[Giant traumatic diaphragmatic hernia as a complication after laparoscopic liver surgery]. / Gigantskaya travmaticheskaya diafragmal'naya gryzha kak oslozhnenie posle laparoskopicheskoi operatsii na pecheni.

Laparoscopic surgery is now one of the main options for patients with surgical diseases of abdominal cavity, pelvis and retroperitoneal space. Postoperative complications are known, and methods for their prevention after such interventions are well developed. However, there are rare complications, and their management deserves a special attention. The authors present a patient with giant traumatic hernia in long-term period after laparoscopic liver surgery. Clinical manifestations of disease are retrospectively analyzed. The authors discuss surgical aspects of treatment, i.e. choice of access, repair of diaphragmatic defect and peculiarities of postoperative period associated with non-anatomic return of abdominal organs through the diaphragmatic defect. This report will be useful for radiologists, thoracic and abdominal surgeons, anesthesiologists and intensive care specialists.

[Resection of retroperitoneal leiomyosarcoma followed by replacement of cavarenal segment of inferior vena cava]. / Udalenie zabryushinnoi leiomiosarkomy s rezektsiei i protezirovaniem kavarenal'nogo segmenta nizhnei poloi veny Klinicheskoe nablyudenie.

The authors reported a rare clinical case of successful surgical treatment of young female with retroperitoneal leiomyosarcoma followed by lesion of the cavarenal segment of inferior vena cava, left renal vein. Clinical and morphological features of disease, postoperative outcomes and prognostic factors in patients with retroperitoneal leiomyosarcoma are discussed.

[Delayed coloesophagoplasty in difficult clinical situations].

AIM: To improve immediate and long-term results of delayed coloesophagoplasty in cancer patients. MATERIAL AND METHODS: We presented three case reports of coloesophagoplasty in difficult clinical situations including technical impossibility of primary plasty, extraordinary anesthetic situation, transplant necrosis after primary plasty. RESULTS: Gastrointestinal tract integrity was restored in all cases and patients returned to nutrition per os, that provided good quality of life and compensated nutritional deficiencies. Only one patient had bleeding in postoperative period that required relaparotomy. There were no postoperative complications in two other patients. CONCLUSION: Delayed coloesophagoplasty should be performed in all patients who underwent esophagogastrectomy if progression of primary disease is absent. Graft placement and colic segment are chosen individually. However left half of colon with retrosternal location of transplant is preferable for plasty.

[Experience of surgical treatment of abdominal and intraabdominal desmoid fibromas].

It is presented the treatment results of abdominal and intraabdominal desmoid fibromas. Group of abdominal localization included 19 patients. 15 of them had primary tumors, 4 - recurrent tumors after surgical treatment. Radical (R0) operations were performed in all cases. Tumor removal was associated with plastic of abdominal wall by synthetic implant in 17 patients. Wide excision of surrounding tissues and musculo-aponeurotic layer of anterior abdominal wall allows to achieve long-term disease-free period. There weren't recurrent symptoms in terms from 4 to 60 months of observation. The second group included 28 patients with intraabdominal desmoid fibromas. Operations were performed in 11 (35.2%) patients including 3 cases of reoperations. There were 14 operations. Radical (R0) volume was applied in 11 (78.6%) operations, cytoreductive (R2) volume - in 1 (7%) operation. Explorative laparotomy was used in 3 (21.4%) cases because of involvement of mesenteric vessels. Combined treatment was performed in 4 (14.3%) patients. 14 (50%) patients received conservative therapy because of unresectable tumor including chemo-, hormone- and radiotherapy. Operated patients were under observation in terms from 11 to 156 months, median was 63.2 months. Recurrence developed in 4 of 10 (40%) patients after R0-surgery. Cytoreductive (R1/R2) volume is admitted for intraabdominal desmoid fibromas. But even in case of unresectable process and explorative intervention stabilization and regression of tumor is possible by means of chemo-, hormone- and radiotherapy in different combination. It allows to preserve a good life quality.