Long-term Results Of Surgical Treatment Research Articles

Comparative analysis of long-term results of surgical treatment of children with basal encephaloceles

Basal encephaloceles (skull base hernias) are a rare pathology manifested by prolapse of altered membranes and brain tissue through a bone defect of the skull base. Endoscopic access is safer and is currently used as the method of choice in the treatment of this pathology. Available literature studies do not cover the quality of life of these patients at follow-up. There is a controversy regarding the impact of endoscopic access on the growth centers of the facial skeleton. Material and methods. A retrospective analysis of a series of 100 patients aged 0 to 18 years with basal encephaloceles who underwent surgical treatment at the N. N. Burdenko National Medical Research Center of Neurosurgery from 2005 to 2022 was carried out to determine the effectiveness and safety of the endoscopic method in the treatment of patients with basal encephaloceles and identify factors affecting the quality of life of these patients. Results and conclusions. Endoscopic endonasal access in the treatment of children with basal encephaloceles is effective and safe. Patients have a high quality of life (>85 points) at follow-up. After the operation, there is an improvement in nasal breathing and an increase in the degree of psychomotor development. Patients have a high quality of life (>85 points) at follow-up. A lower quality of life at follow-up was observed in children with delayed psychomotor development before surgery (OR=0.6; p=0.003). The follow-up study of the dynamics of craniometric parameters did not reliably show any disturbances in the growth of the bones of the facial skeleton in patients after endoscopic surgery.

Surgical treatment of chronic pancreatitis in children

Chronic pancreatitis in children is a continuous or recurrent disease characterized by irreversible inflammatory and destructive changes in the pancreas (PG), progressive fibrosis, accompanied by a gradual decrease in its exocrine and endocrine functions. In recent decades, there has been a significant increase in patients with CP; the incidence in children is estimated at 2 cases per 100,000 people. According to the literature, pancreatic cancer in the outcome of chronic pancreatitis in childhood is 6.2%. Mortality rates for CP vary in different studies: 15-20% of children with CP die from complications and secondary disorders. The purpose of the study is to study current problems and determine the prospects for the treatment of chronic pancreatitis in children based on a review of modern literature. Materials and methods. As part of the preparation, a systematic review of the world and domestic literature on the surgical treatment of chronic pancreatitis in children was carried out. Results. A literature search confirmed the lack of consensus regarding the surgical treatment of CP in children. The small number of observations does not allow us to analyze the long-term results of surgical treatment of children with CP. Patients with hereditary pancreatitis pose a particular challenge; treatment algorithms for this group of patients are not described in the literature. Also in the literature there are isolated descriptions of complications with CP in children; there are no reliable results of the effectiveness of surgical intervention for endocrine and exocrine insufficiency in children. It is necessary to conduct scientific and practical research to develop indications for surgical treatment of children with CP and to verify specific complications.

[Mid- and long-term results of surgical treatment of brachiocephalic Takayasu arteritis].

Objective: To examine the mid - and long-term outcomes of surgical treatment of brachiocephalic Takayasu arteritis. Methods: This is a retrospective case series study. The clinical data of 39 patients,which had been diagnosed as brachiocephalic Takayasu arteritis (244 cases),who underwent surgical treatment,were analyzed between July 2012 to November 2022 at Department of Endoluminal Vascular Surgery, the First Affiliated Hospital of Zhengzhou University. There were 5 males and 34 females, aged (37.9±14.0)years (range:13 to 71 years). Despite medical treatment, the patients suffered severe ischemic symptoms continually and then underwent surgical interventions. Among them, 20 patients underwent endovascular procedures, 11 underwent open surgical procedures, and 8 underwent hybrid procedures. Patients were followed up through outpatient visits at 1, 3, 6 months after surgery and once every year later. Follow-up was conducted until November 2022. Operation status, postoperative complications and re-intervention of patients were recorded and the Kaplan-Meier survival curves were used to analyze postoperative vascular patency rates. Results: All 39 surgeries were successful, with no intraoperative death or serious complications. The follow-up period was (48.8±38.2) months(range:1 to 123 months). Thirty-three patients experienced symptom relief after surgery, and 6 patients required secondary surgical interventions. The patency rates for the endovascular treatment group at 1-, 3-, 5-, and 10-year were 95.0%, 75.2%, 60.2%, and 60.2%, respectively, while the patency rates for open surgery were all 90.9%. In the hybrid surgery group, the patency rates at 1-, 3-, 5-, and 8-year were all 87.5%. Conclusion: For patients with brachiocephalic Takayasu arteritis, choice of an appropriate blood flow revascularization intervention should be based on the patient's condition,and the mid-and long-term outcomes are satisfactory.

Schwannoma of the Upper Extremity: A Clinical Series

Background: Schwannoma, the most common primary neural tumor of the upper extremity, arises from Schwann cells of the nerve sheet. The tumor is usually painless and slow-growing. Symptomatic masses could be treated through intra- or extra-capsular excision. Herein, we aim to evaluate the long-term results of surgical treatment of 12 cases of upper extremity Schwannoma.
 Methods: Twelve cases of confirmed Schwannoma who were treated in Imam Khomeini University Hospital, Tehran, Iran, from 2011 to 2022, were included in our case series. All operations were done using loupe magnification or under a microscope. Age, sex, location of the mass, size of the tumor, affected nerve, histological diagnosis, and clinical follow-up, including the neurological status of the patients, were documented.
 Results: Twelve patients with a mean age of 44 years were included. Seven (58.3%) were men and five (41.66%) were women. The mean follow-up period was 45 months (range: 6-135). The hand was the most common location of involvement and the digital nerve was the most frequent origin of Schwannoma. Postoperative evaluation showed no tumor recurrence and pain resolved in all twelve patients (100%). Sensory dysfunction resolved completely in 5 out of 8 patients who reported sensory impairment preoperatively (62.5%) and no motor function improvement was seen in the patient with motor deficit.
 Conclusion: Adequate operative techniques can lead to complete tumor removal without neurological loss or recurrence. Neural function improvement in most cases is achieved. New neurologic impairment after excision of Schwannoma is rare.

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.

Analysis of surgical treatment of patients with pancreatic cancer at the Samara Regional Clinical Oncological Dispensary

BACKGROUND: Surgery is the only treatment option for tumors of the head and tail. To date, the most optimal operations used for tumors of the head of the pancreas are gastro-pancreatoduodenal resection, and for tumors of the tail — distal subtotal resection of the pancreas and splenectomy. The main access for these operations is median laparotomy. In our article, we analyze the surgical interventions that have been performed for pancreatic cancer in our center, Samara Regional Clinical Oncological Dispensary.
 AIM: Analysis of surgical interventions for pancreatic cancer in the Samara Regional Clinical Oncological Dispensary to assess the immediate and long-term results of surgical treatment.
 METHODS: This article presents the results of treatment of 236 patients with pancreatic cancer in the Department of abdominal Oncology of the Samara Regional Clinical Oncology Dispensary from 2018 to 2023. Most patients underwent surgical interventions, including choledochal stenting, bile duct drainage, and cholecystostomy. In inoperable or unresectable processes, palliative surgery was performed, such as the formation of cholecystoenteroanastomosis and gastroenteroanastomosis. Most of the patients underwent radical surgery, and some of them were preceded by neoadjuvant polychemotherapy. In the postoperative period, various reconstruction methods were performed, including the formation of pancreato-gastro-anastomosis and pancreatoejunoanastomosis. Combined operations were also performed in some patients with tumor invasion of adjacent organs.
 RESULTS: The medical records of 99 patients who underwent radical surgery were examined. 30 of them had significant clinical complications according to the Clavien–Dindo classification and included pancreatic fistula, failure of pancreatoejunoanastomosis, failure of pancreato-gastro-anastomosis and subhepatic abscess. All patients underwent laparotomy, sanitation and drainage of the abdominal cavity, and continued treatment in intensive care units. Some patients required a relaparotomy to stop intra-abdominal erosive bleeding. The mortality rate was 12.02%, the cause of death in some cases was the failure of pancreatoenteroanastomosis together with pancreatic fistula and cardiopulmonary insufficiency caused by pulmonary embolism. The patients were divided into four groups depending on the operation performed. Mortality after distal subtotal pancreatic resection was 2.02%, after.
 CONCLUSION: Surgical intervention is the main method of treating pancreatic cancer. Radical surgery is a key factor that affects the prognosis of the disease. However, the lack of verification of pancreatic cancer before admission to the hospital does not allow chemotherapy to be performed in the mode of preoperative treatment for a common form of the disease. In about 70% of patients, the syndrome of mechanical jaundice becomes the first manifestation of the disease, which requires additional methods of diagnosis and treatment. The complexity of the operation lies in the proximity of the pancreas to vascular structures. Most patients are already inoperable at the time of diagnosis confirmation due to the spread of the tumor process. Due to the technical complexity of operations, the high number of complications and high postoperative mortality, treatment of pancreatic cancer should be carried out in large specialized centers. The treatment of the disease requires interdisciplinary cooperation to achieve optimal diagnosis.

[Outcomes of hemi-Descemet membrane endothelial keratoplasty and phacoemulsification for the treatment of primary Fuchs' endothelial corneal dystrophy combined with cataract].

This study evaluates the long-term results of surgical treatment of patients with Fuchs' endothelial corneal dystrophy and cataract. The study included 24 patients (24 eyes) with primary Fuchs' endothelial corneal dystrophy and cataract, who underwent cataract phacoemulsification with IOL implantation and of Descemet's membrane endothelial keratoplasty with a semicircular graft (hemi-DMEK). The effect of treatment was assessed by best corrected visual acuity (BCVA), central corneal thickness (CCT) and endothelial cell density (ECD). In total, surgical treatment involved 14 donor corneas that were divided in half during the preparation and isolation of the Descemet's membrane (DM). By month 12 after the surgery an increase in visual functions and graft transparency were observed in 23 patients (23 eyes) out of 24. Repeated keratoplasty was required in one case due to fibrosis of the posterior layers of recipient's corneal stroma. At 12 months postoperatively, the study group showed an increase in BCVA from 0.16±0.1 to 0.75±20, a decrease in CCT from 650.9±4.5 μm to 519.6±43.9, and a decreased in ECD from 2850.5±84.7 cells/mm2 up to 1285.5±277.2 cells/mm2. Thus, the loss of endothelial cells at one year after surgery amounted to 54.9%. The developed method for transplantation of a semicircular DM fragment provides a tissue-saving approach to endothelial keratoplasty, and considering the high percentage of transparent engraftment of grafts and complete visual rehabilitation, it can be recommended in the treatment of patients with cataract and Fuchs' endothelial corneal dystrophy.

Gastric resection in emergency surgery

The success of the therapeutic treatment of gastric and duodenal ulcers has also changed the attitude of surgeons to the complications of peptic ulcer. Currently, the main aim of the surgeon is to eliminate the life-threatening consequences of perforation or bleeding. In addition, methods of intraluminal endoscopy continue to develop vigorously, in some cases competing with both open and laparoscopic surgeries for perforated ulcers, and endoscopic and endovascular hemostasis is increasingly used for ulcer bleeding.Purpose. To analyze the immediate and long-term results of surgical treatment of complicated gastric and duodenal ulcers and to evaluate the place of gastric resection in emergency surgery.Results. The paper analyzes the results of resection and organ-preserving gastric surgeries in perforated and bleeding ulcers using modern instruments that improve the results of the operation. As a reserve for improving the results of this intervention, one should consider performing optimal mobilization and a full revision of the ulcer defect zone, and, of course, involving a more experienced surgeon.

Surgical treatment of genital prolapse in combination with endometrial hyperplastic processes in postmenopausal women

Aim. To study the long-term results of surgical treatment of postmenopausal patients with genital prolapse III and IV according to the POP-Q classification in combination with endometrial hyperplastic processes and to assess their quality of life.
 Materials and methods. Fifty one elderly and senile patients with grade III–IV prolapse according to the POP-Q classification in combination with endometrial hyperplastic processes. 2 groups were formed: 1st – 21 patients after one-stage vaginal extirpation of the uterus with appendages and unilateral sacrospinous fixation of the vaginal stump with a synthetic endoprosthesis-tape in combination with reconstruction of II and III levels of pelvic floor support according to DeLancey; 2nd – 30 patients after one-stage vaginal extirpation of the uterus with appendages and median colporrhaphy using the Lefort and Neugebauer technique.
 Results. The study was evaluated 1–7 years after surgical treatment. The average age of patients at the time of surgery in group 1 was 63.12±4.32 years, in group 2 – 74.2±3.28 years. The number of women with somatic pathology in the 1st group was 1.7 times less in percentage terms than in the 2nd. The disappearance of symptoms of an overactive bladder after surgery was noted by 4 (50.0%) of 8 patients of the 1st group and 4 (26.7%) of 15 women of the 2nd. Uroflowmetry after surgical treatment showed an increase in the maximum flow rate (Qmax) and a decrease in the volume of residual urine (Vom) in both groups (p0.001). Recurrence of genital prolapse was detected in the apical region in 1 (4.8%) woman, prolapse of the anterior vaginal wall in 1 (4.8%). There were no recurrences of genital prolapse in the 2nd group. A significant improvement in the quality of life after surgery, according to the results of processing the PFDI-20 questionnaire, was noted by 19 (90.5%) women in the 1st group and 29 (96.7%) – in the 2nd.
 Conclusion. The long-term results of the proposed operational benefits have shown satisfactory results and can be successfully used in the elderly and senile age. The choice of the volume of surgery taking into account age, sexual activity, concomitant gynecological and somatic pathology reduces the number of complications and improves the results of surgical treatment in this category of patients.

OUR EXPERIENCE IN THE TREATMENT OF FRACTURES OF THE PROXIMAL HUMERUS

Improvement of both means of osteosynthesis and methods of restorative treatment of nearand intra-articular fractures of the humerus is an urgent problem of modern traumatology and therefore often attracts the attention of researchers. Purpose: to study the long-term results of surgical treatment of patients in whom fractures of the proximal humerus were fixed with lockable plates. Materials and methods. The authors presented in the article the outcomes of treatment of 36 patients with a fracture of the proximal part of the shoulder. The age of the patients varies in the range of 18-75 years, all of them were operated on in the traumatology department of the city hospital No. 4 in 2019-2021. There were 12 (33.4%) men and 24 (66.6%) women. Results and conclusions. Excellent and good results of treatment were observed mainly in 2- and 3-fragment fractures, as well as in those operated on in the early stages. Blocked plates made it possible to obtain positive results of treatment in 69.5% of cases, and satisfactory results in 16.7% of cases. Unsatisfactory outcomes were noted in 13.8% of patients, complications after surgery — in 19.4%. Ensuring stable osteosynthesis in multifragment fractures of the proximal humerus is considered a difficult task. Our material and literature data confirm that the percentage of complications after osteosynthesis of the humerus can increase not only if the operation technique is not followed, but they are also associated with the presence of osteoporosis, osteonecrosis, and pathological tissue regeneration.

Urinary incontinence in obese women

In recent decades, obesity has assumed the features of a pandemic. Leading to the development of many complications, obesity also contributes to the development of urinary incontinence. The review presents current data on the etiology, pathophysiology and approaches to the treatment of stress urinary incontinence in obese patients. There are a large number of publications by foreign authors on the problem of urinary incontinence in patients with obesity. The results of the studies allow us to say with confidence about the direct relationship between an increase in body mass index and the risk of developing urinary incontinence. Long-term results of surgical treatment of urinary incontinence in obese patients require reflection and further observation. It is noteworthy that this problem is practically not reflected in the works of domestic authors. It is relevant to conduct domestic clinical studies on the problems of urinary incontinence in patients with obesity.

Prediction of late results of surgical treatment of traumatic retina detachment in eye injury of multiple origin

Purpose. To evaluate the possibility of predicting the anatomical and functional results of surgical treatment of traumatic retinal detachment (RD) in trauma of various geneses, taking into account the clinical picture and the severity of the proliferative syndrome based on large clinical data.Materials and methods. A comprehensive analysis of the clinical picture (using 22 features) and long-term results of surgical treatment of 427 patients with traction traumatic RD (TRD) after open and closed eye injury was carried out. The patients were divided into 7 groups depending on the mechanism of injury. The observation period was 5 years.Results. The most severe proliferative syndrome was observed in TRD after an open injury: OEI A (contusions with scleral rupture), OEI D (double puncture wound) and OEI E (explosive trauma with scleral rupture), when both the process of mooring and PVR are present, as well as with CEI A (contusion) in the event that after the first operation PVR continued to progress. We found a direct dependence of PVR activity in TRD on the area of the detached retina and the presence of a traumatic cataract, and the inverse dependence on the presence of intraocular foreign body (IFB), its size and the ability of IFB to cause metallosis. A direct dependence of long-term functional results of treatment on the PVR stage, the area of detached retina and the diagnosed retinal rupture during the first vitreoretinal surgical intervention was established.Conclusion. In order to make the surgical treatment of TRD more effective, it is worth using antiproliferative drugs intravitreally during vitreoretinal surgery, especially in OEI A, OEI D and OGI E, when the proliferative syndrome is caused both by PVR and mooring, as well as in CEI A in the case of a pronounced PVR stage.

Early and long-term results of surgical treatment of popliteal artery aneurysms using a heparin-bonded expanded polytetrafluorethilene graft.

The aim of the present study was to assess early and long-term results of open surgical interventions for popliteal artery aneurysms (PAAs) with the use of heparin-bonded expanded polytetrafluorethylene (HePTFE) in a single center, retrospective, non-comparative cohort study. A retrospective analysis of a prospectively maintained dataset, including 207 open interventions for PAAs between 2002 and 2022, was performed and 170 procedures carried on with the use of a HePTFE graft were found. Perioperative results were analyzed in terms of mortality, graft thrombosis and amputation rates. Follow-up results were analyzed in terms of survival, primary and secondary patency, freedom from amputation, freedom from reintervention with life-table analysis and Kaplan Meier curves. Follow-up results were considered as primary outcomes, whereas perioperative results were considered as secondary outcomes. In 82 interventions (48%) the PAA was asymptomatic. In 140 cases a medial approach was used, while in 30 cases a posterior approach was preferred. The level of the distal anastomosis was the p3 tract of the popliteal artery in 89% of the cases. One perioperative death occurred; early thromboses occurred in eight cases and the overall perioperative amputation rate was 2.8%. The median duration of follow-up was 48 months (range 1-251). Estimated survival rate at 10 years was 55% (standard error, SE, 0.065). The 10-year rates of primary and secondary patency and freedom from amputation were 40.8% (SE 0.06), 47.6% (SE 0.065) and 93.4% (SE 0.04), respectively. The estimated freedom from reintervention rate at 10 years was 57% (SE 0.05). The results of this large monocentric experience showed that open surgical repair of PAAs with HePTFE is a safe procedure, with low rates of perioperative complications, and excellent results in the long-term setting.

Отдаленные результаты хирургического лечения сквозных макулярных разрывов без тампонады витреальной полости

Purpose. To evaluate the long-term results of surgical treatment of full-thickness macular holes without vitreous cavity tamponade. Methods. The analysis of surgical treatment of 64 patients (64 eyes) with full-thickness macular holes of large diameter was carried out. Tamponade of the vitreal cavity at the end of the operation was not performed. Results. In all cases surgical treatment provided a positive anatomical, morphological and functional result. Conclusions. The study demonstrated the possibility of surgical treatment of of full-thickness macular holes without vitreous cavity tamponade. Key words: macular hole, platelet-rich plasma.

Clinical features of patients with cancer of thoracic esophagus and results of their surgical treatment

Esophageal cancer takes one of the first places in the structure of morbidity and mortality among malignant diseases. The development of anesthesiology and thoracic resuscitation provided the evolution of the surgical method. Resections of the esophagus with locally-disseminated and complicated forms of cancer have become possible. But even today, the long-term results of surgical treatment don’t satisfy clinicians. Often this is due to the dissemination of the tumor process in most patients at the time of treatment. For this purpose, an analysis of clinical material was carried out, including 89 patients with cancer of thoracic part of esophagus, who underwent reconstructive surgeries (extirpation of the thoracic part of esophagus with simultaneous retromediastinal plasty by stomach tube) in the surgical unit of Republican Clinical Hospital (RCH), n.a. academic M.A.Mir-Gasimov, Baku city. Interventions on the esophagus were performed either of two approaches – upper median laparotomy and left-sided cervicotomy (76 patients – 85,4%) or from three-with the addition of a right sided lateral thoracotomy in the fifth intercostal space (13 patients – 14,6%). There were no deaths due to surgical complications. The fundamental possibility and reasonableness of performing expanded radical interventions has been detected, taking into account the technical resectability of the tumor, which is especially important in working with a group of patients with “late” esophageal cancer criteria, such as the age of the patient, the size of the primary tumors, its local dissemination are not a contraindication to radical surgery.

Nutritional support for primary patients with esophageal cancer (analytical review)

In order to study the feasibility and safety of nutritional support in primary esophageal cancer, an analysis of publications on the topic in the medical databases e-Library, PubMed, Medline was performed. Based on the data obtained, it is shown how anorexia-cachexia syndrome is diagnosed in patients with primary esophageal cancer, which transforms into sarcopenia. Nutritional support provided in the perioperative period improves the immediate and long-term results of surgical treatment. When conducting systemic antitumor treatment, nutritional support is considered as an integral component of complex therapy, allowing to achieve the best results at all stages of the treatment process, as well as after its completion. The drug of choice is enteral nutrition with a high protein and energy content.

Results of surgical treatment of polycystic ovarian syndrome in women of reproductive age

BACKGROUND: Polycystic ovarian syndrome (PCOS) is one of the most common and to some extent mysterious diseases falling under the competence of gynecologists. PCOS occurs in 510% of women of reproductive age. This paper presented the long-term results of surgical treatment of patients with PCOS.
 AIM: This study aimed to determine the efficiency of surgical treatment of the ovaries to restore reproductive function in women with PCOS.
 MATERIALS AND METHODS: The initial diagnosis of PCOS was made at the outpatient examination. The study included 121 women of reproductive age diagnosed with PCOS when other factors of infertility and menstrual dysfunction were excluded. Patients with PCOS as an initial diagnosis for hospitalization and absence of tubal-peritoneal infertility and male infertility were included. All patients (n = 121) underwent surgical treatment and histological examination. Patients were referred for treatment to gynecological surgical hospitals. In particular, 54 (group 1), 48 (group 2), and 19 (group 3) women were treated in a municipal clinical hospital, research center, and commercial clinic, respectively. Statistical data analysis was performed with the STATISTICA Base software package using parametric and nonparametric methods. Arithmetic mean, standard deviations, medians, and percentiles of the indices were calculated. Confidence limits to the arithmetic mean were calculated based on Students distribution. The exact 95% confidence limits to frequencies and the reliability of differences in frequencies between the groups were determined using binomial distribution and the chi-square test, respectively. In addition, the MannWhitney (U) and Wilcoxon nonparametric tests were used because several indicators had significantly normal distributions. Differences were considered statistically significant at p 0.05.
 RESULTS: Of the total number of patients (n = 121), 108 (89%) became pregnant postoperatively, and 13 (11%) did not. Moreover, 47 (39%) of the total number of patients became pregnant for up to 1 year and 61 (50%) for over a year, and 48 (39.6%) of 108 patients became pregnant post-in vitro fertilization (IVF, 12 attempts in 37 (32%) and more than 3 attempts in 11, or 9% patients). PCOS was confirmed in 6 (14%) patients; of these, spontaneous pregnancy occurred in 5 (83%), including 4 patients in the first year and 1 in over a year. These patients had clinical and biochemical signs of hyperandrogenism and insulin resistance.
 PCOS-like conditions were diagnosed in 37 (86%) patients; of these, pregnancy occurred in 33 (89%), including spontaneous pregnancy in 10, or 27% (4 within 1 year and 6 over 1 year) patients. Post-IVF pregnancy was diagnosed in 23 (62%) patients (12 attempts in 20, or 54.1%, and more than 3 attempts in 3, or 8.1% women).
 CONCLUSIONS: Surgical treatment of patients with PCOS is an independent treatment of this gynecological and metabolically burdened disease. This method has both indications and contraindications, and it has specific types, which require certain patient preparations, such as weight loss, blood glucose control, hyperinsulinemia analysis, and compensation of arterial hypertension, to increase treatment efficiency.

Twenty-Year Experience with Surgery for Native and Prosthetic Mitral Valve Endocarditis.

Background and Objectives: To evaluate the early and long-term results of surgical treatment of isolated mitral native and prosthetic valve infective endocarditis. Materials and Methods: All patients undergoing mitral valve repair or replacement for infective endocarditis at our institution between January 2001 and December 2021 were included in the study. The preoperative and postoperative characteristics and mortality of patients were retrospectively reviewed. Results: A total of 130 patients, 85 males and 45 females, with a median age of 61 ± 14 years, underwent surgery for isolated mitral valve endocarditis during the study period. There were 111 (85%) native and 19 (15%) prosthetic valve endocarditis cases. Fifty-one (39%) patients died during the follow-up, and the overall mean patient survival time was 11.8 ± 0.9 years. The mean survival time was better in patients with mitral native valve endocarditis compared to patients with prosthetic valve endocarditis (12.3 ± 0.9 years vs. 8 ± 1.4 years; p = 0.1), but the difference was not statistically significant. Patients who underwent mitral valve repair had a better survival rate compared to patients who had mitral valve replacement (14.8 ± 1.6 vs. 11.3 ± 1 years; p = 0.06); however, the difference was not statistically significant. Patients who underwent mitral valve replacement with a mechanical prosthesis had a significantly better survival rate compared to patients who received a biological prosthesis (15.6 ± 1.6 vs. 8.2 ± 0.8 years; p < 0.001). Patients aged ≤60 years had significantly better survival compared to patients aged >60 years (17.1 ± 1.1 vs. 8.2 ± 0.9; p < 0.001). Multivariate analysis showed that the patient's age >60 years at the time of surgery was an independent risk factor for mortality, while mitral valve repair was a protective factor. Eight (7%) patients required reintervention. Freedom from reintervention was significantly higher in patients with mitral native valve endocarditis compared to patients with prosthetic valve endocarditis (19.3 ± 0.5 vs. 11.5 ± 1.7 years; p = 0.04). Conclusions: Surgery for mitral valve endocarditis is associated with considerable morbidity and mortality. The patient's age at the time of surgery represents an independent risk factor for mortality. Mitral valve repair should be the preferred choice whenever possible in suitable patients affected by infective endocarditis.

Management of External Auditory Canal Anterior Wall Defect: A Case Series and Literature Review.

Although rare in etiology, anterior bony wall defects of the external auditory canal (EAC) accompanied by temporomandibular joint herniation may cause various otologic symptoms. Surgical treatment can be considered based on symptom severity because many previous case reports have highlighted its efficacy. This study aimed to review the long-term results of surgical treatment of EAC anterior wall defect and to suggest a stepwise approach when creating a treatment plan. We performed a retrospective review of 10 patients who underwent surgical management to address the EAC anterior wall defect and its associated symptoms. Medical records, temporal bone computed tomography scans, audiometry, and endoscopic examination findings were analyzed. The primary repair of the EAC defect was the first to be surgically addressed in most cases, excluding one case with a severe combined infection. Of the 10 cases, 3 patients exhibited either postoperative complications or symptom recurrence. Six patients had resolved symptoms consequent to primary surgical repair, and four patients underwent revision surgery undergoing a more invasive procedure, such as canalplasty or mastoidectomy. Primary repair of the anterior wall defect of the EAC seems to be overpromoted for lasting results but is not as promising as previously noted. We therefore propose to create a novel treatment flowchart regarding the surgical treatment of anterior wall defects of the EAC based on clinical experience. IV.

Evaluation of long-term results of surgical treatment of patients with hiatal hernia by the method of daily pH-metry

A comparative assessment of the long-term results of surgical treatment of patients with hernia of the esophageal opening of the diaphragm was made. All patients were divided into two groups. The first group included patients who underwent isolated correction of a hernia of the esophageal orifice of the diaphragm. Patients of the second group, in addition to correcting a hernia of the esophageal orifice of the diaphragm, performed simultaneous operations depending on the concomitant pathology in the abdominal cavity. The results of surgical treatment were evaluated using the method of daily pH-metry. It is concluded that performing simultaneous operations in patients with hernia of the esophageal orifice of the diaphragm is justified.