[Fast track rehabilitation in perforated duodenal ulcer]. / Uskorennaia reabilitatsiia pri probodnoi iazve dvenadtsatiperstnoi kishki.

AIM: To analyze the outcomes of fast track rehabilitation program in patients with perforated duodenal ulcer (PDU). MATERIAL AND METHODS: For the period 2013-2016 at the Department of Surgery and Endoscopy 206 PDU patients have been treated. Inclusion criterion for the main group (n=77) was duodenal ulcers, their dimension up to 1 cm, laparoscopic suture of perforated ulcer, fast track rehabilitation program implementation. The control group consisted of 129 patients who underwent open suturing of perforated ulcer followed by conventional treatment in postoperative period. RESULTS: In the main group (n=77) laparoscopic suturing of ulcerative defect with the use of Fast Track program was performed. Postoperative complication i.e. sutures failure was observed in 1 (1.3%) case. There were no lethal outcomes in the main group. Mean length of hospital-stay was 4.8 days. In 129 patients of the control group open suturing of the perforated ulcer and conventional postoperative therapy were applied. Postoperative surgical complications were absent in the control group; mortality rate was 2.3%. Mean length of postoperative hospital-stay was 8.1 days. CONCLUSION: Laparoscopic treatment of perforated ulcers facilitates application of fast track rehabilitation program in emergency patients. Fast track rehabilitation protocol after laparoscopic suturing of the perforated ulcer creates conditions for early discharge and is followed by good clinical and economic effects. Recurrent peptic ulcers are noted if antiulcer therapy is absent.

[Optimal time of surgery for acute adhesive small bowel obstruction]. / Vybor sroka operativnogo lecheniia pri ostroi spaechnoi tonkokishechnoi neprokhodimosti (mul'titsentrovoe prospektivnoe randomizirovannoe issledovanie).

AIM: To define optimal terms of surgery for acute adhesive non-strangulatory small bowel obstruction. MATERIAL AND METHODS: The analysis included 703 publications from e-LIBRARI.RU (342 works) and NCBI (361 works) databases for acute adhesive intestinal obstruction. The vast majority of articles presented retrospective analysis of single-center experience. RESULTS: It has been established that short course of medication is predominantly used for acute adhesive intestinal obstruction in the Russian Federation. International studies point 2-5 days for conservative treatment. The advantages and disadvantages of short and long courses of medication were analyzed. Therefore, multicenter, prospective, randomized trial 'Comparison of early operative treatment (12-hour medication) and long-term conservative treatment (48 hours) for acute adhesive small bowel obstruction' (COTACSO) was planned and registered (Unique Protocol ID: 14121729). The study protocol involves clinical, laboratory and instrumental exclusion of strangulation, randomization and conservative treatment of 2 groups of patients for 12 and 48 hours. Patients will undergo surgical interventions if obstruction will be present by that date. The main endpoint is mortality rate in both groups. The end of the study is December 2020.

Morphological changes in the anterior abdominal wall of rats with peritonitis and implanted synthetic film.

Histological study and electron microscopy of the anterior abdominal wall and laparotomy wound closed using a polytetrafluoroethylene film was performed on rats with experimental peritonitis. We studied 4 types of polytetrafluoroethylene films differing in the size of micropores and technology of treatment. The tissue response differed after implantation of various films. A multilayer film with minimum size of pores was optimal to repair the laparotomy wound.

Use of polytetrafluorethylene films for closing of abdominal cavity under conditions of experimental peritonitis.

Four variants of polytetrafluorethylene films differing by size of micropores and manufacturing technology were used for closing of the abdominal cavity under conditions of experimental peritonitis in rats. The results of tensiometry and planimetry helped us to select the optimal variant of polytetrafluorethylene film characterized by sufficient strength, minimum size of micropores, and causing minimum complications.