MSS15: MINIMALLY INVASIVE SURGERY FOR THE MANAGEMENT OF THORACOABDOMINAL GUNSHOT INJURY TO THE ABDOMEN AT THE LEVEL II FIELD HOSPITALS OPERATING IN ONGOING WAR IN UKRAINE
Igor Lurin, Professor, Academician, MajorGeneral1; Oleh Vorovskiy, MD, PhD2; Vitalii Makarov, MD, PhD3; Eduard Khoroshun, MD, PhD3; Volodymyr Nehoduiko, MD, PhD, Associate, Professor3; Andrii Ryzhenko, MD, PhD4; Maksym Gorobeiko, MD, PhD, Professor5; Andrii Dinets, MD, PhD, Associate, Professor5; 1National Academy of Medical Sciences of Ukraine; 2National Pirogov Memorial Medical University, Vinnytsya, Ukraine; 3Department of Thoraco-Abdominal Surgery, Military Medical Teaching Center of the Northern Region of Ministry of Defense of Ukraine, Kharkiv, Ukraine; 4Military Medical Clinical Center of the Central Region, Vinnytsya, Ukraine; 5Department of Surgery, Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
Introduction: Simultaneous gunshot injuries to the chest and abdomen are common in armed conflicts or war, including the ongoing war of Russia against Ukraine. These kinds of injury are associated with a high mortality and physical disability due to severe damage of the lungs, heart, major vessels, liver or intestine etc. It is also important to mention, that Ukrainian army and civil people are on permanent violation of the international humanitarian law during the war by the Russian army because of artillery strikes on medical facilities, causing significant problems for the safe evacuation of wounded to appropriate Levels of medical care and interruption in supplying of medical goods.
The aim of this study was to demonstrate an experience of the patients management with severe gunshot injury to chest and abdomen in the Level II field hospitals in Ukraine during the ongoing war.
Patients and methods: A 56 male patients with gunshot shrapnel blind thoracoabdominal injuries were surgically treated the Level II filed hospital in Ukraine. These patients were treated by using video-assisted thoracoscopic surgery (VATS) and magnetic tool.
Results: The mean age of the patients was 32 years (range 19-54). Laparoscopy was performed in 36 (64.3%) patients, followed by conversion in 4 (7.1%) patients due to deep liver damage and severe bleeding. Laparoscopic removal of metal fragments of projectiles was performed in 23 (41/1%) patients. VATS was performed in 10 (17.9%) patients who underwent removalof metal fragments using magnetic tool, removal of removal of traumatic collapsed hemothorax, lung suturing, electrocautery of the liver wound through the gunshot defect of in diaphragm, which was subsequently sutured. In 28 (50%) patients laparoscopy was performed with electrocautery of the liver wound. In 4 (7,1%) patients liver damage was sutured. Laparotomy was performed in 20 (35,7%) patients with unstable hemodynamics: suturing the liver was made in 8 (14,3%), and gauze packing in 12 (21,4%) patients.
Conclusions: Minimally invasive laparoscopic methods are useful for application in the field hospitals at Level II and might be applied even under the risk of artillery strikes on medical facilities. Applying of magnetic tools should be considered for combat patients with gunshot injury to the chest and abdomen to remove metal fragments.