Vol 5, No 1 (2012)

The aim of the study was to develop a new method of organ-preserving surgical treatment of pancreatic fistula, which allows
efficient and reliable to eliminate external pancreatic fistulas by internal drainage of the pancreatic duct into the lumen of
the jejunum, does not interfere with normal passage of pancreatic secretion in the digestive tract. With the application of the
developed techniques operated on 8 patients. Results of surgical treatment of patients with chronic pancreatitis with external
pancreatic fistulas, operated by the developed technique confirmed the efficiency of the method to eliminate the fistula while
preserving the physiological passage of pancreatic secretion in the digestive tract, and the way to reduce the risk of failure of
fistula and disseminated septic complications of the abdominal cavity.

The article represents the analysis of treatment of 238 patients with a chronic pancreatitis. Among them 174 (73,1 %) patients
have undergone to various kinds of operations. The long-term results (after 5 and more years) have been followed in a
medical group of 91 (52,3%) patients, quality of life – in a group of 53 (30,4%) patients. It is established that in the nearest
as well as in the remote period at chronic pancreatitis resectional operations are more effective. Compared with draining
operations their performance is accompanied with a mortality decrease and improved quality of life of patients. To improve
the passableness of pankreatodigestive anastomoses at their narrowing in a remote period it is expedient to use an endoscopic
balloon dilatation of the anastomosis zone through the lumen of the isolated nestis. This improves the state of patients, their
physical and psychological status.

The  treatment  analysis  of  56 patients, suffering  from  generalized  purulent  peritonitis , was  held  at the  department  of  purulent  surgery  SISRCCSTМA  of  Stavropol  from  2007 to 2010.The principal cause of  GPP  development  was  peritonitis  at  the  background  of  pancreonecrosis - 42,8 %. The majority of patients (44,6 %) at  the moment of  laparostomy  application were  in  grave  condition (20-30 points on MPI  scale).All  patients  with  GPP  were  forcedly  treated  with  longterm  programmed  sanations  of  abdominal  cavity  with  number  of sanations  which is more  than  4. At  the occurrence of  polyorganic dysfunction  with  the part of patients, the  conduction  of extracorporal  methods  of detoxication  even after  the  first  session  considerably  reduced  the  signs of  RDSA, renal  and  hepatic  insufficiency. At  the background  of  multiple sanations,  the current  of  pyoinflammatory  process  in  abdominal  cavity acquired  positive  dynamics  at  stable  hemodynamic  indicators. In  the  course of  treatment  11 patients died (19,6 %),  45 patients  were  discharged   from  hospital (80,4 %).  The  main  reasons  of lethal  outcome  were  sepsis (46 %), polyorganic  insufficiency (27,3 %), cardiovascular  insufficiency(18%)  and  RDSA (9 %).

This paper is a detailed study of electrophysiological indicators of electrogastrointestinography at 64 patients with a
perforated ulcer of a duodenum after isolated (without a vagotomy) operations. For an estimation of electrophysiological
indicators we used the multifactorial statistical analysis that has allowed to frame mathematical electrophysiological model
of postoperative disturbances of motility and evacuation. The multifactorial statistical analysis also allowed us to carry out
the comparative analysis of results of the executed operative measures. We establish the dependence of electrophysiological
indicators of a motility of a gastroenteric tract from character and volume of the executed operative measures.

Clinical trials on 119 patients after operative treatment of the acute intestinal non-tumor obstruction. Designed the diagnostic
algorithm for prognosis of pathologic adhesion, included the dynamic of auto-antibodies formation index, type of acetylation,
external signs of dysplasia of connective tissue, pathological scars, ets. Antiadhesion therapy is appropriate to use in patients
with high risk of pathologic adhesion formation. We developed and introduced into practice the aspects of by-step applying of
medicines and different physical factors in complex of prophylaxis the intraabdominal adhesion in patients with predisposing
to it. By using the rating test method it was established the reliable decreasing (in 3 times) of the adhesion formation risk in
patients with predisposing to its formation to whom was applied the complex antiadhesion treatment. Dynamics of changes
the serum titer in patients' blood to adhesion antigen complex during treatment letting to evaluate the effectiveness of
providing anti-adhesion treatment.

The tension-free repair of abdominal wall is standard procedure in surgery of hernias. However, experience of glue using in
Russia is small. In work are studied results of IPOM with glue and ximedon local using. Four groups of rats were operated by
IPOM technique. Macroscopic and morphological changes were observed in 14, 21, 28, 90 days after implantation. Is noted,
the mesh fixation using cyanoacrylate glue and ximedon has best results of reliability and toughness, low level of adhesions
in comparison to sutures.
The new technique of tension-free plasty is a perspective way in surgery of abdominal wall reconstruction.

Portal vein thrombosis (PVT) is the main cause of extrahepatic portal hypertension. Risk factors for PVT are divided into
systemic (inherited and acquired thrombophilia) and local (abdominal inflammation, injury of the portal system). Acute
PVT is usually asymptomatic or oligosymptomatic and thereby often misdiagnosed. Most frequent first manifestation of
chronic PVT is the life threatening complication of portal hypertension – gastroesophageal variceal bleeding. Doppler
ultrasonography, oesophagogastroduodenoscopy, and also computed or magnetic-resonance angiography should be included
in clinical investigation for these patients. Early anticoagulation is the main point in the treatment of acute PVT. Selective
portocaval shunt surgery is the most radical procedure for deliverance from portal hypertension and it’s complications
in case of chronic PVT. Endoscopic treatment in combination with nonselective β-blockers are effective for primary and
secondary prophylaxis of variceal bleeding. Despite severity of the PVT complications, prognosis is good in these patients:
5-years survival is 85-95% if adequate treatment and prophylaxis performed.

With the purpose to study the blood supply to the left half of colon the experimental study on 18 human cadavers and clinical
study of two groups of patients who underwent resection of infrarenal abdominal aortic aneurysm with and without the use
of prophylactic measures to prevent ischemic complications of the left half of the colon were realized. Experimental study on
human cadavers showed that by the value in the blood supply to the distal descending colon, sigmoid colon and rectum the
2nd place in percentage internal iliac arteries have occupied. Among operated on for infrarenal abdominal aortic aneurysm
without the use of objective methods for the prevention of ischemia of the left half of colon chronic ischemia developed in 12
(30%) cases. The proposed package of measures of preoperative examination and intraoperative method of measurement of
the retrograde pressure in inferior mesenteric artery with clamping the internal iliac arteries can determine the indications
for reimplantation of the involved arteries into the vascular prosthesis branches at resection of abdominal aortic aneurysm
and get encouraging results.

Experience of treatment of 413 patients with achalasia is represented in article. General method of treatment is cardiodilatation
was performed in 377 patients (91,3%): wth Stark apparatus – in 35, pneumatic method – in 312 and hydrobaloon
method – in 30. Complications rate (bleeding, esophagitis escalation, perforation et c.) after different methods of cardiodilatations
was investigated. The less complications rate occurs by using of pneumatic and hydrobaloon models of dilatators.
Examination of distant results shown direct dependence between increasing of dysphagia recurrence and stage of disease
independenly from cardiodilatation method.

Necrotizing fasciitis (NF) is a rare but still life-threatening soft-tissue infection characterized by rapidly spreading necrosis
of the muscle fascia and of the surrounding tissues. The aim of the study was to develop the early methods of diagnosis of
NF, analyze the clinical and laboratory findings of 17 patients and identificate the major characteristics that could help to
diagnose NF in the early stages of infection. Our data suggest that NF may exert particular tropism and/or toxicity for muscle,
responsible for early muscle necrosis, as a primary cause of CPK level elevation. At the average the exceedence of a normal
level was about 77,4 U/L. In 10 days after appropriate treatment (surgical debridement with antibiotic therapy) the CPK
level didn’t exceed the bounds of normal value (195 U/L). Early diagnosis and treatment, consisting of surgical debridement
along with appropriate antibiotic therapy, are required to reduce morbidity and mortality rates.

The results of complex treatment of chronic osteomyelitis of cortical bones. The experiment was carried out on 56 outbred rats.
To study the dynamics of structural and functional changes produced in the bone histological and radiological investigation
were hold. The data obtained indicate that the use of jet reorganization and platelet concentrate is an effective guide for
achieving the desired results in the treatment of chronic osteomyelitis.

The comparative estimation of a microcirculatory bed condition and components of a vascular tonus regulation was done by the laser Doppler fluometry method at 14 patients with electric current lesion of top extremities. All surveyed showed the
decreased microcirculation indicator, the increased myogenetic vessels tonus, the decreased highest possible amplitudes in myogenetic, sphygmic and endothelial ranges. The reactance of a vascular wall at a electrocurrent lesion of top extremities weakened in reply to the occlusion, the reserve of a capillary blood flow decreased in 1,5-2 times. Thus, electric current influence led to proof changes of a microcirculatory bed condition.

The problems of diagnosis and treatment of acute pan-
Creatine (OP) is traditionally considered one of the most
Complicated in surgical practice. This is
On the one hand, a significant increase in the frequency
Its occurrence. So, if at the beginning of the twentieth century, the OP was
He was seen as casuistry, but now
Acute surgical diseases of the abdominal organs
Cavity, it is second only to acute appendicitis and
Acute cholecystitis [1, 3, 4, 5, 16, 26]; Moreover, the co-
The socio-economic significance of the problem lies in the
That the OP is mainly affected by persons working
Of the same age (30-50 years) [10, 11, 16, 26]. On the other hand,
Although the overall lethality in OP varies from 1
Up to 7% [3, 4, 10, 16], then under destructive forms it
Remains at an extremely high level (from 12 to 87%), not
With a clear downward trend in recent years
20 years [1, 3, 7, 10, 26].

The use of mini-access and video-laparoscopic technologies - the main directions of reducing the traumatism of operations, reducing the patient's stay in the hospital and speeding up the rehabilitation period. As a rule, laparoscopic technologies are introduced in large hospitals - regional and urban. At the same time, in different regions, up to 40% of operated patients are residents of rural areas and small towns, and they are assisted in the conditions of the central regional hospitals (CRH). The relative disadvantages of laparoscopic operations are the high cost of equipment and supplies, the high incidence of complications at the stage of development of the operation. Therefore, it is difficult to provide hospitals with enough qualified personnel who are able to perform laparoscopic operations around the clock in CRH conditions, where surgeons often have 1-2 doctors. In this regard, mini-access seems more pragmatic and affordable solution. The hernia operation remains one of the most frequent
And in the urgent, and in routine practice of the surgeon.
Laparoscopic hernioplasty has not yet received unequivocal recognition and wide spread even in large surgical
Hospitals. Therefore, the idea of reducing the traumatism of surgery for abdominal hernia due to the use of mini-access, especially in the practice of the regional surgeon, seems to us very relevant and promising.

The purpose of the work: to assess the possibility and effectiveness of the use of mini-access in hernia under conditions of CRH.

In the last decade, an increasing spread the question of acquiring surgical corobesity of the reaction, one of which is pawroscopically gastro-bypass surgery (LGS). The at least, the main method of treating metabolic syndrome (MS) and weight loss remains therapeutic treatment [6, 8]. Due to the fact that co the number of patients with MS is growing, a critical question is you boron species correction. Bearing in attention insufficient experience with the use bariatriical operations in Russia, we compared the effecness of surgical treatment of MS efficacy conservative treatment of this dislevania.

Imperfect osteogenesis (HO), or fragility Bones, is a congenital malformation of the Tion. This pathology of the whole organism with predominant Damage to bone tissue, related to
A large group of diseases - osteogenezis imperfekta. More common in males [1, 4]. The clinical picture of the NO is characterized in Mainly multiple fractures of long Tubular bones, which subsequently lead to Curvature of the limbs and the progression of weShear atrophy. It should be noted that such Patients there is a clinical feature - the presence Blue sclera and "amber teeth", and with the age of for Mirated triangular shaped face. After birth Child fractures of the bones arise from different
Chin - swaddling or shifting the child, with Try to sit, stand on legs, at runtime Massage. Fractures in patients with DU are accompanied Classic signs: soreness, swelling, Lost, crepitation of fragments; Consolidation of Walks in normal terms, according to the age of reBenches. It should be noted that with the growth of the child and with Change in the static-dynamic conditions of the origin of the Formation of deformation of the lower extremities, Which further determines their shape. Most Frequent deformation of the thigh is a curvature At an angle, open to the inside and back like a riding breeches. The bones of the lower leg are curved in the sagittal planeIn the form of a saber-like shape. In the future, with A noticeable discrepancy Between the shortened limbs and normally Twisted body [3]. Treatment of patients with ND is to provide Proper care, prevention of fractures, preDeflection of deformations, strengthening of muscular The skeleton and the elimination of deformed
Tions. For surgical correction of deformities The lower extremities are developed and applied in Orthopedics quite a lot of methods: osteoclasis, Osteotomy, segmental osteotomy, for fixation Fragments are used metal rods with n- Tearing, decortication, segmental osteotomy And plastic by allografts by type "Fagots". The use of distraction apIlizarov for correcting deformations in the Soil is difficult because of osteoporosis and
Of the spoke [2, 5]. All this leads the patient to a deep invalid.
That determines the relevance of this pathology As in the choice of surgical strategy, and in tactics Restorative treatment.
Objective. Assess the effectiveness of the Of titanium nickelide materials during surgical Correction of clinical manifestations of BUT in children

The anatomical and clinical description of the funnel-shaped deformity of the chest (DVGK), the bootmaker's chest, pectus excavatum, was made in
Late 16th century and published as an essay by the famous anatomist and physician Bauhinus in 1594 in Frankfurt.
The first operation in the area of HDCE was performed in 1911 by Ludwig Meyer, who resected the rib cartilage. DVGK, according to a number of authors, occurs in 0.6-2.3% of cases, which is 91% of congenital deformations of the chest (Willital et al., 1981). DVGK - the most frequent pathology of the chest wall in children. Most deformations of this kind are accompanied by impaired breathing and hemodynamics. Even a slight cosmetic defect causes significant changes in the child's psyche, leads to a closed way of life, neurosis-like conditions and, ultimately, social maladjustment. The only way to change the configuration of the chest is surgical correction. To correct the funnel-like deformity of the chest, more than 50 different surgical procedures have been proposed (L. Ombredan, R. Gross, GA Bairov, F. Rebein, A. Brunner, V. Paltia, I. Krause, M. Ravich, F. Robichek , AI Kondrashin, I. Vada, VI Geraskin, YA Brodko).

Perforation of the stomach - life-threatening osFalsification of a number of diseases, primarily gastric ulcers, Complication, in which lethality reaches 17% [11, 38]. If treatment of ulcer bleeding is good, In 90% of cases of minimally invasive
Endoscopic technologies has undergone significant Changes, the methods of closing the perforatedTh hole remain fundamentally unchanged [15]. The operation of choice in urgent surgery is perforatinUp to now, suturing remains Perforation hole [26]. However, with laparoIntensive intervention takes most of the time Not on the main stage of the operation, but on access and suturing Wound, and the severity of the course of the postoperative period In many respects depends not on the amount of operative intervention Of the size of the operating wound [21].

In recent years, most surgeons are giving increasing importance to the issue of the choice of suture material. Close attention to this issue due to the fact that the outcomes of any operation depend largely on the quality and structure of the suture material and its interactions with surrounding tissues [7, 11, 13, 18].
Suture material – General name for a variety of materials (threads, needles) used for connecting tissues or ligation of vessels. The need to use threads for the needs of surgery originated in the very early stages of development of medicine. In ancient times for sutures used tendinous fibers of mammals, amphibians leather, fiber, rubber tree, coconut. Later, surgical practice has found its application thread from flax and silk. However, each of these materials had a number of limitations, such as the ability to provoke inflammation and infection of the tissue, low mechanical reliability of the formed seams, and other negative qualities that led to many postoperative complications and, consequently, limit their applicability. In the last 10-15 years thanks to the development of the chemical industry and the introduction of nanotechnology in the Arsenal of the surgeon appeared in a wide range of modern suture material, which can be classified according to the following characteristics [3, 10, 32].