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Objective: To study the possibility of total extraperitoneal inguinal hernia repair under local anesthesia in patients with contraindications for general or regional anesthesia.

Material and methods: A retrospective clinical trial involved 14 patients who underwent total extraperitoneal inguinal hernia repair under local anesthesia with lidocaine between 2019 and 2022. Potential indications for this surgery under local anesthesia may be certain clinical situations and their combinations: high anesthetic risk, anatomical difficulties for regional anesthesia, coagulopathy, long-term antithrombotic therapy, refusal of patient from general and regional anesthesia.

Results: There was ASA grade IV in 13 (92.9%) patients. Mean age of patients was 73.5 (64.0; 84.0) years, Charlson comorbidity index - 5.0 (4.3; 6.0) points. All patients with inguinal hernia successfully underwent total extraperitoneal inguinal hernia repair under local anesthesia. There were no conversions to open surgery or general anesthesia. Three (21.4%) patients developed intraoperative pneumoperitoneum that required intravenous administration of opioid analgesic. After that, endoscopic surgery was successfully continued in all cases. There were no typical postoperative complications of herniation. Patient activation occurred after 2-3 hours after surgery. Narcotic analgesics in postoperative period were not required in any case. Mean hospital-stay was 25.0 (21.7; 42.0) hours. No recurrence of hernias was observed within 7.5 (6.3; 14.3) months.

Conclusion: Total extraperitoneal inguinal hernia repair under local anesthesia is a technically feasible intervention in patients with limitations to general or regional anesthesia.

Objective: To create a scale for predicting amputation in patients with acute limb ischemia.

Material and methods: We retrospectively analyzed inpatient treatment data of 1.353 patients over a 22-year period. Patients were divided into two groups depending on limb salvage (n=1.212) and limb loss (n=141). Six factors influencing the risk of limb amputation were identified, and odds ratio for each factor was assessed.

Results: A scoring scale including 15 clinical and laboratory parameters was created. Prognostic ability of the scale was assessed using ROC analysis. AUC was 0.794 with 95% CI 0.755-0.833. The median score for group 1 (limb salvage) was 17 [14; 21], for group 2 (amputation) - 23 [19; 26] (p<0.0001). We stratified groups of low (up to 4.2%), medium (4.3-19.2%) and high (19.3-55.7%) risk of limb amputation in patients with acute limb ischemia.

Conclusion: A simple scale for assessing the probability of limb amputation in patients with acute ischemia was developed. Practical application of this tool is possible in surgical and specialized departments.

Background: The issue of improving hemorrhoid treatment outcomes in outpatient practice is one of the most pressing in the daily work of coloproctologists today. Advances in the treatment of hemorrhoidal disease, the most common pathological condition in general proctology, in recent decades have been associated not only with the adoption of minimally invasive surgical techniques but also with the enhancement of pharmacological therapy. A key component of systemic pharmacotherapy for chronic and acute hemorrhoids is the use of venotonic drugs, including flavonoids which are included in the clinical guidelines. Therefore, a comprehensive and reliable evaluation of the clinical efficacy of diosmin is an important area of research, especially in cases of acute hemorrhoids.

Objective: The study aimed to assess the effectiveness of using Phlebodia 600 and evaluate the dynamics of patients' quality of life with acute hemorrhoids of grades I-II in outpatient practice without employing minimally invasive surgical methods.

Material and methods: A Russian multicenter prospective observational study was conducted involving an adult population of patients with grade I-II acute hemorrhoids in the city of Rostov-on-Don and the Rostov region. Outpatients (both men and women) aged 18 to 64 with a confirmed diagnosis of grade I-II acute hemorrhoids (thrombosis of external or internal hemorrhoidal nodes, including those with bleeding) established through standardized clinical examination were included. Therapy with Phlebodia 600 (diosmin) commenced no later than three days after the onset of clinical symptoms, which included a dominant set of symptoms such as enlarged hemorrhoidal nodes, pain, bleeding, anal itching, burning, or discomfort. The total sample size analyzed was 220 patients, and the medication was administered for at least 36 days.

Results: The use of Phlebodia 600 for grade I-II acute hemorrhoids allowed for the resolution of complaints and stabilization of all key clinical parameters within the timeframes set by the study design. Following the proposed treatment regimen, early resolution and reduction of complaints such as pain, discomfort, itching, and blood streaks during defecation were observed by the control visit after seven days of therapy, compared to baseline. In 73% of cases, a reduction in the size of hemorrhoidal nodes was noted within this period. The proposed treatment regimen can be considered rational since, after 30 days, not only was there consistent resolution of complaints in the majority of patients, but there was also a significant improvement in quality of life (SF-36). No cases of intolerance to Phlebodia 600 or adverse reactions associated with its use were identified, indicating a high safety profile.

Conclusions: A 35-40 day course of Phlebodia 600 administered continuously according to the manufacturer's recomm

Objective: To analyze treatment outcomes in patients with retrosternal goiter.

Material and methods: There were 13 patients aged 32-77 years with retrosternal goiter between 2016 and 2024. The ratio of men and women was 2:11.

Results: Twelve patients underwent thyroidectomy, one patient - video-assisted thoracoscopic thymectomy with resection of aberrant goiter. Among 12 patients, thyroidectomy through collotomy was performed in 6 patients, sternotomy was performed in 5 patients. Aberrant goiter was removed through thoracotomy in one patient with recurrent retrosternal goiter. Complicated postoperative period was observed in 4 patients. Two patients underwent postoperative tracheostomy (prevention of respiratory failure following high risk of bilateral paresis of recurrent laryngeal nerves in one case and laryngeal edema in the second case). There were no deaths in long-term period.

Conclusion: Preoperative planning should include CT-based analysis of intrathoracic component of thyroid gland and volume of chest cavity. This is valuable to plan the optimal surgical approach and reduces the risk of intraoperative complications.

Objective: To evaluate the effectiveness of intraoperative visualization and risk factors of central lymph node metastases in unilateral PTC without preoperative clinical signs of central lymph node metastases.

Material and methods: There were 227 patients with preoperatively verified thyroid cancer in one lobe without lymph node metastases between January 2018 and December 2018. They underwent hemithyroidectomy and prophylactic central lymphadenectomy (CLE).

Results: The follow-up period was 47.6±10.6 months. Metastases were detected in 57 (25.1%) patients during intraoperative visualization and in 72 (31.7%) patients after morphological analysis. Sensitivity and specificity of intraoperative visualization were 76.4% and 98.7%, respectively. Extrathyroidal invasion was significantly associated with higher risk of central lymph node metastases (p=0.006, p<0.001; and p<0.001, respectively). Oncological outcomes did not differ significantly between true- and false-negative results of intraoperative visualization.

Conclusion: Intraoperative imaging is valuable to obtain accurate information about status of disease and extent of surgery. Further long-term studies are needed to evaluate clinical benefits of intraoperative visualization.

Duodenal injury in blunt abdominal trauma is a rare and often requires complex repair. We present a case of duodenal injury successfully managed with primary repair and jejunostomy. Additionally, we reviewed the literature devoted to the management of duodenal injuries, particularly D4 duodenal injuries. A 34-year-old male patient came to the emergency department with severe abdominal pain caused by a workplace accident. The patient's condition on arrival was stable. Abdominal examination: severe epigastric pain, bruising and skin scratches in epigastric area, positive signs of abdominal rigidity, and inaudible peristaltic movements. Computed Tomography (CT) of the abdomen revealed free air in abdominal cavity and retroperitoneal space. The patient underwent emergency surgery 4 hours after the accident. Intraoperatively, we found rupture of the fourth part of duodenum and stomach. These injuries were chosen for primary repair combined with jejunostomy. The patient recovered after surgery, and there were no complications. Rupture of D4 duodenum can result from falling and hitting the back on a hard surface, while gastric rupture may occur due to direct impact on abdominal wall. Free retroperitoneal air adjacent to D4 segment is indicative of duodenal injury. Extensive suturing of surrounding tissues and two-layer suture repair at the injury site are necessary. Additionally, jejunostomy was imposed to prevent complications such as duodenal leaks. Due to anatomical characteristics of D4, primary repair can be effective for duodenal injuries up to grade III. Extensive abdominal drainage and jejunostomy are essential for fast recovery and minimal risk of complications related to duodenal leaks.

Objective: To determine prognostic factors in resectable common bile duct (CBD) cancer and feasibility of adjuvant therapy.

Material and methods: We retrospectively studied the results of pancreatoduodenectomy for CBD cancer in 1999-2023.

Results: There were 89 patients, mortality rate was 5.6% (n=5), complications developed in 66 patients (74.2%), complications ≥ grade III - in 37 (41.7%) cases. Postoperative pancreatic fistula (POPF) grade B/C was detected in 29 (32.6%) cases. Postoperative chemotherapy was administered to 43 patients (gemcitabine-based therapy - 27, capecitabine alone - 15, capecitabine/oxaliplatin combination - 1). The median overall survival was 33 months, disease-free survival - 19 months. Among patients selected for assessment of long-term results (n=79), the median OS was 37 months, DFS - 30 months. Retroperitoneal invasion (RPI), pancreatic invasion (PI), perineural invasion (PNI), moderate/poor differentiation, R1 resection, retroperitoneal lymph node (LN) involvement worsened long-term results in multivariate analysis, regional LN involvement and elevated CA 19-9 - in univariate analysis. Accumulation of factors worsened prognosis. Postoperative chemotherapy improved OS (median OS 35 months vs. 16.5, p=0.035) in patients with two or more negative prognostic factors. Chemotherapy mode did not affect prognosis.

Conclusion: Retroperitoneal, pancreatic and perineural invasion, R1 resection, moderate/poor tumor differentiation, lymph node involvement and elevated CA 19-9 are negative prognostic factors in CBD cancer. Postoperative capecitabine monotherapy is justified in patients with two or more negative factors.

Despite low prevalence compared to other thermal injuries, severe electrical trauma with large area of injury and deep burns is associated with extremely high risk of death. Severity of pathological process depends on many factors: electric current itself, body status. Treatment of these injuries is a labor-intensive process, including numerous surgical interventions. Surgical treatment should be started as early as possible after admission. The authors describe electric injury from high-voltage power transmission network. This example demonstrates how early intensive care and surgical treatment affect the outcome.

Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive and effective treatment for gastrointestinal variceal bleeding and refractory ascites associated with portal hypertension. However, TIPS dysfunction occurs for various reasons and can lead to recurrent complications. In such cases, repeated endovascular intervention can be performed for portal hypertension. This article presents one of the methods of endovascular correction (Y-stenting) for TIPS thrombosis.

Knowledge of extrahepatic biliary anatomy is important for surgeons involved in the diagnosis and treatment of biliary tract diseases. The use of new diagnostic methods allows for the development of optimal surgical treatment regimens and the prevention of postoperative complications. The presented clinical case illustrates the effectiveness of using 3D modeling in diagnosing biliary system anomalies to plan and adjust surgical treatment. In addition, the method allows for the monitoring of the postoperative formation of new duct-to-duct anastomoses and the adjustment of subsequent non-surgical treatment regimens. The use of a 1.5% meglumine sodium succinate solution in the postoperative treatment, due to its antioxidant/antihypoxant mechanism of action, contributed to reduction of inflammatory reactions, normalization of biochemical parameters, and improvement of subjective indicators of the patient's quality of life.