Креативная хирургия и онкология (May 2020)
Drug-Induced Hypocoagulation: Results of Emergency Surgical Treatment
Abstract
Introduction. The drug-induced hemorrhagic syndrome in surgical patients has become a serious problem of contemporary surgery, complicating the choice of treatment tactics and often leading to death. The present study is aimed at optimising emergency surgical treatment of acute cholecystitis and strangulated hernia in patients receiving warfarin.Material and methods. The study involved 18 patients with hypocoagulant state caused by warfarin (the main group). The control group (10 patients) consisted of patients taking no drugs affecting the coagulation profile. The study was conducted during 2013-2019. The range of diseases included acute cholecystitis and strangulated hernia. The scope of surgery was presented by laparoscopic cholecystectomy and cholecystectomy using minimally invasive technologies. In patients with strangulated hernias, prosthetic tension-free hernioplasty and local tissue rearrangement were used. In the main group, the INR values comprised 8.7 ± 2.8 and 8.4 ± 0.8 in the case of laparoscopic cholecystectomy and short-scar incision, respectively. In patients with strangulated hernias, the pre-surgery INR indices were 8.1 ± 2.7 and 8.0 ± 1.5 with local tissue rearrangement and prosthetic hernioplasty, respectively. The examination included: complete blood count, common urine analysis, US, endoscopic examination, etc.; in the setting of hemorrhagic syndrome, coagulogram, INR and others were added.Results and discussion. In patients with hypocoagulation syndrome, no significant differences were observed in coagu-logram parameters of the pre- and postoperative period in spite of the corrective therapy by quarantine fresh-frozen plasma. The patients with acute cholecystitis receiving warfarin demonstrated the contact bleeding of the liver and longterm serous-hemorrhagic discharge through the drains. However, the rate of hemorrhage in the group of patients with short-scar incision cholecystectomy was observed to be significantly higher as compared to the laparoscopy-operated group. In patients with strangulated hernias, in cases of drainage of the postoperative wound, a long-term serous-hemorrhagic discharge was observed.Conclusion. Laparoscopic cholecystectomy is the operation of choice in patients receiving warfarin and developing acute cholecystitis. However, in case of strangulation in patients with hernias, the optimal operation consists in local tissue rearrangement.
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