Research Article
Volume 8 Issue 1 - 2021
The Role of Endovideosurgical Interventions in Correcting Intra-Abdominal Hypertension Syndrome in Patients with Severe Acute Pancreatitis
BM Belik1*, R Sh Tenchurin1,2, GM Chirkinyan1 and DV Mareev2
1Department of General Surgery, State Budgetary Educational Institution of Higher Professional Education Rostov State Medical University of the Ministry of Health of the Russian Federation, Rostov-on-Don, Russia
2Surgical Department №2, MBUZ “City Hospital №1 Named After N.A. Semashko “Ministry of Health of the Russian Federation, Rostov-on-Don, Russia
*Corresponding Author: BM Belik, Head of the Department of General Surgery, State Budgetary Educational Institution of Higher Professional Education Rostov State Medical University of the Ministry of Health of the Russian Federation, Rostov-on-Don, Russia.
Received: August 10, 2020; Published: December 10, 2020




Abstract

Introduction and Purpose of the Study: One of the leading pathogenetic mechanisms that complicate the course of acute pancreatitis (OP) is intra-abdominal hypertension (IHD) syndrome, which contributes to the development and progression of early organ dysfunctions in patients. At the same time, the possibilities of endovideosurgical interventions (EVHI) in the correction of IHD syndrome in the early phase of severe OP remain not fully understood, which greatly complicates the choice of the most rational surgical tactics. The aim of the present study is to assess the role and significance of EVHV in the correction of IHD syndrome in patients with severe AP.

Materials and Methods: The analysis of the results of examination and treatment of 65 patients with severe acute AP with IHD syndrome was carried out. All patients were divided into four groups depending on the severity of AP and the severity of organ dysfunctions. In addition to generally accepted studies, intra-abdominal pressure (IAP) was monitored and the severity of the condition was assessed according to the APACHE II scale within 1-7 days from the onset of the disease. Sixty-one patients underwent EVHV and 4 patients underwent wide laparotomy.

Results: It has been established that in patients with severe AP, the main predictor of persistent IHD and early organ failure is widespread retroperitonecrosis (RN). In 33 patients with OP with transient organ dysfunction and/or functional insufficiency of one organ, video laparoscopic sanitation (VLS) of the abdominal cavity was performed. Of 32 patients with AP with functional insufficiency of two or more organs, in 28 patients, VLS of the abdominal cavity was supplemented by laparoscopic decompression of the retroperitoneal tissue (PCA) by wide dissection of the peritoneum in the ROP zones. Of these patients, 8 (28.6%) in connection with the persistence of IHD in the future additionally required decompression interventions on the anterior abdominal wall by means of mini-laparotomy with the imposition of pancreatomomentoburstomy. Decompression laparotomy and nasointestinal intubation of the intestine were initially performed in 4 patients with severe AP with grade 4 IHD due to ineffectiveness of IHD correction by means of EVHV. Of 61 patients with severe AP, who underwent EVHV during the first 3 days from the onset of the disease, 46 (75.4%) achieved a positive clinical effect, manifested by a decrease in the IAP level and the APACHE II scale indicators. Out of 65 patients with severe AP, death occurred in 17 (26.1%). Within 14 days from the onset of the disease in patients with severe OP with grade 1 IHD, the lethality was 4.5%, with grade 2 IHD - 20.0%, with grade 3 IHD - 57.1%, with IVH grade 4 - 75.0%.

Conclusion: Persistent IHD, combined with organ failure and widespread ROP, is an absolute indication for early decompression interventions on the PBC and the abdominal wall in patients with severe AP. In the majority of patients with severe AP, early sanitation and decompression EVHV, supplemented, if necessary, with mini-laparotomy and decompression pancreatomomentobursostomy, is a fairly effective method of surgical correction of IHH and underestimation of the severity of organ dysfunctions. In patients with severe AP with grade 4 IHD, due to the insufficient effectiveness of the correction of IHV by means of EVHI, it is necessary to initially resort to early decompression laparotomy and nasointestinal intestinal intubation.

Keywords: Severe Acute Pancreatitis; Intra-Abdominal Hypertension; Retroperitonecrosis; Endovideosurgical Interventions

Citation: BM Belik., et al. “The Role of Endovideosurgical Interventions in Correcting Intra-Abdominal Hypertension Syndrome in Patients with Severe Acute Pancreatitis”. EC Gastroenterology and Digestive System 8.1 (2021): 11-15.

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