[Analysis of learning curves for mini-gastric bypass in 341 patients with obesity]. / Izuchenie opyta osvoeniya mini-gastroshuntirovaniya metodom postroeniya krivykh obucheniya u 341 patsienta s ozhireniem.

OBJECTIVE: To analyze learning curves and appropriate experience on the features of mini-bypass surgery in 341 obese patients. MATERIAL AND METHODS: A total of 341 laparoscopic mini-gastric bypass surgeries performed by one surgeon were studied. The median age of patients was 40.5 [34; 48.3] years. There were 284 (83.2%) women and 57 (16.8%) men. The median BMI was 45 [40;52] kg/m2. RESULTS: The period of MGB development consisted of 138 interventions. Surgery time was 120 [100; 130] min and 90 [82.5; 100] mins after development of this technique (p=0.001). Complications occurred in 5 (1.5%) patients (1 patient with Clavien Dindo grade IIIA and 4 ones with grade IIIB). Of these, there were 3 patients with stapler suture defects. There were no complications only in the 4th quartile of surgeries. Surgical experience significantly affects postoperative outcomes. Surgery time was more influenced by surgical skill rather technique of anastomosis imposing. CONCLUSION: Polynomial regression objectively characterizes development of surgical skills lasting 138 interventions. MGB is safe for morbid obesity with a complication rate of 1.5% and no mortality.

[New approach to treatment of polypous rhinosinusitis]. / Novyi vzlyad na lechenie polipoznogo rinosinusita.

ANNOTATION: Polypous rhinosinusitis (PRS) is a hardly treatable disease due to the unknown etiology and recurrent course. Standard treatment regimens are aimed at removing polyps and reducing the activity of inflammation, while little attention is paid to pathogenesis factors such as oxidative stress and mucociliary insufficiency. OBJECTIVE: To improve the combined treatment of PRS. MATERIAL AND METHODS: The study involved 98 patients (50 people - the study group, 48 people - control group). The structure of the comorbid pathology of patients in the control group was selected so as to correspond to the pathology in the study group. Patients of both groups received combined treatment, including surgical treatment in accordance with the FESS principles, followed by the prescription of 200 mcg mometasone furoate in each half of the nose for 6 months. The treatment of patients of the study group also included the drug N-acetylcysteine - 3 ml (300 mg) in each maxillary sinus intrasurgicaly, then 600 mg orally in the morning after meals for 6 months. Survey methods included a questionnaire survey using the SNOT-22 questionnaire, the prevalence of the polypous process was assessed by endoscopy (Claus Bachert scale) and CT (Lund-Mackay scale), and mucociliary function was also evaluated by performing a saccharin test. The results were compared with each other before surgery and after 6, 12 and 24 months after surgery. RESULTS: Patients who have been taking N-acetylcysteine for a long time have a more pronounced and long-term improvement in their general condition (according to SNOT-22, an average by 1.7 times, p<0.05) compared with patients in the control group. Also, the frequency of relapses decreases and the effectiveness of surgical treatment increases (according to the Lund-Mackey scale - 5.02 in the experimental group and 10.75 in the control; according to S. Bachert - 1 point and 3 points, respectively). CONCLUSIONS: Long-term use of N-acetylcysteine in PRS increases the effectiveness of surgical treatment, reduces the frequency of relapses, and also improves the general condition of patients.

[Possibilities of surgical treatment of cicatrical stenosis of the trachea].

The treatment of cicatrical stenosis of the trachea was performed in 193 patients at the age 8-65 years (132 of men and 61 women). The length of cicatrical stenosis shaped mainly by growth of granulation tissue and its different combinations consisted of 0.5 to 2.5 cm, getting 3.0 cm and more in 74 cases. The peculiar features of such cicatrical changes were characterized differently depending on its dominating localization on the length of the trachea--in the area of the neck or in the range of the mediastinum. Respiratory distresses, which were the main clinical manifestation of the disease, depended on the degree of stenisis of the trachea opening with the cicatrical process in each case. The decrease of size of the trachea opening with respect to natural size on 1/3 was considered as the first degree of stenosis, on 2/3 - II degree, more than on 2/3 - III degree. The efficiency of endoscopic methods of treatment was the most significant in cicatrical stenosis of trachea with the length not more than 0.5-1.5 cm and dramatically decreased with the increase of length. The cicatrical stenosis of trachea with the length more than 3.5-3.0 cm should be considered as the indication for radical surgical intervention such as resection and plasty of trachea with forming of intertracheal or laryngotracheal anastomosis.

[Jejunostomy by Midle in patients with insufficiency of anastomotic sutures of upper parts of gastrointestinal tract]. / Midle ieiunistomiia v lechenii nesostoiatel'nosti shvov anastomoza verkhnikh otdelov zheludochno-kishechnogo trakta.

Insufficiency of anastomosis is one of the main causes of peritonitis. Progressed cachexia due to great losses through intestinal fistulas in combination with peritonitis was the indication to jejunostoma creation. Jejunostomy by Middle in the treatment of postoperative peritonitis due to sutures insufficiency of upper anastomosis of gastrointestinal tract permits to optimize treatment: to realize adequate enteral nutrition, intestinal decompression, to return fistula's losses. Polyorganic insufficiency, number of repeated surgeries and volume of loss through fistulas influence results of the treatment. Respiratory distress-syndrome and errosive bleeding have the most prognostic significance among the syndromes of polyorganic insufficiency.