The mainstay of rectal cancer treatment is surgery, which includes rectal resection with the creation of a primary or delayed colorectal anastomosis or rectal extirpation. The most severe complication of rectal resection with primary anastomosis is its failure. One of the approaches to reducing the rate of anastomotic failure is the formation of a preventive intestinal stoma, such as an ileostomy or colostomy. To date, there is no consensus on the optimal type of preventive stoma. This study analyzed 12 national and international studies published over the past 5 years. It was found that the existing data on this issue are contradictory and cannot be interpreted unambiguously. Some authors point to the advantages of ileostomy, justifying this choice by a lower incidence of purulent-septic complications, parastomal hernias, and the availability of modern tools for managing peristomal dermatitis, dehydration, and renal insufficiency. Other authors emphasize the significant disruptions in water-electrolyte balance, an inevitable component of postoperative complications associated with ileostomy. Certain studies highlight the clear advantages of transverse colostomy in terms of fewer postoperative complications compared to ileostomy, while others find no differences. These contradictory findings underscore the relevance of this issue and the importance of further research to determine the optimal type of preventive stoma for low anterior rectal resection to achieve satisfactory outcomes in the surgical treatment of rectal cancer patients.
INTRODUCTION. Hypospadias is a common congenital anomaly of the external genitalia in boys, characterized by the external urethral opening located on the ventral surface of the penis, scrotum, or perineum. Surgical treatment aims to restore normal anatomy and urinary function, correct penile curvature, and achieve an aesthetically pleasing result. This article analyzes current hypospadias correction methods, optimal surgical timing, the incidence and types of complications, and short- and long-term treatment outcomes. Based on international and domestic research, it is concluded that the choice of method should be based on the severity of hypospadias, the characteristics of the urethral repair, the surgeon’s experience, and postoperative management options.The OBJECTIVE of this study was to improve the outcome of surgical treatment for distal hypospadias in children.METHODS AND MATERIALS. The study included 85 children with distal hypospadias, aged 1 to 16 years, between 2021 and 2025. RESULTS. Complications during surgical interventions occurred in 14.2 % of cases, with a success rate of 84.2 %. CONCLUSION. Successful hypospadias treatment depends not only on the correct choice of surgery but also on many aspects of postoperative care, including optimal urinary diversion and dressing application techniques. The use of modern atraumatic suture material and microsurgical instrumentation significantly improves surgical outcomes.
INTRODUCTION. The laparoscopic IPOM hernioplasty technique using the domestic composite prolenic mushroom shaped prosthesis with polytetrafluoroethylene coating technology has been developed for the correction of ventral hernias with orifices up to 4 cm. However, publications on the use of this technique in patients with morbid obesity are limited.The OBJECTIVE was the comparative evaluation of the results of using the domestic composite prolenic mushroom-shaped prosthesis with polytetrafluoroethylene coating alone and in combination with bariatric intervention in patients with ventral hernias and morbid obesity.METHODS AND MATERIALS. The comparative study included 64 subjects with ventral hernias <4 cm and abdominal obesity. The body mass index (BMI) in the sample was ≥35 kg/m2. The patients were divided into 2 groups: group 1 (n=35) consisted of patients who underwent laparoscopic hernioplasty using the domestic composite prolenic mushroom-shaped prosthesis with polytetrafluoroethylene coating (LLC «Icon Lab GmbH», Russia) composite endoprosthesis, and group 2 (n=29) consisted of patients whose hernioplasty was supplemented by bariatric intervention.RESULTS. Of the early postoperative complications: in 1 case, a hematoma was observed (in a patient of group 1), 1 case in each group – the appearance of seromas. Recurrence of hernia occurred in 1 case in a patient of group 2. Weight loss over 12 months of observation in group 2 of patients was noted to be up to 28 kg/m2, while in patients in group 1, on the contrary, an increase in body weight of 8–12 kg was recorded (p<0.05).CONCLUSIONS. Performing bariatric intervention does not increase the time of hernioplasty surgery, does not increase the percentage of postoperative complications, while contributing to a 25 % reduction in patients’ weight over a 12-month observation period. In the case of a combination of a small (W1) ventral hernia with morbid obesity, in our opinion, it is advisable to perform hernioplasty using the domestic composite prolenic mushroom-shaped prosthesis with polytetrafluoroethylene coating, simultaneously with bariatric intervention.
The OBJECTIVE was to estimate the incidence and risk factors of seroma following hernioplasty of ventral hernias and to present a clinically applicable prognostic model (nomogram).METHODS AND MATERIALS. From 01, Feb 2024 to 01, May 2025, 214 hernioplasties of ventral hernias were per formed at the State Healthcare Institution Ulyanovsk Regional Clinical Center for Specialized types of Medical Care named after E.M. Chuchkalov at the Surgical Department № 5 inUlyanovsk. We identified statistically significant variables associated with postoperative fluid accumulation at the mesh implantation site.RESULTS. In multivariable logistic regression, independent risk factors were coronary artery disease (OR 5.57; 95 % CI 1.98–15.64; p<0.001), preoperative neutrophil-to-lymphocyte ratio (per 1 unit: OR 1.46; 95 % CI 1.19–1.79; p<0.001), and hernia defect diameter (per 1 cm: OR 1.15; 95 % CI 1.06–1.25; p<0.001). The integrated model showed good discrimination: AUC 0.87 (95 % CI 0.78–0.97), sensitivity 82.6%, specificity 81.7%. Median length of hospital stay was longer with seroma – 16 [14–20] vs 6 [4–9] days (p<0.001). Using artificial intelligence (AI) and machine-learning techniques, we developed a nomogram to predict this complication after hernioplasty.CONCLUSION. Seroma occurred in 10.7 % (23/214). Independent predictors after hernioplasty of ventral hernias were coronary artery disease, higher preoperative neutrophil-to-lymphocyte ratio, and larger hernia defect diameter. The prognostic model and nomogram were developed to estimate individual risk.
INTRODUCTION. Shrapnel wounds during combat may damage peripheral arteries. In some cases, a false aneurysm is formed. Surgical reconstruction of the vessel after its removal is reduced to two surgical techniques – autovenous saphenous prosthetics and end-to-end anastomosis.The OBJECTIVE was to analyze the results of various surgical treatment techniques for removing a false peripheral arterial aneurysm in a military field hospital in a special military operation zone.METHODS AND MATERIALS. During the period from 01.02.2025 to 01.08.2025, 22 reconstructive interventions were performed in the military field hospital in the special military operation zone for the development of a false peripheral arterial aneurysm after a shrapnel wound to the limb. Depending on the chosen surgical technique, all patients were divided into two groups: Group 1 – autovenous saphenous prosthetics with a reversed great saphenous vein (GSV), n=11; Group 2 – end-to-end anastomosis between arterial stumps, n=11.RESULTS. Acute arterial thrombosis was observed in 3 (20 %) patients in Group 1 and 1 (6.7 %) patient in Group 2. Arteriovenous fistula was detected in 2 (13.3 %) patients and 1 (6.7 %) patients, respectively. In the vast majority of cases, the false aneurysm diameter was 3–5 cm. In all cases, mural thrombotic masses were visualized. The localization sites of pathology in the total sample (n=30) were: n=4 (13.3 %) – axillary artery; n=4 (13.3 %) – brachial artery; n=4 (13.3 %) – posterior tibial artery; n=3 (10.0 %) – popliteal artery; n=2 (6.7 %) – superficial femoral artery; 1 case each (3.3 %) – ulnar artery, radial artery, common femoral artery, deep femoral artery, peroneal artery. The average operation time in the first group was 226.5±24.8 minutes, in the second – 115.7±31.4 minutes (p=0.03). Autovenous grafting of the reversed GSV was performed only in patients with damage to the axillary artery (n=4, 26.7 %), brachial artery (n=4, 26.7 %) and popliteal artery (n=4, 20 %). End-to-end anastomosis was performed in cases of damage to the posterior tibial artery (n=4, 26.7 %), superficial femoral artery (n=2, 13.3 %), common femoral artery (n=1, 6.7 %), deep femoral artery (n=1, 6.7 %), peroneal artery (n=1, 6.7 %), ulnar artery (n=1, 6.7 %), radial artery (n=1, 6.7 %). During 30 days of postoperative observation, no deaths, thrombosis of the reconstruction zone, or infectious complications were recorded. Symptoms of acute ischemia and limb edema completely regressed in all cases.CONCLUSION. The implementation of autovenous grafting and end-to-end anastomosis after removal of a false peripheral arterial aneurysm is an effective and safe treatment method.
INTRODUCTION. Bronchial suture ischemia and necrosis is a serious complication following lung resection. Traditional treatments are often ineffective. Hyperbaric oxygen therapy may be useful as an adjuvant therapy for bronchial suture ischemia following lung resection.The OBJECTIVE was to study the potential of hyperbaric oxygenation in patients with ischemic changes in the bronchial suture after oncothoracic surgery with systematic mediastinal lymph node dissection.METHODS AND MATERIALS. A study was conducted involving 174 patients with bronchial raphe ischemia/necrosis following oncothoracic surgery with systematic mediastinal lymph node dissection. All patients underwent HBO sessions. The clinical course of each patient, treatment outcomes, and any adverse effects were analyzed. Treatment outcomes were compared between groups, including those with ischemic and necrotic changes in the bronchial raphe zone.RESULTS. Ischemia/necrosis was detected after surgery on day 6 [4–7], and HBO was started on day 8 [6–10]. The median duration of HBO was 8 [6–10] sessions. In 127 (93.4 %) patients, HBO allowed to significantly improve the endoscopic picture with subsequent healing of the bronchial suture, in 9 (6.6 %) patients, there was worsening of ischemic changes, which required further surgical intervention. Mortality was higher in the group of necrotic changes of the bronchial suture and amounted to 9 people (23.7 %), than in the ischemia group – 7 patients (5.1 %) (p<0.001). The cumulative 100-day survival probability (according to the Kaplan – Meier curve) in patients with ischemic changes was 94.9 %, and in patients with necrotic changes of the bronchial suture – 76.3 %.CONCLUSIONS. The obtained clinical data confirm the effectiveness and demonstrate the potential of using HBO to improve bronchial suture healing after lung resection, particularly in cases of tissue ischemia.
Based on a retrospective analysis, the OBJECTIVE was to develop an algorithm for predicting the risk of complications of abdominoplasty in overweight patients (BMI 25-29.9 kg/m2) using laboratory markers of carbohydrate metabolism and cytokine status, as well as to evaluate the efficacy of a modified surgical technique in high-risk patients.METHODS AND MATERIALS. The study was conducted in two stages: 1) a retrospective analysis of 49 patients (2016-2018) who underwent standard abdominoplasty to identify predictors of complicated wound healing; 2) a prospective cohort study of 30 patients (2022-2023) with a BMI of 25-29.9 kg/m2 and identified risk predictors (HOMA-IR≥3.1, insulin level>14.0 µIU/mL, interleukin-1β level (IL-1β)≥45.0 pg/ml), who underwent modified abdominoplasty with limited dissection, preservation of suprapubic tissue, Scarpa’s fascia and flap fixation. The main evaluation criteria were the duration of the operation, the frequency of seromas, hematomas, and ligature fistulas.RESULTS. The retrospective analysis revealed three independent predictors of the development of local wound complications: HOMA-IR≥3.1, insulin level≥14.0 µIU/mL and lL-1β level≥45.0 pg/ml. The use of the modified technique in female patients with these predictors led to a statistically significant decrease in the incidence of complications compared with the retrospective group of similar risk: the incidence of seromas decreased from 43% to 3% (p=0.001), hematomas from 10% to 0% (p=0.04). The average surgery time was reduced by 40%.CONCLUSION. The proposed algorithm, combining preoperative detection of markers of insulin resistance, carbohydrate metabolism disorders and systemic inflammation with the use of a gentle modified abdominoplasty technique, makes it possible to objectify the risk and significantly reduce the frequency of postoperative local wound complications in overweight patients, which can serve as a basis for individualizing surgical tactics.
INTRODUCTION. Non-healing wounds do not pose an immediate threat to the patient’s life, but they can become a portal for infection penetration. Surgical methods have demonstrated high efficacy in the treatment of such wounds. However, modern medicine strives to shift its focus from the treatment of complicated wound processes to the prevention and minimally invasive techniques. One of the potential methods for stimulating tissue regeneration is the use of autologous platelet-rich plasma (PRP). However, data on its effectiveness in the treatment of chronic non-healing wounds are mixed, the main reason is the lack of standardized protocols for obtaining and using PRP.METHODS AND MATERIALS. The study included 40 cases of pressure ulcer treatment. There were 35.0 % men and 65.0 % women among the patients. All treatment cases were divided into two comparison groups. The first group consisted of 20 (50%) cases of pressure ulcer treatment with PRP. The second group consisted of 20 (50%) cases of pressure ulcer treatment serving as a control group. The study included stage 2 and 3 pressure ulcers. Statistical analysis was performed using SPSS 26.RESULTS. PRP therapy significantly accelerated healing: the average healing time was 35.4±14.8 days versus 23.4±5.6 days in the control group (p=0.03). After the first PRP injection, 100 % of patients (p=0.001) experienced accelerated pressure ulcer epithelialization, with a reduction in ulcer area and peak epithelialization induction by day seven. The most pronounced effect was observed in patients with a normal BMI, whereas patients with an elevated body mass index (BMI>35) demonstrated a less pronounced response to conservative therapy due to a greater mechanical load.CONCLUSIONS. The study demonstrated the high clinical efficacy of platelet-rich plasma (PRP) therapy compared to standard treatment. Complete healing was achieved in 65.0 % patients in the study group compared to 50.0 % in the control group (p=0.03). The average healing time in the PRP group was 35,4±14.8 days, while in the control group it was 23.4±5.6 days (p=0.03), demonstrating both qualitative improvements and a temporal advantage of PRP therapy.
A prominent Soviet surgeon, scientist and teacher, one of the pioneers of esophageal and diaphragmatic surgery in the USSR, founder of the famous Moscow school of thoracoabdominal surgeons, Corresponding Member of the USSR Academy of Medical Sciences (1975), laureate of the USSR State Prize, Doctor of Medical Sciences (1964), Professor (1965) Eduard Nikitich Vantsyan was born on September 13, 1921 in Tbilisi to a doctor’s family. In 1939, he entered the 1st Moscow Medical Institute, then transferred to the Tbilisi Medical Institute, from which he graduated in the summer of 1943. After receiving his diploma, he served in various medical positions in the Ministry of Internal Affairs hospital, and after demobilization in 1946, he worked as a surgeon in the emergency hospital, then as a resident in the surgical department of the Transcaucasian District Military Hospital. In 1951, E. N. Vantsyan entered graduate school at the Department of Faculty Surgery of the Pediatric Faculty of the 2nd MMI and in 1954, defended his candidate’s dissertation, «Bilateral Operative Pneumothorax». In 1958, he transferred to the position of assistant Professor at the Department of Hospital Surgery at the 1st MMI. In 1963, he was appointed head of the esophagus and stomach surgery department at the All-Union Research Institute of Clinical and Experimental Surgery, and from 1969, he served as deputy Director for research at the same Institute. In 1964, he defended his doctoral dissertation «Clinical and Surgical Treatment of Esophageal Diverticula». Eduard Nikitich’s primary research interests included neuromuscular diseases of the esophagus, esophageal hernias, gastroesophageal reflux disease, esophageal diverticula, esophageal tracheal fistulas, benign tumors and esophageal cancer, chemical burn strictures of the esophagus, and diseases of the operated and artificial esophagus. E. N. Vantsyan founded a significant Moscow school of thoracoabdominal surgeons; under his supervision, 26 candidate’s and 9 doctoral dissertations were defended. He was the author and co-author of approximately 170 scientific and practical works, including nine monographs and manuals. Eduard Nikitich was a member of the Presidium of the Scientific Medical Council of the USSR Ministry of Health, was elected to the Board of the All-Union Scientific Society of Surgeons, served as Deputy Chairman of the Surgical Society of Moscow and the Moscow Region, was Deputy Editor-in-Chief of the journal «Surgery», was elected a member of the International Society of Surgeons, and was an honorary member of the surgical societies of the GDR and Cuba. Professor E. N. Vantsyan died tragically in a car accident on February 17, 1989, and was buried at the Babushkinskoye Cemetery in Moscow
The OBJECTIVE was to reconsider the strategy of perioperative antibiotic prophylaxis in patients after pancreaticoduodenectomy (PD) against the background of preoperative biliary drainage to reduce the incidence of surgical site infection (SSI).METHODS AND MATERIALS. The pilot study was conducted on the effect of personalized perioperative antibiotic prophylaxis in PD on the incidence of acute respiratory viral infections in patients with percutaneous preoperative biliary drainage. The control retrospective group received standard perioperative antibiotic prophylaxis. The main prospective group received perioperative antibiotic prophylaxis based on preoperative bile culture from biliary drainagea. The primary control endpoint was the incidence of SSI.RESULTS. The control and main groups included 46 and 11 patients, respectively. The susceptibility of pathogens during preoperative bile culture to cephalosporins of the 1st-2nd generation was 21.2%. The highest susceptibility rates were to inhibitor-protected β-lactams of a narrow spectrum: amoxicillin/clavulonate, ampicillin/sulbactam – up to 83.4%. There wasn’t statistical difference in SSI rate between groups: 76.1 % (n=35) vs 81.8 % (n=9), while it’s severity by Clavien – Dindo did not exceed 1-2 degrees of severity in most cases (63.0 % vs 54.5 %). The match between the bile microbiome from the biliary drain and the SSI microbiome was 45.5 %. SSI pathogens were represented by extended-spectrum β-lactamase producers, carbapenem-resistant Enterobacterales.CONCLUSIONS. The bile microbiome, as well as SSIs following PD, are resistant to cephalosporins of the 1st-2nd generation.The bile microbiome from preoperative biliary drainage does not reflect the features of pathogens involved in SSI, the components of which are both bile pathogens and gastrointestinal pathogens with the properties of extended-spectrum β-lactamases. Further refinement of SSI prevention methods in this patient cohort is required, along with the implementation of perioperative therapy for possible subclinical cholangitis.
INTRODUCTION. Injuries to the median nerve are among the most functionally disabling upper limb traumas, often resulting in sensory deficits, loss of fine motor skills, and impaired quality of life. When nerve gaps exceed 3 cm, complex reconstruction with autologous nerve grafts is the required treatment. The sural nerve remains the most commonly used donor nerve due to its length and expendability.The OBJECTIVE was to present a clinical case involving the successful reconstruction of a 5 cm median nerve defect using a double-strand sural nerve autograft and to evaluate the functional outcome achieved through microsurgical repair.METHODS AND MATERIALS. A 42-year-old male patient sustained a deep penetrating forearm injury with sensory loss and impaired flexion of digits I–III. After confirming the diagnosis, nerve reconstruction was performed using a 12 cm sural nerve autograft, prepared in a looped configuration. Microsurgical epineural suturing was done using 8/0 monofilament. Postoperative care included physical therapy, kinesitherapy, neuroprotective and neurotropic medication support.RESULTS. At 6-month follow-up, the patient regained full finger flexion and sensory recovery in the median nerve distribution. Thumb opposition was preserved. Mild thenar hypotrophy was noted without significant functional limitation.CONCLUSION. This case demonstrates successful functional restoration in extensive median nerve defects using sural nerve autografts, highlighting the importance of microsurgical precision and structured rehabilitation.
INTRODUCTION . This study examines the impact of the degree of interventricular septum reduction (<5 mm and ≥5 mm) on outcomes following alcohol septal ablation. METHODS AND MATERIALS . Data from 597 patients with obstructive hypertrophic cardiomyopathy who underwent alcohol septal ablation were analysed. Patients were divided into two groups: septal reduction <5 mm (329 patients); septal reduction ≥5 mm (268 patients). To correct the imbalance between the groups, the propensity score matching method was used. Outcomes were studied in both matched and unmatched cohorts. RESULTS . In the long-term follow-up period, 63 deaths were recorded. In the group with ≥5 mm reduction, gradients of the left ventricular outflow tract were lower (p<0.0001). Residual obstruction was more frequently observed in the <5 mm reduction group: unmatched cohort: 87 (26 %) vs. 37 (14 %), p<0.0001; matched cohort: 66 (33 %) vs. 21 (10 %), p<0.0001. Long-term survival was statistically significantly lower in the<5 mm reduction group: HR 0.47 (95 % CI: 0.24–0.89), p=0.019. CONCLUSION . Septal reduction of less than 5 mm following alcohol septal ablation is associated with: higher gradients of the left ventricular outflow tract; a higher incidence of residual obstruction; worse long-term survival.
The OBJECTIVE was to evaluate the results of endovascular reconstruction in patients with dialysis-dependent ischemic kidney disease caused by bilateral renal artery disease. METHODS AND MATERIALS . From October 2017 to September 2024, in the Department of Vascular Surgery of the Pavlov First Saint Petersburg State Medical University, 174 patients (100 men and 74 women, mean age 65±7 years) underwent endovascular reconstruction of renal arteries, including 3 (2 %) patients with dialysis-dependent ischemic kidney disease. Preoperative examination of patients included an assessment of clinical manifestations, laboratory parameters (serum creatinine and urea levels, estimated glomerular filtration rate), ultrasound examination of the kidneys with an assessment of the thickness and condition of the parenchyma, parameters of extrarenal and intrarenal arterial blood flow (peak systolic blood flow velocity, resistivity indices), and performing catheter arteriography and/or CT angiography. In patients with dialysis-dependent ischemic kidney disease, indications for revascularisation were the hemodynamically significant damage to both renal arteries and signs of preserved renal parenchyma viability. In the immediate and late postoperative period, renal function was assessed based on clinical, laboratory, and instrumental data. RESULTS . Bilateral hemodynamically significant (stenosis > 50 % or occlusion) renal artery lesions were detected in 69 (40 %) patients. Clinical observations of 3 (2 %) patients are presented, in whom restoration of patency of one or both renal arteries through endovascular reconstruction allowed discontinuing haemodialysis. CONCLUSION . In the presented case series with occlusive-stenotic lesions of the renal arteries, 2 % of patients had a dialysis-dependent form of ischemic kidney disease. Timely endovascular reconstruction of the renal arteries in such patients can lead to regression of renal dysfunction and discontinuation of renal replacement therapy.
INTRODUCTION . Recurrent hiatal hernias are a separate problem of surgery. The scientific community has no generally accepted views on the indications for repeated operations for this pathology, their ideology and technical principles. The results of surgical treatment of recurrent hiatal hernias presented in the literature are also different. The OBJECTIVE was to present his own experience in the treatment of recurrent hiatal hernias. METHODS AND MATHERIALS . The article presents a ten-year experience of revision operations for recurrent hiatal hernias in 96 patients at Pavlov First Saint Petersburg State Medical University. The majority patients (56 – 58.3 %) were initially operated on in other clinics. In 31 (32.3 %) patients, the primary hernia was axial, in 37 (38.5 %) – paraesophageal or mixed type. In 28 (29.2 %) cases, the type of hernia was unknown. Primary plastic surgery using own tissues was performed in 89 patients (92.7 %), in 7 (7.3 %) – using prostheses. Indications for reoperation were not responded to drug therapy gastroesophageal reflux or food transport disorders (“gastric valve”). RESULTS . Laparoscopic access was used in 92 (95.8 %) cases, left-sided thoracotomy – in 4 (4.2 %) cases. Remote treatment results were assessed in 79 patients (82.3 %). A good outcome – absence of anatomical and clinical recurrence of the hernia – was noted in 64 cases (77.7 %). Repeated stomach dislocation into the thoracic cavity with the resumption of clinical symptoms was found in 15 patients (22.3 %). CONCLUSION . The presented data illustrate the complexity of the problem of surgical treatment of recurrent hiatal hernias and the need to search for new approaches to the solution.
The article discusses the current problems of organizing modern surgical care in Russia. A historical analysis of surgery development over the past century was carried out. It was based on the S. P. Fedorov’s ideas expressed in his work “Surgery stands at the parting of the ways” (1926).The focus is on the issue of providing high quality, high-tech, especially emergency, surgical care to the population of rural areas. It is demonstrated that modern regulatory requirements and the introduction of complex diagnostic technologies (CT, MRI, and angiography) have made it impossible to fully deploy them in every region, which has led to the need for resource concentration.The introduction of a three-level system of specialized medical care is proposed as a strategic way to solve the problem. A key element is the creation of a network of inter-district «flagship specialized care centers» equipped with a full range of equipment for invasive surgery, designed to serve 150–200 thousand people. These centers should be integrated into a unified system of emergency medical care and medical evacuation with centralized dispatching, which will provide effective patient routing within the first 24 hours. According to calculations, such system will allow for providing the care to the majority of emergency patients (80%) at district hospitals, and ensuring timely evacuation of others to specialized centers.The proposed model is considered as the development of the principle of staged treatment with evacuation by destination, which has proven its effectiveness in military field surgery.
