The aim — to evaluate the modern treatment methods effectiveness for gunshot fractures of limb bones.
Materials and methods. The treatment results of 237 patients with long bones gunshot fractures that were treated in the trauma departments in the period from 01.03.2014 to 01.03.2016 were analyzed. The tactics of surgical care for gunshot fractures with the help of VAC-therapy and ultrasound wound debridement (UAW) was used. Patients were divided into two groups: study (n = 119) and comparisons (n = 118): the patients of the main group used surgical treatments according to the standard protocol always together with negative pressure therapy (VAC-therapy) or ultrasound debridement (both the single method and in combination with negative pressure therapy), the comparison group patients were treated by  surgery and in some cases with negative pressure therapy. The age of patients was from 21 to 43 years. All patients were men.
Results and discussion. After 1 — 1.5 years after treatment, complications such as chronic osteomyelitis, pseudoarthrosis, and contractures of large joints were noted in patients of both groups. Patients of the stuy group had a decrease in the complications rate such as pseudoarthrosis (by 2.6 %), chronic osteomyelitis (4.2 %) contracture (by 12.0 %) compared to patients in the comparison group.
Conclusions. A well-founded and timely replacement of the fixing gunshot fractures method for long limb bones allows the implementation of an individual medical rehabilitation program that will ensure an optimal functional result. Treatment of gunshot fractures of long bones should be conducted with a differentiated approach to the choice of surgical tactics, depending on the nature and location of the lesion.

Keywords: gunshot wounds of extremities, surgical tactics, ultrasound wound debridement (UAW), VAC-therapy.

List of references:  
1.    Bejdik OV, Kotel’nikov G. P., Ostrovskij NV. Osteosintez sterzhnevymi i spicesterzhnevymi apparatami vneshnej fiksacii: Monografiya. Samara: Perspektiva, 2002:28 (Russian).
2.    Brizhan’ L.K. Sistema lecheniya ranenyh s ognestrel’nymi perelomami dlinnyh kostej konechnostej (kliniko-eksperimentalnoe issledovanie): Avtoref. dis. doktora med. nauk: spec. 14.01.17, 14.01.15 D 215.009.01. M.: Gos. in-t usovershenstvovaniya vrachej MO RF, 2010:33 (Russian).
3.    Gordienko DI, SHmidt IZ, Litvina EA. Intramedullyarnyj blokiruyushchij osteosintez pri lechenii otkrytyh perelomov goleni. Vestn. Ros. gos. med. un-ta. 2003;5:34-38 (Russian).
4.    Zaruckij YA. L. Vkazіvki z vіjs’kovo-pol’ovoyi hіrurgіyi. K.: VSV Medicina, 2014:752 (Ukrainian).
5.    Myakota AV. Zakrytyj blokiruyushchij intramedullyarnyj osteosintez diafizarnyh perelomov kostej goleni: Avtoref. dis. kand. med. nauk: 14.00.22. M., 2003:23 (Russian).
6.    Homutov VP, Gricanov AI. Vozmozhen i dostupen li vnutrennij osteosintez otlomkov pri ognestrelnyh perelomah dlinnyh kostej. Evolyuciya osteosinteza: Sb. nauch. tr. SPb, 2012:37-47 (Russian).
7.    Shapovalov VM. Ognestrel’nyj osteomielit: monografiya. Morsar,, 2000:142 (Russian).
8.    Bartlett C et al. Gunshot wounds to the extremity. Encyclopedia of Trauma Care. 2015:703-707.
9.    Franke A et al. Treatment of gunshot fractures of the lower extremity: Part 2: Procedures for secondary reconstruction and treatment results. Der Unfallchirurg. 2014;117(11):985-994.
10.    Ibrahim AM.S., El Hajj M, Saliba A et al. Fracture patterns following gunshot wounds to the upper extremity. Plast. Reconstruct.Surg. Glob. Open.— 2016.— 4 (suppl. 9).
11.    Sathiyakumar V et al. Gunshot-induced fractures of the extremities: a review of antibiotic and debridement practices. Curr Rev Musculoskelet Med. 2015;8(3):276-289.
12.    Volna A. The evolution of the principles and philosophy АО/ASIF. The path of 50 years. Orthopaedics, Traumatology and Prosthetics. 2013;N 2:89-96.

The aim — to evaluate the laparoscopic and open adrenalectomy results in patients with adrenal tumors.
Materials and methods. The results of 148 patients with adrenal tumors after adrenalectomy during the period from 2001 to 2016 has been studied. The average age of the patients in study was 42.7 ± 5.8 years; there were 100 (67.6 %) women and 48 (32.4 %) men. Open adrenalectomy was performed in 58 patients: on the left-side — 20 (34.5 %) operations, on the right-side — 38 (65.5 %) operations. Laparoscopic adrenalectomy was performed in 90 patients: right-sided — in 62 (68.9 %) patients, left-sided — in 28 (31.1 %) patients. There were 120 (81.1 %) patients with an adrenal cortex tumor, 16 (10.8 %) patients had an adrenal medullary tumor and 12 (8.1 %) patients had an adrenal cyst.
Results and discussion. The average duration of open adrenalectomy lasted for 88.6 ± 19.8 min, the duration of laparoscopic surgery was 62.3 ± 14.3 min (T = 1.1, p = 0.28). In 7 (7.8 %) cases, laparoscopic adrenalectomy finished by conversion. The average term of in-patient treatment after laparoscopic adrenalectomy was 4.1 ± 1.1 days, after open surgery — 8.3 ± 1.4 days (T = 2.4, p = 0.02). There were 2 (2.2 %) patients after laparoscopic adrenalectomy with postoperative pancreatitis in the early postoperative period. The same postoperative complication had 2 (3.4 %) patients after open surgery (χ2 = 0.2; p = 0.65). All cases of postoperative pancreatitis were successfully treated by conservative methods. The bleeding from the stump of the central adrenal vein occurred in 2 (3.4 %) cases after open right-sided adrenalectomy. Long-term results of treatment have been followed in 84 (56.8 %) patients, 3 (3.6 %) patients with malignant cortical cyst after open adrenalectomy have died within 1 year after surgery due to cancer progression.
Conclusions. Laparoscopic adrenalectomy allows to reduce twice the time of postoperative in-patient treatment versus to open adrenalectomy. The surgery duration and early postoperative complications rate after laparoscopic adrenalectomy is the same as after open surgery.

Keywords: adrenal, adrenal tumor, adrenalectomy, laparoscopic operation, open surgery.

List of references:  
1.    Baulin AA, Baulina EA, Baulin NA. Endokhirurgiya nadpochechnikov [Endosurgery of the adrenal glands] (Russian). Materialy X s’yezda po endoskopicheskoy khirurgii. Endoskopicheskaya khirurgiya [Endoscopic surgery]. 2007;1:7-8 (Russian).
2.    Borisov AE, Zemlyanoy VP, Kashchenko VA et al. Endovideokhirurgiya organov zabryushinnogo prostranstva [Endovideosurgery of organs of retroperitoneal space]. Saint Petersburg: EFA, 2000:204 (Russian).
3.    Saval’dzhi R, Ellis G. Klinicheskaya anatomiya dlya khirurgov, vypolnyayushchikh laparoskopicheskiye i torakoskopicheskiye operatsii [Clinical anatomy for surgeons performing laparoscopic and thoracoscopic operations]. Translation from English. Moskov: Meditsina, 2000:360 (Russian).
4.    Kettfl VM, Arki RA. Patofiziologiya endokrinnoy sistemy [Pathophysiology of the Endocrine System]. Translation from English. Saint Petersburg: Binom, 2001:336 (Russian).
5.    Maystrenko VA, Dovganyuk VS, Fomin NF, Romashchenko PN. «Gormonal’no-neaktivnyye» opukholi nadpochechnikov» [«Hormonal-inactive» adrenal tumors] Saint Petersburg: Elbi, 2001:171 (Russian).
6.    Romanchishin AF, Borisov AE. Ispol’zovaniye endovideotekhniki v khirurgii nadpochechnikov [The using of endovideotechnology in the surgery of the adrenal glands] (Russian). Materialy XIX zizdu khirurhiv Ukrainy. Kharkiv (Ukrainian), 2000:290-291.
7.    Rybakov SI. Gormonal’no-aktivnyye opukholi korkovogo veshchestva nadpochechnikovykh zhelez: printsipy diagnostiki i lecheniya [Hormonal-active tumors of the cortical substance of the adrenal glands: the principles of diagnosis and treatment] (Russian). Materialy XIX zizdu khirurhiv Ukrainy. Kharkiv (Ukrainian), 2000:292-293.
8.    Frantzaydes K. Laparoskopicheskaya i torakoskopicheskaya khirurgiya [Laparoscopic and thoracoscopic surgery]: Translation from English. Saint Petersburg: Binom (Russian).
9.    Brunt LM. Minimal access adrenal surgery. Surg Endosc. 2006;20(3):351-361.
10.    Chan JE, Meneghetti AT, Meloche RM, Panton ON. Prospective comparison of early and late experience with laparoscopic adrenalectomy. Am J Surg. 2006;191(5):682-686.
11.    Gagner M, Lacroix A, Bolte E. A case report of laparoscopic adrenalectomy. Nipp Hinyok Gakk Zasshi. 1992;83:1130-1133.

The aim — to study efficacy of individual minimally invasive step-up approach (MISUA) in surgical treatment of patients with acute necrotizing pancreatitis compared with primary open (laparotomic) surgical interventions.
Materials and methods. The analysis of 226 patients with acute necrotizing pancreatitis treatment has been conducted. Study group included 116 patients in whom diapeutic methods, endoscopic and lumbotomic video-assisted pancreatic sequestrectomy, minimal laparo- and lumbotomy, in case their insufficiency — open surgery was applied consequently. In 110 patients of control group traditional surgical tactic with application of laparotomic procedures were performed.
Results and discussion. MISUA allowed to decrease the extended number of surgeries  for 3.4 times as well as to postpone its performance (85 % surgeries in study group versus 33 % in control were performed after 4th week of disease). First diagnosed organ failure frequency after surgical intervention was significantly lower compared with control group (12.5 % against 28.2 %), number of patients who required prolonged intensive care during postoperative period was much lesser (17.5 % against 38.2 %). 4 patients in study group and 26 — in control died.
Conclusions. The application of step-up individualized tactic in patients with acute necrotizing pancreatitis ensures to decrease the number of laparotomic pancreatic sequestrectomy and allows to postpone open operations on 4th week  associated with postoperative organ failure and mortality reduction.

Keywords: acute necrotizing pancreatitis, surgical treatment, minimally invasive procedures.

The aim — to improve the diagnostic and treatment results in patients with intestinal bleeding.
Materials and methods. The study was based on 167 patients with intestinal bleeding in surgical and proctological departments. The main group consisted of 98 patients who were diagnosed and treated according to original diagnostics and treatment algorithm for the period from May 2013 to December 2015. The comparison group consisted of 69 patients, who were diagnosed and treated according to the traditional management scheme, including oesophagogastroduodenoscopy, videocolonoscopy, contrast radiography, infusion and hemostatic therapy from April 2000 to December 2013.
Results and discussion. In the main group, a source of bleeding was found with a capsule endoscopy in 91 patients. Only in 43 (43.9 %) patients a definitive diagnosis could be established. In the comparison group — the source of bleeding with the traditional algorithm at the preoperative stage was found only in 10 (14.5 %) patients. A total of 14 (14.3 %) surgical interventions were performed in the main group. In the comparison group, 53 (76.8 %) surgical interventions were performed.
Conclusions. The sensitivity of capsule endoscopy in establishing the source of intestinal bleeding was 92.9 %. Capsule endoscopy in the establishment of the final diagnosis was 29.4 % more effective than the traditional algorithm of examination at the preoperative stage in patients with small intestinal bleeding. The use of capsule endoscopy for intestinal bleeding allowed to reduce the level of diagnostic laparotomy by 62.5 %.

Keywords: small intestine bleeding, capsule endoscopy, diagnostic value.

List of references:  
1.    Pat. Ukraine № 109155, MPK’A61V 1/00, A61V 17/100. Sposib diahnostyky ta likuvannya tonkokyshkovykh krovotech [The method of diagnosis and treatment of intestinal bleeding / Feleshtynskyy YaP, Grechana UI, Pirogovsky VY] (Ukrainian); patent owner National Medical Academy of Postgraduate Education named after PL Shupik — № 201602464; 03.14.16 claimed.; publ. 08.10.16., Bull. № 15.
2.    Ell C, May A. Mid-gastrointestinal bleeding: capsule endoscopy and push-and-pull enteroscopy give rise to a new medical term. Endoscopy. 2006;38:73-75.
3.    May A, Manner H, Aschmoneit I et al. Prospective, cross-over, single-center trial comparing oral double-balloon enteroscopy and oral spiral enteroscopy in patients with suspected small bowel vascular malformations. Endoscopy. 2011;43:477-483.
4.    Norton ID, Andrews JC, Kamath PS. Management of ectopic varices. Hepatol. 1998;28:1154-1158.
5.    Rabe FE, Becker GJ, Begozzi MJ et al. Efficacy study of the small bowel examination. Radiol. 1981;140:47-50.
6.    Raju GS, Gerson L, Das A et al. American Gastroenterological Association (AGA) institute technical review on obscure gastrointestinal bleeding. Gastroenterol. 2007;133:1697-1717.
7.    Takano N, Yamada A, Watabe H et al. Single-balloon vs double-balloon endoscopy for achieving total enteroscopy: a randomized, controlled trial. Gastrointest Endosc. 2011;73:734-739.
8.    Teshima CW, Kuipers EJ, van Zanten SV et al. Double balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding: an updated meta-analysis. J Gastroenterol Hepatol. 2011;26:796-801.
9.    Zuckerman GR, Prakash C, Askin MP et al. AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterol. 2000;118:201-221.

The aim — to determine the best algorithm for patient preparation for endoscopic or radiological examination of the colon.
Materials and methods. Analysis of methods for colon preparation to endoscopic or radiologic examination provided in 120 patients with suspected colon chronic disease. Endoscopic examination was prescribed to 75 patients, radiologic examination — 45. By the method of preparation of the large intestine, the patients were divided into three groups (25 patients with endoscopic examination and 15 patients assigned with X-ray examination). In the first group, the preparation included the use of only cleansing enemas, in the second — the use of macrogol 4000, in the third — macrogol 3350 (Diagnostin, LTD «Pharmaceutical company Zdorovie»).
Results and discussion. During examination, the clean colon was revealed in 4 (16 %) patients of first group, 20 (80 %) patients of second group, 23 (92 %) patients of third group. Subjective discomfort noted 87,5 % patients of first, 30 % patients of second and 17.5 % of third group. Determined, that macrogol 3350 (Diagnostin) provides better intestinal tube purification on 12 % in compare with another method with the maximum comfort for the patient and may be recommended as the optimal method of colon examination preparation.

Keywords: colonoscopy, irrigoscopy, macrogol 3350, Diagnostin, preparation for colonoscopy.

List of references:  
1.    Anastassiades CP, Cremonini F, Hadjinicolaou D. Colonoscopy and colonography: back to the roots. Eur Rev Med Pharmacol Sci. 2008;N 12:345-347.
2.    Baumgart DC, Sandborn WJ. Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet. 2007;369 (9573):1641-1657.
3.    Bechtold ML, Choudhary A. Bowel preparation prior to colonoscopy:a continual search for excellence. World J Gastroenterol. 2013;N 19:155-157.
4.    Bibbins-Domingo K et al. Screening for colorectal cancer. JAMA. 2016;315 (23):2564-2575.
5.    Burke CA, Church JM. Enhancing the quality of colonoscopy:the importance of bowel purgatives. Gastrointest Endosc. 2007;66:565-573.
6.    Chokshi RV, Hovis CE, Hollander T et al. Prevalence of missed adenomas in patients with inadequate bowel preparation on screening colonoscopy. Gastrointest Endosc. 2012;75:1197-1203.
7.    Guindi M, Riddell RH. Indeterminate colitis. J Clin Pathol. 2004;57:1233-1244.
8.    Hassan C, Bretthauer M, Kaminski MF et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2013;45:142-150.
9.    Hillyer GC, Basch CH, Lebwohl B et al. Shortened surveillance intervals following suboptimal bowel preparation for colonoscopy: results of a national survey. Int J Colorectal Dis. 2013;28:73-81.
10.    Jawad N, Direkze N, Leedham SJ. Inflammatory bowel disease and colon cancer. Recent Results in Cancer Research. 2011;185:99-115.
11.    Marshall JB, Pineda JJ, Barthel JS, King PD. Prospective, randomized trial comparing sodium phosphate solution with polyethylene glycol-electrolyte lavage for colonoscopy preparation. Gastrointest Endosc. 1993;39:631-634.
12.    Matthew L et al. Optimizing bowel preparation for colonoscopy: a guide to enhance quality of visualization. Ann Gastroenterol. 2016;29:137-146.
13.    Wexner SD, Beck DE, Baron TH et al. A consensus document on bowel preparation before colonoscopy: prepared by a task force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Dis Colon Rectum. 2006;49:792-809.

The aim — to study features of damage control orthopedics (DCO) tactics in the surgical treatment of gunshot extremities wounds.
Materials and methods. The total array of studies was 1809 wounded, who were admitted to hospital from the anti-terrorist operation zone in the period from 2014 to 2016. The 9.20 % of wounded were delivered in a serious and critical condition, in stable — 90.80 % by FTS scale. Among the total number of victims in 978 (54.06 %) limb gunshot wounds were observed.
Results and discussions. In the DCO first phase anti-shock measures, including stop bleeding, pain relief, the imposition of aseptic dressings and immobilization of a limb should be carried out. In the DCO second phase the secondary surgical debridement with fasciotomy, vacuum therapy and ultrasonic cavitation are very important. In the third DCO phase the reconstructive surgery is used, in case of gunshot fractures of long bones, the replacement of external fixation by plate or intramedullary locked nail should be provided.
Conclusions. Differentiated DCO surgical tactics for the injured in serious and critical condition (4 — 9 points by FTS) is necessary for the life salvation of combatant in the first traumatic disease period and complications prevention in the second and third periods.

Keywords: gunshot wounds limbs, during medical evacuation, levels of care, treatment in wounds.

List of references:  
1.    Abakumov MM., Bogopolsky PM. Damage-control: what’s new? Chirurgiya [Surgery]. 2007;11:59-62 (Russian).
2.    Boroday AL., Pohribnyy KM, Klapchuk Yu.V., Antonov AB. Our experience treating gunshot landmark hip fracture Litopis traumatologii ta ortopedii [Annals of Traumatology and Orthopedics]. 2013;1-2:211-216 (Ukrainian).
3.    Bryusov PG. Multi-stage surgical tactics («damage control») in the treatment of victims with polytrauma. Voenno-medicinsky zhurnal [Military Medical Journal]. 2008;329, № 4. C. 19-24 (Russian).
4.    Buryanov OA, Laksha AM, Yarmolyuk Yu.O., Laksha AA. Staged surgical treatment of victims with gunshot wounds. Litopis traumatologii ta ortopedii [Annals of Traumatology and Orthopedics]. 2015;1-2:50-53 (Ukrainian).
5.    Korol SO. Conversion method of osteosynthesis in patients with gunshot fractures in hospital territorial base in terms of fighting. Problems of military health care. Proceedings of UVMA. 2014;Вип. 37 — С. 274-282 (Ukrainian).
6.    Krivenko SN., Grebenyuk A.M System damage control in the treatment of victims with high-energy fractures of the lower limbs bones (Russian). Proceedings of the XVI Congress of Orthopedic trauma Ukraine (Ukrainian). 2013:35-36.
7.    Loskutov OYe, Zherdyev II, Domanskyy AM, Korol S.O Surgical treatment in limb gunshot wounds in terms of multi-hospital. Trauma [Injury]. 2016;17(3):169-172 (Ukrainian).
8.    Roschin GG. Organizational aspects of emergency care in severe combined trauma in the prehospital and hospital stages. Founding congress of doctors and emergency medical emergency and disaster medicine. К., 2005:98-100 (Ukrainian).
9.    Samokhvalov IM., Badalov VI, Goncharov AV. and others. The concept of multi-stage surgical treatment as a modern strategy of heavy injury surgery. Vestnik Rossiyskoi voenno-medicinskoi akademii [Bulletin of the Russian Military Medical Academy]. 2009;25,1, ІІ:830-830.
10.    Samokhvalov IM., Manukovsky VA, Badalov VI. and others. The use of tactic of multi-stage treatment «damage control» in military field surgery. Voenno-medicinsky zhurnal [Military Medical Journal]. 2011;9:30-36 (Russian).
11.    Skobenko OYe, Pastushkov OV, Ostapenko SM, Korol SO, Burlukа VV. , Kukuruz Ya.S., Holod Ya.O Comparative analysis of single and double-staged surgical treatment of fractures of long bones and pelvis in patients with combined trauma. XV Congress of orthopedic trauma Ukraine: Collected works, 2010:345 (Ukrainian).
12.    Sokolov VA. «Damage control» is a modern concept of treatment of victims with a critical polytrauma. Vestnik traumatologii i ortopedii im. N.N.Priorova [Herald of Traumatology and Orthopedics. N.N. Priorov]. 2005;1:81-84 (Russian).
13.    Khomenko IP. Applying tactics «Damage control» during medical evacuation (Ukrainian). Military Health Problems: Proceedings of UVMA. 2013;28, 1:36-42 (Ukrainian).
14.    Shapovalov VМ, Khominets VV. Possibilities of sequential osteosynthesis in the treatment of the wounded with gunshot fractures of long limb bones. Genii Ortopedii [Genius of Orthopedics]. 2010;3:5-13 (Russian).
15.    Shapovalov VМ, Khominets VV. Features of the application of external and sequential osteosynthesis in the wounded with gunshot fractures of long bones. Traumatologiya і ortopediya Rosii [Traumatology and Orthopedics of Russia]. 2010;1 (55):7-13 (Russian).
16.    Andersen RC, Ursua VA, Valosen JM. Damage control orthopaedics: an in-theater perspective. J Surg Orthopaedic Advances. 2010;N 1:13-17.
17.    Ateeq M, Jahan S, Hanif M. Damage control surgery; a safe approach for exsanguinating trauma patients. Professional Med J. 2009;N 16:12-16.
18.    O’Toole RV, O’Brien M, Scalea TM et al. Resuscitation before stabilization of femoral fractures limits acute respiratory distress syndrome in patients with multiple traumatic injuries despite low use of damage control orthopedics. J Trauma-Injury Infection & Critical Care. 2009;67(5):1013-1021.
19.    Sala F, Capitani D, Castelli F et al. Alternative fixation method for open femoral fractures from a damage control orthopaedics perspective. Injury. 2010;41(2):161-168.
20.    Tuttle MS, Smith WR, Williams AE et al. Safety and efficacy of damage control external fixation versus early definitive stabilization for femoral shaft fractures in the multiple-injured patient. J Trauma-Injury Infect Crit Care. 2009;67(3):602-605.

The aim — to compare the early treatment results in patients with front abdominal wall ptosis after abdominal surgery and simultaneous lipodermectomy by traditional and laparoscopic methods, and/abdominolplasty.
Materials and methods. The treatment results analysis of 124 patients with front abdominal wall ptosis, front abdominal wall esthetic deformation, abdominal diseases, on whom lipodermectomy and simultaneous operations were performed by using traditional (70 cholecystectomy, 4 adhesiolysis — 1st group,) and laparoscopic (54 cholecystectomy, 5 adhesiolysis — 2nd group) methods. All patients were aged 51.42 ± 0.74 years, men — 5 (4 %); women — 119 (96 %). Ventral hernia and/or diastases of rectus muscles — 23 (18.5 %) were treated traditionaly.
Results and discussion. The average pain index during all research periods after operation was significantly increased in the first group compared to the second group (p < 0.01). Cardiac rate abnormalities among the patient with coronary heart disease appeared in 1st group — 17.6 %, in 2nd group — 4 % of cases. Postoperative wound complications were being decreased from 12.2 % to 8 %, intraperitoneal complications from 6.8 % to 0 % and long-term postoperative complications from 9.5 % to 0 %.
Conclusions. Postoperative complications level among the patients who were operated by using developed operative method, cardiovascular complications in patients with ischemic heart disease (4 % vs 17.6 %), wound (8 % and 12.2 %); inflammatory intraabdominal (0 % vs 6.8 %), long-term postoperative complications (0 % and 9.5 %); were significantly decreased compared to the control group.

Keywords: simultaneous operation, cholecystectomy, adhesiolysis, front abdominal wall ptosis.

List of references:  
1.    Vetshev PS, Vetsheva MS. Printsipy analgezii v rannem posleoperatsionnom periode (Russian). Khirurgiya [Surgery]. 2002;12:49-50 (Russian).
2.    Dronova VL, Dronov AI, Kryuchina YeA et al. Simultaneous Operations in Combined Surgical and Gynecological Diseases (Russian). Ukrajinsjkyj zhurnal Khirurghiji [Ukrainian Journal of Surgery] (Ukrainian). 2013;2 (21):143-151 (Russian).
3.    Mіshalov VG, Bondarev RV, Ivantsok VM, Kondratenko SO. Treatment results of uncomplicated acute cholecystitis in elderly and senile patients (Russian). Khirurghija Ukrajiny [Surger of Ukraine] (Ukrainian). 2015;4 (56):49-53.
4.    Mishalov VG, Bondarev RV, Kondakova EYu et al. Laparoscopic adhesiolysis feature in the treatment of anterior abdominal wall ptosis in a combination with adhesive diseases of the abdominal cavity (Russian). Ghalycjkyj likarsjkyj visnyk [Galician Medical Journal] (Ukrainian). 2016;23(3):80-82.
5.    Ovechkin AM. Posleoperatsionnaya bol’: sostoyanie problemy i sovremennye tendentsii posleoperatsionnogo obezbolivaniya (Russian). Regionarnaya anesteziya i lechenie ostroi boli [Regional anesthesia and acute pain management]. 2015;9(2):29-39 (Russian).
6.    Khvorostov ED, Tomin MS, Zakharchenko YuB. Etiologiya, patogenez i profilaktika obrazovaniya vnutribryushnykh spaek. Kh.: KhNU imeni V. N. Karazina, 2012:31 (Russian).
7.    Ishizaki Y, Miwa K, Yoshimoto J. Conversion of elective laparoscopic to open cholecystectomy between 1993 and 2004. Br J Surg. 2006;93:987-991.
8.    Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63, N 11. S. 240-252.
9.    Matarasso A. Abdominolipoplasty: A system of classification and treat  ment for combiner abdominoplasty and suction assisted lipectomy. Aesth Surg J. 1991;15:111.
10.    Muysoms FE, Miserez M, Berrevoet F et al. Classification of primary and incisional abdominal wall hernias. Hernia. 2009;13(4):407-414.
11.    Pitman GH. Liposuction and body contouring. Grabb and Smith’s Plastic Surgery / Ed by S J Aston, R W Beasley, C H M Thorne. Philadelphia: Lippincott-Raven, 1997:676.
12.    Practice Committee of the American Society for Reproductive Medicine in collaboration with the Society of Reproductive Surgeons. Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery: a committee opinion. Fertil Steril. 2013;99(6):1550-1555. Moda access: http://www.fertstert.org/article/S0015-0282 (13)00322-1/pdf.
13.    Rubert CP, Higa RA, Farias FV.B. Comparison between open and laparoscopic elective cholecystectomy in elderly, in a teaching hospital. Rev Col Bras Cir. 2016;43(1):2-5.
14.    Terho PM, Leppäniemi AK, Mentula PJ. Laparoscopic cholecystectomy for acute calculous cholecystitis: A retrospective study assessing risk factors for conversion and complications. World J Emerg Surg. 2016;11(1):2-9.

The aim — to improve the treatment results of patients with anal fissure by complex treatment use.
Materials and methods. From 2008 to 2016, 425 patients were examined and treated in hospital. 248 patients were in the study group, and 177 patients — in the control group. In the main group, along with fisurectomy, a complex treatment with venotonic drug (Detralex) was performed.
Results and discussion. In the main group, the duration of treatment averaged 23.8 ± 0.6 days, and recovery term was 17.3 ± 0.8 days. Improvement of life quality were noted at 14 ± 0.2 day, and the relapse rate was only 2.8 %. Patients of the control group achieved complete healing by 28.0 ± 1.2 days. The duration of recovery was 21.3 ± 1.4 days, and the duration of treatment was 28.0 ± 1.2 days. Improvement in the quality of life was noted in patients for 20.0 ± 1.1 days.
Conclusions. Therapy of patients with anal fissure on the use of an integrated approach, reduced the probability of recurrence by 15.2 %, a decrease in the recovery period of operability — by 4.0 ± 0.6 days. The use of venotonic drug (Detralex) in complex therapy accelerated the anal fissures healing by 4.2 ± 0.3 days. These results give all grounds for using complex therapy as a standard method in the anal fissures treatment.

Keywords: anal fissure, complex therapy, conservative treatment of anal fissure, systemic venotonics.

List of references:  
1.    Douglas W, Schum M, Worley A.  The epidemiology and treatment of anal fissures in a population-based cohort. BMC Gastroenterol. 2014;Vol. 14. P. 129. doi:  10.1186/1471-230X-14-129.
2.    Perry WB, Dykes SL, Buie WD, Rafferty JF. Practice parameters for the management of anal fissures (3rd revision). Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Dis Colon Rectum. 2010;53(8). P. 1110-1115. doi: 10.1007/DCR.0b013e3181e23dfe.
3.    Stein E. Diseases: Textbook and Color Atlas of Proctology. Springer-Verlag Berlin Heidelberg, 2002. P. 89-97, 317-320. ISBN 978-3-642-18977-7.
4.    Surgical Proctology / Ed. by J. Lange, B. Mölle, J. Girona, V. W. Fazio. 1st ed. Springer, Germany, 2015. P. 234-252.

The aim — to evaluate the role of clinical examination and selection in patients for technical and clinical results of selective arterial embolization (SAE) improving.
Materials and methods. Inclusion criteria for SAE were: male patients, age > 50 years, high operative-anesthesiologic risk (ASA grade III — IV), prostate volume > 40 cm3 and benign prostatic hyperplasia with moderate to severe lower urinary tract symptoms (LUTS) refractory to medical treatment for at least 6 months (International Prostate Symptom Score (IPSS) > 18, or quality of life (QoL) > 3). Exclusion criteria were: malignancy (based on digital rectal and trans-rectal ultrasound examinations and prostate specific antigen measurements with positive biopsy), bladder diverticula, big bladder stones, chronic renal failure, tortuosity, and advanced atherosclerosis of iliac or prostatic arteries on pre-procedural computed tomographic angiography, active urinary tract infection and unregulated coagulation parameters.
Results and discussion. Only 40 % of patients meet the criteria for SAE performing. The group of patients with favorable prognosis after SAE contains patients with severe LUTS (IPSS level > 18), low level of maximal urine flow rate (Qmax < 10 ml/s) and confirmed infravesical obstruction.
Conclusions. Preliminary clinical evaluation and selection of patients plays critical role in improving of technical and clinical results of SAE.

Keywords: selective arterial embolization, benign prostatic hyperplasia, inclusion criteria.

List of references:  
1.    Kaplan SA. Update on the American Urological Association guidelines for the treatment of benign prostatic hyperplasia. Rev Urol. 2006;N 8:10-17.
2.    Kiefe C, Allison J, de Lissovoy G. Predicting hospital readmission:different approaches raise new questions about old issues. Med Care. 2013;N 51:11-12.
3.    Radomski SB. Update on medical therapy for male LUTS. Can UrolAssoc J. 2014;N 8:148-150.
4.    Shim SR, Kim JH, Choi H. Association between self-perception period of lower urinary tract symptoms and International Prostate Symptom Score: a propensity score matching study. BMC Urol. 2015;N 15:30.
5.    Sinqam P, Hong GE, Hee TG. Nocturia in patients with benign prostatic hyperplasia: evaluating the significance of ageing, co-morbid illnesses, lifestyle and medical therapy in treatment outcome in real life practice. The Aging Male. 2015;N 18:112-117.
6.    Thompson IM, Ankerst DP. Prostate-specificantigen in the early detection of prostate cancer. CMAJ. 2007;N 176:1853-1858.
7.    Tombal B, Filip A, Taiile A. Biopsy and treatment decisions in the initial management of prostate cancer and the role of PCA3; a systematic analysis of expert opinion. World J Urol. 2011;N 10:1007.
8.    Utomo E, Blok BF, Pastoor H. The measurement properties of the five-item International Index of Erectile Function (IIEF-5): a Dutch validation study. [Електронний ресурс]. Androl. 2015;URL: http://onlinelibrary.wiley.com/doi/10.1111/andr.12112/full.

The aim — to analyze the species spectrum of microorganisms isolated from urine and  determine the bacteriological and clinical efficacy, safety, and tolerability of the drug levofloxacin in patients with complicated urinary tract infections.
Materials and methods. The study is based on the retrospective treatment analysis results of 54 patients with complicated urinary tract infections. Urological examination included complaints and anamnesis clarification; general examination with digital rectal examination (in men); a blood count; urine analysis; serum creatinine test. The ultrasound examination of the kidneys, bladder and prostate gland has determined the volume of residual urine. Patients urine was sown before drug prescription and on the 7th day after treatment.
Results and discussion. 64 pathogens have been detected by the culture method before antimicrobial therapy. In 11 (20.4 %) patients, two pathogens were identified. A great clinical efficacy of levofloxacin was noted in 47 patients, its absence — in 3 patients (strains not susceptible to levofloxacin were isolated, an antibiotic was replaced according to the antibioticogram). A partial treatment effect was obtained in 4 patients. Side effects of treatment including gastrointestinal tract were observed as nausea in 5 (9.3 %) patients, metallic taste in the mouth — in 2 (3.7 %) patients, diarrhea — in 4 (7.4 %) patients.
Conclusions. The obtained results demonstrate high clinical and bacteriological efficacy, good tolerability, and prove levofloxacin safety in patients with complicated urinary tract infections. The availability of this drug allows us to recommend it as an antibacterial first-line drug for empirical therapy in such patients.

Keywords: urinary tract infections, levofloxacin.

The aim — to study the effects and efficacy of a nutraceutical Unibiol for the local treatment of the chemical burns of esophagus in children and elaborate recommendations for its use under this condition.
Materials and methods. 76 patients with chemical burns of the esophagus were treated in specialized pediatric unit during 1990 — 2010. Patients were divided into two groups. The control group comprised 42 (55.3 %) patients treated by the classical method during 1990 — 2000 period along with the preventive bougienage. The 34 (44.7 %) children of the main group received a proposed innovative method of local chemical esophageal burn treatment during 2000 — 2010. The main group patients were administrated nutraceutical Unibiol per os starting from the first day of acute period 3.0 g (0.5 teaspoon) for every two hours in case of the first and second grade burns and in case of the third grade — every hour. In both groups, the initial endoscopy — fibro-esophagogastroscopy — was conducted at admission, and the consecutive endoscopic control was performed every 7 — 10 days.
Results and discussion. In the study group, the most often esophageal burns were caused by alkaline solutions — 10 (29.4 %) cases, mostly II — III grade burns; caused by acidic agents — 4 (11.8 %) cases, I — III grade. Inorganic agents and other various substances were registered in six (17.6 %) and 13 (38.2 %) patients respectively, I — II grades; caused by boiling water only in one (2.9 %) child with grade II. According to the results of initial and dynamic endoscopic examination, the first-grade chemical burn was found in 13 children (38.3 %) of the study group and in 17 patients (40.5 %) of the control; the II grade burn was diagnosed in 10 (29.4 %) and 13 (31 %) cases respectively; and the third-grade burns were determined in 11 patients (32.3 %) and 12 children (28.6 %) respectively. During the first 5 days of treatment at the intensive care unit 18 (94.7 %) patients of the study group and 15 (60.0 %) children of the control group were treated. The rest of patients, 1 (2.9 %) patient of the index group and 10 (40.0 %) patients of the control group, were treated more than six days at the intensive care unit. It is important to note that 22 (64.7 %) patients of the index group and only 12 (28.6 %) children of the control one started liquid food and fluid intake during the first 2 days. The absolute advantage of innovative treatment method was the reduction in number of patients, who needed a preventive bougienage that in the main group was in two (5.9 %) cases compared with 23 (54.8 %) patients in the control group, as well as reduction in inpatient days, which in case of the first-grade burn was limited to two days, and in case of second and third grade — 4 and 9 days, respectively.
Conclusions. The innovative treatment has a positive impact on the disease course and the outcome of chemical esophageal burns in pediatric patients that was clinically proved. In addition, 97.1 % of patients treated with the nutraceutical Unibiol had no complications compared to 52.4 % of the control group. We managed to avoid esophageal cicatrices changes in all patients with the I — II grade chemical burns and, as a consequence, to ensure appropriate quality of life. The reduction in number of patients with III grade lesions, who needed a preventive bougienage that in the main group was observed.

Keywords: chemical burns of esophagus, local treatment, nutraceutical, children.

List of references:  
1.    Ashcraft KW, Holder TM.  (eds). Pediatric surgery. 2nd ed. 1992. Philadelphia, Pennsylvania: W. B. Saunders.
2.    Vantsyan EN. Treatment of burn and cicatricial narrowing of the esophagus[Treatment of burn and cicatricial narrowing of the esophagus]. M.: Medicine, 1971:194 (Russian).
3.    Zhukov MD. Rationalization proposal for the method of treatment of chemical burns of the digestive tract with the therapeutic mixture «OMPABAL» in the acute period. Zhukov MD. Oskretkov VI.  Certificate of AGMI № 860 dd. 28.11.1978 (Russian).
4.    Karvial HF., Parks DH. Burns in children (Eng). M.: Medicine, 1990:68-70 (Russian).
5.    Kravchuk BO, Domaratsky VА, Serhienko АV, Dzhezherya Yu. І., Kotovskyi VI. Electrochemical esophageal burn in children. Chirurgia dytjcogo viku [Pediatric surgery Ukrainianaine]. 2009;6, № 2 (23):66-70 (Ukrainian).
6.    Krivchenya DYu, Dubrovin AG, Andrishchev SA. Diagnosis and treatment of esophageal stenosis in children. K.: League-Inform, 2008:182 (Russian).
7.    Makarov AV, Danilov AA, Sokurov PP, Ribalchenko VF. Chemical burns of the esophagus in children and their consequences. K.: Vishcha shcola, 2002:107 (Ukrainian).
8.    Smirnova IV, Tsmokalyuk LI, Smirnov VV, Vyshpinskyy IM. Experience treatment of partial aplasia of the anterior abdominal wall using the ointment «Unibiol Tsmokalyuka» (A case from practice). [Plastic, reconstructive and aesthetic surgery]. 2016;1-2:39-44 (Ukrainian).
9.    Tsmokalyuk LI, Funnikov AV, Rusak PS, Voloshin PI, Gusak OJ, Yanchuk AI, Melnik BA. Successful treatment of a child with widespread necrotic skin lesions [Pediatric Surgery]. 2005;2, № 2 (7):115-116 (Ukrainian).

The aim — to compare the effectiveness of endovenous laser coagulation (EVLC) with the use of bare-tip and radial fiber in the remote postoperative period (in a year), depending on the diameter of the saphenofemoral anastomosis (SPA).
Materials and methods. A prospective study included 192 patients with varicose veins of the lower extremities, among them 134 (69.8 %) were women and 58 (30.2 %) men aged 20 to 67 years (mean 39.2 ± 0.7 years). Class of chronic venous disease was II-VI by CEAR. The diameter of the SPS is from 5 to 21 mm. The venous dysfunction severity (VSS) average score was 10.62 ± 0.47 points. The length of the GSV segment on which EVLC was performed was 7 to 94 cm (mean — 37 cm). The observation period for patients was 1 year. EVLC was performed with diode laser with a 1470 nm wavelength. Patients were divided into two groups. The T group included 112 patients who underwent EVLC with the use of bare-tip fiber, in the R group — 80 patients, who were operated with EVLC with radial fiber. The groups were representative of the sex ratio, age, CEAP class, average SPS diameter, VSS score, length of the treated segment of the GSV.
Results and discussion. One year after the operation, the cumulative frequency of relapse of vertical reflux in patients of group T was 12.5 %, in patients of group R — 1.2 % (p = 0.005); The average score on the VSS scale was 2.69 ± 0.49 and 0.98 ± 0.16 points (p = 0.004), respectively. There were no statistically significant differences in the frequency of relapse between the T and R groups (5.9 and 0.0 %, respectively, p = 0.061) and the mean VSS score (1.26 ± 0.33 and (0.39 ± 0, 14) points, p = 0.161).
Conclusions. The bare-tip and radial fiber EVLC results in a year by the VSS scale score and the vertical reflux recurrence frequency are statistically significantly different in patients with SPS diameter from 5 to 16 mm. With an increase in the SPS diameter (more than 16 mm), the EAVC results are statistically significantly better in the case of the use of a radial fiber.

Keywords: endovenous laser coagulation, bare-tip fiber, radial fiber, diameter of saphenofemoral anastomosis, varicose veins, long-term results.

List of references:  
1.    Usenko OYu, NIkulnIkov PI, Chernuha LM. Hronichni zahvoryuvannya ven nizhnih kintsivok i taza: diagnostika, terapiya, likarsko-trudova ekspertiza, profilaktika uskladnen: kliniko-praktichni rekomendatssyi [Chronic venous disease of the lower extremities and pelvis, diagnosis, treatment, medical and labor inspection, prevention of complications: clinical practice guidelines]. Kyiv, 2014:120 (Ukrainian).
2.    Coleridge-Smith P, Labropoulos N, Partsch H et al. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs — UIP consensus document. Part I. Basic principles. Eur J Vasc Endovasc Surg. 2006;31:83-92.
3.    Gloviczki P, Comerota AJ, Dalsing MC et al. The care of patients with varicose veins andassociated chronic venous diseases: clinical practice guidelines of theSociety for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53 (suppl.):2S-48S.
4.    Lane T, Onida S, Gohel1 MS et al. A systematic review and meta-analysis on the role of varicosity treatment in the context of truncal vein ablation. 14th Meeting of the European Venous Forum, Belgrade, Serbia, 27-30 June 2013. Phlebol. 2013;28(2):375-394.
5.    Merchant RF, DePalma RG, Kabnick LS. Endovascular obliteration of saphenous reflux: A multicenter study. Vasc Surg. 2002;35(6):1190-1196.
6.    O’Donnell TF, Balk EM, Dermody M et al. Recurrence of varicose veins after endovenous ablation of the great saphenous vein in randomized trials. J Vasc Surg Venous Lymphat Disord. 2016;4(1):97-105.
7.    Piazza G. Varicose veins. Circulation. 2014;130(7):582-587.
8.    Rutherford RB, Padberg FT. Jr., Comerota AJ et al. Venous severity scoring: An adjunct to venous outcome assessment. J Vasc Surg. 2000;31, N. 6:1307-1312.
9.    Van der Velden SK, Lawaetz M, De Maeseneer MG et al.; Members of the Predictorsof Endovenous Thermal Ablation Group. Predictors of recanalization of the great saphenous vein in randomized controlled trials 1 year after endovenous thermal ablation. Eur J Vasc Endovasc Surg. 2016;52(2):234-241.
10.    Varicose veins in the leg. The diagnosis and management of varicose veins. Issued July 2013. NICE Clinical Guideline 168. Available at: Guidance.NICE.org.uk/cg 168. Accessed July 14, 2013.

The aim — to improve the method of preoperative perforating veins viability in patients with varicose veins of the lower limbs and to develop low-impact way to radical surgery.
Materials and methods. The study included 132 patients with varicose veins of the lower extremities (VVLE) C2-C6 by CEAP
Results and discussion. A combined diagnostic method that reveals the peculiarities of the lower leg perforating veins system and varicose veins was developed. A method of radical surgical treatment consists from crossectomy, short stripping of the great saphenous vein trunk with Boyd`s perforant removal and mini-phlebectomy by Muller.
Conclusions. The established features of the venous system functioning in the lower limb varicosity allow to personalize and standardize the volume of surgical intervention, depending on the stage of the disease. The developed surgical treatment method for VVLE is radical, provides the best results in the early and late postoperative periods.

Keywords: varicose veins of the lower extremities, diagnosis, treatment, perforating veins re-entry.

List of references:  
1.    Mishalov VG, Hodos VA, Selyuk VM, Chernyak VA. Subfascial endoscopic dissection of perforating veins in the treatment of patients with chronic venous insufficiency of the lower limbs (Russian). Hirurgiya Ukrayini [Surgery Ukraine] (Ukrainian). 2012;3:39-43.
2.    Nurmeev IN, Mirolyubov LM, Nurmeev NN, Mirolyubov AL, Ibragimov SV, Hakimyanov AI, Umarov NA, Nagimmulin RR. New in the treatment of varicose veins of the lower extremities (the practice of private phlebological practice) (Russian). Vestnik eksperimentalnoy i klinicheskoy hirurgii tom 7 (Russian).   [Announcer of experimental and clinical surgery volume 7]. 2014;2:141-145.  Palamarchuk VI, Smorzhevskiy VI, Hodos VA. Neurological complications after an operation on the veins of lower limbs (Russian). Hirurgiya Ukrayini [Surgery Ukraine]. (Ukrainian). 2014;7,2:142-145.
3.    Паламарчук ВИ, Сморжевский ВИ, Ходос ВА. Неврологические осложнения после операции на венах нижних конечностей. Хірургія України. 2010;4:53-57.
4.    Usenko OYu, NIkulnIkov PI, Chernuha LM. Hronichni zahvoryuvannya ven nizhnih kintsivok i taza: diagnostika, terapiya, likarsko-trudova ekspertiza, profilaktika uskladnen: kliniko-praktichni rekomendatssyi [Chronic venous disease of the lower extremities and pelvis, diagnosis, treatment, medical and labor inspection, prevention of complications: clinical practice guidelines]. Kyiv, 2014:120 (Ukrainian).
5.    Chernuha LM, Guch AA, Bobrova AO. Problem of varicose illness of lower limbs today. Most debatable questions. Hirurgiya Ukrayini [Surgery Ukraine]. 2010;1:42-49 (Ukrainian).
6.    Coleridge-Smith P, Labropoulos N, Partsch H et al. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs: UIP consensus document: part I. Basic principles. Eur J Vasc Endovasc Surg. 2006;31:83-92.
7.    Eklof B, Perrin M, Delis KT et al. Updated terminology of chronic venous disorders; the VEIN-TERM transatlantic interdisciplinary consensus document. J Vasc Surg. 2009;49:498-501.
8.    Malas MB, Quasi U, Lazarus G et al. Comparative effectiveness of surgical interventions aimed at treating underlying venous pathology in patients with chronic venous ulcer. J Vasc Surg: Venous Lymphat Disord. 2014;N 2:212-225.
9.    Rabe E, Panier F. Epidemiology of chronic venous disorders. Handbook of venous disorders: guidelines of the American Venous Forum / Ed by P Gloviczki. 3rd ed. London: Hodder Arnold, 2009:105-110.
10.    Ricci St. The venous system of the foot: anatomy, physiology and clinical aspects. Phlebolymphol. 2015;22(2):64-75.

The aim — to study the effect of bishofite on geriatric patients and clinical indexes in the wound complications treatment after abdominal wall surgery.
Materials and methods. 57 patients aged over 60 years with various types of wound complications after abdominal wall surgery were sampled for study. Wound complications treatment included both traditional methods and bishofite pledget.
Results and discussion. On the third day after the treatment the pain intensity  significantly reduced for 31.7 %, the amount of fluid for 84.6 %, the width of the congestion zone for 32.9 %, leukocytosis for 20.5 %. A noticeable difference in pain intensity within the wound area (60.8 %) and the flu id amount (72.8 %) were indicated on 7th day.
Conclusions. Bishofite pledge in the postoperative wound complications treatment such as hematoma, serous cyst and infiltration leads to a significant wound exudation reduction, rapid pain intensity reduction, which improves patients’ state significantly.

Keywords: wound complications, bishofite, elderly patients.

List of references:  
1.    Bayazitov MR. Alloplastyc efficiency of large and giant postoperative ventral hernias. Avtoref. dys.... kand. med. nauk. Ternopil, 2001:19 (Ukrainian).
2.    Belokonev VY. Biomechanical concept of the pathogenesis of postoperative ventral hernias. Vestnik khirurgii im. I. I. Grekova. 2000;5:23-27 (Russian).
3.    Dzyak GV, Koval’ YA, Zorin AN, Mason, Coxon. Study of immunomodulatory properties of aqueous solution bishofit experiment. Medychni perspektyvy. 1997;3:80-85 (Ukrainian).
4.    Zhebrovsky VV, Ilchenko FN, Salem Mohamed Mahmoud. Complications of wound healing after surgery for hernia and their prevention (Russian). Klinicna hirurgiya (Ukrainian). 1999;12:26-28.
5.    Lyhman Viktor Nikolaevich. Experimental and clinical substantiation of complex surgical treatment of large and giant postoperative ventral hernias: Dis... Cand. honey. Sciences: 14.01.03 / Dnipropetrovsk state. Medical Academy, 2005:170 (Ukrainian).
6.    Mytrofanova YYu, Sysuev BB, Sysuev BB, Ozerov AA, Ozerov AA, Samoshyna EA, Akhmedov NM. Innovative medicines based on mineral bischofite deep cleaning: Prospects and problems of application. Fundamental’nyye issledovaniya. 2014;9-7:1554-1557 (Russian).
7.    Spasov AA. Magnesium in medical practice. Volgograd. OOO Otrok, 2000:268 (Russian).
8.    Sysuyev BB, Mitrofanova I.YU., Stepanova EF. Prospects and problems of creation based on mineral bischofite effective dosage forms. Fundamental’nyye issledovaniya. 2011;6:218-221 (Russian).
9.    Tkachenko AE Reconstructive abdominoplasty in surgical rehabilitation of patients with ventral hernias. Author’s abstract. Dis.... cand. honey. Sciences. Ekaterinburg, 1999. 20 c (Russian).
10.    Feleshtinsky JP. Surgical treatment of postoperative abdominal hernia in elderly and senile patients. Klin. hirurgiya. 1997;11:17-20 (Russian).
11.    Yagudin MK. Prediction and prevention of wound complications after plastic ventral hernias (Russian). Hirurgiya (Ukrainian). 2005;N 9:69-72.
12.    Chevrel JP, Rath AM. Polyester mesh for incisional hernia repair. Incisional hernia / Ed by V Schumpelick, A N Kingsnorth. Berlin; Heidelberg: Springer-Verlag, 1999 — P. 327-333.
13.    Dumanian GA, Denhan W. Comparison of repair techniques for major incisional hernias. Am J Surg. 2003;185:61-65.
14.    Klein M et al. Directly energized uptake of beta-estradiol 17-(beta-D-glucuronide) in plant vacuoles is strongly stimulated by glutathione conjugates. J Biol Chem. 1998;N 273 (1):262-270.
15.    White TJ, Santos MC, Thompson JS. Factors affecting wound complications in repair of ventral hernias. Am Surg. 1998;N 64 (3):276-280.

The aim — to improve surgical treatment efficiency for necrotizing soft tissue infection in injured and wounded patients.
Materials and methods. Diagnostic and treatment strategy of 8 patients with different localizations necrotizing soft tissue infection have been analysed in this article.
Results and discussion. Necrotizing form of erysipelas, necrotizing cellulitis, necrotizing fasciitis, and necrotizing myositis were distinguished according to the morphological substrate lesion’s depth. Early clinical signs of necrotizing infections are minor and do not differ from the normal inflammatory process. The area of skin changes is usually less than the lesion of underlying tissues. A lack of clinical effect from therapy within 12 hours and increasing intoxication, should encourage the surgeon to active surgical tactics — excision of necrotic tissues and exudate evacuation.
Conclusions. Repeated necrectomy and surgical debridement of wounds in combination with intensive therapy, hyperbaric oxygenation, VAC-therapy, and plastic closure of wounds after elimination of acute process are essential components of treatment.

Keywords: necrotizing fasciitis, necrotizing myositis.

List of references:  
1.    Lipatov KV, Komarova EA, Guryanov RА. Streptococcal necrotizing soft tissue infection: diagnosis and surgical treatment. Rany i Ranevyje infektsii. 2015;2(1):6-12 (Russian).
2.    Ahrenholz DH, Ripple JM, Irwin RS et al. Necrotizing fasciitis and other infections. Intensive Care Medicine. 2 ed. Boston, Little, Brown, 1991:1334.
3.    Al Shukry S, Ommen J. Necrotizing Fasciitis-Report of ten cases and review of recent literature. J Med Life. 2013;6, N 2, — P. 189-194.
4.    Anaya DA, McMahon K, Nathens AB et al. Predictors of mortality and limb loss in necrotizing soft tissue infections. Arch Surg. 2005;140:151-158.
5.    Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis. 2007;44(5):705-710.
6.    Cuschieri J. Necrotizing soft tissue infection. Surg Infect (Larchmt). 2008;9(6):559-562.
7.    Glass GE, Sheil F, Ruston JC, Butler PE. Necrotising soft tissue infection in a UK metropolitan population. Ann R Coll SurgEngl. 2015;97(1):46-51.
8.    Mishra SP, Singh S, Gupta SK. Necrotizing soft tissue infections: Surgeon’s prospective. Int J Inflam. 2013;2013 — P. 1-7.
9.    Mullangi PK, Khardori NM. Necrotizing soft tissue infections. Med Clin N Am. 2012;96:1193-1202.
10.    Panesar K. Necrotizing soft tissue infections: «Flesh eating bacteria». US Pharmacist. 2013;38, N 4. P. HS 8-HS 12.
11.    Sadasivan J, Maroju NK, Balasubramaniam A. Necrotizing fasciitis. Ind J Plast Surg. 2013;46(3):472-478.
12.    Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg. 2009;208(2):279-288.
13.    Stewart L, Shaikh F, Bradley WP.  et al. Combat-Related Extremity Wound Infection Epidemiology: Trauma Infectious Disease Outcomes Study 2009-2012. Open Forum Infect Dis. 2015;Suppl. 1:1551.
14.    Wang JM, Lim HK. Necrotizing fasciitis: eight-year experience and literature review. Braz J Infect Dis. 2014;18(2):137-143.

The aim — to compare the efficacy and safety of dexketoprofen for analgesia in the early postoperative period in patients operated on for abdominal tumors.
Materials and methods. The study involved 64 patients operated for retroperitoneal tumors (44 (69 %)), ovarian tumors (20 (31 %). The design envisaged the creation of two randomized groups: group I (34 (53 %)), in which anesthesia was carried out with morphine at a dose of 10 mg in standard execution, group II (30 (47 %)), in which anesthesia was carried out with dexketoprofen (Keywer). The daily dose of the drug did not exceed 150 mg. The indices of intra-abdominal pressure by the Crohn method and abdominal perfusion pressure were studied. Dopplerometry of mesenteric blood flow was performed in the upper mesenteric, renal and splenic arteries. Quantitative blood flow parameters in arterial vessels were determined: peak systolic and terminal diastolic blood flow velocity, peripheral resistance index.
Results and discussion. Research of arterial circulation of blood in the superior mesenteric and renal arteries revealed a higher value of the resistance index in group I than in group 2, that testified to the blockade of microvasculature and, as a result, ­the uneffective anaesthetizing in group I. In group I, additional morphine boluses (10 mg) were administered to 4 (11.7 %) patients. In group II, there was no need for additional morphine administration. The use of dexketoprofen (Keywer) for postoperative analgesia contributed to a decrease in the intra-abdominal hypertension syndrome manifestations (p < 0.05) and improved blood flow in the main vessels of the abdominal cavity.
Conclusions. A comprehensive behavioral pain reaction study, physiological indices and laboratory stress tests showed that the use of dexketoprofen for postoperative analgesia contributed to an effective analgesia after traumatic operations, which significantly reduced the need for opioids.

Keywords: dexketoprofen, anesthesia, opioids, children.

List of references:  
1.    Ajzenberg VL, Ulryx GЕ, Czуpyn LE, Zabolotskyj DV. Regyonalnaya anestezyya v pedyatryy [Regional anesthesia in pediatric patients]. Syntez Buk, 2012:304 (Russian).
2.    Veteshev PS, Vetesheva MS. Principles of analgesia in the early postoperative period. Hyrurgyya [Surgery]. 2002;12:49-52 (Russian).
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A case of patient`s successful treatment with familial adenomatous coli was described. The 18 year old patient was diagnosed with familial adenomatous coli, the total affection of the colon, the classical form. The treatment was being performed at the surgical department of the Oleksandrivska Clinical Hospital in Kyiv from 12.02.16 to 24.12.16. The patient had been examined before surgery. The survey found that the mother’s aunt had colon polyps. Due to patient`s young age colectomy was performed. The continuity of the gastrointestinal tract was restored by using ileorectoanastomosis. The patient has categorically refused total coloproctectomy. The rectum contained multiple polyps and was left intact. Mutations of APC gene in the middle of 5q21 alleles, codon 1256 were found during genentic study, Histological examination has implied adenomatous polyps, although no malignant transformation has been found. The patient was inspected within a month and colon polyps were removed via endoscopic methods. Medical management of family adenomatosis of the colon is not clearly established. The main treatment is a surgery to remove the amount of affected areas of the colon with segmental lesions, and total colectomy with diffuse lesions. We have used such surgical methods as total colectomy with restoration of the gastrointestinal tract continuity by using end-to-end ileorectoanastomosis for our patient’s treatment. We believe that this method should by applied in young patients with no signs of malignant transformation in polyps. Pfannenstiel incision has good cosmetic effect, which enables to perform this surgery in full, in the presence of modern logistics.

Keywords: familial adenomatous coli, gene APC, total colectomy.

The article defines the principles of modern evidence-based clinical guidelines completion. Informativity value of clinical symptoms and additional examination methods in the acute appendicitis diagnosis were estimated on literature review background. The national clinical guideline for patients with acute appendicitis (2010) were analyzed in the context of leading surgical associations current recommendations.

Keywords: evidence-based medicine, clinical practice guidelines, medical guidelines, clinical protocols, acute appendicitis.

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In the literature review the modern diagnostic and therapeutic approaches to gastric ulcers perforations were presented. The information content of different instrumental diagnostics methods was determined. Differences in the approach to this pathology treatment in our country and in abroad were identified. However, no surgical treatment method which gives the best postoperative results has been determined yet. Gastrectomy and different vagotomies are traumatic operations, which are accompanied by the development of specific complications in the late postoperative period. Closure of perforation, being technically simple and low-invasive intervention has controversial long-term results. Questions for perforated ulcers surgical treatment remain relevant to the present and require further investigation.

Keywords: ulcer perforation, diagnosis, treatment, clinic tactical approaches.

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