Tactics Of Surgical Treatment Research Articles

Infectious complications of external fixation in patients with polytrauma

Annotation. Among the main causes of mortality and in the structure of primary disability in Ukraine, the consequences of injuries consistently rank third, second only to cardiovascular and oncological diseases. The intensive use of implants in traumatology and orthopedics in the second half of the 20th century, along with significant advantages in the tactics of surgical treatment and further improvement of the quality of life of patients, also contributed to the emergence of infection. The purpose of our work was to determine the features of the occurrence and localization of the infectious process after external fixation as a result of polytrauma. An analysis of the treatment of 181 patients who were hospitalized in the Department of osteomyelitis surgery at the Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine was conducted. Statistical processing was carried out using the method of calculating the coefficient of the polychoric relationship indicator according to K. Pearson. As our study indicated, in 93.6% of patients with infectious complications of external fixation as a result of polytrauma, the pathological process was localized in the lower limb, which is associated with high-energy injuries inherent in multisystemic and multiorgan damage. Most often, the purulent process in patients with external fixation as a result of polytrauma was found in the lower third of the tibia (21.0%), the middle third of the tibia (17.9%) and the lower third of the femur (15.8%). Purulent complications in the area of the upper extremity in patients with external fixation as a result of polytrauma were observed four times less often than in patients with the same complications as a result of an isolated injury.

TREATMENT OF PURULENT-NECROTIC COMPLICATIONS OF SOFT TISSUES IN DIABETES MELLITUS

One of the frequent complications of diabetes mellitus (DM) is the lesion of human blood vessels, leading to the development of diabetic foot. Literature and daily practical observation show an increase of the rate of diabetic foot (30-70%), which raises the actuality of the problem of diabetic foot treatment. This article contains data concerning the results of surgical treatment of 151 patients with diabetes mellitus complicated by diabetic foot and purulent-necrotic soft tissue inflammation. Our work presents the basic principles of treatment of purulent-necrotic complications of diabetes mellitus. The effectiveness of local application of Acerbin solution and two-stage surgical tactics in the complex surgical treatment of purulent-necrotic complications of diabetes mellitus has been proved.

Principles of diagnosis and choice of treatment tactics for patients with pancreatic-pleural fistulas

Introduction. Pancreatic-pleural fistula is a rare complication of pancreatitis that has no pathognomonic symptoms and unified approaches to the choice of treatment tactics.The aim of the study was to formulate the principles of diagnosis and choice of treatment tactics in patients with pancreatic-pleural fistulas.Materials and methods. Five patients with pancreatic-pleural fistulas were treated from 2012 to 2022. All patients underwent standard clinical-laboratory and instrumental methods of investigation.Results. The diagnosis of pancreatic-pleural fistula was made at 18−65th day from the disease on the basic of amylase activity in the pleural effusion from 29462 to 51328 U/L. Surgical treatment consisted of pleural cavity and pancreatic pseudocyst drainage in two patients, in one patient we performed pleural cavity drainage and Virsung’s duct stenting, one patient underwent pancreatic duct stenting and repeated pleural punctures, one patient had papillosphincterotomy, video-thoracoscopy and pleural cavity drainage. Discussion Diagnosis of pancreatic-pleural fistulas is based on a set of criteria: history of acute attacks or exacerbation of chronic pancreatitis, presence of pancreatic pseudocyst, recurrent hydrothorax, brown pleural effusion, and high amylase activity in it. Surgical treatment tactics can be staged and characterized by the principle “from simple to complex”.Conclusion. The diagnostic algorithm of pancreatic-pleural fistulas is based on the data on acute pancreatitis, recurrent hydrothorax, hemorrhagic nature of the effusion and high level of amylase in it. The choice of surgical treatment tactics implies combination of pleural cavity drainage with Virsung’s duct stenting, as well as external drainage of pancreatic pseudocyst (if any).

Giant myxoma of the right sections of the heart obstructing the inferior vena cava: A case report

Objective: We present a rare case of surgical management of giant myxoma of the right heart with obstruction of the orifice of the inferior vena cava (IVC), obstruction of the right atrioventricular orifice, with the development of high pulmonary hypertension, and severe heart failure. Case presentation: A 39 years old male patients applied to the consultative polyclinic with typical complaints of severe shortness of breath, palpitations, severe weakness, almost bed rest, severe swelling of the lower extremities, with a transition to the anterior abdominal wall (edema). On physical examination signs of severe heart failure NYHA class IV were revealed. Imaging demonstrated giant right atrial myxoma obstructing IVC with base originated in fossa ovalis, obstructing tricuspid valve and protruding in the right ventricle occupying 50% of its cavity. The surgical removal of the giant RA myxoma protruding the right ventricle and obstructing IVC and tricuspid valve was performed under cardiopulmonary bypass and hemodynamic support. The patient was discharged on the 10th day after surgery and only residual minimal tricuspid regurgitation was revealed on follow-up examination. Conclusion: The described case from our practice proves the possibility of a severe course of giant myxomas of the right heart, with the development of deep hemodynamic complications of systemic and pulmonary circulation. The chosen correct tactics of surgical treatment provided a favorable result, despite the severity of the initial condition and the degree of hemodynamic disturbance. Intraoperative tactics and technique for performing the stages of urgent surgery were chosen based on the situation, the features of the anatomical structure of the tumor, and the severe complications that arose. Our case proves the possibility of adequate implementation of such interventions, when choosing the right tactics of surgical treatment. Take home message: If clinical signs of circulatory failure, heart failure are detected, it is necessary to perform echocardiography. If mass formations of the heart chambers are detected, immediately refer the patient to specialized cardiac surgery clinics to resolve the issue of surgical correction of pathology.

The choice of tactics for surgical treatment of abdominal aortic aneurysm in octogenarians

Currently, the treatment of abdominal aortic aneurysm does not pose significant difficulties, with modern cardiovascular surgery offering the possibility of both open and endovascular repair (EVAR) techniques. However, the personalized selection of the most optimal surgical intervention for each patient remains a relevant question. In some cases, one of the important factors influencing the choice of surgical method is the patient’s age and accompanying diseases. Abdominal aortic aneurysm is an age-related condition with a high risk of fatal outcomes. In our practice, we encountered a rare case of abdominal aortic aneurysm in an octogenarian woman with severe somatic status, poorly controlled arterial hypertension, and complex anatomical enlargement of the aneurysm. The question arose regarding the choice of optimal tactics and surgical treatment method. According to the MSCT, the diameter of the expansion was 67 mm, posing a 20% risk of rupture in the first year. In this clinical case, EVAR technique was unsuitable due to the anatomical features of the aneurysm, as the length of the neck in the infrarenal segment of the aorta was 2.5–3 cm, and the angle of inclination to the right exceeded 85°. Additionally, considering gender-specific factors, particularly female gender, indications for EVAR need to be carefully determined, as women have a higher likelihood of complications following the operation, as shown in several studies. After a detailed analysis of the re-evaluation results and assessment of surgical risk factors, we determined an individual surgical strategy and minimized risks, ultimately achieving a good outcome.

Local complications of acute pancreatitis and methods of their instrumental diagnosis

The literature review considers the characteristics of local complications in the classifications of acute pancreatitis, as well as analyzed the effectiveness of modern methods of their diagnosis. Understanding the morphology of changes occurring in the pancreas and parapancreatic tissue in acute pancreatitis is of great importance, as it often determines the tactics of surgical treatment. Modern diagnostic methods for local complications of acute pancreatitis, such as contrast-enhanced ultrasound, endoscopic ultrasound, computed tomography, magnetic resonance imaging and cholangiopancreatography are highly informative, but the effectiveness of their use depends on the duration of the disease and the type of local complications, which makes to apply the differentiated approach to their use.

Modern approaches to performing organ-preserving operations in adenomyosis

The incidence of adenomyosis in young patients who have not realized their reproductive function is steadily increasing, with the tactics of surgical and drug treatment being an unresolved problem. In clinical practice, special attention is focused on the possibility of surgical treatment of adenomyosis with preservation of the uterus; and a variety of new options for such operations are proposed, as well as ways to optimize the treatment of such patients. This article summarizes our own and world experience in managing such patients. We present current views regarding the selection of patients for such interventions and determining the indications for surgery, and we herein highlight the technical features of such interventions. A particular attention is paid to management tactics being aimed at ensuring reproductive function implementation.

Surgical treatment of unstable uncomplicated vertebral fractures

Aim. To enhance the outcomes of surgical treatment of unstable uncomplicated vertebral fractures.Materials and Methods. This research involves an analysis of surgical treatment data from 237 patients aged 18 to 74 years, all with unstable uncomplicated vertebral fractures. These patients underwent surgery using the technique of posterior transpedicular fusion. The primary group, constituting 51.9% of cases, utilized enhanced approaches, while the control group (48.1% of cases) employed standard methods. The treatment outcomes were evaluated using a newly developed scale, while the Oswestry scale was used to gauge the quality of life.Results and Discussion. The primary components of the refined surgical treatment tactics used in the main group were low-traumatic manipulations, which aimed to minimize tissue trauma and avert intraoperative complications. Utilizing the proposed objective scoring method, a statistically significant improvement in long-term outcomes was established in the primary group compared to the control group, with scores of 95.5±0.4 points and 88.7±0.7 points respectively (P<0.05). According to the Oswestry scale, the sum of points in the main group was 2.5±0.05, compared to 5.1±0.06 in the control group. The Oswestry index in the analyzed groups was 7.1±1.6 and 22.4±1.2 respectively.Conclusion. The findings demonstrate a statistically significant increase in the proportion of favorable outcomes, and the absence of unsatisfactory results, in the primary group as compared to the control group. Furthermore, an improvement in the quality of life for patients in the primary group was observed.

Diagnosis and treatment of the giant malignant peripheral nerve sheath tumor in the anterior mediastinum: A case report

INTRODUCTION: Malignant peripheral nerve sheath tumor (MPNST) occurs in young and middle-aged people, more frequently in those with the genetic disease known as neurofibromatosis type 1 (NF1). Approximately, 50% of people with MPNST have NF1 and 13% of people with NF1 will get MPNST during their lifetime.
 CASE REPORT: A 30-year-old patient after surgery for MPNST of the right hip in 2013 was observed. In 2017, a relapse was detected, and combined treatment was performed, including surgical excision of the relapse and postoperative distance radiotherapy with a total focal dose of 66 Gy. In 2018, MPNST of the left femoral nerve was diagnosed, and the tumor was excised. In 2020, a chest X-ray diagnosed a single focus of localized opacity in the anterior mediastinum, adjacent to the right lung. Computed tomography (CT) was performed to further verify the neoplasm, which revealed a single hypodense focus in the anterior mediastinum, adjacent to the right lung. According to histological examination of a tumor biopsy obtained by transthoracic ultrasound-guided biopsy, MPNST was verified. Magnetic resonance imaging (MRI) with intravenous contrast enhancement, including real-time MRI, was performed to assess the invasion of the mass into soft tissues and vessels and to plan surgical treatment. The following surgeries were done: right thoracotomy, removal of a neoplasm of the anterior mediastinum with resection of the upper lobe of the right lung, and marginal resections of the lower lobe of the right lung. This case demonstrates a rare localization and non-standard instrumental diagnosis of mediastinal MPNST. Apart from CT scanning, the patient underwent MRI of the thoracic organs. MRI allows assessing the invasion of the neoplasm into the surrounding tissues. This cannot always be achieved by CT scans, including those with contrast enhancement. Invasion is an important component in the planning of further surgical treatment tactics.
 CONCLUSIONS: MPNST is a tumor with an aggressive course and a poor prognosis due to resistance to therapy. This clinical case demonstrates a rare localized MPNST with a recurrent course and metastases to the lungs. The current radiological methods, such as CT and MRI, may be used effectively both for diagnosing MPNST and determining the appropriate surgical access to the lesion and the extent of surgery.

On the issue of surgical treatment of highly differentiated thyroid cancer. Case reports

The article discusses the modern surgical tactics of treatment of differentiated thyroid cancer, with an emphasis on organ-preserving operations. The clinical cases in which preoperative diagnostics was not able to reveal the extent of tumor spread are presented. Non-radical surgical tactics in such situations inevitably leads to repeated surgery that is performed against the background of ongoing cancer progression, in which case the patient may be at a higher risk of recurrence than s/he would be with a timely radical operation and therefore may require further treatment.

Возможности оптической когерентной томографии переднего отрезка в режиме ангио (AS-OCTA) в диагностике и тактике хирургического лечения заболеваний роговицы

Purpose. To describe three clinical cases of corneal vascularization of different etiologies, to evaluate the possibilities of the method of optical coherence tomography of anterior segment in the mode of angiography (AS-OCTA) in diagnostic and selection of treatment strategies of corneal diseases, as well as to provide diagnostic protocol. Material and methods. For the first time AS-OCTА was performed at the S. Fyodorov Eye Microsurgery (Moscow). The presented clinical cases included three patients with different pathologies of the anterior segment of the eye: postherpetic neovascularization, superficial epithelial fibroplasia and limbal stem cell deficiency syndrome (LSCD). The scan was performed on an Avanti xR optical coherence tomography device (Optovue Inc. Fremont, California, USA) in the «OCT» and «Angio OCT» modes using the AngioVue program and the SSADA algorithm. Results. In the presented clinical cases, the use of AS-OCTA makes possible to accurately assess the depth, area and architectonics of the vessels, and helps to determine the tactics of surgical treatment and type of keratoplasty. However, the disadvantages of this technique include the complexity and long time required for its implementation, as well as the appearance of a large number of artifacts even with minimal eye movement of patients. At the same time, in the presence of a qualified operator and with proper compliance with the patient, it is possible to obtain valuable diagnostic data. Conclusion. Our study is the first in the Russian Federation to demonstrate the use of anterior segment OCT angiography to visualize the corneal vasculature and provide a protocol for performing it on an Avanti xR optical coherence tomograph. In this preliminary study of patients with corneal neovascularization, we regard the results obtained using AS-OCTA as promising for non-invasive vascular imaging, in particular, before and after the treatment of various conditions with corneal neovascularization. Key words: cornea, neovascularization, limbal stem cell deficiency, anterior segment optical coherence tomography, angiography, corneal limbal vasculature

Combined operations in outpatient laser treatment of chronic hemorrhoids of stage 2–3

Introduction. When performing laser coagulation of hemorrhoids, there is a demand for the elimination of simultaneous diseases, but their laser treatment is under study and implementation in the practice of coloproctologists.Aim. To study the features of transmucous laser thermal ablation of chronic hemorrhoids of stage 2–3 with simultaneous elimination of other anal canal diseases in outpatient settings.Materials and methods. Transmucous ablation of hemorrhoids of 2–3 degrees was performed in 104 (27.5%) people in combination with laser removal of chronic anal fissures in 82 (75%) patients, intra-sphincter fistulas in 10 (9.6%) and other anal canal pathology in 18 (17.4%) patients. The median age of patients was 43 years, 48 men (46.2%), 56 women (53.8%).Results. Surgical tactics of laser treatment of simultaneous and underlying pathology allowed one-step elimination of both diseases in all 100% of patients. The duration of combined operations was 20.0 min. (15; 20) the pain intensity was 2.5 points (2; 3). Intraoperative blood loss was minimal. Pain in the postoperative period persisted for 5 days. After surgery, bleeding occurred in 2 (1.9%) patients. During the year, a recurrence of hemorrhoids occurred in 2 (1.9%), anal fissure in 10 (12.2%), condyloma in 2 out of 3 operated.Discussion. The obtained characteristics of combined operations showed that all their signs corresponded to minimally invasive interventions, both operations, the main and combined, were low-traumatic, performed under local anesthesia and had one access and a common operating field.Conclusion. Combined pathology of the anorectal region is observed in a quarter of patients with chronic hemorrhoids. In 100%, it was eliminated by simultaneous operations that were minimally invasive, which allowed them to be performed on an outpatient basis under local anesthesia.

Iatrogenic damage to the vascular-nerve bundle and lymphatic collectors of the femoral triangle during phlebectomy

The rapid development of innovative medical technologies, the expansion of indications for surgical treatment, a significant increase in the number of operations performed for varicose veins entails a steady increase in the frequency of iatrogenic damage to the vascular-nerve bundle and lymphatic collectors of the lower limb. This can lead to severe complications requiring surgery, social and economic consequences associated with the need forlong-term outpatient and inpatient treatment, social security costs and a marked decrease in quality oflife. Reports on the occurrence of this pathology in the medical literature are few and, as a rule, describe extremely rare clinical cases. Timely diagnosis of complications, tactics of surgical treatment of patients with iatrogenic injuries in the surgical treatment of varicose veins and possible options for correcting emerging complications continue to cause discussion and remain one of the discussed problems of modern angiosurgery. The article provides a review of the literature devoted to the analysis of possible causes of iatrogenesis in varicose vein surgery: damage to the neurovascular bundle and lymphatic vessels of the femoral triangle, femoral vein, great saphenous vein, femoral artery, concomitant damage to the artery and vein, lymph nodes and basins, saphenous nerve during phlebectomy. The issues of diagnosis and options for correcting the complications that have arisen. The problem of mistakes and complications in the vein surgery should be resolved through comprehensive training of phlebologists, including compulsory teaching of vascular surgery skills, as well as supplying special equipment and instruments to the clinics.

Topical issues of surgical treatment of pelvic floor dysfunction. A literature review

This article presents a review of the current literature on the problem of omission and prolapse of the internal genitalia in women. Patients diagnosed with pelvic organ prolapse need pelvic floor plastic surgery. Currently, in spite of the extensive experience in managing this category of patients, there is still no single and unambiguous approach to the choice of surgical treatment tactics.
 This review describes the latest information on the etiopathogenesis of pelvic floor supporting apparatus lesions, namely, systemic connective tissue dysplasia as the main development factor. Prospective development of genetic and immunohistochemical marker diagnosis is the key to individual selection of treatment options for this multidisciplinary problem. The results of interventions are characterized by extreme variability in terms of both effectiveness and the frequency of intra- and postoperative complications. The treatment of rare forms of prolapse after surgery for rectal cancer also raises many questions. The current multitude of types of surgical interventions for genital prolapse and variants of pelvic floor defect closure is constantly being modified. To date, there is no universal treatment option, and all available techniques have both advantages and disadvantages, as well as limited application due to the risk of somatic complications, high recurrence rate, and the need for expensive equipment and a highly qualified surgeon.
 New research is needed, taking into account the current knowledge about the cellular and molecular mechanism of the lesion of the pelvic floor supporting apparatus. All of this will improve the methods of correction of pelvic organ prolapse in both typical and rare forms caused by iatrogenic factors. As a result, this may lead to an improvement in the quality of life of such patients.

Biological and physical mechanisms of cerebral aneurysms formation, growth and rupture

According to various researchers, the prevalence of unruptured cerebral aneurysms (CAs) in the general population varies from 2 to 5 %. In the vast majority of cases, CAs do not have clinical and neurological manifestations and are discovered incidentally during routine neuroimaging studies. CAs can cause intracranial hemorrhage. As a rule, hemorrhages of this type occur in patients aged 40–60 years. It has been established that about 10–15 % of patients die from an aneurysmal hemorrhage before they receive specialized medical care. Recurrent aneurysmal intracranial hemorrhage is the main cause of high mortality and disability in this group of patients. The search for literature sources in the scientific databases PubMed/Medline, EMBASE, Cochrane Library and eLibrary demonstrated the existence of numerous studies devoted to the study of molecular biology and biophysical mechanisms of formation, growth and rupture of CAs. Combining the results of these studies was the motivation for writing this literature review. The paper reflects in detail the role of inflammation and molecular genetic factors in the growth and rupture of the CAs, and presents the biophysical factors of the rupture of the CAs. The authors pay special attention to the shape, size and coefficient of the CAs as the most important geometric risk factors for the formation and rupture of the CAs. This review presents current data on mathematical modeling of various types of CAs with an assessment of the risk of rupture of the latter, which has found its application in wide clinical practice. The authors also attempted to describe the hemodynamic features in various types of CAs. In turn, the type of blood flow in the CAs cavity largely depends on the size and shape of the latter and the geometry of the carrier artery, which is the basis for preoperative planning and the choice of tactics for surgical treatment of patients with unruptured CAs.

Prophylaxis of postoperative hypoparathyroidism in thyroid surgery.

There are a number of thyroid gland diseases that require surgical treatment. Therefore, it is important to improve the surgical approaches and treatment tactics in patients that need such surgery. To provide an algorithm to prevent parathyroid gland damage during surgery. This work was based on treatment results of 226 patients with different thyroid diseases. All patients received extrafascial surgical interventions using modern methodological approaches. For prevention of postoperative hypoparathyroidism, we used the "stress-test", 5-aminolevulenic acid, and a method of double visual-instrumental registration of photosensitizer-induced fluorescence of parathyroid glands. Transient hypoparathyroidism was registered in four (1.8%) cases after surgery. Permanent hypocalcemia in patients was not recorded. Autotransplantation of parathyroid gland was required only in one case (0.44%). A deficiency or low level of vitamin D was detected in 35% of the cases, and in the majority of those cases, it was due to secondary hyperparathyroidism. The deficiency was corrected with the administration of vitamin D in all cases. In 10.17% (23 patients) of cases, there was no proper visual glow effect after administration of 5-aminolevulinic acid (5-ALA), which required proceeding to the second part of the proposed method (a helium-neon laser and registration of fluorescence using a laser spectrum analyzer). The proposed methodological approach allows prevention of persistent hypoparathyroidism and reduces the frequency of transient hypoparathyroidism and other complications in surgical treatment of patients with various thyroid gland diseases.

Surgical treatment of the perihilar cholangiocarcinoma with portal vein invasion

Background. Perichilar cholangiocarcinoma is a rare type of malignant neoplasm and is 3-7 cases per 100,000 population. Surgical method is the only radical method of treatment, allowing to improve long-term survival results. One of the important and characteristic features of perihilar cholangiocarcinoma is tumor invasion to the area of the portal vein bifurcation, which occurs in 30–45% of cases. Portal vein invasion is the one of the main causes of perihilar cholangiocarcinoma irresectability. However, innovative surgical technologies allow resection of the liver with resection and reconstruction of the portal vein with acceptable mortality.
 The aim. The aim of our study was to asses results of surgical treatment of perihilar cholangiocarcinoma with (Group 1) and without (Group 2) portal vein invasion.
 Materials and methods. From 2003 to January 2023 in the Department of Surgery and Liver Transplantation of the Ukrainian National Institute of Surgery and Transplantation, 208 patients with perihilar cholangiocarcinoma underwent major extended liver resections. We compared 93 (46%) patients who received extended liver resection with portal vein resection (Group 1) with 115 (54%) patients who underwent liver resections without vascular reconstructions (Group 2). The average Ca 19–9 in the group 1 was 288 (8 – 1000) U/ml, in the group 2 –262 (10 – 612) U/ml. The level of total bilirubin in patients of the group 1 was 312 (43 – 621) mcmol/l, in the group 2 – 267 (10 – 612) mcmol/l. In view of this, in the preoperative period, 190 (91,3%) patients underwent decompression of the bile ducts, using percutaneous transhepatic cholangiostomy (PTBD) or retrograde endobiliary stenting. For patients with small remnant liver volume less than 40 %, in 80(38,5%) cases we did preoperative PVE of a resected part of the liver. In 9 cases we made simultaneous PVE and PTBD. When choosing the volume of surgical intervention, we proceeded from the tumor type of Bismuth-Corlette classification, invasion into the portal vessels and the depth of the liver lesion. The portal vein reconstruction was in all cases performed in an “end-to-end”. In all cases we made extended lymphadenectomy.
 Results. All complications were classified according to the Dindo-Clavien classification. Postoperative mortality in the main group was 11.5%. The overall 1, 3, 5-year survival in the group 1 was 96%, 68,3%, 57,4%, respectively. 1, 3, 5-year survival rate in the comparison group 2 was 98,4%, 76,7%, 47,3%, respectively.
 Conclusions. Aggressive tactics of surgical treatment of perihilar cholangiocarcinoma provides maximum radicality, allows to increase resectability in case of tumor invasion of the portal vein with acceptable mortality and long-term survival.

Modern treatment management strategy for inflammatory bowel diseases

MODERN TREATMENT MANAGEMENT STRATEGY FOR INFLAMMATORY BOWEL DISEASES Olexander I. Poida1, Volodymyr M. Melnyk1, Mykola D. Kucher1, Tetiana G. Kravchenko1, Myroslav I. Kryvoruk2 1 O. O. Bogomolets National Medical University, Taras Shevchenko Boulevard, 13, Kyiv 01601, Ukraine 2 UNCE (Utility non-commercial enterprise) «Kyiv City Clinical Hospital №18», Taras Shevchenko Boulevard, 13, Kyiv 01601, Ukraine Introduction. Enrichment of knowledge in etiology and pathogenesis, improvement of existing and development of new methods and technologies, strategies and tactics for IBD will contribute to improving the results of their diagnosis and treatment. The aims. To improve the treatment results of patients with IBD by developing and implementing modern treatment management strategies for their diagnosis and treatment. Material and methods: The modern diagnostic and treatment management of IBD has been developed and put into practice. It provides for the improvement of diagnosis and differential diagnosis of diseases, justification and selection of the optimal personalized method of treatment, depending on the characteristics of the clinical course, the severity of the patient's condition, and the existing risk of complications. Results. From 2013 to 2022, 1340 patients, 732 (54.6 %) men and 608 (45.4 %) women with IBD were treated at the Coloproctology Center of Ukraine. There were 812 (60.6 %) patients with ulcerative colitis and 528 (39.4 %) with CD. Conservative therapy received 1107 (82.6 %) patients, and surgical treatment – 233 (17.4 %). Postoperative complications occurred in 37 (15.9 %) patients, and deaths – were in 5 (2.1 %). All patients in the conservative treatment group had positive therapeutic dynamics, and improvement of morphological changes in the intestinal mucosa according to the control colonoscopy and biopsy. Positive functional results and life quality improvement were obtained in most patients after surgical treatment. Conclusion. 1. Conservative treatment involves the use of modern and highly effective drugs that can modify the course of IBD and thus prevent complications. 2. The choice of surgical strategy and treatment tactics is reasonable in the presence of a high risk of adverse course of UC and CD, as well as the development of complications that pose a threat to the patient's life. 3. Implementation of the proven treatment management for inflammatory bowel disease allowed: to increase to 82.6 % the number of patients who are indicated conservative therapy and reduce the risk of recurrence of these diseases; to decrease the number of surgical interventions to 17.4 %, increase the performance of surgical interventions according to relative indications to 62.5 %, even before the occurrence of severe complications of diseases; reduce the incidence of postoperative complications to 15.9 %, postoperative mortality to 2.1 %, and improve functional outcomes and quality of life of operated patients. Keywords: bowel, inflammatory diseases, diagnosis, treatment.

Long-term results of revascularization of the lower extremities in patients with critical ischemia and diabetes mellitus with localization of the occlusive-stenotic process in the femoral artery

Aim: to determine the most preferable tactics of surgical treatment of patients with critical ischemia of the lower extremities of atherosclerotic genesis and diabetes mellitus based on a comparison of the results of revascularizing interventions. Methods: The study involved 82 patients who were treated in the department of vascular surgery due to critical ischemia of the lower extremities as a result of atherosclerotic occlusive-stenotic lesion of the femoral arterial segment against the background of diabetes mellitus. After the diagnostic stage and preoperative preparation, the patients were divided into two groups depending on the nature of the intervention performed: endovasal revascularization or femoropopliteal autovenous bypass grafting above the knee joint gap. In the postoperative period, dynamic observation of patients was continued with a predominant assessment of the clinical status. Results: Clinically, circulatory decompensation requiring repeated intervention or amputation was observed in 9 (30 %) patients from the first group and in 13 (25 %) patients from the second. High amputation was performed in 2 (6.6 %) study participants from the endovasal revascularization group and 3 (5.7 %) from the open surgery group. Over the entire observation period, 2 (6.7 %) and 4 (7.8 %) patients died in the groups under consideration, respectively. No statistically significant differences were obtained for any of the studied parameters, however, repeated interventions were significantly more frequently performed in patients undergoing endovascular revascularization. Conclusion: When analyzing the advantages and disadvantages of endovascular and open surgery in patients with diabetes mellitus and critical ischemia, the first should be preferred due to the possibility of repeated repetition throughout the patients life. Particular attention should be paid to conservative therapy and assessment of clinical status in the late postoperative period.

Optimal Surgical Treatment Tactics in Patients with Synchronous Metastatic Colorectal Cancer

Aim: The aim of the study is to choose the optimal tactics of surgical treatment in patients with colorectal cancer (CRC) with synchronous intra-abdominal metastases. Materials and methods: The study included 74 patients with CRC with synchronous intra-abdominal metastases (peritoneal carcinomatosis and/or liver metastases), which were divided into 3 groups: I group (25 patients)-Intestinal stoma + neoadjuvant chemotherapy + Cytoreductive Surgery (CRS) + Adjuvant Chemotherapy (ACT); II group (18 patients)-Colon/rectal resection + ACT + CRS + ACT; III group (31 patients)-CRS + ACT. Results: The best oncological results were obtained in III group (median overall survival 46 months vs 27m. in I group and 31m. in II group). In contrast, a higher incidence of postoperative complications was observed also in this group (29%). There is no significant difference in overall survival (p>0.05 according to Log-Rank test) and the rate of postoperative complications between all groups of patients. The mean length of hospital stay was shorter in III group-9.8 days (p<0.01). Conclusions: All three options could be selected for the treatment of synchronous metastatic CRC. Therefore, the main goal remains the achievement of complete cytoreduction. So, it is necessary to focus on its possibility when choosing the sequence of stages of treatment in such patients. However, if it is possible to achieve complete cytoreduction and in the setting of the oncological center it is recommended cytoreductive surgery as the first step followed by adjuvant chemotherapy as the best treatment tactics for patients with synchronous metastatic CRC.