The aim — to improve the surgical treatment results in patients with inguinal hernias through the development and introduction of a new peritoneal edges closure over the mesh implant during laparoscopic transabdominal preperitoneal hernia repair.

Materials and methods. The study included 38 patients with inguinal hernias. Men were 34 (89.5 %) women — 4 (10.5 %). Surgery was performed under general and regional anesthesia. Depending on the type of peritoneal edges closure patients were divided into two groups. In the first group, which was 21 (55.3 %) patients, mesh peretonisation performed by welding technology. Second group was 17 (44.7 %) patients, peritoneum flaps was sutured using suture material Vicryl 2.0.

Results and discussion. Control examination of patients operated with the electric welding of the peritoneal edges over the mesh implant without the suture material use and fixing conducted in the period from 0.5 to 3 years, showed no recurrence of the hernia and chronic groin pain, and ultrasonography of welding zone — no abnormalities or peritoneal defects.

Conclusions. The proposed method of the peritoneum edges closing over the mesh implant during laparoscopic TAPP, is a new, reliable and safe, and does not require additional use of suture and fixing material.

Keywords: inguinal hernia, biological tissues welding, laparoscopic hernia repair

The aim — to substantiate development mechanism and to determine the compression degree of inguinal-scrotal hernia on the blood vessels and testicles due to the dopplerography introduction in the treatment process.

Materials and methods. In neonatal surgery department in the period from 1992 to 2014 were treated 290 patients with congenital hernias. Depending on the period when the treatment was carried out, the patients were divided into two groups: the study group consisted (196 patients) 2004 — 2014 and a control group (94 patients) — 1992 — 2003. Congenital unilateral hernia was diagnosed in 194 (66, 89 %) patients, congenital bilateral — in 36 (12.42 %), strangulated hernia — in 60 (20.69 %). The age of patients ranged from birth to 3 months. Clinical and laboratory examination in 100 %, ultrasound dopplerography for groin and scrotum — in 182 (62.76 %), X-ray studies — in 18 (6.21 %), morphological study of the material — in 8 (2.76 %) were used to verify the diagnosis.

Results and discussion. The diagnosis of inguinal-scrotal hernia was based on complaints of parents and children examinations. In 230 (79.31 %) patients the clinical and laboratory parameters were within normal limits, and in 60 (20.69 %) — the signs of intestinal obstruction due to strangulated hernia and the development of the inflammatory process has revealed. To assess the inguinal canal and scrotum organs state the ultrasound and Doppler sonography study was done in 182 study group patients. Research indicates testicle and epididymis swelling with sustained outflow, indicating a blood flow disorders in the testicle, which emerged at birth. In the case of strangulated hernia in 21 patients a testicular and intestinal blood flow disorders were found (on 40 — 50 % compared with the norm), and in 8 patients the blood flow was absent. Term from strangulation beginning mattered during hospitalization of patients with strangulated hernias in 60 persons, 12 of whom were hospitalized in 43 hours (14.83 %), 12 to 24 hours — 13 (4.48 %), 24 to 72 hours — 4 (1.38 %). Surgery was performed in all patients. In 230 patients without strangulation, surgery was carried out in a planned order (in 194 — with unilateral hernias and in 36 — with bilateral ones). During the surgical correction of congenital unilateral hernias in 88 of 194 patients external inguinal ring did not open. Inguinal canal plastic was performed in all patients. Bilateral operation simultaneously was conducted in 10 patients. Laparoscopic inguinal hernia correction was performed in 11 (3.79 %) patients, 3 of which was bilateral inguinalscrotal hernia, right-sided — 5, left-sided — 3. Surgical treatment of strangulated hernia was performed without bowel resection in 52 patients, and resection of the strangulated intestinal part was performed in 8. All operations were performed with a groin access, but in three cases conversion — laparotomy was done, in one child of which the end ileostomy was superimposed (strangulation term was 17 hours). In 26 infants the strangulated hernia was complicated by testicular and epididymis disease (thrombosis, orchitis, epididymitis), the right testicle was affected in 23 individuals and left testicle — in 3. The period of strangulation was 1.5 — 6 hours.

Conclusions. The presence in a newborn baby inguinal-scrotal hernia is an indication for ultrasound examination to determine the state of the scrotum and blood flow studies of the endocrine glands — the testes. All congenital (cord and testicular hernia, gonads and epididymis torsion) and acquired (injury) defects of inguinal-scrotal area is initially a factors of testicular varying degrees hypoxia, and later — testicular hypoplasia and atrophy. The operation should be performed immediately after diagnosis to prevent complications — ischemia and necrosis of the testis.

Keywords: testicular hypoxia, children, inguinal-scrotal hernia, strangulated hernia, diagnosis, treatment.

The aim —as to compare analgesic efficacy of different abdominal wall blocks in children.

Materials and methods. The study included 165 children aged 1 month to 5 years, who underwent minor abdominal wall surgery under regional anesthesia with sedation: caudal block (group 1, n = 28), thoraco-abdominal paravertebral block in Th12-L1 (group 2, n = 49), transverse abdominal plane block (group 3, n = 49), ilioinguinal-iliohypogastric nerve block (group 4, n = 39) with 0.25 % bupivacaine. The intraoperative dose of fentanyl, postoperative pain scores, postoperative dose of morphine and time to first analgesia demand were studied.

Results and discussion. The intraoperative doses of fentanyl were 0.12 ± 0.05 mcg/kg in group 1, 0.18 ± 0.05 mcg/kg in group 2, 1.6 ± 0.09 mcg/kg in group 3, and 2.6 ± 0.1 mcg/kg in group 4. Maximal pain intensity postoperatively was 4.1 ± 0.3 units in group 1, in other groups it did not exceed 2 units. Postoperative morphine administration was required in 64.2 %, 10.2 %, 12.2 % and 12.8 % children of groups 1, 2, 3 4, respectively. The dose of morphine was significantly higher in group 1. The time to first postoperative analgesia demand was 244.1 ± 9.1 min in group 1, 861.4 ± 15.4 min in group 2, 823.4 ± 20.0 min in group 3, and 689.9 ± 23.2 min in group 4.

Conclusions. Caudal and paravertebral blockades for anterior abdominal wall surgery in children allow to decrease significantly intraoperative fentanyl doses in comparison with transverse abdominal plane block and ilioinguinal-iliohypogastric nerves block. Peripheral blocks allow 5-fold decreasing postoperative opioid administration in comparison to caudal block. The thoraco-lumbar paravertebral block has advantages of both central and peripheral abdominal wall blocks, requires minimal intraoperative potentiation with opioids, and has prolonged high quality postoperative analgesia.

Keywords: children, regional anesthesia, caudal block, paravertebral block, transversus abdominis plane block, ilioinguinal-iliohypogastric nerve block, postoperative analgesia

The aim — to explore the possibilities and to e.valuate the effectiveness of catheter-directed duplex ultrasound-guided microfoam phlebo-scleroobliteration (CUMPSO) in the treatment of lower extremities varicose veins.

Materials and methods. The results of CUMPSO in 102 patients with С2 — С6 CEAP varicose insufficiency for the period from 2012 to 2014 were analyzed. Based on the duplex ultrasound data, which was revealed out after 1 day, 7 days, 1 month, 6 months and 12— 18 months after CUMPSO the status of the SFJ and SPJ and occlusion stability in the GSV and SSV trunks were e.valuated. In the late period the number of disease relapses was studied.

Results and discussion. Between 12 — 18 months the CUMPSO treatment results were analyzed in 62 patients. Ultrasound data indicate the presence of irreversible fibrotic veins’ transformation. In 57 (91.94 %) of the patients in these terms the GSV and SSV obliteration was achieved without pathological stump formation. In 4 (6.45 %) patients the formation of stump length of 5 — 8 mm without peri-ostial inflow reflux in was revealed. The formation of stump pathological with reflux in v. epigastrica superficialis without clinical manifestations was recorded in 1 (1.61 %) patients.

Conclusions. Catheter-directed duplex ultrasound-guided microfoam phlebo-scleroobliteration in 91.94 % of cases leads to complete occlusion followed by saphenous veins’ fibrous transformation in more than 12 months period and is an alternative to the standard phlebectomy. During more than 12 months after catheter-directed duplex ultrasound-guided microfoam phlebo-scleroobliteration the prerequisites for recurrent disease occurrence in the form of the great saphenous vein stump 5 — 8 mm length were found in 8.07 % patients.

Keywords: varicose veins, microfoam scleroobliteration, ultrasound diagnostics.

The aim — on the results of bacteriological studies of fluid from the abdominal cavity to verify the species composition and analyze the sensitivity to antibiotics of isolated and cultivated colonies of microorganisms obtained from the multifocal sampling in patients with appendicular peritonitis.

Materials and methods. 356 case histories of the patients with acute appendicitis operated in the Surgery and Endoscopy department on the basis of City Emergency Hospital during 2012 — 2014 were analyzed. To purpose of microbiological study during the operation a separate local sapling of biological material — abdominal exudation was conducted. The antibacterial efficiency of 33 antibiotics was investigated.

Results and discussion. Express-diagnostic of the abdominal exudation with Gram and Kalinichenko stain confirmed the high frequency of aerobe-anaerobe microbial associations and considerable identity of appendix and abdominal exudation microflora. This confirms the role of the autoinfection in the development of acute appendicitis and peritonitis. Among all operated patients with acute appendicitis in 50 (14.1 %) the purulent peritonitis was diagnosed. The frequency of exposed microbial flora in abdominal exudation inoculations in 50 patients with acute appendicitis, complicated with purulent peritonitis was analyzed. The positive bacteriological result of the pus from the abdominal cavity with appendicular peritonitis was sampled in 44 (88 %) patients, in 6 (12 %) — there was no flora growth. The highest antibacterial activity was detected among third generation cephalosporin, carbapenems, and Generation IV fluoroquinolones. Effectiveness was proved to gatifloxacin (100.0 %), imipenem (86.1 %) and meropenem (85.7 %).

Conclusions. Acute appendicitis is a polyetiological disease, which has direct connection with microbiocenosis of the large intestine. this pathology provides by exceed polymicrobial associations’ colonization of aerobe gram-negative and non-clostridia anaerobe intestine flora. The abdominal exudation bacteriological investigations in patients with appendicular peritonitis in 71.1 % stated growing of Escherichia coli colonies in monoculture as well as in association with other bacteria, first of all with Staphylococcus aureus and Staphylococcus epidermidis (in 28). Appropriated bacterial cultures where sensitive to carbapenems, fluoroquinolones and third generation cephalosporin and was not sensitive to the aminoglycosides, penicillin, glycopeptides, lincosamides, and oxazolidinones.

Keywords: acute appendicitis, appendicular peritonitis, microflora, antibiotic therapy.

The aim — to analyse the treatment results in patients with acute necrotizing pancreatitis in a specialized surgical unit.

Materials and methods. The treatment results in 242 patients with acute necrotizing pancreatitis (ANP) were analyzed. 31 (12.8 %) patients underwent drainage of acute necrotic collection (ANC). Forty (16.5 %) patients with necrotizing infectious complications underwent fine needle aspiration (FNA) and ultrasound guided drainage. Open necrectomy was performed in 12 (4.9 %) patients in whom minimally invasive surgery had proved ineffective. Phagocytic activity and oxidative metabolism of circulating monocytes and granulocytes were e.valuated by flow cytometry with metabolic reserve estimation.

Results and discussion. Patients with a significant reduction in the functional reserve of peripheral blood neutrophils and monocytes on 5th — 7th day after onset the infectious complications has developed. Overall mortality in patients with acute necrotizing pancreatitis was 7.4 %, and in infectious complications presence — 14.3 %.

Conclusions. Treatment of patients with acute necrotizing pancreatitis/paraduodenal pancreatitis should be aimed on the necrosis areas infiltration formation with its following resorption. Surgery in patients with necrotizing infectious complications should be a two-step with the mandatory use of minimally invasive surgical technologies in the first phase. The functional reserve of the phagocytic activity and the reactive oxygen species production in circulating monocytes and neutrophils were significantly (p < 0.001) reduced in patients with infectious complications of acute necrotizing pancreatitis compared with those without infection ones. To prevent stress ulcers and provide pancreatic functional balance in patients with necrotizing pancreatitis the proton pump blockers, during all treatment period should be applied.

Keywords: necrotizing pancreatitis, paraduodenal pancreatitis, minimally invasive surgical techniques, functional status of neutrophils and monocytes.

The aim — to analyze the treatment results in patients with pancreatic (PG) pseudocysts using percutaneous and laparoscopic treatments against the background of rational antibiotic therapy.

Materials and methods. During the period from 2002 to 2012, 264 patients with the liquids structures in the PG projection were examined and treated. Among patients men predominated — 208 (78.8 %). The average age of patients was (42.9 ± 3.1) years. Most patients were aged 30 to 60 years, 229 patients (86.7 %) — of working age. Cyst existence duration (by ultrasound, computed and magnetic resonance imaging) at the time of hospitalization was less than 4 weeks in 77 (29.2 %) patients, 4 to 12 weeks — in 53 (20.1 %) from 3 to 12 months — in 122 (46.2 %) over 1 year — in 12 (4.5 %). Diagnosis and monitoring of treatment results was carried out based on clinical data and laboratory results analysis, biochemical and instrumental studies. The main method of instrumental diagnosis of acute pancreatitis was ultrasonography, which was carried out at hospitalization and in the disease dynamics.

Results and discussion. Pancreatic pseudocysts were diagnosed in 236 patients (89.4 %), pancreatic abscesses — in 10 patients (3.8 %), true pancreatic cysts — in 18 patients (6.8 %). Surgical treatment was done after careful diagnostic and therapeutic program of main and accompanying diseases. Transabdominal minimally invasive intervention under the ultrasound control were performed in 125 patients (47.3 %), laparoscopic treatment — in 38 patients (14.4 %), open operations — in 30 patients (11.4 %). In pseudocysts treatment the prophylactic broad-spectrum antibiotics administration (cephalosporin’s third and fourth generation, fluoroquinolones, and carbapenems) was used.

Conclusions. Minimally invasive methods for the pancreatic pseudocysts contributed recovery in 92 % cases. An important role in the pseudocysts treatment plays an adequate antibiotic therapy, which should include broad-spectrum antibiotics (cephalosporin third and fourth generation in combination with fluoroquinolones). In particularly advanced cases, the use of carbapenems is indicated. The duration of antibiotic therapy should be no more than 7 days to avoid the development of fungal superinfection.

Keywords: pseudocysts of the pancreas, fluid structure in the projection of the pancreas, complications, treatment strategy.

The aim — to study the burn wound contamination terms and of the microbiological results verification received from different bacteriological laboratories.

Materials and methods. 20 patients with burns were microbiologically examined: 10 patients underwent wound microbiological examination within first twenty-four hours after the injury, other — on 16th twenty-four hours. In the last group the sample was taken from the same wound area at the same time into two tubes that were sent to different bacteriological laboratories. The microflora of the burn wounds of these patients was studied by the vegetative resonance test.

Results and discussion. Microbiological burn wounds studies in 10 patients on admission showed that already within twenty-four hours after the injury the causative agent of the opportunistic pathogenic microflora could be observed in 100 % of cases, 30 % of the wounds were clean-contaminated, 40 % — contaminated and 30 % — dirty, infected. The analysis of the microbiological studies from the burn wounds identical areas in different bacteriological laboratories showed that verification of causative agents coincided in 10 % of cases, partially coincided in 30 % and did not coincide in 60 % of cases. According to the vegetative resonance, testing of the same areas of burn wounds at least 8 — 10 causative agents vegetated therein simultaneously.

Conclusions. The received results of the studies show that already within twenty-four hours after the injury the causative agent of the opportunistic pathogenic microflora can be observed in the burn wounds in all cases and wounds can be determined as clean-contaminated in 30 %, contaminated — in 40 %, dirty and infected — in 30 % that obviously depends on the injury circumstances, paramedical care and living conditions of the victims. The significant verification error of the microflora from identical areas of burn wounds on its determination in different bacteriological laboratories is obviously connected with the quality of the nutrient media, competitors’ pathogens, laboratory equipment, range of possibilities of the diagnostic method and personnel qualification.

Keywords: burn, infection, microflora, colonization.

The aim — to e.valuate the efficacy and safety of laparoscopic treatment in patients with neuroendocrine pancreatic tumors.

Materials and methods. Laparoscopic surgery for neuroendocrine pancreatic tumors was performed in 23 patients: laparoscopic distal pancreatic resection was performed in 10 (43.5 %) patients, enucleation of the pancreatic tumor — in 9 (39.1 %), spleen-preserving distal pancreatic resection — in one (4.3 %), central resection —in one (4.3 %) patient.

Results and discussion. External pancreatic fistula was found in four (19.1 %) patients (Grade A — three patients, Grade B — one, Grade C — 0). Average operation time — 154 (72 — 327) min, laparoscopic pancreatic resection- 196 (154 — 327) min, enucleation — 123 (72 — 176) min. The average volume of intraoperative blood loss — 300 (50 — 1100) ml, during tumor enucleation — 185 (50 — 640) ml, during pancreatic resection — 320 (90 — 1100) ml.

Conclusions. Laparoscopic intervention is a safe and effective treatment for pancreatic neuroendocrine tumors.

Keywords: neuroendocrine tumors, laparoscopic pancreatic resection, insulinoma.

The aim — to e.valuate the therapeutic bacteriophages (BF) effectiveness for pyo-inflammatory complications prophylaxis after laparoscopic cholecystectomy (LCE) in patients with acute destructive cholecystitis (ADC).

Materials and methods. Treatment results in 753 patients aged 60 years and older with ADC after LC were analysed. 137 (18.2 %) were men and 616 (81.8 %) — women. The comparison group (n = 606) included patients who underwent sanitation with decision solution in inflammatory focus and trосar wound (in gallbladder projection) after LCE, in the main group (n = 147) adapted BF for irrigation of the inflammatory focus was used. The adequacy of treatment was assessed by quantifying the degree of intoxication (leukocyte intoxication index (LII) in the general circulation, the level of medium-weight molecules (MWM) in blood plasma) and by the postoperative inflammatory complications incidence in wounds and abdominal cavity.

Results and discussion. BF application in complex treatment for patients with destructive forms of cholecystitis reduced 2.3 times a postoperative inflammatory wound and the abdominal cavity complications and prevented the occurrence of septic complications, thus in comparison group they were observed in 14 (2.3 %) patients. The normalization of LII, MSM indexes trend was registered on the 4thday in the study group, on the 7th — 8thdays in the comparison group. Lethal outcomes were not observed.

Conclusions. Bacteriophages have a positive impact on the inflammatory process regression, the earlier endotoxemia reduction, as evidenced by almost 2 times faster normalization of intoxication leukocyte index and medium-weight molecules.

Keywords: acute destructive cholecystitis, laparoscopic cholecystectomy, therapeutic bacteriophages.

The aim — to analyse the clinic results of single-port laparoscopic surgical transumbilical approaches and to compare them with the conventional laparoscopic procedure results in the patients with calculous cholecystitis.

Materials and methods. Single-port transumbilical laparoscopic cholecystectomy (SPTLCE) was used in 118 patients with calculous forms of cholecystitis, both alone or for combined pathology. The different devices (ports) for introducing instruments into the abdominal cavity were used.

Results and discussion. The average hospital stay in 109 patients who did not undergo abdominal drainage after SPTLCE was 1.49 ± 0.05 days, in 9 patients who underwent abdominal drainage — 2.22 days. The pro-inflammatory cytokines IL-1 and TNF-ɑ concentration in postoperative period in patients after conventional laparoscopic cholecystectomy (CLCE) was 1.2 times higher than in individuals after SPTLCE. During postoperative pain subjective e.valuation with the visual analogue scale (VAS) and with the Mc Jill Pain Questionnaire, it was found that the pain intensity in patients after SPTLCE was less expressed and was, compared with patients after CLCE — 3.42 ± 0.16 points vs. 5.98 ± 0.19 points (p < 0.05), respectively.

Conclusions. Subjective and objective postoperative pain indicators after single-port laparoscopic transumbilical cholecystectomy (SPTLCE) were less than after traditional laparoscopic cholecystectomy (TLCE). By SPTLCE is possible in the majority of cases (92.37 %) to finish the surgery without abdominal drainage. Postoperative scar cosmetic effects was better after SPTLCE compared with TLCE one.

Keywords: calculous cholecystitis, single-port laparoscopic surgery, laparoscopic surgery.

The aim — to study the adhesion prevention effectiveness of multifunctional anti-adhesive solution Defensal after organ-preserved gynecological surgery.

Materials and methods. In the study group (158 women) for the adhesions prevention during laparoscopy, the surgical field underwent irrigation with 100 ml 0.02 % sodium decametoxine solution (Dekasan) for every 30 minutes. After surgery, the 250 — 500 ml of multifunctional anti-adhesive solution (sodium hyaluronate 1250 mg, decamethoxine 50 mg, succinate buffer pH 7,3 up to 250 ml per 250 ml of solution) in the abdominal cavity was administered one time per day. In the comparison group (191 patients), preventive measures were carried out in the traditional way. The indirect signs of pelvic adhesion served for the intra-operative preventive measures effectiveness e.valuation during bimanual examination and ultrasonography. Long-term treatment results was e.valuated by fallopian tubal patency during hystero-salpingography and pregnancy rate.

Results and discussion. According to the analysis of organ-preserved gynecological surgery, it was found that the use of 0.02 % sodium decametoxine and multifunctional anti-adhesive solution for the adhesive disease prevention helped to reduce the incidence of adhesion from 45.0 to 20.3 %, reproductive function resumption in 65.8 % of patients versus 45.5 % in the comparison group.

Conclusions. During laparoscopic and open surgery for reproductive function resume, the anti-adhesive prophylactic means must be widely used. The use of multifunctional anti-adhesive solution helped reduce the abdominal adhesions frequency and reproductive function resumption.

Keywords: gynecologic surgery, adhesive disease, drug prophylaxis.

The aim — to determine the relationship between methods of appendicular stamp’s processing and the peritoneum’s adhesions manifestations in the experiment on rabbits.

Materials and methods. The study was conducted on 28 rabbits, which were divided into 4 groups with 7 animals: The first (control) group consists of intact rabbits, in the second group classic appendicular stamp’s processing with purse-string and Z-shaped sutures was performed, in the third group two vicryl ligatures on appendix base was used, in the fourth group two tantalum clips was placed on appendicular base with subsequent resection. Severity and extension of post-operative peritoneal adhesions was graded with peritoneal adhesion index scale (PAI) at 7-th day after appendectomy after intravenous administration of the thiopental sodium (1.5 % — 2.0 on 20 ml isotonic solution) lethal dose and midline abdominal cavity section.

Results and discussion. Severity and spread of post-operative peritoneal adhesions by the PAI scale after appendectomy was the lowest in rabbits of the second group (1.14 ± 0.14 points), the third group of animals was 2.29 ± 0.36 points and the fourth group of rabbits was 4.71 ± 0.87 points, all p < 0.05.

Conclusions. The priority method of appendicular stamp’s processing that is associated with the lowest spread rate of post-operative peritoneal adhesions by the PAI scale should be the classic appendicle stamp’s processing with use purse-string and Z-shaped sutures (1.14 ± 0.14 points). In the case of laparoscopic appendectomy overlay to the base of the appendix two ligatures, has advantages over the method of application of two tantalum clips for the prevention of the peritoneum’s adhesions (2.29 ± 0.36 score points against 4.71 ± 0.87 points), p < 0.05.

Keywords: appendectomy, methods of stamp’s processing, adhesions of the peritoneum, the experimental study.

The aim — to improve the surgical treatment results in patients with burn contractures of the neck by the use of expanded supraclavicular skin and fascial flap with the inclusion of the supraclavicular artery.

Materials and methods. The anatomical and clinical studies were done. Study of topographic anatomy of supraclavicular area, identifying sources of blood flow and vascular topographical layout options, surgical technique of forming and transposition of supraclavicular flaps was carried on 5 males and females corpses aged from 38 to 55 years. Clinical part of the material were 13 patients aged from 5 to 56 years. All patients underwent surgical treatment of neck contractures by expanded supraclavicular skin — fascial flap with the inclusion of the supraclavicular artery. In 8 patients flaps on both sides were used, in 5 patients — from one side. Total amount of expanded supraclavicular flap was 21.

Results and discussion. The possibility of a pocket forming for the expander regardless of the anatomical features of the supply vessel branching was shown thus enabling to form «flap — propeller» with the pedicle isolation, as well as the flap on a broad basis.

Conclusions. Fascio-cutaneos flap with the inclusion of the supraclavicular artery should be used for burn neck contractures surgery in case of intact undamaged shoulders skin. This allows to achieve good results in 69.3 % cases and satisfactory — in 30.7 % of cases in early post-operative period and in 90.8 % of cases in the remote follow-up period.

Keywords: post-burns neck contractures, tissue expansion, supraclavicular flap.

The aim — to study the features of plastic surgery for men and to compare ones with similar operations for women.

Materials and methods. The results of 765 aesthetic operations performed from 2000 to 2014 were analyzed. Among the patients women predominated — 679 (88.7 %). The analysis of the 86 aesthetic surgery performed in male patients, 5 of which was soft tissues lifting, 8 — blepharoplasty, 24 — different anatomic zones liposuction, 48 — abdominoplasty and one — torso plastic surgery.

Results and discussion. The features of the male plastic surgery performing, particularly facelift, blepharoplasty, liposuction, abdominoplasty were defined.

Conclusions. The tendency to increase the men’s appeals number to surgeons for aesthetic surgery is marked. Knowledge of the male body anatomical features and its use in the surgery is a guarantee of a good aesthetic result.

Keywords: facelift, blepharoplasty, liposuction, abdominoplasty.

The aim — to develop evidence-based recommendations to improve the surgical treatment effectiveness patients with impaired consolidation of tibial fractures by reparative disorders study in fracture zone, surgery method choice optimization according to bone fragments’ status, vitality and local reparative processes activity.

Materials and methods. In the period 2008 — 2013 on the Kyiv Regional Clinical Hospital base, 181 patients with noninfectious disorders shinbone fracture repair was under our supervision. Patients were divided into 2 groups according to the observation time (2008 — 2010 and 2011 — 2013). The mechanical stability, bone replenishment, local blood circulation disorders, cellular and humoral activity were taken into account. The results were e.valuated according to the Neer — Grantham — Shelton modified scale.

Results and discussion. New techniques application allowed to obtain the positive results in 47 (51 %), satisfactory — in 39 (42 %) patients from second group. Unsatisfactory results (lack of bone fragments consolidation) was revealed in 6 (7 %) patients after the first stage surgery. At follow-up examination after 12 and 24 months, the satisfactory fracture healing observed in 163 and 181 cases, respectively.

Conclusions. The principles of diagnosis, treatment and reparative osteogenesis disorders prevention were formed by optimization of biomechanical conditions for musculoskeletal system functioning, hemodynamics disorders treatment and the local repair mechanisms normalization, which contributed to an increase in the number of satisfactory treatment results by 11 % and reducing the number of poor — by 50 %.

Keywords: bone fractures repair disorders, shinbones pseudarthrosis, bone fragments viability.

The main causes of the different complications after enterostomy and colostomy forming is highlighted. After literature review summarizing, the author has identified three main groups of stoma complications causes in small and large intestines surgery: the operative urgency, technical and tactical errors in operation, some anatomical and clinical patient’s characteristics.

Keywords: enterostomy, colostomy, stoma complications.

Due to the organ saving operations indications expansion for rectal cancer (low anterior rectal resection, resection with intrasphincter colon-anal anastomosis formation), the number of protective loop ileostomy and colostomy has increased. The frequency of loop colostomy in colorectal malignancy reached 33.4 %. Mostly protective loop colostomy require reoperation to restore intestinal continuity («closing» of stoma). However, the results of recovery operations are still unsatisfactory and in need of improvement.

Keywords: loop colostomy, bowel continuity restoration, surgery.

The problem of the chronic lower limb ischemia treatment, especially its critical manifestations remains relevant to this day. Prospects for the use of umbilical cord blood in the treatment of lower limb ischemia is extremely important that needs to be addressed and further development. The article provides an overview of research in this area and the outstanding issues of the use of therapy with cord blood. In the aspect of accessibility and lack of ethical problems, cord blood is likely to become a source for cell therapy.

Keywords: cell therapy, chronic lower limb ischemia, cord blood.

The treatment case of post patients with scar obliteration of the upper and medium thoracic oesophageal part in combination with subcompensated cicartrical stenosis the stomach output is submitted. Recovery option of gastric function in the first treatment stage, followed by surgery (plastic) on the oesophagus (the second stage) is described. Complications were not. The function of restored organs (oesophagus and stomach) in the remote period was good.

Keywords: burn, cicartrical stenosis, oesophagus, stomach.

The diagnosis and surgical treatment results of two patients with abdominal lymphangioma were analysed. Based on the complaints, physical examination results, ultrasound and computed tomography of the abdominal cavity data, preoperatively the abdominal cysts was diagnosed. Clinical manifestations depend on the location, size and growth rate of lymphangioma. The diagnosis of abdominal lymphangioma was histologically confirmed. Lymphangioma with its wall structures resection usually promotes healing.

Keywords: lymphangioma, surgery, abdominal cavity.

Цель работы — проанализировать результаты применения однопортовых трансумбиликальных лапароскопических вмешательств при калькулезных формах холецистита и сравнить их с результатами традиционных лапароскопических вмешательств.

Материалы и методы. Однопортовая трансумбиликальная лапароскопическая холецистэктомия (ОТЛХЭ) была применена у 118 пациентов с калькулезными формами холецистита как с изолированными, так и при сочетанной патологии. Использованы разные устройства (порты) для введения инструментов в брюшную полость.

Результаты и обсуждение.Средний койко-день у 109 пациентов, которым не проводили дренирование брюшной полости после ОТЛХЭ, составил 1,49 суток, у 9 пациентов, которым осуществляли дренирование брюшной полости, — 2,22 суток. В послеоперационный период концентрация провоспалительных цитокинов (интерлейкина-1 и фактора некроза опухоли ɑ) у лиц, которым применили традиционную лапароскопическую холецистэктомию (ТЛХЭ), превышала в 1,2 раза показатели лиц после ОТЛХЭ. При субъективной оценке боли в послеоперационный период по визуально-аналоговой шкале и опроснику Мак-Гиловского установлено, что интенсивность боли в группе пациентов с ОТЛХЭ была менее выражена, по сравнению с пациентами после ТЛХЭ — соответственно (3,42 ± 0,16) и (5,98 ± 0,19) балла (р < 0,05).

Выводы. Субъективные и объективные показатели послеоперационной боли после ОТЛХЭ меньше, чем после ТЛХЭ. При ОТЛХЭ существует возможность у большинства (92,37 %) пациентов закончить оперативное вмешательство без дренирования брюшной полости. Вид послеоперационного рубца был лучше после ОТЛХЭ по сравнению с ТЛХЭ.

Keywords: калькулезный холецистит, однопортовые лапароскопические операции, лапароскопические операции.