Simultaneous laparoscopic lifting operations in combined pathology of the abdominal organs, retroperitoneal space and pelvis in patients with cardiopulmonary pathology

B.S. Zaporozhchenko, V.V. Kolodiy, A.A. Gorbunov, M.B. Zaporozhchenko, D.A. Bondarets, I.G. Kholodov

Abstract


Background. The widespread introduction of vi­deoendoscopic technologies, suturing devices and other technical means caused a powerful impetus to the development of simultaneous operations in combined surgical diseases. However, the frequent comorbidity of surgical pathology of the cardiovascular and respiratory systems greatly limits, and in some cases eliminates the laparoscopic simultaneous operations in a number of patients with reduced cardiopulmonary reserve. Gasless laparoscopy is designed to solve this problem, it is not widely used today due to the lack of universal, easy-to-use and affordable laparolifting systems. The aim of the study was to optimize the treatment policy for concomitant diseases of the abdominal cavity, pelvic cavity and retroperitoneal space in patients with a high index of polymorbidity through the application of developed lifting system. Materials and methods. In the department of clinical surgery of Odessa Regional Medical Center at the premises of Department of Surgery N 2 of Odessa National Medical University in the period from 2011 to 2016, there were carried out 84 simultaneous laparoscopic surgeries for concomitant diseases of the abdominal cavity in patients with concomitant diseases of the cardiovascular and respiratory systems. All patients were divided into two groups. The first, or study (main), group included 36 patients, who underwent surgery with the use of developed by the author technology of laparolifting. The second (comparison, control) group included 48 patients, who had laparoscopic surgery performed by the classical method with the imposition of a carboxiperitoneum. In all patients of the main group, we have established the presence of comorbidities that determine their relationship to the III–IV class of risk according to ASA classification, in the control group — I–II class operational and anesthetic risk, respectively. Results. The average time of patients’ stay in the intensive care unit and hospital stay were significantly lower in the group of patients operated in gasless mode. Duration of hospital stay after surgery was lower in group 1 — 8.56 bed-days, in group 2 — 10.5 bed-days (p < 0.05). The average time in the intensive care bed was 1.29 days in the study group and 1.58 days in the control group (p < 0.05). In the main group, complications were registered in 3 patients (8.3 %), in the control group — in 7 (14.6 %) (p < 0.05). In the majority of cases, there have been registered non-severe wound complications, which were not life-threatening, but in 4 patients from the comparison group, the potentially fatal complications have been reported, such as a paroxysm of atrial fibrillation, ventricular tachycardia, exacerbation of chronic obstructive pulmonary disease. Exacerbations of chronic diseases of the respiratory and cardiovascular systems and lower limbs were recorded more frequently in the control group — 6 (12.5 %) cases, which influenced the length of hospital stay and cost of treatment. In the main group, 2 patients had an exacerbation of duodenal ulcer. Three patients in the control group and 2 — in the main group had abdominal bleeding stopped intraoperatively. No deaths have been registered during the observation. Conclusions. The use of developed technology of laparolifting was not associated with serious technical difficulties in surgical operations and has just a little duration. The latter, in our opinion, is not critical at this stage of anesthesiology and intensive care development. Also, we found statistically significant differences during the early postoperative period and intensity of functional systems of the body. Such benefits of gasless endovideosurgical simultaneous correction of comorbidity, as an extension of the indications for laparoscopic interventions for the most complex, somatically burdened category of patients, the absence of the negative impact of stress carboxiperitoneum on homeostasis, decrease in the incidence of intra- and postoperative complications, reducing the time spent of hospital stay, make it possible to recommend these interventions for implementation in the clinical practice.

Keywords


simultaneous laparoscopy; gasless laparoscopy; laparolifting

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DOI: https://doi.org/10.22141/1997-2938.1.32.2017.98491

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