[Impact of late admission on mortality from acute abdominal diseases in the Central Federal District of the Russian Federation]. / Vliyanie pozdnei gospitalizatsii na letal'nost' pri ostrykh abdominal'nykh zabolevaniyakh v TsFO Rossiiskoi Federatsii.

OBJECTIVE: To analyze the effect of late hospitalization on mortality from acute abdominal diseases in the Central Federal District of the Russian Federation. MATERIAL AND METHODS: Analysis of late hospitalizations and in-hospital mortality was based on metadata (616.742 clinical observations between 2017 and 2021). Primary statistical data were obtained from reports of chief surgeons in 18 regions of the Central Federal District of the Russian Federation and presented in analytical collections «Surgical care in the Russian Federation¼. RESULTS: The number of patients admitted to surgical hospitals of the Central Federal District with acute abdominal diseases later than 24 hours from clinical manifestation varies depending on the underlying disease. The greatest number of late hospitalizations was observed in acute intestinal obstruction (50.82%), acute adhesive intestinal obstruction (48.49%) and acute pancreatitis (47.36%). In acute cholecystitis, gastrointestinal bleeding and acute appendicitis, admission after 24 hours was observed in 44.72, 38.65 and 33.83% of cases, respectively. Late hospitalization is even less typical for strangulated hernia (27.43%) and perforated ulcer (26.23%). In-hospital mortality significantly differs in both groups (within and after 24 hours) for all acute abdominal diseases. Extended surgery and widespread peritonitis increase these differences for strangulated hernia by 9.2 times (0.92% within 24 hours and 8.48% after 24 hours), for acute appendicitis by 8 times (0.05% within 24 hours and 0.40% after 24 hours) and for perforated ulcer by 6.3 times (4.50% within 24 hours and 28.59% after 24 hours). CONCLUSION: In the Central Federal District, about 25-50% of patients with acute abdominal diseases admitted to the hospital later than 24 hours after clinical manifestation depending on disease. We found the highest in-hospital mortality following late hospitalization in patients with strangulated hernia, acute appendicitis and perforated ulcers.

[Perforated peptic ulcer in patients with cancer: prediction of postoperative morbidity and mortality]. / Probodnaya yazva u patsientov s onkologicheskimi zabolevaniyami: prognozirovanie posleoperatsionnykh oslozhnenii i letal'nogo iskhoda.

OBJECTIVE: To analyze treatment outcomes and approaches to predicting the postoperative morbidity and mortality in patients with perforated ulcers and cancer. MATERIAL AND METHODS: A non-randomized trial included 194 patients. The first group enrolled 45 (23%) patients with perforated ulcers and concomitant cancer who underwent at the oncology center; the second group included 149 (77%) patients with perforated ulcers and no cancer who underwent surgery in general surgical hospitals. Organ-sparing procedures prevailed (40 (88.9%) and 138 (92.6%) cases, respectively). Resections were performed in 5 (11.1%) and 11 (7.4%) patients respectively. Analyzing the factors affecting treatment outcomes, we studied crude (COR) and adjusted (AOR) odds ratios. ROC-analysis was used to assess diagnostic significance of the models for prognosis of morbidity and mortality. RESULTS: Length of hospital-stay was 10 (range 9-14) and 8 (range 7-9) days respectively. Postoperative complications (Clavien-Dindo grading system) occurred in 18 (40%) in 37 (24.8%) patients, respectively. According to multivariate analysis, predictors of complications in patients of the first group were treatment with NSAIDs/glucocorticoids and Charlson-Deyo index >3. Sensitivity of this model was 82.4%, specificity - 75.0%. Postoperative mortality was 15.6% (n=7) and 7.4% (n=11) respectively. According to multivariate analysis, predictors of mortality were age over 65 years and more than 5 chemotherapeutic courses. Sensitivity of the model was 85.7%, specificity - 97.4%. CONCLUSION: The stratified approach makes it possible to improve prediction of postoperative morbidity and mortality in patients with perforated ulcers.

[Positioning of mesh implants in endoscopic inguinal hernia repair]. / Sposoby pozitsionirovaniya setchatykh implantov pri endovideokhirurgicheskoi pakhovoi gernioplastike.

OBJECTIVE: To improve the results of endoscopic inguinal hernia repair by determining the optimal access to inguinal region and method of positioning of the mesh implant. MATERIAL AND METHODS: There were 221 patients with inguinal hernia who underwent 278 operations. We formed 2 groups: the main group A consisted of 92 (41.6%) patients who underwent extraperitoneal interventions (TEP/e-TEP); the control group B - 129 (58.4%) patients after transabdominal surgery (TAPP). In each group, 3 subgroups were identified depending on the method of mesh implant positioning: subgroups A1 and B1 - stapler reduced fixation at 1-3 points, subgroups A2 and B2 - glue fixation, subgroups A3 and B3 - vacuum positioning without fixation. Acute, chronic pain syndrome and quality of life were evaluated using visual-analogue scale (VAS), Short-Form Inguinal Pain Questionnaire (sf-IPQ) and SF-36 questionnaire, respectively. RESULTS: All interventions were completed in minimally invasive fashion. Regression of acute pain syndrome after 3, 24, 48, 72 hours and 7 days was as follows: in group A - from 3.39±0.37 to 0.53±0.18 scores, in group B - from 4.47±0.34 to 0.94±0.24 scores. The lowest values were observed in subgroups with non-invasive positioning (p<0.05). Chronic pain syndrome was evaluated by all patients as less than 2 scores in 6 months after surgery. SF-36 values after 6 months ranged from 78±1.5 to 92±1.0 at TEP/e-TEP and from 75±1.6 to 92±1.1 at TAPP. Between-group and within-group differences were not significant (p>0.05). Control examination within 0.5-2 years was performed in 189 (85.5%) patients. No relapses were detected. CONCLUSION: E-TEP technology is a priority. Glue fixation increases the congruence of mesh implants with inguinal region due to enlarged area of immobilization. This ensures safety and reliability of hernia repair, comfort for patients.

[Staged bilateral total extraperitoneal allohernioplasty by e-TEP in a patient with recurrent oblique inguinal hernia on the left and combined strangulated femoral hernia on the right]. / Étapnaia dvustoronniaia total'naia ékstraperitoneal'naia allogernioplastika po metodike e-tep u patsienta s retsidivnoi kosoi pakhovoi gryzhei sleva i kombinirovannoi ushchemlennoi bedrennoi gryzhei sprava.

A case of two-stage minimally invasive surgical treatment of an elderly patient with bilateral inguinal hernia is presented: a recurrent oblique on the left, combined (femoral, obturator, oblique and direct inguinal) on the right with incarceration and necrosis of the small intestine in the femoral canal. Previously, the patient underwent closure of perforated ulcer of duodenum from upper-midline laparotomy, epicystostomy, transvesical adenomectomy from the lower-midline laparotomy. The first stage we performed diagnostic laparoscopy, minilaparotomy, reduction and resection of necrotic small intestine loop. The second stage was carried endovideoscopic total extraperitoneal allohernioplasty by the method of Extended-View Totally Extraperitoneal (e-TEP) on two sides. The positive results of the treatment indicate a high efficiency of video endoscopic alloplasty of occult hernias in a complex case. To diagnose and perform adequate surgical intervention with a combined femoral hernia, when the obturator and inguinal hernias are formed, but clinically do not manifest themselves, it is possible only with endoscopic examination of potential sites of hernia formation in the inguinal region, which is not possible with open plastic hernia of the inguinal region.

[Application of anti-adhesive barrier for recurrent acute adhesive intestinal obstruction]. / Applikatsiya protivospaechnogo bar'era pri retsidiviruyushchei ostroi spaechnoi kishechnoi neprokhodimosti.

Surgical treatment of a patient with recurrent acute adhesive intestinal obstruction is described. Seven plates of anti-adhesive barrier agent made from oxidized regenerated cellulose were applied to small bowel in order to prevent adhesions. Control examination did not reveal viscero-parietal adhesions between hollow organs and delayed passage through the gastrointestinal tract. Long-term results indicate the need for intraoperative prevention of intra-abdominal adhesions in patients with abdominal adhesive disease.

[Single-port transumbilical dissection of multiple liver abscesses after choledochoduodenostomy]. / Odnoportovoe transumbilikal'noe vskrytie mnozhestvennykh abstsessov pecheni posle kholedokhoduodenostomii.

It is presented case report of a patient with multiple cholangiogenic abscesses of right liver lobe in 7 years after primary surgery. High efficiency of minimally invasive technologies for purulent complications of biliary surgery was emphasized. Moreover, it was confirmed that choledochoduodenostomy as a variant of internal biliary drainage is not desirable for complicated course of cholelithiasis.

[Endoscopic surgery and laparoscopy are new insights of evolution of inguinal hernia repair (in Russian only)]. / Éndovideokhirurgiia i laparoskopiia - novyi vitok évoliutsii operativnogo lecheniia pakhovykh gryzh.

This article is devoted to general and particular problems of inguinal hernia repair through the analysis of statistical data and comparison of advantages and disadvantages of various methods of inguinal hernia repair. Particular attention is paid to the analysis of current options of mesh implant fixing during endoscopic hernia repair: TAPP, TER, e-TER. Long-term outcomes are essential to determine surgical technique. The authors consider that careful adherence to the basic principles of minimally invasive surgery can reduce the incidence of complications, recurrences and chronic pain syndrome after inguinal hernia repair. The main advantages of current surgical technologies are accelerated rehabilitation, earlier restoration of social activity, improvement of the quality of life.

[Technical features of laparoscopic cholecystectomy in patients with overweight and obesity]. / Laparoskopicheskaia kholetsistéktomiia u patsientov s izbytochnoi massoi tela.

AIM: To improve surgical treatment of patients with cholelithiasis and obesity by using of different technologies of laparoscopic cholecystectomy. MATERIAL AND METHODS: There were 88 (16.4%) patients with overweight and obesity among 538 patients who underwent laparoscopic cholecystectomy. Conventional laparoscopic cholecystectomy was performed in 33 (6.1%) cases, cholecystectomy through single laparoscopic access - in 12 (2.3%), cholecystectomy via single laparoscopic access with trocar support - in 43 (8.0%) patients with body mass index 25-52.3 kg/m2. The article describes the technical features of laparoscopic cholecystectomy. RESULTS: Complications were absent in 83 (94.3%) of 88 cases after laparoscopic cholecystectomy. The lowest pain severity in early postoperative period was noted in case of single laparoscopic access (p<0.05). CONCLUSION: Conventional and single-port laparoscopic cholecystectomy is advisable in patients with calculous cholecystitis, overweight and obesity.