[Diagnosis and treatment of post-operative peritonitis and intra-abdominal abscess].

Early diagnosis of post-operative infectious complications was established based on semiotic evaluation, SAPS-based analysis of severity of the disease, and results of ultrasound studies. SAPS analysis of functional disorders proved a reliable tool for diagnosis of peritonitis but less accurate for diagnosis of intra-abdominal abscess. Ultrasound revealed meaningful symptoms of infectious complications, such as the presence of free and confined fluids in the abdominal cavity, increased small intestine diameter, disturbed peristalsis.

[Surgical aspects of the treatment of generalized peritonitis].

Advantages and disadvantages of different methods of surgery termination at generalized peritonitis are discussed. Drainage of abdominal cavity can not guarantee adequate sanation. Disadvantages of peritoneal lavage exceed the clinical value of this method.

[Diagnosis and treatment of postoperative intraabdominal complications].

Postoperative complications after 8168 reoperations were seen in 143 (1.8%) patients. Clinical symptoms, laboratory tests, results of x-ray and ultrasound examinations were taken into account in diagnosis of the complications.

[Postoperative complications in patients with peritonitis].

One thousand three hundred and ten patients with peritonitis have undergone surgery: local limited peritonitis was in 230 patients, local unlimited--in 342, general--in 738 patients. After surgery suppuration of the wound was seen in 92 (7.1%) patients, phlegmons of the abdominal wall--in 16 (1.

[Complications of laparascopic cholecystectomy].

1389 laparoscopic operations were fulfilled for chronic and acute cholecystitis. In 41 patients (3%) it was necessary to pass on to laparotomy. Injury of hepaticocholedochus was made in 6 patients (0.

[Intraabdominal cholerrhea after cholecystectomy].

Cholecystectomy (CE) was performed in 2303 patients with cholelithiasis and its complications. Cholerrhea (CR) after operation was in 31 (1.34%) patients: after laparoscopic CE (1425 patients)--in 18 (1.

[Results and prospects of treatment of general forms of peritonitis].

956 patients with general peritonitis were operated: 596 patients--for diffuse peritonitis, 360--for general peritonitis. The causes of peritonitis were: perforating gastroduodenal ulcers (454), acute destructive appendicitis (190), acute destructive cholecystitis (82), perforation of small intestine and colon (96), postoperative peritonitis (80), other diseases (54). In low degree of bacterial contamination of abdominal cavity (not more Ig 5 CFU/g) operations were completed without abdominal drainage, laparoscopic variant of the operation being optimal.

[Can perforated ulcer be not sutured?].

Experiments in 5 pigs and 18 mongrel dogs have shown the possibility to close perforating ulcers with plates of biopolymer "Tachocomb". The method is proposed as an alternative to suturing perforations in the zone of pylorus in order to prevent stenosis of the pyloric part of the stomach. The experimental data obtained have confirmed good adhesive and stimulating properties of the fibrin-collagen substance.

[Laparoscopy in the diagnosis of acute appendicitis].

The results of diagnosis of acute appendicitis (AA) were retrospectively analyzed in 2403 patients, in 336 of them diagnostic laparoscopy (DLS) was performed. Acute appendicitis was diagnosed in 132 (39.3%) patients, other surgical diseases were found in 102 (20.

[Mode of surgery completion in peritonitis].

1310 patients with various forms of peritonitis were operated during 1989-1998. The tactics of the treatment was determined depending on bacterial contamination of the abdominal cavity. In abscesses of the abdominal cavity with massive bacterial contamination (6-7 CFU/g) drainage procedure was used.

[Laparoscopic operations in emergency surgery].

582 laparoscopic operations for various urgent diseases of the organs of abdominal cavity were made. 190 of them were performed for acute appendicitis, 266--for acute cholecystitis and its complications, 33--for pancreonecrosis, 39--for perforated gastro-duodenal ulcers, 32--for acute bowel obstruction and 22--for other pathological conditions. The necessity of conversion to conventional open surgery has arose in 41 (7.

[Technical aspects of nasointestinal intubation].

According to the authors' opinion nasointestinal intubation have some advantages over "open" methods of decompression of the small bowel in paralytic intestinal obstruction resulted from peritonitis and mechanical obstruction of the small bowel. The authors' experience with more than 500 their own cases indicates, that application of nasointestinal intubation is not only necessary, but safe as well if keeping strictly to the established technique. Technical aspects of the method, possible errors which could occur during the performance of nasointestinal intubation and introduction of the probe are described.

[Laparoscopy in perforated gastroduodenal ulcers].

The authors have performed operations on 32 patients with perforated ulcers of the duodenum and 7 patients with perforated ulcers of the stomach. The diameter of the perforations was 2-8 mm. In 10 of the 39 patients the perforation defects could not be sutured by the laparoscopic method.

[The efficacy of different antimicrobial preparations in treating patients with disseminated peritonitis].

The results of our investigations revealed that in 68% of cases the treatment of patients with diffuse peritonitis with ampiox, gentamicin and metronidazole led to arresting the infectious process and to a considerable decrease in microbial contamination of the abdominal cavity. The use of cephalosporins and metronidazole proved to be effective in 85% of cases. In this treatment a considerable decrease in the amount of aerobic and anaerobic bacteria in peritoneal exudate was registered.

[The microflora of the peritoneal exudate in patients with disseminated peritonitis].

In 11 patients with diffuse peritonitis and 39 patients with general peritonitis the microflora of peritoneal exudate and the sensitivity of isolated microorganisms to antimicrobial preparations were studied. The study revealed that in the total number of microorganisms isolated from peritoneal exudate enterobacteria prevailed in patients with diffuse peritonitis and bacteroids, in patients with general peritonitis. Enterobacteria were most sensitive to ciprofloxacin and claforan, while bacteroids, to ciprofloxacin; at the same time 15.

[Chemical mucolysis and obliteration of the gallbladder lumen in high surgical risk patients (experimental study)].

A method for obliteration of the gallbladder, based on its mucoclasis with phenol preparations, was developed in experiments on unbred dogs. The safety of using preparations based on phenol for chemical demucosation of the gallbladder is demonstrated. The suggested method may serve as a prototype for the development of similar interventions in clinical practice in acute cholecystitis and cholelithiasis after endoscopic cholecystostomy and cholecystolithoextraction.

[The effect of different antimicrobial preparations on the normalization of the intestinal microflora in patients with disseminated peritonitis].

These investigations revealed that the treatment of patients with generalized peritonitis with ampiox, gentamicin and metronidazole, as well as with cephalosporins and metronidazole, led to the aggravation of dysbiotic disturbances in normal intestinal microflora, observed in these patients before treatment. Ciprofloxacin had a selective decontaminating effect on the intestine, which facilitated the decrease of suppuration in postoperative wounds.

[Ciprofloxacin and other antimicrobial drugs in the treatment of disseminated peritonitis].

Forty two patients with general peritonitis were treated with ciprofloxacin and combinations of various antimicrobial drugs. Ciprofloxacin had the highest effect on aerobic and anaerobic microbes in the peritoneal cavity which defined the favourable clinical results in all the patients. Moreover, there were observed no disorders in the composition of the normal intestinal microflora which in the end promoted a decrease in the number of the patients with suppuration of the surgical wound.

[Treatment of peritonitis of appendicular etiology].

The authors had 475 patients with appendicular peritonitis under observation. All of them underwent emergency operation and were given antibacterial therapy with metronidazole and agents of the aminoglycoside series. Among 223 patients, the operation on whom was completed by traditional drainage of the abdominal cavity and complete closure of the operative wound, 148 patients developed postoperative complications.

[Characteristics of the course of peritonitis in relation to the degree of perforation of the gastrointestinal tract].

An examination and treatment of 80 patients with general forms of peritonitis has shown that the course of the disease is greatly dependent on the character of the bacterial dissemination of the abdominal cavity. A microbiological examination has shown that in all the levels of perforation of the gastro-intestinal tract there are associations of various microorganisms. The most severe course of peritonitis is observed when caused by infection by colonic contents with prevailing anaerobic ++non-clostridial microflora in the exudate.