[A new method of aponevrosis suturing after laparotomy in urgent abdominal surgery]. / Sposob ushivaniia aponevroza posle laparotomii v urgentnoi khirurgii.

OBJECTIVE: To improve the results of treatment of patients undergoing laparotomy by using of a new method of aponeurosis suturing after laparotomy. MATERIAL AND METHODS: Training process for a new method of aponeurosis suturing after laparotomy was organized on the patented medical simulator for learning the technique of laparotomy closure. The method was introduced into surgical practice later. The study involved 130 patients who underwent emergency abdominal surgery through median laparotomy. The main group consisted of 70 patients (laparotomy closure using the proposed method (RF patent No.2644846 dated 02/14/18). Interrupted sutures were applied for aponeurosis suturing in the control group. RESULTS: Duration of laparotomy closure was similar in both groups. Postoperative ventral hernias in 1 year after surgery occurred in 5 (8%) patients of the main group and in 11 (18%) patients of the control group. CONCLUSION: The proposed method of aponeurosis suturing after laparotomy is mastered by students and serves as effective method for prevention of postoperative ventral hernias and eventration.

[Preventive abdominal wall repair in high-risk groups of postoperative ventral hernia]. / Preventivnoe éndoprotezirovanie briushnoi stenki v gruppakh riska razvitiia posleoperatsionnykh ventral'nykh gryzh.

AIM: To identify the most important predictors of postoperative hernia and to determine the indications for preventive surgical repair of abdominal wall. MATERIAL AND METHODS: Prospective analysis included 398 medical records of patients who underwent median laparotomy. Experimental tensiometry was applied to determine strength of intact fascia. RESULTS: The main predictors of postoperative hernia are age over 60 years, obesity, upper median laparotomy, connective tissue insufficiency. Combination of factors increases the risk of hernia. The most 'intense' foci of aponeurosis is middle portion of epigastric and initial part of mesogastric areas. You need to consider this features during laparotomy closure. CONCLUSION: Preventive repair may be an effective method for prophylaxis of postoperative hernia after median laparotomy.

[The consequences of cholecystectomy]. / Posledstviya kholetsistektomii (s kommentariem).

AIM: to analyze the consequences of cholecystectomy. MATERIAL AND METHODS: 348 patients were under observation within 10  years after cholecystectomy. Surgery for destructive and chronic cholecystitis was performed in 115 and 233 patients respectively. The consequences of cholecystectomy were assessed using bile acids level in blood plasma, stomach and duodenal pressure, pancreatic and stomach changes. RESULTS AND DISCUSSION: It was established that lithocholic, deoxycholic, taurodeoxycholic acids were increased by 44% within 10 years after surgery. At the same time glycocholic and tauroursodeoxycholic acids were decreased by 21.5% in 5 years after surgery. Bile acids level changes were associated with changes of stomach and duodenal pressure. The most pronounced disorders were observed in distal duodenum. There was more than 2.8-fold excess of normal pressure in this area. Duodenal hypertension was accompanied by pancreatic ducts enlargement in 9.5% of cases and increased echogenicity in 93% of cases. CONCLUSION: Changes of the level and proportion of blood plasma bile acids and hypertension in upper gastrointestinal tract are the most important in chronic pancreatitis pathogenesis after cholecystectomy. Such conditions occur within first 3 years after surgery.

[Evaluation of long-term results of surgical treatment of thyroid's diseases].

It was analyzed the surgical treatment results of thyroid's diseases in 462 patients in terms 1-15 years. Relapse of the disease was defined in 39.4% of cases after organ-preserving operations. Relapse formation was through 5-10 years after surgery. There were nodes up to 1 cm in diameter after hemistrumectomy and maximum subtotal resection of thyroid. Large nodes more than 3 cm in diameter were after subtotal resection of thyroid. Good results after interstitial laser photocoagulation were achieved in all patients, after sclerotherapy - in 89.5% of cases. An average degree of node reduction after laser destruction was 55.5±3.0%, after sclerotherapy - 49.7±_5.6%.

[Perforative gastroduodenal ulcers].

Treatment results of 986 patients with perforative gastroduodenal ulcers were analyzed. The sequence of surgeon's acts was diagnostically effective in 99.5%. 776 (78.7%) of patients presented with duodenal ulcer; 210 (21.3%) had gastric ulcer. Ulcer closure was performed in 934 (94.7%) cases; gastric resection was made in 52 (5.3%) cases. Postoperative lethality rate was 4.3%. Tissue destruction proved to be partly connected with the level of the connective tissue metabolites in blood. The balance of factors of aggression and defense (Helicobacter invasion, level of mucus formation, mucosal leucocytal infiltration, acid level in stomach and level of necrosis factor in blood) was registered in long-term follow-up in dependence of the operation performed. Ulcer perforation recurrence was registered in 18.8% of simple closure cases and in 3.8% of patients after gastric resection.

[The surgical treatment of the incarcerated hernia].

The treatment results of 1540 patients with the incarcerated hernias of various localization were analyzed. It was revealed, that treatment results depend not only of the patient's age and concomitant diseases and operating time but the choice of surgical access and the type of intestinal anastomosis. The main postoperative negative factor proved to be the increase of the intraabdominal pressure, which severely impairs the lung ventilation. The factor can be excluded by using the prosthetic methods of hernioplasty, though.

[Principles of determination of surgical policy in general peritonitis].

Based on clinical examination and analysis of treatment results of 575 patients with general peritonitis, the most informative factors were determined which predict lethal outcome, progression of peritonitis and help choose the most effective surgical policy. It is demonstrated that conventional treatment is preferable in the interval of perioperative score of APACHE II from 0 to 10, and programmed sanation relaparotomies -- from 11 to 15. Data about efficacy of total intestinal decompression and peritoneal-enteral lavage, and also methods of mathematical prediction of postoperative complications and outcomes are presented. Prognostic value of individual symptoms, different degree of organs dysfunction and SIRS criteria in early postoperative period were determined.

[Neurohumoral changes in acute intestinal obstruction].

Neurohumoral changes were studied in 431 patients with acute intestinal obstruction and in experiments in 165 small laboratory animals with the model of small intestine ileus. The results were obtained on the basis of estimation of the concentration of catecholamines, acetylcholine-like substances, serotonine, histamine, their metabolism products in blood plasma and of the cardiointervalography data. The neurohumoral changes were shown to appear as early as the initial stage of the disease and to be progressing when the disease period became longer. The prevailing sympathetic activity was dependent on the decreased acetylcholine-like substances in blood plasma and tissues. The serotonine and histamine metabolism changed depending on the stage of the disease.

[Complicated gastroduodenal ulcers].

The results of the treatment of 2384 patients with gastric and duodenal ulcers are analyzed. It is demonstrated that over last years the number of complications has increased: perforations -- 2.6 fold, and bleedings -- 7 fold. Markers of a destructive injury of gastric and duodenal mucosa (helicobacter contamination, immunological disorders, level of tumor necrotic factor alpha, indices of catabolism of connective tissue) were studied. It is revealed that such disorders have direct influence on destruction of gastric and duodenal wall manifesting as life-threatening complications.

[Directed therapy in complex treatment of lower limb diabetic angiopathy]. / Metody napravlennoi terapii v kompleksnom lechenii diabeticheskoi angiopatii nizhnikh konechnostei.

Clinical efficiency of directed therapy was assessed for 312 patients with distal type of lower limb diabetic angiopathy. Methods of directed therapy included indirect electrochemical detoxication, hemosorption and their combination. It was shown that while successful rate of conventional conservative therapy does not exceed 50%, hemosorption and indirect electrochemical detoxication can increase this rate by 5-35%, depending on the initial severity of lower limb ischemia. Directed therapy improves peripheral circulation and attenuates regional toxemia. Optimal results were achieved for combination of hemosorption and indirect electrochemical detoxication: treatment was effective for 87% of patients with 2-grade disease and for 73% - with 3-grade. One can speculate that synergic clinical effect may be attributed to functional normalization of antioxidant system. In conclusion, advantages of directed therapy comparing with conventional conservative treatment lie in its higher efficiency and prolonged therapeutic effect.

[The application wound sorption in complex treatment of destructive forms of erysipelas inflammation]. / Applikatsionnaia ranevaia sorbtsiia v kompleksnom lechenii destruktivnykh form rozhistogo vospaleniia.

The method of application wound sorption with sorbent Vaulen was used in treatment of erysipelatous inflammation in 49 patients. The first signs of healing appeared 1.5-2 times quicker, the rate of lessening the area of the wound surface was 21-35% greater. The period of staying in the hospital was 20-23% shorter.

[Mechanism of action of paravasal infiltration]. / O mekhanizme deistviia paravazal'noi infiltratsii.

In order to study the mechanisms of action of paravasal infiltration the content of middle mass molecules and general thiol groups in the central and regional blood flow were studied in 65 patients with obliterating atherosclerosis. The relationship between the stage of extremity ischemia and concentration of general thiol groups was shown.

[The prognosis of the course of endogenous intoxication in emergency surgery]. / Prognozirovanie techeniia éndogennoi intoksikatsii v neotlozhnoi khirurgii.

On the basis of an analysis of 256 patients with diffuse peritonitis, destructive pancreatitis, mechanical jaundice and purulent cholangitis and complex investigations it was established that the degree of clinical manifestations of endointoxication corresponded to a definite degree of disorders of the central nervous system. The most adequate indices of the course and prognosing the toxic process are thought to be the level of the leukocytic index of intoxication, the prothrombin index, the degree of monocytopenia and proteinuria. Their dynamics reflects changes of the concentration of toxic intermediary metabolites and main characteristics of electron paramagnetic resonance of blood plasma.

[The structure of endotoxemia in peritonitis and means of eliminating it]. / Struktura éndointoksikatsii pri peritonitakh i puti ee ustraneniia.

An examination of 43 patients has revealed 11 toxic compounds of intermediary metabolism (aldehydes, methylizocyanide, ethanol, aceton etc.) whose concentration in blood became several tens times higher. Their accumulation was most considerable at the decompensation phase. It was shown that hemosorption and hyperbaric oxygenation made the concentration of toxic substances lower.

[Endogenous toxicity in acute hepatic failure and ways of eliminating it]. / Ob éndogennoi intoksikatsii pri ostroi pechenochnoi nedostatochnosti i vozmozhnostiakh ee ustraneniia.

The structure of causes of the endogenous intoxication in 39 patients with acute hepatic insufficiency is studied. Eleven toxic compounds of an organic nature were found responsible for genesis fo the disorders and outcomes of acute hepatic insufficiency. Possible use of hemosorption and hyperbaric oxygenation for the elimination of toxic products is analysed. A combination of them is proved to be expedient. The selectivity of sorption for each toxin separately in various types of hepatic insufficiency is established.