[Four years of experience in plastic surgery of anterior abdominal wall hernias with mesh implants made of titanium thread]. / Chetyrekhletnii opyt plastiki gryzh perednei bryushnoi stenki setchatymi implantatami iz titanovoi niti.

OBJECTIVE: To evaluate the results of using titanium thread mesh implants in the treatment of anterior abdominal wall hernias. MATERIAL AND METHODS: This article evaluates the titanium thread mesh implant used by us in the treatment of 240 patients with anterior abdominal wall hernias; describes the features of this type of implants and the technical features of various types of operations using them. RESULTS: The overall rate of postoperative complications was 2.9%. Hernia recurrence was observed in 2.4% of patients after laparoscopic transabdominal preperitoneal hernioplasty. CONCLUSIONS: The use of a mesh implant made of titanium thread did not reveal any specific complications for this implant. At the stage of gaining experience with a mesh implant made of titanium thread, technical difficulties may occur when placing and fixing it, which increases the duration of surgery.

[Surgical treatment of colon cancer in advanced age patients with severe comorbidities]. / Vliyanie komorbidnogo fona na vozmozhnost' khirurgicheskogo lecheniya bol'nykh rakom obodochnoi kishki pozhilogo i starcheskogo vozrasta.

OBJECTIVE: To analyze surgical (including minimally invasive) treatment of advanced age patients with colon cancer and severe comorbidities. MATERIAL AND METHODS: Advanced age patients with colon cancer (≥60 years) were compared with younger ones. Concomitant diseases were detected in 94,4% of older patients and in 45,9% of patients in the control group (χ2=51,747; p<0,001). RESULTS: Surgery time, intraoperative blood loss, length of hospital-stay, postoperative morbidity and mortality were similar. CONCLUSION: Severe comorbidities did not significantly affect surgical outcomes in these patients and did not increase postoperative morbidity and mortality.

[Early and long-term outcomes of minimally invasive interventions in urgent colon surgery]. / Blizhaishie i otdalennye rezul'taty mini-invazivnykh vmeshatel'stv v urgentnoi khirurgii tolstoi kishki.

OBJECTIVE: To analyze the results of minimally invasive surgical treatment of patients with urgent colon diseases. MATERIAL AND METHODS: There were 89 patients with urgent colon diseases. All patients were divided into 2 groups: the main group - 31 patients who underwent laparoscopic surgeries, the control group - 58 patients operated via open access. Both groups were comparable by age and underlying disease. However, significant differences in gender, severity of comorbidities and complications of the underlying disease were observed. RESULTS: Surgery time, postoperative morbidity (9.7% vs. 6.9%) and postoperative hospital-stay were similar in both groups. Quality of life was significantly better in the main group compared with the control group if colostomy was absent. In case of stoma, there were no between-group differences. CONCLUSION: Laparoscopic surgery is associated with reduced need for analgesics, similar duration of intervention and postoperative morbidity. Complete restoration of quality of life in these patients is observed in 6 months after surgery. Colostomy results similar quality of life after laparoscopic and open surgery.

[Treatment of postoperative ventral hernias with the use of mesh implants made of titanium thread]. / Lechenie posleoperatsionnykh ventral'nykh gryzh s ispol'zovaniem setchatykh implantov iz titanovoi niti.

AIM: Study of the results of the use of titanium thread mesh implants in the treatment of postoperative ventral hernias. METHODS: The study included 84 patients with postoperative ventral hernias. All performed open-access prosthetic hernioplasty. 2 groups were formed: the main group consisted of 32 patients who used a mesh implant made of titanium thread as an implant, the comparison group consisted of 52 patients whose hernioplasty was performed using a polypropylene mesh implant. There were no statistically significant differences between groups of patients by age, gender, average body mass index, risk class of anesthesia (ASA), size and location of hernias. RESULTS: The frequency of postoperative complications in the main group was 6.2%, in the comparison group - 3.8%. There were no statistically significant differences in this indicator between the groups. At the time of discharge from the hospital, the level of plasma C-reactive protein in patients of the main group was significantly lower than in patients of the comparison group. CONCLUSION: The use of titanium thread mesh implants in the treatment of postoperative ventral hernias is accompanied by a less inflammatory response of the body to the implant and does not lead to an increase in the frequency of postoperative complications.

[Minimally invasive interventions in emergency large bowel surgery]. / Miniinvazivnye vmeshatel'stva v urgentnoi khirurgii tolstoi kishki.

The current trends in the treatment of various surgical diseases of large bowel using minimally invasive operations are reviewed in the manuscript. It is shown that laparoscopy is currently possible in most cases for urgent large bowel diseases.

[Surgical treatment of acute calculous cholecystitis followed by one-day discharge of patients]. / Khirurgicheskoe lechenie ostrogo kal'kuleznogo kholetsistita s dosutochnoi vypiskoi bol'nykh.

AIM: To develop rational tactics of surgical treatment of patients with acute calculous cholecystitis with their subsequent discharge within 1 day since admission. MATERIAL AND METHODS: There were 283 patients with acute cholecystitis and 58 patients with chronic cholecystitis. All patients underwent laparoscopic cholecystectomy. Patients with acute cholecystitis were divided into 2 groups: main group - 136 patients were discharged within 1 day since admission, control group - 147 patients who were discharged later. Age, gender, duration of attack and ASA score were similar in both groups. RESULTS: Incidence of intraoperative complications was significantly higher in the control group compared with the main group (6.1% vs. 0.7%). There were no postoperative complications in the main group; postoperative morbidity in the control group was 6.1%. Criteria preventing discharge within 1 day since admission were developed. Uneventful early postoperative period after laparoscopic cholecystectomy allows us to discharge 48% of patients with uncomplicated acute calculous cholecystitis within 1 day since hospitalization. The developed algorithm of treatment is followed by reduced hospital-stay by 4 days. CONCLUSION: The developed algorithm of treatment of patients with acute calculous cholecystitis can reduce hospital-stay up to 1 day. Favorable early postoperative period and follow-up of patients after discharge are essential for safe treatment.

[Minimally invasive surgery for colorectal cancer in advanced age patients]. / Miniinvazivnaia khirurgiia kolorektal'nogo raka u bol'nykh pozhilogo i starcheskogo vozrasta.

AIM: To evaluate the role of laparoscopic surgery for colorectal cancer in advanced age patients. MATERIAL AND METHODS: 290 patients with colorectal cancer were enrolled including 121 patients with rectal cancer and 169 patients with colon cancer. Main group consisted of 171 patients over 60 years old, control group - 119 patients younger 60 years old. RESULTS: Radical advanced procedures on different parts of colon including laparoscopic approach were performed in the majority of advanced age patients. Outcomes were considered as good, we did not notice serious complications (5.4% after rectal surgery, 3.9% after colon surgery). Differences were not significant compared with younger patients including laparoscopic interventions for emergency indications. Nevertheless, surgical treatment of advanced age patients with colorectal cancer makes special demands for equipping of the clinic and physicians' qualification. CONCLUSION: Advanced age is not a serious limitation in choice of laparoscopic access in both elective and emergency surgery in patients with colorectal cancer.

[Efficacy of video-assisted procedures in advanced age patients with colorectal cancer]. / Éffektivnost' videoéndoskopicheskikh vmeshatel'stv u bol'nykh kolorektal'nym rakom starshikh vozrastnykh kategorii.

AIM: To assess advisability of video-assisted surgery in advanced age patients with colorectal cancer. MATERIAL AND METHODS: The study involved 44 patients with large intestine tumors. There were 30 patients with colon cancer aged 78.0±1.1 years and 14 patients with rectal neoplasms aged 75.0±1.8 years. All of them underwent elective video-assisted resections without conversion of the approach. RESULTS: Good and satisfactory results were achieved in 95.5% of patients. Postoperative complications occurred in 5 (11.4%) cases followed by redo surgery in 2 (4.5%) patients. Mortality was absent. CONCLUSION: Video-assisted procedures are preferable in elective surgery of colorectal cancer in advanced age patients regardless stage and localization of the process.

[Laparoscopic cholecystectomy in short-stay hospital]. / Laparoskopicheskaya kholetsistektomiya v usloviyakh statsionara odnogo dnya.

AIM: To develop the protocol of surgical management of cholelithiasis in short-stay hospital. MATERIAL AND METHODS: Surgical treatment of 161 patients with cholelithiasis was analyzed. All of them underwent elective cholecystectomy. Short-stay hospital group included 41 patients. 120 patients were operated in surgical department (group 2). RESULTS: Incidence of intraoperative complications was 2.4% and 3.4% in both groups respectively (p>0.05). Postoperative complications were more frequent in group 2 (8.3% vs. 2.4%, p<0.05). Mean hospital-stay was 1 and 4.4 days in both groups respectively. CONCLUSION: Treatment of chronic calculous cholecystitis is advisable in short-stay hospital. Indications for this approach and its safety in certain patients were determined. The protocol of surgical management of chronic cholecystitis in short-stay hospital was develped.

[Results of surgical treatment of cholelithiasis by laparotomic and minimally invasive accesses].

The article presents the results of surgical treatment of 1038 patients with cholelithiasis, acute and chronic calculous cholecystitis and complicated forms of the disease. Operations were performed with traditional laparotomic and minimally invasive approaches. Indications for choosing access, as well as the advantages and disadvantages of various options of surgery in patients with cholelithiasis are discussed.

[The quality of life after cholecystectomy].

The quality of life (QOL) of three groups of patients who had undergone the routine cholecystectomy (RCE), laparoscopic cholecystectomy (LCE), or cholecystectomy using the minilaparatomy approach (MCE). QOL was assessed using the standard SF-36 questionnaire and on selected criteria. The postoperative complications rate after any version of cholecystectomy did not exceed the average rate in other studies. Patients with a history of LCE and MCE, returned to their normal social and intellectual activity faster; they reported higher perception and judgment on the state of their health and well-being, which in turn suggests the higher quality of life. Patients after RCE reported worse results due to a longer recovery period.

[Surgeries on gastrointestinal tract without components of donor's blood].

Results of surgical treatment without transfusion of donor's blood in 58 patients were compared with ones in 40 patients treated with allogenous transfusions. Blood-saving program included preoperative storage of autoplasma, acute normovolemic hemodilution, recombinant human erythropoietin and perftoran. Both groups of patients were similar by types of surgeries performed on gastrointestinal tract. Results of treatment in the study group (58 patients) were better: there were less postoperative complications; period of postoperative rehabilitation was shorter. It is demonstrated that it is possible to refuse allogenous hemotransfusion in 96.6% cases of traumatic surgeries on gastrointestinal tract.

[Traumatic surgeries on organs of gastrointestinal tract without components of donor's blood]. / Travmatichnye operatsii na organakh pishchevarutel'nogo trakta bez ispol'zovaniia komponentov donorskoi krovi.

The authors propose a complex program aimed to refuse completely using donor's blood components in surgeries on organs of digestive tract. This method was used in 25 patients who underwent surgeries with 380-1500 ml of blood loss. No patients received transfusion of donor's blood components before, during and after surgery.

[One-stage esophagoplasty without transfusion of donor blood components]. / Odnomomentnaia plastika pishchevoda bez ispol'zovaniia komponentov donorskoi krovi.

Six patients aged from 27 to 62 years were operated for subtotal burn strictures, cancer and glandular polyp of a low-thoracic part of the esophagus using a complex program of non-blood surgery. The following methods were used: collection of autoplasma before surgery by plasmapheresis, collection of autologic packet red cells, normovolemic hemodilution during surgery, use of perftoran for oxygen transport and recombinant human erythropoetin to stimulate erythropoiesis and raise preporative level of hemoglobin. Components of donor blood were not used in these patients. There were no complications associated with these methods. Partial failure of esophagol-colonic anastomosis on the neck was seen in 1 patient. The complex program permits one to avoid completely transfusion of donor blood components in esophagol surgery.