[Combined treatment of colorectal cancer followed by metastatic liver injury]. / Analiz rezul'tatov kombinirovannogo lecheniia bol'nykh kolorektal'nym rakom s metastaticheskim porazheniem pecheni.

AIM: To increase the effectiveness of treatment of colorectal cancer followed by metastatic liver lesion. MATERIAL AND METHODS: This study included 319 patients with colorectal cancer and metastatic liver lesion Gennari grade I, II, and III for the period from 2002 to 2017. All patients received combined treatment. 107 patients underwent liver resections: right-sided hemihepatectomy - 10, advanced right-sided hemihepatectomy - 7, left-sided hemihepatectomy - 9, triple segmentectomy - 33, bisegmentectomy - 29, segmentectomy - 19 cases. Radiofrequency ablation of liver metastases was performed in 105 patients. Cool tip device with a power of 200 W was used for destruction. Fifty-seven patients underwent microwave destruction of liver tumor (AveCure MWG 881, 34 W). Transarterial chemoembolization by doxorubicin and HepaSpheres 150-250 ng was applied in 34 patients. RESULTS: Annual, 2-, 3- and 5-year survival was 83.1%, 73.5%, 60.2% and 24.6%, respectively after liver resection. RFA of liver metastases was followed by annual, 2- and 3-year survival near 73.5%, 53.3% and 32.1%, respectively. In case of MWA of liver metastases annual survival was 78.5%, 2-year - 63.3%, 3-year - 58.3%. CONCLUSION: Chemotherapy combined with targeted therapy, radiofrequency and microwave ablation is able to increase resectability up to 35-40% in patients with colorectal cancer followed by liver metastases. Minimally invasive procedures (RFA, MWA) reduce surgical risk in critically ill patients.

[Non-strain methods of hernioplasty in the treatment of postoperative ventral hernias]. / Gernioplastika bez natiazheniia tkanei v lechenii posleoperatsionnykh ventral'nykh grysh.

In the last 2 years we performed 26 nonstrain hernioplasties for postoperative ventral hernias (16 laparoscopic and 10 open operations). Indications for laparoscopic operation were hernias after "primary" laparotomy, multiple aponeurosis defects, and also demand of simultaneous operations. We preferred open plastics in recurrent hernias, repeated abdominal operations, laparoscopic hernioplasty impossibility revealed during the operation. Fast rehabilitation and their early return to work are advantages of nonstrain hernioplasty. Mean hospital stay was 7.5 days with a general disability of 22.3 days. We believe that open hernioplasty is most simple and reliable. As to laparoscopic hernioplasty, we think it less reliable.

[One-row continuous suture in abdominal surgery]. / Odnoriadnyi nepreryvnyi shov v abdominal'noi khirurgii.

One-row continuous suture (OCS) was used in 3605 patients while placing anastomoses in different parts of the digestive tract, extrahepatic bile ducts and pancreas as well as suturing after gastrostomy and choledochotomy. Two techniques of OCS were used. In 526 patients OCS was used for biliary tract surgery with complications rate 1.3%. In surgery of the stomach and small intestine OCS was used in 2606 patients; the insufficiency rate of stomach and small intestine anastomoses was equal (0.04%). In surgery of colon and rectum OCS was used in 405 patients; insufficiency rate was 1.5%. In surgery of the pancreas this suture was used in 70 patients without complications after surgery. Analysis of the data shows high reliability of OCS for anastomoses in abdominal surgery and allows to recommend its wider use in clinical practice.

[Lychtenstein's hernioplasty in inguinal hernmias]. / Plastika po Likhtenshteinu pri pakhovykh gryzhakh.

The choice of plastic treatment of inguinal hernias is stile a problem. The rate of relapses in conventional methods of hernioplasty averages 8%. The commonest complications are nerves' injuries and damage to the arterial and venous vessels of the spermatic cord. The hope for the decrease of complications rate is based on implementation of "unstretched" surgery. The rate of relapses after endoscopical hernioplasties varies from 0.8% after transabdominal preperitoneal hernioplasty to 3.2%--after intraperitoneal one. Laparoscopic methods for hernioplasty are technically complicated and expensive. The authors used Lychtenstein's hernioplasty as an alternative to laparoscopic hernioplasty methods. The technique is described according to which 76 operations were carried out. The method is much easier than laparoscopical one. The course of the early postoperative period is comparable with that one after laparoscopical operations. It is stressed that Lychtenstein's hernioplasty should be considered as a method of choice in majority of patients with inguinal hernias.

[Pancreatoduodenal resection with application of suturing device]. / Pankreatodudenal'naia rezektsiia s primeneniem sshivaiushchikh apparatov.

Operation of Whipple (pancreatoduodenal resection) is one of the most complicated in abdominal surgery; it is accompanied by great number of postoperative complications and lethal outcomes. The authors were the first in Russia to use suturing apparates by the firm USSC in pancreatoduodenal resection. The apparates were used in 8 patients, control group consisted of 10 patients previously operated conventionally with the use of uses UO series instruments. The application of the suturing devices made it possible to cut by half the duration of the operation, to secure painless postoperative course, to unify the operative procedure and makes it available for additional medical institutions.

[Method of pancreatoduodenal resection and intraoperative prevention of acute pancreatitis]. / Tekhnika pankreatoduodenal'noi rezektsii i intraoperatsionnoi profilaktiki ostrogo pankreatita.

In the period from 1988 to 1991 the authors carried out 27 pancreatoduodenal resections with 11.1% mortality. From analysis of the results they formulated the main technical principles of this operation and suggested a complex of intraoperative measures for prevention of acute postoperative pancreatitis. The complex included application of a 5-fluorouracil-containing covering of the pancreas at the stage of exposure of the complex which will be removed; individualization of the methods for treatment of the pancreatic stump depending on the diameter of the pancreatic duct; the use of prolene in forming the pancreaticoenteroanastomosis; intraoperative administration of cephalosporins and dioxidine followed by antibacterial therapy; application of microsphere with cytostatics to the pancreas at the operation end for prolongation of pancreatic secretion suppression.

[Comprehensive therapy of obstructive jaundice with neoplastic origin]. / Kompleksnoe lechenie obturatsionnoi zheltukhi opukholevogo geneza.

The authors treated 67 patients with jaundice on the ground of biliopancreatoduodenal tumors. Of them, 49 underwent the palliative operations. In 31 patient, the conventional two-stage treatment was employed. The postoperative complications occurred in 28.6% of the patients. The lethality was 20.8%. Examination for 1-3 days, intensive preoperative preparation, antibacterial prophylaxis, regional chemotherapy were performed in 18 patients. The incidence of postoperative complications in these patients was 11.2%, the lethality--5.6%.