Objective. To compare short- and long-term outcomes of open surgery, laparoscopic adhesiolysis and non-operative management in patients with adhesive small bowel obstruction. Material and methods. A multiple-center retrospective cohort study included 366 patients with small bowel obstruction (SBO) treated across seven hospitals in Moscow. All patients were hospitalized between 01/01/2017 and 12/31/2019. Primary endpoints were overall survival and mean life expectancy (MLE) over 6 years after initial hospitalization, cumulative probability of rehospitalization and surgery at rehospitalization, mean duration of index hospitalization, mean duration of a single hospitalization and overall hospital-stay per a patient over 6 years. Statistical analysis included Kaplan—Meier survival analysis, Aalen—Johansen estimator, Markov modeling, Cox proportional hazards regression, log-rank test, Gray’s test, Fisher’s exact test, and Welch’s t-test. Results. At index hospitalization, non-operative management (NOM) was successful in 228 patients (62%). Open surgery (OS) was performed in 87 patients (24%) and laparoscopic adhesiolysis (LA) in 51 patients (14%). Over subsequent 6-year follow-up, 94 (26%) patients died, and 67 (19%) patients were re-hospitalized with recurrent small bowel obstruction. Of these, 17 (5%) ones underwent surgery. Over 6 years, MLE did not differ significantly between the LA and NOM groups. However, it was significantly longer compared with the OS group (by 12.7 months (95% CI: 4.2—21.2; p<0.001) and 13.8 months (95% CI: 3.7—23.8; p=0.003), respectively). The risk of SBO recurrence (rehospitalization) after NOM was higher by 5.26 times (95% CI: 1.54—16.7; p=0.004) and after OS by 3.76 times (95% CI: 1.01—13.97; p=0.046) compared to LA. Mean total hospital-stay over 6 years was significantly shorter after LA and NOM compared to OS (by 6.2 days (95% CI: 1.1—8.9; p=0.011) and 6.1 days (95% CI: 1.8—8.0; p=0.002), respectively). Cumulative probability of surgery at rehospitalization did not differ significantly (p=0.229). Conclusion. Six-year survival of patients with SBO was better after NOM and LA compared to OS. Recurrence of SBO was more common after NOM and OS.
Objective. To analyze surgical management of tuberculosis and main bronchus stump fistula after failed surgical treatment and vascular occluders. Material and methods. Two cases are presented. The study included patients with Amplatzer ASD occluders placed for bronchopleural complications after pneumonectomy. Transsternal occlusion of the main bronchus was performed for surgical correction of complications. Results. The authors demonstrate effective staged surgical treatment of the main bronchial stump fistula after failed surgical management with vascular occluder. Conclusion. Surgical treatment after failed closure of the main bronchial stump fistula with vascular occluders under persistent infection and empyema is an extremely complex staged approach. This management should consider all previous surgeries and endoscopic interventions, can last for several years and requires a highly qualified team of thoracic surgeons.
Objective. To evaluate the effectiveness of correction of protein and energy deficiency after total gastrectomy for stomach cancer with domestic special metabolic enteral mixtures with detoxification and restorative focus LEOVIT ONCO, as well as to analyze the effect of correction on postoperative period. Material and methods. A prospective randomized trial included 100 cancer patients who underwent total gastrectomy. They were divided into two groups by 50 people each. Patients in the main group took domestic enteral nutrition with LEOVIT ONCO, in the control group — imported enteral nutrition. The total course of enteral nutrition was 12 days (3 days before surgery and day 2—10 after surgery). Anamnestic data, anthropometric and laboratory parameters were studied before surgery, 2—3 days and 10—12 days after surgery. Non-parametric methods were used for analysis (Fisher’s exact test for qualitative data, Mann-Whitney test for quantitative data). Results. Domestic enteral nutrition with detoxification and restorative orientation increased serum total protein, albumin, hemoglobin and erythrocyte count after 10—12 postoperative days by 18.8%, 13.8%, 10.9% and 15.2%, respectively. Imported nutrition decreased total protein by 2.8%, increased albumin, hemoglobin and erythrocyte count by 7.5%, 1.7%, and 5.2%, respectively. Domestic enteral nutrition reduced postoperative hospital-stay by 1.38 times, postoperative morbidity by 1.33 times, time to gas discharge by 2.5 times and time to the first bowel movement by 1.7 times compared to appropriate values in the control group. Domestic enteral nutrition increased skin-fat fold thickness and shoulder circumference by 1 cm compared to baseline values, whereas the control group had no changes. LEOVIT ONCO nutrition did not cause intolerance or allergic reactions. Patients did not refuse to take it and drank the whole portion. Conclusion. This study demonstrates comparable and in some key indicators higher clinical and economic efficiency of domestic enteral nutrition products in perioperative period for cancer patients with nutritional disorders. This may be explained by minor biologically active substances in domestic nutrition improving not only protein absorption in the body, but also metabolic and detoxification processes.
This study analyzes the main advantages and disadvantages of various surgical and endoscopic techniques in bariatric surgery. Screening of foreign and domestic literature with appropriate keywords revealed studies devoted to various treatment approaches in patients with obesity. Thanks to analysis of these publications, it is possible to demonstrate the effectiveness and safety of endoscopic interventions in bariatric surgery. Intraluminal endoscopic approach, in particular endoscopic sleeve gastroplasty is a modern and minimally invasive alternative to traditional surgery in patients with morbid obesity.
Objective. To study treatment outcomes in patients with traumatic bowel injury in peacetime. Material and methods. A retrospective study involved 27 patients with traumatic bowel injury who underwent surgery at Botkin Hospital in 2016-2024. All patients were delivered to the shock room of the emergency department for initial examination. In 25 cases, we performed contrast-enhanced CT before surgery; 2 patients were sent to the operating theater immediately. Results. Primary repair of small bowel was performed in 4 patients, small bowel resection — in 12 patients, colon resection — in 8 patients. Primary anastomosis was formed in 12 cases, ileostomy/colostomy — in 11 patients. Risk factors for primary anastomosis are unstable hemodynamics requiring inotropic support; massive transfusion therapy; fecal contamination of abdominal cavity; more than 6-hour preoperative period. Conclusion. Available experience, damage control surgery and necessary reconstruction of bowel continuity inspired own treatment algorithm for this category of patients to reduce morbidity and mortality.
Surgical treatment for complications of hepatic form of portal hypertension requires precise preoperative planning. The automated software complex “Autoplane” based on CT and/or MRI data allows you to outline necessary anatomical structures and build a personalized 3D model of venous and arterial systems of abdominal organs with their exact boundaries. Visualization of data based on 3D modeling allows you to plan adequate surgical intervention. Two cases of successful preoperative 3D modeling in the treatment of patients with complications of hepatic form of portal hypertension are described.
Background. Facial burns represent not only a somatic injury but also a complex psychosocial condition associated with a high risk of psychological disorders and social maladaptation, particularly in children. In 2024, 1.892 patients were treated at the pediatric burn center of G.N. Speransky Children’s City Clinical Hospital No. 9 (Moscow), including 246 (13%) with facial burns and 32 with deep injuries. Objective. To evaluate the effectiveness of a multidisciplinary approach and active surgical strategy in the treatment of deep facial burns in children. Materials and methods. A retrospective analysis of patients with facial burns treated in a specialized burn center in 2024 was performed. Clinical outcomes of a surgical technique for deep total facial burns (RF patent No. 2632776) were assessed. The method includes wound bed preparation, full-thickness skin grafting, graft fixation, and vacuum therapy of donor sites. A clinical case of a 13-year-old patient is presented. Long-term outcomes were evaluated. Results. Full-thickness skin grafting resulted in satisfactory functional and cosmetic outcomes. Four months postoperatively, no significant scar deformities or tissue tension were observed. Vacuum therapy accelerated granulation tissue formation (7—10 days), while subsequent split-thickness grafting ensured complete skin restoration. Conclusion. Management of children with deep facial burns requires treatment in specialized burn centers and a multidisciplinary approach. Full-thickness autodermoplasty using the Bogdanov technique reduces scar formation and improves functional and aesthetic outcomes.
The life of the Academician of the Academy of Medical Sciences S.S. Yudin was inextricably linked with military field surgery. As a volunteer, an ordinary doctor, he participated in the First World War and received his first medical experience there. During the Great Patriotic War, he was the chief surgeon of the N.V. Sklifosovsky Research Institute, which was converted into a hospital for the wounded, and a surgeon-inspector under the chief surgeon of the Red Army N.N. Burdenko. In 1942 he was awarded the Stalin Prize, 2nd degree, for his “Notes on Military Field Surgery”, based on the experience of the First World War and an analysis of the actions of European doctors at the beginning of the Second World War. The methods of a solid plaster cast, spinal anesthesia, hemotransfusion, and the use of sulfamides for the treatment of wounds, developed by Yudin and his students, were used during the Great Patriotic War and significantly influenced the treatment of the wounded.
Objective. To compare the results of percutaneous and endoscopic biliary decompression for resectable perihilar tumor (PT). Material and methods. Treatment outcomes were analyzed in patients with PT who underwent surgery between 1999 and 2023. The 1st group included patients who underwent percutaneous transhepatic cholangiostomy as the first stage for biliary decompression, the 2nd group — patients who underwent endoscopic biliary drainage. Results. There were 58 patients with percutaneous transhepatic cholangiostomy and 18 ones with endoscopic biliary drainage. Both groups were comparable in main parameters. There were patients with isolated resection of extrahepatic bile ducts in the group of percutaneous transhepatic cholangiostomy, but these were absent in the 2nd group (p=0.328). Extended right-sided hemihepatectomies were more common in the 1st group (29.3% versus 11.1%, p=0.210). Post-manipulation complications grade ≥ III degree more common after endoscopic biliary drainage (50.0% versus 22.4%, p=0.037), and percutaneous cholangiostomy was also more common to correct complications (44.4% versus 10.3%, p=0.003). There was no difference in the rate of post-resection complications grade ≥III (p=0.787) and postoperative mortality (p=0.721). There was also no difference in peritoneal metastases (p=1.0) and implantation metastases (p=1.0). In addition, we found no worsening of long-term results after percutaneous transhepatic cholangiostomy. The median overall survival in this group was 25 months versus 15 months after endoscopic biliary drainage (p=0.740). There was also no difference in disease-free survival (p=0.500). Conclusion. Percutaneous transhepatic cholangiostomy as the primary method for obstructive jaundice in patients with resectable PT is accompanied by better immediate results of biliary decompression without worsening the results of resection.
OBJECTIVE:To evaluate the effectiveness of comprehensive treatment of mediastinal germ cell tumor in a child with emphasis on the role of neoadjuvant chemotherapy and total resection. MATERIAL AND METHODS:The authors present a boy with primary mediastinal germ cell tumor. RESULTS:Treatment of a 17-year-old patient with stage IVA anterior mediastinal choriocarcinoma was followed by complete clinical and laboratory remission. Intensive induction polychemotherapy according to the MAKEI 2005 protocol led to significant tumor shrinkage (~85.5%) for subsequent en bloc resection of tumor and adjacent tissues. Postoperative period and final course of chemotherapy were uneventful; follow-up examinations showed normalization of tumor markers, favorable clinical status and no signs of recurrence. CONCLUSION:This case demonstrates that comprehensive treatment, including induction chemotherapy and subsequent total resection, enables complete remission even in aggressive and advanced forms of mediastinal germ cell tumors in adolescents. This confirms high effectiveness of modern therapeutic approaches.
OBJECTIVE:To assess the incidence of postoperative hemothorax and influence of redo surgery timing on outcomes. MATERIAL AND METHODS:A multiple-center retrospective study included 70 out of 7.796 postoperative patients who underwent redo surgery for postoperative hemothorax following lung resection between 2019 and 2024 in four specialized thoracic centers in Russia. Of these, 57 (81.4%) patients underwent anatomical resections (including 45 lobectomies), and 13 (18.6%) underwent non-anatomical wedge resections. Patients were stratified into early (<24 hours) and delayed (≥24 hours) redo surgery groups. Postoperative complications were assessed using the Thoracic Morbidity and Mortality (TMM) classification. The primary outcome was 90-day mortality. RESULTS:The incidence of hemothorax was 1.1% after anatomical resections and 0.5% after non-anatomical resections. Ninety-day mortality was significantly lower in the early redo surgery group (12.5% vs. 36.6%, p=0.037). Early redo surgery was associated with higher rate of intraoperative identification of bleeding source (67.5% vs. 36.7%, p=0.030). The Charlson comorbidity index was significantly higher in the delayed group (p<0.001). Delayed interventions demonstrated a trend towards more severe complications and higher rates of pleural empyema. Delayed redo surgery beyond 24 hours was associated with more than threefold increase in the risk of death (OR 3.98; 95% CI 1.21-13.07). CONCLUSION:Early surgical intervention for postoperative hemothorax, especially within the first 24 hours, is associated with better clinical outcomes and significantly lower 90-day mortality.
OBJECTIVE:To identify the prevalence of venous thromboembolism (VTE) in patients with hypertensive intracerebral hematoma, aneurysmal subarachnoid hemorrhage and severe traumatic brain injury complicated by intracranial hemorrhage. MATERIAL AND METHODS:A non-randomized retrospective observational study recruited subjects between January 2020 and May 2024 (53 months). The study group included 311 patients with various intracranial hemorrhages: hypertensive intracerebral hematoma (n=194), ruptured intracranial aneurysm with subarachnoid hemorrhage (n=41), and traumatic brain injury complicated by intracranial hemorrhage (n=76). All patients underwent ultrasound of lower limb veins upon admission or within 24 hours, and then vein patency was checked every 7 days. In case of emergency or urgent surgery, ultrasound was performed on the first postoperative day and repeated every 7 days. The diagnosis of pulmonary embolism (PE) was established using CT pulmonary angiography or autopsy data. The primary endpoints were venous thrombosis in inferior vena cava system, nonfatal and fatal PE. Secondary endpoints included recurrent intracranial hemorrhage, any other clinically significant bleedings (gastrointestinal, nasal, etc.) and death. RESULTS:The incidence of VTE in patients with hypertensive intracerebral hematoma was 32.5% (50 patients with venous thrombosis and 13 patients with PE). Among patients with aneurysmal subarachnoid hemorrhage, the prevalence of VTE was 60.9% (21 patients with venous thrombosis and 4 patients with PE). In patients with traumatic intracranial hemorrhage, VTE was detected in 28.9% of cases (21 patients with venous thrombosis and 1 patient with PE). CONCLUSION:VTE remains one of the main and often fatal complications of various intracranial hemorrhages. Regular ultrasound of IVC system allows timely diagnosis of venous thrombosis in patients with intracranial hemorrhage, prescription of therapeutic doses of anticoagulants and minimization of risks of fatal PE.
Accessory spleen is a rare anomaly occurring in approximately 10% of people. Most often, accessory spleen can be located in spleen gate. However, localization in parenchymal abdominal organs, retroperitoneal space, pelvis and chest is also possible. Congenital accessory spleen is extremely rare, and only several cases are described in the literature. Diagnosis causes some difficulties. CT-based differentiation with malignant tumor is difficult. We present a 72-year-old patient with congenital intrathoracic accessory spleen.
OBJECTIVE:To identify the causes of cystic duct stump failure after cholecystectomy and diagnostic effectiveness of magnetic resonance cholangiography. MATERIAL AND METHODS:We retrospectively analyzed examination and treatment of 30 patients with cystic duct stump failure after cholecystectomy. Patients underwent ultrasound (30), CT (17), MR-cholangiography (25), transfistular cholangiography (3). Minimally invasive (83.33%) and open surgical interventions (16.67%) were used. The Statistica 10 program was used for statistical analysis. RESULTS:The causes of bile leakage from cystic duct stump were ligation defects in 60% and biliary hypertension in 40% of cases. MR-cholangiography allowed to exclude intersection of bile ducts in 24 out of 25 cases and to diagnose biliary hypertension in 10 cases. Specificity and negative prognostic value of MR-cholangiography for diagnosis of intersection of extrahepatic bile ducts was 96%. Patients with external biliary fistula (24) underwent endoscopic papillotomy and bile duct stenting with a stent above cystic stump (with removal of bile stones in 7 cases). A nitinol stent was installed in one case. Five (16.67%) patients underwent additional relaparoscopy for abdominal effusion. In all cases, bile leakage stopped within 1-5 (1 [0; 3]) days. Laparotomy, choledocholithotomy (1), transduodenal papillotomy (1), and external drainage of bile ducts (5) were performed for signs of peritonitis. CONCLUSION:Endoscopic papillotomy combined with bile duct stenting with or without lithoextraction makes it possible to early eliminate bile leakage in case of cystic duct stump failure with bile leakage.
The Russian consensus document on current issues in diagnosis and treatment of gastroduodenal ulcerative bleeding was prepared by a group of experts in surgery, endoscopy, interventional radiology and intensive care. The purpose of this consensus was to identify and consolidate opinions of Russian specialists on such current issues as diagnostic measures for gastroduodenal ulcerative bleeding, timing of diagnosis and order of diagnostic tests, as well as necessity and feasibility of conservative measures for gastroduodenal ulcerative bleeding, analysis of surgical strategy depending on severity of bleeding.
Congenital portosystemic shunts (CPSS) are rare vascular anomalies with portal blood bypassing hepatic filtration and subsequent various metabolic and developmental complications. Early diagnosis and timely intervention are crucial to prevent severe complications. We describe a 3-month-old boy with persistent jaundice and developmental delays. Laboratory tests revealed hyperbilirubinemia and elevated transaminases. Doppler ultrasound and contrast-enhanced computed tomography revealed a large intrahepatic PSS up to 25 mm in diameter with hypoplasia of the right liver lobe. Endovascular embolization was performed via transjugular approach. Postoperative migration of one coil into pulmonary artery required endovascular procedure. Gradual normalization of liver function tests, restoration of portal blood flow, regeneration of liver parenchyma and age-appropriate development were achieved. This case demonstrates technical feasibility and effectiveness of endovascular closure of large intrahepatic CPSS, even in infants. Key factors for successful outcomes include careful anatomical assessment, individual treatment plan and meticulous postoperative monitoring.
A 40-year-old men received a shrapnel wound of the neck with common carotid artery rupture on the left in 2023. Carotid artery replacement with a diepoxy-treated biological prosthesis was performed. After 6 months, transient ischemic attack developed. Ultrasound revealed 60% restenosis of prosthesis. After conservative treatment, he continued serving in the armed forces. In June 2025, CT angiography revealed 86% restenosis of prosthesis and occlusion of external carotid artery. Autovenous redo internal and external carotid artery replacement was performed at the military field hospital. Postoperative period was uneventful.
Diseases of the artificial esophagus can occur at different times after esophagoplasty. Their incidence varies widely from 10% to 50% and depends on plastic material and surgical technique. The authors present successful treatment of a patient with skin tube cancer after previous esophagoplasty with small bowel interposition back in the 40s of the 20th century.
The intensification of armed conflicts in recent years has led to an increase in the number of casualties with injuries to major vessels. The use and search for optimal regimens of angiotropic therapy in the early postoperative period for patients undergoing surgical interventions for injuries to major arteries remains a debatable issue. This article describes two successful clinical cases of using a vasoactive peptide complex in the postoperative period in patients who sustained gunshot wounds with injuries to the major arteries of the extremities, treated at different medical institutions.
OBJECTIVE:To establish a laboratory marker of infection in destructive pancreatitis based on peripheral blood macrophage response. MATERIAL AND METHODS:A prospective study (2019-2024) enrolled 78 patients with phase IB and II acute pancreatitis. Macrophage response was assessed three times (on days 1-2, 7-8, and 18-20) using native blood smears stained with methylene blue and examined under microscopy in six fields of view. Quantitative parameters (leukocytosis, leukocyte intoxication index, qSOFA, Dzhanelidze, Ranson, and Balthazar scores) were analyzed with correlation coefficients (Pearson and Spearman tests). RESULTS:In patients with infected necrosis, there was a significant increase in macrophage count (from 0.5±0.5 to 1.5±1.0 cells per six fields; p<0.001), whereas macrophage count remained unchanged in the aseptic group (0.1±0.3). Macrophage count moderately correlated with leukocytosis (r=0.48), leukocyte intoxication index (r=0.50), severity scores (ρ=0.34-0.49), and necrosis area (r≈0.50; p<0.001). CONCLUSION:Original method enables detection of infected necrosis as early as phase II of acute pancreatitis and may serve as a guide for timely surgical intervention.
