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Multimodal concept of the use of innovative technologies in thoraco-abdominal surgery in the diagnosis and treatment of the wounded, traumatized and sick in the conditions of modern war


Presented National Institute of Surgery and Transplantology A.A. Shalimov NAMS of Ukraine

A.V. Sidyuk, O.S. Tivonchuk, O.V. Grinenko, O.E. Sidyuk, V.V. Makarov, E.M. Khoroshun, S.A. Shipilov, S.V. Tertyshnyi.


 work is the implementation of innovative and modern technologies for thoraco-abdominal wounds, injuries and diseases in the conditions of providing medical assistance to improve the results of diagnosis and treatment and reduce mortality by optimizing and modernizing the methods of diagnosis, treatment and rehabilitation.
In the largest-scale war since World War II, both sides are using state-of-the-art weaponry on the battlefield, resulting in an increased percentage of combined damage. The frequency of explosive and shrapnel wounds in the thoraco-abdominal zone has increased, which at one time stimulates the development of innovative approaches to medical care, as well as the involvement of doctors of various specialties and directions to improve treatment results.
The authors have developed innovative methods of treatment of thoraco-abdominal wounds based on the modern realities of providing medical care in wartime conditions. The latest methods of anesthetic and surgical care, which worsen the outcome of treatment, have been revealed.
Considering the life of a citizen of Ukraine as the highest value, even in the conditions of armed aggression of the Russian Federation, clinical research aimed at preventing the most advanced diseases continues. In the conditions of long-term stress, in which there is an overwhelming number of Ukrainian citizens with an increase in oncological diseases. Cancer of the disease takes the third place among oncological diseases of the abdominal organs. Therefore, the development of modern complex approaches to the treatment of this category of patients does not lose its relevance in modern conditions and requires further study.
The author's developments were used in the treatment of more than 2,500 wounded and showed a reduction in the time of surgical interventions by almost 5 times, a high quality of treatment, and a halving of the length of hospitalization.
The introduction of innovative technologies in thoraco-abdominal surgery allows to reduce the volume and number of surgical interventions, which leads to a decrease in bed days and treatment costs. For example, stenting of the esophagus costs UAH 71,396, installation of the VAK system in the esophagus costs UAH 54,045, compared to the classic one - UAH 148,733, or the laparoscopic one - UAH 183,013. surgery on the esophagus. Thus, it makes it possible to significantly (by 52-70%) reduce the costs of treating this contingent of wounded and sick.
The use of NPT therapy contributes to the rapid healing of postoperative wounds and the consequences of combat injuries in comparison with classical methods, and also reduces the number of repeated surgical interventions, which leads to a decrease in bed-days by an average of 20.5 (the cost of 1 bed-day is UAH 2017, on average, it reduces the cost of treating one patient by UAH 41,348.5).
Mini-invasive interventions and drainage (cost - UAH 84,859) under ultrasound control on the chest and abdominal organs are used as alternative classical methods of treatment (cost - UAH 121,257) for fluid accumulations, abscesses, etc., due to a 30% reduction in the cost of treatment, and also allows to significantly reduce the number of bed days, which in turn significantly affects the economic efficiency of this treatment method.
X-ray endovascular embolization of the branches of the portal vein (cost – UAH 129,253) or/or percutaneous transhepatic stenting of the bile ducts (cost – UAH 128,281) allows you to completely avoid disease resections with reconstruction of the yellow ducts and vascular plastics (cost – UAH 812,088), which leads to to a significant increase in financial efficiency (reduces the cost of treating one patient by 84%).
As a result, data were obtained that indicate that the introduction of modern innovations and technologies significantly increases the effectiveness of treatment, which leads to the saving of public funds due to the reduction of the cost of treatment of the wounded and sick (in terms of the number of bed days by an average of 33.6%). In the future, the saved funds arise to increase the financing of the expenses that consume it.