The aim – to improve methods and evaluate the effectiveness of mini-invasive surgery for the distal common bile duct (CBD) obturation.

Materials and methods. The study is based on the treatment experience in the period from 2005 to 2010 at the department of laparoscopic surgery and cholelithiasis of 334 patients with of the CBD distal obturation by various origins using mini-invasive surgery. For CBD stenting teflon and nitinol transpapillar implants were used. Before stenting in all cases the endoscopic retrograde pancreatocholangiography, in 70 % of cases – the previous diagnostic atypical papillotomy was performed.

Results and discussion. The use of mini-invasive techniques has allowed to reduce the mortality rate to 2.1 % (7 patients died) and the incidence of complications by 17 % (bleeding occurred in 37 patients, ascending suppurative cholangitis – in 11, acute biliary pancreatitis – 9 patients). The average stent compatibility duration in the treatment group of inoperable patients was 1.2 years.

Conclusions. Our experience of endobiliary stenting using transpapilar endoprosthesis suggests that it is an effective alternative to traditional surgical treatments in incurable cases. Minimal intervention less dangerous and traumatic than laparotomy surgery and accompanied by fewer complications. CBD stenting has greatly improved the life quality in inoperable patients by preserving natural bile outflow way. Nasobiliary drainage in suppurative cholangitis allows to prepare the patient for radical surgery and significantly reduce the patients’s hospital stay time.

Keywords: obstruction of the distal common bile duct, endobiliar stenting, endoscopic papillosphincterotomy

The aim – comparative evaluation of hepatic parenchyma dissection methods.

Materials and methods. A randomized study was conducted in 90 patients who underwent liver resection with a scalpel prior suturing its parenchyma by Vicryl, using radiofrequency coagulator, techniques clamp crushing, ultrasonic (Sonoca 300) and water-jet (Hydrojet) dissector. In no event the dissection was performed in combination with the methods of liver vascular exclusion. Initially intraoperative blood loss at the stage of dissection, duration of dissection, the incidence of complications and their character in the postoperative period were estimated.

Results and discussion. Parenchymal dissection technology by scalpel with previous stitching by block-shaped suture was characterized by a maximum speed of dissection ((4.20 ± 0.54) sm2/min) and maximum blood loss ((7.50 ± 2.05) ml/sm2) compared with radiofrequency dissection ((4.00 ± 0.16) sm2/min and (5.90 ± 0.84) ml/sm2) methodology clamp crushing ((3.60 ± 0.26) sm2/min and (6.80 ± 0, 83) ml/sm2), ultrasonic dissection ((2.20 ± 0.37) sm2/min and (3.40 ± 0.63) ml/sm2) and waterjet dissection ((2.30 ± 0.29) sm2/min and (3.60 ± 0.96) ml/sm2). When using ultrasonic techniques and water-jet dissection the lowest number of patients who needed a transfusion of packed red blood cells was revealed. The level of postoperative complications was highest in groups where hepatic parenchyma suturing (54.5 %) and radio frequency dissection (50 %) were used compared with the methodology of clamp crushing (29.4 %), ultrasound (23.5 %) and water-jet (22.2 %) dissection.

Conclusions. When performing a planned hepatic resection the priority should be given to ultrasonic or jet dissection accompanied by minimal blood loss and the number of postoperative complications. Application methods of slamp crushing appropriate only in conjunction with one of the liver vascular exclusion method. Methods of scalpel parenchyma separation with previous block-shaped suturing and radio-frequency coagulation can be used when performing marginal liver resections, and for certain indications in emergency liver surgery.

Keywords: liver resection, liver dissection, ultrasonic dissection, water-jet dissection, radio-frequency dissection, liver suturing.

The aim – to improve the results of surgical treatment in patients with malignant tumors of the pancreas head and periampullary region by new surgical techniques development and implementation.

Materials and methods. The results of 412 pancreaticoduodenectomies (PDE) in patients with periampullary malignancies in the 2001–2011 years period were analyzed the article. In 296 patients standard PDE was performed, in 116 patients with tumors of the major duodenal papilla and distal common bile duct the pylorus-preserving technique was used. We applied an individualized approach using modern pylorus-preserving PDE technology with gastroduodenal artery preserving, right branch of the selective dorsal pancreatic artery and lower pancreaticoduodenal arteries ligation, posterior and trans-lateral access. In 26 patients the PDE with vascular resection was done. In 30 patients, we used the no-touch PDE. The analysis of the results of a modified extended lymphadenectomy in patients with PDE procedure was performed.

Results and discussion. Complications occurred in 29.5 % of patients, mortality was 2.7 %. Median survival is 24, 38, 72 months in patients with tumors of the pancreas, distal common bile duct and major duodenal papilla, respectively. Introduction of new methods PDE can improve early and late results of the PDE.

Conclusions. Tumor invasion into the portal/superior mesenteric vein is indication for PDE with resection and reconstruction of the vein. The execution of the PDE maintaining gastroduodenal and dorsal pancreatic arteries reduces the incidence of postoperative complications in 14.8 %. The application of selective lower pancreaticoduodenal artery ligation when performing pancreatoduodenectomy was accompanied by a significantly intraoperative blood loss lower rate (mean 120 ml vs. 550 ml with the standard PDE). The developed new approaches and surgical techniques has allowed to increase the radical surgery frequency in patients with cancer of the pancreatic head and periampullary area by 23.8 % and reduce postoperative mortality from 4.9 to 2.7 %.

Keywords: pancreaticoduodenectomу, tumors, pancreas, periampullary area.

The aim – to study the effectiveness and determine the place for the echo-foam-scleroobliteration in the outpatient treatment of the lower extremities varicose veins.

Materials and methods. Echo-foam-scleroobliteration varicose veins in outpatient setting was made in 105 patients with varicose disease aged 32 to 72 years (mean age – (48.6 ± 2.9) years). In 5 (4.76 %) patients an echo-foam-scleroobliteration was performed due to greater saphenous vein (GSV) re-canalization, 72 (68.57 %) due to an isolated form of varicose veins, in 28 (26.67 %) for insufficient perforating veins (PV). A total of 115 procedures on 105 lower extremities were done, 10 of which were repeated, due to the inefficiency of the first procedure.

Results and discussion. Echo-foam-scleroobliteration for recanalized GSV segments have led to a complete and persistent occlusion of the sclerosed areas in all patients. After the еcho-foam-scleroobliteration in unvisualized varicose tributaries the complete occlusion was achieved in all 72 (100.00 %) patients with foam-form insufficient PV – in 24 (85.71 %) patients from 28. Of the 105 patients treated by this method, stable occlusion was achieved in 101 (96.19 %) with a total observation duration of 18 months. The overall complication rate was 5 (4.76 %).

Conclusions. Echo-foam-scleroobliteration in 96.19 % cases leads to permanent occlusion of varicose veins with minimal (4.76 %) complication number.

Keywords: varicose veins, echo-scleroobliteration, insufficient perforating veins, ultrasound angioscanning.

The aim – to examine a possible correlation between the wound healing characteristics in cancer patients and disease clinical course in case of patients with melanoma.

Materials and methods. The wound healing in 472 patients with melanoma after radical surgery was analysed, of whom 157 (33.3 %) patients only surgical removal of melanoma, in 170 (36.0 %) – a combination of radiation therapy with surgery, at 145 (30.7 %) – neoadjuvant chemotherapy, radiation therapy and surgery were performed. Depending on the wound surgical plastic patients were divided into groups: P1 (165 patients) – with the usual wound edges reduction, P2 (62) – with urgent or delayed autodermoplasty, P3 (120) – with plastic skin and fat grafts transposition, P4 (125) – with open wounds with self-healing ointment under bandages or later autodermoplasty.

Results and discussion. In 353 (74.8 %) patients the wound healed without complications, and in the rest wound complications were revealed. In 19.4 % of patients at P1 linear sutures partially gapped in the centre of the scar to form a chronic wound. In the P2 group 21.0 % patients had autodermograft lysis. In 16.7 % patients from P3 group ischemic disorders in transposition flaps were complicated by surface or edge necrosis. In the group P4 infectious complications were observed in 43.2 % of patients. During the follow-up in 64 (13.5 %) patients locoregional recurrence of melanoma was diagnosed. A retrospective comparison of wound healing process with the melanoma loco-regional recurrence emergence showed that patients with prolonged wound healing recurrence rate was 2.55 times higher (46 patients, or 9.7 %) than in patients with uncomplicated surgical wounds healing (18; 3.8 %). In applying the transposition surgical wound plastic methods (group P3) loco-regional recurrence was observed in 5.8 %, in patients with acute or delayed autodermoplasty (group P2) – in 9.4–10.0 %, with the normal edges (group P1) – in 14.5 %, with long-term self-healing wounds (group P4) – in 17.6–24.3 % of patients.

Conclusions. Pathophysiological mechanisms of wound healing in cancer patients have a complicated relationship at the cellular and molecular levels, which almost leveled the distinction between physiological and pathological processes – the repair of wounds, on the one hand, and the initiation of neoplasia – on the other. Based on clinical and morphological studies have established that there is indirect connection between the size of the wound, the healing nature, internal wound metabolic processes and loco-regional melanoma recurrence. The presence of chronic wound healing process is important risk factors for disease recurrence. Loco-regional recurrences of melanoma occur 2.5 times more frequently in patients with chronic wound healing process than in normal wound healing ones.

melanoma, wounds, plastics methods, pathophysiology of wound healing, relapses.

Keywords: melanoma, wounds, plastics methods, pathophysiology of wound healing, relapses.

The aim – to develop a new method in the field of ischial tuberosity bedsores plastic.

Materials and methods. In the period from 2006 to 2012 under observation were 39 patients (30 men and 6 women) aged 21 to 62 years who were operated in regional septic for bedsores in ischial tuberosity area. We have developed a way for gluteal defects area plastic using m. gracilis. In case of severe malnutrition in the area of the operated hip, confirmed histologically, the patient was administered according to standard electrical methods.

Results and discussion. The use of electrical stimulation with electric current selected parameters in the preoperative period causes paralyzed muscles irritation and their contraction. This increases blood flow to the muscles, improves metabolism and nerve conduction in them, so we can deal with muscle atrophy and improve results of bedsores myoplasty. Applications developed by us in surgical treatment of bedsores in the gluteal region through the use of rotary gracilis muscle flap and electrical stimulation was not accompanied by the complications development in the postoperative period. M. gracilis location under the skin in the affected area creates an additional «cushion» of tissue that prevents recurrence of pressure sores. The use of complex treatment method allowed to reduce the risk suppuration in wounds, stitches gapping from 15 to 6 % and shorten the wounds treatment period to 12–14 days.

Conclusions. Developed surgical method application for pressure ulcers treating in the gluteal area allowed to reduce the frequency of pressure ulcers recurrence from 12 to 5.2 %. Atrophied muscles electro-stimulation conducting in preoperative period in paralyzed patients enables to shorten wound treating process up to 12–14 days, to reduce the risk of postoperative complications (wound suppuration, gapping) from 15 to 6 %, which significantly improves the life quality in this patients.

Keywords: buttocks bedsores, graciloplasty, atrophied muscles electrical stimulation.

The aim – to evaluate the clinical efficacy of ciprofloxacin in combination with tinidazole in treatment of purulent necrotic complications in patients with diabetic foot syndrome (SDS).

Materials and methods. The examination and treatment of 105 patients with SDS in the department of surgery in the period from January 2011 to October 2012 was done. Men were 47 (44.8 %), women – 58 (58.2 %). The age of patients ranged from 25 to 78 years (mean – (58.7 ± 6.5) years). There were 47 men (44.8 %), women – 58 (55.2 %) aged 25 to 78 years (mean age 58.7 ± 6.5 years). The defeat of the 1st degree by Wagner classification had 3 (2 %) patients, 2nd – 40 (38.1 %), 3rd – 35 (33.3 %), 4th – 19 (18.1 %), 5th degree – 8 (7.6 %) patients. For the defeat of the 1st degree no antibiotics were administered, patients with 2 nd degree have been treated with the drug Ciprolet A (ciprofloxacin (500 mg), tinidazole (600 mg)) in mode 1 tablet every 12 hours. Duration of treatment was 7–14 days. In patients with lesions 3rd–5th grade the stepwise method antibiotics used – at first antibacterials were administered parenterally, in the future – combined medication for 7–10 days. To evaluate the effectiveness of treatment general clinical, laboratory, biochemical, instrumental, microbiological, statistical methods were used.

Results and discussion. After microbiological research of wound excretion in 47.7 % of patients with DFS monoculture was found, in the rest – microbial associations. In monoculture most frequent representative gram-positive microorganisms was S. aureus (20.6 %), gram-negative flora – P. aeruginosae (16.5 %). On the 5th day of combined drug use reduction of microbial contamination in the wound (p < 0.05) was marked. According to antybiotcogramms, sensitivity to ciprofloxacin was 91.7 %. The positive dynamics of clinical signs of necrotic process was achieved in 90 % of patients with 2nd degree. From the 33 patients with 3rd degree lesions 19 (57.5 %) patients have recovered, the remainder were discharged to outpatient treatment for superficial wounds. In 2 cases with lower extremities obliterating atherosclerosis gangrene of the foot with the transition to the shin has developed. The amputation at the lower third of the thigh was done. It was no mortality.

Conclusions. Conducted clinical and laboratory studies have shown that ciprofloxacin combined with tinidazole (Ciprolet A) had high clinical efficacy in treatment of purulent-necrotic complications in patients with DFS. Combination product containing a fixed combination of ciprofloxacin and tinidazole can be used in the treatment of surgical infections as empiric antibiotic therapy in compliance with the principle of de-escalation antibiotic therapy.

Keywords: diabetus melitus, chronic necrotic complications, diabetic foot syndrome, antimicrobial therapy, ciprofloxacin, tinidazole.

The aim – to examine the nature of inflammation in periulcerosis area and determine their impact on the local endoscopic hemostasis and re-bleeding risk.

Materials and methods. A comprehensive survey of 20 patients with bleeding gastric and duodenal bulb ulcer, which were treated at the center of gastrointestinal bleeding. An immunohistochemical study to determine the activity of inducible NO-synthase (iNOS) was conducted in mucous periulcerosis area.

Results and discussion. In 27 % patients revealed expressed activity of inducible NO-synthase in periulcerosis area: in 40 % of cases with severe blood loss and in 50 % with unstable local endoscopic hemostasis with high risk of re-bleeding.

Conclusions. Data on activity level inducible NO-synthase in the periulcerosis area mucosa allow to predict the nature of the pathological process and improve the therapeutic program.

Keywords: gastric and duodenal ulcers, gastroduodenal bleeding.

The aim – to examine the diagnostic and prognostic values of immune status, cytokine profile and endogenous intoxication in patientswith diffuse generalized peritonitis (GP).

Materials and methods. The study involved 60 patients with GP based on the severity of peritonitis from Mannheim peritoneal index (MPI).

Results and discussion. In patients with GP I severity by MPI in preoperative period changes in the immune status characterized by reduced T-line cells, the level of CD11a, phagocytosis index, phagocytosis ending index, circulating immune complex constant and increased performance of B-cell immunity, CD8, concentrations of proinflammatory cytokines TNF-α, IFN-γ, IL-1, IL-2, IL-4. There was a high level of anti-inflammatory cytokine IL-6 and low content of IL-10. The content of total protein, general and effective albumine concentration, connective albumin ability was significantly reduced. In patients with MPI-II in the preoperative period revealed profound changes in the immune status, cytokine profile, lipid peroxidation-antioxidant protection system with the progression of endogenous intoxication. In patients with GP at MPI-III identified endogenous intoxication syndrome, severe degree of immunodeficiency, multiorgan dysfunction against systemic inflammatory response syndrome. The level of total protein, catalase activity, general and effective albumine concentration, connective albumin ability was reduced compared with normal indices, and C-reactive protein, lactoferrin and ferritin – significantly higher than the control value.

Conclusions. In the generalized inflammation and systemic inflammatory response syndrome played leading role in secondary immune deficiency of cytokine deregulation on endogenous intoxication background. Preservation of high concentrations of SMP, malondialdehyde and IL-6 in peritoneal fluid and blood in the 1st–7th day postoperative period indicates the preserved systemic inflammatory response. Low rates of T-immunity cytokine profile with imbalance on the 7th–14th day postoperative period indicates the presence of immunodeficiency at high risk of septic complications and slow the course of inflammation.

Keywords: peritonitis, immune status, cytokine profile, endogenous intoxication.

The aim – to analyse the operations that are performed in the emergency surgery for acute appendicitis and associated cysts and ovarian apoplexy.

Materials and methods. In the surgical department from 2009 to 2011, 199 patients who were hospitalized for acute appendicitis were operated on, among them were 129 (64.8 %) women. The study group included 41 women. The women were aged from 16 to 42 years (mean age – (27.45 ± 6.72) years). In 37 (31.8 %) patients simultaneous operations for acute appendicitis and co-morbidity ovaries were performed. In 4 (3 %) patients, the appendix had no changes and therefore it was not removed.

Results and discussion. The proportion of patients with concomitant diseases of the ovaries from all patients hospitalized with acute appendicitis, was 33.3 %. The disease was detected mainly in women under the age of 25 years (76 %). It was no differences in clinical acute appendicitis and ovarian apoplexy, which is not accompanied by a significant loss of blood, but Volkovych-Kocher symptom was found in patients with acute appendicitis in 45.5 % of cases, and in patients with apoplexy and more than 400 ml blood loss were more prevalent symptoms of intra-abdominal haemorrhage. When ovarian cysts rupture appendicitis mostly secondary catarrhal changed. As the inflammatory process in the appendix can progress, as indicated by 29.5 % of patients in phlegmonous appendicitis, whose dynamics in the postoperative period is difficult to track, even in the presence of secondary inflammatory changes in the walls of the appendix should always perform appendectomy.

Conclusions. The proportion of patients with concomitant diseases of the ovaries from all patients hospitalized with acute appendicitis, was 33.3 %. The disease is mainly detected in women under the age of 25 years (76 %), which, in our opinion, has structures maturity insufficiency results in unregulated sexual function. Despite of patients’ age the pathological process is often localized in the right ovary part (65.4 %). The surgical access suggested by us is suitable for intraoperative pelvic revision, gynaecological operations and cosmetic effect.

Keywords: appendicitis, ovarian apoplexy, surgical treatment.

The aim – to improve the complex treatment efficiency in patients with purulent-necrotic complications of diabetic foot syndrome (DFS) by intraarterial administration of drugs.

Materials and methods. The observation involved 62 patients aged 42 to 74 years with type 2 diabetes mellitus and DFS purulent necrotic complications stage III–IV by Vagner classification and who had the magisterial arteries primary lesion. Patients were randomized into two clinical groups: 1st – 22 (35.5 %) patients who had used the intraarterial injection of drugs, the 2nd group – of 40 (64.5 %) patients who were administered drugs intravenously and intramuscularly.

Results and discussion. Patients in 1st group compared with the control group on the third day experienced fewer pain syndrome by 22 %, increased body temperature – 37.6 %, tachycardia – 31 %. On day 10, patients in Group 1 rarely complained about pain and tachycardia than those of the 2nd (55.7 and 21.3 %, respectively). During the first ten days of hospitalization high amputation performed in 1 patient (4.5 %) patients in group 1 and 4 (10 %) – in the 2nd if indicated.

Conclusions. Intraarterial injection of drugs in patients with DFS purulent-necrotic complications promotes more rapid regression of clinical symptoms, which reduces hospital stay by 21.4 % and to reduce the major amputation frequency by 5.5 % compared with conventional treatments, so reduces the disability rate in these patients.

Keywords: diabetes mellitus, chronic necrotic complications of diabetic foot infections, intraarterial injection of drugs.

The aim – the study venous and liquor components of intracranial pressure (IP) in patients with the benign intracranial hypertension syndrome (BICHS) during carotid endarterectomy performance, to evaluate IP pharmacological correction by venous drainage improving to prevent cerebral hyperperfusion syndrome (CHPS).

Materials and methods. On the basis of clinically and instrumentally confirmed BICHS 60 patients aged 40 to 65 years (mean age – 55 years) were involved in the study who were treated in the vascular unit. Venous outflow from the cranial cavity examined by sonography in two-dimensional and Doppler modes, allowing to evaluate the morphological changes in blood vessels, functional blood flow parameters. Pharmacological correction of venous tone in patients with IP signs conducted with combined medication Normoven (diosmin with hesperidin (DH), Kyiv Vitamin Plant) at a dose of 500 mg twice a day every 12 hours for 14 days. Patients were divided into two groups: control – 30 patients who did not receive drugs in the preoperative period and the basic group – 30 patients treated with DH within 1 month before surgery.

Results and discussion. Rapid normalization of venous-liquor parameters were observed in the group of patients who, in addition to standard medical therapy, used DH.

Conclusions. Venotonics application improves venous outflow from the cranial cavity by reducing venous and liquor constituents in patients with BICHS during carotid endarterectomy. It is appropriate to include venotonics in the complex treatment of patients with CHPS.

Keywords: intracranial pressure, benign intracranial hypertension syndrome, carotid endarterectomy, diosmin with hesperidin.

The aim – to study the structure of postoperative intraabdominal complications and analysis of laparoscopic correction method results.

Materials and methods. The treatment results in 187 patients 16–85 (101 man, 86 women), operated on the organs of abdominal region and retroperitoneum, which had intraabdominal complications in postoperative period were analyses. Depending on the treatment methods two groups of patients were identified: 1st group (basic) – 75 patients treated with mini-invasive technology, 2d (control) – 112 patients where relaparotomy was executed. Endovideosurgery was conducted using laparoscopic trocar racks, kits and instruments by «Karl Storz». abdominal ultrasound, x-ray and endoscopy, general clinical and biochemical analyzes of blood, urine and abdominal effusion was performed in all patients.

Results and discussion. As postoperative complications intestinal obstruction and abdominal abscesses were often recorded. Most from complications were infectious in nature. In 7 cases in the early postoperative period were intraperitoneal bleeding in 2 – bleeding from the liver parenchyma, 2 – bleeding wounds in the location and drainage trocar, 2 – bleeding from cystic artery (after cholecystectomy) in 1 – from omentum stump, damaged spleen. Laparoscopic hemostasis successfully performed in 6 patients. Intestinal obstruction in 53 cases had postoperative adhesions in nature, 3 – arose from strangulation of the small intestine in the parietal peritoneum, volvulus, intestinal stricture and anastomosis. Most adhesions observed after surgery for destructive appendicitis with peritonitis – in 16 (8.55 %) patients.

Conclusions. Laparoscopic surgery is not only an additional diagnostic method for postoperative complications but also effective minimal-invasion treatment method based on contraindications. Laparoscopic in a postoperative period can appear the final treatment method for most postoperative complications, including such, as peritonitis and intraabdominal bleeding.

Keywords: postoperative complications, laparoscopic, laparotomy, treatment efficiency.

The historical and practical aspects of modern treatment of inguinal-femoral hernia is highlighed. The questions about need for non-tension hernioplasty methods and place of each of them in hernia surgery are still controversial. There is still no optimal classification of inguinal hernias, without which it is not possible to personalize and unify the surgical approach. Tension are the main methods in the surgical treatment of femoral hernia, the results of applying the non-tension «plug» method by domestic surgeons can not be specified because of the few publications. There is no tactical doctrine when considering treatment of inguinal hernias, and the views of various authors on the advantages and disadvantages of modern methods of surgical plastic of inguinal and femoral hernias are contradictory, indicating the absence of the developed technique in this disease treatment, which would be consistent with the requirements of the present day.

Keywords: hernia of inguinal-femoral area, hernioplasty, elderly and senile patients.

A case of successful surgical treatment of patients with locally common squamous micro-carcinoma in right lung with germination in the left atrium is described. Under cardiopulmonary bypass the right-sided pulmonectomy, lymphodissection, mediastinal resection of left atrium with its subsequent plastic was performed. Postoperative period ran smoothly. The patient was investigated 9 month later – no signs of tumor recurrence was diagnosed.

Keywords: squamous lung carcinoma, pneumonectomy, atrium resection.

The aim – to develop a new way of suspended loop colostomy forming, which would help reduce the number of postoperative complications and cases of cutaneous stoma displacement in the abdominal cavity.

Materials and methods. Under the supervision were 8 patients who were operated by suggest way of forming suspended loop colostomy.

Results and discussion. In all cases, complications such as skin maceration and stoma displacement in the abdominal cavity were not observed. It was possible to shorten the hospital stay and expedite the return of patients to active (preoperative) life.

Conclusions. The proposed colostomy technique allows reduce postoperative complications and skin stoma displacement in the abdominal cavity.

Keywords: protective colostomy, inflammatory skin complications, supporting device.