Peer-reviewed journal "Moscow Surgical Journal"
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Professor, cardiac surgeon Vladimir Nikolaevich Ilyin and his contribution to the development of moscow healthcare. (On the 80th anniversary of his birth)
The article describes the contribution of pediatric cardiac surgeon, Honored Doctor of the Russian Federation, Laureate of the Moscow Government Prize and Academician V.I. Burakovsky Prize, Professor V.N. Ilyin to the organization and development of pediatric cardiac surgery in Moscow at the N.F. Filatov Children's Clinical Hospital of the Moscow Department of Health. The archived, printed, visual and verbal sources collected by the interview method, including reports from the Department of Cardiac Surgery and Intensive Care at the N.F. Filatov State Clinical Hospital, headed by Professor V.N. Ilyin since 2008–2025. The facts of V.N. Ilyin’s performance of the first operations in Russia to correct complex congenital heart defects in newborns and children of the 1st year of life were established, and V.N. Ilyin's priorities in creating a system for providing highly qualified cardiological and cardiac surgical care to children with congenital heart defects and combined pathology have been identified. V.N. Ilyin’s contribution to the creation and organization of the prenatal diagnostic service in Moscow healthcare was assessed.
The diagnosis of undifferentiated connective tissue dysplasia and its role in the recurrence of incisional ventral hernia
Introduction. According to statistics, 12,8 % of patients develop an incisional hernia within 2 years after laparotomy. At the same time, the probability of hernia recurrence after hernioplasty can reach 30 %. Recently, researchers have been actively studying the relationship between connective tissue diseases, such as undifferentiated connective tissue dysplasia (UCTD), and the occurrence of hernias of the anterior abdominal wall. However, to date, no studies have been conducted that would establish a link between the phenotypic and morphological methods of diagnosing UCTD in patients with incisional ventral hernias (IVH). In addition, there is no information in the literature on how the severity of UCTD affects the risk of recurrence of incisional ventral hernias after various hernioplasty methods. Materials and methods of research. The main group consisted of 91 patients with IVH. The control group consisted of 20 patients who underwent cholecystectomy and had a previous history of laparotomy surgery without herniation. All participants underwent a phenotypic assessment of the severity of UCTD using the Luzgina-Shkurupiya method. A morphometric study was performed in 40 patients with IVH and 20 patients from the control group. Results. There were statistically significant differences in the number of pixels reflecting the ratio of collagen types I and III between the groups of patients with IVH and UCTD of varying severity (p<0.05). It was found that as the severity of UCTD increased, there was a significant increase in the number of IVH recurrences (p<0.05). Conclusion. It was found that the probability of recurrence of IVH increases significantly with increasing severity of UCTD. The phenotypic method of assessing UCTD, proposed by Luzgina-Shkurupiy, corresponds to the data of morphological research and can be used as a screening method to assess the severity of UCTD in patients with IVH.
Determination of severity and prognosis of acute pancreatitis using electron and atomic force microscopy
Introduction. The purpose of this study is to determine the predictors of the severity of acute pancreatitis by electron and atomic force microscopy of peripheral blood erythrocytes. Materials and methods. Electron and atomic force microscopy of peripheral blood erythrocytes of healthy people and patients with pancreatitis of varying severity was performed. Venous blood sampling was performed from the cubital vein upon admission to the hospital. Blood from donors was used as a control group. The shape of the erythrocyte, the volume of the erythrocyte, the state of the membrane and cytoplasm, as well as the content of potassium, sodium, calcium, nitrogen and oxygen in the cell were compared. Results. Electron and atomic force microscopy of red blood cells revealed a change in the size and membrane of red blood cells, significantly dependent on the severity of acute pancreatitis, as well as the effect of membrane-protective therapy on the condition of red blood cells. Discussion. Comparative scanning of erythrocyte membranes can clearly trace the negative changes in the latter compared to the membrane of healthy people and depending on the severity of the process. Conclusions. According to these changes in red blood cells, it is possible to indirectly judge the processes occurring in the cells of the pancreas. Accordingly, it is possible to determine the severity of acute pancreatitis.
Assessment of the risk of recurrence of peptic ulcer bleeding scale: a new tool for assessing relapse and choosing treatment tactics
Introduction. Peptic ulcer bleeding is still the main reason for hospitalization and maintains a high mortality rate. Dividing patients by the risk of recurrence will allow identifying the most vulnerable group of patients and choosing the optimal treatment strategy. Study purpose. To create a scale for assessing the risk of recurrence of ulcerative bleeding to stratify risks and determine treatment tactics. Materials and methods. The study included 160 patients with ulcerative bleeding. Factors were compared to assess the effect on relapse: NSAIDs, anticoagulants, antiplatelet agents, corticosteroids; hypocoagulation; ulcer location and size, bleeding vessel size, the type of inflammatory process, Forrest type of bleeding, Rockall scores. To assess the risk of recurrence, the Rockall scale and the ulcerative bleeding risk assessment scale were compared. Results. ANOVA using Fischer's F-test was performed to determine statistically significant differences between the selected factors and relapse. The intake of NSAIDs (Fgr = 1,88, Femp = 1,63), antiplatelet agents (Fgr = 1,88, Femp = 1,61), and hypocoagulation (Fgr = 1,88, Femp = 1,39) were insignificant. Based on the data obtained, a scale of scoring indicators is formed, the sum of which determines the degree of risk of relapse and treatment tactics. Conclusion. The ulcerative bleeding Recurrence Risk Assessment scale is an effective tool for assessing recurrence. It can be used in clinical practice.
Single-component endoscopic vacuum therapy technique in the treatment of transmural defects of the upper gastrointestinal tract: results of a retrospective study
Background. Transmural defects of the upper gastrointestinal (GI) tract remain a challenging clinical condition associated with high morbidity and mortality. Minimally invasive techniques, particularly endoscopic vacuum therapy (EVT), have emerged as a promising treatment option. Objective. To evaluate the efficacy and safety of EVT applied as monotherapy in patients with transmural defects of the upper GI tract. Materials and methods. A retrospective study included 65 patients treated with EVT at a single tertiary center (2021–2023). Negative pressure was individually adjusted (−70 to −120 mmHg), with sponge replacement every 3–5 days. Outcomes were evaluated by defect closure rate, number of sessions, hospital stay, and complications. Results. Defect closure was achieved in 86,2 % of cases. Acute perforations required fewer sessions, while anastomotic leakage and chronic fistulas demanded prolonged treatment. Adverse events were rare and manageable; mortality (12,3 %) was mainly due to comorbidities. Conclusion. EVT used in monotherapy is an effective and safe modality for the management of transmural defects of the upper GI tract and may serve as a first-line treatment option in patients not eligible for surgical intervention.
Risk factors for the development of sterile fluid accumulations (PSSC) after endoscopic hernioplasty of inguinal hernias
Introduction. Inguinal hernioplasty is one of the most frequently performed operations in general surgery. Over the past decades, the introduction of minimally invasive technologies has shown advantages over traditional "open" techniques. However, one of the urgent problems remains postoperative fluid accumulation in the area of intervention. Despite the fact that such phenomena often have a favorable course, they can cause discomfort, slow down rehabilitation, and sometimes require additional interventions. Identification of PSSC risk factors is important for prevention and a personalized approach in the postoperative management of patients after inguinal hernioplasty. The purpose of the study. To determine the frequency of occurrence of postoperative sterile serous clusters (PSSCS) and to identify the factors influencing their development in patients after endoscopic inguinal hernioplasty. Materials and methods. The study was performed on the basis of the short-stay hospital of the O. M. Filatov Municipal Clinical Hospital № 15 of the Moscow Department of Health from January 1, 2024 to July 1, 2025. The analysis included patients who underwent laparoscopic inguinal hernioplasty using TAPP, TEP and their modifications. Results. In a comparative analysis of quantitative variables between groups with and without PSSC, statistically significant differences were found in the following indicators: hernial sac size, age, BMI, and type of hernia. Discussion. Inguinal hernioplasty remains one of the most common operations in general surgery, and in recent decades, endoscopic techniques such as TAPP and TEP have taken priority. Their benefits include reducing the intensity of postoperative pain, reducing recovery time, and reducing the risk of chronic pain. Conclusions. Postoperative sterile serous accumulations were detected in 46,1 % of patients after laparoscopic inguinal hernioplasty. The independent risk factors for their formation were overweight, oblique type of hernia and increased duration of surgery
Comparative study of surgical treatment methods in patients with severe acute pancreatitis complicated by enzymatic peritonitis
Introduction. Treatment of acute pancreatitis remains one of the most difficult and urgent – severe forms require surgical intervention. The purpose of the study. To substantiate the expediency of using an innovative method of surgical treatment of patients with severe acute pancreatitis complicated by enzymatic peritonitis. Materials and methods of research. 80 patients (25–80 years old) with severe acute pancreatitis participated. The experimental group consisted of 40 patients receiving treatment using the method developed by us using the "Heptral" in the round ligament of the liver and external drainage of the biliary tract. The control group consisted of 40 patients (standard treatment). Treatment results. Experimental group showed favorable results: there was a marked decrease in LII by day 10, reflecting effective relief of the systemic inflammatory response. Significantly significant differences were found in the following parameters: the level of leukocytes in the postoperative period, the level of triglycerides in dynamics, the level of C-reactive protein, the level of diastase (urine). In the main group, there was a significant decrease in amylase activity by days 5 and 10, while in the control group this indicator remained high. In the main group, creatinine levels were 3–5 days lower than in the control group, indicating a lower severity of renal dysfunction. Conclusions. Use of “Heptral” in the circular ligament of the liver with external drainage of the biliary tract as a method of surgical treatment increases the effectiveness of therapy for severe acute pancreatitis complicated by enzymatic peritonitis. Method is patented (patent for invention).
Resistant ascites in liver cirrhosis: a comparative analysis of pathogenetically based treatment approaches
Introduction. Ascites significantly impacts the prognosis of liver cirrhosis (LC). Current treatment methods are effective but have side effects. A comparative evaluation of these approaches will help personalize treatment strategies and improve outcomes in LC patients. Objective. To compare the efficacy and safety of pathogenetically justified treatments for refractory ascites in patients with liver cirrhosis. Materials and Methods. The study, conducted at the Botkin Hospital, Moscow, included 92 patients with LC and ascites, divided into three treatment protocols: Group 1 (n=35) received diuretic therapy, Group 2 (n=31) underwent transjugular intrahepatic portosystemic shunt (TIPS), and Group 3 (n=26) received combination therapy with Terlipressin 1000 mcg/day plus Furosemide 40–200 mg/day. The groups were comparable in sex and age; the mean MELD score was 13±2,6 in Group 1, 14,13±3,51 in Group 2, and 15,15±3.4 in Group 3. Monitoring was performed at baseline, after 14 days, 30 days, and then every 2 months for one year. Compensation criteria included no progression of ascites or signs of liver decompensation. One-year mortality was assessed. Results. In Group 1, the compensation period lasted 31,2±10,31 weeks with a mortality rate of 26 % (9 patients). Group 2 showed a significantly longer compensation duration of 41,5±13,17 weeks compared to Group 1 (p<0,05), though hepatic encephalopathy worsened in 17 patients (54,8 %) within one month, with a mortality rate of 10 % (3 cases). In Group 3, the compensation period was 37,4±11,4 weeks, also significantly longer than in Group 1 (p=0,012), with an 11 % mortality rate (3 cases). These findings demonstrate that pathogenetically targeted treatments for ascites significantly prolong the compensation period in patients with liver cirrhosis.
Evaluation of the effectiveness of intraoperative transverse abdominal muscles stretching during retromuscular allohernioplasty
Introduction. Retromuscular alloplasty for postoperative ventral hernias in the classical version, without transversus abdominal release, often cannot be performed due to big tension during the suturing the posterior line. The reason for this is a width of the aponeurotic defect or the narrowness of the sheathes. The search for less traumatic alternatives to posterior component separation remains relevant. The purpose of this study is an evaluation of the possibility of acute stretching of the transverse abdominal muscle during Rives-Stoppa surgery to reduce the distance between the edges of the aponeuroses of the posterior sheathes. Materials and methods. During the study, this distance was measured intraoperatively in 20 patients with postoperative ventral hernias classified as M2,3W2, before stretching the transverse muscle and after manipulation. The stretching was performed by traction of the edges of the aponeuroses of the posterior sheathes in the medial direction for 2 minutes on each side. Previously, the posterior lamina of the internal oblique muscle aponeurosis, which covers the transverse muscle, was crossed. Results. Research results. It turned out that this manipulation can significantly reduce the transverse size of the aponeurotic wound by 5,8±0,9cm (p<0,001) and suture the aponeurosis in 16 out of 20 cases without transversus abdominal release. Conclusion. Acute stretching of the transversus abdominal muscles can be used in retromuscular hernioplasty in order to avoid its complete release in a number of patients.
Medium-long-term results of using aortic homographs and Bentall procedures in aortic root pathologies: the experience of one center
Introduction. Aortic root replacement in young patients requires balancing the durability of mechanical valves with the reduced risk of thromboembolism and bleeding associated with biological implants. Cryopreserved homografts represent a promising alternative to the Bentall procedure. Objective. To perform a comparative analysis of clinical and valve-related outcomes in patients undergoing elective aortic root replacement using either homografts or mechanical prostheses. Materials and methods. This retrospective study included 85 patients operated on from 2015 to 2021: 19 patients received cryopreserved homografts (mean age 50,05 ± 16,35 years), and 66 patients underwent the Bentall procedure (mean age 52 ± 14,03 years). The cumulative follow-up was 423 patient-years. Survival rates, hospital and mid-term mortality, and complication rates were analyzed. Results. Hospital mortality was 2 cases in the Bentall group; no hospital deaths occurred in the homograft group. Mid-term mortality in the Bentall group was 4 cases (one related to valve thrombosis and stroke), while one death in the homograft group was unrelated to the prosthesis. In the Bentall group, bleeding events (n = 5, 7,58 %) and thrombosis (n = 3, 4,5 %) were observed; no such complications occurred in the homograft group. Leaflet stenosis was detected in one homograft patient without clinical significance and without need for reoperation. Conclusion. Both approaches provide satisfactory outcomes in elective settings. However, homografts showed a more favorable safety profile, including absence of thrombosis, bleeding, and reoperations. This makes them a promising option for young patients, although long-term durability data are needed
The impact of comorbidity on the risk of postoperative complications in patients with colon cancer
Introduction. Colon cancer is one of the most common malignancies and typically affects elderly patients with comorbidities. Comorbidities worsen the prognosis and increase the risk of postoperative complications. Objective. To evaluate the diagnostic efficacy and practical value of the "Surgical risk assessment scale for comorbid colon cancer patients" Materials and methods of research. A comparative study was conducted involving 260 comorbid patients with T3-4N0-1M0 colon adenocarcinoma undergoing surgical treatment in Botkin Hospital, Moscow from 2023 to 2025 years. Patients were divided into two groups based on the nature of the postoperative course – with or without complications. Statistical data analysis was performed using IBM SPSS software. Study results: the average score on the surgical risk assessment scale in patients with complicated postoperative course was 18,02 ± 2,89 and was significantly higher than in patients without complications – 16,7 ± 2,15, the pooled T-score was 3,309 (p = 0,001) (95 % CI: 0,38–2,102). The most significant indicators for assessing the risk of complications in the study group were the levels of hemoglobin, potassium, urea, and patient compliance (p < 0,05). Treatment results. The developed "Scale for assessing the surgical risk in patients with comorbid colon cancer" demonstrated its diagnostic effectiveness AUC = 0,681 (p = 0,00). The rationale for using this scale is ensured by the implementation of the developed MedDocMobile mobile application in diagnostics. The use of this scale in clinical practice is promising due to the proven influence of modifiable risk factors on the course of the disease.
Laparostomy for combat abdominal trauma. criteria for the possibility and optimal timing of laparostomy closure
Introduction. The article is devoted to the analysis of the use of laparostomy in patients with combat abdominal trauma (BAT) and the definition of criteria, timing and methods of its closure. A multifactorial retrospective analysis of the data of 304 patients with laparostomy formed at the stages of medical evacuation revealed that the timing and method of laparostomy closure depend on the initial severity of the injury, the effectiveness of programmatic sanitation and the choice of technology for temporary closure of the abdominal cavity. Materials and methods. A retrospective multifactorial analysis of the primary medical documentation of a sample of 304 patients hospitalized at the Vishnevsky National Research Medical Center of the Ministry of Defense of the Russian Federation in the period 2022–2024 inclusive with laparostoma formed during surgery for BAT at the stages of medical evacuation was carried out. The results of the study. When comparing the average severity of the condition of patients in clinical groups 1 and 2 at the time of hospitalization from the stages of medical evacuation to the Vishnevsky National Research Medical Center of the Ministry of Defense of the Russian Federation, significant differences (p < 0,05) in these indicators were revealed for all scales used in the study. The optimal period for primary fascial closure of laparostomy is the period 7–8 days after the initial operation. Control of the source of infection and adequate systemic antibacterial therapy make it possible to complete the open management program by closing the laparostome. Laparostomy closure at a later date is associated with an increased risk of intra-abdominal and wound complications. Primary fascial closure of the laparostome cannot be performed in the presence of intestinal fistula, massive adhesions (Bjork > 2b), extensive abdominal wall defect, intraabdominal hypertension; under these circumstances, laparostome closure is performed by applying skin sutures. Discussion. The formation of a laparostomy with subsequent abdominal rehabilitation at the stages of medical evacuation is currently a common treatment strategy for patients with BAT. The transformation of criteria for the possibility of completing the program of stage-by-stage rehabilitation and primary fascial closure of laparostomy into surgical tactics algorithms for BAT is the subject of further research. Conclusion. The conducted study illustrates the fact that the timing and technology of completing the program of staged rehabilitation for laparostomy depend on the initial severity of BAT, the adequacy of intra-abdominal infection control, and the choice of a method for temporary closure of the abdominal cavity.
Strategy for surgical treatment of patients with morbid obesity
Introduction. The approach for choosing the type of bariatric intervention remains a controversial, as well as the issue of insufficient weight loss and postoperative weight regain. Aim. Development and outcomes of a personalized algorithm for bariatric procedure selection and postoperative management in morbid obesity. Development and evaluation of the effectiveness of a differentiated approach to the choice of bariatric intervention and the intensity of postoperative monitoring in patients with morbid obesity. Methods. The study was conducted in two stages. First, treatment outcomes were evaluated in a retrospect comparison group of 502 patients who underwent various bariatric procedures (sleeve gastrectomy, Roux-en-Y gastric bypass, mini gastric bypass) without a standardized selection protocol. The results gained from this evaluation were used to develop a structured selection algorithm, which was then validated in a prospective main cohort of 380 patients. Results. By implementing a bariatric surgery selection algorithm that considers mental disorders, factors associated with unsatisfactory metabolic surgery outcomes, and the characteristics of diabetes and gastroesophageal reflux disease, we achieved an improvement in %EWL one year after surgery (from 58,7 to 65,6 %), with a further increase in the difference after 5 years due to lower weight regain. Better results were achieved in the study group with respect to concomitant carbohydrate metabolism disorders and gastroesophageal reflux disease. Conclusion. The developed algorithm for selecting bariatric surgery and postoperative follow-up intensity-based on the patient's psychological and comorbidity profile is recommended for clinical practice.
Methods of restoring the white line of the abdomen during abdominoplasty (advantages and disadvantages)
Introduction. The pathology of the muscular-aponeurotic apparatus of the anterior abdominal wall is progressively increasing. Despite the significant prevalence of this pathology among men and women, accurate statistical data do not exist. This is partly due to the fact that rectus muscle diastasis is not considered a true hernia. In plastic surgery, the restoration of the white line during abdominoplasty is one of the primary tasks. The purpose of the work: based on the data from clinical studies, to consider the disadvantages and advantages of various methods of diastasis of the rectus abdominis during abdominoplasty. Materials and methods. The retrospective single-center study included 63 patients who underwent abdominoplasty to eliminate diastasis of the rectus abdominis at the clinical base of the Krasnoyarsk State Medical University named after Prof. V. F. Voino-Yasenetsky of the Ministry of Health of the Russian Federation from 2021 to 2024. Results. Depending on the method of correction of breast cancer, the time spent on the operation varied. The most time-consuming operation was abdominoplasty with implantation of a fixed mesh endoprosthesis. The number of postoperative complications is the same in groups 1 and 3. However, in group 1, eruption of sutures naturally prevails. The number of gray is higher in the 2nd group. In group 3, 2 patients had partial dislocation of the mesh implant. Two clinical cases are given as an illustration. Discussion. Suturing the diastasis with a wrapping suture reduces the risk of developing hematomas, seromas, and suppuration of the postoperative wound. Mesh prosthetic surgery increases the percentage of hematomas and gray matter. Plastic surgery with a mesh prosthesis without fixation significantly reduces the level of pain, but it is dangerous to dislocate the implant. Conclusion. Each of the considered methods of breast plastic surgery has both advantages and disadvantages. The choice of method should be justified individually, taking into account all the data of the patient's preoperative examination.
Ways to improve the results of reconstructive lipoabdominoplasty
Introduction. Reconstructive lipoabdominoplasty is a surgical technique aimed at restoring the anatomical and aesthetic integrity of the anterior abdominal wall. An important aspect of the effectiveness of the intervention is the choice of the method of electrodissection, which affects the extent of injury, the severity of pain, and the frequency of complications. Materials and methods. A prospective cohort study was conducted involving 90 patients who underwent reconstructive lipoabdominoplasty using three different modes of electrodissection: monopolar coagulation, monopolar cutting, and Valleylab mode. Intraoperative parameters, the frequency of complications according to the Clavien-Dindo scale, the intensity of pain (VAS), and patient satisfaction according to the BODY-Q questionnaire were studied. Results. The best results were achieved when using the Valleylab mode within the proposed step-by-step algorithm, taking into account features of blood supply (location of perforators of the superior and inferior epigastric vessels) to the anterior abdominal wall, local tissue status and concomitant pathology. In this group, the minimum duration of surgery (on average 120 min), the lowest blood loss (150 ml), and the lowest frequency of seromas (6,67 %) and hematomas (3,33 %) were recorded. A lower value of pain syndrome and high satisfaction with the aesthetic results according to the BODY-Q scale were noted. Discussion. The use of the Valleylab mode in combination with an algorithm that includes Doppler assessment of the vascular bed and stratification of patients by risk provides a gentle effect on tissues, reduces the likelihood of thermal damage and helps improve clinical and functional outcomes. The effectiveness is especially pronounced in elderly patients and with comorbid pathology. Conclusion. A comprehensive algorithmic approach to reconstructive lipoabdominoplasty with an individualized choice of the electrodissection method, including the use of the Valleylab mode, allows for increased safety and predictability of the intervention, reduced complication rates, and improved quality of life for patients. The proposed protocol can be recommended as a basis for standardizing surgical tactics in reconstructive surgery of the anterior abdominal wall.
The first experience of hybrid surgical treatment in a patient with a perforative duodenal ulcer using a fully covered self-expandable nitinol stent (clinical case)
Introduction. Perforation of gastric and duodenal ulcers continues to be one of the most widespread complications of peptic ulcer disease. The main treatment method is surgical. The most common type of surgical intervention is videolaparoscopic suturing of a defect. However, in conditions of diffuse peritonitis, large infiltrative inflammation, and comorbidity of patients, especially in the presence of diabetes mellitus, the risk of suture failure is high. In order to minimize postoperative complications, new surgical techniques are being sought to avoid repeated surgical interventions. The purpose of the study. Improving the results of treatment of patients with perforated gastroduodenal ulcers by evaluating the effectiveness of a hybrid surgical intervention. Materials and methods of research. The article presents a clinical case of a 54-year-old patient with a diagnosis of duodenal ulcer perforation. Diffuse serous fibrinous peritonitis. The patient has numerous chronic non-communicable diseases. The Charlson Comorbidity Index (CCI) is 6. Treatment results. The patient underwent a hybrid surgical intervention – videolaparoscopic suturing of the perforation, preventive endoscopic stenting of the perforation zone. No complications were in the postoperative period. The length of hospital stay was 9 days. Conclusions. Hybrid minimally invasive intervention made it possible to avoid the transition to laparotomy and reduce the risk of intra- and postoperative complications in a comorbid patient. However, further studies are required for meaningful evaluations of the effectiveness of this surgical method.
Resistant ascites and hepatic encephalopathy in a patient on the liver transplant waiting list
Introduction. Treatment of a patient with liver cirrhosis involves achieving maximum control over its complications. Objective of the Study. To demonstrate a staged approach to the management of a patient on the liver transplantation waiting list using a clinical case example. Discussion. Minimally invasive surgical techniques opens up new therapeutic opportunities for patients with liver cirrhosis. The implementation of TIPS (Transjugular Intrahepatic Portosystemic Shunt) has proven to be an effective method for managing refractory ascites. The exacerbation of hepatic encephalopathy in the postoperative period following TIPS is an anticipated adverse effect that must be considered when planning the intervention. Screening examinations for the diagnosis of hepatic encephalopathy should be regularly conducted for all patients who have undergone TIPS. Treatment of TIPS-associated hepatic encephalopathy aims to reduce the production and absorption of ammonia or increase its elimination. It should be initiated in the early days following the procedure. Since intestinal sanitation is a pathogenetically justified objective of this therapy, the use of antibacterial agents to suppress excessive bacterial growth in these patients becomes the cornerstone of the treatment protocol. Conclusions. TIPS is an effective treatment method for refractory ascites, while the risk of developing hepatic encephalopathy should be taken into account when implementing early postoperative period management interventions.
A foreign body of the thyroid gland after a gunshot shrapnel wound to the neck. A clinical case
Introduction. Foreign bodies in the thyroid gland due to a gunshot wound to the neck are quite rare and descriptions in the literature are presented by isolated clinical observations. In most cases, with penetrating wounds and injuries to the thyroid gland, surgical intervention is limited to hemostasis and, if necessary, hemi- or thyroidectomy. In the delayed period, under favorable conditions and the patient's desire, an individualized approach to surgical treatment is possible. Clinical case. A 29-year-old patient was hospitalized in the Hospital for War Veterans No. 3 for treatment and rehabilitation, with the consequences of a combined multiple gunshot shrapnel wound to the neck, upper and lower limbs. During additional examination, the patient was confirmed to have a foreign body in the right lobe of the thyroid gland without dysfunction of the gland and involvement of the main vessels. Surgical treatment was performed in the volume of minimally invasive video-assisted organ-preserving removal of a foreign body with a good clinical effect. Conclusion. The presented clinical observation demonstrates the possibilities of using minimally invasive video-assisted organ-preserving surgical technique in removing foreign bodies of the thyroid gland under favorable conditions - a delayed period, the absence of purulent-inflammatory complications, adequate topical diagnostics.
Gastropancreatoduodenal resection in the treatment of duodenal cancer in a patient who previously underwent surgery on organs of the hepatoduodenal zone
Duodenal cancer is a rare oncological disease that presents significant difficulties in diagnosis and treatment. This article presents a clinical observation of a 35-year-old man who had previously undergone surgery for a chronic disease of the hepatoduodenal zone. The diagnosis included endoscopic, radiological, and histological methods, which confirmed the presence of a highly differentiated adenocarcinoma of the duodenum with infiltration into the head of the pancreas and the common bile duct. The patient underwent an extended gastropancreatoduodenal resection with lymph node dissection. A histological examination showed no lymphovascular invasion or metastases in the 30 lymph nodes examined. The postoperative period was uncomplicated. No recurrence of the disease was observed during a 5-year follow-up period.
Metabolic markers as prognostic factors for complications of abdominoplasty
Introduction. Performing plastic surgery, in particular, abdominoplasty, is characterized by a high risk of complications, primarily seromas. It is assumed that the cause of poor wound healing results in these patients may be proteolytic disorders. At the same time, it is believed that some biological markers can be considered as factors for predicting the risk of complications. The aim of the work was to analyze the literature data on the role of biologically active substances as risk factors for the development of complications of abdominoplasty. Results. A number of studies have demonstrated the different effects of body contouring surgery on glucose metabolism. At the same time, there was a significant improvement in insulin sensitivity after the interventions, but no significant normalization of fasting glucose levels was detected. Information about changes in the lipid profile of patients undergoing plastic surgery is contradictory, and a number of studies have noted a significant normalization of high-density lipoprotein levels. In the light of modern ideas about the role of adipose tissue as a source of pro-inflammatory cytokines (in particular, interleukin-4), it is obvious that liposuction during abdominoplasty can help reduce the severity of inflammatory reactions in the body. Attention is drawn to the possibility of using C-reactive protein as a marker for predicting complications during body contouring. The prospects of evaluating the activity of enzymes of the matrix metalloproteinase family, whose role as pro-inflammatory mediators and modulators of immunity is currently widely recognized, are noted. Conclusion. It is concluded that it is necessary to further improve the tools for predicting the development of complications during plastic surgery, in particular abdominal and contouring.
Effect of platelet-rich plasma on the regeneration of damaged tissues (review)
Introduction. Platelet-rich plasma (PRP) is a universal stimulator of damaged tissue regeneration, promotes healing of damaged tissue, has anti-inflammatory, bactericidal and bacteriostatic effects, not only at the tissue level, but also at the cellular level. Main part. Platelet-rich plasma can be used in clinical practice as an alternative to antibacterial drugs (mainly beta-lactams) and hormonal drugs, which in turn can lead to significant side effects. An important advantage of using platelet-rich plasma is the fact that it does not have an oncogenic effect. With a combination of platelet-rich plasma and mesenchymal stem cells, additional stimulation of regeneration occurs, while mesenchymal stem cells adapt their secretome to the environment and their paracrine action can last for several days after transplantation. PRP is a safe stimulator of damaged tissue regeneration, an anti-inflammatory treatment. PRP is used in many areas of medicine: cosmetology, dermatology, surgery, dentistry, gynecology. Conclusion. The use of platelet-rich plasma is relevant wherever stimulation of damaged tissue regeneration and anti-inflammatory therapy are required. Also, PRP has proven itself in preclinical studies on laboratory animals.
The impact of frailty on outcomes of minimally invasive laparoscopic surgery in elderly patients: a scoping review
Introduction. Aging is accompanied by a growing number of patients requiring surgical treatment, necessitating a reassessment of traditional approaches to preoperative risk stratification. In recent years, the concept of frailty has gained significant attention as a key factor influencing surgical outcomes. Frailty is characterized by a decline in physiological reserves, leading to an increased risk of postoperative complications, prolonged hospitalization, and impaired functional recovery. Methods. For this review, a systematic literature search and analysis were conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol, which includes a clear step-by-step procedure for identification, screening, eligibility assessment, and inclusion of relevant data. Publications indexed in the PubMed and eLibrary databases from 2012 to 2025 were analyzed. A total of 51 studies were included in the final analysis, of which 21 met the inclusion criteria: studies assessing the impact of frailty on the incidence of postoperative complications, length of hospital stay, mortality rates, and the need for rehabilitation in patients undergoing minimally invasive surgical procedures. The selection of publications was performed independently by two reviewers, and any disagreements were resolved through discussion with a third expert. Data from the included studies were systematized according to key outcomes and methods used to assess frailty. Results. A scoping review of the literature was conducted, summarizing data on surgical outcomes in frail patients undergoing minimally invasive procedures. The analysis confirms that patients with a high degree of frailty have a significantly increased risk of adverse outcomes, even in minimally invasive surgeries. However, modern frailty assessment tools allow for better risk prediction and adaptation of surgical strategies. While minimally invasive techniques demonstrate superior outcomes compared to open surgeries, they still require a personalized approach and enhanced perioperative monitoring. Conclusion. This review highlights the need for routine frailty screening in clinical practice to improve the safety of surgical treatment in elderly patients and optimize perioperative management strategies.
Using local negative pressure to preserve the mesh prosthesis in late purulent – necrotic complications of hernioplasty
Introduction. Hernioplasty remains one of the most common surgical interventions. The “gold standard” in our time is tension – free hernioplasty using mesh implants, which, on the one hand, has reduced the number of relapses, but on the other hand is associated with the development of postoperative complications caused by infection of the prosthesis. The literature provides data on the preservation of mesh implants in the event of early complications. Objectives. To study the available literature on postoperative complications after hernioplasty using mesh implants. Materials and methods. Analysis of available literature data. Results. The available literature data of domestic and foreign authors on postoperative complications after hernioplasty with the use of mesh implants are analyzed. The question of preserving the implant in the late period remains open. Conclusion. An analysis of the literature data has shown that the use of LNP to preserve a mesh implant in case of late complications remains an urgent issue.
Application of local negative pressure therapy in the complex treatment of extensive wounds: analysis of clinical outcomes and innovative techniques
Introduction. A wound represents a disruption of the anatomical integrity of the skin or mucous membranes resulting from physical or thermal injury. Despite the natural potential for healing, various factors, particularly comorbid conditions, can significantly impede this process. The relevance of the problem of treating extensive and complex wounds is determined by their substantial proportion within the structure of surgical pathology (35–40 %), the high costs associated with treatment, and their significant social impact. Particular challenges arise in the closure of extensive defects, where traditional suturing is often impossible or leads to complications. Objective. To review the available literature on modern methods and approaches to the treatment of extensive and complex wounds and to identify promising directions for further research. Results. Analysis of the literature demonstrated an evolution in the approaches to treating extensive wounds, moving from traditional methods to comprehensive, high-technology strategies. Negative Pressure Wound Therapy (NPWT) has been recognized as a promising direction in various surgical fields. Conclusion. The modern management strategy for extensive wounds should be based on an approach that combines radical surgical debridement, the selection of an optimal plasty method, and the application of adjuvant therapies. The method of local negative pressure (NPWT) has proven its efficacy in reducing complications and improving treatment outcomes. However, there remains a need for large-scale randomized controlled trials to assess cost-effectiveness, develop unified protocols, and study the long-term results of applying new technologies.
Iatrogenic bowel injury in laparoscopic cholecystectomy in patients with a history of prior laparotomy: an analytical review
Introduction. Iatrogenic bowel injury during laparoscopic cholecystectomy (LC) is a rare but potentially life-threatening complication, with the risk markedly increased in patients with previous laparotomies due to dense intra-abdominal adhesions. The aim of this study was to analyze the incidence, clinical outcomes, and risk factors associated with such injuries and to develop practical recommendations for their prevention and management. Materials and methods of research. An analytical literature review was conducted covering the period from 2015 to 2025 using the PubMed, Google Scholar, and Embase databases. The analysis included systematic reviews, meta-analyses, national registries, and clinical guidelines from leading surgical societies (WSES, SAGES). Results. The overall incidence of iatrogenic bowel injury during LC ranges from 0,04 % to 0,3 %, while in patients with a history of laparotomy it increases to 0.1%–1%. The presence of adhesions elevates the risk of bowel injury during initial entry by 3–5 times. The timing of diagnosis is the key prognostic factor: when identified and corrected intraoperatively, mortality is close to zero; however, with delayed recognition (typically on postoperative days 2–5) due to peritonitis and sepsis, mortality may reach 20–30 %. Conclusion. To minimize the risk of bowel injury, surgeons should employ open (Hasson) entry or alternative trocar insertion sites, avoid blind Veress needle access, maintain a high index of surgical suspicion, and keep a low threshold for conversion to laparotomy in the presence of technical difficulties compromising visualization or safety.
The surgeon’s estimation of fibrosis-sclerotic alteration in the thyroid. Part 2
Introduction. Fibrosclerotic changes in thyroid nodules are often the result of diagnostic and therapeutic manipulations that affect the structure and morphology of the nodes. The assessment of changes is ambiguous and depends on both the time factor and the initial structure of education. A decrease in the size and volume of cysts, nodules and tumors of the thyroid gland as a result of various diagnostic manipulations is a consequence of induced progressive fibrosis and sclerosis, which affect the assessment, course and outcome of the pathological process. The purpose of the study. To evaluate the variants and outcomes of fibrosclerotic changes in thyroid formations after diagnostic and therapeutic manipulations based on literature data. Methods. Search for literary sources in the databases E-library, PubMed, Scopus for the keywords "fibrosis", "sclerosis", "calcification", "hyalinosis", "puncture" in conjunction with the phrase "thyroid gland". Treatment results. The use of various puncture diagnostic methods, which allow obtaining material for a reliable morphological assessment of the processes occurring in the thyroid gland, is now unconditionally recognized by the scientific community of the world. In some cases, in addition to diagnosis, punctures have a therapeutic (diapeutic) effect aimed at reducing or completely eliminating the pathological focus in the organ. The removal of cellular material without aspiration, and especially with aspiration, is always accompanied by damage to both normal tissue and pathological foci of the thyroid gland with the development of alterative and sclerotic processes of varying severity. The changes can be not only minimal, but also significant, leading to gross structural changes, sometimes with complete replacement of the primary morphological structure of thyroid nodule formation by fibrosis. After performing diapeutic manipulations, the formation of fibrosis and sclerosis is an expected, predictable, therapeutic result. Conclusion. Today, puncture methods for thyroid nodules are the main components of diagnosis and choice of treatment tactics. However, in some cases, after previously performed repeated punctures and diapeutic interventions, it is difficult to obtain informative material for cytological examination. Fibrosis, hyalinosis and sclerosis that occur in the tissue and nodules of the thyroid gland at various times after diagnostic and therapeutic manipulations can significantly affect both the verification of the nature of the disease and the choice of therapeutic tactics.
Mediastinal Tumors: Classification, Pathogenesis, and Modern Approaches to Diagnosis and Treatment
Introduction. The relevance of the study of tumors of the plexus is due to the optimization of diagnosis and improvement of treatment efficiency of patients with these neoplasms, as well as the choice of optimal treatment tactics. Materials and Methods. For the analysis, various databases were used, including MedLine, Science Direct, PubMed, and eLIBRARY.ru. The search was conducted using keywords. Research methods included analytical analysis and generalization of data. Results. The choice of surgical treatment should be based on a thorough evaluation of each individual case. According to clinical guidelines, thoracoscopy is preferred for tumors measuring 2–5 cm, availability of an experienced surgical team, and absence of severe comorbid pathology. Open surgeries remain the method of choice for giant leiomyomas, central localization near the cardia, and cases combined with other esophageal diseases. Conclusion. Modern studies confirm that thoracoscopic techniques provide comparable radicality with significantly reduced invasiveness when patients are properly selected. However, the final decision must consider all clinical factors and the technical capabilities of the medical facility. Open surgeries remain relevant for giant tumors and complex localizations. Current evidence demonstrates that thoracoscopic approaches, under appropriate patient selection, achieve equivalent efficacy while minimizing procedural trauma
Esophageal leiomyoma: modern aspects of diagnosis and treatment
Introduction. The relevance of studying esophageal leiomyomas lies in the necessity of differential diagnosis with malignant processes and the selection of an optimal treatment strategy. Objective of the study: To review current aspects of diagnosis and treatment of esophageal leiomyomas. Materials and Methods. For the analysis, various databases were used, including MedLine, Science Direct, PubMed, and eLIBRARY.ru. The search was conducted using keywords. Research methods included analytical analysis and generalization of data. Results. The choice of surgical treatment should be based on a thorough evaluation of each individual case. According to clinical guidelines, thoracoscopy is preferred for tumors measuring 2–5 cm, availability of an experienced surgical team, and absence of severe comorbid pathology. Open surgeries remain the method of choice for giant leiomyomas, central localization near the cardia, and cases combined with other esophageal diseases. Conclusion. Modern studies confirm that thoracoscopic techniques provide comparable radicality with significantly reduced invasiveness when patients are properly selected. However, the final decision must consider all clinical factors and the technical capabilities of the medical facility. Open surgeries remain relevant for giant tumors and complex localizations. Current evidence demonstrates that thoracoscopic approaches, under appropriate patient selection, achieve equivalent efficacy while minimizing procedural trauma.
Controlled minimally invasive surgical interventions in the treatment of patients with benign thyroid gland nodules with increased volume. (Literature Review part I)
This literature review presents a systematic evaluation of contemporary studies, encompassing representative works dedicated to various methods of managing thyroid nodules with increased volume under ultrasound guidance. Special attention is given to the fundamental principles of performing interventions and to the analysis of technologies applied in hyperthermic (laser, radiofrequency, ultrasound, and microwave ablation), chemical (percutaneous ethanol injection, percutaneous polidocanol injection) and mixed (photodynamic therapy) ablations. The review also provides a comparative analysis of controlled minimally invasive treatment methods for the benign thyroid nodules with increased volume, with the aim of assessing their clinical efficacy and safety, as well as feasibility of selecting these methods as alternatives to traditional surgical interventions.
Controlled minimally invasive surgical interventions in the treatment of patients with benign thyroid gland nodules with increased volume. (Literature Review part II)
THE FOLIAGE WITHERED AND SLOWLY FLEW OFF
I WISH I COULD GO TO THE FIREPLACE, GET WARM AND COZY
AND THEY'RE IN A HURRY AGAIN, NOT CLOSING THEIR EYES
MEDICATIONS, CATHETERS, TOURNIQUETS, OXYGEN
THE FISHERMAN OR THE SONG OF A DREAM COME TRUE