Objective. To evaluate the association of access conversion with 30-day mortality in patients with pancreatic necrosis who underwent minimally invasive interventions, and to identify clinical factors associated with the need for conversion. Material and methods. This prospective comparative multicenter study was conducted in three clinical centers of Kyrgyzstan from January 2019 to December 2024. The study included 105 patients with verified diagnosis of pancreatic necrosis who underwent minimally invasive interventions. Patients were divided into two groups: the main group (n=48, patients with lethal outcome) and the control group (n=57, patients with favorable outcome). Univariate and multivariate logistic regression analysis of six risk factors was performed. Results. Univariate analysis showed that age over 60 years, presence of comorbidities, surgeon’s qualification, and operation duration did not have a statistically significant effect on mortality (p > 0.05). The presence of widespread peritonitis (p=0.03) and conversion to laparotomy (p<0.001) demonstrated a significant association with adverse outcome. According to multivariate analysis, conversion was independently associated with mortality (OR=8.94; 95% CI: 2.81—28.47; p=0.0002). The conversion rate in the main group was 45.8% (n=22), in the control group — 10.5% (n=6). Conclusion. Access conversion in minimally invasive interventions in patients with pancreatic necrosis was significantly associated with 30-day mortality and retained independent significance in a multivariable model including widespread peritonitis. These findings allow considering conversion as an integral marker of an unfavorable clinical scenario and substantiate the need for developing objective criteria for timely transition to open surgery.
Background. Combined penetrating injuries of the perineum, rectum, and vagina in children are rare, and there is no unified algorithm for their surgical treatment. Clinical case. The case of a 10-year-old girl with a penetrating injury to the perineum, accompanied by damage to the anterior wall of the rectum and the posterior wall/vault of the vagina with penetration into the abdominal cavity, is presented. Diagnostic laparoscopy, laparoscopic suturing of the vaginal injury, transvaginal correction, and primary suturing of the rectal defect without forming a disconnecting colostomy were performed. The postoperative period proceeded favorably. No dysfunction of the intestines, urinary tract, or reproductive system was detected during a 4-year follow-up. Conclusion. A combined laparoscopic, transvaginal, and transanal approach can provide a comprehensive assessment of the injuries and simultaneous reconstruction in carefully selected cases of combined penetrating injuries to the perineum in children.
Preoperative diagnosis of an Amyand hernia is difficult and has little practical significance. In most cases, this is an intraoperative diagnosis. The very fact of a strangulated hernia is important. Laparoscopic herniotomy is also possible for pinched inguinal hernias. If we assume the possibility of open surgery for a pinched inguinal hernia, then in this case, after appendectomy, it is possible to perform hernioplasty using a mesh implant (like Lichtenstein surgery). Laparoscopic hernioplasty with a mesh implant can be performed simultaneously with appendectomy, provided that there are no phenomena of perforation of the appendix and peritonitis.
Background. Solid pseudopapillary tumor (SPPT) is the most common neoplastic process affecting the pancreas; the main method of its treatment is surgical intervention. The Beger operation is a surgical intervention that allows preserving the head of the pancreas and reducing the volume of the excised parenchyma, as well as avoiding postoperative complications associated with duodenal resection. Clinical case. This article presents a clinical case of a laparoscopic Beger procedure in a 16-year-old patient with SPPO of the pancreatic head, as well as a literature review devoted to resections of the pancreatic head in neoplastic processes. Special attention is paid to the technical aspects of the procedure, as well as the course of the postoperative period. Results. The laparoscopic Beger procedure demonstrated comparable efficacy compared to classic resections of the pancreatic head, despite the prolonged duration of the surgical intervention, and can be considered a promising direction for further development. Conclusion. Based on the example of clinical observation, it can be concluded that laparoscopic resections of the pancreatic head in children are possible, but its safety and oncological adequacy require further study. I would also like to note that this operation takes quite a long time, which is directly related to the high learning curve, technical difficulties and low patient flow, and therefore it is advisable to perform such surgical procedures in specialized centers.
Background. Endoscopic removal of epithelial neoplasms of the colon remains the primary method for the prevention of colorectal cancer. The underwater endoscopic resection technique (underwater EMR, uEMR), introduced in 2012, demonstrates several advantages over conventional EMR, including technical simplicity, higher completeness of resection, lower complication rates, and the possibility of outpatient performance. However, the method remains insufficiently studied in Russia, necessitating an evaluation of its effectiveness in domestic clinical practice. Objective. To evaluate the clinical outcomes of underwater endoscopic resection (uEMR) of epithelial neoplasms of the colon up to 50 mm in size in inpatient and outpatient settings. Material and methods. The study included 122 cases of patients who underwent underwater endoscopic resection of epithelial neoplasms of the colon between August 2023 and June 2025. The procedures were performed at the Department of Therapeutic and Diagnostic Endoscopy of University Clinical Hospital No. 2, Sechenov University. The main inclusion criteria were the benign nature of the lesion, the absence of signs of deep invasion, and a lesion size of up to 50 mm. We assessed resection completeness, procedure duration, complication rates, and recurrence. Results. The mean size of resected neoplasms was 15.6 mm, and the mean procedure time was 5.3 minutes. Complete resection was achieved in 94.5% of cases. Intraoperative and delayed complications were rare and clinically insignificant. The method demonstrated high efficacy and safety, including in outpatient settings. Conclusion. Underwater endoscopic resection (uEMR) proved to be an effective and safe technique for removing epithelial neoplasms of the colon. The findings support its broader implementation in routine endoscopic practice in both outpatient and inpatient settings.
