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dc.contributor.authorКолосович, І. В.-
dc.contributor.authorГаноль, І. В.-
dc.identifier.issnDOI 10.36074/logos-28.04.2023.74-
dc.description.sponsorshipAcute pancreatitis is a widespread disease of the abdominal organs with a high risk of complications and a mortality rate of 15-55% [1]. Among the causes of death of patients with severe acute pancreatitis, purulent-septic complications, which occur in 20-40% of cases of the disease, take the first place [2]. Currently, the problem of drainage of fluid collections in the abdominal cavity and retroperitoneal space in patients with a complicated course of acute pancreatitis is solved by performing traditional surgical interventions or using methods using devices with which, under ultrasound or radiological control, it is possible to perform a puncture, establish drainage, evacuate content, and thus achieve the elimination of the pathological formation. However, the use of these devices is not always effective. In particular, some devices are designed for puncture drainage of formations with liquid and finely dispersed content, which is related to their design characteristics (insignificant diameter). The use of other, larger diameter devices to ensure the necessary drainage capacity in the presence of sequestrations in the cavity of formations is accompanied by significant tissue resistance in the path of the puncture channel and is associated with a high risk of iatrogenic damage as a result of possible uncontrolled advancement of the working part of the device. Therefore, in order to obtain better results, it is necessary to combine in one device the qualities necessary for its safe, smooth passage through tissues and the possibility of installing drains of the required diameter with sufficient evacuation properties. This is a well-known method of draining fluid collections in the complicated course of acute pancreatitis, in which drainage is performed with a trocar, which consists of a sleeve placed in the sleeve of a stylet with a through central channel and a conical working section, a needle with a sharp end located in the through channel of the stylet and a mandrel placed in the channel of the needle [3]. The essence of the method is that after determining the acoustic window and the optimal trajectory, the surgical field is treated, the skin is dissected 2 cm long under local anesthesia, and the fluid collections is punctuated with the working end of the needle under ultrasonographic control. After controlling the position of the needle with the help of translational and rotational movements, along the needle, the stylet with the sleeve is carried into the fluid collections cavity. Next, the needle with the mandrel and the stylet are removed, drainage is introduced through the sleeve, the sleeve is removed and the drainage tube is fixed to the skin and the extension tube is connected. The disadvantage of this method is the high risk (from 8% to 35%) of iatrogenic damage when using trocars of a large diameter during the puncture of slitlike, deeply located fluid collections. This is due to the need to apply significant compression to overcome tissue resistance when inserting a stylet-catheter, which can lead to the collapse of the cavity, changes in the syntopy of the surrounding mobile anatomical structures, and thus complicates their high-quality visualization [4]. The proposed model was based on the task of developing a method of draining fluid collections in complicated acute pancreatitis using a device that combines the qualities necessary for a technically simple, safe installation of drainage with sufficient evacuation properties. The technical result will consist in the elimination of fluid collections by means of a controlled puncture, the establishment of drainage, the evacuation of the contents of the cavity, without the use of significant compression in the process of carrying the device, with a clear visualization of the surrounding anatomical structures and fluid formation, without the risk of its contents leaking along the puncture channel and with the possibility of repeated using the device after appropriate sterilization measures. The task was solved by modifying the distal part of the sleeve and the conical working part of the stylet, namely by applying an external screw thread. The specified changes make it possible to smoothly and atraumatically pass the tissues, step by step, within the framework of one procedure, to increase the diameter of the puncture channel with a significant reduction in the effort to insert the instrument, and to safely install drainage with sufficient evacuation properties. For the period from 2016 to 2023 in the clinic of the Department of Surgery №2 Bogomolets National Medical University were treated 24 patients who underwent puncture drainage of fluid collections using the proposed device, without applying significant compression in the process of conducting the device, with clear visualization of the surrounding anatomical structures and fluid formation, without leakage of its contents along the puncture channel and the need for numerous reciprocating movements. No complications were observed in the patients, while obliteration of the cavities was noted, which was confirmed by instrumental examination methods. Conclusion. The proposed model makes it possible to reduce the frequency of postoperative complications and improve the results of surgical treatment of patients with acute pancreatitis with a complicated course. References: [1] Baron, T. H., DiMaio, C. J., Wang, A. Y., & Morgan, K. A. (2020). American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis. Gastroenterology, 158(1), 67–75.e1. https://doi.org/10.1053/j.gastro.2019.07.064 [2] Kolosovych, I. V., Bezrodnyi, B. H., Hanol, I. V., & Cherepenko, I. V. (2020). Stage approach in surgical treatment of acute pancreatitis. Medicni Perspektivi, 25(2), 124–129. https://doi.org/10.26641/2307- 0404.2020.2.206384 [3] Hollemans, R. A., van Brunschot, S., Bakker, O. J., Bollen, T. L., Timmer, R., Besselink, M. G., van Santvoort, H. C., & Dutch Pancreatitis Study Group (2014). Minimally invasive intervention for infected necrosis in acute pancreatitis. Expert review of medical devices, 11(6), 637–648. https://doi.org/10.1586/17434440.2014.947271 [4] Nguyen, A. K., Song, A. J., Swopes, T., Ko, A., & Lim, B. S. (2019). Percutaneous Endoscopic Necrosectomy of Complex Walled-Off Lateral Necrosis of the Pancreas with the Aid of Laparoscopic Babcock Forceps: A Case Report of an Endoscopic and Radiologic Team Approach. The Permanente journal, 23, 18-230. https://doi.org/10.7812/TPP/18-230uk_UA
dc.publisherTheoretical and practical aspects of modern scientific research: Collection of scientific papers «ΛΌГOΣ» with Proceedings of the II International Scientific and Practical Conference, Seoul, April 28, 2023. Seoul-Vinnytsia: Case Co., Ltd. & European Scientific Platform, 2023.uk_UA
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