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Assessment of biliary complication after liver transplantation in Mongolia

Bat-Ireedui B ; Ganzorig B ; Batsaikhan B ; Erdene S ; Batchuluun P ; Amgalan L ; Sergelen O

Journal of Surgery.2016;19(1):10-18. doi:Article Digital Object Identifier

Introduction: A considerable proportionof adult living donor liver transplantation(LDLT) recipients experience biliarycomplication (BC), but there are few reportsregarding BC based on long-term studies ofa large LDLT population.Methods: The present study examinedBC incidence, from 16 adult and pediatricpatients (14 right liver and 2 left liver graft )between 2011 and 2016 First Central Hospitalof Mongolia.Results: The mean follow-up period was36±1 months. First Central Hospital has DDanastmosis (n=22) double DD (n=2) singlehepaticojejunostomy (n=3). There 3 caseshave biliary stricture after operation. One ofthe 3 cases has biliary laek 2 months laterafter the operation.Conclusion: Close surveillance for BCappears necessary for at least the first 3 yrafter LDLT. In terms of anastomotic stenosisrisk, HJ appears a better choice than DD forright liver grafts involving ducts less than 4mm in diameter.

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Intraoperative cholangiography during Laparoscopic cholecystectomy in the GrandMed Hospital

Bulgan CH ; Batkhuu A ; Enkhbayar D ; Altankhuyag B ; Saruul E ; Mishigdorj L

Journal of Surgery.2016;19(1):19-22.

Introduction: In gallstone diseases,common bile duct stones and thickened bilecould cause hepatitis or other difficulties.Therefore intraoperative cholangiography ishelpful in many operations besides detectingand diagnosing the gallstones in commonbile duct.Materials and Methods: Out of 266patients who had undergone LaparoscopicCholecystectomy surgery in GrandMedHospital, 14 patients were found to havejaundice and cholestasis after undergoinglaboratory and radiology tests.Results: These 14 patients have allundergone IOC. 7 out of 14 patients werefound to have positive cholangiogram andthe other 7 - negative. Biliary tract tumorand anatomic anomalies were not identifiedamong these patients.Conclusion: Making analysis usingonly laboratory data is not adequate fordirectly detecting choledocholithiasis. IOCnot only shows bile tract obstruction anddetermines cholestasis causes, but it alsoidentifies the anatomy biliary tract, whichis a procedure that facilitates dissection.Therefore IOCcan prevent the most seriouscomplication of laparoscopic cholecystectomy- common bile duct injury. The sensitivityof IOC ensures the gathering of importantinformation on time, so suggest to use it forevery suspicious case.

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AIRWAY FOREIGN BODY DIAGNOSIS AND TREATMENT

Dulguun E ; Zorigtbaatar M ; Ganbayar L ; Tsendjav A ; Gankhuyag V ; Adyasuren J

Journal of Surgery.2016;19(1):29-32.

Introduction: The aim of this study was tostudy the pattern of foreign-body aspiration inthe tracheobronchial tree as well as the successrate of rigid bronchoscopy in children admittedto the National Center for Maternal and ChildHealth, Mongolia during 2012-2016.Materials and Methods: In this crosssectionaldescriptive study, the required datawere collected from the medical reports ofall children under the age of 13 years withsuspected foreign-body aspiration who wereadmitted and underwent explorative flexibleand rigid bronchoscopy during 2012-2016. Thedata was retrospective viewed.Results: Among 40 patients with aconfirmed aspiration, 57.5% (23) were malesand 42.5% (17) were females. 42.5% were1-3 years old. The most common complaints(symptoms) of patients were non-productivecough (82.5%), wheezing (52.5%) andrespiratory distress (22.5%). The mostfrequently aspirated foreign bodies were nuts(peanuts). In total, 57.5% of foreign bodieswere lodged in the right bronchial tree. In 100%of cases, the foreign body was completelyextracted by bronchoscope. The majority ofcases were admitted more than 24 hours afterthe occurrence of aspiration, and pneumoniawas the most common complication. In X-rayfindings Golitsknyekhta Yakobsona’s symptomswere in 10 /25%/ cases.Conclusion: Patient history, especiallyinitial suspicion of aspiration, coughing,wheezing and respiratory distress, can behelpful in the diagnosis of foreign-bodyaspiration. All foreign bodies were removed bybronchoscope /100%/ without complications.In X-ray findings Golitsknyekhta Yakobsona’ssymptoms were in 10 /25%/ cases.

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LAPAROSCOPIC NEEDLE-ASSISTED REPAIR OF INGUINAL HERNIA (LNAR)

Chuluunkhuu D ; Baterdene E ; Unurjargal J ; Zorigtbaatar M ; Ganbayar L ; Tsendjav A

Journal of Surgery.2016;19(1):33-36.

Introduction: In our hospital we didfirst laparoscopic surgery in October 2013with doctors from Samsung Medical Center,Seoul, Korea. In NCMCH we did about 3000operations per year, and about 400 of themtakes inguinal hernia. Bilateral and unilateralbig hernias has a lot of complications,like swelling, recurrence etc. Goals andobjectives:comparison between LNAR andstandard open technique of hernia repair.Calculate the outcome, hospital stay,recurrence, complications.Materials and Methods: We describeour technique and experience with thelaparoscopic needle-assisted repair of inguinalhernia (LNAR). We report retrospectively 42cases (hernias) from September 2014 toDecember 2015. We have 2 groups. In firstgroup we did standard open hernia repair in23 (54,7%)cases, in second group we didLNAR in 19 (45,3%) cases. Hernia repairis accomplished with a one port needleassistedtechnique. After identification of apatent processusvaginalis, the internal ringis encircled in an extraperitoneal plane usinga 22G-Touhy needle for placement of apurse-string suture, tied extracorporally, andburied beneath the skin. The technique wasstandardized for second group cases. Inguinalhernias were laparoscopically repaired in19patients (16 boys and 3 girls) age range1year to 16 years. All 19 cases had bilateralrepair. Mean operating time for bilateral was45 min. No complications in second group.For the first group we had 18 boys and 5girls same age range. Mean operating time1hour 20min.8 minor complications wereidentified(8 swelling) and 1 recurrence. Postoperativedata show our technique is safewith no complication. No recurrence.Results: First group: we had 18 boysand 5 girls,age range 1year to 16 years.Mean operating time1 hour 20min. 8 minorcomplications were identified (8 swelling)and 1 recurrence. Second group: we had16 boys and 3 girls, age range 1year to 16years. All 19 cases had bilateral repair. Meanoperating time for bilateral was 45 min. Nocomplications.Conclusions: In our technique meantime was shorter than in standard opentechnique. Post-operative data show ourtechnique is safe with no complication.No recurrence. Furthermore, laparoscopyobjectively identifies asymptomatic or occultcontralateral defect, uses a smaller incision,and eliminates dissection of the cordstructures potentially reducing the risk ofcord injury.

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THE TREATMENT OUTCOME OF HEPATOCELLULAR CANCER

Gan-Erdene B ; Chinburen J ; Narmandakh TS ; Altanchimeg N ; Onon B ; Sanchin U ; Bilguun G ; Ankhbayar E ; Tuvshinbayar M

Journal of Surgery.2016;19(1):37-40.

Introduction: Hepatocellular carcinoma(HCC) is the 6th most common cancer inthe world, but the first most commoncause of cancer death in Mongolia. Thereis no universally accepted consensuspractice guidelines for HCC owing to rapiddevelopments in new treatment modalities,the heterogeneous epidemiology and clinicalpresentation of HCC worldwide.Methods and Materials: This study wasconducted in the department of generalsurgery of Second Central Hospital ofMongolia between 2015 and 2016 on a totalof 36 patients with hepatocellular carcinoma.Results: The average of operationtime is a 132.2 min, the hospital stay 18.2days. Postoperative bleeding was 2.7% (1),encephalopathy 5.4% (2), wound infection5.4% (2), and incisional hernia 8.1% (3).There were not bile leak during 30 dayspostoperative day.Conclusion: Postoperative complicationis a comparable to different researcher.There were no death within first month.

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ANTICOAGULANT TREATMENT OUTCOMES FOLLOWING ARTIFICIAL JOINT REPLACEMENT SURGERY

Dasgtsogt S ; Temuulen М ; Tuvshinjargal B ; Choidog О ; Zolboo E ; Enkhtaivan M ; Otgonbayar М

Journal of Surgery.2016;19(1):41-43.

Introduction: Orthopedic surgery is a highrisk of surgical formation of thromboemboliccomplications.Many researchers are exploringprevent surgical complications.Anticoagulanttreatment is the first choice to preventthromboembolic complications.Artificial jointreplacement surgery has been made in 2008,in National First Central Hospitals (NFCH).Wehave not guideline of anticoagulant treatmentafter surgery and have not principle of choisefollow-drug treatment and unclear testingschedule to monitor anticoagulant treatment,that has become the basis for this study. Westudied by comparing a comparative benefitfor anticoagulant treatment of unfractionatedand low molecular weight heparin results.And studied thromboembolic complications,monitoring test of anticoagulant treatment,fatal bleeding, changes hemostasis ofanticoagulant therapy in both groups. Thesurvey results in practice is doing researchaims to introduce and review the results of thelong-term results.Materials and Methods: Included in thesurvey about 1,400 patients, who had kneeand hip replacement surgery in 2008-2016, inJoint Center of NFCH. All patients are dividedin three group. The first group is control group,do not use anticoagulation treatment, in thesecond group used unfractionated heparin andin the third group used low-molecular-weightheparin.Each group studied comparativewhether thromboembolic complications anddeath caused by thromboembolic, fatalbleeding.Between surgical complication andanticoagulant therapy relationship to investigatethe relationship the correlation is likely trueof 95%. Caused by other thromboemboliccomplications detected cases were removedfrom the study.Results: Control groups has not hospitalmortality, but has 3 cases of sudden death ina after discharge.Hemostasis is longer (INR1,3-1,5) in the second group. There hospitalmortality occurred in 1 (cardiac infarction),and thromboembolic complications 1 (arterialthrombosis in the jugular) in the third group.Low molecular weight heparin are no changeshemostasis, it is strongly dependent (r=0,8).Also in this group there is no fatal bleeding.Conclusions: Orthopedic surgery isnecessary for prevention of thromboemboliccomplications are showing from in controlgroup has sudden death.2 groups have not fatalbleeding when used heparin in normal doses.Other countries researchers conclude lowmolecular-weight-heparin is more effectivethan unfractionated heparin, our study is notvisible correlation reliability.When used lowmolecularweight heparin, hemostasis is notchanged is showing a strong dependence.

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HYPEREXTENSION TRAUMA IN PATIENTS WITH CERVICAL SPONDYLOSIS

Oyuntugs J ; Battugs B ; Delgerkhuu T ; Bayrsaikhan D ; Ariunkhuu E ; Narangerel B

Journal of Surgery.2016;19(1):44-48.

Introduction: Due to cervical spondylosispatients with cervical stenosis who hadhyperextension trauma developed spinalcord stress and contusions, tetraplegia anddisability and mortality. Cervical spondylosispatients with hyperextension traumatreatment management still not clearedout throughout the world and very fewresearch has been done in our country.We have been introduced our surgical andrehabilitation comparison research study ofcervical spondylosis trauma in 2015. Our goalis to develop treatment management forthe hyperextension trauma in patients withcervical spondylosis.1. To compare surgical treatmentresults between patients who hadhyperextension injury to the cervical spinewhich were treated at the Departmentof Spinal Surgery of the National Traumaand Orthopaedic Research Center ofMongolia.2. To study biomechanical effects after thesurgeryMaterial and methods: 42 cervicalspondylosis patients with hyperextensioninjury have been chosen retrospectively toevaluate the surgical, conservative, andrehabilitative treatments and results wereanalyzed by SPSS, EXCEL program who weretreated at the Department of Spinal Surgeryof the National Trauma and OrthopaedicResearch Center of Mongolia from 2012-September 2016. Over 20% canal stenosiscases were chosen for laminectomy andanterior discectomy and fusion surgeriesalong with conservative and rehabilitationtreatment. Up to 20% canal stenosis 10cases which is 23.8% of all patients weretreated by conservative treatment.Results: From 42 patients there was 10females and 32 males. Average ages were56±7.9. By the cause of injury 62% werecar accident, 23% motorcycle accident, 10%fall from horse riding and 5% were otherfalls respectively. All patients had neurologicdeficits according to the level of spinal cordinjury. 36 (85.7%) patients had C4-C5 andC5-C6 level injury and 15 (35.7) patients wererecovered from spinal shock after high dosesteroid treatment. According to the X-RAYall patients had cervical spondylosis signand 4 (9.5%) of them had facet fractureswith stable spine condition. After CT scanspinal cord injury located at C3-C4, C4-C5and C5-C6 levels and patients developedfacet arthrosis, ossification of ligaments andintervertebral discs. Clinical signs and CT scans were evaluated and 4 cervical spondylosispatients with hyperextension injury hadlaminectomy and 2 patient had anteriordiscectomy and fusion surgeries. Canalstenosis is decompressed after laminectomysurgery and cervical lordosis is reduced by 7degrees but after anterior discectomy andfusion surgery cervical lordosis is reducedby 3 degrees. Neurological deficit increasinglaminectomy cases had C5 palsy becauseof cord shift (2.4-4mm) which resulted bydenticulate ligament tethering.Conclusion: There were no significantstatistical (P≤.05) differences betweensurgical and rehabilitation treatmentsin cervical spondylosis patients withhyperextension injury who’s canal stenosiswere below 20% [1,2,3,4,5].In our practice itis essential to make laminectomy and anteriordiscectomy and fusion surgeries in 72 hoursafter trauma to help the patient recoverfrom the spinal shock and reabsorption ofcord contusion. For one or two level canalstenosis especially with the OPLL, artificialdisc replacement and ADF surgeries showedbetter results. In multiple level canal stenosiswith OLF and OPLL cases laminectomyand laminoplasty are choice for surgery. Incomparison to foreign study/ Biomechanicalinvestigation of spinal cord injury and diseasein cervical spine Batbayar.K Seoul.2016[2]/ our surgical treatment showed similarresults. Among cervical spondylosis patientswith hyperextension trauma cases whotreated in Spine Department of NationalTrauma and Orthopaedic Hospital, mortalityand disability is increasing and it is essentialto follow correct diagnostic and treatmentalgorithms.

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FEMORAL NECK FRACTURE SURGERY TREATMENT OPTIONS

Dasgtsogt S ; Temuulen М ; Tuvshinjargal B ; Choidog О ; Zolboo E ; Enkhtaivan M ; Otgonbayar М

Journal of Surgery.2016;19(1):49-52.

Introduction: We performed more than1200 arthroplasty surgeries at National FirstCentral Hospitalfrom 2008, so we haveour surgical technique and experiences.Thepurpose of this study is to assess our surgicalresults and complications after surgery forfemoral neck fracture made in Joint Center,National First Central Hospital, and tocomparingsimilar studies in other countries,and to develop the best optionsurgicaltherapy.Materials and Methods: Between 2008-2015, hip replacement surgery accountedatotal of 168 cases, that was 13.9% allof replacement surgery. A retrospectiveanalysis of patient database based onhospital discharge data and medical recordswas performed. The medical records ofthese patients were reviewed to confirmthe presence of a surgical site infection asdescribed by the Centers for Disease Control(CDC)/NNIS guidelines.Results: Between 2008-2015, in theJoint Center,National First Central Hospital,are seeing increasing number of patientswith hip replacement surgery each year.The cause for hip replacement surgery isaseptic necrosis (42%), at second is femoralneck fractures (22%). Joint Center,NationalFirst Central Hospital currently not providedemergency trauma care center. Therefore,younger patient with femoral neck fracturewas not to happen duringresearch. Olderthan 60 year patients with osteoporosis and,in some cases with nonunion, was doneforhip replacement surgery. The averageage of 75.7 (61-87).Bipolar hip arthroplastywas 14 cases all of 36 patients with femoralneck fracture.9 (5,31%), complications ariseall of hip replacement surgery (168 cases).Including: Infection - 1 (0.59%), sliding - 1(0.59%), dislocation - 2 (1.78%), fracture- 2 (1,18%), nerve injury - 2 (1,18%) andpostoperative mortality - 1 (0.59%).Conclusion: Internal Fixation- for patientage under 60 andgood bone quality. Thatoperation complication is femoral headnecrosis, not healing /nonunion/ delivery ofa lot of research that shows focus. Further,most surgery for femoral neck fracture is hipreplacement that is expected to be widelyavailable.

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STUDY OF POSTOPERATIVE INFECTIOUS COMPLICATION IN JOINT CENTER OF NATIONAL FIRST CENTRAL HOSPITAL

Dasgtsogt S ; Temuulen М ; Tuvshinjargal B ; Choidog О ; Zolboo E ; Enkhtaivan M ; Otgonbayar М

Journal of Surgery.2016;19(1):53-56.

Introduction: Artificial joint replacementsurgery started in 2008, in Joint centerof National First Central Hospital. Hasexperienced a variety of post-surgicalcomplications.Postoperative infectiouscomplications, prevent and investigate thecauses of the research is carried out todetermine whether the opportunity.Materials and Methods: Facilitiesrandomly selected cases difficult patientswith postoperative septic, and analyzedby descriptive method. In all cases,Bacteriological analysis of the clinicallaboratory department of joint fluidsamples received. We determined artificialjoints causes of postoperative infectiouscomplications and artificial joints determinethe factors of postoperative infectiouscomplications. Calculate the treatment ofinfectious complications.Results: Since 2008, done a total1200 with an artificial joint replacementsurgery. Each year, a surgical number isincreasing. 82% of all cases were kneeartificial joint replacement surgery and18% were hip artificial joint replacementsurgery. There are 20 cases of postoperativeinfectious complications.Most suppurativecomplications (14 cases, 70%) are earlycomplications, that directly related to thesurgery and hospital infections are likelyto be. Pathogenic bacterial samples weredetected 10 cases. An assay blanks dependon laboratory capacity and the number ofsamples. Open surgery is 83,3% effective,when early infectious period. No mortalitydue to infectious complications in our center.Conclusion: The main reason of thepostoperative infectious complications ofartificial joint surgery is S. Aureus (99%).14 cases (70%) of all postoperativecomplications are early complications, thatdirectly related to the surgery and hospitalinfections are likely to be. The main factorsaffecting disinfection of the surgical roomand trauma.

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LAPAROSCOPIC ECHINOCOCCECTOMY IN CHILDREN

Dulguun E ; Zorigtbaatar M ; Ganbayar L

Journal of Surgery.2016;19(1):57-59.

Introduction: In Mongolia laparoscopicsurgery starts 25 years ago, in our center /NCMCH/ we start laparoscopic surgery fromOctober 2013.Materials and metods: The articleanalyzes the results of treatment of 2patients 16 years old girl and 14 yearsold boy, who underwent laparoscopicechinococcectomy. Abdominal ultrasoundshowed solitary echinococcosis in VII liversegment, diameters is 9.8cm and 7.4cm.The echinococcus cysts were removed bylaparoscopy. In residual cavity of echinococcuscyst was performed laparoscopic coagulationof the inner wall of the fibrous capsulewithout drainage. After laparoscopic liverechinococcectomy postoperative period wasmuch more favorable than after traditionalechinococcectomy.Results: to evaluate the therapeutictactics and ways to improve the eliminationof residual cavities after laparoscopicechinococcectomy of liver in children.Conclusions: The hospital stay in thepostoperative period was 3 bed days.Laparoscopic echinococcectomy is goingwithout postoperative complications,without residuals, reduce the duration ofpostoperative hospital stays.

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