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Objective: To study treatment outcomes in children with blunt combined abdominal injuries.

Material and methods: Over the past 20 years, 274 children presented with combined injuries. Of these, 65 (25%) people died at the scene, 7 (0.3%) children died in hospitals. Road injuries occurred in 77% of cases. Three or more areas were injured in every third child. Sixty-three children admitted to the hospital. Standard examination included ultrasound, X-ray (including CT and MRI) and laboratory methods, laparoscopy and thoracoscopy, bladder catheterization. Three cases are described.

Results: Thirty-two children had spleen injury, 12 - liver injury, 7 - duodenum injury, 7 - small intestine injury, 3 - colon injury, 2 - pancreas injury. TBI was detected in 28 children, thoracic injuries - in 14, kidney injuries - in 11, fractures of pelvis and limbs - in 10 patients. Forty-four children underwent surgery. Other ones underwent conservative treatment under laparoscopic and ultrasound control. Nine 9 children required neurosurgical interventions. Four children died with severe liver injury and TBI, 2 children - with thoracoabdominal injury and TBI, one girl - with ruptured cecum, peritonitis and TBI.

Conclusion: The objective of care for combined abdominal injuries is to save the lives of victims through diagnosis and treatment of life-threatening syndromes (shock, acute respiratory failure, bleeding, brain dislocation with vital disorders, etc.).Treatment of blunt combined abdominal injuries should consist of 2 stages. At the first stage, intraabdominal bleeding and peritonitis are eliminated, and neurosurgical correction of TBI is performed at the second stage. Children with combined injuries require timely hospitalization to multi-field hospitals.

Isolated cecal necrosis is a rare disease with poorly understood etiology often mimicking acute appendicitis. Its diagnosis is difficult due to the absence of specific clinical, laboratory, ultrasound and X-ray features. We present 3 cases of isolated cecal necrosis diagnosed intraoperatively in 2023 and 2024.

The authors present successful hybrid surgical intervention of a patient with multifocal atherosclerosis, aneurysmal lesions of infrarenal aorta, iliac and femoral arteries. Taking into account multi-level damage to aortofemoral segment and possible technical difficulties of staged treatment, the authors preferred a hybrid surgical intervention: stenting of abdominal aorta and iliac arteries, resection femoral artery aneurysms with external iliac-deep femoral bypass. Success of this intervention lies in exclusion of aortic and iliac artery aneurysms, excision of aneurysms of femoral arteries with reconstruction, relief of critical ischemia within the same surgical session. Considering sporadic nature of such cases, we considered it appropriate to share our experience, as well as provide literature data on modern treatment approaches for these patients.

Objective: To assess the safety and efficacy of one-step surgical interventions using the "rendezvous" technique in patients with acute and chronic (exacerbated) calculous cholecystitis complicated by choledocholithiasis.

Methods: A meta-analysis of randomized controlled trials (RCTs) was conducted using studies retrieved from the PubMed and eLibrary databases. The analysis compared the outcomes of procedures performed using the «rendezvous» technique (simultaneous laparoscopic cholecystectomy and endoscopic transpapillary interventions within a single operation) with two-stage procedures (sequential endoscopic transpapillary interventions followed by laparoscopic cholecystectomy). The primary endpoints included the incidence of specific postoperative complications (acute post-manipulative pancreatitis, cholangitis, biliary peritonitis, and bleeding from the major duodenal papilla), mortality rates, and length of hospitalization.

Statistical analysis was performed using the R programming language and the «meta» software package. Heterogeneity among included studies was assessed using the Q-test and the I² and tau² statistics. The risk of publication bias was evaluated using Funnel Plot analysis with Trim and Fill correction. The meta-analysis was conducted using a random-effects model.

Results: Ten RCTs, comprising data from 1.492 patients diagnosed with acute or chronic (exacerbated) calculous cholecystitis complicated by choledocholithiasis, were included in the meta-analysis. Among them, 741 patients (49.7%) underwent one-step procedures using the "rendezvous" technique, while 751 patients (50.3%) underwent two-stage procedures.

Patients who underwent the "rendezvous" approach demonstrated a significant reduction in the overall incidence of specific postoperative complications (RR: 0.63, CI: 0.45-0.90, p=0.0097), particularly acute post-manipulative pancreatitis (RR: 0.54, CI: 0.32-0.91, p=0.0223), as well as a shorter hospital stay (MD: -3.0912, CI: -3.5653 to -2.6171, p<0.0001) compared to those who underwent two-stage procedures. However, a statistically significant difference in mortality rates between the study groups could not be determined.

Conclusion: One-step surgical interventions using the "rendezvous" technique in patients with acute and chronic calculous cholecystitis complicated by choledocholithiasis represent a safe and effective minimally invasive approach to surgical treatment. This technique significantly reduces the incidence of specific postoperative complications and shortens hospitalization duration.

Benign, fluid-filled lesions called simple liver cysts are commonly seen incidentally on imaging. While they are usually asymptomatic, they can cause complications including infection, rupture, or hemorrhage. The formation of a fistula into the abdominal wall is a rare complication, with diagnostic and therapeutic challenges.

Case presentation: In April 2024, a 29-year-old obese (body mass index 30.56) male presented to Madinat Zayed Hospital with left pneumonia, which was resolved with intravenous antibiotics. A subsequent CT scan, however, showed an 11×10×5 cm hypodense lesion in the right hepatic lobe, with partial marginal calcification but no significant contrast enhancement. Differential diagnoses included hydatid cyst and biliary neoplasm. The findings in the laboratory were normal hepatitis markers and tumor markers except for elevated CA19-9 levels. Laparoscopic deroofing of the cyst revealed a 15×15 cm cyst adherent to the liver and abdominal wall containing 400 ml of bile. There was histopathological confirmation of a benign biliary cyst. The patient recovered well postoperatively and did not have recurrence or complications on follow-up.

Conclusion: This is a rare case of a simple liver cyst complicated by a fistula into the abdominal wall. Successful outcome resulted from multidisciplinary management using imaging, laboratory investigations, and surgical intervention. It is important to consider rare complications of liver cyst management to provide optimal patient care and this report highlights the importance of this.

Considering individual characteristics of each patient with inguinal hernia, we can potentially predict the most likely complications following laparoscopic hernia repair. A personalized analysis of risk factors allows for the most suitable prevention method in each case. Comparative characteristics of endovideosurgical approaches are discussed. We established the risk factors of potential postoperative complications and perioperative preventive measures.

Objective: To analyze the ultrasound characteristics of iliocaval floating thrombi in patients with deep vein thrombosis regarding embolic risk.

Material and methods: The study included 221 patients with deep vein thrombosis and iliocaval floating component. According to indications, all patients underwent implantation of infrarenal vena cava filter and received adequate anticoagulation. We analyzed the following parameters: length of floating clot, clot neck-to-stem ratio (minimum diameter of floating thrombus and diameter of clot attachment to occlusive thrombus), ratio of diameter of the clot neck to the widest part of the floating thrombus, as well as presence of large lateral inflow (internal iliac vein) near floating thrombus. Vena cava filter area was assessed regarding emboli. Ultrasound examinations were performed daily until primary endpoint (floating clot detachment or attachment to venous wall). The embolism group included 23 patients with clot detachment and cava filter embolism. The fixation group included 198 patients without cava filter embolism and floating thrombus attached to venous wall.

Results: The risk of floating thrombus detachment increases by 2.49 times in patients with floating clot 70-79 mm [odds ratio (OR) 2.49; 95% confidence interval (CI) (1.2; 5.16); p=0.02] and 4.8 times in case of length >80 mm [OR 4.8; 95% CI (1.34; 17.19); p=0.03]. Minimum diameter of floating clot divided into diameter of clot attachment <30% increases the risk of detachment by 2.81 times [OR 2.81; 95% CI (1.44; 5.48); p=0.01]. Large lateral tributary near the neck of the floating thrombus increases the risk of detachment by 1.99 times [OR 1.99; 95% CI (1.1; 3.71); p=0.04].

Conclusion: There are certain risk factors in patients with deep vein thrombosis, iliocaval floating thrombus and no contraindications to anticoagulation (clot length >70 mm, minimum diameter of floating clot divided into diameter of clot attachment <30% and large lateral tributary near the neck of the thrombus). These ones should probably be classified as a group with extremely high risk of fatal pulmonary embolism and need for endovascular prophylaxis of venous thromboembolic complications (cava filter implantation) in addition to anticoagulation.

Objective: To study the immediate results of spleen-preserving distal pancreatectomy and to compare the outcomes after Kimura and Warshaw procedures.

Material and methods: A retrospective non-randomized study included 27 patients with benign tumors of pancreatic tail and body who underwent spleen preserving distal pancreatectomy between 2020 and 2024. All patients were divided into 2 groups: 1 - Kimura procedure (n=16), 2 - Warshaw procedure (n=16). We excluded patients who underwent enucleations, central resections, and other interventions instead of distal pancreatectomy.

Results: Mean surgery time was 269.06±70.95 (95% CI 227.74 - 319. 95) and 197.27±42.09 min (95% CI 184.36 - 240.64), respectively (p=0.006). Blood loss, length of hospital day, incidence of laparotomy, splenectomy, splenic infarction, and redo surgeries were similar. Clinically significant postoperative fistula B-C was more common in 1^st group (10 (62.4%) vs. 5 (45.5%) cases, p=0.028). There were no significant between-group differences in the incidence of postoperative complications Clavien-Dindo grade >III and mortality.

Conclusion: Laparoscopic spleen preserving distal pancreatectomy is the «gold» standard for benign tumors of pancreatic body and tail. The Warshaw and Kimura techniques are safe and effective surgical approaches with similar results. The Warshaw procedure may be more advantageous regarding less surgical resources without deterioration of immediate postoperative results.

Background: The steady increase in the incidence of colorectal cancer and its early diagnosis contribute to the identification of resectable forms of this disease, which in turn increases the number of minimally invasive surgical interventions. Therefore, the question of studying the influence of risk factors for the development of hernias and the search for an "ideal" place on the abdominal wall, which would provide the most convenient access for safe removal of the macropreparation and subsequent extracorporeal surgical procedures, as well as a low incidence of wound complications and postoperative ventral hernias, is the most pressing issue in colon cancer surgery.

Objective: To study the differences in the incidence of postoperative ventral hernias during transabdominal extraction of the specimen depending on the type of access after minimally invasive colon resections for cancer, and to evaluate the risk factors for the occurrence of postoperative hernias.

Material and methods: We retrospectively analyzed the medical records of 216 patients who underwent colon resection at the Botkin Medical Scientific and Clinical Center from January 2022 to September 2023. We used a cohort study to determine the impact of the type of access after minimally invasive colon resections for cancer on the incidence of postoperative ventral hernias. The formation of postoperative hernias was detected when longitudinal minilaparotomy was used for the extracorporeal stage of the operation or extraction of the removed preparation.

Results: Of the 216 patients included in the study, 3 patients dropped out according to the exclusion criteria, so 213 patients were analyzed. Median criteria for operative time and blood loss did not differ (p>0.05) in both groups. There were no differences depending on the technique of videoendoscopic intervention used p=(0.762). A strong tendency to use a longitudinal approach was also observed when performing minimally invasive right hemicolectomy (p=0.051), and for distal colon resections, Pfanenstiel minilaparotomy was performed significantly more often (p=0.047). Among patients who underwent transverse minilaparotomy for the extracorporeal stage of surgery or extraction of the removed specimen, hernias in the incision area did not develop (p=0.0001), and in the longitudinal minilaparotomy group, hernias in the area of the access performed were detected in 21.9% of the operated patients.

Conclusion: In our study, patients who underwent minimally invasive radical surgery for colon cancer using the longitudinal minilaparotomy method had a higher risk of hernia compared with patients who underwent surgery using transverse approaches.

The authors present successful treatment of a patient with aortoenteric fistula and chronic critical lower limb ischemia after previous aortobifemoral bypass grafting (ABF). Examination revealed intimate contact of inferior duodenal wall near proximal anastomosis and thrombosis of the right branch. The patient underwent hybrid surgery, i.e. unilateral endovascular repair and crossover replacement. Despite severe status upon admission and concomitant diseases, postoperative period was uneventful. The authors reviewed literature data regarding pathogenesis and diagnosis of secondary aortoenteric fistulas, immediate and long-term results of open and endovascular treatment, advantages and limitations of various surgical tactics and materials.