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Internal hernias, in particular, hernia of the foramen of Winslow, are rare and occur in typical sites. Laparotomy is common in these cases while laparoscopic surgery is rarely used in such urgent cases. However, modern diagnosis and treatment including computed tomography and laparoscopy allowing minimally invasive interventions are not an exception for patients with hernia of the foramen of Winslow. This approach is effective for this problem and prevents adverse outcomes of disease.

The issue of the treatment of purulent-inflammatory conditions affecting the fingers is a significant one, given the high prevalence of such cases, with up to 1.5 million instances reported annually in our country. The results of surgical treatment are frequently unsatisfactory, particularly in regard to functional indices, even in cases of mild soft tissue injury. The primary determinant of successful whitlow treatment is adequate anaesthesia, which enables the performance of high-quality surgical wound treatment.

Objective: To conduct a comparative analysis of the efficacy of local anaesthetics (2% Novocain, 2% Lidocain and 2% solution of Artikain-Binergy) in conducting anaesthesia in accordance with the Oberst-Lukashevich technique for surgical treatment of patients with whitlow.

Material and methods: The retrospective observational study included 124 patients, of whom 83 (67%) were male and 41 (33%) were female, with an age range of 27 to 64 years. The patients were divided into three groups: the first group received 2% Novocaine (n=42), the second group received 2% Lidocaine solution (n=41), and the third group received 2% Articaine solution (n=41). The rapidity of onset of the analgesic effect (duration of latent period), its duration, and the absence of the need for repeated application of the drug were evaluated.

Results: For local anesthesia with articaine and lidocaine the same amount of drug was required - 2-3 ml, which is less than when using novocaine - 3-4 ml (p<0.05); articaine has the shortest latent period of 5-7 minutes, in contrast to lidocaine - 6-9 minutes and novocaine - 8-10 minutes (p<0.05); the duration of the analgesic effect of articaine is longer than that of lidocaine, novocaine - 3-3.5 hours, 0.83-1.33 hours and 0.58-0.66 hours, respectively (p<0.05); in the articaine group repeated anesthesia was not required either after 1 hour or after 2 hours.

Conclusion: Articaine demonstrated the greatest efficacy as a local anaesthetic in the surgical treatment of whitlow. It has the shortest latency period, which facilitates manipulation. The prolonged analgesic effect with a reduced anaesthetic dose allows for surgical procedures to be conducted without the necessity for post-procedure analgesics.

Objective: To analyze the short- and mid-term results of posterolateral endoscopic discectomy (PLED) in patients with lumbosacral junction intervertebral discs (IVD) herniations.

Material and methods: A retrospective observational cohort study included 95 medical records of respondents (35 (36.8%) males, 60 (63.2%) females, age 21 - 72 years), who underwent PLED for lumbar IVD herniations. Mean postoperative follow-up period was 14.4±3.2 months. Clinical outcomes and incidence of complications were studied.

Results: VAS scores of back and lower limb pain significantly decreased after 1, 3, 6, 9 and 12 months (p<0.01). Disability significantly improved in short- and mid-term follow-up period (Oswestry Disability Index, p<0.01). Analysis of subjective satisfaction with surgical intervention (modified MacNab scale) revealed that 92 (92.9%) respondents had excellent results. Complications occurred in 5 (5.2%) patients.

Conclusion: PLED is effective and safe in patients with lumbosacral joint IVD herniations. No significant complications were noted in our respondents.

We present successful surgical treatment of a patient with chronic kidney disease (CKD) and hyperparathyroidism undergoing renal replacement therapy. At baseline, parathyroidectomy via cervical access was performed for parathyroid adenomas. After 6 years, clinical and laboratory relapse of disease required thoracoscopic resection of atypically located anterior mediastinal adenoma. This case demonstrates that this disease is one of the most difficult in modern medicine requiring a special approach in diagnosis and treatment. Patients with CKD and hyperparathyroidism need for follow-up, control of total and ionized serum calcium, inorganic phosphorus and parathormone, osteodensitometry, ultrasound and scintigraphy of thyroid and parathyroid glands, and, if necessary, CT or MRI of the neck and chest organs.

Objective: To create a formalized method for predicting papillary thyroid cancer recurrence after hemithyroidectomy based on preoperative data.

Material and methods: At this stage of the study, we selected 101 patients with papillary thyroid cancer who underwent surgical treatment in 2017-2023. Recurrence was observed in in 47 patients. Fifty-four patients had no recurrence within 5 years after surgical treatment, i.e. these patients underwent surgery in 2017-2018. To find prediction rules, we used original classification method based on searching for subsets of variables and piecewise linear rules separating classes in pairs with subsequent voting of such rules to make a decision.

Results: The exam was carried out using a training sample (101 cases) and sliding control method (10 tests on 10 random cases). On the training sample, sensitivity of predictive algorithm was 91%, specificity 78% and error rate 13%. The aggregated result of 10 trials using sliding control method revealed sensitivity of predictive algorithm 86%, specificity 75% and error rate 15%. This result is close to overall sample and confirms the effectiveness of this method for predicting recurrence.

Conclusion: The pilot experiments revealed the patterns in data for potential prediction of recurrence based on preoperative indicators. Further study of this problem may be valuable for decision-making and adjustments in the management of patients with papillary thyroid cancer.

The number of elderly and senile patients who are in need of surgical care delivery is growing steadily year over year. This category of patients is characterized by comorbidity, polypragmasy and high prevalence of geriatric syndromes including loss of autonomy, malnutrition and cognitive impairments that increase the risk of developing perioperative complications. Management of these patients at all stages requires a comprehensive multidisciplinary approach. Nevertheless, there is no uniform understanding of solution of this problem at present. Determination of consensus on certain issues using the Delphi method will allow to gather and unite expert opinions. In this regard, the working group formulated the main points of management of elderly and senile patients before, during and after surgical treatment and conducted a cross-sectional analysis of experts' opinions.

Objective: To analyze morphological changes in wall of functioning and non-functioning small intestine in patients with preventive ileostomy and to determine histological predictors of water-electrolyte disorders.

Material and methods: We prospectively analyzed 57 patients >18 years old who underwent rectal resection with preventive ileostomy between January 2022 and November 2023. Anthropometric data included gender, age, body mass index, ECOG and ASA classes. Complications associated with large losses through ileostomy were water-electrolyte disorders, dehydration and acute renal failure with repeated hospitalization. Morphological analysis implied intraoperative full-layer biopsy of small intestine on anterior abdominal wall (ileostomy). Intraoperative biopsy of efferent and afferent loops was also carried out. Tissue samples were examined by light microscopy. We analyzed mean height of mucous membrane villi and depth of crypts, as well as their ratio. Fibrosis and swelling of submucosa were evaluated too. The results were analyzed in the SPSS Statistics 20 software.

Results: Mean height of intestinal villi <465 microns (p=0.028), ratio of their height to crypt depth <4.38 (p=0.034) and submucosal fibrosis (p=0.031) significantly affected malabsorption and readmission of patients. The risk of readmission was 11.5 and 5.5 times higher in univariate analysis. Multivariate analysis revealed in-hospital dehydration with resumption of infusion therapy as a predictor of readmission (p=0.046).

Conclusion: Ileostomy is a certain stress for the patient's body. Not every patient is able for adaptation. One of the adaptation mechanisms is hypertrophy of mucous membrane villi involved in digestion. This mechanism is less pronounced in patients with repeated hospitalizations. Preoperative morphological examination of ileum mucosa may be an additional objective predictor of possible complications of preventive ileostomy.

McKittrick-Wheelock syndrome is a rare disease when villous adenoma of the distal colon predisposes to profuse watery diarrhea with subsequent severe electrolyte disturbances and acute renal damage. A differentiated approach to correct diagnosis requires in-depth pathophysiological knowledge of regulation of water-electrolyte metabolism, functional and organic disorders of gastrointestinal tract and clinical manifestations of hypoosmolar dehydration. The peculiarity of the McKittrick-Wheelock syndrome is a 100% probability of death without treatment and complete regression of symptoms under complex correction of homeostasis and total resection of tumor. We demonstrate the main clinical trends of the McKittrick-Wheelock syndrome. This report may be useful for general practitioners, gastroenterologists, oncologists, nephrologists and anesthesiologists.

Objective: To systematize tactical and technical aspects of liver resections with reconstruction of afferent and efferent blood supply and/or inferior vena cava; to study postoperative outcomes in patients with focal liver lesions using transplantation technologies.

Material and methods: We enrolled 413 patients with parasitic lesions, primary and secondary liver tumors involving great vessels (portal vein, hepatic artery, hepatic veins, inferior vena cava, right atrium). All ones underwent liver resections with vascular resection and reconstruction, as well as liver autotransplantation in vivo, ante situ (ex situ in vivo), extracorporeal liver resections with autotransplantation (ex vivo).

Results: We obtained satisfactory immediate results after liver resections using transplantation technologies.

Conclusion: Transplantation technologies in liver surgery can significantly increase resectability of tumors and survival of patients. Transplantation technologies are an important new surgical strategy and necessary option in modern hepatic surgery.

The review is devoted to diagnosis and treatment of internal carotid artery tortuosity. The authors consider modern classification, epidemiology and diagnostic options using neuroimaging or ultrasound-assisted functional stress tests depending on medical history and complaints. In addition to standard Doppler ultrasound, rotational and orthostatic tests are advisable due to possible changes of local shape and hemodynamic parameters following body position changes, especially in patients with concomitant atherosclerotic stenosis. Thus, a personalized approach is especially important for treatment and diagnostics of internal carotid artery tortuosity.