[The improved method of minilaparotomy by cholecystectomy].

The new improved method of minilaparotomy by cholecystectomy is characterized by transversal cut of the abdominal wall and using a contra aperture for inserting a clamp for the gallbladder. The use of such an access was applied in 47 patients with good immediate and long-term results.

[Surgical treatment of patients with chronic lower limb venous insufficiency and trophic disorders].

The experience in surgical treatment of 326 patients with IV-VI degree chronic lower limb venous insufficiency (CEAP) is analyzed. Correction of disorders of venous hemodynamics was performed with surgical methods and sclerotherapy. The best clinical and functional results in long-term period were achieved in patients undergone surgery in an early stage of the disease without deep veins valves insufficiency and external trophic disorders. Pathology of deep veins required correction of valves function. It is concluded that these patients require complex approach to the treatment.

[A comparative analysis of effectiveness of surgical treatment of fibroadenomas in young girls]. / Sravnitel'nyi analiz éffektivnosti khirurgicheskogo lecheniia fibroadenom u devuchek-podrostkov.

Results of the examination of young girls (13-17 years of age) who came to consult a doctor for different complaints of the state of their mammary glands are described. Age-dependent peculiarities of the mammary gland tissue in this category of patients imply the thorough preoperative examination. The ultrasonic investigation of the mammary gland is the method of choice. Fibroadenoma was diagnosed in 50 patients, fibrocystic mastopathy in 27, mastopathia cystica in 81, mastitis and other diseases in 5 patients. In 54 patients no pathology of the mammary glands was revealed. A comparative analysis of two groups of patients operated upon is given: a control group (25) with the operations in the volume of a classical sectoral resection and a main group (25) with a sectoral resection performed by a modified method. In the control group the cosmetic effect after the traditional sectoral resection was estimated as dissatisfactory in 76%: there were signs of keloidization of the scar, hypertrophic scar with pigmentation. In the majority of patients there was an atrophic scar with a pronounced deficiency of the volume of the mammary gland and its asymmetry. In the main group patients the complete absence of the signs of postoperative scar was noted in 16 (64%) patients. They were operated on by the modified method (periareolar resection). A conclusion is made that when the operation is thought to be inevitable, the low degree of risk of breast cancer requires a transformation of the surgical strategy towards the reduction of the volume of ablated tissues and employment of modified variants of surgery resulting in the maximum cosmetic effect.

[Application of xenogeneic bioprostheses in reconstruction of the arteries of infrainguinal localization]. / Primenenie ksenogennykh bioprotezov v rekonstruktsii arterii infraingvinal'noi lokalizatsii.

The application of 37 xenogenous bioprostheses was carried out in reconstruction of the arteries of infrainguinal localization in 37 patients (34 men and 3 women). Patients older than 60 years made up 67.2%. Most of the patients had occlusion of the femoral artery and lesions of the tibial arteries: one artery in 26 (70.2%), two arteries in 3 (8.1%) patients. The femoro-proximal-popliteal shunt was performed in 15 (40.5%) patients, in 22 (59.5%) patients long shunts were implanted (in 9--femoro-proximal-popliteal shunting, in 13--femoral-tibial). During the shunting operations a reconstruction of the inflow pathways was carried on (aorto-femoral shunting, endarterectomy from the iliac-femoral segment). The results of the reconstructive operations on the lower extremities with the application of xenoprostheses were estimated as good in 28 (75.6%) patients, in 6 (16.2%) patients--as satisfactory, in 3 (8.2%)--as bad. There were no lethal outcomes.

[Dermal autograft immersion plasty by a flap method for large postoperative hernias of the abdomen]. / Autodermal'naia pogruzhnaia plastika loskutnym metodom pri bol'shikh posleoperatsionnykh gryzhakh zhivota.

The authors present results of treatment of 128 patients aged 32-75 with great ventral hernias using the method of autodermal immersion graft hernioplasty. Hernias most often appeared after low median laparotomies. Planned operations were performed in 94.6% of cases, in 5.4% plasty was carried out in patients with incarcerated hernias without pyo-inflammatory alterations in the hernia sac. The implant was treated by the V.N. Yanov method. The postoperative period was mainly favorable, without lethal outcomes. Suppuration of the wounds took place in 2.3% of cases. Long-term results were followed-up in 80.5% of the patients (during the periods 6 months--11 years). Recurrent hernias were found in 3.1%. The other patients had good results of operations.

[Reconstructive surgeries on deep femoral artery in chronic critical limb ischemia]. / Rekonstruktivnye operatsii na glubokoi arterii bedra pri khronicheskoi kriticheskoi ishemii konechnostei.

Possibilities of revascularisation of the lower extremity through the deep femoral artery in elderly and aged patients with chronic critical limb ischemia were evaluated. Forty-nine patients with high surgical risk were studied. Safety of the extremity, decrease of ischemia degree and level of amputation were the main problems in surgical treatment. Deep-femoral-popliteal index was very important. If this index was less 0.3 surgeries on deep femoral artery were effective. If index was 0.3-0.5 results of surgery were questionable. Index more than 0.5 is the factor of unsuccessful revascularisation through the deep femoral artery.

[Surgical treatment of choledocholithiasis complicated by obstructive jaundice]. / Khirurgicheskoe lechenie kholedokholitiaza, oslozhnennogo obturatsionnoi zheltukhoi.

Cholecystectomy was conducted in 820 patients. In 115 (14,0%) of them it was combined with interventions performed on extrahepatic biliary ducts for choledocholithiasis and obstructive jaundice. Patients aged from 20 to 90 years. There were 30 men and 85 women. Choledocholithotomy with subsequent inspection of the common biliary duct (CBD) distal portion was considered as the operation of choice. Operation was concluded with external drainage of CBD, choledochoduodenal anastomosis formation and transduodenal papillosphincterotomy conduction. Of the patients operated on 6 (5,2%) have died.

[Relaparotomy: the indications, procedure and results]. / Relaparotomiia: pokazaniia, taktika, rezul'taty.

Based on an analysis of 284 observations amounting to 1.8% of the total number of operations on organs of the abdominal cavity the authors give more exact indications to early relaparotomy and to more optimal methods to eliminate complications appearing after primary operations. They recommend wider use of additional methods of diagnosis of postoperative complications which will result in less lethality after relaparotomies.