POSSIBILITIES OF ENDOVIDEOSURGERY IN THE TREATMENT OF INJURIES AND ABDOMINAL INJURIES AT THE SECOND LEVEL OF MEDICAL CARE IN THE ATO AREA

Intoduction. Since 2014 the eastern territory of Ukraine is occupied by a long armed conflict in which there conducted a large-scale anti-terrorist operation in the Donetsk and Lugansk regions. As part of the anti-terrorist operation in the Eastern Ukraine there open mobile hospital, aid volume of which corresponds to the second level in the system of medical care of wounded and sick in times of crisis.

Materials and methods. In the period from January 2015 until now, field hospitals operate on the basis of district hospitals, which need to maximize the proximity of specialized assistance to the battle line. From January to December 2015, 58 video-endoscopic surgeries were performed for various injuries and diseases of the abdominal cavity. Videolaparoscopy for abdominal and pelvic injuries was performed in 15 patients. In seven victims with gunshot wounds of the abdomen, in which in 5 cases diagnostic laparoscopy was transferred to the treatment room due to the penetrating nature of the wound, in two cases the non-penetrating wound was detected, the operation was completed by a diagnostic stage. In eight cases, diagnostic laparoscopy with closed abdominal injuries is completed with a diagnostic stage.

Results and discussion. In penetrated wounds 1 injured got laparoscopy, the final stop bleeding from liver wounds with electrocoagulating methods, supplemented with plugging the wound liver hemostatic gauze from chitosan, 2 patients — laparoscopic suturing breaks of the small intestine’s mesentery, 1 — laparoscopy, then laparotomy due to multiple fragmentated wounds to the small intestine, diffuse peritonitis in later stages, when it was indicated to intubate the small intestine, performed resection of the small intestine. One patient was performed a laparoscopy, suturing unit fragmented wounds of sigmoid colon, transversostomy. Acute diseases of the abdominal cavity were observed in 43 patients, 14 were operated for acute appendicitis, 26 — acute cholecystitis, 1 patient — for hemoperitoneum, 2 patients — acute destructive pancreatitis.

Conclusions. The maximum closeness of specialized surgical care to accidents’ area can improve health of outcomes wounded.

Using of endovideoendoscopic technologies at the second level of care made it possible to avoid 14 useless laparotomies in patients with wounds and injuries of the abdomen.