Long-term Results Of Surgical Treatment Research Articles

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.

Developmental Aspects of Cardiac Adaptation to Increased Workload

The heart is capable of extensive adaptive growth in response to the demands of the body. When the heart is confronted with an increased workload over a prolonged period, it tends to cope with the situation by increasing its muscle mass. The adaptive growth response of the cardiac muscle changes significantly during phylogenetic and ontogenetic development. Cold-blooded animals maintain the ability for cardiomyocyte proliferation even in adults. On the other hand, the extent of proliferation during ontogenetic development in warm-blooded species shows significant temporal limitations: whereas fetal and neonatal cardiac myocytes express proliferative potential (hyperplasia), after birth proliferation declines and the heart grows almost exclusively by hypertrophy. It is, therefore, understandable that the regulation of the cardiac growth response to the increased workload also differs significantly during development. The pressure overload (aortic constriction) induced in animals before the switch from hyperplastic to hypertrophic growth leads to a specific type of left ventricular hypertrophy which, in contrast with the same stimulus applied in adulthood, is characterized by hyperplasia of cardiomyocytes, capillary angiogenesis and biogenesis of collagenous structures, proportional to the growth of myocytes. These studies suggest that timing may be of crucial importance in neonatal cardiac interventions in humans: early definitive repairs of selected congenital heart disease may be more beneficial for the long-term results of surgical treatment.

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.

Analysis of long-term results of surgical treatment of patients with a closed fracture of the patella using a new method

The purpose of the study was to analyze the long-term results of surgical treatment of patients with a patella fracture, in the treatment of which a new method of osteosynthesis was applied.Materials and methods. The long-term results of surgical treatment of 18 patients with a closed patella fracture were analyzed, the functional state of the knee joint was assessed after 12 months from the operation using clinical and radiological methods. A clinical example of a patient with a traumatic closed fracture of the patella is given, illustrating the surgical treatment of this patient. The results of treatment are presented.Results. The data obtained indicate the effectiveness and biomechanical validity of the patented method. The prospects for further research are outlined.

ДИАГНОСТИЧЕСКИЕ ВОЗМОЖНОСТИ В ОЦЕНКЕ ОТДАЛЕННЫХ РЕЗУЛЬТАТОВ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ АНОМАЛЬНОГО ОТХОЖДЕНИЯ ЛЕВОЙ КОРОНАРНОЙ АРТЕРИИ ОТ ЛЕГОЧНОЙ АРТЕРИИ

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome is a rare congenital coronary artery anomaly and a complex congenital heart defect (CHD) condition. According to the bibliographical sources a good result is noted with the restoration of the heart size and its functional state after the CHD correction. Nevertheless, after a radical correction of the defect, a number of problems may remain, such as: the occurrence of malignant arrhythmias, sudden cardiac death, decompensated heart failure (HF), coronary artery stenosis that require medical or repeated surgical treatment. The detection of even minor deviations in the functional state of the myocardium in the population of patients with ALCAPA is of great clinical importance, and this category of patients requires the regular and dynamic follow-up. The evolution of diagnostic research methods, such as biomarkers of heart failure, echocardiography with tissue myocardial Doppler and speakle tracking, magnetic resonance imaging, single photon emission computed tomography, positron emission tomography and stress testing, provide opportunity to assess the functional and anatomical recovery of the left ventricular myocardium in detail and to identify the signs of latent HF in the late postoperative period. The purpose of the research was to provide an up-to-date review of the data on the diagnostic and prognostic significance of laboratory and instrumental research methods in assessing the long-term results of surgical treatment of the anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome.

Long-term results of surgical treatment with the use of transverse carpal ligament reconstruction in patients with carpal tunnel syndrome depending on the age categories and severity of the disease

Carpal tunnel syndrome is one of the most common neuropathies of the upper extremities. The disease is manifested by pain in the hand, accompanied by numbness, paresthesia, muscle weakness, a significant decrease in grip strength and a marked deterioration in the functional state of the hand as a whole, which causes disability of patients. Surgical treatment of pathology is considered the most effective. In order to assess the long-term results of surgical treatment with the use of transverse carpal ligament reconstruction, depending on the age and severity of the disease, a clinical examination of 48 patients was conducted in the periods before surgery and 6 months after surgery. The patients were divided into four groups by age categories: from 18 to 44 years old, from 45 to 60 years old, from 61 to 75 years old, over 75 years old, and into three groups according to the severity of the disease according to the classification of R. Szabo. The examination included a clinical examination with specialized provocative tests and questionnaires, dynamometry and electoroneuromyography. It was determined that patients with grade II severity of SPC of categories from 18 to 44 years and from 44 to 60 years had the best indicators.

Neurological complications in cardiac surgery: a new view on an old problem

In modern conditions, it is necessary to take into account many factors that affect both the course of the underlying disease and the course of postoperative rehabilitation and long-term results of surgical treatment to improve the results of treatment in cardiac surgery patients. One of these factors is neurological complications associated with cardiac surgery. The article represents a clinical classification of neurological complications of cardiac surgery with a description of the main pathophysiological mechanisms of their development, and the reasoning of a neurologist’s role expansion in the examination and treatment of cardiac surgery patients. Ranging patients according to the risk of developing neurological complications, working out individual protocols of neuroprotection, as well as the further study of pathophysiological mechanisms of nervous tissue damage with the identification of triggers for their prevention, will improve the results of cardiac surgery patients’ treatment and reduce the time of their postoperative recovery.

Long-term results of surgical treatment of patients with cerebral arterial aneurysms

To study the long-term results of surgical treatment of patients operated on for cerebral aneurysms and their impact on functional recovery, independence and cognitive functions in the long-term period. A multivariate regression analysis of long-term results of surgical treatment of 324 patients for cerebral aneurysms was performed (on average after 3.5 years). Upon admission of the patient to the hospital for surgical intervention, a clinical diagnostic examination was performed to confirm the diagnosis and determine the volume, timing and type of intervention. In the late period, a clinical neurological study was performed, which included an assessment of the degree of disability with the Barthel index and a modified Rankin scale, cognitive functions with MMSE, and the mental sphere with HADS. The severity of the condition at admission, corresponding to grade III-IV according to the Hunt-Hess classification, was the risk factor for an unfavorable prognosis for the recovery of patients in the long-term period of cerebral aneurysm surgery. The severe condition of patients at the onset of the disease increases the risk of disability by 1.9 times (p<0.05) and the risk of dementia by 6 times (p<0.05). An independent risk factor for the development of cognitive impairment is the patient's age: with an increase in age by 1 year, the MMSE score decreases by 0.27 (p<0.05). The prevalence of hemorrhage according to the Fisher classification, corresponding to grade III, is a predictor of the development of angiospasm in 91% of cases. In patients with established angiospasm, the risk of developing dementia and pre-dementia cognitive impairment was 57.3% (p<0.05). The best predictions for recovery of cognitive functions in the long-term period were observed in patients who underwent simultaneous aneurysm clipping with extra-intracranial anastomosis (mean MMSE score 25) compared with patients who underwent only aneurysm clipping (mean score 20), endovascular intervention (average score 21) or microsurgical intervention followed by intrathecal fibrinolytic injection (mean MMSE score of 20) (p<0.05). The predictors of unfavorable recovery of cognitive functions and the development of disability in the long-term period of surgical treatment of cerebral aneurysms were the severity of the condition at admission, corresponding to III-IV st. according to the Hunt-Hess classification, the age of the patient at the time of the intervention, the prevalence of hemorrhage according to Fisher, and the choice of surgical technique.

Results of Revision Knee Arthroplasty With Individual Implants

Background. The presence of extensive bone defects significantly complicates the possibility of stable fixation and correct spatial positioning of the revision endoprosthesis components. The primary task of revision surgery is to restore the lost bone. The use of modern implants makes it possible to replace large metaphyseal defects of the tibia and femur, including AORI type 2B и 3 bone defects.&#x0D; The aim of the study was to evaluate the long-term results of surgical treatment of patients with extensive bone defects (2B and 3 according to AORI) of the proximal tibia and/or distal femur using custom-made implants for revision knee arthroplasty.&#x0D; Methods. A retrospective clinical study was performed in 24 patients who underwent revision arthroplasty using individual implants (9 femoral and 18 tibial) made on a 3D printer in the period from 2017 to 2021. T3 defect according to AORI classification was diagnosed in 12 patients (50%), F3 defect in 1 (4.17%), F2B in 8 (33.3%), T2B in 6 (25%). All patients before surgery and 3, 6, 12 months after surgery were surveyed according to the international scales VAS, KSS, WOMAC and SF-36.&#x0D; Results. At the follow-up examination 12 months after the surgery, 9 out of 24 patients (37.510%) walked without additional means of support, 10 out of 24 (41.710%) with a cane, 4 out of 24 (16,78%), walkers 1 out of 24 (4.210%). There were no periprosthetic fractures during surgery and in the postoperative period. When evaluating the functional state of the knee joint, an excellent result was registered in 45.810% and 33.310%; good in 37.510% and 54.210%; satisfactory in 16.678% and 12.57% according to the KSS and WOMAC scales, respectively. When assessed on the VAS scale, there was a positive trend in the form of statistically significant decrease in pain in all patients (p0.01).&#x0D; Conclusion. The use of individual implants made using additive 3D printing technologies in revision knee arthroplasty in the presence of extensive bone defects (2B and 3 according to AORI) allows to perform an organ-preserving surgery without loss of the statodynamic function of the lower limb. This study has limitations due to the small sample size. We believe that it is promising to study the long-term results of surgical treatment of patients with extensive bone defects (2B and 3 AORI) of the proximal tibia and /or distal femur using individually manufactured implants for revision knee replacement and a comparative analysis of these results with those using conventional implants.

THE CHOICE OF SURGICAL TACTICS FOR THE CORRECTION OF A HIATAL HERNIA IN PATIENTS WITH CHOLELITHIASIS COMBINED WITH GASTROESOPHAGEAL REFLUX

Reported here are the results of the examination and surgical treatment of 70 patients with cholelithiasis combined with hiatal hernia, of which 36 patients being in the main group and 34 patients in the comparison group who were hospitalized and underwent surgery in the clinic between 2020 and 2022. Based on an in-depth comparative analysis of early and long-term results of surgical treatment it has been proven to improve the efficiency of surgical treatment of patients with cholelithiasis, combined with gastroesophageal reflux disease and hiatal hernia. According to different authors, hiatal hernia is combined with cholelithiasis in 8-12% of cases. Insufficient preoperative examination of this group of patients often leads to underdiagnosis of concomitant pathology requiring surgical correction, and to failure to perform the necessary surgical treatment in such cases. Many authors indicate that up to 11% of patients with cholelithiasis after cholecystectomy during re-examination have a clinic of gastroesophageal reflux disease refractory to conservative therapy and requiring surgical treatment. In practice, the tactics are chosen in a calculation method using the original formula. Thanks to the research, it was possible to optimize the tactics of surgical treatment of patients with comorbidities