RESUMEN
OBJECTIVE: To analyze learning curves and appropriate experience on the features of mini-bypass surgery in 341 obese patients. MATERIAL AND METHODS: A total of 341 laparoscopic mini-gastric bypass surgeries performed by one surgeon were studied. The median age of patients was 40.5 [34; 48.3] years. There were 284 (83.2%) women and 57 (16.8%) men. The median BMI was 45 [40;52] kg/m2. RESULTS: The period of MGB development consisted of 138 interventions. Surgery time was 120 [100; 130] min and 90 [82.5; 100] mins after development of this technique (p=0.001). Complications occurred in 5 (1.5%) patients (1 patient with Clavien Dindo grade IIIA and 4 ones with grade IIIB). Of these, there were 3 patients with stapler suture defects. There were no complications only in the 4th quartile of surgeries. Surgical experience significantly affects postoperative outcomes. Surgery time was more influenced by surgical skill rather technique of anastomosis imposing. CONCLUSION: Polynomial regression objectively characterizes development of surgical skills lasting 138 interventions. MGB is safe for morbid obesity with a complication rate of 1.5% and no mortality.
Asunto(s)
Derivación Gástrica , Laparoscopía , Curva de Aprendizaje , Obesidad Mórbida , Tempo Operativo , Complicaciones Posoperatorias , Humanos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Derivación Gástrica/métodos , Derivación Gástrica/efectos adversos , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Laparoscopía/métodos , Laparoscopía/efectos adversos , Competencia Clínica , Índice de Masa Corporal , Federación de Rusia/epidemiología , Resultado del TratamientoRESUMEN
Now current of a stomach ulcer differs special aggression. Treatment of patients with complicated current gastroduodenal ulcer remains the big problem. The method argon plasma coagulations (APC) now finds primary application for a stop extensive [Russian characters: see text] bleedings. At the same time, the important factor of favorable current of the complicated stomach ulcer is the continuity in treatment of patients and carrying out of adequate therapy from the moment of receipt in a surgical hospital and its continuation at an outpatient stage.
Asunto(s)
Atención Ambulatoria/métodos , Úlcera Duodenal/rehabilitación , Hemostasis Endoscópica/métodos , Coagulación con Láser , Úlcera Péptica Hemorrágica/rehabilitación , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Evaluación de la Discapacidad , Úlcera Duodenal/complicaciones , Úlcera Duodenal/epidemiología , Úlcera Duodenal/microbiología , Úlcera Duodenal/cirugía , Femenino , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/tratamiento farmacológico , Infecciones por Helicobacter/epidemiología , Infecciones por Helicobacter/microbiología , Helicobacter pylori/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Úlcera Péptica Hemorrágica/epidemiología , Úlcera Péptica Hemorrágica/etiología , Úlcera Péptica Hemorrágica/microbiología , Úlcera Péptica Hemorrágica/cirugía , Resultado del TratamientoRESUMEN
Thirty patients with colon disease in need of urgent surgery have undergone resection of the colon with formation of terminal afferent colostomy and compressive colon-colon anastomosis using oval and linear nikelid-titanium implants. Complications were seen in 6 (20%) patients, lethality was 6,7% due to multiorgan failure in the presence of generalized peritonitis. There were no complications due to colon-colon anastomosis. The above method permits one to reduce surgical trauma of future reconstructive surgeries.
Asunto(s)
Colectomía , Colon/cirugía , Enfermedades del Colon/cirugía , Colostomía/métodos , Urgencias Médicas , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica/instrumentación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
The clinico-statistical investigation performed has revealed that the compressive suture of the transverse termino-lateral gastrojejunal anastomosis in gastric Billroth-II resection formed with the help of a titanium nickelide device considerably lowers traumatism of the operation and bacterial contamination of the operation area, abdominal cavity and the abdominal wall wound which leads to pronounced (3-4 times) drop of the level of early postoperative complications and minimizes the postoperative lethality.