[Surgical treatment of a patient with tubular colonic duplication complicated by perforation and peritonitis]. / Uspeshnoe lechenie patsienta s tubulyarnoi duplikatsiei tolstoi kishki, oslozhnennoi perforatsiei i peritonitom.

We present successful treatment of a patient with tubular colonic duplication complicated by fecal impaction, perforation and fecal peritonitis. This anomaly is usually detected in children younger 2 years old. In adulthood, this diagnosis is of a precedent-setting nature. If the diagnosis was not confirmed in early childhood, the absence of typical clinical picture, long-term course of disease and difficult interpretation of clinical data complicate subsequent verification of congenital anomaly. Only infectious complications and emergency surgery in adults can make a correct diagnosis.

[Perioperative augmented reality technology in surgical treatment of locally advanced recurrent rectal cancer]. / Perioperatsionnoe primenenie tekhnologii dopolnennoi real'nosti v khirurgicheskom lechenii bol'nogo mestnorasprostranennym lokoregionarnym retsidivom raka pryamoi kishki.

Rectal cancer occupies the leading position among cancers, and incidence of locally advanced recurrences is still high despite comprehensive treatment. Combined resections are usually associated with high perioperative risks. These procedures are technically complex interventions requiring further improvement. Virtual reality technology in surgical treatment of locally advanced rectal cancer recurrence has not been widely discussed. The authors present multidisciplinary construction of the matched topographic-anatomical virtual model and virtual planning of the combined surgical intervention. Intraoperative use of augmented reality allowed specifying topographic and anatomical features of surgical area, level of vascular ligation, localization of tumor fixation points and resection borders. These data ensured safety and quality of resection. Further research of augmented reality technology and improvement of its technical aspects will improve the results of surgical treatment of patients with locally advanced pelvic tumors and recurrences.

[Diagnosis and treatment of kidney damage following stab and blunt abdominal injuries]. / Diagnostika i lechenie povrezhdenii pochek pri zakrytykh travmakh i koloto-rezanykh raneniyakh zhivota.

OBJECTIVE: To improve treatment outcomes in victims with kidney damage following blunt and stab abdominal trauma by using of minimally invasive methods of diagnosis and treatment. MATERIAL AND METHODS: About 1.2-3.5% of all victims arrived to the Dzhanelidze St. Petersburg Research Institute for Emergency Care have kidney injuries. We analyzed the results of treatment of 117 patients with isolated and combined blunt and stab abdominal injuries. The retrospective (2014-2017) group included 62 victims, and the prospective (2018-2021) group enrolled 55 patients who were treated according to the new algorithm. This algorithm included non-surgical and minimally invasive management for patients with systolic blood pressure >90 mm Hg after contrast-enhanced CT. Angiography with selective embolization was required for ongoing bleeding. We analyzed incidence of open interventions, organ-sparing procedures, complications, duration of treatment and mortality. Between-group differences were assessed using the χ2 test and Student's test. RESULTS: In both groups, kidney damage in most victims with abdominal trauma was due to road accident and catatrauma. Most patients had combined abdominal injuries, mainly in combination with head and chest lesions. Severity of injuries and clinical condition were similar in both groups. In the retrospective group, there were 9 laparotomies with nephrectomy. Nephrorraphy was performed in 8 cases, kidney vessel suture - in 4 patietns. In the prospective group, nephrectomy was performed in 3 patients with unstable hemodynamics and injuries AAST grade V. Nephrorraphy was performed in 4 victims. In one case, vascular suture was applied for tangential vein damage. All laparoscopies in both groups were diagnostic without nephrectomy. We used non-surgical treatment in 34 patients of the prospective group. One patient underwent angiography and selective embolization of renal artery branches. There were no significant between-group differences in the incidence of infectious and non-infectious complications. Mortality rate was 30.6% (n=19) and 27.3% (n=15) in the retrospective and prospective groups, respectively. CONCLUSION: The proposed algorithm for kidney injury made it possible to reduce the incidence of laparoscopies and laparotomies by 2 times, preserve the damaged kidney in 94.5% of cases and avoid invasive treatment in 62% of victims.

[Staged approach in the treatment of patients with enterocutaneous fistulae]. / Etapnyi podkhod v lechenii bol'nykh s nesformirovannymi kishechnymi svishchami.

OBJECTIVE: To determine an optimal approach in the treatment of patients with intestinal fistulae. MATERIAL AND METHODS: We have used the above-mentioned algorithm in the treatment of 46 patients. The majority of patients (n=44, 96%) were transferred under supervision of our multidisciplinary team with severe water-electrolyte disturbances and signs of secondary protein-energy malnutrition (PEM) that required complex combined nutritional support. A two-stage approach was applied in all cases. The first one was conservative and included correction and prevention of infectious complications, nutritional and metabolic therapy, local wound treatment, and anatomical assessment of the fistula. The second stage was reconstructive and implied various reconstructive interventions not earlier than 3 months after formation of the fistula. RESULTS: Conservative approach was followed by fistula healing in 6 patients, surgery was required in 25 patients. Complications with subsequent redo surgery occurred in 4 cases. In all cases, favorable outcome was noted. All 25 patients were discharged. Three patients refused reconstructive surgery after development of fistula, they were also discharged. Mortality rate was 26% (n=12). CONCLUSION: A multidisciplinary two-stage approach can significantly improve treatment outcomes in patients with intestinal fistulae.

[Prediction and differentiated approach in the treatment of patients with secondary peritonitis and abdominal sepsis]. / Prognozirovanie i differentsirovannyi podkhod v lechenii bol'nykh s vtorichnym peritonitom i abdominal'nym sepsisom.

OBJECTIVE: To identify the most important high risk criteria for predicting course of disease, as well as optimal preoperative preparation and surgical strategy in patients with secondary peritonitis. MATERIAL AND METHODS: A prospective study enrolled 43 patients with diffuse secondary peritonitis. RESULTS: Significant predictors were Charlson's comorbidity index (p=0.001) and SOFA score of organ dysfunction within 3 days after admission. Rapid regression of organ dysfunction (SOFA1 - p=0.0001, SOFA2 - p=0.012, SOFA3 - p=0.017) and reduced time of examination and preoperative preparation (threshold value - 520 min after admission) are predictors of favorable outcome in patients with diffuse secondary peritonitis. There was no reliable correlation between the treatment outcome and preoperative preparation (infusion volume p=0.23, duration p=0.37, absence/presence of antibacterial therapy p=0.26). Elimination or control of infection is the fundamental principle of the management of patients with diffuse secondary peritonitis.

[Evolution of enhanced recovery after surgery: from the beginning of the study of stress to the introduction in emergency surgery]. / Évoliutsiia kontseptsii uskorennogo vosstanovleniia posle operatsii: ot istokov ucheniia o stresse do ispol'zovaniia v neotlozhnoi khirurgii (obzor literatury).

Effectiveness of enhanced recovery program is being earnestly confirmed in various surgical areas. Certain aspects of fast track rehabilitation are analyzed in the article.

Isolated pelvic perfusion in treatment for malignant tumors.

Rationale and feasibility of isolated pelvic perfusion (IPP) as a high-tech treatment modality for patients with pelvic malignancies was studied and analyzed based on the systematic review of the literature. Indications, techniques and regimens of IPP are reviewed. There is a focus on anticancer agents for IPP and methods of complete vascular isolation of the perfusated region. Data on the short- and long-term outcome of patients after IPP are presented. To the best of authors' knowledge this is the first Russian article regarding application of IPP in oncology practice.

[Percutaneous endoscopic gastrostomy].

The percutaneous endoscopic gastrostomy takes an important place in operative endoscopy of the digestive system. At the same time it is the method of choice in patients who need a long-term administration of enteral feeding. Given article reflects the main indications, contraindications and complications of the percutaneous endoscopic gastrostomy and presents the basic stages of the method. The authors hope, that the data would be useful for both entry-lever surgeon-endoscopists and specialists who used the method.

[The inexpediency of using the term "iatrogenicity" in expert and legal practices].

Various contradictory definitions of "iatrogenicity" are considered. Bearing in mind the absence of the universally recognized interpretation of this concept, the authors believe it nappropriate to use the term "iatrogenic" in expert and juridical practice.

[Iatrogenes of manipulator character in abdominal surgery].

The authors analyzed the data of 281 cases of iatrogenes of manipulator character in abdominal surgery in order to investigate the circumstances and character of origin. There were 187 cases of operative confirmation and 84 cases of unintentional intraoperative retained foreign bodies. It was detected, that primary planned intervention of higher category of complexity should be related to the high risk group of the development of the operative confirmation. Retained foreign bodies with soft fabric base were diagnosed in early postoperative period as the result of the beginning of postoperative complications. The retained foreign bodies with tough backer material as a rule didn't cause the complications in early postoperative period. They were diagnosed in long-term postoperative period in majority of cases.

[Associated complications of peptic ulcer and their surgical treatment].

Based on an experience with treatment of 269 patients with complicated peptic ulcer the authors came to a conclusion that the most sparing and radical operation was subdiaphragmatic truncal vagotomy with Finney pyloroplasty with lethality of 6.8%. Resection of the stomach and forced palliative interventions such as suturing of perforated and bleeding ulcers resulted in lethal outcomes in more than 50% of them.

[The single-row suture in the pyloroplasty of patients with perforated pyloroduodenal ulcers]. / Odnoriadnyi shov pri piloroplastike u bol'nykh s perforativnymi piloroduodenal'nymi iazvami.

The authors made an analysis of the immediate and long-term results of truncal vagotomy for perforating gastroduodenal ulcers in accordance with the kind of the suture in operation of stomach drainage. In 282 patients pyloroplasty was performed with placing a two-row suture, in 239 patients a one-row suture was used. Lethality among the patients with the two-row sutures was 2.1% in those with the one-row suture--0.4%. The placing of one-row sutures was followed by a relatively smaller amount of complications at the early postoperative period. An analysis of long-term results has shown that the one-row suture gives much greater amount of excellent results as compared with the two-row suture. The authors recommend to use the one-row suture in all the cases of perforating pyloroduodenal ulcers irrespective of the phase of intraperitoneal inflammation.

[The surgical treatment of gastroduodenal ulcers complicated by perforation and hemorrhage]. / Khirurgicheskoe lechenie gastroduodenal'nykh iazv, oslozhnennykh perforatsiei i krovotecheniem.

Medical histories of 67 patients with perforation of gastroduodenal ulcers combined with gastroduodenal hemorrhage were analyzed. The frequency of this complication makes 7.5% of all patients with perforated peptic ulcers. High mortality rate is thought to result from wrong diagnosis and inadequate operation. Best results were obtained when truncal bilateral subdiaphragmatic vagotomy was used in combination with some pyloroplasty techniques. Resection of the stomach is known to be dangerous because of frequent complications often leading to death. Operations aimed at the arrest of hemorrhage and liquidation of peritonitis are indicated to patients in critical state. X-ray examination of the abdomen and fibrogastroduodenoscopy allowed the combination of perforation and hemorrhage to be diagnosed in due time in all the patients.

[The late results of the surgical treatment of perforated gastroduodenal ulcers in young people]. / Otdalennye rezul'taty khirurgicheskogo lecheniia perforativnykh gastroduodenal'nykh iazv u liudei molodogo vozrasta.

The article is devoted to surgical treatment of perforating gastroduodenal ulcers. An investigation of remote results of palliative and radical interventions for the perforation of the stomach and duodenum in patients of young age has shown that recurrent ulcers after suturing the perforation take place in 67.2% of the people operated upon against 21% of those subjected to bilateral truncal subdiaphragmatic vagotomy with pyloroplasty. A conclusion is made that for perforating ulcers it is expedient to perform radical operative interventions as a bilateral truncal subdiaphragmatic vagotomy with pyloroplasty.