[Reversal of Hartmann's procedure in patients with diverticular disease]. / Rekonstruktivno-vosstanovitel'nye vmeshatel'stva posle operatsii Gartmana u patsientov s divertikulyarnoi bolezn'yu.

OBJECTIVE: To analyze intraoperative and early postoperative results of open and laparoscopic reversal of Hartmann's (HR) procedure in patients with diverticular disease. MATERIAL AND METHODS: A single-center retrospective non-randomized study included 31 patients with complicated form of diverticular disease between 2018 and 2022. Patients underwent reversal of Hartmann's procedure (laparoscopic surgery - 19, laparotomy - 12). RESULTS: Mean time of laparoscopy and open surgery was 202±36.7 and 223±41 min, respectively. There were no intraoperative complications in both groups and conversions of laparoscopic reversal of Hartmann's procedure. No preventive stoma was required. Mean postoperative hospital-stay was 7.6±3.2 and 9.5±4.6 days, respectively. Overall incidence of postoperative complications was 32.2% (n=10), i.e. 4 (21%) and 6 (50%) patients in both groups, respectively. Anastomotic leakage occurred in one patient after open surgery. CONCLUSION: In our sample, incidence of complications was low after reversal of Hartmann's procedure in patients with complicated diverticular disease. There was 1 (3.2%) patient with anastomotic leakage, and no temporary stoma was formed. In patients who underwent laparoscopic Hartmann's procedure at the first stage and selected patients after open surgeries, laparoscopic reversal procedures were accompanied by no conversions. There were favorable results typical for minimally invasive surgery. Selection criteria for laparoscopic access are discussable. Large-scale studies including randomized trials are needed to verify selection criteria for minimally invasive reversal of Hartmann's procedure and demonstrate its advantages over open surgery.

[The results of colorectal resection for bowel deep infiltrating endometriosis]. / Osobennosti kolorektal'nykh rezektsii pri glubokom infil'trativnom endometrioze.

OBJECTIVE: To study the early postoperative outcomes of segmental bowel resections in patients with colorectal endometriosis. MATERIAL AND METHODS: A retrospective study included 60 patients diagnosed with deep infiltrative endometriosis who underwent surgical treatment with segmental bowel resection between 2016 and 2022. RESULTS: All surgeries performed by two teams (gynecologic & colorectal). 59 operations were performed by laparoscopic access and one open. The average operation time was 263.5±86.0 min, estimated blood loss 126.1 ml (10-400 ml). There were no intraoperative complications. There were no conversions during laparoscopic surgery. A protective stoma was not required in any patient. The median postoperative hospital stay was 7.5±4.2 days. Bowel function was restored by an average of 4.3±3.1 days. Postoperative complications were in 7 cases (11.6%). Anastomotic leakage occurred in one patient (1.6%). The incidence of urine retention requiring repeated bladder catheterization was 2 (3.3%). CONCLUSION: The use of a minimally invasive multidisciplinary approach makes it possible to perform the required volume of surgery with excision of all tissues affected by endometriosis with a low level of complications and the absence of conversions.

[Pain and quality of life after laparoscopic transabdominal preperitoneal hernioplasty with different ways of fixing the peritoneum. Results of early completion randomized clinical trial]. / Bolevoi sindrom i kachestvo zhizni posle laparoskopicheskoi transabdominal'noi preperitoneal'noi gernioplastiki s raznymi sposobami fiksatsii bryushiny. Rezul'taty dosrochno zavershennogo randomizirovannogo klinicheskogo issledovaniya.

OBJECTIVE: To compare and statistically evaluate the severity of pain syndrome and quality of life depending on the method of fixation of the parietal peritoneum during laparoscopic hernia repair (suture fixation or the use of tack fixation). METHODS: A randomized clinical trial was conducted from May to June 2021 at the Lomonosov Moscow State University Medical Center. It was planned to observe patients for a year. In the first group, the fixation of the parietal peritoneum was performed using suture fixation, in the second group, the peritoneal flap was fixed using a fixation device. In the course of statistical data processing, it was planned to study the dependence of the duration of the operation, the severity of the pain syndrome in the early postoperative period, the frequency of complications, the quality of life of patients in the postoperative period on the chosen method of the fixation of the parietal peritoneum. RESULTS: At the initial stage of the study, 8 patients with inguinal hernias were selected in the first group during randomization, and 6 patients were selected in the second group. Each patient of the second group in the early postoperative period had a more pronounced local pain, protective muscle tension in the projection of fixation of the parietal peritoneum with tacks, which was accompanied by negative psychoemotional reactions, an increase in the dose of analgesic drugs. Due to the revealed features of the early postoperative period in patients of second group, it was considered unethical and inappropriate to continue the study within the protocol. CONCLUSION: The results obtained do not allow us to draw statistically supported conclusions. The solution of the problem of the peritoneal flap fixation method is possible in two ways: abandoning stapler fixation in favor of suture or conducting additional clinical studies with an analysis of the impact of the choice of peritoneal fixation technique not only on acute and chronic postoperative pain, but on quality of life in the early and delayed postoperative periods.

[Results of laparoscopic pelvic exenterations]. / Rezul'taty laparoskopicheskikh tazovykh ekzenteratsii.

OBJECTIVE: To analyze clinical outcomes after pelvic exenteration for advanced primary or recurrent pelvic cancer. MATERIAL AND METHODS: We analyzed the outcomes in 35 patients after pelvic exenteration for advanced primary or recurrent pelvic cancer (gynecological cancer, urologic cancers, colon cancer). There were 3 (8.57%) men and 32 (91.43%) women. Mean BMI was 26 kg/m2. RESULTS: Total exenteration was performed in 10 (28.57%) patients, anterior exenteration - 18 (51.43%) patients, posterior exenteration - 7 (20.0%) patients. Intraoperative complications (damage to the common iliac vessels) occurred in 1 (2.86%) patient. Mean surgery time was 280 minutes (range 180-600), mean intraoperative blood loss - 400 ml (range 100-2000). Mean postoperative ICU-stay was 24 hours. Major postoperative complications Clavien-Dindo grade 3-4 were detected in 3 (8.57%) patients. One (2.86%) patient died in 84 days after surgery from multiple organ failure due to progression of disease (Clavien-Dindo grade 5). There were 4 (11.43%) patients with complications Clavien-Dindo grade ≥3. Negative resection margin (R0) was achieved in 32 (91.43%) cases. The follow-up period ranged from 2 to 70 months (median 16.5 months). Overall survival was assessed in 25 patients. Other 10 patients or their relatives did not get in touch and therefore did not participate in assessment of survival. Overall 2-year survival assessed in 6 patients with cervical cancer was 24%. Overall 2-year survival estimated in 8 patients with bladder cancer was 100%. A patient with colon cancer lived for 23 months. Among 2 patients with vulvar cancer, 1 patient died in 25 months after surgery, the second one was followed-up for 11 months. Patients with primary multiple tumors were followed-up for 10-21 months. Overall 1-year survival was 100%. One patient died after 21 months. CONCLUSION: Analyzing own findings and world literature data, we can conclude that laparoscopic technique ensures better intra- and postoperative results compared to standard laparotomy. However, there are insufficient data to confirm superiority of laparoscopic approach regarding oncological results.

[Features and results of minimally invasive treatment of recurrent achalasia]. / Osobennosti i rezul'taty maloinvazivnogo lecheniya retsidiva akhalazii kardii.

OBJECTIVE: To evaluate the early and long-term postoperative outcomes in patients with recurrent achalasia, as well as the main features of surgical treatment. MATERIAL AND METHODS: There were 7 patients (4 men and 3 women) with recurrent achalasia. Mean age of patients was 42.3±13.5 years, body mass index - 22.7±3.3 kg/m2. Physiological status ASA grade 1-3 was observed in all patients. Concomitant diseases were diagnosed in 5 (71.4%) cases. Six (85.7%) patients underwent laparoscopic Heller cardiomyotomy with Dor fundoplication. Peroral endoscopic myotomy (POEM) was performed in 1 (14.3%) patient. Mean preoperative Eckardt score was 10.7±1.4 points, mean GERD-HRQL score - 42.7±6.4 points. According to preoperative radiography, 5 (71.4%) patients had achalasia stage III, 2 (28.6%) ones - stage IV. RESULTS: All patients underwent laparoscopic Heller esophagocardiomyotomy with anterior Dor fundoplication and posterior partial fundoplication with posterior cruroraphy. Intraoperative complications (perforation of esophageal mucosa) occurred in 3 (42.9%) patients. Mean surgery time was 130±56 min, mean blood loss - 37 ml (35-205 ml), mean hospital-stay - 11.3±7.7 days. Postoperative complications Clavien-Dindo grade 3-4 were detected in 1 (14.3%) patient. One patient was diagnosed with bilateral pneumonia (SARS-Cov-2 infection) in 4 postoperative days. Median postoperative follow-up period was 22 months. Mean BMI in 6 months after surgery was 25.3±3.1 kg/m2, mean Eckardt score - 2.1±0.7 points, mean GERD-HRQL score - 3.3±0.9 points. CONCLUSION: Our data confirm the effectiveness and safety of the modified laparoscopic Heller procedure with Dor fundoplication as the main method for recurrent achalasia.

[Unilateral combined lap partial nephrectomy and pyelolithotomy for ipsilateral tumor & kidney staghorn stone]

OBJECTIVE: To discuss the feasibility, safety, and effectiveness of conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone. MATERIALS AND METHODS: Retrospective multicentral comparative study. Group "Combo" was presented by patients with the mentioned combined pathology (n=15). Group "Standart" (n=69) formed from common patients who underwent standard lap partial nephrectomy for renal tumor in the absence of kidney stones. Perioperative factors and results were studied and compared. Video presentation of combined surgical technique is available at: https://youtu.be/fAfYJDvGzsU. RESULTS: Of all patients, no positive margins, no conversions to open surgery or nephrectomy & any complications Clavien >III were detected. There were no any significant differences between the two groups except for OR time (150 [120; 210] vs 130 [100; 180] min; p=0,001). Differences between indexes of WIT (16,27+/-3,8 vs 15,9+/-4,5 min; p=0,107), EBL (200 [150; 300] vs 200 [150; 300] cc; p=0,981), length of stay (7 [6;9] vs 8[6;9] days; p=0,611), intraop complications (0,00 vs 4,3%; p=0,411) and values of postop Clavien III rate (0,00 vs 4,3%; p=0,411) for "Combo" & "Standart" respectively were comparable as well as oncological outcomes. Stone-free rate for combined procedures reached 93,3%. CONCLUSION: conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone is safe and efficient alternative to 2-step treatment of this rare disease.

[Esophageal achalasia: possible pathogenic concepts from the perspective of modern notions]. / Akhalaziya kardii: vozmozhnye patogeneticheskie kontseptsii s pozitsii sovremennykh predstavlenii.

Esophageal achalasia is an esophageal motility disease characterized by impaired relaxation of lower esophageal sphincter (LES) and severe clinical symptoms. The main etiological factors and other essential aspects of pathogenesis and progression of this disorder are actively studied. To date, the question of significance of etiological factors is experimental and requires further study. In this review, the authors analyzed and summarized the modern data on etiology and pathogenesis of this disease considering the new researches devoted to this issue.

[Outcomes of various techniques of mesh prosthesis fixation in laparoscopic hernia repair]. / Rezul'taty razlichnykh metodik fiksatsii setchatogo proteza pri laparoskopicheskoi gernioplastiki (TAPP).

OBJECTIVE: To compare early and long-term results of various mesh prosthesis fixation methods in laparoscopic inguinal hernia repair. MATERIAL AND METHODS: It is a prospective clinical non-randomized trial. The study included 212 patients. Conventional stapler fixation (112 patients), self-gripping mesh implants (48 patients) and n-butyl cyanoacrylate adhesive fixation (52 patients) were compared. We estimated surgery time, pain syndrome severity in early and long-term postoperative period, postoperative morbidity and recurrence rate were evaluated. RESULTS: Early postoperative morbidity, activation of patients and hospital-stay were similar in all groups. Pain syndrome within 6 postoperative hours in the first group exceeded the same parameter in the second group by 1.23 times (95% CI 1.15-1.31, p<0.05) and by 1.19 times in the third group (95% CI 1.12-1.26, p<0.05). Within 12 hours, pain syndrome in the first group was 1.27 times more severe compared to the third group (95% CI 1.20-1.34, p<0.05). Pain syndrome in long-term period was similar in all groups. In the first group, one recurrence was detected (0.9%). CONCLUSION: There were no significant between-group differences. However, we found the correlation of postoperative pain syndrome with mesh implant fixation technique.

[Comparison of efficiency and safety of laparoscopic manual esophagoenterostomy and esophagoenterostomy with mechanical anastomotic devices after laparoscopic gastrectomy for stomach cancer]. / Sravnenie bezopasnosti i effektivnosti primeneniya metodiki ruchnogo intrakorporal'nogo ezofagoenteroanastomoza i apparatnogo ezofagoenteroanastomoza s ispol'zovaniem lineinykh sshivayushchikh apparatov posle laparoskopicheskoi gastrektomii po povodu raka zheludka.

OBJECTIVE: To compare laparoscopic manual esophagoenterostomy and esophagoenterostomy with mechanical stapling anastomotic devices after laparoscopic gastrectomy for stomach cancer. MATERIAL AND METHODS: There were 34 patients who underwent laparoscopic gastrectomy for stomach in 2015-2018. Roux-en-Y esophagoenterostomy was used to reconstruct the gastrointestinal tract. Manual anastomoses were performed in 18 patients (group 1), stapled anastomoses (endogia 45 mm, covidien, mansfield, ma, usa) - in 16 patients (group 2). There was no randomization. Surgery duration, length of icu-stay, terms of enteral nutrition initiation, postoperative complications, hospital-stay were analyzed. RESULTS: Mean duration of surgery in the first group was 217 (184-302) min, in the second group - 201 (162-311) min. Duration of surgery in the first group was 1.08-fold higher than in the second group (95% CI 1.03-1.13, p=0.05). Mean blood loss was 145 ml in both groups. Mean icu-stay was 20.2 (17-42) hours in the first group and 21.1 (16.2-46) hours in the second group (ratio 0.96, 95% CI 0.92-1.01, p=0.06). Total enteral feeding (sipping) was initiated on the third day in both groups. Mean postoperative hospital-stay was 9.21 (6-13) days in the first group and 9.23 (6-12 days) days in the second group (ratio 0.99, 95% CI 0,95-1.02, p=0.06). Postoperative morbidity was 5.5% in the first group and 6.25% in the second group. CONCLUSION: Laparoscopic manual esophagoenterostomy proposed by our surgical team does not have disadvantages in comparison with stapling anastomotic devices and these methods may be alternative to each other.

[Methods of the videoendoscopic correction of the ureters strictures].

THE PURPOSE OF THE STUDY: a retrospective analysis of the results of patients treatment with ureteral strictures by evaluating the effectiveness of various methods of laparoscopic operations. MATERIALS AND METHODS: a retrospective analysis of the treatment of 30 patients operated in the Central Hospital of Civil Aviations from 2013 to the present time with strictures of all departments of the ureters, except the pelvic-ureteral segment (LMS), was performed. The study included 18 women and 12 men. The age of patients was 54+/-8.1 years (29-79 years) for men and 51+/-8.5 years (28-74 years) for women. According to the results of x-ray examinations, the length of ureter stricture was determined, after that selected the tactics of surgical treatment. The study included patients who underwent intestinal plastics of the ureter, the operation Boari, ureterocystoanastomosis, ureteroureterostomy. All stages of surgical interventions were performed laparoscopically. RESULTS: 23 patients (76.66%) had a smooth postoperative period. A month after the operation, ureteral stents were removed. Attacks of acute pyelonephritis, relapses of the disease were not observed during the follow-up period from 7 months to 3 years. Possible complications are analyzed. In one case, after intestinal plastic surgery of the ureter in the postoperative period, the phenomena of small bowel obstruction were noted, which required surgical treatment in the volume of applying a bypass eunoascendoanastomosis "side by side". In 7 cases, anastomosis strictures were diagnosed in the postoperative period. In the 5 cases, after examination (CT of the urinary tract with contrast, antegrade ureteropyelography), the anastomosis was recognized compensated. CONCLUSION: It is shown that all the necessary range of operations can be performed by laparoscopic method while preserving all the advantages of low-trauma access.

[Comparison of minimal invasive technologies for treatment of infected pancreatic necrosis]. / Sravnitel'naia otsenka minimal'no invazivnykh metodik lecheniia infitsirovannogo pankreonekroza.

AIM: the assessment of the role of minimally invasive interventional procedures in the treatment of patients with infected pancreatic necrosis and their safety, as well as comparison of the results of the most common modern minimally invasive techniques among themselves. METHODS: The results of treatment of 310 patients are presented with infected destructive pancreatitis from 2013 to 2018 on the basis of the city clinical hospital named after I.V. Davydovsky. The patients were divided into three groups: in the first one (n=170) patients underwent puncture followed by drainage of necrotic foci under ultrasound and CT control, in the second (n=98) patients underwent sanation of foci completely by laparoscopic access, in the third (n=42) a series of retroperitoneoscopy was used for the same purpose. RESULTS: In 114 (67.1%) cases, patients from the first group did not require further surgical intervention. The results of percutaneous drainage were successful. The average length of hospital stay in the first group was 27 days, in the second and third groups - 31 days (the ratio in the 2nd and 3rd groups was 1.03 (95% CI 0.97-1.08; p<0.05)). In the course of treatment, complications were identified in 35 (35.7%) patients in the 2nd and 17 (40.4%) patients in the 3rd group (ratio 0.88 (95% CI 0.82-0.94)). There were 22 (7.1%) deaths. The causes of death were: 1 (0.3%) of the patient had arrosive bleeding, 2 (0.7%) had duodenal fistulas, 19 (6.1%) multiple organ failure against the background of widespread retroperitoneal phlegmon. CONCLUSION: The efficacy of treatment of infected pancreatic necrosis depends on the possibility of full drainage of the necrotic focus, regardless of approach. Minimally invasive techniques can reduce intraoperative trauma by reducing the wound surface, which contribute to develop systemic inflammatory response syndrome.

[Early ileostomy closure in patients with rectal cancer. Primary results of the randomized controlled multicenter trial]. / Rannee zakrytie ileostom u bol'nykh rakom priamoi kishki. Pervye rezul'taty randomizirovannogo mul'titsentrovogo issledovaniia.

AIM: To evaluate safety of early closure of ileostomy in patients with rectal cancer after primary surgery. MATERIAL AND METHODS: The trial included patients from several medical centers without signs of anastomotic leakage. CT-proctography or rectoscopy were performed in 8 days after primary surgery to confirm integrity of the anastomoses. Exclusion criteria were factors affecting normal tissue regeneration (diabetes mellitus, steroid drugs prescription, etc.). Patients with intact anastomoses and no exclusion criteria were randomized into 2 groups: group 1 (n=31) with early closure of ileostomy (in 8-13 days after surgery) and group 2 (n=34) with delayed closure (after 12 weeks). All data were analyzed. RESULTS: Postoperative morbidity was similar in both groups (6.45% vs. 5.88%, p=0.08). However, less duration of reconstructive surgery was noted in group 1 (50 (27-126) min vs. 71 min (31-134). This value was 1.42 times less in the main group (95% CI 1.30-1.52; p=0.02). CONCLUSION: Early closure of ileostomy in patients after surgery for rectal cancer is feasible and does not result increased postoperative morbidity. This approach may be considered as an alternative to delayed closure. However, further researches devoted to analysis of ileostomy-associated complications and quality of life are necessary.

[Horseshoe kidney tumor laparoscopic surgery. First 19 cases].

INTRODUCTION: Although horseshoe kidney (HSK) is the most common congenital anomaly of the upper urinary tract, renal cell cancer (RCC) in HSK develops extremely rarely. Until 2012 y. there were less than 200 cases of RCC in HSK published in PubMed. Only five cases of laparoscopic partial nephrectomies and some cases of heminephrectomies have been described in PubMed. AIM: To conduct a multicenter retrospective analysis of laparoscopic surgery for tumors in HSK. MATERIAL AND METHODS: From January 2013 to December 2018 a total of 19 conventional laparoscopic interventions were performed in patients with RCC in HSK, including 1 isthmusectomy, 5 partial nephrectomies and 13 heminefrectomies. In addition, 16 divisions of isthmus were done in 15 patients. The video describing our operation technique is available on: http://youtu.be/nk-WlbjNtIs . RESULTS: There were no conversions to open surgery and mortality as well as intra- and postoperative complications of Clavien grade 3 or higher. Warm ischemia time during partial nephrectomy didnt exceed 19 minutes. Operative time ranged from 110 to 270 min, while max estimated blood loss was 400 ml. All patients were followed for 6 month and no case of disease recurrence or progression was noted. CONCLUSIONS: The small number of laparoscopic interventions in patients with RCC in HSK doesnt allow to carry out a proper statistical analysis and draw certain conclusions. We presented the largest experience available in the literature and our results demonstrate the efficacy and safety of conventional laparoscopic technologies in the treatment of RCC in HSK.

[Redo laparoscopic surgery for recurrent gastroesophageal reflux disease and hiatal hernia]. / Povtornye laparoskopicheskie operatsii pri retsidive gastroézofageal'noi refliuksnoi bolezni i gryzhi pishchevodnogo otverstiia diafragmy.

AIM: To assess mechanisms of recurrent gastroesophageal reflux disease and the ability to perform adequate surgical correction after previous surgery. MATERIAL AND METHODS: The authors from various surgical centers have operated 2678 patients with gastroesophageal reflux disease and hiatal hernia for the period 1993-2018. 127 (4.74%) patients underwent redo surgery for recurrent disease, 46 of them were previously operated in other clinics. RESULTS: Median follow-up after redo surgery was 63 months (12-139). Satisfactory functional result was achieved in 76.4% of patients.

[Laparoscopic ileal ureteral substitution. Results of the first 40 operations].

INTRODUCTION: Despite the twenty-year history of laparoscopic ileal ureteral substitution, the literature is lacking studies reporting its outcomes, and those few are mainly case reports. Besides, they usually describe surgery from combined access, when the ileal segment resection and ileo-ileal anastomosis are performed from mini-laparotomy, and the remaining stages are done endoscopically. AIM: To conduct a multicenter retrospective analysis of our series of patients undergoing laparoscopic ileal ureteral substitution using only endoscopic access. MATERIAL AND METHODS: From 2010 to 2017, 48 ureters were replaced completely laparoscopically in 40 patients. Of them, 33 patients underwent total ureteric replacement, and the others had a subtotal ileal ureteral substitution. Video describing the operation technique is available on https://youtu.be/IeA60pSiUBE. RESULTS: The mean operating time was 335 minutes, and the estimated blood loss was 221 ml. Intraoperative complications (7.5%) were resolved during surgery. No patients required conversion to open surgery. There was no mortality. Postoperative Clavien III complications were observed in 7.5% of patients. The mean length of hospital day was 13.5 days. Functional results were followed from 6 months to 7 years. CONCLUSIONS: The presented material is the largest available in the literature, and the results, including long-term functional outcomes, demonstrate the efficacy and safety of laparoscopic technologies in the treatment of extensive strictures and obliterations of the ureter.

[Laparoscopic pyelolithotomy for staghorn kidney stones. multi-center study].

AIM: To analyze the effectiveness and safety of laparoscopic pyelolithotomy (LP) in treating staghorn stones. MATERIALS AND METHODS: A multicentre retrospective analysis of the results of LP performed from January 2004 to December 2016 was conducted. INCLUSION CRITERIA: patients with staghorn calculi K3-K4, who underwent LP as an alternative to percutaneous nephrolithotripsy. The analysis included the incidence and structure of intra- and postoperative complications, the causes of access conversion, operating time, duration of postoperative hospital stay and stone clearance. RESULTS: A total of 137 patients met the inclusion criteria, including 78 (56.93%) men. There was no mortality and access conversion. Intraoperative complications occurred in 2 (1.46%) patients. Operating time was 130 [100; 150] min, blood loss was 150 [100; 200] ml. No need for blood transfusion was observed. The cumulative rate of postoperative complications was 5.11%, stone clearance was achieved in 86.13% of observations, the duration of postoperative hospital stay was 7 [7; 11] days. CONCLUSION: In cases of dense staghorn calculi located in a large "extra-renal" pelvis and have calyceal branches equal to the diameter of their necks, laparoscopic pyelolithotomy is an alternative not only to open, but also to percutaneous surgery.

[Comparative assessment of treatments for prostate adenoma greater than 100 cm3].

AIM: To compare holmium laser enucleation of the prostate (HoLEP) and endovideosurgical (EVS) adenomectomy in the treatment of prostate adenoma. MATERIALS AND METHODS: We compared treatment results of 180 patients with prostate adenomas greater than 100 cm3 who underwent EVS adenomectomy (n=90) and laser enucleation of the prostate (n=90). The analysis included the following parameters: duration of catheterization, length of postoperative hospital stay, I-PSS score, maximum urinary flow rate measured by uroflowmetry and complications according to Clavien-Dindo grading systems. RESULTS: There were no significant differences in patient age, preoperative prostate size, glandular tissue weight, and operative time. The duration of catheterization (p=0.0008) and length of postoperative hospital stay (p<0.0001) were significantly shorter in the HoLEP group. Both groups showed a statistically significant improvement in functional performance at three months post-surgery. Complications in the HoLEP and EVS adenomectomy group occurred in 18 (20%) and 23 (25.55%) patients, respectively (p>0.99). CONCLUSION: The two methods mentioned above are widely used in the treatment of prostate adenoma. However, holmium laser enucleation of the prostate shows similar short-term functional results and complication rates compared with EVS adenomectomy for prostate adenomas greater than 100 cm3. The patients of the HoLEP group had better results regarding the duration of catheterization and length of postoperative hospital stay. Therefore, laser enucleation is the preferred surgical modality for prostate adenomas greater than 100 cm3.