RESUMEN
Results of 3009 elected herniotomies in adults (1761) and children (1248) for inguinal, postoperative ventral and umbilical hernias were analyzed. Out of 734 (57%) adults operated for inguinal hernia recurrences were seen in 28 (3.95%) cases: after Girare-Spasokukotsky-Kimbarovsky plastic operation--in 12 (2.5%), Martynov plistic operation--6 (9.5%), Bassini plistic operation--2 (1.5%), other methods--5. Recurrences were also revealed in 18 children. Experience of treatment of 224 patients with uncomplicated postoperative ventral hernias was also analyzed, 105 of them underwent autodermal Yanov's plistic operation. Small hernias were in 75 patients, middle--size in 56, large--in 66, giant--in 27. Of 224 patients 138 (61.6%) were followed-up, recurrences were revealed in 10 patients, in 9 (6.5%) of them--after autodermal plistic operation. It is demonstrated that plistic operation on posterior wall of inguinal canal is preferable. Plistic operation of anterior wall is justified in small oblique inguinal hernias. Recently, four-layer plistic operation on posterior wall of inguinal canal by Schouldice was introduced in the Hospital. The best results of postoperative hernias treatment were achieved in muscular-aponeurotic plastic repair with local tissues. When it is impossible other methods must be applied. Of present methods, autodermal Yanov's plastic operation is the most favorable with good long-term results.
Asunto(s)
Hernia Ventral/cirugía , Adulto , Niño , Humanos , Persona de Mediana Edad , Recurrencia , Procedimientos Quirúrgicos Operativos/métodosRESUMEN
In operations for bleeding ulcers a situation often occurs in which the surgeon has to restrict the operation to a small intervention. The danger of a recurrent hemorrhage is the main shortcoming of the existing palliative operations. Excision of the ulcer and subsequent closure of the defect is the only measure after which the bleeding will not recur. However, in penetrating ulcers of the posterior wall or its adjacent areas, this operation cannot be carried out practically. At the same time, it is just these ulcer that are the most common sources of bleeding. The author suggests the following method for such cases: without performing anterior gastroduodenotomy, the upper and lateral borders of the ulcer are excised, the bleeding vessel is ligated, and the separated duodenal wall is sutured to the inferior border of the ulcer and peritotration is conducted. The suggested method makes it possible to exclude the ulcer from the gastrointestinal lumen, which ensures reliable hemostasis. Good results were produced in 3 cases in which the method was applied. A description of the method had not been encountered in the available literature.
Asunto(s)
Úlcera Duodenal/complicaciones , Úlcera Péptica Hemorrágica/cirugía , Anciano , Úlcera Duodenal/cirugía , Femenino , Estudios de Seguimiento , Humanos , Factores de TiempoRESUMEN
The work is based on the analysis of surgical treatment of 2,985 patients with hydatid diseases of the organs of the abdominal cavity and retroperitoneal space. The character of the operative intervention is determined by the period of hydatid vital activity, its size, and the features of its localization within the organ. The authors identified the following periods of hydatid vital activity: living parasite, dead parasite; complicated echinococcosis. Organ preserving operations are indicated in subcortical localization of the hydatid in the liver, in one of the poles of the spleen and in the kidney when the fibrous capsule is well preserved. Splenectomy or nephrectomy must be carried out in large and giant hydatids of the spleen and kidney localized in the organ or in its hilus and in irreversible changes in the organ. Open echinococcectomy is indicated in suppuration of large hydatids in the subdiaphragmatic space in occasional cases.