Khirurgiia
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Randomized Controlled Trial Comparative Study
[The efficacy of the moisture and warmed CO(2) for laparoscopic surgery].
A prospective, randomized study comparing 150 patients undergoing laparoscopic operations (110 patients undergoing laparoscopic cholesystectomy and 40 patients laparoscopic fundoplication) with standard CO2 insufflation vs those receiving warmed, humidified CO2 was performed. All patients were randomized into 2 groups - 84 receiving standard CO2 insufflation (control group) and 66 receiving warmed, humidified CO2 (main group). ⋯ We revaeled that warmed, humidified CO2 has advantages that were statistically significant. Patients undergoing warmed, humidified carbon dioxide (CO2) insufflation for maintain a warmer intraoperative core temperature, and have less postoperative pain and need less analgesic requirements than patients with standard CO2 insufflation.
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Two-stage liver surgery with preliminary right portal vein occlusion procedure (ligation or embolisation) became standard in clinical practice and allows liver resections in 60-82% of initially inoperable patients. Right portal vein ligation with concomitant liver partition in situ (in situ splitting, ISS) is innovatory and promising approach. Right portal vein ligation and in situ splitting was performed in 40 years old male with two metachronous rectal metastases in right liver lobe and insufficient volume of future liver remnant (22%). ⋯ There were no signs of postoperative liver failure. Conclusion. New two-stage surgery approach (ISS) can decrease number of patients who were inoperable because of insufficient volume of future liver remnant and high risk of postoperative liver failure.
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The 10-year experience of treatment of closed isolated and combined abdominal trauma and renal injury included data of 117 cases. The diagnose was made basing on the clinical analysis, ultrasound investigation and computed tomography. 61 patients were operated on, though only 6 of them on the reason of the renal injury. ⋯ Authors worked out the indications for the visual intraoperative kidney revision, if the severity of the injury had been not assessed before. Nevertheless, the conservative therapy proved to be effective in 98.2% of patients with kidney trauma stage I-IV.