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Current Issue. Articles

4(64) // 2017



1. advanced article


World trends in pilonidal sinus disease treatment (sacrococcygeal fistula)

Ye. V. Tsema

O. O. Bogomolets National Medical University, Kyiv

The main reports presented at the world’s first international conference dedicated to the treatment of pilonidal disease, International Pilonidal Sinus Disease Conference (Berlin, September 23, 2017) have been analysed. The main trends and perspectives of the pilonidal surgery development are outlined. The modern knowledge on epidemiology, etiopathogenetic and classification of pilonidal disease are presented. The results of pilonidal sinus treatment with modern approaches such as Gips-technique, Lord-Millar technique, EPSiT, Bascom II (cleft-lift) operation, rhombic flap (Limberg, Dufourmentel, Webster), Karydakis, sclerotherapy and others are described in the paper. The contemporary principles of pilonidal surgery — «off-midline closure», «cleft-lift», «tissue-safe technique» are outlined.

Keywords: pilonidal sinus disease, surgical treatment, international conference.

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Original language: Ukrainian

2. Original researches


Scientific substantiation of the optimal evacuation scheme for wounded with severe limb traumatic injury based on homeostasis indices pathophysiological changes

S. O. Korol

Ukrainian Military Medical Academy, Kyiv

The aim — to prove scientifically optimal evacuation circuit of the wounded with severe fight limbs injuries (FLI) based on the clinical and statistical analysis of homeostasis indexes changes during medical evacuation stages (MES).
Materials and methods. The 378 victims with FLI who were injured during the antiterrorist operation from April 2014 to February 2015 were included in study. The average age of the wounded was 33.18 ± 4.21 years. The wounded were divided into three groups according to the characteristics of the MES: group 1 — 162 wounded, medical aid was provided on all MES, group 2 — 170 wounded, medical aid was rendered with the reduction of one MES, group 3 — 46 wounded, medical care was provided with the reduction of two MES. The groups were comparable (p > 0.05) for age, sex, traumogenesis, clinical-nosological structure, severity and nature of gunshot wounds, damaged segments of extremities, and the array of the study was representative. The control group included 35 healthy servicemen of the corresponding age, who were defined as indicators in the state of physiological dormancy. Pathophysiological evaluation of homeostasis in response to the FLI was performed by 26 general clinical, biochemical tests and respiratory-circulation disorders, immediately after admitting to intensive care or operative room during medical evacuation. The determination of respiratory and circulatory changes was carried out by the integral rheography method according to M. I. Tishchenko (1973).
Results and discussion. In the wounded with severe FLI in group 1, after the assistance in the previous stages and the intake of MES IV, gradual normalization of the homeostasis has occurred, in group 2 there has been noted a positive trend of moderate changes, in group 3 the indices showed severe disorders with a tendency to worsen, which in 6 cases led to the death of the wounded.
Conclusions. Based on the clinical and statistical analysis it was found that the consistent provision of trauma care during medical evacuation with timely interventions and anti-shock measures against the background of reserve body forces conservation led to improvement through gradual change of respiratory and circulatory disorders from severe to moderate. Medical aid for wounded with severe limb injuries by reduced evacuation scheme led to a deterioration of injuries to very severe and irreversible respiratory and circulatory changes on the background of a decreased single and minute heart output and the tendency to cardiovascular and respiratory failure.

Keywords: limb trauma, shock, assessment of trauma severity, respiratory and circulatory changes, medical evacuation stages.

List of references:  
1.    Bykov IY, Efimenko NA, Gumanenko EK, Samokhvalov IM. Modern combat surgical pathology. Size and structure of sanitary losses to the surgical profile (Russian) /Voenno-polevaya hirurgiya: nacionalnoe rucovodstvo [Military field surgery: national leadership](Russian)/Ed. I.Yu.Bykova, N. A.Efimenko, E. K.Gumanenko. Moscow: GEOTAR — Media. 2009 : 40-50.
2.    GumanenkoE. K. Principles of organization of surgical assistance and features of the structure of sanitary losses in counter-terrorist operations in the North Caucasus (Communication First)(Russian) /E. K.Gumanenko, I. M. Samohvalov, A.TRussianov [and others]. Voenno-medicinskiy zhurnal [Military Medical Journal](Russian). 2005;1 : 4-13.
3.    Zarutsky Ya.L. Characteristics of sanitary losses of a surgical profile with fractures of long bones in conditions of combat operations (Ukrainian)/Ya.L.Zarutsky, A. M.Laksha, Ye.B.Lopin [and others]. Viyskova medicina Ukrainianaini [Military Medicine of Ukrainianaine](Ukrainian). 2011;3-4:41-47.
4.    Laksha AM. Analysis of the structure of sanitary losses with fractures of long bones in the Armed Forces of Ukrainianaine in the conditions of combat operations (Ukrainian)/A. M.Laksha. Problemi viyskovoi ohoroni zdorovia: Zbirnik naukovih prac UVMA [Problems of military health: Collection of scientific works of UVMA](Ukrainian). 2011;31:P.61-71.
5.    Sinopalnikov IV. Sanitary losses of Soviet troops during the war in Afghanistan (Second Communication)(Russian). Voenno-medicinskiy zhurnal [Military Medical Journal](Russian).2000;3 : 4-9.
6.    Denisenko VN. Assessment of severity and prognosis of traumatic shock in victims with a combined trauma (Russian)/V. N.Denisenko, V. V.Burluka, S. A.Korol, V. V.Bondarenko. Problemi viyskovoi ohoroni zdorovia: Zbirnik naukovih prac UVMA [Problems of military health: Collection of scientific works of UVMA](Ukrainian).2002;11 : 8-15.
7.    Denisenko V. Assessment of the severity of traumatic shock and the choice of surgical tactics with combined abdominal trauma (Ukrainian)/V. M.Denisenko, N. M.Baramia, S. O.Korol, V. V.Burluka, V. V.Petkau. Actualnie problemisuchasnoi medicini: Visnik Ukrainianainskoi Medicinskoi Stomatologichnoi Academii [Actual problems of modern medicine: Visnyk Ukrainian Medical Stomatological Academy](Ukrainian).2008;1-2 : 174-177.
8.    Shapovalov VM. Martial injuries of limbs: infrastructure of wounds and features of the condition of the wounded in the period of local wars (report 1) (Russian)/V. M. Shapovalov. Traumatologia i ortopedia Rossii [Traumatology and orthopedics of Russiansia](Russian).2006;2 : 301-302.
9.    Kolesnikov IS. Integral rheography of the body as a method for assessing the state of the circulatory system in surgical diseases (Russian)/I. S.Kolesnikov, M. I.Lytkin, M. I.Tishchenko [and others]. Bulleten Hirurgii [Bulletin of Surgery](Russian).1981;1 : 9-15.
10.    Tischenko MI. Characteristics and clinical application of integral rheography — a new method for measuring the shock volume (Russian)/M. I.Tishchenko, A. D.Smirnov, L. N.Danilov [and others]. Kardiologia [Cardiology](Russian).1973;11 : 54-62.
11.    Zarutsky Ya.L. Differentiated tactics for the provision of traumatic care to the wounded with traumatic limb traumas at the stages of medical evacuation (Ukrainian)/Ya.L.Zarutsky, S. O.Korol, Ye.A.Kreshun. Odesskiy medicinski zhurnal [Odessa Medical Journal](Ukrainian).2017;3 : 18-23.

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Original language: Ukrainian

3. Original researches


Severity (by TG13) and histological forms of acute calculous cholecystitis in patients with ischemic heart disease

V. G. Mishalov 1, S. O. Kondratenko 2, L. Yu. Markulan 1

1 O. O. Bogomolets National Medical University, Kyiv
2 Oleksandrivska Clinical Hospital, Kyiv

The aim — to determine the severity of acute calculous cholecystitis (ACC) according to the Tokyo agreements (TG13) and its pathohistological forms in patients with coronary artery disease (CAD) with different functional classes of chronic heart failure.
Materials and methods. 166 patients with ACC (78 (47.0 %) women and 88 (53.0 %) men aged 55 to 82 years, mean age 70.1 ± 0.5 years) with a disease length up to 72 hours were examined. Patients were divided into two groups. The main group included 107 patients with ACC and CAD, in the comparison group — 59 patients with ACC with no signs of CAD. The groups were not statistically different by gender, age and body mass index. The final points of the study were the ACC severity structure according to TG13, pathohistological forms of gallbladder wall inflammation and their relationship to CAD. The data was analysed with IBM SPSS Statistics 22 software.
Results and discussion. In the main group, the severity of ACC, significantly (p = 0, 024) differed from that in the comparison group due to a larger percentage of patients with grade III: 27.1 % versus 15.3 % and grade II 38.3 % versus 28.8 %, and a smaller percentage of patients with grade I — 34.6 % versus 55.9 %. The frequency of edamatous, phlegmonous and gangrenous forms of ACC in the main group was 43.0 %; 27.1 % and 22.9 % against 66.1 %; 23.7 % and 10.2 % in the comparison group, respectively, p = 0.005. The severity of ACC according to TG13 correlated with the structure of pathohistological forms of ACH: r = 0.495 in the main group and r = 0.595 in the comparison group and with NYHA class, r = 0.595 (in the main group).
Conclusions. The structure of the ACC severity in patients with CAD according to the TG13 classification, significantly (p = 0.024) differs from that in patients without CAD with a high percentage of severe disease: 27.1 % versus 15.3 % and moderate severe — 38.3 % vs. 28.8 %. The severity of ACC in patients with CAD moderately correlates with the severity of pathohistological forms of inflammation of the gallbladder wall (r = 0.495). And with mild course of ACC and moderately severe, destructive forms are more frequent (47.4 %) compared to patients of the comparison group (24.0 %), p = 0.008. The functional class of CAD positively correlates with the severity of ACC, r = 0.595 and the severity of pathological changes in the gallbladder, r = 0.435.

Keywords: acute calculous cholecystitis, coronary artery disease, severity grading of cholecystitis TG13.

List of references:  
1.    Ambe PC, Christ H, Wassenberg D. Does the Tokyo guidelines predict the extent of gallbladder inflammation in patients with acute cholecystitis? A single center retrospective analysis. BMC Gastroenterol. 2015;15:142.
2.    Ansaloni L, Pisano M, Coccolini F et al. 2016 WSES guidelines on acute calculous cholecystitis. World J Emerg Surg. 2016;4(11):52.
3.    Attili AF, Carulli N, Roda E et al. Epidemiology of gallstone disease in Italy: prevalence data of the Multicenter Italian Study on Cholelithiasis (M. I. COL.). Am J Epidemio. 1995;141(2):158.
4.    Chandler CF, Lane JS, Ferguson P. Prospective evaluation of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Am Surg. 2000;66:896-900.
5.    Degrate L, Ciravegna AL, Luperto M et al. Acute cholecystitis: The golden 72-h period is not a strict limit to perform early cholecystectomy. Results from 316 consecutive patients. Langenbecks  Arch Surg. 2013;398(8):1129-1136.
6.    Eldar S, Eitan A, Bickel A et al. The impact of patient delay
and physician delay on the outcome of laparoscopic cholecystectomy for acute cholecystitis. Am J Surg. 1999;178:303-307.
7.    Gracie WA, Ransohoff DF. The natural history of silent gallstones: the innocent gallstone is not a myth. N Engl J Med. 1982;307:798-800.
8.    Lillemoe KD. Surgical treatment of biliary tract infections. Am Surg. 2000;66:138-144.
9.    McSherry CK, Ferstenberg H, Calhoun WF et al. The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients. Ann Surg. 1985;202:59-63.
10.    Papadakis M, Ambe PC, Zirngibl H. Critically ill patients with acute cholecystitis are at increased risk for extensive gall­bladder inflammation. World J Emerg Surg. 2015;10.  P. 59.
11.    Saklad M. Grading of patients for surgical procedures. Anesthesiol. 1941;N 2:281-284.
12.    Shaffer EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century?. Curr Gastroenterol Rep. 2005;N 7:132-140.
13.    Strasberg SM. Acute calcolous cholecystitis. N Engl J Med. 2008;358:2804-2811.
14.    Yokoe M et al. Validation of TG13 severity grading in acute cholecystitis: Japan-Taiwan collaborative study for acute cholecystitis. J Hepatobil Pancreat Sci. 2017;24(6):338-345.
15.    Yokoe M, Takada T, Strasberg SM et al. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobil Pancreat Sci. 2013;20(1):35-46.

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Original language: Ukrainian

4. Original researches


Cryofixation of resectable pancreatic ductal adenocarcinoma

O. I. Dronov 1, D. I. Khomenko 1, S. V. Zemskov 1, P. P. Bakunets 2, E. S. Kozachuk 1

1 O. O. Bogomolets National Medical University, Kyiv
2 Kyiv Center of Surgery for Diseases of the Liver, Bile Ducts and Pancreas named after V. S. Zemskov

The aim — to determine the temperature gradient changes in a resectable solid malignant pancreatic tumor  during the process of cryofixation at discrete depths of 3 mm, 8 mm, 13 mm and 18 mm from the working surface of the cryoapplicator, and quantitatively assess the nature of the morphological changes at the points of temperature measurement.
Materials and methods. During  the period from 2015 to 2016, cryofixation of resectable solid tumor with the subsequent classic resection option was performed in 21 patients (women — 8 (38.1 %), men — 13 (61.9 %), mean age 61.6 ± 2.1 years). Cryofixation of the tumor with localization in the gland head was performed in 14, with localization in the body — 6, in the gland tail — 1. In all patients, the histological type of tumor was confirmed — the ductal adenocarcinoma. Cryofixation was performed by a double cycle of universal cryosurgical device «Cryo-Pulse» (Ukraine) with the use of a cryoapplicator with a 30 mm diameter. The duration of freezing in every cryofixation cycle lasted for 10 min, melt period was spontaneous, the temperature in the tumors at discrete depths (3, 8, 13, 18 mm) was recorded by a developed the complex of measuring intraoperative thermocouple (KMIT-4). The calculation of the tumor cells (TCs) percentage with irreversible changes and the presence/absence of thrombosis in the tumor tissue vessels was performed utilizing the Quick Photo Micro 2.3 software. The influence of tumor localization in the proximal and distal part on the average temperatures level in the negative values range at depths of 3, 8, 13, 18 mm during cryofixation was studied. The correlation between the average reached temperature in the tumor and the irreversibly damaged TCs percentage at the studied depths was investigated.
Results and discussion. The average temperature at the end of the 10th minute of the freezing period on the second cryofixation cycle in the resectable pancreatic tumor localization in its proximal part, according to the T1 thermocouple’s parameters (3 mm), was –54.7 ± 3.0 °C, T2 (8 mm) was –30.2 ± 2.2 °C, T3 (13 mm) was –12.9 ± 1.7 °C, the thermocouple T4 (at a depth of 18 mm) was +2.3 ± 2.1 °C. In case when the tumor was localized in the distal part of the gland, the average temperature at a depth of 3 mm was –70.1 ± 1.3 °C, at a depth of 8 mm, it was –41.4 ± 1.5 °C, at a depth of 13 mm was –20.5 ± 1.0 °C and at a depth of 18 mm it was –6.7 ± 1.7 °C, which was significantly lower than the average temperature at the localization of the tumor in the proximal part of gland at the level of significance p < 0.001. The percentage of TCs with irreversible destructive changes correlates (R = –0.980), with an indicator of the level attained at a specific depth in the tumor. So at a depth of 3 mm the average temperature was –60.4 ± 10.0 °C, while the dead TCs were 99.6 ± 0.7 %; at a depth of 8 mm –36.3 ± 5.8 °C, and dead TCs  78.5 ± 7.6 %; at a depth of 13 mm –16.5 ± 4.7 °C, dead TCs were 28.5 ± 7.4 %; at a depth of 18 mm –1.4 ± 5.0 °C, dead TCs 2.7 ± 2.9 %.
Conclusions. In patients with the resectable pancreatic solid tumor localized in the body and tail the significantly lower mean temperatures at depths of 3 mm, 8 mm, 13 mm, and 18 mm were achieved during cryofixation compared with patients whose tumor was localized in the head. Two cycle cryofixation of resectable pancreatic solid tumor by cryoapplicator with a 30 mm diameter and the freezing exposure duration of 10 minutes with the following subsequent spontaneous melting, did not guarantee 100 % irreversible destruction of the TCs due to primary tumor tissue damage at depths of 3 mm, 8 mm, 13 mm and 18 mm from the working surface of the cryoapplicator.

Keywords: tumor cryofixation, ductal adenocarcinoma of the pancreas, resectable solid tumor of the pancreas, tumor cells, pancreatic cancer, tumor temperature, cryoapplicator, thermocouple.

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Original language: Russian

5. Original researches


Surgical tactics optimization in the acute pancreatitis treatment according to Atlanta, 2012 classification

M. S. Krykun

SI «Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine», Dnipro

The aim — to optimize the surgical tactics of acute pancreatitis treatment by early diagnosis and its local complications prediction.
Materials and methods. A total of 62 patients with local complications were studied. The patients were divided into 2 groups. The first (main) study group comprised 30 patients who were screened with CT and were undergoing the treatment from 2014 to 2016, according to Atlanta, 2012 classification of acute pancreatitis and the comparison group included 32 patients treated in 2011 — 2013, who underwent the ultrasound examination according to Atlanta, 1992 classification for diagnosis, in addition to clinical and laboratory methods. In both groups, men predominated: 19 (63.33 %) and 24 (75.00 %), respectively, in the main group and the comparison group. The mean age in the main group was 46.13 ± 2.17 years, in the comparison group 45.47 ± 2.92 years. In both groups, persons up to 60 years of age predominated. The groups did not differ by the drug treatment.
Results and discussion. Of the local complications of acute pancreatitis, more often there was delimited necrosis — 7 (38.89 %) cases, somewhat less often (5 (27.78 %) cases) — acute necrotic congestion and delimited necrosis with signs of infection. The pancreatic pseudocyst was recorded at 5.55 %. Encapsulated forms that occur later than 4 weeks of the disease predominated. In the main group, 20 (70.0 %) operations were performed, in the comparison group — 27 (84.38 %).
Conclusions. The introduction of the current Atlanta 2012 classification and based on it, the staged CT examination in combination with the clinical and laboratory assessment provides the opportunity to timely diagnose the acute pancreatitis local complications and to adjust the therapeutic tactics according to delaying surgical intervention or timely minimally invasive techniques.

Keywords: acute pancreatitis, local complications, operations.

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Original language: Ukrainian

6. Original researches


Evaluation of clinical severity of patents with acute pancreatitis in the emergency department

C. R. Kazimzade

Azerbaijan State Advanced Training Institute for Doctors named after A. Aliyev, Baku, Azerbaijan

The aim — to study clinical features and diagnostic approaches in patients with acute pancreatitis in the emergency department.
Materials and methods. Retrospective evaluation of patients (age ≥ 18) who were diagnosed as acute pancreatitis in Baku City Hospital N3 between 2013 and 2016 years was performed.
Results. Among the patients were 31 (50.8 %) men and 30 (49.2 %) women, the average age was 60.6 ± 15.4 years. Abdominal pain and nausea were common complaints at the time of admission. Clinically, 32 (61.5 %) patients were mild and 20 (38.5 %) were severe. The computed tomography severity index (CTSI) was assessed in these patients. The sensitivity, specificity, positive predictive value, negative predictive value (90 %, 97 %, 95 %, 94 %) were calculated for CRSI > 3 patients for severity of pancreatitis. 50 (82 %) patients were hospitalized. There was a correlation between CTSI and duration of hospitalization in these patients (p = 0.001, r = 0.497).
Conclusions. Early detection of clinical severity may provide an effective treatment approach because the acute pancreatitis clinic has different characteristics and variability. Early detection of a computed tomographic index of severity in acute pancreatitis in emergency departments contributes to an adequate choice of treatment tactics and a forecast of the duration of hospitalization of patients.

Keywords: acute pancreatitis, computed tomography severity index, diagnostics.

List of references:  
1.    Alhajeri A, Erwin S. Acute pancreatitis: value and impact of CT severity index. Abdom Imaging. 2008;33:18-20.
2.    Ayten R, Çetinkaya Z, Yeniçerioğlu A. Akut pankreatitli olgularimizin retrospektif değerlendirilmesi. F Ü Sağ Bil Derg. 2007;21:133-136.
3.    Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiol. 1990;174:331-336.
4.    Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am Gastroenterol. 2006;101:2379-2400.
5.    Bollen TL. Imaging of acute pancreatitis: update of the revised Atlanta classification. Radiol Clin N Am. 2012;50(3):429-445.
6.    Bollen TL, van Santvoort HC, Besselink MG et al. The Atlanta Classification of acute pancreatitis revisited. Br J Surg. 2008;95:6-21.
7.    Carroll JK, Herrick B, Gipson T, Lee SP. Acute pancreatitis: diagnosis, prognosis, and treatment. Am Fam Physician. 2007;75:1513-1520.
8.    De Waele JJ, Delrue L, Hoste EA et al. Extrapancreatic inflammation on abdominal computed tomography as an early predictor of disease severity in acute pancreatitis: evaluation of a new scoring system. Pancreas. 2007;34:185-190.
9.    DiMagno MJ, DiMagno EP. New advances in acute pancreatitis. Curr Opin Gastroenterol. 2007;23:494-501.
10.    Elmas N. The role of diagnostic radiology in pancreatitis. Eur J Radiol. 2001;38:120-132.
11.    Gürleyik G, Emir S, Kiliçoglu G et al. Computed tomography severity index, APACHE II score, and serum CRP concentration for predicting the severity of acute pancreatitis. JOP. 2005;N 6:562-567.
12.    Hirota M, Takada T, Kawarada Y et al. JPN Guidelines for the management of acute pancreatitis: severity assessment of acute pancreatitis. J Hepatobil Pancreat Surg. 2006;13:33-41.
13.    Karaca E, Oktay C. Travmadışı akut pankreatitol gularında prognostik kriterlerin sonuçüzerineetkisi. Türkiye Acil Tıp Dergisi. 2008;N 8:18-25.
14.    Kaya E, Dervisoglu A, Polat C. Evaluation of diagnostic findings and scoring systems in outcome prediction in acute pancreatitis. World J Gastroenterol. 2007;13:3090-3094.
15.    Kim YS, Lee BS, Kim SH et al. Is there correlation between pancreatic enzyme and radiological severity in acute pancreatitis?. World J Gastroenterol. 2008;14:2401-2405.
16.    Koizumi M, Takada T, Kawarada Y et al. JPN Guidelines for the management of acute pancreatitis: diagnostic criteria for acute pancreatitis. J Hepatobil Pancreat Surg. 2006;13:25-32.
17.    Lankisch PG, Burchard-Reckert S, Lehnick D. Underestimation of acute pancreatitis: patients with only a small increase in amylase/lipase levels can also have or develop severe acute pancreatitis. Gut. 1999;44:542-544.
18.    Maher MM, Lucey BC, Gervais DA, Mueller PR. Acute pancreatitis: the role of imaging and interventional radiology. Cardiovasc Intervent Radiol. 2004;27:208-225.
19.    Pezzilli R, Uomo G, Zerbi A et al. Diagnosis and treatment of acute pancreatitis: the position statement of the Italian Association for the study of the pancreas. Dig Liver Dis. 2008;40:803-808.
20.    Sargent S. Pathophysiology, diagnosis and management of acute pancreatitis. Br J Nurs. 2006;15:999-1005.
21.    Taylor SL, Morgan DL, Denson KD et al. A comparison of the Ranson, Glasgow, and APACHE II scoring systems to a multiple organ system score in predicting patient outcome in pancreatitis. Am J Surg. 2005;189:219-222.
22.    Vlodov J, Tenner SM. Acute and chronic pancreatitis. Prim Care. 2001;28:607-628.
23.    Vriens PW, van de Linde P, Slotema ET et al. Computed tomography severity index is an early prognostic tool for acute pancreatitis. J Am Coll Surg. 2005;201:497-502.
24.    Yousaf M, McCallion K, Diamond T. Management of severe acute pancreatitis. Br J Surg. 2003;90:407-420.

Original language: English

7. Original researches


Ultrasound-guided percutaneous catheter drainage of acute fluid collections in patients with acute necrotizing pancreatitis

O. I. Dronov 1, 2, I. O. Kovalska 1, 2, K. O. Zadorozhna 1, A. I. Gorlach 1, 2

1 O. O. Bogomolets National Medical University
2 Kyiv Center of Surgery for Diseases of the Liver, Bile Ducts and Pancreas named after V. S. Zemskov

The aim — to analyze the US-guided percutaneous drainage effectiveness on fluid collections in different phases of acute pancreatitis, to investigate the effect of drainage on systemic inflammatory response syndrome manifestations.
Materials and methods. 81 patients with moderate and severe acute pancreatitis were included to the study. The groups were formed according to the term of fluid collections drainage (group A (n = 32) — drainage was performed in the early phase of acute pancreatitis (up to 7 days), group B (n = 33)— in the reactive phase (6th — 15th day), group C (n = 16) — in sequestration phase (after 14 days).
Results and discussion. Minimally invasive drainage of acute fluid collections became the final treatment in 55.6 % of patients with acute pancreatitis (49.3 % — in sterile acute necrotic pancreatitis, 6.2 % — in infected pancreatitis). The use of minimally invasive interventions allowed to postpone the traditional surgical intervention after 21 days in 71.8 % of patients. Most patients needed surgical intervention in the group, where drainage was performed in the late phase of the disease, as compared with those, who were drained in the early and intermediate phases (62.5 % vs. 42.4 % and 25 % respectively, p = 0.039). The statistically significant decrease in hyperthermia (from 38.26 ± 0.55 °C to 37.7 ± 0.55 °C, p < 0.01), leukocytosis (from 11.79 ± 2.98 · 109/L to 9.34 ± 2.4 · 109/L, p < 0.01), leukocyte index of intoxication (from 7.15 ± 5.11 to 4.66 ± 3.1, p < 0.01) after percutaneous drainage of fluid collections, increase of absolute number of lymphocytes (from 882, 49 ± 415.35 to 1026.94 ± 330.199, p = 0.015) after drainage indicated the effectiveness of minimally-invasive drainage interventions in reducing the manifestations of endogenous intoxication and indirect positive effect on the patient’s immunoreactivity.
Conclusions. The percutaneous drainage of fluid collections reduces systemic inflammatory response syndrome manifestations in patients with acute moderate and severe pancreatitis, which allows to postpone the traditional surgery until necrosis demarcation.

Keywords: percutaneous drainage, fluid collections, acute pancreatitis.

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Original language: Ukrainian

8. Original researches


The experience of conducting surgical procedures with the mesh allografts for patients with inguinal hernias

V. G. Mishalov 1, S. M. Goyda 1, I. M. Leschishin 1, L. Yu. Markulan 1, O. V. Balaban 1, A. A. Burka 1, R. V. Gonza 1, S. M. Vamush 2

1 O. O. Bogomolets National Medical University, Kyiv
2 Oleksandrivska Clinical Hospital, Kyiv

The aim — to estimate reasons of unsatisfactory treatment results in patients with inguinal hernias, work out a practical recommendations complex to prevent complications and improve treatment results in such patients.
Materials and methods. 1661 patients with inguinal hernia were operated in 2003 — 2017 years, of which 1477 (88.9 %) were men, 184 (11.1 %) were women aged 16 to 98 years. The classification of inguinal hernia Nyhus (1993) was used. Primary hernias were observed in 1429 (86 %) cases, relapse — in 232 (14 %). About 131 (7.9 %) patients underwent surgery for strangulated ones. The inguinal canal plasty with the patients’ own tissues was performed according to Bassini, Girard — Spasokukotskiy and Postempskiy methods, the plasty with the mesh allografts — using Lichtenstein Gilbert, Rutkov — Robbins methods. For bilateral direct inguinal hernias, the Stoppa plasty was used.
Results and discussion. Inguinal hernias of the I type were found in 73 (4.4 %) patients, of the II type — in 415 (25.0 %), of the IIIA type — in 619 (37.3 %), of the IIIB type — in 228 (13.7 %), of the IIIC type — in 75 (4.5 %), of the IV type — in 251 (15.1 %) patients. Sliding hernias were examined in 254 (15.3 %) cases of our research. Bilateral inguinal hernias were diagnosed in 94 (5.5 %) patients. Single-stage surgical procedures were performed in 67 patients, two-stage procedures — in 25. The estimation of the treating results of patients with inguinal hernias was performed by comparing intraoperative, early, and late postoperative complications.
Conclusions. Mesh transplants for hernioplasty have benefits: the number of autoplasty complications reached 16.8 % while the number of alloplasty complications was 6.6 %. The causes of certain unsatisfactory treatment results were the wrong choice of inguinal canal plasty operations (6 %) and technical mistakes during the operations (1.6 %). To improve the results the individual approach to the inguinal canal plastic operations method should be applied.

Keywords: inguinal hernias, operative treatment, postoperative complications.

List of references:  
1.    Bobrov O. Ye., Mendel’ N. A. Vybor sposoba gernioplastiki pri pakhovykh gryzhakh. II VseUkrainian. nauk.-prakt. konf. z mizhnar. uchastyu: Materiali konferentsii (24 — 25 veresnya 2004 r., Alushta). Simferopol’, 2004:185-186.
2.    Grubnik VV, Losev AA, Bayazitov NR, Parfentyev R. S. Sovremennyye metody lecheniya bryushnykh gryzh. — K.: Zdorov’ya, 2001:278.
3.    Zhebrovskiy VV. Ranniye i pozdniye posleoperatsionnyye oslozhneniya v khirurgii organov bryushnoy polosti. — Izd. tsentr KGMU, Simferopol’, 2000:687.
4.    Zhebrovskiy VV, Mokhamed Tom El’bashir. Khirurgiya gryzh zhivota i eventeratsiy. — Simferopol’: Biznes-Inform, 2002:440.
5.    Zavgorodniy SN, Golovko NG, Russiananov IV, Detsik DA. Lecheniye pakhovykh gryzh metodom plastiki «bez natyazheniya». II VseUkrainian. nauk.-prakt. konf. z mizhnar. uchastyu: Materiali kon- ferentsii (24 — 25 veresnya 2004 r., Alushta). Simferopol’, 2004:21-23.
6.    Ioffe IL. Operativnoye lecheniye pakhovykh gryzh. M.: Meditsina, 1968:171.
7.    Kukudzhanov NI. Pakhovyye gryzhi. — M.: Meditsina, 1969:440.
8.    Mariyev AI, Fetyukov AI. Operativnoye lecheniye pakhovykh i bedrennykh gryzh s ispol’zovaniyem predbryushinnogo dostupa. Vestn. khir. 1990;4:119-121.
9.    Sayenko VF, Belyanskiy LS, Manoylo NV. Sovremennyye napravleniya otkrytoy plastiki gryzhi bryushnoy stenki. Klin. khirurgiya. 2001;6:59-64.
10.    Smirnov AB. Khirurgicheskoye lecheniye pakhovykh gryzh. Vest. khir. 1994;3-4:116-118.
11.    Feleshtinskiy YA. P. Patogenez, khirurgichne likuvannya i profilaktika retsidiviv grizh cherevnoi stinki u patsiyentiv pokhilogo i starechnogo viku: Avtoref. dis. ...d-ra med. nauk. ., 2000:35.
12.    Feleshtinskiy YA. P. Preperitoneal’naya gernioplastika dostupom cherez pakhovyy kanal s ispol’zovaniyem implantata pri retsidivnykh pakhovykh gryzhakh. Vestn. khir. 1998;2:64-65.
13.    Cheren’ko M. P. Bryushnyye gryzhi. K.: Zdorov’ya, 1995:260.
14.    Gilbert AI. An anatomical and functional classification for the diagnosis and treatment of inguinal hernia. Am J Surg. 1989;157(3):331-337.
15.    Lichtenstein IL, Shulman AG, Amid PK. Twenty quesnios about Hernioplasty. Am Surg. 1991;57(11):730-733.
16.    Nyhus LM, Condon RE. Hernia. Philadelphia: J. B. Lippincott Co, 1995:615.
17.    Stoppa RE, Soler M. Chemistry, geometry and physics of mesh materials. Expert meeting on hernia surgery (St Moritz, 1994). Basel: Karger, 1995:166-171.

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9. Original researches


Comparative evaluation of inguinal hernia treatment depending on type of mesh implant

I. V. Babiy 1, V. V. Vlasov 2

1 Khmelnytskyi Regional Clinical Hospital
2 National Pirogov Memorial Medical University, Vinnytsya

The aim — to assess the surgery results in patients with inguinal hernia treated with various types of alloplasty and implants.
Materials and methods. The study included 97 patients with inguinal hernia. Patients were divided into two groups: the first group — 45 (46.4 %) people, who were operated with I. L. Lichtenstein alloplasty method (in 15 (15.5 %) for patients in this group «heavy» mesh implant was used, and in 30.9 % —the «light» one), the second group — 53.6 % of the patients, were operated using the author’s preperitoneal alloplasty of the hernial defect (in 17.5 % of patients in this group, «heavy » mesh implant were used, and in 36.1 % the «light» one).
Results and discussion. The greatest number of postoperative complications was observed in patients after alloplasty by I. L. Lichtenstein (p < 0.01) especially in patients with «heavy» implants. Complications associated with inguinal nerves irritation marked in 8.2 % (p < 0.01). In patients after transsinguinal preperitoneal alloplasty operated according to the author’s method, no significant correlation between the complications number and the implant type was found (p > 0.05). Patients after alloplasty with a «heavy» implant by I. L. Lichtenstein method had painful sensations 1.5 times more often.
Conclusions. The placement of different mesh implants in the preperitoneal space allows avoiding foreign body sensation and inguinal neuralgia. The use of a «heavy» mesh implant by I. L. Lichtenstein method increases the risk of a foreign body sensation in the operated area, inguinal neuralgia and increases the pain intensity in the postoperative period.

Keywords: inguinal hernia, alloplasty, mesh implant.

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10. Original researches


Laparoscopic diagnostics of acute abdominal pain

M. I. Tutchenko 1, B. . Slonecki 2, . . tajeva 1, . V. Verbitskii 2

1 O. O. Bogomolets National Medical University, Kyiv
2 P. L. Shupik National Medical Academy of Postgraduate Education, Kyiv

The aim — to evaluate the laparoscopic diagnostic expediency and effectiveness in patients urgently hospitalized with acute abdominal pain complaints.
Materials and methods. The diagnostic and treatment results of 875 patients admitted by ambulance or urgently in the Emergency Hospital with acute abdominal pain complaints and treated in Surgery departments were analyzed. All patients were divided into two groups. In the second group (227 patients), in contrast to the first (648 patients), the diagnostic complex was expanded with urgent laparoscopy. Clinical and diagnostic algorithm included laboratory, instrumental and biochemical methods of research.
Results and discussion. A significant prevalence of female patients aged 18 to 59 years has been revealed. almost one in six (18.98 %) patients were senior and almost every twelfth (8.02 %) was senile. In each third patient, the cardiovascular disease was observed, and in every seventh — the respiratory system disease. The correct diagnosis was established in 365 (56.32 %) patients during the first 6 hours in the hospital, in 116 (17.90 %) patients — in the interval between 6 and 12 hours, in 97 (14, 97 %) — in the interval between 12 and 24 hours, and in 70 (10.81 %) patients later than 24 hours in first group. The urgent laparoscopy allowed to make the correct diagnosis in the first 12 hours in 211 (92.95 %) and in 16 (7.05 %) patients within 12 — 24 hours in the hospital.
Conclusions. The urgent laparoscopy allowed to establish the correct diagnosis in the majority of patients (186 (81.94 %)) with acute abdominal pain during the first 6 hours of the hospital stay and to prevent the explorative laparotomy in 11 (4.85 %) cases, whereas in patients referred to the first group it was performed in 16 (2.47 %) patients.

Keywords: acute abdominal pain, laparoscopy, urgent surgery, abdominal cavity.

List of references:  
1.    Adam QM, Alex MR, Tjun YT et al. Early laparoscopy versus active observation in acute abdominal pain: Systematic review and meta-analysis Department of General Surgery, Addenbrooke’s Hospital, Cambridge, UK article. Int J Surg. 2008;N 6:400-403.
2.    Agresta F, Ansaloni L, Baiocchi, G. L. et al. Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell’Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2012;N 26:2134-2164.
3.    Ciarrocchi A, Amicucci G. Laparoscopic versus open appendectomy in obese patients: A meta-analysis of prospective and retrospective studies. J Minim Access Surg. 2014;N 10:4-9.
4.    Francesco R, Francesc C, Ildo S. Emergency laparoscopic surgery in high — risk patients. Global J Surg. 2014;N 2:49-51.
5.    Schietroma M, Piccione F, Carlei F et al. Peritonitis from perforated appendicitis: stress response after laparoscopic or open treatment. Am Surg. 2012;N 78:582-590.
6.    Schietroma M, Piccione F, Carnei F et al. Peritonitis from perforated peptic ulcer and immune response. J Invest Surg. 2013;N 26:294-304.
7.    Sista F, Schietroma M, Santis GD et al. Systemic inflammation and immune response after laparotomy vs laparoscopy in patients with acute cholecystitis, complicated by peritonitis. World J Gastrointest Surg. 2013;N 5:73-82.
8.    Wevers KP, van Westreenen HL, Patin GA. Laparoscopic cholecystectomy in acute cholecystitis: C-reactive protein level combined with age predicts conversion. Surg Laparosc Endosc Percutan Tech. 2013;N 23:163-166.
9.    Zdichavsky M, Bashin YA, Blumenstock G et al. Impact of risk factors for prolonged operative time in laparoscopic cholecystectomy. Eur J Gastroenterol Hepatol. 2012;N 24:1033-1038.

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11. Original researches


Differential surgical tactics for unstable pelvis injuries at polytrauma in aute period of traumatic illness

V. V. Burluka 1, M. L. Ankin 2, V. M. Kovalenko 1, V. M. Dorosh 3, M. A. Maksymenko 4

1 Ukrainian Military Medical Academy, Kyiv
2 Regional Clinical Hospital, Kyiv
3 Kyiv City Clinical Hospital of Ambulance
4 PI «Ukrainian Scientific and Practical Center of Emergency Medical Aid Medicine of Catastrophes of the Ministry of Health of Ukraine», Kyiv

The aim — to improve the surgical care system for victims with unstable pelvic injuries and polytrauma (UPIP) in the acute period of traumatic disease (TD), considering the trauma severity and the clinical prognosis.
Materials and methods. The treatment analysis of 406 patients with UPIP who underwent the inpatient treatment at the Clinical Emergency Hospital from 2000 to 2014 was analyzed. The patients were divided into two clinical groups: the main one was 137 (33.74 %) patients who had differentiated surgical treatment tactics considering the severity of injury, the clinical prognosis of TD depending on its period, as well as modern methods of diagnosis and treatment of pelvic injuries and other anatomical sites, and control — 269 (66.26 %) patients who had surgical tactics according to the standards of inpatient care for the adult population. A quantitative assessment of the anatomical scales of ATS and FTS.
Results and discussion. In the acute period of the injury, the external pelvis fixation on admission was performed in 54.74 % of the main group and in 21.93 % of the control group. Pelvic cavity tamponade for hemostasis was performed in 5 (3.65 %) of the main group. Thoracotomy was performed in 8 (9.31 %) patients of the main group, in 6 of them — according to urgent indications, indications for thoracotomy were extended in 34 (19.21 %) cases in the control group. Abdominal tamponade for massive blood loss was performed in 6 (10.34 %) victims of the main group and in 1 (1.09 %) — in the control group. According to urgent indications, in 30.91 % of patients in the main group and in 11.98 % of the control group the long bones fractures immobilization with an external fixation device were performed. In the acute period of TD mortality was 74.30 %, in the main group — 63.93 %, in the control group — 77.66 %.
Conclusions. The extent, duration, and surgery priority in victims with an UPIP in the acute period of TD should be determined by the injury severity, the TD prognosis, and the type of pelvic ring instability.

Keywords: unstable pelvis, polytrauma, weight of trauma, prognosis, lethality.

List of references:  
1.    Ankyn LN, Ankyn NL. Povrezhdenyya taza y perelomi vertluzhnoy vpadyni [Damage to the pelvis and fractures of the acetabulum] (Russian). Kyev. Knyha plyus. 2008:216.
2.    Ankyn LN, Pypyya HH, Zarutskyy Ya.L., Lyabakh AP, Baramyya NN, Ankyn NL. Lechenye povrezhdenyy taza u postradavshykh s polytravmoy. Rossyyskyy nats. konhress «Chelovek y eho zdorov’e» [Treatment of pelvic lesions in patients with polytrauma. Russian Naz. Congress «Man and his health»] (Russian). SPb, 2005:4.
3.    Ankyn LN, Pypyya HH, Lyabakh AP, Ankyn NL. Nekotorie vozmozhnosty snyzhenyya letal’nosty y ynvalydnosty u postradavshykh s sochetannmy povrezhdenyyamy taza. Ort., travm. y protezyrovanye [Some opportunities for reducing mortality and disability in the victims with combined pelvic lesions. Ort., Injuries. and prosthetics] (Russian). 2005;4:53-57.
4.    Humanenko EK, Kozlov VK. Polytravma: travmatycheskaya bolezn’, dysfunktsyya ymmunnoy systemi, sovremennaya stratehyya lechenyya [Politapram: traumatic illness, dysfunction of the immune system, modern treatment strategy]. M.: HEOTAR – Medya, 2008:608.
5.    Kazhanov YV. Obosnovanye khyrurhycheskoy taktyky v ostrom peryode travmatycheskoy bolezny pry nestabyl’nkh travmakh taza na etapakh medytsynskoy vakuatsyy [Tekst] : avtoref. dys. … k.m.n.: 14.01.17 – khyrurhyya, 05.26.02 – bezopasnost’ v cherezvchaynkh sytuatsyyakh. – SPb, 2013:18.
6.    Patent na korysnu model’ # 61359, MPK (2011.01) A61V 8/00. Sposib anatomichnoyi otsinky politravm / Zaruts’kiy YL, Denysenko VM, Zhovtonozhko  O.I., Burluka VV. ta in.; zayavnyk ta patentovlasnyk Ukrainianayins’ka viys’kovo-medychna akademiya MO Ukrainianayiny [Patent for Utility Model No. 61359, IPC (2011.01) 61 8/00. Method of anatomical evaluation of polytrauma / Zarutsky Ya.L., Denisenko VM, Zhovtonozhko OI, Burluka VV. etc.; Applicant and Patent Owner Ukrainian Military Medical Academy of Ukrainianaine] (Ukrainian). zayavl. 17.05.2011; opubl. 11.07.2011; byul. 13.
7.    Patent na korysnu model’ 61897, MPK (2011.01) A61V 5/00. Sposib anatomo-funktsional’noyi otsinky politravm / Zaruts’kyy Ya.L, Denysenko VM, Zhovtonozhko OI, Burluka VV. ta in.; zayavnyk ta patentovlasnyk Ukrainianayins’ka viys’kovo-medychna akademiya MO Ukrainianayiny [Patent for Utility Model No. 61897, IPC (2011.01) 61 5/00. Method of anatomical-functional evaluation of polytrauma / Zarutsky YL., Denisenko VM, Zhovtonozhko OI, Burluk VV. etc.; Applicant and Patent Owner Ukrainian Military Medical Academy of Ukrainianaine] (Ukrainian). zayavl. 09.06.2011; opubl. 25.07.2011; byul. 14.
8.    Sokolov VA. «Damage control» — sovremennaya kontseptsyya lechenyya postradavshykh s krytycheskoy polytravmoy. Vestn. travmatol. y ortoped. ym. N.N. Pryorova [«Damage control» — the modern concept of treatment of victims with a critical polytrauma. Vestn. traumatic and the orthopedist. to them N.N. Prior] (Russian). 2005;1:81-84.
9.    Tyshchenko MY, Smyrnov AD, Danylov LN. y dr. Kharakterystyka y klynycheskoe prymenenye yntehral’noy reohrafyy – novoho metoda yzmerenyya udarnoho obema. Kardyolohyya [Characteristics and clinical application of integral rheography - a new method of measuring the impact volume. Cardiology.] (Russian). 1973;11:54-59.
10.    Ushakov SA, Lukyn S.Yu, Ystokskyy KN. s soavt. Lechenye travm taza, oslozhnennoy povrezhdenyyamy urohenytal’noho trakta. Henyy ortopedyy. [Treatment of pelvic trauma complicated by damage to the urogenital tract. Genome of orthopedics. 2011;11:140-144.
11.    Culemann U, Burkhardt M, Knopp W et al. Pelvic fractures. German medical journal. 2012(1):15-31.
12.    Gansslen A, Hildebrand F, Pohlemann T. Management of haemodynamic unstable patients «in extremis» with pelvic ring fractures. Acta Chirurgiae Orthopaedicae et Traumatologiae Ceechosl. 2012;79:193-202.
13.    Gansslen A, Krettek C, Pape H, Machtens S. Acute management of pelvic fractures: a European perspective. Fractures of the pelvis and acetabulum / W R Smith, B H Ziran, S J Morgan— Informa Healthare, 2007:27-71.
14.    Geeraerts T, Chhor V, Cheisson G et al. Clinical review: initial management of blunt pelvic trauma patients with haemodynamic instability. Crit Care, 2007;11:204-209.
15.    Sturmer KM, Neugebauer E. Guideline on treatment of patients with severe and multiple injuries. 2011:421.
16.    Tal D, Li W, Lee K et al. Retroperitoneal pelvic packing in the management of hemodynamically unstable pelvic fractures:A level 1 trauma center experience. J Trauma. 2011:1-8.
17.    Tile M. Fractures of the pelvis and acetabulum.— Williams & Wilkins, 1995:480.

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12. Original researches


Endoscopic balloon pyloro- and duodenoplasty in the treatment of ulcerative pyloroduodenal stenosis

V. M. Ratchik, B. F. Shevchenko, S. O. Tarabarov, O. M. Babii, N. V. Prolom

SI «Institute of Gastroenterology of NAMS of Ukraine», Dnipro

The aim — to improve the treatment results for ulcerative pyloroduodenal stenosis with endoscopic balloon pyloro- and duodenoplasty techniques.
Materials and methods. 17 patients with ulcerative pyloroduodenal stenosis were examined in the Department of Surgery during the period 2015 — 2017 years and underwent the endoscopic balloon pyloro- and duodenoplasty treatment. 14 (82.4 %) were men among them and 3 women (17.6 %) with the mean age of 57.2 ± 10.4 years. All patients have undergone laboratory, endoscopic, roentgenologic and morphological examination. The mucosal status and the degree of changes were assessed according to the Minimum Standard Terminology. 3 — 5 sessions of balloon pyloroduodenoplasty were performed depending on the degree of narrowing, the interval between sessions was kept for up to 3 days.
Results and discussion. Decompensated stenosis of the antrum (with duodenal narrowing to 4 — 6 mm) was diagnosed in 2 (11.8 %) patients, subcompensated stenosis (with narrowing up to 7 — 8 mm) in 10 (58.8 %) patients and compensated stenosis (with duodenum diameter more than 9 — 11 mm) — in 5 (29.4 %) patients. During our study, new indications for the endoscopic balloon pyloruodoendoplasty were clarified, which was performed in all patients, according to the degree of narrowing. No complications have been found in our study. In 16 (94.1 %) patients, the normal duodenum diameter restoration (up to 16 — 20 mm) was achieved. In one (5.9 %) case, the clinical presentations of decompensated stenosis with gastrostasis and gastroparesis have remained that requires a surgical intervention.
Conclusions. The method of endoscopic balloon pyloro- and duodenoplastics in the treatment of ulcerative pyloroduodenal stenosis had good effect (94.1 %), and was characterized by the absence of complications or recurrence in the remote period.

Keywords: peptic ulcer disease, pyloroduodenal stenosis, endoscopic balloon pyloro- and duodenoplasty techniques.

List of references:  
1.    Anzymyrov VL, Bazhenova AP, Bukharyn VA. Klynycheskaya khyrurhyya: Spravochnoe rukovodstvo (Russian) Moscow: Medytsyna; 1988:640.
2.    Bulhakov HA, Dyvylyn V.Ya., Stradyumov AA. Khyrurhycheskoe lechenye yazvennoy bolezny dvenadtsatyperstnoy kyshky u lyts pozhyloho y starcheskoho vozrasta. Khyrurhyya [Surgery] (Russian). 2002; 11:24-26.
3.    Dydyhov MT, Klyuchnykov O.Yu. Khyrurhycheskoe lechenye dekompensyrovannoho rubtsovo-yazvennoho stenoza dvenadtsatyperstnoy kyshky: rezektsyya zheludka yly duodenoplastyka. V myre nauchnikh otkrityy [World of scientific discoveries] (Russian). 2013; 2(47):175-196.
4.    Durleshter VM. Sposob radykal’noy duodenoplastyky pry dekompensyrovannom protyazhennom rubtsovo-yazvennom stenoze lukovytsi dvenadtsatyperstnoy kyshky (Russian). Kuban. nauch. med. vestn. [Kuban scientific medicine bulletin] (Russian). 2013; 7(142):79-81.
5.    Durleshter VM, Taktyka lechenyya bol’nikh dekompensyrovan- nim rubtsovo-yazvennim stenozom dvenadtsatyperstnoy kyshky (Russian). Kuban. nauch. med. vestn. [Kuban scientific medicine bulletin] (Russian). 2013; 7(142):81-86.
6.    Nikishayeva VI, Endoskopiya travnoho traktu. Minimal’na standartna terminolo hiya (Ukrainian). Veterans USA:Administration Medical Center; 1998:38.
7.    Onopryev VY, Durleshter VM, Dydyhov MT, Bal’yan A.S. Khyrurhycheskaya patomorfolohyya (hystotopohrafyya) dekompensyrovannoho duodenal’noho stenoza y tekhnolohycheskye osobennosty radykal’noy duodenoplastyky (Russian). Kuban. nauch. med. vestn. [Kuban scientific medicine bulletin] (Russian). 2006; 8(88-89):48-53.
8.    Onopryev VY. Novie kontseptsyy, taktyka y tekhnolohyy khyrurhycheskoho lechenyya oslozhnennoy yazvennoy bolezny dvenadtsatyperstnoy kyshky (Russian) Fyzyolohyya y patolohyya pyshchevarenyya [Physiology and pathophysiology of digestion] (Russian). 2002:3-7.
9.    Tytkov BE. Khyrurhycheskoe lechenye oslozhnennoy yazvennoy bolezny u HP-ynfytsyrovannikh bol’nikh: Author’s abstract for MD dissertation (Russian). Moscow; 2002:38.
10.    Artifon EL, Sakai P, Hondo FY. An evaluation of gastric scintigraphy pre- and postpyloroduodenal peptic stenosis dilation. Surg Endosc. 2006;N 20 (2):243-248.
11.    Banerjee S, Cash BD. ASGE Standards of Practice Committee. The role of endoscopy in the management of patients with peptic ulcer disease. Gastrointest Endosc. 2010;N 71 (4):663-668.
12.    Benjamin SB, Cattau EL, Glass RL. Balloon dilation of the pyloRussian: therapy for gastric outlet obstruction. Gastrointest Endosc. 1982;N 28:253-254.
13.    Benjamin SB, Glass RL, Cattau EL. Preliminary experience with balloon dilation of the pyloRussian. Gastrointest Endosc. 1984;N 30:93-95.
14.    Boylan JJ, Gradzka MI. Long-term results of endoscopic balloon dilatation for gastric outlet obstruction. Dig Dis Sci. 1999;N 44:1883-1886.
15.    Cherian PT, Cherian S, Singh P. Long-term follow-up of patients with gastric outlet obstruction related to peptic ulcer disease treated with endoscopic balloon dilatation and drug therapy. Gastrointest Endosc. 2007;N 66:491-497.
16.    Choi WJ, Park JJ, Park J. Effects of the temporary placement of a self-expandable metallic stent in benign pyloric stenosis. Gut Liver. 2013;N 7 (4):417-422.
17.    DiSario JA, Fennerty MB, Tietze CC et al. Endoscopic balloon dilation for ulcer-induced gastric outlet obstruction. Am J Gastroenterol. 1994;N 89 (6):868-871.
18.    Hamzaoui L, Bouassida M, Ben Mansour I. Balloon dilatation in patients with gastric outlet obstruction related to peptic ulcer disease. Arab J Gastroenterol 2015. N 16 (3-4):121-124.
19.    Heo J, Jung MK. Safety and efficacy of a partially covered self-expandable metal stent in benign pyloric obstruction. World J Gastroenterol. 2014;N 28:16721-16725.
20.    Kochhar R, Poornachandra KS, Dutta U. Early endoscopic balloon dilation in caustic-induced gastric injury. Gastrointest Endosc. 2010;N 71:737-744.
21.    Kochhar R, Sethy PK, Nagi B. Endoscopic balloon dilatation of benign gastric outlet obstruction. J Gastroenterol Hepatol. 2004;N 19:418-422.
22.    Morar PS, Faiz O, WaRussianavitarne J. Systematic review with meta-analysis: endoscopic balloon dilatation for Crohn’s disease strictures. Aliment Pharmacol Ther. 2015;N 42 (10). . 1137-1148
23.    Noor MT.1, Dixit P, Kochhar RN. SAIDs-related pyloroduodenal obstruction and its endoscopic management. Diagn TherEndosc. 2011:957-967.
24.    Rana SS, Bhasin DK, Chandail VS. Endoscopic balloon dilatation without fluoroscopy for treating gastric outlet obstruction because of benign etiologies. Surg Endosc. 2011;N 25 (5):1579-1584.
25.    Schilling D, Martin WR, Benz C. Long-term results of endoscopic balloon dilatation of ulcer-induced pyloric stenoses — follow-up of 25 patients. J Gastroenterol. 1997;N 35 (2):105-108.
26.    Solt J, Bajor J, Szabo M, Horvath OP. Long-term results of balloon catheter dilation for benign gastric outlet stenosis. Endoscopy. 2003;35(6):490-495.

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13. Original researches


Reconstructive surgery of postburn facial deformities with combined expanded perforator-based flaps

O. A. Zhernov 1, M. Kitri 1, A. O. Zhernov 2, V. S. Savchyn 3, S. V. Staskevich 2

1 P. L. Shupyk National Medical Academy f Postgraduate Education, Kyiv
2 Kyiv City Clinical Hospital N 2
3 Lviv City Municipal Hospital N 8

The aim — to improve the surgical treatment results in patients with post-burn face deformatis via combined expanded perforator-based flaps.
Materials and methods. 10 patients (7 — male, 3 — female) aged from 10 to 49 years (mean age 24.8 years) with postburn face deformities were included into the study. All of them have undergone a reconstructive surgery to remove scar defects depending on anatomical face zones by using preexpanded combined flaps based on septocutaneous and muscle perforators of infraorbital artery, transverse facial artery, facial and maxillary arteries.
Results and discussion. The application of combined expanded and perforator-based flaps in various anatomical face zones made it possible to obtain good (7 (70.0 %)), satisfactory (2 (20.0 %)) and 1 (10.0 %) unsatisfactory results of treatment in the nearest period. Good functional and cosmetic results were observed in 6 cases available for remote follow-up period.
Conclusions. The possibility of forming a pocket for the expander and using combined expanded flaps based on the perforator vessels has been demonstrated.

Keywords: post-burn face deformaties, tissue expansion, perforator vessels.

List of references:  
1.    Zhernov OA, TrachR.Ya., Zhernov AO. Expanded supraclavcularfasciocutaneous flap with supraclavicular artery inclusion in the burn contractures neck surgery(Russian). Surgery of Ukraine (Ukrainian). 2015;2 (54):84-91.
2.    Pat. 73769, UA, MPK A61V 17/58, A61V 17/88. Sposibocinky` rezul`tativoperaty`vnogolikuvannyarubcevy`xdeformacij ta kontraktur / Zhernov OA, Zhernov AO. (UA); zayavny`k ta patentovlasny`k DU «Insty`tutgematologiyi ta transfuziologiyi NAMN Ukrayiny`» (UA). (Ukrainian). u201202734 ;zayavl. 06.03.12 ;opubl. 10.10.12, Byul. 19.
3.    D’Arpa S, Toia F, Pirrello R et al. Propeller flaps: A review of indications, technique and results. BioMed Res Int;2014. Article ID 986829. : http://dx.doi.org/10.1155/2014/986829
4.    Gunnarsson GL, Jackson IT, Thomsen JB. Freestyle facial perforator flaps — a safe reconstructive option for moderate-sized facial defects. Eur J Plast Surg. 2014;37(6):315-318. doi:10.1007/s00238-014-0936-6
5.    Gunnarsson GL, Thomsen JB. The versatile modiolus perforator flap. Plast Reconstr Surg Global Open. 2016;4, N 3, [e661]. doi: 10.1097/GOX.0000000000000611
6.    Houseman ND, Taylor GI, Pan WR. The angiosomes of the head and neck: anatomic study and clinical applications. Plast Reconstr Surg. 2000;105(7):2287-2313. PMID: 10845282
7.    Kannan RY, Mathur BS. Perforator flaps of the facial artery angiosome. J Plastic, Reconstr Aesthetic Surg. 2013;66(4):483-488. doi: 10.1016/j.bjps.2012.11.027.
8.    Mehrara BJ. Reconstruction of the Cheeks. Thone CH Grabb and Smith’s Plastic Surgery. 6th ed. Philadelphia: Lippincott-Raven, 2007:375-388.
9.    Qassemyar Q, Havet E, Sinna R. Vascular basis of the facial artery perforator flap: analysis of 101 perforator territories. Plast Reconstr Surg. 2012;129(2):421-430. doi: 10.1097/PRS.0b013e31822b6771.
10.    Saint-Cyr M, Wong C, Schaverien M et al. The perforasome theory: vascular anatomy and clinical implications. Plas Reconstr Surg. 2009;124(5):1529-1544. doi: 10.1097/prs.0b013e3181b98a6c.
11.    Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg. 1987;40:113-141. PMID: 3567445
12.    Wallace CG, Wei FC. The Current status, evolution and future of facial reconstruction. Chang Gung Med J. 2008;31(5):441-449. : http://memo.cgu.edu.tw/cgmj/3105/310503.pdf

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14. Original researches


Treatment of morbid obesity by sleeve gastrectomy

V. V. Grubnik, V. V. Ilyashenko, O. L. Kovalchuk, S. O. Usenok, Vikt. V. Grubnyk

Odesa National Medical University

The aim — to study various modifications of laparoscopic sleeve stomach resection in order to determine the factors affecting the effectiveness of this operation.
Materials and methods. In this study, we present the results of three randomized prospective studies in patients with morbid obesity in whom sleeve gastrectomy was performed. In the first study, the need for partial removal of the antral part of the stomach was elucidated, in the second — the role of the bougie diameter for greater curvature resection, in the third — the effectiveness of laparoscopic sleeve gastrectomy and laporoscopic great gaster curvature plication.
Results and discussion. In patients in whom excision of the greater gastric curvature started 2 cm below pylorus, better long-term results were obtained compared to the patients with gastric dissection started at a distance of 6 cm from the pylorus. Thus, the need for of the antral gastric partial removal for weight reduction was confirmed. Significant better effectiveness after laparoscopic sleeve resection was obtained when bougie 36 Fr was used rather than with 50 Fr one. The third study clearly demonstrated the superiority of sleeve resection of the stomach before the large curvature plication. Despite the relative simplicity of the large curvature laparoscopic plication, in the remote terms after this intervention an adequate reduction was not achieved in the patient’s mass due to stomach tube stretching.
Conclusions. The conducted studies showed a rather high efficiency of laparoscopic sleeve resection of the stomach and a relatively low therapeutic efficacy of laparoscopic great curvature plication.

Keywords: sleeve gastrectomy, morbidity, gastric plication, bariatric surgery, laporoscopic surgery.

List of references:  
1.    Angrisani L, Santonicola A, Iovino P et al. Bariatric Surgery Worldwide 2013. Obes Surg. 2015;25:1822-1832. doi: 10.1007/s11695-015-1657-z
2.    Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26:1509-1515. doi: 10.1007/s00464-011-2085-3
3.    Baker MT. The history and evolution of bariatric surgical procedures. Surg Clin N Am. 2011;91:1181-1201, viii. doi: 10.1016/j.suc.2011.08.002
4.    Baltasar A, Perez N, Serra C et al. Weight loss reporting: predicted body mass index after bariatric surgery. Obes Surg. 2011;21:367-372. doi: 10.1007/s11695-010-0243-7
5.    Berger ER, Clements RH, Morton JM et al. The impact of different surgical techniques on outcomes in laparoscopic sleeve gastrectomies. Ann Surg. 2016;264:464-473. doi: 10.1097/SLA.0000000000001851
6.    Fried M, Dolezalova K, Buchwald JN et al. Laparoscopic greater curvature plication (LGCP) for treatment of morbid obesity in a series of 244 patients. Obes Surg. 2012;22:1298-1307. doi: 10.1007/s11695-012-0684-2
7.    Grubnik VV, Ospanov OB, Namaeva KA et al. Randomized controlled trial comparing laparoscopic greater curvature plication versus laparoscopic sleeve gastrectomy. Surg Endosc. 2016;30:2186-2191. doi: 10.1007/s00464-015-4373-9
8.    Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252:319-324. doi: 10.1097/SLA.0b013e3181e90b31
9.    Melissas J, Daskalakis M, Koukouraki S et al. Sleeve gastrectomy—a «food limiting» operation. Obes Surg. 2008;18:1251-1256. doi: 10.1007/s11695-008-9634-4
10.    Noel P, Nedelcu M, Gagner M. Impact of the surgical experience on leak rate after laparoscopic sleeve gastrectomy. Obes Surg. 2016;26:1782-1787. doi: 10.1007/s11695-015-2003-1
11.    Rosenthal RJ, International Sleeve Gastrectomy Expert Panel. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of > 12,000 cases. Surg Obes Relat Dis. 2012;N 8:8-19. doi: 10.1016/j.soard.2011.10.019
12.    Sakran N, Raziel A, Goitein O et al. Laparoscopic sleeve gastrectomy for morbid obesity in 3003 patients: results at a high-volume bariatric center. Obes Surg. 2016;26:2045-2050. doi: 10.1007/s11695-016-2063-x
13.    Talebpour M, Amoli BS. Laparoscopic total gastric vertical plication in morbid obesity. J Laparoendosc Adv Surg Tech. 2007;17:793-798. doi: 10.1089/lap.2006.0128

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15. Original researches


Safety of low-emolecular weight heparins in surgery

N. V. Yakymchuk 1, I. V. Miastkivska 1, R. Yu. Vododyuk 1, O. O. Budnyuk 1, P. I. Pustovoyt 2

1 Odesa National Medical University
2 Odesa Regional Clinical Hospital

The aim — to study the thrombosis prophylaxis safety with sodium enoxaparin by detecting the influence on the patients’ immune system in patients at risk of moderate thromboembolic event risk after laparoscopic cholecystectomy.
Materials and methods. The study involved 30 patients with calculous cholecystitis, who underwent laparoscopic cholecystectomy in 2017. The age of patients varied from 54 to 67 years. The majority of patients included women — 25 persons (83.3 %) and 5 (16.7 %) were men. The risk of general anesthesia by ASA averaged 3.3 ± 0.6 points, most often 3 points. All patients had a moderate risk of venous thromboembolic complications developing. Patients were divided into two groups. In the control group (n = 15) the prevention of venous thromboembolic complications was succeeded by original enoxaparin sodium; in the main group (n = 15) — by enoxaparin sodium (Flenox PAM «Farmak»). Immunogram studies were performed prior to surgical intervention and two days after administration of enoxaparin in postoperative period.
Results and discussion. There is no difference (according to non-parametric Mann — Whitney criteria) between the groups before thromboprophylaxis. This fully confirms the homogeneity of the groups. At the second stage of the study, there was no statistically significant difference (p > 0.05) between the immunological indexes after thromboprophylaxis with Flenox and the original enoxaparin.
Conclusions. By the effect on blood anticoagulant properties and the safety profile the enoxaparin sodium (Flenox, PAT Farmak) can be considered as a safe and effective drug for thromboprophylaxis in patients at a moderate risk of venous thromboembolism.

Keywords: cholecystitis, thromboprophylaxis, enoxaparin, safety, immunity.

List of references:
1.    Bokarev IN, Popova LV, Kozlova TV. Trombozy i protivotromboticheskaya terapiya v klinicheskoi praktike. M.: OOO «Meditsinskoe informatsionnoe agenstvo»; 2009 : 512. (Russian)
2.    El’tsova EA, Ramenskaya GV, Smolyarchuk EA, Bushmanova AV. Biosimilyary — preparaty budushchego (Russian). Farmakokinetika i farmakodinamika [Pharmacokinetics and Pharmacodynamics] (Russian). 2015;1 : 12-15.
3.    Levshin NYu, Baranov AA, Arshinov AV. Nizkomolekulyarnyi geparin vtorogo pokoleniya: effektivnost’, bezopasnost’, motivatsiya prioritetnogo primeneniya v klinicheskoi praktike (Russian). Trudnyj pacient [Difficult Patient] (Russian). 2014;12(6):7-14.
4.     Mamchur VI, Levykh AE, Podpletnyaya EA. Vosproizvedennye nizkomolekulyarnye gepariny: voprosy registratsii biosimilyarov (Russian). Khrurgya Ukrainianani [Surgery of Ukrainianaine] (Ukrainian). 2011;3 : 57-62.
5.    Matvva OV, Blkhar V, Yaichenya VP. Bosimlyari. Pitannya bezpeki kh zastosuvannya (Ukrainian). Ukrainian. med. Chasopis [Ukrainian Medical Journal] (Ukrainian). 2012;1 (87):26-30.

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. . 1, . . 1, . . 2, . . 1, . . 1, . . 1, . . 1, . . 1, . . 1

1 National Military Medical Clinical Centre «The Main Military Clinical Hospital», Kyiv
2 O. O. Bogomolets National Medical University, Kyiv

. , .

Keywords: , , , .

List of references:  
1.    Lokhmatov MM, Gaydayenko A. Ye., Shavrov AA, Volkov MO. Melanoz tolstoy kishki u rebenka 15 let: klinicheskoye nablyu- deniye. Pediatricheskaya farmakologiya. 2015;12(3):327-329.
2.    Orlinskaya NY, Bederina Ye. L., Kosolapov AG. i dr. Sluchay melanoza tolstogo kishechnika (klinicheskiy sluchay). Med. al’manakh. 2014;1 (31):50-52.
3.    Benavides SH, Morgante PE, Monserrat AJ et al. The pigment of melanosis coli: A lectin histochemical study. Gastrointest Endosc. 1997;46:131-138.
4.    Freeman HJ. Melanosis in the small and large intestine. World J Gastroenterol. 2008;14 (27):4296-4299.
5.    Ghadially FN, Walley VM. Melanoses of the gastrointestinal tract. Histopathology. 1994;25:197-207.
6.    Kou Nagasaco   ( ) http://www.colonoscopy.ru/ projects/nagasako/index.htm). 2012. 34.
7.    Li D, Browne LW, Ladabaum U. Melanosis coli. Clin Gastroenterol Hepatol. 2009;N 7. A20.
8.    Loveday RL, Hughes MA, Lovel JA, Duthie GS. Melanosis coli in the absence of anthranoid laxative use harbouring adenoma. Colorectal Dis. 2013;15:1044-1045.
9.    Nusko G, Schneider , Muller G et al. Retro spective study on laxative use and melanosis coli as risk factor for colorectal neoplasm. Pharmacol. 1993;47:234-241.

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Accidental diagnostics of parathyroid cancer in soldiers-participants of the combat conflict in east of Ukraine. Case study

V. G. Khperiya 1, O. I. Khrchnk 1, D. I. Dudla 2, Ye. V. Tsema 2, 3,
V. Ye. Safonov 2, O. M. Grytsenko 1, O. V. Malynovska 1

1 Taras Shevchenko National University, Educational and Research Center «Institute of Biology and Medicine», Kyiv
2 National Military Medical Clinical Centre «The Main Military Clinical Hospital», Kyiv
3 O. O. Bogomolets National Medical University, Kyiv

Asymptomatic hypercalcemia is commonly a result of a primary hyperparathyroidism and in 5 % is the first subclinical sign of parathyroid cancer. The experience in diagnostics and treatment in two servicemen with the osseous form of parathyroid cancer with clinical signs of the primary hyperparathyroidism are presented in the article. In the first case the disease was an accidental finding during the patient’s examination for collarbone traumatic fracture while the patient’s stay in the hospital for military medical commission. In the second case, parathyroid cancer was inadvertently detected during examination and treatment of the injured left thigh gunshot wounds. The opportunities of the modern imaging methods (multispiral CT, osteoscintigraphy) and the importance of calcium metabolism rates and parathyroid hormone level changes in the blood serum revealed by laboratory are analyzed in the article. The guidance for early diagnostics of parathyroid cancer has been proposed.

Keywords: hyperparathyroidism, parathyroid cancer, hypercalcemia, early carcinoma diagnostics.

List of references:  
1.    Cetani F, Pardi E, Marcocci C. Parathyroid carcinoma: a clinical and genetic perspective. Minerva Endocrinol. 2017;42(3):238-241.
2.    Clayman GL, Gonzalez HE, El-Naggar A, Vassilopoulou-Sellin R. Parathyroid carcinoma: evaluation and interdisciplinary management. Cancer. 2004;100(5):900-905.
3.    Gao Y, Yu C, Xiang F et al. Acute pancreatitis as an initial manifestation of parathyroid carcinoma: A case report and literature review. Medicine (Baltimore). 2017;96(4):8420.
4.    Grey J, Winter K. Patient quality of life and prognosis in MEN2. Endocr Relat Cancer. 2017;24(11):24-29.
5.    Kim BY, Park MH, Woo HM et al. Genetic analysis of parathyroid and pancreatic tumors in a patient with multiple endocrine neoplasia type 1 using whole-exome sequencing. BMC Med Genet. 2017;18(1):106-107.
6.    Shane E. Parathyroid carcinoma. J Clin Endocrinol Metab. 2001;86(2):485-493.
7.    Sharretts JM, Kebebew E, Simonds WF. Parathyroid cancer. Semin Oncol. 2010;37(6):580-590.
8.    Taniegra ED. Hyperparathyroidism. Am Fam Physician. 2004;69(2):333-339.

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Tibial revascularization in 12 hours after the popliteal artery traumatic rupture. A case report

T. I. Kobza, V. F. Petrov

Lviv Regional Clinical Hospital

The treatment result in 15-years old boy with right thigh distal fracture, popliteal artery and vein rupture after a car accident is described. Six hours after the injury, bone fragments were repositioned. The absence of arterial pedal pulse was revealed after the surgery. 12 hours since the onset of disease the popliteal artery grafting with saphenous vein, suture repair of the popliteal vein and fasciotomy were performed. Multiple organ failure with renal insufficiency prevailing has developed in the early postoperative period. One year later the patient’s condition was relatively satisfactory, ankle-brachial index referred to the normal value, deficit of the medial tibial muscle group and ankle nerves paresis on the right side were found. The boy follows a complex rehabilitation course with walking improvement. Alertness against accompanying vascular damage in the traumas of the distal thigh can reduce morbidity and mortality due to severe ischemic-reperfusion syndrome consequences prevention.

Keywords: artery rupture, popliteal artery, popliteal vein, venous grafting, children.

List of references:  
1.    Abou-Sayed H, Berger DL. Blunt lower-extremity trauma and popliteal artery injuries. Arch Surg. 2002;137(5):585-589. DOI: 10.1001/archsurg.137.5.585
2.    Allen CJ, Straker RJ, Tashiro J et al. Pediatric vascular injury: experience of a level 1 trauma center. J Surg Res. 2015;196(1):1-7. DOI: 10.1016/j.jss.2015.02.023
3.    Bambini DA. Vascular injuries. Arensman RM Bambini, D A Almond, P S Pediatric Surgery. Landes Bioscience, 2000. ISBN: 1-57059-499-6
4.    Bosse M, MacKenzie E. The mangled lower extremity: amputation or limb salvage. Program and abstracts of the 67th annual meeting of the American Academy of Orthopaedic Surgeons; March 15-19, 2000. Orlando, Fla. Orlando, 2000.
5.    Cardneau JD, Henke PK, Upchurch GR. Jr. et al. Efficacy and durability of autogenous saphenous vein conduits for lower extremity arterial reconstructions in preadolescent children. J Vasc Surg. 2001;34(1):34-40. DOI: 10.1067/mva.2001.115600
6.    Corneille MG, Gallup TM, Villa C et al. Pediatric vascular injuries: acute management and early outcomes. J Trauma. 2011;70(4):823-828. DOI: 10.1097/TA.0b013e31820d0db6
7.    Cvetkovi S, Jakovljevi N, Simi D et al. Popliteal artery injury following traumatic knee joint dislocation in a 14-year-old boy: a case report and rewiev of the literature. Vojnosanit Pregl. 2014;71(1):87-90. DOI: 10.2298/VSP1401087C
8.    Gifford SM, Propper BW, Eliason JL. The ischemic threshold of the extremity. Perspect Vasc Surg Endovasc Ther. 2011;23(2):81-87. DOI: 10.1177/1531003511410356
9.    Hafez HM, Woolgar J, Robbs JV. Lower extremity arterial injury: results of 550 cases and review of risk factors associated with limb loss. J Vasc Surg. 2001;33(6):1212-1219 DOI: http://dx.doi.org/10.1067/mva.2001.113982
10.    Kawada S. What phenomena do occur in blood flow-restricted muscle?. Int J KAATSU Training Res. 2005;N 1:37-44.
11.    Keeley J, Koopmann M, Yan H et al. Factors associated with amputation following popliteal vascular injuries. Ann Vasc Surg. 2016;29(5):83-87. DOI: 10.1016/j.avsg.2015.03.030
12.    Jagdish K, Paiman M, Nawfar A et al. The outcomes of salvage surgery for vascular injury in the extremities: a special consideration for delayed revascularization. Malays Orthop J. 2014;8(1):14-20. DOI: 10.5704/MOJ.1403.012
13.    Mowlavi A, Reynolds C, Neumeister MW et al. Age-related differences of neutrophil activation in a skeletal muscle ischemia-reperfusion model. Ann Plast Surg. 2003;50, N 4. 403-411. DOI: 10.1097/01.SAP.0000041663.28703.54
14.    Percival TJ, Rasmussen TE. Reperfusion strategies in the management of extremity vascular injury with ischaemia. Br J Surg. 2012;99, suppl. 1:66-74. DOI: 10.1002/bjs.7790

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Acute calculous cholecystitis at intraperitoneal (pendular) location of gallbladder. Case study

V. M. Braslavets, K. I. Pavlov, . V. Bondarenko, K. S. Ryazantseva

Pavlograd City Hospital N 4 of the Dnipropetrovsk Regional Council

Clinical observation of acute calculous phlegmonous holecystitis at abnormal intraperitoneal (pendular) location of the gallbladder has been presented. According to the literature, gallbladder anomalies occur in 17 — 20 % of cases. Casuistic cases of the gallbladder location outside the abdominal cavity are also described. Even though abnormal gallbladder position cases are not often, they should be remembered and taken into account not only during the operation, but also at the prehospital stage in patients with acute cholecystitis.

Keywords: gallbladder, anomaly, intraperitoneal location, acute cholecystitis.

List of references:  
1.    Anomalii biliarnogo trakta u detei / A Zaprudnov, L Bogomaz, L Kharitonova. Meditsinskaya gazeta. 2005;78:2-10. (Russian)
2.    Samokhina AV. Variantystroeniyazhelchnogopuzyrya i zhelchevyvodyashchikhprotokovpriispol’zovaniisovremennykhmetodovinstrumental’nogoissledovaniya. ZhurnalGrodnenskogogosudarstvennogomeditsinskogouniversiteta. 2011;3:3-6. (Russian)
3.    Sinel’nikov R. D., Sinel’nikov YR, Sinel’nikov AY. Atlasanatomiicheloveka. Moskva, «Novayavolna», 2007:247. (Russian)
4.    Shalimov AA, Shalimov SA, Nichitailo ME, Domanskii BV. Khirurgiyapecheni i zhelchevyvodyashchikhputei. Kiev, 1993:232. (Russian)
5.    Al-Hakkak SM. Agenesis of gall bladder in laparoscopic cholecystectomy –A case report. Intern J Surg Case Reports. 2017;39:39-42.
6.    Ghosh SK. Laparoscopic cholecystectomy in double gallbladder with dual pathology. J Minim Access Surg. 2014;10(2):93-96.
7.    Hiromichi Ishii, Akinori Noguchi, Mie Onishi et al. True left-sided gallbladder with variations of bile duct and cholecystic vein. World J Gastroenterol. 2015;N 21:6754-6758.

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Current Issue Highlights

4(64) // 2017

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V. V. Grubnik, V. V. Ilyashenko, O. L. Kovalchuk, S. O. Usenok, Vikt. V. Grubnyk

V. M. Braslavets, K. I. Pavlov, . V. Bondarenko, K. S. Ryazantseva

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