Surgical treatment of inflammations and adhesions of the abdominal cavity in adolescents using stream hydroscalp

V.V. Skiba, V.F. Rybalchenko, O.V. Ivanko, Yu.G. Demidenko, V.M. Badakh, V.P. Bocharov


The aim of the study was to improve the results of surgical treatment of inflammations and adhesions of the abdominal cavity in adolescents using stream hydroscalpel. Materials and methods. Sixty eight adolescents aged 17–18 years underwent treatment at the surgical department of Kyiv Municipal Clinical Hospital N 1 from 2009 to 2016. There were 39 male (57.35 %) patients, and 29 (42.65 %) — female. Abdominal infiltrates were detected in 52 (76.47 %) patients, and adhesive intestinal obstruction — in 16 (23.53 %). Upon admission to the hospital, clinical blood and urine tests, X-ray and ultrasound study of the abdominal organs were performed. Results. The cause of the inflammatory process was inflammation of the appendix in 49 (72.05 %) individuals and of Meckel’s diverticulum — in 3 (4.41 %). The causes of adhesions were appendectomy in the past medical history of 9 males (13.23 %), 5 females (7.35 %); and in two (2.96 %) other female adolescents the cause of the first surgery were gynecological diseases. Hospitalization period: during the first day, there were hospitalized 11 (16.17 %), on the second day — 25 (36.76 %), on the third day — 32 (47.07 %) patients. Upon hospitalization, the general condition was classified as critical in 36 (52.94 %) people, and extremely critical — in 32 (47.06 %), with signs of organ fai­lure — oliguria. Analysis of the clinical picture showed that all 57 (83.82 %) patients had the vomiting syndrome, of them in 29 (42.65 %), vomiting was unbearable, with hiccups. Abdominal pain syndrome has been detected in 63 (92.65 %) patients, of whom in 23 (33.82 %), pain was cramping, and in 40 (58.83 %) — permanent. Pain syndrome was absent in 5 (7.35 %) patients, but they had a feeling of heaviness in the epigastric region. The asymmetry of the anterior abdominal wall is detected in 62 (91.17 %) patients, of them, the asymmetry of the right and left sections — in 34 (50.0 %), and upper and lower — in 28 (41.18 %). In 6 (8.82 %) patients, abdominal cavity wasn’t distended, but they had a significant abdominal pain syndrome of cramping nature. X-rays showed that 29 (42.65 %) patients had air-fluid levels. According to ultrasound data, abdominal infiltrates were detected in 52 (76.47 %) individuals, of them in 32 (47.06 %) — in the lower right quadrant, and in 20 (29.41 %) — in the entire right half of the abdomen. In 14 (20.58 %) patients, according to ultrasound examination, it was established the absence of peristalsis in all parts of the intestine, and in 2 (2.95 %) — pendular movements in the left hypochondrium. Free fluid was detected in the pelvic cavity in 23 (33.82 %) patients, and in 31 (45.58 %) — on the right flank. The study found that 12 (17.64 %) persons had atypical clinical symptoms of the disease. All patients were operated using stream hydroscalpel. By separating the inflammatory process, it was found that the cause was the inflammation of the appendix in 49 (72.05 %) and of Meckel’s diverticulum — in 3 (4.41 %) patients, the latter has been removed with segmental resection of the colon. The following adhesions were diagnosed: multiple planar in all 16 patients, of which on the background of plane ones, cord-like were detected in 8 patients, and full coverage with volvulus — in 4. Thus, the surgical treatment using stream hydroscalpel for the separation of adhesions has a gentle non-traumatic effect on blood vessels and the intestinal wall in the separation of adhesions and infiltrates that in the future contribute to a more adequate restoration of peristalsis in the early and remote periods after surgery. Two patients due to strangulation required segmental resection of the small intestine in a volume of 25 cm, end-to-end anastomosis was placed with double-row suture. Conclusions. Using the method of direction of infiltra­ted tissues and adhesions by means of stream hydroscalpel allows precise separation of organ structures and parenchymal organs. Thus, it is possible to minimize blood loss, to prevent damage to anatomical structures and to reduce the time of the surgery.


inflammations of the abdominal cavity; ileus; diagnosis; treatment; stream hydroscalpel


Averin VI, Grin’ AI, Sevkovskij AI. Treatment of appendicular peritonitis in children on the modern stage. Hirurgija. Vostochnaja Evropa. 2015;3:82-86. (in Russian).

Grona VM, Tejshejra Zh, Grona KV. Etiopathogenetic mechanisms of development of primary amentity in children. Zdorov’e rebenka. 2009;2:73-74. (in Ukrainian).

Anishhenko VV, Ganichev DA, Bass AA, Vasil’ev SL. The use of water jet dissection in the complex treatment of complicated forms of diabetic foot. Bjulleten’ RAMN. 2013;33(3):63-66. (in Russian).

Mel’nichenko MG, Antonjuk VV, Kvashnіna AA. Adhesive intestinal obstruction in children. In: XXIII Congress of Surgeons of Ukrainе. 2015 Oct 21–23; Kiev, Ukrainе. Kyi’v: Klinichna hirurgija; 2015. (in Ukrainian).

Rybal’chenko VF. Neprokhodimost’ kishechnika u detei. Diagnostika i lechenie. Dokt Diss [Bowel obstruction in children. Diagnosis and treatment. Doct Diss]. Kyiv; 2008. 36р. (in Ukrainian).

Rybal’chenko VF, Rusak PS. Acute omantic in children: classification and selection of surgical tactics. Shpytal’na hirurgija. 2014;1:88. (in Ukrainian).

Rybal’chenko VF, Rusak PS, Domans’kyj OB. To the question of drainage of the abdominal cavity in appendicular peritonitis in children. Shpytal’na hirurgija. 2014;1:108. (in Ukrainian).

Skiba VV, Hmel’nickij SJ, Suhin IA. The use of liquid jets of high pressure in tissue dissection in surgical practice. Aktual’ni problemy suchasnoi’ medycyny: Visnyk Ukrai’ns’koi’ medychnoi’ stomatologichnoi’ akademii’. 2008;8(21–22):130-132. (in Russian).

Skiba VV, Hmel’nickij SJ, Suhin IA. Dissection of tissue with a jet of fluid under high pressure in surgical practice. Klinichna hirurgija. 2008;4–5:30-31. (in Russian).

Skiba VV, Hmel’nickij SJ, Suhin IA. The use of liquid jets of high pressure in tissue dissection in surgical practice. Hirurgija Ukrai’ny. 2008;4(28):94-97. (in Russian).

Skiba VV, Suhin IA, Bilylovec’ OM. The use of liquid jet of disector in the surgical treatment of inflammatory infiltration of the abdominal cavity. Aktual’ni problemy suchasnoi’ medycyny: Visnyk Ukrai’ns’koi’ medychnoi’ stomatologichnoi’ akademii’. 2011;11(33):121-123. (in Ukrainian).

Perejaslov AA, Borova LJe, Bobak AI. Ultrasonography in the diagnosis of acute appendicitis in children. Hirurgija dytjachogo viku. 2013;3:59-63. (in Ukrainian).

Suško VY, Kryvčenja DJu, Dehtjar’ VA, autors; Suško VY, Kryvčenja DJu, editor. Hyrurhyja detskoho vozrasta: učebnyk [Surgery of childhood: a textbook]. Kyev: Medycyna; 2014. 568p. (in Russian).

Rau HG, Zimmermann A, Wardemann C, Schildberg FW. Dissecting with the high-pressure water-jet. Standards of Surgical Techniques in Liver Metastases. Chirurgische Gastroenterologie. 2003;19:333-339. doi: 10.1159/000076069.

Piek J, Oertel J, Gaab MR. Waterjet dissection in neurosurgical procedures: clinical results in 35 patients. Journal of Neurosurgery. 2002;96:690-696.

Köckerling F, Yildirim C, Rose J, Scheidbach H, Geers P. Total mesorectal excision with the waterjet dissection. Technique and results. Techniques in Coloproctology. 2004;8(1):217-225. doi: 10.1007/s10151-004-0163-4.

Copyright (c) 2017 CHILD`S HEALTH

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2019


   Seo анализ сайта