[Prospects for development of laparoscopic surgery in the Central Federal District of the Russian Federation]. / O perspektive razvitiya laparoskopicheskoi khirurgii v Tsentral'nom federal'nom okruge Rossiiskoi Federatsii.

OBJECTIVE: To analyze the achievements of laparoscopic surgery in the Central Federal District of Russia and outline perspective trends for further application. MATERIAL AND METHODS: The study included adult patients with abdominal surgical diseases hospitalized in general surgical departments of the Central Federal District between 2014 and 2021. We analyzed the prevalence of elective and emergency laparoscopic surgeries. Incidence and results of laparoscopic interventions between 2018 and 2021 were estimated considering primary statistical data presented in the annual collections of the Chief Surgeon of the Ministry of Health of Russia «Surgical care in the Russian Federation¼. RESULTS: The absolute number of laparoscopic surgeries in the Central Federal District increased from 23.686 to 80.489 (by 3.4 times) between 2014 and 2021. The annual number of elective laparoscopic surgeries exceeded the number of emergency ones up to 2019. In 2020-2021, this situation changed in favor of emergency abdominal procedures. Laparoscopic surgeries are the most common for in acute cholecystitis (71.06-81.10% of all laparoscopic interventions annually) and acute appendicitis (46.85-55.60%). In 2020 and 2021, the absolute number of laparoscopic appendectomies exceeded the number of laparoscopic cholecystectomies. These values are lower for perforated ulcers (15.44-20.39%) and acute pancreatitis (32.40-36.71%). Laparoscopic operations are rare for acute intestinal obstruction, strangulated hernia and ulcerative gastroduodenal bleeding. In elective surgery, high availability of laparoscopic surgeries was noted in patients with cholelithiasis (89.40-93.78%), hiatal hernia (62.12-77.27%) and adrenal gland diseases (64.23-87.25%). The most intensive increment of availability (by 2.4 times) was noted for inguinal hernia from minimum level (10.98%) in 2018 to 26.00% in 2021. Mortality after some laparoscopic operations decreased in comparison with laparotomy by 12-45 times (2018-2021). However, this aspect and results of laparoscopic surgeries in case of delayed hospitalization require additional study. CONCLUSION: Analysis of laparoscopic surgery showed the timeliness of beginning and development of this direction In Russia. The prospect of further development of laparoscopic surgery for abdominal diseases is determined by modern trends. These are increase in the number of laparoscopic operations for acute appendicitis, acute cholecystitis and perforated ulcers, as well as higher number of early (after admission) operations.

[Impact of late admission on mortality from acute abdominal diseases in the Central Federal District of the Russian Federation]. / Vliyanie pozdnei gospitalizatsii na letal'nost' pri ostrykh abdominal'nykh zabolevaniyakh v TsFO Rossiiskoi Federatsii.

OBJECTIVE: To analyze the effect of late hospitalization on mortality from acute abdominal diseases in the Central Federal District of the Russian Federation. MATERIAL AND METHODS: Analysis of late hospitalizations and in-hospital mortality was based on metadata (616.742 clinical observations between 2017 and 2021). Primary statistical data were obtained from reports of chief surgeons in 18 regions of the Central Federal District of the Russian Federation and presented in analytical collections «Surgical care in the Russian Federation¼. RESULTS: The number of patients admitted to surgical hospitals of the Central Federal District with acute abdominal diseases later than 24 hours from clinical manifestation varies depending on the underlying disease. The greatest number of late hospitalizations was observed in acute intestinal obstruction (50.82%), acute adhesive intestinal obstruction (48.49%) and acute pancreatitis (47.36%). In acute cholecystitis, gastrointestinal bleeding and acute appendicitis, admission after 24 hours was observed in 44.72, 38.65 and 33.83% of cases, respectively. Late hospitalization is even less typical for strangulated hernia (27.43%) and perforated ulcer (26.23%). In-hospital mortality significantly differs in both groups (within and after 24 hours) for all acute abdominal diseases. Extended surgery and widespread peritonitis increase these differences for strangulated hernia by 9.2 times (0.92% within 24 hours and 8.48% after 24 hours), for acute appendicitis by 8 times (0.05% within 24 hours and 0.40% after 24 hours) and for perforated ulcer by 6.3 times (4.50% within 24 hours and 28.59% after 24 hours). CONCLUSION: In the Central Federal District, about 25-50% of patients with acute abdominal diseases admitted to the hospital later than 24 hours after clinical manifestation depending on disease. We found the highest in-hospital mortality following late hospitalization in patients with strangulated hernia, acute appendicitis and perforated ulcers.

[In-hospital mortality in acute abdominal diseases in the Central Federal District of Russia depending on availability of laparoscopic procedures]. / Dinamika gospital'noi letal'nosti pri ostrykh abdominal'nykh zabolevaniyakh v Tsentral'nom federal'nom okruge Rossii v zavisimosti ot chastoty primeneniya laparoskopicheskikh operatsii.

OBJECTIVE: To study in-hospital mortality in acute abdominal diseases in the Central Federal District and compared effectiveness of laparoscopic and open surgeries. MATERIAL AND METHODS: The study was based on the previous data for 2017-2021. The odds ratio (OR) was used to assess significance of between-group differences. RESULTS: The absolute number of deceased patients with acute abdominal diseases increased significantly and exceeded 23 thousand in the Central Federal District between 2019 and 2021. This value approached 4% for the first time over the last 10 years. In-hospital mortality from acute abdominal diseases in the Central Federal District increased for 5 years and reached maximum value in 2021. The greatest changes occurred in perforated ulcers (mortality increased from 8.69% in 2017 to 14.01% in 2021), acute intestinal obstruction (from 4.7% to 9.0%) and ulcerative gastroduodenal bleeding (from 4.5% to 5.5%). In other diseases, in-hospital mortality is lower, but trends are similar. Laparoscopic surgeries are common in acute cholecystitis (71-81%). At the same time, in-hospital mortality is significantly lower in regions with more active use of laparoscopy (0.64% and 1.25% in 2020; 0.52% and 1.16% in 2021). Laparoscopic surgeries are significantly less actively used for other acute abdominal diseases. We analyzed availability of laparoscopic surgeries using the «Hype Cycle¼. Percentage range of introduction reached conditional «productivity plateau¼ only in acute cholecystitis. CONCLUSION: Most regions are stagnating in laparoscopic technologies for acute appendicitis and perforated ulcers. Laparoscopic operations are actively used for acute cholecystitis in most regions of the Central Federal District. Annual increase in the number of laparoscopic operations and their technical improvement are promising in reducing in-hospital mortality associated with acute appendicitis, perforated ulcers and acute cholecystitis.

[AUTOVENOUS REVASCULARIZATION OF THE LOWER EXTREMITY ARTERIES IN PATIENTS WITH VARIANT ANATOMY OF THE PERIPHERAL BLOOD FLOW AND THE PROGRESSIVE ATHEROSCLEROTIC PROCESS].

Obliterating diseases of the lower extremity arteries occupy a high proportion in the structure of cardiovascular morbidity in the population among the developed countries. The steadily progressing course of obliterating atherosclerosis leads to the critical lower limb ischemia and causes an unfavorable prognosis for preserving the extremity, as well as the patient's life. Nowadays, there are two ways of surgical management of this pathology: endovascular and open reconstructive interventions. The choice of the method is based on a comprehensive keeping of the patient-specific records, including the anatomical characterization of the arterial bed lesions. In case of extended occlusion of the superficial femoral artery, the open reconstructive surgery using a large saphenous vein as a transplant is recommended. This circumstance is confirmed by the autovein patency in the long term compared with a synthetic prosthesis according to the results of randomized clinical trials. Therefore, with the formation of a distal anastomosis below the gap of the knee joint, the patency of the autovein and synthetic prosthesis after 5 years is 71% and 44% respectively. In this article, we represent a clinical case of successful treatment of a patient with progression of atherosclerotic lesions of the infrainguinal segment arteries. A staged revascularization of the femoral-popliteal segment arteries using technique of a reversed vein on both lower extremities after attempts of the conservative treatment and x-ray endovascular intervention was performed. A feature of this case is the creation of a new bifurcation of the popliteal artery during the formation of a distal anastomosis below the fissure of the knee joint under the contitions of a high discharge of the anterior tibial artery.The given clinical case demonstrates the advantages of invasive surgical tactics with the aim of preserving the limb and improving the patient's quality of life.

[Large outpatient surgery. Are there prospects?] / Bol'shaia ambulatornaia khirurgiia. Est' li perspektivy?

AIM: To study frequency of 'hospital registry' operations in the polyclinics of the Central Federal district, to analyze previous experience of outpatient surgical care and to assess perspective directions of its development. MATERIAL AND METHODS: Over 48 million people who referred to polyclinics for medical care in 17 regions of Central Federal district for 6 years (2011-2016) were studied. RESULTS: Mean surgical activity in the polyclinics of Central Federal district is 4.5%. The annual number of 'hospital registry' operations does not exceed 150-200 (0.01%) for the entire district. Large outpatient surgery in Russia has evolved from active development to complete apathy and was almost always associated with health care reforming and attempts to reduce the volume of 24-hour in-patient surgical care. CONCLUSION: Advanced outpatient surgery is able to compensate routine in-hospital operations and to focus resources of these hospitals on the development of high-tech surgical care. It is necessary to change the insurance share of financing of patients operated in day surgical hospitals for successful development of 'large outpatient surgery'.

[Surgical risks and their prevention in laparoscopic cholecystectomy].

It was analyzed the treatment results of 3739 patients with chronic and acute cholecystitis who underwent laparoscopic cholecystectomy. Three groups of predisposing factors were determined in 427 high risk patients. Laparoscopic cholecystectomy in view of these factors and enhancement of approach to dissect gall-bladder decreases the number of intraoperative complications.