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Khirurgii

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Year 2019 Vol. 27 No 3

ONCOLOGY

YU.V. SLABADZIN, E.A. ADUTCKEVICH, S.A. SIDOROV

LAPAROSCOPIC SURGERY OF COLORECTAL CANCER UNDER THE CONDITIONS OF ADHESIVE PROCESS OF THE ABDOMINAL CAVITY ORGANS

Republican Clinical Medical Center of the Presidential Administration of the Republic of Belarus, Minsk,
The Republic of Belarus

Objective. To assess safety and radicality of laparoscopic surgery of colorectal cancer in conditions of adhesive process of the abdominal organs.
Methods. 124 patients took part in the retrospective study, 41 of them were performed against the background of the existing adhesive process of the abdominal organs. Patients were divided into 2 groups: the main group (41 patients) – patients operated on for colorectal cancer on the background of the adhesive process of the abdominal cavity and control group (comparison group) – 83 patients operated on for colorectal cancer and not having any adhesive process in the abdominal cavity. In order to assess the severity of the adhesive process, as well as the places of fixing the intestinal loops to the anterior abdominal wall, to determine the point of possible installation of the first trocar, preoperative ultrasound examination was performed. Places through which it is possible to introduce trocars were marked. The severity of the adhesive process was assessed intraoperatively according to the scale of the peritoneal adhesion index.
Results. When installing the first 10 mm trocar or Veress needle, there was no damage to the internal organs in any case. The duration of surgical interventions was 40-50 minutes longer in the main group, this time was required for adhesiolysis. Mean hemorrhage in the first and the second group was minimal. Adhesive process of the abdominal cavity and laparoscopic method of surgical intervention did not violate the necessary lymph dissection. In the main and control groups in remote macroparts the proximal and distal margins of the resection were negative from the tumor process, which indicates the correct volume of resection and the possibility of performing laparoscopically in conditions of the adhesive process of the abdominal cavity.
Conclusions. Ultrasound examination of the abdominal cavity at the preoperative stage allows choosing the right points of the trocar entrance into the abdominal cavity. Execution of adhesions by laparoscopic method increases the visualization of the operation area and the quality of the conducted adhesiolysis, which increases the safety of the performed surgical intervention.

Keywords: laparoscopy, colorectal cancer, adhesions, adhesion index, adhesiolysis
p. 291-299 of the original issue
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Address for correspondence:
223028, The Republic of Belarus,
Minsk region, Zhdanovichi, 81/5,
Republican Clinical Medical Center
Of the Presidential Administration
of the Republic of Belarus,
Surgery Department.
Tel. mobile.: +375 29 230-66-84,
e-mail: s.i.d.o.r.o.v@mail.ru,
Sergey A. Sidorov
Information about the authors:
Slabadzin Yury V., PhD, Surgeon, Deputy Chief Physician for Surgery, Republican Clinical Medical Center of the Presidential Administration of the Republic of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-7881-8326
Àdutñkevich Ekaterina A., Oncologist, Republican Clinical Medical Center of the Presidential Administration of the Republic of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-0127-9042
Sidorov Sergey A., Surgeon, Republican Clinical Medical Center of the Presidential Administration of the Republic of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-7609-5427
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