The aim — to develop, manufacture and to perform the practical device testing for low-energy laser irradiation of deep wound channels, cavities and foreign bodies diagnosis in the mobile condition.
Materials and methods. The developed device consists of a housing, which houses the power source, a laser diode and a power button, and a connector that allows to use of various interchangeable tool accessories. The device was used in the examination and treatment of 312 injured with soft tissues gunshot wounds.
Results and discussion. The developed device has shown to be effective when used in diagnostic (soft tissue transillumination, wound channel assisted visual inspection) and treatment (laser therapy, photodynamic therapy) techniques.
Conclusions. The developed device application allows to efficiently perform the deep wound channels, cavities irradiation, and foreign bodies diagnose. It is advisable to equip by designed device the surgical military and civilian medicine mobile units.

Keywords: mobile laser device, wounds radiation.

The aim — definition of the main mechanisms of formation and clinical course of pronation foot deformity in different age groups at the children with a cerebral palsy.
Materials and methods. The data obtained from treatment of 68 patients aged from 2 till 16 years were analyzed. In all cases deformation of foot was noted bilateral pronation foot deformity. Clinical methods included definition of a position of a calcaneal bone (valgus, an equines deformity in degrees), the pronation of foot and forefoot abduction, a condition of the longitudinal arch at loading and in a prone position. Degree of mobility of foot was determined by coefficient.
Results and discussion. Depending on nature of changes of foot shape has been allocated three variants of pronation foot deformity. Equines plano-valgus deformity — a combination of an equines deformity of a calcaneal bone (displacement of its rear in a proximal direction) with the pronation of foot and forefoot abduction. Plano-valgus deformity — the pronation of foot is combined with forefoot abduction and a valgus abduction of a calcaneal bone. At the third variant the main component of deformation is the pronation of foot in talocrural and subtalar joints. Abduction of the forefoot is not present or poorly expressed at loading.
Conclusions. Plano-valgus deformity of foot is a heavy complication of cerebral spastic infantile paralysis that causes violation of a statics and locomotion walk, increases motive insufficiency. Depending on the character of a muscular imbalance, a condition of the ligaments, speed of progressing of deformation allocate three variants of its development. Clinical course pronation foot deformity is caused by the age of patients, body weight and physical activity.

Keywords: pronation foot deformity, children, cerebral palsy, plano-valgus deformity.

The aim — to improve the surgical treatment results in patients with obesity and anterior abdominal wall ptosis for chronic calculous cholecystitis after early surgeries on upper abdomen organs, to develop the laparoscopic surgery technique for these patients.
Materials and methods. The treatment results analysis of 18 patients with obesity, anterior abdominal wall ptosis, chronic calculous cholecystitis, and previous abdominal organs surgery after cholecystectomy and lipodeormectomy has been conducted. All women were aged 39 to 67 years, mean age 53.9 ± 1.8 years. Concomitant somatic pathology was observed in all patients. Depending on the specific technical surgery, the patients were divided into three subgroups. In  subgroup 1 (n = 7) traditional open cholecystectomy was followed by lipodermectomy. In subgroup 2 (n = 5) laparoscopic cholecystectomy was followed by lipodermectomy. In  subgroup 3 (n = 6) — dermal-fat flap separation was performed before cholecystectomy through aponeurosis-muscular layer punctures (under the flap) followed by lipodermectomy via original developed laparoscopic method. The treatment results have been evaluated for surgical site infection rate (SSI), intraoperative complications type, as well as the remote postoperative complications frequency.
Results and discussion. In the first subgroup, the SSI was noted in 5 patients (71.4 %) (in 4 patients — superficial (wound) SSI, in one — the deep SSIs (infiltration in subhepatic space)). In all cases, these complications were treated with the conservative methods. In the second subgroup, the SSIs occurred in 4 (80.0 %) patients, in all cases the wound inflammation was observed. In the third subgroup, the SSIs was noticed in 1 patient (seroma wound in lipodermectomy zone). In 1 (20 %) patient of subgroup 2, with concomitant coronary heart disease, atrial fibrillation occurred intraoperatively, that was the reason for the conversion and in 2 (40 %) patients the arterial hypertension was revealed for 2 — 3 days after surgery. In the remote three-years postoperative period the persistent pain in the right abdomen associated with adhesive disease were observed in 1 (14.3 %) patient after conventional cholecystectomy. Postoperative hernia was observed in one (14.3 %) patient after abdominal surgery and postoperative trocar hernia after standard cholecystectomy — in two.
Conclusions. The new original laparoscopic cholecystectomy in patients with obesity, anterior abdominal wall ptosis and the abdominal cavity adhesions allows to perform adhesiolysis without significant trauma interventions before the main surgery stage, to reduce the intra- and postoperative complications incidence from 75.0 % to 16 7 % (p = 0.019), reduce the adhesions recurrence risk complications, thereby improving the patient’s quality of life.

Keywords: chronic calculous cholecystitis, laparoscopic cholecystectomy, obesity, ptosis of the anterior abdominal wall.

The aim — to evaluate the treatment results in patients with complicated purulent peritonitis after intraoperative abdominal sanitation with physiological saline solutions, 0.02 % decametoxine solution and medical bacteriophages.
Materials and methods. The treatment results of 306 patients (248 women (81 %) and 58 men (19 %) aged 36 — 84 years) with acute destructive cholecystitis complicated with purulent peritonitis after laparoscopic cholecystectomy have been analyzed. The number of patients with local purulent peritonitis was 270 (88.2 %), with diffuse purulent peritonitis — 36 (17.8 %) persons. Patients were divided into three groups depending on the applied solution. A saline solution was applied in the first group (comparison group 1, n = 54) after laparoscopic cholecystectomy. Physiological saline solution and 0.02 % decametoxine solution was applied in the second group (comparison group 2, n = 144). The third group (main group, n = 108) included patients after sanitation with therapeutic bacteriophages.
Results and discussion. Application of bacteriophages for abdominal cavity sanitation allowed to reduce the incidence of postoperative intra-abdominal inflammatory complications from 5.6 to 1.9 % and wound complications from 13 to 3.7 % compared to group with saline solution application: from 4.9 to 1.9 %, from 11.1 to 3.7 % compared to the group with saline solution and 0.02 % decametoxine solution application.
Conclusions. Therapeutic bacteriophages application during laparoscopic cholecystectomy for the abdominal cavity and trocar wound sanitation in patients with acute destructive cholecystitis, complicated by purulent peritonitis, is appropriate and effective. Bacteriophages usage allowed reducing postoperative intraabdominal inflammatory complications by 2.9 times and wound — 3.5 times compared to the group with saline solution application, and by 2.6 and 3 times next to the group with saline solution and 0.02 % decametoxine solution application.

Keywords: acute destructive cholecystitis, laparoscopic cholecystectomy, purulent peritonitis.

The aim — to improve the diagnosis and treatment results in patients with intestinal bleeding.
Materials and methods. The study examined the diagnosis and treatment of 98 patients with small intestinal bleeding, managed in surgery and proctology departments during the period from May 2013 to December 2015. Among the patients there were 62 men (65.2 %), women — 36 (34.8 %) aged 16 to 76 years, mean age was 45.3 ± 1.3 years. Capsule system OMOM and enteroscop Pentax VSB-2990i were used for the study. The patients were divided into 3 clinical groups according to the advanced algorithms of acute gastrointestinal bleeding diagnostics and treatment. Group I included patients with clinical signs of bleeding, a group II — patients with severe symptoms of anemia, but without any apparent clinical and laboratory signs of bleeding, group III — patients with established (by anamnestic and objective evidence) fact of gastrointestinal bleeding but with mild or moderate clinical manifestations of post-hemorrhagic anemia.
Results and discussion. The erosions have caused small intestinal bleeding in 33.67 % cases, ulcers — in 24.49 %, vascular pathology (angiectasia, varicose veins of the small intestine, arteriovenous malformations, etc.) — in 24.49 %, small bowel tumors — in 10.2 % cases. Ulcers were the most common cause of bleeding in group I (49.9 %), in 6 cases as a result of taking medication and 4 inflammatory ulcers. The second highest rate was due to vascular changes — in 6 patients (27.2 %). Erosions triggered bleeding — in 5 patients (22.7 %). There were no tumors revealed in this group. In the second group erosions were a common cause of bleeding (31.03 %) in almost every third patient, as well vascular pathology was the second highest rate — 27.6 %. Neoplasms took the third place (20.7 %). In contrast to the first group, ulcers were detected in 13.8 % of patients only. Although, in the third group erosions were the leading cause of bleeding (40.4 %). Ulcers and vascular pathology have distributed with almost the same tendency — 19.1 % and 21.3 %, respectively. Neoplasms in this group were the least common cause of bleeding. Identified data allowed to work out a differentiated approach for the treatment tactics.
Conclusions. Videocapsule enteroscopy allows to accurately determine the source and cause of small intestinal bleeding and evaluate its intensity. Double-balloon enteroscopy application not only has the capabilities for both effective and minimally invasive hemostasis, and tumors diagnosis and removal.

Keywords: small bowel bleeding, videocapsule endoscopy, double-balloon enteroscopy.

The aim — to study the antimicrobial activity of the developed nanosilver-mineral-based composite in relation to hospital infections pathogens and its compliance with the medical requirements.
Materials and methods. The composite based on kaolin medication Kremnevit and silver nanoparticles (AgNP) was investigated. The size measuring and form definition of AgNP and kaolin particles was performed using  penetrating electron microscope, stability of composite water suspension — with the ZetaSizer-3 spectrometer, silver concentration — by the atomic-emission spectroscopy method. Antimicrobial activity was determined for E. coli, P. aeruginosa, S. aureus and C. albicans. Simulation of organic contamination was performed by 0.3% bovine serum albumin. The time of observation: 2, 4, 6, 24, 48 h and 7 days.
Results and discussion. The size of nanoparticles Kremnevit from 60 nm to 140 nm, which allows to relate the drug to the natural nanoob CTU. Electron microscopic image of silver nanoparticles adsorbed on particles Kremneva spherical shape and sizes from 14 to 61 nm. Bactericidal concentration of silver nanoparticles for E. coli was 0.07 µg/ml, for P. aeruginosa – 0.07 µg/ml, C. аlbicans – 0.017 µg/ml, and S. аureus — 0.27 µg/ml. Protein load led to an increase in the minimum effective concentration of drug from 2 to 10 times.
Conclusions. A high antimicrobial activity of the composite and AgNP, obtained structure stability, curative kaolin and silver and properties allow to recommend further study of the composite for the prophylactic and treatment agents development for external and internal use in medicine, biology and various industrial branches.

Keywords: silver nanoparticles, kaolin (China clay), Kremnevit, antimicrobial effect, physical properties.

The aim — to justify the simultaneous omentectomy as cytoreductive phase in metabolic syndrome treatment.
Materials and methods. The study involved 50 patients with metabolic syndrome (MS) and obesity (O). The patients were divided into two groups. The first group included 25 people who underwent abdominal and/or pelvic surgery, the second group — 25 people with similar surgeries followed by simultaneous omentectomy. During pre- and postoperative period the levels of glucose and insulin in the blood plasma were measured in addition to routine examinations. Insulin resistance (IR) was judged on the HOMA index basis.
Results and discussion. The theoretical pathological efficiency justification of simultaneous omentectomy in patients with abdominal surgery has been proved. It was revealed that the blood glucose level did not reflect a carbohydrate metabolism abnormality. Despite normal glucose level in 88 % of patients, and insulin in 60 % — IR was detected in 92 %, while the rate was exceeded, on average, in 69.9 %. After simultaneous cytoreduction of visceral fat by omentectomy the IR had been detected already in 64 %, while IR severity decreased by an average of 44.91 %. The studies have demonstrated a hyperinsulinemia manifestations and IR severity reduction after greater omentum debulking.
Conclusions. Metabolic debulking (simultaneous omentectomy) should become a routine step in the surgical benefits in patients with MS and O. However, simultaneous omentectomy should be considered to be a palliative treatment, and give preference to bariatric surgery. The criterion of carbohydrate metabolism disorders is the insulin resistance index, but not a blood glucose level.

Keywords: metabolic syndrome, obesity, omentectomy, insulin resistance.

The aim — to improve the surgical treatment results in patients with colon diseases by prediction methods improvement, targeted prevention and anastomotic leak treatment.
Materials and methods. A prediction and prevention method were developed, treatment strategy for anastomotic leak after colonic reconstructive surgeries was improved. The method of prediction and prevention is based on determining complications risk factors and targeted preventive measures adequate to specified risk factors application. Treatment strategy improvement included the surgical intervention choice depending on the particular intestinal anastomosis location in the abdominal cavity and the clinical course of complications. With the implementation of this method there has been operated 138 patients with colon diseases.
Results and discussion. Developed methods helped to reduce the frequency of anastomosis sutures failure after colonic operations to 2 (1.4 %) and postoperative mortality to 1 (0.7 %). Improved surgical results achieved mainly through targeted preventive measures: mechanical cleaning of the colon, the selection of the intestinal anastomosis formation method, bowel segments join type with modern circular staplers, designed single-row everted intestinal suture, the most technically complicated colon-endoanal and ileo-endoanal anastomoses, bowel segments dislocation in other anatomical abdominal parts, protective ileostomy or colostomy forming, correction of anemia, hypoproteinemia, rheological blood properties and tissue perfusion.
Conclusions. The essential pre-operative stage for recovery colonic surgery should be targeted forecasting and prevention of the most difficult and dangerous postoperative intra-abdominal complications — intestinal anastomosis suture failure. This prognostic method of colonic anastomotic leak after restorative operations, prevention methods, improved treatment strategies helped to reduce the incidence of these complications to 2 (1.4 %) and postoperative mortality to 1 (0.7 %).

Keywords: colonic anastomotic leak, prediction, prevention, treatment.

The aim — to improve the surgical treatment results for pilonidal cyst by Bascom II procedure (cleft lift).
Materials and methods. The radical surgical treatment results of the 25 patients with pilonidal cyst in the proctology center during 2015 — 2016 years have been analyzed. Among the patients there were 21 men (84 %) and 4 women (16 %). Average age of the operated persons was 27.76 ± 1.13 years.
Results and discussion. During the postoperative period the complications were not observed. The in-patient period lasted up to 5.76 ± 0.20 days. The out-patient period of treatment lasted up to 15.32 ± 0.25 days. Total disability duration was up to 21.08 ± 0.34 days. During 18 months, the relapses were not observed.
Conclusions. The problem of pilonidal cyst cure has an important social and economic value because patients are usually young persons of working age (27.76 ± 1.13 years). Method of pilonidal cysts excision by Bascom II procedure is simple to implement and provides a complete cure with minimal risk of recurrence.

Keywords: pilonidal cyst, epithelial coccygeal course, radical surgical treatment, Bascom’s procedure, cleft-lift procedure.

The aim — to study the histological changes in different diameters veins under the influence of laser coagulation using the radial and end optical fibres.
Materials and methods. The study included 30 patients (19 (63.3 %) women and 11 (36.7 %) males) aged 22 to 55 years (mean age — 38.9 ± 1.6 years) with varicose veins disease (VVD) of lower limbs. Patients underwent endovasal laser coagulation (EVLT) of the great saphenous vein with radial (group R, n = 15) and end (group E, n = 15) optical fibers with a capacity of radiation 15 and 8 W, respectively and a wavelength of 1470 nm. Accordingly, the Class II chronic venous disease by CEAP classification were 8 (26.7 %) patients, III class — 10 (33.3 %), IV class — 7 (23.3 %), V class — 5 (16.7 %). Per gender, age, class of the CEAP, the groups were comparable. EVLT were completed with mini-phlebectomy by Muller, during which the great saphenous vein segment of 3 cm in length and 0.5 to 1.4 cm in diameter was resected for histological examination. result was considered excellent when burning was done through the all wall layers, or endothelium and media around the veins perimeter, good — through the vein’s wall within all or endothelium and media over 3/4 of the perimeter, unsatisfactory — no burning or burning through the 1/4 vein’s perimeter, the other cases are attributed to a satisfactory.
Results and discussion. In Group R was no unsatisfactory EVLT results in contrast to the group E, a smaller proportion of satisfactory results (4.0 and 12.0 %, respectively) and a large proportion of excellent results (86.7 and 57.3 %, p < 0.001). EVLK efficacy decreased with increasing vein’s diameter in both groups. The group E if vein’s diameter was less than 1 cm poor results has been observed, satisfactory results proportion was 5.7 %, in 22.5 % of patients with the vein diameter from 1 cm to 1.4 cm an unsatisfactory result and satisfactory results increased proportion (17.5 %) were marked. In group R the proportion of the incomplete vein ablation was 5.7 % with 0.5 — 0.9 cm diameter and 17.5 % — with 1.0 — 1.4 cm diameter.
Conclusions. EVLT efficiency for great saphenous vein 0.5 to 1.4 cm in diameter with mechanical fiber inferior to that with radial fiber: burning through all vein’s layers or the endothelium and media takes place in 82.6 and 97.3 %, respectively (p < 0, 05), burning through the 75 % veins in perimeter and more — in 78.6 and 96.0 % of cases (p < 0.05). With the increase in vein’s diameter the burning depth decrease after application of mechanical (r = –0.460) and radial (r = –0.333) optical fibers and a burning perimeter portion (r = –0.478 and r = –0.333, respectively). When using radial fiber were no cases of the absence of the vein’s wall burning and vein perimeter less than 50 % burning, whereas with mechanical fiber the frequency of such cases was respectively 5.3 and 10.6 %.

Keywords: radial and end optical fibres, laser coagulation of veins, varicose veins disease of lower limbs.

The aim — to analyze the results of bare-tip and radial laser fibers’ use while endovenous laser ablation in varicose vein disease treatment.
Materials and methods. The study included 423 patients aged from 18 to 84 years, who underwent surgical treatment for from 2013 to 2016. The research included 342 women and 81 men. In terms of chronic venous insufficiency, per the CEAP international classification, patients were distributed in such a way: C2 — 211 patients, С3 — 170, С4 — 31, С5 — 2, active open trophic ulcers C6 — 9. Patients of the group one (n = 248) underwent endovenous laser ablation (EVLA) of the GSV’s or MSV’s trunk on the femur using two-ring radial fiber (Biolitec laser, the wavelength of 1470 nm and the power of 10 — 12 watts) and Muller’s mini-phlebectomy on the femur and crus. Group two patients (n = 175) were subjected to proximal and/or distal crossectomy followed by endovenous laser ablation (EVLA) using bare-tip fiber (Dornier laser, the wavelength of 940 nm and the power of 10 — 12 watts) and Muller’s mini-phlebectomy modification on the femur and crus.
Results and discussion. In  group one we managed to achieve obliteration of the GSV’s trunk in 248 patients (100 %) with no additional interventions, and in  group two it was achieved in 161 (92 %) patients. In 14 patients of  group two (8 %) recanalization of the trunk occurred, and among them only in 9 cases vertical reflux was diagnosed using duplex sonography. These 9 patients required performing a secondary surgical procedure (stripping), after which we reached the elimination of vertical and horizontal refluxes in all patients. There was no evidence of deep-vein thrombosis in both groups.
Conclusions. In case of performing EVLA using laser apparatus with two-ring radial fiber there is no need in crossectomy and, compared to the bare-tip fiber, there is a significantly lower risk of such complications as varicose veins recurrence, subcutaneous hematomas, a sense of a strand along the GSV’s or MSV’s trunk, whereas the risk of skin pigmentations is higher.

Keywords: great and small saphenous veins, endovenous laser ablation, bare-tip and radial laser fiber, proximal and or distal crossectomy, laser crossectomy.

The aim — to improve the surgical treatment results in patients with post-burn elbow deformations by the expanding of extended lateral arm and forearm perforator-based flap.
Materials and methods. The study was included both anatomical and clinical aspects. Gross anatomy study of the arm and forearm, blood flow sources and vascular topographical options identification, surgical specific technique of forming and transposition of extended lateral arm and forearm perforator-based flap was carried on 10 upper extremities in 5 male’s and female’s cadavers aged from 43 to 72 years. Clinical material part involved 12 patients aged from 7.5 to 46 years. All patients underwent elbow reconstruction by expanded extended lateral arm and forearm perforator-based flap. Total amount of expanded flap was 12.
Results and discussion. The possibility of joint expansion by forearm tissue accession to lateral arm surface tissue and elbow with significant flap size increasing, as well as the permanent perforating vessels and nerves inclusion has been explored. The ability for flap re-movement with neurovascular relationships with donor site preservation and its primary closing was identified.
Conclusions. During the reconstruction of post-burn elbow joint deformities with upper limb outer intact skin the expanded and extended arm and forearm perforator based on flap should be used. This treatment allows to achieve good results in 75 % and satisfactory in 25 % of cases in the early period, and in 77.6 % and 22.4 % cases in the remote period respectively.

Keywords: post-burn elbow deformities, tissue expansion, extended lateral arm and forearm perforator-based flap.

Leiomyoma is rare esophageal pathology and at the same time the most common gullet benign tumor. Clinical manifestation depends on the tumor size. Differential diagnosis with gastrointestinal stromal tumor (GIST) presents some difficulties. Treatment is surgical — the tumor enucleation. The article describes diagnosis, differential diagnosis methods and surgical specifics for esophageal leiomyoma in chest part. Two cases of this pathology treatment are described.

Keywords: leiomyoma, esophagus, enucleation, submucosal tumor.

In this article there is shown the complex treatment effectiveness in patient with defect scars, deformation and defect of mammal glands after massive thermal burn by the modern reconstructive surgery methods: expander dermotension, Z-plastics, free autodermoplastics, xenoplastics, dermabrazy, new artificial areolas and nipples forming.

Keywords: scars, breast, dermotension, breast reconstruction, expanders, thermal trauma, treatment, autodermoplasty.

Intraabdominal adhesions are a widespread complication after all surgical interventions in the abdominal cavity and small pelvis. This process does not only cause bowel obstruction, but also such complications as female infertility and chronic abdominal pain. Adhesiogenesis further leads to a significant impairment of patient’s quality of life and technical difficulties during the next surgeries. The pathogenesis of the mentioned process is complex, interactions of all pathological pathways have not been comprehensively studied yet to develop an effective therapeutic measures algorithm. The present paper contains a macro- and microscopic classification of adhesions, modern opinions regarding the pathogenesis of the disease, an analytic review of the studies evaluating different methods of adhesion preventions.

Keywords: adhesion, bowel obstruction, fertility, hyaluronan, anti-adhesion barriers.

The analysis of antibiotic resistance dynamic of main pathogens causing severe intra-abdominal infections in patients treated in Institute of General and Emergency Surgery during 2012 — 2015 years is performed in the article. The «microbiological passport» of clinic in general as well as each department was created, based on permanent monitoring of the microflora detected in patients. Epidemiological data on the prevalence and antimicrobial resistance of bacterial pathogens with certain localization was used for prescribing antibiotics for the initial treatment of intra-abdominal infection. With respect to the growing Gram-negative pathogens antibiotic resistance, particularly of the main pathogens causing intra-abdominal infections to cephalosporins of III and IV generation and their high sensitivity to protected ceftriaxone (Sulbactomax) prescribing of III generation cephalosporins protected with sulbactam (Sulbactomax and Norzidim — ceftazidime and sulbactam) in initial antibacterial therapy for mild and moderately severe intra-abdominal infections seems to be perspective. For the treatment of severe intra-abdominal infections, abdominal sepsis using of Norzidim in combination with an aminoglycoside and antianaerobic antimicrobial drug or protected cephalosporin of IV generation (Norfepim) even in monotherapy should be used for initial treatment. Norfepim was mentioned as a «reserve» antimicrobial drug for the treatment of nosocomial infections in the ICU.

Keywords: antibiotic resistance, intra-abdominal infections, antibacterial therapy, Sulbactomax, Norzidim, Norfepim.

Contemporary literature data revealing the basic components of diagnostic and therapeutic doctrines in patients with non-varicose upper gastrointestinal bleeding have been collected and summarized. The structure of etiological factors and lymphoma disease that led to non-varicose gastrointestinal bleeding and the place of conservative and surgical methods of comprehensive treatment strategy was disclosed.

Keywords: acute surgical pathology, gastrointestinal bleeding, digestive tract.