The objective was to improveNorwood procedure outcomes by discovering optimal surgical technique and perfusion strategy.

Material and methods. Results of treatment of single-ventricle patients with obstructed systemic output during 2005–2017 were analyzed (64 patients). 61 patients underwentNorwood procedure. Outcomes were compared between groups with different perfusion strategies and different methods of aortic arch reconstruction.

Results. Mortality in two-regional perfusion group was 23 %, in group of circulatory arrest and selective cerebral perfusion – 53 % (p=0.020). Early aortic obstruction was a risk factor of mortality (p=0.024). Median time of freedom from obstruction of aorta was 3 days in xenopericardium group, 76 days in pulmonary allograft group, and 390 days in isthmus resection and pulmonary allograft group (p=0.002).

Conclusion. Two-regional perfusion and aortic arch repair with pulmonary allograft patch after isthmus resection are our methods of choice as they allow to reduce the incidence of complications afterNorwood procedure.

Risk stratification in elderly patients is very important, as none of the applied models for the prediction of mortality in cardiac surgery does not take into account the whole complex of physiological features of the aging organism.

The objective was to analyze the effectiveness of the method of qualitative assessment of biological age.

Material and methods. Our study included 127 patients (87 male and 40 female) aged 65 to 84 years (mean age – 72.2±4.7 years) who underwent elective cardiac surgery. Perioperative factors were analyzed. The primary endpoint of the study was a 30-day mortality rate.

Results. The total 30-day mortality rate was 13.4 % (17 patients). Perioperative predictors of 30-day mortality rate were the calculated values of the CAF scale (p=0.006), the surgery volume (p=0.044), the use of extracorporeal blood circulation (p=0.048).

Conclusion. The use of qualitative assessment of biological age allows to more accurate predict the mortality in cardiac elderly patients.

The objective was to estimate the immediate results of thoracoscopic pneumonectomies in various surgical lung diseases.

Material and methods. Patients were divided into groups depending on the surgical access: thoracoscopy – group 1 (15 patients), thoracotomy – group 2 (30 patients). We performed 12 left-sided (80 %) and 3 right-sided (20 %) operations in group 1. We performed 23 left-sided (76.7 %) and 7 right-sided (23.3 %) operations in group 2.

Results. The average duration of the operation in group 1 was (161±27) min (from 120 to 230 min), in group 2 – (128±34) min (from 75 to 180 min). The number of removed lymph nodes during lymphadenectomy in group 1 was (19±10) nodes (from 6 to 40), in group 2 – (18±9) nodes (from 6 to 38). The severity of the pain syndrome after surgery on the Visual Analogue Scale for Pain in group 1 was 2.4±0.3, in group 2 – (4.4±0.3) (p=0.04), duration of ICU stay in group 1 was (2.0±0.7) days (from 1.0 to 3.0), in group 2 – (4.1±1.2) days (3.0 to 6.0). There were no mortality in both groups.

Conclusion. In carefully selected patients, thoracoscopy access during pneumonectomy demonstrates better immediate results comparing to thoracotomy (less pain syndrome, shorter duration of treatment in the ICU, hospital) with the same duration of operation and volume of lymph dissection.

The objective was to evaluate the effectiveness of endobronchial photodynamic therapy (PDT) for preventing a non-small cell lung cancer (NSCLC) relapse after R1 resection with positive bronchial resection margins.

Material and methods. This study included 17 patients. The planned morphological diagnostics revealed the presence of tumor cell complexes at the bronchial resection margins in 5 (29 %) patients (cancer in situ – 2, invasive cancer – 3), in peribronchial tissues – in 5 (29 %) patients, in lymphatic vessels at the resection margins – in 7 (41 %) patients.

Results. All patients underwent one session of endobronchial PDT as an adjuvant treatment. No complications of PDT were noted. The five-year observation revealed a relapse at the bronchial stump area in 1 patient only (6 %). 16 (94 %) patients lived for 1 year, 12 (71 %) patients – for 5 years. Long-term results were significantly worse in patients with tumor complexes in lymphatic vessels at the bronchial resection margins (5-year survival rate – 29 %, p=0.04), with pN2 (0 %, p=0.01), lung adenocarcinoma (20 %, p=0.03).

Conclusion. The use of endobronchial PDT as an adjuvant treatment for patients with NSCLC after R1 resection with positive bronchial resection margins is simple, safe and characterized by good immediate and long-term results.

The objective was to research the effect of burdened comorbid status on the course of severe traumatic brain injury (TBI) in the elderly.

Material and methods. 243 injured elderly patients (182 men and 61 women) with severe TBI and burdened comorbid status.

Results. It was found that the postoperative period was characterized by more severe course of injury associated with the development of infectious and inflammatory complications.

Conclusion. Early medical rehabilitation does not have a significant impact on the state of comorbid status, but is important in the prevention of infectious and inflammatory complications due to the early activation of the victims and the elimination of hypodynamia in intensive care and neurosurgical departments.

The objective was to determine the optimal therapeutic and diagnostic algorithm for thoracoabdominal injury.

Material and methods. The results of the examination and treatment of 389 injured patients with combined stab wounds of chest and abdomen were analyzed. The injuries were thoracoabdominal in 54 (13.9 %) cases.

Results. We analyzed instrumental invasive and non-invasive diagnostic methods. The sequence of surgical interventions was determined.

Conclusion. We revealed that the correct sequence and volume of surgical intervention ensured the success of treating the injured patients, while in cases of competing sources of bleeding, priority should be given in favor of performing thoracotomy.

The objective was to compare the effectiveness of isolated anatomical antegrade reconstruction of the anterior cruciate ligament (ACL) with bonetendon-bone autograft (BTB autograft) and in combination with lateral extra-articular tenodesis (LEAT) graft from the iliotibial tract (ITT).

Material and methods. We analyzed 187 arthroscopic ACL reconstructions in patients with a Pivot shift test – 3+ degree. We performed an isolated ACL-R in 118 (63.1 %) patients in group 1 and added the LEAT from ITB to it in group 2.

Results. According to IKDC-2000: 176 (94.1 %) patients were included in categories A and B, 11 (5.9 %) – in C. Significant differences in these groups appeared 15 months after the operation. According to KOSS: in group 2, the anterior and rotational knee stability, as well as the level of sports activity were higher, and pathological symptoms were less common.

Conclusion. LEAT from ITB increases stability and functionality of the knee joint in patients with anatomical antegrade ACL reconstructions with BTB-autograft for terms over 15 months after the operation, and is an economically procedure.

The objective was to evaluate the possibilities of using the polypropylene mesh “Surgipro” to increase the compression and reduce the operational injury in extrapleural superior posterior thoracoplasty.

Material and methods. 64 cases of surgical treatment of fibrous-cavernous tuberculosis were studied. The volume of compression of the lung tissue and the effectiveness of the intervention were compared.

Results. Clinical and radiologic examination of patients in three weeks after the operation indicates that occurrence of exacerbation, preservation of bacterial excretion and lack of compression are much lower in the group using polypropylene mesh. The use of polypropylene mesh “Surgipro” increases the degree of compression in the field of intervention and the effectiveness of thoracoplasty.

Conclusion. The use of a mesh implant in thoracoplasty is reasonable and effective.

The objective was to show the preventive principles of postoperative complications of anterior abdominal wall hernias in patients with metabolic syndrome.

Material and methods. The authors analyzed the surgical treatment with tension-free plasty and prosthetic mesh in 162 patients with metabolic syndrome.

Results. Pathogenetically grounded preoperative normalization of parameters of metabolic syndrome, conducting of anticoagulant and antibiotic therapy, using of lower limb compression and observation by the surgeon during the postoperative period reduced the percentage of postoperative complications to 11,1 %, in contrast to the group of patients where prevention was not carried out, complications accounted for 37,5 %.

Conclusion. Surgical patients with metabolic syndrome need to normalization of their parameters in the preoperative period, as well as the appointment of anticoagulants and antibiotics during their hospitalization.

The objective of the study was to detect the frequency and sources of hemorrhagic complications in patients with pancreatitis, evaluate the tactics and effectiveness of methods of hemostasis.

Material and methods. A retrospective analysis of hemorrhagic complications of pancreatitis was carried out in 40 patients.

Results. Bleeding developed mainly on the background of infected acute necrotic collections (77.8 %), the main source of bleeding was the splenic artery (37.0 %). Emergency laparotomy for bleeding was performed in 9 (22.5 %) patients, selective angiography was performed in 10 patients, it was effective only in 5 (50 %) cases. 12 (44.4 %) deaths were recorded in cases of arrosive bleeding.

Conclusion. The preferred tactics in case of bleeding from the retroperitoneal space during minimally invasive treatment is crossclamping of drains and endovascular hemostasis.

The objective was to evaluate the efficacy of donor thromboconcentrate and collagen preparations for improving the results of autodermoplasty of extensive venous trophic ulcers.

Material and methods. The study included 66 patients with extensive venous trophic ulcers larger than 20 cm2 in the second 2 phase of wound process. Patients were randomly divided into the main group and 3 control groups.

Results. The activation of regeneration processes using a combination of platelet-rich donor plasma and native unreconstructed collagen before autodermoplasty leads to improving the viability and engraftment of transplant, progressive decreasing the area of the wound defect.

Conclusion. The use of a combination of donor thromboconcentrate and collagen preparations statistically significantly improves the results of skin transplantation.

We present an observation from practice, which describes a multidisciplinary approach to the treatment of patient with acute mesenteric ischemia.

Gastrectomy is performed in an average of 80 % of resectable malignant stomach tumors. Rupture of the esophagus at the formation of esophagojejunum anastomosis in gastrectomy is one of the terrible complications that can occur during surgery. In our clinical observation, the patient experienced such complication: when trying to place the head of the stapler apparatus into the esophageal lumen, there was a longitudinal rupture of its wall, extending to the abdominal and lower thoracic areas. Given the length of the mesentery of the transverse colon, sufficient for carrying into the thoracic cavity, plastic surgery was performed using a graft from the colon. The postoperative period proceeded without complications. The patient was discharged from the hospital under the supervision of a regional oncologist. This observation demonstrates the possibility of the successful use of the transverse colon as a graft in case of esophageal rupture when using circular staplers apparatus for the formation of the esophageal anastomoses.

The paper presents the clinical observation of a rare case of metastasis of amelanotic melanoma of the small intestine without a clinically determined primary tumor complicated with perforation, bleeding and small intestinal obstruction, successfully treated by surgery, with good immediate and long-term results.

The article presents the case of development of anaerobic non-clostridial phlegmon of the anterior abdominal wall, phlegmon of the hernial sac because of the perforation of the small intestine in the hernial sac due to its entrapment in an elderly patient with severe concomitant pathology. The course of the disease, the management of the patient and surgical treatment are described in detail. The given example is interesting because despite the wide availability of qualified medical care in a big city, there are still rare and severe complications of ventral hernias in clinical practice. Moreover, despite the significant concomitant pathology and extremely serious condition of the patient, we carried out stage-by-stage surgical treatment and used the modern methods of treatment of purulent infection, such as specific antibacterial therapy and VAC-therapy (Vacuum-assisted closure), which led to full recovery of the patient.

The objective of the study was to evaluate the effect of bariatric operations on the course of nonalcoholic fatty liver disease (NAFLD) and determine the possibility of using non-invasive diagnostic methods for NAFLD.

Material and methods. The published data review of the NAFLD dynamics after bariatric surgery.

Results. Currently there is no common opinion on the effectiveness and safety of bariatric operations in NAFLD treatment.

Conclusion. Further research and randomized controlled clinical study are needed.

The article presents modern ideas of types II–IV hiatal hernias as a variant of visceral anatomical abnormality. The latest techniques of surgical removal of hiatal hernias aimed at improving the results of surgical treatment are described in this article. 

To date, there are no clear indications and reasons for transfusion therapy in patients with cirrhosis. The article discusses the basic pathophysiological changes in the patient’s body during the formation of the liver cirrhosis as the outcome of hepatitis of different etiology. Particular attention is given to a component of donor plasma fibronectin, the lack of which, including in patients with liver cirrhosis, causes progressing endotoxemia.