Alexander Evgenievich Borisov – head of the Department of surgery named after N. D. Monastyrskii (Available at: https://www.livelib.ru/author/733938/series-aleksandr-borisov)

The OBJECTIVE of the study was to assess the immediate results of the use of two internal thoracic arteries during coronary bypass surgery.

MATERIAL AND METHODS. 200 patients with coronary artery disease underwent coronary artery bypass grafting in Samara cardiology dispensary from 2016 to 2018. Patients were divided into 2 groups. Group 1 (100 people) used both internal thoracic arteries (ITA) and the radial artery as conduits; group 2 (100 people) used the left ITA and the great saphenous vein as conduits. The duration of the operation, complications in the early postoperative period, and hospital mortality were evaluated.

RESULTS. Groups (1 – 73 % of men, average age (59±12) years, average number of conduits – (3.1±0.4), 2 – 62 % of men, average age (67±7) years, average number of conduits – (3.3±0.6)) were significantly different only in age. The average duration of the operation in the group 1 was (174±25) min, in 2 – (165±18) min (p<0.05). Hospital mortality in the group 1 – 0 %, in 2 – 1 % (p>0.05). The number of complications in the early postoperative period did not have a statistically significant difference between the groups.

CONCLUSION. Bilateral internal thoracic arteries coronary artery bypass grafting in CHD patients did not lead to a significant increase in the duration of the operation, an increase in mortality and infectious  complications from the sternum, compared with single internal thoracic arteries grafting.

The OBJECTIVE was to demonstrate clinical outcomes of minimally invasive aortic valve replacement (MIAVR).

MATERIAL AND METHODS. We retrospectively analyzed surgical results of treatment of patients underwent isolated AVR in our Institution between 2006 and 2018. Overall number of operations was 122; 56 of patient were operated via upper ministernotomy approach. Preoperative characteristics were similar in both groups.

RESULTS. In our series MIAVR procedures had prolonged CPB and aortic cross clamping time, what significantly contributed to the increase in manifestations of heart failure in the early postoperative period, but didn’t affect the perioperative mortality and major morbidity rates. MIAVR led to reduction in postoperative blood loss and perioperative red blood cell transfusion rate. Most severe complications occurred in frail patients older than 75 years, and in those with extensive aortic annular calcification.

CONCLUSION. MIAVR was the safe and reproducible surgical intervention and rarely led to significant complications in low-risk patients. Prolonged CPB time adversely affected the frequency of significant complications, especially in elderly patients. Although, selected high risk patients might benefit with MIAVR.

The OBJECTIVE was to analyze the experience of using a vascular prosthesis as a temporary bypass for spinal cord and visceral organs ischemia prevention during the clamping time in surgical reconstruction of thoracic and thoracoabdominal aortic aneurysm.

MATERIAL AND METHODS. The study included 60 patients with the pathology of aortic arch, descending and thoracoabdominal aorta (TAAA) from 1997 to 2018. Among them, 42 (11 %) patients were diagnosed with TAAA I–IV types according to E. S. Crawford classification, 18 (32 %) – with the aortic arch aneurysm and the descending thoracic aorta. Planned interventions were performed in 43 (72 %) patients, emergency – in 17 (28 %). A temporary bypass made from vascular prosthesis with a diameter from 15 to 20 mm was used in 29 (48 %) cases as a protection of internal organs and the spinal cord against ischemia, and in 31 (52 %) surgical cases the reconstruction was performed with a cross clamping method.

RESULTS. 30 days mortality was 16.6 % (n=10), total hospital mortality was 28.3 % (n=17). The mortality was 23.2 % (n=10) after planned interventions, and 41 % (n=7) – in emergency interventions. When using a temporary bypass during planned operation 9.3 % (n=4) of the patients died within 30 days, while cross clamping method without visceral protection showed 13.9 % death rate (n=6). Acute renal failure developed in 7 (11.6 %) cases and it was observed more often in the group without using of temporary bypass technique. The spinal cord ischemia turning into a spinal stroke occurred in 8 (13.3 %) cases. Five-year survival rate was 61 %.

CONCLUSION. The use of a temporary bypass during the thoracic and thoracoabdominal aneurysms repair could be used for prevention of the visceral organs, kidneys and spinal cord ischemic complications during operations with need in cross clamping of the descending thoracic aorta. 

The OBJECTIVE was to compare the efficiency of autologous bone marrow cell implantation and lumbar sympathectomy in the treatment of chronic critical lower limb ischemia.

MATERIAL AND METHODS. The complex examination and treatment of 66 patients with critical lower limb ischemia, divided into 2 statistically homogeneous groups, was analyzed. The first group underwent sympathectomy, and the second – autologous bone marrow cell transplantation.

RESULTS. After 1 year, in patients of the second group, compared with the first, the clinical status increased by 51.5 %, the number of amputations decreased by 3 %, the physical component of health increased by 7.9 %, the psychological component – by 17.7 %.

CONCLUSION. The autologous bone marrow cell transplantation was pathogenetically substantiated and effective.

The OBJECTIVE of the study was to improve the results of treatment in patients with cholecystocholedocholithiasis complicated with acute cholangitis and biliary sepsis by analyzing the possibilities of hybrid surgery.

MATERIAL AND METHODS. 126 patients with acute cholecystitis, cholangitis and biliary sepsis on the background of the cholecystocholedocholithiasis were treated during the period 2015–2018. We performed the comparative analysis of treatment results in different groups for evaluating the effectiveness of various hybrid operations.

RESULTS. When analyzing the comparison of treatment results we determined that single-stage laparoscopic biliary tract lavage was more effective in the case of large or multiple bile ductus stones. Endoscopic transpapillary management performed by «Rendezvous» method was more effective than endoscopic papillosphincterotomy.

CONCLUSION. With the development of acute cholecystitis, cholangitis and biliary sepsis on the background of cholecystocholedocholithiasis, the implementation of single-stage hybrid surgical interventions taking into a specificity for each of the methods was indicated.

The OBJECTIVE was to analyze the treatment results of patients with acute anaerobic paraproctitis in 2009–2017.

MATERIAL AND METHODS. The treatment results of 71 patients with acute anaerobic paraproctitis were analyzed. All patients were divided into 2 groups depending on the applied diagnostic and treatment methods.

RESULTS. General number of patients who required several operative sanation was 47 (66.2 %). 9 (26.5%) patients died in the comparison group, 4 (10.8 %) patients died in the main group.

CONCLUSION. The optimization of diagnostic and treatment algorithm in patients with acute anaerobic paraproctitis allowed to reduce the all-cause mortality in patients with acute paraproctitis from 1.2 to 0.5 % (p<0.01), and mortality in patients with acute anaerobic paraproctitis from 26.5 to 10.8 %.

To treat the patient with Achalasia and prevent the symptoms of gastroesophageal reflux the Peroral Endoscopic Myotomy with Simultaneous Endoscopic Fundoplication was done by the current authors. After performing a myotomy the endoloop was fixated to the stomach and was attached to the muscle of the esophagus by using the endoclips. The endoloop was tightened therefore shaping the cuff. This operation has been technically feasible and no immediate or delayed complications occurred.

The case of combination of acute myocardial infarction and acute adhesive small bowel obstruction in 70-years old female patient was reported.

This paper contained data from different literature about problem of minimally invasive treatment of patients with choledocholithiasis. The clinical example justified the use of partial papillosphincterotomy with balloon dilatation in the case of large choledocholithiasis. It was shown that the use of this operation did not increase the risk of intra and postoperative complications during the lithoextraction of large stones from the biliary tract.

This article presented the clinical observation of the giant duodenal ulcer complicated by bleeding in the HIV-infected patient. The original method of forming the duodenal stump was used during the resection of the stomach by Billroth-2. The method was characterized by using the post-ulcer stenotic ring as a skeleton of the formed duodenal stump and the double-row continuous suture that allowed to avoid the suture insufficiency in the patient.

Academic Aleksandr Vasilievich Melnikov (Available at: URL: https://ru.wikipedia.org/wiki/Мельников,_Александр_Васильевич_(хирург))

Neurogenic oropharyngeal dysphagia (NOD) was a frequent complication after a stroke, determining the further prognosis and quality of life, causing a number of serious complications. Patients with severe NOD was recommended enteral feeding through the nasogastric tube (NGT) with the subsequent formation of a percutaneous endoscopic gastrostomy (PEG). Prolonged use of NGT had its own complications – sinusitis, gastroesophageal reflux, aspiration pneumonia, etc., and therefore it should be limited in time. In various recommendations, the length of terms before the formation of the PEG remained controversial. The analysis of modern tactics of PEG in patients after severely developed NOD was performed on the basis of literature data.

The objective was to compare the most common methods of minimally invasive treatment of pilonidal disease and to evaluate their effectiveness according to the literature. Minimally invasive methods of treatment could be successfully used in patients with a small spread of pilonidal disease. Improving the effectiveness of treatment of this category of patients was directly related to the strict selection of patients.