Modern Surgical Approaches Research Articles

Oncologic outcomes and survival of modern surgical approaches for gastric gastrointestinal stromal tumor (GIST)

BackgroundStudies have demonstrated comparable outcomes between laparoscopic and open resection of gastrointestinal stromal tumor (GIST). We sought to compare outcomes among robotic, laparoscopic, and open resection of gastric GIST in the era of expanding minimally invasive surgery.MethodsA retrospective analysis was performed of adult patients with gastric GIST undergoing definitive surgery using the National Cancer Database from 2010 to 2020, excluding cases converted to open. Patients were stratified into minimally invasive surgery (MIS), (combined robotic (R) and laparoscopic (L)), and open (O). Hospital length of stay (LOS), 30-day mortality, 90-day mortality, and margin status were assessed. Subgroup analysis was performed to evaluate outcomes between R and L cohorts. Entropy balancing was used to adjust for intergroup differences. Kaplan–Meier survival estimates were used to compare unadjusted 5-year survival.ResultsOf the 15,022 patients (R = 10.4%, L = 44.3%, O = 45.3%), 63.2% were stage I and 70.6% underwent partial gastrectomy. MIS approach was associated with shorter hospital LOS (β: − 2.58; 95% CI: − 2.82 to − 2.33) and lower odds of 30-day (OR 0.45; 95% CI: 0.30–0.68) and 90-day mortality (OR 0.54; 95% CI: 0.39–0.74) compared to O. Likelihood of R0 resection similar between groups (OR 1.00; 95% CI: 0.88–1.14). Hospital LOS (β: + 0.25; 95% CI: − 0.14–0.64), odds of 30-day (OR 0.99; 95% CI: 0.40–2.46) and 90-day mortality (OR 0.89; 95% CI: 0.47–1.70), and rate of R0 resection (OR 1.02; 95% CI: 0.82–1.27) were comparable between R and L cohorts. Compared to O, MIS approach was associated with improved 5-year OS (log rank p < 0.001). Overall survival was not significantly different between R and L (log rank p = 0.44).ConclusionThese findings suggest that MIS approach may be considered for resection of gastric GIST in select patients. Among patients receiving an MIS approach, the robotic technique can be considered an oncologically safe alternative to laparoscopic surgery.Graphical

Modern surgical approaches to the prostate and methods of prostatectomy in patients with benign prostatic hyperplasia (literature review)

Modern surgical approaches to the prostate and methods of prostatectomy in patients with benign prostatic hyperplasia (literature review)

A ten-year experience of musculoskeletal tuberculosis at a tertiary care hospital in South India

BackgroundThe delayed identification and management of musculoskeletal tuberculosis (MSTB) poses substantial health challenges and leads to significant morbidity. This study aimed to collate ten years of hospital data and provide valuable insights into the clinical, diagnostics, and outcomes of the patients diagnosed with MSTB. MethodsA retrospective study was undertaken to review clinic records from 2013 to 2022 for all individuals diagnosed with MSTB in a tertiary care hospital in South India. ResultsOver a decade, 400 cases of MSTB were diagnosed, revealing 57 % males and 43 % females with a mean age of 43.2 ± 18.9 years. Spinal TB constituted 72 % of cases, with the most common involvement of thoracic vertebrae (50.9 %). Extra-spinal MSTB accounted for 28 %, prevalent more in the pediatric age group (p < 0.05). Surgical intervention was required for 80 % of spinal TB cases and 58 % of extra-spinal MSTB cases. The average follow-up duration was two years, with 73 % completing treatment. Unfortunately, seven patients died, and three experienced relapse. ConclusionSpinal TB is the most common type of MSTB and is predominant in young and middle-aged adults, while extra-spinal MSTB is more frequently observed in children. Where use of MRI facilitates early detection of spinal TB; histopathological and microbiological examination confirm the diagnosis. Combining anti-tubercular drugs with modern surgical approaches is essential for obtaining favorable outcomes and improving the quality of life of such patients. It is crucial to have advanced and affordable diagnostic facilities, along with increased public awareness, to reinforce tuberculosis control strategies.

Перспективи внутрішньоутробного лікування запальних змін евентрованих органів при гастрошизисі у плодів (огляд літератури)

Gastroschisis (GS) - is one of the most severe defects of newborns, which is characterized by congenital eventration of the abdominal organs outside the anterior abdominal wall into the amniotic fluid, due to a through defect of the anterior abdominal wall. The defect is adjacent to the normal, unaltered umbilical cord, usually to the right of the umbilicus, the umbilical ring is split, the eventrated organs are not covered by embryonic membranes or their remains. The frequency of gastroschisis is 0.31-4.72 per 10,000 births. Although, with the development of modern surgical approaches over the past 15 years, the mortality of newborns with gastroschisisis dynamically decreasing, however, this pathology remains a significant problem in neonatal and pediatric surgery, as it requires early surgery, associated with a significant risk of disability in children due to short bowel syndrome, abdominal cancer and recurrent esophageal disease, adhesive intestinal obstruction, etc. Purpose - to analyze, according to the literature, the prospects for the use of cellular technologies for the in utero treatment of inflammatory changes in the enteric organs in fetal GS in experimental conditions. The main reason for the unsatisfactory results of GS treatment is the pathological changes of the eventrated organs and their consequences. Therefore one of the ways to reduce mortality in GS is intrauterine treatment and the prevention of inflammatory changes of the eventrated organs in the fetuses. Modern regenerative medicine offers several new approaches for the treatment of fetal malformations, including the use of cell technology. Stem cells, from various sources, are one of the alternative therapies that can inhibit inflammatory processes in tissues, activate endogenous reparative mechanisms, and, ultimately, together with the implementation of preventive measures, reduce perinatal mortality and disability. The availability of domestic cell drugs, the development of technologies for their transplantation, and methods of delivery of pregnant women with GS in the fetus, with proven clinical efficacy, will significantly improve the comprehensive treatment of patients with congenital malformations, which is significant social and economic importance. Therefore, the study of regenerative potential and assessment of the prospects for the use of stem cells in obstetrics and perinatal medicine from various sources is of great scientific and practical interest. No conflict of interests was declared by the authors.

Use of hydrosurgical technologies in the treatment of adults and children. Review

Every year, new medical equipment is introduced to surgeons to improve the techniques of surgical interventions and reduce the risk of postoperative complications. One of these methods is hydrosurgery.&#x0D; This study aimed to analyze medical literature on the experience of using hydrosurgical units in various branches of modern surgical practice, provide information on their effectiveness, and evaluate their main advantages, disadvantages, and prospects for use in pediatric surgery.&#x0D; Publication search and information analysis were carried out using the databases PubMed, eLibrary, Web of science, and Cyberleninca. The following search phrases were used: hydrosurgery, water jet devices, hydrosurgery, water jet hydrodissection, HybridKnife, Erbejet, VersaJet, water-jetdevices, and water-jetdebridement. For the literature review, only sources in Russian and English published from 2015 to 2022 were selected. The experience of using hydrosurgical units in adult and pediatric surgical practices was considered. According to the specified search parameters, we analyzed 54 articles, 38 of which were included in the literature review. The remaining 16 articles were excluded due to the small sample of patients and incomplete stages of the study.&#x0D; RESULTS: The results indicated the significant effectiveness and versatility of hydrosurgical methods. The fixed advantages of their use in the modern practice of a surgeon largely prevailed over their disadvantages, allowing their potential application in surgical interventions of varying degrees of complexity. Hydrosurgical technologies in pediatric practice were used in combustiology, treatment of wounds, skin neoplasms, and destructive pneumonia.&#x0D; CONCLUSIONS: In conclusion, hydrosurgical methods are one of the effective modern surgical approaches to the treatment of patients with various pathologies. An in-depth study of this method in pediatric surgery is warranted.

Similarities and special features of modern approaches to surgical treatment of intra-articular fractures of tibial proximal and distal metaepiphyses

SummaryIntroduction. Analysis of special scientific literature concerning the modern principles of diagnostics, preop-erative planning and surgical treatment of intra- articular fractures of two localizations: proximal and distal me-taepiphyses of the tibia, was carried out. Aim of the review. To evaluate, through the analysis of specialized scientific publications, similarities and differences in classification approaches, diagnostic methods, princi-ples of planning and performing osteosynthesis in pa-tients with intra-articular fractures of the proximal and distal metaepiphyses of the tibia. It is noted that the modern classifications of both tibial plateau and pilon fractures are based on the column theory. A thorough analysis of computed tomography data is necessary to precisely determine the fracture pattern. On this ba-sis, osteosynthesis surgeries are planned as to provide fixation of all damaged columns. Authors discuss the combinations of surgical approaches necessary for this purpose. Variants of osteosynthesis are also considered, with special attention paid to fixation of the posterior aspects of the tibial plateau and pilon. The differences in approaches to surgical treatment of patients with frac-tures of the tibial plateau and pilon are primarily due to a significant difference in the overall size of the tibia in the area of the knee and ankle joints and, in particular, with a significantly smaller volume of soft tissues at the level of the distal metaepiphysis of the tibia. These dif-ferences in anatomy should be taken into account by surgeons when choosing surgical approaches for osteo-synthesis of the discussed fractures. Conclusion. Adher-ence to the classical principles of surgical treatment of intra-articular fractures with the use of modern surgical approaches and osteosynthesis techniques is a sure way to improve specialized trauma care for a complex category of patients with intra-articular fractures of the proximal and distal tibial metaepiphyses, which should help to reduce the incidence of postoperative complica-tions and improve treatment outcomes.

Modern surgical approaches for tuberous breast deformity

Modern surgical approaches for tuberous breast deformity

CHOICE OF INGUINAL HERNIA REPAIR PROCEDURE

Introduction. Modern surgical approaches to inguinal hernia repair are laparoscopic (TAPP and TEP) and open (Lichtenstein procedure), which are based on prolene mesh prosthetics. Despite the widespread use of these methods of hernia repair in surgical practice, the frequency of typical postoperative complications: hematoma of the scrotum and inguinal region, false recurrence, paresthesias, neuralgia, etc.&#x0D; Aim. To compare TAPP, TEP, and Lichtenstein based on analysis of long-term treatment outcomes.&#x0D; Materials and methods. We performed surgical treatment of inguinal hernia in 211 patients. All of them underwent tension-free hernia repair using a prolene prosthesis. Lichtenstein procedure was performed in 65 patients (Lichtenstein group), TAPP (TAPP group) in 81 patients and TEP (TEP group) in 65 patients. In 30 patients of different groups, the blood flow in the vessels of the testis was studied after the procedures performed within 45–60 days.&#x0D; Results. Probably (p&lt;0.001) faulty recurrence was observed more often in the Lichtenstein group. Seromas that persisted for more than 30 days (p&lt;0.01) and seromas that required surgical intervention — puncture (p&lt;0.05) were more likely to be noted in the TEP group. Indicators such as hernia recurrence (up to one year) and the intensity and frequency of chronic postoperative neuralgia in the Lichtenstein, TAPP and TEP groups differed improbably. The systolic velocity of blood flow in the vessels of the testis in patients of the Lichtenstein group before the operation was (19.70±3.53). In the postoperative period, an incredible decrease in blood flow was observed (19.28±3.41). In patients of the TAPP group, the preoperative systolic velocity was (19.83±3.27) and improbably decreased to (19.47±3.44) within 45–60 days. A similar improbable decrease was observed in the TEP group — (19.80±3.56) and (19.63±3.51)&#x0D; Conclusions. The Lichtenstein procedure and endoscopic methods of inguinal hernia correction (TAPP and TEP) are safe procedures in terms of long-term complications and do not likely affect the systolic blood flow velocity in the testicular arteries.

What Are Risk Factors for and Outcomes of Late Amputation After Treatment for Lower Extremity Sarcoma: A Childhood Cancer Survivor Study Report.

What Are Risk Factors for and Outcomes of Late Amputation After Treatment for Lower Extremity Sarcoma: A Childhood Cancer Survivor Study Report.

Surgical Aspects of Recurrent Macular Holes Treatment

Despite the high level of development of modern macular surgery, recurrent macular holes remain a rather serious problem for vitreoretinal surgeons. Recurrent macular holes can be of two types: macular holes that have not closed after primary surgery, and macular holes that have reopened after a successful initial surgery. In foreign literature they are called persistent and recurrent macular holes. This article presents a review of modern scientific literature on epidemiology, causes of development and surgical treatment of recurrent macular holes. This review provides information on the rationality and effectiveness of modern surgical approaches to the treatment of this condition. The most effective methods for treating large macular holes, which are one of the main causes of failure to close a defect during the first surgery or the development of a recurrence of this condition sometime after the first surgery, are covered. Based on the literature data, we can say that the main methods of choice in surgery for recurrent macular holes today are the use of platelet-rich plasma and various modifications of the inverted internal limiting membrane flap technique, transplantation of the autologous internal limiting membrane, including the displaced internal limiting membrane flap technique patented in the Russian Federation.

Robot assisted electrical impedance scanning for tissue bioimpedance spectroscopy measurement

Intraoperative tissue identification is important and frequently required in modern surgical approaches for guiding operation. For this purpose, a novel robot assisted sensing system equipped with a wide-band impedance spectroscope is developed. Without introducing an external sensor probe to the operating site, the proposed system incorporates two robotic instruments for electric current excitation and voltage measurement. Based on the developed measurement strategy and algorithm, the electrical conductivity and permittivity of the tissue region can be calculated. Experiments based on simulation, salines and ex-vivo tissue phantoms are conducted. The experimental results demonstrate that the proposed system has a high measurement accuracy (≥97%). Through a simple support vector machine, a 100% accuracy is achieved for identifying five different tissues. Given the convincing results, the presented sensing system shows great potential in offering effective, fast, and safe tissue inspection.

Rare variants of histiocytic tumors: peculiarities of diagnosis and choice of treatment (literature review)

Histiocytic tumors are a highly heterogeneous group of diseases, with Langerhans cell histiocytosis occupying the main place among it. Despite the rare frequency of occurrence, long-term analysis of clinical, morpho-immunological and molecular-biological features has allowed the development of effective treatment protocols (especially in the pediatric cohort of patients). In addition to Langerhans cell histiocytosis, the histiocytic tumors group includes rare and casuistic variants, which include histiocytic sarcoma, Langerhans cell sarcoma, indeterminate dendritic cell tumor, interdigitating dendritic cell sarcoma, follicular dendritic cell sarcoma, and fibroblastic reticular cell tumor. The incidence of certain nosological variants is several cases per hundreds of millions of the population. Not surprisingly, the diagnostic criteria for this group of tumors need to be clarified, as do the therapeutic approaches. This review presents current data on rare histiocytic tumors, clinical features as well as morphological and immunobiological characteristics of the tumor substrate. The results of modern surgical and therapeutic treatment approaches are presented.

ПРИМЕНЕНИЕ УГЛЕВОДНОЙ СМЕСИ С БЕЛКОМ В РАМКАХ КОНЦЕПЦИИ «FAST-TRACK» ПРИ ПЛАНОВОЙ АРТРОПЛАСТИКЕ КРУПНЫХ СУСТАВОВ

Objective: To evaluate the effect of feeding with a whey protein plus carbohydrate drink on metabolic parameters, general state of the patient and recovery time after knee and hip arthroplasty. Methods: The results of the perioperative period of 60 patients with osteoarthritis (OA) of the hip and knee were evaluated between March and July 2021. All patients underwent hip or knee arthroplasty under spinal anaesthesia. In addition, patients of the study group received the ProvideXtra® Drink 2 hours before surgery. Otherwise, the management of patients in the perioperative period was the standard. Mobilisation and verticalisation of patients were carried out after achieving physical fitness, resolution of the spinal block and haemodynamic stability on the day of surgery or the next day. Results: In all patients after 4 hours, increased glucose levels were recorded in both groups, statistically significant in the control group – 7.15±0.94 versus 7.88±1.18 mmol/l (p=0.02). The decrease in haemoglobin level had no difference in the study groups and before discharge was 100±16 g/l versus 101±18 g/l (p=0.86). The difference in total protein level before discharge was in favour of the study group, 63.1±6.1 versus 59.2±5.9 g/l (p=0.17). Verticalisation timing in the study group was as follows: 10 patients were verticalised on the day of surgery, and the remaining 20 patients – were on the next day. In the control group – 8 patients were verticalised on the day of surgery and 22 – on the next day. In the control group, 2 cases of postoperative nausea requiring correction were observed. Conclusion: The modern surgical approaches include the maximal preservation of natural feeding, based on the Enhanced Recovery after Surgery (ERAS®) concept. However, guidelines for choosing a particular diet on the day of surgery remain to be finally established. Using ready-made carbohydrate-protein mixtures is a convenient solution that delivers the required amount of energy and protein. Therefore, the effect of the mixture on protein metabolism in the postoperative period remains to be elucidated through further studies. Keywords: Accelerated rehabilitation, nutrient mixture, hip arthroplasty, knee arthroplasty.

Neovascular glaucoma in patients with diabetes mellitus — the current state of the problem

Today, diabetes is one of the leading medical and social problems. This is due to a pandemic increase in the development of the disease. Eye complications that occur against the background of diabetes are complex. Diabetic damage to the visual organ is the main cause of visual acuity in these patients. One of the serious complications of proliferative diabetic retinopathy is secondary neovascular glaucoma, which is often refractory to treatment and eventually leads to irreversible blindness. Currently, neovascular glaucoma is an important and urgent problem in modern society, as it leads a large number of patients to disability and impaired social adaptation. The paper presents a review of the literature on the current state of the problem of neovascular glaucoma and presents the results of major international studies.Based on the data of domestic and foreign literature, the authors provide up-to-date information on the incidence, evaluate the clinical manifestations of the disease, paying attention to new methods of diagnosis and treatment. These data allow us to evaluate the effectiveness of modern therapeutic and surgical approaches in the treatment of neovascular glaucoma, as well as its various complications and measures for their prevention.

New technologies applied to canine limb prostheses: A review.

Although only a few studies have investigated about the development of animal prosthesis, currently, there is an increasing interest in canine limb prosthesis design and its clinical application since they offer an alternative to killing the animal in extreme situations where amputating the limb is the only option. Restoring normal function of amputated canine limbs with the use of a prosthesis is challenging. However, recent advances in surgical procedures and prosthesis design technology appear promising in developing devices that closely recreate normal canine limb function. Surgical advances such as evolution of osseointegration (bone-anchored) prostheses present great promise. Likewise, modern computer-aided design and manufacturing technology, as well as novel motion analysis systems are now providing improved prosthesis designs. Advances in patient-customized prostheses have the potential to reduce the risk of implant failure. The objective of this investigation is to present a general review of the existing literature on modern surgical approaches, design and manufacturing methods, as well as biomechanical analyses so that veterinarians can make more and better-informed decisions on the development and selection of proper canine limb prosthesis. Isolated research efforts have made possible an improvement in stability, comfort, and performance of canine limb prosthesis. However, continued multidisciplinary research collaboration and teamwork among veterinarians, engineers, designers, and industry, with supporting scientific evidence, is required to better understand the development of canine limb prosthesis designs that closely replicate the normal limb function.

Surgical Evacuation of Intracerebral Hemorrhage: The Potential Importance of Timing.

Surgical Evacuation of Intracerebral Hemorrhage: The Potential Importance of Timing.

THE ROLE OF SOME CYTOKINES IN THE FORMATION OF CRYPTOGLANDULAR ANAL FISTULA

Abstract. Aim. Modern surgical approaches to the treatment of anal fistulas involve operations that least damage the sphincter complex of the rectum. The essence of the operation is a complete excision of the anal fistula, which is often accompanied by a significant number of recurrences depending on the chosen method of operation. Failure is likely the result of inflammation that persists after surgery, and cytokines play an important role in these processes.&#x0D; The aim of the study: evaluate local production and determine the role of IL-6 and TNFα in the formation of rectal fistulas.&#x0D; Materials and methods. The tissue of the fistula tract was obtained in 90 patients of both sexes with transsphincteric fistula of cryptoglandular origin in the period from September 2018 to February 2020, who underwent surgery (fistulotomy, modified technique LIFT, use of biowelding technique of the fistula tract).&#x0D; Results. The frequency of IL-6 producing cells was highest (32.0±4,0) specimens in the field of view not only in inflammatory infiltrate, but also in granulation tissue and immature connective tissue of the fistula tract. The lowest rates of IL-6 producing cells were (23.0±3,0) specimens in the field of view. The frequency of TNFα receptor-producing cells ranged from (17.0±1,0) specimens in the field of view to (24.0±3,0) specimens in the field of view.&#x0D; Conclusions. A large number of IL-6 and TNFα-producing cells has been identified not only in inflammatory infiltration but also in granulation and immatureconnective tissue, indicating the active role of these cytokines in the formation of rectal fistulas.

DIAGNOSTIC CRITERIA AND SURGICAL APPROACHES TO THE TREATMENT OF OVARIAN TUMOR NOMINATIONS

Resume. The aim of the work was to study modern diagnostic criteria and surgical approaches to the treatment of ovarian tumors.&#x0D; The objectives of the work were to highlight the arsenal of diagnostic and therapeutic capabilities of modern medicine for various ovarian tumors, discuss the advantages and disadvantages of methods and select the optimal algorithm for managing patients with this pathology.&#x0D; Materials and methods. A retrospective study of cases of ovarian tumors in patients over the past 5 years, studied the current data of the world literature on this topic.&#x0D; The conclusions of the work indicate the need for a comprehensive approach to the diagnosis and treatment of ovarian tumors and an individual approach to the patient in each case.

Current aspects of surgical treatment of gastro-esophageal reflux disease

Gastroesophageal reflux disease (GERD) is characterized by abnormal reflux of gastric content into the esophagus, pharynx, respiratory tract and oral cavity. In recent years, there has been a significant increase of the incidence of this disease, that significantly aggravates quality of life of the population. The 'gold standard' for treating GERD is anti-secretory therapy with proton pump inhibitors (PPIs). However, up to 40% of patients are unresponsive to PPIs even after dose adjustment. Advantages and disadvantages of modern surgical approaches for this pathology are reviewed. Laparoscopic fundoplication including Nissen (360°), Toupet (270°) and Dor procedures (180°) is the most common anti-reflux operation. In addition, new alternative surgical options are also discussed. For example, these are minimally invasive methods such as LINX reflux control system, electrical stimulation of the lower esophageal sphincter and transoral incisionless fundoplication (TIF). These methods are less aggressive and have less side effects. A comparative assessment of modern methods of surgical treatment of GERD is made.

ЛАПАРОСКОПИЧЕСКИЙ ГАСТРОЭНТЕРОАНАСТОМОЗ ПРИ ПОСЛЕОЖОГОВОМ ДЕКОМПЕНСИРОВАННОМ ПИЛОРОДУОДЕНАЛЬНОМ СТЕНОЗЕ

Background. A burn of the gastrointestinal tract due to the ingestion of corrosive substances is one of the most common causes leading to the development of persistent pathological changes. Objective. To analyze a clinical case of laparoscopic gastroenteroanastomosis in a patient with gastric outlet obstruction secondary to accidental acid ingestion. Material and methods. The laparoscopic gastroenteroanastomosis was successfully performed on a patient with gastric outlet obstruction secondary to accidental acid ingestion in October, 2019 at Grodno University Hospital. During the postoperative period, the patient was followed up and diagnostic observation was conducted. The patient’s medical record was analyzed as well. Results. The surgery proceeded uneventfully and lasted for 3 hours. Enteral feeding was initiated on the 3rd day after the operation and was delivered via a feeding tube using liquid diet. The postoperative period elapsed without complications. The patient was discharged from the hospital after nutritional status compensation on the 12th day after the operation. Conclusions. Laparoscopic gastroenteroanastomosis is a minimally invasive, easily tolerated and effective operation, and can be considered a good alternative to other modern surgical approaches to the treatment of post-burn pyloric stenosis.