Uncomplicated Postoperative Period Research Articles

Laparoscopic resections for stage IV colorectal cancer - safety and effectiveness of the method as a guarantee for an uncomplicated postoperative period and optimal pharmacotherapeutic results

Introduction: Primary tumor resection can prevent future tumor-related complications in patients with stage IV colorectal cancer. This may influence the quality of life and prevent colostomies associated with the emergency surgery. Laparoscopic approach plays an important role in attempts to reduce perioperative complications in this specific group of patients. Purpose: The aim is to assess early perioperative results in a group of 17 patients with stage IV colorectal cancer—multiple incurable liver metastases and/or pulmonary/peritoneal metastases of the disease. On the other hand, postoperative complications may delay administration of chemotherapy and influence survival. Materials and methods: We analyze retrospectively the perioperative results in a group of 17 patients with laparoscopic palliative colorectal resections for stage IV colorectal cancer. Assessment includes perioperative complications, median hospital stay, perioperative blood loss, need for blood transfusion, operative time, and type of surgical procedure. Results: We performed totally laparoscopic 10 sigmoid resections, five left colectomies, and two right colectomies. Fourteen simultaneous liver biopsies were performed during laparoscopy. No perioperative deaths were registered. Perioperative mortality rate is 0%. Perioperative morbidity rate is 0%. No perioperative complications. The median perioperative stay is 5.3 days. Median blood loss is 47.9 mL. Overall, three units of blood were transfused. The median transfusion rate is 0.17 units per patient. The median operative time is 130.2 minutes. Conclusion: The laparoscopic approach is associated with very good perioperative results in patients with stage IV colorectal cancer and palliative resection of the primary tumor. Early hospital discharge and minimal operative trauma may not influence early administration of chemotherapy.

Laparoscopic Access in Radical Surgical Treatment of Complicated Gastric Cancer: a Single-Center Experience

Over the past decades, there has been an active introduction of minimally invasive surgical technologies in the treatment of various diseases, including gastric cancer. In Asian countries and Europe, laparoscopic gastrectomy is an alternative to open gastrectomy for early gastric cancer, with a tendency to displace the latter. In the Russian Federation, laparoscopic gastrectomy is performed in a few specialized centers. From 2013 to 2022, the surgeons of our Center treated 141 patients diagnosed with gastric cancer at different stages (64 men, 39 women, mean age of 60.5±10 years). Of these, 52 patients (50.5%) underwent open surgeries (group I), 51 (49.5%) — laparoscopic surgeries (group II). The study included patients diagnosed with gastric cancer complicated by bleeding or gastric outlet/cardioesophageal junction obstruction, over 18 years of age, who signed consent for the processing of personal data and inclusion of their clinical data in the research and underwent surgical treatment. We analyzed such parameters as the duration of surgical intervention and the duration of hospital stay, the rates of hospital/relapse-free 2-year survival, and uncomplicated postoperative period. Laparoscopic-assisted surgeries lasted longer; however, due to more precise technique and better visualization of anatomical structures, there was a smaller volume of intraoperative blood loss. During laparoscopic-assisted radical gastrectomy, it is possible to perform more precise lymph node dissection, increase the number of harvested lymph nodes and, thus, increase the probability of detecting lymph nodes with metastases; which, in turn, has a direct impact on increasing the 2-year relapse-free and 2-year overall survival of patients. There was no significant difference in the incidence or severity of postoperative complications and mortality. These data are an important indicator of the effectiveness of the minimally invasive surgical method of treatment, which indicates greater safety of the laparoscopic method compared to intervention from laparotomy access.

Local proteolytic system indicators as suspective factors of keratolysis development after urgent keratoplasty

Purpose: to determine the concentration of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinases-1 (TIMP-1) in the tear of patients with cornea melting and to assess whether these factors can be used as prognostically significant biomarkers of keratolysis. Material and methods. 20 patients who underwent urgent penetrating keratoplasty were tested for cornea perforation (melting) before and after the procedure. For control, 12 healthy adults (24 eyes) were tested. The tear fluid was collected before the surgery and on the 7th day after it with the help of filtering paper. MMP-9 and TIMP-1 concentrations were determined by ELISA. The course of the early postoperative period was assessed according to the area of keratotransplant epithelization on the 7th day after surgery. Results. MMP-9 and TIMP-1 concentrations in the tears of all patients before the surgery were significantly higher than the ones of healthy controls. The patients who were supposed to have re-keratoplasty had a significantly higher MMP-9 concentration than the ones who expected the first keratoplasty. An uncomplicated early postoperative period showed a statistically significant decrease of MMP-9 and TIMP-1 concentrations, whilst the complicated one demonstrated a significant increase of both markers. The highest increase of both markers was shown by the patients who underwent re-keratoplasty. Conclusion. MMP-9 concentration in the tears is a valid marker of the clinical course of the early post-keratoplasty period. To ensure a successful donor cornea engraftment, the levels of MMP-9 and TIMP-1 in the tear must be high enough before the surgery and the concentration of the ferment should decrease timely after its main functions have been completed. A 2-fold (or greater) decrease of MMP-9 concentration in the tear on the 7th day after keratoplasty can be considered a marker of the favorable prognosis for engraftment.

The impact of anastomotic leakage on the quality of life of patients after surgery for rectal cancer

AIM: to assess the impact of colorectal anastomotic leakage on the severity of low anterior rectal resection syndrome and the quality of life.PATIENTS AND METHODS: the results of 375 patients with rectal tumors were analyzed. In 26 patients, surgery was complicated by anastomosis failure. For a assessment of the quality of life of patients with anastomotic leakage, each patient was matched with a pair from the group of respondents with an uncomplicated postoperative period. The quality of life was assessed in all patients using the EORTC QLQ-C30 questionnaire with the Cr-29 module.RESULTS: patients with anastomosis leakage have more severe low anterior rectal resection syndrome — 29 (17;34), versus 20 (9;28) points (p = 0.03) and a lower global score (p = 0.01), physical (p = 0.01) and social (p = 0.04) functioning. The symptom scales of the EORTC QLQ-C30 questionnaire, supplemented by the Cr-29 module, had significant differences between groups on the scales of body image (p = 0.01), fecal incontinence (p = 0.04) and embarrassment (p = 0.01).CONCLUSION: colorectal anastomosis leakage negatively affects the quality of life of patients.

#1431 Risk factors of adverse cardiovascular events in the early postoperative period in kidney transplant recipients

Abstract Background and Aims Kidney transplantation improves quality of life and increases life expectancy in patients with Stage 5 Chronic Kidney Disease. However, the frequency of adverse cardiovascular events in the postoperative period remains high and reduces the effectiveness of transplantation. The aim was to study the incidence of cardiovascular risk factors in the preoperative period in kidney transplant recipients with adverse cardiovascular events in the early postoperative period. Method The study included 51 kidney transplant recipients whose age was 46.1 ± 4.6 years. 12 (23.5%) recipients had adverse cardiovascular events (acute myocardial infarction, unstable angina, rhythm disturbance, complicated hypertensive crisis) in the early postoperative period. 39 (76.5%) recipients with uncomplicated postoperative period formed the comparison group. The study groups were comparable by gender and age. Results Traditional cardiovascular risk factors were assessed. The study groups had comparable rates of arterial hypertension, obesity, hyperglycemia, dyslipidemia and smoking in the preoperative period and graft function in the postoperative period. The study groups didn't have significant differences in the incidence of anemia and hemoglobin blood concentration. But the erythropoietin blood level in the preoperative period in recipients with adverse cardiovascular events was higher—38.5 (23.5-155.0) mU/mL versus 16.0 (10.0-32.0) mU/mL, p < 0.01, and hypererythropoietinemia was diagnosed more often—58.3% (n = 7) versus 25.6% (n = 10), p < 0.05, than in patients without cardiovascular events. The incidence of elevated interleukin-6 blood level in the preoperative period was higher in recipients with adverse cardiovascular events—25.0% (n = 3) versus 5.1% (n = 2), p < 0.05. At the same time C-reactive protein levels and white blood cell counts were not significantly different. Recipients with adverse cardiovascular events had a lower left ventricular ejection fraction—59.5 ± 10.6% versus 65.6 ± 7.1%, p < 0.05, and a higher incidence of left ventricular diastolic dysfunction in the preoperative period—75.0% (n = 9) versus 35.9% (n = 14), p < 0.05, than in recipients without cardiovascular complications. Conclusion Kidney transplant recipients with adverse cardiovascular events in the early postoperative period had a higher incidence of left ventricular diastolic dysfunction, increased blood levels of erythropoietin and interleukin-6 and a lower left ventricular ejection fraction before transplantation than recipients with an uncomplicated postoperative period.

#951 Structural and functional indicators of the left heart in the aspect of contrast-induced nephropathy

Abstract Background and Aims To study the structural and functional features of the left heart in patients with coronary artery disease depending on the development of contrast-induced nephropathy (CIN) against the background of radiopaque endovascular procedures (REP). Method The study included 303 patients with stable forms of coronary artery disease who underwent X-ray endovascular procedures (REP). Patients with eGFR, determined by serum creatinine concentration, less than 60 ml/minute were not included in the study. 20 healthy volunteers were examined as a control group. All patients were divided into 2 groups - patients with an uncomplicated postoperative period of REP (CIN- group, 206 patients, 67.99%) and patients who developed contrast-induced nephropathy (CIN+ group, 97 patients, 32.01%). Subsequently, the CIN+ and CIN- groups were retrospectively compared based on baseline echocardiographic parameters. Results The present study demonstrated that EchoCG predictors of CIN in patients with stable forms of coronary artery disease are dilatation of the left ventricular (LV) cavity more than 136 ml (relative risk 1.65, p < 0.01), an increase in the index of impaired regional contractility of the LV to 1.2 points or higher (relative risk 1.77, p < 0.01) and a decrease in the e/a ratio of tissue Dopplerogram of the lateral edge of the mitral annulus to 0.7 relative units or less (relative risk 1.59, p < 0.01). Conclusion In patients with coronary artery disease after REP, despite the improvement in the index of impaired regional contractility and the index of LV sphericity, in the CIN+ group there is a more significant deterioration in the structural and functional properties of the LV myocardium, which manifested itself in an increase in systolic myocardial stress, a decrease in ejection fraction and an increase in the degree of diastolic dysfunction, which indicates a toxic effect of the radiocontrast drug not only on the kidneys, but also on the myocardium.

#980 Lipid spectrum in patients with coronary artery disease with contrast-induced nephropathy during X-ray endovascular procedures

Abstract Background and Aims Study of the main indicators of the lipid spectrum in patients with coronary artery disease with contrast-induced nephropathy (CIN), which developed during X-ray endovascular procedures (ERP). Method The study included 303 patients with stable forms of coronary artery disease who underwent X-ray endovascular procedures (REP). The average age of the patients was 53.79 ± 1.27 years. Based on the results, all patients were divided into 2 groups - patients with an uncomplicated postoperative period of REP (CIN− group, 206 patients, 67.99%) and patients who developed contrast-induced nephropathy (CIN+ group, 97 patients, 32.01%). Kidney filtration function was assessed by the clearance of endogenous cystatin C with calculation of the glomerular filtration rate (eGFRcys=90.63 × cystatin C – 1.192). Three fractions of lipoproteins were selected as indicators of the lipid spectrum: cholesterol containing LDL and HDL, as an anti-atherogenic factor, and VLDL, the main triglyceride-containing fraction. Results It was found that in patients in the CIN+ group, the LDL level was significantly higher than that characteristic of the CIN− group (p<0.001) and CG (p<0.001). At the same time, in the CIN− and CG groups, the LDL concentration was comparable, despite the use of statins in the groups of patients with coronary artery disease. The concentration of the second studied atherogenic fraction, VLDL, was also increased in patients with IHD compared with the CG (p<0.001 compared with both groups of patients with IHD) with a maximum increase in patients of the CIN+ group (p<0.01 significance of the difference between the CIN+ and KIN−). The concentration of the antiatherogenic fraction of the lipid spectrum—HDL—was significantly and comparable reduced in both groups of patients with coronary artery disease (p<0.001 when comparing both groups of patients with CG). Conclusion In the course of this study, it was found that one of the risk factors for the development of CIN in patients with coronary artery disease after REP is an increased concentration of atherogenic lipoproteins in the peripheral blood. A decrease in the level of anti-atherogenic HDL in the present study was not associated with the risk of developing CIN, but serves as a marker of impaired glomerular function kidney.

Pathogenetic significance of polymorphic variants in the <i>TREM-1</i> gene in the multiple organ failure risk after cardiac surgery

Introduction. Searching of highly specific, sensitive and easy-to-use markers of multiple organ failure (MOF) that will help to the early prognosis of this unfavorable condition, prevent complications and reduce mortality in the early postoperative period is very urgent for the modern medicine.Aim: To study the pathogenetic significance of the TREM-1 gene polymorphism in MOF in patients with coronary artery disease (CAD) in the early postoperative period.Material and methods. 592 CAD patients (564 patients with uncomplicated postoperative period and 28 MOF patients) were selected for the presented study. Genotyping polymorphic variants rs1817537, rs3804277, rs6910730, rs7768162, rs2234246, rs4711668, rs9471535 and rs2234237 in the TREM-1 gene was carried out by polymerase chain reaction.Results. It was found that the allele T (rs2234246), the allele G (rs1817537) and the allele T (rs3804277) in the TREM-1 gene were associated with an increased MOF risk after elective surgery according to the dominant inheritance model. TREM-1 polymorphic loci rs7768162 and rs4711668 were associated with a decreased MOF risk according to the additive inheritance model. We found no significant associations between polymorphic variants rs2234237, rs6910730, rs9471535, as well as inherited haplotype and MOF risk. Using the MDR analysis, three most significant models of gene-gene interactions of TREM-1 polymorphic loci associated with MOF risk in patients after cardiac surgery were identified.Conclusion. The obtained results demonstrate a significant contribution of polymorphic variants in the TREM-1 gene to the development of MOF in patients undergoing cardiac surgery.

Impact of acute coronary graft failure and subsequent urgent endovascular revascularization after planned coronary artery bypass grafting on hospital outcome

Highlights The authors conducted a comparative analysis of early postoperative complications, mortality and economic costs in patients who underwent additional urgent endovascular revascularization and patients with standard postoperative period.There are statistically significant differences between the groups in terms of the number of resternotomies performed, the need for transfusable blood components and economic costs.It is necessary to introduce routine intraoperative quality control of the intervention, and a set of measures aimed at early detection of coronary graft failure in real clinical practice. Abstract Aim. To assess the impact of coronary graft failure and subsequent urgent endovascular revascularization in the early postoperative period after elective coronary artery bypass grafting on hospital outcome.Materials and methods. 8801 patients underwent isolated coronary artery bypass grafting at the Federal State Budgetary Institution “Federal Center for Cardiovascular Surgery” of the Ministry of Health of the Russian Federation in Chelyabinsk from 2011 to 2020. Inclusion criteria were as follows: patients with stable coronary heart disease, patients undergoing elective coronary artery bypass grafting. Exclusion criteria were as follows: patients with unstable angina and acute myocardial infarction who underwent urgent revascularization. The primary endpoint was hospital mortality, secondary endpoints are bleeding requiring resternotomy, acute abdominal and infectious complications, and multiple organ failure. Due to suspected acute myocardial injury, 196 (2.23%) patients underwent urgent coronary angiography, and according to angiogram, additional endovascular correction was performed in 60 (0.68%) patients (the group I). To assess the impact of coronary graft failure and subsequent revascularization on hospital outcome we have analyzed: hospital mortality, complications in the early postoperative period, financial costs. Moreover, we have formed the group II of 60 people with uncomplicated postoperative period for comparative analysis.Results. Of 196 (2.23%) patients who underwent urgent angiography 60 (0.68%) patients required stenting of native coronary arteries or conduits due to coronary graft failure. Hospital mortality in the group with complicated postoperative period was 10 % (6 cases), hemorrhagic complications occurred in 13 (21.7%) patients, acute abdomen was noted in 4 patients, and sternal wound infection was noted in 5 patients, hemodialysis due to multiple organ failure was performed in 5 patients. An intergroup comparative analysis revealed a clear trend towards an increase in deaths in the group I (n = 6/10%) compared to the group II (n = 1/1.7%), however, there were no significant differences (p = 0.11F). Hemorrhagic complications occurred significantly higher in group I (13/21.7% versus 1/1.7%, p = 0.001F); there were no statistically significant differences associated with the other complications. The number of bed-days spent in the hospital and in the intensive care unit was statistically significantly higher in the group I, financial costs per patient were also significantly higher in the group I.Conclusion. Coronary bypass graft failure in the early postoperative period leads to an increase in hospital mortality, in the frequency of multiple organ failure and hemorrhagic complications, and significantly increases the amount of needed economic resources.

LATE DIAGNOSIS OF INFECTIVE ENDOCARDITIS: CLINICAL CASE REPORT

Infective endocarditis is a rare but clinically variable and difficult to diagnose disease. Delayed diagnosis of infective endocarditis can lead to total valve damage, which can require surgical treatment. We present a case report of a 36-year-old patient admitted to the hospital because of swelling and pain in the left shin and febrile fever. Two-dimensional transthoracic echocardiography was performed and infective endocarditis was suspec­ted. ¹⁸F-FDG PET-CT did not confirm the diagnosis of infective endocarditis and the patient was discharged as an outpatient with antibiotic therapy. The patient was readmitted with persistent inflammatory markers. Tran­sesophageal echocardiography showed a ruptured mitral valve with severe regurgitation. When the inflammatory parameters were reduced by antibiotic therapy, the patient underwent mechanical mitral valve replacement surgery. The patient had an uncomplicated postoperative period.

Analysis of treatment outcomes of patients with colorectal cancer in the COVID-19 pandemic

Introduction. The COVID-19 pandemic has made adjustments to the health care system. Among other things, it has led to shortened hospital stays. In the surgical treatment of patients with colorectal cancer (CRC), the possibility of reducing the bed-day is limited. The aim of the study was to evaluate the results of treatment of CRC patients during and before the pandemic new coronavirus infection. Material and methods. We analyzed the results of treatment of patients with CRC who were treated at the Oppel Hospital Surgery Clinic in 2015 and 2020. Group A included 58 patients treated in 2020, Group B included 44 patients treated in 2015. Patients with stage II disease predominated in both groups: in group A — 31 patients (53.4%), in group B — 19 (43.2%). Results. The average period of hospitalization in the patients of the group A was 12 days, in the group B — 16 days in the patients with uncomplicated postoperative period, in case of complications — 31 days. In group B 47.7% of surgical interventions were performed using laparoscopic techniques, in group A this index was 74.1%. In Group A complications in the early postoperative period were detected in 8 patients (13.8%). In group B complications were diagnosed in 10 patients (22.7%). The incidence of anastomosis failure tended to decrease in group A. In group B six patients (85.7%) who developed this complication required repeated surgical treatment, and in group A only two patients (50%). Discussion. The results demonstrate the effectiveness of the recommendations for perioperative management of patients with CRC and prevention of anastomosis failure. Conclusion. Based on the results obtained, we can say that the quality of surgical care for patients with CRC was avoided during the pandemic. The implementation of research recommendations in this area has helped to reduce the incidence of serious postoperative complications (anastomosis failure).

Delta-He a new biomarker for a surgical clinic

Delta-He the difference between hemoglobin content in reticulocytes and erytrocytes is a relatively new laboratory indicator that is easily measured in everyday practice. This parameter is directly related to iron bioavailability for hemoglobin synthesis and can reflect various conditions accompanied by cytokine expression including systemic inflammation. To analyze the prospects for practical application of hemoglobin delta in assessment of neurosurgical patients throughout in-hospital treatment. We analyzed complete blood counts (Sysmex XN-1000 analyzer) with optical determination of reticulocyte hemoglobin and automatic calculation of Delta-He in 82 neurosurgical patients. Exclusion criteria were severe decompensated comorbidities, exacerbation of chronic infectious processes, cancer of other organs. Blood sampling for analysis of delta-hemoglobin was carried out before all diagnostic and therapeutic measures. Reference interval is indicated by the analyzer manufacturer as 1.7-4.4 pg. Delta-He values at admission ranged from -1.8 to 6.1 pg. There was a consistent decrease of these values throughout 3-4 postoperative days. Then, the values could increase or continued to decrease. Increment of the index was noted in 76 patients (92.7%). Such dynamics was observed in case of uncomplicated postoperative period. Further decrease of Delta-He was observed in 6 patients (7.3%). These ones were characterized by a longer recovery after surgery, and the events required additional medical or surgical correction were recorded. Negative dynamics of Delta-He values could precede clinical manifestations of certain complication. Clarification of diagnosis and correction of therapy were accompanied by gradual increase of Delta-He values. Estimation of Delta-He values over time can be used for monitoring of patients and effectiveness of therapy. From a practical point of view, it is important that examination can be performed at any time of the day.

The impact of early acute rejection on kidney graft survival after repeat kidney transplantation

Introduction. Despite the improvements in immunosuppressive therapy, the growing number of repeat kidney transplantations and associated risks of acute rejection make it relevant to assess the impact of early acute rejection on a long-term kidney graft survival.Objective. The aim of the study was to evaluate the rate, the clinical aspects of early acute rejection after repeat kidney transplantation and the outcomes of its treatment, to perform the assessment of the impact of rejection episodes on a long-term kidney graft survival.Material and methods. We carried out the retrospective analysis of kidney graft survival after 121 repeat kidney transplantations performed in N.V. Sklifosovsky Research Institute for Emergency Medicine in the period from 2007 to 2018. Group I included 96 recipients after kidney transplantation without acute rejection in postoperative period. Group II consisted of 25 patients with early acute rejection after kidney transplantation. We performed the assessment of the impact of early acute rejection on the kidney graft survival in comparison with recipients with uncomplicated postoperative period. Statistical processing was carried out by nonparametric methods. Survival was assessed using the Kaplan–Meier curves.Results. 1-year and 3-year kidney graft survival rates amounted to 90.3% (95%, confidence interval 85–95) and 85.4% (95%, CI 79–91), respectively, in recipients of Group I; and 72% (95%, CI 58–86) and 60% (95%, CI 46–76) in patients of Group II. Significant differences in 1-year and 3-year kidney graft survival between patients of Group I and II have been noticed (P=0.0022 and P=0.0065, respectively).Conclusions. Patients with early acute rejection after kidney transplantation had poorer kidney graft survival in comparison with patients without rejection episodes in postoperative period.

NT-proBNP in young healthy adults undergoing non-cardiac surgery

ObjectivesN-terminal pro-brain natriuretic peptide (NT-proBNP), a standard marker for diagnosis and treatment guidance of heart failure, has previously been investigated in high-risk patients undergoing cardiac and non-cardiac surgery. However, the kinetics of NT-proBNP in healthy patients undergoing non-cardiac surgery are unknown. Design & methodsA secondary analysis of a prospective cohort study was conducted. NT-proBNP plasma concentrations were measured preoperatively, 2–6 h, and 18–30 h after surgery in 120 patients, 18–35 years, undergoing elective non-cardiac surgery. Reasons for non-inclusion: history or symptoms of cardiac disease, kidney disease, pulmonary embolism, thrombosis, stroke, diabetes, head or chest trauma, pregnancy, incomplete panel of perioperative NT-proBNP plasma samples.Absolute and relative change of NT-proBNP plasma concentration were calculated. Changes between preoperative, 2–6 h, and 18–30 h (POD 1) NT-proBNP values, and of within-patient change in NT-proBNP were analyzed. ResultsIn 95 patients, NT-proBNP plasma concentrations (median [IQR]) were 8 [5–26] pg/mL at baseline, 17 [5–53] pg/mL 2–6 h, and 42 [11–86] pg/mL 18–30 h after surgery. Absolute and relative NT-proBNP increase after surgery was 32 [5–74] pg/mL and 196% [61 – 592%] compared to baseline. NT-proBNP elevation above the age- and sex-specific reference range was observed in 6/95 (6%) patients prior to surgery and in 39/95 (41%) patients after surgery. ConclusionsEven after uncomplicated surgery and postoperative period, NT-proBNP concentrations markedly increase in otherwise healthy adult patients. The aetiology of postoperative NT-proBNP increase is currently unknown and may be multifactorial.

Peculiarities of the postoperative period and postoperative consequences of left hemicolectomy in patients with obesity

Annotation. Obesity is considered a risk factor for postoperative complications and postoperative mortality. The aim of the study was to assess the impact of obesity on the postoperative period and the level of postoperative mortality after left hemicolectomy. A retrospective analysis of the medical records of 217 patients who underwent left hemicolectomy for colon tumors was performed. Assessment of comorbid conditions was performed using the Charlson index. Postoperative complications were assessed according to the Clavien-Dindo classification. The calculation of postoperative survival was performed by the Kaplan-Mayer method. Database formation and statistical analysis were performed using Microsoft Excel and STATISTICA 10.0. It was determined that the mean values of the Charlson index did not differ significantly between the two groups (6,31 ± 2,07 and 6,33 ± 2,08 respectively), but there was a significantly higher level of endocrine diseases in the group of obese patients. Non-disseminated (I-II) stages of the tumor process predominated in patients of both groups (60% and 57.5%, respectively). Among non-obese patients n = 107 (51.8%) patients had an uncomplicated postoperative period and n = 59 (28.5%) patients had mild complications that were not associated with the surgical site, but were associated with concomitant chronic pathology of other organs and systems, and did not require any invasive interventions. In contrast, among obese patients n = 6 (60%) patients had severe early postoperative complications requiring surgery, and n = 2 (20%) patients underwent relaparotomy. The rate of early postoperative mortality differed significantly between the two groups and was significantly higher among obese patients (40% vs 6.8% among non-obese patients). This study showed a significantly higher percentage of postoperative mortality and severity of postoperative complications in the group of obese patients. The prospect of further research is to study and analyze the course of the postoperative period in obese patients undergoing extended, multi-visceral and multi-stage surgery for cancer of the left half of the colon.

РАННИЕ ДИАГНОСТИЧЕСКИЕ КРИТЕРИИ НЕСОСТОЯТЕЛЬНОСТИ ЛИНИИ ШВОВ ЖЕЛУДКА И АНАСТОМОЗОВ ПОСЛЕ БАРИАТРИЧЕСКИХ ОПЕРАЦИЙ

Staple line and anastomotic leakage is frequent and threatening complication of bariatric surgery. Its early diagnostics is difficult, and search for new diagnostic criteria is necessary. Objective. To improve post-bariatric staple line and anastomotic leakage diagnostics by revealing new early diagnostic criteria. Materials and methods. Following hypothesis considered: postoperative stab neutrophils level is early sign of staple line and anastomotic leakage after bariatric surgery. Retrospective comparative study performed to test the hypothesis. Study group consisted of patients with staple line and anastomotic leakage in postoperative period (n=9). Control group consisted of patients with uncomplicated postoperative period (n=253). ROC-curves for stab neutrophils levels in 12 and 36 hours after surgery analyzed in both groups. The reference method was a comprehensive dynamic examination. Results. Area under the ROC-curve for stab neutrophils in 36 hours (AUC=0,613) was higher, than area under ROC-curve for stab neutrophils in 12 hours (AUC= 0,543). So stab neutrophils in 36 hours is more sensitive and specific early diagnostic criterion for staple line and anastomotic leakage. Sensitivity Se=55,56% and specificity Sp=72,13% achieved at the stab neutrophils in 36 hours after surgery level above 9%. Conclusion. As staple line and anastomotic leakage early diagnostic criterion stab neutrophils level in 36 hours after bariatric surgery has high specificity. Proposed criterion available in early postoperative period, when signs of leakage are obscured. In combination with other methods it promotes staple line and anastomotic leakage earlier diagnostics, what improve patients’ treatment results.

P0142CONTRAST INDUCED NEPHROPATHY AFTER CORONARY ANGIOGRAPHY

Abstract Background and Aims Determination of markers of kidney damage in patients with coronary artery disease after coronary angiography. HYPERLINK “https://www.healthline.com/health/coronary-angiography” Method The study included 303 patients with coronary artery disease who were planned coronary angiography. The initial examination of patients included an assessment of the structural and functional state of the kidneys, metabolic profile and the functional state of the cardiovascular system. Renal filtration function was assessed by the clearance of creatinine and cystatin C with the calculation of glomerular filtration rate (eGFRcr and eGFRcis) All coronary artery disease patients included in the study underwent coronary angiography using a contrast drug unigexole. If there is necessity, stenting of the coronary arteries was performed. On the 2nd day after coronary angiography, a serum creatinine concentration was determined to isolate patients in whom coronary angiography was complicated by CIN. Contrast induced nephropathy was defined as an increase in serum creatinine concentration by 25% 24 hours after coronarography. According to the study, patients were divided into 2 groups - 67.99% of patients with an uncomplicated postoperative period of caranoroangiography; CIN (-) group and CIN (+) group 32.01% of patients who developed contrast-induced nephropathy. Subsequently, the CIN + and CIN- groups were retrospectively compared according to the initial hemodynamic parameters, structural and functional state of the kidneys, and metabolic characteristics. Results The results of the study showed that eGFRcr did not significantly differ in the CIN(+) and CIN(-) groups, although it turned out to be lower in both groups. (p <0.05). While eGFRcis in the CIN(+) group was significantly lower than in patients with uncomplicated coronary angiography. Correlation analysis showed a reliable positive average relationship between the values of eGFRcr and eGFRcis in the CIN(+) group (r = 0.32, p <0.001). Correlation revealed a reliable average negative relationship between eGFRcis and the relative density of urine (r = -0.46, p <0.001), indicating a combined violation of the glomerular and canalicular function of the kidneys, which indicates that in these patients, despite the preserved eGFRcr, pathogenetic markers of impaired renal function are detected. The Resistance Index (RI), which characterizes the resistance of the microvasculature of the kidneys in all patients with coronary artery disease significantly exceeded the control values. The selected groups according to the value of RI were arranged as follows: the minimum value of RI is in the CIN(–) without diabetes mellites group, and the maximum value is in patients with СIN(+) and diabetes mellitus. Conclusion In patients with coronary artery disease undergoing endovascular procedures, eGFRcis is a more accurate indicator of latent impaired renal filtration function than eGFRcr. Decrease in eGFRcis below 89ml / min in patients with coronary artery disease at risk of developing contrast-induced nephropathy during caranoroangiography. An increase in RI of segmental arteries of the kidneys is associated with a decrease in the filtration function of the kidneys and patients with maximum RI have the greatest risk of developing glomerular dysfunction under conditions of exposure to contrast.

SELECTION OF PATIENTS WITH CONCOMITANT CHRONIC OBSTRUCTIVE DISEASE FOR ANATOMICAL RESECTIONS IN LUNG CANCER (review of literature)

The analysis of literature on the possibility of performing anatomical pulmonary resections in patients with concomitant COPD was performed. According to most researchers, FEV1 and DL (CO) more than 80 % indicated a high probability of an uncomplicated postoperative period after any anatomical resection of the lung. If the specified parameters were less than 80 %, additional studies were required: functional tests (6-minute walk test, staircase test), stress testing, calculation of predicted postoperative values of respiratory function, and, if necessary, lung scintigraphy could be performed to study regional respiratory function. The decision about the possibility and need for surgical treatment should have been made individually at the threshold values of these parameters. At the same time, there is currently no system for assessing the risk of postoperative complications for a particular patient, based on all the information about it, which represents the potential for further research.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

Externalized Mesentery Monitoring of Vascularized Jejunum Transfers.

The use of externalized jejunal monitoring flaps for jejunum transfers could be facilitative for the direct clinical assessment. Although this monitoring method would seem to be highly reliable, we modified this method and used mesentery only as a monitor to make it easy to manage the monitor more. Between 2013 and 2018, 43 patients underwent vascularized jejunum transfer for reconstruction of laryngopharyngectomy using the externalized mesentery monitor. There were 39 men and 4 women, and patient ages ranged from 40 to 80 years (average, 66.6 years). The nursing staff monitored the externalized mesentery by using handheld Doppler ultrasonography every 2 hours for 7 days after surgery. Three patients had rather weak signal of handheld Doppler ultrasonography on the externalized mesentery monitors during operation, and handheld Doppler ultrasonography could not be applied. Of the remaining 40 patients using the externalized mesentery monitor with handheld Doppler ultrasonography, 39 had an uncomplicated postoperative period. In 1 patient, no signal of Doppler ultrasonography and lack of bleeding by pin prick from the monitor segment were noted in the immediate postoperative period, and revision of the vascular anastomosis was performed. Finally, the graft was salvaged. There was no case of infection in the monitoring flap or hypertrophic scar at the resected part of the flap. Using the externalized mesentery monitoring flaps, clinical monitoring by examining the exteriorized monitoring flap is possible, and only mesentery monitors were managed easily compared with jejunum monitoring flaps.

Медикаментозное сопровождение и особенности хирургии увеальной катаракты. Предварительные результаты

Purpose. To present the results of complicated uveal cataract surgery using medication treatment schemes and a minimally invasive surgery technique. Materials and methods. The study included 13 eyes of 12 patients with uveitis-associated cataract, who underwent phacoemulsification with implantation of hydrophobic acrylic intraocular lenses. All cases were categorized into two groups with different preoperative treatment. The patients of the group 1 received the intravitreal application of Ozurdex (main group) and in the group 2 subtenon corticosteroids injections in combination with systemic pulse-therapy (the control group). The etiology of the disease was established in 10 patients where relapse-free period was 7.3±2.5 months. Minimization of surgical trauma was provided by the use of vitreoretinal instruments 25-27G, an intraoperative local (step-by-step) pupil dilatation and a gentle posterior capsule peeling. The postoperative follow-up period was from 4 to 22 months. In addition to the standard ophthalmological examination, all patients underwent B-scanning, optical coherence tomography (OCT) on Carl Zeiss Cirrus 5000, and laser flare photometry. Results. The postoperative BCVA increased in all patients (0.47±0.17) and was significantly higher than the preoperative BCVA (0.11±0.1, p<0.05). Reactivation of the inflammation was observed in 3 patients (two – in the control group and one – in the main group); an additional use of Ozurdex implant allowed to stop inflammation and macular edema. Conclusion. The use of minimally invasive phacoemulsification technique and intravitreal administration of Ozurdex implant in uveitisassociated cataract patients provides an uncomplicated postoperative period.