[Effectiveness of laparoscopic bariatric surgery: gastric plication vs sleeve gastrectomy]. / Sravnitel'naya otsenka effektivnosti laparoskopicheskikh bariatricheskikh operatsii: gastroplikatsii i prodol'noi rezektsii zheludka.

OBJECTIVE: To evaluate an effectiveness of laparoscopic bariatric surgery - sleeve gastrectomy and gastric plication. MATERIAL AND METHODS: In 2017, laparoscopic gastric plication in 47 obese patients and sleeve gastrectomy in 108 patients were performed at the Askerkhanov Medical Center and Loginov Moscow Clinical Scientific Center. Patients with morbid obesity (BMI ≥40 kg/m2) and obesity grade II (BMI ≥35.0 kg/m2) with one of such comorbidities as hypertension, diabetes mellitus type II, sleep apnea, degenerative joint disease, cholelithiasis underwent surgical treatment. The first group consisted of 35 patients who underwent laparoscopic gastric plication, the second group - 87 patients after laparoscopic sleeve gastrectomy. Overweight loss, quality of life, and course of comorbidities were evaluated before surgery, in 12 and 24 months after surgery. MOS SF-36 questionnaire was used to assess the quality of life. RESULTS: Overweight loss after 24 months was 52.4±6.1% and 67.9±8.4% in the first and second groups, respectively (p=0.001). Quality of life after gastric plication is lower compared to sleeve gastrectomy. The greatest difference in favor of sleeve gastrectomy was obtained after 24 months regarding physical functioning (64.3±14.9 vs. 79.2±17.7; p=0.010) and emotional functioning (60.7±28.8 vs. 78.0±25.2; p=0.009). Regression of comorbidities after sleeve gastrectomy is more significant than after gastric plication. CONCLUSION: Gastric plication is less effective than sleeve gastrectomy. However, postoperative morbidity requiring redo surgery is lower after gastric plication.

[Perftoran emulsion in complex therapy of critical lower limb ischemia].

The paper presents comparative assessment of treatment outcomes in patients with critical lower limb ischemia treated with conventional therapy or combined with ozonized Perftoran. The study included 72 patients with Fontain-Pokrovsky III stage ischemia caused by impaired distal leg circulation. Thirty five patients received intra-arterial injections of ozonized Perftoran in addition to conventional "base" therapy. Emulsion of ozonized Perftoran was shown to have beneficial effect on blood coagulation, blood gases, parameters of systemic hemodynamics, microcirculation and other treatment outcome measures.

[Catheter balloon scleroobliteration as a new modality of sclerosurgical treatment of lower limb varicosity].

This paper deals with a new low-invasive method for catheter scleroobliteration of the trunks of the greater and lesser saphenous veins using a balloon multichannel catheter (CBST). The authors make a comparative evaluation of the efficacy of combined phlebectomy (the first control group, n=80), traditional intraoperative trunkal catheter sclerotherapy (the second control group, n=22) and of the technique offered (the third study group, n=50) in patients and outpatients seen at the Vascular Department of the regional clinical hospital and at the R.P. Askerkhanov Medical Center, Makhachkala, between September 2001 and January 2004. The new technology lies in catheter scleroobliteration of the saphenous vein trunk and ostial tributaries without crossectomy by means of temporary occlusion of the saphenofemoral or saphenopopliteal anastomoses using a catheter balloon. The use of the given technology allowed to activate the patients directly after operation and to avoid complications common to crossectomy and phleboextraction according to Babcock. In the first group, the good isolate results were obtained in 9 (11.2%) patients on 9 operated legs; the results were satisfactory in 66 (82.5%) patients on 104 operated legs; the results appeared unsatisfactory in 5 (6.3%) patients. In the second group, good results with complete obliteration of the lumen of the saphenous vein trunk: were recorded on days 7-10 after operation in 16 (72.776) patients on 23 (79.355) lower limbs, satisfactory results in 5(22.7%) persons on 5 (17.2%) lower limbs; the result was unsatisfactory in one (4.6%) patient. In the third group, good results were obtained in 42 (84%) patients on 58 (86.6%) lower limbs; the results turned out unsatisfactory in 8 (16%) patients on 9 (13.4%) lower limbs. Judging from the short- and long-term results, CBST marked by the high radicality and low traumatism makes it possible to achieve a beneficial cosmetic effect which allows to recommend it for wide use in outpatient practice.

[Intraperitoneal perfusion of perftoran in the treatment of patients with diffuse purulent peritonitis]. / Vnutribriushinnaia perfuziia perftorana v lechenii bol'nykh rasprostranennym gnoinym peritonitom.

For higher efficacy of general purulent peritonitis treatment, intraperitoneal perfusion of Perftoran emulsion was proposed. The drug was administered as a single dose of 100-150 ml before wound suturing. In 48 hours an increase of phagocytizing cells fraction in peritoneal exudate and their higher functional activity was revealed: the phagocytic activity and phagocytic index was 2 times higher than in the control group, complete phagocytosis index--1.5 times higher. Significant reduction of microbial contamination in abdominal cavity was also revealed: in 48 hours there were less aerobic bacteria than in the control group, there were no anaerobic bacteria, or anaerobes were detected in a minimum quantity. Local use of Perftoran allowed to decrease the rate of repeated peritoneal sanitation by 44.4% and to decrease mortality by 5.2%.

[Programmed relaparotomy in peritonitis]. / Programirovannaia relaparotomiia pri peritonite.

Statistical analysis of the clinical picture, history data, intraoperative findings and outcomes of treatment in 214 patients with generalized purulent peritonitis provided an algorithm for defining of indications for programmed relaparotomy. The algorithm allowed errors to decrease from 25.2 to 2.4% in the choice of surgical policy for peritonitis and to decrease mortality from 21.0 to 16.7%.

[The surgical treatment and prevention of rethromboses in acute ileofemoral venous thromboses]. / Khirurgicheskoe lechenie i profilaktika retrombozov pri ostrykh ileofemoral'nykh venoznykh trombozov.

The paper outlines the results of surgical management of acute ileofemoral venous thrombosis in 44 patients. In 23 patients from Group 1 venous thrombectomy was performed by the femoral access, in 21 patients from Group 2, by intraperitoneal pararectal access. For prevention of rethromboses in the postoperative period, in Group 2 continuous regional infusion of a rheopolyglucine-streptokinase-heparin mixture with concomitant administration of the mixture into the paravasal fat of a diseased segment was made. Good results were obtained in 76.2%.

[Omentoplasty of residual cavities of the liver]. / Omentoplastika ostatochnykh polostei pecheni.

Results of omentoplasty of residual cavities of the liver are described. New variants of operations of omentoplasty following hydatidectomy and abscessotomy gave good near and remote results of the treatment.