Riga A. Management of postoperative intra-abdominal abscesses using mini-invasive technologies

The dissertation is devoted to the improvement of the results of surgical treatment of patients with postoperative abdominal abscesses due to the introduction of mini-invasive technologies. The clinical material is based on the health status of 93 patients. The complexity of clinical diagnosis of postoperative abscesses is demonstrated and the risk factors for their occurrence depending on the use of laparotomy access or the use of mini-invasive surgical treatment technologies are identified. The low informativeness of clinical blood analysis in the diagnosis of postoperative abscesses has been proved. The data of immunological depression in patients with postoperative abdominal abscesses have been clarified. Data on the relationship between pro- and anti-inflammatory cytokine response in postoperative abdominal abscesses have been established. Scientific data on the trajectories of changes in pro- and anti-inflammatory cytokine reactions in the perioperative period in the treatment of postoperative abscesses have been clarified. The leading causative agents of postoperative abscesses have been elucidated. The frequency of gram-negative antibacterial therapy-resistant flora has been determined. It is proved that the treatment of postoperative abdominal abscesses involves adequate control of the pathological focus (aspiration and drainage of the abscess) and early appointment of antibacterial therapy, taking into account the bacterial flora. The role of percutaneous puncture and percutaneous drainage under the control of ultrasound and laparoscopic drainage in the treatment of postoperative abdominal abscesses was determined. The study allowed to optimize the diagnostic process of postoperative abdominal abscesses. The algorithm of diagnostics and indications for the use of mini-invasive technologies of surgical treatment of postoperative abdominal abscesses is substantiated and developed, which allows to systematize the ideas of general practitioners about modern surgical tactics of treatment, to reduce the time of diagnostic search. The efficiency of their use is proved. Innovative elements of treatment of postoperative abdominal abscesses have been further developed. The use of mini-invasive technologies, namely laparoscopy, percutaneous puncture, percutaneous drainage of the abscess cavity under ultrasound control, is an effective method of treatment of postoperative abdominal abscesses; which allowed to improve the immediate results of treatment; reduces the duration of antibacterial therapy by two days; hospitalization for five days; the frequency of complications, which improves the quality of life of the patient and reduces the cost of treatment.