[Hemorrhoidal artery ligation without Doppler navigation in surgical treatment of hemorrhoidal disease]. / Ligirovanie gemorroidal'nykh arterii bez ul'trazvukovoi doplernoi navigatsii v khirurgicheskom lechenii gemorroidal'noi bolezni.

OBJECTIVE: To compare the immediate and long-term results of surgical treatment of hemorrhoidal disease (GD) stage II-III using two methods of identification of hemorrhoidal arteries (HA) with their subsequent ligation and mucopexy. MATERIAL AND METHODS: A prospective, randomized, controlled, single-center study was conducted to evaluate the effectiveness of HA ligation with and without Doppler navigation. The study included 120 patients: group A - Doppler-guided ligation (n=60) and group B - ligation without ultrasound (n=60). RESULTS: GD stage II was found in 27 patients of the group A and 30 patients of the group B (p=0.4). Mean number of ligated HA in the group A was 3.36, in the group B - 2.83 (p=0.062). Mean number of mucopexy was 3.2 and 3.5, respectively (p=0.8). Mean follow-up period was 8.3±2.1 and 8.1±1.9 months, respectively (p=0.96). Relapse of all preoperative symptoms was registered in 1 patient (1.6%) in the group A. Intermittent bleeding was observed in 5 (8.3%) and 3 (5%) patients, respectively (p=0.71). Periodic hemorrhoid prolapse (GP) occurred in 6 (10%) and 4 (6.6%) respondents, respectively (p=0.74). VAS score of pain syndrome after 2 months and later was 0 - 1 points (p=1.0). Most of patients in both groups (group A - 89%, group B - 94%; p=0.7) noted that surgery did not disrupt their usual lifestyle and relieved from symptoms of GD. CONCLUSION: There are no significant advantages of Doppler-guided HA ligation compared to palpation regarding incidence of hemorrhoid prolapse (p=0.74) and hemorrhoidal bleeding (p=0.71). Pain syndrome (p=0.24), incidence of postoperative complications (p=0.51) and relapses (p=0.31) showed comparable safety of both techniques.

[Morphometry of adipose tissue for prediction of the outcomes of total pancreatectomy with pancreatic islets autotransplantation in patients with chronic pancreatitis]. / Morfometriya zhirovoi kletchatki dlya prognoza rezul'tatov total'noi pankreatektomii s autotransplantatsiei ostrovkov podzheludochnoi zhelezy u bol'nykh khronicheskim pankreatitom.

OBJECTIVE: To compare different clinical and morphometric features of patients undergoing TPAIT for prediction of postoperative outcomes. MATERIAL AND METHODS: A retrospective review enrolled patients who underwent TPAIT for the period from January 2007 to October 2017. Morphometric parameters were analyzed using preoperative CT scans and patients were grouped to examine association of these characteristics with postoperative morbidity. Sarcopenia was defined as the presence of a TPA in the lowest sex-specific quartile. The impact of sarcopenia on pancreatic islet features, perioperative blood transfusion, ICU- and hospital-stay, complications, repeated admission within 90 days and islet function was assessed. RESULTS: A total of 34 patients were included in this study (12 males and 24 females). At the time of diagnosis, mean age of patients was 43.1 years. Mean body mass index (BMI) in sarcopenic patients was 24.9 kg/m2, mean BMI in those without sarcopenia - 24.8 kg/m2 (p=1.00). Various surgical complications were observed in 11 patients (32.3%). Patients with sarcopenia experienced more complications (83.3%) compared with patients without sarcopenia (50%). However, differences were not significant (p=0.31). Islet characteristics (islet numbers, purity), readmission, ICU- and hospital-stay, incidence of blood transfusion and islet function were also similar in both groups. CONCLUSION: Sarcopenia is not a predictor of postoperative complications and islet cell function in chronic pancreatitis patients following TPAIT.

[Choice of optimal treatment strategy for acute perianal thrombosis. Results of online survey]. / Vybor metoda lecheniia ostrogo perianal'nogo tromboza. Rezul'taty oprosa vrachei.

OBJECTIVE: To study the factors influencing the physicians' choice of treatment strategy in patients with acute perianal thrombosis. MATERIAL AND METHODS: A survey was conducted among 124 Russian colorectal surgeons. RESULTS: This survey showed that the choice of treatment strategy varies between private and state clinics. Conservative approach is preferred in government clinics (p=0.024). The time factor is more important for professionals. Hemorrhoidectomy is preferred in private clinicians, thrombectomy - in public clinics. The majority of physicians note that pregnancy significantly affects choice of treatment tactics. The most important factors to refuse surgery are pregnancy (r=0.796), age over 70 years (r=0.655), duration of thrombosis over 4 days (r=0.791). Large thrombosed node (2-3 cm), severe pain syndrome (r=0.858) and duration of disease less than 3 days (r=0.901) determine preferable surgical approach. CONCLUSION: The choice of treatment of acute perianal thrombosis depends on not only duration of disease, severity of pain syndrome, age and pregnancy, but also on the type of the hospital. Conservative treatment is preferable in the majority of national state hospitals. Moreover, most surgeons prefer less aggressive treatment options in the state clinics. Further research is needed to determine any important factors limiting more effective surgical treatment besides pain and patient's attitude toward the disease.

[Gastric neuroendocrine tumors]. / Neiroéndokrinnye opukholi zheludka.

Gastrointestinal neuroendocrine tumors are rare neoplasms. Currently, incidence of gastric neuroendocrine tumors (gNETs) is being significantly increased. There are 3 groups of gNETs: types I, II and III. Each type has important features regarding clinical picture, prognosis and treatment strategy. Type I is the most common (70-80%) and associated with chronic atrophic gastritis including autoimmune gastritis and Helicobacter associated atrophic gastritis. Type II (5-6%) is associated with multiple endocrine neoplasia type I and Zollinger-Ellison syndrome (MEN I - ZES). Both types are characterized by hypergastrinemia and small tumor dimension. These neoplasms are multiple and mostly benign. On the contrary, NETs type III (10-15%) is not associated with hypergastrinemia and represented by single large neoplasms. Tumors are malignant as a rule. Therefore, surgical resection and chemotherapy are preferred for these tumors. Endoscopic surgery followed by observation is acceptable for almost all NETS type I and II. At the same time, this approach is advisable only for small and highly differentiated neoplasms type III.

[Duodenal neuroendocrine tumors]. / Neiroéndokrinnye opukholi dvenadtsatiperstnoi kishki.

Significant augmentation of the incidence of duodenal neuroendocrine tumors duodenum has been observed in recent decades. There are 5 histological types of these tumors: gastrinoma (50-60%), somatostatin-producing tumor (15%), inactive serotonin-containing tumors (20%), poorly differentiated neuroendocrine carcinoma (<3%) and gangliocytic paraganglioma (<2%). The majority of tumors are localized within the bulb and postbulbar part of duodenum, 20% are found in periampular area. Treatment strategy depends on dimensions, localization, histological class, stage and type of tumor. It is believed that endoscopic resection is permissible for small inactive tumors (G1) located above major duodenal papilla. The majority of other neoplasms requires surgical resection. Personal experience of various surgeons is limited by small group of patients. Therefore, it is necessary to summarize results for selection of optimal treatment.

[Problem of decision-making in surgery]. / Problema priniatiia reshenii v khirurgii.

Decision-making process is often complex, responsible and not always reflected in surgical protocol. Some surgeons usually prefer standard finishing of procedure; others talk about individual approach but they have some preferences; the third ones analyze all possible perioperative factors (pre- and intraoperative data) and seek to justify differentiated approach. Some aspects of these processes are discussed in this report.

[Pancreatic tuberculosis]. / Tuberkulez podzheludochnoi zhelezy.

Prevalence, risk factors of primary pancreatic tuberculosis, clinical symptoms and data of instrumental and laboratory diagnosis are reviewed in the article. The authors emphasized the peculiarities of differential diagnosis with pancreatic malignancies and advisability of the most informative methods - endoscopy and fine-needle aspiration procedure.

[Current state of the problem of allotransplantation of Langerhans cells (achievements and prospects)]. / Sovremennoe sostoianie problemy allotransplantatsii kletok Langergansa (dostizheniia i perspektivy).

Literature data devoted to transplantation of Langerhans cells have been analyzed. The main stages, indications, dissection of islets, immunosuppressive therapy, complications and data of the latest clinical trials were discussed.

[The causes of recurrent ulcerative gastroduodenal bleeding]. / Prichiny retsidiva yazvennogo gastroduodenal'nogo krovotecheniya.

AIM: To explore microcirculatory changes within the first 48 hours after admission, to compare them with clinical manifestations of bleeding and to define the dependence of recurrent bleeding from the therapy. MATERIAL AND METHODS: The study included 108 patients with ulcerative gastroduodenal bleeding who were treated at the Clinical Hospital #71 for the period 2012-2014. There were 80 (74.1%) men and 28 (25.9%) women. Age ranged 20-87 years (mean 54.4±16.8 years). Patients younger than 45 years were predominant (33.4%). J. Forrest classification (1974) was used in endoscopic characterization of bleeding. Roccal Prognostic Scale for gastroduodenal bleeding was applied in all patients at admission to assess the risk of possible recurrence. Patients were divided into 2 groups. Group 1 included 53 (49.1%) patients without recurrent bleeding; group 2-55 (50.1%) patients who had recurrent bleeding within the first two days of treatment. RESULTS: Investigation of microcirculation showed the role of vegetative component including blood circulation centralization, blood flow slowing, blood cells redistribution providing sufficient blood oxygenation. By the end of the first day we observed pronounced hemodilution, decreased blood oxygenation, blood flow restructuring with its acceleration above 1 ml/s, violation of tissue oxygenation, signs of hypovolemia. These changes were significantly different from group 2 and associated with circulatory decentralization with possible pulmonary microcirculation disturbances and interstitial edema. This processes contribute to disruption of tissue oxygenation. We assume that recurrent bleeding in group 2 was caused by fluid therapy in larger volumes than it was necessary in this clinical situation. CONCLUSION: Infusion therapy should be significantly reduced for the debut of gastroduodenal ulcerative bleeding. Sedative therapy is advisable to reduce the influence of central nervous system.

[Perforated peptic ulcer closure: laparoscopic or open?] / Ushivanie perforativnoi pepticheskoi yazvy: laparoskopicheskoe ili otkrytoe? (s kommentariem A.S. Ermolova).

AIM: To compare laparoscopic and open closure of perforated peptic ulcer (PPU). MATERIAL AND METHODS: The study included 153 patients who underwent PPU suturing. 78 patients underwent laparoscopic closure (laparoscopic group) and open suturing via upper midline laparotomy was performed in 75 cases (open group). Surgery time, postoperative pain severity, time of analgesics intake, postoperative complications, hospital-stay and and cosmetic effect were compared. RESULTS: Laparoscopic PPU closure may be effective and accessible in experienced endoscopic surgeon. It significantly reduces postoperative pain severity, need for analgesics, incidence of postoperative complications and provides excellent cosmetic effect. However, there is greater time of surgery compared with open intervention. There were no significant differences in hspital-stay between groups. CONCLUSION: Laparoscopic PPU suturing can be considered a good alternative to open surgery. Further researches are needed for standardization, assessment of safety, real advantages and disadvantages of laparoscopic technique.

[Single-port laparoscopic cholecystectomy: advantages and disadvantages]. / Odnoportovaya laparoskopicheskaya kholetsistektomiya: preimushchestva i nedostatki.

AIM: To analyze the outcomes of single-port laparoscopic cholecystectomy. MATERIAL AND METHODS: Early and long-term postoperative period has been analyzed in 240 patients who underwent laparoscopic cholecystectomy (LCE) including 120 cases of single-port technique and 120 cases of four-port technique. Both groups were compared in surgical time, pain syndrome severity (visual analog scale), need for analgesics, postoperative complications, hospital-stay, daily activity recovery and return to physical work, patients' satisfaction of surgical results and their aesthetic effect. RESULTS: It was revealed that single-port LCE is associated with lower severity of postoperative pain, quick recovery of daily activity and return to physical work, high satisfaction of surgical results and their aesthetic effect compared with four-port LCE. Disadvantages of single-port LCE include longer duration of surgery, high incidence of postoperative umbilical hernia. However hernia was predominantly observed during the period of surgical technique development. CONCLUSION: Further studies to standardize, evaluate the safety and benefits of single-port LCE are necessary.

[Postoperative complications after inguinal PHS hernioplasty using PHS and lichtenstein hernioplasty].

Immediate and delayed results of inguinal hernioplasty with the use of PHS and Lichtenstein hernioplasty in 228 patients are reported. It is concluded that inguinal hernioplasty with PHS and Lichtenstein hernioplasty do not significantly different in terms of the frequency of postoperative complications and relapses. Seroma occurred less frequently after PHS hernioplasty (a = 0.022). Although the frequency of a chronic postoperative pain was lower after PHS hernioplasty its severity was not significantly different in the two groups.

[Open alloplasty of postoperative ventral hernias].

Early and long-term results of the open ventral postoperative hernia alloplasty in 118 patients have been analyzed. The onlay and sublay techniques of the hernioplasty have been employed. The frequency of complications, local status and quality of life were studied a year after the operation. The overall postoperative morbidity and recurrence rates were reliably less after the sublay mesh implantation. The method has also provided better quality of life and local status characteristics.

[Endoscopic subfascial dissection of perforating veins of lower legs in patients with venous ulcers].

Prospective analysis of the results of endoscopic subfascial dissection of perforating veins of lower legs in 68 patients with venous ulcers is presented. Four patients developed postoperative wound infection. Mean duration of hospitalization was 4.5 days. The patients were able to resume routine daily activity within 8 days after surgery. Mean length of ulcer healing was 7.0 months. Complete healing required 3 months in 22.1% of the patients, 6 months in 38.2%, 9 months in 66.2%, and 1 year in 97.1%. Ulcers recurred in 2 patients. Mean clinical and disability scores 8 months after surgery were on an average very low. It is concluded that subfascial dissection of perforating veins of lower legs in patients with venous ulcers improves clinical symptoms, promotes healing of ulcers, produces minimal postoperative complications, and plays an important role in correction of concomitant pathology.

[Endovenous laser photocoagulation for the treatment of varicose vein disease of the lower extremities].

Varicose vein disease of the lower extremities is a challenging socio-medical problem because it is responsible for high disability rate and requires substantial expenditures. According to different authors, the disease occurs in 10.4-23.0% of men and 29.5-39.0% of women. Numerous methods for its treatment have been proposed, each having advantages and drawbacks. The main criteria for the efficiency of treatment are the injury rate, aesthetic outcome, and frequency of relapses. These criteria can be met if new methods are developed allowing for good cosmetic results without detriment to clinical efficiency of radical operation. This paper presents results of analysis of original and published data on the practical application of endovenous laser photocoagulation for the treatment of varicose vein disease A total of 74 patients (79 legs) were operated by this method between 2006 and 2008. Ecchymosis occurred in 85.1% of the patients, induration in 18.9%, skin hyperpygmentation in 24.3%, paresthesia in 14.8%, greater saphenous vein thrombophlebitis and thigh hematoma in 2.7%, skin burn in 1.3%. Complete occlusion was achieved in all patients. No relapses were documented during a 18 month follow-up period. Quality of life (SF-36 questionnaire) improved on weeks and 12 after surgery. It decreased week after surgery (AVVQ) but improved thereafter. A similar trend was observed when quality of life was evaluated (VCSS) on week 12 postoperatively. It is concluded that endovenous laser photocoagulation is an efficacious method for the treatment of varicose vein disease but further randomized studies are needed to better assess its reliability and safety.

[Diagnosis and treatment of Helicobacter infections in patients with stomach ulcer associated with hemorrhage]. / Diagnostika i lechenie khelikobakterial'noi infektsii u bol'nykh iazvennoi bolezn'iu, oslozhnennoi krovotecheniem.

Diagnosis and treatment of stomach ulcer associated with helicoid-bacterial infection and with hemorrhage are discussed in the paper. The many-year observations show that the risk of relapsing hemorrhage is high in patients with the above diagnosis. Eradication of the causative agent by using the modern therapeutic schemes cuts significantly the rate of such relapses. The most effective method of monitoring the infection and eradication results is suggested, i.e. urease test combined with microbiological diagnosis involving the method of polymerase chain reaction.

[Importance of the morphofunctional status of APUD cells in the prognosis of duodenal ulcer hemorrhage]. / Znachenie morfofunktsional'nogo sostoianiia apudotsitov dlia prognoza krovotecheniia pri iazvennoi bolezni dvenadtsatiperstnoi kishki.

In 24 patients with uncomplicated duodenal ulcer and 40 patients with acute bleeding duodenal ulcer morphofunctional status of the local paraendocrine adjusting system of the duodenal mucous membrane in the periulcer, ulcer and remote zones was studied with histochemical and electron-microscopic techniques. It is established, that ECL- and G-apudocytes hyperplasia and hyperfunction and vice versa D-cells reduction of the number and suppression of the secretory activity are reliable prognostic criteria of duodenal ulcer bleeding.

[Importance of some apudocytes in gastric ulcer bleeding prediction]. / Znachenie nekotorykh apudotsitov v prognozirovanii oslozhneniia iazvennoi bolezni zheludka ostrym krovotecheniem.

In 6 patients with uncomplicated gastric ulcer (GU) and 8 patients with GU complicated by acute bleeding morphohistochemical and ultrastructural analysis of apudocytes of gastric mucous membrane in the ulcer, periulcer and remote zone was carried out with detection of morphofunctional changes predicting ulcer bleeding. It is established that G- and ECL-apudocytes hyperplasia and hyperfunction in these zones have stable, irreversible nature in gastric ulcer bleeding, and are reliable prognostic criteria of this complication.