Aim. The aim of this study is to assess the effectiveness of a modified postoperative rehabilitation protocol in patients who underwent their first carpometacarpal joint resection suspension interposition autotendoplasty.Materials and Methods. The study included 52 patients treated for trapeziometacarpal joint osteoarthritis stage II—IV according to the Eaton-Littler and Kellgren-Lawrence classification in the Upper Limbs Surgery Department of the Bauman City Clinical Hospital from 2017 to 2022. All patients underwent trapeziometacarpal joint resection suspension interposition autotendoplasty and a course of rehabilitation. The evaluation of surgical treatment and rehabilitation results was carried out based on indicators on the VAS, DASH, and hand grip strength scales 12 months after surgery.Results. The complex treatment resulted in the complete restoration of hand function. Twelve months after surgery, there was a significant improvement in hand functional parameters. According to the DASH scale, the improvement was 80 % compared to the preoperative level (p = 0.000). The pain syndrome, according to the VAS scale, decreased by 84 % from the baseline (p = 0.000). Affected hand grip strength reached its maximum value of 26.2 kg, exceeding the preoperative level by 67 % (p = 0.006).Conclusion. The modified rehabilitation protocol used after performing trapeziometacarpal joint resection suspension interposition autotendoplasty in clinical practice enabled the full restoration of affected hand function.

Aim. To enhance the outcomes of treating patients with acute non-occlusive mesenteric ischemia (focal) following colostomy, aiming to gain a better understanding of the prevalent risk factors for complications and exploring ways of their reduction.Materials and methods. A clinical case detailing the treatment of a patient with acute non-occlusive mesenteric ischemia amidst abdominal sepsis and stoma necrosis, compounded by inflammatory disease of the spinal cord membranes, is presented. Additionally, the clinical observation of a patient experiencing postoperative complications, including coronavirus infection and bilateral hydrothorax, is provided.Results. In a patient presenting severe coronary pathology alongside a nuanced clinical manifestation of mesenteric ischemia in the delayed phase, a surgical intervention involving intestinal tract resection and subsequent stoma removal was conducted. Regrettably, stoma necrosis ensued, necessitating reconstructive surgery. The patient’s initial critical state, compounded by the requirement for repeated surgical intervention, precipitated a swift progression of multiple organ failure, culminating in mortality. Conversely, another patient, postoperatively diagnosed with coronavirus infection and bilateral hydrothorax, exhibited amelioration in clinical status following administered treatment, ultimately warranting hospital discharge.Conclusions. Early diagnosis and timely surgical intervention contribute to improving the prognosis of treatment. Early postoperative complications and repeated surgical interventions significantly worsen the prognosis.

Aim. To enhance the treatment outcomes of complicated inguinal hernias (characterized by a high inguinal gap, a large hernia orifice, a weakened posterior wall of the inguinal canal, or recurrence) through the implementation of a developed technique involving multilayer alloplasty.Materials and Methods. Within the overall cohort of 396 patients who underwent inguinal hernia surgeries between 2019 and 2023, the prevalence of complicated hernias was investigated. The main study group comprised 28 patients with complicated inguinal hernias who underwent surgery following the proposed method utilizing a two-layer prosthesis.Results. Complicated inguinal hernias, necessitating additional reinforcement of the posterior wall of the inguinal canal, predominantly manifest in patients with a large hernia orifice size (W3 — 6.57 ± 1.25 %), a significant inguinal gap (13.13 ± 1.70 %), and a history of relapses (8.59 ± 1.41 %). An associated condition complicating hernioplasty and elevating the risk of recurrence (0.618) is obesity (61.76 ± 8.33 % in the recurrent hernia group). The application of the developed hernioplasty method shows no significant difference in terms of complication risk and subjective sensations compared to the Lichtenstein method. Notably, no hernia recurrences were observed with the utilization of the duplication plasty technique.Conclusion. The suggested duplication design of the prosthesis proves effective in providing ex- tensive reinforcement for the inguinal gap in cases of problematic hernias. It is easy to position and is associated with minimal discomfort, as reported by the subjective sensations of patients.

In the hierarchy of acute abdominal diseases, acute cholecystitis holds the third position, surpassing both acute appendicitis and acute pancreatitis. Despite advancements in laparoscopic cholecystectomy, intraabdominal complications following cholecystectomy for acute cholecystitis remain pertinent, and their prevalence increases with open cholecystectomy, contributing to elevated mortality rates. This underscores the critical need for timely diagnosis and comprehensive understanding of the development of postoperative intraabdominal complications. This article is a literature review encompassing various randomized clinical trials sourced from open-access journals worldwide. Leveraging electronic libraries such as PubMed, Scopus, Web of Science, elibrary.ru, Cochrane Library, and others, we explore different approaches to the diagnosis and treatment of complications arising after cholecystectomy for acute cholecystitis over the past decade. The primary objective of this review is to discern the most contemporary diagnostic methods and surgical approaches employed in the treatment of patients experiencing diverse postoperative complications.

Complications of shoulder joint traumas stand as a significant concern in modern traumatology. Various forms of endoprosthetics offer the potential to restore lost function resulting from fractures or dislocations of the proximal humerus. In the context of a significant deficiency in the rotator cuff of the shoulder (RC) in elderly patients with notably aged injuries, reverse endoprosthetics (RE) emerges as a justifiable choice. The accrued experience from the widespread adoption of anatomical arthroplasty of the shoulder joint (PS) has significantly influenced the evolution of this approach. Complications and progressive failures with short-term outcomes prompted the quest for solutions to the challenges posed by complex fractures and dislocations through the method of reverse arthroplasty, originally devised for treating rotatory arthropathy of the shoulder. However, the extensive application of RE has not consistently yielded excellent and good results in all cases of post-fracture and dislocation consequences. Mechanical complications, particularly periprosthetic fractures, are prevalent in RE and occur three times more frequently than in anatomical total arthroplasty of the shoulder joint. The urgency of this problem, considering the diminished rehabilitation potential of patients against the backdrop of intraoperative or postoperative fractures of the humerus and scapula, leading to a persistent deficit in the function of the shoulder joint, underscores the necessity of this study.

Aim. To investigate potential strategies for enhancing the treatment outcomes of patients with fractures and injuries to the proximal humerus through delayed reverse endoprosthesis.Materials and methods. From 2014 to 2022, reverse shoulder endoprosthesis (RSE) was performed on 64 patients aged 44 to 85 with fractures and dislocations. Among them, 39 patients were classified as elderly (60—74 years) at the time of surgery. Specifically, 22 patients underwent RSE within the first 6 months after the injury, 15 within the period from 6 to 12 months post-injury, and 27 were operated on no earlier than a year after the injury. Radiographs were analyzed, and postoperative complications and treatment results were evaluated before surgery, as well as at 3, 6, 12, and 24 months using the Constant Shoulder Score, UCLA, and ASES questionnaires.Results. Over a 2-year period post reverse shoulder endoprosthesis (RSE), there was a notable improvement in average scores across all assessment scales: Constant Shoulder Score improved from 18.2 ± 10.5 to 69.9 ± 20.7 points; ASES increased from 22.0 ± 10.3 to 82.0 ± 14.4 points, and UCLA rose from 14.7 ± 21.3 to 27.8 ± 5.92 points.Conclusions. Performing reverse shoulder endoprosthesis in patients with fractures and fractures-dislocations of the humerus in the delayed period allows achieving better treatment outcomes. Reverse shoulder endoprosthesis is a complex operation and is associated with a fairly large number of complications. Hence, engaging surgeons with expertise in such procedures is recommended.

Aim: identification of the main causes of failures of previous surgical interventions and methods of their prevention during the primary surgical treatment of hernia of the esophageal orifice of the diaphragm.Material and methods. To address the scientific inquiry, an extensive review was conducted across global scientific literature focused on the treatment of primary and recurrent hernias of the esophageal orifice of the diaphragm (GPOD). Additionally, a clinical observation is provided, detailing a surgical intervention performed on a patient who had undergone correction for hernia and gastroesophageal reflux disease (GERD) on two prior occasions.Results. The scientific literature reports limited instances of successfull correction of the recurrence of gastroesophageal reflux disease (GERD) and gastroesophageal orifice di- aphragmatic hernias (GPOD) in patients after two fundoplications. The term ‘failed fundo- plication’ is introduced, a concept not yet described in domestic literature. Eliminating the incorrectly formed antireflux mechanism, which leads to a programmed recurrence of GPOD, and implementing technically correct antireflux interventions allow for the achievement of a pronounced clinical effect in patients who have undergone one or more fundoplications, provided there is adequate peristalsis of the esophagus and stomach. In the presented clin- ical case, the surgical procedure is based on the principles of mitigating the consequences of the previous intervention through repeated intervention primarily focused on eliminating gastroesophageal reflux.Conclusion. Repeated antireflux surgical interventions pose a significant challenge in surgical treatment, attributable to multiple factors concurrently. Identifying technical errors during ear- ly antireflux surgical interventions, eliminating them, and establishing an adequate antireflux mechanism contribute to the success of repeated interventions. Standardization of antireflux interventions is imperative, as adherence to the technical aspects of primary surgical interven- tions represents the most effective means to diminish the risk of disease relapse and the fre- quency of subsequent revision antireflux operations.

Aim. To conduct a comparative analysis of the effectiveness of local anesthetics used for regional anesthesia.Methods. An open randomized study was conducted to assess the effiacy and safety of Articaine-Binergia 20 mg/ml and Lidocaine as local anaesthetics for anaesthesia at two levels (axillary and wrist) during surgical procedures on the upper limbs of geriatric patients with degenerative-dystrophic hand and forearm conditions.Results. The results of the study convincingly proved the advantage of Articaine-Binergia 20 mg/ml in terms of effiacy and safety. A notable advantage observed was the shorter latency period, which translates into reduced patient time in the operating room and increased operational effiiency.Conclusions. Based on the study fidings, Articaine-Binergia is recommended for anaesthesia in traumatology-orthopedics involving upper limb procedures, especially for patient groups at higher risk of systemic toxicity.

Aim. To compare the clinical effectiveness of argon plasma coagulation (APC) and radiofrequency ablation (RFA) for the treatment of patients with chronic radiation proctitis (CRP) complicated by recurrent rectal bleeding.Methods. A prospective, randomized, single-center study conducted in the State Medical University of the Loginov Moscow State Medical Scientifi Centre. The study included 73 patients with 1—2 degrees of CLP on the RTOG/EORTC scale. The indication for endoscopic treatment was recurrent rectal bleeding. Endoscopic treatment was performed: APC (36 patients) and RF (37 patients), depending on randomization.Results. In 44 patients (60.2 %), of which 18 (50 %) patients in the APC group and 26 (70.2 %) patients in the RF group, a complete regression of the disease was revealed. Telangiectasia was detected in 18 patients (50 %) in the APC group and in 11 patients (29.7 %) in the RF group, which were a continuing source of bleeding. After regression of inflmmatory changes, the patients underwent the second stage of surgery corresponding to the randomization group. After the second stage of surgery in the APC group in 17 patients (94.4 %) and in the RF group in 11 patients (100 %), a complete regression of the disease was revealed. Postoperative pain syndrome occurs in two groups; however, the RF group experiences higher intensity and longer duration of pain.Conclusion: Radiofrequency ablation and argon plasma coagulation are effective and safe treatments for rectal bleeding in chronic radiation proctitis without erosive or ulcerative lesions.

Aim. This study aimed to evaluate the therapeutic effiacy of two laser modalities, namely a 595-nm pulsed dye laser and a 755-nm long-pulse alexandrite laser, in the treatment of hemangiomas in patients with concurrent anemia.Methods. A total of 194 patients diagnosed with infantile hemangiomas, characterized by a thickness ranging from over 2 mm to under 8 mm, were included in this study. The patients were randomly assigned to two groups: the control group received treatment with the 595-nm pulsed dye laser, while the experimental group underwent sequential therapy, beginning with the 755-nm long-pulse alexandrite laser followed by the 595-nm pulsed dye laser.Results. In the control group, the overall treatment effiacy was 36.1 %. In contrast, the experimental group exhibited a signifiantly higher effiacy of 76.3 %. Statistical analysis of the abundance data was conducted using the Chi-square (X2) test, with results deemed statistically signifiant at a signifiance level of P < .05.Conclusion. Sequential therapy, which integrates both the 755-nm pulsed dye laser and the 595-nm pulsed dye laser, demonstrates remarkable effectiveness in treating hemangiomas, particularly in cases complicated by anemia.