The aim — to increase the effectiveness of the large defects reconstruction of soft tissues of different localization with the anterolateral thigh flap.
Materials and methods. Anatomical features and surgical technique of anterolateral thigh flap formation have been described. Anterolateral thigh flap was used for 9 patients: in 6 cases as a free flap and in 3 cases as a transposition of the propeller pedicle flap.
Results and discussion.In all cases, a good result was obtained. The flaps survived and allowed to completely reconstruct soft-tissue defects. In 5 cases, the plantar, support surface of the foot was closed. In these cases, the flaps showed sufficient wear resistance under loads.The complications were not observed.
Conclusions.Despite the variable vascular anatomy, the anterolateral thigh flap is the most adaptable plastic resource for effective closure of extensive soft tissue defects in any area of the body.The flap can be effectively used in different ways: to close defects in the hip, knee and hip joints by the type of pedicle flap transposition and to close distant defects by the type of free microsurgical transplantation.

Keywords: perforator flap, wounds, anterolateral thigh flap.

The aim — to evaluate the effectiveness of the balloon pneumatic dilation technique in the treatment of patients with cardiac achalasia.
Materials and methods. 208 patients with the cardiac achalasia of 1 — 4 stages were examined and the complex treated with the balloon pneumatic dilation technique in the surgery department from 2006 to April 2017. 73 were men (35.1 %), 135 (64.9 %) — women at the age of 22 to 76 years (mean age 38.6 ± 5.2 years).
Results and discussion. With the radiation imaging, it was established that cardiac achalasia of the 1st stage was in 15 (7.2 %), the second stage in 86 (41.3 %), the third stage in 62 (29.8 %) and the 4th stage — in 45 (21.6 %) patients. The duration of the disease longed from 2 to 27 years, on average 11.3 ± 2.6 years.The effectiveness of the treatment was assessed according to the following criteria: disappearance of food disorders and its delay in the field of cardia; absence of fluid and food masses in the lumen of the esophagus during subsequent dilatation sessions; free passage of the device through the cardia into the stomach. Complications in the performance of balloon pneumatic dilation was not.
Conclusions. Relapses of cardiac achalasia after the courses of balloon pneumatic dilation were established in 48 (23.1 %) patients: 13.3 % — stage 1, 20.9 % — stage 2, 16.1 % — stage 3, and 40.0 % of cases — stages 4 in the period from 6 months to 2 years. At relapses of cardiac achalasia in 29 (13.9 %) cases the repeated application of balloon pneumatic dilation was ineffective.

Keywords: cardiac achalasia, balloon pneumatic dilation, relapses.

The aim — to study postoperative period surveyin patients with liver cirrhosis with varicose oesophageal and stomach veins after azigo-portal dissociation.
Materials and methods. The comparative consequences of surgical azygo-portal separation have beenanalysed to determine the surgical tactics efficacy in treatment of 67 patients with м and varicose oesophageal and stomach veins. The patients were randomized as follows: the 1st clinical group consisted of patients who underwent traditional azygo-portal separation — Patsiora’s surgery with additional complete gastric veins devascularization, the 2nd group consisted of patients with the Patsiora’s operation accompanied by partial gastric veins devascularization, 3rd group patients onlyunderwent the surgery of oesophageal and gastric veins inserting (without additional devascularization).
Results and discussion. The average duration of operations and the average volume of intraoperative blood loss were comparative among all three groups. 2 patients from the 1st group, 5 from the 2nd and 7 complications in the 3rd had complications during the early postoperative period. 2 patients in the 2nd and 1 in the 3rd groups died. 4 patients in the 2nd group and 3 patients in the third group died duringremote postoperative period.
Conclusions. According to the number of complications and lethal episodes during the early and late postoperative periods, a pronounced advantage achieved by surgical interventions was found in the 1st clinical group. The efficacy of azygo-portal separation operations was shown in the surgical treatment of patients with liver cirrhosis with varicose veins of the oesophagus and stomach. Attention is accentuated by the fact that in the conditions of complete gastric devascularization it is possible to significantly reduce the number of complications during the postoperative period, the number of lethal outcomes and postoperative bleeding episodes.

Keywords: liver cirrhosis, varicose oesophageal and stomach veins, azygo-portal dissociation, devascularization, postoperative complications.

The aim — to determine the species composition of bacteriophages for abdominal sanitation in patients with destructive forms of acute cholecystitis (AC) (most effective in some certain forms of gallbladder destruction and its complications), by means of the microbiological study of bile and abdominal cavity exudate for microorganisms verification and its sensitivity to bacteriophages determination.
Materials and methods. The microbiological study of bile (in case of abdominal cavity exudate absence) and abdominal cavity exudate in 30 patients aged 39 — 89 years with a destructive form of AC was performed. Among the concomitant pathology, patients with obesity I — II degree prevailed (86.7 %) and patients with diabetes mellitus (26.7 %). Laparoscopic cholecystectomy (LC) was done in all patients. After LC, the area of the inflammatory focus in the abdominal cavity was sanitized with a physiological solution of sodium chloride followed by irrigation with therapeutic bacteriophages. Forgallbladder empyema and local peritonitis, the sanitation of inflammation focus was performed with the volume of 20—80 ml, for diffuse peritonitis — 80—150 ml. The following bacteriophages were used: sextaphage, bacteriophage amount proteaceae, intesti-bacteriophage, pseudomonas bacteriophage and their combination.
Results and discussion. Estimate of the bacteriophages sensitivity to the microorganisms in acute destructive cholecystitis and complicated forms of AC has shown that among the patients with gallbladder empyema and serous peritonitis after LC, for sanitation of the inflammatory focus of the abdominal cavity, it is sufficient to use bacteriophages — sextaphag, while in patients with perivesical abscess, purulent peritonitis, for the sanitation of the abdominal cavity, it is necessary to use sextaphage, bacteriophage amount proteaceae, intesti-bacteriophage, pseudomonas bacteriophage and their combination.
Conclusions. Microbiological study of bile and abdominal cavity exudate in the patients with acute destructive cholecystitis and its complicated forms, allowed to determine the algorithm of using of bacteriophages for abdominal sanitation. It has been established that in patients with empyema of the gallbladder and serous peritonitis only the bacteriophage — sextaphage is needed to sanitize the abdominal cavity, due to the predominance of gram-negative, gram-positive aerobes, monoculture (73.3 % of cases). On the contrary, in patients with perivesical abscess, purulent peritonitis, it is advisable to use the following bacteriophages — sextaphage, bacteriophage amount proteaceae, intesti-bacteriophage, pseudomonas bacteriophage and their combination due to the prevalence of microbial associations (76.7 — 86.6 %) and anaerobic flora presence.

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

The aim — to improve the surgical treatment results in patients with post-burn breast deformations with combined expanded lateral thoracic key- and perforator-based flaps.
Materials and methods. The work included anatomical and clinical studies. The study of lateral thoracic area topographic anatomy, blood flow sources identifying and vascular topographical layout options, surgical technique of forming and transposition of flaps were carried out on 5 fresh female cadavers aged from 43 to 72 years. The clinical part of the study consisted of 16 patients aged from 3.5 to 21 years. All patients underwent surgical treatment for breast deformations with combined expanded flaps with the lateral thoracic artery inclusion as a key vessel and the vascular network of perforating vessels of adjacent tissues — medium perforators of V—VII intercostal arteries and thoracodorsal artery perforators.
Results and discussion. The possibility of forming a pocket for the expander and combined expanded lateral thoracic flaps based on the key and perforating vessels was shown.
Conclusions. Data from anatomical and clinical studies using combined expanded lateral thoracic key- and perforator-based flaps made it possible to obtain good (17 (72.3 %) and 10 (71.4 %)) and satisfactory ((5 (22.7 %)), and (4 (28.6 %)), respectively, the results of treatment in the nearest and remote follow-up periods.

Keywords: post-burn breast deformations, tissue expansion, perforating vessels.

The aim — to make a comparative assessment of the Quality of Life Associated with the Disease (QLAD) in patients after 1 year of postoperative period after abdominoplasty and simultaneous operations of the abdominal organs.
Materials and methods. A comparative assessment of QLAD in 1 year after the operation in 148 (84.1 %) of 176 patients who were operated by abdominoplasty of anterior abdominal wall ptosis and simultaneous operation for the combined surgical pathology of the abdominal organs was conducted. Chronic calculous cholecystitis has 154 (87.5 %) patients, the polyp of the gall bladder was diagnosed in 7 (4 %), and the painful form of adhesive diseasewas in 15 (8.5 %) patients. In the treatment of anterior abdominal wall ptosis, simultaneous operation was performed in 17.6 % of patients with abdominal hernia and/or diastasis of the rectus abdominis. According to the simultaneous operation methods, the patients were divided into 3 groups. In the first group (n = 74) the first stage was laparotomy (cholecystectomy, adhesion), thendermolipectomy. In the second group (n = 52), the laparoscopic interventions (laparoscopic cholecystectomy, laparoscopic adhesion) were performed as the first stage. In the main group (n = 50) — the laparoscopic interventions (laparoscopic cholecystectomy and laparoscopic adhesion) were performed at the first followed by thendermolipectomy. Based on the sex, age, degree of obesity and anterior abdominal wall ptosis, the type of combined surgical and non-surgical pathology, the observed groups were not statistically different (all p > 0.05). QLAD was evaluated after 1 year of operation by questioning patients with the SF-36 questionnaire.
Results and discussion. In 1 year after the operation, the index for the health physical component of the QLAD was significantly better in the main group compared to the comparison groups 1 and 2, 87.89 ± 1.03, 79.61 ± 0.94 and 81.43 ± 0.91 points, respectively (p < 0.001). The indicator of the health psychological component was also significantly higher in the main group, 86.25 ± 1.23, 80.60 ± 0.96 and 81.86 ± 1.15 points, respectively (p < 0.001).
Conclusions. The developed laparoscopic methods of simultaneous interventions for combined diseases of the abdominal cavity organs and ptosis of the anterior abdominal wall, were more effective (p < 0.001) in a comparison with traditional laparoscopic procedures and had more influence on life quality indexes in one year after operation.

Keywords: simultaneous operation, cholecystectomy, adhesiolysis, ptosis of the anterior abdominal wall.

The aim — to study the results of combined surgeries in patients with large inguinoscrotal hernias.
Materials and methods. 87 patients with large inguinoscrotal hernias were operated in Odesa Regional Clinical Hospital during the period from 2014 to 2016. The age of patients ranged from 43 to 82 years, the mean age — 51.2 ± 1.8 years. Among patients, men dominated (68). In the first group (43 patients), classic hernia repair of TAPP was performed using Ethicon meshes, in the second group (44 patients) combined hernia repair was performed.
Results and discussion. The average duration of the surgical operation was relatively smaller in the second group of patients 42.7 ± 3.8 min vs 63.5 ± 5.3 min in the first group (p < 0.05). In 2 patients, during TAPP laparoscopic operation, a conversion was performed, while in the case of combined surgeriesthere was no need in such conversion. Patients were consistently observed for 18 — 24 months, a recurrent hernia was detected in 3 patients of the first group and was absent in the second group.
Conclusions. The combined surgeriesfor large inguinoscrotal hernias is a worthy alternative to Liechtenstein’s operations. The number of intraoperative and postoperative complications was 1.5 fold decreased, and the recurrences in the long term after the operation were absent.

Keywords: hernia, inguinal and scrotal hernia, laparoscopic hernia repair, mesh.

The aim — to evaluate the effectiveness of transabdominal preperitoneal alloplasty with the combined fixation of a mesh implant with inguinal hernias.
Materials and methods. The analysis of surgical treatment for inguinal hernias in 162 patients aged 25 to 75 years (mean age — 50.0 ± 2.5 years) was carried out. All the patients were male. Patients were divided into two groups. In the I group (81 patients), the classical transabdominal preperitoneal alloplasty technique was performed, in the II group (81 patients) the improved transabdominal preperitoneal alloplasty technique with larger-size mesh implant and glue fixation at the iliac or ileopubic tract level. The choice of ethyl-α-cyanoacrylate based glue was substantiated by a preliminary experimental study on 90 sexually mature male rats.
Results and discussion. The long-term treatment results were studied in a period of 1 to 5 years in 72 patients of the group I and 73 — II. Specially developed questionnaire, repeated ultrasound examination of the anterior abdominal wall and abdominal cavity were used for this purpose. Chronic postoperative inguinal pain was observed in 5 (6.94 %) in group I, and in 2 (2.73 %) in the group II. These complications were treated by hydrocortisone blockades in the pain points sites and nonsteroidal anti-inflammatory drugs (Diclofenac, Nimesil). Recurrence of inguinal hernia confirmed by ultrasound examination was revealed in 5 (8.33 %) patients from group I and in 1 (1.36 %) from group ІІ in 1 — 3 months after the operation.
Conclusions. The adhesive fixation of the mesh implant in an experimentally-morphological study with rats proved to be most effective in comparison with other variants. After proposed transabdominal preperitoneal alloplasty with the combined fixation of the mesh implant, there was a decrease in the incidence of chronic postoperative inguinal pain by 4.21 % and the occurrence of recurrences of inguinal hernias by 6.97 % compared with the classical technique.

Keywords: inguinal hernia, ethyl-α-cyanoacrylate glue, relapses, advanced transabdominal preperitoneal alloplasty, classical transabdominal preperitoneal alloplasty, mesh implant.

The aim — to reveal the correlation between indexes of APACHE II scale and the indexes of quantitative specific LAL-test and non-specific hematological indexes of endotoxicosis in patients with extended purulent peritonitis and to evaluate their diagnostic and prognostic value.
Materials and methods. The diagnostic value and the correlation between laboratory and clinical indexes of endogenic intoxication were defined based on the complex diagnostics and treatment of 115 patients with extended purulent peritonitis. The quantitative specific (LAL-test) and non-specific hematological indexes of endotoxicosis (leukocytic index of intoxication, hematological index of intoxication) were compared to the scale evaluation of the seriousness of the patients’ condition based on the complex of clinical and laboratory data obtained with the help of APACHE II scale, modified by A. P. Radzykhovsky (1997).
Results and discussion. It has been found that the indexes of LAL-test, unlike the non-specific hematological indexes of endotoxicosis, with high certainty allow to evaluate the level of endogenic intoxication, and the severeness of patients’ condition, while having high sensitivity and specificity as to the lethality prognosis, correlate with the objective systems of evaluating the severeness of patients’ condition according to SIRS and APACHE ІІ scale.
Conclusions. The quantitative specific method of endotoxicosis evaluation LAL-test with high certainty allows to evaluate the level of endogenic intoxication, and the severeness of patients’ condition and has an important prognostic value.

Keywords: extended purulent peritonitis, endotoxicosis, LAL-test, leukocytic index of intoxication, hematological index of intoxication, APACHE ІІ scale.

The aim — to analyze the surgical tactics optimizationfor pathological nipple discharge.
Materials and methods. 263 endoscopic mammoductoscopy were performed. Results of 144  endoscopу has been verified pathohistologically. Depending on a way of preoperative marks intraductal neoplasms 2 groups of observations were distinguished. In the basic group (n = 66) the proposed way of surgical tactics choice was followed. In control group (n = 78) after a routine endoscopy the traditional ductectomy was performed.
Results and discussion. Diagnostic accuracy of endoscopic mammoductoscopy in control group was equal to 48.0 %, in basic–98.2 %. The application of the author’s technique reduced frequency for central ductectomy use (more traumatic intervention than selective ductectomy) on 87.8 %.The volume of removed tissues decreases from 55.4 ± 4.8 to 33.8 ± 3.9 sm3 that led to the complications rate reduction on 5.9 % and decreased hospital stay duration for 3 days.
Conclusions. Double preoperative marks for intraductal neoplasms localisation under endoscopic and echographic control with additional definition of arterial blood supply features in an operation zone allowed to improve surgical tactics for pathological nipple discharge by preliminary planning of operative measures, differentiated choice of type and topography of a surgical cut.

Keywords: pathological nipple discharge, surgical tactics, endoscopy.

The aim — to determine the peculiarities of a threatened abortion clinical course in women with different genotypes of progesterone receptor gene polymorphism.
Materials and methods. The study included 67 women with threatened abortion. Clinical research methods, molecular genetic methods, pelvic organs ultrasound examination, statistical methods were used. The pain evaluation was done with digital rating scale. The analysis of the threatening abortion clinical course peculiarities considering the allele polymorphism of the progesterone receptor gene (PGR) rs590688 and rs500760, was conducted withsigns severity assessment: pain intensity, presence of bloody secretions and retrochorial hematoma.
Results and discussion. It was found that variants of genotypes for rs590688, but not for rs500760, have a statistically significant effect on the clinical course of threatened abortion. The correlation analysis between the severity of pain and the number of minor alleles for rs590688 revealed a moderate negative correlation — the more minor alleles, the less pain patients suffer. Logistic regressions have been constructed to predict the discharges, depending on the allele polymorphism of the progesterone receptor gene. Thus, in a model in which the predictor rs590688 acted, both the CG genotype and genotype GG were associated with a lower risk of the appearance of bloody discharges at 11 and 24 times, respectively, compared to the major genotype CC (p < 0.01). There was no statistically significant association between the presence and absence of retrochorial hematoma, depending on the studied allele polymorphisms of the progesterone receptor gene.
Conclusions. The severe clinical course of threatened abortion is associated with the presence of major homozygote CC for the progesterone receptor gene rs590688 polymorphism. In this case the risk of occurring severe pain than moderate is in 26 times higher (p < 0.001) and the risk of bloody discharges occurrence is in 24 times higher (p < 0.01). When predicting the clinical course of threatened abortion in women, it should be taken into account that the more severe course is associated with the presence of a major CC major homozygote in the patient for the progesterone receptor gene rs590688 (C/G) polymorphism.

Keywords: abdominal pain, pregnant women, threatening abortion, bloody discharges from a genital tract, polymorphism of a progesterone receptor gene.

The aim — to compare the early results of stapledcircular hemorrhoidectomy vs transanalhemorrhoidal dearterialization for grade III internal hemorrhoids.
Materials and methods. 65 patients with grade III internal hemorrhoids were admitted for surgical treatment from 2015 to 2017. Patients were randomly divided into two groups: the first (main) — 34 (52.3 %) patients after stapled circular hemorrhoidectomy according to our method, and the second group (comparison) — 31 (47.7 %) patients after transanal hemorrhoidal dearterialization.
Results and discussion. The average surgery duration in 1st group was slightly (in 3.9 %) shorter than in the 2nd (p < 0.05). The average intraoperative blood loss in the second group was 1.7 times higher than in the first. There were no significant differences between two groups in number and types of early postoperative complications (р > 0.05). Both groups results offer that two operative methods are associated with «fast track surgery» principles.
Conclusions.The average intraoperative blood loss in transanal hemorrhoidal dearterialization group was 1.7 times higher than in stapled hemorrhoidectomy group. The early results did not show highor significant differences. Stapled hemorrhoidectomy is the operation of high priority for grade III internal hemorrhoids surgery.

Keywords: hemorrhoids, surgery, results.

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Three cases of posttraumatic diaphragmatic hernia with a long disease historyhave been described. the clinicalmanifestations and instrumental examination methods of this life-threatening disease were highlighted. Analysis of the reasons for late diagnosis of posttraumatic diaphragmatic herniawas conducted. The peculiarities of surgical treatment forsuch kind of pathology and possible postoperative complicationswereproposed.

Keywords: diaphragmatic hernia, thoracotomy, pleural cavity.

A case of successful surgical treatment of 40-year-old patient with acute mesenteric thrombosis hospitalized in the surgical department in urgent order with intense epigastric pain and nausea was described. We consider this observation to be topical, since mesenteric thrombosis remains surgical pathology, the treatment results of which are often unsatisfactory because of the absence of a typical, and especially pathognomonic, clinical picture, and the complexity of the diagnostics as a whole. A number of diagnostic measures was carried out, including diagnostic video-assisted laparoscopy, which allowed to establish a timely correct diagnosis and to determine the surgery volume. The patient was successfully operated and 10 days after the intervention was discharged in a satisfactory condition.

Keywords: mesenteric thrombosis, surgical treatment, diagnostic video-assisted laparoscopy.

Biologically similar medicines (biosimilars) have become common in the European Union, the United States of America and other countries, in particular in Ukraine. Despite on established legal manuals for biosimilars in the European Union since 2005 and increasing and detailed regulatory guidance on data requirements for their development and licensing, many clinicians are reluctant to consider biosimilars as a treatment option for their patients. Major concerns have been raised on biosimilars relate to their pharmaceutical quality, safety (especially immunogenicity), efficacy (particularly in extrapolated indications), and interchangeability with the originator product. A clear understanding of the scientific principles of the biosimilar concept and access to unbiased information on licensed biosimilars are extremely important for physicians to make informed and weighted decision on patient care. The possibility of using biosimilars of low molecular weight heparins in clinical practice is discussed in this article. Data on bioequivalence and interchangeability of bioanalogs of the enoxaparin sodium Flenox and the original drug Clexane are given. The quality of enoxaparin sodium Flenox is regulated by the requirements of its own specification and meets the pharmacopeia requirements. Clinical trials have confirmed the high efficacy and safety of this drug.

Keywords: biosimilars, original preparation, interchangeability, bioequivalence, low molecular weight heparins, Flenox.

The most significant changes that have taken place recently in the treatment of renal-cell carcinoma (RCC) is the active implementation nephron-sparing surgery when the tumor size to 4 cm. The main problem at present is to reduce the complications associated with these procedures. Because of the problems associated with hemostasis, only a limited number of experienced surgeons performing laparoscopic partial nephrectomy. In today’s developed numerical methods and instruments, including laparoscopic duplications open surgery technique of hand-assistant, a double loop and cable-tie tourniquet; ultrasonic scalpel; RF, micro-wave, and laser hemostasis; Endosnare method; hydro-yet dissection. Just as open surgery urolithiasis replaced extracorporeal lithotripsy and endoscopic technology, surgical treatment of RCC gradually has changed from open to minimally invasive techniques.

Keywords: small kidney tumors, laparoscopic partial nephrectomy.

The literature review devoted to the risk factors evaluation of thromboembolic complications in abdominal surgery, as well as the possibility of evaluation scales application were analyzed. Hereditary risk factors for venous abdominal thrombosis are mutations of genes that encode the coagulation factors, synthesis of the glycoprotein receptors family, and the methylene tetrahydrofolate reductase level. The presence of hyperhomocysteinemia, tortuous type of intestinal angioarhitectonics, malignant neoplasms, and liver disease are background prognostic factors for the abdominal venous thromboembolism development. Caprini scale should be used in patients undergoing abdominal surgery for gradual risk assessment.

Keywords: risk, venous thrombosis, polymorphic genes, hyperhomocysteinemia, angioarhitectonics, neoplasms, liver disease, Caprini scale.