ART OF MEDICINE 2017
ОPTIMIZATION OF CHOICE METHODS OF SURGICAL TREATMENT OF ACUTE APPENDICITIS
M. Vasylyuk, Y. I. Kozan,A. G. Shevchuk, V. M. Fedorchenko, I. R. Labyak, O.I. Falat
SHEE «Ivano-Frankivsk National Medical University»
Abstract. The treatment of 800 patients with acute appendicitis has been analyzed during the period 2011- 2016 who underwent appendectomy with standard methodology in 481 patients, and laparoscopic technology in 319 (39,1%) patients. Their number grew as more urgent surgeons has got the mastery of these technologies. So, in 2011, with 194 appendectomy performed only 10 were made laparoscopically, and in 2015 96 patients were indicated urgent laparoscopic appendectomy. The analysis of the main system and local factors that influenced the decision of surgery type in relation to transition to the laparotomy has been made. It was established that the main system factors of conversion is time from the beginning of the disease, the patient's age and the presence of concomitant cardiopulmonology pathology. Local factors are the prevalence of signs of inflammation in the abdomen, anatomical appendicular process and the nature of its inflammation. Morphology forms of appendicitis has not an important impact.
One of the major factors was the period from the onset of illness until admission to hospital. We found that in 32 patients with acute gangrenous and perforated appendicitis, gangrenous and in phlegmons of 21 (45.5%), that period made more than 48 hours. Patients over 60 years (72.8%) dominated. After abdominal imaging and inflammatory amended appendix in 77.8% of cases the cause of conversion was perforated appendicitis localized at the base of the dome cecum. In 55.6% of patients with comorbidity observed in stage of subcompensation, 7.7% - in the stage of decompensation, while 45.7% had a combination of several diseases that have an impact on the choice of anesthesia and postoperative period. One of the videoendoscopic features of perforated appendicitis was the presence of fibrin deposits in the bed of appendix and the loops of the small intestine in the right iliac region. This criterion is in half of the cases. In 51.8% of patients inflammatory changes in large omentum were the cause of conversion, which formed a loose or tight appendicular infiltrate, often make visualization process impossible for its mobilization and removal.
So, using laparoscopic techniques for appendicitis treatment it has been seen that this method reduces treatment time to 3-4 days, eliminates the number of postoperative complications of destructive appendicitis.
When choosing a method of appendectomy in the preoperative period one should take into account a number of system (time of illness onset, patient age, presence of concomitant cardiopulmonic disease) and local (inflammation spread signs in the abdomen, anatomical features of appendicular process and the nature of its inflammation) factors that cause tactics change during surgery.
Perspectives in terms of future research is to develop urgent experienced crews of laparoscopic surgeons and the development of methods of laparoscopic appendectomy, which would allow to mobilize and remove inflammatory process despite of appointed criteria.
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