Objective. To analyze organ and functionally sparing surgical interventions in patients with non-epithelial tumors of the esophagogastric junction. Material and methods. The study included 126 patients with non-epithelial tumors of the esophagogastric junction who underwent surgery between 2000 and 2024. All patients were divided into two groups: the main group (n=82) — functionally sparing surgeries with preoperative endosonographic tumor typing, the control group (n=44) — no endoscopic sonography. Non-epithelial tumors of the abdominal esophagus (anterior/lateral walls) were observed in 16 patients and in 8 patients, tumors of posterior esophageal wall — in 9 and 6 patients, tumors at the esophagogastric junction extending to the gastric fundus — in 13 and 6 patients, respectively. Gastric cardia tumors (mainly closer to the lesser curvature) were identified in 15 and 8 patients, gastric fundus tumors — in 14 and 7 patients, posterior gastric wall tumors — in 15 and 9 patients, respectively. Results. Surgical interventions were technically successful in all cases. There were no postoperative complications and functional disorders in the main group. In the control group, 39% of patients had postoperative complications and severe functional disorders. Among them, 23% had gastroesophageal reflux, 9% — hiatal hernia, 7% — impaired motor function of the stomach. In 14% of cases, redo surgical interventions were required for postoperative functional disorders. No tumor recurrences were noted throughout the follow-up period (1—10 years). Conclusion. Organ and functionally sparing surgical treatment of nonepithelial neoplasms of the gastroesophageal junction ensures high precision and minimal invasiveness of interventions. This approach significantly reduces the rate of postoperative complications and provides excellent functional outcomes in short-term and long-term postoperative period.
Internal hernia with a gate in the sternocostal triangle of the diaphragm (Morgagni—Larrey hernia) is very rare. Strangulated hernia is more common in elderly and senile patients. Diagnosis is difficult and requires instrumental methods. The authors present successful treatment of an 85-year-old patient and appropriate literature data. CT is a highly informative method for diagnosing this pathology. The probability of necrosis of the affected organs is relatively low. Repair with autologous tissues is preferable.
Objective. To analyze postoperative outcomes in patients with Dunbar syndrome. Material and methods. We analyzed postoperative outcomes of 6 patients with Dunbar syndrome admitted to the Inozemtsev Moscow City Clinical Hospital between 2014 and 2025. Results. A comprehensive multidisciplinary approach and minimally invasive techniques resulted in positive immediate and long-term results in patients with Dunbar syndrome. Contrast-enhanced CT and Doppler ultrasound with analysis of peak systolic blood flow velocity at baseline and after celiac axis decompression enabled us to evaluate the effectiveness of intervention and feasibility of subsequent transluminal balloon angioplasty and stenting. Conclusion. A multidisciplinary approach to treating patients with Dunbar syndrome using safe, effective and minimally invasive techniques (laparoscopic decompression and, if necessary, stenting) is a modern alternative to open surgery and offers good immediate and long-term outcomes. However, further data collection and analysis of immediate and long-term outcomes are necessary to define clear criteria for selecting the optimal treatment method, develop diagnostic algorithms, and evaluate their effectiveness.
Objective. To assess the feasibility of extracorporeal blood purification (EBP) for acute pancreatitis. Material and methods. A retrospective study enrolled 128 patients with moderate-to-severe pancreatitis in 2020—2024. Of these, 53 ones underwent EBP. Clinical outcomes and laboratory parameters were assessed. Results. Early effect of EBP was short-term, and long-term dynamics of laboratory parameters did not demonstrate the advantages of this method. The negative effects of extracorporeal treatment included adverse effects on hemostasis system, serum albumin and hemoglobin. With the same baseline severity of organ dysfunction, EBP showed more severe progression and delayed regression of symptoms. Severe dysfunction (SOFA score > 5) was more common by 10%. After 5-6 days, SOFA score was 1.67±0.31 vs. 0.70±0.10 (95% CI 0.45—1.48, P<0.001). Maximum severity of multiple organ failure was higher by 0.75±0.32 points in case of EBP (95% CI 0.12—1.39, P<0.028). Conclusion. Routine EBP for extrarenal indications is not advisable in moderate-to-severe acute pancreatitis.
Objective. To compare functional results of laparoscopic and robot-assisted rectal resection and evaluate the effect of pelvic parameters on intestinal and urinary function, as well as the quality of life. Material and methods. A two-center retrospective study included 87 patients after sphincter-sparing rectal resection: 48 patients underwent laparoscopic surgery, 39 – robot-assisted surgery. Functional outcomes were assessed using the LARS, IPSS, FACT-C, and SF-36 questionnaires. Pelvimetry was based on preoperative pelvic MRI. Results. Robot-assisted resection was associated with significantly better functional results: lower LARS and IPSS scores and higher values of FACT-C and all SF-36 domains (p<0.001). Moderate correlations between unfavorable pelviometric parameters and worse functional outcomes were found in general sample. In stratified analysis, these correlations were preserved in laparoscopic cohort, but were absent in the group of robot-assisted interventions. Conclusion. Small pelvis anatomy affects functional results after laparoscopic rectal resection, whereas there are no clear effects in case of robot-assisted surgery. Robotic platform is associated with more favorable restoration of pelvic organ functions and quality of life.
