Mini-invasive technologies in the treatment of patients with closed abdominal injuries

Authors

  • S. Yo. Zaporozhan I. Horbachevsky National Medical University
  • V. S. Khomenko I. Horbachevsky National Medical University

DOI:

https://doi.org/10.11603/2414-4533.2022.4.13603

Keywords:

closed abdominal injury, non-invasive methods of diagnosis, mini-invasive methods of surgical treatment, hemodynamic instability

Abstract

The aim of the work: to improve the results of diagnosis and treatment of patients with closed abdominal trauma.

Materials and Methods: Analysis of diagnosis and treatment of 140 patients with closed abdominal trauma who were treated at different levels of medical care: secondary level – central district hospitals of Zhytomyr region and Zhytomyr city hospitals; tertiary level – ME “Regional Clinical Hospital named after O.F. Herbachevsky” of the Zhytomyr Regional Council. The majority of patients were men – 111 (79 %), women – 29 (21 %), which in the proportional ratio was 4:1. By type of injury, the main share was traffic accidents – 108 patients (77.14 %). The majority of patients were hospitalized within the first two hours from the moment of receiving an injury – 21 (43.8 %) patients of the regional clinical hospital and 52 (56.5 %) patients of city and district health care institutions. Isolated damage to internal organs, namely the spleen, liver, and intestinal mesentery accounted for the main share – 85 cases (60.7 %). 47 % of patients with closed abdominal trauma had severe blood loss.

Results and Discussion. The use of non-invasive diagnostic methods was more frequent than invasive ones. An important aspect in choosing a diagnostic tool was its informativeness, reliability and access to technology. Thus, among the non-invasive methods of diagnosis, computer tomography had the most informativeness – 92.86 %, ultrasonography and inspection radiography had slightly lower indicators: 89.41 % and 86.96 %, respectively. Among the invasive methods of diagnosis, the accuracy of diagnostic laparoscopy and laparocentesis were comparable: 93.75 % and 93.02 %, however, the laparoscopy technique was more widely used at the tertiary level. The analysis of operated patients depending on the type of surgical intervention showed that the use of resection types of surgical intervention was predominant at all levels of care: 33 (64.7 %) patients of secondary level institutions and 29 (53.7 %) patients of regional institutions. Mini-invasive approaches were used in providing care to 26 patients, the main part of them was carried out in the conditions of the regional clinical hospital – 22 out of 26 patients, moreover, medical diagnostic surgical interventions were carried out in 12 (31.58 %) cases, mini-invasive medical – in 10 (26.32 %) of patients who were treated in the conditions of a regional clinical hospital. The share of mini-invasive interventions in district institutions was only 4 cases (5.97 %) and were represented exclusively by diagnostic operative interventions. Access conversion was 2 (2.98 %) cases among patients of secondary level institutions and 4 (10.52 %) cases among patients of the regional clinical hospital. The use of minimally invasive technologies showed effectiveness in terms of an indirect economic component (reduction of bed days) and a reduction in the number of postoperative complications by 3.83 % against 24.7 % in the group of traditional surgical interventions.

References

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Published

2022-12-29

How to Cite

Zaporozhan, S. Y., & Khomenko, V. S. (2022). Mini-invasive technologies in the treatment of patients with closed abdominal injuries. Hospital Surgery. Journal Named by L.Ya. Kovalchuk, (4), 10–18. https://doi.org/10.11603/2414-4533.2022.4.13603

Issue

No. 4 (2022)

Section

ORIGINAL INVESTIGATIONS

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