OBJECTIVE. The purpose of this study was to evaluate the methods for preservation the patency of the internal iliac arteries during infrarenal aortic aneurysm resection.

MATERIAL AND METHODS. The retrospective review was conducted in 200 patients who had undergone infrarenal aortic aneurysms resection between 1998 and 2017. The group 1 consisted of 8 patients who underwent the antegrade internal iliac arteries flow restoration by bypass or prosthetics. The group 2 consisted of 25 people who did not undergo restorating the patency of these arteries. The results were compared in both groups during the intraand early postoperative period.

RESULTS. During the statistical analysis, there were no significant differences in duration of operation postoperative period, blood loss between two groups. Among the patients of the group 2, a transient ischemic colitis developed in one case, a prosthesis thrombosis developed in 5 patients. The complications described above have never been noted in the group 1.

CONCLUSION. Direct revascularization of the internal iliac arteries during infrarenal aortic aneurism resection is an important factor of preventing the ischemic disorders of the pelvic organs and the left half of the colon do not significantly affect the volume of blood loss and the duration of the operation and the postoperative period.  

OBJECTIVE. The reason of therapeutic and diagnostic tactics in patients with otogenic venous sinus thrombosis of the brain.

MATERIAL AND METHOD. The analysis of 89 clinical cases of treatment of patients with meningoencephalitis due to inflammatory diseases of the middle ear.

RESULTS. The differentiated tactics was used during the surgical treatment of patients with intracranial purulent inflammatory diseases differentiated tactics. This tactics depended on the results of CT or MRI studies of the brain, the clinical stage of an intracerebral abscess and the organ dysfunction of the patient.

CONCLUSION. At the primary medical care stage it is necessary to identify predictors of infectious brain damage. If they are identified, the patient evacuation to a hospital is recommended urgently. CT of the temporal bones CT and MRI of the brain are performed in a hospital. A surgical sanation of infection sites, a systemic, regional antibiotic therapy are began to perform.  

OBJECTIVE. The enhancement of direct results of treatment in patients with a bleeding gastro-duodenal ulcer and the Mallory–Weise syndrome using endoscopic and endovascular methods of hemostasis.

MATERIAL AND METHODS. In this paper, the treatment results of the 253 patients with Mallory–Weise syndrome and the results of the 1063 patients with a bleeding gastro-duodenal ulcer are analyzed.

RESULTS. An endoscopic hemostasis was conducted for all patients with a Mallory–Weise syndrome. For patients with bleeding ulcer: the injection therapy and unipolar coagulation were done for 238 patients (the bleeding recurrence was detected in 21 cases (8.8 %)); the injection therapy and argon plasma therapy were conducted for 341 patients (the bleeding recurrence was detected in 19 cases (5.6 %)); the injection therapy and clipping of vessels were conducted for 236 patients (the bleeding recurrence was detected in 11 cases (4.7 %)); the ulcer ligation was done for 98 patients without bleeding recurrences. 151 persons were treated only with the conservative treatment, while the recurrence was detected with 49 persons (32.5 %). The primary surgical treatment was done for 46 (4.3 %) patients, who had the traces of a heavy blood loss but it was not possible to visualize its source. Two patients died. 106 patients underwent an X-ray endovascular surgical procedure aimed at reaching the hemostasis. 100 patients of them had a bleeding recurrence and 6 of them had a comorbidity index over 30 points and a high risk of bleeding recurrence. One person with an acute cardiac insufficiency died.

CONCLUSION. The bleeding recurrence and a high comorbidity index provide an evidence for undertaking X-ray endovascular method of hemostasis.  

OBJECTIVE. Improvement of surgical treatment of patients with adhesive intestinal obstruction.

MATERIAL AND METHODS. This article shows the analyzing results of surgical treatment of 73 patients with adhesive intestinal obstruction. The main group consisted of patients with adhesive intestinal obstruction; adhesiolysis was performed for them laparoscopically. The comparison group included patients who underwent laparotomy.

RESULTS. Conversions to laparotomy were not noted in the main group. There is no significant difference in the number of complications in the compared groups. In the main group, the duration of the operative intervention was significantly less, the level of postoperative pain was lower, the recovery of intestinal peristalsis was faster, the hospital stay was shorter (p<0.05).

CONCLUSION. Laparoscopic access in comparison with laparotomy for patients with adhesive intestinal obstruction has several advantages, and can be used in this category of patients.  

OBJECTIVE. The objective of the study is to research the anatomical features of stomal and non-transit areas of colon after obstructive resections and ways of preoperative determination of diastase liquidation for choosing a rational type of reconstructive surgery.

MATERIAL AND METHODS. Topographo-anatomical features of stomal and non-transit areas of colon of 197 terminal colostomy patients with reconstruction surgery were examined. Their impact on conduction of reconstructive surgeries from midline, parastomal incision and laparoscopic assisted method were also studied.

RESULTS. The objects of anastomosis can be located in the same, in neighboring or in separate abdominal areas that determine diastasis size between them. 74 (37.56 %) patients had parastomal area localization of stump. 93 (47.21 %) patients had stump located in adjacent areas and 30 (15.23 %) had a stump located in separate abdominal areas. Besides the location of anastomosed segments, mobility of bowels also has a great impact on conjunction which determines by the place of stump and stoma formation. The techniques of preoperative determination of reconstruction possibility of passage continuity without colon mobilization were developed taking into account these anatomical features.

CONCLUSION. Localization of anastomosing objects, their length and mobility allowedreconstructing bowel continuity of 167 patients (84. 77 %) without coloplastics. Possibility of preoperative determination of reconstruction of bowel continuity without colon mobilization objectifies the choice of rational reconstructive surgery method.  

OBJECTIVE. The objective of the study is to improve the results of treatment of patients with local recurrences of rectal cancer by implementing active surgical tactics within multidisciplinary approach.

MATERIAL AND METHODS. The analysis of results of surgical treatment of 57 patients with the diagnosis: recurrence of a rectal cancer. The morphological structure of the primary tumor and its recurrences was adenocarcinoma of the intestinal type. In most cases, recurrences of rectal cancer were intraintestinal genesis with invasion of neighboring organs and structures. In addition, almost all patients had sufficiently paratumoral complications, significantly worsening their general condition.

RESULTS. All recurrences and rerecurrences (repeated recurrences) of rectal cancer led to 73 operations: 9 patients underwent two interventions, 2 patients underwent three operations and 1 patients underwent four operations. The remaining 45 patients were operated on once. Resectability of recurrent tumors was 93 %. The development of complications in the postoperative period was noted in 37 % of patients. Hospital mortality was 1.5 %. The median duration of life reached 30.1 months. The overall three-year survival rate was 47.2 %.

CONCLUSION. The following of the comprehensive diagnostic program and subsequent active surgical tactics allows achieving encouraging results of treatment in patients with recurrences of a rectal cancer.  

OBJECTIVE. Based on our own experience and analysis of the literature, we want to demonstrate the features of diagnosis and treatment of ascending deep phlebothrombosis of the lower limbs and pelvis.

MATERIAL AND METHODS. During the period from October 2008 to September 2016, in the First Clinic of Surgery (postgraduate medical education) of ”Military Medical Academy named after S. M. Kirov” we analyzed the results of treatment of 44 patients with this pathology. Selective surgical tactics was based on the evaluating of general status, activity of the patient, the presence of concomitant pathology, complications of the disease. Implantation of the cava-filter was performed in 23 patients. In active patients, without significant concomitant pathology, open thrombectomy operations were performed from the deep veins of the lower limbs or from the inferior vena cava and iliac veins (21 patients). In some of these patients, a removable cava-filter was implanted before thrombectomy (8 patients). Thrombectomy from the deep veins of the lower limbs was supplemented in 12 patients by the plication of the main vein.

RESULTS. This tactic made it possible to achieve favorable results in the majority of patients (27 patients, 87 %) – there were no signs of recurrence of venous thromboembolic complications, there was complete or almost complete (more than 90 %) recanalization of thrombosed veins, venous insufficiency was limited by the presence of transient edema. Small hemorrhagic complications were noted in 2 patients. Relapses of venous thromboembolic complications occurred in a distant period in 3 patients. In order to prevent fatal pulmonary embolism, patients with ascending deep phlebothrombosis need surgical treatment.

CONCLUSION. The choice of surgical treatment (cava filter implantation, deep vein thrombectomy) should be determined depending on the general status, patient activity, the presence of concomitant pathology, complications of the disease, and also individually in each specific clinical situation.

OBJECTIVE. The objective of this study is to investigate the surgical management of pilonidal cyst with abscess and to improve short-term and long-term outcomes.

MATERIAL AND METHODS. The initial sample consisted of 353 patients operated for pilonidal cyst with abscess. The first group included 105 patients, receiving treatment with the excision of pilonidal cyst and the suturing in staggered rows. The second group consisted of 136 patients with the excision of pilonidal cyst using a unique patented technique. The third group of 112 patients underwent an identical operation to that of the second group, but with additional platelet growth factors (PGF) to improve the wound healing.

RESULTS. The current study found that in comparison to the traditional technique, the optimal surgical treatment of pilonidal cyst with abscess was the original one-staged surgical technique, based on an economical excision, which led to an improvement in sickness leave of up to 27 days and in long-term outcomes (2 % of long-term complications). Another important finding was that the application of platelet growth factors (PGF) in the complex treatment of patients with pilonidal cyst with abscesses reduces the recovery time by up to 21 days and resulted in 30 % lower postoperative pain scores (Visual Analog Scale for Pain).

CONCLUSION. In general, this finding shows that the original one-stage excision of pilonidal cyst with abscess with the application of PGF and with no suturing reduces disability time without increasing the number of early or late postoperative complications.  

OBJECTIVE. Analysis of GLUT1 levels as a prognostic marker for highly differentiated thyroid carcinoma.

MATERIAL AND METHODS. The expression levels of GLUT-1, NIS, thyroglobulin and the presence of BRAF mutation were analyzed in 32 patients with highly differentiated thyroid cancer from the Department of Surgical Endocrinology at the Research Institute for Surgery and Emergency Medicine of “Pavlov First Saint Petersburg State Medical University”.

RESULTS. There was a trend to increased levels of GLUT-1 in patients with regional or intra-organ metastases or peripheral invasion. This suggests that increased expression of GLUT-1 is found in proliferatively active cells. In our study, the expression level of GLUT-1 was independent of the level of NIS, thyroglobulin and the presence of BRAF mutation. Thus, the level of expression of GLUT-1 can be considered as an independent factor of the prognosis of the course of highly differentiated thyroid carcinoma.

CONCLUSION. The level of expression of GLUT-1 could potentially be used as a prognostic marker in highly differentiated thyroid cancer.  

OBJECTIVE. The objective is to develop differentiated tactic of surgical treatment of patients with postoperative sternomediastinitis.

MATERIAL AND METHODS. The work is based on the results of treatment of 56 patients. The classification of sternomediastinitis by El Oakley & John E. Wright (1996) was used. Depending on the time of the plastic surgery, the patients were divided into two groups. I group (n = 32) consisted of patients got the plastic stage of the operation immediately after the sanative surgery. II group (n = 24) consisted of patients got the operative treatment in time-divided two stages. Patients of both groups were comparable in terms of key indicators. RESULTS. Recovery was achieved in 31 (96 %) patients in I group and in 21 (88 %) patients in II group. The duration of follow-up was between 6 months and 3 years.

CONCLUSION. With the fifth type of sternomediastinitis according to El Oakley & John E. Wright (1996), it is advisable to perform a sanative and plastic surgery in the first stage. With the I–IV type of sternomediastinitis, it is advisable to separate the operation and conduct it in 2 stages.  

OBJECTIVE. The objective is to compare the effectiveness of standard conservative therapy (SCT) and the complex therapy with preparation based on VEGF165 gene in patients with the stage II of chronic lower limb ischemia according to Fontaine classification during 5 years.

MATERIAL AND METHODS. In total, 92 patients were enrolled in the study. Patients were divided into 2 groups (n=46 for each group). In the first group, patients got only conservative therapy and in the second group, patients were received SCT in combination with injection of gene drug into the ischemic limb muscles.

RESULTS. The using of gene therapy in complex management in patients with the stage II of chronic lower limb ischemia led to significant increasing of the average pain-free walking distance (up to 500 %) (p=0.007). In addition, there were 65 % of the patients in the second group obtaining a significant and moderate improvement. By contrast, there was only 3 % of cases in the first group having similar results with standard therapy. Only gene therapy has statistically significance in the secondary parameters of treatment efficiency.

CONCLUSION. The efficiency of complex treatment with gene therapy in patients with the stage II of ch ronic lower limb ischemia for 5 years exceeds significantly the efficiency of standard conservative therapy.  

OBJECTIVE. Inventing of the system of auditory brainstem implantation.

MATERIAL AND METHODS. 3 patients were chosen for study: 2 adults with neurofibromatosis of type II and a 2 years old child with bilateral cochlea aplasia.

RESULTS. In the end of the first rehabilitation, the auditory thresholds accounted 45–50 dB. In 2 years after surgery, the adults differentiate words from the closed set. Passive vocabulary of the child amounted for 200 words. Speech intelligibility was 30–70 % in these patients.

CONCLUSION. Wearing of auditory processor for five months led to significant dynamics.