Objective: to present an analysis of the results of 100 cadaveric liver transplants performed at Botkin Hospital from July 2018 to October 2021. Materials and methods. From July 2018 to October 2021, 100 orthotopic liver transplantation (LTx) from a deceased donor were performed at the surgical clinic of Botkin Hospital. The recipients were 58 males (58%) and 42 females (42%). The mean age of the recipients was 48.73 ± 8.56 (24–66) years, while their mean MELD was 19.54 ± 4.35 (15–33). The main indications for LTx were cirrhosis resulting from chronic viral hepatitis (CVH) C (52%), nutritional-toxic cirrhosis (20%), autoimmune liver and bile duct disease (18%), CVH B (7%), and hepatocellular carcinoma (HCC) (3%). During the period under study, 119 potential liver transplant donors were evaluated. The mean age of the donors was 44.2 ± 11.12 (21–63) years. Median levels of sodium, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin were 141 (138–146) mmol/L, 27 (20.7–47.4) units/L, 25 (17–41.5) units/L, and 9.65 (6.42–13.7) μmol/L, respectively. The median graft hepatic steatosis was 10% (5–15). LTx was performed using the piggyback technique (99/100 cases) and classic technique with inferior vena cava resection (1/100). End-to-end porto-portal vein anastomosis was performed (99/100 cases). Anastomosis of the donor organ’s portal vein with the recipient’s left gastric vein due to occlusive thrombosis of the recipient’s portal vein was carried out (1/100). In all cases, a continuous end-to-end arterial anastomosis was formed. End-to-end choledochocholedochal anastomotic strictures (95/100) and end-to-side hepaticojejunostomy (5/100) were formed. Results. Median cold ischemia time was 312.5 minutes (280–380). Mean operative time was 488.91 ± 65.34 (95% CI: 475.9–501.9) minutes, median intraoperative blood loss was 1000 (600–1500) mL. Thirty-day mortality was 2% (Clavien–Dindo class V). Early postoperative complications (Clavien–Dindo class IIIa–IVa) developed in 12/100 patients (12%). Graft arterial thrombosis occurred in 3 cases (3%), biliary anastomotic strictures in 6 (6%), and subhepatic hematoma in 2 (2%). The average intensive care unit (ICU) bed day was 2.34 ± 1.67 (1–8). Total postoperative bed-day was 14.63 ± 5.35 (10–39). During case follow-up, a prolonged form of calcineurin inhibitor (CNI) was administered as immunosuppressive therapy in mono regimen (85 patients), in combination with mycophenolic acid derivatives (7), and in combination with everolimus (6). Of the 93 patients, 46 patients (49.46%) had the new coronavirus infection (COVID-19) before or after transplantation; in no case did COVID-19 lead to death. Six patients (13.04%) were hospitalized due to COVID-19. To date, 33/93 (25.48%) patients have been vaccinated, resulting in 75 (75%) liver transplant recipients immune to COVID-19. The overall 1-year survival rate was 95% and the 3-year survival rate was 91%. Conclusion. Introduction of LTx in multidisciplinary hospitals allows to, already at the start of the program, achieve immediate and long-term treatment outcomes (in decompensated diffuse liver disease) that are comparable to those of leading transplantation centers.

The aim of this work was to provide a critical analysis of the ten-year experience of using transpapillary interventions in an urgent surgical hospital with a detailed study of all groups of registered complications.Material and methods. In the period from 2008 to 2018, 1188 retrograde endoscopic transpapillary grafts were performed on the bile ducts with dissection of the major duodenal papilla in a typical and atypical way on the basis of our clinic. The group of observed patients included 1188 patients with endoscopic papillosphincterotomy, including 839 women (70.6%) and 349 men (29.4%). The average age was 63.2 ± 1.25.Results. During the period, 25 complications (2.1%) were revealed when performing transpapillary interventions with dissection of the major duodenal papilla: acute pancreatitis — 10 patients (0.8%); bleeding from the opening of the major duodenal papilla — 4 (0.33%), perforation 12p. intestines — 4 (0.33%), breakage of the basket cable with wedging — 1 (0.08%), cholangitis — 1 (0.08%), overlapping with a stent of the lobar duct — 1 (0.08%). The overall mortality associated with complications is 0.25%. Based on the analyzed material, the iatrogenic index was calculated. It was 0.044. After the analysis of complications, on the basis of the data obtained, we proposed an algorithm of actions when performing transpapillary interventions.Conclusion. Based on the study, we come to the conclusion that it will not be possible to completely level the risk and avoid possible papillotomic-induced complications. In this regard, the early, preferably intraoperative diagnosis of the latter and the prompt implementation of correlating therapeutic measures are of great importance, which will undoubtedly improve the treatment results and have a positive eff ect on the outcome of the disease.

May-Thurner syndrome (CMT) is a disease characterized by compression of the left common iliac vein of the small pelvis by the right iliac artery. Clinically manifested by persistent pelvic pain as well as pain in the left lower extremity. One of the most common symptoms of this syndrome which should be considered is an edema of the left lower limb. The peculiarity of this disease is that the clinical picture is not always specific and is often masked by venous insufficiency of the lower extremities. Therefore, it is important to determine the main cause of the disease and conduct the entire complex of the necessary additional examination. Traditional open surgical interventions in this direction are practically not used today due to their trauma and long rehabilitation period, giving way to a safer and more effective method of treating the compression of the iliac veins - endovascular venous stenting. The first successful stenting of the iliac vein was performed back in 1995. Thus, the tactics of treating May-Turner syndrome have evolved and today, endovascular treatment is preferred as the main method of treatment. Thanks to venous angioplasty and stenting, it is possible to achieve the required clinical result in a low-traumatic and fast manner.

Objective: to evaluate the effectiveness of vacuum-assisted closure (VAC) therapy in comparison with standard treatments for infected and chronic non-healing wounds after kidney transplantation.Materials and methods. From June 2018 to November 2019, 75 kidney transplants from deceased donors were performed at the Transplantation Ward of Botkin City Clinical Hospital. There were 47 men (62.6%) and 28 women (37.4%). Standard surgical technique was used. Immunosuppressive therapy was carried out according to a three-component scheme with anti-CD25 monoclonal antibody induction (basiliximab) intraoperatively and on day 4. All patients received antibiotic therapy with protected third-generation cephalosporins for 7 days after surgery. Postoperative complications were evaluated according to the Clavien-Dindo classification. Standard methods, including daily dressings using modern dressing materials (group I) and VAC therapy (group II) were used for treating infected and chronic non-healing wounds.Results. 30-day mortality in the postoperative period was zero. Postoperative complications were recorded in 11 patients (14.6%), of which 7 had postoperative wound complications. Group I included 3 patients (1 with aKlebsiella pneumonia-infected wound and 2 with chronic non-healing wounds and no microflora growth). Group 2 had 4 patients (3 with infected wounds (Esherichia coli- 1,Klebsiella pneumonia- 2) and 1 with chronic non-healing wound). Complete cleansing of wound, absence of bacterial growth according to the microbiological examination, and maturation of granulations according to histological examination were considered as the criteria upon which a wound could be sutured in both groups of patients. The average time between the start of treatment and secondary suturing in group 1 patients was 33.11 ± 5.43 (28-37) and 15.01 ± 3.15 (13-17) days in group 1 and group 2 respectively.Conclusion. VAC therapy in patients with wound complications resulting from kidney transplantation, in comparison with standard treatment, can achieve rapid wound cleansing, acute inflammation relief and accelerated maturation of mature granulation tissue, thereby improving treatment outcomes in this category of patients.

Aim. The purpose of describing this clinical observation was to demonstrate the clinical and instrumental picture and tactics of reconstructive surgery in the development of combined ischemia of the large intestine and lower extremities due to thrombotic occlusion of the infrarenal aortic aneurysm. Case. Patient R., 72 years old, was admitted to the clinic on 09/11/2020. with complaints of numbness in the toes of both feet, pain in the muscles of both thighs and legs, discomfort and bloating in the left abdomen, delayed bowel movements. After an additional examination in the hospital, the following clinical diagnosis was formulated: Atherosclerosis of the aorta and its branches. Thrombosis of the infrarenal aortic aneurysm. Thrombosis of the iliac arteries. Critical ischemia of the lower extremities. Essential hypertension of the II degree, erosive gastritis, ischemic colitis. 09/13/2020 the patient underwent surgery: Thrombectomy from the infrarenal aorta, aorto-femoral bifurcation prosthetics with a synthetic prosthesis with silver ions with replantation of the inferior mesenteric artery into the main branch of the prosthesis from a mini-access. Smooth postoperative course. Conclusion. In the given clinical observation, long-term stenosing atherosclerosis of the aorta and iliac arteries in combination with essential hypertension led to the formation of an aneurysm of the abdominal aorta and was complicated by thrombosis. This clinical picture required a complete revascularization of all affected arterial basins: the left half of the large intestine, lower extremities. Carrying out a large volume of surgery using minimally invasive technology contributes to the restoration of the function of the intestines and lower extremities in the shortest possible time, as well as rapid physical and social rehabilitation of the patient.

We report successful surgical treatment of inferior pancreaticoduodenal artery aneurysm combined with celiac trunk occlusion. Considering angioarchitectonics of the afferent and efferent arteries (significant tortuosity), possible liver ischemia during endovascular occlusion of pancreaticoduodenal artery and expected low efficiency of embolization, the patient underwent open surgery (celiac trunk replacement and resection of pancreaticoduodenal artery aneurysm). Postoperative period was uneventful. The first and subsequent postoperative controls showed an adequate function of the prosthesis and no contrast enhancement of the aneurysm. We concluded that rational surgical approach ensured optimal solution of the problem, i.e. surgical treatment of pancreaticoduodenal artery aneurysm was the most radical and functional.

AIM To improve the results of treatment of patients with focal liver formations by preventing the development of postoperative complications after liver resections. METHODS The study included 304 patients with benign and malignant liver lesions. In 196 (64.4%) patients, resections were performed for malignant liver damage, in 108 (35.6%) - for a benign process. To assess the impact of ongoing measures to prevent the development of postoperative complications, patients were divided into two time periods: from 2007 to 2012 and from 2013 to 2018. RESULTS The introduction of a protocol of preoperative examination of patients for whom resection of 3 or more liver segments is planned, with the inclusion of SPECT/CT, which allows determining the volume of the remaining functioning liver parenchyma, allowed to reduce the percentage of development of acute post-resection liver failure from 11.6% to 3.6% during the second time period (p=0.0064). The use of modern suture material, surgical binocular loops, as well as the use of the concept of predominantly performing parenchyma-saving resections, reduced the number of biliary complications from 8.1% to 5.7% (p=0.1). The use of a proprietary dissection algorithm for the liver parenchyma significantly reduced hemorrhagic complications from 5.3% to 1.04% (p=0.0074). CONCLUSION The use of modern pre- and intraoperative technologies has reduced the number of postoperative complications after liver resections from 38.3% to 20.9% (p=0.018) and mortality from 2.6% to 0.5% (p=0.004), thereby improving the results of liver resections.

Objective: to evaluate the first results of the Botkin Hospital transplant program. Materials and methods. From June 2018 to October 2019, 100 solid organ transplants were performed at the Botkin City Clinical Hospital. Out of the 100 transplantations, 72 were kidney transplants (average age of recipients was 45.65 ± 11.35 years, HLA match averaged 2.09 ± 1.03) and 28 were liver transplants (average age of recipients was 50.14 ± 7.62 years, average MELD was 17.78 ± 3.28 (14–34). Results. After transplantation, there was no 30-day mortality. Postoperative complications following kidney transplantation were established in 11 patients (15.2%). In 3 patients (4.3%) – suppuration of postoperative wound, in 2 patients (2.8%) – hematomas in the area of the postoperative suture during hemodialysis, in 5 patients (6.9%) – retroperitoneal lymphocele, in 1 patient (1.4%) – urosepsis. There were 4 cases (5.5%) of acute rejection, 3 cases (4.2%) of humoral rejection, and 1 case (1.3%) of cellular rejection. Early postoperative complications following liver transplantation were detected in 2 patients (7.2%). In one patient – hematoma under the right lobe of the liver on the 1st day after surgery, the diaphragm was the source of bleeding, in one patient – ascites leakage through postoperative sutures, which required relaparotomy. In 2 patients (7.2%), postoperative complications were found in the separated postoperative period. In one case, of choledochocholedochal anastomotic stricture – stricture stenting was performed with coated nitinol stent. In another case, acute adhesive intestinal obstruction, which required laparotomy, adhesiolysis. Conclusion. Implementation of the transplantation program in multidisciplinary hospitals can boost transplant care in a district and improve the treatment results of patients with terminal organ damage.

Surgical wound infection is the most common complication after kidney transplantation. It is associated with a prolonged hospital stay, repeated surgical procedures, significant costs, which explains the constant search for optimized treatment for wound infections. We describe a clinical case of a patient with an infected lymphocele of the upper pole of the renal graft at Day 29 after kidney transplantation from a donor after brain death. The infected lymphocele was opened and VAC system was installed without the removal of the graft. With antibiotic therapy and modification of the immunosuppressive therapy, the graft function remained stable and no generalization of the infection occurred. The wound was completely clean at Day 28 of VAC therapy, with subsequent tight closure of the wound. The patient was discharged with a functioning graft.

AIM:To study neocollagenogenesis after implantation of polypropylene endoprosthesis and polypropylene combined with polylactic acid endoprosthesis on background of «potassium orotate» administration.MATERIAL AND METHODS:We used two different types of endoprosthesis in the experiment. The first type was made of just polypropylene, the second type was made of polypropylene combined with polylactic acid. Histological examination was performed using polarizing microscopy. Collagen types I and III ratio in connective tissue around the prosthesis was analyzed according to the color that was individual for each type.RESULTS:The results were significantly better in case of collagenogenesis stimulation with Potassium orotate within 30 days and later for one type of endoprosthesis. Also we revealed that collagenogenesis and paraprosthesis capsule formation were more active in case of combined endoprosthesis. We revealed stimulating action of «Potassium Orotate» for collegenogenesis process, this fact was proved by increased collagen I/III ratio.CONCLUSION:Optimization of collagenogenesis was based on persistent 1,37-fold increase of collagen I/III ratio in case of combined endoprosthesis after 90 days. It was manifested by accelerated formation of connective tissue capsule and facilitated early isolation of the implant from surrounding tissues.

Using the proper type of endoprosthesis which is combined with medicines reducing inflammation in the implantation area could decrease relapses as well as improve quality of treatment. We used endoprosthesis «Parietene ProGrip» when working with laboratory animals. The animals of the experimental group were given the solution of Solcoseryl every other day within 90 days, at first intraoperatively, then intraperitoneally. The animals from the control group didn't get the drug. The combination of «Parietene ProGrip» endoprosthesis together with Solcoseryl created special conditions for reducing inflammation area, increasing pool of fibroblasts. A capsule made from compact fibrous connective tissue formed a solid carcass whose main function was mechanical: keeping together filaments of endoprosthesis. It will set a lasting link with surrounded tissues and improve management results at the end.

Nowadays treating patients with hernia disease is a purely surgical question. Development and introduction of new materials for the replacement will certainly have a positive impact on the treatment of patients with hernias of the anterior abdominal wall, but do not solve the problem of dysplasia of connective tissue structures. The experimental study included 120 white laboratory mice. Animals were divided into two groups, 60 animals each. The division into two groups was due to using "Solkoseril". The effectiveness of "Solkoseril" on the formation of connective tissue was evaluated by counting the I and III types collagen in a paraprosthesis region, determining their ratio and density of connective tissue structures by using polarizing microscopy. The study revealed the collagen stimulating effect of "Solkoseril". The combination of a half-absorbable material for replacement therapy with "Solkoseril" allows to obtain maximum results, both for maturation of connective tissue structures and significant (p ≤ 0.05) increase in their density.

Aim. To conduct a comparative evaluation of the effectiveness of surgical treatment of chronic pancreatitis and define the quality of life of patients depending on the methods of surgical treatment. Methods. The study included 81 of the 165 patients with chronic pancreatitis, who underwent the following operations: endoscopic transmural interventions through the wall of the stomach and duodenum, endoscopic transpapillary surgery, percutaneous interventions for sanitation and drainage of the cystic cavity, laparotomic operations of internal drainage, resection interventions. The quality of life of patients was assessed using the general health questionnaire SF-36. Results. The lowest level of life quality was established in the group of patients after endoscopic transpapillary interventions. Statistically significant differences in the level of physical and psychological health were established when comparing patients after endoscopic transpapillary interventions and after endoscopic transmural surgical interventions, which were carried out through the wall of the stomach and duodenum; differences only in the level of physical health were noted when comparing with the group of resection interventions. Conclusion. The quality of life of patients with chronic pancreatitis depends on the type of surgical intervention, age and sex of the patients.