Mischenko N. Substantiation of the role and place of laparoscopy in diagnosis and treatment of acute surgical diseases and traumas of the abdomen.

Object of the study: .Patients with acute surgical diseases and injuries of the abdomen who were performed diagnostic laparoscopy and laparoscopic surgery for acute appendicitis, acute cholecystitis, acute pancreatitis, intestinal ileus and adhesions. Purpose of the study: To improve the results of diagnosis and treatment of acute surgical abdominal diseases and injuries by working out an algorithm of diagnostic and therapeutic laparoscopy in urgent surgery. Methods of the study: Clinical, laboratory and radiation methods. Flexible endoscopy (esophagogastroduodenoscopy, colonoscopy). Objective evaluation of diagnostic laparoscopy was done according to sensitivity and efficacy parameters. Control-dynamic and therapeutic laparoscopy was recorded and evaluated with the use of videorecording. Statistical methods. Practical significance of the obtained results: The possibility to perform diagnostic and therapeutic laparoscopy under local anesthesia was proved, which expands the number of hospitals which canuse the method in their practical work. High informativity of laparoscopy in patients with combined abdominal and head injury in diagnosis of the first stage of two-stage spleen rupture, intraabdominal injuries in penetrating traumas expand the indications to diagnostic laparoscopy in case of trauma. The sug-gested cartridge for dynamic laparoscopy allows to perform repeated laparoscopy and intraabdominal injections of the drugs without repeated punctures, cuts, troachar laparocentesis. The worked out methods of treatment of the appendix ыегьз in laparoscopic appendectomy and the method of diagnosis of inflammatory diseases of the pancreas as well as the suggested devices for laparoscopy and suturing the wounds after introduction of the laparoscopic instruments expand the capabilities of diagnosis and improve the results of treatment in patients with acute surgical diseases and injuries of the abdomen. The developed algorithm can help to define the sequence of the traditional diagnostic techniques, the placeand role of diagnostic and therapeutic laparoscopy and laparotomy in diagnosis and treatment of acute surgical diseases and injuries of the abdomen. Novelty of the obtained results: For the first time, in contrast to syndrome-based classification, which determines a complex of signs characterizing the disease, semiotic classification, which allows to determine possible diseases and traumas basing on laparoscopic signs, was worked out. For the first time, objective comparative evaluation of sensitivity and efficacy of traditional methods of diagnosis and treatment laparoscopy in patients with acute surgical diseases and injuries of the abdomen was done. For the first time, the results of laparoscopic cholecystectomy allowed to revise the generally accepted in "open" surgery 72-hour limit of urgent surgery. For the first time, classification of variants of transition from laparoscopy to laparotomy was suggested with limited interpretation of conversion. For the first time, an algorithm which determines the roleand place of laparoscopy in the sequence of diagnostic and therapeutic measures in patients with acute abdominal diseases was suggested. Degree of introduction: The finding of the research are used in the work of surgery department of Odessa City Clinical Hospitals No. 1 and 11, Central Clinical Military Hospital of Southern Operative Command No. 411. Main ideas of the work are used in the teaching process at the department of surgery of Odessa State Medical University. Area of application: medicine, surgery.