• Surgical treatment of the commissural intestinal obstruction in adolescents with using the jet hydro scalpel

Surgical treatment of the commissural intestinal obstruction in adolescents with using the jet hydro scalpel

PAEDIATRIC SURGERY.2016.3-4(52-53):51-57; doi 10.15574/PS.2016.52-53.51

Surgical treatment of the commissural intestinal obstruction in adolescents with using the jet hydro scalpel

Skiba V. V., Rybalchenko V. F., Ivanko O. V., Demidenko Yu. G., Badakh V. M., Bocharov V. P. 
Bogomolets National Medical University, Kyiv, Ukraine 
Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine 
National Aviation University, Kiev, Ukraine 
Kyiv Medical University of the UANM, Ukraine 
Kyiv City Clinical Hospital №1, Ukraine

The aim is to improve the outcome of surgical treatment of intestinal obstruction due to adhesions in adolescents using the jet hydro scalpel the separation process.

Material and methods. In the surgical department of the Kyiv city clinical hospital №1 from 2009 to 2016 was located in the treatment of 16 adolescents aged 17–18 years. Patients were 9 males (56.25%), female 7 (43.75%). At the hospital conducted a general clinical examination of blood and urine tests, X-ray and ultrasound of the abdomen.

Research results. The causes of adhesions were: a history of appendectomy of which 9 males (56.25%), female 5 (31.25%) and тwo female (12.5%) teenagers reasons first operations were gynecological diseases. The term hospitalization: a cont first day hospitalized 11 (68.75%), the second time of 3 (18.75%) for the third time of 2 (12.5%) patients. In general hospitalization status was classified as severe in 12 (75.0%) patients, and extremely heavy in 4 (25.0%) with signs of organ failure – oliguria. Analysis of the clinical picture showed that vomiting syndrome were all 16 (100.0%) patients, of which 11 (68.75%), vomiting bore the unbearable nature of Ikot. Abdominal of pain were 12 (75.0%) patients, of whom 8 (50.0%), cramping, and in 4 (25.0%) permanent. Of pain was absent in 4 (25.0%) patients, but had a feeling of guilt tyahotinnya in the epigastric region. The asymmetry of the anterior abdominal wall installed in 14 (87.5%) patients, of which the asymmetry of the left and right in 8 (50.0%), and upper and lower in 6 (37.5%). Instead, two patients 12.5% abdominal cavity was vzdutoyu but was pronounced abdominal cramping nature of pain. X-ray study indicated that the level of fluid in all patients. According to the US in 14 (87.5%) is set absent peristalsis in all parts of the intestine and in 2 (12.5%) in the pendulous movements pidreberri left. Set free fluid in the pelvic cavity in 13 (81.25%) patients and in 3 (18.75%) on the right flank. Studies have shown that 25% of patients were missing one of the four main features of intestinal obstruction, indicating atypical clinical symptoms, course of illness. After preoperative preparation, all patients were operated. Adhesions, the following: multiple ploskosni in all 16 patients, of which against the backdrop ploskosnyh shnurovydni occurred in 8 (50.0%) and total coverage of pantserne twist set in 4 (25.0) patients. Use the purpose of separation of adhesions jet hydro scalpel prevented significant part drawbacks of standard separation of adhesions. Complications of adhesions separation was not. Thus the method of surgical treatment using to separate adhesions jet hydro scalpel has not schadlyvu traumatic effect on blood vessels and the intestinal wall the separation of adhesions, which further serves more adequate restoration of peristalsis and separated in the early period after surgery. During the operation, after the separation of adhesions jet hydro scalpel two patients with strangulation reason was the need for segmental resection of the small intestine in the amount of 25cm. imposed anastomosis end-to-end in-line seam.

Conclusions. Using the method of management jet hydro scalpel adhesions in the surgical treatment of adhesions in the abdominal cavity and allows precise adhesive obstruction offices of the structures of adhesions and parenchymal organs. This can not minimize blood loss, prevent damage to anatomical structures and reduce the operation.

Key words: intestinal obstruction, diagnosis, treatment, hydro jet scalpe.

References

1. Averin VI, Grin AI, Sevkovskiy AI. 2015. Lechenie appendikulyarnogo peritonita u detey na sovremennom etape. Hirurgiya Vostochnaya Evropa. 3: 82–86.

2. Bagmet NN. 2003. Metod vodostruynoy dissektsii pri vyipolnenii rezektsii pecheni. Avtoreferat dis … kand med nauk: 14.00.27 hirurgiya. Moskva: 16.

3. Hrona VM, Teisheira Zh, Hrona KV. 2009. Etiopatohenetychni mekhanizmy rozvytku pervynnoho omentytu v ditei. Zdorove rebenka. 2: 73–74.

4. Anischenko VV, Ganichev DA, Bass AA, Vasilev SL. 2013. Ispolzovanie vodostruynoy dissektsii v kompleksnom lechenii oslozhnennyih form diabeticheskoy stopyi. Byulleten RAMN. 33; 3: 63–66.

5. Melnychenko MH, Antoniuk VV, Kvashnina AA. 2015. Spaikova kyshkova neprokhidnist u ditei. KhKhIII z’izd khirurhiv Ukrainy, 21–23 zhovt. 2015 r. Zb nauk pr. Kyiv, Klinichna khirurhiia: 447–448.

6. Rybalchenko VF, Rusak PS. 2014. Hostryi omentyt u ditei: klasyfikatsiia ta vybir khirurhichnoi taktyky. Shpytalna khirurhiia. 1: 88.

7. Rybalchenko VF, Rusak PS, Domanskyi OB. 2014. Do pytannia pro drenuvannia cherevnoi porozhnyny pry apendykuliarnomu perytoniti u ditei. Shpytalna khirurhiia. 1: 108.

8. Pereiaslov AA, Borova LIe, Bobak AI et al. 2013. Ultrasonohrafiia v diahnostytsi hostroho apendytsytu v ditei. Khirurhiia dytiachoho viku. 3: 59–63.

9. Sushko VI, Krivchenya DYu, Degtyar VA et al. 2014. Hirurgiya detskogo vozrasta. Uchebnik. Pod red VI Sushko, DYu Krivcheni. Kiev, Meditsina: 568.

10. Rau HG, Zimmermann A, Wardemann C, Schildberg FW. 2003. Dissecting with the high-pressure water-jet. Standards of Surgical Techniques in Liver Metastases. Chirurgische Gastroenterologie. 19: 333–339.

11. Piek J, Oertel J, Gaab MR. 2002. Water-jet dissection in neurosurgical procedures: clinical results in 35 patients. Journal of Neurosurgery. 96: 690–696. https://doi.org/10.3171/jns.2002.96.4.0690; PMid:11990809

12. Kockerling F, Yildirim C et al. 2004. Total mesorectal excision with the water-jet dissection. Technique and results. Techniques in Coloproctology, Springer Milan. 8; Suppl 1: 217–225.