[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.

[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.

[Topical diagnostics and surgical treatment of giant pheochromocytoma].

Laparoscopic operation is considered to be the optimal for treatment of pheochromocytoma nowadays. Though by the large size of the tumor the laparoscopic approach can be quite troeblecome because not only difficulties with the central tumor vein identification and visualization, but severe intraoperative hemodynamic disorders. On the other hand, the traditional open surgery for such patients has certain technical features and requires a more thorough and intentional examination. Data of 5 operated patients with giant pheochromocytoma was processed and analyzed. Features of the preoperative examination and operative technique were described.

[Endoscopic ureterolithotomy in large concrements of the upper third of the ureter].

Endoscopic ureterolithotomy was made in 38 patients who had concrements in the upper third of the ureter more than 1 cm in size. Operations were retroperitoneoscopic and laparoscopic in 20 and 18 cases, respectively. Five patients had recurrent stones, 7 patients had prior extracorporeal shock-wave lithotripsy, 2 patients failed contact ureterolithotripsy. In the rest cases endoscopic ureterolithotomy was a first-line treatment. A complete elimination of the stone was achieved in all the cases. Mean time of the operation in a retroperitoneoscopic approach was 149 min, in laparoscopic - 125 min. Mean blood loss was the same. Conversion was performed in one case in the group of retroperitoneal approach. Postoperative stay in hospital in retroperitoneo- and laparoscopic ureterolithotomy was 3 - 16 days. Laparoscopic ureterolithotomy produced a complication in one case - an insignificant injury of the colon. Urinous infiltration and pneumonia developed after retroperitoneoscopic ureterolithotomy in one and one case, respectively. Thus, endoscopic ureterolithotomy in large stones of the upper third of the ureter via retroperitoneal and transperitoneal approach is a safe, low-invasive and effective operation which provides complete stones elimination. Endoscopic ureterolithotomy should be done in uneffective first-line treatment. It is a leading method in the treatment of large and long-standing stones of the upper third of the ureter.

[Competitive hormonally active adrenal tumours (aldosteroma and pheochromocytoma)].

The development of two hormonally active tumours in one adrenal gland is a very rare event. Four cases with this condition are reported. Clinical, instrumental, and morphological characteristics of aldosteromas and pheochromocytomas are presented. Peculiarities of anesthesiological management of such patients are discussed. Classification of concomitant adrenal pathologies and proposals on its modification are presented. Relevant literature publications are reviewed and analysed.

[The wound healing stimulation].

The aim of the study is to work out the method of stimulation of postoperative wound healing after emergency abdominal surgery. Morphologic and morphometric studies showed that serotonin and/or NO-therapy use in the treatment of surgical laparotomic wounds furthers its healing by decreasing distrophic and inflammatory processes and favouring fibroblast proliferation, neoagiogenesis, collagen production etc. Results of 763 patients with laparotomic wounds treated with serotonin, mexidole and NO postoperatively demonstrate faster wound healing and absence of infectious suppurative complications.

[Efficacy of endoscopic dissection of perforant veins in lower limb chronic lymphovenous insufficiency].

Overall 156 patients with lower limb chronic lymphovenous insufficiency were treated and analyzed. All the patients were divided into 3 groups depending on method of perforant veins dissection. First group consisted of 46 patients who underwent epifascial dissection (Cokket's operation), 2nd group--50 patients undergone isolated subfascial dissection from small separate incisions (Madden-Kim's operation), 3rd group--60 patients after endoscopic subfascial dissection (SEPS technology). The results were followed-up to 5 years. It is demonstrated that SEPS technology is associated with the best results in early and late postoperative period (8.3% of recurrences) and prevents the progress of chronic lymphovenous insufficiency. Subfascial dissection promotes early normalization of lower limb microcirculation parameters. Epifascial dissection permits to achieve satisfactory early results, but long-term results are associated with high rate of recurrences especially at the patients with trophic lesions.

[Endovideosurgical methods at the treatment of patients with cholelithiasis].

Experience of 10,046 laparoscopic cholecystectomies is analyzed. The were 8097 female and 1949 male patients aged 13 to 93 years. Complicated cholelithiasis was seen at 4310 (42.9%) patients including 792 patients with acute inflammation of gallbladder, 2375--with chronic empyema, 1143--with gallbladder hydrops. Choledocholithiasis was diagnosed at 502 patients, Mirizzi syndrome--at 8, biliodigestive fistulas--at 12, cancer of gall bladder--at 5 patients. Mini-invasive endoscopic methods were used at all the patients, conversion to open surgery was necessary at 23 cases. Average time of surgery was 20-35 min, hospital stay--1-6 days. Intra- and postoperative complications were diagnosed at 86 patients among the first 3000 procedures. Among successive 7000 operations (after development of prophylactic complex) there were only 3 cases of trocar puncture infection. There were 2 cases of lethal outcome due to pulmonary embolism and pancreonecrosis.

[Characteristics and results of retroperitoneoscopic operations in urology].

The aim of the study was analysis of retroparietoscopic operations made in patients with renal cysts, anomalies of the kidneys, uretero-pelvic strictures, concrements of the upper third of the ureter to optimize treatment policy. A total of 29 patients were treated in the urological department (17 males, 12 females, age 23-70 years, mean age--49.7 years). Of them, 18--for renal cysts, 4--for ureteropelvic stricture (postoperative structure--1, ureterovasal conflict--2, high position of the ureter--1), postoperative stricture of the lower third of the left ureter--1, urolithiasis--5 (located in the upper third of the ureter--4, located in the pelvis and lower calyces of the dystopic left kidney--1), hydroureteronephrosis of the upper half of the double right kidney--1. Ultrasound scanning was followed by multispiral computed tomography. Retroparietoscopic method is characterized by limited positions of the instrumental trochar, absence of definite anatomic marks and difficulties in maintenance of necessary pressure in the cavity. Valid position of the trochars in the retroperitoneoscopic operation is a necessary condition of successful operation. In retroparietoscopic interventions the operative approach includes creation of the primary cavity, placement of trochars and creation of working cavity. Duration of retroperitoneoscopic operations ranged from 1 hour to 4 hours 30 min. Only short-term fever was a complication. Postoperative hospital stay was 1 to 7 days. Thus, retroperitoneoscopic operations are a good alternative to conventional surgery.

[Use of laparoscopic suturing devices in abdominal surgery]. / Ispol'zovanie laparoskopicheskikh sshivsiushchikh apparatov v abdominal'noi khirurgii.

The article deals with the results of clinical use of a laparoscopic suturing instrument in appendectomy in 2 patients with acute appendicitis. The authors describe the techniques of laparoscopic appendectomy with application of a mechanical suture to the mesentery and stump of the process. The advantages of this operation over the traditional interventions in acute appendicitis are shown: the absence of the pain syndrome after the operation, shorter duration of in-patient treatment, and the best cosmetic effect.

[Perforated pyloric and prepyloric ulcers]. / Perforativnye piloricheskie i prepiloricheskie iazvy.

Various surgical interventions were conducted in the clinic on 63 patients for perforation of pyloric and prepyloric ulcers. Closure of the perforated ulcer was performed in 8 patients, excision of the ulcer and transverse pyloroplasty in 14, truncal and selective vagotomy in combination with antrumectomy in 6, and truncal vagotomy and pyloroplasty in 3 patients. According to the authors, the operation of choice is anterior seromyotomy of the body and fundus of the stomach in combination with posterior truncal or posterior selective vagotomy and obligatory excision of the ulcer for histological study, and transverse pyloroplasty of the Aust-Holle type which was performed in 22 patients. The indications for radical operations were expanded bearing in mind the peculiarities of the course of peritonitis in patients with perforated gastric ulcers. In addition to the traditional prophylactic treatment of the abdominal cavity, the complex treatment of peritonitis included the use of low-frequency ultrasound during the operation and prolonged laparoscopic prophylactic treatment with low-intensity laser beam in the postoperative period.

[Surgical treatment of diseases of the small intestine]. / Khirurgicheskoe lechenie zabolevanii tonkoi kishki.

The article deals with experience in surgical treatment of 375 patients with various diseases of the small intestine, rare diseases (tuberculosis, enterolithiasis, tumors, etc.) among others. These diseases were usually manifested clinically in the late stages by ileus, peritonitis or bleeding into the gastrointestinal tract. Most patients with surgical diseases of the small intestine were subjected to operation for emergency indications. Such instrumental methods as laparoscopy, selective endoscopic radiocontrast study of the small intestine, angiography, etc. are important in the diagnosis of the diseases. The authors emphasize the high diagnostic efficacy of a special method of selective endoscopic radiocontrast study, especially in tumors of the small intestine. According to the authors, general mortality rate in diseases of the small intestine is high (13%) and is mainly due to such diseases as disorders of mesenteric blood circulation, incarceration of the intestine in a hernia, adhesive obstruction, volvulus, etc. The authors claim that mortality in diseases of the small intestine can be reduced if early diagnosis, early hospitalization, and adequate surgical interventions are ensured. Among the factors contributing to increase of the efficacy of surgical operations the authors indicate efficacy of surgical operations the authors indicate precision techniques of intestinal suture application with atraumatic suture material, the use of complex biological protection of the anastomosis including treatment with low-frequency ultrasound and subsequent application of collagenic films in which antibacterial agents are deposited, and measures for stimulating reparative regeneration.(ABSTRACT TRUNCATED AT 250 WORDS)