Osmanov R. Surgical tactics and management of patients with duodenal and high intestinal fistulas

The object of research: The duodenal and high intestinal fistulas. The purpose of study: The purpose of thesis was to develop optimal surgical tactics and conservative treatment methods of the patients with duodenal and high intestinal fistulas. Methods of research: The standard clinical methods of definition of common analysises of blood and urine, biochemical analysis of blood and urea, a level of an excrecshin of Na+ and K+ in urine were used. The complex of tool examination of duodenal and high intestinal fistulas, endoscopy and X - ray methods. Practical significance: clinical and morphological criteria of evaluation of tissue condition in the area of fistula defect were worked out that allow wide usage of modern conservative and minimally invasive methods of treatment directed on reduction and prevention of losses of intestinal contents. New models (confirmed by patents of Ukraine) of high fistula obturators allowing reliable closure of fistula for a long period were worked out. Introduction of proposed algorithm of surgical tactics allow in due time usage of adequate individualized treatment and thus to decrease quantity of urgent interventions. Number of instrumental and surgical interventions was proposed, terms of usage of conservative and operative treatment of patients with duodenal and high small bowel fistulas were substantiated. Scientific novelty: clinical classification of duodenal and high small bowel fistulas was proposed, that is the basis of choice of treatment and type of surgery. Main directions of conservative measures were worked out and introduced into practice, indications for them were defined. As a result of conducted research diagnostic and treatment algorithm for patients with duodenal and high small bowel fistulas was proposed for the first time. Dependence of the choice of type of surgery from the time of existence and localization of fistula was showed. Original method of duodenal diverticulization in fistulas locating in major duodenal papilla area was worked out (proposal for invention N 222005). Based on ultrastructure of intestinal wall in area of fistular defects for the first time were proposed obturators of various types, novelty of which was confirmed by patents of Ukraine (“Obturator with carving fixing element” – Patent of Ukraine N 59304A and “Obturator with inflated intraintestinal element” – Patent of Ukraine N 51428A). Introduction: Results of the study were introduced into the practice of department of urgent surgery of organs of abdominal cavity of Institute of General and Urgent Surgery of AMS of Ukraine, surgical departments of 2th, 4th, 17th and 26th city clinical hospitals of Kharkiv city. Basic conclusions of conducted research are used during seminars in the department of hospital surgery of Kharkiv state medical university. Sphere of application: medicine, surgery.