[The emergency simultaneous abdominal and pelvic surgery].

The authors summarized the experience of the emergency surgical treatment of 965 patients with combined gynecological and general surgical diseases. Patients were aged 15-80 years. 410 (42.5%) of women were fertile. The laparotomic access was chosen individually, though the majority (965-97.2%) had the middle or oblique-transverse laparotomy. The volume and risk level of the operation were assessed using the score method. The most frequent diseases were: the acute appendicitis, the incarcerated ventral hernia, the intestinal tumor obstruction and the acute calculous cholecystitis. The high medical and economical efficacy of the simultaneous operations allow to recommend them , considering the proper high level of surgical help.

[Combined simultaneous operations in emergency surgery and gynecology].

Results of 927 simultaneous urgent operations performed on account of associated surgical and gynaecological pathology were analyzed. Urgent combined operations on account of acute gastrointestinal diseases and concomitant gynaecological pathology, independently of a primary cause, are advisable and justified. Non-eliminated concomitant disease or deferred second operation can lead to complications. The V (extreme) stage of operative risk can be the contraindication to the simultaneous combined surgery.

[One-stage combined operations in cholelithiasis].

Immediate results of one-stage combined operations in 509 patients aged 16 to 90 years with cholelithiasis performed in 1981-2005 were analyzed. Main indications for one-stage combined operations in these patients in urgent and elective surgery are listed. The operation was elective in 457 (89.8%) cases and urgent -- in 52 (10.2%). Laparotomy and cholecystectomy with hernioplasty were performed in 180 (35.4%) patients, resection of the stomach in patients with duodenal and gastric ulcer -- in 89 (17.5%), extirpation of the stomach for cancer -- in 89 (17.5%) patients. Retroperitoneal surgeries were performed in 13 (2.6%) patients. The operations were performed under general anesthesia in all the 509 patients. Postoperative lethality was 0.8% (4 patients).

[Anatomic resection of spleen in experiment]. / Anatomicheskaia rezektsiia selezenki v éksperimente.

The study was carried out in 35 dogs. Basic surgical techniques developed experimentally for organ-saving operations on the spleen are presented. Methods of lobar and segmental resections of the spleen based on detailed study of variants of branching of splenic artery and vein are described. Angiography visualized sharply splenic arteries after lobar and segmental resections, including the stumps of transected arteries. Ultrasonic examination, performed before operation and in different terms after it (3-360 days), specified the size, shape echostructure and anatomic relationship of the spleen with adjacent organs before and after operation.

[Resection of spleen with plastics by muscular pedicled flap in experiment]. / Rezektsiia selezenki s platikoi myshechnym loskutom v ¿eksperimente.

Operation for resection of the lower pole segment (lobe) of the spleen with plastics of resected surface by pedicled flap from external oblique muscle of the abdomen has been developed in experiments on 25 dogs. The animals were followed up for 12 months. It was established, that muscular flap covered wound surface and promoted hemostasis as well as fixed the spleen in physiological posture.

[Combination of appendicitis with gynecologic diseases]. / Sochetanie appenditsita s ginekologicheskimi zabolevaniiami.

782 patients with combined diseases of abdominal and retroperitoneal organs were operated on from 1970 to 1996. In 321 patients (41.0%) at the age from 15 to 80 years appendectomy in combination with gynaecologic operations were performed. The catarral appendicitis was detected in 202 patients, phlegmonous--in 113, gangrenous--in 6 patients. The rate of inflammatory genital disorders was variable: ovarian cyst rupture (183 patients), suppuration (7 patients), over-winding (15 patients), purulent salpingitis (76 patients), ulchanges cyst (6 patients). The extirpation and supravaginal amputation of the uterus were performed in 34 patients. The abdominal exudate was detected in 284 patients. The oblique incision in the ilias region was used in 177 patients. In was extended in 80 patients. The median laparotomy was performed in 64 patients. The combination of appendicitis and gynaecologic diseases are commonly seen in clinical practice.

[Repair of the wounded and resected kidney surface by the flap of musculus obliques externus abdominus (experimental study)]. / Zakrytie ranevoi i rezetsirovannoi poverkhnosti pochki loskutom naruzhnoi kosoi myshtsy zhivota.

The experimental studies in 15 human cadavers and 15 animals (dogs) have been performed to test the use of the flap musculus obliques externus abdominis in plastic repair of wound and resected kidney surface. The vascular and nervous bundle of the muscle has been detected. It is easy to mobilise the muscle, that has good hemostatic, fixing, and plastic properties. Morphological tests of the flap demonstrated no signs of necrosis. There were no changes in kidney parenchyma either.

[Combined operations as a method for increasing the capacity of a surgical clinic]. / Sochetannye operatsii kak metod intensifikatsii raboty khirurgicheskoi kliniki.

The work shows the economical effect of concurrent surgery on the abdominal organs and organs of the retroperitoneal space undertaken in 404 patients whose ages ranged from 16 to 81. The time taken by the concurrent operations and the duration of treatment at the hospital were studied. In 63.1% of patients the concurrent operations lasted up to 3 hours. The duration of treatment was least in concurrent appendectomy (14.2 +/- 0.5 days) and longest on oncological patients (40.9 +/- 2.2 days). It is noted that the sum terms of treatment reduce, while in separate performance of the operations they are prolonged. The highest economy of finances is noted in urolithiasis, nephroptosis, acute appendicitis, hernias, and cholelithiasis. The national economic effect in the treatment of 404 patients at the clinic came to 60,471 rubles and 18 kopecks.

[Combined surgical operations in the abdominal cavity and retroperitoneal space]. / Sochetannye khirurgicheskie operatsii v briushnoi polosti i zabriushinnom prostranstve.

The authors discuss their experience in combined operations on the organs of the abdominal cavity and retroperitoneal space in 366 patients whose ages ranged from 16 to 81 years. In 96 patients (26.2%) the operations were carried out for emergency indications and in 270 (73.8%) in a planned order. The authors substantiate the expediency of performing combined operations by a low mortality rate (1.9%) (in carrying out the operations separately the mortality rate comes up to 15%) and by an economical effect.