»» No. 7-8 "99" »Nova medical encyclopedia Igor Volodimirovich Fedorov, keeper of the primary center of Endoscopic and minimally invasive surgery, vikladach of the Kazan State Medical Academy (KSMA), Dr.RMED. sciences

• gostry appendicitis- the most widespread incidence of organs black wastes, Yake vinikak in the protest of life in 7% of the population of the earth.
• Apendectomy to carry every tenth inhabitant of the planet.
• As a result of hyperdiagnostics, 30% of additional operations are performed.
• In children and women of early childhood, through the flexibility of differential diagnostics of a severe appendicitis with the other diseased organs of the worm, the whole age grows up to 40-45. The sight of an insignificant worm-like outgrowth was not too daunting, as it was allowed earlier. For example, women have one of the main reasons for the development of secondary safety through the transfer of the state route, which is due to the operation in the right club hole and the emptying of the small pelvis.

1. Crazyly taken by the medical support - the endoscopic surgeries show themselves very well, their effectiveness is not sufficient (laparoscopic cholecystectomy, surgery on the appendages of the uterus, fundoplikatsiya).

2. Ymovіrno vіdkinіtі - the effectiveness of minimally invasive surgery sumnіvna not reported (surgery for cancer of the developmental localization, resection and visualization of the slunk or to the abdominal tract).

3. Acceptance of shown in singing groups of patients (for example, laparoscopic resection of the intestine, surgery for swelling of the supra-nirkoval zalosis, appendicectomy). On laparoscopic apendectomy, where my adherents and opponents are, we can explain in greater detail.

Laparoscopic appendectomy is possible for all endoscopic surgery: low trauma, decreased terms of rehabilitation and transfer to hospital, fast frequency and severe complications, cosmetic effect. Diagnostic laparoscopy, before the appendectomy, allowing you to look again at the thinning, and, for the duration of the changes in the appendix, when the changes in the appendix occur, and when the vagina is lost (the appearance of the vagina) Bagatorial discussions in the press have brought about the fact that the boules are shown before the worm-like growth is visible by laparoscopic access:

1. Clinical situation, which is in the process of diagnosing laparoscopy, in the course of which the diagnosis of a gastrointestinal appendicitis has been confirmed. It is logical to have a visonati apendectomy with laparoscopic access. Diagnostic laparoscopy is indicated for patients with an unclear diagnosis, if in the process of a 4-6-year dynamic caution it is unwise to confirm or to see appendicitis. In the first place, for excellent reasons, we should be introduced to women and children.

2. Appendicitis on aphids of grade II-III, which is characterized by a wide range of curvatures for rejection of adequate McBarney access. In cich patients, besides, there is also a lot of wounds.

3. Appendicitis on aphids of diabetic diabetes (through some kind of gnіynyh accelerated from the side of the wound).

4. Bazhannya ailing vidalyti worm-like growth with minimally invasive access.

5. Calculation of a worm-like outgrowth in the adhesive-ignition process of the pelvic organs on the same internal diseases (pelvic peritonitis, hospry salpingit, pyosalpinx and in.). If you save the appendex during the laparoscopic gynecological operation, it is not safe, and it is not blind.

At the same time, it is necessary to provide a contraindication to laparoscopic apendectomy:

1. Term ovoryuvannya more dobi, if there is a great development of accelerated forms of burning (infiltration, abscess, perforation).

2. Transition to the dome of the slit intestine (typhlitis). Ligaturny method, stasis during laparoscopic apendectomy, in the whole situation, it is not safe for possible thread breakdown and degermisation of the sprout.

3. Razlitiy peritonitis, which leads to the improvement of retinal sanitation and drainage of the empty waste.

4. Signal indications before laparoscopy (gostriy, myocardial infarction, cardiac insufficiency, obstructive pulmonary disease, etc.).

In such a rank, laparoscopic appendectomy, the viconana is technically competent with urahuvannya indications and prototypes - an effective and efficient procedure, as volodya all passages of minimally invasive surgery.

Ministry of Health Protection and Social Development of the Russian Federation.

PIVNICHNY DERZHAVNIY MEDICHNYY UNIVERSITY

Department of Faculty Surgery

Head of the department: Dinko S.M.

Vikladach: Odintsov V.A.

Topic: Endoscopic appendectomy

Vikonav: 4th year student of the 4th group of pediatric faculty Borodin V.V.

m Arkhangelsk 2007 r

Introduced into the clinical practice of endoscopic apendectomy surgery - especially the head of endoscopic surgery, as seen by K. Semm (1982) and J. Schrieber (1987). The first "incidentally" saw a worm-like outgrowth during a gynecological operation, and sometimes during a chronic appendicitis, and the other - for the first time during a gastric appendicitis.

The Russian surgeons, stretching out for three ten years, made an uncomplicated laparoscopy in the case of hospitals who were ill, they went through a rich diet of endoscopic diagnostics and tactics for treating a guest's appendicitis. Moreover, they were afraid to try combined method yogo vidalennya, vikoristovuyuchi small growth, through yaky vityaguvsya sprout with the dome of the intestine behind an additional jam. But the facts did not become publicity, and the endoscopic treatment of a severe appendicitis, which was discussed on the sidelines, did not come with enough respect, so yak, from one side, with mild forms surgical operation she did not know the revision through simplicity and shortness, and in case of destructive forms, which were supravuated with peritonitis, the principle of wide access and retreating sanitation of empty waste was unhealthy.

Russian surgeries knew about some offenders (K. Semm, R. Gotz, U. Nowzaradan, W. Geis, A. Pier), who made the traditional target, introduced into the class a new way of seeing the worm-like chronic growth appendicitis.

Quiet the fact that the actions of our surgeons-entusies (Yu.I. Gallinger, A.D. Timoshin, 1993; A.F. drop z spivavt., 1994; V.I. Lutsevich z spivavt., 1994; V.V. Strіzheletskiy z spіvavt., 1994) quickly measured the time distance and confirmed the feasibility and perspective of endoscopic treatment for appendicitis, incl. accelerated by peritonitis, the contrast with opponents and hunts was reduced even more.

Shown and counter-shown

Endoscopic appendectomy is indicated for chronic and gastric appendicitis. However, it is necessary to look at clinical and endoscopic positions prior to the operation of laparoscopic appendicitis in case of severe appendicitis.

From a key position, it is possible to conduct a discussion about such situations:

the diagnosis of a severe appendicitis is not clear and it is necessary to endoscopic diagnosis; є The clinical picture of the local peritonitis and the need for revision and sanitation of empty waste. The first situation does not need to be explained, a friend is not required, as the traditional concept (the law!), But only a wide surgical access will prevent the transmission of problems and struggle with peritonitis.

Aleksandr Ikraz in general and see the change of traditional glances of the surgeons, especially in the child surgery. Dumka (V.I. gnіynomuperitonіtі of the rosettes of schools V.S. Hostry cholecystitis, Trauma) and treatment of chemically peritonitis.

In the position of endoscopic feeding, there is food: why є appendicitis, how can it be possible to perform an apendectomy technically, why would there be adequate sanitation of emptying?

Laparoscopic diagnostics of severe destructive appendicitis does not become difficult, behind the blame of retrocecal localization of the adnexa, when such diagnosis is based on indirect signs. With so-called "catarrhal" appendicitis on the coryliness of the apendectomy, say a little of the instrumental symptoms - the propensity and rigidity of the growth.

Gostry appendicitis;

visibility gostrich zapalen in adolescence and onset of illnesses with the presence of pain syndrome;

The visibility of twisting fumes into the outgrowth in the presence of surgical (Crohn's ailment) and gynecological ailments (alternating between the choice of tactics of treatment in case of recurrences).

When there are no firing changes in the sprout and other organs, especially in children, the appendectomy is not sufficient. Dynamical latsaroskopiya (G. I. Perminova, 1982) can be used to diagnose and tactical problems.

Prototype

The vision of backward indications, up to those of the agonal stance, heart-shaking, legenevia, etc., is hardly logical: in some cases, the operation is simply insufficient, in the others - laparoscopically, the operation can be performed, ).

Mіscevі prototypes, as shown by the authors, can be combined in the following groups:

Variations of destructive changes in the black empty, wormy sprout, and slice of intestines (zagalny fibrinous-gnarial peritonitis, perforation of the appendix, abscesses of bridgework, appendix)

Atypical growth of the worm-like outgrowth (retrocecal, retroperitoneal);

Puffs of the worm-like outgrowth (carcinoid, cancer);

The emergence of other illnesses of organs of the black waste, which leads to the recovery of the disease.

The skin is a counter-indication, naturally, and it is often based on a certain amount of evidence, technically equipped and equipped with factors.

Possession and tools

In addition to standard tools, a set for carrying out a manual check-in of a transferable method of operation, including a bipolar tool, a clamping device, which can be used for a device (Endo GIA-30 for STA-30, Endopath) (from the introduction of extracorporal forms of the university), drainage.

Preparation. Premedication. anesthesia

Anesthesia during laparoscopic apendectomy can be developed by the age of the patient, the nature of the patient's illness, the qualifications of the anesthesiologist, etc. It is possible to get involved in anesthesia in the context of neuroleptanalgesia and epidural anesthesia. However, by the method of vibor є zeboluvannya іf zasosuvannyam miorelaksantіv. This will allow the establishment of an adequate pneumoperitoneum, without providing an optimal mind for the examination of all stages of the operation and revision of organs in the black emptying and the inability to recognize the patient's illness.

Development of staff, possession of a sick person

The operative brigade at the vison of the operative appendectomy is stored with the surgeon, the assistant and the operative nurse. Hirurg and video camera assistant-operator are known to be from the patient, and the video-resistant with a monitor on the protelezhny boat. The position of the assistant and the right-handed person from the sick person may be seen. Patient perebuvaє on the operating table in the position on the back with raised legs, with a lowered head end and a small heaped table in to the left side... For a greater look at the emptying and sanitation during the operation, you can change the table and the sick person (shift to the position of Trendelenburg, Fowler, turn to the right side, etc.).

technology

Operation of laparoscopic apendectomy includes the onset of stages:

Sanitation of the empty waste;

Mobilization of the worm-like outgrowth;

apendectomy;

Control revision and completion of the operation.

At the connection with the possibility of ante- and retrograde methods of apendectomy, the number of stages can change.

The operation is made from three or three accesses. In the area of ​​the umbilical funnel, there is a small (10 - 11 mm) pinhole, through which, following the standard technique, a pneumoperitoneum is applied using an additional head and a 10-mm trocar for a laparoscope is inserted. The advance of the introduction of the trocar for the instruments to work before the control of the gap and to get around individually in the debris due to the anatomical features of the patient's empty empty space. Krym "umbilikalny" into the void, insert two more trocars: above the pubis along the middle line (5-mm trocar) and in the right rib along the middle-clavicular line (10-12-mm trocar).

Such a vibration of points of operative access is dictated both by the speed of the onset of manipulations, and by the need to preserve a good cosmetic effect of the operation. If necessary, it is possible to change the insertion of the trocar at the same number (up to 4 and 5).

Pіslya Introduction іnstrumentіv held retelna revіzіya cherevnoї porozhnini i viznachayutsya nayavnіst i stupіn poshirenostі peritonіtu character roztashuvannya i form chervopodіbnogo vіdrostka, morfologіchnі zmіni brizhі, pіdstavi vіdrostka i dome slіpoї intestine mozhlivіst Yogo vidalennya endoskopіchnim way i tehnіchnі osoblivostі operatsії - Ways mobіlіzatsії i peretinu.

The worm-like sprout will be thirsty for a breeze, push forward and down and "vivish" for the revision of the breech. It is always due to the advice of the surgeon, the nature of the changes of the brigade and the manifestation of the tools to find ways of repetition - coagulation, ligature, crimping and apparatus.

There is no need to see and ligate around the appendicular artery. If the fat tissue is not in the breeze and does not rotate, the arteries and the blood are visible, then you can use any of the methods of mobilization and combination.

At the entrance of the adolescent in the brigade, a dissector or knives open a small opening, a ligature is carried out through the yake, and the brigade is bandaged for additional intra- or extracorporeal technology. In a personal situation (a small breech, bends of the main vessel), it is possible to create a liguvannya breech by a clerk. With a wide breeze and swiveling arteries, it is possible to lastly clink and reposition.

In quiet vipadkah, if the artery is not like a mainstay, in the brigade it turns fatty cells And it means that it’s igniting infiltration, more beautifully coagulating the coagulation method with a bipolar float. Vykonutsya chain stage last ante- and retrograde in the fallowness of the peculiarities of the exposition: the coagulated part of the bridgewith knives, etc.

As soon as there are bends of the nabryak, іnfіltratsіya і microabssesi (1), then the brigade will change for the additional equipment, applying the yakomog proximally.

It is a good idea to use the laser technique to retract the brigade, but when you are victorious, you need to take special care. It’s not easy for me, and it’s not safe for your intestines and organs.

On the basis of an endoscopic surgery for an hour of endoscopic apendectomy, it is not necessary to go into the significant mobilization of the spine at the dome of the intestine during the firing changes of the brigade.

The process of mobilization of the growth begins in a manner of appendix, which can be either traditional legal and from the stasis of children. Stagnation of the last is shown, especially in case of infiltration and perforation of the adductus and typhlitis, if the edge resection of the dome of the loin is possible.

Traditionally, in endoscopic surgery, two ligatures of a handrail are applied at the endoscopic surgery, having entered 1 - 1.5 cm, - the third. Ways that principle of ligation of zagalnovіdomі. By hand, victoristovuvati ready endopetlі, scho to cheer up the victorious stage.

The growth of the growth is carried out with knives from the electrocoagulation or a high-energy laser. They can reach the sterilization of the lineage of the worm-like outgrowth, allowing it to be seen as a traditional method of completing the appendix - peritonization, insertion of the yogo kuksi into the dome of the intestine with different types of sutures. Prior to the speech, the whole stage of the operation of the open-ended appendectomy is not safe to develop.

The worm-like outgrowth is seen from a black empty through a 10-mm trocar. In the case of the developed destruction of the adolescence with the method of prevention of the anterior cherevnoї stinki in the area of ​​puncture it is necessary to put it in a special plastic container.

Deyakі hіrurgi, admitting the tradition of appendicitis in case of gastric appendicitis, ligate a wormlike appendage with a single ligature into the dome of the lumen of the intestine with a hand-shaped suture, with.

retrograde mode

Singing hard can be seen in a visible retrocecal retroperitoneally rosted outgrowth. In general, the method of retrograde yogic visualization: the first stage of the growth from the intestine, and further away from the pedestal, a blunt way is carried out by a blunt gate from the vicars of the gauze sack.

Laparoscopic operation to smoke the visible gas and trocars from the black empty, to control the flow of bleeding from the holes through the laparoscope.

Results. Failure and acceleration

Analyzing and enhancing accumulations of additional operations, which among some authors (F. Gotz, 1994) has changed a thousand, it is possible to refer to the number of transfer of the endoscopic method before the surgical one: a slight overload of the transfer of 80% of the total short (1-3 days) period of hospitalization and turning to work performance, less number (1 - 4%) of operational acceleration and low mortality (0.5 - 0.7%).

The triviality of the operation of laparoscopic apendectomy, ale the world of accumulated dosage, changes from 40 - 60 minutes to 20 - 30.

The operation of laparoscopic apendectomy is given to the viconati in 95 - 98% of patients. The reasons for the transition to laparotomy are peritonitis, atypical growth of the worm-like appendage, periapendicular infiltration and abscess, perforation of the appendage of the worm-like appendage, development of the worm-like appendage, the development of the worm-like appendage.

Infectious acceleration of abdominal emptying (infiltration, abscess, peritonitis) and anterior abdominal wall are the main problems of the operative period, which were often seen in patients with apnea. Їx syaga frequency 1.5 - 2.0%. By the method of prophylaxis and treatment, drainage and dynamic laparoscopy with the sanitation of empty waste, which includes a few sessions. When there is no evidence of endoscopic management of ailments, laparotomy is shown in the operative period.

In such a rank, the operation of the laparoscopic appendectomy, as a nyaka of the operation with the endoscopic technologies, can great value for the practical protection of health in conjunction with the great frequency of grievous appendicitis. In a number of Europe's clientele (A. Pier, F. Gotz, 1993), the traditional trend before the last decision, and the process of endoscopic and surgical operations became 17: 1.

Russia has already prepared for a long time before the laparoscopic apendectomy is stopped in non-operational surgery, since there are a large number of medical institutions that widely use laparoscopy in differential diagnostics the reasons for the "hospitable belly" and amassed a great deal of information about tactful food for help. Even more tsіkavі in the whole world of the world of deceased foreign surgeries (W. R. Geis, 1992), how to ground the storage of the laparoscopic method and repeat the information of Russian surgeries. It smells like a laparoscopic technology, with wide diagnostic and medical capabilities and low trauma, the most promising for women, for patients with typical types of growth class; people have a kidnapped vіku; for patients with special professions (sportsmen, actors), for individuals who suffer Infectious diseases and not safe information for medical personnel, such as storing food items.

The widespread use of the laparoscopic method of treatment for appendicitis has been well known to the public about tactics in case of "catarrhal" appendicitis. In quiet cases, if there is visual evidence of non-congestion, and the results of instrumental palpation (proficiency, rigidity of the growth) are negative, it was later seen from the apendectomy, especially in children (A.F. Dronov, 1993). organs of worms emptying with the method of diagnostics of their illnesses, for the purpose of providing ailing relief for the laparoscopy.

There is a tactic, until you can’t stop it install The prospect of introducing diagnostics and tactful pardons, speeding up in 2 - 3 times the implementation of March appendectomies, prevention of operational acceleration, changing material vitrates and trivialities.

The great power of dynamic laparoscopy allows to prevent ailments with destructive forms of appendicitis in the form of development of important slow-moving operations and expansion is shown until laparoscopic apendectomy is achieved.

Also, in the practice of the operation of laparoscopic appendicitis, a new chapter is introduced in the non-operational surgery of the most common ailment, such as appendicitis.

List of Victory Literature

endoscopic appendectomy infectious disease

· Lustrovannye krivnitstvo on endoscopic surgery under the editorship of S.I. Emelyanov. Navchalnyy pos_bnik.

· Internet resources.

Felling of the enlargement of the intestinal tract (appendix) is one of the most common ailments. Yogo is called appendicitis.

One method of treatment is visualization. Traditional surgery can be performed, as well as laparoscopy for appendicitis. If you tighten it up with surgical interventions, then people can have peritonitis, perforation of the intestines, and you can cause it to be consumed with pus in the empty stomach.

Stagnation of laparoscopy for diagnostics and visualization of appendicitis

Laparoscopy is seen as a classic operation, so that all manipulations come through the opening of a small size - up to 1.5 cm.

Laparoscopy is stagnant for diagnostics, as well as for visualization of the appendix. With this method, the doctor has the ability to report back to the internal organs, as if it were due to the fact that he was ignorant.

Laparoscopy does not quite allow for diagnostics and surgery, soon an hour for the appearance of appendicitis.

Perevagi and shortcomings of the given method

Laparoscopia has a number of perevag before the traditional operation:

• reabilitation of a loan in less than an hour;
• less waste of fabric, less for empty operations;
• natural scars (small, uncomfortable);
• more information about the renewal of registration;
• the patient sees less pain, it’s faster to go through the operation;
• the intestinal robot is more efficient;
• Decrease in risiku;
• fast term transfer to stationary.

Є the method and the negative side. In the main, the difficulties in robotics are:

• to speak with gibini;
• little time to manage tools;
• dull tactile vision;
• folding control over tools and hands;
• There is a number of absolute and definite contraindications.

What is the use of laparoscopy itself?

The Danish method is widely popular when performing gynecological operations. Likewise, if you need more manipulation in the abdomen.

Laparoscopy is carried out in offensive situations:

• gostry appendicitis;
• chronic form of illness with severely swiveling symptomatology and severe pain.

As soon as it was burnt up, peritonitis or abscess, then an empty operation is shown.

Who is laparoscopy indicated for?

Seeing a small group of patients, which is more beautiful than seeing the appendix using the laparoscopic method:

• if at diagnosis it is not clear, the appendicitis is tse or inshe become ill; when the diagnosis of laparoscopy becomes lykuvalnoy;
• as a woman in maybutnyy get up to vagitnitis and peoplezhuvati children;
• in case of deyakykh supporters who have become ill, how to promote the development of rapid development (suppuration, approval of adhesions and in.), for example, to a diabetic or obese;
• children, so how to lower the risik, show the spike;
• bazhannya of the ailing one has great gross scars (only when the prototype is shown).

Yak pidgotuvatisya before the operation

You can see the worm-like outgrowth of the slit intestine to be brought in the termine order. At the patient's and at least one hour. Preparation before the loan operation is 2-3 years.

Before the appendectomy, you will have to go through the deyaki of cleaning: ultrasonic examination of the black emptying, zagalny analiz blood and blood, reaction to IL, SNID, hepatitis. If necessary, check the EHC.

It is possible to add additional laboratory data in the fallowing area as indicated.

If you reject the results and analyzes, diagnostics clarified Given during the year at the surgery, the patient will fix the gotuwati before the operation. At the end of the day it is close to 2 years. For a whole hour, they prepare an operation, patients inject antibiotics, zaspokіylivі and zanuryuyut in zalny anesthesia.

Then, in the navel area, to control small growth and through the head, they live in carbon dioxide gas. The price is necessary in order for the likar zmig to display internal organizations And also not having spent an hour of manipulation of the empty waste.

Surgery to carry out a survey and take a residual decision about the possibility of a laparoscopic examination.

An operation is carried out

The most visible of appendicitis is the laparoscopic method of borrowing from 30 hvili until decilkoh years. All to lay down all the way to the patient and to get over the ailments.

When carrying out laparoscopic vikoristovuyut zagalny anesthesia, t. K. At the same time it is possible to enter speech, which will relax the mucus. Mistsev anesthesia should be stashed only if there is evidence of a contraindication to the outside.

Before the hour of the operation, the ailments lie on their backs, and they wake up at the same time. For rakhunok tsih natural rank tidy up intestinal loops and omentum, lodged access to the appendix.

Shkira is covered with an antiseptic zasob.

For the navel to slow down a small amount, through a new injection of carbon dioxide gas into the abdomen. It is possible to introduce 1 trocar through the same opening - a special surgical instrument, through which the empty space is passed through, while ensuring air tightness.

Behind the additional trocar, we carry out developmental manipulation of empty spaces without breaking the tightness.

Let us slow down more stress in the left club area, for example, below the navel in the middle. Introduce 2 trocar for laparoscope through the end of the opening. After 2 cichs, you can open the opening in detail, you can see the shape and size of the worm-like outgrowth.

For a total of 3 cuts and 3 trocar to be inserted. The appearance of the appendix is ​​atypical, for the presence of pereshkodi (for example, adhesions), maybe 4 trocars. Do not be afraid of any great coarse problems. Open the trocars to make more punctures.

If a contraindication was not revealed before the laparoscopy, then proceed to the operation. Sphatku appendix fix. Then we can shrug off a little stress, through which to impose a ligature. After 1.5 cm, apply 2 ligature. Among them, the surgeon grows into a growth and a neatly knight, does not consume any internal organizations.

Suturing of the slit intestine is carried out. The laparoscopic operation is completed with a control examination of the emptying and sanitation. I sew all the bleeding. Yaksho є gniy, there were some signs of acceleration, then drainage should be carried out.

You can get faster and more legacy

In the course of the operation, you can get lost, but through the earlier surgical interventions, the adhesions were detected. The process of advancing the processing of the organs of the second half of the hour of laparoscopy.

As soon as the appendectomy was carried out correctly, then the risk of the appointment was minimal. Smells come through the heavy interruption of the appendicitis, the backward rotten camp of the patient, the obviousness of the fellow sickness, the mercy of the hirurg.

In general, the development of the development of the laparotomy is accelerated to a lower degree than in the case of traditional apendectomy. For a decrease in їх ymovіrnostі you can use a bandage.

The following problems are encountered in children of small families:

• bleeding in the abdomen;
• development of peritonitis;
• the appearance of adhesions;
• development of abscesses;
• gostry tiflit;
• hypotonia;
• shedding grizzlies on the front end of the black empty;
• development of secondary infection.

Who is laparoscopy recommended for?

Vaughn is becoming more and more popular and in some cases it is possible to use the most beautiful method of visualization of the appendix. However, there are a number of vipadk_v, if it is not promptly involved, it is unfortunate or not.

Absolutely contraindicated:

• 3 trimester of vaginosti;
• cellulite phlegmon;
• intolerance to anesthesia;
• filthy blood loss;
• infiltrate;
• the appendix is ​​not fired up, the classic picture is even better.

Typical indications:

Operation update

The renewal period for laparoscopy takes only an hour. The period of repeated physical activity is interconnected by several years. On the coming day, the patient is already allowed to get up from the bed and get too tired, for example, independently go to the office, to get rid of the dressing.

It’s not a matter of being overwhelmed by zahoplyuvatisya: give the body more new options can only be in 2 months, if the intestines are healed. Especially suvorі obmezhennya on the transfer of important objects.

In the first place, there may be more pain in the laparoscopy in the area of ​​punctures and seams. That patient will be given anesthetics.

Carry out the sewing in 7-10 days. Cheating in the polyclinic or in the case of the operation was carried out. Bagatyokh turbu, chi is sick more znimati shvi. Given that the stink is small, the procedure is practically inconvenient.

You can pick up self-dissolving threads. Todi know Shvi will not happen.

How can you write an operation? In the first place, I will give a laparoscopic laparoscopy for the ailing one to go to the main drinking and drinking day. At the beginning of the day, sparing food is shown. However, literally through the day you can go to the menu.

Ale tse is not addicted to alcohol! You can live alcoholic drinks not earlier than in 1.5-2 months after the apendectomy. Fix it more beautifully with easy drinks in small numbers, For example, 100 ml of red wine for the first one will be finished once. Alcohol is guilty but yakisnim.

How to speed up the update process

pomirnі physical options stimulate wear. Smell є prophylactic development of accelerated period of operation.

The patient will gladden the growth of the first crocus after the laparoscopic laparoscopy. On the coming day, Rukhov's activity expands, it is possible to take small walks. Proceedings are required to pay for the delivery.

Increase the organism will be updated only in 2 months. During the period, it will be necessary for those who have healed cicatrices, and have lost the appearance of a visible appendix.

The stench didn’t come out, it’s necessary to settle down in order to pick up important objects and go to the right, to move the internal vise. To such a kind of action, you can turn only when passing through the main course of rehabilitation.

If the robot is not in the middle of the great physical zusil, then the ailment can begin to it in 1-2 days.

Virizannya to appendicitis is an extraordinary operation. Vaughn is one of the hired ones, in any case not in general. The idea is that the people are not proud of them.

In order to drive a state of the art appendicitis, we operated on a laparoscopic method 124 patients from 15 to 78 years (middle age 31.3 years). Over 50 years of age, there are 12 children, over 60 years of age - 4. The main percentage of women and men is 50 and 50%. From the term up to 6 years old, 29 (23.3%) patients were hospitalized, from 7 to 12 years old - 33 (26.7%), from 13 to 24 years old - 31 (25%), from 25 to 48 years old - 24 (19.1%), more than 48 hours - 7 (5.9%). In 76% of patients, the diagnosis with appropriate "gostry appendicitis" was diagnosed. The middle hour from the moment of hopefulness before the operation was laid 4 hours 53 minutes.

42 (34%) patients were obese in I-III stages, in 4 patients had diabetes, in 8 patients with diagnoses of buli had ischemic ailment of the heart, angina pectoris, hypertensive ailment. In the middle of the operated boules, 2 women with a visit of 14 and 16 years.

The temperature at the beginning of the hour was lower than 37 ° С in 36 (29%) patients, in the interval 37-38 ° С - in 84 (68%), 38 ° С in 4 (3%).

s methods laboratory diagnostics in a large number of leukocytes in the blood. It was lower than 910 / l in 12 (10%) patients, in the interval (9-15) 10 / l in 88 (71%), 1510 / l in 24 (19%).

The triviality of operations ranged from 8 to 95 min (in the middle 35.1 min).

All patients were operated for the drive of destructive appendicitis: 6 - gangrenous-perforating, 4 - gangrenous, 2 - the pace of the appendix, іnshі - for the drive of phlegmonous appendicitis.

Fakhivtsi went to the first laparoscopic apendectomy (in 1992 r) through a trivial period of diagnostics of laparoscopy in case of a "grievous stomach". In 1988, 71 laparoscopic diagnostics were carried out, in 1989 - 265, in 1990 - 350. In the world, there has been a widening of laparoscopy, decreasing the pitoma of the catarrhal appendicectomy. In 1988, the appendicectomy with the drive of catarrhal appendicitis was found in 24% of cases, in 1989 it was 19%, in 1990 it was 14%. In the rest of the rockets, the increase rate is up to 3-4%. It is important to look at the fact that it is important to look at the fact that the very appendectomy itself will pull the most number of problems.

At the same time, they began to use the same methodology, which can be called "laparoscopically assisted apendectomy". The essence of її is in the offensive. When laparoskopії vstanovlyuєtsya dіagnoz GOSTR destructive apenditsita, otsіnyuyutsya peredbachuvanі operatsіynі minds (peredayutsya statevim perіprotsessa, ruhlivіst brizhі chervopodіbnogo vіdrostka, virazhenіst i poshirenіst destruktsії) viznachaєtsya proektsіya pіdstavi apendiks on front cherevnu stіnku, pіslya chogo robitsya mіnіmalny for dermal particular vipadku rozrіz in cross napryamku. In not huge patients with apparently "poor" appendicitis, the operation was carried out with a small size of 2.5 cm. The lateral growth at a small size made it possible to trim even a good cosmetic result.

In Danish hour, at the surgeons, there was a set-up to the laparoscopic appendicectomy as before the rivnosic alternative to the open surgery in case of a state of emergency. Laparoscopic way to visually close 30% of the appendix.

The vibration of the laparoscopic version of the appendectomy is based on the adherence to the surgeon's access, and in some cases to the patient's needs. Naybilsh is shown to be involved in laparoscopic appendectomy for patients with obesity, childhood diabetes, and vagina.

All surgeries are subject to oral anesthesia from tracheal intubation and to the introduction of muscle relaxants. Several surgeries performed during internal anesthesia have shown that there is a lot of relaxation and rapid laparoscopic manipulation.

Absolute contraindications to laparoscopic apendectomy є absolute contraindications to zagalny anesthesia. At the same hour it is possible to let it go, but in some situations epidural anesthesia will be effective, however, the price has not been confirmed by the doctors.

General indications prior to laparoscopic apendectomy є:

destruction of the appendix;

poured peritonitis.

Laparoscopic apendectomy is shown either for the presence of an accurate diagnosis of a gastric appendicitis, or for a diagnostic laparoscopy. In the end, the diagnostic stage is carried out under the microscope anesthesia. Saved contact and great mobility of the patient on the operating table for medical anesthesia to undergo diagnostics. A laparoscope with a diameter of 5 mm is inserted through the opening into the navel. When installed, the indication before the operation and the transition to postal anesthesia, a 5-mm trocar is replaced by a 10-mm trocar. In general, the technology is identical.

The operational style is shifted to the Trendelenburg position with a slight left turn for a short visualization of the right club hole and small pelvis. The monitor roztashovuutsya at the foot end of the table from the right side, the operator is in the right direction, the assistant is on the right. In most of the functions of the assistant, the vicon has a sister.

Instrumental trocari is inserted above the pubis (12 mm) and along the midclavicular line on the right, 4-5 cm below the costal arch (5 mm). The suprapubic vikoristovuyutsya for the introduction of working instruments with a diameter of 5, 10 and 12 mm, as well as for the removal of the drug. The ribbed trocar vikoristovuєtsya for the introduction of the Asistyuchy instrument - atraumatic blockage. Take the roztashuvannya trocars maє perevagi:

the best for the size of the wound appears in a cosmetically larger position;

the working tool goes to the slips of the intestine from the bottom, from the side of the breech of the appendix, which lays down the mobilization of the rest.

It’s a common shortage of those who surgeried the temptations with the head of the rank with the left hand. It’s hard for a right-handed surgeon to have a hard time, you can get a good start: when you’ve seen the most laborious stages of an operation, a laparoscope and a working tool can be used with a mouse, so that a laparoscope is done with a rosette. Zberigayuchi pererakhovani vishche perevagi, with a simple reception, allowing more part of an hour of operation with the right hand.

For vivedennya of the appendix in the field of view, like a working tool, an atraumatic jam is applied. A hand 10-millimeter instrument of the Babcock type for the removal of adherent loops of the intestine and the great omentum. Viveniy the appendix is ​​a thirsty instrument for a breech or for stress relief. If necessary, use a knife to enlarge the dissector. With a lot of coagulation, vicorization is minimal. With the presence of "old men" of vascularized growth, titanium clips will be applied.

Peretin mesoappandix.

At 89 operations for the repetition of the mesoappendix, the electrocoagulation was performed (at 10, it was monopolar, at 79, it was bipolar), at 5 operations - the endostepler STA-30, at 20 - the application of titanium clamps (in 14 types of additional methods) with 24 operations - "manual" stitching.

An excellent way of mobilization of the appendix is ​​to repetitively use an endostepler. However, it’s easy to get into the connection with the head and one short-cut - the high quality of the one-time vikorystannya tool.

On the edge of the court, especially close intestinal symptoms, It is important to impose titanium klipsi.

appendectomy

In the course of the pre-session an apendectomy was performed in three ways:

ligaturnim (96 operations);

grouted (8);

aparatnim (28).

Ligaturny method is used in most cases. At the front of the appendix, two catgutovies of the endopetl are applied with a tied university across Loebet. Sensation of imposition of other ligature - adjustment of hopes. The third ligature is applied to the appendix, having advanced 8-10 mm from the first two. The appendix is ​​located in the middle with knives, with a slightly more targeted coagulation of mucous kuksi.

Immersion method of polyagaє in preadatkovom overlay purse-string seam. It’s hard-working and it’s stagnant to get there by the way through the outskirts of the hundreds of passes in front of the logistic ones.

Completed operation. Rinse the malium pelvis to "clean water". Drain the empty kernels. Shown before draining black emptying is not seen as such during an open appendage. For larger operations, drainage is not required. Shkіrnі shvi are applied. Only for large diameter trocars (15 and 20 mm), it is necessary to apply ball sutures to the wound.

results

Switch to laparotomy... Two in the course of the last session the surgeons switched to laparotomy at the end of the visit to the clinics of the intraoperative expeditions. The offense is tricky, as it is reported before the period of mastering the technique, with a retrospective analysis of the boules, they are tied with incomplete equipment.

One of the patients, 23 years old, operated on for the drive of a severe phlegmonous appendicitis in 15 years from the moment of illness, with prolonged ligature on the inflated appendix became the first amputation. Bula underwent a McBurney laparotomy, purse-string and Z-padded sutures were applied. Pislyaoperats_ynyy interruption without delay In this hour, with the presence of twisting firing changes from the appendix, as has already been said, the endostepler is shown from the resection of the dome of the mucous intestine in the boundaries of healthy tissues.

Іnshy patient, 68 years old, who is suffering for obesity, ischemic sickness of the heart, for hypertensive ailments, Buv operations with the drive of gangrenous appendicitis in 16 years from the moment of becoming ill (after 2 years of going to the hospital). The monopolar coagulation was stagnant, it was not necessary to hemostasis on the embankment of the appendix. Trivial bleeding stifled the transition to the test method. A low-medium laparotomy was performed. The bleeding is zupinena to the stitching of the brigi, the drainage of the drainage through the additional growth in the right club area. Pislyoperatsіyny interruption accelerated the form of abscess of black emptying in the right club yamtsі, so relaparotomy squeezed on the 5th additional release of the first operation. Patient oduzhav, vipisaniy on the 25th dobu.

There was no fatal outcome. In 9 (7.3%) patients, there was an acceleration of surgery. In 3 (2.4%) cases, the infection accelerated from the side of the wound, through the yak, the drug was injected. In all 3 vipads, the appendix does not extend into the skin without contact with the tissues of the cranial wall, but it must be respected with a rough technical pardon. In 6 (4.8%) patients in the period of the operative period, an abscess of a void was formed. Coagulation was observed in all of them for the retinus of the mesoappendix. Abscess in all 6 ailments was localized in the zone of coagulation scab of the appendix. The lack of assistance of the kuksi appendix of the surgeon did not mean it. The analysis showed that the frequency of abscess formation after coagulation of the appendix was 6.7%.

Having crossed over, so that they are rendered literary, it is possible to come to a notice about the inadmissibility of storing coagulation of a significant array of fabrics in the presence of the presence of a rotten blaze. After seeing the closure of the coagulation, with the remaining 24 operations with the stitching of the mesoappndix, the fahivts did not slow down.

For 6 patients with surgical abscesses of black emptying, 2 boules were operated in an open manner, and 4 patients were operated laparoscopically for abscesses.

The average triviality of a patient's transfer to a stationary took 4.37 days (from 1 to 25 days). As soon as you get better results, then the indicator will last for 3.55 days. The triviality of the operational transfer to the slope took 4.16 and 3.33 days.

Patients do not require the use of narcotic analgesics. typical pain syndrome if pneumoperitoneum was easily stopped with analgin.

Negotiation

Before the short laparoscopic apendectomy, there was a lot of work in the main possession of that vitrailous materials, especially in the case of the operative team, the need for stagnation of traumatic anesthesia for the intubation

Head crossings of the center of operations for the reduction of traumatization of the cartilage; making the contact of the information material with the tissue of the warty wall and by ourselves bringing up to the minimum the risk of early delay; Possibility of a new revision of black emptying; Possibility of obmezhitsya diagnostics laparoscopy or other laparoscopic examination is shown. The value of such gallant houses of laparoscopic surgery, as a shorter tolerance of the operation by patients, a greater speed of turning to normal living efficiency, a high cosmetic result, in contrast to laparoscopic apendectomy.

»Placed approximately tenth of a skin person. One of the problems of this pathology in the diagnosis and ineffectiveness of the sinus apendectomy. I did not have an operation at all, it could lead to serious acceleration in the period of operation. Among the negative inheritances of the traditional appedectomies, it is necessary to mean adhesions of intestinal obstruction, problems with unpleasantness and grids. The laparoscopic method of pre-examination gives the possibility of more accurate diagnostics of appendicitis with further effective operations.

special features of the procedure

When carrying out a laparoscopic apendectomy of a sick person, place the patient in the Trendelenburg position in a thirty-degree position, so that you set the optimal mind for surgical engagement.

Hirurgical gallant anesthesia... Infrastructure access to the empty passage is provided with a twelve-millimeter trocar due to the availability of open or closed technology. As a rule, Veresh's goalkeeper is victorious. The instrument should be introduced through the arc opening in the area above the navel. For retinal examination of the appendix and adjacent organs, an additional p'yatymilimetric trocar is inserted, and a puncture on the left side is inserted. When the scrap is found in the black empty, it will be removed. More than one ten-millimeter instrument should be administered in the right mesogastric region. In some cases, there may be a quarter trocar, which is passed over the pubis. In case of severe appendicitis, it is indicated that antibiotics are taken before and after the operation.

The process of completing the stage of diagnostics for additional laparoscopy begins with the volume of surgical involvement. It is necessary to note that the worm-like sprout can easily collapse behind an auxiliary tool and change its shape. Fundamentally important is the method of processing the kuksi of a given outgrowth. In the given hour, there will be a number of ways to display laparoscopic apendectomy: extracorporeal, intracorporeal and combinations.

With the extracorporeal method, the diagnosis is clarified for additional instrumental follow-up, for which the surgeon is able to diagnose and fix the growth for an additional blockage. Writing the entire appendix at once from a duplicate of the queue will be called. The tradition of appendectomy with the overlays of the chain sewing machines is being created. Zayva Ridina is seen from the black empties. The method is fixed in the case of a mucous membrane and a small diameter of the worm-like outgrowth. Daniy can be recommended for those who want to learn laparoscopic technology.

Combinations pidhid vikoristovyutsya in the times of a short infiltrated brigade, as coagulation in the middle. Ruchomy appendix grows and grows in the traditional way. With the intracorporeal method, all manipulation is performed laparoscopically through punctures in the black empty space. Most of the extensions to the operation methods.

Details of the laparoscopic apendectomy and

The distant end of the worm-like outgrowth is fixed by a grip, which is introduced through the opening of the third trocar. Kinets goes straight to the front end of the black light. The appendix is ​​relieved from growth and adhesions, for which one is organized in such a rank, the brigi appeared at the frontal area.

A duplicate of a queue can be rewound in a decilcom in the following ways:

• through the opening of another trocar, a monopolar electro-surgical plug is introduced. Let the fabric of the breeches be consumed in portions of two millimeters at a time. The breeches are coagulated right up to the base of the worm-like outgrowth. When carrying out the procedure, the strict sequence of the manipulations is observed. A small amount of tissue can be swallowed with an instrument, introduced from the intestine and then coagulated. It is necessary to stitch for the closeness of the intestinal loops to the instrument. The technique is given to lead to simplicity and to the preservation of a superior homeostasis during the operation;
• Storing bipolar coagulation for processing the duplicate of boryushin. The whole technology is safe, but it is not necessary to use a special tool and the operation takes more than an hour;
• the breech can be bandaged with a ligature. For a whole worm-like outgrowth in the production of a worm-like outgrowth, the additive is introduced through it. The offense of the thread will be called through the trocar. The moldings of the vuzol should be lowered into the empty chapel. Duplicate the queue to be shaken with knives. Victory of titanium clips is not recommended in case of unreliability;
• The breeches can be rewound with a stapler. Kuksa appendix is ​​molded in a ligature way. However, the first one is more effective. For that, as a duplicate, the endoplate is inserted through the opening of the third trocar through the opening of the third trocar; Then the loop is tightened, and the thread is visible. As a rule, there are two ligatures on the cult, as one is imposed on the one.

period of operation

After the completion of the operation, the area of ​​the surgical procedure should be rinsed with soil antiseptic in the total of five hundred mil. Ailments move into a wired position. Promyvna ridina seen. Wounds are sewn up, a drainage tube is inserted into the empty hole.

Pislyoperatsіyny period pass more easily, less at the bottom of the classic appendectomy. The first time of life in the native viglyad is allowed for twenty years from the moment of the drainage. The reabilitation period is indicated by the intake of antibiotics. The hospitalization of the operation takes up to seven days. When outside, the accelerated term becomes two terms.

Naybіlsh іmovіrnyh accelerated writing for operations єinfections fired. Rizik of such an accelerated dressing with the method of forcing a sprout from a worm. Infection can occur through the wrong drainage of black emptying or the devastation of industrial development. However, the decay of the laparoscopic apendectomy fizzles out more and more in the past, less than the traditional surgical involvement. Gostry appendicitis was given for this procedure.