[Surgical access for small-sized lung lesions].

Experience of diagnostics and surgical treatment of of 100 patients with small-sized lung lesions was analyzed. Thus, authors pose, that patients with lung focal lesion less than 10mm in diameter, should have a lung resection, performed from minithoracotomy. Videthotacoscopic lung biopsy is appropriate by multiple focal lesions. Patients with solitary peripheral lung lesion more than 1sm in diameter, should get a lung resection, performed from minithoracotomy with videoassistance. Patients with solitary lesion less than 5 mm in diameter requier radiological dynamic follow-up (CT-scan each 6 months).

[Severity levels of intraoperative injury in patients with diffuse disseminated pulmonary syndrome].

Differential diagnosis of diseases manifested with lung diffuse dissemination syndrome is very difficult. Final diagnosis is possible only after pathologic examination of specimens taken during diagnostic surgical procedures. Results of open and videothoracoscopic lung biopsy at 107 patients are analyzed. Assessment of surgical trauma was based on respiratory function, neuroendocrine system response and doses of analgesics in postoperative period.

[Diagnosis and choice of surgery of non-parasitic cysts of the liver]. / Diagnostika i vybor metoda khirurgicheskogo lecheniia neparazitarnykh kist pecheni.

Results of treatment of 342 patients with non-parasitic cysts of the liver (NCL) were analyzed. Based on obtained data diagnostic algorithm was developed. Indications and contraindications for transcutaneous and laparoscopic methods in NCL are clarified and substantiated. Features of laparoscopic operations in different location of cysts are presented. In mini-invasive surgeries postoperative complications rate was minimum, there were no lethal outcomes. The authors believe that conventional surgeries in NCL should be performed in critical states only.

[Surgical stress in different cholecystectomies]. / Khirurgicheskii stress pri razlichnykh variantakh kholetsistéktomii.

For determination of surgical stress degree and evaluation of long-term results prospective randomized study was carried out. Three representative groups were compared: patients undergone traditional cholecystectomy (TCE)--95 patients (1 group), laparoscopic cholecystectomy--91 patients (2 group), minimally invasive cholecystectomy--92 patients (3 group). Level of stress hormones (before, during and after surgery), parameters of external respiration (before and after surgery), doses of analgetics (or their combinations) which were necessary for adequate analgesia in early postoperative period depending on surgical method were used as objective criteria of surgical stress. Based on evaluation of patients quality life reliable difference in first three years after surgery between patients undergone TCE and ones undergone minimally-invasive surgery was demonstrated.

[Use of regulated silicone bandage in horizontal gastroplasty in patients with morbid obesity]. / Ispol'zovanie reguliruemogo silikonovogo bandazha pri gorizontal'noi gastroplastike u bol'nykh morbidnym ozhireniem.

From 1984 in N.N. Burdenko Surgical clinic of I.M. Sechenov MMA more than 500 horizontal gastroplasties (HGP) were performed for the treatment of patients with extreme degree of alimentary-constitutional obesity. In 1996 for the first time in our country HGP was performed, including laparoscopic method, with use of regulated silicon bandage "Lap-Band" (LB) made by "Bioenterics", USA. Laparoscopic HGP was performed in 29 patients (7 males, 22 females), aged from 23 to 60 years, mean age was 34.2 +/- 10 years. Minimal body weight was 85 kg, maximal--180 kg, mean--131 +/- 27.2 kg. Mean body mass index was 47 +/- 9.9 kg/m2. Open operations were performed in 14 cases, laparoscopic operations--in 15 cases. 11 laparoscopies were performed in initial stages in very stout patients and in the absence of laparoscopic equipment. In 3 cases the conversion from laparoscopic to open operation was necessary: in 1st case because of hemorrhage from lesser omentum's vessels, when hemostasis cannot be performed by laparoscopy; in 2nd case as a result of bronchospasm associated with tense pneumoperitoneum in the patient with bronchial asthma; in 3rd case because of significant enlargement and rigidity of liver left lobe, which didn't permit to create the space for manipulations in cardial portion of the stomach. The mean bed day turnover after traditional HGP with LB and after laparoscopic HGP was 12.2 and 5.4 respectively. Intraoperative complication was observed in one case--hemorrhage from lesser omentum's vessels. One complication was observed in immediate postoperative period, on the 6th day after traditional HGP: the eventration as a result of hard diarrhea due to antibacterial treatment was diagnosed. One more complication was observed in a year after traditional HGP: small stomach evacuatory function disorders as a result of its significant dilatation. These disorders occurred because of gastric mucosa inflammatory edema, decrease of anastomosis diameter and frequent vomiting due to aspirin taking. In this case the repeated operation--bandage's reposition was performed. There were no other complications. The rate of repeated operations was 4% which agrees with literature data.

[Laparoscopic and standard cholecystectomy: comparison of immediate results]. / Laparoskopicheskaia i traditsionnaia kholetsistéktomia: sravnenie neposredstvennykh rezyl'tatov.

The advantages of laparoscopic cholecystectomy (LChE) are undoubtable in comparison with traditional one. However the experience showed, that LChE is not devoid of some shortcomings. It is characterized by the same typical complications as in ChE, besides it may be followed by some specific complications. The literature concerning the rate of complications in LChE are controversial. The comparative analysis has been carried out concerning the rate of complications after ChE (6800 operations) and LchE (900). The mean age of patients with choledocholythiasis--61.4 years. 40% of the patients had severe accompanying diseases coronary artery disease, complicated forms of arrythmia, arterial hypertension, diabetes mellitus, obesity. There were no significant differences between patients who underwent ChE (group 1) and LChE (group 2) by their age and the rate of accompanying diseases. Intraoperative cholangiography was performed in 3.5% of cases of group 1 and in 1.1%--in group 2. The average rate of the operations on extrahepatic bile ducts in group 1 was also lower--choledocholithotomy was carried out in 2.7%, transduodenal papillosphyncterotomy--in 1.7% of cases, drainage of the choledochal duct--in 1.9%. Combined operations were carried out in 10% of patients of group 1 and in 9.1% cases of group 2. The rate of intraoperative bleedings which demanded repeated operations made up in patients of group 1 0.1%, in patients of group 2 0.5%. Intraoperative damage of the choledochal duct in group 1 were detected in 0.14% and in group 2--in 0.11% of cases (the only complication of LChE in a patient was assessed as a endogenous wall clipping).

[Laparoscopic horizontal gastroplasty]. / Laparoskopicheskaia gorizontal'naia gastroplastika.

The analysis of the first 14 operations of horizontal gastroplasty in patients with end-stage alimentary constitutional obesity was carried out, the operations being performed according to standard (9 patients) as well as laparoscopic method (5 patients). The mean body mass made up 133.6 kg, the mean height being 167.8 cm. Patients age was from 22 to 42 years. All the patients operated by laparoscopic method were women. Technique of laparoscopic horizontal gastroplasty is described, indications and contraindications to the operation are established. It is demonstrated, that laparoscopic gastroplasty, as well as previously performed 530 horizontal gastroplasties with the help of fluoric-lausan goffer band, performed in clinic since 1984, in present time is one of the most perspective method of surgical correction of obesity. The application of this method results in substantial and steady decrease of body mass of the operated patients with minimal risk of complications during surgical procedure as well as in postoperative period.

[The effect of various surgical management methods of stenosing duodenal ulcers on the stomach mucosa defence barrier]. / Vliianie razlichnykh metodov khirurgicheskogo lecheniia iazv dvenadtsatiperstnoi kishki na zashchitnyi slizistyi bar'er zheludka.

The article deals with one of the pressing problems of clinical medicine-restoration of the mucosal defence barrier in surgery for stenosing duodenal ulcer (SDU). The authors studied the defence barrier of the mucosa of the upper part of gastrointestinal tract by measuring the transmural potential difference (TPD) and the level of oxygenation of the organ mucosa in the early and late periods after surgical treatment of 118 patients with SDU. The defence barrier of the gastric mucosa (GM) and the duodenal mucosa (D) was effectively restored after selective proximal vagotomy (SPV) with duodenoplasty (DP) performed in 58 (49.2%) patients. Evidence of this was an increase of the TPD values and oxygenation level of the mucosa, whereas after SDU with Jaboulay's gastroduodenoanastomosis (CDA) conducted in 60 (50.8%) patients, the desired restoration of the mucosal defence barrier did not occur and in some areas of the stomach and duodenum it was damaged. The incidence of recurrences was 8.6% after SPV with DP and 10% after SPV with CDA. Therefore, SPV with DP does not yield to SPV with CDA in efficacy, and from the standpoint of curing peptic ulcer it also promotes effective restoration of the defence barrier of the gastric and duodenal mucosa.

[Late results of the treatment of patients with the extreme degree of alimentary-constitutional obesity by the method of formation of a small stomach]. / Otdalennye rezul'taty lecheniia bol'nykh s krainymi stepeniami alimentarno-konstitutsional'nogo ozhireniia metodom formirovaniia malogo zheludka.

The work analyses the results of treatment of 311 patients with extreme degrees of alimentary-constitutional obesity by formation of a small stomach. Fatal outcomes (1.9%) were encountered in the period of operative technique mastering. The late-term results were studied in 167 patients in follow-up periods of up to 3 years. The patients' average body weight was 149.4 kg, average height 166.2 cm, average body weight excess as compared to the ideal weight was 125.6%. Study of the late-term results of the operation showed that the postoperative weight loss depends on the initial weight excess and the diameter of the anastomosis formed between the proximal and distal parts of the stomach. The more the initial excess of weight as compared to the ideal value, the more the loss of body weight is. The diameter of the formed anastomosis should be no larger than 15 mm. Besides loss of weight, the activity of vital organs and systems is normalized after the operation, and arterial hypertension, diabetes mellitus, the Pickwickian syndrome, and metabolic polyarthritis take a milder course. The operation for formation of a small stomach made it possible for the patients to resume their customary occupation, freed them of the threat of invalidation, and reduced the duration of the disability period by 4.3 times. After surgical treatment the nature of the patients' life significantly improved; 95.8% of patients appraised the effect of the treatment as excellent and good.

[Changes in the degree of oxygenation of gastric mucosa before and after the operation of creating a small stomach in patients with the extreme degree of alimentary-constitutional obesity]. / Izmeneniia urovnei oksigenatsii slizistoi obolochki zheludka do i posle operatsii formirovaniia malogo zheludka u bol'nykh s krainymi stepeniami alimentarno-konstitutsional'nogo ozhireniia.

The authors examined 131 patients with alimentary-constitutional obesity of Degrees III-IV before and after operation for "small stomach" formation. All patients underwent pre- and post-operative endoscopy of the esophagus, stomach and duodenum. The level of gastric mucosa oxygenation was measured in 50 patients before and in various periods after surgery. For this purpose the authors suggested an original endoscopic +spectrum analyzer and a method for determining the level of oxygenation of the mucosa of the organ. The level of gastric mucosa oxygenation was significantly lower in patients with obesity than in healthy individuals of the control group. After the operation the oxygenation level increased significantly, which was connected with an altered diet regimen, reduced amount of the ingested food, loss of weight, and improved microcirculation in the mucous membrane of the organs of the alimentary tract. The authors emphasize in particular the absence of blood supply disorders at the site of application of a synthetic fluoronlavsan band (in the region of the anastomosis), which is among the indices of the physiological property of this method for surgical treatment of patients with alimentary-constitutional obesity.

[Status of the protective gastric mucosal barrier in patients with alimentary-constitutional obesity before and after creating a "small stomach"]. / Sostoianie zashchitnogo bar'era zheludka u bol'nykh alimentarno- konstitutsional'nym ozhireniem do i posle formirovaniia "malogo zheludoczka".

The authors examined 131 patients with degree III-IV alimentary-constitutional obesity before and after operation for formation of a "small stomach". The average body weight of the patients before surgery was 145 +/- 2.28 kg. In the first 12 postoperative months it reduced by 41.9 +/- 1.76 kg as compared to the initial weight. Diminution of body weight in the second year was statistically insignificant. All patients underwent endoscopy of the esophagus and stomach before and after the operation with appraisal of the degree of macroscopic changes of the mucous membrane. The incidence of chronic gastritis and esophagitis reduced in the postoperative late-term periods more than 1.5 times, that of erosive lesions more than 10 times. Targent measurement of the transmural potential difference (TPD) of the esophagus and stomach was conducted in 36 patients. The TPD value is much less in patients with obesity than in the control group of healthy individuals. After operation the TPD value grows significantly which is due to changes of the diet regimen, reduced amount of the ingested food, reduction of body weight, and improved processes of microcirculation in the mucous membrane of the gastrointestinal tract.