E.A. Vagner Perm State Medical University OBJECTIVE. The authors would like to improve the results of surgical treatment of patients with threat of bleeding from esophageal varices. MATERIALS AND METHODS. The study included 90 patients with esophageal varices on the background of liver cirrhosis. Portocaval bypass was performed on 21 patients. The direct interventions on the stomach and esophageal varices were carried out in 29 patients. The endoscopic ligation of esophageal varices was used in 40 cases. RESULTS. The rate of cumulative survival after portocaval bypass was 93,3±6,4 % (up to1 year), 3-year survival rate counted 66,7±12,2 % and 5-year rate was 60,0±12,7 % , respectively. The rate of survival after direct interventions on the stomach and esophageal varices consisted of 92,9 %±6,9 %, 76,0±12,2 % and 65,1±14,5 %, respectively. The survival rate after the endoscopic ligation of esophageal varices class A and B in Child-Pugh numbered 100 %, 91,0±8,7 % and 54, 6±20,6 %, but in case of the class C survival rate counted 60,0±20,4 %, 45,0 %±18,8 and 22,5±18,5 %, respectively. CONCLUSIONS. The authors recommend to apply the long-term courses of endo scopic ligation of esophageal varices in order to prevent bleeding from them. The methods of portcaval bypass or direct intervention should be used in case of lack of effect of endoscopic ligation method.

Department of hospital and pediatric surgery, Novosibirsk State Medical University OBJECTIVE. The authors made a complex assessment of functioning of the artificial esophagus, which was formed from the stomach. The pathological study of biopsy material of mucous coat of the stomach was carried out at different terms after surgery. MATERIALS AND METHODS. The research analyzed the results of esophagogastroplasty in cases of scarry strictures of the stomach after burns and esophageal achalasia in 101 patients. All the patients underwent extirpation of the esophagus with the gastric tube plasty. RESULTS. There weren’t noted any complications with gastric graft functioning. These data were confirmed by X-ray and endoscopy. The structural reorganization of the mucous coat with signs of atrophy was revealed according to the data of pathologic research. CONCLUSIONS. The authors indicated the necessity of the dynamic follow-up of the patients after esophagoplasty.

OBJECTIVE. The authors made an analysis of short-term results of surgical treatment of the patients with gastrointestinal stromal tumors. MATERIALS AND METHODS. The data of medical histories of 94 patients were analyzed. The traditional, laparoscopic and endoscopic interventions were performed on the patients in order to remove the stromal tumors of the stomach and small intestine using radical methods. RESULTS. All surgeries (100 % of patients) were carried out in an adequate volume. There wasn’t noted the postoperative mortality and statistical difference of length of hospital stay (13,1 bed days after laparotomy and 11,5 bed days after minimally invasive interventions). The rate of early postoperative complications was higher after endoscopic interventions. CONCLUSIONS. Minimally invasive methods as well as traditional interventions are radical methods of treatment of gastrointestinal stromal tumors. An application of diverse and non-standardized approaches requires both the development of interdisciplinary collaboration and creation of optimal algorithm for choice of specific surgical technique based on localization, size and type of tumor growth in order to improve safety and reliability of treatment.

OBJECTIVE. The authors would like to consider the possibility and feasibility of simultaneous revascularization of two arterial segments in patients with lower extremity arterial occlusive disease by method of semiclosed loop endarterectomy. MATERIALS AND METHODS. The research included 143 patients. Revascularization of aortofemoral segment was performed on 67 patients. The simultaneous revascularization of aortofemoral and femoropopliteal segments was carried out for 76 patients. The follow-up period was 5 years. RESULTS. There was revealed that the long-term results of multilevel reconstruction were worse that single-level reconstruction. This method requires an individual approach. The best results of simultaneous interventions were obtained in patients aged 60 and older with the III stage of chronic limb ischemia and 2 or 3 working shin arteries. The worst results were observed in patients younger than 50 year old with IV stage of critical limb ischemia and significant lesions of shin arteries.

OBJECTIVE. The authors investigated the value of comprehensive assessment of clinical and laboratory factors including prostate specific antigen (PSA) fractions and prostate health index (PHI) in diagnostics of prostate cancer. MATERIALS AND METHODS. The study numbered 148 patients who were examined for suspected prostate cancer. Clinicians made the measurement of total PSA and fractions, PHI, multifocal transrectal biopsy of prostate. The statistical data were analyzed. RESULTS. The formulas obtained used the discriminant analysis of all clinical and laboratory factors (PSA fractions and PHI). These formulas showed the high possibility (77-80 %) to predict the presence of prostate cancer with sensitivity 70-78 % and specificity 77-83 %. Percentage of [-2]proPSA depended on PHI value and had the significant influence on the possibility of prostate cancer detection.

OBJECTIVE. This study evaluated the possibilities of ultrasound in diagnostics of early thyroid carcinoma. MATERIALS AND METHODS. The authors have compared the ultrasound results with data of postoperative histological examination in 106 patients with differentiated thyroid carcinoma. There were 140 patients with nodular proliferating colloid goiter and 42 patients with follicular thyroid adenomas. RESULTS. The individual ultrasound signs of differentiated thyroid tumors with the size of 1cm in diameter were determined. The ultrasound symptom complex of papilliary carcinoma was defined. Ultrasound features of follicular carcinoma were nonspecific. Noncapsulation papillary carcinoma had pathognomonic ultrasound picture. The ultrasound image of follicular and papillary carcinoma would be similar in presence of capsule. CONCLUSIONS. The accurate analysis of ultrasound image gave the possibility of diagnostics of papilliary carcinoma at early stage with high degree of probability.

OBJECTIVE. The study investigated methods of improving the results of active surgical treatment of patients with severe burns and at the same time the possibility of determination of optimal terms of autografting and shortening the terms of hospital stay. MATERIALS AND METHODS. Researches were carried out in patients aged from 18 to 60 at the period from 2007 to 2015. Immunohistochemical techniques were used to detect an expression of Ki-67 gene and localization of immune cells in dynamics. RESULTS. The authors have obtained the morphological criteria of readiness of burned wound to autografting with following prediction of results. The graft healing processes depended on angiogenesis activity and quantity of functioning blood vessels in the burn wound and at its border of intact skin. The regenerative potential of tissue structures in the burn area and at its border was determined by the expression of Ki67gene. These data allowed the authors to forecast the outcome of skin grafting. CONCLUSIONS. The optimal ratio of immune cells in burn wound at its border with intact skin is a criterion of readiness for autodermoplasty. Autodermoplasty should have been performed in terms of 9 days since the moment of burn injury in order to have a significant advantage compared with subsequent terms of grafting.

OBJECTIVE. The authors created an effective system of prediction of acute erosive-ulcerative lesions of the stomach and duodenum in victims with extensive burns. MATERIALS AND METHODS. The patients (85) were divided into two groups. The first group included 45 patients (53 %) with erosive ulcerative lesions of the stomach and duodenum which developed during 14 days after injury. The second group numbered 40 patients (47 %) without complications. The clinical, laboratory and instrumental methods of investigations were applied. RESULTS. According to data analysis of patient’s examination, the scale of assessment of sign rates was developed. The amount of rates corresponded to the index of prediction (IP). The values of IP were calculated at the interval from -15 to +15 units. The high possibility (85 %) of development of acute erosive and ulcerative lesions of the stomach and duodenum could be expected in cases when IP was about +15 units. CONCLUSIONS. The developed predictive scale of erosive-ulcerative complications of gastrointestinal tract appeared to be highly reliable and allowed doctors to use preventive measures on time.

OBJECTIVE. The study determined the choice of treatment method according to morphological structure of large and giant congenital melanocytic nevi of maxillofacial region. MATERIALS AND METHODS. Several options of surgical treatment were applied in 40 children of different age such as local plasty, expander dermotension and transplantation of free skin graft. The features of maxillofacial region were taken into account. RESULTS. The scheme of staged surgical treatment was developed. All the patients had constant positive results. These data were evaluated conside ring choice of surgical treatment and features of morphological structure of removed nevi. CONCLUSIONS. The guidelines of staged surgical treatment developed by authors allowed them to improve the results of patient cure.

OBJECTIVE. The study evaluated the efficacy of application of the method of vacuum-assisted closure in neonates with complicated healing of sternotomy soft tissue wounds after cardiac surgery. MATERIALS AND METHODS. Vacuum-assisted therapy of soft tissue of the thorax was performed on 9 patients with poststernotomy wound infection. The patients were infants aged 1 to 27 days (mean age 6 days) with weight from 2,3 to 3,6 kg (mean value 3,2 kg). RESULTS. The time of revealing the signs of incompetence of soft tissues of the thorax numbered 5-9 days. The duration of vacuum drainage was 5-14 days (mean value 9 days). Given period allowed clinicians to reach the effective wound cleansing and healing without problems after secondary closure. CONCLUSIONS. The application of the method was effective and healing of soft tissues of sternotomy wound of infectious and noninfectious nature was carried out in short terms in neonates after cardiac interventions.

OBJECTIVE. The study analyzed preoperative errors and intraoperative risks in cystic transformations of the bile duct in children. MATERIALS AND METHODS. The data of 76 patients with cystic transformations of the bile duct were evaluated. Various operations were performed on 74 (97,4 %) patients. RESULTS. There were noted different complications in 34 cases on the stage of diagnostics and surgical treatment. The iatrogenic complications were observed in patients with complex anatomical and topographic anomalies. The article presents the most frequent complications, their causes and features of treatment approach. CONCLUSIONS. Diagnostic and tactical errors were made due to low awareness of doctors regarding cystic transformations of the bile duct and lack of clear symptoms of dynamic characteristics of clinical signs of the defect. Risk of intraoperative complications would be increased because of earlier performed an erroneous or inadequate surgery and expressed inflammatory process of hepatoduodenal area.

OBJECTIVE. The study investigated and compared the efficacy of plasty of dura mater using different collagen materials in the experiment. MATERIALS AND METHODS. The experimental study in vivo was carried out on 60 laboratory animals. Rabbits were divided into 4 groups after performing the craniotomy and dura mater opening. It depended on the material used for plasty of dural defects such as Duraform, Lyostypt and Russian prototype of collagen matrix for dural grafting. The fourth group was the control group. The presence and severity of meningo-cerebral adhesion, histological and immunological researches of duraplasty areas were performed after the experiment. RESULTS. The severity of meningo-cerebral adhesion was significantly higher in control group, but there wasn’t noted any meaningful difference in the groups with different collagen matrices. These groups had similar histological and immunohistochemical features. CONCLUSIONS. An application of collagen matrix improved the results of duraplasty and prevented formation of meningo-cerebral adhesions in the experiment. This data predict the high clinical efficacy of the method.

OBJECTIVE. The study compared the efficacy of anatomic and transtibial ACL (anterior cruciform ligament) reconstruction. MATERIALS AND METHODS. The authors analyzed 586 operations at the period from 2010 to 2015. The anatomic ACL-R was performed in the first group of 289 patients (49,3 %). The transtibial ACL-R was carried out in the second group of 297 patients (50,7 %). RESULTS. The adverse outcomes were rarely observed in the first group (p<0,05), where IKDC-2000 and KOSS were applied. The knee stability was higher in the first group (p<0,05). The graft was often positioned vertically and it had signs of destruction in the second group. There was detected the bone tunnel enlargement (p<0,01) more frequently compared with the first group. The operation time was shortened (p<0,05) in the second group. CONCLUSIONS. The anatomic ACL-R allowed doctors to obtain some stability in the perfect and good results compared with the transtibial ACL-R.

OBJECTIVE. The research assessed the efficacy of WHO checklist for prevention of avoidable complications in surgery. MATERIALS AND METHODS. The article presents the results of implementation of WHO recommendations (checklist of measures) for prevention of so-called avoidable complications in surgery during performance of 35300 operations in 3-year period. The authors included two additional issues in the checklist about prevention of thromboembolic complications and temperature control in the operating unit. RESULTS. The number of preventable complications decreased in clinic after the implementation of WHO recommendations. The rate of thromboembolic and different postoperative complications also reduced in comparison with other clinic, where these recommendations haven’t been applied. CONCLUSIONS. The introduction of principles of prevention of complications in surgery according to WHO recommendations allowed significant decrease of the number of avoidable complications.

OBJECTIVE. The authors investigated the peculiarities and character of complications in gerontological patients with disseminated forms of colon cancer after combined and extended operative interventions. MATERIALS AND METHODS. A retrospective analysis of treatment results of 154 patients was made. The single-stage combined operations were performed on 32 patients of the first group with IV stage of colon cancer. The operation included removing of primary tumor and liver metastases. Combined and extended operative interventions were carried out on 122 patients of the second group with locally-advanced colorectal cancer (T3-4N1-3M0). The patients of both groups were divided into 2 subgroups according to the age: subgroup A - over 60 years of age, subgroup B - younger than 60. Comparison of parameters of postoperative period was made separately in each group between subgroups. RESULTS. There weren’t noted any reliable increase in rate of surgical complication in patients of elderly and senile age with disseminated forms of colon cancer after combined operations. These operations accompanied by high risk of development of functionally-somatic complications as a rule connected with decompensation of concurrent pathology. CONCLUSIONS. The authors recommend to make the careful assessment of general somatic status of gerontological patients with disseminated forms of colorectal cancer and apply the multidiscipline approach in order to balance on time the concurrent pathology after combined operations.

OBJECIVE. The authors would like to design an original device for aerosol laparoscopic chemotherapy and propose the most effective and safe mode. MATERIALS AND METHODS. The experimental and clinical studies were carried out and included 6 series. Male rabbits (n=71) were used for experimental part and the method was applied on 4 patients in clinical part. RESULTS. The original device and the effective mode of its application were developed for aerosol laparoscopic chemotherapy. The supposed method of chemotherapy appeared to be more effective than the standard method. There weren’t noted any complications or side effects. The method proved its safety. CONCLUSIONS. The aerosol laparoscopic intraperitoneal chemotherapy using the proposed regime is the effective and safe method of peritoneal carcinomatosis treatment.

OBJECTIVE. The study aimed to improve the results of gastric bypass surgery. MATERIALS AND METHODS. The article analyzed the results of surgical treatment of 342 patients with metabolic syndrome who underwent operation at the period from 2008 to 2016.The patients were divided into 2 groups according to the type of operation. The first group included 224 (65,4 %) patients who underwent standard surgery LGB using Lontron procedure. The second group numbered 118 (34,5 %) patients whom LGB operation with ARC (the original method) were performed. The efficacy of operation was evaluated in different terms (after 3-month, one year and 3 years). The article described in detail and showed the technique of proposed modified operation of gastric bypass surgery. RESULTS. The proposed method of operative treatment was validated by researches performed. There was demonstrated higher efficacy of operations compared with the standard gastric bypass surgery. CONCLUSIONS. The operation of modified laparoscopic gastric bypass with formation of antireflux valve allowed clinicians to improve the results, decrease the number of complications and have a strong influence on main components of metabolic syndrome.

OBJECTIVE. The research evaluated the data of robotic thoracoscopic interventions. MATERIALS AND METHODS. The article presents the results of robotic surgery in 30 patients aged 41 to 78 years with lung tumors of various localization and tumors of anterior mediastinum. The non-typical resection of the upper lobe was performed on 17 patients and extended lobectomy was conducted in 10 cases. The removal of anterior mediastinal tumor was made in 3 patients. RESULTS. There weren’t noted any complications in early postoperative period. The length of non-typical resection consisted of 40-50 min, but in case of removal of lung lobe with lymphodissection the duration of surgery was 3-3,5 hours. The removal of tumor from the anterior mediastinum took from 80 min to 1,5 hours. The diagnosis was made according to postmortem examination in all cases. All the patients were discharged from hospital in order to continue treatment. CONCLUSIONS. The results obtained showed the safety and efficacy of robotic interventions.