Authors
Levchuk A.L.1, Abdullaev A.E.2
1 Pirogov National Medical and Surgical Center, Moscow
2 GKB SMP, Vladimir
Abstract
Objective. To evaluate the possibility of performing, timing and scope of radical surgical interventions after minimally invasive treatment of purulent-septic complications of diverticular colon disease (DBTC).
Materials and methods. Prospective analysis from 2018–2022 of 71 patients (study group) who underwent radical surgical interventions for DBTC after previously performed minimally invasive drainage operations. A retrospective analysis of patients in the control group (n-50) for 2014–2018, who underwent one-stage surgical interventions with colostomy removal according to the type of Hartmann operation. 79 men (65.2%), 42 women (34.7%). The average age is 52±1.3 years.
Results. Obstructive resection of the sigmoid colon in 5 (7%). Sigmoid colon resection with anastomosis in 22 (30.9%). Resection of the sigmoid colon with the imposition of a loop colostomy in 6 (8.4%). Left-sided hemicolectomy (LGE) with anastomosis in 30 (42.2%). LGE with Thornball preventive ileostomy in 8 (11.2%). In patients of the main group, complications developed in 6 (8.4%) cases. In the control group, complications were noted in 19 (38%) patients. In the control group, reconstructive and reconstructive operations were performed no earlier than 7–9 months after the initial intervention. In patients of the study group in the interval from 2.5 to 3 months with a good clinical effect.
Conclusion. A delimited paracollar abscess developed as a result of perforation of the diverticulum in DBTC is an indication for minimally invasive drainage. This gentle technique was considered by us as a «tactical bridge» to a radical one-stage planned reconstructive and reconstructive operation in DBTC, with the possibility of applying a primary colon anastomosis, avoiding the need for obstructive resection and removal of colostomy. The number of complications in group I is 8.4%, in group II-38%. Relapse of the disease in patients of group I in 28 (56%), in group II in 5 (7%) patients. No deaths were observed. The quality of life of patients in the study group was higher than that of patients in the control group.
Keywords: diverticular colon disease, paratonsillar abscess, minimally invasive drainage, radical surgical treatment, reconstructive and reconstructive operations.
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