Method Of Surgical Correction Research Articles

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.
 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.
 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.
 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.
 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.

Historical and modern aspects of surgical treatment of hypertrophic cardiomyopathy in children (literature review)

Hypertrophic cardiomyopathy (HCM) is a common, genetically determined myocardial pathology that can manifest itself at any age. The manifestation of this pathology in childhood always means a high risk of sudden cardiac death and the rapid progression of symptoms. The annual mortality in asymptomatic patients over 1 year is 1%. There are many recommendations for the management of patients with obstructive cardiomyopathy, but they are all written for the adult population. Drug treatment of symptomatic patients with this pathology is effective only in 70% of patients. The remaining 30% should be given preference to surgical treatment. It is important for a cardiac surgeon to know the main methods of HCM correction, their advantages and disadvantages. The literature review shows the evolution of methods of surgical correction of obstructive HCM from the middle of the 20th century until now. The main surgical methods for treating left ventricular outflow tract obstruction, correcting SAM-syndrome (systolic anterior motion syndrome) and mitral insufficiency, which have had a great influence on the development of HCM surgery, are presented. A clinical experience of treating left ventricular outflow tract obstruction in children is presented. The most promising method today is “transaortic extended septal myectomy”. Thus, there is a need to evaluate and modify existing methods for correcting obstructive HCM and their complications. Works aimed at their improvement and elimination of shortcomings are promising.

Comparison of clinical results of Transanal Endorectal Pull-Through of the colon with and without laparoscopic assistance in children with Hirschsprung’s disease

Introduction. Techniques of Transanal Endorectal Pull-Through (TEPT) with and without laparoscopic assistance have been widely used in pediatric surgery for correction of Hirschsprung’s disease (HD) in children with. Many clinics in their studies have noted the positive features of this approach compared to classical methods, but the long-term results after such operations in children are still debated. Purpose - to study and compare the clinical results of TEPT with and without laparoscopic assistance in children with HD. Materials and methods. We analyzed the experience of TEPT approach with laparoscopy (n=65 (29.41%)) and without laparoscopic assistance (n=144 (70.59%)) in childreb for correction of HD. For confirmation diagnosis we used the results of general clinical and special procedures (barium enema, anomanometry, histological, determination of acetylcholesterase activity). Results. Overall, among 55 (26.32%) of 209 patients who underwent TEPT, postoperative in long term follow up we found intestinal problems like - moderate stenosis of the colo-anal anastomosis without incontinence 4 (1.91%), constipation 9 (4.31%), partial faecal incontinence 20 (9.57%) and enterocolitis (EC) 22 (10.53%). There was no significant difference in the clinical results of TEPT with laparoscopy and without laparoscopic assistance in our patients. After TEPT without laparoscopic assistance, 6 (4.17%) of 144 patients had constipation, 11 (7.64%) had partial fecal incontinence, and 16 (11.11%) had enterocolitis (EC). And among 65 children after TEPT with laparoscopy, 3 (4.62%) patients were diagnosed with constipation, 9 (13.85%) with partial fecal incontinence and 6 (9.23%) with EC. All children with postoperative intestinal problems were treated conservatively. There was no need for redo surgical interventions in these patients. Conclusions. The technique of TEPT with laparoscopy and without laparoscopic assistance is a modern method of surgical correction of HD, which has significant technical advantages compared to other existing methods. In 26.32% of children with HD who were operated by the TEPT method, persistent intestinal problems continue in the long term follow-up period. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all institutions mentioned in the work. Informed consent of the children’s parents was obtained for the research. No conflict of interests was declared by the authors.

Experience of Surgical Treatment of Complex Forms of Ebstein’s Anomaly through the Method of Hemodynamic Correction

Ebstein’s anomaly (EA) is a rare and complex congenital heart disease, with a prevalence of 4 to 7 cases per 100,000 live births. At this stage of the development of EA surgery, significant progress has been made in our understanding and treatment of EA, but the question of the tactics of treating complex forms, especially in the period of infancy and early childhood, remains open. Due to significant phenotypic heterogeneity, the treatment of EA varies greatly from patient to patient and depends on many factors that require a comprehensive approach. The choice of the method of surgical correction directly depends on the anatomical features: the degree of dysplasia, rotation and displacement of the tricuspid valve, the degree of atrialization of the right ventricle, the combination with other congenital heart diseases, and the severity of hemodynamic disorders.
 The aim. To evaluate perioperative characteristics in patients with complex forms of EA, immediate and long-term results after hemodynamic correction.
 Materials and methods. In the period from 1996 to 2022, at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, one and a half ventricle repair was performed in 18 patients with complex forms of EA. There were 12 (67%) male patients, 6 (33%) female patients. The median age of the patients at the time of surgery was 30 months [3.5; 312]. The main diagnostic method in determining the defect and assessing the immediate and remote results was echocardiography and probing of the heart cavities. In order to qualitatively evaluate the perioperative, immediate and long-term results to determine the optimal tactics and terms of surgical intervention, prevention of possible complications, all the patients were divided into two age groups: I group up to 2.5 years including 9 patients (50%), II group older than 2.5 years including 9 patients (50%).
 Results. In the postoperative period, 2 (11%) deaths were noted in both groups. In all the deceased patients, the cause of death was acute heart failure and acute respiratory failure. The analysis of the postoperative period showed normal results in such a cohort of highly complex patients of both groups, but a more stable course was noted among patients of the I group, as indicated by statistically significant values for the duration of mechanical ventilation, stay in the intensive care unit, stay in the hospital, the average dose of sympathomimetic support and its duration, the total duration of exudation in the comparison groups.
 An uncomplicated course of the early postoperative period was observed in 8 (44%) patients. The remaining 10 (56%) patients of both groups had: I group, 3 (33%) patients: 7 complications; II group, 5 (55%) patients: 13 complications. In 5 patients (2 patients in I group and 3 patients in II group), attention-grabbing acute heart failure was observed, which required high doses and long-term sympathomimetic support, and in 2 patients caused death. The average observation period was 45 months [6; 190]. No deaths were observed during the observation period among 13 (72%) patients of both groups, contact was lost with 3 (17%) patients. There were no violations in the functioning of the right ventricle, but the recovery of the systolic function of the left ventricle occurred only in 8 (44%) patients.
 Tricuspid insufficiency was minimal in 5 (28%) patients, moderate in 6 (33%), severe in 2 (11%) patients.
 Conclusions. Determining the tactics of treatment of complex forms of EA is a serious problem in patients of various ages, especially in newborns and infants, due to pronounced dilatation and systolic dysfunction of the left ventricle, a sharp decrease in systemic output due to changes in the geometry of the left ventricle. The technique of hemiventricular correction shows very promising results and may become the technique of choice for patients with severe forms of EA and pronounced right ventricular insufficiency.

Оптические методы коррекции посткератопластической аметропии

Purpose. The analysis of the advantages and disadvantages of existing optical methods for correcting postkeratoplastic ametropia (PA). Material and methods. When studying the literature review on PA correction, a search was carried out for sources in the PubMed and Scopus abstract databases for the period up to 2021 inclusive. In total, 50 articles related to the topic of the review were selected, including long-term observations on the methods of optical correction of PA that are currently used worldwide. Results. Today, in addition to spectacle and contact correction, there is a large selection of various methods of surgical correction of PA: wedge resection, various options for keratotomy, implantation of toric intraocular lenses, phakic toric lenses, refractive laser surgery – photorefractive keratectomy, laser in situkeratomileusis, ReLEx SMILE technology, and also implantation of intrastromal corneal segments. The choice of the most optimal optical method for PA correction, depending on the initial individual clinical and functional parameters of the patient, remains quite relevant today. This is due both to a large number of different methods of PA correction, each of which has its own advantages and disadvantages, which necessitates their improvement, and to the need to develop new techniques. Conclusion. Currently, there are a large number of various methods for correcting postkeratoplastic ametropia, each of which has its own advantages and disadvantages. It is necessary to develop a systematic approach to the personalized choice of an optical method for correcting postkeratoplastic ametropia, taking into account its effectiveness and safety, depending on the individual clinical and functional data of the patient. There is a need for the development of new methods of correction that would effectively and safely correct high values of postkeratoplastic ametropia, especially with an asymmetric type of keratotopogram. Key words: postkeratoplastic ametropia, femtosecond laser, corneal segments, scleral contact lenses

Current Concepts in Diagnostics and Treatment of Patellar Instability: Review

Background. Patellar instability is one of the most common pathologies of the musculoskeletal system, predominantly observed in physically active young individuals. It ranks third in the structure of knee joint injuries after anterior cruciate ligament and meniscal injuries.
 The aim of this review to present modern perspectives on the diagnosis, principles, and surgical treatment techniques for patients with patellar instability based on an analysis of the literature.
 Methods. Publications were searched in the PubMed/MedLine and eLIBRARY databases. A total of 112 foreign articles published between 1984 and 2023 and 12 domestic publications from 2011 to 2022 were found. During the analysis, 68 articles were selected, which had full texts or abstracts containing sufficient information on diagnostic methods, commonly used standard and modified surgical correction methods for patellar instability, and treatment protocols considering patient age structure, instability characteristics, and functional demands.
 Results. A qualitatively new stage in the reconstructive and restorative surgery of patellar instability is the in-depth examination of patients to determine the extent of damage to the medial retinaculum and the presence of dysplastic changes in anatomical structures that provide normal biomechanics of the knee extensor apparatus. A strictly individual approach to the selection of surgical treatment methods considering risk factors contributing to the development of chronic patellar instability becomes of particular importance.
 Conclusion. Precise restoration of the medial patellofemoral ligament, supplemented by the correction of identified dysplastic changes in anatomical formations of the knee joint area, allows for better functional outcomes in patients with acute and chronic patellar instability.

Возможности хирургической коррекции спонтанной дислокации комплекса «интраокулярная линза – капсульный мешок», развившейся в различные сроки после факоэмульсификации возрастной катаракты

Purpose. Substantiation of surgical correction method of spontaneous dislocation of the complex «intraocular lens – capsular bag» (CICB), that developed after phacoemulsification (PE), in relation to its severity. Material and methods. The clinical material consisted of 28 patients (28 eyes) aged 61 to 89 years. The terms of spontaneous dislocation of CICB after PE performed widely varied from 3 months to 11 years, averaging 5 ± 2 years. According to our proposed classification degrees of severity spontaneous dislocation of CICB, its 1st degree took place in 8 eyes; 2nd – in 9 eyes; 3rd – in 16 eyes; 4th – in 3 eyes. Surgical correction was performed in all cases dislocation of CICB 2nd or more degrees, the volume of which was commensurate with the initial severity of the eye condition. Results. All operations were carried out as planned, without complications. The postoperative response of the eyes was assessed on the 1st and next days of the postoperative period. In all cases, it corresponded to the volume of performed surgical intervention. So, in 19 eyes, it corresponded to the 1st degree; in 6 eyes – 2nd degree; 3 eyes developed 3rd degree postoperative response of the eyes (postoperative uveitis). Indexes of uncorrected visual acuity on days 3–5 in 14 eyes (50 %) ranged from 0.05 to 0.4; in 8 eyes (29 %) we achieved indexes like they were immediately after PE. Conclusion. Thus, in our experience, the surgical correction of spontaneous dislocations of CICB of the 2–4th degrees has shown itself to be effective in all of these cases. Keywords: phacoemulsification, spontaneous dislocation of the «intraocular lens – capsule bag» complex, surgical treatment

Reconstructive surgeries in the case of the knee joint osteoarthritis

Objective. To clarify the indications and volume of reconstructive surgeries under conditions of knee joint arthritis and to improve the methods of surgical correction of peri-articular deformations using an external rod fixator. Methods. During the last 10 years (2012‒2022), reconstructive surgeries were performed in 45 patients (49 joints). Indications for surgery were based on the study of pain and its localization, peri-articular deformation of the limb, ultrasound (USD) and X-ray examinations. Results. Indications for certain reconstructive surgical interventions on the knee joint are substantiated. The role of pathological changes of the meniscus in the development of knee joint arthritis has been determined. The positive clinical effect of paracapsular resection of the front part of the meniscus with hyperplastic growths of synovial tissue is shown. Deformation of the extremety (43 patients — with varus deformity, 2 — with valgus deformity) limited the function of the limb and caused pain. Surgical treatment in such cases were aimed at eliminating the deformation of the proximal part of the tibia. The types of osteotomies, the features of the author's rod external fixation device application, and the postoperative management of patients are presented. Due to external fixator, it is possible to perform, if necessary, angular correction of the limb axis during the period when the patient begins to walk with partial weight bearing, and the functional load of the limb makes it possible to achieve fusion of fragments within 3.5–4 months. A long-term positive clinical effect was obtained in 42 (93 %) patients. Conclusions. Indications for pathogenetic treatment should be based, first of all, on the identification of the source (or pathogenesis) of the pain syndrome, then on the analysis of the type and magnitude of peri-articular deformation of the limb, signs of functional insufficiency of the limb associated with it. In the third place, the X-ray signs should be analyzed. Elimination of angular peri-articular deformation of the limb has a positive effect on the course of knee arthritis, reduces pain, increases physical activity, and slows down the progression of cartilage destruction.

Morphological structure of the levator muscle in congenital and acquired ptosis of the upper eyelid

AIM: To examine the relationship between the morphological structure of the levator in congenital and acquired ptosis based on dynamometric data and histological research.
 MATERIAL AND METHODS: Dynamometric and histological examination of the morphological structure of the levator in congenital and acquired ptosis of the upper eyelid was conducted. Twenty-seven fragments obtained during the operation to eliminate blepharoptosis were studied.
 RESULTS: With congenital ptosis of the upper eyelid, the average values of SS and fatigue were 1.060.39 g and 1.880.89 g, respectively; with acquired ptosis, the average values of SS and fatigue were 1.470.66 g and 2.310.91 g, respectively (p 0.05). All the biopsies were divided into two groups. Group 1 included biopsies of 16 patients with congenital ptosis (n=16), and group 2 included 11 levator fragments with acquired ptosis. Macroscopic examination revealed greater levator fragment lengths in the acquired ptosis group than in the congenital ptosis group: 2.331.32 mm and 1.220.34 mm, respectively (p 0.05). The levator fragments differed in color and had denser elastic consistency in the acquired ptosis group than in the congenital ptosis group. The histological picture in congenital ptosis (n=11) was an overgrowth of the fibrousadipose tissue, and five biopsies showed an overgrowth of fibrous tissue with signs of protein dystrophy. In levator biopsies with acquired ptosis, seven biopsies with aponeurotic ptosis of the upper eyelid were characterized by the overgrowth of fibrousadipose tissue. The first biopsy (myasthenic ptosis of the upper eyelid) demonstrated the predominance of adipose tissue, with scattered bundles of striated muscle fibers and areas of connective tissue with bundles of smooth muscle fibers. In the remaining three biopsies, fragments of adipose tissue with signs of edema and hyperplasia were identified.
 CONCLUSION: Congenital ptosis is characterized by relatively low strength and rapid fatigue of the upper eyelid levator, higher occurrence of fibrousadipose tissue, and fibrous tissue proliferation. Acquired ptosis is characterized by average strength and fatigue. In the acquired ptosis group, histological data indicate an equal ratio of fibrousadipose and adipose tissue growth. These results can be used in the diagnosis of various forms of ptosis and selection of an effective method for surgical correction for this pathology.

Віддалені наслідки пілороміотомії в дітей

Hypertrophic pylorostenosis is one of the most frequent causes of vomiting in newborns requiring surgical intervention. While the intraoperative complications and immediate results of pyloromyotomy are widely reported in the literature, the remote consequences of this intervention, especially depending on the method of correction, are not well understood and contain contradictory results. Purpose - to study the remote consequences of pyloromyotomy depending on the method of surgical correction - open (OMPT) or laparoscopic pyloromyotomy (LMPT). Materials and methods. The primary assessment of long-term outcomes was performed by analysing the answers to the questions of the Diagnostic Questionnaire for Paediatric Functional Gastrointestinal Disorders, which was sent to 246 patients and their parents; responses were received from 169 (68.7%) respondents, who were included in the study. Re-hospitalisation was required in 57 (33.7%) children who underwent X-ray examination, fibrogastroscopy and ultrasonography. Statistical processing of the study results was performed using the software StatPlus: mac, AnalystSoft Inc. (version v8). Results. The average age of patients involved in the study was 8.5±0.3 years (range of fluctuations - from 2 to 18 years old). Among the respondents, 132 (78.1%) children underwent OPMT, and 37 (21.9%) children underwent LPMT. No complaints were expressed by 102 (60.4%) children, including 81 (61.4%) children after OPMT and 21 (56.8%) after LPMT (p=0.6152). The main complaint in children after pyloromyotomy, which required re-hospitalisation, was chronic abdominal pain, as indicated by 38 (22.5%) of the respondents. There was no correlation between the occurrence of chronic abdominal pain and the age at which hypertrophic pylorostenosis was diagnosed (R=0.183, p=0.2588), the duration of the disease (R=0.079, p=0.6275) and the child's body weight at the time of the intervention (R=0.048, p=0.768). Functional disorders of the digestive tract were diagnosed in 15 (8.9%) children. In 24 (14.2%) children, a slowdown in barium passage through the intestine was detected, which, in combination with periodic pain, indicated chronic adhesive disease. Fibrogastroscopy revealed duodenogastric reflux in 18 (10.7%) children, which in 5 (2.96%) patients was combined with pylorus insufficiency and in 12 (7.1%) with gastritis, and in 17 (10.1%) children gastroesophageal reflux was diagnosed. Conclusions. Thus, in the long term after pyloromyotomy, 33.7% of children required re-hospitalisation due to various pathologies of the gastrointestinal tract. Duodenogastric and gastroesophageal reflux and chronic adhesive disease were most often detected in the long term after pyloromyotomy, and the frequency of their occurrence did not depend on the method of surgical intervention. 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 the institution mentioned in the paper. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Хірургічне лікування повного тубулярного подвоєння товстої кишки, асоційованого з природженою аноректальною вадою розвитку - ректовестибулярною норицею та аномаліями сечостатевої системи

Doubling of the colon is a rare, complex congenital anomaly, both in terms of diagnosis and in the choice of treatment tactics. Patients with this pathology need a thorough comprehensive examination to determine the type of doubling (cystic, diverticular or tubular) and to diagnose possible associated malformations, in particular, the genitourinary system. Anorectal duplications in most cases are tubular doublings that end in distal fistula / fistula on the perineum, or in the genitourinary system. Surgical treatment of this malformation requires a differentiated approach for each patient. Until now, various methods of surgical correction of this defect are used: dissection of the common wall, resection of only the duplicate section, resection of both parts of the double colon, mucosectomy of the duplicate intestine. Their main task is to maximize the anatomical integrity of the colon, with adequate blood supply. In the postoperative period, patients definitely need constant monitoring and rehabilitation treatment. Purpose - to analyze the methods of correction of this defect and evaluate their effectiveness; to present a case of our own staged surgical treatment of complete tubal doubling of the TC associated with congenital anorectal malformation - rectovestibular fistula and anomalies of the genitourinary system. Our proposed phased surgical treatment of complete tubular doubling of the colon, with rectovestibular fistula, allowed to normalize of the motor-evacuatory function of the formed main intestine and the retaining function of the anal sphincter apparatus with good functional results. The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent from the child’s parents was obtained for the research. No conflict of interests was declared by the authors.

Case report of optimizer implantation to modulate cardiac contractility in patients with chronic heart failure and atrial fibrillation

A cardiac contractility modulation device is a new treatment used in patients with heart failure. CCM therapy is associated with an increase in physical activity tolerance, improved quality of life, reduced hospitalizations due to heart failure, and reverse remodeling of the left ventricle in patients with systolic heart failure. In this case, the clinical benefit of cardiac contractility modulation in a patient with chronic heart failure, atrial fibrillation and postinfarction left ventricle aneurysm was reported. Development of postinfarction left ventricle aneurysm in patients with reduced ejection fraction is associated with a high risk of surgical complications. However, an adequate assessment of the functional reserve of the left ventricle myocardium and the choice of surgical correction method allows for receiving favorable outcomes of surgery. We present a case of a successful combination of interventional and surgical treatment of a patient with heart failure and post-infarction left ventricular aneurysm.

Review of recent advances in the ptosis treatment of the upper eyelid

The article provides a literary review of the methods of surgical correction of blepharoptosis. The methods are divided into the following groups: upper blepharoplasty, operations with hanging the upper eyelid to the frontalis muscle, operations with various methods of shortening the eyelid levator muscle, operations with attachment of the levator of the eyelid to the upper rectus muscle of the eye, Muller’s muscle resection technique. The advantages and disadvantages of these methods are indicated.