Results Of Surgical Treatment In Patients Research Articles

Impact of perioperative high-protein nutritional support on postoperative outcomes in the treatment of primary lung cancer: Russian prospective multicenter comparative study (NUTRILUNC-study)

BACKGROUND: Up to 60% of lung cancer pts experience weight loss. Prevalence of sarcopenia in patients (pts) with non-small cell lung cancer (NSCLC) is about 43% and is an independent predictor of worse overall survival. It was shown that nutritional support improves outcomes in pts with cancer. AIM: To evaluate impact of perioperative nutritional support on surgical treatment outcomes of patients with NSCLC. MATERIALS AND METHODS: Patients with primary NSCLC (n=112, 69 males), aged 57,2±8,2, awaiting lung surgery and being at risk of malnutrition (Nutritional Risk Screening Assessment 2002 score ≥3) were randomized into 2 groups. Study group (n=55) received oral nutritional support (Nutridrink Compact Protein, Nutricia LLC), 250 ml/d (36 g of protein, 612 kcal) for 14 d before and 14 d after surgery in addition to standard diet. Control group (n=57) had a standard diet. The number of respiratory complications after surgery, length of hospitalization, anthropometric, functional, laboratory parameters, quality of life (according to Quality of Life Questionnaire Core-30) were assessed. Results were presented as mean ± standard deviation. Differences were considered significant at p ≤0.05. RESULTS: In the study group there were fewer respiratory complications (p 0.01), and a shorter length of hospitalization (p=0.03). Body weight in the study group did not change significantly, while in the control group it decreased (0.15±3.7 kg versus loss of 3.47±3.6 kg). Results of six-minute walk test and hand grip dynamometry were higher in the study group then in the control group (411.8±56.0 m versus 383.2±52.1 m; 33.5±8.4 kg versus 27.1±6.8 kg). Quality of life was better in the study group, p 0.05. The total protein and albumin levels were higher in the study group (70.9±5.6 g/l versus 63.1±4.0 g/l; 38.5±5.8 g/l versus 33.2±3.0 g/l). One patient in study group experienced 1st grade diarrhea. CONCLUSION: In patients with NSCLC at risk of malnutrition perioperative nutritional support with high protein oral nutritional support has a positive effect on surgical treatment outcomes.

Assessment of Surgical Treatment and Outcome of Chronic Subdural Hematoma at University of Gondar Comprehensive Specialized Hospital, a one Year Prospective Study

IntroductionChronic subdural hematomas are a relatively common condition defined as an abnormal collection of blood and its break down products in the subdural space, usually accompanied by a history of preceding mild head trauma. Surgical management remains the mainstay of treatment. The objective of this study was to assess the surgical treatment outcome of patients operated on for chronic subdural hematoma at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. This comprehensive novel study serves as a benchmark for assessing therapeutic outcomes among patients with chronic subdural hematoma in the context of Ethiopia. MethodInstitution-based prospective observational study was conducted among patients operated on for symptomatic chronic subdural hematoma at University of Gondar Comprehensive Specialized Hospital from January 1, 2023, to December 31, 2023 G.C. ResultA total of 107 patients (70 males (65.4%) and 37 females (34.6%) with a male to female ration of 1.9:1 and mean age of 62.4 and a standard deviation of 13.7 (range from 23 to 92) were studied. 51 (47.7%) of the patients had a history of antecedent trauma. In terms of clinical symptoms, 86 (80.4%) patients had weakness as the chief complaint, followed by headache in 81 (75.7%). Among complications, recurrence is the most common, which was seen in 16 (15%) patients, followed by altered mental status (confusion, delirium) in 18 (16.8%) patients. The mean duration of the hospital stay was 6 days, with a standard deviation of 4 days. The majority of the patients had a good recovery with the resumption of normal life: 92 (86%), 10 (9.3%) patients had moderate disability, were disabled but independent, 2 (1.8%) patients had severe disability, were dependent on daily support, and 3 (2.8%) patients died. ConclusionChronic subdural hematomas are a relatively common condition characterized by an abnormal collection of blood. Antecedent trauma is the usual risk factor. Complication can happen following surgical intervention; however, patients with chronic subdural hematoma generally have a good prognosis.

Comparative Assessment of Surgical Treatment Results of Patients with Early-Stage Avascular Necrosis of the Femoral Head

Background. The observed sharp increase in patients with avascular necrosis of the femoral head (ANFH) associated with a new COVID-19 infection determines the need to find some new effective strategies for surgical treatment to achieve long-term positive results.
 Aim of the study is to make a comparative assessment of surgical treatment results of patients with early-stage avascular necrosis of the femoral head using different techniques of core decompression and autogenous bone grafting of the femoral head.
 Methods. We performed a comparative analysis of the treatment results of patients with early stages of ANFH. The patients were divided by the treatment method into two groups: control and main. Surgical treatment in the control group (n = 19) consisted of an open decompression and autogenous bone grafting of the femoral head using the Rosenwasser’s “light bulb” technique. The main group (n = 17) included the patients who had undergone the developed combined impaction autografting of the femoral head. Clinical and functional assessment of the treatment results was performed using the Harris Hip Score (HHS) questionnaire and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score. Assessment was performed preoperatively and at 3, 6, and 12 months postoperatively.
 Results. The performed comparative analysis showed statistically significant difference in clinical and functional results after operative treatment in patients of the control and the main groups at all follow-ups. Change of the HHS values presented as Me (Q1;Q3) in patients of both groups at 3, 6 and 12 months was 77.0 (68.0;84.0) and 82.0 (75.0;91.0), p = 0.001; 79.0 (69.0;85.0) and 88.0 (79.0;95.0), p0.001; 81.0 (71.0;86.0) and 90.0 (85.0;92.0), p0.001, respectively. According to the WOMAC, the following dynamics was revealed for the same values: 30.0 (25.0;35.0) and 25.0 (21.0;32.0), p = 0.002; 27.0 (22.0;33.0) and 20.0 (17.0;27.0), p0.001; 24.0 (17.0;30.0) and 15.0 (13.0;24.0), p0.001.
 Conclusion. Comparative assessment of efficacy of the open core decompression with autogenous bone grafting of the femoral head defect using the light bulb technique and closed intralesional resection of necrosis focus with combined impaction grafting of the femoral head showed that the minimal damage to para- and intraarticular tissues when performing the approach to the area of the pathological focus and the main stages of the operation allows to achieve the best clinical and functional results and create optimal conditions for bone remodeling in the grafting area.

Abstract 4160: V7 targeted liposomes detect pancreatic adenocarcinoma via multispectral optoacoustic tomography

Abstract Purpose: Pancreatic ductal adenocarcinoma (PDA) remains one of the most aggressive malignancies with a 5-year survival rate of 9-10%. Insufficient early detection coupled with limitations in operating surgery renders PDA as one of the most challenging tumors to treat. Accurate localization of tumor margins can tremendously improve surgical treatment outcomes in patients. Recently, nanotechnology has emerged as a promising platform for theranostic applications in the field of drug discovery, although the clinical success is limited by their tumor-specific uptake. Hypoxia due to aberrant vascularization is a hallmark of PDA and can be exploited for active targeting. pH-low insertion peptide variant 7 (V7) is used as hypoxia and acidosis-dependent biomarker for selective targeting of pancreatic cancer tissue. This work is focused on using IR 780 contrast agent loaded, V7 peptide conjugated liposomes for the active targeting of PDA towards enhanced surgical outcomes. Methods: Liposomes encapsulating IR780 dye were prepared using thin film hydration technique. V7 peptide was conjugated to liposomes using an SMCC linker and liposomes were characterized for their size, polydispersity and surface potential. In-vitro uptake of IR780-V7-liposome by S2VP10 at pH 7.4, 6.8, and 6.6 was evaluated through NIR fluorescence imaging using an Odyssey Infrared System. Athymic mice were orthotopically implanted with S2VP10 cells. After tumors were 3 mm, V7-liposomes and untargeted liposomes (0.01 OD) were intravenously injected and biodistribution and tumor specific uptake was accessed using multispectral optoacoustic imaging (MSOT). Results: Dynamic light scattering (DLS) revealed the size of liposomes to be 109 nm with a polydispersity index of 0.198 and zeta potential of +35.8 mV. Surface conjugation of V7 peptide was confirmed using the zeta potential measurement. NIR fluorescence imaging in S2VP10 cells established enhanced tumor specific uptake of V7 conjugated liposomes than passively targeted liposomes (p<0.05). Biodistribution of V7-liposomes demonstrated tumor specific accumulation (PDAC tumor 23.7 a.u, liver 3.6 a.u., and kidney 1.1 a.u.) while untargeted liposomes had the greatest uptake in liver (PDAC tumor 2.1 a.u., liver 6.3 a.u., and kidney 0.7 a.u.) p<0.05. Conclusion: pH-specific actively targeted liposomes can be used to specifically target PDA with minimal off-target binding effects. V7-IR780-liposome formulation can be used to efficiently deliver contrast agent for imaging tumor margins and to expand the potential of MSOT towards clinical applications. Citation Format: Happy Agarwal, Phillip Chuong, William E. Grizzle, Barish H. Edil, Ajay Jain, Lacey R. McNally. V7 targeted liposomes detect pancreatic adenocarcinoma via multispectral optoacoustic tomography [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4160.

Comparative Assessment of Surgical Treatment Outcomes in Patients with Sacroiliac Joint Injury

stract The aim of the study is to evaluate the results of surgical treatment in patients with sacroiliac joint injury. Methods. An analysis of the results of surgical treatment of 60 patients with sacroiliac joint injury was conducted at the Center of polytrauma and orthopedic surgery of the State Public Healthcare Institution “Emergency Hospital” in Abai Region, the Trauma and Endoprosthetics Department of the State Public Healthcare Institution “Multispecialty City Hospital No. 1” in the city of Astana, and the “Shymkent City Clinical Hospital No. 1” from June 2019 to August 2022. Patients were divided into two groups. Patients in the control group underwent surgery using the standard technique, while patients in the experimental group underwent surgery using a device developed by us for minimally invasive locking osteosynthesis of sacroiliac joint injuries. The study was a randomized controlled trial by design. Results. The use of the device for minimally invasive locking osteosynthesis of sacroiliac joint injuries leads to a significant reduction in the length of hospitalization for all types of sacroiliac joint injuries regardless of the patient’s initial condition (p=0.001). Correlation analysis revealed a correlation between the observation group and patient pain assessment at 12 months (p=0.001). According to the Majeed Pelvic Score at 12 months, the maximum score in the experimental group was 98 points, while in the control group, it was 70 points. A satisfactory assessment on the Majeed Pelvic Score at 12 months was observed in 3 (10%) of patients in the control group and none in the experimental group. There were no unsatisfactory responses in both groups (significant differences were found, p=0.001). Conclusions. The use of the device developed by us for minimally invasive locking osteosynthesis of sacroiliac joint injuries reduces the length of hospitalization and the time to return to work (12 months in the control group and 8 months in the experimental group). The absence of pain in patients after 12 months in the experimental group was 26 (86.7%) and 20 (66.6%) in the control group. According to the Majeed Pelvic Score in the long term (3, 6, and 12 months), the frequency of excellent results increases from 13.3% to 90.0% in the experimental group and from 10% to 73.4% in the control group.

Surgical Treatment Outcomes of Patients with Non-Small Cell Lung Cancer and Lymph Node Metastases

This study aimed to investigate the appropriate subgroups for surgery and adjuvant chemotherapy in patients with non-small-cell lung cancer (NSCLC) and nodal metastases. We retrospectively reviewed 210 patients with NSCLC and nodal metastases who underwent surgery and examined the risk factors for poor overall survival (OS) and recurrence-free probability (RFP) using multivariate Cox proportional hazards analysis. Pathological N1 and N2 were observed in 114 (52.4%) and 96 (47.6%) patients, respectively. A single positive node was identified in 102 patients (48.6%), and multiple nodes were identified in 108 (51.4%). Multivariate analysis revealed that vital capacity < 80% (hazard ratio [HR]: 2.678, 95% confidence interval [CI]: 1.483–4.837), radiological usual interstitial pneumonia pattern (HR: 2.321, 95% CI: 1.506–3.576), tumor size > 4.0 cm (HR: 1.534, 95% CI: 1.035–2.133), and multiple-node metastases (HR: 2.283, 95% CI: 1.517–3.955) were significant independent risk factors for poor OS. Tumor size > 4.0 cm (HR: 1.780, 95% CI: 1.237–2.562), lymphatic permeation (HR: 1.525, 95% CI: 1.053–2.207), and multiple lymph node metastases (HR: 2.858, 95% CI: 1.933–4.226) were significant independent risk factors for recurrence. In patients with squamous cell carcinoma (n = 93), there were no significant differences in OS or RFP between those who received platinum-based adjuvant chemotherapy (n = 25) and those who did not (n = 68), at p = 0.690 and p = 0.292, respectively. Multiple-node metastases were independent predictors of poor OS and recurrence. Patients with NSCLC and single-node metastases should be considered for surgery despite N2 disease. Additional treatment with platinum-based adjuvant chemotherapy may be expected, especially in patients with squamous cell carcinoma.

Anatomical and functional results of surgical treatment of familial exudative vitreoretinopathy in children

Familial exudative vitreoretinopathy (FEVR) is a rare hereditary disease characterized by abnormal angiogenesis, presence of avascular zones on the periphery of the retina, and clinical manifestations ranging from an asymptomatic course to total retinal detachment. Surgical interventions are performed to eliminate vitreoretinal traction, epiretinal membranes, and retinal detachment. Studies of the surgical treatment outcomes of patients with FEVR are limited and findings are ambiguous
 AIM: To analyze surgical treatment outcomes of different stages of FEVR in childhood.
 MATERIAL AND METHODS: From January 2012 to October 2021 at the Helmholtz National Medical Research Center of Eye Diseases, surgical treatment was performed in 35 eyes of 33 patients aged 11 months15 years (average, 7 years). The effectiveness of treatment was evaluated 12 months after the treatment, and patients were examined every 36 months for 15 years (average 2 years).
 RESULTS: Аfter the primary surgery, a decrease in retinal traction in the posterior pole and periphery was achieved in all cases. Complete and incomplete reattachment was achieved in 30% and 70% of the eyes at stage 3 and in 12.5% and 87.5% of the eyes at stage 4, respectively. The long-term effectiveness rates of the intervention in stages 2, 3 (including complete and incomplete reattachment), and 4 were 100%, 87.5%, and 73.3%, respectively.
 Increases in the best-corrected visual acuity (BCVA) were observed in 83%, 50%, and 28.6% of the eyes in stages 2, 3, and 4, respectively. In other cases, successful surgical treatment allowed the preservation of visual functions. During the follow-up, visual acuity of 0.1 or more was maintained in 100%, 85.7%, and 36% of the eyes at stages 2, 3, and 4 of FEVR, respectively.
 CONCLUSION: Аnatomical and functional results of surgical treatment of FEVR correlate with the disease stage: the efficiency is greater in stage 2, and it was organ-preserving surgery in stage 5. To increase the effectiveness of treatment, early diagnosis of FEVR, laser coagulation of avascular zones, and active vessels are necessary, which makes it possible to stop the progression of the early stages of FEVR in 70%100% of cases and enables regular monitoring of patients for the timely detection of indications for additional laser coagulation or surgical intervention.

Own experience of surgical treatment for advanced cancer of the tongue and the mouth floor

Purpose of the study. Improvement of surgical treatment outcomes in patients with advanced cancer of the tongue and the mouth floor providing radical surgery with preservation of the organ functions.Materials and methods. Two patients with advanced cancer of the tongue and the mouth floor with metastases to lymph nodes in the neck (St.4 (IVA, рT4a N2b M0), clinical group 2, were operated on according to our special technique. The surgery was performed under endotracheal anesthesia. After cervical lymph node dissection, the tongue and the mouth floor tissues were resected intraorally. The incisions were made through their entire thickness along healthy tissues. Smears were taken from the dissected tissues for intraoperative pathology consultation control for the presence of cancer cells. The tissues of the mouth floor affected by the tumor were completely removed without going beyond the hyoglossus muscle, since the lingual and hypoglossal nerves go along its outer surface. This allowed radical tumor removal with preservation of the tongue functions.Results. Patients operated on according to our special technique have been observed for more than 9 months without continued tumor growth and recurrences tumor with preservation of the tongue and the mouth floor functions.Conclusion. In such patients, ablastics principles are combined with the preservation of the tongue functions. This can be achieved because after removal of the tongue tumor, resection of the mouth floor is performed without going beyond the hyoglossus muscle not affected by the tumor, since the lingual and hypoglossal nerves go along its outer surface. Complying with ablastics, it preserves the tongue functions: chewing, swallowing, articulate speech, taste perception.

Pulmonary Hamartomas: A Single-Center Analysis of 59 Cases.

This study investigated the clinical, radiological, and surgical treatment results of patients who underwent surgical treatment for pulmonary hamartomas. Fifty-nine consecutive patients who underwent surgical treatment for pulmonary hamartomas in our clinic between January 2001 and February 2021 were analyzed retrospectively. Forty-three out of 59 (72.9%) of the cases were male and 16 (27.1%) were female. The average age was 52.0 ± 15.0 (between 5 years and 80 years). While pulmonary hamartoma was in the form of a solitary pulmonary nodule in 55 (93.2%) of the cases, there were multiple lesions in 4 (6.8%) cases. Simultaneous gastric adenocarcinoma was detected in 1 patient. One case had been operated on for Wilms tumor. Twenty-two (37.3%) of the cases were asymptomatic and were detected incidentally. Locations of pulmonary hamartomas were 18 (29.0%) in the left lower lobe, 16 (25.8%) in the right upper lobe, 12 (19.4%) in the right lower lobe, 9 (14.5%) in the left upper lobe, and 7 (11.3%) in the right middle lobe. The mean lesion diameter was 22.0 ± 9.5 mm (between 10 mm and 56 mm). Mild to moderate fluorodeoxyglucose (FDG) uptake was observed in 11 of 15 cases that were evaluated with positron emission tomography/computed tomography. Surgically, 44 (74.6%) patients underwent wedge resection, 13 (22.0%) patients underwent enucleation and two (3.4%) patients underwent lobectomy. Perioperative morbidity and mortality were not observed in any of the cases. The cases were followed up for an average of 40.6 ± 38.7 months (between 1 month and 151 months). No recurrence was observed in any of the cases during follow-up. Pulmonary hamartomas are usually detected incidentally and as a solitary pulmonary nodule. Although radiological findings provide important information, a definitive diagnosis is usually made during surgery. Parenchyma-sparing surgery should be preferred in these cases whenever possible.

Reconstruction of postoperative defects using carbon nanostructured implants with intramedullary osteosynthesis after extremity long bone resection for primary and metastatic tumors

Background. Recent studies have shown that a combination of surgery with chemotherapy and radiotherapy can signifcantly improve survival in patients with primary and metastatic bone tumors. Reconstruction of bone defects after resection of long bones is critical for successful functional limb salvage. The choice of the reconstruction technique depends on the tumor location, tumor extension, presence of pathological fracture, and somatic status of the patient. Reconstruction of bone defects in cases with diaphyseal tumor location can pose a surgical challenge. For the reconstruction of diaphyseal bone defects, endoprostheses, alloimplants, and autologous bone grafts are used. To achieve stability of the affected segment of the limb, various options for osteosynthesis are used. Modern technological achievements provide the emergence of materials with characteristics close to those of human bone tissue, however, without the disadvantages inherent in allo- and autologous implants. The purpose of the study was to improve surgical treatment outcomes in patients with long tubular bone tumors. Material and Methods. For the reconstruction of postoperative long bone defects, we used carbon nanostructured implants (СNI) in combination with intramedullary osteosynthesis with a blocked pin. A total of 25 patients underwent surgery (including 9 patients with a pathological fracture), 24 of them had metastases. Results. There were no intraoperative and postoperative complications. All patients had a signifcant decrease in pain 1 month after surgery. At 3 months after surgery, functional outcomes were satisfactory. None of the patients had a local recurrence, instability of the operated limb segment, or a reaction of rejection of a carbon nanostructured implant. Conclusion. Reconstruction of postoperative defects with carbon nanostructured implants after resection of long tubular bones for metastatic cancer provides good functional results and satisfactory local control.

Calcaneus fractures: characteristics of radiological and clinical outcomes of surgery treatment

Background: Calcaneus fracture is one of the types of fractures that have a fairly frequent clinical frequency. Recently, there are many other values on X-rays and CT scans of the calcaneus used for diagnosis, evaluation, and prognostic in outcomess.This study aims to evaluate the imaging characteristics on radiographs and CT scans of calcaneus fractures and surgical treatment outcomes in patients with calcaneus fractures as well. Materials and Method: from October 2019 to June 2021, 32 patients with calcaneus fractures were diagnosed and underwent open and internal fixation surgery at Department of Orthopedic-Thoracic Trauma Surgery, Hue University of Medicine and Pharmacy Hospital. All calcanues were estimated for Boehler angle, Gissane angle, height, length, and calcasneus width, the results of treatment are evaluated on the scale of the American Orthopaedic Foot & Ankle Society (AOFAS). Results: There were 20 cases of left and 12 cases of right calcaneus. The average follow-up period is 03-06 months.The average AOFAS score at post-operative 3 and 6 months was 78.73 ± 11.86 (65-93) and 88.44 ± 4.98 (81-97), respectively. Boehler angle value preoperative 10.56 ± 9.410 increased post-operative 24.34 ± 9.360, p<0.001, Gissane angle pre-operative 93.580 (850 - 1000) increased post-operative 114.70 ± 5.230, p<0.001. The width of the pre-surgery heel bone is 65.4 (60-68) mm and post-operative 60.1 (58-63) mm. Pre-operative heel bone height was 37.1 (26-49) while post-surgery calcaneus height was 48.2 (41-58) p<0.05. Pre-operative calcaneus length was 83.2 (75-92) and post-operative calcaneus length was 82.7 (75-91) p>0.05. Conclusion: The findings of the study reveal that open reduction and internal fixation for calcaneal fractures has positive results in terms of imaging and ankle function for patients. Furthermore, the inclusion of extra characteristics on calcaneus X-rays and CT scans helps to improve treatment outcomes in calcaneal fracture surgery. Key words: calcaneus fractures, calcaneus fractures open reduction and internal fixation

Innovative technologies in the diagnosis and safe surgical treatment of thyroid diseases

This study clarified the results of using innovative technologies in the diagnosis and surgical treatment of patients with thyroid diseases by evaluating the role of modern diagnostic methods and effectiveness of minimally invasive thyroid surgery. The results of a comprehensive examination and treatment of 332 patients with thyroid diseases, who were examined using modern diagnostic methods and underwent conventional and various minimally invasive approaches, were analyzed. The sensitivity, specificity, accuracy, and positive and negative predictive values of multiparametric neck ultrasonography, 99mTc-MIBI thyroid scintigraphy, fine-needle cytology, and molecular testing of thyroid nodules were compared. The minimally invasive procedure was performed in 70.4% of the patients. Postoperative complications were found in 4.9% of the patients who underwent surgery, functional dysphonia in 0.9%, and transitory hypoparathyroidism in 2.4%. The use of the main criteria that determine the choice of a rational minimally invasive surgery, such as the nodule size and thyroid volume, hyperfunctioning thyroid, clinical thyroiditis, substernal extension, extrathyroid extension, and necessity of implementation of central and lateral neck dissection due to lymph node metastases, avoids the conversion of access to the traditional approach, prevents damage to the recurrent laryngeal nerve with the development of transitory or permanent recurrent laryngeal nerve palsy, and minimizes injury to the parathyroid glands with the development of isolated cases of transient hypoparathyroidism. Therefore, results of the multiparametric analysis of the examination and surgical treatment outcomes of patients with thyroid diseases show the feasibility of using innovative technologies in their diagnosis and surgical treatment. Modern examination methods allow us to determine with great accuracy the morphological form of thyroid disease and choose a rational volume and surgical intervention. In this study, minimally invasive procedures are optimal and safe in the surgical treatment of this category of patients.

Surgical Treatment of Retrograde Type A Aortic Dissection After Thoracic Endovascular Aortic Repair.

Data are scarce regarding retrograde type A dissection (RTAD) after thoracic endovascular aortic repair (TEVAR). This study aimed to investigate the clinical characteristics and surgical treatment outcomes of patients who developed RTAD after TEVAR.From January 2015 to January 2020, 25 consecutive patients (aged 52 ± 11.69 years) of RTAD after TEVAR received open surgery. All patients received total arch replacement (TAR) with the frozen elephant trunk (FET). The proximal part of the TEVAR stent was removed using a wire scissor. The distal part of the TEVAR stent in the descending aorta was preserved. Data of 50 random patients of type A aortic dissection without prior TEVAR were collected during the same period. We compared the perioperative and midterm follow-up outcomes between patients with prior TEVAR and patients without prior TEVAR.The mean cardiopulmonary bypass time, aortic cross-clamp time, and deep hypothermic circulatory arrest time were 173.7 ± 44.1, 109.5 ± 31.4, and 21.6 ± 6.8 minutes in the RTAD group, respectively. These times are similar to those of the no-RTAD group. The median interval between the initial TEVAR procedure and RTAD was 8.5 months (range, 0-72 months). New entry tears that were induced by the proximal end of the TEVAR stent were found in 23 (92%) patients of the RTAD group. There were no significant differences in major adverse events and overall survival between the two groups.TAR with the FET technique was feasible for the treatment of RTAD after TEVAR, with acceptable early and midterm results.

Optimization of surgical approach for the treatment of gallstone disease complicated by obstructive jaundice

An elevated morbidity rate due to gallstone disease (GSD) is accompanied by a 35% increase in the frequency of complication occurrence. Surgical treatment of GSD complicated by obstructive jaundice (OJ) is an urgent problem due to a relatively high percentage of complications and lethal outcomes. To improve the surgical treatment outcomes of patients with GSD complicated by OJ by introducing a differentiated approach to the choice of surgical intervention tactics. The surgical treatment outcomes of 384 patients operated for cholelithiasis complicated by mechanical jaundice in the period from 2016 to 2020 were analysed in this work. The performed study demonstrates that minimally invasive interventions and their sequence in this category of patients should be defined based on the severity of OJ. Minimally invasive surgery positively affects LPO indices and significantly decreases MDA (1.2-fold in subgroups with mild and moderate OJ (p < 0.0001), 1.4-fold (p < 0.0001) - with severe OJ). Compared to conventional surgery, catalase activity increased 1.1-fold in the subgroups with mild to moderate OJ (p < 0.0001) and 1.3-fold in those with severe OJ (p < 0.0001). The illness severity-differentiated surgical approach for GSD complicated by OJ allows the optimal minimally invasive surgical intervention to be chosen in patients with this pathology.

Adenoid and Tonsil Hypertrophy in Zaria, North Western Nigeria: Review of Clinical Presentation and Surgical Outcome.

Background:Adenotonsillar hypertrophy is one of the most common childhood disorder that necessitates presentation to the ear nose and throat specialist. The disorder may be managed conservatively or by surgery.Aim:To highlight the clinical presentation and surgical treatment outcome of patients managed for adenoid and tonsillar hypertrophy at Ahmadu Bello University Teaching Hospital Zaria, Nigeria.Materials and Methods:The case records of patients managed for adenoid and tonsil hypertrophy were reviewed from January 2013 to December 2017 at the Division of Otorhinolaryngology, Department of Surgery Ahmadu Bello University Teaching hospital Zaria, - Northwestern Nigeria. Case notes with incomplete information and /or missing pages were excluded. The data were analyzed using IBM SPSS (for windows, version 23)Results:There were 56 (55.4%) males and 45 (44.6%) females with male to female ratio of 1.2:1. Their ages ranged from 2–16 years with a mean and standard deviation of 4.0 and 3.2 respectively. The most common symptom at presentation was snoring 85 (84.2%) followed by rhinorrhea 81(80.2%). Findings from the radiologic investigations revealed that majority of the patients had severely narrowed nasopharyngeal air column 83(82,2%) Adenotonsillectomy was the most common surgery performed on most of the patients 63(62.4%) who presented with adenotonsillar hypertrophy. Majority of the patients 95(94.1%) had resolution of symptoms within the period of follow up. Four (4.0%) of them had recurrent adenoidal growth.Conclusion:Snoring, rhinorrhea and mouth breathing were the most common symptoms of adenotonsillar hypertrophy. The outcome of adenotonsillar surgeries in our patients is good, with the majority having resolution of symptoms.

Improvement of surgical methods for the treatment of spontaneous rupture of the esophagus ­complicated by purulent mediastinitis

Aim. To improve surgical treatment outcomes of patients with spontaneous rupture of the esophagus complicated by purulent mediastinitis.&#x0D; Methods. Over the past 30 years, we have experience in the surgical treatment of 31 patients with spontaneous rupture of the esophagus complicated by purulent mediastinitis. Depending on the tactics and techniques of surgical treatment, we identified two groups of patients. The first group (n=8) consisted of patients operated with conventional techniques: thoracotomy, transpleural mediastinotomy according to Dobromyslov, suturing of the esophagus with drainage of the mediastinum and pleural cavities, blind mediastinal drainage. The second group (n=23) consisted of patients treated with programmed re-thoracotomy. Re-thoracotomy was performed along with the postoperative thoracotomy wounds. The delimited foci of purulent mediastinitis were opened and sanitized (necrotic tissues were excised and removed). Preventive hemostatic methods were used in the area of pressure ulcers from drainage tubes. Replacing and changing the position of the drainage tubes in the mediastinum was a strictly compulsory technique. Pus and necrotic soft tissue that appeared in the thoracotomy wound were subsequently eliminated by a device consisting of two titanium brackets connected by a lock embodied in the form of an oval ring during the wound suturing at the stage of programmed re-thoracotomy. The groups were comparable in age and comorbidities. The average diagnosis of spontaneous esophageal rupture took 3.5 days; the maximum time is 10 days. The statistical significance of differences in immune status indicators was assessed by using the Student's t-test and Pearson's 2 test.&#x0D; Results. A systematic approach using the tactical and technical surgical techniques developed by us (such as suturing esophageal wall defects regardless of the rupture time, multifunctional nasoesophagogastric tube installation; the imposition of a purse string suture to prevent reflux from the stomach into the esophagus; programmed re-thoracotomy using the method of temporary fixation of the ribs) allowed to reduce the number of complications, such as haemorrhage from the mediastinal vessels, by 3 times, sepsis 1.5 times, mortality almost 2 times.&#x0D; Conclusion. The introduction of patented techniques allowed to reduce the number of life-threatening complications and mortality in patients with spontaneous rupture of the esophagus complicated by purulent mediastinitis.

Unconventional Technique of Terminolateral Pancreatojejunostomy &#x0D; Formation

Backgraund. Pancreatoduodenal resection (PDR) is the only radical treatment for malignant tumors of the periampullary zone. The development of postoperative pancreatic fistula (POPF) is the most common complication of PDR. The main risk factors for the development of POPF are the narrow main pancreatic duct and the soft, "juicy" pancreatic parenchyma. Thus, it is the stage of formation of a pancretodigestive anastomosis that is of decisive importance for the course of the postoperative period.The aim of the study was to improve immediate surgical treatment outcomes of patients suffering from oncological diseases of the periampullary zone with a soft pancreas and a narrow pancreatic duct.Methods. A novel method to form terminolateral reservoir invagination pancreatojejunostomy has been developed and introduced into clinical practice. The results of treatment of 94 patients with tumors of the periampullary zone were analyzed. Based on preoperative radiological diagnosis and intraoperative findings, such factors of a high risk of POPF development as a soft pancreas and a narrow major pancreatic duct ( 3 mm) were detected in 23 patients (24.4%). In 11 patients who were treated in 2018-2019, a novel method of pancreato-jejunoanastomosis formation was applied. The comparison group consisted of 12 patients who received treatment in 2014-2017; a differentiated approach to the formation of a pancreatodigestive anastomosis was not applied.Results. In patients of the main group, there was a tendency to an increase in the proportion of pylorus-saving PDRs. The only statistically significant difference was the use of reservoir terminolateral pancreatojejunostomy at the reconstructive stage of surgery. Complicated postoperative course was observed in 7 (63.6%) patients of the main group and in all patients of the comparison group (p 0.05). There was also a decrease in the incidence of postoperative pancreatic fistulas from 66.6 to 18.2% (p 0.05) in the study group. Repeated surgery was required in 3 (27.2%) patients of the main group and 7 (58.3%) patients in the comparison group (p 0.05). The lethal outcome was recorded in 2 (18.2%) patients of the main group and in 3 (25%) in the comparison group (p 0.05).Conclusion. A soft, loose pancreas and a narrow main pancreatic duct are the most significant risk factors for complications in the postoperative period. Management of this condition requires a differentiated approach to the treatment option of pancreatodigestive anastomosis formation, depending on the characteristics of the pancreas of an individual patient. The proposed technique for the reservoir terminolateral pancreatojejunoanastomosis formation allowed statistically significantly reducing the incidence of complications from 100 to 63.6% and the incidence of postoperative pancreatic fistulas from 66.6 to 18.2% in high-risk patients..

Results of treatment of acromioclavicular joint injuries

Introduction. Acromioclavicular joint has an important role in the shoulder function. Loss of joint function due to injury or disease affects the biomechanics of the shoulder. The aim of this study was to evaluate the results of surgical treatment of acromioclavicular joint injuries, identify risk groups within the age groups, and to indicate the most common mechanisms of injury. Material and Methods. A retrospective study included 20 patients with acromioclavicular injury. We analyzed the results of surgical treatment in patients with acromioclavicular injury from January 2017 to January 2019. Patients were treated using Bosworth and Phemister surgical techniques. The Constant shoulder score was used to assess the results of surgeries. We compared the results of the operated and non-operated shoulders in each patient. Statistical analysis was performed using Student?s T-test and ?? test. Results. Functional assessment was done using the Constant shoulder score: 9 patients had excellent results, 7 had good results and 3 had satisfactory results; there were no patients with poor outcome. We compared the total Constant shoulder score of the operated shoulder with the results of the opposite healthy shoulder, as well as the range of motion of external rotation, and internal rotation range of motion of the operated and the opposite healthy shoulder. There was a statistically significant difference (p &lt; 0.05) in all compared parameters. The total Constant shoulder score of the operated shoulder was by 14% lower in relation to the healthy shoulder. Conclusion. The basic precondition for positive treatment results is timely diagnosis and early surgical intervention. Shoulder function was surgically restored and 95% of patients can perform all activities of daily living.

M37 Comprehensive Analysis of Surgical Treatment Outcomes in Patients With Secondary Spontaneous Pneumothorax

This study aimed to analysis the outcomes of surgical treatment in patients with secondary spontaneous pneumothorax (SSP) and evaluate the risk factors of recurrence and morbidity.

Multiglandular Parathyroid Disease: the Results of Surgical Treatment

Background. Sporadic multiple gland disease in primary hyperparathyroidism occurs in 7 to 33 % of cases. The absence of specific risk factors, low sensitivity of imaging methods, and low efficiency of bilateral neck exploration and intraoperative monitoring of parathyroid hormone indicate the complexity of the diagnosis and treatment of this disease’s form. Aim of the research. To analyze the results of surgical treatment of multiple lesions of the parathyroid gland in primary and secondary hyperparathyroidism. Methods. There was retrospective study, which included 100 observations of surgical treatment for primary and secondary hyperparathyroidism in the thoracic department of Irkutsk Regional Clinical Hospital from May 2018 to September 2019. The main point was to identify the frequency of surgical treatment outcomes in patients with multiple parathyroid lesions. As part of the study, potential predictors of multiple gland disease in primary hyperparathyroidism were analyzed. Results. Multiple gland disease in primary hyperparathyroidism occurs in 29 % of cases and causes persistence of the disease (p ≤ 0.01). Signs of multiple gland disease in primary hyperparathyroidism include the level of ionized calcium, parathyroid hormone (p ≤ 0.05), creatinine level and glomerular filtration rate (p ≤ 0.01). A negative result of intraoperative monitoring correlates with persistence of primary hyperparathyroidism in multiple lesions (χ2, p ≤ 0.05). Selective parathyroidectomy is associated with persistence of hyperparathyroidism in multiple lesions (χ2, p ≤ 0.05), while total parathyroidectomy is associated with remission of the disease (χ2, p ≤ 0.05). We did not find a statistically significant relationship between the results of surgical treatment for morphology of the parathyroid glands (χ2, p &gt; 0.1). Conclusion. Multiple gland disease is the main cause of persistence of primary hyperparathyroidism. This form of the disease corresponds to lower levels of calcium, parathyroid hormone, and kidney function. Persistence factors have been established: removal of less than four parathyroid glands and a negative result of intraoperative monitoring of parathyroid hormone. Bilateral neck exploration does not reduce the incidence of disease persistence.