[The Capsule Endoscopy Crohn's Disease Activity Index, clinical activity and fecal calprotectin level in patients with isolated small intestine lesions]. / Vzaimosvyaz' endoskopicheskoi aktivnosti, klinicheskoi aktivnosti bolezni Krona i urovnya fekal'nogo kal'protektina.

OBJECTIVE: To identify a correlation between diagnostic markers of Crohn's disease and endoscopic data using the Capsule Endoscopy Crohn's Disease Activity Index for isolated small intestine lesions. MATERIAL AND METHODS: We studied 127 patients over previous 19 years. All patients were divided into 2 groups: isolated Crohn's disease of small intestine (group 1) and lesion of small and large intestine or large intestine only (group 2). All patients underwent capsule enteroscopy (MiroCam system, South Korea). Clinical activity of Crohn's disease was determined using the Best's scale, endoscopic activity - using the the Capsule Endoscopy Crohn's Disease Activity Index. We also analyzed fecal calprotectin and other laboratory markers. RESULTS: We found moderate correlation between fecal calprotectin and clinical activity of Crohn's disease, as well as endoscopic activity, C-reactive protein and leukocytes in overall sample of patients. There was moderate correlation between endoscopic activity and clinical activity in overall sample of patients. We found no correlation between fecal calprotectin and endoscopic activity, endoscopic activity and clinical activity, endoscopic activity and C-reactive protein and leukocytes in patients with isolated small bowel disease. Isolated small intestine lesion is accompanied by significantly lower level of fecal calprotectin compared to lesion of small and large intestine. CONCLUSION: In isolated small intestine lesion, endoscopic data do not correlate with clinical symptoms and fecal calprotectin level. Thus, analysis of severity of disease using the Crohn's Disease Clinical Activity Scale alone and fecal calprotectin may not always be effective for isolated small bowel lesion.

[Redo surgery after laparoscopic fundoplication]. / Povtornye operatsii posle laparoskopicheskikh fundoplikatsii.

OBJECTIVE: To analyze the results of redo surgeries after previous laparoscopic fundoplication. MATERIAL AND METHODS: A retrospective analysis included 37 repeated anti-reflux surgeries. Control group consisted of 38 patients after the first anti-reflux surgery performed on the same clinical base. The causes of unsatisfactory results of the first operations were studied. Intraoperative data, immediate and long-term results of surgical treatment were compared in both groups. Quality of life in both groups was studied before surgery and in long-term period using GIQLI questionnaire. RESULTS: The most common cause of recurrent reflux was a hernia recurrence combined with slipping or destruction of the fundoplication cuff. Dysphagia was usually a result of compression of the esophagus by tightly sutured diaphragmatic crura and recurrent paraesophageal hernia. The main group was characterized by significantly greater surgery time, hospital-stay, incidence of intraoperative and postoperative complications. However, a more significant improvement of quality of life (∆GIQLI) was observed in the main group due to the low QOL index before redo surgery. CONCLUSION: Redo surgeries are effective and safe procedures. These operations significantly improve QOL in long-term period despite certain technical difficulties. Repeated surgeries for dysphagia accounted for 2%, for recurrent reflux - 6%. Persistent postoperative dysphagia is usually associated with diaphragm repair rather fundoplication cuff. Reflux recurrence is often caused by cuff slippage and recurrent hernia.

[The influence of the surgical access on the endotoxemia level].

The systemic inflammatory response, induced by the lipopolysaccharides of the normoflora of the operated patients was studied on the example of the plasma changes in 107 patients. All patients were divided in 4 groups, depending on the level of lipopolysaccharides in plasma. Thus, patients with the complicated course of the acute cholecystitis, demonstrated the increased lipopolysaccharides levels. The last correlates with the surgical access, the duration of the operation and early complications development. The results may be used for the diagnostics and decision making in emergency situations.

[Choice of plastic surgery in ventral hernias].

Morphological changes in the zone of plastic surgery with polypropylene graft were studied in experiment. Results of treatment of 195 patients with ventral hernias were analyzed. Study group consisted of 86 (44.1%) patients who underwent hernioplasty with subaponeurotic localization of the graft. Subaponeurotic hernioplasty was performed in 109 (55.9%) patients (control group). Algorithm of choice of plastic surgery's method in ventral hernia was developed with consideration of localization and size of hernia that permitted to reduce rate of early postoperative complications and to improve long-term results.

[Laparoscopic splenectomy in a general surgery department of a hospital]. / Laparoskopicheskaia splenéktomiia v obshchekhirurgicheskom statsionare.

The results of treatment of 32 patients with spleen diseases who have undergone laparoscopic splenectomy (LSE) are analyzed. Surgery was performed most often for idiopathic thrombocytopenic purpura. Some technical features of surgery are discussed. It is demonstrated that high-technology methods (suturing device "EndoGia", electrosurgical unit "LigaSure") increase reliability of hemostasis, decrease blood loss during surgery and reduce time of surgery. Complications during surgery were seen in 3 (9.3%) cases, conversion - in 2 (6.3%). Mean time of surgery was 121.3 min, mean blood loss - 346 ml, postoperative complications were seen in 4 (12.5%) patients, mean hospital stay - 5.7 days. There were no lethal outcomes. It is concluded that LSE is safe and effective procedure reducing rate of infectious and hemorrhagic complications after surgery.

[Associated laparoscopic interventions for gallstones]. / Sochetannye laparoskopicheskie vmeshatel'stva pri zhelchnokamennoi bolezni.

Since 1994 till 2000 the authors have performed 1152 laparoscopic cholecystectomies. Coexistent diseases of the organs of the abdominal cavity were diagnosed in 13.02% of the patients operated on by using laparoscopic techniques. In parallel the simultaneous interventions were performed for hiatal hernias, ulcer of the duodenum, commissural disease of the peritoneum, chronic duodenal obstruction, ventral hernias, diseases of the genital organs, liver and chronic appendicitis. The greater volume of the operations when performing the associated operations by the laparoscopic method does not make the course of the postoperative period more severe and gives good results in 89.3% of the patients.

[Choice of surgical method in patients with inguinal hernias]. / Vybor metoda operativnogo lecheniia bol'nykh s pakhovymi gryzhami.

Results of surgical treatment of 310 patients with inguinal hernias were analyzed depending on hernioplasty method. Advantages of hernioplasty methods without tissues tension over traditional ones were demonstrated. Indications and contraindications of each method were determined. Algorithm of individual choice of surgery method for inguinal hernias has been developed.

[Minimally invasive technologies in the surgical treatment of patients with mechanical jaundice and suppurative cholangitis]. / Maloinvazivnye tekhnologii pri operativnom lechenii bol'nykh s mekhanicheskoi zheltukhoi i gnoinym kholangitom.

Minimally invasive technologies were used in treatment of 89 patients with cholelithiasis complicated by mechanical jaundice and purulent cholangitis. Advantages of the two-stage operative treatment of such patients were shown. The first stage is decompression of the bile duct, the second stage is a radical operation either by laparoscopic or minilaparotomic methods. It allows to avoid extensive and traumatic operations and secures better immediate and long-term results of treatment.

[Surgical treatment of patients with purulent cholangitis in cholelithiasis]. / Khirurgicheskoe lechenie bol'nykh gnoinym kholangitom pri zhelchekamennoi bolezni.

Results of treatment of 89 patients with cholelithiasis complicated by obstructive jaundice and purulent cholangitis using the minimally invasive technologies are analyzed. The advantages of two-stages surgical treatment of these patients are demonstrated. The decompression of biliary tract are performed as the first stage, radical operations by laparoscopy or minilaparotomy--as the second stage. This method permits to refuse the large and traumatic operations and to improve significantly the nearest and long-term results of treatment.

[Method of surgical treatment of hiatal hernia]. / Sposob khirurgicheskogo lecheniia gryzh pishchevodnogo otverstiia diafragmy.

A method of hiatal hernia surgery providing an opportunity to decrease postoperative complications has been proposed. The method eliminates the development of a pathologic hiatal narrowing during diaphragmocrurorraphy. The method has been used in 65 patients. The advantages of the method are demonstrated.

[Simultaneous surgeries in the treatment of stomach and duodenal diseases]. / Simultannye operatsii pri lechenii zabolevanii zheludka i dvenadtsatiperstnoi kishki.

The results of diagnosis and treatment of diseases of the stomach and intestine associated with diseases of the abdominal organs: hiatal hernia (97 cases), commissural disease of the peritoneum (31), calculous cholecystitis (28), abdominal wall hernia (22) are presented. In 34 patients, 3 and more diseases were revealed. Simultaneous operations were performed in 181 patients. At the long-term period, a good result was noted in 68.6%, a satisfactory one--in 25.5%, and unsatisfactory result--in 5.9%. The substantiated performance of simultaneous operations in patients of the given category is a perspective trend in surgery, it ensures the high medico-social and cost effectiveness of treatment.

[Diagnosis and the results of surgical treatment of perforated gastroduodenal ulcers]. / Diagnostika i rezul'taty khirurgicheskogo lecheniia perforativnykh iazv zheludka i dvenadtsatiperstnoi kishki.

The results of treatment of 438 patients with a perforating gastric and duodenal ulcer are presented. The use of emergency +gastroduodenal fibroscopy for early diagnosis permitted to reduce the incidence of diagnostic errors from 7.1% to 0. The indications for different types of operations have been established. Of the methods for gastric resection, a method with creation of +terminal-lateral +gastroduodenal anastomosis developed in the clinic is preferable. The excellent and good long-term results after closure of a perforative hole were noted in 11.7% of the patients, after vagotomy--in 91.6% after gastric resection--in 88%.