Гастроезофагеалната рефлуксна болест (ГЕРБ) и ахалазията представляват две самостоятелни нозологични единици, характеризиращи се с различни патофизиологични механизми, но със значително припокриване на клиничната симптоматика. Прояви като киселини, ретростернална болка, регургитация и дисфагия могат да се наблюдават както при пациенти с ГЕРБ, така и в ранните стадии на ахалазията, което затруднява диференциалната диагноза и създава предпоставки за избор на неподходящ терапевтичен подход. Прецизното разграничаване между двете заболявания е от съществено значение при предоперативната оценка на пациентите, планирани за антирефлуксна хирургия, тъй като недиагностицираната ахалазия представлява противопоказание за извършване на стандартна фундопликация и налага прилагането на принципно различна хирургична стратегия. Високорезолюционната езофагеална манометрия (High-Resolution Manometry, HRM) се утвърди като златен стандарт за диагностика на моторните нарушения на хранопровода. Въвеждането на Chicago Classification версия 4.0 значително подобри диагностичната точност чрез стандартизиране на манометричните критерии и възможност за прецизно разграничаване на различните подтипове ахалазия и други нарушения на езофагеалната моторика. Съвременните диагностични алгоритми препоръчват комбинирането на HRM с горна ендоскопия, контрастно рентгеново изследване и при необходимост функционално лумен-имиджинг сонда (FLIP), което позволява комплексна оценка на структурните и функционалните нарушения. Настоящият обзор разглежда клиничното припокриване между ГЕРБ и ахалазия, диагностичните предизвикателства и ролята на високорезолюционната манометрия в предоперативната оценка на пациентите. Представени са актуалните международни препоръки относно диагностичния алгоритъм и значението на HRM за оптималния избор на хирургично лечение.
Objective. To summarize data on augmented reality technology in various surgical fields. Material and methods. Between 2022 and 2024, specialists in abdominal, interventional, maxillofacial, reconstructive and head & neck surgery, as well as urology performed augmented reality assisted treatment of 68 patients at the University Hospital of the Russian University of Medicine. This technology was used for preoperative planning and intraoperative navigation. Results. Integration of augmented reality did not significantly prolong surgery time. In head and neck tumor surgery, augmented reality reduced surgery time by 15%. In interventional surgery, improved spatial understanding of vascular anatomy reduced fluoroscopy time and surgery time. Likert scale assessments confirmed high usability of this technology. Conclusion. Augmented reality is effective and perspective in various surgical fields. However, this technology requires further refinement. Enhancing the precision of 3D models and spatial registration processes, improving adaptability to intraoperative anatomical shifts, and automating routine tasks will collectively increase versatility and adoption of augmented reality systems throughout surgical care.
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.
OBJECTIVE:To evaluate the impact of multimodal prehabilitation, including a structured proprietary kinesiotherapy program with a video-guided module, on early postoperative outcomes in elder patients after gastropancreatoduodenectomy, gastrectomy and low anterior rectal resection. MATERIAL AND METHODS:A single-center two-stage comparative cohort study (retrospective and prospective cohorts) included 216 patients (108 in the prehabilitation group and 108 in the control group). Both groups used an accelerated recovery protocol after surgery. The study group additionally underwent a 14-day multimodal prehabilitation program with original video-guided kinesiotherapy program. The primary endpoint was any postoperative complication within 30 days. Secondary endpoints included severity of complications (Clavien-Dindo classification), length of ICU- and hospital-stay and time to adjuvant chemotherapy. RESULTS:The incidence of postoperative complications was 18.6% and 41.7%, respectively. No severe complications (Clavien-Dindo grade IIIb-V) were reported in the prehabilitation group, whereas high-grade complications, including one death, were observed in the control group. Prehabilitation was associated with shorter ICU- and hospital-stay, as well as a trend towards earlier initiation of adjuvant chemotherapy. In multivariate analysis, prehabilitation was associated with lower risk of postoperative complications. CONCLUSION:A structured multimodal prehabilitation with video-guided kinesiotherapy is associated with better early postoperative outcomes in elderly patients after abdominal surgeries for cancer.
