The place of fast-track technologies in patients with strangulated abdominal hernias without hollow organ resection

IF 0.1 Q4 MEDICINE, GENERAL & INTERNAL
B. I. Slonetskyi, I. V. Verbytskyi, V. O. Kotsiubenko
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Abstract

The aim of the study is to substantiate the possibilities and analyze the results of fast-track technologies in patients with strangulated abdominal hernias without hollow organ resection. Materials and methods. The work was based on the result analysis of surgical treatment for 691 patients with strangulated abdominal hernias without resection of a hollow organ, who were divided into 2 groups depending on the specifics of diagnostic and therapeutic tactics, and into 2 subgroups depending on the localization of strangulated hernias. For patients of group 2, in contrast to group 1, the following diagnostic tactics: mandatory and justified laparoscopic intra-abdominal assessment of the strangulated organ condition; mandatory physicochemical intraoperative assessment of the hernial fluid condition; mandatory intraoperative instrumental assessment of the strangulated organ condition; as well as the therapeutic tactics: mandatory use of a comprehensive fast-track program; expansion of indications for laparoscopic surgery were used. The clinical and diagnostic algorithms included laboratory, instrumental and biochemical methods of examination. Results. It has been found that the proposed diagnostic and therapeutic tactics in group 2 patients with strangulated abdominal hernias without hollow organ resection, in contrast to group 1 patients, allowed to increase the number of laparoscopic operations by 51.15 % as well as the number of surgical interventions using fast-track technology by 51.21 %. This was accompanied by a decrease in complications according to the Clavien-Dindo scale from 83 (24.56 %) in group 1 patients to 39 (11.05 %) in group 2 patients. In addition, in group 2 patients, in contrast to group 1, a decrease in the acute pain severity in the early postoperative period and chronic pain according to the sf-IPQ in the late postoperative period has been revealed. Conclusions. The indication expansion for fast-track technologies in group 2 patients with strangulated abdominal hernias without hollow organ resection has allowed using these procedures in 238 (67.23 %) cases, while there were only 54 (16.02 %) such cases in group 1 patients. The proposed diagnostic and therapeutic tactics in group 2 patients with strangulated abdominal hernias without hollow organ resection, in contrast to group 1 patients, have enabled an increase in the number of laparoscopic operations from 16.27 % in group 1 patients to 67.42 % in group 2, which was accompanied by a decrease in postoperative complications according to the Clavien-Dindo scale from 24.56 % to 11.05 %.
快速通道技术在非空心器官切除绞窄性腹疝患者中的地位
本研究的目的是证实快速通道技术在没有空心器官切除的绞窄性腹疝患者中的可能性和分析结果。材料和方法。本研究基于691例不切除空心脏器的绞窄性腹疝的手术治疗结果分析,根据绞窄性疝的具体诊断和治疗策略分为2组,根据绞窄性疝的定位分为2个亚组。对于组2患者,与组1相比,以下诊断策略:强制性和合理的腹腔镜腹腔内评估绞窄器官状况;术中疝液状况的强制性理化评估;强制术中仪器评估绞窄器官状况;以及治疗策略:强制使用一个全面的快速通道程序;扩大适应证用于腹腔镜手术。临床和诊断方法包括实验室、仪器和生化检查方法。研究发现,在不切除空心器官的绞窄性腹疝2组患者中,与1组患者相比,所提出的诊断和治疗策略可使腹腔镜手术次数增加51.15%,使用快速通道技术的手术干预次数增加51.21%。根据Clavien-Dindo量表,这伴随着并发症的减少,从1组患者的83例(24.56%)减少到2组患者的39例(11.05%)。此外,根据sf-IPQ, 2组患者术后早期急性疼痛程度和术后后期慢性疼痛程度均较1组患者有所降低。快速通道技术在没有空心器官切除的2组绞窄性腹疝患者中的适应症扩大,238例(67.23%)患者允许使用这些手术,而在1组患者中只有54例(16.02%)患者允许使用这些手术。与第1组患者相比,第2组未切除空心器官的绞窄性腹疝患者所提出的诊断和治疗策略使腹腔镜手术的数量从第1组的16.27%增加到第2组的67.42%,同时根据Clavien-Dindo评分,术后并发症从24.56%减少到11.05%。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Zaporozhye Medical Journal
Zaporozhye Medical Journal MEDICINE, GENERAL & INTERNAL-
自引率
0.00%
发文量
72
审稿时长
8 weeks
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