BACKGROUND: Laparoscopic cholecystectomy after endoscopic bile duct clearance for choledocholithiasis is often performed in the setting of marked inflammatory and fibrotic changes in Calot’s triangle. Safe cholecystectomy tools and endoscopic lithotripsy techniques are usually evaluated separately, and their combined use within a single algorithm has not been sufficiently studied. AIM: To compare the rate of difficult laparoscopic cholecystectomy in patients with chronic calculous cholecystitis after endoscopic bile duct clearance for choledocholithiasis before and after the implementation of a diagnostic and treatment algorithm. METHODS: Single-centre cohort study with historical controls. Group I (January 2019 to December 2023) underwent bile duct clearance with mechanical lithotripsy without a formalised intraoperative checklist; group II (January 2024 to July 2026) was treated according to an algorithm comprising cholangioscopic thulium fibre laser lithotripsy for complex stones, formalised timing of surgery and an intraoperative safety checklist. The primary outcome was difficult cholecystectomy (at least one of: operative time 90 min, blood loss 200 mL, gallbladder perforation with bile spillage). Secondary outcomes were achievement of the critical view of safety, conversion and Clavien–Dindo grade IIIa or higher complications within 30 days. RESULTS: Of 108 patients, 56 were in group I and 52 in group II. The groups were comparable in sex, age and clinical course but differed in the timing of surgery (early cholecystectomy in 16.1% vs 69.2%; p0.001). Difficult cholecystectomy occurred in 33/56 (58.9%) vs 17/52 (32.7%) patients (odds ratio 0.34; 95% confidence interval 0.15–0.74; p=0.006). The critical view of safety was achieved in 38/56 (67.9%) vs 45/52 (86.5%) patients (p=0.022), and conversion occurred in 6/56 (10.7%) vs 1/52 (1.9%) (p=0.115). There were no bile duct injuries. Open choledochotomy was required in 4/56 (7.1%) vs 1/52 (1.9%) patients (p=0.365), and postoperative complications occurred in 4/56 (7.1%) vs 1/52 (1.9%) (p=0.365). CONCLUSION: Implementation of the algorithm in patients with chronic calculous cholecystitis and choledocholithiasis was associated with a significantly lower rate of difficult laparoscopic cholecystectomy and a higher rate of achieving the critical view of safety; differences in conversion and complication rates were not significant. The historical-control design, the imbalance in the timing of surgery and the simultaneous implementation of several components preclude assessment of the contribution of each component; prospective validation is required.
AIM: To study the MRI signs of HT and QT grafts remodeling after primary ACL reconstruction. METHODS: We analyzed the case histories of adult patients with complete rupture of the ACL who underwent surgery in the Department of Traumatology and Orthopedics of the FNCC of the FMBA of Russia from 2010 to 2025. On the postoperative MRI scans we measured the diameter of the graft, assessed the signal intensity from the graft and bone marrow around the bone channels, and the severity of knee synovitis. The data were compared in groups with different types of grafts and duration of the postoperative period. RESULTS: The average thickness of the QT graft was greater than that of the HT graft in general (p=0.000968) and in groups 0-3 and 7-12 months after surgery. Patients under 1 year of follow-up were more likely to have a pathological graft signal (p=0.015), especially in the QT group (60.9%), compared with HT (42.9%), as well as the severity of knee effusion (p=0.006). Moderate knee effusion was more common in the QT group (60.7%), and small effusion in the HT group (48.7%) (p=0.008). The highest incidence of moderate and severe effusion was found for the QT group 0-3 months after surgery (100%), compared with the HT group (69.2%) (p=0.010880). The number of patients with abnormal bone marrow signal around the bone channels decreased between groups 0-3 (78.3%) and 4-6 (36.1%) months (p=0.001). In the QT group, a hyperintensive signal around bone channels of any severity was observed in 50% of patients, and in the HT group – in 31.4% (p=0.063). CONCLUSION: The QT graft showed a larger diameter, but more frequent pathological signals from the graft and bone marrow around the bone channels and more pronounced synovitis in the early stages of follow-up than the HT graft.
Lower limb amputations are approximately three times more common than upper limb amputations, yet sensory feedback restoration methods, including sensory mapping, have historically been developed mainly for the upper limb. In patients with lower limb amputation, the lack of information about the interaction between the prosthesis and the ground increases cognitive load and the risk of falls. Dorsal root ganglion stimulation (DRG-S) and spinal cord stimulation (SCS) are considered as means of delivering an artificial sensory signal; however, comparative data on the perceptual patterns and motor side effects they evoke, and on their use in closed-loop biofeedback in such patients, are lacking.We report a male patient with a right lower leg amputation at the level of the distal third following a mine-blast injury sustained 4 years before the observation, and phantom limb pain (background pain of 3–6 points on the visual analogue scale with paroxysms of 8–10 points occurring 15–20 times a day). DRG (L5–S1) and SCS (L4–L5) test electrodes were implanted electively. During sensory mapping with concurrent surface electromyography, S1 DRG stimulation evoked focal sensations in the phantom phalanges without motor responses across the entire amplitude range (up to 8 mA), whereas SCS projected to the heel area and was accompanied by pronounced muscle contractions and contralateral radiation. In closed-loop testing with a sensory insole, stimulus recognition accuracy with the DRG electrode and the prosthesis worn was 87% with both electrical and sham stimulation. With the SCS electrode and the prosthesis removed, accuracy increased from 80% to 97% (sensitivity 100%) after a 30-minute sensorimotor adaptation period. The protocol was completed in full, and no serious adverse events were recorded.This case shows that sensory mapping and biofeedback techniques can be adapted for patients with lower limb amputation. DRG-S provides focal sensations without motor artifacts, SCS requires a sensorimotor adaptation period, and the evaluation of feedback systems requires control of mechanical pressure transmission through the prosthetic socket. These conclusions are based on a single case with different electrode testing conditions and need to be verified in a larger sample.
Abdominal intercostal hernias are rare defects of the thoracoabdominal wall and, in most reported cases, are associated with trauma, rib fractures, previous surgery, or chronic conditions causing repeated increases in intra-abdominal and intrathoracic pressure. Cough-induced variants without direct external trauma and without previous abdominal or abdominal wall surgery are much less common. The optimal repair strategy for large lateral intercostal defects with herniation of the liver and colon also remains unclear, because no standardized reconstruction approach has been established for such cases. We present a 66-year-old woman with class II obesity who developed a large right-sided abdominal intercostal hernia after severe cough during an airplane flight. She denied previous trauma and any history of abdominal or abdominal wall surgery. Computed tomography demonstrated a right mesogastric hernia with a 139×118 mm defect and a 122×133 mm hernia sac containing loops of the colon and the right hepatic lobe. The patient underwent endoscopic totally extraperitoneal posterior component separation hernia repair (eTEP-TAR) with placement of a 30×30 cm macroporous Bard SoftMesh prosthesis in the retromuscular plane. Intraoperatively, a hernia measuring up to 15×22 cm was identified between the right 10th and 11th ribs. During mobilization of the hernia sac, the pleural cavity was opened in the projection of the right pleural sinus, resulting in capnothorax; the defect was closed with a two-layer continuous suture on a hyperventilated lung. No systemic infection developed. On postoperative day 5, with C-reactive protein of 40.6 mg/L and negative procalcitonin, an intramuscular seroma measuring 116×37×60 mm with a volume of 140 mL was detected; culture of the drainage fluid showed no microbial growth. The patient was discharged in satisfactory condition on postoperative day 6. At 12-month clinical follow-up, there were no signs of recurrence, recurrent seroma, or mesh infection. This case suggests that minimally invasive extraperitoneal retromuscular reconstruction may be feasible for selected rare cough-induced abdominal intercostal hernias with liver and colon herniation. However, conclusions from a single case should not be generalized, and the choice of repair should be individualized according to the anatomy of the defect, hernia contents, and surgical expertise.
Objective. To evaluate the clinical safety and efficacy of a new dynamic magnetic retraction system with electronic control of magnetic field strength and six-axis positioning to ensure adequate exposure of the surgical field in patients undergoing elective laparoscopic colon resections. Methods. A prospective descriptive study included patients aged 46 to 78 years with histologically verified cancer of the cecal, ascending, descending, or sigmoid colon, who were scheduled for elective laparoscopic surgery at a single surgical hospital. The intervention studied was the intraoperative use of a dynamic-controlled magnetic system. The primary endpoint was the incidence of intraoperative complications associated with the use of the magnetic device. Additional outcomes: duration of surgery, volume of blood loss, number of removed lymph nodes, frequency of R0 resection, frequency of postoperative complications, time of restoration of peristalsis, and duration of hospitalization. Results. The study included 12 patients (7 men, 5 women; median age 64 years). In all cases, the system provided adequate visualization of the surgical field without conversion to an open intervention or the installation of additional trochars. There were no intraoperative complications associated with the magnetic device (0%; 95% confidence interval 0–26.5). The median duration of surgery was 170 minutes, and the median blood loss was 50 ml. The median number of lymph nodes removed was 12 (range 8–18). R0 resection was achieved in all 12 patients. Peristaltic activity was restored on the second day, and the median hospital stay was 10 days. One case of postoperative wound seroma was recorded (8.3%; 1/12), and no deaths were reported. Conclusions. Dynamic magnetic retraction with smooth adjustment of force and traction vector is safe and provides adequate oncological results in laparoscopic colon resections. Due to the small sample size and the absence of a comparison group, it is currently not possible to assess the superiority of this method over standard approaches.
