In Russian].
4. Fomin PD, Bereznytskyi YaS, Andriushchenko VP, Boiko VV, Velihotskyi MM, Dronov OI, et al. Udoskonaleni alhorytmy diahnostyky ta likuvannia hostroho pankreatytu: metodychni rekomendatsii. Kyiv; 2012. 80 p. [In Ukrainian].
5. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013 Jul-Aug;13(4 Suppl 2):e1-15. doi: 10.1016/j.pan.2013.07.063.
6. Babu BI, Sheen AJ, Lee SH, O'Shea S, Eddleston JM, Siriwardena AK. Open pancreatic necrosectomy in the multidisciplinary management of postinflammatory necrosis. Ann Surg. 2010;251:783-6. doi: 10.1097/SLA.0b013e3182172a48.
7. Andriushchenko DV. Osoblyvosti terminolohii ta klasyfikatsii hostroho pankreatytu. Klinichna khirurhiia. 2014;(11): 35-7. [In Ukrainian].
8. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013 Jan;62:102–11. doi: 10.1136/gutjnl-2012-302779. Epub 2012 Oct 25.
9. Aitken EL, GoughV, Jone A. Observation study of intra-abdominal pressure monitoring in acute pancreatitis. Surgery. 2014 May;155(5):910-8. doi: 10.1016/j.surg.2013.12.028. Epub 2013 Dec 28.
10. Windsor JA. Infected pancreatic necrosis: drain first, but do it better. HPB (Oxford). 2011;13:367–8. doi: https://doi.org/10.1111/j.1477-2574.2011.00313.x.
11. Türkvatan A, Erden A, Seçil M, Türkoğlu MA. Fluid collections associated with acute pancreatitis: a pictorial essay. Can Assoc Radiol J. 2014 Aug;65(3):260-6. doi: 10.1016/j.carj.2013.08.003. Epub 2014 Mar 17.
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