Vol 13, No 2 (2020)

Introduction. Clinical outcomes of surgery for patients with chronic pancreatitis (CP), considering low rates of 10-year survival, are often unsatisfying for surgeons. Due to the absence of common diagnostic criteria, especially at an early stage of the disease, patients of young and working age undergo surgery at different periods and with different methods. The development of optimal criteria for the selection of diagnostic signs of chronic pancreatitis will improve treatment outcomes.
The aim of the study is 1) to perform a comparative assessment of the informative value of methods that specify diagnostics of CP with obstruction of the main pancreatic duct; 2) to develop criteria for the selection of diagnostic signs to highlight the main types of structural changes in the pancreas in chronic pancreatitis with obstruction of the main pancreatic duct.
Materials and methods. The study included radiological findings of 231 patients with CP with obstruction of the main pancreatic duct operated from 1996 to 2018 in Omsk regional surgical hospital. X-ray investigations were performed in 120 patients, ultrasound investigations were performed in 231 patients, multislice spiral computed tomography (MSCT) was performed in 226 patients, MRI was performed in 18 patients, endoscopic retrograde cholangiopancreatography (ERCP) was performed in 22 patients and angiography was performed in 5 patients. All patients were divided into two groups: control (n ​​= 88, until 2008) and case (n = 143, after 2008), where new methods of surgery were used and the structure of the applied diagnostic methods has been changed.
Results. Ultrasound sensitivity was 74.5%, fistulography/virsungography sensitivity was 80%, MSCT sensitivity was 97.8%, MRI sensitivity was 88.9% and ERPC sensitivity was 95.5%. The use of invasive diagnostic methods in the main group of patients was minimized with the priority of MSCT. The main criteria for the selection of diagnostic signs of CP were determined as follows: obstruction of the main pancreatic duct (with localization at the level of the pancreatic head exclusively or along its entire length), dilatation of the main pancreatic duct (more than 3 mm), local damage to the pancreatic head with an increase in its size over 32 mm, cystic formations (more than 5 mm) in the projection of any part of the pancreas. The main types of structural changes in the pancreas were identified as follows: 1. CP with obstruction of the main pancreatic duct at the level of the pancreatic head exclusively; 2. CP with obstruction of the main pancreatic duct along its entire length with an increase in the size of the pancreatic head; 3. CP with obstruction of the main pancreatic duct along its entire length without an increase in the size of the pancreatic head.
Conclusion. 1) MSCT has the highest sensitivity in CP diagnostics (98.6%). MRI (Magnetic Resonance Cholangiopancreatography (MRCP)) complements MSCT and replaces it in case of patient’s intolerance to contrast media. Indications for ERCP should be minimized. 2) The designed criteria for the selection of diagnostic signs of CP will optimize diagnostics of chronic pancreatitis with obstruction of the main pancreatic duct and highlight the main types of structural changes in the pancreas, the fact being important for validation of surgical treatment methods and techniques.

Introduction. The problem of colonic anastomosis failure remains unsettled in colorectal surgery, since the use of various techniques of anastomotic protection does not preclude the development of complications.
The aim of the study was to highlight surgical treatment outcomes of colorectal cancer using preventive stomas.
Material and methods. The study included clinical outcomes of 248 patients with colorectal cancer. Group 1 included 85 patients who had a preventive colostomy after rectum resection and restoration of intestinal continuity. Group 2 (control) included 163 patients who had rectum resection without unloading stomas. The following parameters were evaluated in the study: gender, age, presence or absence of the preventive intestinal stoma, duration of stay in the surgical department, anastomotic failure.
Results. In patients of group 1, colorectal anastomosis failure was manifested in 1 case (1.2%), in patients of group 2 - in 14 cases (8.6%). The average number of inpatient day in group 1 was 18, the average number of inpatient days in group 2 was 21.
Conclusion. The application of a preventive intestinal stoma can reduce the incidence of failure, duration of hospital stay and improve long-term treatment outcomes

Introduction. The development of modern surgery requires the advancement of expertise about individual characteristics of large vessels development. The expansion of surgical treatment options of liver diseases determines the necessity of more detailed information about the anatomy of the portal, biliary and arterial systems, and about the anatomy of the hepatic veins in particular.
The aim of research was to study characteristics of the left hepatic vein formation based on ultrasound examination findings.
Materials and methods. The study included 39 outpatients, 11 males and 28 females, aged 17-84. Using ultrasound imaging methods, the authors determined linear dimensions, variations and angles of junction of the veins forming the left hepatic vein.
Results. The main six variations of the left hepatic vein were determined as follows: variation I was observed in 9 cases (23.1%), variation II - in 7 cases (17.9%), variation III - in 11 cases (28.2%), variation IV - in 6 cases (15.4%), variation V - in 5 cases (12.8%), variation VI - in 1 case (2.6%). The angle of junction of the veins I and III at the site of their entry into the main trunk of the venous system was from 19-21 degrees to 80-85 degrees; the angle of junction of the vein II was from 21 degrees to 61.6 degrees. Deviation of veins in the plane perpendicular to the rest veins ranged from 32 degrees to 81.7 degrees. Additional veins entered at the angles from 22.5 degrees to 45 degrees. When observing, the vein diameter for veins I and II was from 1.3 mm to 4.8 mm, and for vein III - from 1.5 mm to 3.5 mm. There were additional veins determined with an average diameter equal 2.25 mm ± 0.25 mm. The size of the trunk of the left hepatic vein directly corresponded to a diameter of 2 mm to 7.7 mm.
Conclusion. The presented variations are of major importance for modern diagnostic methods, they also expand the understanding of the anatomical variations in the left lobar vein formation, which should be taken into account by surgeons during liver operations.

Introduction. Currently, rubber band ligation of internal hemorrhoids is performed during surgical treatment of hemorrhoids in 26,88–44,0 % of cases. However, this technique can lead to the need for repeated interventions. Moreover, at stage IV hemorrhoids a relapse occurs in almost 40% of cases.
The aim of the study was to improve clinical outcomes of the senile and elderly outpatients with stage II-III internal hemorrhoids by optimizing a rubber band ligation technique and indications for its use.
Materials and methods. The authors analyzed clinical outcomes of 60 senile and elderly outpatients with stage II-III internal hemorrhoids. Patients were divided into 2 study groups. Patients of the control group received standard treatment including ligation of hemorrhoidal nodes with latex ligatures using a KARL STORZ suction ligature instrument with an integrated vacuum pump at a pressure equal 0.8 atm. Patients of the case group were exposed to ligation of hemorrhoidal nodes with latex ligatures using a KARL STORZ suction ligature instrument with an integrated vacuum pump at a pressure equal to 0,6–0,7 atm. Ligation in the case group was performed on the following conditions: high and medium degree of compliance in patients, hemorrhoids size less than 1,5 cm, absence of anemia, no antiplatelet drug intake a possibility to discontinue an antiplatelet drug in case it is taken
Results. The study results demonstrated that 60 % of patients of the case group required pain relief on Day 1 after the intervention, 13,3% of patients of the case group required pain relief on Day 3 after the intervention. The correspondence to these parameters in the control group was 66,6% and 16,6% of patients respectively. The first defecation in patients of the case group occurred in 1,73 ± 0,48 days on average; in patients of the control group – in 1,74 ± 0,47 days. Acute swelling of the external hemorrhoids was reported in 13,3% of patients of the case group and in 16,7% patients of the control group. Thrombosed external hemorrhoids, rectal bleeding, acute urinary retention were reported in 6,7% of patients of the case group and in 10,0% of patients of the control group. Vaso-vagal syndrome and local wound complications were reported in 6,7% of patients of the case group and in 3,3% of patients of the control group. Stricture of the anal canal was noted in 3,3% of patients of the case group and in 3,3% of patients of the control group. Anal sphincter incompetence was not detected in patients of the case group, while it was reported in 3,3% of patients of the control group. The average time of temporary disability was 2,3 ± 0,4 days in patients of the control group and 1,9 ± 0,4 days in patients of the case group. In 6 months after ligation, 60,0% of patients of the control group and 63,3% of patients of the case group manifested “good” results; 30,0% and 33,3% manifested satisfactory results; and 10,0% and 3,3% manifested unsatisfactory results respectively. After rubber band ligation, the relapse rate of the disease was 13,3% in patients of the control group and 10,0% in patients of the case group.
Conclusion. Rubber band ligation is well tolerated by the senile and elderly patients. To reduce pain, tenesmus, vaso-vagal conditions, and urinary retention, the negative pressure created in the device sleeve degressed, which resulted in an improvement of patients’ general state and decrease in the number of complications.

The problem of unsuccessful (incomplete) esophagoplasty is still urgent nowadays. Simultaneous esophagoplasty remains a method of choice in reconstructive surgery of the esophagus. However, in the case of ischemic disorders in the transplant, its initially insufficient length, deficiency of the organs of the plastic reserve, the completion of esophagoplasty seems to be a technically complicated task, forcing surgeons to perform multi-stage intervention techniques. These techniques are associated with longer treatment periods and deterioration in the quality of life of patients.
The article highlights a rare experience of esophagoplasty with combined grafts consisting of visceral segments on a natural source of blood circulation. Applied operational techniques allowed to complete esophagoplasty in a single step, including rational disposal of “compromised” plastic material, and also to preserve digestion.

The review is devoted to the treatment methods of inguinal hernia. Inguinal hernia repair is one of the most common operations in the world and is performed on more than 20 million patients per year. Recurrence rates of inguinal hernias after different types of surgical interventions range from 10 to 15%. The use of synthetic materials reduced the rates of hernia recurrence on average to 1-5%. Currently there are traditional tissue-based techniques, open tension-free mesh hernia repair, and laparoscopic mesh hernioplasty. Nowadays tension-free repair with synthetic mesh is a technique of choice for inguinal hernia repair. The emphasis has been placed on endoscopic methods of inguinal hernia prosthetic repair. According to the literature, laparoscopic repair is associated with low rates of wound infection and fewer haematomas, which leads to early resumption of everyday activities compared with Lichtenstein hernia repair. The paper discusses two standardized endoscopic methods for inguinal hernia treatment, namely laparoscopic transabdominal preperitoneal patch (TAPP) and total extraperitoneal (TEP) repair. Analysis of the literature has shown that criteria of necessity and method of mesh fixation during TAPP procedure were not completely identified. However, a number of researches have demonstrated that TAPP technique without mesh fixation proved to be a safe procedure which can be used in most patients with unilateral and bilateral inguinal hernia showing no increase in postoperative complications and low recurrence rates.

Introduction. Modern standards for the treatment of acute abdominal surgical diseases suggest a temporary exclusion of the impaired intestinal part from the digestion. This reduces the morbidity of the primary operation, but also results in specific postoperative complications.
The aim of the study was to analyze current data on the technique and effectiveness of urgent intestinal neostomy and bypass surgery.
Results. The authors analyzed 39 modern literature sources that deal with the problem of urgent intestinal neostomy and bypass surgery. Currently, there is a growing interest in developing techniques for early (before anastomosis) restoration of the chyme passage across the intestine bypassing the impaired intestinal area. It has been reported that a number of unresolved issues do not yet allow full implementation of the concept of “intestinal bypass (shunt)”: a safe mechanism for performing an anastomosis between the small intestine and a synthetic prosthesis has not been developed, the problem of creating unidirectional pathway along a non-peristaltic intestinal prosthesis has not been solved.
Conclusion. Solution of these problems can contribute to a significant improvement in the clinical outcomes of patients with acute ischemic or traumatic damage to the intestine.

Richard Folkman was born in 1830 in Leipzig in family of the privatdozent of the local university. Richard Folkman studied medicine at Gallet and Gissen's universities, in 1854 graduated from medical faculty of the Berlin university. In 1854 Folkman defended the dissertation then he works as the assistant, the privatdozent, extraordinary professor in surgical clinic of professor Blazius at Halle University. He participates in the German military campaigns 1865-1866 and 1870-1871 of. During the French-German war works as the chief physician in the 4th army body, is later in the Maas and Southern army. In 1866 receives the invitation to management of surgery of Halle University of department. From 1867 to 1885 Folkman ordinary professor of surgery and the director of university surgical clinic in Halle. From 70th years he begins to publish a series of monographs devoted to internal diseases, surgery and gynecology "A collection of clinical reports", since 1880 becomes the coeditor of the surgical edition "Zentralblatt fur Chirurgie". One of the main merits of Richard Folkman is broad promoting of a method of antiseptics. Folkman made extremely important contribution to increase in efficiency of treatment of the patients by use of an occlusive bandage in the conditions of wartime developed by it wire T-shaped immobilized tires, ways of treatment of bone changes by an extension method. It described several forms of bone tuberculosis. In 1872 Richard Folkman with colleagues created the German society of surgeons which chairman he was since 1885. In 1885 Folkman was awarded a noble rank. The name of Folkman is born by the contracture described by it, a number of surgeries, devices and tools. In 1889 Richard Folkman died.