[Hemobilia as a sign of arterio-biliary fistula]. / Gemobiliya kak proyavlenie arteriobiliarnoi fistuly.

Hepatic artery aneurysms (HAA) are rare (20% of all visceral arteries). Most often, HAAs are asymptomatic and detected at autopsy. However, their ruptures and/or bleeding following pressure ulcers in visceral gastrointestinal organs are a significant clinical and diagnostic problem. We present 2 patients with obstructive jaundice and hemobilia. Diagnostics revealed aneurysm of the right hepatic artery with arterio-biliary fistula. Life-threatening hemobilia is a consequence of HAA rupture into biliary system. Endovascular approach is preferable for HAA without clinical manifestations. Awareness of this disease is important for early detection and active surgical intervention before possible complications.

The rare thoracic complication: perforation of gastric fundus ulcer: a case report.

BACKGROUND: Gastropleural fistula is an exceptionally rare condition, the incidence of which is currently unknown (Kunieda et al. in Intern Med 51(3):331, 2012,  https://doi.org/10.2169/internalmedicine.51.6823 , Iqbal et al. in Cureus 11(2):e4136, 2019, https://doi.org/10.7759/cureus.4136 , Kathayanatt et al. in Lung India 37(2):174-175, 2020, https://doi.org/10.4103/lungindia.lungindia_242_17 ). The etiology varies from traumatic or iatrogenic injury to perforation in a herniated stomach due to ischemia, ulceration, or malignancy. CASE PRESENTATION: A 27-year-old European male presented to our hospital with complaints of general weakness and shortness of breath. The patient had a single episode of hemoptysis before admission. A computed tomography scan demonstrated a left-sided pyopneumothorax, a defect in the left main bronchus, and signs of pneumonia in the lower sections of the right lung. Therefore, a rare complication of perforation of a gastric fundus ulcer with the formation of a subdiaphragmatic abscess, gastropleural fistula, gangrene of the left lung with circular necrosis of the left main bronchus and diastasis of its edges, and pleural empyema on the left is presented in this report. CONCLUSIONS: Although, a radical surgery may be preferable for this suspected malignancy; it should be weighed carefully against the risk of sepsis and the morbidity associated with a prolonged procedure in a sick patient. Damage-control surgery may be a viable option for a very sick patient, with more extensive resection reserved for later, provided the risk of infection and bleeding has been mitigated.

[Damage control strategy in surgical treatment of patients with severe gastroduodenal bleeding]. / Primenenie strategii Damage control pri khirurgicheskom lechenii patsientov s tyazhelymi gastroduodenal'nymi krovotecheniyami.

OBJECTIVE/: To objectify patient condition and improve treatment outcomes in patients with benign severe gastroduodenal bleeding. MATERIAL AND METHODS: We analyzed the immediate results of staged surgical treatment of patients with benign severe gastroduodenal bleeding according to the accepted concept of «Damage Control Surgery¼. The Rockall risk scoring system and the Glasgow-Blatchford score (GBS) were used. We preferred two-stage intervention in patients with Rockall score ≥5 and Glasgow-Blatchford score ≥11. RESULTS: Staged approach according to the concept of «Damage Control Surgery¼ in patients with benign severe gastroduodenal bleeding ensures positive results by minimizing surgical trauma and perioperative bleeding, early stabilization of hemostasis and subsequent successful restoration of digestive function. CONCLUSION: The concept of «Damage Control Surgery¼ in patients with benign severe gastroduodenal bleeding can reduce mortality and incidence of postoperative complications.

[Minimally invasive correction of anatomical features of anterior abdominal wall and ventral hernias]. / Miniinvazivnye metodiki v korrektsii anatomicheskikh osobennostei perednei bryushnoi stenki i v lechenii ventral'nykh gryzh.

Conventional «open¼ procedures for ventral hernias and diastasis recti are widely known, used everywhere and have a great number of author's improvements related to surgeon's experience, availability of modern information, equipment and materials. K. LeBlanc and W. Booth (1993) reported IPOM-method with non-adhesive coating that is considered a milestone in surgery of anterior abdominal wall and ventral hernia. This technique has gained recognition among surgeons around the world due to its technical simplicity, minimal invasiveness and high reproducibility. However, certain disadvantages of this technique have been shown over the past time that justified advisability of searching for another methods of anterior abdominal wall reinforcement. Thus, E-Milos, LIRA, TESAR, eTEP, REPA, TARM, TARUP techniques are currently available. This review is devoted to technical features of these techniques, their potential advantages and disadvantages.

[Results of anterior abdominal wall repair with mesh implants in patients with postoperative ventral hernia]. / Rezul'taty vosstanovleniia perednei briushnoi stenki pri posleoperatsionnykh ventral'nykh gryzhakh s ispol'zovaniem setchatykh implantatov.

AIM: To analyze the results of the restoration of the anterior abdominal wall in postoperative ventral hernias using mesh implants. MATERIAL AND METHODS: The study was of 680 patients, who underwent abdominal wall reconstruction using mesh implants. RESULTS: A total of 105 postoperative complications (15.44%) in 84 (12.35%) patients; the postoperative period was without complications in 596 (87.65%) patients. The greatest number of complications was noted after laparoscopic IPOM - 13 patients (20.31%); the smallest - after posterior component separation - 24 (7.5%). Also described 10 systemic complications: 8 of which were stopped by conservative therapy, in 2 cases repeated surgical intervention was required with a change in the type of wall reconstruction. Statistical analysis did not show statistically significant differences in the incidence of complications between the different versions of the performance of hernioplasty, except for the posterior muscular plastics. Statistical analysis also showed a link between the likelihood of various complications and the type of ventral hernia repair. CONCLUSION: Conducting different methods abdominal wall reconstruction using mesh implants is techniques with a low level of postoperative complications and comparable results when performing various types of plastics.

[Outcomes of minimally invasive biliary decompression in obstructive jaundice]. / Analiz rezul'tatov miniinvazivnoi dekompressii zhelchevyvodiashchikh putei pri mekhanicheskoi zheltukhe.

AIM: To study postoperative complications and mortality after minimally invasive biliary decompression in patients with mechanical jaundice. MATERIAL AND METHODS: Prospective analysis included 2.072 patients with mechanical jaundice who underwent differential biliary decompression depending on the cause, level of obstruction, severity of jaundice and patient's condition. RESULTS: Relief of bilirubinemia and stabilization of the state were achieved in 1696 patients of the main group (98,6%) and in 328 (93.18%) patients of the control group. Mortality was similar in both groups: 8 (0.46%) and 2 (0.56%) patients. The best results were obtained in the main group for in-hospital and post-hospital complications after retrograde interventions (χ2=4.440821; df=0.891435; p<0.05) and post-hospital complications after antegrade interventions (χ2=35.52869; df= 1; p<0.05). CONCLUSION: Differentiated approach to minimally invasive biliary decompression is followed by reduced postoperative morbidity.