First Stage Of Surgical Treatment Research Articles

Strategy of stage treatment for patients with perforated diverticulitis: first experience

BACKGROUND: The results of surgical treatment of patients with perforative diverticulitis of the colon are still unsatisfactory today. Since the majority of patients undergo Hartmann surgery, the main problem is a large number of stoma patients. Three quarters of them live with a stoma for a long time, which negatively affects their quality of life and increases the cost of treatment.
 AIM: The purpose of this research work is to improve the immediate results of treating patients with perforative diverticulitis and peritonitis by using staged surgical tactics.
 MATERIALS AND METHODS: The reaserach included 14 patients with perforative diverticulitis Hinchey grade II-III. The average value of the Mannheim peritoneal index is 18.9 ± 6.3 points. At the first stage of surgical treatment, all the patients underwent colon resection with a zone of perforation of the diverticulum and leaving its muffled ends in the abdominal cavity. After lavage and drainage, temporary closure of the anterior abdominal wall was performed. After 24–48 hours, all the patients underwent colon reconstraction.
 RESULTS: The average age of the patients was 52.3 ± 12.4 years with 4 women (28.6%) and 10 men (71.4%). The average duration of the first stage was 105.7 ± 27.2 minutes, the second one — 113.2 ± 40.5 minutes. The average hospital-stays were 16.4 ± 7.2 days. There were no anastomosis failures and no lethal outcomes. Complications were noted in 9 patients (64.3%), grade I according to Clavien – Dindo — 83.4%.
 CONCLUSIONS: The tactics of early surgical treatment is a promising concept for patients with perforative diverticulitis. It provides rapid elimination of the septic focus during the first surgical operation, assumes early reconstruction of the intestine without increasing the number of complications and mortality, and can be used in patients with peritonitis.

Application of Reversed Radial Forearm Flap for Reconstruction of a Dorsal Hand Soft Tissue Defect: А Clinical Case

Worldwide, surgical techniques for soft-tissue hand defects have made use of the reversed radial forearm flap. Generally, has been used in dorsal hand defects. In this case report, we showed the outcome of a case where the reversed radial forearm flap was applied to treat the dorsal hand defect. A 45-year-old patient who was injured in November 2020 as a result of stacking the right hand in the rotational mechanism. The injury was received 3 days before admission to the hospital. The first stage of surgical treatment was performed - necrectomy of the wound of the right hand. Afterwards, therapy using vacuum-assisted closure (V.A.C) was administered for 18 days. Once granulations had formed in the wound, the patient underwent the second phase of surgical intervention. The reversed radial forearm flap was turned and placed in order to close an opened, exposed bones and tendons in the dorsum of hand. There was no complication with flap viability in the postoperative period. Patient’s joint range of motion and vital functions were acceptable. This case showed that the Reversed Radial Forearm Flap can also be used in dorsal hand defects.Keywords: flap, pedicled flap, soft tissue injuries, hand injuries

Changes of the morpho-functional parameters of the retina of patients after surgical treatment of rhegmatogenous retinal detachment complicated by macular hole in the early postoperative period

Objective: to realize the effectiveness of surgical treatment of patients with retinal detachment and macular hole PVR C, depending on the method of closing the macular hole. Material and methods. The data of 20 patients (20 eyes) with a diagnosis of retinal detachment with macular hole PVR С were studied. Patients of the 1st group (10 patients, 10 eyes) underwent surgical treatment with closure of the macular hole with an inverted flap of the inner limiting membrane. Patients of the 2nd group (10 patients, 10 eyes) did not undergo closure of the macular hole during the first stage of surgical treatment. Results. In the 1st group, it was possible to achieve closure of the macular hole in 80% of cases. In the 2nd group, a day after the operation, there was a significant decrease in the diameter to 263±46 urn. When re-examined a month later, in 80% of cases, the macular hole was closed. When studying the results of micro-perimetry one day after the operation, positive dynamics was noted. While after a month of observation, the indicators of patients in the second group were significantly higher. Conclusion. The method of surgical treatment of retinal detachment with macular hole showed greater efficiency in refusing to perform membranopiling; in patients of this group, higher functional results were achieved. During the observation period, cases of a decrease in the diameter of an intact macular hole and its complete closure under the action of silicone tamponade were recorded. If necessary, membrane peeling can be delayed during a second silicone oil removal operation.

Late diagnostics of Hirschsprung’s disease in a 17-year-old girl: a clinical observation

Introduction. The congenital absence of nerve ganglia in the intermuscular and submucosal nerve plexuses of the colon in Hirschsprung’s disease leads to impaired motility and the risk of intestinal obstruction. Most often, Hirschsprung’s disease diagnosis is put in the neonatal period or in early childhood. Rare cases of late diagnostics may be associated with a blurred clinical picture, as well as with delay in histological verification of aganglionosis.
 Clinical observation. This clinical observation describes a case of 17-year-old patient who was admitted to the surgical department with complaints on the lack of independent stool, a large fecal stone, abdominal pain. The patient could not have the self-emptying stool since her birth. Conservative therapy had only a partial positive effect. Irrigography findings caused a suspicion on agangliosis pathology of the rectosigmoid colon; however, histological verification of the diagnosis has never been made. Immunohistochemical examination of bioptats of the rectal mucous for calretinin had confirmed the Hirschsprung’s disease, and the first stage of surgical treatment was performed – resection of the sigmoid colon section with a fecal stone and descendostomy formation. Radical surgery was postponed because of patient’s pregnancy.
 Conclusion. Late diagnosis of Hirschsprung’s disease is still a problem even in classical forms of the disease. It is important to be alert in older children and adults with a history of long-lasting constipation. Morphological examination of the neural ganglia of the colon is a key point in verifying the diagnosis.

Reconstruction of the pulmonary vascular bed at the stages of hemodynamic correction in patients with functionally single ventricle

The OBJECTIVE was to study the prevalence and nature of congenital and acquired anatomical features of the pulmonary vascular bed in patients with single ventricle and to evaluate their impact on staged hemodynamic correction.METHODS AND MATERIALS. The study was a retrospective cohort study based on the study of the experience of surgical treatment of patients with a single ventricle from 2005 to 2022. 208 patients, 95 females and 113 males met the inclusion criteria. Depending on the type of the first stage of correction, all patients were divided into three groups: 1 – patients after the Norwood operation (n=84), 2 – patients after the isolated systemic-to-pulmonary shunts (n=74), 3 – patients after pulmonary artery band or those who did not need the first stage of surgical treatment (n=50).RESULTS. From all patients who survived the Stage-I (158 patients), 47 (30 %) patients underwent 72 reconstructive interventions on the pulmonary arteries: 8 % – before Stage-II, 46 % – at Stage-II, 17 % – between stages II and III, 11 % – at Stage-III and 18 % – after Stage-III. When comparing freedom from stenosis of the pulmonary arteries, statistically significant differences were found between groups of patients (p=0.005), with the least freedom from stenosis in group 1 (after the Norwood operation) and the greatest freedom from stenosis in group 3 (after pulmonary artery band or without first stage of correction).CONCLUSIONS. Patients with a functionally single ventricle are at risk of developing pulmonary artery stenosis throughout the entire period of staged hemodynamic correction and after its completion. The identified narrowing needs immediate correction, since a long-term existing narrowing can lead to hypoplasia of the pulmonary vascular bed and become an obstacle to the timely Fontan completion. More extensive use of tomographic imaging techniques is recommended in order to fully assess the degree of narrowing.

Призматическая коррекция остаточного или рецидивирующего косоглазия

Introduction. Recurrent strabismus is a common issue after operations because of heterotrophy. Many scientific works have examined clinical parameters that may predispose to relapse of esotropia after surgery, including poor sensory status, high ratio of accommodative convergence to accommodation, uncorrected farsightedness or combination of these factors. Purpose. To evaluate the effectiveness of prismatic correction of recurrent esotropia in patients after the first stage of surgical treatment. Material and methods. The study group included 24 patients. They were divided into two groups in depends on the postoperative functional treatment. 1st group consisted of 12 patients with partially accommodative esotropia aged 5 to 8 years (6,48 ± 1,12 years) with average hypermetropic refraction +3,10 ± 0,54 diopters. This group of patients was assigned prismatic correction after a relapse of esotropia. 2st group consisted of 12 patients with partially accommodative esotropia aged 5 to 8 years (6,22 ± 1,29 years) with average hypermetropic refraction +3,13 ± 0,61 diopters. This group of patients was assigned orthoptic treatment after a relapse of esotropia. Results. Prismatic correction contributed to recovery binocular vision at 75 % of patients with recurrent esotropia ≤ 20 PD, in the comparison group (orthoptic treatment) – at 50 %. Moreover, the number of patients with stereopsis in the group «EFP» after the treatment was higher than in the group «Synoptophore» (p < 0,05). Conclusion. Prismatic correction ensures optimal motor status while maintaining sufficient sensory balance in most patients with recurrent esotropia after performing recession rectus medialis in combination with median duplication m. rectus lateralis. Keywords: Recurrent strabismus, binocular vision, elastic Frensel prism

Choosing the tactics of surgical treatment of vascular leukomas based on impression cytology

Purpose: to provide clinical and morphological evaluation of the corneal epithelium phenotype in total vascular leukomas of varied etiologies and determine the optimal surgical treatment using impression cytology (IC).Materials and methods. 44 patients (44 eyes) with corneal vascular leukomas of various etiologies underwent optic keratoplasty preceded by IС. The patients were divided into 2 groups according to IC findings. Group 1 included 30 patients who were shown by IC to have corneal epithelium. These patients received penetrating keratoplasty (PK). Group 2 consisted of 14 patients whose epithelium was determined to be of conjunctival phenotype. Eight of group 2 patients had their corneal epithelium phenotype restored by limbal transplantation followed by PK. The remaining patients of group 2 were not operated for various reasons.Results. In the remote postoperative period (9–12 months after the operation) corrected visual acuity of group 1 patients ranged from 0.3 to 0.6 (ave. 0.450 ± 0.073). A relapse of corneal leukoma was observed in three patients of group 1 (10%). In group 2, a transparent vascular-free engraftment of keratotransplants was observed in 5 patients after limbal transplantation (the first stage of surgical treatment) and PK, their corrected visual acuity ranged from 0.1 to 0.5 (ave 0.37 ± 0.12), 1 (20%) patient had a relapse of the leukoma. Conclusions. Impression cytology is an acceptable and low invasive diagnostic technique that allows clinical and morphological evaluation of the epithelium phenotype that covers the vascular leukoma and helps determine validated indications for the choice of a surgical treatment technique for such patients.

Evaluation of results of combined treatment in patients with disseminated ovarian cancer

Background. According to the modern concept of surgical treatment of ovarian cancer (OC) it is necessary to perform cytoreductive surgery (CRS) without residual tumor in order to achieve more favorable oncological prognoses. However, the possibilities of achieving it with a disseminated process (stages IIIIV) are limited, and therefore, for some patients, neoadjuvant chemotherapy (NACT) is the optimal initial treatment.
 Aim. To compare the duration of progression-free survival (PFS) of patients with advanced OC after treatment, as well as to assess the value of the prognostic nutritional index (PNI) in predicting this outcome.
 Materials and methods. We conducted a retrospective cohort study of 78 patients with stages IIIIV OC, who received combined treatment between January 2016 and March 2020 (54 patients after primary CRS (PCRS)+platinum-based chemotherapy (CT), 24 patients after NACT+interval CRS (ICRS)+postoperative CT. The predictive value of the PNI was calculated.
 Results. The complete PCRS is associated with increased PFS: after complete PCRS 3211.21 months (95% confidence interval CI 10.0953.97); after optimal PCRS 223.46 months (95% CI 15.2128.79); after suboptimal PCRS 147 months (95% CI 0.2827.72). Performing a complete ICRS is associated with decreased PFS compared to PCRS, even if the complete CRS is achieved: after complete ICRS 143.34 months (95% CI 7.4620.54); after optimal ICRS 172.16 months (95% CI 12.7721.23); after suboptimal ICRS 7 months. PNI27.86 correlates with an increased probability of complete PCRS in patients with advanced PCR (AUC 94.3, sensitivity 80%, specificity 91.7%; p0.001).
 Conclusion. Achieving complete PCRS in patients with disseminated OC leads to an improvement in the oncological outcome. The prognostic value of pre-treatment calculation of PNI has been revealed: an increased PNI is associated with more favorable perioperative outcomes. Objective criteria should be developed for a strictly reasoned refusal to carry out the first stage of surgical treatment due to the obviously less favorable prognosis of the tactics of "NACT+ICRS+CT".

Прогнозируемая интраоперационная индукция задней отслойки стекловидного тела

Purpose. To develop a technique for predictive intraoperative induction of posterior vitreous detachment as the first stage of surgical treatment of various vitreoretinal pathologies based on data of preoperative spectral optical coherence tomography (SOCT) and to evaluate its clinical effectiveness. Material and methods. 30 patients were performed surgery, 15 of them (15 eyes) with epiretinal fibrosis and 15 (15 eyes) with macular hole. Preoperatively, SOCT was used to determine the place of the retina in the parapapillary area, which is the most optimal for induction of posterior vitreous detachment during the operation. For this, a vitreoretinal interface was used on a Solix device (Optovue, USA) with a Full Range Retina protocol with a scan length of 16 mm, according to which the degree of vitreomacular and vitreopapillary adhesion was assessed. In the optimal zone of the posterior hyaloid membrane, microperforations were applied with a parapapillary vitreotom. At maximum vacuum (650 mm Hg), the vitreous body fibers were aspirated into the hole of the vitreotom until a characteristic “wave” or “meniscus” (“crescentic fold”) appeared along the edge of the optic disc. At the final stage, in the “vacuum mode”, movements from the optic nerve head to the periphery by the aspiration method raised the cortical layers of the vitreous body and torn off the posterior hyaloid membrane from the edge of the optic nerve head, separating the vitreous body from the center to the periphery of the retina. Results. In all 30 cases, it was possible to initiate intraoperatively posterior vitreous detachment without the use of dyes. There were no intraoperative complications. Conclusion. The proposed technique makes it possible to perform a predictable intraoperative induction of detachment of the posterior cortical layers of the vitreous from the retina, which is a necessary step for subsequent vitreoretinal surgery. Keywords: intraoperative induction of posterior vitreous detachment, posterior hyaloid membrane, posterior cortical layers.

Extensive penile skin necrosis after surgery for Peyronie's disease

The clinical case represents the surgical correction of postoperative complications in a patient with Peyronie's disease. The patient underwent flap corporoplasty using an autovein. The late postoperative period in the patient was complicated by extensive necrosis of the penile skin, which required repeated surgery as follows. The first stage of surgical treatment was performed by excision of necrotic tissues of the penile skin. Within 10 days of the postoperative period, chymotrypsin with an ointment containing dioxomethyltetrahydropyrimidine with chloramphenicol was applied to the penile wound surface to prepare the wound for subsequent skin autotransplantation. Further, within 5 days, the polymeric drainage sorbent «Aseptisorb DT» was applied to the wound surface until the wound was cleansed and granulation tissue was formed. The second stage of the surgical treatment performed penile skin replacement plasty with a free perforated skin graft taken from the patient's femoral surface.

Experience of managing neonates and breastfed in-fants with grade IV bilateral hydronephrosis

To analyze the clinical cases of four patients with grade IV bilateral hydronephrosis. Ultrasound examination of the urinary system was used as the main examination method. During the first stage of surgical treatment, all children underwent preliminary urinary diversion; a month later, the results were assessed. The result of the preliminary urinary diversion was the implementation of the Heines-Andersen-Kucher reconstructive operation. According to the control ultrasound performed a month after the nephrostomy, pelvis on the nephrostomy was reduced in all cases, parenchyma thickness increased by an average of 4.5 times, improvement in intragranular blood flow was noted. Evaluation of the effectiveness of pyeloplasty was carried out according to three criteria: restoration of urodynamics, restoration of kidney function and the presence of infectious complications. The parenchyma of the operated kidney grew by an average of 3 times, the pelvis decreased by an average of 3.5 times. Restoration of intrarenal blood flow to the cortical layer, inclusive, was noted in 5 of 8 renal units. Before pyeloplasty, there were marked changes in the renal parenchyma and a decrease in its function by an average of 34 14 %; a year after reconstructive surgery, the changes became moderate, there was an improvement in renal function, a decrease in function by 25 10 %. In our opinion, the starting method for providing urgent surgical care to neonates and breastfed infants with grade IV GN is preliminary urinary diversion, which allows us to determine the functional reserve of the renal parenchyma, delay reconstructive surgery, thereby giving time for the restoration of renal function and avoiding organ-carrying surgery.

Тактика и сроки проведения хирургического лечения у ребенка с врожденной эссенциальной эзотропией. Клинический случай

Purpose. To evalute the effective of the proposed volume of surgical treatment for the progressive course of infant esotropia. Material and мethods. A premature baby with congenital esotropia, which was diagnosed at the sith month of life. The patient was assigned a spectacle correction taking into account the par of ametropia and constant alternating occlusion. In connection with the subsequent increase in horizontal esodeviation and the appearance of a paretic component, a bilateral recession of the internal rectus muscle by 5mm was carried out in combination with an injection of Botox in a volume of 2.0. IU. Results and discussion. After the first stage of surgical treatment, a stable decrease of horizontal esodeviation and an increase of the amount of abduction were achieved. Conclusion. Bilateral combined weakening of medial rectus muscles (classical recession and chemorecession) allows to achieve predicted good results in case of large strabismus angles, combined with limi of abduction. Key words: congenital esotropia, chemodenervation, chemorecession.

Stagewise treatment of tandem lesions of the internal carotid artery in patients with ischaemic stroke

The study was aimed at assessing the results of a stagewise approach to surgical treatment of patients with ischaemic stroke and tandem lesions of coronary arteries. We analysed the results of treating a total of 19 patients with ischaemic stroke having endured in 2017-2018 surgical interventions for tandem lesions of the internal carotid artery. All 19 patients with tandem lesions underwent as the first stage of surgical treatment recanalization of the intracranial portion of the internal carotid artery. Nine patients were subjected to thromboextraction followed by carotid stenting (Group One), ten underwent thromboextraction and carotid endarterectomy (Group Two). One patient was subjected to simultaneous endovascular intervention at the intra- and extracranial level, in 18 patients reconstruction of the internal carotid artery at the extracranial level (second stage) was performed within a postponed period (3-5 days). In the postoperative period we assessed neurological deficit and the results of 90-day survival. No deterioration of neurological deficit was observed after the first stage of surgical treatment. There were statistically significant differences in the degree of regression of a stagewise treatment at discharge, with predominance in the second group. The 90-day survival rate had no prevalence in either group, despite 1 lethal outcome in a patient with simultaneous thromboextraction and stenting of the extracranial portion of the internal carotid artery. Adequate prevention of haemorrhagic transformation of the damaged zone of cerebral tissue in patients with ischaemic stroke caused by tandem lesions of carotid arteries may be ensured by means of selecting stagewise treatment, i. e., postponed elimination of extracranial stenosis of the internal carotid artery. Given a small sample size, the study requires further examination and assessment of the obtained results.

The use of computer‐aided design/ computer‐aided manufacturing technologies in the treatment of Graves' orbitopathy

AbstractPurposeTo study the advantages of using Computer‐Aided Design (CAD)/Computer‐Aided Manufacturing (CAM) technologies in the treatment of Graves Orbitopathy (GO).MethodsResearch analysis of contemporary scientific medical publications on the subject, The 2018 European Group on Graves ‘Orbitopathy Guidelines for the Management of Graves’ Orbitopathy (EUGOGO), Philips Diamond Select Brilliance CT64, software environment Sim Plant 13.02 and Geomagic Freeform Plus.ResultsGraves Orbitopathy (GO) is an autoimmune disease that results in dysteroid optic neuropathy (DON) in 3–5% of patients and progressive vision loss. According to the recommendations of EUGOGO 2018, orbital decompression is performed at the first stage of surgical treatment as scheduled with moderate inactive GO or immediately in patients with DON and/or rupture of the cornea with the involvement of a multidisciplinary team of radiodiagnosis, endocrinologist, ophthalmologist and maxillofacial surgeon. To increase the volume of bone orbit, surgeons extend the medial, lateral walls of the orbit, or the floor of the orbit, and remove a certain amount of infraorbital fat, but the only correct approach to date has not been determined (EUGOGO 2016). Given the need for an individual approach to the patient, the use of CAD/CAM technology to obtain three‐dimensional models of the skull expands the ability to study the features of the anatomy of the walls of the orbit, its volume, planning of surgery.ConclusionsThe result of a carefully planned orbit decompression using CAD/CAM technology is not only the reduction of intraocular pressure and exophthalmos for optimal treatment, but also the reduction of intraoperative complications (traumatization of the neurovascular bundles, muscles, etc.), shortening the duration of surgery.

A CASE REPORT OF SUCCESSFUL TREATMENT OF STAGE IV EWING’S SARCOMA IN AN ADOLESCENT PATIENT

Background. Ewing’s sarcoma is one of the most common musculoskeletal cancers in children and adolescents. Extremely aggressive clinical course of Ewing’s sarcoma makes a successful treatment of this tumor difficult. Despite a comprehensive multidisciplinary approach to the treatment of this cancer, including chemotherapy, surgery and radiation therapy, rapid tumor progression, recurrence and resistance to chemotherapy are still common.Our purpose was to present the results of a personalized approach to multidisciplinary combination treatment for musculoskeletal cancer involving polychemotherapy, 3D conformal radiation therapy and modern surgical technologies.Description of the clinical case. A female patient presented to Rostov Research Institute of Oncology complaining of a tumor and moderate pain in soft tissues of the left iliac region, left lower extremity, and lameness when walking. After complete examination, the patient was diagnosed with Ewing’s sarcoma of the left ilium with lung metastases (Т3N0M1). The patient received 6 cycles of neoadjuvant chemotherapy according to EURO EWING 2008 protocol; tumor progression and lung metastasis were registered. Two cycles of second-line chemotherapy were performed; by the decision of the doctors’ council, the first stage of surgical treatment was performed: resection of the left ilium and the defect replacement with a temporary cement spacer. In the postoperative period, the patient underwent 8 cycles of adjuvant chemotherapy, external beam radiation therapy to the lungs (12 Gy total dose) and the primary tumor (46 iGy total dose), and 12 cycles of supporting therapy. A delayed second reconstructive stage of surgical treatment involved removal of a temporary cement spacer and implantation of an individual pelvic stability system. The patient was followed-up for 25 months after the combination treatment, had no complaints, and was able to ambulate without assistance; the motor function of the left hip joint was fully preserved. Conclusion. The use of non-standard high-technology approaches to surgical treatment of unfavorably localized Ewing’s Sarcoma in combination with chemo-radiation therapy allows patients with advanced tumors to achieve satisfactory results and good quality of life.

SURGICAL TREATMENT OF TOTAL COLONIC AGANGLIOSIS IN CHILDREN

Introduction. Surgical treatment of total colonic aganglionosis in children after colectomy requires complex radical reconstructive plastic surgery. There are wide ranges of views for the selection of optimal approach for the correction of such anomalies. The main purpose of surgical intervention is to eliminate the consequences of colectomy by restoring the integrity of intestinal tract and normalize the disorders of water-electrolyte balance, improve normobiosis of intestine, increase the possibility of formation and accumulation of feces, slowing the passage of chyme in the digestive tract and correction of other metabolic disorders.The aim is to develop optimal approaches for surgical treatment of total colonic aganglionosis in children.Materials and methods. From 1980 to 2020 we have analyzed the surgical treatment of 41 children with total colonic aganglionosis using optimal reconstructive surgery for the formation of a functional intestinal reservoir. Isolated total colonic aganglionosis was found in 36 (87.80%) of 41 patients, while aganglionosis of total colon and a fragment of the small intestine in 5 (12.20%) of them.Results. The imposition of a protective ileostomy was performed as the first stage of surgical treatment in all the patients. 8-14 months later these children went through radical surgical intervention - colectomy with reconstructive operation for the formation of functionally advantageous small intestinal reservoir for restoring the integrity of the intestinal tract, with the reservoirs such as "J" - reservoir (n=1); ileotransplant with lateral ileo-ileoanastomosis (n=28); ileotransplant with lateral ileo- colo anastomosis (n=7); ileo-rectal primary anastomosis (n=1) or entero-enteroanastomosis with intussusception valve (n=4). The protective ileostomy was closed in 3-4 months after formation of reservoir.There were no complications in the postoperative period. The first 3 months the frequency of stool was 10-15 times, and after 1 year - 2-4 times a day. All patients survived. Functional treatment results are good. Intestinal function is satisfactory. Radiographs showed formed rectum with sufficient volume of reservoir and colonization.Conclusions. Surgical treatment of total colonic aganglionosis in children requires a three-stage approach: the imposition of a protective small intestinal stoma (1st stage); radical operation - colectomy with reconstructive-plastic operation for the formation of functionally advantageous reservoir as variant of "neorectum" (2nd stage) and closure of the ileostomy after adaptation of the formed small intestinal reservoir (3rd stage). Interoperative period (between ileostomy and radical surgery) lasting 8-14 months provides the restoration of important structural and homeostatic changes in children at the stages of surgical correction of the total colonic aganglionosis. Restoration of integrity of intestinal tract with the formation of functionally advantageous reservoir "side-by-side" with ileo-colon graft or ileo-ileo graft – is the best option for reconstructive surgery after total colectomy in children with aganglionosis. The formation of a functionally beneficial reservoir in children prevents water-electrolyte imbalance, improves normobiosis, formation and accumulation of feces, slows down the passage in the digestive tract and prevents the development of other metabolic disorders.No conflict of interest was declared by the authors.

FEATURES OF DEBRANCHING TECHNIQUE FOR AORTIC DISSECTIONS AND ANEURYSMS IN THORATIC AND THORACO-ABDOMINAL AORTAS

This article describes a hybrid surgical technique for high-risk patients with thoraco-abdominal aortic dissections and aneurysms. The technical aspects of the first stage of surgical treatment - visceral and brachiocephalic debranching are described in detail. 17 surgical interventions for chronic dissection and aneurysm in the thoracic and thoracoabdominal aortas were performed at the Vishnevsky National Medical Research Center of Surgery of Ministry of Health of the Russian Federation in the period from 2014 to 2019. In two cases, we observed postoperative pancreatitis after surgical treatment of the abdominal aorta branches, which we managed using conservative therapy. After open surgery, all patients were discharged in a satisfactory condition. The selected technique made it possible to prepare patients for the following stage of treatment - endografting of the aorta - without developing serious complications.

Diagnosis and treatment of destructive forms of acute pancreatitis

Purpose of the study. The study of the diagnosis and treatment of destructive forms of acute pancreatitis and the identification of possible ways to optimize them.
 Materials and methods. Destructive forms of acute pancreatitis were found in 16,8%. The algorithm for treating acute destructive pancreatitis consisted in artificial ventilation of the lungs, adequate infusion therapy, peridural anesthesia, setting up a nasoenteric probe, stimulating the bowels, correcting hemodynamics, intraand extracorporal detoxification, antisecretory, anti-bacterial, hepatoprotective, cerebroprotective, antioxidant therapy, directed immune correction, use of anti-enzyme drugs, suppression of the release of mediators inflammation, external secretory activity of the pancreas. Medical video laparoscopy and puncture interventions under the control of ultrasound were used as the first stage of surgical treatment. The indications for traditional surgical interventions are large areas of aseptic destruction, unlimited infected pancreatic necrosis, infection of necrotic areas with complete cell sequestration, abscesses with large sequesters, abdominal phlegmon, signs of progressive multiple organ failure and the development of arousal hemorrhage, perforation of cystic formations in the abdominal cavity, perforation of a hollow organ, purulent peritonitis.
 Results. The developed therapeutic tactics allowed, in destructive forms of acute pancreatitis, to achieve a reduction in overall mortality to 23,4%.
 Conclusion. Diagnostic and treatment tactics for destructive forms of acute pancreatitis should be standardized depending on the timing, severity of the disease, localization and prevalence of the destructive process, systemic and local complications.

CONSEQUENCES OF BURN INJURY OF ADNEXA IN CHILDREN. THE EFFECTIVENESS OF SURGICAL TREATMENT

Аim. Тo assess the effectiveness of surgical treatment of consequences of burn injury of adnexa in children. Material and methods. The analysis of clinical material over the past 10 years. The clinical group consisted of 59 patients (44 - male, 15 - female) with the consequences of burn injury of adnexa in age from 2 months to 18 years (m = 9.17 ±3.23 years). The burn trauma were the following: thermal (flame, hot objects, gas explosion) - 43, chemical (acid, alkali) - 11, combined (melted lead/glass) - 5. The time that has passed after the burn until the first stage of surgical treatment ranged from 1 month to 2 years (m= 9.7 ± 5.1 months). The author describes in detail the clinical picture, noting that significant lagophthalmos is dominated by the consequences of thermal burns, the consequences of chemical burns occurred entropion, symblepharon, leucoma. 11 patients had anophthalmos. In all, 121 operations were performed in 59 patients (1 to 4 stages, m = 2,1±1,1) with an interval from 3 to 12 months (m=8.3 months): removal of lagophthalmos with method of local plastics or free skin grafting; elimination of symblepharon or reconstruction of the conjunctival cavity with lips/cheeks’ mucous grafting; the strengthening of the eyelids’ edges, eyelashes plastic. The technics of the operation is described. Follow up period for patients from 6 months to 13 years (m=6,7±2,1). Results. Wound healing in all cases took place in the usual time. Skin sutures were removed after 7-9 days, traction sutures in 3 weeks, blepharorophy in 1-6 months. Engraftment of the transplanted free skin and mucous’ grafts was without a significant reduction. Visual function were preserved and improved in all the cases (44 patients). Cosmetic contact lenses were chosen in 4 patients with Vis = 0. A stable position of the prosthesis achieved in patients with anophthalmos. Conclusion. Consequences of burn injury of adnexa in children are diverse and require a differentiated approach to the choice of timing, priority, and methods of surgical treatment. Eyelid plasty is advisable to perform in the “cold” period after the completion of processes of scar tissue formation in the absence of threats to the condition of the eye.. Reconstruction should be performed at any time to prevent the development of ulcers or perforation of the cornea in the presence of the inversion of eyelids, symblepharon, significant lagophthalmos causing suffering of cornea.

METHODS OF MINIMALLY INVASIVE DECOMPRESSION OF THE BILIARY TRACT WITH MECHANICAL JAUNDICE

OBJECTIVE. The aim of the study is to improve the results of treatment of patients with mechanical jaundice. MATERIAL AND METHODS. The results of treatment of 350 patients with mechanical jaundice of benign genesis were analyzed. The causes of this disease in 230 (68.6 %) cases were choledocholithiasis, in 75 (21.4 %) cases were cicatrical narrowing of the large papilla of the duodenum (n = 50), in 45 cases were the formed biliodigestive anastomoses (n=25) and chronic pancreatitis (12.8 %). RESULTS. To eliminate mechanical jaundice, 154 (44 %) patients underwent various percutaneous decompressive echo-controlled interventions under the ultrasound control in terms of their nature and volume. In addition, endoscopic transpapillary interventions were performed in 196 (56 %) observations. various postoperative complications were noted after performing percutaneous decompressive echo-control interventions under ultrasound in 14 (4 %) observations, and after endoscopic transpapillary interventions in 21 (6 %) cases. CONCLUSION. Minimally invasive endoscopic and echo-controlled interventions as the first stage of surgical treatment are effective methods of treatment of patients with mechanical jaundice.