[Laparoscopic preperitoneal and Lichtenstein inguinal hernia repair. What method is preferable?] / Laparoskopicheskaya predbryushinnaya plastika pakhovykh gryzh i gernioplastika po Likhtenshteinu. Kakoi metod predpochtitel'nee?

This review is devoted to laparoscopic preperitoneal and open Lichtenstein unguinal hernia repair. Considering the PubMed, Google, the Springer Link online library and the Cochrane Systematic Review databases, we analyzed the reviews, prospective and retrospective studies devoted to comparison of these most common methods of treating inguinal hernias. Indications and contraindications for endoscopic hernia repair, features of laparoscopic surgeries, causes of conversion to open interventions, early and long-term results of laparoscopic and open operations were estimated.

[Laparoscopic appendectomy for acute appendicitis in pregnancy]. / Laparoskopicheskaya appendektomiya pri ostrom appenditsite u beremennykh.

The review is devoted to the role of laparoscopic appendectomy in surgical management of acute appendicitis in pregnancy. We analyzed reviews, prospective and retrospective studies in the PubMed, Google, the Springer Link online library, the Cochrane Systematic Review databases. The results of laparoscopic and traditional treatment of acute appendicitis in pregnant women were assessed. We analyzed clinical, epidemiological features in these patients, differential diagnosis of acute appendicitis in pregnant women, indications and contraindications for endoscopic treatment, features of laparoscopic procedures. Comparative assessment of laparoscopic and open surgeries for acute appendicitis in pregnant women was carried out. We also estimated the influence of surgical treatment of acute appendicitis on subsequent course of pregnancy.

[Laparoscopic treatment of perforated gastroduodenal ulcers]. / Laparoskopicheskaya tekhnologiya lecheniya probodnykh yazv zheludka i dvenadtsatiperstnoi kishki.

The review is devoted to laparoscopic technology in the treatment of perforated gastroduodenal ulcers. Searching for literature data was performed in the PubMed, Google, Springer Link online library, Cochrane Systematic Review databases. We analyzed reviews, prospective and retrospective studies devoted to various strategies in the treatment of perforated peptic ulcers. Demographic, clinical and epidemiological features of these patients, indications and contraindications for endoscopic suturing of perforations, features of laparoscopic procedures and causes of conversions to open surgery were studied. Finally, we compared the results of laparoscopic and open surgeries.

[Modern minimally invasive technologies for the treatment of cholelithiasis]. / Sovremennye mini-invazivnye tekhnologii lecheniya kholetsistokholedokholitiaza.

Surgical community has not yet reached any consensus on the adequate treatment of gallstone disease with combined stones of the gallbladder and bile ducts. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic papillosphincterotomy (EPST) followed by laparoscopic cholecystectomy (LCE) have been considered the optimal treatment method for the past thirty years. Thanks to improvement of technologies and experience in laparoscopic surgery, many centers in the world offer simultaneous treatment of cholecystocholedocholithiasis, i.e. LCE and laparoscopic choledocholithotomy. Transcystical and transcholedochal extraction of calculi from the common bile duct is the most common. Intraoperative cholangiography and choledochoscopy are used to assess extraction of calculi while T-shaped drainage, biliary stent and primary suture of common bile duct are used to complete choledocholithotomy. Laparoscopic choledocholithotomy is associated with certain difficulties, requires some experience in choledochoscopy and intracorporeal suturing of common bile duct. There are many unresolved issues regarding the choice of laparoscopic choledocholithotomy technique depending on the number and dimensions of stones, diameter of cystic duct and common bile duct. The authors analyze literature data on the role of modern minimally invasive interventions in the treatment of gallstone disease.

[Emergency laparoscopy in the treatment of perforated gastroduodenal ulcers]. / Ekstrennaya laparoskopiya pri lechenii perforativnykh gastroduodenal'nykh yazv.

OBJECTIVE: To compare the results of endoscopic and open treatment of perforated gastroduodenal ulcers. MATERIAL AND METHODS: There were 445 patients with perforated gastroduodenal ulcers between 2013 and 2021. Endoscopic suturing of perforation was performed in 172 patients (38.7%), 273 ones underwent open surgery. RESULTS: Among 172 patients scheduled for endoscopy, 160 (93.6%) ones underwent laparoscopic suturing of perforation. Morbidity rate was 5.0% (n=8), postoperative mortality rate - 1.3% (n=2). Comparison of the outcomes after laparoscopic suturing of ulcers in 160 patients and open surgery in 134 patients showed that laparoscopy was followed by 2.5 times lower incidence of complications and 3 times lower postoperative mortality. CONCLUSION: Diagnostic laparoscopy is advisable in patients with perforated ulcers and no contraindications. In most cases, surgery can be successfully and effectively completed without conversion to laparotomy. Endoscopic closure of ulcerative defect is preferable since this procedure has certain advantages over traditional intervention, contributes to significant reduction in morbidity, mortality and hospital-stay.

[Potential endovascular prophylaxis for pulmonary thromboembolism in the combined treatment of cancer patients].

Our study was concerned with the role of ultrasound examination of the lower extremity veins to detect deep venous thrombosis and to evaluate complex prophylaxis of thromboembolism of pulmonary arteries (TEPA). The procedure involved vena cava filter placement in patients with neoplasia and high risk of TEPA as compared with controls receiving conservative therapy alone. A positive correlation was established between surgery and/or polychemotherapy, on the one hand, and higher stage and high risk of TEPA, on the other. Patients with deep venous thrombosis and neoplasia were referred to groups of extremely high risk of that pathology. Angiological history, physical examination and ultrasound check-ups of the lower vein must be carried out in cancer patients. Vena cava filter placement proved to be an effective and safe measure of TEPA prophylaxis. It lowered the risk of lethal outcome in 24 during surgery and polychemotherapy. Lethality rate among controls was 43.5 +/- 0.51%.

[Use of videolaparoscopy in treatment of peritonitis of appendicular origin].

Videolaparoscopic appendectomy was carried out in 108 patients with acute destructive appendicitis complicated by peritonitis. Local peritonitis was noted in 65 patients, diffuse peritonitis in 33 patients, periappendicular abscess in 10 patients. Postoperative complications were observed in 6 (5.6%) patients. Nobody died. A comparison of results of treatment with a group of 143 patients who underwent appendectomy by laparotomic approach has shown that after endovideosurgical treatment there was no such a serious complication as early adhesive intestinal obstruction. The number of wound complications statistically reliably decreased as well as the time of stay at hospital. The authors consider that videolaparoscopic appendectomy should be used in treatment of peritonitis of appendicular origin much wider.

[Using laparoscopic cholecystectomy in treatment of destructive forms of acute cholecystitis].

Videolaparoscopic cholecystectomy was performed in 352 patients with acute destructive cholecystitis, 236 (67%) of patients having phlegmonous cholecystitis or empyema of the gallbladder, 116 patients (33%) gangrenous cholecystitis. In 74 patients (21%) the course of acute cholecystitis was complicated by the formation of paravesical infiltration or abscess. Standard laparoscopic cholecystectomy was fulfilled in 250 patients (71%), in 102 patients not traditional methods of endovideosurgical dissection of the gallbladder were used, in particular laparoscopic cholecystectomy from the bottom in 18 patients (5.1%) and laparoscopic subtotal cholecystectomy in 84 (23.9) patients. The use of endovideosurgical method of treatment of acute destructive cholecystitis gives statistically reliably shorter time of operative intervention, less number of postoperative complications and lower index of postoperative lethality as compared with traditional cholecystectomy.

[Causes of postoperative lethality in acute cholecystitis and measures to decrease it].

The authors have made a comparative analysis of postoperative lethality in acute cholecystitis for the period of 25 years. The clinical material included 1383 operated patients, of them 87 (6.3%) patients died. In the previous years postoperative lethality was within the limits of 9-10% and the determining factor was elderly age, concomitant diseases, late hospitalization of the patients, belated surgery, strategic and technical errors. The present-day methods introduced into clinical practice of investigation (USI, CT) and laparoscopic method of operating made the lethality several times less. For the last 10 years lethality was 0.4% per 451 operated patients.

[Primary multiple colorectal cancer in elderly patients]. / Pervichno-mnozhestvennyi rak obodochnoi kishki u bol'nykh pozhilogo vozrasta.

Primary multiple malignancy or polyneoplasia, which is regarded as an one-time or a sequence of malignant focal formation, is by no means a rarity nowadays. However, its treatment involves quite an array of complex problems. Primary multiple malignancy frequency ranged 0.04-11%.

[Experience in surgical treatment of injuries of the major vessels]. / Opyt khirurgicheskogo lecheniia povrezhdenii magistral'nykh sosudov.

Eighty-one patients were treated for injuries to the main vessels. They underwent operations at the Novgorod Regional Hospital and in surgical departments of the Novgorod Region. The injuries of the vessels were open in 90.1% and closed in 9.9% of patients. Among 125 reconstructive operations good results with restoration of arterial and venous blood flow and maintained function of the limb were produced in 67.9% and satisfactory results in 9.9% of patients. Amputation of the limb was carried out in 13 patients (16.0%). Mortality was 7.4% (six patients). The authors emphasize that early admission of patients to the hospital and the therapeutic tactics in a vascular trauma guarantee preservation of the injured limb, restoration of its function, and save the patient's life.

[Surgical treatment of recurrent aortic-iliac-femoral occlusions]. / Khirurgicheskaia taktika pri reokkliuziiakh v aortopodvzdoshno-bedrennom segmente.

At the department of vascular surgery of the Novgorod Regional Hospital 455 reconstructive operations for atherosclerotic occlusions in the aorto-ileo-femoral segment were performed in 1984-1991. Thrombotic reocclusion occurred in 58 patients (12.7%) for which a second operation had to be conducted, early thromboses of the reconstructed segment were encountered in 16 patients (3.5%) and late thromboses in 42 (9.2%). The work analyses the causes of early and late reocclusions, substantiates the surgical tactics, and discusses the technical characteristics of the operation. Thrombectomy with reconstruction of the distal anastomosis and the draining paths was the main method of treatment. It was conducted in 12 patients with early and in 21 patients with late reocclusions. The results of surgical treatment are shown. It is concluded that repeated reconstructive operations are a sufficiently effective measure for preserving the function of the earlier operated on limb; they made it possible to produce positive immediate results in 81.0% and late-term results in 64.3% of patients.