Khirurgiya最新文献

The article describes a non-standard surgical approach to the treatment of a tumor with a predominant lesion of the membranous wall of the trachea. The method of circular resection with wide excision of the membranous wall of the trachea and replacement of tissue deficiency with an autopericardial flap is used. This approach, in comparison with the standard technique, allowed to significantly reduce the tension of the anastomosis sutures, ensured a smooth postoperative period and relapse-free survival for more than 7 years in the context of combined treatment of adenoid cystic tracheal cancer.

Objective: To describe the causes and mechanisms of postoperative mortality in abdominal surgery.

Material and methods: The primary endpoints were mechanism and cause of death within 30 days after surgery. Mortality-associated factors were examined in Cox proportional hazards model with mixed effects.

Results: Analysis included 550 patients (335 (60.9%) men and 215 (39.1%) women) who underwent abdominal surgery in level II hospitals; 59 (10.7%) out of 550 patients died within 30 days after surgery. Mean age of patients was 53 years. In respiratory diseases, acute respiratory failure associated with damage to lung parenchyma should be noted. Among cardiovascular diseases, the following mechanisms should be distinguished: distributive (e.g., intestinal ischemia, anastomotic insufficiency, sepsis), hypovolemic (blood loss), obstructive (PE), cardiogenic (acute heart failure, arrhythmia, myocardial infarction). The most common causes of death were gastrointestinal perforations (7 patients), upper gastrointestinal bleeding (2 patients), PE (3 patients), and intestinal gangrene (2 patients). Among 59 patients, 6 (10.2%) died within 24 hours, 21 (35.6%) - within the period from 24 hours to 7 days, 12 (20.3%) - within 8-14 days, 20 (33.9%) - later than 14 days after surgery. Forty-seven (79.7%) out of 59 patients died in hospital and 12 (20.3%) patients died outside the hospital.

Conclusion: Circulatory failure accounts for majority of deaths after abdominal surgery. Differences in time to death highlight the risk of death throughout perioperative period and after discharge. We propose to stratify the causes of death to primary and secondary ones (due to the main disease independent on postoperative outcomes and due to postoperative complication).

Objective: To evaluate the evidence base of the Mannheim Peritonitis Index (MPI) for choice of relaparotomy (programmed vs on-demand) in severe peritonitis.

Material and methods: The study was carried out in 3 stages.

1. MPI-based assessment of evidence base of national guidelines «Peritonitis» regarding the choice of relaparotomy (programmed vs on-demand).

2. Statements and recommendations of current foreign guidelines on MPI-based choice of tactics for peritonitis.

3. Systematic review of evidence base of studies that used MPI to determine surgical tactics.

Results: The studies listed in national guidelines do not provide evidence of feasibility of MPI as a tool for determining tactics. This index is not mentioned in 3 out of 7 foreign recommendations on abdominal surgical infection. In other recommendations with moderate level of recommendations and low level of evidence, MPI is indicated as a tool for predicting mortality. In 7 retrospective studies not included in recommendations, there was no evidence for advisability of MPI to determine surgical tactics.

Conclusion: There is currently no evidence base for MPI in choosing programmed or on-demand relaparotomy in case of severe peritonitis. Further high-evidence studies are required to find significant criteria.

Objective: To compare morphology of three autologous fat tissue fractions (milli-, micro-, and nanofat) obtained through mechanical micronization.

Material and methods: Human adipose tissue harvested during aesthetic liposuction was fixed in glutaraldehyde and examined using light and transmission electron microscopy.

Results: Millifat preserved intact adipocytes, vascular structures, and extracellular matrix. Microfat showed partial tissue disintegration with increased number of vesicular elements. Nanofat is an amorphous emulsion devoid of cells but containing matrix and membrane fragments. Median particle sizes were 1.3 [0.8-1.7], 1.1 [0.8-1.4], and 0.4 [0.3-1.5] mm, respectively. There was a clear morphological gradient reflecting transition from preserved tissue to fragmented components. Micronization degree determines biological properties of the graft: millifat serves mainly as a volumetric filler, microfat combines volumetric and regenerative effects, nanofat demonstrates biomodulatory activity.

Conclusion: These findings provide a morphological basis for standardized fat processing methods and development of automated devices for fat transferring. This is of practical significance in plastic and reconstructive surgery.

Objective: To compare the effectiveness of various treatment options (percutaneous or transluminal methods, laparoscopic, robotic and open interventions) for blunt abdominal trauma.

Material and methods: A systematic review was performed in accordance with PRISMA (2020) and AMSTAR (2017) guidelines. We analyzed non-randomized studies between January 1, 2016 (randomized ones without time limits) and September 10, 2024 in the eLibrary, PubMed and Cochrane library databases.

Results: Laparoscopic interventions in stable/stabilized patients with blunt abdominal injuries are accompanied by significantly fewer complications compared to laparotomy. At the same time, there are still insufficient data regarding the advantages of laparoscopy in hemodynamically stable /stabilized patients with spleen injuries. Well-planned researches are needed for other organs. There are insufficient data on percutaneous, transluminal and robotic techniques, as well as results of laparoscopy in hemodynamically unstable patients.

Conclusion: Laparoscopic interventions in stable/stabilized patients with blunt abdominal injuries are accompanied by significantly fewer complications compared to laparotomy. Further systematic reviews and meta-analyses based on randomized clinical trials are necessary to obtain higher level of evidence and class of recommendations.

Objective: To evaluate the suitability of a biodegradable synthetic material based on poly(L-lactide-co-ε-caprolactone) for the manufacture of ureteral stents in vitro.

Material and methods: An investigation of 10 identical samples of polymeric material was performed. Urine from one patient was used for each sample throughout the study. The material in the form of a 6 cm long rod was placed in a sterile plastic container with the patient's urine and incubated at a temperature of 38 °C until the material was physically destroyed. Urine was replaced in the container once every 48 hours. The appearance and strength maintenance of the material were evaluated on 3, 7, 10, 14, 21, 28, 35 and 42 days. The material fragment of about 5 mm in length was separated in order to change the molecular mass of the polymer during degradation. The weight-average molecular weight (Mw) was measured using gel permeation chromatography.

Results: The samples retained their mechanical properties until the 35th day. A change in color of some samples was noted on the 10th day. The process of degradation started immediately after the initiation of incubation, and in the first 2 weeks a reduction of the molecular mass up to 50-60% from the baseline has been observed, after 35 days - up to 30% from the baseline. At the indicated time, the material was destroyed with minimal mechanical impact. At about 2 months the molecular mass decreased to 10% from the baseline, the samples disintegrated into fragments. There was no significant difference in the dynamics of material degradation in the urine of different patients.

Conclusion: Degradation of the investigated synthetic material occurs at a predictable rate, regardless of individual features of biochemical composition of the urine and its pH. The time of complete degradation of the material is 2-3 months. Lack of incrustation and acceptable degradation profile make the proposed material promising for creation of biodegradable ureteral stents.

This review is aimed to increase surgeons' awareness of diagnosis and management of liver hemangioma. The latter is the most common benign liver tumor. Widespread liver imaging methods improve diagnosis of this tumor. However, there are issues of differential diagnosis and treatment of large hemangiomas. This article considers these issues.

Taeniasis, primarily caused by Taenia solium or Taenia saginata, is the most common zoonotic infection affecting the gastrointestinal tract. Although appendicitis related to this parasitic infection is rare, it represents an important differential diagnosis in patients presenting with abdominal pain. This case report highlights a unique case of appendicitis associated with Taenia infestation, emphasizing the need for clinical awareness of potential parasitic origins in appendicitis. A 35-year-old Ethiopian female, non-diabetic and non-hypertensive, presented with a one-day history of moderate right lower quadrant abdominal pain, nausea, and vomiting. She had no significant family history and reported no use of tobacco or alcohol. Upon examination, she exhibited no fever, weight loss, or acute distress, but tenderness was noted in the right lower quadrant. Radiologic assessments included unremarkable pelvic ultrasound and abdominal ultrasound revealing mild tenderness in the right iliac fossa and enlarged mesenteric lymph nodes. Subsequent non-contrast CT indicated subtle signs of epiploic appendicitis. Pathological analysis confirmed Taenia worms and eggs obstructing the appendix, suggesting that obstruction and symptoms were likely due to parasitic infection. The patient was prescribed Albendazole 400 mg daily for three days, underwent laparoscopic appendectomy, and made a full recovery. This case highlights the significance of considering Taenia as a potential causative agent in appendicitis. Clinicians should maintain a high index of suspicion for parasitic infections in patients presenting with gastrointestinal symptoms, as early diagnosis and management are crucial in preventing complications.

Objective: To compare the musculature of anterior abdominal wall in healthy people and patients with large or gigantic ventral hernia.

Material and methods: A retrospective study included 200 patients between January 2020 and September 2024. Two groups were formed for subsequent analysis. The first group consisted of 100 participants without postoperative ventral hernia who underwent examination and treatment. The second group consisted of 100 patients diagnosed with large or giant ventral hernias. All participants underwent computed tomography (CT) of the abdomen, retroperitoneal space and pelvic region. Analysis of anterior abdominal wall muscles was based on CT findings. Thickness, length, area, density, symmetry, structural integrity, volume and circumference were measured.

Results: There were significant differences in muscle length along the inner and outer contours on the right side and area of anterior abdominal wall muscles on both sides. These findings suggest potential changes of these parameters in the 2^nd group. Thickness of anterior abdominal muscles differed significantly (p-value ~0.017).

Conclusion: There are significant structural differences in anterior abdominal wall musculature between healthy individuals and people with large and giant ventral hernias. This information can improve preoperative management and surgical techniques aimed at restoring the integrity and function of abdominal wall.

Objective: To improve treatment outcomes in patients with obstructive jaundice at the flagship center through distributing patient flows and applying optimal tactics.

Material and methods: A retrospective study included patients with obstructive jaundice between January 2022 and April 2024. Patients were divided into 2 groups: the main group - patients hospitalized between March 2023 and April 2024 (the first year of work of the flagship center); the control group - patients hospitalized between January 2022 and February 2023 (one year before the commissioning of the flagship center). In both groups, we analyzed gender- and age-adjusted distribution of patients, channels of hospitalization, severity of obstructive jaundice and its etiology, nature and number of surgical interventions, postoperative morbidity and mortality. Mean time to diagnosis, waiting time for surgery, postoperative and overall hospital-stay were compared.

Results: There was significantly lower postoperative morbidity in the main group (p<0.05). Moreover, the same group was characterized by significantly shorter time for diagnosis (3.4 versus 12.1 hours; p<0.0001), earlier surgical treatment (6.8 versus 17.4 hours; p<0.0001), postoperative (2.8 versus 5.7 days) and overall hospital-stay (3.6 versus 6.4 days).

Conclusion: The capabilities of the flagship center make it possible to provide specialized high-tech medical care within the first hours after admission, significantly reduce the time for correct diagnosis and period until surgery. Original algorithm for patient distribution and optimal tactics based on minimally invasive technologies significantly improved treatment outcomes in patients with obstructive jaundice.