APPLICATION OF DRAINAGES IN EMERGENCY ABDOMINAL SURGERY

R.E. Baymedetov

International Kazakh-Turkish University named after H. A. Yassavi,

Emergency Hospital, Shymkent

Drains are one of active physical methods of antisepsis, and in some cases, the «main» method of treatment [1,2].

At the same time, there is necessary to remind clinicians about drains in surgery and complement the principles of their use in abdominal surgery. One of them are irrigational, so-called «nipple» drainages that help to irrigate the place of the eliminated pathological focus of an abdominal cavity with antibiotics and / or an antiseptic solution (during destructive appendicitis with presence of a local peritonitis, destructive cholecystitis, appendectomy in pregnant women, perforated gastric ulcer and duodenal ulcer, lesions of hollow organs.). These drainages can be left in abdominal cavity through the basic wound and / or counteraperture cut, mostly in 3-5 days.

The second group consists of indicators or so-called «control drainages» which are left in abdominal cavity to control the place of the eliminated pathological cause, or in places of possible pathological exudation accumulations or on anatomic locations of organs of the abdominal cavity that have inflammatory condition. Control drainages can be done by inserting only through a counter aperture cut on lateral surfaces of a stomach, so inflammatory exudation such as: a blood, pus, bile, intestinal contents - could be deduced outside free by force of the gravity.

For example, it may be applied after appendectomy, through a counter aperture cut that is closer to the right lateral wall, after a cholecystectomy - in the right lateral wall below a costal arch etc. These drainages are also may be used as irrigational one, i.e., it is possible to administer solutions of antibiotics, to press for 15-20 minutes and then to take out cross clamping. Terms of these drainages excision are on average of 4-6 days from indications. These are medical tubes, single lumen diameters ranging from 0.6 to 1.0 cm and they can be silicone, PVC and / or simple rubber, so-called "red" tube. They are left in for 3 - 5 days.

The following group of drainages concern the evacuation drainages, intended for excision serous-purulent liquid, also blood and wound fluids from the focus of a pathological exudation accumulations. These drainages are being left in an abdominal cavity to diffuse in generalized peritonitis, after opening of abscesses of an abdominal cavity as hydatidectomy and so on. Often, these drainages are connected to aspirators or temporary made a pus and blood suction method by syringes or a rubber pear near the place of where pathological exudation accumulate. «Cigar-shaped drainages» these drainages, consisting of glove rubber, cellophane membranula, ora tube wrapped in a gauze napkin also simple rubber (flowing) drainages. These drainages are passive and / or semi-active drainages [3, 4].

This category of drainages includes new drainage, invented by our employees. It is known as drainage «PAFA» - passive-active flow-aspiration drainage of the source of pathological exudation and drainage system «AFA» - an active-flow aspiration device for evacuation of a pathological exudation with compulsory inserted of antibacterial deducing liquids or simple sterile solutions like sterile water or normal saline solution etc.

The drainage «PAFA» is produced from improvised materials -poly vinyl chloride, or silicone drainage tube, a rubber glove and sponge. Two tubes in diameters 0.5 – 0.7 cm with lateral 1-2 apertures take root in a sponge in the size of 20x30x40 mm, leaving between them the layer of 1-1.5 mm, though the lateral tubes should be completely implemented in a sponge, having framed the roundish form. Having removed sponge sides, we put it on the cut finger of a rubber glove with leaving lateral tapes from a glove, further we frame apertures of 1-2 mm in diameter in number of 30-40 pieces with scissors on a rubber finger, while tubes, sponge and rubber finger are fixed by a simple not resorptional ligature stitching (capronum, lavsan, silk).

This drainage is inserted into the immediate pathological focus or in a place of pathological exudation accumulations. By means of the given drainage device it is possible to do active evacuation of a pathological exudation with a lavage of the focus place. Using the drainage «PAFA», it was possible to help and successfully treat 3 patients with odontogenic mediastinitis, to prevent mediastinitis offensive at deep submandibular phlegmons at more than 30 patients in Oral and Maxillofacial Surgery Department of Emergency Hospital in Shymkent city, also to help patients with pancreatonecrosis and a diffuse purulent peritonitis [1]. The prepatent № 12068 from 3/27/2000 of Patent Office of Republic of Kazakhstan was received on the given drainage device.

Evacuation drainages also include drainage device «AFA» - the active-flowing aspiration device on which the prepatent № 17729 from 3/17/2004 of Patent Office of Republic of Kazakhstan was received, too. It has been successfully used in Surgery Departments №1, 2 of Emergency Hospital in Shymkent city. This drainage device is produced from integral silicone, or poly vinyl chloride pipes, a minimum length of 50 cm, focused on the laxative cut aperture and folded into two cut at the prominent sections of the end, having framed the cone-shaped form and, taking some distance of 2.5 - 3 cm, «mirror» located opposite to each other apertures in tubes are cut out. The tubes are fastened by not resorptional ligature (lavsan, capronum, silk), leaving the long extremities and, after tube leading in the focus of a pathological exudation cluster, tubes are re-fastened to each other and drainage device has been fixed in the tense position with the ends of threads by suturing the skin to prevent its migration through counteraperture cut. Drainage device «PAFA» has been inserted and fixed in the same way.

In observation ward suction (electric, water jet) can be connected to one of tubes, solutions of antiseptics are entered into other tube. This drainage has been successfully used for removal of pathological exudation of hydatid cysts, abscesses of the abdominal cavity, postinjection abscesses, hematomas, etc.

REFERENCES

1. O. D. Dairbekov, M. M. Rysbekov, U. A. Mukanova, M. R. Esirkepov et al. Application of drainages in drains in emergency surgery of abdominal cavity// the Bulletin of the South Kazakhstan State Medical Academy, 2003. - № 3. - P. 45-49.

2. 2. I. P. Dudanoz et al. Evaluating the effectiveness of drainage of the abdominal cavity. // the Bulletin of Surgeon, 2001. - № 1. - P. 63-65.

3. 3. N. N. Kanshin. Closed aspiration-lavage treatment in purulent surgery. // Soviet medicine, 1981. № 2.- P. 13-17.

4. Н. G. Poljakov. Drainage in surgery. // Мoscow: Medicine, 1978. - P. 9-10, 24