AIM:To compare results of macroscopic assessment and materials of histological examination of 1635 appendices removed using videolaparoscopy in patients with acute appendicitis. All patients have been treated in N.V.Sklifosovsky Research Institute of Emergency Care for the period from 2002 to 2014.MATERIAL AND METHODS:Intraoperative macroscopic assessment of appendix's inflammatory changes was performed using some conventional signs. Сatarrhal, phlegmonous and gangrenous changes were suspected in 77 (4.7%), 1432 (87.5%) and 126 (7.7%) cases respectively.RESULTS:Histological examination revealed catarrhal, phlegmonous and gangrenous changes in 86 (5.3%), 1338 (81.8%) and 115 (7.0%) cases respectively. In 65 (4.0%) patients changes were estimated as chronic, 31 (1.9%) patients had not inflammation. Intraoperatively suspected diagnosis of different forms of appendicitis was confirmed by histological survey in 94.1%. Most cases of matched intraoperative and histological diagnosis were observed in case of phlegmonous appendicitis (88.2%). Only 5.9% of patients had not acute inflammation of appendix that may be explained by overdiagnosis and excess of indications for appendectomy.

Introduction: Spleen injury appears in 10% to 30% of abdominal trauma patients. Mortality among the patients in the last 20 years remains high (6% to 7%) and shows no tendency to decline. Nowadays nonoperative management is widely accepted management of patients with low-grade spleen injury, whereas management of patients with high-grade spleen injury (III and higher) is not so obvious. There are 3 methods exist in treatment of such patients: conservative (with or without angioembolization), spleen-preserving operations, and splenectomy. Today laparoscopic splenectomy is not a widely used operation and only few studies reported about successful use of laparoscopic splenectomy in patients with spleen injury. The aim of the study was to determine indications and contraindications for laparoscopic splenectomy in abdominal trauma patients and to analyze results of the operations. Patients and Methods: The study involved 42 patients with spleen injury grade III who were admitted in our institute in the years of 2010 to 2014. The patients were divided in 2 groups. Laparoscopic splenectomy was performed in 23 patients (group I) and “traditional” splenectomy was carried out in 19 patients (group II). There was no difference in the demographic data and trauma severity between the 2 groups. Noninvasive investigations, such as laboratory investigations, serial abdominal ultrasound examinations, x-ray in multiple views, and computed tomography had been performed before the decision about necessity of an operation was made. Results: Patients after laparoscopic operations had better recovering conditions compared with patients with the same injury after “traditional” splenectomy. Neither surgery-related complications nor mortalities were registered in both groups. Laparoscopic splenectomy was more time-consuming operation than “traditional” splenectomy. We suggest that as experience of laparoscopic splenectomy is gained the operation time will be reduced. Conclusions: Laparoscopic splenectomy is a safe feasible operation in patients with spleen injury. The operation is indicated in patients with spleen laceration >3 cm of parenchymal depth with moderate continuing bleeding or expanding hematoma and contraindicated in patients with hemodynamic instability and high bleeding rate (>500 mL/h on serial ultrasound examinations).

The treatment results of 769 patients with acute calculous cholecystitis and high operational and anesthetic risk at admission are presented in the retrospective study. High risk was determined by expressed comorbidities, diseases' terms, the complications of acute cholecystitis, age, which was more than 60 years in most cases. The patients were divided into 2 groups depending on the severity of comorbidity and the possible effects of its correction. The first group included 617 perspective patients for cholecystectomy. And the second group included 152 patients unpromising for this. Concept of stage treatment was used in the first group including primary decompression of the gallbladder by using of percutaneous transhepatic micro-cholecystostomy under ultrasound guidance. Cholecystectomy was performed after correction of comorbidities, complications of acute cholecystitis, and readjustment of extrahepatic bile ducts by endoscopy if necessary. Laparoscopic cholecystectomy was successfully performed in 587 patients. There was open cholecystectomy in 11 cases. Cholecystectomy was done in 19 patients as a result of conversion. Cholecystostomy from minimal access with extraction of stones under local anesthesia was performed in the second group for decompression and as definitive treatment. There was not observed deaths in patients with high operational and anesthetic risk as a result of such tactics. Postoperatively 1.7% of patients had complications that were successfully resolved.

This study presents the results of investigation of anti-adhesive properties of the dura combined with polypropylene implant, and a composite mash with a hydrogellayer Parietex Composite. 40 Wistar rats were used for this research work. The study showed that the use of the dura as an anti-adhesive coating prevents fusion of the internal organs with the implant, and the polypropylene used as a mash basis, firmly fuses with the parietal peritoneum, promoting in growth of connective tissue in the grid structure. These results are comparable to results obtained using Parietex Composite.

The objective of our study was to assess the abilities and limitations of laparoscopy and evaluate its role in examination and treatment of patients with abdominal trauma. A total of 628 patients with blunt and penetrating abdominal trauma were included in this retrospective 12-year survey (2000 to 2011). All patients in the study underwent either laparotomy (280 patients) or urgent laparoscopy (348 patients). There was no difference in the demographic data and trauma severity between the 2 groups. Conversion to open surgery was performed in 130 cases (37.3%). Diagnostic laparoscopy without therapeutic manipulations was used in 160 patients (46%) and therapeutic laparoscopy was carried out in 58 patients (16.7%). Quicker recovery time, less pain, shorter hospital stay, and lower complication rate were observed in patients after laparoscopic surgery compared with patients after open surgery. No missed abdominal organs injuries were revealed after laparoscopic examination of abdominal cavity.