Long-term Postoperative Period Research Articles

Prevention of chronic postoperative pain syndrome after Lichtenstein hernioplasty

THE OBJECTIVE was to analyze the development of chronic pain syndrome after performing standardized Lichtenstein hernioplasty.METHODS AND MATERIALS. The prospective single-center study was conducted with 40 patients with inguinal hernias (20 patients in the study group and 20 patients in the control group) who underwent Lichtenstein hernioplasty with adherence to standardization criteria and without. The comparative analysis of the early and long-term postoperative periods was performed.RESULTS. When comparing the early and long-term postoperative periods in patients after standardized Lichtenstein hernioplasty, the following data were obtained: pain syndrome according to the Visual Analogue Scale (VAS) was less pronounced after applying standardization criteria (p < 0.001), and statistically significantly lower number of complications (seroma, paresthesia) developed (p=0.045, p=0.019). In the group of patients who underwent standardized Lichtenstein hernioplasty, chronic pain syndrome was not observed in the long-term postoperative period (p < 0.001).CONCLUSIONS. Prevention of chronic postoperative pain syndrome after hernioplasty using the Lichtenstein method is the significant issue. This article emphasizes the importance of considering various factors and implementing preventive strategies to minimize the risk of this complication and ensure optimal surgical outcomes.

Clinical Neurophysiological Methods Verify Improvement in the Motor Neural Transmission in Patients with Surgically Treated Idiopathic Scoliosis in Long-Term Follow-up

The evaluation of patients after the surgical correction of idiopathic scoliosis in a long-term follow-up with clinical neurophysiological methods has not been presented in detail. This study aimed to compare the results of neurophysiological studies in 45 girls with scoliosis of Lenke types 1–3 performed pre- (T0) and postoperatively, 1 week after surgery (T1) and 6 months after surgery (T2). The parameter values of the surface electromyography while attempting maximal contraction (mcsEMG) and the transcranial motor-evoked potentials (MEPs) recorded in the anterior tibial muscles, as well as the electroneurography (ENG) of the peripheral transmission in the peroneal nerve motor fibers, were compared. The results indicate that efferent neural conduction function both centrally and peripherally, and TA muscle function slightly improved immediately after the surgical correction of scoliosis, and further normalization appeared after six months in the long-term follow-up (at p = 0.03). The sEMG recordings indicate that half a year after surgical treatment in IS patients, the TA muscle motor unit recruitment function, as well as the muscle strength evaluated with Lovett’s scale, was comparable to the normal condition. The ENG recording results indicated a gradual reduction in the motor fiber injury symptoms, mainly of the axonal type, in the peroneal nerves. The surgeries also improved the lumbar ventral roots’ neural transmission to a normal functional status. The MEP amplitude parameter values recorded after the surgical scoliosis corrections in T1 indicated a slight improvement in the efferent transmission of neural impulses within the fibers of the spinal tracts; in the long-term T2 observation period, they reached values comparable to those recorded in healthy volunteers, bilaterally. Preoperatively (T0), the results of all the neurophysiological study parameters in the IS patients were asymmetrical at p = 0.036–0.05 and recorded as worse on the concave side, suggesting the lateralization of neurological motor deficits. One week postoperatively (T1), this asymmetry was recorded as gradually reduced, showing almost no difference between the right and left sides six months later (T2). The presented algorithm for the neurophysiological assessments performed in the pre-, intra-, and long-term postoperative periods using the mcsEMG, MEP, and ENG neurophysiological examinations, together with the clinical studies, may help in the comprehensive functional evaluation of the spinal cord tracts and ventral root neural conduction, which allows the detection of the subclinical neurological changes related to scoliosis itself and the consequences of the corrective surgery. Such an evaluation can also be significant in making final decisions regarding IS surgeries and their personalization after attempting conservative treatments with bracing and kinesiotherapy. Neurophysiological studies, as a sensitive biomarker, allowed us to predict and ascertain the final result of IS treatment in the long-term follow-up, which showed the health status of patients as being comparable to that of healthy volunteers.

ВЛИЯНИЕ ГИПОТЕНЗИВНЫХ ПРЕПАРАТОВ В ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ У ПАЦИЕНТОВ С ПСЕВДОЭКСФОЛИАТИВНЫМ СИНДРОМОМ НА ФОНЕ ОСЛОЖНЕННОЙ КАТАРАКТЫ

In modern surgery of complicated cataracts, an important factor is the preservation of visual functions with minimal costs. The surgeon’s experience and modern technology, which makes it possible to identify hidden symptoms of certain pathologies at the diagnostic stage, allows for a favorable completion of surgery with minimal intraoperative complications. This article shows the approach and observations of patients at risk of increasing eye pressure in the postoperative period due to the anatomical structures of the eye (in these cases, patients with open-angle glaucoma) to antihypertensive drugs. 131 patients (134 eyes) with various signs of pseudoexfoliation syndrome participated in the observation. Before planned surgery for complicated cataracts, all patients underwent ophthalmological diagnostics, medical history, and laboratory tests according to generally accepted methods. All operations were performed by the same surgeon. Cataract surgery was performed according to the standard technique (Phaco + intraocular lens) through a 2.2 mm incision, two 1.2 mm paracentesis, but for some patients other components of surgical interventions were added. In the observation groups, for better fixation and a lower percentage of complications in long-term follow-up periods, RPR, T-19, Myol were implanted in 27.7%. A large percentage of 34% were implanted with the HO Acrylic IOL model lens, which requires a 2.2 mm corneal incision. In observation groups 2 and 3, 32.5 and 31.8% preferred lenses to the Acrysoft IQ model. And in 32.5% and 13.6%, respectively, the AFY model. The choice of the method of surgical intervention, as well as the model of intraocular lenses, made it possible to predict the long-term postoperative period with less toxicity for the patient’s condition. No intraoperative complications were observed; the administration of antihypertensive drops, both in combination and in monotherapy in the early stages of the postoperative period, allowed maintaining eye pressure within normal limits in all observation groups.

Single-center experience of thoracoscopic sympathectomy for palmar hyperhidrosis with long-term postoperative questionnaire survey.

Thoracoscopic sympathectomy is an effective treatment for palmar hyperhidrosis. However, compensatory hyperhidrosis occurs frequently as a postoperative complication of the procedure. The goal of this study was to elucidate the clinical significance of thoracoscopic sympathectomy using our surgical procedure. Consecutive 151 patients who underwent thoracoscopic sympathectomy for palmar hyperhidrosis were studied. In addition, to investigate patients' satisfaction and long-term quality of life, 111 patients were asked to complete a mailing questionnaire survey, and 84 responded (response rate of 75.7%). All of the 151 patients reported a reduction in palmar sweating during the immediate postoperative period. None of the patients had pneumothorax, hemothorax, Horner's syndrome, or worsening of bradycardia. Based on the questionnaire, the surgical success rate was 98.8%. None of the patients had a recurrence of palmar hyperhidrosis during the long-term postoperative period. However, compensatory hyperhidrosis was reported in 82 patients (97.6%). In total, 94.0% of patients had high levels of postoperative satisfaction. Thoracoscopic sympathectomy is an effective surgical treatment for palmar hyperhidrosis. By contrast, the careful preoperative explanation of compensatory hyperhidrosis is considered to be very important.

Long-term outcomes after formation of a low-flow STA-MCA bypass for treatment of symptomatic occlusion of the internal carotid artery

Aim. To evaluate short‑ and long‑term effectiveness of low‑flow bypass between superficial temporal artery and M4 segment of middle cerebral artery (low‑flow STA‑MCA bypass) in patients with symptomatic occlusion of the internal carotid artery (ICA).Materials and methods. Between 2016 and 2019 at the Department of Neurosurgery of the N. V. Sklifosovsky Research Institute of Emergency Medicine, 54 patients who underwent low‑flow STA‑MCA bypass formation at the side of symptomatic ICA occlusion between 2013 and 2015 were examined. Symptomatic ICA occlusion was more common in men than in women (7:1 ratio). Patient age varied between 48 and 73 years (mean age was 62 years).During low‑flow STA‑MCA bypass formation surgery for symptomatic ICA occlusion, intraoperative flowmetry was used in 52 (96 %) patients, in 2 (4 %) patients this diagnostic method was impossible to perform due to technical difficulties. The main examination methods in the long term after cerebral revascularization were evaluation of neurological status dynamics per the National Institute of Health Stroke Scale (NIHSS); modified Rankin scale; Rivermead mobility index; computed tomography angiography of the extra‑intracranial arteries; ultrasound (US) examination of the STA‑MCA bypass for eval uation of linear and volumetric blood flow velocities; single‑photon emission computed tomography. The type and size of trephination were evaluated, and operative time was taken into account.The patients were divided into 3 groups: group 1 included patients with follow‑up period of 1–2 years after cerebral revascularization, group 2 – 3–4 years, group 3 – 5–6 years. All results were compared to preoperative, early, and longterm measurements.Results. In the long‑term postoperative period between 1 and 6 years after cerebral revascularization, 54 patients were examined. Computed tomography angiography and US showed functioning STA‑MCA bypass in 53 (98 %) patients. According to single‑photon emission computed tomography of the brain, regional cerebral blood flow in the longterm postoperative period varied between 28 and 40 mL / 100 g / min, median regional cerebral blood flow in the long‑term postoperative period was 38 mL / 100 g / min. Intraoperative flowmetry was performed in 52 (96 %) patients, median was 15.5 mL / min. US showed that linear blood flow velocity in the STA‑MCA bypass varied between 20 and 95 cm / s, median was 49 cm / s. Volumetric blood flow varied between 30 and 85 mL / min with median of 75 mL / min.Resection trephination was performed in 36 (67 %) patients, mean size of trephination hole was 3 cm3. In the study, operative time was measured: mean value was 212 min; no significant correlation between operative time and trephination size was observed.Improved neurological status was observed in all study groups. Per the NIHSS, in group 1 (1–2 years) improvement was observed in 59 % of patients, in group 2 (3–4 years) in 48 %, in group 3 (5–6 years) in 47 %. Per the modified Rankin scale, in group 1 improvement was observed in 36.4 % of patients, in group 2 – in 48 %, in group 3 – in 42.9 %. Per the Rivermead mobility index, in group 1 improvement was observed in 63.3 % patients, in group 2 – in 56 %; in group 3 – in 57.1 %. The best outcomes were observed in group 1 (63.3 %).Conclusion. Instrumental diagnostic methods and evaluation of neurological status showed positive dynamics both in the postoperative period and in long‑term period between 1 and 6 years after low‑flow STA‑MCA bypass formation. In the long term, repeat abnormalities of cerebral blood flow of ischemic type and repeat transient ischemic attacks were not observed. Correct selection of patients in the preoperative period and comprehensive treatment including drug therapy in the postoperative and long‑term periods allow to prevent repeat ischemic cerebrovascular disease and therefore improve patients’ quality of life.

Features of detrusor function disorders in patients with dysuria in the long period after transurethral resection of the prostate

BACKGROUND: Transurethral resection of the prostate (TURP) remains the “gold standard” for surgical treatment of patients with benign prostatic hyperplasia. At the same time, a significant number of patients continue to have urinary disorders after surgery. Dysuric disorders may be caused by detrusor dysfunction. AIM: The aim of the study was to determine the frequency, nature and clinical manifestations of detrusor dysfunction in patients with benign prostatic hyperplasia after TURP in the long-term postoperative period. MATERIALS AND METHODS: We examined 128 patients with benign prostatic hyperplasia aged from 56 to 87 years (mean 68.5 ± 7.1 years), who underwent TURP 12–36 months before inclusion in the study. All patients had urinary problems at the time of examination. All patients underwent a urological examination, which included a complex urodynamic study. The control group consisted of 48 patients with benign prostatic hyperplasia of comparable age, who did not have urinary disorders after TURP. RESULTS: Urodynamic signs of detrusor dysfunction were identified in 97 (75.8%) of 128 patients examined. Most often, isolated detrusor overactivity was detected (52.6%), less often a combination of detrusor over- and hypoactivity (25.8%) and isolated detrusor hypoactivity (21.7%). In patients with identified detrusor dysfunction, even before TURP, more pronounced urinary disorders were noted, which were characteristic of a certain type of detrusor dysfunction and persisted after surgical treatment. In patients with detrusor dysfunction, compared with patients from the control group, at the preoperative stage, urgency urinary incontinence, frequent urgency to urinate, diabetes mellitus, and a small volume of the prostate gland with the absence of intravesical protrusion were significantly more often detected. CONCLUSIONS: Detrusor dysfunction is an important cause of dysuria in patients with benign prostatic hyperplasia in the long-term period after TURP. It seems appropriate to conduct further research to clarify the indications for performing preoperative complex urodynamic study in patients with benign prostatic hyperplasia and lower urinary tract symptoms.

EVALUATION OF THE EFFECTIVENESS OF GENIOPLASTY USING BIOPOLYETHYLENE (Su-por) IMPLANTS

Background: The chin an important aesthetic unit of the facial structure and play a key role in the appearance of the face. This study evaluated the surgical results of genioplasty using a Biopolyethylene implant (Su-Por). Material and Methods: The study included 42 patients with a follow-up period of 3 years who underwent genioplasty in the clinic from 2020-2023. All patients underwent a standard clinical examination and computed tomography (CT). To plan the required volume of chin augmentation, cephalometric analysis is used. The genioplasty surgery was planned on a 3D model of the skull, installing standard bioimplants on the 3D model of the obtained 3D printed CT image. Genioplasty was performed using a Biopolyethylene implant (Su-Por). Outcomes were assessed using the Outcome Assessment, consisting of a 10-item questionnaire completed preoperatively, 6 months postoperatively, 1 and 3 years postoperatively. Result: Among the 42 operated patients, no complications were observed during the operation. Complications were noted in the long-term postoperative period: swelling in 4 patients, in 2 patients with unsatisfied aesthetic results without other serious complications. In all clinical observations, stable support of the Biopolyethylene implants. The mean score was 26.4 at preoperative assessment, 78.2 at 6 months postoperatively, and 87.6 at 3 years postoperatively. The surgical results showed favorable aesthetic results, low infection rates, strong implant fixation, good skin texture/skin/soft tissue thickness. This technique is simple and effective and is recommended for inclusion in the practice of a facial plastic surgeon. Conclusions: Augmentation genioplasty using the Biopolyethylene implant is a simple and effective surgical procedure that can lead to aesthetically acceptable results with minimal pain using. Patients are satisfied with the aesthetic and functional results genioplasty.

Management of a child with portopulmonal hypertension due to cavernous transformation of the portal vein and sple- norenal anastomosis

A clinical case of the development of portopulmonary hypertension in a child after splenorenal anastomosis is presented. The surgical intervention was performed to correct the congenital malformation — cavernous transformation of the portal vein, which led to portal hypertension and varicose veins of the esophagus and stomach. In the long-term postoperative period, pulmonary arterial hypertension, hypersplenism with bilinear cytopenia, and moderate liver failure developed. Combined therapy provided a temporary improvement of the patient status, therefore, during subsequent surgery, the size of the anastomosis was changed. This led to a sustained decrease in pulmonary artery blood pressure and clinical improvement in the boy’s condition.

A meta-analysis comparing the efficacy of mineralized collagen-polymethylmethacrylate and polymethylmethacrylate bone cements in the treatment of vertebral compression fractures.

Vertebral compression fractures are often treated with vertebroplasty, and filling the injured vertebrae with bone cement is a key part of vertebroplasty. This meta-analysis was performed to compare the clinical efficacy and safety of mineralized collagen-polymethylmethacrylate (MC-PMMA) and polymethylmethacrylate (PMMA) bone cement in the treatment of vertebral compression fractures by vertebroplasty. A computerized search of the published literature on mineralized collagen-polymethylmethacrylate and polymethylmethacrylate bone cement in the treatment of vertebral compression fractures was conducted in the China National Knowledge Infrastructure (CNKI), Wanfang database, PubMed, Embase, and Cochrane Library. The search was carried out from the time the database was created to March 2023 and 2 researchers independently conducted literature searches to retrieve a total of 884 studies, of which 12 were included in this meta-analysis. Cochrane systematic review methods were used to assess the quality of the literature and a meta-analysis was performed using ReviewManager 5.4 software. The results of the present meta-analysis showed that in postoperative adjacent vertebral fractures [OR = 0.25; 95% CI (0.15, 0.41)], postoperative cement leakage [OR = 0.45; 95% CI (0.30, 0.68)], Oswestry Disability Index (ODI) scores in the first 3 days after surgery [OR = -0.22; 95% CI (-0.42, -0.03)], ODI score at 6-12 months postoperatively [OR = -0.65; 95% CI (-0.97, -0.32)], visual analog scale (VAS) score at 6-12 months postoperatively [OR = -0.21; 95% CI (-0.46, 0.04)], and 1-year postoperative CT values [OR = 5.56; 95% CI (3.06, 8.06)], the MC-PMMA bone cement group was superior to the PMMA bone cement group. However, the differences between the two groups were not statistically different in terms of cement filling time, cement filling volume, operation time, intraoperative bleeding, hospitalization time, postoperative (<1 week, 3-6 months) vertebral body posterior convexity Cobb's angle, postoperative (<1 week, 6-12 months) vertebral body anterior margin relative height, postoperative (≤3 days, 1-3 months) pain VAS score and postoperative (1-3 months) ODI score. Compared with PMMA bone cement, the application of MC-PMMA bone cement is advantageous in reducing postoperative complications (adjacent vertebral fracture rate, cement leakage rate), pain relief, and functional recovery in the long-term postoperative period (>6 months), but there is still a need for more high-quality randomized controlled studies to provide more adequate evidence.

Selection of surgery type for patients with inguinal hernias

The purpose of the study: to investigate the quality of life of patients with inguinal hernias after Lichtenstein’s surgery using the implants with a tissue-gripping system and conduct a comparative assessment of this technique and the results of classical laparoscopic surgery. The prospective controlled clinical study included the results of follow-up of 99 patients with inguinal hernias. The first group included the patients who underwent LHR surgery of the inguinal canal using a composite self-fixing polypropylene mesh. In the patients of the second group, LHR was performed using a composite polypropylene mesh, which was fixed with polypropylene suture material. The third group consisted of the patients operated on using the technique of laparoscopic transabdominal preperitoneal surgery. Indicators of physical and psychological health components were studied in the patients using the SF-36 questionnaire in the preoperative period and 3, 6, and 12 months after surgery. Results: The patients with inguinal hernias in the long-term postoperative period had different periods of restoration of quality of life, which were determined by the type of surgical intervention and the type of fixation of the synthetic implant. Three months after surgery, significant signs of normalization of indicators of the physical health component were recorded only in groups of the patients after LHR using self-fixing implants and TAPP. In the patients with suture fixation of implants during LHR, the first signs of restoration of the physical component of health, comparable to self-fixing meshes, were observed 6 months after surgery. Changes in indicators of the psychological health component in the patients of the LHR and TAPP groups did not differ at all study intervals. Conclusion: The use of implants with a tissue-gripping system when performing LHR leads to optimization and reduction of physical rehabilitation in patients with inguinal hernias, which makes it possible to recommend the use of self-fixing meshes for open repair in cases of relative and absolute contraindications to TAPP.

Modification of Cardiovascular Risk Factors and the Evolution of The Cardiovascular Phenotype of Liver Transplant Recipients in the Long -Term Postoperative Period.

To evaluate the contribution of traditional and additional cardiovascular risk factors (CVRFs) to the development of chronic ischemic heart disease (CIHD) in liver transplant recipients during the long-term postoperative period. A single-center prospective cohort study was conducted. The study included 740 patients with chronic end-stage liver disease (CESLD) and cirrhotic cardiomyopathy (CCMP). During the observation period (5.4±2.29 years), patients were divided into two groups: liver transplant recipients (n=420) and patients with CESLD on the waiting list who did not receive a donor organ (n=320). In patients enrolled to the study upon inclusion in the waiting list, CVRFs, history, clinical and laboratory and instrumental data were studied at all stages of the hepato-cardiac continuum. During the long-term postoperative period, liver transplant recipients belonged to the group of high cardiovascular risk: over a 5-year observation period, 35.7% (n=150) of them developed metabolic syndrome (MS), 9.8% developed verified CIHD associated with MS. The incidence of traditional CVRFs was high (arterial hypertension, 88.6%; obesity, 36.6%; hypercholesterolemia, 77.8%; hypertriglyceridemia, 43.6%; reduced concentration of high-density lipoprotein cholesterol, 35.4%; increased concentrations of low-density lipoprotein cholesterol, 66.8% and very low-density lipoprotein cholesterol, 51.2%; increased atherogenic index, 61.5%). During the long-term postoperative period as compared to the period when patients were on the waiting list, additional CVRFs appeared: increases in body mass index, calcium index, nitric oxide metabolites, endothelin-1, homocysteine, intercellular adhesion molecules VCAM-1 and ICAM-1, and decreases in endothelium-dependent vasodilation and glomerular filtration rate to less than 60 ml/min/1.73 m2. A model for the development of CIHD was created. The model uses a complex of independent risk factors and demonstrates a predictive accuracy of 84.6%. The study results indicate a modification of CVRFs and a dynamic change in the cardiovascular phenotype of liver transplant recipients: progression of CCMP during their stay on the waiting list, regression of CCMP manifestations during the first 12 months after orthotopic liver transplantation, and increases in the total cardiovascular risk and likelihood of CIHD in the long-term postoperative period.

Retrospective study of the early clinical experience with a precontoured angle-stable interlocking nail for fracture repair in dogs and cats.

To report indications, outcomes, and complications with a precontoured angle-stable interlocking nail (CAS-ILN). 90 client-owned animals. Dogs and cats treated with the CAS-ILN between 2020 and 2022 were retrospectively reviewed. Collected data included body weight, fracture configuration, percentage of medullary canal filled, limb alignment, complications, and follow-up. Favorable outcomes were defined when full functional restoration was observed. Thirty-eight dogs and 52 cats were included. Median body weight was 4.3 kg (range, 1.5 to 6.7 kg) for cats and 25 kg (range, 6.8 to 54 kg) for dogs. A total of 54 femurs, 31 tibias, and 5 humeri were treated, including 65 comminuted fractures and 26 metaphyseal fractures. The median percentage of medullary canal occupied by the nail was 76.5% (range, 53% to 97.6%). Radiographic postoperative bone alignment was good in 85.5% (59/69) and satisfactory in 10 cases. The median duration of follow-up (57/90) was 476 days (range, 56 to 1,057 days). In the perioperative period (0 to 12 weeks), lameness had resolved or was mild in all (51/52) but 1 case. In the long-term postoperative period (> 12 months), 97.1% (34/35) of cases showed restoration of full function and 1 case had an unacceptable function. An overall complication rate of 11.5% (7/61) was reported including 1 catastrophic and 6 major complications. Long-term functional outcomes following the CAS-ILN were favorable in 97.1% (34/35) of cases. Complication rates were comparable to previous studies. The CAS-ILN appears to be an alternative surgical option for most long-bone fracture repairs.

A clinical case of a combined method for correcting postkeratoplastic astigmatism of a high degree in a patient with cataract

Background. Performing penetrating keratoplasty in 100 % of cases leads to the occurrence of induced postkeratoplasty astigmatism, which can be more than 12,0 D. If cataracts occur in this category of patients, performing cataract phacoemulsification with implantation of a toric intraocular lens (tIOL) does not completely solve the problem. The use of the method of implantation of intrastromal corneal segments at stage I before cataract phacoemulsification makes it possible to reduce the degree of postkeratoplasty astigmatism and create optimal conditions for additional correction of residual postkeratoplasty astigmatism due to the implantation of tIOL during cataract phacoemulsification.The aim. To analyze the clinical and functional indicators of correction of regular high-grade postkeratoplasty astigmatism in a patient with cataracts using a combined method, including first implantation of intrastromal corneal segments and subsequent cataract phacoemulsification with implantation of toric intraocular lens using the example of a clinical case.Material and methods. A 55-year-old patient with cataracts, who had a history of undergoing penetrating keratoplasty, contacted us. According to the keratotopogram data, a regular postkeratoplasty astigmatism of 18.68 D was diagnosed. The patient underwent a combined method. At stage I, intrastromal corneal segments were implanted into the corneal graft, then after 6 months stage II was performed – cataract phacoemulsification with implantation of tIOL.Results. Six months after intrastromal corneal segments implantation, the patient’s keratometric data stabilized, and corneal astigmatism decreased to 8.98 D. Then the patient underwent cataract phacoemulsification with tIOL implantation. After 1 month, the spherical component of refraction was 0.5 D, the cylindrical component of refraction was –0.5 D, visual acuity increased to 1.0.Conclusions. A combined method for correcting regular high-grade postkeratoplasty astigmatism in a patient with cataracts showed high refractive results, stability and safety in the long-term postoperative period.

Long-term results of operations for hernias of the esophageal orifice of the diaphragm depending on the performance of vagotomy

Introduction. Hernia of the esophageal orifice of the diaphragm, complicated by reflux esophagitis, is one of the most common gastroenterological diseases, occupying the first place among all benign pathology of the cardiofundal zone. Typical complications of this pathology are esophagitis of varying severity, bleeding from the esophagus, peptic stricture and shortening of the esophagus, Barette's esophagus, ulcer and cancer of the esophagus. Indications for surgery include severe reflux esophagitis, the development of complications, and the failure of conservative therapy.Objective: to evaluate the effect of stem vagotomy on the long-term results of surgical treatment of patients with hiatal hernia complicated by reflux esophagitis.Object and methods. The long-term treatment outcomes of 130 patients were studied. All patients had increased acid production. The patients were divided into two groups: group I – 77 patients who underwent correction of hiatal hernia in isolation; group II – 53 patients who had correction of hiatal hernia supplemented by stem vagotomy. In group I, anatomical recurrence of hiatal hernia was diagnosed in 14 patients (18.2%), and in group II – in 1 (1.9%) patient. In the long-term postoperative period, none of the patients who underwent stem vagotomy were diagnosed with severe reflux esophagitis. While in patients who did not undergo stem vagotomy, a severe form of reflux esophagitis was found in 10.3% of patients.Conclusion. In patients with hiatal hernia with increased acid production complicated by reflux esophagitis, it is advisable to supplement the correction operation with a stem vagotomy. This tactic leads to a statistically significant decrease in the number of relapses in the long-term period.

Fifteen-year results of bilateral and unilateral internal mammary artery grafting

To evaluate the clinical effectiveness of bilateral internal mammary artery grafting over long-term (15 years) postoperative period. There were 276 patients divided into two groups: 135 patients (group A) underwent bilateral internal mammary artery grafting and 141 patients (group B) underwent unilateral internal mammary artery grafting together with venous bypass grafts. On-pump surgeries and cardioplegia, parallel CPB and on-pump procedures were performed in equal proportions. Mean age of patients was 57.3±7.6 years. Diabetes mellitus was detected in 21 (15.5%) and 24 (19.1%) patients, respectively (p>0.05). Mean LV ejection fraction was 55.4±9.9%, revascularization index - 3.1±0.8 and 3.0±0.7, respectively. In the 1st group, 43 patients underwent bilateral internal mammary artery grafting alone. Autovenous grafts were additionally used in other 84 patients. Ten-year survival exceeded 90% in both groups. Freedom from adverse cardiac events after 15 years was significantly higher in group A (77.3% vs. 59.3%, p=0.018). In group A, 16 patients died throughout this period due to cancer (50%), myocardial infarction (12.5%), stroke (18.8%) and complications of diabetes mellitus (6.3%). In group B, 22 patients died mainly from cardiac causes (myocardial infarction - 40.9%, cancer - 27.3%). Bilateral internal mammary artery grafting has obvious advantages over traditional coronary artery bypass grafting. If we take into account higher proportion of cardiac causes in structure of mortality in group B, we can talk about positive impact of bilateral internal mammary artery grafting not only on the quality of life, but also on life expectancy in long-term postoperative period.

СТРУКТУРНО-ФУНКЦИОНАЛЬНОЕ СОСТОЯНИЕ СЕРДЦА У ПАЦИЕНТОВ МОЛОДОГО ВОЗРАСТА С ЖЕЛУДОЧКОВОЙ ЭЛЕКТРОКАРДИОСТИМУЛЯЦИЕЙ В ОТДАЛЕННОМ ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ

Aim. To study the structural and functional state of the heart in young patients with ventricular pacing in the long-term postoperative period. Materials and methods. The study included 60 people aged 18 to 35 years (35 men and 25 women) with AV blocks that required the implantation of a permanent pacemaker (PM). The first group consisted of 30 people with permanent PMs implanted after surgical correction of CHD due to postoperative AV blockage. The second group consisted of 30 people with non-surgical AV block. All patients underwent a general clinical examination, echocardiography, and medical documentation was retrospectively studied. The duration of pacing in group 1 was 15.6 (13.1; 18.0) years, in group 2 - 15.7 (13.9; 18.5) years. All patients of both groups at the time of the study were implanted with two-chamber PMs. The median percentage of ventricular stimulation in both groups was 100%.Results. In the study groups, significant differences were revealed in the anteroposterior size of the left atrium (LA): 36.5 (33.5; 39.5) mm and 33.5 (31.0; 36.0) mm (U = 281.0, p = 0.030), suggesting initial changes in LA geometry in patients of group 1. Signs of LV remodeling (concentric and eccentric hypertrophy and concentric remodeling) were detected in 40% (12 people out of 30) of patients in group 1 and in 10% (3 people out of 30) in group 2 (χ2 = 7.20, p = 0.007). In group 1, LV ejection fraction (EF) in B mode was significantly lower than in group 2 and made up 59.0 (52.0; 63.0) % and 61.5 (56.0; 66.0)% (U = 307.5, p = 0.034), respectively. 40% of patients in group 1 and 17% in group 2 had LVEF &lt; 55% (χ2 = 4.02, p = 0.045). LV diastolic dysfunction was detected in 26% of people in group 1; in group 2, no patients with diastolic dysfunction were identified (F = 0.154, p = 0.005).Conclusion. In patients with long-term ventricular stimulation after surgical correction of congenital heart disease, significant structural and functional changes in the heart were revealed (signs of remodeling of the left heart, systolic and diastolic dysfunction of the left ventricle), which appear to be significant predictors of cardiovascular events, including heart failure and mortality. In patients with non-surgical AV block and long-term ventricular pacing no significant impairment of cardiac function was detected.

Ureteropelvic junction obstruction in the first three months of life: is sex a prognostic factor?

Ureteropelvic junction obstruction (UPJO) is a blockage that occurs at the point where the renal pelvis (the part of the kidney where urine collects) meets the ureter (the tube that carries urine from the kidney to the bladder). This study compared outcomes between male and female patients with UPJO. 402 UPJO patients diagnosed and treated before the age of three months were divided into two groups: males and females. The following information was extracted: age at diagnosis, age at surgery, the parenchymal thickness of the UPJ and contralateral sides (preoperatively and at 1 and 3 years postoperatively), pelvic diameter, and kidney function. There were 287 male and 115 female patients (a ratio of 2.5:1). The parenchymal thickness (PTs) at diagnosis and surgery were 5(4) mm and 5(3) mm in males, respectively. In females, these values were 5(3) mm and 6(5) mm, respectively. There was a significant decrease in male PT at the time of surgery compared to diagnosis (p<0.05). After the first postoperative year, PTs were 8(4) mm and 9(4) mm in males and females, respectively, and after the third postoperative year, PTs were 9(4) mm and 10(4.75) mm in males and females, respectively. Among patients diagnosed with UPJO during the first three months of life, males had a more severe disease course than females. Additionally, females experienced better clinical improvement during the long-term postoperative period.

Improving reconstructive operations for “fresh” injuries and scar strictures of the main bile ducts

The aim of the work: prevention of hepaticocholedochal stricture in the long-term postoperative period after reconstructive surgery.&#x0D; Materials and Methods. The study is based on data from a clinical examination of 41 patients with injuries to the main bile ducts, who were operated on in the surgical department of the multidisciplinary clinic of Samarkand State Medical University for the period from 2010 to 2022. Depending on the choice of treatment tactics, the patients were divided into two groups. The first group, the comparison group, consisted of 18 (43.9 %) patients who underwent biliobiliary anastomosis in the traditional way. The second group, the main group, consisted of 23 (56.1%) patients who underwent reconstructive surgery using our improved method.&#x0D; Results and Discussion. Of the 18 patients in the comparison group, 13 (72.2 %) had a cicatricial stricture of the hepaticocholedochus in the long-term postoperative period after 1–3 years, requiring repeated operations. Of these, 9 patients underwent reconstructive hepaticojejuno- and hepaticoduodenoanastomosis, 4 patients underwent X-ray endobiliary interventions with the installation of a stent into the lumen of the hepaticocholedochus.&#x0D; &#x0D; &#x0D;

MINIMAL INCISION SURGERY FOR THE AORTOILIAC SEGMENT – RESULTS OF A SINGLE-CENTER STUDY

The purpose of this prospective single-center study was to determine the feasibility of minilaparotomy for aortoiliac segment and its effect on intraoperative and postoperative outcomes. Materials and Methods: From August 2020 to July 2022, the authors used minilaparotomy in 24 patients with aortoiliac atherosclerotic occlusive disease. The comparison group included 27 patients undergoing laparotomy. The age of the patients ranged from 58 to 83 years, among them 37 men and 14 women. In the group with traditional access, 9 aorto-bifurcational and 18 linear operations were performed; in the minimal incision group, there were 7 bifurcational and 17 linear interventions. Results and Discussion: The duration of surgery was 196.5±26.7 minutes for operations with traditional access, and 146.3±16.7 minutes in the group with minimal incision. On average, minimal incision surgeries were shorter by 52.3±14.4 minutes (p≤0.05). For patients from the group with minimal incision, the length of stay in intensive care was 1.27±0.4 days, and with traditional access 2.3±0.3 (p≤0.05). Postoperative bed stay for the group with mini-access was 6.4±0.5 days, for patients with classic access 9.2±1.2 days (p≤0.05). 4 patients in the comparison group had postoperative paresis, and in one of them it was complicated by eventration. In the long-term postoperative period, two patients in the comparison group required surgery for an incisional hernia. Conclusions: Minimal incision access to the aorta can reduce surgical trauma and intervention time, shorten the patient’s stay in the intensive care unit and postoperative bed, and minimize perioperative and postoperative complications. During repeated reconstructive interventions on the aorta, a “high” mini-access to the aorta allows to quickly reach the optimal area of the aorta for anastomosis and minimize organ trauma, as well as prevent adhesions in the abdominal cavity.

Impact of surgical treatment of endometriomas on ovarian reserve and reproductive outcomes

BACKGROUND: Endometriomas are most common during the reproductive years and have an extremely negative impact on ovarian reserve and fertility. In this case, the main method of treatment remains surgery, which inevitably injures healthy ovarian tissue. Assessing the impact of surgical treatment of endometriomas on ovarian reserve and fertility will help to optimize the management of patients of reproductive age with endometrioid cysts.&#x0D; AIM: The aim of this study was to evaluate the effect of surgical treatment on ovarian reserve and reproductive outcomes in patients with endometrioid cysts.&#x0D; MATERIALS AND METHODS: We analyzed the course of the disease in 289 patients with endometriomas. All patients underwent processing of medical histories and surgical protocols; then, 134 patients were surveyed in the long-term postoperative period (12–24 months after surgery) to gather data on complaints and age of the patients, the size of endometriomas, previous treatment, anti-Müllerian hormone level, and features of reproductive function implementation.&#x0D; RESULTS: Among patients who had pain before surgery, 52.8% of patients noted a complete absence of pain after surgery; in 26.4% of patients, pain significantly decreased. In 65.8% of patients who had dysmenorrhea before surgery, menstruation became painless. Among patients who complained of dyspareunia before surgical treatment, in 80% of patients, pain during sexual intercourse decreased or disappeared after surgery. After surgical treatment, 119 of 134 surveyed patients (88.8%) received drugs for hormonal therapy for endometriosis. After treatment, pregnancy occurred in 54 out of 82 patients interested in reproductive function. The average anti-Müllerian hormone level before treatment was 3.8 ± 1.8 ng/ml in the age group of 20–34 years and 1.9 ± 1.5 ng/ml in the age group of 35–45 years old; after treatment, 2.7 ± 2.0 ng/ml and 1.0 ± 1.8 ng/ml, respectively.&#x0D; CONCLUSIONS: Determining anti-Müllerian hormone level is one of the main methods for obtaining an idea of the patient’s ovarian reserve. At a young age and with not implemented reproductive function, it is mandatory to determine the ovarian reserve and consult a reproductive specialist before starting treatment. According to our results, surgical treatment of endometriomas is the most promising for overcoming infertility in young patients with endometriosis.