July 1, 2022 marks the 85th anniversary of the birth of the outstanding Ukrainian surgeon, Laureate of the State Prize of Ukraine, Honored Worker of Science and Technology of Ukraine, MD, Professor Valeriі Mykolayovych Korotkyі. V. M. Korotkyi was born into a family of employees in the town of Hlukhiv in the Sumy region. He graduated from Chernivtsi Medical Institute in 1961. According to work placement, V. M. Korotkyi was assigned to the Vashkiv central regional hospital in the Chernivtsi region and worked there as a surgeon from 1961 to 1964. From 1964 to 1967, he completed his postgraduate education at the Department of Surgery of the Kyiv Institute for Advanced Training of physicians, after which he successfully defended his dissertation on the surgical treatment of three-dimensional lung formations (supervisor: Academician M. M. Amosov). From 1967 to 1968, he worked as an assistant at the Department of Pediatric Surgery; from 1967 to 1975, as an assistant at the Department of Thoracoabdominal Surgery of the Institute for Advanced Training of Physicians; and from 1975 to 1985, as an associate professor at the same department. In 1984, he defended his doctoral dissertation on the pathogenetic treatment of patients with portal hypertension syndrome (scientific consultant: Academician O. O. Shalimov). From 1980 to 1985, he held the position of head of the Portal Hypertension Department of the Kyiv Institute of Clinical and Experimental Surgery (now the Shalimov National Institute of Surgery and Transplantology). From 1985 to 2006, V. M. Korotkyi headed the Department of Hospital Surgery (since 2008 — Surgery #2) at Bogomolets National Medical University. From 2006 to 2017, he worked as a professor in the same department. Professor V. M. Korotkyi carried out research in such medical fields as surgical gastroenterology, vascular surgery, and the development of technologies for minimally invasive laparoscopic surgical interventions in diseases of the abdominal cavity. He substantiated the tactics of surgical treatment of complications of cirrhosis of the liver, peptic ulcer of the stomach and duodenum, pathology of the pancreatic-biliary tract, intestines, pancreatic cancer, and traumatic injuries of the pancreas and spleen. In 1986, V. M. Korotkyi became a Laureate of the State Prize of Ukraine in the field of science and technology for a series of works titled «Development, theoretical justification and clinical implementation of new methods of surgical treatment, detoxification and rehabilitation of patients with liver and bile duct diseases». In 2001, he was awarded the honorary title of «Honored Worker of Science and Technology of Ukraine». V. M. Korotkyi developed original surgical interventions in the treatment of liver cysts, portal hypertension, benign and malignant diseases of the pancreas, complicated gastric and duodenal ulcers, traumatic splenic injuries, acute and chronic pancreatitis, gallstone disease, acute intestinal obstruction,
2022年7月1日是乌克兰杰出外科医生、乌克兰国家奖获得者、乌克兰科学技术荣誉工作者、医学博士、瓦列里特·米科拉耶维奇·科罗特基耶克教授诞辰85周年。V. M. Korotkyi出生在苏梅地区Hlukhiv镇的一个员工家庭。1961年毕业于切尔诺夫茨医学院。根据工作安排，V. M. Korotkyi被分配到切尔诺夫茨地区的瓦什科夫中心地区医院，1961年至1964年在那里担任外科医生。从1964年到1967年，他在基辅高级医师培训学院外科学系完成了研究生教育，之后他成功地为他关于三维肺形成的外科治疗的论文进行了答辩(导师:院士M. M. Amosov)。从1967年到1968年，他在儿科外科担任助理;从1967年到1975年，担任the Institute for Advanced Training of Physicians的胸腹外科助理;从1975年到1985年，在同一系担任副教授。1984年，以门静脉高压症患者的病理治疗为博士论文答辩(科学顾问:O. O. Shalimov院士)。1980年至1985年，他担任基辅临床和实验外科研究所(现为沙利莫夫国家外科和移植研究所)门静脉高压科主任。从1985年到2006年，v.m. Korotkyi在Bogomolets国立医科大学领导医院外科(自2008年起-外科#2)。2006年至2017年任该系教授。V. M. Korotkyi教授在外科胃肠病学、血管外科等医学领域进行了研究，并开发了微创腹腔镜手术干预腹腔疾病的技术。他证实了手术治疗肝硬化、胃和十二指肠消化性溃疡、胰胆道病理、肠、胰腺癌以及胰腺和脾脏创伤等并发症的策略。1986年，v.m. Korotkyi因一系列题为“肝脏和胆管疾病患者手术治疗、解毒和康复新方法的发展、理论论证和临床实施”的作品而获得乌克兰科学和技术领域的国家奖。2001年，他被授予“乌克兰科学技术荣誉工作者”荣誉称号。v.m. Korotkyi在治疗肝囊肿、门脉高压、胰腺良恶性疾病、复杂的胃和十二指肠溃疡、外伤性脾损伤、急慢性胰腺炎、胆结石疾病、急性肠梗阻和常见形式的腹膜炎方面开发了独创的外科干预措施。科研成果发表在400多篇科学论文、40项发明专利和4部专著中。他培养了4名医生和9名医学候选人。
{"title":"On the 85th anniversary of Laureate of the State Prize of Ukraine, Professor Valeriі Mykolayovych Korotkyі","authors":"V. M. Korotkyĭ","doi":"10.30978/gs-2022-2-5","DOIUrl":"https://doi.org/10.30978/gs-2022-2-5","url":null,"abstract":"July 1, 2022 marks the 85th anniversary of the birth of the outstanding Ukrainian surgeon, Laureate of the State Prize of Ukraine, Honored Worker of Science and Technology of Ukraine, MD, Professor Valeriі Mykolayovych Korotkyі. V. M. Korotkyi was born into a family of employees in the town of Hlukhiv in the Sumy region. He graduated from Chernivtsi Medical Institute in 1961. According to work placement, V. M. Korotkyi was assigned to the Vashkiv central regional hospital in the Chernivtsi region and worked there as a surgeon from 1961 to 1964. From 1964 to 1967, he completed his postgraduate education at the Department of Surgery of the Kyiv Institute for Advanced Training of physicians, after which he successfully defended his dissertation on the surgical treatment of three-dimensional lung formations (supervisor: Academician M. M. Amosov). From 1967 to 1968, he worked as an assistant at the Department of Pediatric Surgery; from 1967 to 1975, as an assistant at the Department of Thoracoabdominal Surgery of the Institute for Advanced Training of Physicians; and from 1975 to 1985, as an associate professor at the same department. In 1984, he defended his doctoral dissertation on the pathogenetic treatment of patients with portal hypertension syndrome (scientific consultant: Academician O. O. Shalimov). From 1980 to 1985, he held the position of head of the Portal Hypertension Department of the Kyiv Institute of Clinical and Experimental Surgery (now the Shalimov National Institute of Surgery and Transplantology). From 1985 to 2006, V. M. Korotkyi headed the Department of Hospital Surgery (since 2008 — Surgery #2) at Bogomolets National Medical University. From 2006 to 2017, he worked as a professor in the same department. Professor V. M. Korotkyi carried out research in such medical fields as surgical gastroenterology, vascular surgery, and the development of technologies for minimally invasive laparoscopic surgical interventions in diseases of the abdominal cavity. He substantiated the tactics of surgical treatment of complications of cirrhosis of the liver, peptic ulcer of the stomach and duodenum, pathology of the pancreatic-biliary tract, intestines, pancreatic cancer, and traumatic injuries of the pancreas and spleen. In 1986, V. M. Korotkyi became a Laureate of the State Prize of Ukraine in the field of science and technology for a series of works titled «Development, theoretical justification and clinical implementation of new methods of surgical treatment, detoxification and rehabilitation of patients with liver and bile duct diseases». In 2001, he was awarded the honorary title of «Honored Worker of Science and Technology of Ukraine». V. M. Korotkyi developed original surgical interventions in the treatment of liver cysts, portal hypertension, benign and malignant diseases of the pancreas, complicated gastric and duodenal ulcers, traumatic splenic injuries, acute and chronic pancreatitis, gallstone disease, acute intestinal obstruction, ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79791811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The article analyzes two methods of breast reconstruction: breast reconstruction with an implant or an LD‑flap after a subcutaneous nipple‑sparing mastectomy in the case of complex treatment of stage I — III breast cancer. In many works, the advantages and disadvantages of different types of reconstruction are indicated and contradictions can often be found, although most prefer reconstruction with implants. Objective — to compare the results of immediate breast reconstruction using an implant or an LD‑flap after a subcutaneous nipple‑sparing mastectomy in patients with I — III stages of breast cancer. Materials and methods. We conducted a comparative study of the results of immediate reconstruction of the mammary gland after a subcutaneous nipple‑sparing mastectomy using the method of putting a silicone implant (endoprosthesis) or the method of LD‑flap reconstruction. Randomization was not carried out. The results of operative interventions were retrospectively and parallelly compared in two groups: reconstruction of the mammary gland with an implant (1) or LD flap (2). In both groups of 30 patients, all patients were diagnosed with stage I — III breast cancer and in most cases (80 — 83 %) received preoperative chemotherapy for regression and reduction of the stage of the process. The evaluation of the treatment result was carried out according to aesthetic indicators, oncological survival indicators, and the subjective evaluation of the aesthetic result by patients. Results. During the observation period since 2018, the analysis of the frequency of development in the groups of relapses and metastases during the 4‑year observation period (since 2018), the frequency of development of local complications in both groups: hematomas, skin necrosis, implant extrusions, seromas, lymphorrhea, capsular contractures, liponecrosis, lymphostasis of the upper extremity on the side of the operation, the degree and duration of the pain syndrome in the postoperative area, and the possibility of a full course of treatment did not show significant differences during the observation period. The quality of life in both groups, according to the Spitzer scale, was comparable (in the first group, 64 %, and in the second group, it was 63 %). Only the duration of postoperative bed rest was longer in the LD flap reconstruction group. Conclusions. The results of the analysis of the study’s data showed that there are advantages and disadvantages to both methods. According to the findings, it is difficult to conclude which of the methods is more optimal, but it is necessary to choose the technique based on the constitutional characteristics of the patient and the size and shape of the mammary gland. An individualized and comprehensive approach is important.
{"title":"Latissimus dorsi flap (LD-flap) or endoprosthesis for breast reconstruction? Which is optimal for immediate reconstruction after a nipple-sparing mastectomy in breast cancer patients?","authors":"V. Cheshuk, M. Anikusko, V. Kozina, V. Gurianov","doi":"10.30978/gs-2022-2-48","DOIUrl":"https://doi.org/10.30978/gs-2022-2-48","url":null,"abstract":"The article analyzes two methods of breast reconstruction: breast reconstruction with an implant or an LD‑flap after a subcutaneous nipple‑sparing mastectomy in the case of complex treatment of stage I — III breast cancer. In many works, the advantages and disadvantages of different types of reconstruction are indicated and contradictions can often be found, although most prefer reconstruction with implants. \u0000Objective — to compare the results of immediate breast reconstruction using an implant or an LD‑flap after a subcutaneous nipple‑sparing mastectomy in patients with I — III stages of breast cancer. \u0000Materials and methods. We conducted a comparative study of the results of immediate reconstruction of the mammary gland after a subcutaneous nipple‑sparing mastectomy using the method of putting a silicone implant (endoprosthesis) or the method of LD‑flap reconstruction. Randomization was not carried out. The results of operative interventions were retrospectively and parallelly compared in two groups: reconstruction of the mammary gland with an implant (1) or LD flap (2). In both groups of 30 patients, all patients were diagnosed with stage I — III breast cancer and in most cases (80 — 83 %) received preoperative chemotherapy for regression and reduction of the stage of the process. The evaluation of the treatment result was carried out according to aesthetic indicators, oncological survival indicators, and the subjective evaluation of the aesthetic result by patients. \u0000Results. During the observation period since 2018, the analysis of the frequency of development in the groups of relapses and metastases during the 4‑year observation period (since 2018), the frequency of development of local complications in both groups: hematomas, skin necrosis, implant extrusions, seromas, lymphorrhea, capsular contractures, liponecrosis, lymphostasis of the upper extremity on the side of the operation, the degree and duration of the pain syndrome in the postoperative area, and the possibility of a full course of treatment did not show significant differences during the observation period. The quality of life in both groups, according to the Spitzer scale, was comparable (in the first group, 64 %, and in the second group, it was 63 %). Only the duration of postoperative bed rest was longer in the LD flap reconstruction group. \u0000Conclusions. The results of the analysis of the study’s data showed that there are advantages and disadvantages to both methods. According to the findings, it is difficult to conclude which of the methods is more optimal, but it is necessary to choose the technique based on the constitutional characteristics of the patient and the size and shape of the mammary gland. An individualized and comprehensive approach is important. \u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89298284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obesity is one of the major challenges facing modern medicine in the 21st century. Medically complicated obesity cases lead to a significant deterioration in quality of life and are associated with excess morbidity and increased mortality. According to the WHO, more than 24 % of the world's population over 18 years of age is overweight. About 3.9 million people of working age died in 2018 due to obesity and its complications. Today, bariatric surgery is the most effective in treating obesity, as it allows achieving optimal metabolic outcomes. After bariatric surgery, the desired effect can be produced by the response of the intestinal microbiome to postoperative anatomical and physiological changes in the gastrointestinal tract. The aim of this study was to conduct a comprehensive literature review and evaluate the effects of bariatric surgery on the human intestinal microbiome. The literature review revealed a stable correlation between quantitative and qualitative characteristics of the intestinal microbiota and bariatric surgery, regardless of the type of a bariatric surgical operation. Roux‑en‑Y Gastric Bypass, Mini‑Gastric Bypass and Sleeve Gastrectomy are the most commonly used bariatric operations in the world. The outcomes of these procedures show a sharp change in the proportion of different microbial phyla, including Firmicutes, Bacterioides and Escherichia, as well as changes in the gene expression parameters of these groups at different time periods after surgery. An increasing number of the reported bariatric interventions worldwide necessitates the study of pathophysiological mechanisms of intermicrobial relationships, which can contribute to better outcomes of surgical treatment of obesity and the development of algorithms for predicting them.
肥胖是21世纪现代医学面临的主要挑战之一。医学上复杂的肥胖病例会导致生活质量的显著恶化，并与发病率过高和死亡率增加有关。根据世界卫生组织的数据，世界上超过24%的18岁以上人口超重。2018年，约有390万劳动年龄人口死于肥胖及其并发症。今天，减肥手术是治疗肥胖最有效的方法，因为它可以达到最佳的代谢结果。在减肥手术后，肠道微生物组对术后胃肠道解剖和生理变化的反应可以产生预期的效果。本研究的目的是进行全面的文献综述，并评估减肥手术对人类肠道微生物组的影响。文献综述显示，肠道微生物群的定量和定性特征与减肥手术之间存在稳定的相关性，而与减肥手术的类型无关。Roux - en - Y胃旁路、迷你胃旁路和袖式胃切除术是世界上最常用的减肥手术。这些手术的结果显示了不同微生物门的比例的急剧变化，包括厚壁菌门、拟杆菌门和埃希菌门，以及这些群体在手术后不同时期的基因表达参数的变化。随着世界范围内越来越多的减肥干预措施的报道，需要对微生物间关系的病理生理机制进行研究，这有助于改善肥胖手术治疗的效果，并开发预测方法。
{"title":"The effects of bariatric surgery procedures on the gut microbiota, features of genetically mediated predisposition to obesity, forecasting algorithms for surgical treatment outcomes. Literature review","authors":"P. Kobzar","doi":"10.30978/gs-2022-1-71","DOIUrl":"https://doi.org/10.30978/gs-2022-1-71","url":null,"abstract":"Obesity is one of the major challenges facing modern medicine in the 21st century. Medically complicated obesity cases lead to a significant deterioration in quality of life and are associated with excess morbidity and increased mortality. According to the WHO, more than 24 % of the world's population over 18 years of age is overweight. About 3.9 million people of working age died in 2018 due to obesity and its complications. Today, bariatric surgery is the most effective in treating obesity, as it allows achieving optimal metabolic outcomes. After bariatric surgery, the desired effect can be produced by the response of the intestinal microbiome to postoperative anatomical and physiological changes in the gastrointestinal tract. \u0000The aim of this study was to conduct a comprehensive literature review and evaluate the effects of bariatric surgery on the human intestinal microbiome. \u0000The literature review revealed a stable correlation between quantitative and qualitative characteristics of the intestinal microbiota and bariatric surgery, regardless of the type of a bariatric surgical operation. Roux‑en‑Y Gastric Bypass, Mini‑Gastric Bypass and Sleeve Gastrectomy are the most commonly used bariatric operations in the world. The outcomes of these procedures show a sharp change in the proportion of different microbial phyla, including Firmicutes, Bacterioides and Escherichia, as well as changes in the gene expression parameters of these groups at different time periods after surgery. \u0000An increasing number of the reported bariatric interventions worldwide necessitates the study of pathophysiological mechanisms of intermicrobial relationships, which can contribute to better outcomes of surgical treatment of obesity and the development of algorithms for predicting them. \u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75350047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Kopchak, Y. Dombrovsky, O. Kvasivka, V. Kopetskyi, V. Sumarokova
Primary pancreatic lymphomas are extremely rare. Clinically, primary pancreatic lymphomas usually present with symptoms of pancreatic carcinoma. A localized and well‑circumscribed tumour that replaces most of the pancreatic gland and compression of the blood vessels are radiological features of lymphoma, which are similar to pancreatic adenocarcinoma. Many patients are diagnosed with lymphoma after radical resection. It’s a challenging clinical task for physicians, radiologists, and pathologists. We report a case of primary pancreatic lymphoma that was confirmed by surgical resection. A 60‑year‑old woman came to the clinic with non‑specific upper abdominal pain that lasted 8 weeks. Computed tomography (CT) scan showed a mass in the body of the pancreas, involving the superior mesenteric artery and the celiac trunk, and regional lymphadenopathy. Endoscopic ultrasound‑guided fine needle aspiration of the pancreatic mass was performed. A morphological pattern indicated ductal carcinoma. The tumour board determined the treatment plan (chemotherapy) for the patient. The patient underwent 3 courses of GEMCAP chemotherapy in our hospital. A follow‑up radiological exam showed no improvement. The chemotherapy regimen was changed to FOLFIRINOX. The patient underwent 6 courses of the FOLFIRINOX regimen. A follow‑up magnetic resonance imaging of the pancreas showed tumour regression by more than 90 % in comparison with the previous study. The patient underwent distal pancreatosplenectomy with standard lymph node dissection. Postoperative period was uncomplicated. These pathological results confirm the diagnosis of diffuse B‑cell lymphoma. Conclusions. This case shows that lack of tissue can make histological examination of FNA specimens challenging and mistakes can happen due to rare occurrence of primary pancreatic lymphomas.
{"title":"Primary pancreatic lymphoma: a rare tumour that mimics pancreatic carcinoma. Clinical case","authors":"K. Kopchak, Y. Dombrovsky, O. Kvasivka, V. Kopetskyi, V. Sumarokova","doi":"10.30978/gs-2022-1-61","DOIUrl":"https://doi.org/10.30978/gs-2022-1-61","url":null,"abstract":"Primary pancreatic lymphomas are extremely rare. Clinically, primary pancreatic lymphomas usually present with symptoms of pancreatic carcinoma. A localized and well‑circumscribed tumour that replaces most of the pancreatic gland and compression of the blood vessels are radiological features of lymphoma, which are similar to pancreatic adenocarcinoma. Many patients are diagnosed with lymphoma after radical resection. It’s a challenging clinical task for physicians, radiologists, and pathologists. \u0000We report a case of primary pancreatic lymphoma that was confirmed by surgical resection. A 60‑year‑old woman came to the clinic with non‑specific upper abdominal pain that lasted 8 weeks. Computed tomography (CT) scan showed a mass in the body of the pancreas, involving the superior mesenteric artery and the celiac trunk, and regional lymphadenopathy. Endoscopic ultrasound‑guided fine needle aspiration of the pancreatic mass was performed. A morphological pattern indicated ductal carcinoma. The tumour board determined the treatment plan (chemotherapy) for the patient. The patient underwent 3 courses of GEMCAP chemotherapy in our hospital. A follow‑up radiological exam showed no improvement. The chemotherapy regimen was changed to FOLFIRINOX. The patient underwent 6 courses of the FOLFIRINOX regimen. \u0000A follow‑up magnetic resonance imaging of the pancreas showed tumour regression by more than 90 % in comparison with the previous study. The patient underwent distal pancreatosplenectomy with standard lymph node dissection. Postoperative period was uncomplicated. These pathological results confirm the diagnosis of diffuse B‑cell lymphoma. \u0000Conclusions. This case shows that lack of tissue can make histological examination of FNA specimens challenging and mistakes can happen due to rare occurrence of primary pancreatic lymphomas.","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86618960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lung cancer remains the leading cause of cancer mortality. It ranks first in the incidence of cancer in the world. According to the European Association of Oncologists, the annual incidence of lung cancer is increasing with every passing year and amounts to about 1.8 million new cases worldwide. Men have a higher prevalence of lung cancer (33.8 per 100,000) than their female counterparts (13.5 per 100,000). In most cases, it is diagnosed at an advanced stage (III — IV), which is characterised by mediastinal lymphadenopathy. Early detection of lung cancer allows seeking early treatment. Lung cancer screening is used to find a tumour and/or lung cancer metastasis, determine its location and size as well as its morphological verification. Objective — to define the most accurate invasive and non‑invasive methods of verification and diagnosis of mediastinal lymphadenopathy and improve diagnosis and treatment of lung cancer through the extensive use of cervical mediastinoscopy and creation of an algorithm for its optimal use. Materials and methods. The study included 146 patients. A wide range of clinical, laboratory, endoscopic (Endobronchial ultrasound transbronchial needle aspiration (EBUS‑TBNA), Cervical Mediastinoscopy (CM)), radiographical (Computed tomography (CT), Positron emission tomography (PET)), morphological, immunohistochemical and statistical methods were used. Statistical analysis was performed using Statistics for Windows Version 10.0 (Stat Soft Inc., USA). Results. The study involved 146 patients who underwent screening for mediastinal lymphadenopathy using mediastinoscopy. According to the laboratory findings, 98 patients had lung cancer. The rest of the cases were presented by other pathologies. Colorectal and stomach cancers were most commonly seen. In one case, the patient had a comorbidity, a combination of lung cancer and colorectal cancer. Conclusions. Mediastinoscopy is the most effective diagnostic method for mediastinal lymphadenopathy, especially in lung cancer.
肺癌仍然是癌症死亡的主要原因。它的癌症发病率居世界首位。根据欧洲肿瘤学家协会的数据，肺癌的年发病率每年都在增加，全世界大约有180万新病例。男性肺癌患病率(每10万人中有33.8人)高于女性(每10万人中有13.5人)。在大多数情况下，它被诊断为晚期(III - IV)，其特征是纵隔淋巴结病。早期发现肺癌可以早期治疗。肺癌筛查用于发现肿瘤和/或肺癌转移，确定其位置和大小以及形态学验证。目的-定义最准确的纵隔淋巴结病验证和诊断的侵入性和非侵入性方法，并通过广泛使用宫颈纵隔镜检查和创建最佳使用算法来提高肺癌的诊断和治疗。材料和方法。该研究包括146名患者。广泛采用临床、实验室、内窥镜(支气管超声经支气管针抽吸(EBUS - TBNA)、颈纵隔镜(CM))、影像学(计算机断层扫描(CT)、正电子发射断层扫描(PET))、形态学、免疫组织化学和统计学方法。使用Statistics for Windows Version 10.0 (Stat Soft Inc.， USA)进行统计分析。结果。这项研究包括146名患者，他们接受了纵隔淋巴结检查。根据实验室结果，98名患者患有肺癌。其余病例表现为其他病理。结直肠癌和胃癌最为常见。在一个病例中，患者患有肺癌和结直肠癌的合并症。结论。纵隔镜检查是诊断纵隔淋巴结病，尤其是肺癌最有效的方法。
{"title":"Cervical mediastinoscopy in diagnosis and treatment of lung cancer","authors":"R. Vereshchako, I. Sukhin, O. Piskorskyi","doi":"10.30978/gs-2022-1-43","DOIUrl":"https://doi.org/10.30978/gs-2022-1-43","url":null,"abstract":"Lung cancer remains the leading cause of cancer mortality. It ranks first in the incidence of cancer in the world. According to the European Association of Oncologists, the annual incidence of lung cancer is increasing with every passing year and amounts to about 1.8 million new cases worldwide. Men have a higher prevalence of lung cancer (33.8 per 100,000) than their female counterparts (13.5 per 100,000). In most cases, it is diagnosed at an advanced stage (III — IV), which is characterised by mediastinal lymphadenopathy. Early detection of lung cancer allows seeking early treatment. Lung cancer screening is used to find a tumour and/or lung cancer metastasis, determine its location and size as well as its morphological verification. \u0000Objective — to define the most accurate invasive and non‑invasive methods of verification and diagnosis of mediastinal lymphadenopathy and improve diagnosis and treatment of lung cancer through the extensive use of cervical mediastinoscopy and creation of an algorithm for its optimal use. \u0000Materials and methods. The study included 146 patients. A wide range of clinical, laboratory, endoscopic (Endobronchial ultrasound transbronchial needle aspiration (EBUS‑TBNA), Cervical Mediastinoscopy (CM)), radiographical (Computed tomography (CT), Positron emission tomography (PET)), morphological, immunohistochemical and statistical methods were used. Statistical analysis was performed using Statistics for Windows Version 10.0 (Stat Soft Inc., USA). \u0000Results. The study involved 146 patients who underwent screening for mediastinal lymphadenopathy using mediastinoscopy. According to the laboratory findings, 98 patients had lung cancer. The rest of the cases were presented by other pathologies. Colorectal and stomach cancers were most commonly seen. In one case, the patient had a comorbidity, a combination of lung cancer and colorectal cancer. \u0000Conclusions. Mediastinoscopy is the most effective diagnostic method for mediastinal lymphadenopathy, especially in lung cancer.","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85909846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Badiul, S. Sliesarenko, O. V. Nosulko, O. Rudenko
Millions of people worldwide require urgent medical care annually due to bites and injuries inflicted by wild or domestic animals. Injured patients most frequently suffer from extensive and deep wounds resulting in traumatic shock of different degrees. The extensive wounds are characterized by severe damage to fascial muscles, tendons, bones, major vessels and nerve trunks. Therefore, the management of patients attacked by wild or domestic animals includes the elimination of life‑threatening conditions and the application of various techniques and methods of reconstructive plastic surgery and their combinations to preserve the injured areas of the body (most commonly limbs). In each particular case, the prognosis and the choice of the most effective reconstructive surgery technique for the treatment of a wound defect depend on the state of the deep structures of the injured limb. The «reconstructive ladder principle» ensures the selection of the most appropriate treatment strategy, as it focuses on the nature of the injury and the patient’s overall health status, thus providing an adequate assessment of all possible surgical risks, general postoperative complications and challenges in wound healing. This algorithm allows prioritizing the most beneficial techniques from simple to difficult, as well as considering the «second line» methods. The «second line» methods are defined as simpler techniques that may be applied in case of some complications occurring after the administration of the primary method. Some additional difficulties may be experienced throughout the period of wound management in children and the elderly, in patients with complicated comorbidities and exacerbation of chronic diseases.This article presents a case study of a patient undergoing the treatment for an extensive and deep bite wound that is complicated by acute coronary syndrome and severe cardiogenic shock in the early postoperative period.
{"title":"Surgical management of a dog bite in a patient with comorbidities. Case study","authors":"P. Badiul, S. Sliesarenko, O. V. Nosulko, O. Rudenko","doi":"10.30978/gs-2022-1-66","DOIUrl":"https://doi.org/10.30978/gs-2022-1-66","url":null,"abstract":"Millions of people worldwide require urgent medical care annually due to bites and injuries inflicted by wild or domestic animals. Injured patients most frequently suffer from extensive and deep wounds resulting in traumatic shock of different degrees. The extensive wounds are characterized by severe damage to fascial muscles, tendons, bones, major vessels and nerve trunks. Therefore, the management of patients attacked by wild or domestic animals includes the elimination of life‑threatening conditions and the application of various techniques and methods of reconstructive plastic surgery and their combinations to preserve the injured areas of the body (most commonly limbs). In each particular case, the prognosis and the choice of the most effective reconstructive surgery technique for the treatment of a wound defect depend on the state of the deep structures of the injured limb. The «reconstructive ladder principle» ensures the selection of the most appropriate treatment strategy, as it focuses on the nature of the injury and the patient’s overall health status, thus providing an adequate assessment of all possible surgical risks, general postoperative complications and challenges in wound healing. This algorithm allows prioritizing the most beneficial techniques from simple to difficult, as well as considering the «second line» methods. The «second line» methods are defined as simpler techniques that may be applied in case of some complications occurring after the administration of the primary method. Some additional difficulties may be experienced throughout the period of wound management in children and the elderly, in patients with complicated comorbidities and exacerbation of chronic diseases.This article presents a case study of a patient undergoing the treatment for an extensive and deep bite wound that is complicated by acute coronary syndrome and severe cardiogenic shock in the early postoperative period.","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86014636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. Ioffe, O. Stetsenko, M. Kryvopustov, Y. Tsiura, T. Tarasiuk
The modern stage of development of surgery, especially minimal invasive technologies, has significantly changed the surgeons' thoughts about the perioperative period. Until the end of the twentieth century, pre‑ and postoperative fasting was the most important requirement in planned surgery. It was believed that it could help to avoid complications both during surgery and in the early postoperative period. H. Kehlet in his fundamental work outlined the factors that allowed to accelerate the patient's recovery after surgery, namely: the absence of preoperative fasting. Objective — to evaluate the effectiveness of nutritional support for surgical patients within ERAS (Enhanced Recovery After Surgery) and ESPEN (European Society for Clinical Nutrition and Metabolism) protocols. Materials and methods. This research included both traditional laparoscopic cholecystectomy (177 cases) and single‑port transumbilical cholecystectomy (8); among laparoscopic bariatric interventions, the major part was represented by classical Roux‑Y gastric shunting (28), as well as sleeve gastrectomy (5) and mini‑gastric shunting (4); among 123 different laparoscopic hernioplasties, in 64 cases transabdominal preperitoneal (TAPP) was performed for bubonocele, intraperitoneal onlay mesh (IPOM) for postoperative ventral and umbilical hernias (59), laparoscopic crurography and fundoplication with and without alloplasty (33). For each type of surgery two groups we identified: control and experimental. Both groups were followed by ERAS protocols in addition to nutritional support. With the prior consent of patients before surgery: the experimental group received full perioperative nutritional support according to our local protocols using protein‑enriched sip feeding formula Nutridrink Protein, the control group followed the traditional scheme of fasting during 12 hours before surgery and received regular drinking water instead of protein mixtures at the first postoperative day. Results. We found statistically significant difference between control and experimental groups in assessing of two important parameters as hunger and weakness. The hunger after laparoscopic cholecystectomy was 1.5 times (p < 0.001), after laparoscopic hernia repair — 1.7 times (p < 0.001), after laparoscopic crurography and fundoplication — 1.26 times (p < 0.001), after laparoscopic bariatric intervention — 1.43 times, and after laparoscopic colon intervention — 1.9 times lower in the experimental group. The weakness after laparoscopic cholecystectomy was 1.8 times (p < 0.001), after laparoscopic hernia repair — 1.31 times (p < 0.001), after laparoscopic crurography and fundoplication — 1.68 times (p < 0.001), after laparoscopic bariatric intervention — 1.67 times (p < 0.001), and after laparoscopic colon intervention — 1.38 times (p = 0.006) stronger in the control group. Conclusions. Traditional long‑term preoperative fasting is inappropriate. Combined with other ERAS postulates, perioperative nutr
{"title":"Nutritional support for patients in general surgery","authors":"O. Ioffe, O. Stetsenko, M. Kryvopustov, Y. Tsiura, T. Tarasiuk","doi":"10.30978/gs-2022-1-48","DOIUrl":"https://doi.org/10.30978/gs-2022-1-48","url":null,"abstract":"The modern stage of development of surgery, especially minimal invasive technologies, has significantly changed the surgeons' thoughts about the perioperative period. Until the end of the twentieth century, pre‑ and postoperative fasting was the most important requirement in planned surgery. It was believed that it could help to avoid complications both during surgery and in the early postoperative period. H. Kehlet in his fundamental work outlined the factors that allowed to accelerate the patient's recovery after surgery, namely: the absence of preoperative fasting. \u0000Objective — to evaluate the effectiveness of nutritional support for surgical patients within ERAS (Enhanced Recovery After Surgery) and ESPEN (European Society for Clinical Nutrition and Metabolism) protocols. \u0000Materials and methods. This research included both traditional laparoscopic cholecystectomy (177 cases) and single‑port transumbilical cholecystectomy (8); among laparoscopic bariatric interventions, the major part was represented by classical Roux‑Y gastric shunting (28), as well as sleeve gastrectomy (5) and mini‑gastric shunting (4); among 123 different laparoscopic hernioplasties, in 64 cases transabdominal preperitoneal (TAPP) was performed for bubonocele, intraperitoneal onlay mesh (IPOM) for postoperative ventral and umbilical hernias (59), laparoscopic crurography and fundoplication with and without alloplasty (33). For each type of surgery two groups we identified: control and experimental. Both groups were followed by ERAS protocols in addition to nutritional support. With the prior consent of patients before surgery: the experimental group received full perioperative nutritional support according to our local protocols using protein‑enriched sip feeding formula Nutridrink Protein, the control group followed the traditional scheme of fasting during 12 hours before surgery and received regular drinking water instead of protein mixtures at the first postoperative day. \u0000Results. We found statistically significant difference between control and experimental groups in assessing of two important parameters as hunger and weakness. The hunger after laparoscopic cholecystectomy was 1.5 times (p < 0.001), after laparoscopic hernia repair — 1.7 times (p < 0.001), after laparoscopic crurography and fundoplication — 1.26 times (p < 0.001), after laparoscopic bariatric intervention — 1.43 times, and after laparoscopic colon intervention — 1.9 times lower in the experimental group. The weakness after laparoscopic cholecystectomy was 1.8 times (p < 0.001), after laparoscopic hernia repair — 1.31 times (p < 0.001), after laparoscopic crurography and fundoplication — 1.68 times (p < 0.001), after laparoscopic bariatric intervention — 1.67 times (p < 0.001), and after laparoscopic colon intervention — 1.38 times (p = 0.006) stronger in the control group. \u0000Conclusions. Traditional long‑term preoperative fasting is inappropriate. Combined with other ERAS postulates, perioperative nutr","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82280192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The article provides insight into significant milestones in the history of organ transplantation in Turkey and region. In 1975, we were the first in Turkey to perform living‑related kidney transplantation and, in 1978, deceased‑donor kidney transplantation, using an organ supplied by Eurotransplant. In 1979, the law on harvesting, storage, grafting, and transplantation of organs and tissues was enacted. The first local deceased‑donor kidney transplantation was performed by our team in 1979. The first successful deceased‑donor liver transplantation, which was a groundbreaking surgery procedure for Turkey, the Middle East and Northern Africa, was carried out by our team in 1988. In 1990, we were the first not only in Turkey but also in the Middle East region as well as Europe to perform pediatric living‑related segmental liver transplantation. One month later, an adult‑to‑adult living‑related liver transplant (a left lobe) was successfully performed for the first time in the history of organ transplantation. On May 16, 1992, we carried out the first combined liver‑kidney transplantation from a living‑related donor, which was the first operation of its kind in the world. Between November 1975 and October 2021, we performed 3,256 kidney transplantations at Hacettepe University Hospitals . Since 1988 to date, we have carried out 695 liver transplantations at Baskent University. According to the registry of the Ministry of Health, from 2002 to 2021, 46,115 kidney transplants were performed nationwide, as compared with 17,868 liver transplants, 1,153 heart transplants and 198 pancreas transplants. In 2001, the Ministry of Health established the National Coordination Center as an umbrella organization to promote transplantation activities, especially deceased‑donor organ procurement. Despite constantly increasing overall living‑donor transplant rate across the country, overall deceased‑donor transplant rate is still far below the desired level.
{"title":"Transplantation in Turkey and region","authors":"M. Haberal","doi":"10.30978/gs-2022-1-8","DOIUrl":"https://doi.org/10.30978/gs-2022-1-8","url":null,"abstract":"The article provides insight into significant milestones in the history of organ transplantation in Turkey and region. \u0000In 1975, we were the first in Turkey to perform living‑related kidney transplantation and, in 1978, deceased‑donor kidney transplantation, using an organ supplied by Eurotransplant. In 1979, the law on harvesting, storage, grafting, and transplantation of organs and tissues was enacted. The first local deceased‑donor kidney transplantation was performed by our team in 1979. The first successful deceased‑donor liver transplantation, which was a groundbreaking surgery procedure for Turkey, the Middle East and Northern Africa, was carried out by our team in 1988. In 1990, we were the first not only in Turkey but also in the Middle East region as well as Europe to perform pediatric living‑related segmental liver transplantation. One month later, an adult‑to‑adult living‑related liver transplant (a left lobe) was successfully performed for the first time in the history of organ transplantation. On May 16, 1992, we carried out the first combined liver‑kidney transplantation from a living‑related donor, which was the first operation of its kind in the world. Between November 1975 and October 2021, we performed 3,256 kidney transplantations at Hacettepe University Hospitals . Since 1988 to date, we have carried out 695 liver transplantations at Baskent University. According to the registry of the Ministry of Health, from 2002 to 2021, 46,115 kidney transplants were performed nationwide, as compared with 17,868 liver transplants, 1,153 heart transplants and 198 pancreas transplants. In 2001, the Ministry of Health established the National Coordination Center as an umbrella organization to promote transplantation activities, especially deceased‑donor organ procurement. Despite constantly increasing overall living‑donor transplant rate across the country, overall deceased‑donor transplant rate is still far below the desired level. \u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80607137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Susak, I. Slychko, O. Nikolayenko, O. Dyrda, V. Korobko, M. Maksymenko
Liver cirrhosis (LC) frequently results in severe complications, high mortality rate and disability in patients suffering from this disease, thus necessitating the study of its course, diagnosis and management. The principle of gradual elimination of pathological syndromes is fundamental in the treatment of LC. Complex therapy requires the use of medicines that act on the general links of pathogenesis. As LC causes damage to the cellular structure of the liver as well as interferes with the normal functioning of other organs and systems, it requires the prescription of medicines with metabolic and immunomodulatory properties. Experimental and clinical results of trials of Erbisol injections necessitated the study of their therapeutic properties in patients with LC. Immunomodulation, hepatoprotection and hepatoreparation play a crucial role in the management of LC. Objective — to investigate the effectiveness of the Erbisol® class medications in complex treatment of patients with liver cirrhosis. Materials and methods. The analysis of treatment outcomes in 57 patients with LC was carried out and is presented in this study. Patients were divided into two groups with 28 patients (15 males and 13 females) in the main group and 29 patients (18 males and 11 females) in the control group. All patients received a comprehensive basic therapy for the management of LC. The main group was also prescribed intramuscular injections of the Erbisol® class medicines (Erbisol® Extra, Erbisol® Ultrapharm) that were administered according to the manufacturer’s instructions (Erbis Ukraine, https//erbisol.com.ua). Specific guidelines were followed during the examination of the patients. In both groups, patients with compensated LC had their liver function assessed according to the Child‑Pugh scoring system. Their point scores were added and classified as class B: 8 — 9 points. All patients were distributed according to gender, age, duration of the disease and severity of the main syndromes. The effectiveness of treatment was evaluated based on clinical symptoms, severity, blood tests, elastography ultrasound and Doppler ultrasonography. Results. The use of Erbisol® medicines significantly improved the dynamics of the clinical course of cirrhosis, relieved astheno‑vegetative disorders, had a pronounced immunocorrective effect that was evidenced by changes in the ratio of serum protein fractions. In the main group, treatment outcomes were characterized by moderate regeneration of the liver parenchyma. It was confirmed by hemodynamic parameters and elastography data. The complex use of Erbisol® drugs helps to slow down and regress fibrosis, contributing to the favorable course of the disease. Conclusions. Complex treatment with the Erbisol® class medications had a positive action on clinical and blood biochemical parameters and ensured a membrane‑protective effect, regression of fibrosis, and improved hepatic blood flow.
{"title":"Effectiveness of the Erbisol® class in complex treatment of patients with liver cirrhosis","authors":"Y. Susak, I. Slychko, O. Nikolayenko, O. Dyrda, V. Korobko, M. Maksymenko","doi":"10.30978/gs-2022-1-54","DOIUrl":"https://doi.org/10.30978/gs-2022-1-54","url":null,"abstract":"Liver cirrhosis (LC) frequently results in severe complications, high mortality rate and disability in patients suffering from this disease, thus necessitating the study of its course, diagnosis and management. The principle of gradual elimination of pathological syndromes is fundamental in the treatment of LC. Complex therapy requires the use of medicines that act on the general links of pathogenesis. As LC causes damage to the cellular structure of the liver as well as interferes with the normal functioning of other organs and systems, it requires the prescription of medicines with metabolic and immunomodulatory properties. Experimental and clinical results of trials of Erbisol injections necessitated the study of their therapeutic properties in patients with LC. Immunomodulation, hepatoprotection and hepatoreparation play a crucial role in the management of LC. \u0000Objective — to investigate the effectiveness of the Erbisol® class medications in complex treatment of patients with liver cirrhosis. \u0000Materials and methods. The analysis of treatment outcomes in 57 patients with LC was carried out and is presented in this study. Patients were divided into two groups with 28 patients (15 males and 13 females) in the main group and 29 patients (18 males and 11 females) in the control group. All patients received a comprehensive basic therapy for the management of LC. The main group was also prescribed intramuscular injections of the Erbisol® class medicines (Erbisol® Extra, Erbisol® Ultrapharm) that were administered according to the manufacturer’s instructions (Erbis Ukraine, https//erbisol.com.ua). Specific guidelines were followed during the examination of the patients. In both groups, patients with compensated LC had their liver function assessed according to the Child‑Pugh scoring system. Their point scores were added and classified as class B: 8 — 9 points. All patients were distributed according to gender, age, duration of the disease and severity of the main syndromes. The effectiveness of treatment was evaluated based on clinical symptoms, severity, blood tests, elastography ultrasound and Doppler ultrasonography. \u0000Results. The use of Erbisol® medicines significantly improved the dynamics of the clinical course of cirrhosis, relieved astheno‑vegetative disorders, had a pronounced immunocorrective effect that was evidenced by changes in the ratio of serum protein fractions. In the main group, treatment outcomes were characterized by moderate regeneration of the liver parenchyma. It was confirmed by hemodynamic parameters and elastography data. The complex use of Erbisol® drugs helps to slow down and regress fibrosis, contributing to the favorable course of the disease. \u0000Conclusions. Complex treatment with the Erbisol® class medications had a positive action on clinical and blood biochemical parameters and ensured a membrane‑protective effect, regression of fibrosis, and improved hepatic blood flow. \u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"322 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79712217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Susak, L. Markulan, R. Palytsya, V. V. Teterina
Palliative treatment for mechanical jaundice is aimed at improving patient quality of life (QoL) and prolonging life. The current QoL studies indicate that there is limited evidence on various techniques for decompression of bile ducts (BD) in terms of their impact on quality of life in patients with distal malignant mechanical jaundice, and their data are contradictory. The aim of the study is to evaluate the effect of minimally invasive palliative techniques on QoL in patients with distal mechanical jaundice (MJ) after palliative decompression of bile ducts. Materials and methods. From 2017 to 2021, 98 patients who underwent palliative decompression of bile ducts for distal MJ of malignant origin were examined. A validated MOS SF‑36 questionnaire was used to assess patient QoL. The survey was conducted before the minimally invasive intervention and 2 months after it. Depending on the technique used for decompression of BD, patients were divided into the following groups: percutaneous transhepatic biliary drainage (PTBD) — 25, internal‑external transpapillary biliary drainage (IETBD) — 19, internal‑external biliary‑jejunal drainage (IEBJD) — 29, and endoscopic retrograde biliary stenting (ERBS) — 25. Results. Before treatment, a low level of patient QoL was detected in all groups on all scales of physical and psychological components of health (all p > 0.05). After 2 months, in the PTBD group, the indicator of the Mental Component Summary (MCS) decreased by an average of 6.9 ± 1.2 points (due to the deterioration of the indicator of social functioning scales by 12.5 ± 5.0 points and mental health by 11.1 ± 1.8 points), while the indicator of the Physical Component Summary (PCS) improved by 11.3 ± 1.1 points. In the IETBD and IEBJD groups, there was an improvement in MCS (by 11.7 ± 1.3 points and 13.0 ± 1.1 points, respectively) and PCS (by 5.2 ± 1.2 and 8.6 ± 1.1 points). With regard to MCS and PCS, slight improvement (by 4.7 ± 2.2 and 2.0 ± 1.9 points) was observed in the ERBS group. Conclusions. The IEBJD technique provided important advantages in comparison with other minimally invasive palliative techniques for decompression of BD in terms of its impact on patient QoL. Patients in the IEBJD group had better PCS scores (on average, 47.3 ± 1.3 points) compared to the IETBD (42.1 ± 1.5 points) and ERBS (39.1 ± 1.3 points, p < 0.05) groups, and those in the PTBD group (46.2 ± 1.4 points) had better scores than patients in the IETBD group (p < 0.05). In the IETBD and IEBJD groups, MCS scores were better 41.9 ± 1.1 and 40.3 ± 1.1 points, respectively) compared to the PTBD (22.6 ± 0.9 points) and ERBS (34.0 ± 1.1 points, p < 0.05) groups, and in the ERBS group, they were better than in the PTBD group.
{"title":"The impact of minimally invasive palliative decompression of bile ducts on quality of life in patients with distal malignant mechanical jaundice","authors":"Y. Susak, L. Markulan, R. Palytsya, V. V. Teterina","doi":"10.30978/gs-2022-1-35","DOIUrl":"https://doi.org/10.30978/gs-2022-1-35","url":null,"abstract":"Palliative treatment for mechanical jaundice is aimed at improving patient quality of life (QoL) and prolonging life. The current QoL studies indicate that there is limited evidence on various techniques for decompression of bile ducts (BD) in terms of their impact on quality of life in patients with distal malignant mechanical jaundice, and their data are contradictory. \u0000The aim of the study is to evaluate the effect of minimally invasive palliative techniques on QoL in patients with distal mechanical jaundice (MJ) after palliative decompression of bile ducts. \u0000Materials and methods. From 2017 to 2021, 98 patients who underwent palliative decompression of bile ducts for distal MJ of malignant origin were examined. A validated MOS SF‑36 questionnaire was used to assess patient QoL. The survey was conducted before the minimally invasive intervention and 2 months after it. Depending on the technique used for decompression of BD, patients were divided into the following groups: percutaneous transhepatic biliary drainage (PTBD) — 25, internal‑external transpapillary biliary drainage (IETBD) — 19, internal‑external biliary‑jejunal drainage (IEBJD) — 29, and endoscopic retrograde biliary stenting (ERBS) — 25. \u0000Results. Before treatment, a low level of patient QoL was detected in all groups on all scales of physical and psychological components of health (all p > 0.05). After 2 months, in the PTBD group, the indicator of the Mental Component Summary (MCS) decreased by an average of 6.9 ± 1.2 points (due to the deterioration of the indicator of social functioning scales by 12.5 ± 5.0 points and mental health by 11.1 ± 1.8 points), while the indicator of the Physical Component Summary (PCS) improved by 11.3 ± 1.1 points. In the IETBD and IEBJD groups, there was an improvement in MCS (by 11.7 ± 1.3 points and 13.0 ± 1.1 points, respectively) and PCS (by 5.2 ± 1.2 and 8.6 ± 1.1 points). With regard to MCS and PCS, slight improvement (by 4.7 ± 2.2 and 2.0 ± 1.9 points) was observed in the ERBS group. \u0000Conclusions. The IEBJD technique provided important advantages in comparison with other minimally invasive palliative techniques for decompression of BD in terms of its impact on patient QoL. Patients in the IEBJD group had better PCS scores (on average, 47.3 ± 1.3 points) compared to the IETBD (42.1 ± 1.5 points) and ERBS (39.1 ± 1.3 points, p < 0.05) groups, and those in the PTBD group (46.2 ± 1.4 points) had better scores than patients in the IETBD group (p < 0.05). In the IETBD and IEBJD groups, MCS scores were better 41.9 ± 1.1 and 40.3 ± 1.1 points, respectively) compared to the PTBD (22.6 ± 0.9 points) and ERBS (34.0 ± 1.1 points, p < 0.05) groups, and in the ERBS group, they were better than in the PTBD group. \u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"44 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91442974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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