Peculiarities of surgical tactics in woundings and traumas of large bowel in the fighting environment

Abstract

Objective. To raise the efficacy of the surgical aid delivery for the wounded persons, suffering fighting trauma of large bowel, on the medical evacuation stages using the improved approaches to estimation of their state of severity, diagnostic and treatment tactics, including introduction of technology of the damage control surgery. Materials and methods. The results of treatment in 23 patients with woundings and traumas of large bowel, who were distributed into two clinical groups - a control and the main one- were analyzed. Into the control group 8 wounded persons were included (2014 - 2018), in whom surgical tactics was applied, based on principles of standard coloproctology; and into the control one - 15 wounded persons (2016 - 2021), whose treatment was based on selective approach for the surgical tactics choice on the ІІ level of medical help. Average age of the patients have constituted 33 yrs old (20 - 45 yrs old), the damage severity in accordance to scale of the Injury Severity Score was estimated as 23 points at average. Taking into account, that severe state of the wounded persons of the main group have become intraoperatively poorer, to them a multi-staged surgical tactics of the damage control surgery was applied. Results. Of 15 wounded persons of the main group, in whom a differentiated choice of surgical tactics was used, taking into account the state of severity degree, volume and degree of the damages severity and technology of the damage control surgery, there have become possible to save the life of 12 patients and to obtain in them good late follow-up results. Conclusion. In wounded persons, suffering fighting trauma of large bowel, application of technology of a damage control surgery permits to prevent the life-threatening complications and to save their lives.