Khirurgiya最新文献

A doubled gallbladder recognized in postoperative period is presented. Intraoperatively, accessory bladder was recognized as a Caroli disease. However, we removed true gallbladder due to unavailable intraoperative cholangiography and risk of iatrogenic complications. Unclearly verified finding required MR cholangiography to confirm additional gallbladder.

Objective: To compare 6- and 12-month results of femoral artery repair with xenopericardial and autologous venous patch in hybrid treatment of critical lower limb ischemia.

Material and methods: A retrospective analysis included 60 patients with critical lower limb ischemia who underwent hybrid treatment (balloon angioplasty and stenting of iliac arteries and open reconstruction of femoral arteries). Patients were divided into 2 groups by 30 people depending on femoral artery repair (group 1 - autologous venous patch, group 2 - xenopericardial patch). Postoperative complications, symptoms of critical ischemia, ankle-brachial index and pain-free walking distance were assessed after 6 and 12 postoperative months.

Results: Postoperative complications occurred in 3 (5%) patients. In 1 case (pulsating hematoma), they were associated with endovascular intervention, in 2 cases (bleeding and lymphorrhea) - with surgical intervention. After 6 months, resting pain and trophic disorders disappeared. Moreover, pain-free walking distance increased in both groups. The ankle-brachial index increased by 1.8 and 1.9 times compared to preoperative data in each group, respectively. After 12 months, femoral artery restenosis occurred in 2 patients of the 1^st group.

Conclusion: After 6 months, there were no significant between-group differences. After 12 months, xenopericardial patch was superior to autologous venous patch.

We present laparoendoscopic hybrid treatment of a patient with choledocholithiasis, cholecystitis and large duodenal diverticula. A 69-year-old patient underwent one-stage hybrid laparoendoscopic intervention. Despite the difficult situation caused by large duodenal diverticula and calculus in terminal part of common bile duct, hybrid technique with rendez-vous procedure allowed successful lithoextraction and cholecystectomy. The follow-up examination found no residual biliary calculi. Hybrid laparoendoscopic intervention in the treatment of a patient with choledocholithiasis, cholecystitis and large duodenal diverticula provided optimal clinical effect, reduced the risk of postoperative complications and shortened in-hospital treatment.

Burns of the hands in pediatrics are an important topic in combustiology. The hand plays a huge role in the development of mental and physical skills in a child. A retrospective analysis of electronic medical records of 282 victims with hand burns who were treated in Moscow Pediatric Hospital No. 9 named by G.N. Speransky was carried out. The study showed that most often children receive burns of the hands in the first three years of life, the main thermal agent is hot liquid. 35 patients had different types of surgery: excision with one stage or delayed grafting, enzymatic debridement and mechanical debridement. Silver containing atraumatic hydrocolloid dressings were used on all stages of treatment. Clinical examples demonstrate different variants of surgical tactics used in children from 0 till 6 years. Surgery types depend of the depth of damage to the integumentary tissues and deep structures of the hand and fingers. The work highlights diagnostic and clinical approaches to the management of patients with this pathology. The algorithm of conservative and surgical treatment of patients with burns II-III and III degree in the area of the palmar and dorsal surfaces of the hand and fingers is presented. This algorithm also includes tactics at rehabilitation stages restoring functional and aesthetic disorders. Compliance all recommendations contributes to the speedy socialization of patients in this age group.

The article highlights the basic experiments of the predecessors, which served as an impetus for the clinical development of transfusiology in surgery in three main directions: hemotransfusion, intravenous transfusion of aqueous solutions of salts and glucose, as well as parenteral administration of natural milk. The immediate results of each of the options are shown, the dangers and complications that accompanied the accumulation of experience are described. The problems that could be solved only with the further development of science are formulated.

Postoperative peritonitis is a rare but dangerous complication of gastrointestinal tract surgeries. Analysis of epidemiology, diagnostics, treatment, and prognosis of postoperative peritonitis was based on 35 manuscripts. Postoperative peritonitis is an uncommon (up to 6-7%) but dangerous complication with mortality rate >30%. Old age, comorbidities, impaired sealing of proximal digestive tract and delayed redo laparotomy are the main factors of high mortality. Late diagnosis of peritonitis is due to no specific signs, and its symptoms are explained by peculiarities of postoperative period and not associated with complication. Surgical treatment consists in eliminating the source of peritonitis or its effective isolating from abdominal cavity, adequate debridement and drainage of the abdominal cavity. The APACHEII scale and the Mannheim Peritonitis Index (MPI) are the most important in assessing the prognosis of peritonitis. The time of the first relaparotomy may be a sign of disease prognosis. The issues of early diagnostics of postoperative peritonitis remain unresolved that necessitates searching for the causes of late relaparotomy and high subsequent postoperative mortality.

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.