Optimal treatment for adhesive small bowel obstruction (SBO) is not defined. Surgery is the only method of treatment for obvious strangulating SBO. Non-operative management (NOM) is widely used among patients with low risk of strangulation, i.e. no clinical, laboratory and CT signs. Randomized controlled trials (RCTs) are recommended to determine the optimal method (early intervention or NOM), but their safety is unclear due to possible delay in surgery for patients needing early intervention. MATERIAL AND METHODS:A RCT is devoted to outcomes of early operative treatment and NOM for adhesive SBO. The estimated trial capacity is 200 patients. Thirty-two patients were included in interim analysis. In 12 hours after admission, patients without apparent signs of strangulation were randomized into two clinical groups after conservative treatment. Group I included 12 patients who underwent immediate surgery, group II - 20 patients after 48-hour NOM. The primary endpoint was success of non-surgical regression of SBO and reduction in mortality. To evaluate patient safety, we analyzed mortality, complication rates and bowel resection in this RCT with previously published studies. RESULTS:In group I, all 12 (100%) patients underwent surgery. Only 4 (20%) patients required surgery in group II. Mortality, complication rates and bowel resection rates were similar in both groups. Strangulating SBO was found in 8 (25%) patients. Overall mortality was 6.3%, bowel resection rate - 6.3%, iatrogenic perforation occurred in 3 (18.8%) patients. These values did not exceed previous findings. CONCLUSION:Non-operative management within 48 hours prevented surgery in 80% of patients with SBO. Interim analysis found no significant between-group differences in mortality, complication rates and bowel resection rate. Patients had not been exposed to greater danger than other patients with adhesive SBO. The study is ongoing.

Aim . To explore the possibilities for assessing and reducing the severity of perioperative stress response to emergency surgery in patients with acute cholecystitis. Materials and methods . 207 patients with acute cholecystitis were registered from January 2017 to January 2019. Patients were randomized into groups. Enhanced recovery techniques were used in the main group. Cortisol and Interleukin-6 levels were measured to examine the perioperative stress response and to identify biochemical predictors of complications associated with acute cholecystitis. Results. The groups did not reveal a statistically significant difference in the number of postoperative complications. The length of postoperative stay was shorter in the main group (33.3 ± 19.6 h and 53.7 ± 32.7 h; p < 0.0001). Within 24 postoperative hours, 54.5% of patients in the main group and 19.8% of the control group were discharged from hospital. Early mobilization and enteral feeding reduced the time of return to physical activity and transition to habitual diet in the main group, which was also noted with a lower incidence of postoperative pain in the shoulder and/or neck: 12 (13.6%) compared to 35 (34.7%) observations. The application of the enhanced recovery protocol provided no significant effect on postoperative cortisol levels in the main group. Conclusion . In surgical patients with acute cholecystitis, enhanced recovery improves the quality of the postoperative period, reducing the severity and frequency of postoperative pain, phrenicus and dyspepsia symptoms. The enhanced recovery techniques diminish the length of hospital stay without increasing the incidence of complications and re-hospitalizations.

1Университетская хирургическая клиника им. В.С. Савельева л/ф РНИМУ им. Н.И. Пирогова (дир. — д.м.н., проф., член-корр. РАН А.В. Сажин), Москва, Россия; 2Городская клиническая больница No1 им. Н.И. Пирогова (гл. врач — А.В. Свет), Москва, Россия; 3Тульская областная клиническая больница (гл. врач — Р.Б. Блюмин), Тула, Россия; 4Кафедра акушерства и гинекологии педиатрического факультета РНИМУ им. Н.И. Пирогова (зав. — д.м.н., проф., акад. РАН М.А. Курцер), Москва, Россия

FIELD: medical equipment. SUBSTANCE: group of inventions relates to medical equipment, namely to electrosurgical tools for electric coagulation and dissection of tissue, in particular, to devices for dissection of cicatricial tissues surrounding the extravascular fragments of endocardial electrodes of implanted pacemaker, and can be used for safe separation of electrodes of pacemaker during replacement or upgrade pacemaker. Device includes a housing, having lower and upper parts, working part with sharpened edge, fixed on the lower part of the housing. Working part with sharpened edge is made in the form of a chute with arc-like cross section with skewed downward chamfer on the front part of the chute or smooth pointing on the front part of chute. In the lower part of the housing is a slot with possibility of contact of the working part of inserted electrode-knife with its tissue. In the first version of the housing it is made in the form of elongated element with lengthwise inner channel for introduction of electrode-knife, note that longitudinal inner channel is made with fixation element. In the second version of the housing it includes outer tubular body and spring-loaded internal tubular body, made with possibility of introduction of electrode-knife and displacement relative to the outer tubular body. At that, between outer and inner tubular bodies are installed limiters, determining internal stroke length of the tubular body. EFFECT: use of a group of inventions will allow to cut scar tissues around extravascular fragment of the pacemaker electrode without breaking the electrode, which reduces injuries and duration of operative interventions compared to existing techniques. 22 cl, 11 dwg

Two cases are given of the implanted permanent cardiac pacemaker failure after electrical defibrillation during cardiopulmonary resuscitation in patients with ventricular tachycardia which transformed into ventricular fibrillation.

The number of patients with purulent complications in area of electric cardiostimulator is increasing. The maximal danger represents bacterial endocarditis and sepsis though 90% of patients have local purulent process. The main mode of treatment of purulent complications in area of electric cardiostimulator is the deimplantation of stimulation system. This technique is traumatizing and highly unprofitable and demands alternative modes of treatment. Nowadays, the reports exist concerning such successful interventions as surgical d-bridement of area of electric cardiostimulator without deimplantation of stimulation system in patients with local purulent process. This information needs to be comprehensively analyzed.

The number of patients with purulent complications in area of electric cardiostimulator is increasing. The maximal danger represents bacterial endocarditis and sepsis though 90% of patients have local purulent process. The main mode of treatment of purulent complications in area of electric cardiostimulator is the deimplantation of stimulation system. This technique is traumatizing and highly unprofitable and demands alternative modes of treatment. Nowadays, the reports exist concerning such successful interventions as surgical d-bridement of area of electric cardiostimulator without deimplantation of stimulation system in patients with local purulent process. This information needs to be comprehensively analyzed.

Results of surgical treatment of local septic complications after the electrocardiostimulator (ECS) implantation in 86 patients were analyzed. Comparison of two patient groups allowed to prove the importance of the preoperative echocardiography and bacteriological blood test as well as the thorough surgical treatment.

The operation of an implanted pacemaker was evaluated in 99 patients aged 62.4 ± 9.6 years during non-cardiac operations. Electrocoagulation (EC) caused inhibited EC stimuli in 9 (9.1%) patients, short-term episodes of ineffective stimulation with impaired synchronization in 2 (2%), and an altered stimulation regimen in 2 (2%). The abnormalities were short-term and depended on EC duration. Four patients were found to have EC-unassociated episodes of myopotential inhibition. The revealed abnormalities require meticulous patient examination prior to surgery, intraoperative ECG monitoring, and time-limited use of monopolar EC.