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Khirurgii

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Year 2019 Vol. 27 No 5

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

B.E. TULEUBAEV, D.A. SAGINOVA, A.M. SAGINOV, E.T. TASHMETOV, A.A. KOSHANOVA, A.M. BELYAYEV

ANTIBIOTIC-IMPREGNATED ALLOGRAFT: MICROBIOLOGICAL COMPARATIVE ANALYSIS

Karaganda State Medical University, Karaganda,
The Republic of Kazakhstan

Objective. To develop a method of the femoral head allograft impregnation, prepared according to the Marburg system of the bone bank, with antibiotics.
Methods. In the experiment the allografts of the femoral heads, prepared according to the Marburg system of the bone bank, were impregnated with gentamicin. Four groups were formed depending on the impregnation parameter. In the I and II groups, a whole femoral head was used, in the III and IV – perforated. In groups I and III, antibiotic impregnation was carried out simultaneously with the heat-treated femoral head and groups II and IV after heat treatment. In the control group, the whole bone allograft was subjected to standard heat treatment without its impregnation with antibiotic. From each group, 4 bone fragments were cut from a certain level of depth (cortical, subcortical, and central). The antibiotic release was evaluated by agar diffusion test against S. aureus after 24 hours.
Results. The obtained results of the study indicate the presence of antimicrobial activity in all groups except the control group. However, in the II and IV group, the inhibition zone was higher compared with the I and III groups (p <0.05). The antimicrobial activity of gentamicin in the groups where heat treatment was carried out together with the antibiotic (I, III groups) was lower than in the groups by soaking the allografts in solution with the antibiotic (II, IV groups) (p <0.05). In the control, group V, continuous growth of S. aureus was observed.
Conclusions. Allograft impregnated with antibiotic, prepared according to the Marburg system of the bone bank, provides the inhibition of growth of Staphylococcus aureusin vitro. Perforation of bone allograft according to the developed method allows increasing the antibiotic soaking on average by 10%.

Keywords: chronic osteomyelitis, bone infection, bone allograft, S. aureus, antibiotics, local transport
p. 489-495 of the original issue
References
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  6. Volkmann R, Bretschneider K, Erlekampf E, Weller S. Revision surgery in high grade acetabular defects with thermodisinfected allografts. Z OrthopUnfall. 2007 Sep-Oct;145(Suppl 1):S44-48. doi: 10.1055/s-2007-965660
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  14. Mouzopoulos G, Kanakaris NK, Kontakis G, Obakponovwe O, Townsend R, Giannoudis PV. Management of bone infections in adults: the surgeon’s and microbiologist’s perspectives. Injury. 2011 Dec;42(Suppl 5):S18-23. doi: 10.1016/S0020-1383(11)70128-0
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Address for correspondence:
100000, The Republic of Kazakhstan,
Karaganda, Gogol Str., 40,
Medical University of Karaganda,
Department of Surgical Diseases ¹2.
Tel. +7 701 599 8758,
e-mail: saginova@kgmu.kz,
Dina A. Saginova
Information about the authors:
Tuleubayev Berik E., MD, Professor of the Department of Surgical Diseases ¹2, Medical University of Karaganda, Karaganda, Republic of Kazakhstan.
https://orcid.org/0000-0002-9640-2463
Saginova Dina A., PhD, Assistant of the Professor of the Department of Surgical Diseases ¹2, Medical University of Karaganda, Karaganda, Republic of Kazakhstan.
http://orcid.org/0000-0001-9551-5354
Saginov Azim M., PhD, Associate Professor of the Department of Surgical Diseases ¹2, Medical University of Karaganda, Karaganda, Republic of Kazakhstan.
https://orcid.org/0000-0002-0411-8693
Tashmetov Elyarbek R., Applicant for Master’s Degree, Medical University of Karaganda, Karaganda, Republic of Kazakhstan.
http://orcid.org/0000-0002-2614-4710
Koshanova Amina A., Applicant for Doctor’s Degree, Assistant of the Department of Surgical Diseases ¹2, Medical University of Karaganda, Karaganda, Republic of Kazakhstan.
https://orcid.org/0000-0001-8620-2196
Belyayev Andrey M., PhD, Associate Professor of the Department of Clinical Immunology, Allergology, Microbiology, Medical University of Karaganda, Karaganda, Republic of Kazakhstan.
http://orcid.org/0000-0002-1527-6080

GENERAL & SPECIAL SURGERY

A.N. POPOV1, B.A. VESELOV 2, E.P. BURLEVA 3

DISTAL ARTERIOVENOUS FISTULAS IN PATIENTS WITH TERMINAL CHRONIC RENAL FAILURE

Municipal Clinical Hospital ¹ 40 1,
Clinical Hospital at the Station Yekaterinburg-Passazhirsky, Russian Railways 2,
Ural State Medical University 3, Yekaterinburg
The Russian Federation

Objective. To carry out comparative analysis of the complications structure and the four-year survival of two types of radial-cephalic arterial-venous fistula – in the “anatomical snuffbox” and the Brescia-Cimino type.
Methods. 323 patients with the terminal chronic failure were analyzed, with 358 radial – cephalic fistulas applied. Group I included 53 patients with a radial – cephalic fistula in an “anatomical snuffbox” (n=53). Group II was made up of 270 patients with a radial – cephalic fistula of the Brescia-Cimino type (n=305). Complications and primary cumulative patency of the fistulas were evaluated in both groups in terms of 12 and 48 months.
Results. 9 thrombotic complications were revealed in the group I. 4 reconstructive operations were performed; 5 accesses were lost without surgery.
136 complications were revealed in the group II. There were 123 cases of thrombotic complications; a true aneurysm was in 3 cases, the failure of fistula in connection with the failure of volumetric blood flow rate – in 4, stenosis in the anastomosis – in 6. 48 operations were performed in thrombosis: 26 reconstructive and restorative 22 ones. In aneurysms, their resection was performed; in case of inadequate volume blood flow, 4 operations were performed to ligation the tributaries, in 6 – reconstruction of the fistula with the formation of a new anastomosis. In connection were lost 87 of 305 of vascular accesses with the thrombosis.
Cumulative patency after 12 and 48 months in group I was 90.33% and 52.12%, in group II 76.95% and 46.69% (p<0.05).
Conclusions. Radial-cephalic fistula, formed in the «anatomical snuffbox», has fewer complications and a higher four-year cumulative patency compared to the type of fistula Brescia-Cimino. The availability of the cephalic vein and the radial artery to assess their suitability before the formation of the fistula during clinical examination and the technical simplicity of applying the radial-cephalic fistula in the “anatomical snuffbox” allows considering this vascular access as a priority among the distal fistulas.

Keywords: arteriovenous fistula, anatomical snuffbox, Brescia-Cimino fistula, cumulative patency, complications
p. 496-504 of the original issue
References
  1. Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med. 1966 Nov 17;275(20):1089-92. doi: 10.1056/NEJM196611172752002
  2. Rassat JP, Moskovtchenko, Perrin J, Traeger J. Artero-venous fistula in the anatomical snuff-box. J Urol Nephrol (Paris). 1969 Dec;75(12):Suppl 12:482. https://europepmc.org/abstract/med/5386922 [Article in French]
  3. Raza MW, Waqas K, Ayub M, Hanif M, Khan MM. Anatomical snuff box arteriovenous fistulas for haemodialysis. J Rawalpindi Med College (JRMC). 2014;18(1):80-82. https://journalrmc.com/volumes/1405750166.pdf
  4. Simoni G, Bonalumi U, Civalleri D, Decian F, Bartoli FG. End-to-end arteriovenous fistula for chronic haemodialysis: 11 years’ experience. Cardiovasc Surg. 1994 Feb;2(1):63-66. doi: 10.1177/096721099400200114
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  6. Scher LA, Shariff S. Strategies for Hemodialysis Access: A Vascular Surgeon’s Perspective. Tech Vasc Interv Radiol. 2017 Mar;20(1):14-19. doi: 10.1053/j.tvir.2016.11.002
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  12. Gibbons CP. Primary vascular access. Eur J Vasc Endovasc Surg. 2006 May;31(5):523-29. doi: 10.1016/j.ejvs.2005.10.006
  13. Moisiuk IaG, Beliaev AIu. Postoiannyi sosudistyi dostup dlia gemodializa. Tver’, RF: Triada; 2004. 152 p. (in Russ.)
  14. Twine CP, Haidermota M, Woolgar JD, Gibbons CP, Davies CG. A scoring system (DISTAL) for predicting failure of snuffbox arteriovenous fistulas. Eur J Vasc Endovasc Surg. 2012 Jul;44(1):88-91. doi: 10.1016/j.ejvs.2012.03.014
Address for correspondence:
620102, The Russian Federation,
Yekaterinburg, Volgogradskaya Str., 189,
Municipal Clinical Hospital ¹ 40,
Vascular Surgery Unit.
Tel.: 8 912 600 300 8,
e-mail: burleva@gkb40.ur.ru,
e.p.burleva@gmail.com,
Elena P. Burleva
Information about the authors:
Popov Alexey N., PhD, Vascular Surgeon of the Vascular Surgery Unit, Municipal Clinical Hospital ¹ 40, Yekaterinburg, Russian Federation.
http://orcid.org/0000-0002-7213-4505
Veselov Boris A., PhD, Vascular Surgeon of the Vascular Surgery Unit, Clinical Hospital at the Station Yekaterinburg-Passazhirsky, Russian Railways, Yekaterinburg, Russian Federation.
http://orcid.org/0000-0002-4350-5282
Burleva Elena P., MD, Professor of the Department of Surgery, Endoscopy and Coloproctology, Ural State Medical University, Yekaterinburg, Russian Federation.
http://orcid.org/0000-0003-1817-9937

R.E. KALININ, I.A. SUCHKOV, A.A. EGOROV, A.A. NIKIFOROV, N.D. MZHAVANADZE

MARKERS OF ENDOTHELIAL DYSFUNCTION IN PRIMARY HEMODIALYSIS PATIENTS

Ryazan State Medical University, Ryazan,
The Russian Federation

Objective. To evaluate the markers of the endothelial dysfunction in patients on hemodialysis with native arteriovenous fistula in different terms.
Methods. An open prospective study included 45 subjects with end-stage chronic kidney disease of the 5th stage with a native arteriovenous fistula for hemodialysis. At baseline, 1, 6, and 12 months after the operation the levels of asymmetric dimethylarginine ADMA, advanced oxidation protein products AOPP, endothelin-1, adhesion molecules (VCAM, ICAM), C reactive protein (CRP), angiotensin-2, selectin (Sl), copper zinc superoxide dismutase (Cu/Zn-SOD) and OxyStat assay.
Results. Increased levels of ADMA and AOPP were registered in patients with the arteriovenous fistula thrombosis after 1, 6, and 12 months as compared to the subjects with normal fistula function (ð<0.01). Total peroxide concentration was increased after 6 and 12 months in patients with thrombosis (ð<0.01). Endothelin 1 level was increased after 6 and 12 months in patients with fistula thrombosis (ð<0.05). CRP level was elevated in patients with thrombosis after 1, 6, and 12 months (ð<0.01). In subjects with normal fistula function ICAM level decreased after 6 and 12 months (ð<0.01), VCAM level increased after 1 and decreased after 6 months as compared to baseline (ð<0.01). Selectin sL level increased after 1, 6, and 12 months in subjects with thrombosis. Cu/Zn-SOD concentration in patients with fistula thrombosis was lower at baseline and increased at 12 months (ð<0.01). Angiotensin 2 level in subjects with thrombosis was lower at baseline and increased after 6 and 12 months (ð<0.01).
Conclusions. Endothelial dysfunction is characteristic for dialysis patients. Increased levels the endothelial dysfunction markers are associated with thrombosis of native arteriovenous fistulas.

Keywords: endothelial dysfunction, hemodialysis, arteriovenous fistula, thrombosis, endothelin, oxidative stress
p. 505-514 of the original issue
References
  1. National Kidney Foundation. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 update. Am J Kidney Dis. 2015 Nov;66(5):884-30. doi: 10.1053/j.ajkd.2015.07.015
  2. Akoh JA, Hakim NS. Preserving function and long-term patency of dialysis access. Ann R Coll Surg Engl. 1999 Sep; 81(5):339-42. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503277/
  3. Kalinin RE, Suchkov IA, Egorov AA, Medvedeva OV. Examples of non-standard reconstructions in hemodialysis patients with permanent vascular access Novosti Khirurgii. 2017 Jan-Feb;Vol 25(1):87-92 doi: 10.18484/2305-0047.2017.1.87 (In Russ.)
  4. Oleskowska-Florek W, Połubinska A, Baum E, Matecka M, Pyda M, Pawlaczyk K, Bręborowicz A. Hemodialysis-induced changes in the blood composition affect function of the endothelium. Hemodial Int. 2014 Jul;18(3):650-6. doi: 10.1111/hdi.12148
  5. Leivaditis K, Panagoutsos S, Roumeliotis A, Liakopoulos V, Vargemezis V. Vascular access for hemodialysis: postoperative evaluation and function monitoring. Int Urol Nephrol. 2014 Feb;46(2):403-9. doi: 10.1007/s11255-013-0564-2
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  8. Cao W, Hou FF, Nie J. AOPPs and the progression of kidney disease. Kidney Int Suppl (2011). 2014 Nov;4(1):102-106. doi: 10.1038/kisup.2014.19
  9. Yang XB, Hou FF, Wu Q, Zhou H, Liu ZR, Yang Y, Zhang X. Increased levels of advanced oxidation protein products are associated with atherosclerosis in chronic kidney disease. Zhonghua Nei Ke Za Zhi. 2005 May;44(5):342-46. https://www.ncbi.nlm.nih.gov/pubmed/16009002 [Article in Chinese]
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Address for correspondence:
390026, The Russian Federation,
Ryazan, Vysokovol’tnaya Str., 9,
Ryazan State Medical University,
Department of Cardiovascular,
Endovascular, Operative Surgery
and Topographic Anatomy.
Tel.: +7 9038362417,
e-mail: suchkov_med@mail.ru,
Igor A. Suchkov
Information about the authors:
Kalinin Roman E., MD, Professor, Head of the Department of Cardiovascular, Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University, Ryazan, Russian Federation.
http://orcid.org/0000-0002-0817-9573
Suchkov Igor A., MD, Professor of the Department of Cardiovascular, Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University, Ryazan, Russian Federation.
http://orcid.org/0000-0002-1292-5452
Egorov Andrey A., PhD, Applicant of the Department of Cardiovascular, Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University, Ryazan, Russian Federation.
http://orcid.org/0000-0003-0768-7602
Nikiforov Aleksander A., PhD, Associate Professor, Head of the Central Research Laboratory, Ryazan State Medical University, Ryazan, Russian Federation.
http://orcid.org/0000-0003-0866-9705
Mzhavanadze Nina Dzh., PhD, Associate Professor of the Department of Cardiovascular, Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University, Ryazan, Russian Federation.
http://orcid.org/0000-0001-5437-1112

V.P. ANDRIUSHCHENKO, D.V. ANDRIUSHCHENKO, V.V. KUNOVSKYI, Y.S. LYSIUK

EFFICIENCY OF NUTRITIONAL SUPPORT IN SURGICAL TREATMENT OF PATIENTS WITH ACUTE PANCREATITIS

Danylo Halytsky Lviv National Medical University, Lviv,
Ukraine

Objective. To estimate the efficiency of nutritional support in patients with acute pancreatitis using methods of enteral feeding via the probe.
Methods. The investigation included 82 patients with acute pancreatitis: medium-severe - 28; 34% and severe – 54; 66%. A general clinical, laboratory-biochemical, ultrasonographic and computed tomography examinations were used. Two groups of patients were identified that were comparable in age, sex, and severity of the disease – the main (58), in the treatment complex of which probe enteral nutrition was used and comparative (24), with traditional therapeutic approaches. In the main group, surgical intervention was performed in 43 (74%) and comparative - in 11 (46%) cases. Nutritional support was realized in three ways: by fibrogastroduodenoscopic placement of the probe in the initial section of the small intestine (25), suboperative nasogastrointestinal intubation of the small intestine (12), and the formation of a suspended jejunostoma according to Witzel (21). We used official nutritional mixtures in combination with the probiotic Saccharomyces boulardii (I-745) and the metabolism corrector Malat Citrulline. The following data were evaluated: intestinal motility, indicators of laboratory and biochemical studies (3, 7 days), the dynamics of microstructural changes in the mucous membrane of the small intestine (after finishing the enteral nutrition), suboperative characteristics of the purulent-necrotic focus.
Results. Positive effect was manifested in accelerated restoration of peristalsis, normalization of leukocytosis indexes and blood plasma proteins, positive dynamics of microstructural changes of the small intestine mucous membrane – decreasing of necrotized fibers from 16 (94%) to 5 (29%) (χ²=12.454; ð=0.004), amount of basal/apical membranes detachment from 15 (88%) to 6 (35%) (χ²=7.971; ð=0.004) and erosive changes from 13 (76%) to 5 (29%) (χ²=5.785; ð=0.01). Faster cleaning of purulent – necrotic focus on the programmed relaparotomy was also registered.
Conclusions. Nutritional support by enteral feeding via the probe is an effective component in surgical treatment of patients with acute pancreatitis. Usage of suspended jejunostomy was the most optimal method and it totally corresponds to the principles of “Fast-track” surgery.

Keywords: acute pancreatitis, nutritional support, feeding via the probe, jejunostoma, medication compounds, probiotics, metabolism corrector
p. 515-521 of the original issue
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  8. Shorokh GP, Shorokh SG. Ostryi destruktivnyi pankreatit. Minsk, RB: Paradoks; 2013. 208 p. (in Russ.)
  9. Dronov AI, Kovalskaya IA, Uvarov VYu, Gorlach AI. Features of pathogenetic approach to the treatment of acute necrotizing pancreatitis. Ukra¿n Zhurn Kh³rurg³¿. 2013;(3):145-49. http://www.ujs.dsmu.edu.-ua/journals/2013-03/2013-03.pdf (in Russ.)
  10. Freeman ML, Werner J, van Santvoort HC, Baron TH, Besselink MG, Windsor JA, Horvath KD, van Sonnenberg E, Bollen TL, Vege SS. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas. 2012 Nov;41(8):1176-94. doi: 10.1097/MPA.0b013e318269c660
Address for correspondence:
79010, Ukraine,
Lviv, Pekarskaya Str., 69,
Danylo Halytsky Lviv National Medical University,
Department of General Surgery.
Tel. office +38-032-291-72-31,
e-mail: avp.victor@gmail.com,
Victor P. Andriushchenko
Information about the authors:
Andriushchenko Victor P., MD, Professor, Head of the General Surgery Department, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0003-1848-7358
Andriushchenko Dmytro V., MD, Associate Professor of the Surgery Department of the Post-Graduate Training Faculty, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0003-1046-7889
Kunovskyi Volodymyr V., PhD, Associate Professor of the General Surgery Department, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0003-2796-4814
Lysiuk Yuriy S., PhD, Associate Professor of the General Surgery Department, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0002-9470-6738

V.N. NIKITIN 1,, V.L. POLUEKTOV 1, S.G. KLIPACH 2, V.M. SITNIKOVA 1

DUODENOPLASTY FOR GIANT PERFORATED DUODENAL ULCER PENETRATING TO THE HEPATODUODENAL LIGAMENT

Omsk State Medical University 1,
Omsk Region Emergency City Clinical Hospital ¹2 2,
Omsk,
The Russian Federation

Objective. The development and introduction into clinical practice of a reliable method for radical duodenoplasty in the operations for the perforated giant duodenal ulcers penetrating into the hepatoduodenal ligament.
Methods. 15 patients with giant perforated duodenal ulcers were operated on. There were 13 men (86.7%) and 2 women (13.3%), the age varied from 51 to 81 years, the average age was 63.5+9.7 years. 4 (26.7%) patients were admitted two hours after the moment of perforation; in terms from 2 to 10 hours – 11 (73.3%). All 15 (100%) patients had ulcerative anamnesis from 2 to 35 years. Ulcer niches larger than 2.5 cm were referred to the giant perforated duodenal ulcers. The surgery volume was the following: the upper-median laparotomy, transverse duodenotomy through the perforated hole, exteriorization and treatment of ulcer crater, penetrating into the hepatoduodenal ligament; excision of the affected tissue of the duodenum anterior wall, the ulcer with the perforated hole, sewing the wound bowel duplex with a continuous suture. The results of treatment were evaluated by the surgery time terms, hospitalization terms, the number of complications and deaths, fibrogastroduodenoscopy (30 days and 1 year after surgery), indicators of life quality, according to the SF-36 questionnaire.
Results. The average duration of surgery was 78.0+10.5 minutes. Terms of hospitalization were from 11 to 17 bed-days, the average value – 13.3+2.1. Complications in the early postoperative period were the following: 2 cases of infected seroma of the postoperative scar and 1 case of the right lower lobe pneumonia. Suture failures in the sutured duodenal wound were not marked. Fibrogastroduodenoscopy revealed no ulcerative defects and severe deformation of the duodenal lumen in the duodenoplasty area.
Conclusions. The application of the proposed method of duodenoplasty with the use of two-layer continuous suture in case of giant perforated duodenal ulcers to minimize the likelihood of fatality due to failure of sutures is reproducible and can be used in clinical practice.

Keywords: giant duodenal ulcer, perforation, penetration, radical duodenoplasty, old age
p. 522-529 of the original issue
References
OL>
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  • Vavrinchuk SA, Kosenko PM, Chernyshov DS. Sovremennye aspekty khirurgicheskogo lecheniia perforativnoi iazvy dvenadtsatiperstnoi kishki: monogr. Khabarovsk, RF: IPKSZ; 2013. 241 p. http://www.gastroscan.ru/literature/pdf/vavrinchuk-sa-2.pdf (in Russ.)
  • Bertleff MJ, Lange JF. Perforated peptic ulcer disease: a review of history and treatment. Dig Surg. 2010 Aug;27(3):161-69. doi: 10.1159/000264653
  • Christensen S, Riis A, Nørgaard M, Sørensen HT, Thomsen RW. Short-term mortality after perforated or bleeding peptic ulcer among elderly patients: a population-based cohort study. BMC Geriatr. 2007 Apr 17;7:8. doi: 10.1186/1471-2318-7-8
  • Alekberzade AV, Krylov NN, Rustamov EA, Badalov DA, Popovtsev MA. Perforated peptic ulcer closure: laparoscopic or open? Khirurgiia (Mosk). 2017;(2):45-50. doi: 10.17116/hirurgia2017245-50. [Article in Russian; Abstract available in Russian from the publisher]
  • Thorsen K, Søreide JA, Kvaløy JT, Glomsaker T, Søreide K. Epidemiology of erforated peptic ulcer: Age- and gender-adjusted analysis of incidence and mortality. World J Gastroenterol. 2013 21;19(3):347-54. doi: 10.3748/wjg.v19.i3.347
  • Nishikant Gujar, Sachin DM. Comparative study between omental plugging with controlled tube duodenostomy for management of giant duodenal ulcer perforation. Int J Sci Res (IJSR). 2015 Mar;4(Is 3):1675-79. https://www.ijsr.net/archive/v4i3/SUB152378.pdf
  • Nobori C, Kimura K, Ohira G, Amano R, Yamazoe S, Tanaka H, Naito K, Takami T, Hirakawa K, Ohira M. Giant duodenal ulcers after neurosurgery for brainstem tumors that required reoperation for gastric disconnection: a report of two cases. BMC Surg. 2016;16:75. doi: 10.1186/s12893-016-0189-3
  • Sanjay Gupta, Robin Kaushik, Rajeev Sharma, Ashok Attri. The management of large perforations of duodenal ulcers. BMC Surg. 2005;5:15. Published online 2005 Jun 25. doi: 10.1186/1471-2482-5-15
  • Newton EB, Versland MR, Sepe TE. Giant duodenal ulcers. World J Gastroenterol. 2008 Aug 28;14(32):4995-99. Published online 2008 Aug 28. doi: 10.3748/wjg.14.4995
  • Zharov SV, Narezkin DV, Romanenkov SN. Rezul’taty operativnogo lecheniia patsientov pozhilogo i starcheskogo vozrasta s oslozhnennymi gigantskimi iazvami zheludka i dvenadtsatiperstnoi kishki. Novosti Khirurgii. 2012;20(2):25-28. http://www.surgery.by/pdf/full_text/2012_2_5_ft.pdf (in Russ.)
  • Garelik PV, Dubrovchik OI, Dovnar IS, Tsilindz IT. Perforated gastroduodenal ulcers: a view on the issue of choosing a specific surgical approach. Novosti Khirurgii. 2014;22(3):321-25. http://www.surgery.by/pdf/full_text/2014_3_7_ft.pdf (in Russ.)
  • Onopriev VI, Voskanyan SE, Uvarov IB, Pahilina AN, Pahilin DV. Surgical patomorphology (gistotopography) of perforation ulcers, and technological features of radical duodenoplasty. Kuban Nauch Med Vestn. 2006;(7-8):74-78. https://elibrary.ru/download/elibrary_9253572_97342355.pdf (in Russ.)
    • Address for correspondence:
    644043, The Russian Federation,
    Omsk, Lenin Str., 12,
    Omsk State Medical University,
    Department of Faculty Surgery, Urology.
    Tel: +7 3812 35-91-30,
    e-mail: nikitin-1966@inbox.ru,
    Vyacheslav N. Nikitin
    Information about the authors:
    Nikitin Vyacheslav, PhD., Associate Professor of the Department of Faculty Surgery, Urology, Omsk State Medical University, Omsk, Russian Federation.
    https://orcid.org/0000-0002-7250-9266
    Poluektov Vladimir, MD., Professor, Head of the Department of Faculty Surgery, Urology, Omsk State Medical University, Omsk, Russian Federation.
    https://orcid.org/0000-0002-9395-5521
    Klipach Sergei, Head of the surgical unit, Region Emergency City Clinical Hospital ¹2, Omsk, Russian Federation.
    https://orcid.org/0000-0001-5679-6448
    Sitnikova Valentina, PhD., Assistant of the Department of Faculty Surgery, Urology, Omsk State Medical University, Omsk, Russian Federation.
    https://orcid.org/0000-0002-2239-6072

    TRAUNATOLOGY AND ORTHOPEDICS

    P.G. KRAVCHUN 1, M.I. KOZHYN 1, F.S. LEONTIEVA 2, P.M. VORONTSOV 2, N.A. ASHUKINA 2, O.P. MARUSHCHAK 2, V.YU. DIELIEVSKA 1

    REVEALING WEAK A AND B ANTIGENS IN PATIENTS WITH KNEE AND HIP JOINT ARTHROPLASTY

    Kharkiv National Medical University 1,
    Institute of Spine and Joint Pathology named after M. I. Sytenko 2, Kharkiv,
    Ukraine

    Objective. To analyze the methods of revealing weak A and B antigens on the erythrocytes in AB0 system.
    Methods. Patients after knee and joint arthroplasty were examined on group-specific characteristics with revealing weak A and B antigens on the erythrocytes. Methods of absorption, agglutination, agglutination with complement and antiglobulin test were used.
    Results. Antiglobulin test with the use of polyclonal serum as well as serum containing the only IgG allowed revealing weak A and B subgroups on erythrocytes at 37ºÑ. In some patients A and B antigens on erythrocytes were found while absorption with anti-A, anti-B polyclonal sera and also revealed in agglutination at 37ºÑ, but were not revealed while incubation at the room temperature. Agglutination test with the use of complement and IgG was also helpful in determining the weak antigens. Presence of IgG antibodies was revealed by the treatment of the serum with unithiol in antiglobulin test. Presence of complement and only IgG antibodies corresponding to the antigens led to the more expressed changes of erythrocytes as compared to the presence of both types of antibodies – IgM and IgG.
    Appearance of hemolysis was associated with the increased sizes of erythrocytes and hypochromia. Presence of weak subgroups was mostly associated with hemolytic rather than agglutinating abilities of the patient’s serum, as well as with the presence of complement binding IgG antibodies.
    Conclusions. Absorption, agglutination at 37ºÑ, antiglobulin test at 37ºC with serum both treated and non-treated with unithiol and agglutination with use of the complement helped to define weak antigens in AB0 system.

    Keywords: antigen, blood, antiglobulin, complement, erythrocytes
    p. 530-540 of the original issue
    References
    1. Heier HE, Namork E, Calkovská Z, Sandin R, Kornstad L. Expression of A antigens on erythrocytes of weak blood group A subgroups. Vox Sang. 1994;66(3):231-36. doi: 10.1111/j.1423-0410.1994.tb00315.x
    2. Donskov SI, Morokov VR. Gruppy krovi cheloveka: ruk po immunoserologii. Moscow, RF: Binom; 2014. 1016 p. http://www.booksmed.com/allergologiya-immunologiya/3145-gruppy-krovi-cheloveka-donskov-si.html (In Russ.)
    3. Subramaniyan R. Diminished expression of B antigen mimicking B3 phenotype in a patient with AML-M3: a rare case report. Rev Bras Hematol Hemoter. 2016 Jul-Sep;38(3):264-66. doi: 10.1016/j.bjhh.2016.05.008
    4. Brecher ME, ed. Technical Manual. 14th ed. Bechesda, MD: American Association of Blood Banks; 2002. p. 667.
    5. Bryant N. An Introduction to immunohematology. 3rd ed. Philadelphia: W.B. Saunders Co; 1994. p. 115-16, 136. doi: 10.1111/j.1537-2995.1994.tb06021.x
    6. Motghare P, Kale L, Bedia AS, Charde S. Efficacy and accuracy of ABO blood group determination from saliva. JIAOMR. 2011;23(3):163-67. doi: 10.5005/jp-journals-10011-1120
    7. Noda H, Yokota M, Tatsumi S, Sugiyama S. Determination of ABO blood grouping from human oral squamous epithelium by the highly sensitive immunohistochemical staining method EnVision+. J Forensic Sci. 2002 Mar;47(2):341-44. doi: 10.1520/JFS15254J
    8. Denomme GA, Rios M, Rcid ME. Molecular Protocols in Transfusion Medicine. London, United Kingdom: Academic Press Publications; 2000. 186 p. https://www.elsevier.com/books/molecular-protocols-in-transfusion-medicine/denomme/978-0-12-209370-8
    9. Zhu Z, Ye L, Li Q, Gao H, Tan Y, Cai W. Red Cell Immunohematology research conducted in China. Transfus Med Rev. 2017 Apr;31(2):102-106. doi: 10.1016/j.tmrv.2016.11.004
    10. Chun S, Choi S, Yu H, Cho D. Cis-AB, the Blood Group of Many Faces, Is a Conundrum to the Novice Eye. Ann Lab Med. 2019 Mar;39(2):115-20. doi: 10.3343/alm.2019.39.2.115
    11. Mohammadi S, Moghaddam M, Babahajian S, Karimian MS, Ferdowsi S. Discrepancy in ABO Blood Grouping in a Blood Donor: a case report. IJBC. 2018; 10(2):61-63. http://ijbc.ir/article-1-795-en.pdf
    Address for correspondence:
    61022, Ukraine,
    Kharkiv, Nauky Ave.,4,
    Kharkiv National Medical University,
    Department of Internal Medicine ¹2,
    of Clinical Immunology and Allergology
    named after Academician L.T.Malaya.
    Tel. +380688888201,
    e-mail: valentinka_1987@ukr.net,
    Dielievska Valentyna Yuriivna
    Information about the authors:
    Kravchun Pavlo G., MD, Professor, Head of the Department of Internal Medicine ¹2, of Clinical Immunology and Allergology Named After Academician L.T.Malaya, Kharkiv National Medical University, Kharkiv, Ukraine.
    https://orcid.org/0000-0002-8285-6763
    Kozhyn Mykhailo I., PhD, Associate Professor of the Department of Internal Medicine ¹2, of Clinical Immunology and Allergology Named After Academician L.T.Malaya, Kharkiv National Medical University, Kharkiv, Ukraine.
    https://orcid.org/0000-0002-8359-8890
    Leontyeva Frida S., PhD, Head of the Department of Laboratory Diagnostics and Immunology, Institute of Spine and Joint Pathology named after M. I. Sytenko, Kharkiv, Ukraine.
    https://orcid.org/0000-0001-9801-7908
    Vorontsov Petr M., PhD, Head of the Department of Experimental Modeling and Transplantology, Institute of Spine and Joint Pathology named after M. I. Sytenko, Kharkiv, Ukraine.
    https://orcid.org/0000-0002-5758-7223
    Ashukina Nataliya A., PhD, Head of the Morphology of Connective Tissue, Institute of Spine and Joint Pathology named after M. I. Sytenko, Kharkiv, Ukraine.
    https://orcid.org/0000-0002-0478-7440
    Marushchak Oleksii P., Orthopedist and Traumatologist, Institute of Spine and Joint Pathology named after M. I. Sytenko, Kharkiv, Ukraine.
    https://orcid.org/0000-0002-5606-8763
    Dielievska Valentyna Y., PhD, Assistant of the Department of Internal Medicine ¹2, of Clinical Immunology and Allergology Named After Academician L.T.Malaya, Kharkiv National Medical University, Kharkiv, Ukraine.

    PEDIATRIC SURGERY

    D.A. MOROZOV1, E.K. AYRYAN1, E.N. TCMOKALUK2, K.D. MOROZOV1, Z.F. SATAEVA1

    CLITOROPLASTY WITH MORPHOLOGY OF THE GLANS SENSITIVE ZONES IN CHILDREN WITH DISORDERS OF SEX DEVELOPMENT

    I.M. Sechenov First Moscow State Medical University1,
    A.I. Evdokimov Moscow State University of Medicine and Dentistry 2, Moscow,
    The Russian Federation

    Objective. Òo improve the results of feminizing plastics of the external genital organs in children with disorders of sex development.
    Methods. 114 patients were operated on from the period of 1998 to 2017. The two-stage correction of the genitals was performed in the majority – 108 patients (94%). 79 (69%) children underwent feminizing plastic surgery according to A.B. Okulov, the feminizing plastic with preservation of the dorsal vascular-neural bundle was done in 35 (31%) patients. Among the patients of this group, in 29 (25%) the removal of excess tissues of the clitoral glans along the lateral surfaces and in 6 (5%) along the ventral surface was performed. Control examination of patients after plastic was performed on the 10th, 30th, 60th, 90th, 180th, 360th day, the appearance of the genitals was assessed for feminine type and clitoral reperfusion timing. 18 patients (15%) underwent the morphological examination of the resected sections of the clitoral glans. Morphological studies of 25 samples of full-layer sections of the clitoris glans were performed: 14 lateral, 6 ventral and 5 dorsal fragments.
    Results. Evaluation of cosmetic results in the early and long-term after surgery did not show significant differences, regardless of the method of clitoroplasty. Reperfusion timing in the group where the plastic was performed according to A.B. Okulov was higher in comparison with the groups with the preservation of the dorsal vascular-neural bundle 3.8 sec. (3; 4.4)/ 2.5 sec. (1.9; 3.1) (ð=0.003). During microscopy it was revealed that the head of the clitoris is rich in nerve trunks and tactile bodies, which are located mainly on the ventral and dorsal areas of the glans of the clitoris. The innervation of the skin of the lateral sections of the clitoris glans is due to small nerve endings without sensitive bodies.
    Conclusions. While carrying out clitoroplasty, preference should be given to the methods with preservation of the dorsal vascular-neural bundle. When the glans is resected, the ventral and dorsal surfaces of the organ should be preserved.

    Keywords: clitoroplasty, resection of the clitoris glans, feminizing plastics, virilization, disorders of sex development
    p. 541-552 of the original issue
    References
    1. Akramov NR, Zakirov AK. Sexual development disorder in girls: evolution of views on surgical treatment. Reproduktiv Zdorov’e Detei i Podrostkov. 2012;(5):50-63. https://elibrary.ru/item.asp?id=18913158 (in Russ.)
    2. Lean WL, Hutson JM, Deshpande AV, Grover S. Clitoroplasty: past, present and future. Pediatr Surg Int. 2007 Apr;23(4):289-93. doi: 10.1007/s00383-007-1893-y
    3. Acimi S, Acimi MA, Debbous L, Bessahraoui M, Bouanani I. Clitoroplasty: A variant of the technique by Acimi. Arab J Urol. 2018 Feb 22;16(2):232-37. doi: 10.1016/j.aju.2017.12.005. eCollection 2018 Jun.
    4. Okulov AB, Negmadzhanov BB. Khirurgicheskie bolezni reproduktivnoi sistemy i sekstransformatsionnye operatsii: ruk dlia vrachei. Moscow, RF; 2000. (in Russ.)
    5. Patil UA, Patil PU, Devdikar MS, Patil SU. Reduction clitoroplasty by ventral approach: technical refinement. J Obstet Gynaecol India. 2019 Apr;69(Suppl 1):48-52. doi: 10.1007/s13224-017-1062-8
    6. Mouriquand PD, Gorduza DB, Gay CL, Meyer-Bahlburg HF, Baker L, Baskin LS, Bouvattier C, Braga LH, Caldamone AC, Duranteau L, El Ghoneimi A, Hensle TW, Hoebeke P, Kaefer M, Kalfa N, Kolon TF, Manzoni G, Mure PY, Nordenskjöld A, Pippi Salle JL, Poppas DP, Ransley PG, Rink RC, Rodrigo R, Sann L, Schober J, Sibai H, Wisniewski A, Wolffenbuttel KP, Lee P. Surgery in disorders of sex development (DSD) with a gender issue: If (why), when, andhow? J Pediatr Urol. 2016 Jun;12(3):139-49. doi: 10.1016/j.jpurol.2016.04.001
    7. Creighton SM, Minto CL, Steele SJ. Objective cosmetic and anatomical outcomes at adolescence of feminising surgery for ambiguous genitalia done in childhood. Lancet. 2001 Jul 14;358(9276):124-25. doi: 10.1016/S0140-6736(01)05343-0
    8. Creighton SM, Liao LM. Changing attitudes to sex assignment in intersex. BJU Int. 2004 Mar;93(5):659-64. doi: 10.1111/j.1464-410X.2004.04694.x
    9. Sane K, Pescovitz OH. The clitoral index: a determination of clitoral size in normal girls and in girls with abnormal sexual development. J Pediatr. 1992:120(2 Pt 1):264-66. doi: 10.1016/S0022-3476(05)80439-1
    10. Asafo-Agyei SB, Ameyaw E, Chanoine JP, Zacharin M, Nguah SB. Clitoral size in term newborns in Kumasi, Ghana. Int J Pediatr Endocrinol. 2017;2017:6. doi: 10.1186/s13633-017-0045-y
    11. Yang J, Felsen D, Poppas DP. Nerve sparing ventral clitoroplasty: analysis of clitoral sensitivity and viability. J Urol. 2007 Oct;178 (4 Pt 2):1598-601. doi: 10.1016/j.juro.2007.05.097
    12. Yankovic F, Cherian A, Steven L, Mathur A, Cuckow P. Current practice in feminizing surgery for congenital adrenal hyperplasia; a specialist survey. J Pediatr Urol. 2013 Dec;9(6 Pt B):1103-7. doi: 10.1016/j.jpurol.2013.03.013
    13. Baskin LS, Yuce lS, Cunha GR, Glickman SE, Place NJ. A neuroanatomical comparison of humans and spotted hyena, a natural animal model for common urogenital sinus: clinical reflections on feminizing genitoplasty. J Urol. 2006 Jan;175(1):276-83. doi: 10.1016/S0022-5347(05)00014-5
    Address for correspondence:
    119991, The Russian Federation,
    Moscow, Trubetskaya Str., 8-2,
    I.M. Sechenov First Moscow
    State Medical University,
    Department of Pediatric Surgery
    and Urology-Andrology.
    Tel. +7-968-067-18-95,
    e-mail: edikayryan@mail.ru,
    Eduard K. Ayryan
    Information about the authors:
    Morozov Dmitry A., MD, Professor, Head of the Department of Pediatric Surgery and Urology-Andrology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
    https://orcid.org/0000-0002-1940-1395
    Ayryan Eduard K., Assistant of the Department of Pediatric Surgery and Urology-Andrology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
    https://orcid.org/0000-0002-8267-0205
    Tcmokaluk Elena N., Assistant of the Pathologic Anatomy Department, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
    https://orcid.org/0000-0003-2722-6096
    Morozov Kirill D., Student of the Educational Program «Medicine of the Future», I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
    https://orcid.org/0000-0002-6300-1102
    Sataeva Zifa F., Student of the Pediatric Faculty, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
    https://orcid.org/0000-0003-3780-577X

    REVIEWS

    V.A. GOMBOLEVSKIY 1, A.E. NIKOLAEV 1, A.N. SHAPIEV 1, A.O. KOSOLAPOV 2, P.B. GELEZHE 1, 2, A.A. BARCHUK 3, P.A. DREVAL 4, Y.S. ESAKOV 5, S.P. MOROZOV 1

    MANAGEMENT OF PATIENTS WITH SOLID PULMONARY NODULES DETECTED IN LUNG CANCER SCREENING

    Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies1,
    European Medical Center 2,
    N.N. Petrov National Medical Research Center of Oncology 3,
    Moscow City Oncological Hospital ¹ 624,
    A.V. Vishnevsky Institute of Surgery5 Moscow,
    The Russian Federation

    According to the low-dose computed tomography, conducted as a part of the screening, the pulmonary nodule is the most common finding, but the primary low-dose computed tomography does not allow determining the etiology, so these patients are repeated the low-dose computed tomography depending on the size, or additional methods of examination and verification are performed.
    In the international medical communities that develop lung cancer screening programs, a fundamental place is occupied by guideline for pulmonary nodules identified by low-dose computed tomography.
    The literature review is devoted to the relevance of the problem in pulmonary nodule verification with additional studies (computed tomography, positron emission tomography combined with computed tomography) and different variations of biopsies under visualization control (under the control of CT, ultrasound). It is shown that different methods of verification are to be used most efficiently depending on the localization of pulmonary nodule, as well as on the basis of the oncoconsilium decision.
    Unfortunately, the analysis of the literature revealed no scientific papers showing the positive and negative sides of subpleural biopsy nodules identified in the screening under the control of ultrasound and computed tomography. When assessing pulmonary nodule using such an expensive method as positron emission tomography combined with computed tomography, which have many false positive results. In subpleural localization of the pulmonary nodule it is more rational to use biopsy under visualization control. Conducting in this aspect of large prospective randomized controlled studies would allow a more reasonable approach to the selection of the choice verification and additional methods for assessing pulmonary nodule.

    Keywords: low-dose computed tomography, lung cancer screening, lung cancer, biopsy of subpleural nodules, nodule verification, guideline for pulmonary nodules, solid nodules
    p. 553-562 of the original issue
    References
    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394-24. doi: 10.3322/caac.21492
    2. National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, Gareen IF, Gatsonis C, Marcus PM, Sicks JD. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011 Aug 4;365(5):395-409. doi: 10.1056/NEJMoa1102873
    3. Bach PB, Mirkin JN, Oliver TK, Azzoli CG, Berry DA, Brawley OW, Byers T, Colditz GA, Gould MK, Jett JR, Sabichi AL, Smith-Bindman R, Wood DE, Qaseem A, Detterbeck FC. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA. 2012 Jun 13;307(22):2418-29. doi: 10.1001/jama.2012.5521
    4. Field JK, Smith RA, Aberle DR, Oudkerk M, Baldwin DR, Yankelevitz D, Pedersen JH, Swanson SJ, Travis WD, Wisbuba II, Noguchi M, Mulshine JL. International association for the study of lung cancer computed tomography screening workshop 2011 report. J Thorac Oncol. 2012 Jan;7(1):10-19. doi: 10.1097/JTO.0b013e31823c58ab
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    Information about the authors:
    Gombolevsky Victor A., PhD, Head of the Department of Radiology Quality Development of Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation.
    https://orcid.org/0000-0003-1816-1315
    Nikolaev Alexander E., Junior Researcher of the Department of Radiology Quality Development of Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation.
    https://orcid.org/0000-0001-5151-4579
    Shapiev Arsen N., Analyst of the Department of Scientific Activities Coordination of Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation.
    https://orcid.org/0000-0002-1890-6711
    Kosolapov Anatoly O., Radiologist of European Medical Center, Moscow, Russian Federation.
    https://orcid.org/0000-0002-6257-892X
    Gelezhe Pavel B., Radiologist of European Medical Center, Researcher of Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation.
    https://orcid.org/0000-0003-1072-2202
    Barchuk Anton A., PhD, Researcher of N.N. Petrov National Medical Research Center of Oncology, Saint-Petersburg, Moscow, Russian Federation.
    https://orcid.org/0000-0002-4629-3326
    Dreval Petr A., PhD, Surgeon of Moscow City Oncological Hospital ¹ 62, Moscow, Russian Federation.
    https://orcid.org/0000-0003-3641-868X
    Esakov Yury S., PhD, Surgeon of A.V. Vishnevsky Institute of Surgery, Moscow, Russian Federation.
    https://orcid.org/0000-0002-5933-924X
    Morozov Sergey P., MD, Director of Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation.
    https://orcid.org/0000-0001-6545-6170

    E.L. KALMYKOV1, M.K. GULOV2, B.B. KAPUSTIN3, D.K. MUHABBATOV2, O. NEMATZODA4, S.M. ZARDAKOV2, A.R. KODIROV2

    TO THE QUESTION ABOUT MINI-INVASIVE SURGERY OF LIVER ECHINOCOCCOSIS

    University Hospital Cologne1, Cologne, Germany,
    Avicenna Tajik State Medical University2, Dushanbe, The Republic of Tajikistan
    Izhevsk State Medical Academy3, Izhevsk, The Russian Federation
    Republican Scientific Centre for Cardiovascular Surgery 4, Dushanbe,
    The Republic of Tajikistan

    The possibilities of using mini-invasive technologies (laparoscopic echinococcectomy, PAIR technology, removal of an echinococcus cyst from the mini-access) in treating patients with the liver echinococcosis have been analyzed in the review. Currently, there is a tendency to expand the indications for laparoscopic echinococtectomy, both in case of “difficult” localization and in the presence of complicated cysts. The main danger in laparoscopic echinococcectomy is the rupture of a cyst and the discharge of its contents into the abdominal cavity with the development of anaphylactic shock and dissemination of the parasite, bleeding. The frequency of postoperative complications is 6-22% of cases, mortality approaches zero. Relapses are practically not observed.
    The success of the PAIR procedure reaches 97%; the frequency of deaths and complications is 0-1% and 8.5-32%, respectively. The recurrence rate also varies considerably from 0 to 48%. However, a sufficiently large number of applications of this technology, a small number of patients included in the research, as well as limited indications for its use, do not allow us concluding about the comparative effectiveness of the method.
    The difficulty of comparing the advantages and disadvantages of using echinococcectomy from mini-access is due to the small number of observations, the lack of comparative studies, and the short observation period in the postoperative period. The frequency of postoperative complications reaches 7%, the mortality rate approaches zero.
    The choice of the method of minimally invasive treatment of the liver echinococcosis is based on the size and localization of the cyst, the presence of cysto-biliary communications, as well as the presence of a complicated course of the disease or the lack thereof.
    Complicated cysts and cysts of complex localization remain unsolved issues in the treatment of the liver echinococcosis with the use of mini-invasive methods of surgical treatment

    Keywords: liver hydatidosis, PAIR, laparoscopic echinococcectomy, mini-access, complications
    p. 563-573 of the original issue
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    Address for correspondence:
    734003, The Republic of Tajikistan,
    Dushanbe, Sanoi Str., 33,
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    Centre for Cardiovascular Surgery.
    Tel.: +992 91 525 00 55,
    e-mail: sadriev_o_n@mail.ru,
    Nematzoda Okildjon
    Information about the authors:
    Kalmykov Egan L., PhD, Research Assistant of the Vascular and Endovascular Surgery Unit, University Hospital Cologne, Cologne, Germany.
    https://orcid.org/0000-0001-6784-2243
    Gulov Mahmadsho K., MD, Professor of the General Surgery Department ¹1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
    https://orcid.org/0000-0001-5151-937X
    Kapustin Boris B., MD, Professor, Head of the Hospital Surgery Department, Izhevsk State Medical Academy, Izhevsk, Russian Federation.
    https://orcid.org/0000-0003-4076-9466
    Mukhabbatov Dzhiyonhon K., MD, Assistant of the General Surgery Department ¹1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
    https://orcid.org/0000-0002-2100-310X
    Nematzoda Okildjon, PhD, Leading Researcher, Republican Scientific Centre for Cardiovascular Surgery, Dushanbe, Republic of Tajikistan.
    https://orcid.org/0000-0001-7602-7611
    Zardakov Sorbon M., Post-Graduate Student of the General Surgery Department ¹1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
    https://orcid.org/0000-0002-8233-2732
    Kodirov Abdurauf R., PhD, Assistant of the General Surgery Department ¹2, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
    https://orcid.org/0000-0001-8982-2243

    CASE REPORTS

    S.A. KUSHTUMOV 1, 2, S.A. ATAMANOV 1, E.V. SHINKEVICH 1, P.I. MURAVIEV 1, A.G. MAKEEV 1, 2, E.G. GRIGORYEV 2, 3

    HYBRID HEMOSTASIS IN STAB WOUND OF THE VERTEBRAL ARTERY, COMPLICATED BY A FALSE ANEURYSM

    Irkutsk State Clinical Hospital 1,
    Irkutsk State Medical University 2,
    Irkutsk Scientific Centre of Surgery and Traumatology 3, Irkutsk
    The Russian Federation

    The article reports the staged management of a patient with stab wound of the neck, the injury of the left vertebral artery in the transverse processes canal of the cervical spine and the injury of the internal jugular vein. Emergency care in the district hospital included surgical debridement and wound canal revision, as well as the closure of the anterior wall of the internal jugular vein. On the fifth postoperative day, a tumor-like soft pulsating painful mass was detected above the clavicle. Auscultation revealed a systolic murmur. The patient was moved to the vascular surgery department of the regional hospital. MSCT-angiography showed a saccular mass lesion 40×30×23 mm with irregular contours at the level of C3-C4 vertebrae - false arteriovenous aneurysm. During the surgical wound exploration and aneurysm opening, arterial bleeding from the injured artery occurred. Temporary bleeding arrest was performed by tamponade of the bone defect with wax. The final hemostasis was achieved by X-ray-endovascular occlusion of the vertebral artery using catheter retrograde and antegrade spiral and amplatzer techniques. In the postoperative period, ultrasound study revealed subcutaneous fluid mass in the area of postoperative suture. After removing the sutures, 30 ml of lysed blood and clots were evacuated.
    The patient was discharged in a satisfactory condition on the 13th postoperative day. Examination in two months revealed no complaints. Physical activity is in full volume. There are no violations of the quality of life.

    Keywords: stab wound, vertebral artery, internal jugular vein, posttraumatic aneurysm, endovascular hemostasis
    p. 574-578 of the original issue
    References
    1. Greer LT, Kuehn RB, Gillespie DL, White PW, Bell RS, Armonda RA, Fox CJ. Contemporary management of combat-related vertebral artery injuries. J Trauma Acute Care Surg. 2013 Mar;74(3):818-24. doi: 10.1097/TA.0b013e31827a08a8
    2. Rahme R, Hamilton JF. Vertebral artery injuries in penetrating neck and cervical spine trauma. In: Ecklund JM, Moores LE, editors. Neurotrauma management for the severely injured polytrauma patient. Switzerland: Springer International Publishing; 2017. p. 103-13. https://link.springer.com/book/10.1007%2F978-3-319-40208-6
    3. Sarkari A, Singh PK, Mahapatra AK. Lethal penetrating stab injury to the vertebral artery: A case report with review of literature. Asian J Neurosurg. 2016 Jul-Sep;11(3):317. doi: 10.4103/1793-5482.144192
    4. Antonov GI, Miklashevich ER, Gladyshev SYu, Bogdanovich SO. New surgical treatment for vertebral artery pseudoaneurysm at the boundary between the V2 and V3 segments. Vopr Neirokhirurgii im NN Burdenko. 2015;79(3):90-95. doi: 10.17116/neiro201579390-95 (in Russ.)
    5. Yaguchi S, Yamamura H, Kamata K, Shimamura N, Kakehata S, Matsubara A. Treatment strategy for a penetrating stab wound to the vertebral artery: a case report. Acute Med Surg. 2019 Jan;6(1):83-86. Published online 2018 Nov 28. doi: 10.1002/ams2.381
    6. Uchikawa H, Kai Y, Ohmori Y, Kuratsu J. Strategy for endovascular coil embolization of a penetrating vertebral artery injury. Surg Neurol Int. 2015; 6:117. Published online 2015 Jul 8. doi: 10.4103/2152-7806.160320
    Address for correspondence:
    664003, The Russian Federation,
    Irkutsk, Krasnogo Vosstaniya Str., 1,
    Irkutsk State Medical University,
    Hospital Surgery Department.
    Tel. +7 9025 111 027,
    e-mail: egg@iokb.ru,
    Eugene G. Grigoryev
    Information about the authors:
    Kushtumov Sergei A., PhD, Assistant of the Hospital Surgery Department, Irkutsk State Medical University, Head of the Vascular Surgery Department, Irkutsk State Clinical Hospital, Irkutsk, Russian Federation.
    http://orcid.org/0000-0003-4630-1274
    Atamanov Sergey A., PhD, Specialist on X-ray Endovascular Diagnostics and Treatment, Irkutsk State Clinical Hospital, Irkutsk, Russian Federation.
    http://orcid.org/0000-0002-9660-3740
    Shinkevich Eduard V., PhD, Cardiovascular Surgeon of the Vascular Surgery Department, Irkutsk State Clinical Hospital, Irkutsk, Russian Federation.
    http://orcid.org/0000-0002-2729-4278
    Muraviev Pavel I., Cardiovascular Surgeon of the Vascular Surgery Department, Irkutsk State Clinical Hospital, Irkutsk, Russian Federation.
    http://orcid.org/0000-0002-9061-0544
    Makeev Alexander G., PhD, Associate Professor of the Human Anatomy Department, Irkutsk State Medical University, Cardiovascular Surgeon of the Vascular Surgery Department, Irkutsk State Clinical Hospital, Irkutsk, Russian Federation.
    http://orcid.org/0000-0002-4512-2656
    Grigoryev Eugene G., MD, Professor, Corresponding Member of RAS, Supervisor, Irkutsk Scientific Centre of Surgery and Traumatology, Head of the Hospital Surgery Department, Irkutsk State Medical University, Head of the Vascular Surgery Department, Irkutsk State Clinical Hospital, Irkutsk, Russian Federation.
    https://orcid.org/0000-0002-5082-7028

    N.M. MALASHENKO 1, S.A. YESKOV 2, V.T. MALKEVICH 3, A.V. ZAPALIANSKI 1, A.A. SVIRSKY 1, YU.M. GRINEVICH 1, K.YU. MARAKHOVSKY 1, YU.I. LINNIK 1, E.S. RYABUSHKO 1, A.I. ZAMAREEV 1, V.I. AVERIN 2

    PRIMARY CONGENITAL TRACHEAL STENOSIS IN AN INFANT

    Children’s Surgery National Applied Research Hospital 1, Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology2 N.N. Alexandrov National Cancer Centre of Belarus3, Belarusian State Medical University 4 Minsk, The Republic of Belarus

    Primary congenital stenosis of the trachea is a rare malformation and occurs in 1 of 64,500 newborns, prevailing in boys. Combined malformations are detected in 80% of these patients, and cardiovascular malformations are in half of the cases. The clinical picture of the tracheal stenosis is non-specific, especially in children older than 1 month. Generally, symptoms can be distinguished for all age groups: stridor, tachypnea, tachycardia, acrocyanosis, perioral cyanosis, which are aggravated during feeding and physical exertion. Without surgical treatment mortality reaches 80%.
    The article presents a clinical observation of an 8-year-months child with multiple congenital malformations: congenital heart disease, diverticulum and tracheal stenosis at the Th2 level, bilateral vesicoureteral reflux, grade 4, right ureterohydronephrosis.
    Clinical manifestations of tracheal stenosis haven’t been marked in this patient for a long time, as a result, the defect was suspected quite late. The diagnosis was estimated by tracheobronchoscopy, angiopulmonography, bronchography and computed tomography.
    The patient underwent a circular resection of the thoracic trachea with an “end-to-end” anastomosis under conditions of cardiopulmonary bypass. The child was discharged home on the 15th day in satisfactory condition.

    Keywords: primary congenital tracheal stenosis, children, clinical presentation, diagnosis, resection of the trachea
    p. 579-585 of the original issue
    References
    1. Antón-Pacheco JL, Morante R. Operative or non-operative treatment of congenital tracheal stenosis: is there something new? J Thorac Dis. 2017 Dec;9(12):4878-80. doi: 10.21037/jtd.2017.11.75
    2. Herrera P, Caldarone C, Forte V, Campisi P, Holtby H, Chait P, Chiu P, Cox P, Yoo SJ, Manson D, Kim PC. The current state of congenital tracheal stenosis. Pediatr Surg Int. 2007 Nov;23(11):1033-44. doi: 10.1007/s00383-007-1945-3
    3. Hoffer ME, Tom LW, Wetmore RF, Handler SD, Potsic WP. Congenital tracheal stenosis. The otolaryngologist’s perspective. Arch Otolaryngol Head Neck Surg. 1994 Apr;120(4):449-53. doi: 10.1001/archotol.1994.01880280077015
    4. Rudenko ЄÎ. Complete cartilage rings – a rare and severe trachea stenosis in children/ Minimally invasive and surgical treatment. Khirurgiia Ditiachogo Viku. 2018;(1):66-74. doi 10.15574/PS.2018.58.66 (in Ukr.)
    5. Perel’man MI. Khirurgiia trakhei. Moscow RF: Meditsina; 1972. 190 p. https://studfiles.net/preview/1215219 (in Russ.)
    6. Grillo HC. Surgery of the trachea and bronchi. London, UK: BC Decker Inc Hamilton; 2004. 872 p.
    7. Volosianko AB, Khodan VV, Bagr³i MM, Kuzik SV, Navrots’ka LB, ²l’k³v MV. Kl³n³chna kharakteristika stenotichnikh urazhen’ verkhn³kh v³dd³l³v dikhal’nogo traktu u d³tei rann’ogo v³ku [Elektronnyi resurs]. Zdorov’e Rebenka. 2012;(1):66-69. [Data obrashcheniia 01 Ianv 2019]. http://www.mif-ua.com/archive/article/26008 (in Ukr.)
    8. Shevchenko IuV, Seliverstov PV, Nechaev EV. MÑT-isometry of stenoses of a throat and trachea. [Elektronnyi resurs]. Sib Med Zhurn. 2014;(1):117-21. [Data obrashcheniia 20 Okt 2018]. http://smj.ismu.baikal.ru/index.php/osn/issue/view/29/2014-1 (in Russ.)
    9. Tatur AA. Circular tracheal resection in treatment of cicatricial stenosis [Elektronnyi resurs]. Med Zhurn. 2014;(1):119-24. [Data obrashcheniia 25 Okt 2018]. https://www.bsmu.by/medicaljournal/category47/ (in Russ.)
    10. Krivcenya DU, Rudenko EO, Dubrovin A.G. Minimally invasive treatment of airway stenoses in children. Perinatologiia i Pediatriia. 2018;(1):118-24. doi: 10.15574/PP.2018.73.118 (in Ukr.)
    11. Komori K, Toma M, Shimojima N, Yamamoto Y, Uto K, Ogata S, Kano M, Hirobe S. Laryngeal release with slide tracheoplasty for long-segment congenital tracheal stenosis. Gen Thorac Cardiovasc Surg. 2015 Oct;63(10):583-85. doi: 10.1007/s11748-013-0329-y
    12. Tsugawa C, Kimura K, Muraji T, Nishijima E, Matsumoto Y, Murata H. Congenital stenosis involving a long segment of the trachea: further experience in reconstructive surgery. J Pediatr Surg. 1988 May;23(5):471-75. doi: 10.1016/S0022-3468(88)80451-2
    13. Backer CL, Holinger LD. A history of pediatric tracheal surgery. World J Pediatr Congenit Heart Surg. 2010 Oct;1(3):344-63. doi: 10.1177/2150135110381602
    14. Chiu PP, Kim PC. Prognostic factors in the surgical treatment of congenital tracheal stenosis: a multicenter analysis of the literature. J Pediatr Surg. 2006 Jan;41(1):221-25; discussion 221-5. doi: 10.1016/j.jpedsurg.2005.10.043
    Address for correspondence:
    220013, The Republic of Belarus,
    Minsk, Independence Ave., 64,
    Children’s Surgery National
    Applied Research Hospital.
    Tel. +375 29 386 81 79,
    e-mail: kisandra@yandex.ru,
    Nikita M. Malashenko
    Information about the authors:
    Malashenko Nikita M., Pediatric Surgeon, Surgical Department ¹3, Children’s Surgery National Applied Research Hospital, Minsk, Republic of Belarus.
    https://orcid.org/0000-0002-4340-7623
    Yeskov Sergey A., PhD, Thoracic Surgeon, Head of the Thoracic Department, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
    https://orcid.org/0000-0001-9957-1644
    Malkevich Viktar T., MD, Associate Professor, Thoracic Surgeon, Head of the Laboratory of the Thoracic Cancer Pathology, N.N. Alexandrov National Cancer Centre of Belarus, Lesnoy, Minsk District, Republic of Belarus.
    https://orcid.org/0000-0001-6138-8713
    Zapalianski Andrei V., PhD, Pediatric Surgeon, Head of the Surgery Department, Children’s Surgery National Applied Research Hospital, Minsk, Republic of Belarus.
    https://orcid.org/0000-0001-6854-7625
    Svirsky Aliaksandr A., PhD, Associate Professor, Pediatric Surgeon, Deputy Director for Medical Work, Children’s Surgery National Applied Research Hospital, Minsk, Republic of Belarus.
    https://orcid.org/0000-0001-6323-6537
    Grinevich Yuri M., PhD, Associate Professor, Pediatric Surgeon, Head of the Surgical Department ¹4, Children’s Surgery National Applied Research Hospital, Minsk, Republic of Belarus.
    https://orcid.org/0000-0003-4376-9971
    Marakhovsky Kirill Yu., PhD, Pediatric Surgeon, Head of the Diagnostic Department, Children’s Surgery National Applied Research Hospital, Minsk, Republic of Belarus.
    https://orcid.org/0000-0002-4191-6053
    Linnik Yuri I., Pediatric Cardiovascular Surgeon, Head of the Department of Pediatric Cardiovascular Surgery, Children’s Surgery National Applied Research Hospital, Minsk, Republic of Belarus.
    https://orcid.org/0000-0002-8281-3149
    Ryabushko Elena S., Perfusiologist, the Department of Anesthesiology and Resuscitation ¹1, Children’s Surgery National Applied Research Hospital, Minsk, Republic of Belarus.
    https://orcid.org/0000-0002-6248-9847
    Zamareev Aliaksandr I., Anesthesiologist - Resuscitator, Head of the Department of Anesthesiology and Resuscitation ¹1, Children’s Surgery National Applied Research Hospital, Minsk, Republic of Belarus.
    https://orcid.org/0000-0002-3712-8505
    Averin Vasily I., MD, Professor, Head of the Department of Pediatric Surgery, Belarusian State Medical University, Minsk, Republic of Belarus.
    https://orcid.org/0000-0003-3343-8810

    EXCHANGE OF EXPERIENCE

    A.F. CHERNOUSOV, T.V. KHOROBRYH, F.P. VETSHEV, V.I. KOROTKIY, N.M. ABDULKHAKIMOV, R.E. SALIKHOV

    EXPERIENCE OF FUNDOPLICATION AND GASTROPLICATION IN TREATMENT OF REFLUX ESOPHAGITIS IN CARDIOFUNDAL, SUBTOTAL AND TOTAL HIATAL HERNIAS

    I.M. Sechenov First Moscow State Medical University, Moscow,
    The Russian Federation

    Objective. To present the surgical treatment results of patients with cardiofundal, subtotal and total gastric hiatal hernias with a complete symmetric fundoplication or gastroplication cuff from the traditional and laparoscopic approaches.
    Methods. Surgeries were performed in 81 patients with reflux esophagitis and cardiofundal, subtotal or total hiatal hernias. In the first group laparoscopy was conducted in 33 patients (fundoplication-11, gastroplication-22, posterior cruroraphy-23), laparotomy – in 48 patients (fundoplication – 8, gastroplication – 40, posterior cruroraphy – 28). The first group consisted of 30 women, the second one - 33.
    Results. I – II degree complications according to the Clavien-Dindo classification were in 10 (12.3%) patients, treated conservatively. Surgical treatment was effective in all patients. 2 patients after laparoscopy required reoperation in the early postoperative period due to technical errors at the early stage of mastering the method. 1 patient after laparotomy required a reoperation due to the developed bleeding from the abdominal wall’s drainage orifice. Posterior cruroraphy was effective in all patients, regardless of the size of the hiatus. Surgical treatment, according to x-ray studies with contrast, despite the developed complications, was effective in all patients regardless of access in the early postoperative period.
    Conclusions. A complete symmetric anti-reflux cuff effectively corrects reflux, regardless of its location above or below the diaphragm and regardless of the chosen access. The formation of a full symmetric anti-reflux cuff without fixing it to the legs of the diaphragm is the most appropriate and safe way. It is also necessary to remove the hernial sac from the posterior mediastinum. Correction of the diameter of the esophageal orifice with posterior cruroraphy without a mesh is effective in the treatment of cardiofundal, subtotal and total hiatal hernias.

    Keywords: esophagus, diaphragm, hiatal hernia, gastroesophageal reflux disease, surgical treatment, fundoplication, cruroraphy
    p. 586-594 of the original issue
    References
    1. Mozharovskiy VV, Tsyganov AA, Mozharovskiy KV, Tarasov AA. Evaluating an effectiveness of surgical treatment of gastroesophageal reflux disease combined with hiatal hernia. Khirurgiia Zhurn im NI Pirogova. 2017;(6):28-32. doi: 10.17116/hirurgia2017628-32 (In Russ.)
    2. Chilintseva N, Brigand C, Meyer C, Rohr S. Laparoscopic prosthetic hiatal reinforcement for large hiatal hernia repair. J Visc Surg. 2012 Jun;149(3):e215-20. doi: 10.1016/j.jviscsurg.2012.01.006
    3. Lal P, Leekha N, Chander J, Dewan R, Ramteke VK. A prospective nonrandomized comparison of laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication in Indian population using detailed objective and subjective criteria. J Minim Access Surg. 2012 Apr;8(2):39-44. doi: 10.4103/0972-9941.95529
    4. Qin M, Ding G, Yang H. A clinical comparison of laparoscopic Nissen and Toupet fundoplication for gastroesophageal reflux disease. J Laparoendosc Adv Surg Tech A. 2013 Jul;23(7):601-4. doi: 10.1089/lap.2012.0485
    5. Cuschieri A, Shimi S, Lesley K, Nathanson LK. Laparoscopic reduction, crural repair, and fundoplication of large hiatal hernia. Am J Surg. 1992 Apr;163(4):425-30. doi: 10.1016/0002-9610(92)90046-tLI>
    6. MÜller-Stich BP, Achtstätter V, Diener MK, Gondan M, Warschkow R, Marra F, Zerz A, Gutt CN, BÜchler MW, Linke GR. Repair of paraesophageal hiatal hernias – is a fundoplication needed? a randomized controlled pilot trial. J Am Coll Surg. 2015 Aug;221(2):602-10. doi: 10.1016/j.jamcollsurg.2015.03.003
    7. Dean C, Etienne D, Carpentier B, Gielecki J, Tubbs RS, Loukas M. Hiatal hernias. Surg Radiol Anat. 2012 May;34(4):291-99. doi: 10.1007/s00276-011-0904-9
    8. Luketich JD, Raja S, Fernando HC, Campbell W, Christie NA, Buenaventura PO, Weigel TL, Keenan RJ, Schauer PR. Laparoscopic repair of giant paraesophageal hernia: 100 consecutive cases. Ann Surg. 2000 Oct;232(4):608-18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421193/
    9. Chernousov AF, Khorobrykh TV, Vetshev FP, Refliuks-ezofagit. Moscow, RF: Prakt meditsina; 2017. 14, 214 p. (in Russ.)
    10. Awad ZT, Filipi C. The short esophagus. Pathogenesis, diagnosis, and current surgical options. Arch Surg. 2001;136(1):113-14. doi: 10.1001/archsurg.136.1.113
    11. Antiporda M, Veenstra B, Jackson C, Kandel P, Daniel Smith C, Bowers SP. Laparoscopic repair of giant paraesophageal hernia: are there factors associated with anatomic recurrence? Surg Endosc. 2018 Feb;32(2):945-54. doi: 10.1007/s00464-017-5770-z
    12. Yatabe K, Ozawa S, Ito E, Oguma J, Kazuno A, Nitta M, Ninomiya Y. Late esophageal wall injury after mesh repair for large esophageal hiatal hernia: a case report. Surg Case Rep. 2017 Dec 15;3(1):125. doi: 10.1186/s40792-017-0401-4
    Address for correspondence:
    119435, The Russian Federation,
    Moscow, B. Pirogovskaya Str., 6, b.1,
    I.M. Sechenov First Moscow
    State Medical University,
    Clinic of the Faculty Surgery
    named after N.N. Burdenko,
    Department of Faculty Surgery ¹1.
    Tel. +7 906 068-38-12,
    e-mail: dr.korotkiy@mail.ru,
    Valentin I. Korotkiy
    Information about the authors:
    Chernousov Alexander F., MD, Professor, Academician of RAMS, Honored Scientist of the Russian Federation, Head of the Department of Faculty Surgery ¹1, the Clinic of the Faculty Surgery named after N.N. Burdenko, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
    https://orcid.org/0000-0001-8792-1459
    Khorobryh Tatiana V., MD, Professor of RAMS, Professor of the Department of faculty surgery ¹1, the Clinic of the Faculty Surgery named after N.N. Burdenko, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
    https://orcid.org/0000-0001-5769-5091
    Vetshev Fedor P., MD, Associate Professor, the Department of Faculty Surgery ¹1, the Clinic of the Faculty Surgery named after N.N. Burdenko, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
    https://orcid.org/0000-0001-6589-092X
    Korotkiy Valentin I., Surgeon, Post-Graduate, the Department of Faculty Surgery ¹1, the Clinic of the Faculty Surgery named after N.N. Burdenko, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
    https://orcid.org/0000-0002-1359-5379
    Abdulkhakimov Nuriddin M., Surgeon, Assistant, the Department of Faculty Surgery ¹1, the Clinic of the Faculty Surgery named after N.N. Burdenko, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
    https://orcid.org/0000-0002-8324-2376
    Salikhov Rashad, 6-year Student, the Department of Faculty Surgery ¹1, the Clinic of the Faculty Surgery named after N.N. Burdenko, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
    https://orcid.org/0000-0003-1090-2123

    D.V. AFANASYEV 1, A.V. RODIN 1, V.G. PLESHKOV 1, A.P. MOSKALEV 2, V.S. ZABROSAEV 1, N.V. DANILENKOV 1

    ANALYSIS OF COMPLICATIONS FOLLOWING INTRALUMINAL ENDOSCOPIC INTERVENTIONS ON MAJOR DUODENAL PAPILLA

    Smolensk State Medical University 1,
    Smolensk Regional Clinical Hospital 2, Smolensk,
    The Russian Federation

    Objective. To define the ways of complications prevention and improvement of endoscopic papillosphincterotomy outcomes.
    Methods. Outcomes of endoscopic interventions in 2150 patients with the pathology of hepatopancreatoduodenal zone were analyzed. The performed interventions were the following: endoscopic papillosphincterotomy (EPST) – 1485, endoscopic retrograde cholangiopancreatography (ERCPG) – 457, EPST combined with the common bile duct stone extraction – 148, EPST combined with ERCPG – 130, nasobiliary drainage – 18, biliary ducts stenting – 16, intraoperative EPST – 13, sanitation of the stents – 3, cutting the choledochoduodenal anastomosis – 1. Two- and three-staged interventions were performed in 118 patients. The criteria for the evaluation of the endoscopic interventions results were: incidence and outcomes of complications in the period from 1 to 30 days after manipulations.
    Results. Complications following interventions were observed in 60 (2.8%) patients. The most frequent complications were: acute pancreatitis – 26 cases (1.2%), bleeding – 20 cases (0.9%), retroperitoneal perforation of the duodenum – 4 cases (0.2%). Lethal outcomes – in 21 cases (1.0%). The risk of acute pancreatitis increased almost by 2 times in young and middle-aged patients, in patients with postcholecystectomy syndrome. In case of absolute indications absence for endoscopic interventions mortality rate increased by 30 times (27.3%). Bleeding occurred 2 times more often in patients with obstructive jaundice (1.8%). In case when two- and three-staged endoscopic interventions were carried out no complications were observed.
    Conclusions. Prevention of complications should be aimed at diagnosis and treatment of choledocholithiasis in patients with chronic calculous cholecystitis in the preoperative period. Care should be taken in young and middle-aged patients. In cases of obstructive jaundice sparing papillosphincterotomy should be carried out. Endoscopic interventions on the major duodenal papilla should be performed according to strong indications.

    Keywords: endoscopic papillosphincterotomy, endoscopic common bile duct stone extraction, obstructive jaundice, choledocholithiasis, complications
    p. 595-602 of the original issue
    References
    1. Dudin AM, Gredzhev FA, Kosse DM, Kaplun AI, Matvienko VA. Åndoscopic papillosphincterotomy for patients with complicated cholangiolithiasis. Aktual’n³ Problemi Suchasnoï Meditsini: V³snik Ukraïns’koï Medichnoï Stomatolog³chnoï Akadem³ï. 2013;13(1):91-93. http://umsa.edu.ua/pdf/mag2/2013n41_1.pdf (in Russ.)
    2. Krasil‘nikov DM, Safin RSh, Vasil’ev DZ, Zakharova AV, Mirgasimova DM, Yusupova AF. Prevention of complications after endoscopic retrograde cholangiopan creatography and papillosphincterotomy. Kazan Med Zhurn. 2012;93(4):597-601. https://kazanmedjournal.ru/kazanmedj/article/view/1551 (In Russ.)
    3. Lupal’tsov VI, Kotovschikov MS, Dehtyaruk IA, Trofimova AV. Modern aspects of surgical tactics when treating patients with cholelithiasis, complicated with obstructive jaundice. Orenburg Med Vestn. 2016;IV(3 Pril):51-53. https://www.orgma.ru/files/Izdatelstvo/OMV/N/%D0%BE%D1%80%D0%B5%D0%BD_%D0%BC%D0%B5%D0%B4_%D0%B2%D0%B5%D1%81%D1%82%D0%BD%D0%B8%D0%BA_3_web_16.pdf (in Russ.)
    4. Kenzhaev LR, Murodov TR, Turaev UR, Saidov IK, Kholikov FI. Ispol’zovanie maloinvazivnykh metodov lecheniia bol’nykh s mekhanicheskoi zheltukhoi v neotlozhnoi khirurgii. Dostizheniia Nauki i Obrazovaniia. 2018; (14):73-75. https://scientifictext.ru/images/PDF/2018/DNO-14-36/DNO-14-36.pdf (in Russ.)
    5. Nazarov ZN, Iusupalieva DB, Tilavova IuM. Khirurgicheskaia taktika pri zhelchnokamennoi bolezni, oslozhnennoi mekhanicheskoi zheltukhoi. Vopr Nauki i Obrazovaniia. 2019;(7):211-18. https://scientificpublication.ru/images/PDF/2019/53/Questions-of-science-and-education-7-53.pdf (in Russ.)
    6. Yusif-zade KR. Efficiency of endoscopic retrograde cholangiopancreatography and papillosphincterotomy at treatment of biliary system diseases Novosti Khirurgii. 2012;20(5):128-31. http://www.surgery.by/pdf/full_text/2012_5_19_ft.pdf (in Russ.)
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    https://orcid.org/0000-0002-2852-5330

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