Method Of Surgical Correction Research Articles

СОВРЕМЕННАЯ ТАКТИКА ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ БОЛЬНЫХ С ВАРИКОЗНОЙ БОЛЕЗНЬЮ НИЖНИХ КОНЕЧНОСТЕЙ

Varicose veins are a very popular disease. It is observed in 10–15% of men and 20–35% of women and is often accompanied by long-term incapacity and subsequent disability of the patient. That’s why it’s not surprising that endovenosus laser ablation therapy (EVLT) is replacing surgery as the main treatment for varicose veins. Currently, laser radiation with wavelengths in the λ range from 0.45 to 2 is used for EVLT. A positive treatment result was achieved at all wavelengths that were used. The resulting differences in clinical applications in terms of pain levels, complications, and postoperative healing were rates largely subjective, leading to controversy regarding the choice of the most effective method. This was facilitated by the evolution of interpretations of the processes occurring during EVLT, which, from the authors’ point of view, is useful for their understanding. Endovasal methods have been proven to be cost-effective and safe and can be performed under local anesthesia on an outpatient basis. To date, this technique has become quite widespread in vascular surgery. This paper provides a review of the literature on the prevalence and pathophysiology of varicose veins of the lower extremities, the achievements of endovasal methods of treating varicose veins of the lower extremities, and studied modern methods of surgical correction of varicose veins. We analyzed and described the main issues related to endovenous techniques for obliterating varicose veins. Conducted on 20 case histories of patients with venous insufficiency of the lower extremities, operated on at the CHU “KB “RZD-Medicine” named after. N.A. Semashko” comparative analysis of modern surgical methods for the treatment of varicose veins of the lower extremities. The operation was performed on one lower limb in 18 patients, and on two lower limbs in 2 people. All patients underwent endovasal laser coagulation (EVLC) in combination with miniphlebectomy. The disadvantages and advantages of the modern surgical method of treating venous insufficiency of the lower extremities (EVL) have been identified.

Evaluation of the effectiveness of a new surgical correction method for combined pelvic organ prolapse in women of reproductive age: A prospective non-randomized study

Aim. To evaluate the effectiveness of combined pelvic organ prolapse correction using the proposed modification of laparoscopic promontofixation of the uterus and vaginal walls using a mesh graft in women of reproductive age. Materials and methods. A prospective non-randomized study included 41 women of reproductive age (up to 49 years) with grade II–IV symptomatic combined pelvic organ prolapse. The main group (n=19) included women who underwent surgery using the proposed original method (invention patent No. RU2795649C1 dated October 27, 2022), the control group (n=22) included women who underwent conventional laparoscopic promontofixation of the uterus and vaginal walls and vaginal plasty with local tissues. The duration of surgery, intraoperative blood loss, anatomical result, effect on symptoms and sexual function were assessed using the Pelvic Floor Distress Inventory (PFDI-20), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Results. The duration of surgery and intraoperative blood loss were significantly lower in the main group (p=0.043 and p0.001, respectively). Anatomical success was achieved in both groups and persisted throughout the follow-up period (without statistically significant differences). Analysis of the PFDI-20 questionnaire responses showed a significant improvement in both groups with no statistically significant differences. Analysis of the PISQ-12 questionnaire data showed a significant improvement in the quality of sexual life in both groups; however, after a year of follow-up, patients of the main group had a significantly better quality of sexual life (p0.05). Conclusion. The surgical correction of combined pelvic organ prolapse using the proposed method demonstrated a good anatomical result, a decrease in intraoperative blood loss and duration of surgery, as well as an improvement in sexual function in women of reproductive age.

Adnexal torsion in girls: Predictors and methods for surgical treatment. Case reports and review

Modern diagnostic and treatment methods make it possible to establish a preoperative diagnosis of uterine torsion and provide surgical assistance. Thus, the causes of this disease and the scope of surgical treatment must be investigated. This study reports the cases of 20 patients aged 3–17 years with uterine torsion who were treated at the St. Vladimir Children’s City Clinical Hospital between 2017 and 2023. Ultrasonography is a mandatory preoperative screening diagnostic method. All patients underwent laparoscopic surgery. During the postoperative period, magnetic resonance imaging was performed to confirm the diagnosis. Increased ovarian size due to cysts (7), paramesonephric cysts (4), and fixed lateroflexion (6) were identified as predictors of torsion. In 3 (15%) patients, the cause of torsion was unknown. Paramesonephric cysts were resected, and two adnexectomies were performed. After detorsion, 12 (60%) patients underwent fixation of the appendages. A literature search was conducted using PubMed, Scopus, eLibrary, and RSCI. A total of 47 articles were analyzed, 58 articles were reviewed, and 39 on the problems of determining predictors of uterine torsion in children and methods of surgical correction were selected. Based on the data obtained, the main disease predictors were clarified. A change in the angle of the uterus (lateroflexion) was found to cause the atypical location of the ovaries, which in turn can lead to torsion of the changed or unchanged appendage. Suggestions have been made regarding the connection between connective tissue dysplasia and uterine lateroflexion in the development of adnexal torsion in childhood. The results confirmed the complexity of the radiological diagnosis of lateroflexion. The scope of the surgical intervention for acute torsion of the uterine appendages was dependent on the etiology of the torsion and the degree of ischemia of the appendage. Various options for detorsion with unilateral and bilateral oophoropexy and without fixation of the injured appendage have been proposed. Removal of uncomplicated paramesonephric formations of the uterine appendages identified during diagnostic laparoscopy is a simple procedure and helps prevent torsion. Thus, puncture of accidentally detected ovarian cysts in patients who have not been examined for tumor markers is deemed inappropriate.

The role of endoscopic ultrasound in assessment of physiological cardia insufficiency during diagnosis of hiatal hernia

Background. The aim of the study: to determine the role of endoscopic ultrasound (EUS) in assessing the failure of the physiological cardia in the diagnosis of hiatal hernias (HH). Materials and methods. At the Department of Digestive Surgery of the State Institution “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine” in 2023, we have performed surgical treatment of 33 patients with HH: axial HH were diagnosed in 21 (63.6 %) cases (I type), paraesophageal HH — in 12 (36.4 %) patients (II type) (ICD-10 code is K44). Control group included 20 practically healthy people. Results. All patients underwent an X-ray and endoscopic examination of the esophagus, stomach, duodenum, and EUS. All 33 (100.0 %) patients underwent an X-ray to confirm the diagnosis and an endoscopic examination to detect changes in the esophageal mucosa. EUS was performed in 31 (93.9 %) patients. The thickness of the esophageal wall was assessed using EUS, which made it possible to determine the state of the structures of the phy­siological cardia in HH: the displacement of part of the stomach above the diaphragm, location of the gastroesophageal junction relative to the legs of the diaphragm and relative to each other; the distance between the legs of the diaphragm (area of the HH) and their length; the cross-sectional area of the HH (hernial sac). The data obtained during EUS influenced the choice of the method for surgical correction of the physiological cardia with HH. Conclusions. Thus, with HH, EUS makes it possible to evaluate pathological changes of the main structures in the failure of the physiological cardia, to improve diagnosis for the types of HH, the location of the gastroesophageal junction, with determination of dimensions of the esophageal hiatus, the distance between the legs of the physiological cardia, localization and cross-section of the hernial sac, which influenced the choice of the surgery for physiological cardia in HH.

SURGICAL TACTICS TO ELIMINATE COMPLEX VARIANTS OF CONGENITAL CLEFT PALATE

The scientific justification and practice of surgical methods ofcorrection of congenital cleft lip and palate are widely presented in the specialized literature concerning various types of lesions of the maxillofacial region [7, 13, 20, 21, 23-25]. At the same time, the results of international and domestic experienceand scientific research on these issues contribute to the development and implementation of new methods for correcting facial and jaw deformities, continuous improvement of surgical and rehabilitation techniques, the application of innovations in the pediatric healthcare system itself and the accumulation of experience in specialized areas of practice [1, 4, 17 , 19, 20, 23, 24]. In addition, the use of "additional materials" -types of implants (for example, plastic, biologically inert metal), which are surgically implanted into the destroyed structures of the maxillofacial region and meet the requirements of safety, indifference to surrounding tissues, targeted regeneration and the formation of adequate support for the restoration of the upper jaw, including using existing "classic" techniques, detailed and updated. classic" techniques, detailed and updated [5, 6, 8, 9, 15]. In most cases, the use of new surgical techniques of zygoplasty and ureteroplasty requires comprehensive medical and rehabilitation measures with the participation of highly qualified specialists of various profiles, however, it should be emphasized that the main stage of the algorithm of comprehensive care is the operation must be performed [7, 11, 13, 14, 16, 18, 21]. In parallel, theauthors of scientific research note that surgical methods for eliminating congenital clefts of the face and palate are constantly developing and becoming more rational: multi-stage surgical interventions are excluded, and the restoration of maxillofacial structures is achieved by two to three years of a child's life [2, 3, 7, 11].

Distal ureteral atresia, megaureter of a lower pole of a duplicated kidney: the rare clinical case

Ureteral atresia is a rare pathology, the diagnosis of which is difficult, and a unified approach to the method of surgical correction has not been formed. The aim of this study is to demonstrate a rare clinical case of a patient with distal ureteral atresia of a non-functioning lower pole of a duplicated kidney, and also to present the method of surgical treatment. A 12-year-old female patient was diagnosed with a cystic formation of the retroperitoneal space. During the operation, it was determined that this cyst was an atretic, dilated ureter of a lower pole of the duplacated kidney. Lower heminefrureterectomy was chosen as the method of surgical correction. Ureteral atresia is rarely combined with any other anomalies of the upper urinary tract, and the presented clinical case has not previously been described in the available foreign and Russian literature. The methods of surgical correction of ureteral atresia include nephrureterectomy, ureteroureterostomy, intestinal ureteroplasty, and Boari procedure. In the presented case, heminefrureterectomy was chosen because of severe hypoplasia of the lower pole of the duplicated kidney and the almost complete absence of its parenchyma. When examining patients with cystic formations of the retroperitoneal space, it is necessary to remember about the ureteral atresia, which may be accompanied by other anomalies of the upper urinary tract.

AUTOTRANSPLANTATION WITH EXTRACORPORAL RECONSTRUCTION OF RENAL VESSELS: A CLINICAL CASE OF “THE NUTCRACKER SYNDROME” AND LEFT RENAL ARTERIES HYPOPLASIA COMBINATION

Ex vivo kidney autotransplantation with renal artery reconstruction is an effective method of surgical correction of vascular abnormalities (fibromuscular dysplasia, hypoplasia, and renal artery aneurysms) showing good long-term results. The combination of renal artery abnormalities with aorto-mesenteric compression syndrome (“the nutcracker” syndrome) is extremely rare and complicates the diagnosis making greatly. Renal artery hypoplasia is an abnormality that is rarely diagnosed and may not manifest clinically in the absence of contralateral kidney pathology as well as its vascular structures. Renal hypoplasia may be caused by mutations in the kidney development genes (HNF1B, PAX2, PBX1) and/or several environmental factors such as intrauterine growth retardation, maternal diseases (diabetes, hypertension), medication taken by the mother (renin-angiotensin system inhibitors or nonsteroidal anti-inflammatory drugs) and intoxication (smoking and alcohol). Premature delivery (before the 36th week) is also a risk factor due to incomplete nephrogenesis. Renal arteries hypoplasia is associated with fibromuscular dysplasia in most cases. The disease is characterized by non-inflammatory non-uniform focal hyperplasia of the renal artery wall with damage to small and medium arteries. Simultaneous damage to two or more vascular segments is detected in 25% of patients.
 A clinical case of successful treatment of “the nutcracker” syndrome (annular renal vein) combined with hypoplasia of the left main and accessory renal arteries associated with fibromuscular dysplasia is described. A 27-year-old female was admitted to the Department of Vascular Surgery of Municipal Noncommercial Enterprise of the Lviv Regional Council “Lviv Regional Clinical Hospital” on October 4, 2021, with complaints of pain in the left lumbar region and the left half of the abdomen, hematuria, proteinuria, a persistent increase in blood pressure. Ultrasound of the renal veins: the left renal vein in the aorto-mesenteric segment was not visualized, the posterior portion of the left renal vein was determined. Peak systolic velocity was up to 230 cm/s at the point of confluence with the inferior vena cava and 28 cm/s more distally. The vein was up to 12.0 mm in the renal hilum and up to 11.0 mm in the middle third. MSCT of the abdominal cavity, retroperitoneal space and pelvic organs: CT signs of pyelonephritis of the left kidney. Hypoplasia of the left kidney. Reactive para-aortic lymphadenopathy on the left. Hypoplastic left renal artery (3,8 mm) and presense of accessory ones, annular left renal vein. Angiomyolipoma of the right kidney (2,6 cm). Varicose veins of the small pelvis on the left. The patient underwent surgical treatment, namely ex vivo autovenous prosthetic repair of the left renal artery with autotransplantation of the left kidney. The course of the postoperative period was without complications, the reconstruction was functioning. Ultrasound of the renal vessels (1 week after the surgery): the blood flow was located in the renal hilum in the course of Doppler sonography of intrarenal branches. Venous outflow was unobstructed. Corticomedullary differentiation was marked satisfactorily.
 The study presented by us demonstrates the effectiveness of kidney autotransplantation for the correction of renal vascular abnormalities.
 Though of a solitary nature, the combination of renal vessels abnormalities complicates significantly the course of the disease and the possibilities of this pathology diagnostics.

'Suspension Palatoplasty' - A method of surgical correction of VPI post Cleft Palate repair.

To design the technique of 'Suspension Palatoplasty' for Velopharyngeal Insufficiency (VPI) post Cleft Palate (CP) based on optimal spatial positioning of palate at the time of VPI correction, by using a non-obstructive, high, midline pharyngeal flap for predictable velopharyngeal closure and normal speech. To evaluate the results of CP patients with VPI operated using the technique of 'Suspension palatoplasty'. An ambi-spective longitudinal clinical study. Comprehensive cleft care clinic in a private trust hospital. Patients operated using the 'Suspension Palatoplasty' technique for VPI post CP repair between 2014 and 2018 with a minimum follow-up period of 5 years. 'Suspension Palatoplasty' - Double Opposing Z (DOZ) plasty with palatal myoplasty is used to revise soft palate and a narrow superiorly based pharyngeal flap is used to suspend it for a dynamic velopharyngeal closure. Speech outcome and surgical complications. 70 out of 119 studied were found to have normal speech (59%), and another 25 patients (21%) had acceptable speech. Thus 95 out of 119 patients (80%) had normal or near-normal speech and did not require any further speech therapy or surgeries. 12 patients had snoring without difficulty in breathing. One patient had symptoms suggestive of obstructive sleep apnea. Younger patients had a higher percentage of normal speech outcomes. Many of our adult patients also attained normal speech. 'Suspension Palatoplasty' aims to achieve normal speech with little effort. It has minimal side effects. The author has performed 403 cases to date.

The choice of surgical correction method depending on the etiology of decompensated chronic venous insufficiency

Aim. To evaluate the immediate and distant results of treatment depending on the etiology of chronic venous insufficiency in the stage of decompensation. Materials and methods. This work presents an analysis of the results of treatment of 342 patients of CEAP 6 with manifestations of chronic vein insufficiency on the background of varicose disease (VD) and post-thrombotic syndrome (PTS) in the surgical clinic of the Transcarpathian Regional Clinical Hospital named after A. Novak (Uzhhorod) for the last 10 years. At least 169 patients had VD (CEAP 6). Post-thrombotic syndrome (occlusive form) was observed in 173 patients (CEAP 6). The ratio of women to men in VD was 3:1, and in PTS was 3:2. Results. In patients of group I (crossectomy + short stripping + distal scleroobliteration), postoperative complications developed in only 2 (4.3 %) patients in the form of suppuration of the operative wound on the thigh and lymphorrhea. With extended venectomy + SEPS, early postoperative complications were observed in 5 (6 %) patients: three patients had suppuration of the postoperative wound on the thigh, and two patients had lymphorrhea. In classical venectomy + Linton’s operation, inguinal wound suppuration occurred in 2 (5.3 %), lymphorrhea in 3 (7.9 %) patients. Suppuration of the postoperative wound on the lower leg was observed in another 3 (7.9 %) patients. The long-term outcomes in the patients of the group I were: 9 (19.1 %) patients had partial recanalization of the perforated veins of the group of great saphenous vein (GSV) on the lower leg, and one (2.1 %) had complete recanalization. Trophic ulcer (TU) did not heal in one patient after conservative treatment, relapse of TU occurred in 7 (4.1 %) patients. In patients of the group II thrombosis of the cross autovenous shunt (during Palma’s operation) in the early postoperative period was observed in 5 (8.5 %) patients, during autovenous shunting and Husni’s operation (transposition of the GSV into the popliteal vein) in no case. During Linton’s operation, suppuration of the postoperative wound was observed in 7 (15.9 %) cases. TU did not heal with conservative treatment in 5 (56 %) patients. Conclusions. In the stage of decompensation of VD, pathogenetically justified treatment is crossectomy, venectomy with elimination of horizontal reflux in the zone of trophic ulcer. Trophic ulcers <5 cm and >2 cm deep I–II degrees are treated conservatively after surgery and heal independently within a year. Phlebectomy and CE of the affected limb are contraindicated in PTS. Pathogenetically justified method of treatment is reconstructive and restorative surgery to restore main blood flow with elimination of horizontal reflux in the zone of trophic ulcer.

МИНИИНВАЗИВНАЯ ТОРАКОПЛАСТИКА У ПАЦИЕНТОВ С ВОРОНКООБРАЗНОЙ ДЕФОРМАЦИЕЙ ГРУДНОЙ КЛЕТКИ

The article is devoted to a description of our own observations and treatment of patients with pectus excavatum. It is noted that approaches to surgical treatment of patients with pectus excavatum require increased efficiency and safety, which makes this issue relevant. Attention is focused on videothoracoscopic technologies in the form of inserting a plate under the sternum under the control of a videothoracoscopy. It has been established that the operation using the Nuss technique is the optimal method of surgical correction of pectus excavatum. The main advantage of surgery using the Nuss method is a good cosmetic effect and a stable long-term correction result. The use of thoracoscopic navigation reduces the risk of intraoperative complications, minimizes blood loss, reduces the invasiveness of the intervention, and reduces the duration of the operation and the patient’s time in the hospital.

Total Pelvic Floor Lifting: A New Approach for the Anatomic Repair of Pelvic Floor Hypermobility and Vaginal Laxity in Parous Women.

Recent years have seen a steady increase in the information available regarding pelvic floor changes after childbirth. Obstetric trauma, to which all structures of the urogenital sphere are subjected, can affect different anatomical areas, including the vagina, perineum, deep pelvic floor muscles, and sphincter. Main complaints of parous women with regard to their pelvic floor are vaginal laxity, a wide introitus, and increased mobility of the uterus. Unilateral pectineal suspension is a novel method for surgical correction of the sequelae of vaginal birth-giving such as uterine hypermobility and perception of loose tissue, restoring a natural anatomy when conservative therapy has failed. Since the method is not ablative and does not interfere with anatomical structures, subsequent pregnancies and deliveries remain possible. Furthermore, there is no mesh application, adding to the safety aspects of this unique approach. The surgical technique is straightforward and can be adopted by laparoscopically trained surgeons without problems. The procedure consists of five clearly defined steps, which makes it easily reproducible. Unilateral pectineal suspension restores the pelvic floor and the vagina, with a single suture lifting the sagging structures back to their original position. If needed and according to the patient's choice, a short perineum associated with a wide introitus can be corrected in the same session by perineoplasty, resulting in a total aesthetic reconstruction of the female genital anatomy.

Quality of life with minimally invasive repair of pectus excavatum: a systematic review and meta-analysis.

Minimally invasive repair of pectus excavatum (MIRPE) is a popular method for surgical correction of PE, and its impact on quality of life is a growing area of interest. We performed a systematic review and meta-analysis to evaluate the impact of MIRPE on the quality of life of patients. This study was registered with PROSPERO under reference number CRD42020222061. A literature search of PubMed, Cochrane Library, EMBASE and Scopus was conducted from the date of inception till November 23, 2020. We included studies which administered one or more questionnaires on patients up to 60 years old, parents or both, to assess the quality of life before and after MIRPE. Studies not written in English, abstracts, articles without primary data, reviews and studies which combined data on PE and other deformities were excluded. Risk of bias was assessed using the Risk of Bias in Non-randomised Studies of Interventions and the Cochrane risk of bias tool. A random-effects meta-analysis was performed to obtain mean differences for key themes of quality of life before and after MIRPE. Responses from the same questionnaires, as well as common themes across different questionnaires, were compared. Of the 20 studies identified for systematic review, 7 studies that reported the responses of 478 patients were included in the meta-analysis. Patients who underwent MIRPE experienced an increased self-esteem [standardized mean difference (SMD): 1.38, 95% confidence interval (CI): 0.95 to 1.81, P<0.00001] and a smaller degree of chest interference with their social activities (SMD: 0.84, 95% CI: 0.60 to 1.08, P<0.00001). These findings were consistent even after the implanted bar was removed. MIRPE may be associated with a better quality of life for patients with PE as self-esteem and extent of chest interference with social activities are improved after the procedure. The key limitations of this study are the lack of high-quality evidence due to paucity of randomized trials, and the significant heterogeneity in reported outcomes due to variations in the questionnaires and timepoints of administration.

Оцінка виразності післяопераційного набряку мошонки в дітей з патологією вагінального відростка очеревини при різних методах лікування

Congenital malformations, the cause of which is a disturbance of the obliteration of the vaginal process of the peritoneum, such as an inguinal hernia, hydrocele testis, occupy one of the leading places among childhood diseases. This explains the continuation of scientific observations and the analysis of various methods of treatment of patients with lesions of the vaginal process of the peritoneum. Researchers note the possibility of certain complications among male patients, such as swelling of the scrotum, postoperative hydrocele testis, iatrogenic retraction of the testicle (acquired cryptorchidism). This became the reason for additional study of such a complication as postoperative swelling of the scrotum. Purpose - to analyze the severity of postoperative swelling of the scrotum depending on the methods of surgical correction of the pathology in patients with nonoblitereted vaginal process of the peritoneum. Materials and methods. 91 children who underwent surgical correction of the pathology of nonobliterated vaginal process of the peritoneum (inguinal hernias, hydrocele testis) participated in the conducted scientific study. Patients were assessed for postoperative swelling of the scrotum depending on the method of surgical correction of the pathology. Results. The degree of postoperative swelling of the scrotum in patients with pathology of the vaginal process of the peritoneum is directly proportional to the severity of tissue injury during surgical correction in patients with nonoblitereted vaginal process of the peritoneum. Conclusions. Any surgical intervention entails certain consequences that are associated with a violation of the integrity of the body. And although these complications are temporary, a qualitative assessment of their severity can become the basis for choosing a particular method of surgical treatment. The obtained data show the severity of postoperative swelling of the scrotum and the dynamics of its changes depending on access for surgical manipulation. The less soft tissue is injured to access the internal inguinal ring, the smaller the postoperative swelling and the better its dynamics. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.

Study of the corrective effect of different fixators on pectus excavatum during Nuss procedure

Background. A funnel chest is one of the most common chest deformities, which leads not only to cosmetic problems in adolescents, but also to cardiopulmonary complications. The main method of surgical correction is the Nuss procedure. The issues of the interaction between the fixator and the sternocostal joint depending on the choice of the plate length and the location of the tunnel for the fixator inside the chest to exit it on the opposite side remain undefined. Goal: to study the maximum relative deformities and displacements that occur in the chest model depending on the correction for pectus excavatum. Materials and methods. Four schemes for the correction of a funnel chest were modeled: 1) medial delivery of the fixator, the entry point is parasternal, using one retrosternal plate with transverse stabilizing bars (a short plate); 2) lateral passage of the fixator, the point of entry and exit from the chest is at the level of the anterior axillary line, using one retrosternal plate with transverse stabilizing bars; accordingly, the sternal plate is longer, ends at the level of the midaxillary line (a long plate); 3) a double plate with transverse bars connecting the plates with the help of screws (a short bridge-type fixator) with medial delivery; 4) a double plate with transverse bars connecting the plates with the help of screws (a long bridge-type fixator) with lateral delivery. The models were loaded with a distributed force of 100 N applied to the sternum. Results. When correcting pectus excavatum with a short plate, the cartilages of the fourth ribs turn out to be the most deformed — 3.3 %. In the cartilages of the ribs located above, deformities are in the range from 2.7 to 3.1 %. The use of a long plate decreases the relative deformities of the cartilage on almost all ribs. The scheme of correction using a short bridge-type fixator allows significantly reducing the deformities of all costal cartilages. The maximum is observed in the cartilage of the second and first ribs — 2.0 and 1.8 %, respectively. Replacing a short bridge-type fixator with a long one leads to the fact that the cartilages of the upper ribs remain deformed — 1.8 %, and a deformity gradually decreases to 1.0 % in the cartilages of the fourth ribs. The maximum movements in all schemes for pectus excavatum correction fall on the xiphoid process. The maximum displacement of 6.0 mm in the xiphoid process occurs when using a short plate. Replacing the plate with a long one decreases the displacement of the xiphoid process to 5.0 mm. When using a bridge-type fixator, the displacement of the xiphoid process is determined at the marks of 4 and 3 mm for a short and long fixator, respectively. Conclusions. All the investigated indicators testify to the advantages of a double bridge-type fixator. The medial passage of the fixator (short plates) has greater corrective forces on the anterior chest wall during elevation, which should be considered when choosing a correction technique. However, the lateral application of the fixator distributes the corrective effect by area, which can be important in preventing erosion of the tissues of the inner chest wall, the need for extended elevation of the depression in flat-concave forms of pectus excavatum, and the reduction of pain syndrome in the postoperative period.

Computed tomography-guided intraoperative navigation in children with congenital scoliosis versus freehand/fluoroscopy methods

BACKGROUND: The choice of techniques for the treatment of children with congenital spinal deformities remains one of the most significant problems of spinal surgery. This topic is relevant given the peculiarities of the disease course, severity and rigidity of deformities, their steady and rapid progression, formation of compensatory curvature, and a significant decrease in the quality and life expectancy of patients.&#x0D; AIM: To compare screw misposition, adverse outcomes, intraoperative blood loss, and time required for pedicle screw placement with further deformity correction under computed tomography (CT) guidance with intraoperative navigation versus fluoroscopy.&#x0D; MATERIALS AND METHODS: This single-center, prospective comparative study was conducted from 2019 to 2022 at the National Scientific Center of Traumatology and Orthopedics named after academician N.D. Batpenov. Patient demographics and surgical outcomes were obtained from the medical records. All patients underwent a comprehensive clinical and radiological examination before surgery, after surgery, and at the stages of dynamic observation. Data of patients with congenital malformations of the spine were analyzed. The study involved 42 patients aged 318 years with congenital kyphoscoliosis of the thoracic and/or lumbar spine. The patients were divided into two groups according to the method of surgical correction used: the O-arm navigation group and the C-arm group.&#x0D; RESULTS: Data of patients who underwent surgery for congenital scoliosis of the spine were analyzed. The patients were divided into the O-arm navigation group, which included patients who underwent surgery using the O-arm mobile intraoperative CT with the seventh-generation Stealth Station navigation system in combination with intraoperative neuromonitoring, and the C-arm group, which included patients who underwent surgery under the control of the intraoperative C-arm. In both groups, 364 screws were placed, of which 189 screws were placed under neuronavigation, and 175 screws were placed using the C-arm. The effectiveness of the intraoperative neuronavigation system in combination with neuromonitoring showed 97.11% correct placement (grades A and B) of pedicle screws. The use of an intraoperative C-arm showed 89.63% (grades A and B) correctness. The proportion of misplaced screws corresponding to GertzbeinRobbins classes CE was higher in the C-arm group (10.37%) than in the navigation group (1.49%) (p 0.005). No severe neurological disorders, postoperative infection, or adverse clinical outcomes were observed in both groups.&#x0D; CONCLUSIONS: The installation of pedicle screws using CT-guided navigation (O-arm) did not prolong the operation time, did not increase blood loss, and reduced the risk of screw mispositioning compared with freehand and fluoroscopy pedicle screw placement.

A New Diagnostic Method for Ptosis of the Upper Eyelid

Currently, surgical treatment of ptosis of the upper eyelid does not always lead to a good anatomical and physiological result — the frequency of dissatisfaction with the results of treatment is 8–26 %, and repeated operations on the muscle that lifts the upper eyelid are performed in 8.7–18 % cases. An important aspect of the successful treatment of upper eyelid ptosis is the preoperative examination of the patient; however, standard diagnostic methods do not provide complete information about the functional features of the upper eyelid levator. The purpose of the study is to improve the algorithm for preoperative examination of the upper eyelid in ptosis with the study of the contractility and fatigue of the upper eyelid levator. On the basis of the Helmholtz National Medical Research Center of Eye Diseases in the period from 2021 to 2022, 63 patients (67 eyes) aged from 5 to 78 years with different types of blepharoptosis admitted for surgical treatment were examined. We have developed a comprehensive dynamometric preoperative assessment of the upper eyelid levator with a study of the contractility and fatigue of this muscle using weights. For comparison and determination of normal parameters, the study was also carried out on paired intact eyes (59 eyes) and in 40 healthy people. Indicators of contractility and fatigue of the levator of the upper eyelid were obtained in normal conditions and with ptosis of the upper eyelid, and differences in these indicators were revealed in congenital and acquired blepharoptosis. With congenital ptosis of the upper eyelid, the contractility and fatigue of the levator of the upper eyelid is low, while with acquired ptosis (senile), the contractility is medium, and fatigue is medium or high. A gradation of the values of contractility and fatigue of the upper eyelid levator in blepharoptosis was developed, on the basis of it an algorithm for choosing a method for surgical correction of upper eyelid ptosis was proposed. The developed method of dynamometric preoperative study of the anatomical and functional features of the upper eyelid levator using weights is a simple and affordable method for objectively assessing the state of contractility and fatigue of the levator, which can improve the efficiency of surgical correction of upper eyelid ptosis.

Surgical treatment of hammertoe deformity (a literature review)

Aim. To trace developmental origins of surgical treatment of hammertoe deformity and determine the most commonly used methods of its correction based on the published literature analysis. Material and methods. Publications from Google search, electronic databases PubMed, Google Scholar, archives of specialized journals and other relevant sources of scientific and medical information were analyzed. Results. The article covers the developmental origins of surgical treatment of hammertoe deformity both in the historical aspect and at the current level. Attention is paid to soft tissue procedures including tendons, metatarsophalangeal joint capsule, and plantar plate. An overview of operative interventions on the bone apparatus, phalanges and metatarsal bones and the combination of these surgeries is also presented in the article. The disadvantages of the existing surgical treatments, their advantages and the ways for forthcoming research concerning the improvement of surgical care in the treatment of hammertoe deformity are identified. Conclusions. The choice of a particular method of surgical correction between the phalangeal or metatarsal level, the feasibility of combining these interventions with restoring the integrity of the plantar plate and tendon reconstruction, remains debatable. Further study on these issues is a crucial task today for choosing the optimal method of hammertoe deformity correction.

Порівняльний аналіз напружено-деформованого стану грудної клітки при корекції лійкоподібної деформації із застосуванням двох пластин: порівняння паралельного та схрещеного методів встановлення фіксаторів

Minimally invasive correction of funnel-shaped chest deformity by the Nuss is an effective and cosmetic method of surgical correction of this deformity. Some authors have proposed the use of two plates with a crossed technique for correction. Purpose - to study the changes that occur in the stressed-deformed state of the chest model in comparison of the parallel crossed arrangement of the fixators during the minimally invasive correction of funnel-shaped chest deformity according to Nuss. Materials and methods. 2 schemes for the correction of the funnel-shaped deformation of the sternum were modeled: with a parallel arrangement of plates (parallel method), with a cross-shaped arrangement of plates (crossed method). The models were loaded with a distributed force of 100 N applied to the sternum. They studied the stress values in the bone elements, the relative deformations of costal cartilage, as the softest and, as a result, the most favorable to deformation element of the models. The magnitudes of the maximum movements of the sternum and corrective plates were also studied as an indicator of the preservation of the achieved correction. Results. The crossed method of positioning the corrective plates ensures a slightly lower level of stress in almost all bone elements. An exception can be considered the seventh ribs, where the stress, in this case, reaches 9.0 MPa, which is close to the lower limit of the indicators of the strength limit of the ribs. From the point of view of preserving deformation correction, the crossed method of arranging the correcting plates has a slight advantage of 1.0 mm. But the parallel scheme provides a smaller relative deformation of the costal cartilages. Taking into account all of the above, it can be concluded that none of the studied schemes has an unequivocal advantage over the other according to the criteria of mechanical indicators. Therefore, when choosing one or another scheme for the correction of a funnel-shaped sternum deformity, additional information should be taken into account, such as the shape of the sternum deformity and the rib, the convenience of carrying out the plates, the age of the patient, etc. Conclusions. None of the studied schemes has an unequivocal advantage over the other according to the criteria of mechanical indicators. From the point of view of preserving deformation correction, the crossed method of arranging the correcting plates has a slight advantage of 1.0 mm. The parallel scheme ensures a smaller relative deformation of the costal cartilages. According to the criterion of stress distribution in the bone elements of the model, the crossed method of arranging the corrective plates provides a slightly lower level in almost all bone elements, but the maximum stress value of 9.0 MPa on the seventh rib with the cross-shaped arrangement of the corrective plates approaches the lower limit of the index of the strength limit of the ribs which, in some cases, can cause its fracture. Additional information should be taken into account when choosing one or another scheme for the correction of the funnel-shaped deformity of the sternum. No conflict of interests was declared by the authors.

Vascular injury during lumbar discectomy: risk factors, diagnosis, methods of surgical correction, features of anaesthetic management and intensive care

One of the priority tasks in neurosurgery is to reduce the frequency of postoperative complications and mortality. Lumbar discectomy is the most frequently performed intervention in spinal neurosurgery and it is a fairly safe procedure. One of the possible intraoperative surgical complications, that threatens the patient’s life is vascular injury. The first clinical case of damage to the large vessels during discectomy was described in 1945. It is believed that the frequency of this complication is 1‒5 cases per 10,000 surgical interventions, but the literature notes that these figures may be significantly underestimated. Some authors indicate that the frequency of this complication, despite the development of surgical techniques over the past 50 years, has not significantly decreased, so it is important for surgeons to be informed and alert about the possibility of such a problem. Among the factors that significantly increase the risk of vascular damage congenital, acquired and technical are determined. Variability of clinical symptoms of damage to lagre vessels is due to different localization of injury, type (arterial, venous or combined) and scale of vascular disaster. For each level of surgical intervention, the "most typical" vessel damage is identified. Vascular injury during discectomy can occur according to three clinical and pathomorphological scenarios: manifestation of vessel rupture symptoms, arteriovenous fistula or a pseudoaneurysm formation. According to different authors, the frequency of these findings varies significantly. This review examines the symptoms of possible variants of vascular damage development during discectomy and describes the characteristics of surgical correction methods. Along with clarifying the location and variant of vascular damage, the critical thing is assessing the amount of blood loss and the rate of ongoing bleeding. In the case of suspected massive bleeding, the paramount importance is the involvement of additional medical personnel for the surgical haemostasis and providing sufficient blood for haemotransfusions. In case of a vascular accident, the key requirement for adequate anaesthetic management is the maintenance of permissive arterial hypotension until the moment of surgical haemostasis. Targeted treatment of haemorrhagic shock in case of damage to large vessels consists of rapid haemostatic resuscitation including blood components and products in a balanced 1:1:1 ratio, such as plasma, red blood cells, fresh frozen plasma, platelets, and coagulation factors. In Ukraine, obtaining a sufficient amount of blood components and products (according to the protocol of massive haemotransfusion) in case of unpredicted blood loss is a difficult task, therefore, in the absence of certain components or blood products, whole blood can be used as an alternative. The number and severity of complications and outcomes primarily depend on the efficiency and timeliness of blood transfusions, along with the speed of surgical arrest of bleeding. This publication describes in detail the main points of management of patients with massive bleeding according to modern international standards and Ukraine regulatory documents.

Surgical correction of senile entropion of the lower eyelid in non-hospital setting

Aim. To present a method for surgical correction of senile entropion by excision of a triangular musculocutaneous flap in non-hospital setting.Material and methods. We analyzed the outcome of surgical treatment of 11 patients aged 60–83 years diagnosed with senile entropion (3 men and 8 women). Out of the studied group, 3, 5 and 3 patients suffered from a mild, average and pronounced entropion degree, respectively (Bystrov’s classification, 1979). The results were assessed based on the presence of complications and the occurrence of relapses.Results. The recovery was observed in 9 patients; the disease recurrence – in 2 cases.Conclusion. The proposed method of surgical correction of senile entropion implies excision of a triangular musculocutaneous flap with the base to the outer or inner commissure of the eyelid with the movement of the sliding skin flap. The method showed high efficiency (81.8%) in eliminating the horizontal and vertical weakness of the musculocutaneous plate of the lower eyelid.