Нospital-replacing technologies:Ambulatory surgery

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ISSN / EISSN : 1995-1477 / 2658-3542
Published by: Remedium, Ltd. (10.21518)
Total articles ≅ 88
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, A. I. Nedozimovanii, D. E. Popov, A. S. Vasiliev, I. V. Gor
Нospital-replacing technologies:Ambulatory surgery; https://doi.org/10.21518/1995-1477-2020-3-4-89-94

Abstract:
Introduction. The market presents a huge amount of topical preparations, which manage the clinical manifestations of hemorrhagic disease, and there is also no shortage of means that affect post-operative pain. However, there is no single consensus of patient management in the preoperative period, and there is no generally recognized protocol for the treatment of pain after hemorrhoidectomy.Aim. To determine the effectiveness of using Fleming’s ointment during pre- and post-surgery in patients with 3–4 grade hemorrhoids.Material and methods. 85 patients with a diagnosis of hemorrhoids III–IV grade were divided into 2 groups. The Milligan-Morgan’s hemorrhoidectomy using standard electrocoagulation methods under intravenous anesthesia was performed in all patients. Fleming ointment was used as a topical agent for 2–3 weeks before the operation and for 2.5 weeks after the operation in Group A (43 patients). In group B (42 patients), depending on the prevalence of symptoms, suppositories with phenylephrine, lidocaine, local, hormonal ointments were used, also Liniment Levomekol was used as a local therapy after surgery in the group B. The results were evaluated according to the following criteria: Pain level, symptoms’ degree of the disease against the background of the use of local agents was evaluated by VAS. The multiplicity of the introduction of NSAIDs in 2 groups was considered. The adequacy of the wound healing correlated with the duration of maintaining inflammation in the wound, we also considered the daystay and days of disability.Results. Pain level according to VAS on the 1, 3, 7, 12 days after surgery in patients from group A is 0,6 points lower than in patients from group B. The average number of NSAIDs intake in the postoperative period in Group A was 1,4 times less than in Group B. There was no significant difference in wound reaction, day-stay and days of disability. The symptoms of hemorrhoids, estimated by VASh, were significantly less pronounced in patients who used Fleming ointment (see table 0)Conclusions. Fleming ointment can be recommended as an adequate topical agent in the perioperative management of patients with 3–4 grade hemorrhoids.
M. V. Abritsova, A. M. Bogomazov, E. B. Golovko, E. A. Zagriadskii
Нospital-replacing technologies:Ambulatory surgery; https://doi.org/10.21518/1995-1477-2020-3-4-74-79

Abstract:
Hemorrhoids is one of the most common diseases in human. According to the latest data for 2017, the prevalence rates of hemorrhoids per 100 000 population in Russia are 410,3 in adults, 26.7 in children aged 15 to 17 years and 4,0 in children under 14 years old. Quality of life (QoL) is an important non-specific subjective parameter of well-being, representing an integrative characteristic of the physical, psychological, social and emotional status of the patient. Despite the high prevalence of hemorrhoids and the variety of modern methods of surgical treatment, there are very few studies addressing the QoL in this category of patients. There are significant differences between the patient and the Coloproctologist in the perception of HD, which, possibly, can lead to the hypertrophy of indications for surgical treatment. Understanding the effect of HD on social life and the concept of the well-being of a particular patient can help the doctor choose between conservative and surgical approaches in the treatment of hemorrhoids. On the other hand, due to the excessive shyness and mentality in our country, patients with HD tend to adapt to their disease, which leads to later seeking medical help and suboptimal efficacy of conservative therapy and minimally invasive surgical methods.This review presents the first Russian multicenter observational program EQUALISER (impact of different trEatment modalities on QUAlity of life of the patientS with acute and chronic hEmorRhoid disease) aimed at assessing the QoL of patients with HD, as well as the effect of the treatment method and types of surgical treatment on the social adaptation of the population.
M. V. Abritsova, N. R. Torchua
Нospital-replacing technologies:Ambulatory surgery; https://doi.org/10.21518/1995-1477-2020-3-4-95-100

Abstract:
An anal fissure is one of the most common diseases of the anal canal with the incident rate of 20–23 cases per 1000 citizens. Most of acute anal fissures are healed spontaneously but a few of them can become chronic process. Chronic anal fissures are characterized by any two of the criteria: pain after defecation lasts longer than 3 months, sentinel pile is present, fibers of internal sphincter at the base of the anoderm.The spasm of the internal sphincter is a guiding pathogenetic mechanism in the development of chronic anal fissures. It leads to circulatory disorder in the anoderm and non-healing wounds. Therefore, the treatment of anal fissures primarily must be focus on eliminating of internal sphincter spasms and then excising of fissures.Recently, botulinum toxin type A injection in treatment of chronic anal fissures has become popular as a noninvasive method of eliminating internal sphincter spasms.Botulinum toxin as a medical agent has been studied since the late 1960s. Botulinum toxin type A has been used to treat of various pathologies including coloproctology diseases for more than 40 years.The botulinum toxin injections make the internal sphincter relax, and as a result create optimal conditions for healing chronic anal fissures.Using of botulinum toxin type A does not cause dangerous complication. Fecal incontinence after using botulinum toxin is transitory.The review describes the use of botulinum toxin type A injections to treat chronic anal fissures.
V. V. Davydenko, A. N. Galileeva, O. P. Ivanova, A. V. Romanov, B. I. Afanasyev, R. R. Reytel
Нospital-replacing technologies:Ambulatory surgery; https://doi.org/10.21518/1995-1477-2020-3-4-124-129

Abstract:
Introduction. Over the last 20 years the widespread introduction of ultrasound imaging into clinical practice and the emergence of new endovascular technologies in the treatment of varicose veins have brought about a paradigm shift in the surgical treatment and the introduction of innovative minimally invasive technologies (thermoobliteration, chemical obliteration, microphlebectomy), which can be performed on outpatient basis under local anesthesia. Therefore, the widespread introduction of these technologies into the outpatient practice is the foremost task.Objective of the study. Analyse the results of the experience gained in the St Petersburg polyclinics concerning the introduction of hospital-replacing surgical treatment of varicose vein diseases and appropriate training. Materials and methods. We have performed 854 surgeries including endo-venous laser coagulation (EVLС), sclerobliteration (SO) and Varadi miniflebectomy (MF) under local infiltration anesthesia: EVLC + MF in 71%, MF in 12%, EVLC + SO in 9%, EVLC + MF + SО in 3%, EVLC in 3% and SО in 2% of cases. The patients operated on ranged in age from 19 to 78 years (53 ± 21 g), among them there were 611 women and 202 men. The clinical distribution of patients was in accordance with CEAP classification: C2 – 62%, C3 – 22%, C4a/b – 12%, C5 – 2.5%, C6 – 1.5%.Results and discussion. The evaluation of treatment results based on a retrospective analysis of patients’ examination findings after 1, 39, 180 and 365 postoperative days has demonstrated that there is no evidence of intra- and postoperative complications requiring hospitalization, disease recurrence. However, ecchymosis in 35% of cases, limited superficial infiltrates - in 18%, limited superficial thrombophlebitis - in 0.8% have been reported after MF. They have been treated using topical agents. According to the questionnaire, after a year of treatment 96% of patients appear to be satisfied with the results obtained. After a year payback financial costs have been achieved. An effective practical training program has been developed and implemented for innovative technologies for surgery of varicose veins of lower extremities. 42 physicians of outpatient clinics underwent the program.Conclusions. It can therefore be concluded that the further introduction of innovative technologies into the polyclinics is reasonably practicable as it is safe, effective, expands the population’s access to modern technologies, is economically feasible and is perceived positively by patients, reduces the burden on surgical hospitals, improves professional qualifications and expands the professional competencies of surgeons in outpatient settings.
Н. Г. Артемьева, O. A. Romanova
Нospital-replacing technologies:Ambulatory surgery; https://doi.org/10.21518/1995-1477-2020-3-4-66-72

Abstract:
Introduction. Russia has a high mortality rate of cutaneous melanoma – 2.5 per 100,000 population whereas the incidence rate is 7.7 per 100,000 population, i.e. one in every three patients dies. In the foreign countries (the USA, Australia), melanoma mortality rate is 10-15%. Such high rates are explained by the fact that patients with early-stage disease do not seek medical advice, as in early stages a tumour does not cause inconvenience to a patient and looks like an ordinary mole.The purpose of the study was to confirm the advisability of removing a progressive dysplastic nevus (grade 3 lentiginous melanocytic dysplasia) with a view to prevent and make early diagnosis of cutaneous melanoma.Materials and methods. The authors removed 180 pigmented lesions that were clinically diagnosed as a progressive dysplastic nevus in the Surgery Department of Central Polyclinic of Literary Fund from 2009 to March 2020. The patients were referred to the Surgery Department by physicians, dermatologists and other specialists of the polyclinic. Following an oncologist consultation, excisional biopsy of a nevus was performed under local anesthesia.Results. Histological examination revealed 29 (16%) dysplastic nevi with grade 3 LMD and 18 (10%) early-stage melanomas.Conclusions. If excisional biopsy of a dysplastic nevus becomes routine in Ambulatory Surgery practice, it will increase the early diagnosis of melanoma and significantly reduce mortality rates of this disease. For excisional biopsy, the authors recommend to excise at a distance of 0.5 to 1.0 cm from the lesion boundaries, since it is not possible to clinically distinguish a progressive dysplastic nevus from early melanoma.
A. B. Sannikov, E. V. Shaydakov, V. M. Emelyanenko, T. G. Tolstikova
Нospital-replacing technologies:Ambulatory surgery; https://doi.org/10.21518/1995-1477-2020-3-4-113-123

Abstract:
Introduction. In order to perform endovasal vein lining, the American Rodney D.Raabe developed a system for varicose veins obliteration, consisting of a glue gun and two catheters, called “VenaSeal”. As an occlusant for varicose veins in this system, “Medtronic” company today proposes to use an adhesive compound synthesized on the basis of butyl ether of α-cyanacrylic acid.Materials and methods. Endovasal catheter obliteration of tributaries and main trunks of the great saphenous vein on the tibia was performed in 15 patients with varicose disease (C2 to CEAR) in order to substantiate the possibility of using the adhesive compound Sulfacrylate. Severity of pain, presence or absence of phlebitis and thrombophlebitis, hyper pigmentation, neurological disorders, allergic reaction were clinically evaluated.Results and discussion. All patients after the introduction of the glue Sulfakrilat had a clinic of moderate phlebitis, without the formation of blood clots in the lumen of the vein. No local or general allergic reaction was observed. From day 7 occluded venous segments were palpated in the form of moderate density bands, without infiltration to surrounding tissues. In the absence of blood flow ultrasound examination showed gradual biodegradation of the adhesive strip inside the vein with the development of complete obliteration of the lumen starting from the 4th month. Starting with the 7th day gradually stopped aseptic inflammation in the wall of the vein was observed on histological examination. Monocytic infiltration of the venous wall with the formation of multinucleated cells of foreign bodies was present until the time of complete biodegradation of the glue. The process of diffuse growth of connective tissue with the presence of fibroblasts from the subendothelium and in the middle shell was most actively observed in histological material from 90 to 120 days after occlusion. Within 180 days, the lumen of the veins occluded by “Sulfacrylate” was completely obliterated by mature connective tissue, in the absence of glue particles, which indicated its complete biodegradation.Conclusion. The experimental studies conducted with the assessment of clinical symptoms, ultrasound examination and histological study of morphogenesis in the lumen of blood vessels in different periods up to 6 months allow us to conclude the potential use of the adhesive compound “Sulfacrylate” (produced in Russia) for endovasal obliteration of varicose veins in humans.
, D. A. Churikov
Нospital-replacing technologies:Ambulatory surgery; https://doi.org/10.21518/1995-1477-2020-3-4-108-112

Abstract:
The article is a discussion of the advantages of a patient’s position during an ultrasound examination of the lower-limb venous system. The presented material is intended to objectively assess the advantages of this or that position of an examined patient in order to obtain necessary information about the state of the veins of the lower limbs from the position of doctors who have years of experience in diagnostics and treatment of acute and chronic diseases of the lower-limb venous system. The material of the article is primarily designed for doctors who, in addition to the ability to use an ultrasound scanner to some extent, know about venous hemodynamics and can afford to think outside the generally accepted concepts and clinical recommendations.The characteristics of the state of the lower-limb venous system at vertical and horizontal position of the patient are given. Schemes of venous pressure distribution in the system of the inferior vena cava in the horizontal and vertical position of the patient are presented. Methods of manual compression of the muscular mass and straining at different patient positions are described.The vertical position of the patient (or sitting position) is the most reliable way to identify the peculiarities of anatomical structure and pathological changes of the subcutaneous vein walls, which may be of great importance for planning and carrying out subsequent invasive manipulations, but there is a question about the expediency of making linear measurements in this position, if the invasive intervention is carried out while lying down. Carrying out compression ultrasound, assessment of hemodynamic parameters of venous blood flow, including the use of samples with straining and manual compression of muscle masses of the limb, it is much more convenient to perform in the lying position.
V. I. Lomakin, A. S. Kuzmichev, A. L. Akinchev
Нospital-replacing technologies:Ambulatory surgery; https://doi.org/10.21518/1995-1477-2020-3-4-130-134

Abstract:
The treatment of scars and impact by them their deformations, as well as the formation of pathological scars, remain one of the most difficult and insufficiently explored problems of plastic and reconstructive surgery. The most severe type of pathological scars is keloid a tumor-like growth of immature connective tissue due to uncontrolled proliferative fibroblast activity. The simple removal of keloids even within healthy tissue was often accompanied by their recurrence. Here presented clinical observation of the patient with benign fibroma of 1 finger of the right foot, who had after excision of formation, keloid scar has developed. Repeated operations with keloid excision and the use of free skin plastic have proved ineffective. Only long-term therapy with diprospan injections for 1.5 years allowed to achieve cure of the patient.
S. M. Markin, , S. V. Grishin, P. F. Kravtsov,
Нospital-replacing technologies:Ambulatory surgery; https://doi.org/10.21518/1995-1477-2020-3-4-27-35

Abstract:
Introduction. The simplicity of the sclerotherapy procedure, its high efficiency and low cost along with the possibility of performing the procedure on an outpatient basis stimulate the widespread use of the method.Objective of the study. Examine the current state of actual clinical practice regarding the treatment of patients with varicose veins using the sclerotherapy procedure.Materials and methods. An anonymous survey of 162 doctors, members of the professional community of specialists engaged in the treatment of venous diseases was performed. It comprised 15 questions concerning the features of the sclerotherapy procedure and following up of the patients.Results and discussion. The lack of clear-cut standardization for sclerotherapy in the regulatory documents contributes to the significant heterogeneity in the approaches of specialists to the performance of the procedure. The views on the use of sclerotherapy to remove perineal varicose veins (routinely performed only by 25.3% of physicians) and the upper extremity veins (less than 4%) turned out to be controversial. There were significant differences in the therapeutic approaches to the administration of anticoagulants by the patients (refusal in the procedure – 26.3% of respondents, discontinuation of drugs during sclerotherapy – 7.5%). Approximately a third of the respondents regularly exceed recommended 10 ml-volume of foam per session, there is no consensus on the choice of the needle diameter, drug concentration even in the similar clinical situations. About half of them have experience in using glucose as the sclerosant, every third – in using a transcutaneous laser, 5.6% – in using the mechanochemical obliteration techniques that are not currently certified in the Russian Federation. The use of compression therapy after sclerotherapy is not standardized; the regulatory documents provide contradictory durations of its use, which is due to the weakness of clinical research data on this issue. Up to 99% of physicians observe pigmentation, 83.2% – development of secondary telangiectasias and 60.2% – superficial necrosis in their practice. These circumstances arouse legal suspicion in relation to this type of treatment and the legal vulnerability of physicians. At the same time, physicians need to be more informed about the current requirements for some issues.Conclusion. The current legislation regulating the practical aspects of the sclerotherapy considers it largely through the lens of medicine, ignoring a significant cosmetic component. It is necessary to work out the provisions describing the specifics of cosmetic manipulations performed by the phlebologists, and the need for more detailed familiarization with the regular updates of the guidelines.
D. V. Pakhnov,
Нospital-replacing technologies:Ambulatory surgery; https://doi.org/10.21518/1995-1477-2020-3-4-135-139

Abstract:
Introduction. The hydatid form of echinococcal disease of EB is a rather urgent problem and over time the degree of its significance does not decrease. The main target organ is the liver, according to various authors, it accounts for up to 84% of all clinical observations. The probability of lung tissue involvement in the pathological process is 15%. Echinococcosis of other organs and tissues, as well as a combined lesion occurs in 25% of cases. Lesion of echinococcosis of muscle tissue is observed in 0.7–0.9% of all cases. The main method of treatment at present is surgery with its various options such as echinococcectomy, pericystectomy, resection.Objective. To demonstrate on the available clinical example the feasibility of using surgical treatment of EB of rare localization in the area on the anterior abdominal wall.Materials and methods. The result of treatment of a patient with echinococcosis of rare localization on the anterior abdominal wall is presented. The diagnosis is established in accordance with the available clinical recommendations. The examination was carried out using a standard set of clinical metols, and included: collection, analysis of complaints, as well as an anamnesis of life and disease. Standard clinical and biochemical studies were performed.Results. The hydatid form of echinococcosis with localization on the anterior abdominal wall is a rather rare pathology. However, treatment issues and diagnostic difficulties are quite relevant for doctors of various specialties. As a result of this clinical observation and the treatment, the patient recovered; after 17 months there was no data for a relapse of the disease.Conclusion. 1. Timely diagnosis of hydatid echinococcosis of any localization is fundamental in improving the results of treatment of this category of patients. 2. A multidisciplinary approach in the selection of therapeutic tactics, namely the appointment of chemotherapeutic effects before and after surgery, an active surgical one, allows to achieve a good therapeutic result.
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