Peculiarities of liver foreign bodies (metal fragments) removal of gunshot origin depending on their location
DOI:
https://doi.org/10.15574/PS.2025.3(88).6370Keywords:
gunshot wounds of the liver, magnetic surgical instruments, thoracoscopyAbstract
Aim - to determine the possibility and expediency of removing foreign bodies of the liver (metal fragments) of gunshot origin, located in the VII-VIII segments of the liver, using thoracoscopy and ferromagnetic instruments.
Materials and methods. Wounded patients with gunshot-related foreign bodies (FB) in the liver were randomized into two groups. The main group (82 observations) was formed in the period 2022-2025 and used the proposed methods of FB diagnosis and removal; the comparison group (80 observations) was formed in 2014-2022 and used traditional methods of FB diagnosis and removal. A clinical analysis was conducted using two wounded patients who underwent the removal of foreign bodies (metal fragments) from the liver. To access the VII-VIII segments of the liver, thoracoscopy and diaphragmotomy were used. Identification of fragments was carried out under visual control and intraoperative use of an electron-optical transducer. Removal of metal fragments was carried out with ferromagnetic tools.
Results. Taking into account the peculiarities of the location of metal fragments in the VII-VIII segments of the liver, the absence of bleeding and bilious removal of fragments at the previous stages of medical care, the removal of fragments was not carried out. The use of thoracoscopy, diaphragmotomy, intraoperative visualization, the use of an electron-optical converter, and the removal of fragments with the help of ferromagnetic instruments made it possible to complete the surgical intervention in a minimally invasive way, without complications in the postoperative period.
Conclusion. The use of thoracoscopy with a diaphragmotomy when metal fragments of gunshot origin are located in the VII-VIII segments, with subsequent removal of fragments using magnetic surgical instruments, allows for avoiding laparotomy and completing the surgical intervention in a minimally invasive way.
The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee for all participants.
The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
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