An outstanding orthopedic traumatologist and military field surgeon, scientist and teacher, one of the founders of orthopedics in Russia, founder and long-term director of the St. Petersburg Orthopedic Institute (1906–1924), organizer of the first Department of Pediatric Surgery in Russia (1933) and creator of a large scientific school of orthopedic traumatologists, Professor Roman Romanovich Vreden was born on March 9 (21), 1867 in St. Petersburg in the family of a well-known otorhinolaryngologist, Professor Robert Robertovich Vreden. From childhood, Roman chose the profession of a doctor for himself, and after graduating with a gold medal from the First Classical Gymnasium in St. Petersburg in 1885, he entered the Imperial Military Medical Academy. After graduating from the academy in 1890, he passed the competition and left for further development of the specialty as an adjunct at the Department and Clinic of Hospital Surgery founded by N. I. Pirogov and led by Professor V. A. Ratimov. In 1893, R. R. Vreden successfully defended his dissertation for the degree of Doctor of Medicine on the topic: «On the etiology of cystitis», after which he was sent to Kiev, where from 1893 to 1896, he worked as a resident at the Kiev Military Hospital, headed the Surgical and Ear Departments there. In 1896, Roman Romanovich returned to the Military Medical Academy and received the position of senior assistant in the Hospital Surgical Clinic of V. A. Ratimov. In 1898, R. R. Vreden was awarded the academic title of Privatdozent. In 1902, in connection with the retirement due to illness of V. A. Ratimov, a competition was held to fill the position of the head of the Department of Hospital Surgery, but R. R. Vreden lost to S. P. Fedorov in it, after which he left the Department. In 1902–1904, he was a leading surgeon and director of the French Hospital in St. Petersburg and a surgical consultant at the Nikolaev Military Hospital. In 1903, R. R. Vreden was appointed an official for special assignments at the Main Military Medical Directorate. In February 1904, the Russo-Japanese War began and R. R. Vreden was sent to the Far East. In March 1905, Roman Romanovich returned to St. Petersburg, until 1906, served as head of the faculty surgical clinic of the Women’s Medical Institute. In July 1906, Roman Romanovich was appointed the first director of the first Russian Orthopedic Institute in St. Petersburg. R. R. Vreden can rightfully be considered the founder of operative orthopedics in our country. Such surgical interventions as arthrotomy, arthroplasty, arthrodesis, bone and joint resections, tendon and bone plasty, osteotomy, open reduction of dislocations and others were widely performed at the Institute. In 1911, Roman Romanovich was elected a professor at the Psychoneurological Institute and created the Department of Orthopedics on the basis of his Institute. In 1912, he organized training in orthopedics for doctors at the Clinical Institute of the Grand Duchess Elena Pavlovna, and in 1918, he created and headed the Department of Orthopedics at the First Petrograd Medical Institute. In 1925, the «Practical Guide to Orthopedics» was published, which summed up the 18-year activity of R. R. Vreden in this field of medicine. Roman Romanovich created one of the first and largest scientific schools of orthopedic surgeons in our country. Professor Roman Romanovich Vreden died in Leningrad on February 7, 1934 and was buried at the Smolensk Lutheran cemetery. In 1967, the Leningrad Research Institute of Traumatology and Orthopedics was named after R. R. Vreden.

The OBJECTIVE was to compare the immediate results of aortic valve replacement using Perceval S seamless biological prosthesis and aortic valve replacement using Ozaki technique.

METHODS AND MATERIALS. From January 2021 to March 2022, 110 patients who underwent aortic valve replacement were analyzed. From this group, patients over 65 years of age with isolated aortic stenosis were selected, who underwent aortic valve replacement using Perceval S seamless biological prosthesis or replacement of aortic valve flaps using S. Ozaki technique. 2 groups were formed from the selected patients. Group 1 included patients over 65 years of age with isolated aortic stenosis (n=20), who underwent replacement of the aortic valve flaps using S. Ozaki technique. Group 2 included patients over 65 years of age with isolated aortic stenosis (n=20) who underwent aortic valve replacement using Perceval S seamless biological prosthesis.  

RESULTS. There was a decrease in the average and peak pressure gradients on the aortic valve, as well as an increase in both the absolute effective and indexed effective area of the valve opening in the group of patients operated using S. Ozaki technique.  

CONCLUSION. S. Ozaki surgery and aortic valve replacement using Perceval S seamless biological prosthesis demonstrate satisfactory immediate results of surgical treatment of aortic stenosis. The S. Ozaki technique reduces the likelihood of developing a “prosthesis-patient„ mismatch, but requires a longer time of myocardial ischemia. 

OBJECTIVE. Despite the increasingly use of video-assisted approaches in thoracic surgery, intraoperative conversion from minimally invasive to «open» takes place quite often, especially during anatomical lung resection.  

METHODS AND MATERIALS. A retrospective analysis of 106 consecutive anatomical lung resections (lobectomies) initiated by thoracoscopic access was performed. The patients were divided into two groups: a group of 90 patients without conversion and a group of 16 patients (15%) who required conversion before thoracotomy. We analyzed reasons for conversion, attempted to predict conversion, and estimated the effect of conversion on the postoperative course.  

RESULTS. The reasons for conversions were: absence of an interlobar fissure – 5 (31 %), bleeding – 4 (25 %), discrepancy between the CT and intraoperative situation – 2 (13 %), intrapleural adhesions – 2 (13 %), variant anatomy of pulmonary vessels and bronchi – 2 (13 %), lymph nodes invasion into the main vessels – 1 (6 %). Conversions were divided into «forced» (in order to stop bleeding) and «unforced» (in order to prevent the development of possible intraoperative complications and unjustified prolongation of the duration of the operation). There was no significant difference in the frequency of early postoperative complications in patients after “unforced” conversion and in patients operated according to the plan by thoracoscopy. Prolonged air leakage was noted in 5 out of 16 patients (31.3 %) in the conversion group and in 35 out of 90 patients (38.9 %) in the thoracoscopy group (p=0.28). The severity of the pain syndrome in 24 hours after the surgery assessed by visual analogue scale was also comparable; the average values of pain assessment were 3+2 in the thoracoscopy group and 4+2 in the conversion group (p=0.19).  

CONCLUSION. “Unforced” conversion in thoracoscopic lobectomies is not accompanied by an increasing incidence of postoperative complications; it should be considered as a natural course of the operation in order to prevent intraoperative complications and reduce the duration of the surgery. 

The OBJECTIVE was to determine the optimal approaches to the choice of the method of tension-free inguinal hernioplasty based on the clinical and economic analysis.

METHODS AND MATERIALS. A comparative study of the results of treatment of 95 male patients with primary unilateral inguinal hernia using the Lichtenstein method and TAPP was carried out. Before surgery and a year later, patients’ quality of life parameters were assessed using the EQ-5D questionnaire and used to calculate QALY (Quality Adjusted Life Years), the growth of which during the year served as a criterion for the effectiveness of the analyzed surgical technologies. A cost-utility analysis was carried out using direct costs.

RESULTS. With a 34 % higher cost of endoscopic hernioplasty compared to the operation using the Lichtenstein method, the effectiveness of TAPP was higher, which manifested itself in a more significant increase in the quality of life of patients in the postoperative period. The calculated cost-utility ratio also turned out to be 15 % higher with TAPP. Correlating the result of the incremental cost-utility analysis carried out below with the value of the «willingness to pay threshold» demonstrated the financial acceptability of TAPP. The value of the incremental indicator under TAPP not only did not exceed the «willingness to pay threshold», but was also 49 % lower than the value of GDP per capita.

CONCLUSION. The cost-utility analysis showed that regardless of cost fluctuations and changes in patients’ quality of life, the more expensive endoscopic TAPP intervention for inguinal hernia is economically justified, proving to be a profitable investment. 

The spatial orientation of the endoprosthesis components and the level of the joint line are the conditions for the success of revision knee arthroplasty.  

The OBJECTIVE was to test the proposed tool for precision restoration of the level of the knee joint line along the top of the head of the fibula and to evaluate the effectiveness of the technique based on the results of revision arthroplasty. 

METHODS AND MATERIALS. A single center randomized controlled study was conducted at the Department of Traumatology, Orthopedics and Disaster Surgery of the Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University). Inclusion criteria: aseptic loosening and aging of the knee joint components. Two groups of patients: the first (main) group underwent revision TKA with determination of the level of the joint line according to the method proposed by us using the original instrument, the second (control) – revision arthroplasty according to the standard method. A total of 64 patients were included in the study: 26 men and 38 women, mean age – 66.5±7.2 years, BMI on average – 32.9±2.6 kg/m2, the average period of revision knee arthroplasty was 36.3±6.7 months. Before and after the operation, CT and X-ray in the frontal plane were performed, the height of the joint line was measured, focusing on the top of the head of the fibula; testing on the VAS pain scale, knee joint scales: OKS, FJS-12, KSS, SF-36 for 12 months after operation.  

RESULTS. According to CT data, the height of the joint line in the frontal plane before surgery: group I – 21.9±3.3 mm, group II – 23.4±2.1 mm (p=0.946), after surgery: group I – 23.7±3.4 mm, group II – 20.8±3.0 mm, p=0.584). When testing for VAS, OKS, FJS–12, KSS, SF–36 for 12 months, there was no statistically significant difference between the groups.  

CONCLUSION. The proposed method and instrument make it possible to position the level of the knee joint line more accurately (by 3.9 % according to CT data and by 6.4 % according to X-ray data) during revision arthroplasty. 

The OBJECTIVE was to evaluate the role of mean perfusion pressure in the development of acute kidney injury (AKI) in patients operated with CPB.

METHODS AND MATERIALS. A retrospective monocenter observational study was conducted among patients CPB (n=97) who underwent planned heart surgery using CPB. Inclusion criteria: age over 18 years, duration of surgery from 90 to 180 minutes, no signs of end-stage renal disease. The group was divided into subgroups according to the level of mean perfusion pressure (MPP): 1st – MPP<60 mmHg, 2nd – MPP equal to and >60 mmHg. Diagnosis of AKI was carried out on the basis of changes in serum creatinine and biomarkers (NGAL, IgG, albumin in urine). The studied parameters were recorded 15 minutes after the start and end of general anesthesia as well as 24 and 48 hours after surgery.

RESULTS. In the 1st subgroup, the frequency of AKI was higher: after 24 hours – 48 (78.7 %), in the 2nd subgroup – 10 (27.8 %), and after 48 hours – 21 (34.4 %) and 5 (13.9 %), respectively. In the 1st subgroup, the need for renal replacement therapy was 5 (8.2 %), while in the 2nd subgroup only 1 patient needed renal replacement therapy (2.8 %). Also, in the 1st subgroup, a higher level of lactate was detected at the end of general anesthesia – the median in the 1st subgroup was 4.6 mmol/l (2.5–11.6), in the 2nd – 2.5 mmol/l (1.4–7.2) (p= 0.022). The levels of AKI biomarkers in urine after 24 hours also differed: NGAL in the 1st – 473.1 ng/ml (235.7–749.5) and in the 2nd –111.3 ng/ ml (53.4–152.9) (p=0.003), albumin 174.6 mg/l (151.2–236.9) and 35.8 mg/l (21.3–52.5) respectively (p=0.006), IgG – 61.7 mg/l (24.9–88.5) and 9.7 mg/l (7.1–14.4) (p=0.002).

CONCLUSION. Mean perfusion pressure is an important indicator of the adequacy of cardiopulmonary bypass. Lowering it below 60 mmHg leads to hypoperfusion of the kidneys with the risk of acute kidney injury.

Aortic coarctation in low-weight (less than 2.2 kg) and premature newborns with comorbid conditions is still a current problem of neonatology and cardiac surgery. The closure of the patent ductus arteriosus and the inability to maintain its functioning with prostaglandin medication leads to fatal complications due to a violation of systemic perfusion. Surgical intervention in this group of patients has extremely high risks and unsatisfactory results. In such situations, stage-by-stage correction is a promising direction. Stenting of aortic coarctation allows restoring hemodynamics at the level of the aortic isthmus with minimal risks. In the inter-stage period, it becomes possible to treat comorbid conditions and prepare a patient for radical correction.

The OBJECTIVE was to increase the safety of laparoscopic decompression of the abdominal trunk.

METHODS AND MATERIALS. The results of treatment of 30 patients who underwent laparoscopic decompression of the celiac trunk were analyzed. Intraoperative bleeding requiring conversion to laparotomy occurred in two (6.7%) cases.

RESULTS. To prevent such a complication, a method of preventive installation of a balloon catheter into the celiac trunk was introduced, which allows creating a temporary occlusion of the vessel in case of damage. A similar approach was used in 10 (33.3%) patients. The need to cover the lumen of the vessel with a balloon arose in one observation (3.3% of all patients and 10.0% using this technique). Bleeding from the inferior phrenic artery, which originated from the celiac trunk, was stopped by laparoscopic access.

CONCLUSION. The experience presented in this paper allows us to consider the installation of a balloon boat in the celiac trunk as one of the possible ways to improve the safety of its laparoscopic decompression. Further research is needed to obtain a definitive picture of the effectiveness of this approach.

The OBJECTIVE was to evaluate the efficacy and safety of the original technique of extraperitoneal closure of a loop intestinal stoma.

METHODS AND MATERIALS. A comparative analysis of the results of surgical treatment of 80 ostomy patients who underwent reconstructive and restorative interventions was carried out. The main group included 40 patients operated on according to the original method of extraperitoneal closure of the intestinal stoma. The control group consisted of 40 patients who underwent restoration of the intestinal tract continuity using a standard method with intra-abdominal access.

RESULTS. The incidence of postoperative complications in the main and control groups was 10 % and 22.5 %, and the failure of the intestinal anastomosis was 5 % and 7.5 %, respectively (p>0.05). After applying the original technique, this complication in no case led to the development of peritonitis, and the closure of the intestinal fistula was achieved by local treatment. In two patients of the control group, anastomosis failure led to the development of peritonitis, which required relaparotomy with separation of the anastomosis and reformation of the stoma, which prevented the goal of hospitalization from being realized. In the main group restoration of intestinal continuity was achieved in all patients.

CONCLUSION. The use of the original technique for extraperitoneal closure of loop intestinal stoma can reduce the incidence of complications, prevent the development of peritonitis in case of anastomosis failure, creating prerequisites for increasing the efficiency of the reconstructive and restorative stage of treatment.

INTRODUCTION. Modern technologies for 3D printing of implants for surgical treatment of patients are actively introduce into the medical field. Chronic injuries of the pelvis are an actual problem in traumatology and orthopedics, and the use of the developed original metal structure in conjunction with additive technologies will improve the results of treatment in male and female patients, as it allows creating adapted designs, taking into account the morphology of an individual patient.

The OBJECTIVE was to create the adapted design taking into account anatomical features for stable fixation pelvic bones in each individual patient using modern additive technologies and to compare the results of treatment using a serial polyposition plate and an individual plate.

METHODS AND MATERIALS. We carried out a comparative analysis of the results of treatment in the study groups. Group ¹ 1 consisted of patients with fixation of the anterior pelvis with polyposition plate, group ¹ 2 – fixation with individual reconstructive plate.

RESULTS. We used computed tomography of the female pelvis. A virtual 3D reconstruction of the female pelvis was performed and the original reconstructive plate was modeled taking into account the morphology of the anterior pelvis in a particular case. After sending the results of computed tomography and agreeing on the plate model and its position, a finished titanium original metal structure was obtained. The total period from the CT examination to the manufacture of the plate was 8 days. In the studied groups, the number of destabilizations was: in group ¹ 1 – 6.6 %, in group ¹ 2 – 0 %.

CONCLUSION. The use of additive technologies in the manufacture of metal structures allows creating the adapted design for a particular patient, taking into account his morphology. The use of metal structures using 3D printing technology will improve the results of treatment of patients with chronic pelvic injuries and reduce the number of destabilizations. The short time required for modeling and creating the adapted metal structure allows patients to receive the necessary medical care as soon as possible. 

The OBJECTIVE was to show the effectiveness of video capsule and balloon-assisted enteroscopy in the diagnosis of gastrointestinal stromal tumor of the ileum.

METHODS AND MATERIALS. A clinical observation of a patient with a suspected tumor of the small intestine is presented. During the examination, video capsule endoscopy of the small intestine was performed using the Given Imaging capsule. In the ileum, mucosal infiltration and fresh blood were found. Conclusion: tumor of the small intestine. The patient underwent resection of the ileum with a tumor. Histological conclusion: malignant gastrointestinal stromal tumor with moderate mitotic activity and single metastasis to the mesenteric lymph node.

CONCLUSION. The difficulty in diagnosing tumors of the small intestine is due to the lack of specific clinical symptoms and the complexity of visualizing the neoplasm. In such cases, it is advisable to include video capsule enteroscopy in the diagnostic algorithm, which according to indications can be supplemented with balloon-assisted enteroscopy by oral or transanal access.

Ischemic heart disease is a leading cause of mortality of the adult population. The most mortality of all forms of ischemic heart disease is occurred with development of myocardial infarction. Meanwhile, the direct cause of death are complications of myocardial infarction. Since the advent of catheter-based and surgical reperfusion, there has been a significant decrease in the frequency of these complications. However, patients with large myocardial infarctions or those who do not receive necessary revascularization in time remain at risk of mechanical complications of acute myocardial infarction. The most common mechanical complications are rupture of the papillary muscles of the mitral valve and acute mitral regurgitation, interventricular septal defect, forming of aneurysms and pseudoaneurysms, and free-wall rupture. Although these complications are rare, their prognosis is unfavourable and is associated with high mortality at the prehospital and hospital stage. Early diagnosis, determination of optimal treatment tactics are crucial for increasing the survival rate of patients.

Primary esophageal melanoma is a rare and extremely aggressive malignant neoplasm originating from mucosal melanocytes. The complex histological structure of the tumor, which in 10–25 % of cases may not contain melanin characteristic of these formations, leads to a high frequency of diagnostic errors, reaching 50 %. Immunohistochemical examination is the standard for diagnosing the disease. Primary esophageal melanoma is a tumor with a high potential for hematogenous and lymphogenous metastasis. So, when the tumor spreads to the submucosa, the frequency of locoregional metastasis reaches 54 %. Radical surgery in combination with adjuvant methods of treatment improves the results of treatment in this category of patients. Immunotherapy is a promising method of complex treatment, but requires further study.

The OBJECTIVE to analyze the available researches over the past 5 years and systematized the main groups of factors, which leading to the leakages of colonic anastomoses after resection and reconstructive procedures. Literature analysis was carried in the medical databases PubMed, Medline, Cochrane Library, Web of Science. 22 randomized trials and meta-analyses were included in the literature review. All researches investigated large sample of patients presented and the number of factors evaluated with statistically significant reliability. We analyzed and presented the controlled and uncontrolled factors, which were leading to leakages of colonic anastomoses after reconstructive and resection procedures at different stages of treatment of this category of patients. The frequency of the development of the leakages of interstitial anastomoses according to the studied literature is high. Evaluation of proven factors in the preoperative period will in most cases reduce the risks and, as a consequence, the frequency of leakages of colonic anastomoses. This will be significantly improved to the results of treatment of coloproctological patients.