Tactics Of Surgical Treatment Research Articles

Improvement of surgical tactics in acute destructive cholecystitis

Abstract. Relevance. According to the World Health Organization, in the world due to the increase in the incidence of cholelithiasis, there is an increase in the number of patients with destructive forms of this pathology. The aim of the study is to improve the quality of treatment of patients with acute destructive cholecystitis by improving surgical tactics. Materials and research methods. The work is based on the assessment of the results of surgical treatment of patients with acute destructive cholecystitis who were treated in the surgical departments of the 1st clinic of the Samarkand State Medical Institute (clinical base of the departments of surgical diseases No. 1 and general surgery of the Samarkand State Medical Institute) for the period from 2016 to 2020. Conclusions. The tactics of surgical treatment of patients with destructive cholecystitis, taking into account an integrated approach to the choice of access, made it possible to improve the quality of care by reducing the frequency of immediate postoperative complications from 13.4% (11 patients in the comparison group) to 1.7% (2 patients in the main group).

Methods of Surgical Treatment of Combined Stenosis of the Carotid and Coronary Arteries. Systematic Review

Aim of study. To determine the optimal tactics of surgical treatment of patients with combined stenosis of the carotid and coronary arteries by comparing the results of the simultaneous and staged approach according to the literature.Material and methods. A systematic literature search was performed in the PubMed and MEDLINE databases to compare the results of simultaneous and staged interventions for combined stenosis of the carotid and coronary arteries. The following keywords were used as a search query: (“combined coronary and carotid artery stenosis and simultaneous”), (“combined coronary and carotid artery stenosis and staged”), (“combined coronary and carotid artery stenosis and cost”). We compared the results of simultaneous (interventions on the vessels of both systems are performed simultaneously) and staged operations (interventions are performed alternately, with a time interval from 2 to 160 days). References from included studies were also manually reviewed. The search was conducted by two independent experts (S.L., S.N.), and any disagreement was resolved by the clinical expert (A.A.).Results. A literature search identified 198 potentially relevant studies. A total of 13 studies met the inclusion criteria, of which 5 included two interventions. This systematic analysis includes the results of treatment of 43,758 patients with combined stenosis of the carotid and coronary arteries, who underwent staged or simultaneous revascularization of the vessels of the carotid and coronary flow. Perioperative neurological complications in the group of staged operations were observed somewhat more often than in the group of simultaneous interventions (3.2% versus 4.22%; p=0.8), myocardial infarction was observed with a frequency of 1.5% in the group of simultaneous interventions, and 2.5% (p=0.5) in the group of staged interventions. The mortality rate after simultaneous and staged interventions was 3.9% and 3.6%, respectively, with a fairly high spread in the study groups (p=0.5). Data analysis showed that simultaneous interventions did not affect the incidence of neurological, cardiac complications, and deaths (OR (odds ratio) 1.02; 95% CI (confidence interval) — 0.98–1.14, p = 0, 69; OR — 1.26; 95% CI — 0.66-2.41; p=0.48; and OR — 0.97; 95% CI — 0.67-1.38; p=0.85 — respectively).Conclusion. 1. The cumulative incidence of neurological and cardiac complications and mortality in staged tactics, according to observational studies included in this systematic review, is 4.2%; 2.6% and 3.6%, respectively (p>0.05). 2. The cumulative incidence of neurological and cardiac complications and mortality with simultaneous tactics according to observational studies included in this systematic review is 3.3%; 1.5% and 3.9%, respectively (p>0.05). 3. Given the relatively low risk of developing myocardial infarction (OR — 1.26; 95% CI — 0.66–2.41; I2 — 94%), the low risk of developing neurological complications (OR 1.02; 95% CI — 0,98–1.14; I2=75%), and deaths (OR — 0.97; 95% CI — 0.67–1.38; I2 — 76%) — (p>0.05), with simultaneous interventions, it can be concluded that simultaneous interventions may be the method of choice for surgical treatment for combined stenosis of the carotid and coronary arteries.

Prognostic value of the Tokuhashi scale when choosing a method of surgical treatment of metastatic lesions of the spine

Introduction. Metastatic spinal lesion remains one of the most difficult problems of modern medicine. The purpose of treatment of patients with metastatic spinal lesion is to reduce pain, improve the quality of life, restore stability in the affected segment, prevent or reduce neurological deficits. In order to build the right treatment tactics, it is necessary to evaluate the prognosis of the life of a patient with spinal metastases before treatment.The study objective is to evaluate the prognostic significance of the Tokuhashi scale in patients with metastatic spinal lesion.Materials and methods. The study included 124 patients with metastatic spinal lesion operated in the spinal department in the period from March 2013 to July 2019 (64 (52 %) men and 60 (48%) women). The average age was 59 years and ranged from 18 to 78 years. The catamnesis ranged from 1 month to 6 years. 6 (5 %) spinal tumors were radically removed, palliative removal was performed in 77 (62 %) cases. In the remaining cases, 41 (33 %) underwent vertebroplasty. The mandatory diagnostic protocol of the preoperative examination included oncological status, clinical and neurological examination. The functional status of the patient was assessed on the Karnofski scale, life expectancy – on the Tokuhashi scale. In terms of preoperative examination, patients underwent computed tomography examination with intravenous contrast of three zones: the thoracic, abdominal cavities and pelvic region to determine the degree of dissemination of the process and, in some cases, to identify the primary focus. Currently, positron emission tomography is the optimal method of investigation at the preoperative stage. However, this method is not yet available in all clinics, so performing computed tomography scans of three zones is currently the optimal “gold standard” for examining this category of patients..Results. The life expectancy estimate was calculated for each patient according to the Tokuhashi scale (2005). Survival analysis was performed using Kaplan-Meier curves within the Tokuhashi prognostic groups. The median survival within the Tokuhashi groups was more than 3 years for the group of 12–15 points (life expectancy over a year), 14 months for the group of 9–11 points (life expectancy 6 to 12 months) and 7 months for the group of 1–8 points (life expectancy less than 6 months). The Cox model was used to identify factors related to survival.Conclusion. Determining the tactics of surgical treatment of a patient with a metastatic lesion of the spine is a complex and multicomponent question to which there is no unambiguous answer. A multidisciplinary consultation is currently the most adequate and reliable way to determine the treatment strategy for this category of patients. The use of the Tokuhashi prognostic scale is an additional effective tool for determining the life expectancy of patients with spinal metastases, and thus, in some cases, serve as the tool with which it is possible to determine the tactics of surgical treatment of patients.

Endosurgery in the treatment of children with liver tumors

Introduction. The basic technique for treating patients with liver neoplasms is a surgical one. Currently, there is a trend to decrease a traumatic impact. One of the options for this is to develop and to implement minimally invasive surgical techniques which make postoperative period and rehabilitation easier.Purpose. To find out the most optimal tactics for surgical treatment of children with liver tumors.Material and methods. In 2014-2020, 26 patients, aged 0-17 years, with liver tumors were treated in Morozov Children’s City Clinical Hospital. 16 boys (61.5%) and 10 girls (38.5%). 17 patients with hepatoblastomas (68%); 2 (8%) in twos - hepatocellular cancer, embryonic liver sarcomas and focal nodular hyperplasias; 1 (4%) by ones - adenoma and hamartomas. In the morphological picture, hepatoplastoma was the most common (16 patients). 25 liver resections were performed; in 5 out of them (20%) (patients aged 3-9 years) minimally invasive technologies were used.Results. Surgical time was significantly shorter in patients who were operated on with laparoscopic access (30–60 minutes), if to compare with laparotomic access (180-270 minutes). The volume of intraoperative blood loss in laparotomic access is more than 5 times larger than in laparoscopic access. In the group of patients operated on with the open access, intraoperative complications were noted in 2 (8%) cases: lethal outcome (4%) and injury of the extrahepatic biliary tract (4%).Conclusion. Laparoscopic techniques reduce surgical time and blood loss. They also prevent complications both during surgery and in the postoperative period, shorten the hospital stay and promote early patient’s mobilization and early enteral feedings as well as early chemotherapy; they reduce pharmpreparation loading and prepare conditions for radical surgery

Comparative evaluation of the informative value of methods for determining the volume of intraoperative blood loss in the surgical treatment of burn victims

The OBJECTIVE was to evaluate the informative value of various methods for determining the volume of blood loss during early surgical excision with simultaneous skin grafting with split grafts in patients with full thickness burns.MATERIAL AND METHODS. Our study included 10 patients with burns more than 20 % TBSA. In these patients, from the 2nd to the 5th day after the burn, fascial surgical excision with simultaneous skin grafting with perforated split grafts was performed. To assess the volume of operative blood loss, we used visual, empirical (B. S. Vikhriev; 1986, I. V. Chmyrev; 2011, T. A. Housinger; 1993, T. Janezic; 1997) and calculated (J. B. Gross; 1983, P. G. Budny; 1993, G. D. Warden; 1982) methods. The obtained data were processed by the generally accepted methods of nonparametric statistics.RESULTS. The minimum volume of blood loss was ascertained by visual assessment. We observed the maximum losses in the same patients when using calculated methods. In 5 out of 10 patients, the difference between the minimum and maximum results obtained using different methods exceeded 1000 %.CONCLUSION. Most of the methods used in burn surgery for determining the volume of surgical blood loss are insufficiently representative. To determine the optimal tactics for surgical treatment of patients with severe burns, it is necessary to create formulas for assessing the volume of blood loss, which will take into account laboratory parameters, features of surgical treatment, hydrobalance indicators, anthropometric data and other variables with high predictive value.

Paralytic stenosis of the larynx

The aim of the study was to evaluate the effectiveness of various types of surgical treatment of patients with bilateral paralytic stenosis of the larynx. Study involved 28 patients aged 18 to 75 years, suffering from paralytic stenosis of the larynx, who was treated at the ENT department of the multidisciplinary clinic of the Tashkent Medical Academy in the period from 2015 to 2020. The results of treatment with the use of laterofixation of the vocal fold, partial excision of the vocal fold in the posterior third and the vocal process of the arytenoid cartilage showed that after the above methods of surgical intervention, recurrence of stenosis occurs in 20-25% of cases, therefore it is necessary to develop tactics of surgical treatment and postoperative management of this category patients.

Diagnostic and the surgical treatment tactics in the rectal mucosa prolapse with the anal sphincter insufficiency

Objective. To improve the results of diagnosis and surgical treatment of rectal mucosa prolapse, complicated by the anal sphincter insufficiency.
 Materials and methods. Analysis of the diagnosis and surgical treatment results in the rectal mucosa prolapse with the anal sphincter insufficiency was done in 23 patients, ageing 31 - 65 yrs old and the age median (41.5 ± 1.8) yrs old, of them 17 women-patients.
 Results. There was revealed, that most frequently and in mostly progressive forms the rectal mucosa prolapse with the anal sphincter insufficiency occurs in women, aged more than 36 yrs old.
 Conclusion. Miniinvasive transanal operations, submucosal injection procedures and sphincteroplasty “end-to-end” were used predominantly, owing less morbidity potency (26.1%), favorable remote functional results - the recurrence rate lowering (4.3%), the fecal incontinence degree lowering (78.6%), and the patients’ quality of life improvement.

Опыт лечения синдрома диабетической стопы в клинике общей хирургии Военно-медицинской академии им. С.М. Кирова

We examined 180 patients with purulent-necrotic complications of diabetic foot syndrome, in whom the proposed diagnostic algorithm was used. Magnetic resonance imaging of the feet, ultrasound Doppler with duplex angioscanning, magnetic resonance and computed angiography of the lower extremities, as well as assessment of transcutaneous oxygen tension were performed. Surgical treatment tactics depended on the form of the diabetic foot syndrome, as well as the severity of the disease. As a local treatment, physical methods were used to accelerate the course of the wound process. The proposed diagnostic algorithm for the diagnosis and selection of surgical treatment for various forms of diabetic foot syndrome has made it possible to reduce the number of “high” amputations and maintain a supporting limb. Purpose of the study is to improve treatment outcomes for purulent-necrotic complications of diabetic foot syndrome by developing and applying a diagnostic algorithm and differentiated treatment tactics. The main group consisted of 180 patients with purulent-necrotic complications of diabetic foot syndrome, in whom the developed diagnostic algorithm and differentiated tactics of surgical treatment were used, as well as physical methods of influencing the wound process (ultrasonic cavitation and local ozonation) were used as local treatment. The control group included 40 patients with purulent-necrotic complications of diabetic foot syndrome, whose treatment involved the use of drugs that improve the rheological properties of blood and tissue microcirculation (rheopolyglucin, trental, actovegin) according to conventional schemes. Local treatment included sanitation and treatment of wound and ulcerative surfaces with antiseptic solutions and ointments, depending on the phase of the wound process. Data analysis in this group was carried out based on a retrospective study of case histories and an assessment of long-term results of treatment by follow-up examinations and telephone interviews. Control group included 25 (63%) men and 15 (37%) women; the average age was 67.3±10.3 years. The developed unified approaches in diagnosing and treating patients with purulent-necrotic complications of diabetic foot syndrome, who, in complex treatment, underwent staged necrectomy with simultaneous ultrasonic cavitation of purulent wounds and their ozonization, can reliably reduce the number of ulcer recurrences from 28% to 2.7%, high amputations by 34%, and the number of re-amputations ― 10 times. The use of minimally invasive surgical technologies for the rehabilitation of deep purulent foci of the foot, in comparison with the classical principles of treatment of purulent wounds, makes it possible to achieve a complete cleansing of wounds, preparation for plastic surgery, and an increase in the number of functional supportable lower limbs by 42.7%. According to the data obtained, it is optimal to perform sanitizing operations after revascularization of at least one artery no earlier than 3–4 days, which makes it possible to increase their efficiency and reduce the number of repeated surgical interventions. The approach to managing patients with diabetic foot syndrome at all stages of treatment and rehabilitation should be interdisciplinary and include the following specialists: endocrinologist, orthopedist, surgeon, psychologist, trained nursing staff.

Actual Aspects of Surgical Treatment of Dupuytren's Disease (Literature Review)

Relevance. The variety of manifestations of Dupuytren's disease, caused by the degree of lesions of the palmar aponeurosis, the duration of the disease, the nature of professional activity, and concomitant pathology of patients, has led to the development of numerous surgical techniques with different levels of effectiveness in the acute and long-term periods. A wide discussion of the issues of Dupuytren's disease in the domestic and foreign periodicals, the analysis of treatment methods, complications and rehabilitation indicate the urgency of the problem and the expediency of further research.
 Objective: a retrospective analysis of the leading literary sources devoted to the surgical treatment of Dupuytren's disease; the definition of modern approaches to surgical tactics and restoration of hand function.
 Results. The analysis of literature sources showed the advantages of differentiated approaches to the surgical treatment of Dupuytren's disease, depending on the severity of the disease. With mild and moderate lesions, there is a significant increase in needle aponeurectomy. In severe forms, the segmental aponeurectomy technique is preferred over the total one. There is some discrepancy in carrying out surgical mobilization of the proximal interphalangeal joint and the need to achieve a functional position as a result of treatment. The tactics of surgical treatment and rehabilitation of Dupuytren's disease requires an individual approach, taking into account the age and severity of the disease, and tends to spread minimally invasive fasciotomy techniques.

Tactics of Surgical Treatment of Wounded with Gunshot Injuries of the Upper Limb in Modern Conditions

Summary. Our study aimed to optimize the tactics of surgical treatment of wounded with gunshot wounds of the upper extremity by determining the factors influencing the outcome of treatment of servicemen in modern conditions of specialized and highly specialized medical care.
 Materials and Methods. Surgical treatment of 123 patients with gunshot wounds of the upper extremity who were treated at the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine” and the National Military Medical Clinical Center “Main Military Clinical Hospital” of the Ministry of Defense of Ukraine was analyzed. The mean age of patients was (35.3±8.7). At the level III of medical care, the largest share was occupied by wound closure (28.0%) and surgeries on the skeletal system (6.7%). At the level IV of medical care, the largest share was occupied by surgical procedures for closing unhealed wounds – 28%, due to the consequences of gunshot nerve injuries – 11.5%, fractures – 10.7%, and restorative interventions on muscles – 5.5%.
 Results. By calculating the odds ratio (Odds Ratio, OR), it was found that the presence of compartment syndrome reduces the probability of obtaining a positive result by 11 times (OR=11.3), and late treatment at the level IV of care reduces the effectiveness of treatment by 9 times (OR=9.1). In the group of patients with peripheral nerve damage, satisfactory results were 6.9 times less than in the group without such damage (OR=6.9); the presence of a tissue defect worsened the prognosis of treatment by almost 5 times (OR=4.7). The average time to start surgical treatment after a gunshot wound was 2.8±5.0 days at the level III and 47.2±70.4 days at the level IV. It was found that for patients admitted to the level IV facilities for up to 30 days, the percentage increase in upper extremity function was 42.6±11.8 after treatment and 28.5±10.0 at a later start of treatment.
 Conclusions. The results of the study of the factors influencing the outcome of treatment prove the need for early (up to 3 weeks) admission of wounded with gunshot wounds to the level IV of medical care.

Treatment of Chronic and Complicated Ruptures of the Rotator Cuff of the Shoulder

Relevance. The etiology of ruptures of the rotator cuff of the shoulder (RC) is represented by a variety of diseases, including age-related degeneration, low- and high-energy trauma. Most often, a rupture of the RC, combined with trauma, occurs with anterior dislocation of the shoulder – in 56% of patients. The “terrible triad” of the shoulder, which leads to a loss of function and disability in patients, is diagnosed in 9-18% of patients. RC ruptures of <1-1.5 cm throughout the entire thickness of the tendon have a high risk of progression and formation of a massive rupture of the RC. According to various authors, massive ruptures occur in 40% of all RC ruptures.
 Objective: to evaluate the results of surgical treatment of patients with old and complicated ruptures of the RC.
 Materials and Methods. From 2016 to 2021, in the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine”, Department of Microsurgery and Surgery of the Upper Limb, 140 patients with a ruptured RC were treated. The patients underwent: suture of the RC under arthroscopic control, open RC suture, transposition of the latissimus dorsi tendon into the RC defect, implantation of biodegradable InSpace balloon, or implantation of a biomatrix into the RC defect and reverse shoulder arthroplasty.
 Results. The function was assessed before surgery and in the long-term postoperative period using the Constant-Murley Score. In 5 patients with an implanted balloon, the score increased from 34-38 to 56-61 in 8-12 months. In 7 patients with reinforced biomatrix implantation, the score increased from 34-38 to 65-69 in 9-12 months. In 7 patients with transposition of the latissimus dorsi tendon, the score increased from 35-37 to 68-75 in 9-12 months. In 10 patients with reverse arthroplasty, the score increased from 30-34 to 58-65 in 12-18 months. In 82 patients, after the suture of the RC under arthroscopic control of the shoulder, the score increased from 36-40 to 78-82 in 12-18 months. In 29 patients with an open suture of the RC, the score increased from 34-38 to 68-75 in 12-18 months.
 Conclusions. Early diagnosis and timely surgical treatment for the pathology of the RC make it possible to obtain the best results in the long-term postoperative period. Massive and old ruptures of the RC require a complete instrumental examination in the preoperative period. The degree of adipose degeneration and rotator arthropathy is of key importance for determining the operative tactics of surgical treatment.

Повне подвоєння уретри у хлопчика з епіспадією

Duplication of the urethra is a rare abnormality that can occur with other urogenital tract congenital pathologies. Ischemia at embryogenesis, urogenital sinus defect, Muller`s duct anomaly and incomplete mesodermal fusion are the pathophysiological mechanisms of the pathology onset. Duplication of the urethra diagnostics is based on clinical examination, disease anamnesis, urethrography and magnetic resonance imaging. It is nessessary to consider Effmann and Leibowitz classification, urethras and prostate location and urethral orifice distance on operation of additional urethra removing. Clinical case. Presenting a clinical case of a boy with grade I epispadias and complete duplication of the urethra. Urination was maintained and was performed from the dorsal-epispadic urethra, the ventral urethra was obliterated in the distal region. According to the data of magnetic resonance imaging: double urethra is traced, dorsal – comes out from the anterior parts of the bladder wall, continues along the dorsal surface under the dorsal neurovascular bundle, above the cavernous bodies. The urethra opening is traced at the level of the upper surface of the head of the penis. The distal / ventral urethra comes out from the posterior parts of the lower bladder wall, typically continues down through the prostate embryo, rotated forward between of the corporas cavernosas stipes, and had a typical location with except for the level of the penis head, where it bends and merges with the dorsal urethra, which opens with a single opening. The surgery of excision of an additional urethra on child was performed. During the examination of the child of 6 months after surgery: urination with one stream from the ventral urethra at the apex of the head of the penis, stream freely passes the Nelaton catheter No. 10, child holds urine, there was no complaints. Performing of the next stage of the operation (penis plastic surgery) is planned after 1 year of the previous stage. Conclusions. In cases of epispadias is possible a congenital defect – a complete douplication of the urethra with the ventral urethra obliteration at the top of the head, which may not be determined in epispadias surgery preparation. Doubling of the urethra in boys requires magnetic resonance imaging for a better orientation in the defect anatomy and to determine the tactics of further surgical treatment. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: complete duplication of the urethra, surgical treatment, children.

Radiation Methods in the Diagnosis and Determination of Surgical Treatment Tactics for Primary Multiple Lung Carcinoid

The early and complete diagnosis of lung carcinoid tumors is of great interest in clinical oncology, since this is the basis for the possibility of using options for organ-sparing surgical treatment. According to the 2015 WHO classification, carcinoids belong to the group of neuroendocrine tumors and are divided into two types: a typical carcinoid and an atypical one. Based on the data available in the literature, there are from 0.2 to 2 cases per 100,000 population. The paper considers the possibilities of radiation studies in the early diagnosis of this tumor, as well as those of determining the tactics, type, and scope of surgical treatment.

Хирургическая тактика при лечении больных с грыжами пищеводного отверстия диафрагмы

Цель исследования: разработать показания к хирургическому лечению больных с грыжами пищеводного отверстия диафрагмы (ГПОД) и оценить его результаты. Материалы и методы. В отделении хирургии органов пищеварения ГУ «Институт гастроэнтерологии НАМН Украины» за период 2017–2019 гг. обследовано и прооперировано 45 пациентов с грыжами пищеводного отверстия диафрагмы. Отдаленные результаты лечения изучены в сроки от 6 мес. до 2 лет у 19 (42,2 %) больных. Результаты. В наших исследованиях среди 45 оперированных пациентов у 27 (60,0 %) диагностирована аксиальная ГПОД (тип I), у 9 (20,0 %) — параэзофагеальная ГПОД (тип II), у 8 (17,8 %) — смешанная ГПОД (тип III), у 1 (2,2 %) — укорочение пищевода (тип IV). Гигантские ГПОД, требующие аллопластики, наблюдались у 8 (17,8 %) больных, укорочение пищевода на фоне больших ГПОД с формирующейся стриктурой нижней трети пищевода диагностировано у 1 (2,2 %) пациента. Крурорафия выполнена всем больным: задняя — в 24 (53,3 %) случаях, передняя и задняя — в 13 (28,9 %), аллопластика — в 8 (17,8 %). Проведены лапароскопические фундопликации: по Ниссену — у 36 (80,0 %) пациентов, по Тупе — у 6 (13,3 %), по Дору — у 3 (6,7 %). Летальных исходов не было. Средняя продолжительность вмешательства составила (135 ± 24) мин, среднее время фиксации трансплантата — (24 ± 12) мин. Выводы. Лапароскопические антирефлюксные операции являются высокоэффективными в лечении ГПОД, хорошо переносятся и характеризуются небольшой частотой осложнений (6 (13,3 %) случаев), быстрым восстановлением больных в послеоперационном периоде, что позволяет признать их операциями выбора в лечении данной патологии. Выбор метода хирургического вмешательства при ГПОД определяется особенностями анатомических взаимоотношений и задачами восстановления пищеводно-желудочного перехода и диафрагмы.

Analysis of surgical treatment of liver hemangiomas

Objective. Development of criteria for optimal tactics of surgical treatment of liver hemangiomas of various sizes and localizations.
 Materials and methods. A retrospective analysis of 247 patients with hepatic hemangiomas observed on an outpatient basis and in a hospital was carried out; 59 of them (23.89 %) were operated including 12 men and 47 women over the period of 19992019. Liver resection with hemangioma was performed in 30 patients, hemangioma enucleation in 21, X-ray endovascular occlusion in 8 patients. The diagnosis was established on the basis of ultrasound of the abdominal organs, CT and MRI with contrast as well as angiographic research methods.
 Results. The postoperative complications developed in 4 (6.78 %) cases: reactive pleurisy was detected in 2 patients after the right-sided hemihepatectomy, hematomas in the resection zone of segments of the right lobe of the liver with a tumor were diagnosed in 2 patients. All complications were eliminated by conservative measures. There were no lethal outcomes.
 Conclusions. Surgical treatment of patients with hemangiomas includes resection of the liver with a tumor, enucleation of the hemangioma, and various types of local destruction. In order to reduce the blood circulation of the tumor and decrease the risk of intraoperative blood loss, the ECA of the branches of the hepatic artery was indicated. A comparative analysis of the results of treatment of patients with liver hemangiomas using various methods of surgical interventions made it possible to develop optimal surgical tactics, a system of intra- and perioperative safety in this category of patients.

Late results of surgical treatment of critical ischemia of the lower extremities after one-staged direct revascularization

Objective. To optimize the tactics of surgical treatment in patients, suffering chronic ischemia of the lower extremities with the help of elaboration and introduction of a one-staged direct and indirect revascularization into clinical practice.
 Materials and methods. Analysis of the treatment results in 162 patients, suffering obliterating atherosclerosis of the lower extremities vessels, who were treated in stationary in Department of Vascular Surgery of Zakarpattya Regional Clinical Hospital named after Andriy Novak in 2015 - 2020 yrs. The patients were distributed in accordance to the lower extremities ischemia degree: ІІB – 7 (4.3%), ІІІA – 61 (37.7%), ІІІB – 58 (35.8%), ІV – 36 (22.2%). All the patients have had atherosclerotic affection of femoro-ankle-foot segment of the main arteries with preservation of central blood flow in aorto-iliac segment.
 Results. Occlusion of femoral artery was noted in all patients. Occlusion of anterior tibial artery was revealed most frequently – in 72% of the patients, than in fibular - in 42% of patients (p=0.00), and equally frequently with occlusion of posterior tibial artery – in 68% (p=0.61). The foot arteries were involved into the process in 51 (31.5%) patients. Affection of 2-3 arteries of the shin were registered more frequently, than occlusion of one artery – in 109 (67.3%) and 48 (26.5%) patients, accordingly. Occlusive-stenotic affection of popliteal artery have had 127 (78.4%) patients.
 Mostly frequent affection of the shin arteries was observed in basin of anterior tibial artery – in 67 (41.4%) patients, as well as in combined affection of anterior and posterior tibial arteries - in 45 (27.8%) patients. Іsolated affection of posterior artery was revealed in 36 (22.2%) patients. Combined affection of posterior tibial and fibular was observed in 14 (8.6%) patients.
 Conclusion. Efficacy of indirect revascularization after the arterial inflow restoration is more prognosticated, than efficacy of its isolated conduction in environment of chronic critical ischemia of the lower extremities. Combined application of direct and indirect revascularization guarantees more secure positive result in remote postoperative period and enhancement of the extremities preservation index.

Principles of surgical treatment of chronic post-intubation laryngotracheal stenosis in childhood

Introduction: Post-intubation stenosis of the larynx and trachea in childhood increases annually. This is associated with an increasing number of children with severe pathology of the upper respiratory tract, as well as children requiring artificial ventilation for other reasons. Until now there have been debatable questions about surgical tactics in children with chronic cicatricial laryngeal stenosis. Aim: The aim of this article is to evaluate the effectiveness of different tactics of surgical treatment of children with chronic cicatricial post-intubation stenosis of the larynx, depending on the state of the cartilaginous frame of the larynx. Materials and Methods: We have treated 47 children with chronic cicatricial post-intubation stenosis of the larynx. Preoperative examination included endoscopy and computed tomography of the larynx and trachea. We assessed the cartilaginous framework of the larynx and trachea that influenced the choice of surgical approach. For 20 children with intact laryngeal cartilaginous frame the method of endolaryngeal microsurgery using a CO2 laser was applied. This method allowed to form a wound surface by minimum submucosal resection scar tissue, which made it possible to cover the wound with mucosal microflaps to prevent restenosis. In the surgical treatment of extended stenoses of the middle larynx, there are prerequisites for repeated replacement of the wound with excess scar tissue, which in our observations was avoided by using endoprostheses for a period of 21 days. Despite it, with a lesion of the subglottic part of the larynx, the risk of restenosis remained quite high (5 out of 12 patients), even in the absence of data for damage to the cartilaginous frame of the larynx. In 27 cases of chronic post-intubation cicatricial stenosis of the larynx, in identifying of laryngeal cartilage framework lesion before surgery, extralaryngeal laryngotracheoplasty was performed. Laryngofissure was performed in 18 children, followed by stenting from 6 to 18 months with a T-shaped silicone stent, in 9 cases—one-stage laryngotracheoplasty using auto-cartilage grafts. The applied techniques have shown high efficiency, while the use of autografts made it possible to reduce the stages and duration of surgical treatment. Conclusion: The use of a CO2 laser in combination with balloon laryngoplasty in microsurgical treatment of chronic post-intubation stenosis of the larynx in children significantly expands surgical capabilities due to high accuracy and low level of damage of surrounding tissues.

Spinal lumbar stenosis (analysis of the literature and own results)

The article is devoted to the issues of etiology, pathophysiology and clinical manifestations of spinal stenosis of the lumbar spine. The possibilities of modern instrumental diagnostics of the disease are described, the differential clinical diagnosis of lumbar stenosis is presented. The paper presents a detailed classification of spinal stenosis. The modern therapeutic tactics of the disease are described, indications for the surgical treatment of the disease are given. Modern methods of surgical treatment of stenosis are briefly and schematically described: decompression (microsurgical and endoscopic), interspinous fixation, stabilization (dorsal and ventral) and epidural stimulation of the spinal cord. The data on the immediate and long-term results of surgical methods of treatment are presented. The authors also presented their experience in the treatment of spinal stenosis of the lumbar spine. The use of differentiated surgical treatment tactics in 85–90 % of cases provides good and excellent results in the treatment of lumbar stenosis.

The role of EGFR mutation testing in the choice for surgical tactics in NSCLC treatment

Lung cancer is the most commonly diagnosed cancer in the world, and currently the mortality rate from this disease is one of the highest. The detection of EGFR mutation plays an important role in the choice of treatment in clinical practice. As already known, over the past decade, EGFR mutations have been a predictive factor for the prescription of tyrosine kinase inhibitors (EGFR TKIs) in patients with advanced non-small cell lung cancer (NSCLC). The role of EGFR mutation as a prognostic factor for patients undergoing surgery and the possibility of using surgery to overcome the resistance mechanisms that develop in response to EGFR TKIs remain unexplored. This literature review examines key aspects of the EGFR mutation as a factor that can influence the treatment and using the surgical method.

Current aspects of diagnostics and surgical treatment of acute lung abscesses

Increasing number of lung diseases, unfavorable environmental factors, dissemination of infectious agents in a patient's body result in increased frequency of purulent-septic complications, thereby making the study on methods of their diagnosis and treatment relevant. Aim of the work: to examine the diagnostic value of lung ultrasound (US) and spiral computed tomography (SCT) in the diagnosis of acute abscesses and in determining the tactics of surgical treatment. Materials and methods. A prospective study of 40 cases of acute lung abscesses with diagnostic value of US and SCT examination to choose a surgical method in accordance with the type of acute lung abscess. Results. Male was dominated in the study (82.5 %). The median age was 52 (43.5; 60.0) years. SCT revealed an abscess with sequestration in 9 (22.5 %) of 40 patients, which was confirmed during surgery. A false negative result was obtained in 5 (35.7 %) patients out of 14. Lung US revealed sequestration in 14 (35.0 %) patients: 2 (14.3 %) of them were false positive. Transthoracic drainage was performed in 24 (92.3 %) of 26 patients without sequestration. In 2 (7.7 %) cases – video abscessoscopy (VAS). The median length of hospital stay was 34.5 (29.0; 43.0) days for patients without sequestration and 32.0 (26.0; 35.0) – with sequestration, Р = 0.16. Conclusions. Modern radiation imaging is an effective tool for the diagnosis of lung abscess. The sensitivity and specificity of computed tomography was 64.3 % and 100.0 %, sonography – 85.7 % and 92.3 %, respectively, in the study. The concurrent use of these diagnostic methods increases their information content: sensitivity up to 100.0 %, specificity up to 92.3 %. Video abscessoscopy with sequestrectomy is an effective method of treatment and etiological diagnosis of the process, which allows achieving the length of hospital stay comparable to patients without sequestration: 32.0 (26.0; 35.0) vs 34.5 (29.0; 43.0), Р = 0.16.