[Open and laparoscopic surgery via minimally invasive approach in the treatment of perforated ulcer: a systematic review and metaanalysis]. / Laparotomnye i laparoskopicheski assistirovannye operatsii iz minidostupa v lechenii probodnoi yazvy. Sistematicheskii obzor i metaanaliz.

OBJECTIVE: Systematic review and metaanalysis of the effectiveness of open and minimally invasive laparoscopic suturing of perforated peptic ulcer. MATERIAL AND METHODS: Searching for Russian and English language reports included Scientific Electronic Library, Cochrane Collaboration Library and PubMed databases. We have analyzed contents of specialized journals, reviews and their references. Unpublished data were obtained via communication with chiefs of national surgical hospitals. RevMan 5.3 software was used for metaanalysis. RESULTS: We found no international randomized trials in available literature. Metaanalysis was based on national non-randomized studies. Total sample was 1177 cases. Laparoscopic minimally invasive surgery was performed in 43% of cases (n=503), open suturing - in 57% (n=674) of patients. Choice of these procedures is not currently not standardized. Minimally invasive procedures are shorter in time (mean difference -8.02, 95% CI -11.26 - -4.77, p<0.00001) and ensure less hospital-stay (mean difference -1.93, 95% CI -2.97 - -0.88, p=0.0003). Complications were less common (OR 0.14, 95% CI 0.07-0.27, p<0.00001) after minimally invasive operations (2.4%, 12/503) compared to laparotomy (11.4%, 77/674). Incidence of suture failure was similar (OR 0.4, 95% CI 0.1-1.6, p=0.2) (0.4% (2/503) vs. 0.7% (5/674)). Postoperative mortality was higher (OR 0.14, 95% CI 0.05-0.37, p<0.0001) after laparotomy (8%, 54/674) compared to laparoscopy (0.8%, 4/503). CONCLUSION: A metaanalysis indicates the advantage of laparoscopy-assisted suturing of perforated ulcer via minimally invasive approach over laparotomy. The absence of a standardized approach in choosing of minimally invasive laparotomy and conventional approach is a limitation of these results.

DIAGNOSTICS AND TREATMENT OF PERFORATED PYLORODUODENUM ULCERS IN WOMEN.

The results of treatment of 75 women with perforated ulcers have been studied. There were prevailed women of middle and elderly age groups among patients who underwent surgery. A wound closure of perforated opening and abdominal sanation were performed by laparoscopic means in 30,7% of patients and using midline laparotomy in 29,3% cases. There were carried out the laparoscopic sanation of the abdominal cavity and the wound closure of perforated ulcer from mini-access using the set of mini-assistant in 10,7% patients. Radical operations were applied in 16% cases. The early postoperative complications took place in 8,1% of the patients, the rate of lethality was 4,0%. The long-term results were evaluated and considered as good in 55,5% women, satisfactory ­ in 30,1% and unsatisfactory ­ in 14,2% cases.

[OBTURATIVE BOWEL OBSTRUCTION CAUSED BY GALLSTONES].

The article discussed the results of surgical treatment of obturative bowel obstruction caused by gallstones. An analysis of results was made in two groups of patients. Ultrasonic tomography and laparoscopic diagnostics were used in the main group. An application of modem methods of diagnostics allowed reducing of lethality rate.

[The use of plasma stream for the treatment of chronic osteomyelitis].

80 patients with chronic osteomyelitis were treated. Plasma stream was used in complex treatment in 53,75%, which gave the notably less amount of unsatisfactory results of treatment, then in those patients, who were treated without the use of plasma stream. Therefore, authors declare, that a plasma stream allows the intensification of surgical treatment of osteomyelitis.

Experimental evaluation of rat cord blood as a source of stem cells stimulating regeneration of the bone tissue.

We studied subpopulation structure of rat cord blood and its effects on regeneration of the bone tissue. In cord blood leukocytes, cell fractions with phenotypes CD45+/CD90-, CD45-/CD90+, CD34+/CD45+ were determined. The cells adhered to plastic during culturing and had a fibroblast-like morphology. Transplantation of rat cord blood cells into modeled femoral bone defects stimulated regeneration of the bone tissue and led to recovery of its anatomical integrity, which was confirmed by X-ray examination and histological analysis. No complete recovery of the bone structure was observed in controls (without cell implantation).

[The treatment of patients with Mallory-Weiss syndrome].

Results of treatment of 345 patients with Mallory-Weiss syndrome were analyzed. Classification of the disease with a glance on stages and bleeding activity was given. Methods of hemostasis and indications for the surgical interference were discussed. The importance of consideration and respective treatment of the concomitant gastrointestinal diseases or alcohol intoxication was stressed.

[The Fournier's gangrene].

Data of 17 patients with the Fournier's gangrene are described and analyzed. The incidence of the disease is lesser then 0,09% of patients of urological and proctological departments. Patients with the Fournier's gangrene are to be treated and monitored at the intensive care units. Early and radical necrectomy, massive systemic antibiotic therapy and therapy of the systemic inflammatory response syndrome are the mainstay of the successful Fournier's gangrene treatment. Lethality of the disease amounted up to 17,6%.

[Results of 20 year puncture treatment of cystic disease].

An analysis of results of using the puncture method of treatment of solitary cysts of the liver, kidneys and spleen in 1343 patients has shown that the staged method of treatment makes surgical resection of the cysts considerably less necessary.

[Method of peritonization of the small intestine for prophylaxis of the development of peritoneal adhesions].

Methods of surgical prophylaxis of postoperative adhesions in the abdominal cavity were developed. On the basis of experimental works in 15 animals the application of the methods of peritonization of portions of the small intestine with a transplant of the autologous visceral peritoneum was well founded. These methods were used in operations on 27 patients aged from 25 to 55 years of age. Observations during the periods from 6 months to 2 years after operation did not reveal signs of recurrent postoperative peritoneal adhesions that were confirmed by instrumental methods of investigation.

[Laparoscopic treatment of postoperative peritoneal adhesions].

75 patients with postoperative peritoneal adhesions, complicated by a severe pain syndrome, were operated on during 2003-2006 yy. The preoperative use of the enzyme medication <> in 28 patients allowed therefore the conduction of adequate laparoscopic adhesiolysis. There were no complications and recurrences registered at follow-up. The postoperative hospital stay averaged 3.7 days.

[Method of surgical treatment and prophylaxis of postoperative peritoneal adhesions].

Original methods surgical treatment and prophylaxis of postoperative abdominal adhesions are analyzed. Method of peritonization of small intestine parts with own visceral peritoneum was studied experimentally on 15 animals. Method was used at 6 patients aged 25 to 55 years. There were no recurrences of postoperative peritoneal adhesions in 6 months - 2 years after surgery.

[Prophylactics of urological complications in patients with a vertebro-spinal trauma].

An original method of evacuation of urine from the bladder in spinal patients and patients with infravesical obstruction of different genesis (cystocuteneostoma) was worked out by the authors in experiments and introduced into clinical practice. A comparative analysis of the results of treatment of patients using ordinary methods and that developed by the authors has shown considerable advantages of the latter: less number of complications such as urethritis, urinary bladder calculi, pyelonephritis.

[Use of plasma technology in treatment of patients with pyo-inflammatory diseases of soft tissues].

The authors substantiated the method of treatment of pyo-inflammatory diseases based on experiments in white rats, using plasma flow at different stages of the process. The plasma technology was used in the clinic in 130 patients that allowed shortening the period of preparing the wounds to operative treatment and reducing the period of hospital stay from 15.3 to 9.2 days, improving results of treatment by 20% and saving on expensive bandaging materials and medicines.

[Feasibility of correction of insulin insufficiency after autotransplantation of splenic tissue in duodenopancreatectomy].

Autotransplantation of splenic tissue in two patients after total duodenopancreatectomy and splenectomy for trauma of the duodenum and pancreas has demonstrated positive results and stable compensation of insulin insufficiency in two cases. Experimental studies of autotransplantation of splenic tissue carried out on 20 cats and 100 rats with pancreatectomy- and alloxan-induced diabetes demonstrated good results too. This method may be regarded as the variant of repair therapy with stromal stem-cells of the spleen.

[Minimally invasive and organ-saving operations in abdominal trauma]. / Miniinvazivnye i organosberegaiushchie operatsii pri travmakh zhivota.

Results of surgical treatment with modern minimally invasive methods of 968 patients with isolated and combined abdominal trauma were analyzed. These methods permitted to make topic diagnosis earlier and to perform adequate surgery on injured organs in 82.0% patients, including in 34.0% with endoscopic-assisted operations, in 36.0% patients diagnostic laparotomies were avoided. In spleen trauma organ-saving and replacement operations were performed for prophylaxis of postsplenectomy syndrome. Vagodestruction of the stomach and pancreas with electromagnetic waves was successfully used in 32 patients for prophylaxis of traumatic pancreatitis and gastrointestinal ulcers. Minimally invasive technologies and organ-saving operations permitted to reduce intra- and postoperative complications rate from 29.7 to 16.8%, lethality--from 12.3 to 7.4%.

[Minimally invasive technologies in the surgical treatment of patients with mechanical jaundice and suppurative cholangitis]. / Maloinvazivnye tekhnologii pri operativnom lechenii bol'nykh s mekhanicheskoi zheltukhoi i gnoinym kholangitom.

Minimally invasive technologies were used in treatment of 89 patients with cholelithiasis complicated by mechanical jaundice and purulent cholangitis. Advantages of the two-stage operative treatment of such patients were shown. The first stage is decompression of the bile duct, the second stage is a radical operation either by laparoscopic or minilaparotomic methods. It allows to avoid extensive and traumatic operations and secures better immediate and long-term results of treatment.

[Surgical treatment of patients with purulent cholangitis in cholelithiasis]. / Khirurgicheskoe lechenie bol'nykh gnoinym kholangitom pri zhelchekamennoi bolezni.

Results of treatment of 89 patients with cholelithiasis complicated by obstructive jaundice and purulent cholangitis using the minimally invasive technologies are analyzed. The advantages of two-stages surgical treatment of these patients are demonstrated. The decompression of biliary tract are performed as the first stage, radical operations by laparoscopy or minilaparotomy--as the second stage. This method permits to refuse the large and traumatic operations and to improve significantly the nearest and long-term results of treatment.

[Vagotomy with high-frequency electromagnetic waves in surgical treatment in duodenal peptic ulcer]. / Vagotomiia vysokochastotnymi élektromagnitnymi volnami v khirurgicheskom lechenii pri iazvennoi bolezni dvenadtsatioerstnoi kishki.

Technical complexity and highly traumatic character of selective proximal vagotomy in all its modifications are considered to be the main causes of the postvagotomy complications. Experimental investigations in 38 mongrel dogs allowed the authors to develop and introduce into practice a new method of seromuscular proximal vagotomy with using radio waves. The selective destructive effect of the radio waves on the nerve tissues, evidenced by morphological investigations was taken into consideration and allowed the destruction of the vagus nerve branches in deep layers of the gastric wall to be performed. This method of vagotomy was used in 46 patients with ulcer disease of the duodenum and gave good results. When studying the functional state of the stomach and duodenum the authors widely used their modification of rheography of the gastric blood flow controlled by fibrogastroduodenoscopy in addition to routine methods of the functional diagnostics.

[Perspectives of using radiofrequency surgery in operations on the major duodenal papilla]. / Perspektivy primeneniia radiochastotnoi khirurgii pri operatsiiakh na bol'shom duodenal'nom sosochke.

The article presents the results of an experimental study of the possibility of using radiofrequency surgery for performing papillosphincterotomy. A generator of radiowaves of a high frequency range was used for the generation of the electromagnetic field, which when acting upon the living tissues makes a cut and destruction of the tissue. The experiment was made in 20 dogs divided into two groups for acute and chronic experiments. In the group of chronic experiments the dogs were exterminated on the 7, 14, 21 and 35th days after operations. The area of the influence in all the periods of the experiment was investigated histologically. Significant advantages of the given method as compared with the traditional ones were revealed.

[The minimally invasive surgery of gallstones and their complications]. / Maloinvazivnaia khirurgiia zhelchnokamennoi bolezni i ee oslozhnenii.

The article analyzes results of treatment of 963 patients with cholelithiasis and with the complications of this disease. Operations on these patients were performed using the following methods: laparoscopy (422), minilaparotomy (373), wide (traditional) laparotomy (168). Recommendation for different ways of operations on biliary ducts are discussed as well as the necessity of taking into consideration the results of sonographical examinations, pathomorphological and rheographic changes when choosing a particular method of surgical treatment. A combination of two little-invasive methods of treatment of cholelithiasis complicated by peritonitis is suggested.