The aim – to determine the best recipient vessel for microsurgical breast reconstruction on the basis of comparative analysis of deep inferior epigastric, thoracodorsal and internal mammary vessels diameters.

Materials and methods. From September, 2008 till May, 2010 in vivo measurement of abovementioned three vessels was being carried out in the Department of Mammology.

Results and discussion. Vessels were measured in 61 patients; in 61 thoracodorsal vessels (30 arteries and 31 veins), in 91 deep inferior epigastric vessels (44 arteries and 47 veins) and in 43 internal mammary vessels (23 arteries and 20 veins).

Conclusions. As a result, we found out, that internal mammary vessels own more consistent anatomical features in the third intercostals space (the diameter of artery makes about 2.16mm, and the diameter of vein is 2.55mm), internal mammary vessels are not inferior to thoracodorsal vessels, and with the aid of videothoracoscopic parasternal lymph node dissection it is possible to make the dissection of internal mammary vessels minimally traumatic.

Keywords: internal mammary artery, thoracodorsal artery, video-thoracoscopic parasternal lymph node dissection.

The aim – to study character of abdominal exudates microflora and vermicular appendixes mucosa’s microflora in patients with the destructive forms of appendicitis for empiric antibacterial therapy tactic development in surgical treatment in patients with acute appendicitis.

Materials and methods. The 242 patients with the destructive forms of appendicitis, which were on treatment in a municipal clinical hospital № 4 Kyiv for period 2004–2010 were investigated.

Results and discussion. An inflammatory-destructive process in an appendix is conditioned by both aerobic (E. coli – 46.6 %, Enterobacter – 4.2 %, Citrobacter – 4.2 %, Klebsiella – 3.3 %, Pseudomonas aeruginosa – 5.8 %, Staphylococcus – 4.2 %) and anaerobic microorganisms (Bacteroides – 100 %) and Candida – 17.5 %.

Conclusions. Empiric antibacterial therapy is effective in 46.7 % patients with acute appendicitis. In 49.6 % patients an acute appendicitis develops on a background of dyspeptic intestinal disorders. Clinically the effective charts of empiric antibacterial monotherapy is next one: Moxifloxacini intravenously 400 mgs one time in twenty-four hours during 6 days, Ertapenemi for a 1 g one time in twenty four hours intravenously 6 days and combined – Aztreonami for a 1 g twice in twenty-four hours + of Clindamycini for 600 mgs twice in twenty-four hours, intramuscular during a 6 days; Cefepimumi for a 1 g twice in twenty-four hours + of Clindamycini for 600 mgs twice in twenty-four hours, intramuscular, 6 days.

Keywords: acute destructive appendicitis, abdominal exudates, microbe flora, antibacterial empiric therapy, dysbiotic intestinal disorders.

The aim – to improve the early results of pancreatoduodenal resections by a choice of pancreatoentherostomy optimal method.

Materials and methods. The results of 163 pancreaticoduodenectomies (PD) are analyzed in the article. In all patients postoperative reconstruction of gastrointestinal tract included formation of pancreaticojejunal anastomosis. Extramucosal anastomosis with external pancreatic duct drainage was performed in 7 patients (4.3 %), duct-to-mucosa anastomosis – in 5 patients (3.1 %), including 1 with external pancreatic duct drainage, telescopic duct-to-mucosa anastomosis in 38 patients (23.3 %), telescopic anastomosis in 48 patients (29.4 %), 2-layer pancreatojejunal anastomosis in 63 patients (38.7 %), including 2 with external pancreatic duct drainage, in 2 patients (1.2 %) with IPMN after exploration of the pancreatic duct in the pancreas remnant lateral pancreatojejunostomy was performed.

Results and discussion. Postoperative complications occurred in 51 patients (31.3 %). Statistical analysis shows that only formation of telescopic duct-to-mucosa anastomosis influenced significantly on both specific pancreatic complications and on general complication rates. External pancreatic drainage did not influence on the rate of postoperative complications.

Conclusions. Method of pancreaticojejunostomy could not influence greatly on the rate of postoperative complications.

Keywords: pancreaticoduodenal resection, postoperative complications, pancreaticodigestive anastomosis.

The aim – to estimate the remote effect of anticoagulating therapy for patients with deep venous thrombosis (DVT) by enoxaparin or varfarin on postthrombotic syndrome (PTS) requency during 5 years of supervision, and to define sympomatic venous thromboembolism (VTE) frequency during the period of supervision, because the relapses of VTE are associate with development of PTS.

Materials and methods. Retrospective research included 102 patients’ data, with symptomatic, one-sided first developed DVT. Treatment (at least 3 months) was conducted in patients by varfarin (international normalized relation – 2–3) or enoxaparin twice in a day in the fixed doses (4000 units of Anti-Xa, 40 mgs) 7–10 days with subsequent varfarin by a standard chart and supervision during subsequent 5 years. In a next 5 years of supervision the PTS was diagnosed by angiosurgeon by the Villalta criteria. After setting of therapy all patients was observed in a clinic each month during the first trimester and then in 6 and 12 months, and annually during a 5 years-old observant period. USDS of veins of both legs was executed in every patient.

Results and discussion. From USDS data the effect of therapy was better after enoxaparin treatment whan after varfarin 49.1 ± 51.2 vs 24.0 ± 51 (p = 0.016). Blood clot regression < 30 % observed only for 16 patients (28.6 %), in the enoxaparin group vs 26 patients (56.5 %), in the varfarin group (p = 0.007). A general amount of relapses for 5 years was 23.2 % in the enoxaparin group and 47.8 % in the varfarin group (p = 0.018). Total frequency of relapses for 5 years was 40.5 % for patients with blood clot regression < 30 % as compared to 17.8 % with regression > 30 % after treatment (p = 0.001). Signs and symptoms of PTS were developed in 65 (63.7 %) patients. PTS was moderate in 42 patients and heavy in 22, in 38 patients after 5 years symptoms were absented. The less of PTS was observed in the enoxaparin group (absents in 44.6 %, heavy forms in 14.4 %) what in the varfarin group (absent in 28.3 %, heavy in 30.4 %). Recurrent VTE and low blood clot regression after anticoagulating therapy is PTS predictor. In 5 years the general amount of relapses was made by 6.7 % among patients without PTS, 31.7 % for patients with moderate PTS, and 47.3 % for patients with heavy PTS (p = 0.001). Patients with moderate PTS have in 6 times higher a risk of relapse as compared to patients without PTS (OR = 6.19; 95 % CI 1.39–27.49; p = 0.016). The risk of relapse is increased in 11 times for patients with heavy PTS as compared to patients without PTS (OR = 11.25; 95 % CI 2.5–50.35; р = 0.002).

Conclusions. By USDS data the effect of anticoagulating therapy was better after enoxaparin treatment (Klexan) whan after varfarin treatment (49.1 ± 51.2 against 24.0 ± 51 (p = 0.016)). A general amount of relapses for 5 years was 23.2 % in the enoxaparin group and 47.8 % in the varfarin group (p = 0.018). A risk of recurrent VTE is higher after varfarin treatment (p = 0.018) Among the potential factors of risk the presence of remaining venous thrombosis is increased by the risk of recurrent VTE. Total frequency of relapses for 5 years was 40.5 % for patients by regression of blood clot < 30 % as compared to 17.8 % with regression > 30 % after treatment (p = 0.001). The less of PTS was observed in the enoxaparin group (absents in 44.6 %, heavy forms are in 14.4 %), whan in the varfarin group (absent in 28.3 %, heavy in 30.4 %).

Keywords: postthrombotiс syndrome, venous thromboembolism, anticoagulating therapy.

The aim – to define possibility and methods to improve prevention of cervical cancer in Ukraine.

Materials and methods.Used data of mortality, death rate and methods of prevention of cervical cancer presented in the National and World cancer-registers Bulletins for 2002–2008, in WHO documents and publications and in works of prominent oncologists in Ukraine and other countries.

Results and discussion. The dependence of cervical cancer mortality and death rate on economic, social factors (also in Ukraine) was determined The expediency of change of opportunistic screening on the organized population screening with use of new methods of preventive maintenance and diagnostics of a cervical cancer is proved.

Conclusions. For the cervical cancer prevention improvement in Ukraine it is necessary to substitute opportunistic screening with organized population screening including use of cervical cytology complex smear and new effective cervical cancer diagnostic and primary prophylactic methods.

Keywords: cervical cancer, opportunistic and organized population screening, human papilloma virus (HPV), vaccination, Cervаriks, Gardаsil.

The aim – to improve the rehabilitation results in patients with perineal ruptures by means of reveal and multimodal correction of rectal obturative apparatus functional disorders as well as surgical interventions methods and postoperative management optimization.

Materials and methods. The treatment results of 65 patients from 18 to 50 years old with perineal rupture were analyzed. According to the involvement of organs into the process there have been divided: ruptures of vagina and perineal tissue (10 patients), ruptures of vagina, perineum and rectal sphincter (15 patients), and with injury of the rectal wall (40 patients). In order to evaluate the functional state of the sphincter in each case and detect its insufficiency degree the sphincterometry and manometry were applied. All patients underwent the preoperative preparation.

Results and discussion. 10 patients with vaginal and perineal tissues rupture underwent levatoroplasty. The rest 55 patients with of sphincter and rectal wall injury underwent sphincter-levatoroplasty. In 16 of them the sphincter-levatoroplasty was executed by the modified method. After the repair and suture of levators in these patients 2–3 additional sutures were applied through all layers but not involved rectal mucosa. In the early postoperative period the local laser therapy was applied to these patients. The early results were evaluated in all operated patients 14–15 days after the surgery. In the early postoperative period the wound suppuration was noted in 6 patients of the control group, in 5 (12.8 %) of them within the skin, in 1 (2.6 %) the dehiscence of sphincter sutures occurred. In the main group 1 (6.3 %) patient had wound suppuration within the skin.

Conclusions. In case of rupture of the sphincter the sphincter-levatorplasty seems to be the most appropriate intervention no matter what is the degree of involvement of the rectum wall and vagina into the pathologic process. The application of our modified method of sphincter-levatorplasty improved the results of surgical management of perineal ruptures by 9.2 %. The local laser therapy of the post-operative wound in the multimodal postoperative treatment of patients furthers the reduction of purulent complications rate from 15.4 % to 6.3 %.

Keywords: rupture of perineum, anal incontinence, levatoroplasty, sphincter-levatorоplasty.

The aim – to improve the early and late results of surgical treatment in patients with complicated forms of choledocholithiasis by the surgical correction methods choice optimizing with the use of intraoperative ultrasound.

Materials and methods. We analyzed the treatment results of 80 patients. Patients were divided into 2 groups. The study group included 40 patients operated using ultrasonography during the biliary tract examination. In the control group (40 patients) intraoperatively we used only the traditional methods of biliary tract examination (inspection, palpation, and probing, intraoperative cholangiography). To inspect the extrahepatic bile duct, scanner was placed at the gates of the liver, moving along the hepatoduodenal ligament in the direction of the duodenum.

Results and discussion. Supplementing of audit of biliary tract with intraoperative ultrasound created a visual control in the real time, which ensured the full release of the ducts from the concrements, and minimized the use of biliodigestive anastomosis as sphincter excluding operations in favor of external drainage of common bile duct. Analysis of late results of surgical treatment on the basis of determining the quality of life identified significantly lower quality of life of patients from control group.

Conclusions. Intraoperative ultrasound diagnostic allows the complete elimination of obstacles providing the natural passage of bile and exclude the possibility of residual concrements, which, in turn, reduces the indications for sphincter excluding operations – biliodigestive anastomosis, endoscopic papillosphincterotomy. Using intraoperative ultrasound when examining the biliary tract and an increase in the number of operations that preserve the function of major duodenal papilla and sphincter of Oddi (external choledochal drainage) – positively correlated with quality of life of patients in the late postoperative period.

Keywords: intraoperative ultrasound, obstructive jaundice of non-neoplastic genesis, choledocholithotomy, lithoextraction, the quality of patient’s life.

The aim – to estimate conversion causes of laparoscopic cholecystectomy (LCE) for acute calculous cholecystitis.

Materials and methods. In 157 cases of LCE for acute calculouse cholecystitis. Conversion was done in 17 (10.8 %) from 157 cases.

Results and discussion. The conversion rate depended on time that has passed since the onset of acute cholecystitis: it performed in 6 of 110 patients on third day of disease (5.46 %), in 11 from 47 patients (23.4 %) – in more than three days disease duration.

Conclusions. Final criterion for feasibility of laparoscopic intervention is the morphological changes degree in the gall bladder wall established by diagnostic laparoscopy. At impossibility of Calo triangle elements identification the conversion should be preventive, but not of the forced character. Prophylactic conversion should not be considered as a complication of operation, its main aim is to prevent damage of bile ducts.

Keywords: acute cholecystitis, laparoscopic cholecystectomy, conversion.

The aim – to improve the surgical treatment results in patients with paracolostomal hernias.

Materials and methods. During the period from 2000 to 2010, 27 patients with paracolostomal hernias were operated on at Kyiv City Center of Ventral Hernia Surgery, while performing reparative-reconstructive operations on the colon. There was approbated an original method for the ventral wall defect closure on site of a colostomy with a use of polypropylene meshes in 13 patients with paracolostomal hernias, and 14 patients were operated with autoplastic (the control group).

Results and discussion. The use of autoplastic methods for the ventral wall defect closure, while performing the colostomy removal in patients with paracolostomal hernias, resulted in hernial recurrences in about third of the patients operated in such way. The immediate and remote results of surgical treatment in patients with paracolostomal hernias, which had had reparative-reconstructive operations on the colon, demonstrated high efficacy of the method proposed for alloplastic closure of the ventral wall defect on site of a colostomy removed. Complications on the wound side were only observed in one (7.6 %) patient in form of serous wound inflammation; no case of hernia recurrence was revealed.

Conclusions. The method proposed for allohernioplasty of the ventral wall colostomy defect allows for reliable reinforcement of the ventral wall with a polypropylene mesh fixed to supportive structures within submuscular space, and reduces significantly the number of both hernia recurrences and postoperative complications on wound side.

Keywords: paracolostomal hernia, colostomy removed, allohernioplasty.

The aim – to assess efficacy of anal sphincter non-surgical relaxation using 0.3 % nifedipine ointment by measuring changes in anal canal pressure during treatment.

Methods and materials. The study included 45 patients with chronic anal fissure aged 18 to 74 years (mean age 38.2 ± 1.4 years). The first step of treatment was surgical excision of the anal fissure using ultrasound harmonic scalpel UltraCision (Ethicon Endo Surgery, USA). 0.3 % nifedipine ointment was applied for 4–5 weeks after surgery. Function of the rectal sphincter was assessed using sphincterometer ProMedico (Germany) before surgery and on days 15 and 30 after surgery.

Results and discussion. 45 patients (100 %) had elevated anal sphincter tonus before surgery. Anal canal substantially pressure decrease (p < 0.05) was seen starting from the second week of application of 0.3 % nifedipine ointment. On day 30 after surgery all patients had normal anal sphincter tonus. Cytology of surgical wound smears on day 25 revealed regression of inflammationm epithelization and scar formation in 42 (93.3 %) patients. Follow-up over 5 to 30 months revealed no cases of recurrence.

Conclusions. Sphincterometry is an unbiased and reliable method of assessment of anal sphincter relaxation when treating chronic anal fissures.

Keywords: chronic anal fissure, drug relaxation of anal sphincter, sрhincterometry.

The aim – to improve hemostasis disorders diagnostic in patients with benign prostatic hyperplasia and to develope methods for their prevention and correction on the stages of surgical treatment.

Materials and methods. We analyzed the survey results of hemostasis and thrombohemorrhagic complications prevention in the surgical treatment of 114 patients with benign prostatic hyperplasia.

Results and discussion. We identified a form of haemostatic system response, which determines the postoperative thrombohemorrhagic complications nature. Developed complex of preventive measures can normalize the hemostasis mechanisms disorders and reduce the intensity of micro intravascular coagulation and thereby reduce the incidence of complications.

Conclusions. In patients with benign prostatic hyperplasia in preoperative period we reveal of changes in the haemostatic system. Peak of hypercoagulation after trans-vesicular prostatectomy observed on 3–7 days after surgery and shows a sharp increase in paracoagulative products concentration, fibrinogen, fibrin-stabilizing factor, increases platelet aggregation on the background of antithrombin III reduction and of blood fibrinolytic activity inhibition. Integrated use of prolonged epidural anesthesia, bemiparin and doxazosin at the stages of surgical treatment in patients with benign prostatic hyperplasia normalizes the functional state of the haemostatic system, eliminates the symptoms of hemostasis disorders and reduces at 5.2 times the frequency of DVT versus that ones in the group without thromboprophylaxis specific methods use, 3 times in group with prolonged epidural analgesia, 3 times the frequency of exacerbations of chronic pyelonephritis and nearly 2 times reduces hospitalization terms.

Keywords: benign prostatic hyperplasia, hemostasis, postoperative thrombohemorrhagic complications, low-frequency haemoviscosigraphya.

The aim– to improve varicose veins treatment quality by using combining method of endovenous laser coagulation (EVLC) and intraoperative sclerotherapy.

Materials and methods. 72 patients with varicose veins CEAP C2-C3 were observed during 2009–2010. The basic diagnostic methods were clinical exams and ultrasound Doppler study with colour blood flow mapping. 37 patients were operated with using original combining EVLC and intraoperative sclerotherapy, 35 patients were operated by EVLC and sclerotherapy sequentially.

Results and discussion. The results of the varicose veins treatment with original method were estimated. The comparison of EVLC plus intraoperative sclerotherapy and EVLC and sclerotherapy sequentially was made. The using of EVLC and sclerotherapy in one operation reduces the recanalization rate of veins trunk on 40 %, the relapse of varicose syndrome on 50 % in comparison with staged treatment (1st step – EVLC, 2nd – sclerotherapy).

Conclusions. The original combined treatment method for CEAP C2-C3 varicose veins allows reduce rates of relapses, improve esthetic effects of treatment, and reduce treatment terms.

Keywords: varicose veins disease, endovenous laser coagulation, sclerotherapy.

The aim – to determine the indications for surgical intervention and optimal treatment regimens for the necrotic parapancreatitis.

Materials and methods. From 2006 to 2010 in the surgical clinic of the Kiev Regional Hospital had been treated 179 patients with necrotic pancreatitis, including such complications as parapancreatitis occurred in 119 patients (66.5 %). Necrotic parapancreatitis or retroperitoneal aseptic abscess was diagnosed in 57 patients (47.9 %), purulent-necrotic parapancreatitis or retroperitoneal septic abscess encountered in 62 patients (52.1 %).

Results and discussion. Among the patients of I group needle drainage under ultrasound control ends by recovery in 18 (58.1 %) cases; on the second phase 13 (41.9 %) patients were operated with the open method. Ineffectiveness of the treatment with using of the minimally invasive technologies was associated with the large number of necrotic tissue. Among the patients of the II group minimally invasive interventions ended by recovery in 10 (18.9 %) cases. On the second stage of treatment 43 patients were operated. The operative treatment was done on 29 ± 4 days. Operative surgical intervention had been performed with the maximum removal of the free-lying necrotic masses. If there were difficulty with necrosis elimination the open of the drainage with the gradual local sanitation was performed. In this way 30 (69.7 %) patients were operated. In the absence of the obvious necrotic tissue the closed drainage was done. Complications of treatment were revealed in 69 (38.5 %) patients. However, in patients with necrotic parapancreatitis complications diagnosed in 50 (42 %) patients, and in patients with necrotic pancreatitis in 19 (31.7 %) patients. In patients with extended necrotic process in the retroperitoneal space, complications developed in 1.32 times more frequently. Generally 28 people died, the mortality rate was 15, 6 %. Among the patients with the complications as the parapancreatitis 24 patients died, mortality rate was 20.3 % respectively.

Conclusions. The defeat of the retroperitoneal fat has a prevailing importance in the development of complications and lethal effects of necrotic pancreatitis. Implementation of minimally invasive surgery leads to improved outcomes in patients who has the limited lesions of parapancreatitis fiber content and the presence of liquid in the pathological site. Implementation of minimally invasive surgery for common lesions of retroperitoneal fat leads to evacuation of liquid content, detoxification, and should be used as the first stage to prepare for open surgery. Using the tests to determine of the proteolysis activity of blood plasma and fluid, received to select the optimal time for surgery in infected parapancreatitis. Deferred open surgery at infected parapancreatitis performed on the fourth week after the disease onset helps to improve the treatment outcomes.

Keywords: necrotic parapancreatitis, procalcitonin, C-reactive protein, protein lysis, collagen lysis, non-specific fibrinolysis, minimally invasive intervention.

The clinical case of periappendicular abscess diagnostics and treatment is presented. At ultrasonic diagnostics of abdomen appendicle infiltration with the signs of abscess was found. The punction and sanation of periappendicular abscess under US-control was executed a patient, conservative antibacterial, anti-inflammatory therapy was conducted. In 5 months appendectomy was executed. Patient went home on 4th day after the operation in the satisfactory state.

Keywords: periappendicular abscess, punction, ultrasonic diagnostics.

In the article the case of successful application mesenchimal stem cells therapy in patient with the chronic critical ischemia lower extremities 6 stage by Ruterford on diabetus melitus 2d type background is described, that allowed to avoid amputation and resulted in complete cicatrization of large necrotizing foot defeat.

Keywords: chronic critical ischemia of lower extremities, mesenchimal stem cells, therapy

The aim – to describe the case of successful treatment of pancreas ectopic tumor in the duodenum, which was complicated by bleeding.

Materials and methods. The patient with ectopic pancreatic tumor in the duodenum complicated by bleeding was treated in the surgical department of Kiev Oleksandrivska Clinical Hospital from 11.18.1910 to 09.12.1910. As diagnostic tool we used the chest and abdomen X-ray examination, duodenoscopy, duodenoscopy with biopsy, colonoscopy, and ultrasound scan of the abdomen, magnetic resonance cholangiopancreatography, and pathohistological research.

Results and discussion. Operative removal of the tumor in parapapillar duodenum area (pancreatic fibrous adenoma), complicated by mild bleeding. On the place of surgery the signs of pathology were absent in month after operation.

Conclusions. The specificity of clinical data and modern diagnostic methods for ectopic pancreatic tissue verification in the duodenum remains low. The method of treatment choice should be surgical removal of tumor followed by biopsy, radical surgery feasible in case of its malignant nature.

Keywords: fibrous adenoma of the pancreas, parapapillar tumor, ectopic pancreas, bleeding.

In the literatures review the problem of acute mesenteric circulation disorders are generalized, the basic moments of a pathogenesis, modern classification are stated. Methods of laboratory and tool diagnostics and treatment of acute disturbances of a mesenteric circulation are surveyed.

Keywords: a mesenteric circulation, an intestine infarct, diagnostics, treatment.

The article provides an overview of domestic and foreign literature on vertebrobasilar insufficiency problem. The anatomical and physiological factors of this disease, as well as diagnostic techniques and the basic directions in the surgical and conservative treatment is highlighted.

Keywords: vertebrobasilar insufficiency, occlusion, stenosis.