METHOD OF THROUGHFISTULOUS VIDEOSCOPIC NECROSEQUESTRECTOMY IN PURULENT-NECROTIC PARAPANCREATITIS Russian patent published in 2021 - IPC A61B17/00 A61M25/01 

FIELD: medicine; abdominal surgery.

SUBSTANCE: percutaneous puncture of the omental pouch cavity to the pathological area through the gastro-collar ligament is performed, with the condition of bypassing vascular structures, parenchymal and hollow organs, pleural sinuses, followed by 2–3 rigid conductors through the needle into the omentum chamber. Paracentetic channels are bored and 2–3 bio-inert tubes with diameter 28–32 serving are introduced. Then, 7–10 days later, in one of the formed channels, at the point of percutaneously installed tubes, a flexible endoscope is inserted, working tool—laparoscopic clamp with ribbed inner surface or dissector—is delivered through another channel. To working field, physiological solution is supplied through working channel of endoscope for visualization of freely lying sequesters and washing of stuffing box, with fragmentation and removal of sequestrants with a working tool, wherein a working solution of the endoscope or through a tube-formed channel of a vacuum aspirator is used to extract a washing solution with fine fragments of the remaining sequesters. Thereafter, under the control of the endoscope, double-lumen drainages are placed in each tube formed by tubes and fixed to skin for further fractional washing of the omental chamber cavity. If the patient's clinical-laboratory dynamics is negative, the drains are removed and the necrosequestrectomy is repeated along the formed channels. If observing the positive clinical-laboratory dynamics of the patient's state under X-ray control, the drainages are replaced and every 6 hours, washing is continued to achieve clean flushing water outlet.

EFFECT: method makes it possible to create full-value additional accesses to the omental bag, to improve the treatment results by reducing a suppurative-necrotic omental process using minimally invasive techniques and minimizing an operating injury, reducing a risk of intraoperative complications when removing sequesters, reducing mortality.

1 cl, 2 ex