Khirurgiya最新文献

Objective: To assess the effectiveness of Amplatzer Septal Occluder as a palliative approach for temporary TEF occlusion before radical surgery.

Material and methods: The authors present a patient with multifocal post-tracheostomy TEF after mechanical ventilation for COVID-19. Two Amplatzer Septal Occluders were implanted under endoscopic guidance for temporary occlusion. Effectiveness, recurrence rate, and feasibility of radical surgery were evaluated.

Results: TEF occlusion successfully eliminated aspiration and enabled radical repair after four months with minimal postoperative complications. However, device dislocation and fistula enlargement were identified as limitations.

Conclusion: This method appears promising but requires further research to assess complication risks and optimize implantation techniques.

Objective: To evaluate the efficacy, safety, and tolerability of nutritional metabolic support (NMS) in surgical patients with burn disease (BD) and to analyze its impact on the postoperative course.

Materials and methods: All patients had severe burns with thermal burns covering up to 59% of the body surface area (trunk, chest, abdomen, back, and extremities in various combinations). These patients received conventional therapy appropriate to the stage of their illness (administration of analgesics, sedatives, antibiotics, infusion and transfusion therapy, correction of fluid-electrolyte, acid-base, and blood rheology balances, and surgical treatment of burn wounds). The study group consisted of 31 (61%) burn patients. Their comprehensive treatment included enteral nutritional support using specialized dietary therapeutic and preventive nutrition products - a Detoxifying Protein Cocktail twice daily (morning and lunchtime) and a Restorative Protein Cocktail once daily (evening), manufactured by LEOVIT nutrio - for 21 days. The control group included 20 burn patients who did not receive nutritional support. Burn severity was assessed using the Frank Burn Index (FBI), taking into account the area and depth of the lesion, as well as the presence of respiratory tract burns. Patients in the groups were comparable in severity. Treatment progress was monitored using general clinical laboratory testing methods.

Results: The use of therapeutic metabolic enteral nutrition has a beneficial effect on the general condition of patients; Improves healing and epithelialization, accelerates burn scab rejection, improves clinical and biochemical blood parameters, intoxication and inflammation markers, enhances antioxidant defense, reduces inflammation, and improves patients' quality of life.

Conclusion: This study demonstrates the high clinical efficacy of domestically produced metabolic enteral nutrition products in surgical patients with burn disease. Effective domestic enteral nutrition ensures technological sovereignty and import substitution.

Objective: Evaluation of the effectiveness of various surgical techniques, comparison of their results and study of the effect of polymer hydrogel on treatment outcomes.

Methods: The study included 97 patients with a diagnosis of recurrent or complex PSD (Pilonidal sinus disease). Patients were divided into 3 groups who underwent surgery using the traditional Limberg flap, modified Limberg flap, or operated using modified Limberg flap and polymer hydrogel in the coloproctology department of the A.S. Loginov International Research Center from March 2015 to September 2023. The incidence of complications in the early postoperative period and the frequency of relapses in the late period were assessed.

Results: 97 patients were included in the study; long-term results were observed in 84 patients (86.6%). 88.7% of them are men, 11.3% are women. There were no statistically significant differences in the incidence of complications in the early postoperative period between the groups (p=0.374). The recurrence of the disease in patients who underwent traditional plastic surgery was 10.9%. In the group with modified plastic surgery, recurrence was detected in 2 patients (4.9%). In the group with the use of polymer hydrogel, 1 case of recurrence (2.5%) was recorded. There are no statistically significant differences in the following parameters: average blood loss, duration of hospitalization, indicators of postoperative control, and the level of inflammatory markers. There were no intraoperative complications in any of the groups.

Conclusion: Modified plastic using a polymer hydrogel to eliminate "dead zones" and avoid drainage in the postoperative period has demonstrated its effectiveness, however, further studies are required to confirm the results obtained.

The interest in neoadjuvant chemotherapy (NACT) for resectable ductal pancreatic cancer (PC) has increased significantly in recent years, primarily due to unsatisfactory long-term outcomes in these patients. However, oncological rationale for this approach is currently interpreted controversially. Routine NACT for resectable PC remains controversial due to the lack of uniform standards for regimens and number of drug therapy courses, selection criteria, high incidence of chemotherapy-related complications, toxicity, no evidence of benefit for all patients and risks of tumor transition to inoperable category due to delayed surgery. This review is devoted to effectiveness of NACT for resectable PC. The limitations of NACT and biological factors reducing its effectiveness are identified. NACT should not be considered as a standard for resectable PC without individual approach. The main tasks for future research should be criteria for selecting patients for NACT and standardized optimal regimens and number of chemotherapy courses.

Objective: To determine whether hydronephrosis is a predictive factor for complicated acute appendicitis in patients with acute appendicitis.

Material and methods: Observational, analytical, cross-sectional study; Patients with a histopathological diagnosis of acute appendicitis were included from the Department of Surgery of the Trujillo Regional Teaching Hospital between June and December 2022. They were divided into two groups, complicated and uncomplicated acute appendicitis. Abdominal ultrasound was evaluated to detect the presence or absence of hydronephrosis. Statistical data were analyzed using the Student's t-test for quantitative variables and Chi square for qualitative variables, considering p<0.05 statistically significant.

Results: It was found that 95 of 145 patients (65.5%) had complicated acute appendicitis with histopathological diagnosis, and 50 of 145 patients (34.4%) had uncomplicated appendicitis. Of the patients with complicated acute appendicitis, 6.32% (6) had right hydronephrosis, compared with 2% (1) (p=0.249). Operative time was identified as a statistically significant factor (p<0.05) of complicated acute appendicitis, at an average of 71.34±32.20 minutes in complicated acute appendicitis versus 52.16±21.16 in the other group.

Conclusion: No association was found between the presence of hydronephrosis and complicated acute appendicitis.

The study evaluated outcomes and risk factors of mortality in patients with acute arterial intestinal ischemia. A retrospective analysis enrolled 22 patients. Overall in-hospital mortality was 54.4%. Independent predictors of fatal outcomes were high WBC count (OR=1.188; p=0.005), elevated total bilirubin (OR=1.058; p=0.023), and high CCI (OR=1.272; p=0.037). Technical success of endovascular treatment reached 77.3%. High mortality rate is due to a combination of age, severity of comorbidities and pathophysiological characteristics of ischemic bowel injury. To further refine the treatment algorithm, it is advisable to establish multiple-center registries, implement interdisciplinary "intestinal teams" and further study risk factors for adverse outcomes.

Objective: To present own experience in treating achalasia cardia using peroral endoscopic myotomy, safety and high efficacy of this method, as well as advantages of peroral endoscopic myotomy (POEM).

Material and methods: The study enrolled 129 patients between August 2017 and January 2025 who underwent POEM. Surgery was performed using standard technique at a distance of approximately 20-25 cm from incisors. After creating a hydraulic cushion with indigo carmine-stained gelofusine, we made longitudinal incision for 1.5-2.0 cm using electrosurgical stand and electric knife. After entering submucosal layer, we created a tunnel to subcardia level. Myotomy was then performed 7-8 cm before the cardia and 2-3 cm after it. Hemostasis was achieved if necessary, and mucosal defect was closed with endoscopic clips.

Results: According to the Eckardt scale, we obtained excellent results in 66 (51.2%) patients and satisfactory results in 55 (42.7%) patients. Unsatisfactory results were observed in 5 (3.8%) patients, poor results - in 3 (2.3%) patients. Among 8 patients with unsatisfactory and poor results, 6 ones had recurrent achalasia, and 2 ones had stage 4 achalasia. Eight patients had access to high-resolution manometry before and after surgery that allowed for clear picture of improvement after POEM.

Conclusion: POEM demonstrates excellent results. Most patients experience significant regression or disappearance of dysphagia. Furthermore, POEM offers significant cosmetic benefits, as it eliminates postoperative skin scarring.

Objective: To evaluate the immediate and long-term results of laparoscopic surgical procedures in patients with recurrent hiatal hernias (rHH).

Material and methods: Thirty-six patients with rHH underwent laparoscopic mesh repair and Nissen fundoplication between 2015 and 2024. Nine patients underwent Collis-Nissen esophagogastroplasty due to intraoperative confirmation of short esophagus.

Results: Mean surgery time was 3 (2-4.5) hours, length of hospital-stay - 7 (5-15) days. Intraoperative revision established cuff and part of the stomach displacement into mediastinum as a cause of rHH in 31 cases, eruption of sutures on diaphragmatic crura - in 22 cases, no primary correction of short esophagus - in 9 cases. In 5 cases, we diagnosed distal displacement of cuff. There were no intraoperative or postoperative complications. Recurrence of HH within 5 (1-10) years was noted in 2 (5.5%) patients.

Conclusion: Diaphragmatic crus repair with their reinforcement by mesh endoprostheses and Collis-Nissen esophagogastroplasty for short esophagus significantly reduce the risk of hiatal hernia recurrence.

Objective: To analyze the results of transanal endoscopic and robotic microsurgery for rectal neoplasms.

Material and methods: A retrospective cohort study enrolled 84 patients. We considered clinical and anamnestic data, anatomical characteristics of tumors, intraoperative and histological data. Postoperative complications, data on disease progression and recurrence were analyzed.

Results: Transanal endoscopic surgery was performed in 82 patients; da Vinci Xi robotic complex was used in 2 patients. In 2% of patients, intraoperative complication occurred (full-thickness rectal wall defect with penetration into abdominal cavity). Postoperative complications were observed in 10% of patients: Clavien-Dindo class I - 1%, class IIIB - 7%, class V - 1%. Progression of cancer was observed in 13% of patients with malignant neoplasms. Local recurrence was observed in 4% of patients with benign neoplasms.

Conclusion: Transanal microsurgery, including robotic microsurgery, is effective for rectal tumors. Further research is required to clarify the indications for this treatment option. Patients need for long-term postoperative follow-up regarding complications and recurrence of disease.

Objective. t: O assess the current situation regarding iatrogenic bile duct injuries (BDI) in the Russian Federation.

Material and methods: A retrospective analysis enrolled cases of BDI that required reconstructive surgery in 2023. Data were collected through online survey of medical institutions registered in annual reporting database of the Chief Surgeon of the Russian Ministry of Health, where BDIs were documented.

Results: There were 227 BDIs. Data from 126 (59.0%) patients were obtained via online survey. Laparoscopic cholecystectomy (LC) was performed in 107 (84.9%) cases. Acute cholecystitis was indication in 77 (61.1%) cases. BDI occurred in 25 (19.8%) cases at the first level hospitals, 69 (54.8%) cases - at the second level, 32 (25.4%) cases - at the third level facilities. Intraoperative diagnosis of BDI was established in 62 (49.2%) cases. According to the Strasberg classification, type D injuries accounted for 32 cases, type E - 94 cases. Roux-en-Y hepaticojejunostomy was performed in 72 (57.1%) cases, bilio-biliary anastomosis over a T-tube - 20 (15.9%), bile duct repair over a stent - 8 (6.3%), primary bile duct suture without stent - 9 (7.1%), hemihepatectomy - 1 (0.8%), external biliary drainage - 12 (9.5%), other procedures - 4 (3.2%). Surgical approach and outcomes depended on timing of BDI diagnosis and type of intervention. Complications were observed in 20 (15.9%) cases, including hepaticojejunal anastomotic failure in 10/72 patients (13.9%). Overall mortality rate was 4.8%. The reported leading cause of BDI (83.3% of respondents) was difficult bile duct identification due to fibrotic-inflammatory changes in subhepatic space.

Conclusion: The main cause of BDI during cholecystectomy is fibrotic-inflammatory changes in subhepatic space. Compliance with principles of safe cholecystectomy is of paramount importance. BDI requires referral to a specialized center. Timely diagnosis of BDI improves the outcomes.