The use of low-invasive surgical procedures in the treatment of gunshot wounds of the liver.

The problem of diagnostics and stage surgical treatment of a combat trauma of the abdomen with liver damage is actual in conditions of increasing specific gravity of liver damage, accompanied by its severe functional insufficiency. The aim of the study was to improve the results of surgical treatment of gunshot wounds of the liver using minimally invasive surgical techniques. The analysis of surgical treatment of 23 men aged 19 to 49 years with gunshot liver damage at II-IV levels of medical care was carried out. Shock of I st. was observed in 5 (21.7%), II st. - in 8 (34,8%), III st. - 9 wounded (39.2%), IV st. - 1 woun­ded (4.3%), admitted in an agonizing condition. At the second level of medical care, 12 wounded underwent lapa­roscopic operations (52.1%). 11 wounded underwewnt laparotomy (47.9%) with the use of mechanical, physical and chemical methods of bleeding stopping. In 17 wounded (73.9%), concomitant lesions of other organs of the abdominal cavity and retroperitoneal space (stomach, small and large intestine, kidneys, spleen) were observed. Correction of concomitant damages was carried out according to generally accepted methods. At the IV level of medical care, three wounded (12.9%) underwent puncture and drainage of intrahepatic abscesses using ultrasound navigation. Ultrasound examination allowed to determine the degree of liver damage, localization of a foreign body and safe access to its removal. In the structure of gunshot wounds of the abdomen, liver damage makes up 19.2% and the most often is observed in combined shrapnel wounds. In 30.4% of cases of gunshot liver damages, the condition of the wounded is regarded as severe and critical, which requires immediate surgical and resuscitative measures. The use of minimally invasive techniques (video laparoscopy, interventional sonography) in the surgical treatment of gunshot liver injuries can improve results and avoid unreasonable laparotomies

The features of surgical treatment of ventral hernias after gunshot wounds of the addomen.

The results of treatment of 21 patients with postoperative ventral hernias, formed as a result of surgical treatment for gunshot wounds of the abdomen were analyzed. All patients are men aged 21-48 years. 3 patients underwent laparoscopic allohernioplasty according to the IPOM method with Teflon allograft, 10 patients underwent allohernioplasty with a prolenic mesh graft by the sub lay method, 7 patients underwent alloplasty using the on lay method and 1 – autoplastywith local tissues. Suppuration of wounds was not noted. The average bed-day after laparoscopic hernioplasty was 9.5 days, after open operations - 16.2 days. The advantage of laparoscopic hernioplasty over open operations was noted

The use of low-invasive surgical procedures in the treatment of gunshot wounds of the liver.

The problem of diagnostics and stage surgical treatment of a combat trauma of the abdomen with liver damage is actual in conditions of increasing specific gravity of liver damage, accompanied by its severe functional insufficiency. The aim of the study was to improve the results of surgical treatment of gunshot wounds of the liver using minimally invasive surgical techniques. The analysis of surgical treatment of 23 men aged 19 to 49 years with gunshot liver damage at II-IV levels of medical care was carried out. Shock of I st. was observed in 5 (21.7%), II st. - in 8 (34,8%), III st. - 9 wounded (39.2%), IV st. - 1 woun­ded (4.3%), admitted in an agonizing condition. At the second level of medical care, 12 wounded underwent lapa­roscopic operations (52.1%). 11 wounded underwewnt laparotomy (47.9%) with the use of mechanical, physical and chemical methods of bleeding stopping. In 17 wounded (73.9%), concomitant lesions of other organs of the abdominal cavity and retroperitoneal space (stomach, small and large intestine, kidneys, spleen) were observed. Correction of concomitant damages was carried out according to generally accepted methods. At the IV level of medical care, three wounded (12.9%) underwent puncture and drainage of intrahepatic abscesses using ultrasound navigation. Ultrasound examination allowed to determine the degree of liver damage, localization of a foreign body and safe access to its removal. In the structure of gunshot wounds of the abdomen, liver damage makes up 19.2% and the most often is observed in combined shrapnel wounds. In 30.4% of cases of gunshot liver damages, the condition of the wounded is regarded as severe and critical, which requires immediate surgical and resuscitative measures. The use of minimally invasive techniques (video laparoscopy, interventional sonography) in the surgical treatment of gunshot liver injuries can improve results and avoid unreasonable laparotomies

Особливості хірургічного лікування вентральних гриж після вогнепальних поранень живота

Проведен анализ результатов лечения 21 пациента с послеоперационными вентральными грыжами, которые образовались вследствие оперативного лечения по поводу огнестрельных ранений живота. Все пациенты – мужчины в возрасте от 21 до 48 лет. 3-м пациентам была выполнена лапароскопическая аллогерниопластика по методике IPOM тефлоновым аллотрансплантантом, 10 пациентам выполнена аллогерниопластика проленовым сетчатым трансплантантом по методике sub lay, 7 пациентам выполнена аллопластика по методике on lay и 1 – аутопластика местными тканями. Нагноение ран не отмечалось. Средний койко-день после лапароскопических герниопластик составил 9,5 суток, после открытых операций – 16,2 суток. Отмечено преимущество лапароскопических герниопластик перед открытыми операциями.The results of treatment of 21 patients with postoperative ventral hernias, formed as a result of surgical treatment for gunshot wounds of the abdomen were analyzed. All patients are men aged 21-48 years. 3 patients underwent laparoscopic allohernioplasty according to the IPOM method with Teflon allograft, 10 patients underwent allohernioplasty with a prolenic mesh graft by the sub lay method, 7 patients underwent alloplasty using the on lay method and 1 – autoplasty with local tissues. Suppuration of wounds was not noted. The average bed-day after laparoscopic hernioplasty was 9.5 days, after open operations - 16.2 days. The advantage of laparoscopic hernioplasty over open operations was noted

The Features of Surgical Treatment of Ventral Hernias After Gunshot Wounds of the Addomen.

The results of treatment of 21 patients with postoperative ventral hernias, formed as a result of surgical treatment for gunshot wounds of the abdomen were analyzed. All patients are men aged 21-48 years. 3 patients underwent laparoscopic allohernioplasty according to the IPOM method with Teflon allograft, 10 patients underwent allohernioplasty with a prolenic mesh graft by the sub lay method, 7 patients underwent alloplasty using the on lay method and 1 – autoplastywith local tissues. Suppuration of wounds was not noted. The average bed-day after laparoscopic hernioplasty was 9.5 days, after open operations - 16.2 days. The advantage of laparoscopic hernioplasty over open operations was noted

Применение малоивазивных хирургических вмешательств в лечении огнестрельных ранений печени

Проблема диагностики и этапного хирургического лечения боевой травмы живота с повреждениями печени актуальна в условиях роста удельного веса повреждений печени, сопровождающихся ее тяжелой функциональной недостаточностью. Цель исследования улучшить результаты хирургического лечения огнестрельных ранений печени с использованием малоинвазивных хирургических методик. Проведен анализ хирургического лечения 23 мужчин в возрасте от 19 до 49 лет с огнестрельными повреждениями печени на II-IV уровнях медицинской помощи. Шок I ст. наблюдался у 5 (21,7%), II ст. у 8 (34,8%), III ст. у 9 раненых (39,2%), IV ст. у 1 раненого (4,3%), который был доставлен в агонирующем состоянии. На втором уровне медицинской помощи 12 раненым были выполнены лапароскопические операции (52,1%). 11 раненым проведена лапаротомия (47,9%) с применением механических, физических и химических методов остановки кровотечения. У 17 раненых (73,9%) наблюдались сопутствующие повреждения других органов брюшной полости и забрюшинного пространства (желудка, тонкой и толстой кишки, почек, селезенки). Коррекция сопутствующих повреждений проводилась по общепринятым методикам. На IV уровне медицинской помощи трем раненым (12,9%) выполнены пункция и дренирование внутрипеченочных абсцессов с использованием ультразвуковой навигации. Ультразвуковое исследование позволило определить степень повреждения печени, локализацию инородного тела и безопасный доступ для его удаления. В структуре огнестрельных ранений живота повреждения печени составляют 19,2% и чаще всего наблюдаются при сочетанных осколочных ранениях. В 30,4% случаев огнестрельных повреждений печени состояние раненых расценивается как тяжелое и крайне тяжелое, что требует проведения немедленных хирургических и реанимационных мероприятий. Применение малоинвазивных методик (видеолапароскопия, интервенционная сонография) в хирургическом лечении огнестрельных повреждений печени позволяет улучшить результаты и избежать необоснованных лапаротомий.The problem of diagnosis and staged surgical treatment of a combat trauma of the abdomen with liver damage is actual in conditions of increasing specific specific gravity of liver damage, accompanied by its severe functional insufficiency. The aim of the study was to improve the results of surgical treatment of gunshot wounds of the liver using minimally invasive surgical techniques. The analysis of surgical treatment of 23 men aged 19 to 49 years with gunshot liver damage at II-IV levels of medical care was carried out. Shock of I st. was observed in 5 (21.7%), II st. - in 8 (34,8%), III st. - 9 wounded (39.2%), IV st. - 1 wounded (4.3%), admitted in an agonizing condition. At the second level of medical care, 12 wounded underwent laparoscopic operations (52.1%). 11 wounded underwewnt laparotomy (47.9%) with the use of mechanical, physical and chemical methods of bleeding stopping. In 17 wounded (73.9%), concomitant lesions of other organs of the abdominal cavity and retroperitoneal space (stomach, small and large intestine, kidneys, spleen) were observed. Correction of concomitant damages was carried out according to generally accepted methods. At the IV level of medical care, three wounded (12.9%) underwent puncture and drainage of intrahepatic abscesses using ultrasound navigation. Ultrasound examination allowed to determine the degree of liver damage, localization of a foreign body and safe access to its removal. In the structure of gunshot wounds of the abdomen, liver damage makes up 19.2% and the most often is observed in combined shrapnel wounds. In 30.4% of cases of gunshot liver damages, the condition of the wounded is regarded as severe and critical, which requires immediate surgical and resuscitative measures. The use of minimally invasive techniques (video laparoscopy, interventional sonography) in the surgical treatment of gunshot liver injuries can improve results and avoid unreasonable laparotomies