[Principles of safe endoscopic surgery on the endocrine organs of the neck]. / Printsipy bezopasnykh endoskopicheskikh operatsii na endokrinnykh organakh shei.

OBJECTIVE: To emphasize the main stages of safe endoscopic surgery on endocrine organs of the neck. MATERIAL AND METHODS: There were 79 patients with diseases of thyroid and parathyroid glands who underwent surgery between 2018 and 2021. Of these, 69 ones underwent transaxillary thyroidectomy, 10 patients underwent transaxillary parathyroidectomy. RESULTS: At initial stage of development of this technique, we obtained 2 intraoperative and 2 postoperative complications. Adverse events were completely cured. CONCLUSION: Endoscopic procedures on the endocrine organs of the neck are a safe alternative to traditional approaches. There are certain advantages of this approach. Compliance with surgical technique and focusing on dangerous stages minimize the risk of complications.

[Surgical treatment of colon cancer in advanced age patients with severe comorbidities]. / Vliyanie komorbidnogo fona na vozmozhnost' khirurgicheskogo lecheniya bol'nykh rakom obodochnoi kishki pozhilogo i starcheskogo vozrasta.

OBJECTIVE: To analyze surgical (including minimally invasive) treatment of advanced age patients with colon cancer and severe comorbidities. MATERIAL AND METHODS: Advanced age patients with colon cancer (≥60 years) were compared with younger ones. Concomitant diseases were detected in 94,4% of older patients and in 45,9% of patients in the control group (χ2=51,747; p<0,001). RESULTS: Surgery time, intraoperative blood loss, length of hospital-stay, postoperative morbidity and mortality were similar. CONCLUSION: Severe comorbidities did not significantly affect surgical outcomes in these patients and did not increase postoperative morbidity and mortality.

[Management of mucinous tumor of appendix]. / Lechenie patsientki s mutsinoznoi opukhol'yu cherveobraznogo otrostka.

Low-grade mucinous tumors (MT) of the appendix are rare malignancies. One of the most formidable complications of these tumors is mucin depositing in the peritoneum with development of peritoneal pseudomyxoma. Currently, there are no single clinical - pathomorphological classification and treatment approach to these tumors. This situation is complicated by the fact that tumor of the appendix cannot be preoperatively suspected in many cases and MT is detected after appendectomy for acute appendicitis or its complications. Thus, prognosis of patients is deteriorated.

[Early and long-term outcomes of minimally invasive interventions in urgent colon surgery]. / Blizhaishie i otdalennye rezul'taty mini-invazivnykh vmeshatel'stv v urgentnoi khirurgii tolstoi kishki.

OBJECTIVE: To analyze the results of minimally invasive surgical treatment of patients with urgent colon diseases. MATERIAL AND METHODS: There were 89 patients with urgent colon diseases. All patients were divided into 2 groups: the main group - 31 patients who underwent laparoscopic surgeries, the control group - 58 patients operated via open access. Both groups were comparable by age and underlying disease. However, significant differences in gender, severity of comorbidities and complications of the underlying disease were observed. RESULTS: Surgery time, postoperative morbidity (9.7% vs. 6.9%) and postoperative hospital-stay were similar in both groups. Quality of life was significantly better in the main group compared with the control group if colostomy was absent. In case of stoma, there were no between-group differences. CONCLUSION: Laparoscopic surgery is associated with reduced need for analgesics, similar duration of intervention and postoperative morbidity. Complete restoration of quality of life in these patients is observed in 6 months after surgery. Colostomy results similar quality of life after laparoscopic and open surgery.

[Titanium mesh implants in herniology]. / Titanovye setchatye implanty v gerniologii.

Literature review is devoted to the main implants used in hernia surgery and their disadvantages. Advisability of titanium mesh implants in surgery of anterior abdominal wall hernias is shown.

[Surgical treatment of acute calculous cholecystitis followed by one-day discharge of patients]. / Khirurgicheskoe lechenie ostrogo kal'kuleznogo kholetsistita s dosutochnoi vypiskoi bol'nykh.

AIM: To develop rational tactics of surgical treatment of patients with acute calculous cholecystitis with their subsequent discharge within 1 day since admission. MATERIAL AND METHODS: There were 283 patients with acute cholecystitis and 58 patients with chronic cholecystitis. All patients underwent laparoscopic cholecystectomy. Patients with acute cholecystitis were divided into 2 groups: main group - 136 patients were discharged within 1 day since admission, control group - 147 patients who were discharged later. Age, gender, duration of attack and ASA score were similar in both groups. RESULTS: Incidence of intraoperative complications was significantly higher in the control group compared with the main group (6.1% vs. 0.7%). There were no postoperative complications in the main group; postoperative morbidity in the control group was 6.1%. Criteria preventing discharge within 1 day since admission were developed. Uneventful early postoperative period after laparoscopic cholecystectomy allows us to discharge 48% of patients with uncomplicated acute calculous cholecystitis within 1 day since hospitalization. The developed algorithm of treatment is followed by reduced hospital-stay by 4 days. CONCLUSION: The developed algorithm of treatment of patients with acute calculous cholecystitis can reduce hospital-stay up to 1 day. Favorable early postoperative period and follow-up of patients after discharge are essential for safe treatment.

[Minimally invasive surgery for colorectal cancer in advanced age patients]. / Miniinvazivnaia khirurgiia kolorektal'nogo raka u bol'nykh pozhilogo i starcheskogo vozrasta.

AIM: To evaluate the role of laparoscopic surgery for colorectal cancer in advanced age patients. MATERIAL AND METHODS: 290 patients with colorectal cancer were enrolled including 121 patients with rectal cancer and 169 patients with colon cancer. Main group consisted of 171 patients over 60 years old, control group - 119 patients younger 60 years old. RESULTS: Radical advanced procedures on different parts of colon including laparoscopic approach were performed in the majority of advanced age patients. Outcomes were considered as good, we did not notice serious complications (5.4% after rectal surgery, 3.9% after colon surgery). Differences were not significant compared with younger patients including laparoscopic interventions for emergency indications. Nevertheless, surgical treatment of advanced age patients with colorectal cancer makes special demands for equipping of the clinic and physicians' qualification. CONCLUSION: Advanced age is not a serious limitation in choice of laparoscopic access in both elective and emergency surgery in patients with colorectal cancer.

[Efficacy of video-assisted procedures in advanced age patients with colorectal cancer]. / Éffektivnost' videoéndoskopicheskikh vmeshatel'stv u bol'nykh kolorektal'nym rakom starshikh vozrastnykh kategorii.

AIM: To assess advisability of video-assisted surgery in advanced age patients with colorectal cancer. MATERIAL AND METHODS: The study involved 44 patients with large intestine tumors. There were 30 patients with colon cancer aged 78.0±1.1 years and 14 patients with rectal neoplasms aged 75.0±1.8 years. All of them underwent elective video-assisted resections without conversion of the approach. RESULTS: Good and satisfactory results were achieved in 95.5% of patients. Postoperative complications occurred in 5 (11.4%) cases followed by redo surgery in 2 (4.5%) patients. Mortality was absent. CONCLUSION: Video-assisted procedures are preferable in elective surgery of colorectal cancer in advanced age patients regardless stage and localization of the process.

[Emergency endoscopic surgery of colon cancer]. / Vozmozhnosti ékstrennoi videoéndoskopicheskoi khirurgii raka obodochnoi kishki.

AIM: To assess the role of endoscopic technologies in treatment of complicated forms of colorectal cancer. MATERIAL AND METHODS: Our trial included patients after endoscopic intervention (n=18) and open surgery (n=11). RESULTS: Mean time of surgery in this group was 158.8±10.7 minutes. In elective surgery group this value was 161.3 minutes (p>0.05). Mean blood loss was not great (near 122.5±17.9 ml). Overall and postoperative hospital-stay was 23.1±2.4 and 8.6±0.5 days, respectively. There were no intraoperative and postoperative complications. CONCLUSION: Endoscopic interventions may be performed for colon cancer for emergency indications including patients with severe complications.

[Endoscopic interventions in patients with colorectal cancer: the effect of comorbidities]. / Videoéndoskopicheskie vmeshatel'stva u bol'nykh kolorektal'nym rakom.

AIM: To evaluate endoscopic technologies in treatment of patients with colorectal cancer and severe comorbidities. MATERIAL AND METHODS: Two groups of patients after endoscopic (group 1, n = 58) and open (group 2, n = 40) surgery were assessed. RESULTS: Comorbidities were observed in 90.7% patients in group 1 and 83.3% patients in group 2 (p > 0.05). Mean comorbidity index was 6.9±0.3 (2-14) and 7.1±0.7 (2-18) in both groups respectively. Comorbidities ASA grade 3-4 were observed in 88.2% patients of group 1 had and in 71.4% patients of group 2 (p > 0.05). One patient of group 1 with intra-abdominal bleeding required conversion of surgical approach. In another case the conversion was due to technical difficulties during intestinal resection. Postoperative complications were noted in 2 patients (3.4%). There were no intraoperative complications in group 2. Postoperative complications were observed in two cases (5.0%). CONCLUSION: Severe comorbidities do not impose serious restrictions on the choice of endoscopic approach in colorectal cancer patients.

[Laparoscopic surgery for colon cancer]. / Laparoskopicheskaia khirurgiia raka obodochnoi kishki.

AIM: To assess laparoscopic surgery in treatment of colon cancer patients. MATERIAL AND METHODS: The results of laparoscopic treatment of patients with colorectal cancer are presented in the article. It was estimated the influence of various clinical parameters including age, gender, comorbidities, tumor localization and stage and complications on laparoscopic management of these patients. CONCLUSION: It was revealed that efficiency of laparoscopic surgery in patients with colon cancer is affected by tumor stage and presence of complications.

[Laparoscopic cholecystectomy in short-stay hospital]. / Laparoskopicheskaya kholetsistektomiya v usloviyakh statsionara odnogo dnya.

AIM: To develop the protocol of surgical management of cholelithiasis in short-stay hospital. MATERIAL AND METHODS: Surgical treatment of 161 patients with cholelithiasis was analyzed. All of them underwent elective cholecystectomy. Short-stay hospital group included 41 patients. 120 patients were operated in surgical department (group 2). RESULTS: Incidence of intraoperative complications was 2.4% and 3.4% in both groups respectively (p>0.05). Postoperative complications were more frequent in group 2 (8.3% vs. 2.4%, p<0.05). Mean hospital-stay was 1 and 4.4 days in both groups respectively. CONCLUSION: Treatment of chronic calculous cholecystitis is advisable in short-stay hospital. Indications for this approach and its safety in certain patients were determined. The protocol of surgical management of chronic cholecystitis in short-stay hospital was develped.

[Place of laparoscopic surgery in the treatment of gastroesophageal reflux]. / Mesto laparoskopicheskoi khirurgii v lecheni gastroézofageal'noi refliuksnoi bolezni.

62 patients (57 females and 5 males, mean age 42.3 years) with gastroesophageal reflux disease were treated and followed up in the A.V. Vishnevsky Institute of Surgery. The diagnosis was established at endoscopic examination, which revealed esophagitis of the 1st degree in 39 patients, of the 2nd--in 20, of the 3d--in 2 and of the 4th--in 1. Roentgenologic examination of the esophagus and the stomach revealed manifestations of the reflux in 43 patients, hernia of the esophageal orifice (of the diaphragm)--in 27. According to esophageal manometry data, basal pressure in the area of the lower esophageal sphincter made up 9.8 +/- 5.7 mm Hg; in 24-hour pH-metry the index of the De Meester exceeded normal 4-5 times and made up 61.1 +/- 33.8. All the patients have undergone a course of conservative antireflux therapy which in the majority of patients resulted in temporary improvement. Laparoscopic operations were carried out in 41 patients (fundoplication by Nissen--in 32, Toupet procedure--in 4 and--by Dor--in 5). In 23 patients cruroraphy and in 32 cholecystectomy have been performed. The patients were followed up from 1 to 36 months. In the majority of them the results were good and favourable.

[Leiomyomas of small bowel]. / O leiomiomakh tonkoi kishki.

The analysis of our own country and foreign literature, devoted to the problems of clinical aspects, diagnosis and treatment of leiomyomas of the small bowel for the last 48 years has been carried out. The authors present their personal experience in follow-up of 6 cases of the small bowel leiomyomas, the main clinical manifestations of which being recurrent intestinal bleedings and in lesser degree--small bowel obstruction. The results of preoperative examination evidence that besides thorough physical, endoscopical and ultrasound examination the necessity may arise to use for diagnosis angiographic and computed-tomographic methods. The subject of special attention of each clinical physician should be the danger of malignant transformation of benign leiomyomatous neoplasms of the small bowel, which the authors encountered in 2 patients.