Peer-reviewed journal "Moscow Surgical Journal"
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Endoscopic markers predicting high risk of gastric cancer in patients with chronic gastritis
Introduction. Changes in the gastric mucosa associated with Helicobacter pylori infection, determined during endoscopic examination, can serve as indicators of an increased risk of developing gastric cancer. Study objective. To detect endoscopic predictors of gastric cancer in patients with chronic gastritis. Materials and methods. A retrospective pilot case-control study included 32 patients with gastric adenocarcinoma. The comparison group included 80 patients with chronic H. pylori-associated gastritis. The study included patients with early and localized forms of gastric cancer. The study was conducted at the Federal State Budgetary Educational Institution of Additional Professional Education RMANPO. Patients were examined and treated from September 2020 to January 2025 at Medsi in Otradnoye Clinical Hospital, MEDSI on Krasnaya Presnya Clinical and Diagnostic Center of MEDSI Group of Companies, the V. V. Veresaev City Clinical Hospital, and the Endoscopy Center of the S. P. Botkin Medical Scientific and Clinical Center. Results. Statistically significant differences were obtained for the following predictors: severe atrophy OR = 2,833 (95 % CI: 1,193–6,724); intestinal metaplasia OR = 11,400 (95 % CI: 3,318–39,164), hyperplasia of the gastric folds OR=2,833 95 % (CI: 1,193–6,724), gastric xanthoma OR = 6,333 (95 % CI: 1,752–22,892). The resulting model that determined the probability of neoplasm depending on intestinal metaplasia, enlarged folds and xanthoma has a sensitivity and specificity of 80,6 % and 67,5 %, respectively, PPV 71,3 % and NPV 77,7 %. Conclusion. The study identified additional predictors of gastric cancer: enlarged folds and xanthoma, in addition to the traditionally used atrophy and intestinal metaplasia of the mucosa.
Early parastomal complications in patients after urgent ostomy
Introduction. Despite the improvement of surgical techniques and thorough preoperative examination of patients, postoperative complications cannot always be avoided. Postoperative complications worsen the patient's condition, up to a fatal outcome, increase the length of hospital stay, and reduce the quality of care provided. The purpose of the study. To identify risk factors for early postoperative complications in patients with formed intestinal stomas. Materials and methods of research. The retrospective study included 140 patients from April 2022 to July 2023 (14 months) who underwent surgery at the N.V. Sklifosovsky Research Institute in connection with various disease of the abdominal organs with the formation of a stoma. The patients were divided into two groups (without and with complications). Parastomal complications (excluding peristomal dermatitis) were detected in 13 patients (9,3 %). There were more women than men in both groups. The mean age of patients with parastomal complications was 60,8 ± 14,9 years, in the group without complications – 67,8 ± 14,6. To assess the possibility of comparing groups and the significance of differences in the compared parameters, t-test, χ2 were used. Results. Analyzing the data obtained, the main group of patients with certain early parastomal complications are elderly patients with a high body mass index (BMI) and with more than two comorbid chronic diseases. However, 69,2 % of parastomal complications were related to the technical mistakes during surgery. Conclusion. In order to reduce early postoperative complications, careful preoperative diagnosis, identification and assessment of the comorbid background, as well as improvement of the technique of surgical intervention to reduce intraoperative mistakes are required.
Optimization of treatment for diffuse secondary peritonitis using vacuum-assisted abdominal closure technologies
Introduction. Diffuse secondary peritonitis remains a critical surgical challenge due to high mortality (30–60 % in sepsis) and limitations of traditional relaparotomies. Objective: To improve clinical outcomes in secondary peritonitis using vacuum-assisted abdominal closure technologies. Materials and methods of research. Included 283 patients with peritonitis (MPI≥20), divided into three groups: planned relaparotomies with passive drainage (group 1, n=145), vacuum-assisted laparostomy (VAL) with 48-hour sanitations (subgroup 2,1, n=81), and vacuum-instillation laparostomy (VIL) with 2,5 % glucose solution (group 3, n=57). Groups were comparable in sex, age, abdominal cavity index, Mannheim Peritonitis Index, and APACHE II score. Outcomes included mortality, Comprehensive Complication Index (CCI), surgical site infections, treatment duration, number of operations, and fascial closure in patients with completed sanitations. Treatment results. Group 1 had a mortality rate of 35,2 %, CCI of 66,8±34,2, and fascial closure of 73,0 %. Subgroup 2.1 showed reduced mortality (22.2 %, p=0,047), CCI (52,3±30,8, p=0,0013), and fascial closure of 89,6 %. Group 3 achieved the best results: mortality 19,3 % (p=0,018), CCI 44,43±31,4 (p<0,001), and fascial closure 92,2 %. VIL was optimal for severe peritonitis (MPI≥30, mortality 19,6 %, p=0,008). Conclusion. VAL and VIL outperform relaparotomies, reducing mortality and complications. VIL is optimal for severe peritonitis. The technologies have been implemented.
Effectiveness of the technique of prevention of complications of hernioplasty in patients with inguinal hernias
Approximately 20 million hernia surgeries are performed worldwide each year. When using modern surgical methods, one of the unfavorable complications after alloplasty is chronic postoperative inguinal pain and reproductive dysfunction. Objective: The aim of the study was to evaluate the effectiveness of the original technique of prevention of complications of non-tension hernioplasty in patients with inguinal hernias. Materials and methods. The retro-prospective analysis included 114 patients aged 18 to 65 years who underwent surgery for an inguinal hernia in the amount of non-tensioning hernioplasty. According to the inclusion and exclusion criteria, 37 male patients aged 18 to 65 years were included in the main (prospective) group. These patients underwent surgical intervention in the amount of non-intensive hernioplasty according to the original technique. The comparison group (retrospective) included 77 male patients with inguinal hernia aged 18 to 65 years, who underwent surgery in the amount of non-extensive hernioplasty using the Lichtenstein technique. Results. The study evaluated the effectiveness of non-tensioning hernioplasty in 114 patients with inguinal hernias performed using the original technique (in 37 patients) in comparison with the results of non-tensioning hernioplasty using the Lichtenstein technique (in 77 patients). During the study, we were able to register a decrease in the frequency of postoperative complications after surgical treatment using the original method in the main group. Conclusions. The developed method of hernioplasty, in the postoperative period, reduces the development of foreign body sensation and the frequency of chronic pain, impaired vascular patency, the development of scrotal edema, funiculitis, and can also help reduce the development of reproductive dysfunction in young males. In this regard, the proposed method can be used for the surgical treatment of direct or oblique inguinal hernias.
Modified method of radical excision of epithelial coccygeal passages of median localization
Introduction. The lack of a consensus on the etiology and pathogenesis of the epithelial coccygeal passage has led to the development of a wide variety of surgical treatment methods. However, even this diversity of surgeries does not guarantee a good cosmetic result with no complications and a low risk of recurrence in the long-term postoperative period. The purpose of the study. To improve the results of treatment by developing and implementing a modified method for excising the epithelial coccygeal passage. Material and methods of research. The authors studied the effectiveness of their modified method for excising epithelial coccygeal ducts in the middle position in 36 patients who were operated on between 2021 and 2024. Treatment results. The proposed method improved physical and aesthetic parameters with primary wound healing in all cases, significantly reduced the wound healing time and expanded the angle of the intergluteal cleft. The quality of life assessment showed significant differences in patient groups in physical components and insignificant in psychological components. Conclusion. The proposed technique is characterized by a low percentage of complications in the postoperative period, has a good cosmetic effect and reduces the risk of recurrence due to the alignment of the intergluteal cleft.
Long-term results of the frozen elephant trunk procedure: 10-year experience of a single center
Background. The frozen elephant trunk (FET) procedure is a widely used method for treating extensive thoracic aortic diseases. Despite its significant advantages, a high risk of distal aortic complications requiring reintervention remains. Objectives. To evaluate outcomes of the FET procedure, the frequency and nature of reinterventions, and risk factors associated with reoperations. Materials and methods. We performed a retrospective single-center observational study of 347 patients who underwent FET from 2014 to 2025. Various hybrid prostheses were used, including the Russian dissection-specific stent-graft “Soft Elephant Trunk.” Survival and risk factor analyses were performed using Kaplan–Meier and multivariate logistic regression. Results. The mean patient age was 52,8±11,5 years, with 71 % male. Ten-year survival was 78 %. Reinterventions were required in 13,5 % of patients, including 11,2 % distal and 1,7 % proximal reinterventions. The main cause of unplanned reinterventions (n=19, 5,5 %) was negative remodeling, which in 58 % of cases of new distal stent graft-induced new entry (dSINE), whereas staged reinterventions were performed in 20 cases (5,7 %). Open surgical reinterventions were associated with higher 7-year survival (90 %) compared to endovascular treatments (60 %). Connective tissue disorder was an independent predictor of reintervention risk (HR 4,11, p=0,002). Conclusions. The FET procedure remains the gold standard for treating extensive thoracic aortic disease, ensuring high long-term survival. Our study showed that open surgery after FET provides better long-term results compared to endovascular interventions. Connective tissue disorders require dynamic CT follow-up. Optimization of surgical strategy, and active postoperative monitoring remain key factors in successful treatment and prevention of complications.
Coronary artery bypass grafting in patients with heart failure with preserved ejection fraction
Introduction. Objective. To assess the intraoperative and postoperative course in patients with heart failure with preserved ejection fraction (HFpEF) undergoing coronary artery bypass grafting (CABG), and to compare their outcomes with those of patients with reduced ejection fraction (HFrEF) and patients without signs of heart failure (HF). Materials and methods. A total of 154 patients with coronary artery disease were included in the study and divided into three groups: HFpEF (n = 62), HFrEF (n = 54), and no HF (n = 38). All patients underwent isolated CABG with the use of cardiopulmonary bypass. Intraoperative parameters, incidence of rhythm disturbances, and early postoperative outcomes were analyzed. Results. Patients with HFpEF had a higher incidence of postoperative atrial fibrillation (35,5 % vs. 15,8 % in patients without HF; p = 0,040), longer duration of mechanical ventilation (6,5 [5,1–8,0] h vs. 5,5 [4,0–6,5] h; p = 0,003), and longer hospital stay (11 [8,25–15] days vs. 9 [8–10,75] days; p = 0,013). There was also a trend toward a lower rate of spontaneous rhythm recovery after reperfusion in the HFpEF group. Conclusions. HFpEF significantly affects the postoperative course in patients undergoing CABG. The increased risk of complications and prolonged recovery period highlight the need for an individualized approach to managing this patient population.
Combined operations in pathology of brachiocephalic arteries
Introduction. Radical correction of brachiocephalic artery diseases occupies a leading position in the practice of vascular surgery. Intravascular interventions are becoming increasingly used, with impressive improved results and minimally invasiveness. However, this area is characterized by a variety of pathology, anatomical features and the varying prevalence of the process, which, in some cases, implies an individual (creative) approach to solving the problem. And in particular, this applies to therapeutic tactics for combined pathologies of the region. Materials and methods. In the period from November 2024 to April 2025, the group performed 108 operations for pathology of the brachiocephalic basin. Combined operations were performed in only 3 cases. Results and discussion. A description of 3 clinical cases with combined operations is presented. Conclusion. In specialized vascular departments, if there are indications, simultaneous correction of combined pathology is possible and advisable.
Long-term results of open surgical methods for treating acute arterial thrombosis of peripheral arteries with and without advanced stage of covid-19 infection
Introduction. The pandemic of coronavirus infection has changed the course of diseases familiar to clinical practice. Vascular pathologies are a separate problem, since coronavirus infection affects coagulation processes and the immune response. Against the background of SARS-CoV-2 infection, the likelihood of specific complications increases, so a thorough assessment of treatment results and monitoring of the patency of reconstructed vessels is required. Hypercoagulation promotes the formation of blood clots, which can lead to repeated episodes of ischemia or thrombosis. In addition, inflammatory reactions characteristic of COVID-19 infection may increase the risk of complications after surgery. The purpose of this study was to compare the long-term results of open surgical interventions for DEC in patients with and without the acute stage of the new coronavirus infection COVID-19. Materials and methods. The study included 136 patients with OIC who underwent open surgical revascularization. All patients were divided into two groups. Fifty patients without a history of coronavirus infection made up the first group (control). Group II (studies) included eighty-six patients who developed peripheral arterial thrombosis in the acute stage of COVID-19 infection. The patients' condition was assessed 6 and 12 months after surgical treatment according to ultrasound and MSCT angiography. The statistical analysis of the research materials was performed in the graphical analysis and development software environment "R" of the ComprehensIe R ArchIe Network, CRAN system. Results. 77% of the treated patients were regularly monitored during the year. Patency of the operated arterial basin was comparable in the compared groups both 6 months and one year after surgery. Peripheral arterial retrombosis in the long-term postoperative period was 38.8% (7 patients) in the COVID-19 group and 42.8% (12 patients) in the control group (p<0.066). More often, repeated surgical interventions were performed in group II patients with a history of coronavirus infection. Conclusion. The data obtained indicate that, despite significant differences in the immediate results of DEC treatment with open surgical revascularization in groups of patients with and without coronavirus infection, the frequency of retrombosis in the long-term postoperative period of the compared groups of patients is comparable.
Treatment of reperfusion syndrome and lymphorrhea in patients after arterial reconstructions on the lower extremities
Introduction. Obliterating atherosclerosis of the lower extremity arteries is a major cardiovascular disease, significantly impacting patients' quality of life. Arterial reconstructions, while restoring blood flow to ischemic tissues, often trigger reperfusion syndrome, characterized by limb edema and lymphorrhea from postoperative wounds. These complications prolong recovery and increase hospitalization time. Purpose. To evaluate the clinical efficacy of a modified approach for managing reperfusion syndrome and lymphorrhea in patients with chronic lower extremity ischemia following arterial reconstructive surgery. Materials and methods. The study included 316 patients with lower extremity atherosclerosis treated at the Ulyanovsk Regional Clinical Hospital (2023–2024). Of these, 23 (7,3 %) developed postoperative lymphorrhea and were divided into two groups: Group I 12 (3,8 %) patients received standard postoperative care. Group II 11 (3,5 %) patients underwent a modified treatment protocol for reperfusion syndrome and lymphorrhea. Results and Discussion. Ultrasound analysis of soft tissues revealed: Group I: Increased interfascial edema by day 7. Group II: Reduced interfascial edema. The average duration of lymphorrhea was: Group I: 15,1 ± 7,5 days. Group II: 8,1 ± 1,9 days. Conclusion. The modified treatment method effectively reduced postoperative complications, shortening hospital stays for patients undergoing lower extremity arterial reconstructions. This highlights its potential for improving postoperative outcomes.
The treatment results of patients with hepatocellular carcinoma
Introduction. Hepatocellular carcinoma (HCC) is a primary tumor, accounting for 80–85 % of all malignant liver tumors. According to world statistics, the incidence of HCC ranks 6th, and mortality – 3rd. The prevalence of the disease in the Russian Federation has increased by 8 % over the past 5 years and is 4–5 cases per 100 thousand population per year, while stages III–IV account for about 80 %. Treatment of this pathology is a complex task and should take into account many factors. The aim of the study was to analyze the treatment results of patients with HCC for the period from 2008 to 2024. Materials and methods of research. A retrospective analysis of the treatment of 197 patients with hepatocellular carcinoma (HCC) was performed, the average age was 61.3 ± 8.5 years, men – 140 (71 %), women – 57 (29 %). Liver resection was performed in 82 patients, locoregional techniques were performed in 119 patients. Treatment results. The average duration of the operation was 179 ± 28,3 min; the average bed-day was 11 ± 3 days; the survival rate was 83 % at one year, 75 % at two years, 50 % at three years, and 32 % at five years. The time of LRT procedures were as follows: RFA –12 ± 2,8 min, MVA – 7 ± 2,3 min, LA – 6 min. The survival rate after RFA of liver tumors was 81% at one year, 62 % at two years, 39 % at three years, and 28 % at five years. When performing MVA of liver tumors, the survival rate was 83 % at one year, 67 % at two years, 42 % at three years, and 31 % at five years. Conclusion. An integrated approach to the treatment of patients with primary liver cancer allows us to determine the optimal tactics, which increases the effectiveness of treatment, increases life expectancy and improves its quality, and makes it possible to use local methods in somatically burdened patients.
Methods of surgical treatment of pulmonary emphysema
Introduction. Emphysema of the lungs is treated exclusively surgically, this is due to the need to prevent subsequent pneumothorax and can improve the patient's quality of life and increase the level of exercise tolerance. Marginal lung resection and pleurectomy are the surgery of choice for pulmonary emphysema, the reconstructive nature is associated with a decrease in lung volume by at least 1/3, which will allow the lung to expand into the remaining cavity. It is important to determine the method of resection that is as safe as possible for the patient, who will have the best performance for rehabilitation. The aim of the study is to determine the best method of surgical intervention for pulmonary emphysema, with a minimum number of complications and the ability to maximize the patient's quality of life without relapses. Materials and methods. Within the framework of this work, 280 operations of surgical treatment of emphysema of the lungs were performed, various approaches to surgery were compared, in order to choose the best surgical treatment option, the positive and negative sides of various surgical interventions were described. Results and discussion. When comparing a robot-assisted operation and an open-access operation, there are a number of discrepancies. Conclusion. Maximum effectiveness can be achieved only if highly professional surgical intervention is combined with proper diagnosis and modern surgical techniques are used.
Experience of using negative pressure wound therapy with instillation in complex treatment of purulent-necrotic diseases of soft tissue of the trunk and extremities
Introduction. Negative pressure wound therapy (NPWT) has been widely used for over 20 years in the treatment of purulent–necrotic soft tissue infections. However, negative pressure wound therapy with instillation (NPWT-i) is a newer method employed in complex wound management. Objective. To improve surgical treatment outcomes in patients with purulent-necrotic soft tissue infections. Materials and methods. The study included 25 patients with purulent-necrotic soft tissue infections of the trunk and extremities, divided into two groups. Group I (15 patients) received conventional NPWT as part of comprehensive treatment, while Group II (10 patients) underwent NPWT-i with normal saline instillation. The groups were comparable in age, sex, wound size, and primary pathogen. Results. The mean number of secondary surgical debridements was 5,50 ± 1,25 in Group I and 3,00 ± 0,82 in Group II (p < 0,05). The mean plasma C-reactive protein (CRP) level on day 7 after initial debridement was 99,65 ± 15,50 mg/L in Group I and 47,25 ± 32,26 mg/L in Group II (p < 0,05). The average hospitalization duration was 43,00 ± 8,08 days in Group I and 34,75 ± 4,65 days in Group II (p < 0,05). Computerized planimetric wound surface analysis on day 7 post-debridement showed that the mean granulation tissue area was 48,60 ± 4,34 % in Group I versus 71,25 ± 5,06 % in Group II (p < 0,05). Fibrin coverage was 27,00 ± 5,83 % and 15,75 ± 1,26 %, respectively (p < 0,05), while necrotic tissue area was 24,40 ± 2,70 % in Group I compared to 11,50 ± 2,08 % in Group II (p < 0.05). Conclusion. Negative pressure wound therapy with instillation (NPWT–i) is an effective approach in the comprehensive treatment of purulent–necrotic soft tissue infections of the trunk and extremities.
Prevalence and course of long-term non-healing wounds among residents in the Republic of Dagestan
Introduction. Long-term non-healing wounds are one of the most pressing problems in the field of medical practice and public health, especially in regions with limited resources and high levels of chronic diseases. The aim was to assess the prevalence and analyze the course of long-term non-healing wounds in residents of the Republic of Dagestan. Materials and methods. Analytical cross-sectional design was used in this study. The object of the study was residents of the Republic of Dagestan, selected randomly. The study included 250 patients with long-term non-healing wounds, of which 150 (60 %) were men and 100 (40 %) were women. The collected data was analyzed using statistical data processing software. Results. The presence of concomitant diseases showed a significant correlation with the temporal characteristics of healing (p<0,05). Despite the significance of the data obtained, our study has several limitations due to the design of the cross-sectional study, a sample of 250 patients may not be sufficient to study all possible effects on the course of diseases. Conclusion. This study highlights the importance of prevention and early diagnosis, as well as the need for more active use of modern treatment methods to improve outcomes in patients with long-term non-healing wounds in residents of the Republic of Dagestan.
Immediate and Long-term Outcomes of Platelet-rich Plasma-assisted Lipofilling for Correction of Scar Deformities and Associated Complications Following Breast Cancer Surgery: A Single-Center Experience
Introduction. Postoperative cicatricial deformities and complications after breast reconstructive surgery following cancer treatment remain an urgent issue in modern surgery, necessitating the development and implementation of more effective correction methods. The purpose of the study. To evaluate immediate and long-term outcomes of platelet-rich plasma (PRP)-assisted lipofilling in correcting postoperative scar deformities in breast cancer patients. Materials and methods of research. The study included 30 patients who underwent reconstructive surgery followed by PRP-assisted lipofilling. The effectiveness of correction was evaluated using photographic and video documentation, the Vancouver Scar Scale (VSS), the Patient and Observer Scar Assessment Scale (POSAS), and the BREAST-Q questionnaire over a 12-month follow-up period. Results of treatment. Immediate postoperative results demonstrated high aesthetic satisfaction among both patients and surgeons. PRP enhanced the vascularization and stability of transplanted fat tissues, ensuring stable long-term outcomes. No complications were identified during the year-long follow-up. Conclusion. PRP-assisted lipofilling is an effective and safe method for correcting scar deformities following breast reconstruction. It significantly improves patients’ quality of life and ensures high aesthetic satisfaction.
Possibilities of regulating autograft survival during transplantation
Intoduction. One of the key tasks of tissue transplantation during surgical interventions is to ensure its viability in the recipient area. In this regard, all stages of surgical intervention, including the collection, processing and implantation of the graft, should be aimed at the maximum preservation of its structural and functional properties. Modern researches demonstrate high perspectivity of using autologous adipose tissue both for regenerative and volume-forming purposes within the framework of reconstructive surgeries. The purpose of the study. To evaluate the potential of various artificial solutions for temporary preservation of autologous fat grafts in order to enhance their viability and maintain cellular integrity, as well as to provide a scientific rationale for further experimental and clinical research in this field. Materials and methods of research. For comparison, 3 adipose tissue samples were taken and placed in solutions with different chemical contents for each group (0,9 % NaCl solution, 0,5 % glucose solution, and 15 % dimethyloxobutylphosphonyl dimethylate solution). Then, they were aged for 5 h and the ionic composition was evaluated by low vacuum electron microscopy and energy dispersive X-ray spectral analysis (EDX) using EDAX TEAM software. Treatment results. The study quantified the intracellular content of Na′ and K′ ions in adipocytes incubated in different solutions. According to electron microscopy and spectral analysis, it was found that in samples treated with 0,9 % NaCl solution, there was a significant accumulation of sodium and chlorine ions both on the surface and inside the cells. This was accompanied by disturbance of ionic balance. The best ratio was observed in samples treated with 15 % dimethyloxobutylphosphonyl dimethylate solution. Conclusion. By modifying the chemical composition of the solution containing adipose tissue, it is possible to increase the viability of cells and reduce their sensitivity to unfavorable external influences in the process of transplantation. Addition of components stabilizing cell membranes, antioxidants and ionic regulators to the solution contributes to the reduction of apoptosis, maintenance of osmotic balance and improvement of metabolic stability of cells, which leads to the conclusion that further research in this area is necessary. Such adaptation of microenvironment creates more favorable conditions for autograft engraftment, promotes preservation of its functional integrity and realization of adipose tissue potential in the recipient area.
Assessment of the condition of victims of various gunshot wounds of the abdomen from the civilian population
Introduction. In modern conditions, unfortunately, military conflicts do not subside, our country is no exception. In addition to servicemen who are directly involved in military actions, civilians often suffer. Purpose of the study. To evaluate the condition of the injured in case of shrapnel and bullet wounds of the abdomen in civilian population. Materials and methods of the study. The study was conducted on 165 patients from the civilian population who received gunshot wounds of the abdomen. All patients were in the zone of military operations during the Chechen campaign and in the zone of special military operation. There were 108 (65,4 %) male patients and 57 (34,5 %) female patients, i.e. male patients predominated. The mean age of the wounded was 36 ± 6 years. Patients with gunshot wounds of the abdomen older than 18 years were included. Wounded patients younger than 18 years of age with combined wounds of the chest, head, and extremities were excluded. Medical histories were used as primary documentation. The number of the wounded included in the study, received during the Chechen campaign, amounted to 98 (59,4 %) people, and during the special military operation – 67 (40,6 %). All the wounded were divided into two groups: group A and group B. Group A included the wounded with shrapnel wounds of the abdomen, group B – gunshot wounds. Group A included 87 (52,7 %) people, group B – 78 (47,2 %), in whom the main parameters of vital activity were studied. Results. The study analyzed the condition of wounded civilians who received shrapnel and bullet wounds. As a result, it was found that in case of shrapnel wounds of the abdomen the severity of the condition is determined by the presence of pain syndrome, the more pronounced the pain syndrome, the greater the probability of shock development, and the severity of pain reaction, first of all, influences the degree of shock, then the volume of blood loss. At gunshot wounds of the abdomen the obtained results were somewhat different, so, in the first place was such an indicator as the volume of blood loss, then signs of anemia, and in the third place - pain syndrome. Conclusion. The conducted study shows that gunshot wounds of the abdomen lead to serious changes in the body of the wounded person, which is caused by several factors: pain syndrome, blood loss, all this, in turn, triggers the mechanism of hemorrhagic shock development, which also contributes to the aggravation of the victim.
3D modeling in reconstructive surgery of esophageal-gastric junction
Introduction. Surgical interventions in the gastroesophageal junction are complex manipulations that are often accompanied by iatrogenic complications. This is due to the specific anatomical structure of this area. Therefore, more accurate and secure methods for planning operations are required. Modern technologies, such as three-dimensional modelling, make it possible to create a personalized model of this area, which allows the surgeon to study the anatomical features of the patient in detail. This helps navigate more accurately during surgery and reduces the likelihood of complications. Purpose of the study. To demonstrate the effectiveness of using 3D modelling of the gastroesophageal junction area when performing surgical intervention for recurrent hiatal hernia. Materials and methods. The patient's MSCT was analysed by assessing the anatomical features of the area of interest. Based on this, a 3D model of the gastroesophageal junction area with an altered anatomy was provided to surgeons for planning the upcoming operation. The obtained data were subsequently compared with the intraoperative findings. Results. A patient with recurrent hiatal hernia underwent surgery with preliminary 3D modeling. No intra- or postoperative complications were observed. Considering the smooth course of the postoperative period, the patient was discharged in satisfactory condition on the 5th day after surgery. Conclusion. The use of 3D modeling in a patient with recurrent hiatal hernia enhanced intraoperative navigation, thereby preventing complications.
Application of botulinum toxin as a method to reduce the scope of component separation hernioplasty in postoperative ventral hernia repair
Introduction. TAR hernioplasty (TAR – Transversus Abdominis Muscle Release), as a type of component separation technique, is a standard method for reconstructing the anterior abdominal wall in the treatment of large ventral hernias. However, this method is associated with significant tissue trauma, risk of complications, and a prolonged recovery period. In recent years, the possibility of preoperative botulinum toxin type A (BTA) administration has been explored to reduce the extent of component separation due to BTA's muscle-relaxing effect. The purpose of the study. Demonstration of the potential use of botulinum toxin type A (BTA) to reduce the extent of TAR hernioplasty in patients with large postoperative ventral hernias (PVH) who were initially scheduled for standard bilateral TAR hernioplasty. Materials and methods. The article describes a clinical case of treating a patient diagnosed with a postoperative ventral hernia (PVH) classified as M1-4W3R1. The preoperative preparation included the administration of botulinum toxin type A (BTA). Results. The results showed that preoperative use of BTA allowed reduction of the surgical procedure to unilateral TAR hernioplasty in a patient who was initially scheduled for bilateral TAR hernioplasty. Conclusion. Preoperative use of botulinum toxin type A (BTA) in patients with large and giant ventral hernias reduces the extent of TAR hernioplasty required.
Treatment of cutaneous actinomycosis of the gluteal and sacrococcygeal regions after routine excision of the epithelial-coccygeal passage. Clinical observation
Cutaneous actinomycosis is a rare granulomatous bacterial infection that usually begins in the perianal region. The article describes a clinical case in which a patient came to us with an infected postoperative wound after routine excision of a pilonidal cyst and epithelial coccygeal passage. Our goal is to familiarize surgeons with the diagnosis and treatment of actinomycosis in the absence of clinical manifestations in other areas of the skin, since this issue is not reflected in sufficient detail in the specialized literature. To focus on the importance of visualization before excision of the pilonidal cyst and caution when visualizing granulomas intraoperatively. Based on modern data on surgical and therapeutic treatment of actinomycosis, we performed extensive excision of the edges of the infected wound and the infiltration zone with granulomas, as well as excised the residual epithelial passage. The postoperative period was uneventful. There was no recurrence of the disease in the patient within 12 months after the operation.
Low-temperature Argon Plasma: from the Biophysical Foundations for practical application in clinical medicine
Introduction. Low-temperature argon plasma (LTAP) is increasingly being used in medicine due to its antimicrobial, anti-inflammatory, and regenerative properties. Objective. To compare the energy parameters of ultraviolet radiation emitted by the "Plazmoran" and "PLAZON" devices to evaluate their effectiveness in clinical practice. Materials and Methods. The study was conducted using two devices: – "Plazmoran" (operates on argon) – "PLAZON" (uses air). The energy illumination of UV radiation was measured at distances of 10, 15, and 20 cm. For "Plazmoran," mode B2 was used; for "PLAZON," the maximum mode was applied. Results. "Plazmoran" demonstrated 5 times higher illumination in the UV-C range compared to "PLAZON." This is attributed to the use of argon, which ensures stable recombinant radiation. With increasing distance, the effectiveness decreases due to the absorption of UV radiation by oxygen in the air. Clinical data confirm the efficacy of LTAP in treating wounds, burns, dermatological diseases, and blast injuries in children. The application of plasma promotes faster wound healing, reduces inflammation, and activates tissue regeneration. Conclusion. The "Plazmoran" device has higher energy characteristics and more stable effects, making it preferable for clinical use. The use of argon eliminates unwanted chemical reactions and enhances therapeutic efficacy. The obtained results confirm the promising prospects for further integration of LTAP technologies into medical practice.
Current methods of treating patients with large midline postoperative ventral hernias
Introduction. Ventral hernias are a common postoperative complication, particularly following midline laparotomy, with an incidence exceeding 30%. Surgical treatment presents significant challenges due to pronounced anatomical abnormalities, fibrotic tissue changes, severe comorbidities, and the complexity of planning the extent and nature of reconstructive interventions during preoperative preparation. In recent years, new approaches to treating large postoperative midline ventral hernias (POVH) have emerged, requiring systematic analysis and evaluation of their effectiveness. Objective. To conduct a systematic analysis of modern surgical techniques for treating large POVH, including various separation-based repair techniques, and to assess the efficacy of preoperative botulinum toxin type A (BTA) in the comprehensive management of this condition Results. A reduction in postoperative complications and recurrence rates was observed with the use of posterior separation-based repair (Transversus Abdominis Muscle Release, TAR). Preoperative BTA administration in these patients contributed to an average increase in lateral abdominal wall muscle mobility of 3.2–4.7 cm on each side, facilitating effective closure of midline defects and reducing the extent of separation-based repair. Conclusion. Preoperative BTA administration in patients with large midline hernias allows for a reduction in the extent of separation-based repair, thereby decreasing surgical trauma and the risk of compartment syndrome.
Intraabdominal hypertension and abdominal compression syndrome during laparoscopic operations
Abdominal compartment syndrome (ACS) occurs with a persistent increase in intra-abdominal pressure above 20 mmHg and is associated with organ failure. The prevalence of SAH varies from 2 to 36,4 %. An analysis of the literature data over the past 5 years has been carried out to present a modern concept, classification and integrated approach to the treatment and prevention of severe complications of SAH, including using photodynamic therapy (PDT). The treatment is based on the evacuation of intraluminal contents, detection and treatment of intra-abdominal pathology, improvement of the elastic properties of the anterior abdominal wall and optimal injection of fluids and tissue perfusion. Today, PDT is undoubtedly effective in the treatment of many surgical diseases due to its anti-inflammatory, regenerative, desensitizing, and immunocorrective properties inherent in laser treatment. Thus, the key point in the treatment of ACS is the need for an interdisciplinary focus for intensive care and early rehabilitation of patients. In this regard, the search, definition and implementation of strategies to optimize the care of this category of patients is relevant. ACS should be treated before complications occur, and the introduction of a comprehensive method of preparing patients for surgical treatment during laparoscopic operations using PDT sessions is relevant, especially in elderly and senile patients with a number of concomitant diseases, impaired organ function and systems.
The neuropathic form of diabetic foot – is the current state of the problem (literature review)
Introduction. Diabetic foot syndrome is one of the late complications of diabetes mellitus. Diabetic neuropathy, affecting the peripheral nervous system, leads to a decrease in sensitivity in the foot area and the development of chronic wounds both during its injury and in the outcome of treatment of purulent lesions. Chronization of the wound process, prolonged healing causes radical operations on the lower extremities in the amount of high amputations, leading to disability of patients, deterioration of their quality of life and fatal outcomes. Objectives. To study the available literature data of domestic and foreign authors affecting the problem of chronic wounds in the neuropathic form of diabetic foot, and to find ways to resolve them at the present stage. Materials and methods. Analysis of available literature data, scientific databases PubMed, e-library. Results. The analysis of the literature data confirms the relevance of the problem of wound treatment in the neuropathic form of diabetic foot and the need for further research on this question. Conclusion. The neuropathic form of diabetic foot is a problem that requires a multidisciplinary approach. Future research should focus on developing personalized treatment approaches, preventing this serious complication, and improving the quality of life for patients with diabetic foot.
Abdominoplasty in combination with umbilicoplasty as a promising method of restoring abdominal configuration
Introduction. The methods of modern abdominoplasty have been developed mainly over the past 40 years and are aimed at achieving maximum aesthetic results. The demand for plastic surgery in this area is steadily increasing from year to year. The polyvalence of this pathology is due to an increase in the number of full-term pregnancies, including multiple pregnancies, an increase in bariatric surgery followed by massive weight loss, and an increase in the number of liposuctions performed. All this leads to the formation of abdominoptosis and, as a result, an increase in the demand for abdominoplasty operations. The main part. Classical abdominoplasty was and remains the most frequent and sought-after surgery. As a rule, the operation is combined with the transfer and fixation of the navel. The widespread introduction of liposuction into surgical practice has led to the emergence of a combined operation – lipoabdominoplasty. Miniabdominoplasty has become increasingly practiced. Anchor abdominoplasty is much less commonly used in plastic surgery practice. Over the past 5–7 years, the issue of the effect of Scarp fascia on an increase in the development of complications after abdominoplasty has been actively discussed in the scientific literature. Conclusion. Despite the rather long period of existence of the abdominoplasty operation, there are still a number of unresolved and debatable issues that require further research.
Personalizes approach to selecting revision antireflux surger
Introduction. Recurrences of hiatal hernias and gastroesophageal reflux disease (GERD) following primary surgical treatment remain a challenging problem in abdominal surgery. Failure rates reach 15–60 %, with key manifestations including recurrent reflux, dysphagia, and gas–bloat syndrome. The causes of recurrence are multifactorial: fundoplication wrap migration, cicatricial strictures, diaphragmatic weakness, and technical errors from the initial procedure. The purpose of the study. To analyze existing fundoplication techniques and develop personalized approaches to reoperative antireflux surgery. This strategy is based on comprehensive preoperative diagnostics, analysis of primary surgery failure causes, and selection of optimal corrective methods (fundoplication type, mesh reinforcement necessity, esophageal mobilization). Materials and methods of research. Review of articles published in scientific databases such as PubMed, Web of Science, Scopus, and eLIBRARY. Results of research. Performing comprehensive multimodal diagnostics enables identification of the causes of recurrent hiatal hernia and GERD. For large defects, the use of a U–shaped synthetic mesh is justified. For esophageal shortening less than 1 cm, Collis gastroplasty is indicated; for shortening exceeding 1–2 cm, Chernousov's technique is applied. A complete fundoplication is applicable in cases of severe reflux with normal motility, a partial fundoplication is used for significant dysphagia and hypomotility, and an anterior fundoplication is indicated in the presence of cicatricial fibrosis or as an adjunct to cardiomyotomy for achalasia. Conclusion. Revisional surgery requires strictly individualized management. Success depends on: precise diagnostics, appropriate technique selection (combined cruroplasty, mesh repair, fundoplication), anatomical defect correction, surgical expertise, and adherence to rehabilitation protocols – minimizing recurrences in complex cases.
Modern approaches to treatment of recurrent laryngeal nerve injuries after thyroidectomy
Introduction. Intraoperative neuromonitoring in modern surgical intervention on the thyroid gland, there is a certain risk of postoperative complications. Intraoperative injury to the recurrent laryngeal nerve (RLN) continues to be one of the most common and leads to a decrease in the quality of life of patients and loss of professional activity. The purpose of the study. To study modern conservative and surgical methods of treating intraoperative injury to the recurrent laryngeal nerve in surgical treatment of thyroid diseases. Materials and methods of research. A review of data in PubMed, ScienceDirect, eLIBRARY was performed. Exclusion criteria for the analysis: descriptions of individual clinical cases; books and documents. Of the initially identified 108 sources, 46 were included in the review. Treatment results. The highest efficiency among the options for drug therapy of intraoperative injury of the RLN is demonstrated by the administration of neuromedin, proserin, nimodipine and dexamethasone. Among the methods of surgical treatment of RLN injuries, microsurgical plastic surgery of damaged vocal cords, percutaneous or endoscopic injection laryngoplasty and medializing thyroplasty are used. Conclusion. Drug treatment of RLN injuries is effective in 65-88% of cases, surgical treatment – in 78–94 %. Conservative methods of treatment require long-term use, which leads to a gradual restoration of the RLN function. Despite the high efficiency of surgical methods, there is a high risk of complications in the postoperative period, which requires careful selection of patients and an assessment of the degree of risk of surgical intervention and its absence.
Acute mesenteric ischemia. Possibilities of early diagnostics. Literature review
The article is devoted to the urgent problem of early diagnosis of acute mesenteric ischemia (AMI), which is characterized by high lethality (50–80 %) and difficulty of timely detection. The main causes of AMI development are: Arterial occlusion (embolism, thrombosis); Venous thrombosis; Non-occlusive ischemia. The key risk factors are: Cardiovascular diseases; Blood coagulation disorders. It is fundamentally important to detect pathology as early as possible - in the first 6 hours from the onset of the disease, when the probability of a favorable outcome is 70–80 %. The article details the clinical manifestations of OMI, laboratory markers and instrumental methods of diagnosis. The clinical picture is characterized by a gradual increase in symptoms: from moderate abdominal pain to the development of peritonitis. The peculiarity is the absence of pathognomonic signs, which significantly complicates timely diagnosis. Special attention is paid to CT-angiography as the most informative method of visualization with sensitivity 85–98 % and specificity 91–100 %. Modern approaches to the interpretation of laboratory parameters such as leukocyte count, lactate and D-dimer levels are presented. Despite significant advances in modern medicine, the lethality of AMI remains high and reaches 50–80 %, which emphasizes the need for continuous improvement of diagnostic and therapeutic approaches.
Surgical treatment of scars. Literary review
Introduction. The growing demand for plastic surgeons to eliminate scars on the skin leads the surgical community to the need for a detailed study of the morphogenesis, histochemical structure of scars, and the search for new optimal surgical methods. The purpose of the work: to analyze literary sources on the topic: surgical treatment of scars. Materials and methods. 286 literary sources on surgical treatment of scars were analyzed. The search for literature sources was carried out by keywords using the search engines Cyberleninka, eLibrary, PubMed. The main part. In the main part, the issues of classification and clinical diagnosis based on international diagnostic scales are considered. The methods of therapeutic and surgical treatment are also analyzed. Conclusion. A wide range of treatment methods, both therapeutic and surgical, indicates the lack of a unified approach by plastic surgeons to the management of patients with scars. Scar treatment is a rapidly developing field that currently lacks a structured and validated approach. It is obvious that further clinical and scientific research is needed in this area in order to improve the results of scar treatment.
The concept and significance of medical confidentiality in Russia: protection and security measures. Implementation problems
The article considers the patient's right to protect and defend medical confidentiality, as well as the measures of liability for its disclosure provided for by the legislation of the Russian Federation. Introduction. The author analyzes the concept of medical confidentiality established by the current legislation, shows the problem of leakage of patients' medical information. Legal measures of protection and security are given, the legislation is analyzed in terms of tightening liability for disclosure of patients' medical confidentiality. In the context of the need to protect medical confidentiality, the author emphasizes the issue of the unequal position of the patient and the doctor, in situations where medical information is disclosed by the patient publicly. The author analyzes the measures of civil, administrative and criminal liability applied to doctors and medical organizations, shows the approach of the courts in resolving medical disputes related to the disclosure of the patient's medical confidentiality. Conclusion. Based on the results of the analysis, it was concluded that it is necessary to grant the doctor the right to disclose certain medical information without the patient's consent, in cases where the patient himself makes public information that is a medical secret, as well as to establish restrictions on the list of persons who have the right to access patients' medical data and the storage periods for patient data. It seems possible to introduce multi-level authorization at the legislative level when working with electronic medical records.
The wave was crashing against a barren wall
Gusts of rain and the roar of the wind grew stronger
Motl sheinkman, or the tragic grammar of light
Izya the tailor and his philosophy of buttons
I recognized myself in him – stupid and young