[Gastroesophageal reflux after laparoscopic hiatal hernia repair in patients with axial hiatal hernia]. / Prichiny patologicheskogo gastroezofageal'nogo reflyuksa posle videolaparoskopicheskoi korrektsii zamykatel'noi funktsii kardii u bol'nykh aksial'noi gryzhei pishchevodnogo otverstiya diafragmy.

OBJECTIVE: To find out significance of the main locking mechanisms of lower esophageal sphincter in the relapse of GERD in patients with axial hiatal hernia after previous antireflux laparoscopic surgery. MATERIAL AND METHODS: There were 103 patients with GERD and axial hiatal hernia who underwent original circular laparoscopic esophagofundoplication with correction of hiatal opening dimensions by crural and hiatal repair. Depending on generalized DeMeester index (within the normal range or its excess), all patients were divided into two groups - without relapse (group 1, n=88) and with recurrent GERD (group 2, n=15). Both groups were comparable by the main characteristics and postoperative follow-up period (mean - 6 years). Antireflux function was investigated by X-ray examination and endoscopy, manometry of the esophageal-gastric passage, intra-esophageal 24-hour pH-monitoring. Processing and graphical presentation of data was carried out using Statistica v.10.0 Rus software (StatSoft, USA) and Microsoft Office Excel 2013 (USA). RESULTS: Abnormal gastroesophageal reflux was detected in 14.56±3.48% of patients after laparoscopic anti-reflux surgery. Recurrent hiatal hernia occurred in 20±10.33% of these patients, malfunction of lower esophageal sphincter - in 80±10.33%. Failure of cardia was caused by shortening of its length by 30.43% and decrease of tone by 6.78% with significantly (61.09%) increased tone of the stomach. Failure of cardia was manifested by increase of generalized DeMeester index in the lower third of the esophagus by 3.2 times, acidic gastroesophageal refluxes, reflux index and index reflux values. Preserved esophageal motility combined with shortening of time of esophageal clearance in patient's lying position was associated with reduced incidence of reflux-esophagitis by 77.26% even in case of recurrent GERD. CONCLUSION: Abnormal reflux after antireflux laparoscopic surgery due to GERD with axial hiatal hernia is caused by recurrent hiatal hernia in every fifth patient while the main reason is failure of LES cuff with increased intragastric pressure.

[Endoscopic surgery for benign diseases and injuries of the esophagus (with commentary)]. / Endokhirurgiya dobrokachestvennykh zabolevanii i povrezhdenii pishchevoda (s kommentariem).

AIM: To analyze the results of surgical treatment of patients with benign diseases and injuries of the esophagus. MATERIAL AND METHODS: We summarized the experience of different endoscopic interventions in 159 patients with various benign diseases and perforation of the esophagus. Patients with achalasia (72 cases) underwent videolaparoscopic Geller's esophagomyotomy with anterior hemiesophagofundoplication by Dor. Video-assisted thoracoscopic extirpation of the esophagus with simultaneous or delayed esophagocolo/gastroplasty was performed in 56 patients with post-ambustial cicatricial stenosis of the esophagus. Patients with esophageal perforation (14 cases) underwent videolaparoscopic transhiatal mediastinal drainage. Esophageal leiomyoma has been excised through thoracoscopic (9 cases) or laparoscopic access (4 cases). Removal of esophageal diverticulum was made via VATS-access in 4 patients. RESULTS: Satisfactory early and remote results were achieved in all patients with achalasia. Mortality rate was 5.4% (3 out of 56 patients) and 14.3% (2 out of 14 patients) in groups of cicatricial esophageal stenosis and esophageal perforation respectively. Sutures failure after removal of the diverticulum and leiomyoma occurred in 2 and 1 patient respectively and has been successfully cured. CONCLUSION: Endoscopic technologies allow to perform successfully complex reconstructive interventions for dysphagia in patients with cicatricial esophageal stenosis and achalasia even at late stages, to remove benign tumors and diverticula of thoracic esophagus and provide adequate drainage of posterior mediastinum in case of esophageal perforation.

[Endosurgery of benign diseases and injuries of esophagus].

AIM: To analyze the results of endoscopic interventions for benign diseases and injuries of the esophagus. MATERIAL AND METHODS: 159 patients with benign diseases and perforation of the esophagus were operated. There were 72 (45.3%) cases of achalasia, 56 (35.2%) with post-ambustial stenosis of esophagus, 14 (8.8%) with esophageal perforation, 13 (8.2%) with leuomyoma of esophagus and 4 (2.5%) with diverticulum of thoracic esophagus. RESULTS AND DISCUSSION: In long-term period 56 patients with achalasia were followed-up after laparoscopic Heller cardiomyotomy with Dor fundoplication. Good results were observed in all cases. Three patients died in early postoperative period after thoracoscopic extirpation of esophagus with esophagoplasty via laparotomy at the stage of development of the technique. There were no deaths after thoracoscopic extirpation of esophagus with simultaneous laparoscopic gastroplasty. Postoperative period was significantly less after thoracoscopic extirpation of esophagus with simultaneous laparoscopic esophagogastroplasty using whole stomach compared with esophagogastroplasty and esophagocoloplasty via laparotomy. In long-term postoperative period different complications occurred in 17 cases. Two patients with esophageal perforation died after video-assisted laparotranshiatal drainage of posterior mediastinum. Scarring of esophageal defect was observed in others. Seam failure after esophageal leuomyoma removal was diagnosed in 2 patients that required video-assisted laparotranshiatal drainage of posterior mediastinum and Maydl jejunostomy. Seam failure in thoracic esophagus after thoracoscopic removal of diverticulum was observed in 1 case. The complication was cured by video-assisted laparotranshiatal drainage of posterior mediastinum.

[Choice of treatment in achalasia of the cardia]. / Vybor metoda lecheniia bol'nykh akhalaziei kardii.

Results of examination and treatment of 120 patients with cardiac achalasia (CA) are described. The investigation included 13 patients with the I stage of CA, 35 patients with the II stage, 50 patients with the III stage and 22 patients with the IV stage. Indications were established to cardiodilatation and operative treatment of CA. On the basis of an analysis of long-term results the most effective method of treatment was determined depending on functional impairments of the cardia and the motor function of the thoracic portion of the esophagus. The doses of cardiodilatation were designed giving an objective picture of the dilatation of the cardiac muscles obtained that resulted in better results of the treatment. The potentials of videoendoscopic operative interventions in patients with different stages of CA were studied which allowed to reduce the operative trauma, frequency of intra- and postoperative complications, to shorten the terms of hospitalization.

[Surgical treatment of patients with acute abscessed and phlegmonous lactation mastitis]. / Khirurgicheskoe lechenie bol'nykh s ostrym abstsediruiushchim i flegmonoznym laktatsionnym mastitom.

Under analysis were results of surgical treatment of 256 patients with abscessed and phlegmonous acute lactation mastitis. Radical primary surgical treatment of the purulent cavities allowed prevention of further progression of the inflammation in the mammary gland. The use of the low frequency ultrasound for treatment of the wound allowed to quicker arrest the acute inflammatory process in the tissues of the mammary gland surrounding the purulent cavity. In cases with diffuse purulent acute lactation mastitis it is necessary to take into attention the tension of the suture threads when fulfilling the secondary surgical treatment of the wound and putting in the running secondary early suture.

[Possibilities of recanalization of cicatricial strictures of esophagus]. / Vozmozhnosti rekanalizatsii rubtsovykh stenozov pishchevoda.

Long-term results of recanalization of the esophagus by orthograde bouginage through the guide and by endoprosthesis post-burn strictures were evaluated in 105 patients. The application of these methods enabled in 81% of patients to achieve steadfast restoration of esophageal continuity, sufficient enough for adequate feeding. Orthograde bouginage of the esophagus through the guide showed to be effective in 45.5% patients with strictures up to 100 mm length and over 6 mm in diameter, the end of the bouge being not more than 1.5 kg. Endoprosthetic procedure provided to achieve restoration of esophageal continuity in 95% of patients.

[Results of surgical correction of constriction function of cardia]. / Rezyl'taty khirurgicheskoí korrektsii nedostatochnosti zamykatel'noí funktsii kardii.

The results of surgical correction of insufficiency of locking function of cardia in 113 patients are analysed. The X-ray and endoscopic examination, intraesophageal measurement of pH, manometry in esophago-gastric connection were used to study the reasons of cardia insufficiency in chronic diseases of gastro-intestinal tract. The indications for surgical correction of this status are formulated. The original operation of the dosed out cardio-esophagofundoplication is advocated as the most effective operation in such condition. The rate of morbidity after this type of surgery is 3.1% vs. 41.9% after the fundoplicatin by the method of Nissen.

[Morphological characteristics of the post-burn stenosis of the stomach: its surgical aspects]. / Morfologicheskaia kharakteristika posleozhogovogo stenoza zheludka v khirurgicheskom aspekte.

The results of intraoperative investigation of stomach in 163 patients with its postburn stenosis and the data on histologic investigation of 25 resected gastric specimens are presented. Choice of the most adequate method the term of the operation performance was based on the changes revealed.

[Surgical treatment of chronic gastroduodenal ulcer complicated with duodenal motility disorders]. / Khirurgicheskoe lechenie khronicheskoi gastroduodenalnoi iazvy, sochetaiushcheisia s narusheniem motorno-évakuatornoi funktsii dvenadtsatiperstnoi kishki.

On the basis of the data of examination of 348 patients with ulcer disease of the stomach and duodenum with the use of roentgeno-endoscopic and functional methods, in (25.9 +/- 2.3) % of them the disorders in motor-evacuatory duodenal function with delayed food passage were revealed. Use of isoperistaltic enteroduodenoplication for correction of the impairement in motor-evacuatory function of the duodenum with insignificant duodenogastral reflux permitted to perform operative intervention with preservation of food passage through the duodenum. Roux resection of the stomach has proved to be the most effective method for correction of the pronounced disorders in motor-evacuatory duodenal function accompanied by reflux-gastritis.

[Endoprosthesis of rigid and extended cicatricial strictures of the esophagus]. / Endoprotezirovanie rigidnykh i protiazhennykh rubtsovykh striktur pishchevoda.

The article describes treatment of 65 patients with postburn, extended, rigid cicatricial strictures of the esophagus by the method of temporary endoprosthetics. Most patients had an extended stricture. In 44 patients the diameter of the stenosed segment measured no more than 4 mm. Stage endoprosthesis of the esophagus was carried out in 32 patients. Devices by which intraoperative dilatation of the stricture can be achieved and its rigidity measures are shown, as well as designs of esophageal endoprostheses and an extractor of the endoprosthesis. The method suggested by the authors produced good results in 60 patients, esophagoplasty had to be undertaken in the remaining 5 patients. There were no fatal outcomes.

[Chemical burns of the colon and rectum]. / O khimicheskikh ozhogakh obodochnoi i priamoi kishok.

From the experimental data obtained in 104 animals and clinical observation of 270 cases of digestive tract chemical burns the authors have found that in response to the effect of a corrosion substance, got into the stomach, a complex of protective secretory motor reactions preventing in the most cases from the injury to the intestinal tract occur. In contaminations incompatible with life only, a superficial burn of the colon associated with injuries to the upper portions of gastrointestinal tract, does occur. This was found at the analysis of 62 postmortem protocols of the cases who died ater taking some chemical liquids.

[Intestinal lesions after chemical burns of the digestive tract]. / Porazhenie kishechnika pri khimicheskikh oxhogakh pishchevaritel'nogo trakta

Based on the analysis of 235 patients with chemical burns of the esophagus and stomach and their sequelae, as well as the data of 111 pathoanatomical and medicolegal autopsies in persons, died in different periods after poisoning with corrosive substances, a burn of the duodenum and small intestine was observed in 71 cases. It was found that such factors as an intake of large doses of caustic liquors, poisoning in full stomach, especially in a state of alcohol intoxication, largely contribute to retropyloric penetration of a corrosive substance. A burn of the duodenum and small intestine would considerably aggravate the life prognosis during the first days of poisoning, and the former was observed in every second patient who died. In later period insignificant lesions disappeared completely, while at the site of deep burns an isolated or associated narrowing of the duodenum and small intestine developed. Surgical interventions were performed mainly in later periods in the presence of scarring contractions of the duodenum and small intestine, that impede an intestinal passage, and were aimed at its restoration. In the early period operations were performed only in life risk complications (intestinal hemorrhages, peritonitis), and these were of a palliative character.