Journal of Experimental and Clinical Surgery

Background. Acute pancreatitis remains one of the most common conditions among emergency surgical pathologies. Despite the widespread adoption of step-up minimally invasive strategies, the optimal choice of primary drainage for necrotizing pancreatitis (NP), particularly in patients with different grade of retroperitoneal extension of acute fluid collection (RE), remains controversial.

Aim. To evaluate the effectiveness of the step-up approach and primary open drainage via mini-access in patients with NP depending on the grade of RE.

Materials and methods. The retrospective–prospective study included 116 patients with NP treated in a municipal hospital between 2015 and 2025. The grade of RE was assessed according to the Ishikawa classification, and disease severity according to the revised Atlanta criteria. The comparative analysis was performed between patients managed using a step-up approach (group 1, n = 21) and those who underwent primary open drainage via mini-access (group 2, n = 12). The study endpoints included the need for surgery, the effectiveness of percutaneous catheter drainage (PCD) as definitive treatment, mortality, incidence of erosive hemorrhage and gastrointestinal fistulas, and the need for laparotomy in patients with different grade of RE.

Results. RE of grade III, IV, V was associated with a higher incidence of severe NP and an increased need for drainage of necrotic areas (OR = 6.85; 95% CI = 1.46–32.09; p = 0.0069 and OR = 3.75; 95% CI = 1.42–9.90; p = 0.0071, respectively). PCD served as definitive treatment in 33% of patients. No significant association was found between the grade of RE (OR = 3.33; 95% CI = 0.50–22.1; p = 0.345), timing (OR = 1.78; 95% CI = 0.28–11.1; p = 0.659), or indications for PCD (OR = 2.75; 95% CI = 0.38–19.7; p = 0.354) and the need for a surgical necrosectomy. Mortality in the step-up group was 14% and did not differ significantly from that in the primary mini-access group (p = 0.643), despite a higher proportion of severe NP in the latter. The use of mini-access approaches provided adequate drainage and effective control of the septic process without an increase in mortality.

Conclusion. The step-up approach and primary open drainage via mini-access demonstrate comparable effectiveness in the treatment of patients with NP regardless of the grade of RE. In patients with a predominance of solid necrotic components over fluid collections, primary drainage via mini-access may be considered a reasonable alternative to PCD.

Introduction. Management of patients with intestinal fistulas is one of the most pressing and complex issues in abdominal surgery. It is accompanied by infectious complications, nutrient depletion, pronounced pain syndrome, and fluid and electrolyte disturbances. The lack of a unified, practice-oriented classification complicates diagnosis and treatment decisions.

Objective. To develop a practical, modified classification of intestinal fistulas suitable for routine clinical use and scientific standardisation with presentation of comprehensive and reduced versions.

Materials and Methods. A systematic literature search covering the period from 1945 to 2025 was conducted in international databases (PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus, Web of Science) and Russian databases (eLIBRARY.ru, CyberLeninka, RSCI) using English- and Russian-language search strategies incorporating terms related to intestinal/enterocutaneous/enteroatmospheric fistulas and classification/staging. Deduplication, screening, full-text selection, extraction of classification features, and their comparison by axes were performed. Totally 6,119 records were identified; after deduplication, 254 records remained. Of these, 128 were selected based on titles and abstracts, and 102 articles underwent full-text analysis. Overall, 21 studies and 12 classification systems were included in the final review.

Results. Based on the data analysed, a modified classification of intestinal fistulas was proposed in two versions. The comprehensive version comprises nine criteria: etiology; location of the external opening; anatomical localisation; morphological features; degree of formation with the identification of types of non-formed (unformed) fistulas and their association with clinical variants of the "open abdomen" (degree of formation); functional status; amount of discharge (fistula output/flow/debit); single/multiple; mixed/combined; local and systemic complications. The reduced version is intended for standardised diagnostic reporting and includes six key parameters: location of the external opening, anatomical localisation, degree of formation, functional status, fistula output, and complications. The classification is based on national approaches, expanded and integrated with contemporary clinically relevant parameters.

Conclusion. The proposed modified classification provides a unified framework for describing intestinal fistulas, facilitates accurate diagnosis formulation, and supports the selection of staged treatment strategy. The reduced version is optimal for routine clinical documentation, whereas the comprehensive version is suitable for expert assessment and scientific research.

Treatment strategies for patients with malignant thyroid tumors remain a key issue in modern endocrine surgery. Although prognosis is generally favourable – particularly for papillary microcarcinoma – treatment selection among active surveillance, open surgery, and minimally invasive ultrasound-guided local interventions should be individualised. In recent years, ultrasound-guided minimally invasive techniques have attracted increasing interest as a potential alternative to traditional surgery and active surveillance strategies. These approaches enable targeted tumor destruction with minimal injury to surrounding tissues and a low complication risk. Minimally invasive technologies offer several clinical advantages: procedures can be performed under local anesthesia, on an outpatient basis, and provide rapid recovery and postoperative scar formation. These options are especially relevant for patients who decline active surveillance, refuse surgery, or have contraindications to that. This review summarises clinical experience with various thermal ablation techniques (laser, radiofrequency, microwave) and chemical ablation techniques (percutaneous ethanol injection) for thyroid carcinoma. Both short-term (up to 12 months) and long-term (over 12 months) outcomes are analysed, including tumor volume reduction or complete disappearance, recurrence rate, distant metastasis, and procedure-related complications. Particular attention is paid to comparative studies evaluating efficacy and safety across modalities. The aim of this review is to synthesise current clinical data and to define the role of ultrasound-guided minimally invasive local treatments in selecting an optimal treatment strategy for thyroid carcinoma, including microcarcinoma and recurrent forms.