[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.

[Etiology of "difficult" laparoscopic cholecystectomy].

AIM: To define causes of difficult situations in various forms of acute cholecystitis depending on terms of disease and clinico-morphological changes in gall bladder area and to justify differentiated application of laparoscopic surgery for acute cholecystitis. MATERIAL AND METHODS: It was reviewed 1132 medical records of patients with acute cholecystitis. It is found that morphological changes in gall bladder and surrounding tissues depend on duration of follow-up of patients with acute cholecystitis and type of inflammation. RESULTS: In acute catarrhal cholecystitis "complicated" intraoperative situations are observed in 37.5% due to "loose" tissues infiltration, in phlegmonous and gangrenous forms of inflammation - in 44.6% and 63.6% respectively due to "dense" infiltrates development. CONCLUSION: Technical variants of laparoscopic cholecystectomy for various "difficult" intraoperative situations are suggested.

[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.

[Laparoscopic treatment of perforated ulcers].

It was done comparative analysis the results of different treatment options using of laparoscopic treatment of 331 patients with perforated ulcers. It was defined that postoperative complications frequency is increased to 1.6% in case of perforated ulcers suturing with diameter to 0.7 cm. This indication is increased to 7.1% in case of perforated ulcers suturing and plugging by greater omentum with holes diameter to 1.0 cm. The complications are absent in case of perforated ulcer excision with subsequent vagotomy and pyloroplasty.

[Laparoscopic resection of stomach in case of stomach ulcer].

Laparoscopic resection of stomach was done in 84 patients with complicated peptic ulcer of stomach and duodenum. There were 1.2% post-operative complications in case of laparoscopic resection of stomach in comparison with open resection, which had 33.3% complications. There were not deaths in case of laparoscopic resection of stomach. This indication was about 4% in patients after open resection. It was determined that functionalefficiency afterlaparoscopic resection was in 1.6-1.8 times higher than afteropen resectionof stomach.

[Non-tension abdominal wall plasty by incarcerated postoperative ventral hernias].

Treatment results of 31 patients with incarcerated postoperative ventral hernias were analyzed. Mesh hernia repair was used in all cases. Signs of hernia incarceration or intestinal obstructions were absolute indications for surgical treatment. Irreducible postoperative ventral hernia was considered as a relative indication for the operation. 16 (51,6%) operated patients had complications: 14 (45,2%) patients had seromas of the operative wound, in 11 of them seroma persisted more then 14 days. Seromas were punctured and evacuated in all of them, no suppurations were registered. 1 (3,2%) patient developed pneumonia postoperatively. Lethal pulmonary embolism occurred in one (3,2%) female patient on the first postoperative day. No hernia recurrences were registered.

[Laparoscopic resection of the stomach by Billroth-I technique]. / Laparoskopicheskaia rezektsiia zheludka po Bil'rot-I.

Laparoscopic resection of the stomach by Billroth-I technique is described. Previously different variants of laparoscopic Billroth-II resection and laparoscopy-assisted Billroth-I resection have been performed a complete variant of laparoscopic Billroth-I resection of the stomach the authors reported on Symposium of Endo-surgeons in 2004.