Principles Of Surgical Treatment Research Articles

ВАЖНЕЙШИЕ АСПЕКТЫ ЭПИДЕМИОЛОГИИ, ФАКТОРОВ РИСКА И ЛЕЧЕНИЯ ВАРИКОЗНОЙ БОЛЕЗНИ

The literature review focuses on the significant aspects of epidemiology, analysis of risk factors and modern principles of surgical treatment of varicose veins. Literature data show that considering pathology in recent years has a tendency to increase the frequency and the significant factors at risk of its development are the inheritance, overweight, as also pregnancy and childbirth of two or more. In recent years, new thermal catheter techniques have become more frequent in the treatment of varicose veins, which demonstrate their advantages and high efficiency. The literature analysis shows that the use of a 1470 nm laser wavelength with a radial type of optical fibers has the highest coagulating effect compared to other types of laser. The authors of the article provided detailed coverage of the endovascular laser ablation technique, showing its advantages over other methods, and its role and place in the comprehensive treatment of the varicose veins.

From membrane surgery to compartment surgery: source tracing and discriminating

The theory of membrane surgery actually holds the same concepts as that of traditional cancer surgery, which believes that tumor spread is regarded as an isotropic process but the tumor is confined by the block of the membrane. Therefore, the radical resection can be achieved by complete mesentery excision along the membrane plane. The surgical practice derived from these conceptions is extended excision and lays emphasis on tumor-free margins. But the theory is controversial in the view of the existence of mesorectal fascial envelope and the feasibility of complete excision of mesorectum along the "holy plane". Based on ontogenetic anatomy, the compartment theory suggeststhat tumor spread is not isotropic, and it is locally confined within the ontogenetic compartment derived from a common primordium for a relatively long phase during their natural course. Local tumor is suppressed by the boundary instead of fascia. The anatomical territory developing from each anlage primordium may be separated morphologically. Consequently, ontogenetic compartment theory states that optimal local control of cancer is achieved by whole compartment resection, irrespective of margin width. The compartment model of tumor spread provides explanations for total mesorectal excision (TME) which excises the complete rectum compartment including the rectum and its surrounding vascular and ligamentous mesenteries. The compartment theory may set up the new principles for surgical tumor treatment, namely the resection of the tumor bearing compartment rather than target organ.

Rhegmatogenous Retinal Detachment: Pathophysiology and Risk Factors

Rhegmatogenous retinal detachment is one of the most important retinal diseases requiring urgent surgical treatment. To be aware of the pathophysiology of the disease and to know the risk factors; it is crucial to prevent the development of the disease or overcome the complications that may arise and understand the surgical treatment principles. Major factors in the development of RRD: retinal tears, vitreous liquefaction, and detachment, traction on the retina surface. Myopia, previous cataract surgery, trauma, posterior vitreous detachment, lattice degeneration are the most important risk factors.

A multidisciplinary approach to skin plastic of skull defects formed after implantation

At the present time in connection with the growth craniotomies interventions cranioplasties operations is widespread. The introduction of a significant number of heterogeneous implants to restore the integrity of the structures of the skull is accompanied by an increase in the frequency of complications in the area of their installation (up to 34 % of cases), which first and foremost must include the formation of ulcers of the skin and purulent inflammation. The basic principles of surgical treatment of such category of victims now provide implant removal, long-term conservative preparation of wounds and repeated reconstructive intervention in the long term. The article presents an analysis of four clinical observations of successful treatment of patients with defects of the skin of the skull over the implants using a number of methods of combined skin plastics. It is shown that surgical interventions using skin-fascial flaps and free split grafts can prevent implant removal, preserve foreign structures and avoid complications in the early postoperative period.

GCT-56 - Principles of surgical treatment for germ cell tumours in children

GCT-56 - Principles of surgical treatment for germ cell tumours in children

Rhegmatogenous Retinal Detachment, Pathophysiology and Risk Factors

Rhegmatogenous retinal detachment is one of the most important retinal diseases requiring urgent surgical treatment. To be aware of the pathophysiology of the disease and to know the risk factors; it is crucial to prevent the development of the disease or overcome the complications that may arise and understand the surgical treatment principles. Major factors in the development of RRD: retinal tears, vitreous liquefaction, and detachment, traction on the retina surface. Myopia, previous cataract surgery, trauma, posterior vitreous detachment, lattice degeneration are the most important risk factors.

Surgical principles for optimal treatment of esophagogastric junction adenocarcinoma.

The incidence of esophagogastric junction (EGJ) adenocarcinoma is increasing worldwide. Management of these tumors remains controversial given their unique location between the esophagus and the stomach. Debate surrounding the optimal therapy for EGJ adenocarcinoma has often centered around the tumor origin as defined by the Siewert classification system. However, the optimal surgical management should focus on adhering to important surgical principles that will allow for the best outcomes and prognosis regardless of tumor location including resection with appropriate and negative histological margins, adequate lymphadenectomy, minimization of morbidity and mortality, and preservation of quality‐of‐life. In this article, we provide a discussion of the controversy surrounding EGJ adenocarcinoma within the framework of these concepts.

Transzanális műtéti útmutató

We summarized diagnostic, surgical treatment and follow-up principles of benign and early malignant lesions of the rectum. Our aim is to provide a nationwide practical synopsis of transanal minimally invasive surgical techniques which might be the basis of a Hungarian national audit of rectal polyp management.

EXPERIENCE OF THE USE OF ANTIADHESIVE METHODS AT ADHESIVE DISEASE AS A COMPLICATION AT THE HARD POLYTRAUMA AT THE CHILDRENS

The clinical case of a serious field of injury, which is complicated by adhesive disease in a child with a diagnosis: penetrating wounds of the abdominal cavity, is presented. Damage to the small and large intestines. Separation of the lateral surface of the pelvis and thigh to the left, traumatic amputation of the left idiopathic bone and left femur. Fracture of the caudal and bronchial bones on the right. Fractures of the S5-L1 vertebrae bodies. Hemorrhagic shock of the III degree. Hypovolemic shock of the III degree. Traumatic shock. The postoperative period was complicated: purulent-necrotic wound of the lateral surface of the abdominal wall and the formed cult; necrotic fasciotocellulitis and myositis; wound by sepsis; septicemia; abnormal suction and short loop syndrome, abdominal adhesion’s. The basic principles of patient's surgical treatment are substantiated. The three-stage provision of assistance has been identified: Stage I – life-saving; ІІ – correction of complications of polytrauma and adhesion disease; III – restoration of the function of the damaged organs.

Surgical approach on Reccurent Retroperitoneal Liposarcoma with Involvement of Surrounding Organs

Background: Retroperitoneal sarcomas are neoplasm that are only 0,3-3% of all solid tumors. Liposarcomas is most freguent soft tissue sarcomas in adults. Symptoms would only be detected if the liposarcoma presses on the surrounding organs.
 Case presentation: A 58-year-old woman presented with complaint of progressive abdominal distension, loss of appetite, malaise, constipation and weight loss of about 7 kg. Abdominal CT scanning showed the presence of a retroperitoneal tumor that occupies almost the entire right part of abdominal cavity. 16 months earlier, the patient was operated in another surgical facility due to liposarcom, derived from retroperitoneum (Histopathological finding: Poorly differentiated (G3) liposarcoma pleomorphic cell type). The patient was operated under the diagnosis of retroperitoneal liposarcoma.
 Conclusions: Treatment of choice is radical surgical procedure including elimination of all the structures and organs involved by the tumour process - RO resection as a basic principle of surgical treatment.

Modern principles of surgical treatment of chronic pancreatitis

We reviewed the charts of 752 patients, who have undergone surgery for various forms of chronic pancreatitis at “Shalimov’s National Institute of Surgery and Transplantation of the NAMS of Ukraine” in the years from 2007 to 2017. The average age of the 591 males (78,6 %) and 161 females (22,4 %) was 43,0 ± 3,2 years. Out of these, 446 (62,4 %) patients with pseudocysts and pancreatic fistula and also with isolated main pancreatic duct lithiasis underwent drainage procedures. The 269 (37.6%) patients were subjected to different types of resection, including the Frey operation, pancreatoenterostomy with artificial pancreatic duct formation, the Berne technique, the Beger procedure, pancreatoduodenectomy, distal-pancreatic resection and other procedures. After pancreatic resections, the patients did not require repeated surgical interventions for chronic pancreatitis. In some cases of chronic pancreatitis, there was an isolated lesion of the pancreas: in such cases (13 patients), we performed distal resection of the pancreas. Among the observed patients here were no fatal cases. Satisfactory results were obtained in 92.6 % of cases at longterm follow-up. Post-operative complications occurred in 27 patients (4.6 %), in 6 (1.03 %) patients there was a need for repeated surgery. Progression of the disease in patients previously operated in our clinic was observed in 32 (5.5 %), and 72 patients, initially operated in other medical institutions. Patients after direct resection of the pancreas did not require repeated surgery for chronic pancreatitis. The main causes of unsatisfactory results of the surgical treatment for chronic pancreatitis have been found to be: false indications for initial surgery, improper primary surgical techniques, insufficient use of drainage procedures, as well as, performing a drainage procedure instead of a resection. Key words: chronic pancreatitis, surgical treatment, resection and drainage procedures. For citation: Usenko OY, Kopchak VM, Nychytailo MY, Duvalko OV, Khanenko VV, Trachuk VI, Khomiak AI. Modern principles of surgical treatment of chronic pancreatitis. Journal of the National Academy of Medical Sciences of Ukraine. 2019;25(3):306–12

Surgical Treatment of the Atypical Femoral Fracture: Overcoming Femoral Bowing.

Atypical femoral fractures differ from ordinary femoral diaphyseal or subtrochanteric fractures in several aspects. Although several authors have reported the results of surgical treatment for atypical femoral fractures, the rate of complications (e.g., delayed union, nonunion, fixation failure, and reoperation) is still high. Therefore, we reviewed principles of surgical treatment and describe useful methods for overcoming femoral bowing in these high-risk patients.

The experts consensus on the surgical treatment and perioperative management of cervical spondylosis (2018)

In order to standardize the surgical care and perioperative management for patients with cervical spondylosis, the Editorial Board of Chinese Journal of Surgery has organized the several meetings with certain experienced spine surgeons regarding prevent complications related to surgical procedure, ensure the treatment safety as well as in improving the outcome efficacy. In the meantime, the relevant focused issues and repeated consulting have been reviewed and presented on a larger spectrum. By 2 years efforts, the consensus has been developed for patients with different types of cervical spondylosis. The principle of surgical treatment, including surgical approach, operating procedures, technical consideration, the patient selection and evaluation criteria of cervical spondylosis have been elucidated. The decision-making and management have been also recommended during preoperative, intraoperative, and postoperative respectively. For the controversies of surgical strategy and related clinical issues of cervical spondylosis, the principled and guided advices have been addressed. Due to certain limitation, this consensus is only attempted to provide a recommend conclusion either for the clinical practice or related studies in treatment strategy for patients with cervical spondylosis. This consensus only provides academic guidance.

Improving results in patients with foramen magnum meningiomas by translating surgical experience into a classification system and complexity score.

Foramen magnum meningiomas (FMMs) are challenging lesions and controversy still exists regarding their optimal management. In the present paper, we propose some principles of surgical treatment of FMMs. We analyzed our series of 39 patients: the average maximum diameter was 31.1mm (sd, 10.7). In two cases, there was extradural extension. We operated all anterior lesions through dorsolateral approach to craniovertebral junction and all posterior lesions through midline suboccipital approach and C1 laminectomy, following the prevalence of side of the tumor. There were no complications except for one case of post-operative hypoglossus paresis. We translated our experience with surgery of foramen magnum meningiomas into a classification system and a complexity score, in order to assign a score to each individual case and plan the surgical strategy. When the complexity score is 5 or more, we propose subtotal removal, in consideration of the benign nature.

Genito urinary fistula: a series of 1704 cases

Aims: To review our experience in causes, diagnosis and basic principles of surgical treatment of urogenital fistulas.
 Methods: A retrospective study of 1704 patients with different types of urogenital fistulas were reviewed between October 1995 to October 2018. They were analyzed with regard to age, parity, casual factor, mode of treatment and outcome. Patients were also evaluated at two or three weeks initially, three monthly and later depending upon symptoms.
 Results: We reviewed our series of female urogenital fistulas that have been treated over a 22 years period. Out of these 1704 cases 864 (62.44%) were Vesico vaginal fistulas, 432 (25.35%) were Urethro vaginal fistulas and 188 (12.2%) were Uretero vaginal. Majority of the patients were young in child bearing age between 16 and 30 years of age, although age range was wide i.e., 11 to 50 years. The most common cause of urogenital fistulas were Obstetrical trauma due to obstructed labor in 400(37.59%) & Gynecological (hysterectomy 180(18.79%) & caesarian section in 72 (6.77%). Patients of Uretero vaginal fistulas were mainly due to unrecognized ureteral injuries during Gynecological procedures (hysterectomy in 136 cases & caesarian section in 10 cases. For repair of vesico vaginal fistulas Transvaginal route for repair was used in 424(39.84%) patients, while Thans abdominal route for repair was used in 560 (52.63%) patients. There were 32 (12.03%) failures in Vesico vaginal fistulas with a success rate of 88%. Mean Hospital stay was 15+ 3.5 days (range 4-30 days) and a mean follow-up of 8+ 3.2 months (range 4 months to 2 years).
 Conclusions: Management of Urogenital fistulas are among the most distressing complications of obstetric and gynecologic procedures. The patients suffer physically, emotionally and socially. The lack of skilled supervision and adequate obstetric emergency facilities are to blame.

Technical Aspects of Invaginacionnoj Appendectomy

In the 10th century were developed the basic principles of surgical treatment of acute appendicitis. Much of the credit for this matter belongs Koheru, Mar-Burneju, Volkovichu, Djakonovu and other surgeons. Were developed by the operational access to the tree, techniques appendectomy and drainage of the abdominal cavity. Special attention was given to the technique of peritonizacii the stump of this body.

Second branchial cleft anomalies in children: a literature review.

Branchial cleft anomalies are the second most common head and neck congenital lesions in children. It may sometimes be a part of branchio-oto-renal (BOR) syndrome, so in patients with branchial cleft anomalies associated with a complaint of auricular deformity or a similar history and findings in other family members, we should take an additional examination to find the possibility of BOR syndrome. Complete excision is essential for good prognosis. For the management of branchial cleft anomalies, various methods have been reported. Endoscopically assisted dissection technique and transoral robot-assisted surgery were used in the management of fistula and allowed excellent visualization of the pharyngeal component of the lesion and a minimally invasive approach. It is essential for the surgeon to fully comprehend the congenital lesions to attain the correct preoperative diagnosis and plan for an appropriate surgical approach to prevent the most common complication and recurrence in these lesions. The following sections discuss the anatomy, common presentation, auxiliary examination, differential diagnosis, the current principles of surgical treatment and prognosis for second branchial cleft anomalies in children, and discussed the branchio-oto-renal syndrome.

A briefly discussion of the progress and development direction of incisional hernia surgery in China

Since large-scale popularization of the surgical treatment of hernia in the 1990s, China has made great process in the field of hernia and abdominal wall surgery. In the treatment of incisional hernia of abdominal wall, a relatively complete system has been established in China, for instance, the formulation of guidelines, the purpose of incisional hernia treatment, the principle of surgical treatment, the choice of surgical methods, the improvement of material application, standardized treatment process, optimized management system. Common procedures of incisional hernia are open operations, including direct repair suture, bridging repair, and separation techniques of tissue construction. Meanwhile, the laparoscopic repair develops quickly in China as well. Compared with Western countries however, we still have a long way in overall level, for instance, treatment innovation, data integrity accumulation, quality control, technical innovation, new materials research, and monitoring of side-effects of implant materials. What we should consider and pay attention to is how to further develop hernia surgery and make it sustainable. Based on surgical experiences of incisional hernia in China, this paper intends to share the modern knowledge of incisional hernia and abdominal wall surgery.

Surgical treatment of peritoneal metastases from gynecological primary tumors

The principle of surgical treatment of peritoneal metastases of ovarian cancer in the primary as well as in the recurrent disease setting includes macroscopic complete cytoreductive surgery. The addition of intraperitoneal chemotherapy after cytoreduction is currently not part of the standard treatment. Data on intraperitoneal chemotherapy for treatment of peritoneal metastases of ovarian cancer are presented focusing on overall and progression-free survival and on morbidity and mortality rates. PubMed search including the following terms: ovarian cancer, peritoneal metastases, cytoreduction and HIPEC. Randomized-controlled and non-randomized controlled trials showed that intraperitoneal chemotherapy after maximum cytoreductive surgery results in asurvival benefit regarding overall and progression-free survival for primary as well as recurrent disease. Addition of HIPEC does not impact on the initiation of postoperative systemic chemotherapy. Macroscopic complete cytoreduction is the most important prognostic factor. The addition of intraperitoneal chemotherapy for the treatment of peritoneal metastases of ovarian cancer showed promising results but so far it is not accepted as apart of amultimodal treatment concept.

Organ injuries due to thoracic trauma : Diagnostics, clinical importance and treatment principles

Thoracic trauma can be alife-threatening condition due tothe involvement of vital organs, such as the heart, lungs, tracheobronchial tree and the great vessels. A coordinated interdisciplinary management is vital for the survival of the injured person. Modern diagnostic procedures provide an essential basis for the surgical treatment of patients. Surgical treatment principles include insertion of chest drainage, emergency thoracotomy, complex bronchoplastic and vascular reconstructive techniques and cardiac surgical maneuvers. For this reason highly complex surgical procedures are available, which can be effectively and specifically integrated into an interdisciplinary concept. In this review, the most frequent and prognostically relevant conditions, the indicated diagnostics and their significance as well as the surgical treatment principles, are comprehensively presented under consideration of the clinical situation.