[Serum ghrelin changes after bariatric surgery]. / Kak izmenyaetsya uroven' grelina u patsientov, perenesshikh bariatricheskie vmeshatel'stva.

OBJECTIVE: To study the effect of bariatric surgery on serum ghrelin in patients with morbid obesity. MATERIAL AND METHODS: We experimentally analyzed serum ghrelin in 96 rats. Of these, 84 rats underwent sleeve gastrectomy, and 12 rats comprised the control group (no surgery). We measured body weight and serum ghrelin using ELISA method after 1, 3, 7, 14, 21 and 30 days after surgery. Serum ghrelin was studied before and after bariatric surgery in 23 patients with morbid obesity. RESULTS: Baseline serum ghrelin was lower in larger rats and obese patients compared to normal body weight. We found no decrease in serum ghrelin after resection of fundal ghrelin-releasing part of the stomach. CONCLUSION: Stomach volume changes after restrictive bariatric surgery (sleeve resection or gastroplication) are accompanied by mild increase in serum ghrelin. This increment is greater after more significant body weight loss after surgery. Similar researches will help to find new treatment strategies for pathological obesity.

[Surgical treatment of gallbladder polyps]. / Khirurgicheskoe lechenie polipov zhelchnogo puzyrya.

OBJECTIVE: To study the incidence of gallbladder polyps and the possibilities of modern methods of diagnosis and surgical treatment of this disease. MATERIAL AND METHODS: There were 42 laparoscopic cholecystectomies in patients with diagnosed gallbladder polyps. The polyps were diagnosed preoperatively. Intraoperative diagnosis during surgery for gallstone disease was observed in 3 cases. A comparative analysis of preoperative examination did not reveal any advantages of certain diagnostic approach. RESULTS: Hyperplastic polyp was the most common type (n=20, 47.6%), adenomatous polyps occurred in 19 (45.3%) cases, cholesteric polyps - in 3 (7.1%) patients. All patients had signs of chronic inflammation of the gallbladder wall with its infiltration by lymphocytes and histiocytes. CONCLUSION: Further studies with clear criteria for the diagnosis of gallbladder polyps including ones for determining true polyps, precancerous and malignant polyps are required.

[Gastric plication in treatment of patients with overweight and obesity]. / Sposob gastroplikatsii v lechenii patsientov s izbytochnoi massoi tela i ozhireniem.

AIM: To present the new method of gastric plication in treatment of patients with overweight and obesity. MATERIAL AND METHODS: There were 132 different bariatric interventions in patients with overweight and obesity. RESULTS: It is described an original technique of laparoscopic gastric placation characterized by reduced postoperative morbidity, simplicity, low traumatism, and economic efficiency. The method was applied in 12 patients with morbid obesity. The majority of patients (83.3%) achieved a persistent decrease in body weight. CONCLUSION: The prospects of the method are seen in determining surgical indications and selection of patients for the operation. Further assessment of laparoscopic gastric plication will make it possible to determine its place among restrictive methods for weight loss.

[Creative surgery for hiatal hernia]. / Kreativnaia khirurgiia gryzhi pishchevodnogo otverstiia diafragmy.

AIM: To present an experience of surgical treatment of hiatal hernia. MATERIAL AND METHODS: An experience of more than thousand laparoscopic fundoplications in various modifications has been accumulated in the Clinic of Bashkir State Medical University for the period 2001-2016. RESULTS: An original device for intraoperative measurement of hiatal orifice is described. Hiatal orifice repair was indicated in case of its dimension over 3.5 cm. 310 patients underwent hiatal orifice repair including diaphragmocrurorrhaphy in 189 cases, hiatal orifice replacement by using of mesh implant in 121 cases. Simultaneous interventions were performed in 211 cases due to hiatal hernia combined with other abdominal diseases. CONCLUSION: Thus, selection of hiatal hernia patients for antireflux surgery should be clearly indicated according to clinical and instrumental data in the context of health care system reforming and widespread use of minimally invasive technologies. Laparoscopic operations for hiatal hernia are preferable and contribute to decrease of morbidity and improvement of outcomes.

[SYNDROME OF DIABETIC FOOT: MODERN APPROACHES OF COMPLEX TREATMENT].

The article presents the results of treatment of 201 patients with neuroischemic form of diabetic foot syndrome. The research included 158 women and 43 men of the middle age of 62.5 ± 11.2 years. The complex approach was applied in treatment including medicamentous treatment, revasculization of extremity, an application of modern combined collagenous coating and foot relieving using silicone insoles and orthopedic footwear. The endovascular and open reconstructive operations were performed in order to obtain the revasculization of extremity. Given complex approach allowed reducing the terms of hospital stay, the rate of ulcerous defects recurrences and relapses of ischemia of lower extremities during one year after endovascular interventions.

[The surgical treatment of the combined diseases of the pelvis].

167 women were simultaneously operated on gynecological disease and the combined other surgical diseases. Novel methods of laparoscopic surgery, allowing to decrease intra- and postoperative complications were represented. Authors proved the efficacy and necessity of simultaneous operations.

[Experimental assessment of reparative regeneration of anastomoses of hollow organs of the gastrointestinal tract using preparation "enterosan"].

The article gives an experimental assessment of processes of healing anastomoses of hollow organs using preparation "Enterosan". "Enterosan" decreases inflammatory alterations and accelerates processes of reparative regeneration in the anastomosis zone.

[Endoscopic treatment of gastric polyps].

Data of 258 patients with gastric polipi is analyzed. Endoscopic polypectomy with further microscopical analysis was performed in 218 patients. The method of preoperative submucosal drug injection is proposed. It allowed to decrease the number of postoperative bleedings and recurrences.

[Endoscopy in the diagnosis and treatment of gastric polyps].

The authors present a clinico-statistical analysis of results of endoscopic polypectomy and dynamic observation of 258 patients with gastric polyps. The aim of the investigation was to determine a true histological diagnosis of gastric polyps using excisional biopsy. An endoscopic investigation has revealed 475 polyps in the stomach of 258 patients. Endoscopic polypectomy by the method of electroexcision and preliminary submucous administration of solutions was used for 218 polyps having the size more than 0.5 cm. Patients with formations located submucously and malignant tumors of the stomach (polypoid cancers included) were not investigated. Metaplastic and dysplastic alterations characteristic of adenomatous polyps were detected by the method of chromoscopy.

[The prevention of anastomosis failure in gastrointestinal surgery (an experimental study)].

The analysis of enterosan influence on intestinal anastomosis healing in 90 rats was carried out. The medication is highly active as a regeneration stimulator. The use of enterosan decreases inflammation and activates regeneration in anastomosis area.

[The membrane allotransplantate use in surgery for hygroma].

Reparative processes in calcaneal tendon after the use of new repair technique were studied in two animal series. In both groups the calcaneal tendon was incised to the half of its width. In control group no further manipulations were performed and in the experimental group the defect was covered with allotransplantate of dura mater (membrane stop). The control group demonstrated less active tendon reaction, whereas the experimental group demonstrated stimulation of reparation with the rapid change of inflammatory stages. The membrane stop serves as a modeling frame for new fibers of the regenerate. The obtained results permit recommending the membrane stop in treatment of hand hygromas for the cover of weak tendon areas.

[The role of lipid peroxidation in gall bladder stone formation].

Bile stones formation prognostification method, based on the chemical analysis of bile of patients with chronic cholecystitis, is developed. The method employs the phenomenon of chemiluminescense of the investigated bile in comparison with the model system. Hence, bile in chronic cholecystitis possess antioxidative qualities, whereas bile in chronic cholecystitis combined with cholelithiasis, is oversaturated with free radicals.

[Association of surgical treatment and oxygen active forms with fertility at patients with varicocele].

Study group consisted of 115 patients with varicocele undergone laparoscopic clipping of left seminal vein, control group--121 patients after Ivanisevich's operation. Chemiluminescence of seminal fluid with detection of oxygen active forms were studied at all the patients before surgery, in 14 and 72 days after it. Volume of ejaculate, concentration, mobility and morphology of spermatozoa were also examined. It is demonstrated that level of oxygen active forms may be regarded as criteria of efficacy of surgical treatment. Laparoscopic clipping of left seminal vein demonstrates better results (less postoperative complications and recurrences) compared with Ivanisevich's operation.

[New technologies in the treatment of gastroesophageal reflux disease].

Surgical treatment of 298 patients with gastroesophageal reflux disease with both laparotomy and mini-invasive technologies is analyzed. New method of anti-reflux surgeries using synthetic implants is described. Short- and long-term results are analyzed. Advantage of laparoscopic procedures is demonstrated in long-term period. Excellent and good results were achieved at 82.3% patients.

[Choice of plastic surgery in ventral hernias].

Morphological changes in the zone of plastic surgery with polypropylene graft were studied in experiment. Results of treatment of 195 patients with ventral hernias were analyzed. Study group consisted of 86 (44.1%) patients who underwent hernioplasty with subaponeurotic localization of the graft. Subaponeurotic hernioplasty was performed in 109 (55.9%) patients (control group). Algorithm of choice of plastic surgery's method in ventral hernia was developed with consideration of localization and size of hernia that permitted to reduce rate of early postoperative complications and to improve long-term results.