Long-term Postoperative Period Research Articles

DIFFERENTIATED APPROACH IN VENTRAL HERNIA SURGERY

Relevance. The analysis of scientific, medical and patent documentation indicates that in the literature available to us there is no definition of indications for the use of one or another method of hernioplasty, taking into account various risk factors. The solution of these problems is an urgent and priority problem of modern herniology. Objective of the study: To develop a program for the choice of surgical tactics for ventral hernias. Research material. Based on the analysis of the results of surgical treatment of 228 patients with ventral abdominal hernias, the authors developed a program for scoring preoperative criteria that affect the choice of the optimal method of hernioplasty, taking into account the individual characteristics of the organism. Research results. In the main group of patients, we detected a relapse of the disease in one patient, which was 0.9% of the total number of patients examined in the long-term postoperative period. Relapse was noted in a patient from the 2nd subgroup who underwent hernioalloplasty with defect suturing. The relapse was caused by the insufficient area of the alloprosthesis. Findings. The scoring of perioperative risk criteria in patients with incisional ventral hernias allows choosing the optimal method of plastic surgery, taking into account the individual characteristics of the organism and improving the results of treatment. With pronounced apron-like deformity of the abdomen in obese patients, it is preferable to perform open hernioalloplasty with DLE.

Pathological Nodal and Vascular Involvement Significantly Impacts the Recurrence Risk in Different Time Frames in Patients With Resectable and Borderline Resectable Pancreatic Cancer: Long-term Conditional Recurrence-free Survival Analysis in the Setting of a Neoadjuvant Treatment Strategy.

To investigate the long-term dynamics of recurrence risk and the significance of prognostic variables using conditional recurrence-free survival (C-RFS) analysis in neoadjuvant treatment (NAT) for resectable (R) and borderline resectable (BR) pancreatic cancer (PC). C-RFS analysis assesses the probability of achieving additional RFS according to the RFS already accrued. Patients with NAT and subsequent resection for R/BRPC were enrolled. In the C-RFS analysis, the actual 5-year RFS (5yRFS) rate was calculated separately in the subgroup that had already gained a given amount of RFS. The significance levels of prognostic variables associated with 5yRFS were assessed regarding their time-dependent dynamics in a conditional fashion. Among the total 397 patients, 160 survived for more than 5 years without recurrence after surgery (actual 5yRFS rate: 45%). The probability of 5yRFS incrementally increased based on the RFS already accrued. Pathological nodal and vascular involvement were significant influencers of 5yRFS. The patients with nodal involvement consistently remained at significantly higher risk of recurrence than those without, even after 5yRFS, whereas positivity of vascular involvement was significantly associated with the risk of recurrence only during the early postoperative period and lost its significance after 3yRFS accrued. In NAT for R/BRPC, the probability of gaining additional RFS increases as a function of RFS already accrued, and the significance of prognostic variables time-dependently evolves in their own patterns during the long-term postoperative period.

The Role of Anamnesis in Modern Ophthalmic Practice: a Clinical Case

Eyes’ dryness continues to be the most frequent complication after LASIK. As a rule, it disappear in the vast majority of patients during the first year after surgery. The conducted studies indicate that complaints of eyes’ dryness in the preoperative period significantly increase the risk of developing a severe form of dry eye syndrome in the postoperative period, especially in middle-aged women (45–59 years) and older. The clinical case presented in this article indicates the development of a severe form of dry eye syndrome after LASIK in a middle-aged patient receiving hormone replacement therapy for menopause, complaining of a feeling of dryness and discomfort in the eyes in the preoperative period, with intolerance to contact lenses and taking antidepressants in the absence of signs of severe dry eye in the preoperative period. Consequently, surgical intervention led to the development of the mentioned above condition. It is confirmed by the literature data indicating that the above factors can cause the development of a severe form of dry eye syndrome after LASIK. Taking into account the fact that tear production tests do not always correlate with the intensity of complaints of dryness, burning sensation, pain in the eyes, the most important component at the stage of deciding on the feasibility of refractive surgery in a particular patient is the collection of anamnesis and clinical picture. When preparing patients with a history of dry eye syndrome for refractive surgery, it is necessary to inform them that they have a significantly increased risk of developing dry eye syndrome. It may persist in the long-term postoperative period, and possibly go into a chronic form. Candidates for refractive surgery in the presence of complaints characteristic of dry eye syndrome can only be those patients who respond well to therapy aimed at relieving these symptoms in the preoperative period. Taking into account the multicomponent nature of pain in dry eye syndrome — nociceptive pain, which is formed at the stage of receptor irritation in the corneal tissue, and neuropathic pain that occurs with the participation of the peripheral and central nervous system, a comprehensive approach is needed in the treatment of dry eye syndrome.

Innovative lipid-lowering therapy: experience of inclisiran use in the Republic of Belarus

The article reflects modern aspects of lipid-lowering therapy, based on the as­sessment of cardiovascular risk, and the possibilities of triple therapy, including statins, ezetimibe, and inclisiran.We present our own data on the use of the drug inclisiran in patients with lipid metabolism disorders in the framework of secondary and primary cardiovascular prevention. Low-density lipoprotein levels at different times after the injection is described. The potential of innovative lipid-lowering therapy in liver transplant recipients in the long-term postoperative period are discussed.The addition of inclisiran to statin and ezetimibe therapy is safe and leads to a decrease in low-density lipoprotein levels by more than 50% of baseline values in the general population.

Хірургічна корекція вродженого кіфозу в дітей. Клінічний випадок

Congenital kyphosis occurs as a result of a disorder of vertebral formation or segmentation. There are a number of scientific papers that evaluate and compare various methods of surgical treatment of patients with congenital kyphosis, as well as analyze complications in this group of patients. In the current literature, preference is given to methods with more aggressive correction of angular kyphotic deformity, in particular, corrective spinal osteotomies and various types of vertebrectomy. These methods can achieve significant deformity correction, but have a high risk of complications associated with fractures of the fixation rods in the long-term postoperative period. Purpose - to present a clinical case of surgical treatment of a patient with congenital kyphosis, which allowed to achieve significant correction of the deformity and reduce the number of complications associated with the instability of the metal structure. The clinical case describes the treatment of a 16-year-old patient with an active Th11 wedge-shaped halve vertebrae using the method of decancellation the latter and fixing the spine with a transpedicular metal structure. The peculiarity of the surgical intervention is the use of rib fragments as an autograft to form a posterior spondylodisc. Conclusions. The use of rib fragments as an autograft creates conditions for the formation of a posterior bone block, which reduces the risk of fracture of the fixation rods in the long-term postoperative period. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Хирургическое лечение осложненной начальной катаракты вторым этапом после витреоретинальной хирургии у пациентов с пролиферативной диабетической ретинопатией

Purpose. To evaluate the efficacy of phacoemulsification of primary cataract by the second stage after vitreoretinal surgery of PDR patients. Material and methods. 124 cases of surgery treatment of patients with PDR and complicated primary cataract were enrolled. Thier patients were divided into two groups depending on the treatment tactics. In the 1st group patients were subjected to a two–step surgical procedure: vitreoretinal surgery with silicone oil tamponade performed as the 1st step in their treatment; followed by the 2d step, phacoemulsification surgery and silicone oil removal, and the IOL implantation, respectively. In the 2d group phacoemulsification performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity. Results. In the long-term postoperative period, functional results were better in group I patients than in group II patients (p < 0.001). Conclusion. Outcomes of the preliminary studies suggest that it is more viable to perform phacoemulsification surgery sometime later along with silicone oil removal on PDR patients with complicated primary cataract. This sequence of treatment procedure ensures a more gentle approach to the anatomic structures of the eye during the first stage (vitreoretinal surgery) and contributes to the reduction in the number of intraoperative and postoperative complications. Keywords: diabetic retinopathy, cataract, vitreoretinal surgery

Surgical Treatment of Patients with a Bicuspid Aortic Valve and Concomitant Expansion of the Ascending Aorta

The aim. To evaluate the rate of long-term complications on ascending aorta after bicuspid aortic valve (BAV) replacement depending on the type of defect (stenosis or insufficiency) and to determine the indications to certain type of surgery in this category of patients.
 Materials and methods. One hundred five patients underwent BAV replacement between 2007 and 2014. The patients were divided into two groups. Group 1 included 63 patients with stenosis prevalence, group 2 included 42 patients with insufficiency. Aortic diameter at the level of the sinuses of Valsalva and at the level of the ascending aorta was assessed preoperatively and in the long-term postoperative period.
 Results. Long-term results were studied in 86 (81.9%) patients during 6.8 ± 2.2 years at the average. Sixteen (18.6%) patients developed aortic complications: 6 (6.9%) of them had progressive dilatation (10% from initial diameter), aneurysm formation was detected in 8 cases (9.3%) with 6 cases (6.9%) of dissection, 1 patient (1.3%) had aortic rupture. Freedom from ascending aorta dilatation within 13 years after BAV replacement was 95.1% in group 1 and 62.3% in group 2. Freedom from aortic dissection within 13 years after BAV replacement was 90.1% at the average (97% in group 1 and 80.6% in group 2).
 Conclusion. The tactics of aortic aneurysm correction in BAV depends on its diameter and, to a lesser extent, on the presence of stenosis or insufficiency of the valve. With existing stenosis and a diameter of the ascending aorta up to 4.5 cm, it is possible to consider correction without intervention on the ascending aorta. The presence of valve insufficiency in such a situation often requires additional manipulations on the ascending aorta.

From transabdominal to totally extra-peritoneal robotic ventral hernia repair: observations and outcomes.

While robotic-assisted hernia repair has increased the popularity of minimally invasive hernia surgery, selecting between the types of approaches is a challenge for both experts and novices alike. In this study, we compared a single surgeon's early experience transitioning from transabdominal hernia repair with sublay mesh in either the pre-peritoneal or retrorectus space (TA-SM) and enhanced-view totally extra-peritoneal (eTEP) ventral hernia repair in the peri-operative and long-term post-operative time periods. We conducted a retrospective review of 50 eTEP and 108 TA-SM procedures to collect demographics, intraoperative details, and 30-day and 1-year post-operative outcomes. Statistical analysis was performed utilizing Chi-square analysis, Fisher's test, and two sample t-tests with equal variances. There were no significant differences in patient demographics or comorbidities. eTEP patients had larger defects (109.1 cm2 vs. 31.8 cm2, p = 0.043) and mesh used (432.8 cm2 vs. 137.9 cm2, p = 0.001). Operative times were equivalent (158.3 ± 90.6min eTEP and 155.8 ± 65.2min TA-SM, p = 0.84), but conversion to alternate procedure type was higher for the transabdominal approach (4% eTEP vs. 22% TA-SM, p < 0.05). Hospital stay was less in the eTEP cohort (1.3days vs. 2.2days, p < 0.05). Within 30 days, there were no significant differences in emergency visits or hospital readmissions. There was a greater propensity for eTEP patients to develop seromas (12.0% vs. 1.9%, p < 0.05). At 1 year, there was no statistically significant difference in recurrence rate (4.56% eTEP vs. 12.2% TA-SM, p = 0.28) respective to average time to recurrence (9.17months eTEP vs. 11.05months TA-SM). The eTEP approach can be adopted safely and efficiently, and may have superior peri-operative outcomes including fewer conversions and reduced hospital stay.

Расстройства мочеиспускания и качество жизни у больных ДГПЖ после трансуретральной резекции предстательной железы.

Introduction. Transurethral resection (TUR) of the prostate remains the gold standard for surgical treatment of patients with benign prostatic hyperplasia (BPH). A proportion of patients who have undergone a prostatic TUR for BPH continue to have urinary dysfunction. Aim. The aim of the study was to determine the incidence of urinary disorders and quality of life in the long-term postoperative period in patients after prostatic TUR. Materials and methods. We interviewed and surveyed 176 patients who underwent prostate TUR between 2018 and 2021. To determine the prevalence of lower urinary tract symptoms (LUTs) after prostate TUR, we surveyed 176 patients between 12 and 36 months after surgical treatment. The age of the patients surveyed ranged from 47 to 89 years. Results. 53.4% of the patients were completely satisfied with the surgical treatment and 46.6% reported various urinary disorders. According to the questionnaire about the IPSS scale 47.7% patients moderate to severe symptoms persisted after prostate TUR. In 21.6% of the patients quality of life due to urinary disorders was unsatisfactory, poor and very poor. However, moderate and severe symptoms as well as worsening quality of life were more often observed in the older age groups. Conclusions. After prostate TUR, 10.2% of patients have severe and 37.5% have moderate urinary dysfunction in the long-term postoperative period. These urinary disorders worsen quality of life and are more frequent in older patients.

Results of surgical correction for cervical elongation with vaginal wall prolapse in patients of reproductive and premenopausal age

BACKGROUND: The problem of cervical elongation is becoming increasingly important due to the rising prevalence of pelvic organ prolapse. In Russia, descent and prolapse of pelvic organs account for 39% of all gynecological pathologies.&#x0D; AIM: This study aimed to compare the immediate and long-term results of surgical treatment for cervical elongation in combination with vaginal wall prolapse in patients of three clinical groups.&#x0D; MATERIALS AND METHODS: A total of 105 patients aged 30 to 55 years with a combination of cervical elongation and vaginal wall prolapse of degrees III were followed up. The patients were divided into three clinical groups based on the implemented surgical techniques, including group 1 (n=36) with Moscow surgery, group 2 (n=35) with modification of the Manchester surgery using synthetic implants, and group 3 (n=34) with Manchester surgery.&#x0D; The patients underwent a comprehensive clinical examination, surgical treatment, and follow-up in the early and long-term postoperative periods (1, 6, 12, 24, and 36 months). The efficacy of surgical treatment was assessed using a questionnaire. During dynamic monitoring, a gynecological examination with a Valsalva maneuver, and transperineal, and transvaginal echography were performed.&#x0D; RESULTS: During the first month after the surgery, patients noted irregular dragging pains in the perineum and/or inguinal region every second. A frequent urge to urinate was reported in 16.7%, 17.1%, and 17.6% of patients in groups 1, 2, and 3, respectively. A further survey revealed that the surgical treatment results were satisfactory, as it had a positive effect on the quality of life and mood and contributed to an increase in social and sexual activity. According to the physical examination, there were no signs of prolapse recurrence and mesh-associated complications. Erosion of the anterior vaginal wall over the polypropylene endoprosthesis was detected 6 months after the surgery in 3 (8.6%) patients of group 2.&#x0D; Genital prolapse recurrence was diagnosed after 1236 months in 7 (20.6%) patients of group 3. After 36 months, degree I prolapse of the posterior (n=1) and anterior (n=1) walls of the vagina was revealed in patients of groups 1 and 2, respectively.

Cervical Spine in Scheuermann’s Disease: Review

Background. The state of the cervical spine in patients with Scheuermanns disease has still not been studied enough. This concerns the magnitude of cervical lordosis in the norm and in juvenile kyphosis in both pre- and postoperative periods, as well as the relationship of these changes with the spinopelvic parameters. There is almost no information on the correlation between the state of cervical lordosis and the development of proximal transitional kyphosis.&#x0D; Aim of the study. To determine the features of the cervical spine in patients with Scheuermanns disease in the pre- and postoperative periods by analyzing the literature data.&#x0D; Results. The literature data do not allow us to clearly define the limits of normal in the quantitative assessment of cervical lordosis. The only thing all researchers agree on is that the cervical lordosis should be considered discretely, namely at the C1-C2 and C2-C7 levels. The most commonly used parameters of the cervical-thoracic junction are T1 slope, thoracic inlet angle (TIA) and position of the sagittal vertical axis (SVA).&#x0D; The magnitude of cervical lordosis in Scheuermanns disease varies from 4 to 35, i.e., thoracic kyphosis increase is not always accompanied by the development of compensatory cervical hyperlordosis. In thoracic deformities (the apex is at the level of T10 and cranial), the magnitude of cervical lordosis is significantly greater than that in thoracolumbar deformities (the apex is at the level of T11 and caudal). In the first case, the cervical lordosis (C2-C7) is 19.4-26.2, while in the second one 4.7-8.5.&#x0D; Very few literature data demonstrate that in terms of cervical lordosis dynamics, patients with Scheuermanns disease do not represent a homogeneous group. The only pattern is that the cervical lordosis increases slightly in the longterm postoperative period. The spinopelvic parameters in patients with Scheuermanns disease differ little from the normal ones and almost do not change after corrective interventions. We could not find any publications attempting to relate the risk of PJK to cervical-thoracic junction parameters (T1, TIA, SVA).&#x0D; Conclusion. The state of the cervical spine in patients with severe forms of Scheuermanns disease, subject to surgical correction, has not been studied enough. This concerns the magnitude of cervical lordosis, its dynamics in the postoperative period, its relationship with spinopelvic parameters, as well as the correlation between parameters of transitional cervical-thoracic spine and development of proximal transitional kyphoses. Further studies of this problem are needed.

Risk factors for adverse outcomes of percutaneous endoscopic gastrostomy

Introduction. Presently, percutaneous endoscopic gastrostomy is considered to be the operation of choice when long-term enteral feeding in dysphagia syndrome is required. The technique is characterized by low incidence of early and long-term complications due to low traumatic access and operation time. Aim of the work was to assess the risk predictors of percutaneous endoscopic gastrostomy complications and their significance for the postoperative period. Materials and methods. We searched publications and analyzed literature sources using PubMed and MedLine databases and Cochrane Library and elibrary.ru scientific libraries mainly for the last ten years. The search was performed using a set of key words: percutaneous endoscopic gastrostomy, dysphagia syndrome, postoperative complications, risk factors. Results and discussion. The leading and most studied predictors of early and long-term postoperative period complications after gastrostomy are hypoalbuminemia, uncompensated diabetes mellitus, thrombocytopenia, elevated levels of C-reactive protein, Charlson's comorbidity index (4 points or higher), antiaggregant and anticoagulant therapy, morphoconstitutional features of patients. Conclusion. Data analysis has shown that percutaneous endoscopic gastrostomy at high patient flow and gastropectomy supplementation with gastropexy is practically safe and effective if the selection criteria for the operation are observed taking into account the general condition, risk factors and exclusion of absolute contraindications.

Robot-Assisted Surgery in Treating Postoperative Strictures of Lower Third of Ureter

Introduction. The incidence of postoperative ureteral strictures induced by iatrogenic injuries tends to increase. Reconstructive surgery involves open or laparoscopic intervention to repair strictures. However, both methods have their drawbacks. Surgical treating strictures of the lower third of the ureter can be effectively performed by means of robotic surgery.Aim. To determine outcomes of robot-assisted reconstructive surgery in treating postoperative strictures of the lower third of the ureter.Materials and methods. Five female patients with postoperative strictures of the lower third of the ureter underwent robot-assisted reconstructive surgery. Clinical and radiological outcomes in the long-term postoperative period were determined.Results and discussion. Two patients underwent simultaneous robot-assisted reconstructive surgery, namely, robot-assisted uretero-cysto-neoanastomosis on the right side and Boari operation on the left; robot-assisted Boari operation and isolation of post-traumatic uretero-vaginal fistula. In the remaining three cases, robot-assisted Boari operation and uretero-cysto-neoanastomosis with psoas-hitch were performed. No evidence of ureteral stricture in all cases was detected via multislice spiral CT (MSCT) urography in 3 months after surgery.Conclusion. At present, robot-assisted reconstructive surgery, being suitable for simultaneous surgery, is safe and effective whentreating postoperative strictures of the lower third of the ureter.

Causes of unsatisfactory results of arthroplasty of the knee joint osteoarthritis in long-term postoperative period: literature review

In Russia and globally, total knee arthroplasty (TKA) has been increasingly performed. The high quality of implants, improvement of arthroplasty technologies, and accumulated practical experiences of surgeons did not considerably reduce the frequency of complications and unsatisfactory operative outcomes. The negative consequences of knee replacement are determined both intraoperatively and postoperatively. This review aimed to analyze the literature on the frequency and complications of knee arthroplasty and their causes in the long-term postoperative period. In recent decades, the number of patients who are not satisfied with TKA outcomes has been increasing. Moreover, information about complications, their frequency, their causes, and possibilities of preventing negative consequences remains contradictory. Surgical treatment of complications requires particular attention, with surgical site infections as the most common. Recent studies highlight the important of evaluating surgical site infections during and after TKA, especially for deep infectious complications after TKA, which leads to hospitalizations, and reoperations. To date, many studies have investigated early postoperative complications leading to negative consequences in the long-term postoperative period. In addition, in the absence of postoperative complications, the service life of the implant is limited, and unsatisfactory TKA outcomes were attributed to wear and tear of the endoprosthesis. Domestic and international studies about premature or unreasonable TKA, as one of the reasons for negative osteoarthritis treatment outcomes, are increasing. The discussion about the indications and contraindications for knee arthroplasty continues. This literature review discusses the current state of this topic.

Morphological and immunological markers of repeated heart remodeling after surgical reconstruction of the left ventricle in ischemic cardiomyopathy.

Effective treatment of patients with ischemic cardiomyopathy (ICM) is one of the most challenging issues in modern cardiac surgery. The aim of this study was to assess the state of cardiomyocytes and myocardial extracellular matrix, as well as to identify informative markers of an unfavorable prognosis for surgical treatment of ICM. We retrospectively reviewed patients who underwent surgical treatment of ICM between 2011 and 2018 at a single center. Patients were divided into groups depending on the presence of repeated left ventricle (LV) remodeling in one-year follow-up after surgical reconstruction of the LV in ICM patients. A total of 45 patients with ICM were reviewed. The mean age of the patients was 57.9 ± 7.8 years. According to the results of the study, the area of cardiomyocyte nuclei differed statistically significantly among the regions with varying degrees of impaired local contractility (p = 0.042). According to the results of the pairwise comparison in dyskinetic areas of the myocardium, the area of cardiomyocyte nuclei was higher than in normokinetic areas (p = 0.042). A moderate positive correlation was found between the LV ejection fraction measured in one-year follow-up period after surgery and the number of CD163-positive cells (p = 0.012). In the myocardium of patients with LV reverse remodeling in the long-term postoperative period, perivascular fibrosis occurs more frequently than in patients with progressive LV remodeling. The number of M2-anti-inflammatory macrophages prevails in the myocardium of the patients with reverse remodeling compared with patients with progressive remodeling.

Our experience of surgical treatment of recurrent urinary incontinence in women after the installation of a synthetic implant

BACKGROUND: The article presents data on the frequency of recurrence of urinary incontinence in women after the installation of a synthetic implant, as well as methods for the surgical elimination of this pathology. The described urogynecological problem is relevant and widespread.&#x0D; MATERIALS AND METHODS: The results of surgical treatment of 16 women with pelvic organ prolapse and recurrent urinary incontinence after sling operations are presented. All patients underwent laparoscopic colpovesicosuspension.&#x0D; RESULTS: In the postoperative period positive dynamics was noted during the examination using the POP-Q system and the results of the questionnaire using the ICIQ-SF questionnaire, which was observed throughout the follow-up period of 12 months. Complications in the immediate and long-term postoperative period were not identified. For the entire period of observation of the patients, recurrence of prolapse was not observed in any case.&#x0D; CONCLUSION: The proposed method of surgical treatment of recurrence of urinary incontinence in women with mesh implants is effective and safe.

Математическая модель прогнозирования риска аспиринорезистентности и сердечно-сосудистых осложнений у пациентов с ИБС после коронарного шунтирования

Математическая модель прогнозирования риска аспиринорезистентности и сердечно-сосудистых осложнений у пациентов с ИБС после коронарного шунтирования

КАЧЕСТВО ЖИЗНИ ПАЦИЕНТОВ С АХАЛАЗИЕЙ КАРДИИ В ОТДАЛЕННОМ ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ ПРИ 2–4 СТАДИЯХ ЗАБОЛЕВАНИЯ

Evaluation of life quality in patients with achalasia cardia (AC) during the postoperative period, regardless of the method of surgical treatment, remains an urgent topic. The purpose of the study was to assess the quality of life of patients with AC in the long-term postoperative period, depending on the stage of the disease at the time of surgery, by analyzing the results of patient questionnaires and data from instrumental methods for studying the function of the esophagus. Results. The data of 95 patients were analyzed, of which 32 people were with stage 2, 33 people with stage 3 and 30 patients with stage 4 of the disease. All patients underwent the same type of surgical intervention, video endoscopic myotomy according to Heller with fundoplication according to Dor. The long-term period of postoperative follow-up ranged from 2 to 5 years. The results of traditional esophageal manometry and esophageal fluoroscopy were evaluated and the data from the Eckardt symptom score and GIGLI scale questionnaires were evaluated. The anthropometric data showed a statistically significant decrease in the tone of the lower esophageal sphincter in patients in all study groups to normal values (p =0.001). Data obtained during contrast X-ray examination of the esophagus and stomach after surgery revealed the restoration of the evacuation function of the esophagus in all patients (p=0.001). Motor function of the esophagus could not be restored in 6 patients with stage 4 AC, according to manometric data, atony of the esophagus was observed in these patients. The severity and frequency of dysphagia after surgical treatment, according to questionnaires, decreased significantly in patients with all stages of AC, in the long-term postoperative period, patients with stage 2 showed a decrease in the number of points scored by 68.9%, patients with stage 3 by 70.5% and patients with stage 4 of AC by 66.7% (p&lt;0.05). Conclusions. According to Eckardt score and GIGLI questionnaires and instrumental methods of examination of esophageal function, video endoscopic esophagocardiomyotomy according to Heller with Dor fundoplication leads to a decrease in the main symptoms of achalasia of the cardia in patients with stages 2-4 of the disease and increases quality of life, while the best indicators were obtained in patients with stage 2 of the disease, which allows us to consider that it is advisable to perform this organ preservation operation already at the second stage of AC.

ПРЕДИКТОРЫ АСПИРИНОРЕЗИСТЕНТНОСТИ У ПАЦИЕНТОВ С ИБС ПОСЛЕ КОРОНАРНОГО ШУНТИРОВАНИЯ

Introduction. After coronary bypass surgery (CABG) under artificial circulation (IC), the problem of preventing vascular shunt thrombosis remains unresolved, due to the formation of resistance to the phenomenon of aspirin resistance (AR). Objective: To study the clinical and laboratory signs of AR and identify predictors of AR. Materials and methods. The study included 260 men aged 45 to 70 years with a diagnosis of coronary heart disease (CHD) in the form of stable angina pectoris and pain-free myocardial ischemia, who underwent CABG. Systemic inflammation activity for surgical intervention was evaluated by the concentration of interleukin-6 (IL-6) and highly sensitive C-reactive protein (HCRP) in blood serum, and the severity of endotheliopathy was assessed by the level of endothelin–1 (ET-1). Platelet aggregation activity (AAT) was also studied. Patients with AR included those individuals whose AAT did not reach target values against the background of taking acetylsalicylic acid (ASA) at a dose of 100 mg / day decreased by less than 50% compared to initial parameters. To analyze the influence of various factors (predictors) on AAT, the method of linear step-by-step regression analysis with inclusions was used. Results. On the second day after CABG, AR was detected in 46.9% of the patients who made up the main group. The comparison group included 53.1% of patients who retained AC. A year after surgery in the background of taking ASA, the proportion of patients with AR decreased to 24% of the initial AC in the preoperative period. In two groups of patients, IL-6, VCHSRB, ET-1, AAT were compared at the three stages of the examination, and the duration of IC, the number of vascular shunts after CABG. Statistically significantly higher indicators of the studied parameters were revealed in the main group than in the comparison group both on the second day and 1 year after the departure. As a result of the regression analysis, a set of five predictors was obtained that statistically significantly (F=12.2, p&lt;0.012) affect AAT: ET-1, IL-6, VCHSRB, IR time, number of shunts. Conclusion. The severity of systemic inflammation in CABG in IR conditions affects the development of induced AR. The persistence of systemic inflammation is associated with prolongation of AR in the long-term postoperative period. Regression analysis revealed the important role of markers of systemic inflammation and endotheliopathy in the development of AR.

Skip corpectomy in surgical treatment of cervical spondylotic myelopathy

To evaluate the effectiveness and safety of skip corpectomy in surgical treatment of cervical spondylotic myelopathy. The study included 7 patients with cervical myelopathy following extended cervical spine stenosis. All patients underwent skip corpectomy. Clinical examination included degree of neurological disorders according to the modified scale of the Japanese Orthopedic Association (JOA) with assessment of recovery rate and Nurick score, as well as VAS score of pain syndrome. Verification of diagnosis was based on the data of spondylography, magnetic resonance and computed tomography. The indications for surgical treatment were conduction disorders and their spondylotic genesis confirmed by neuroimaging methods. Score of pain syndrome decreased by 2-4 points (mean 3.1) in long-term postoperative period. The JOA, Nurick scores and recovery rate (mean 42.5%) demonstrated significant improvement of neurological status in all patients. In all cases, the follow-up examination confirmed adequate decompression and spinal fusion. Skip corpectomy provides adequate spinal cord decompression in case of extended cervical spine stenosis and minimizes the risk of complications typical for multilevel corpectomy. Recovery rate indicates the effectiveness of this method in surgical treatment of cervical myelopathy caused by multilevel stenosis. However, further studies on sufficient clinical material are needed.