Pooperační infekční a nekrotizující zánět fascie ve stěně břišní patri v břišní chirurgii k závažným pooperačním komplikacím v ráně. Autoři uvádějí rozbor vlastních zkušeností s léčbou tohoto zánětu, poukazují zejména na n možnost urychlení léčby aktivním pristupem pri kombinaci chirurgického débridementu a vhodného moderního lokálního terapeutika, která zlepšuje celkové výsledky léčby - zkrácení intervalu od drenáže hnisu k sekundární suture rány, zlepšení kosmetického vzhledu výsledné jizvy a možnost včasného zahájení adjuvantní chemo/radioterapie u onkologických pacientů.
Postoperative infectious and necrotizing abdominal wall fasciitis is a serious wound complication. Authors present own analysis of their experience with the treatment of this disease. They refer a possibility to accelerate he healing with active approach using the combination of surgical debridement with a suitable local therapeutic witch results in better healing shortening the interval between the drainage of the pus and the secondary wound suture , bettering the cosmetic look of the scar and the earlier start of postoperative chemo/radiotherapy.
Autoři hodnotí své priznivé zkušeností s použitím nového resorbovatelného loop stehu k uzávěru laparotomie v jedné vrstvě. Procento dehiscencí operačních ran bylo nižší ve skupině pacientů, u nichž byl použit steh Safil Loop, než u skupiny kontrolní, zvýšila se rychlost provedení sutury i bezpečnost uzávěru laparotomie.
The authors evaluate their favourable experience with the use of a new absorbable loop suture for one-layer closure laparotomy. The percentage of dehiscences of surgical wounds was lower in the group of patients where closure laparotomy. The percentage of dehiscences of surgical wounds was lower in the group of patients where the safety of closure of laparotomy was more favourable.
- MeSH
- Laparotomy MeSH
- Humans MeSH
- Suture Techniques MeSH
- Sutures MeSH
- Check Tag
- Humans MeSH
- MeSH
- Surgical Wound Dehiscence surgery MeSH
- Laparotomy methods MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
Náhlé příhody břišní (dále NPB) představují tradiční náplň práce na chirurgických odděleních. Problematika NPB je proto chirurgům velmi dobře známa včetně všech úskalí. Jedním z nich je stále relativně vysoká morbidita a mortalita ošetřených pacientů. Autoři ve své práci sledují mortalitu NPB a výskyt závažných chirurgických komplikací vyžadujících reoperaci a její vliv na prognózu pacientů. V předloženém souboru je zahrnuto 1861 akutně operovaných pacientů v letech 2001–2004. Relaparotomováno bylo 36 pacientů, tj. 1,9 %. Nejčastější indikací k relaparotomii byla peritonitida v některé její podobě (50 %), dehiscence laparotomie (31,2 %), střevní nekróza, ileus, krvácení a další méně časté komplikace. Třicetidenní mortalita pacientů operovaných pro NPB byla 4,8 %. Mortalita ve skupině reoperovaných 19,4 %.
Urgent abdominal disorders are a daily work routine at surgical departments. Therefore, all surgeons are familiar with the problematics, including all its pitfalls, e.g. high morbidity rates and mortality rates of the patients managed. The authors record urgent abdominal disorders mortality rates as well as rates of serious surgical complications requiring re-operations and their effect on the patients‘ prognosis. The trial group includes 1861 patients urgently operated during 2001–2004. 36 patients (1.9%) underwent re-laparotomies. Peritonitis in some form (50%), dehiscence of the laparotomy (31.2%), necrosis of the intestine, ileus, bleeding and some less frequent complications, were the most frequent indications for re-laparotomies. The thirty-day mortality rate in patients, operated for urgent abdominal disorders, was 4.8%. In the re-operated group, the mortality rate reached 19.4%.
- MeSH
- Abdomen, Acute surgery complications MeSH
- Surgical Wound Dehiscence surgery MeSH
- Ileus surgery MeSH
- Laparotomy MeSH
- Humans MeSH
- Multiple Organ Failure MeSH
- Peritonitis surgery MeSH
- Postoperative Complications surgery classification MeSH
- Reoperation mortality statistics & numerical data MeSH
- Retrospective Studies MeSH
- Check Tag
- Humans MeSH
Kazuistika pacienta s ICHS, půl roku po prvním revaskularizačním výkonu, který byl pro uzávěr žílních Štěpů a návrat anginózních potíží úspěšně reoperován z horní střední laoarotomie. Z tohoto operačního postupu byla provedena anastomóza pravé gastroepiploické arterie na ramus interventricularis posterior (dále RIVP) pravé věnčité tepny. Půl roku po operaci je pacient bez anginózních obtíží, žijící plnohodnotný život. Kontrolní koronarografie ukazuje volnou průchodnost štěpu.
Case-history of a patient with IHD, six months after the first revascularization operation, performed on account of occluded venous grafts and relapse of anginous complaints, successfully reoperated from upper median laparotomy. From this surgical approach an anastomosis of the right gastroepiploic artery on the ramus interventricularis posterior (RIVP) of the right coronary artery was made. Six months after operation the patient is free from anginous complaints and lives a fuU life. Control coronarography indicates patency of the graft.
- MeSH
- Arteries transplantation MeSH
- Adult MeSH
- Coronary Disease surgery MeSH
- Laparotomy MeSH
- Middle Aged MeSH
- Humans MeSH
- Reoperation MeSH
- Myocardial Revascularization methods MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
Autori zdôrazňujú výhody priečnej incízie, ktoré sú nesporné, pretože chirurgovi poskytujú nielen vynikajúci prehľad operovanej oblasti obojstranne, ale čo je najdôležitejšie, signifikantně najmenej negatívne ovplj^ňuje respiračné funkcie a zloženie krvných plynov, čo má význam u pacientov s chronickou respiračnou insuficienciou. Vzhľadom na nepoměrné menšie retrakčné sily je i výskyt pooperačných dehiscencií a hernií menší. Ide o rez, ktorý najmenej porušuje inerváciu brušnej steny, čím je nielen menej bolestivý, ale má i lepšie parametre hojenia. Jeho uzatvorenie pokračujúcim rezorbovateľným slučkovým dvojitým stehom je nielen jednoduché, ale čo je najdôležitejšie, je spoľahlivé s minimálnym počtom pooperačných komplikácií.
The authors emphasize the advantages of a transverse incision which are beyond doubt, because they provide the surgeon not only with an excellent bilateral view of the operated area, but what is most important, they have the significantly least negative effect on respiratory functions and the composition of blood gases, which is of major importance in patients with chronic respiratory failure. Due to the much smaller retraction forces the incidence of postoperative dehiscences and hernias is smaller. It is an incision which interferes least with the innervation of the abdominal wall and thus is not only less painful but has also better healing parameters. Its closure by a continuous, absorbable, loop-on mucosa double suture is not only simple, but what is most important. it is reliable and associated with a minimum of postoperative complications.
- MeSH
- Laparotomy methods MeSH
- Humans MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
PURPOSE OF THE STUDY Damage control surgery is one of the major advances in surgical techniques used in polytrauma patients in the past 25 years. It is based on a foreshortened pre-operative examination during ongoing resuscitation which includes surgical intervention in an injured patient with severe hypotension due to haemorrhage. In this seven-year retrospective study the authors evaluate the results of damage control laparotomy in patients with injury to the abdominal organs, retroperitoneum and pelvis. MATERIAL AND METHODS The evaluated group included 21 patients with blunt abdominal trauma who underwent damage control laparotomy in the 2001-2007 period. There were 17 men and four women; the age range was 17 to 69 years, with an average of 36 years. Damage control laparotomy was indicated in the patients with blunt abdominal trauma, or with closed or open pelvic fracture, who developed a progressive haemorrhagic shock. RESULTS Between 2001 and 2007, a total of 21 922 patients were admitted to the Trauma Centre and 12 392 operations were performed. However, only in 21 of them (0.1 %) damage control laparotomy was indicated. The procedure was most frequently performed for liver injury (16 patients), which was associated with multiple injury to the other abdominal organs and retroperitoneum in five patients. Further three patients were operated on for haemoperitoneum at continual bleeding due to type C fracture of the pelvis. In the remaining two patients the damage control procedure was chosen to stop persistent bleeding following splenectomy and nephrectomy for traumatic rupture. In these 21 patients blunt trauma was part of polytrauma (ISS > 15). Repeat surgery was carried out within 48 to 96 hours (average, 58 h). Four patients (19 %) died; two due to progressive traumatic haemorrhagic shock and two because of brain oedema after concussion. DISCUSSION Damage control surgery has become a fundamental component of surgical strategy for severe trauma and has been accepted by surgeons although it cannot be evaluated in randomized clinical studies. Survival after damage control laparotomy in serious intra-abdominal injuries involved in polytrauma is reported in relation to the scoring system values (ISS, GCS), but depends, first of all, on blood loss, degree of acidosis and severity of associated injuries, with craniocerebral trauma in the first place. CONCLUSIONS Damage control laparotomy is an effective procedure in the treatment of severe trauma to the abdominal organs and retroperitoneum in critically injured patients. This time-limited, staged surgical intervention is included in resuscitation of patients with hypothermia, metabolic acidosis and coagulopathy. The outcome of damage control surgery is related to not only the severity of injury, but also experience with comprehensive acute care in trauma centres.
- MeSH
- Adult MeSH
- Laparotomy MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Abdominal Injuries diagnosis surgery MeSH
- Aged MeSH
- Wounds, Nonpenetrating diagnosis surgery MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
