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Objective: To create a method of two-stage repair of high unformed conglomerate delimited debilitating jejunal fistulas via posterolateral laparotomy with low risk of surgical complications., Material and Methods: Methodology and treatment outcomes were analyzed in 37 patients with unformed conglomerate high debilitating delimited jejunal fistulas. Of these, 22 patients underwent one-stage treatment through 2 converging incisions and/or two-stage treatment through anterolateral access. They made up a control group. Fifteen patients in the main group underwent two-stage treatment via posterolateral left-sided laparotomy with unilateral disconnection of jejunum with fistula. In most patients of both groups, fistulas complicated surgery for acute adhesive intestinal obstruction. Topography of adhesions that caused acute intestinal obstruction in both groups was studied in 172 other patients. Identical jejunal fistulas and two different surgical approaches made it possible to consider our groups representative., Results: Two-stage treatment via posterolateral left-sided laparotomy reduced mortality from 63.6±10.2% to 20.0±10.3% ( t =11.8; p <0.001). This approach simplified intraoperative diagnostics that became more informative. Posterolateral access increased the quality of anastomosis and safety of viscerolysis., Conclusion: A new two-stage approach with posterolateral left-sided laparotomy allowed atraumatic imposing of inter-intestinal anastomosis with proximal disconnection of jejunal fistula. This exclusion turns the fistula into analogue of the definitive Meidl's jejunostomy, unloads the intestinal anastomosis and increases the quality of suture. New strategy reduced the risk of complications and mortality.

Objective: To assess the possibilities of fluorescent detection system in qualitative and quantitative assessment of bowel perfusion in colorectal resections., Material and Methods: From May to August 2023, a single-center pilot cross-sectional unblinded study with inclusion of 18 patients with colon cancer (of left-sided - 12, of right-sided - 6, mean age - 72.9 years, m/w - 61/39%) was conducted. All patients underwent laparoscopic colorectal resections with extracorporeal stage of bowel transection. The evaluation of the bowel's ICG perfusion was conducted to assist in decision making about the level of its resection. Qualitative (visual) assessment was carried out in all 18 patients, in one patient twice, quantitative assessment of perfusion was conducted in 8 patients (left-sided resections - 6, right-sided hemicolectomy - 2). The qualitative evaluation was performed in real time on the analysis of the color gradient. The time parameters and fluorescence intensity at different level proximally and distally from the resection line were quantitatively estimated: T start - time of occurrence of minimal fluorescence in the areas of interest after the ICG injection (sec); T max - time to achieve maximum fluorescence intensity after the ICG injection (sec); T max-start - time interval between T start and T max , I max - level of maximum fluorescence intensity (I)., Results: Visual qualitative analysis of fluorescence revealed unsatisfactory perfusion characteristics (black, dark-gray color) in the area planned by the surgeon to anastomose the bowel in 3 of 18 patients (16.6%). When analyzing the quantitative data of this group of patients, there was a 2-6-fold decrease in Imax level, and one patient had an increase in T max-start at the level of intended resection compared to the bowel's sections in the favorable zone. In all cases, the final bowel transection was conducted in the area of good perfusion. There was no clinical evidence of anastomotic dehiscence in the study group., Conclusion: Intraoperative evaluation of bowel perfusion is an important component of safe anastomosis formation in colorectal surgery. The use of ICG-FA allows to conduct qualitative and quantitative assessment of tissue perfusion of the bowel in order to assist in making intraoperative decisions. Quantitative evaluation of fluorescence provides more objective information about perfusion parameters. I max and T max-start are the most promising quantitative indicators of local bowel's perfusion. Nevertheless, the precise interpretation of the quantitative indicators of ICG perfusion needs to be clarified.

The authors describe 2 patients with rare gastric diseases and indications for gastrectomy with delayed esophagojejunostomy for objective causes. In one case, they could not determine extent of resection, and other patient had hemorrhagic shock. Damage control principle was applied in both cases.

Objective: To investigate enteral nutrition as a component of postoperative rehabilitation after reconstructive esophageal and gastric surgeries., Material and Methods: The study included 217 patients who underwent reconstructive esophageal and gastric surgeries between 2010 and 2020. In the main group ( n =121), patients underwent postoperative enhanced recovery program (ERAS). Early enteral feeding including micro-jejunostomy and early oral feeding was essential for postoperative management. The control group included 96 patients who were treated in traditional fashion. The primary endpoint was length of hospital-stay (LOS) and ICU-stay. Restoration of gastrointestinal function (peristalsis, stool, oral nutrition), anastomotic leakage rate and other complications comprised secondary endpoints., Results: Both groups did not differ by sex, age, body mass index, diagnosis and comorbidities. There was significant reduction in postoperative LOS in the ERAS group (14 (12; 15.8) and 9 (6.3; 12) days, p <0.0001). In the same group, we observed less in ICU-stay (4.7 (3.6; 5.6) and to 3.5 (2; 4) days, p <0.001), earlier recovery of peristalsis and X-ray control of anastomosis in patients with and without anastomotic leakage. Incidence of respiratory complications was lower in the ERAS group ( p =0.034). Overall postoperative morbidity and mortality were similar., Conclusion: Early enteral and oral feeding after esophageal and gastric reconstructive surgery reduces hospital-stay and accelerates postoperative rehabilitation.

We present a clinical case of a patient with a post radical robot-assisted prostatectomy recurrent vesicourethral anastamotic stenosis. Successful simplified transvesical correction with buccal mucosa graft fixed by self-anchoring automated V-Loc suture through the needle for epidural anestesia without knot formation was the unique feature of case presented.

Introduction: Congenital ureterovesical junction (UVJ) obstructions quite rarely serve as an indication for ureteral reimplantation, and recurrent obstructions resulting from surgical treatment are even less frequent. Cases of acquired UVJ obstruction following endoscopy and ureteral reimplantation done for vesicoureteral reflux correction are fairly rare. The lack of known publications analyzing treatment of recurrent obstructive megaureter predetermines topicality of our research., Purpose: Evaluate the efficiency and safety of extravesical anti-reflux uretero-cysto-anastomosis performed using Bradis technique for children with recurrent obstructive megaureter (OM)., Materials and Methods: The work is based on the experience of surgical OM correction in 5 children aged 1 to 4 years, 4 boys and a girl with a recurrent UVJ obstruction following prior ureteral reimplantation for correction of UVJ obstruction (4 children) or vesicoureteral reflux (1 patient). Antenatal UVJ obstruction had been diagnosed in 2 patients. In all cases the examination included urine analysis, its culture study, ultrasonography of the kidneys and urinary tracts, dynamic renal scintigraphy, micturating cystography, and, where indicated, intravenous urography and SCT of the kidneys. All patients underwent Bradis extravesical reimplantation., Results: During postoperative care period, a considerable reduction of the dilatation of renal collecting system was accomplished in all five patients along with the differential renal function preserved on the pre-surgery level and a steady remission of urinary tract infection based on clinical manifestations and laboratory findings., Conclusions: The simplicity of Bradis extravesical ureteral reimplantation represents its advantage over intravesical methods. Extravesical approach allows easy ureteral length and width correction. Limited experience of Bradis surgery in pediatric cases of recurrent OM requires confirmation with further randomized clinical trials.

Features of the location of the sphenoid sinus determine the possibility of developing severe intraoperative complications in the surgical treatment of patients with chronic sphenoiditis. Technical difficulties during sphenoidotomy may arise at the initial stage of expansion of the natural anastomosis with its anatomical narrowness and the impossibility of inserting biting forceps., Purpose of the Study: To study the clinical efficacy and safety of the proposed original method of dilatation of the sphenoid sinus fistula in the surgical treatment of various forms of chronic sphenoiditis., Material and Methods: The study included 68 patients of both sexes older than 18 years with chronic sphenoiditis, who are indicated for surgery on the sphenoid sinus. Patients of the 1st group ( n =36) underwent expansion of the fistula of the sphenoid sinus using the traditional method. Patients of the 2nd group ( n =32) underwent dilatation of the anastomosis of the sphenoid sinus using the tool developed by us. Intraoperatively, the quality of visualization of the surgical field, the time of the operation, and the presence of complications were assessed. In the postoperative period, the number of complications, relapses of the disease and the condition of the sinus were recorded according to the results of computed tomography 3-4 months after the operation., Results: The use of the method of dilated expansion of the anastomosis of the sphenoid sinus using special forceps developed by us helps to reduce the duration of the operation, improve intraoperative visualization of the sphenoid sinus and improve the results of treatment according to endoscopy and control computed tomography. When using the developed tool, the number of episodes of intraoperative bleeding that hindered visualization and necessitated coagulation was lower than when using an alternative technique., Conclusion: The technique of endoscopic dilatation of the anastomosis of the sphenoid sinus using the developed tool can be used both independently and as a preliminary step for expanding the anastomosis of the sphenoid sinus, followed by the use of a shaver or Kerrison forceps.

Objective: To evaluate safety and effectiveness of routine splenic flexure mobilization (SFM) in surgical treatment of rectal cancer (RC)., Material and Methods: A single-center randomized study was performed between 2016 and 2019. Patients were randomized into 2 groups (SFM (+), n =156, SFM(-), n =67). Standard anterior and low anterior rectal resection was used. We used a combination of medial, lateral, and anterior approaches for SFM. Intraoperative, early and late postoperative complications, histological data, local recurrence, overall 3-year, relapse-free and cancer-specific survival were analyzed., Results: Surgery time was 253.2±72.8 and 252.0±78.0 min in the SFM(+) and SFM(-) groups, respectively ( p =0.98). Blood loss was 53.3±53.6 and 67.0±108.8 ml, respectively ( p =0.85), length of specimen - 28.6 (95% CI 27.2-29.9) and 24.0 cm (95% CI 22.2-25.7) ( p <0.0001). Length of residual fragment of sigmoid colon was 5.0 (95% CI 3.9-6.1) and 9.1 cm (95% CI 7.2-11.1) ( p <0.0001), respectively. The number of examined lymph nodes was 15.5 (95% CI 14.2-16.8) and 16.1 (95% CI 14.2-18.1) ( p =0.52), number of affected lymph nodes - 1.5 (95% CI 0.9-2.1) and 1.5 (95% CI 0.9-2.2), respectively ( p =0.38). Spleen damage was more common in the SFM (-) group (4.5% vs. 1.3%, p =0.12). Logistic regression analysis indicates that SFM does not affect the incidence of spleen damage. Severity of postoperative complications was similar ( p =0.63). Anastomotic leak (AL) was more common in the SFM group (-) (17.9% vs. 9.6%, p =0.04). AL grade B was more common in the SFM(-) group ( p =0.0001). Logistic regression analysis revealed the following predictors of anastomotic leakage: length of specimen and length of residual sigmoid colon. There was no significant relationship between SFM and incidence of local and systemic recurrences. Overall, cancer-specific and relapse-free 3-year survival was similar., Conclusion: SFM is a safe procedure with various advantages. However, this approach does not improve intraoperative, early and long-term postoperative outcomes that does not allow us to recommend this approach for routine application.

Objective: The aim of the study was to establish the prevalence, diameter and topography of the intraosseous vascular canal of the maxillary sinus lateral wall., Material and Methods: The data of cone-beam computed tomography of 150 dental patients (294 maxillary sinuses) were analyzed., Results: Intraosseus anastomosis of the branches of the posterior superior alveolar artery and infraorbital artery was detected in 87.8% of cases (258 of 294 sinuses). Anastomosis was found inside the wall of the sinus in every tooth location in 9.5% of sinuses; in other cases, the anastomosis was partially or fully embedded in the thickness of the lateral wall of the maxillary sinus in different tooth site. The mean diameter of the vascular anastomosis was 0.95±0.3 mm (range 0.3-2.18 mm). The average distance from the anastomosis to the sinus floor was 8.91±3.39 mm (range 1.68-21.83mm). In most cases, at locations of molars and premolars, the distance from the vascular anastomosis to the alveolar crest was greater than 15 mm (from 75.5% at the location of the first molar to 99.2% at the location of the first premolar)., Conclusion: Detection of the topography of the vascular anastomosis by using cone-beam computed tomography is essential when planning the position of the antrostomy for the lateral sinus lift procedure in order to minimize iatrogenic complications.

Aim: To study the influence of the technique of posterior reconstruction of the vesicourethral anastomosis (VUA) on the prevention of urinary incontinence after robotic-assisted radical prostatectomy (RARP)., Material and Methods: A total of 67 patients (mean age 63 years) with localized prostate cancer were included in the study. All patients were divided into two groups. In the group 1 (n=32) the standard technique of the VUA was used, while in the group 2 (n=35) the two-layer posterior reconstruction was done. The impact of urinary incontinence on the quality of life was analyzed using the ICIQ-SF questionnaire 1, 3 and 6 months after operation. On postoperative days 5-7, all patients underwent cystography to assess the tightness of the VUA., Results: One month after RARP in the group 1 the mean score of ICIQ-SF questionnaire was 6.72, compared to 4.57 in group 2 (p=0.04). After 3 and 6 months the respective values were 3.8 vs. 2.3 (p=0.09) and 1.94 vs. 1.2 (p=0.23), respectively. Cystography revealed no extravasation of the contrast., Conclusion: The results of a retrospective comparative study suggest that a two-layer posterior reconstruction of the VUA during RARP, being a simple method, provides better continence rate one month postoperatively compared to standard technique, although larger randomized clinical trials are needed.

There are usually two main techniques of vessel anastomosis called as; end-to-end or end-to-side. The aim of this study was to investigate surgical vascular anastomotic and its correlation with early outcome after kidney transplantation. Data including gender, age, hospital stay, living or deceased donor, evidence of acute tubular necrosis, preference of artery or vein in addition to biochemical variables were noted analysed by SPSS. The study population was comprised of 84 females and 176 males (174 living versus 86 deceased donor). Surgical vascular anastomic techniques were based on; first artery second vein (FASV; n=209) or first vein second artery (FVSA; n=51). Vascular anastomic were performed as follow; group 1 (FASV with end-to-end; n= 52%), group 2 (FASV with end-to-side; n=29%), group 3 (FVSA with end-to-end; n=15%) and group 4 (FVSA with end-to-side; n= 5%). Comparison of groups showed that; deceased/living donor (group 1 versus group 3; p=0.02), ATN (group 1 versus group 2; p=0.002, group 1 versus group 4; p=0.03). Despite the higher use of deceased donors, those with vascular anastomic technique based on FASV (end-to-end) revealed a lower rate of ATN when compared to other techniques. Further studies in this direction recommended.

The aim of the study was to develop a new method of formation of biliodigestive anastomoses, which would make it possible to form anastomoses both on unchanged bile ducts and in conditions of their inflammation. An experimental study was carried out on 50 rabbits of the "Chinshila" breed, which formed biliodigestive and interintestinal anastomoses by the method of high-frequency (HF) electric welding using the "Patonmed EKVZ-300" coagulator. Anastomoses were formed both on non-inflamed tissues and under conditions of biliary peritonitis. In different terms after the operation macro- and microscopic examination of the formed anastomoses was carried out, their patency, tightness and strength were determined. With HF-electric welding the connection of biological tissues is achieved due to thermal adhesion, the mucous and serous layers in the area of the anastomosis are almost completely destroyed under the influence of electricity and the connection occurs due to the submucosal layer. The suture is well-established, hermetically sealed, the anastomoses have sufficient strength (40-100 mm Hg). The coagulation scar is narrow, thermal damage to the membranes is local (within 2700-3000 microns), the epithelialization of the suture was completed after 3 months and the maturation of the scar after 6 months. The method of HF-electric welding equally allows the formation of reliable biliodigestive and interintestinal anastomoses, both in conditions of unchanged and inflamed tissues. The everting weld connection prevents the occurrence of anastomotic strictures in the future.

This review is devoted to history of pancreatodigestive anastomoses (PDA), technique of the most popular PDA, causes of pancreatic fistula and its prevention. Contradictory data were obtained in randomized trials and meta-analyses devoted to pancreatic anastomoses. There is no optimal anastomosis excluding clinically significant postoperative pancreatic fistula. Therefore, further studies should be aimed at new approaches reducing the incidence of clinically significant postoperative pancreatic fistula.

Objective: To determine the variants of topography and quantity of extraorganic anastomoses of inferior vesical artery (IVA)., Material and Methods: The study included 186 corpses of males (age 22-82 years) and 109 females (age 32-93 years). All people died from accidental causes not associated with pelvic organ diseases. Dissection, vascular injection and statistical analysis were performed., Results: IVA forms anastomoses with other branches of internal iliac artery in 11.3% of cases on the right and in 12.4% of cases on the left in males. These collaterals in females are noted in 9.2% of cases on the right and in 7.3% of cases on the left. Mean length of extraorganic anastomoses of a. vesicalis inferior in males is 1.4 cm, mean diameter - 1.7 mm. Mean length of such collaterals in females is 1.7 cm, mean diameter - 1.7 mm. Extraorganic anastomoses are more common in proximal and middle thirds of IVA, rarely - in distal third. Linear correlation between diameters of a. vesicalis inferior and its extraorganic anastomoses was not detected in females but found in males., Conclusion: Extraorganic anastomoses of IVA are characterized by certain pattern of origination in males and in females.

Pathological tortuosity of the internal carotid artery ranks next to atherosclerosis amongst causes leading to development of ischaemic strokes. In some patients pathological tortuosity of the internal carotid artery is combined with pathological kinking of the common carotid artery. Existing methods of surgical treatment for such concomitant pathology include stegewise elimination of kinking of the internal then common carotid artery, with two anastomoses sequentially formed, thus increasing the overall duration of arterial cross-clamping an prolonging cerebral ischaemia. Another method consists of resection of the common carotid artery with bringing down its bifurcation, restoration of straightness of the internal carotid artery, and formation of an end-to-end anastomosis. The second technique is often associated with technical requirement for ligation of the external carotid artery. In the presence of prolonged atherosclerotic lesions of the bifurcation of the internal and external carotid arteries, this method does not always allow carrying out adequate endarterectomy and fix the intima of the internal carotid artery distal to the bifurcation. The authors developed a method of surgical treatment of patients with a combination of pathological kinking of carotid arteries, providing herein a detailed description of the procedure of performing an operation according to an original technique. The proposed method of reconstruction makes it possible to eliminate pathological kinking of the common and internal carotid arteries in single cross-clamping of vessels, to preserve patency of the external carotid artery and in the presence of an atherosclerotic lesion of the bifurcation to perform adequate endarterectomy. Over the period from 2015 to 2019, a total of 10 patients were operated on according to this technique at the Municipal Vascular Centre of Samara, with no postoperative complications observed. The proposed technique of a reconstructive operation may be effectively used in patients with cerebral ischaemia in concomitant pathological kinking of the common and internal carotid arteries.

Introduction: Combined cerebral revascularization with direct and indirect components is recognized as the most appropriate method for treating patients with Moyamoya disease all over the world, however, large studies on its effectiveness in Russia have not yet been conducted., The Aim of the Study: Was to evaluate the results of combined cerebral revascularization in patients with Moyamoya disease with an analysis of the clinical state and perfusion and angiographic features of neoangiogenesis., Material and Methods: For the period from 2013 to 2020 in N.N. Burdenko National Medical Research Center of Neurosurgery 79 combined revascularizations were performed in 55 patients with Moyamoya disease. The average age was 13.9±10.11 years. All patients were examined according to a single protocol, including a comprehensive assessment of the clinical symptoms, the state of the brain tissue, the cerebral vascular system, and cerebral blood flow. The results of surgical treatment were evaluated in the early postoperative and long-term periods. The average follow-up period was 14.66±13.17 months. In the postoperative period, the dynamics of neurological status and cerebral blood flow were assessed and the features of neoangiogenesis from various components of revascularization were studied., Results: In the early postoperative period, in 77.2% of cases, a good treatment result was observed, with no negative dynamics of the neurological status. Ischemic stroke in the operated hemisphere developed in 4 cases (5.1%). In the follow-up period, an improvement in neurological symptoms was observed in 76.6%. Improvement of cerebral blood flow was noted in 92.4% of cases, direct anastomoses functioned in 94.3%, and signs of neovascularization in the area of indirect synangiosis were observed in 80.0%. At the same time, a complementary influence of direct and indirect components of revascularization was revealed in ensuring good general angiographic and perfusion results., Conclusions: Combined revascularization is a highly effective method of surgical treatment of all patients with Moyamoya disease.

Common carotid artery (CCA) thrombosis is a rare cause of ischemic stroke. In available literature, we found no studies devoted to cerebral revascularization for CCA occlusion in acute period of ischemic stroke. Successful treatment of concomitant occlusion of CCA, internal (ICA) and external carotid arteries (ECA) with microvascular anastomoses is very interesting for various specialists. To demonstrate the possibility of contralateral cerebral revascularization in a patient with CCA, ECA and ICA occlusion in acute period of ischemic stroke. Two-stage intervention was performed in a patient with ischemic stroke and carotid artery occlusion. At the first stage, EICMA was formed between the right superficial temporal artery and the M4 branch of the middle cerebral artery (MCA), at the second stage - anastomosis between the right and left ECAs using an autologous arterial graft from the radial artery. There is no generally accepted surgical strategy for CCA occlusion. Contralateral revascularization with blood flow redirecting from the right carotid artery to the left one makes it possible to avoid thrombectomy from the affected CCA and ECA. We have undertaken this method for the first time. We have not found such an approach in the available literature. This report demonstrates the possibility of successful cerebral revascularization in acute period of ischemic stroke in patients with combined occlusion of CCA, ICA and ECA.

Aim - comparison of biological hermeticity, mechanical strength and differences in morphological characteristics of one-row and two-row colon anastomoses. 20 animals were used in the experiment. Rabbits of both sexes aged from 8 months to 1.5 years and weighing from 1.5 to 2.6 kg were used as experimental animals. The animals were divided into experimental and control groups. In the experimental group we used the developed technique of one-row colon anastomosis (CA) formation, in the control group - the traditional two-row CA. Assessment of mechanical strength was performed by using the original method of pneumopression of colon segment with the anastomosis. The biological hermeticity was assessed by culturing flushing water from the anastomosis line to growth medium. The morphological picture was evaluated by microscopy of histological samples from the anastomosis line. The mechanical strength of the one-row anastomosis, compared with the traditional two-row, was higher at each stage of the study, on the first day by 66.3%, the third - 87.6%, the fifth - 76.1%, the seventh - 85.4%. The formation of a one-row CA allowed to achieve biological hermeticity of the anastomosis area in all periods of the early postoperative period, and when using a double-row suture, the anastomosis area became sterile only from 5 day. Morphologically, the picture was characterized by inflammatory processes in the anastomosis area when using the original technique, which were stopped in 3-5 days, and in the control group they persisted for up to 7 days, accompanied by vascular paresis of the intestinal wall, blood stasis and blood clots, with zones of mucosal necrosis at 3 and 5 day of observation.

Aim - the improvement of treatment results of patients with complicated Crohn's disease based on study and analysis of own results of surgical interventions. Since 2008 to 2020 years 23 patients at the age 1,5-17 years old with Crohn's disease in 3 pediatric surgical hospitals have been observed. The article presents the analysis of surgical treatment of these patients with complications of main pathology. Diagnostics is integrated and includes clinical and laboratorian examination of patients, X-ray, endoscopic, sonography methods of examination and morphological research method of clinical biopsy. Complications of Crohn's disease were presented by intestinal obstructions (34,78% of cases), intestinal perforations (26,09%), acute appendicitis with mesadenitis (13,04%), intraabdominal abscesses (8,7%), intestinal hemorragia from inflammatory wart (4,35%), perianal inflammatory complications with fistulas (13,04%). The article has covered all possible methods of surgical operations depending on the type of complication. The most frequent surgical interventions were resections of intestinal stenosis with formation of intestinal stomas. The majority of patients have achieved good results after surgical interventions. 5 (23,81%) patients have got a relaparotomias because of such postoperative complications as anastomotic failure (1), recurrence of intestinal perforation (2) and recurrence of intestinal obstruction (2). Mortality has not been observed. Conclusions. 1. Because of Crohn's disease is a progressive disease, the opportunity of emergence of acute surgical complications of this pathology preserves. Our data show that urgent surgical complications of Crohn's disease in 47,83% of patients were the first manifestation of the disease, which was diagnosed during treatment and verified morphologically in the postoperative period. 2. In most cases surgical complications were intestinal obstruction (34,78% cases) and intestinal perforations (26,09%), and the most frequent surgical interventions for Crohn's disease in children were resections of the affected areas of the intestine with formation of intestinal stomas. 3. The modern tactic of surgical treatment of complicated of Crohn's disease in children based on local intestinal resections with intestinal stomas. 4. It is very important to use a combined approach combining conservative and surgical treatment. Surgical treatment and drug treatment of Crohn's disease should be complementary treatments.

The Purpose of the Study: a retrospective analysis of the results of patients treatment with ureteral strictures by evaluating the effectiveness of various methods of laparoscopic operations., Materials and Methods: a retrospective analysis of the treatment of 30 patients operated in the Central Hospital of Civil Aviations from 2013 to the present time with strictures of all departments of the ureters, except the pelvic-ureteral segment (LMS), was performed. The study included 18 women and 12 men. The age of patients was 54+/-8.1 years (29-79 years) for men and 51+/-8.5 years (28-74 years) for women. According to the results of x-ray examinations, the length of ureter stricture was determined, after that selected the tactics of surgical treatment. The study included patients who underwent intestinal plastics of the ureter, the operation Boari, ureterocystoanastomosis, ureteroureterostomy. All stages of surgical interventions were performed laparoscopically., Results: 23 patients (76.66%) had a smooth postoperative period. A month after the operation, ureteral stents were removed. Attacks of acute pyelonephritis, relapses of the disease were not observed during the follow-up period from 7 months to 3 years. Possible complications are analyzed. In one case, after intestinal plastic surgery of the ureter in the postoperative period, the phenomena of small bowel obstruction were noted, which required surgical treatment in the volume of applying a bypass eunoascendoanastomosis "side by side". In 7 cases, anastomosis strictures were diagnosed in the postoperative period. In the 5 cases, after examination (CT of the urinary tract with contrast, antegrade ureteropyelography), the anastomosis was recognized compensated., Conclusion: It is shown that all the necessary range of operations can be performed by laparoscopic method while preserving all the advantages of low-trauma access.

Background: Laparoscopic radical prostatectomy (LRP) is the most popular treatment method for localized prostate cancer worldwide. This is a technically-demanding procedure with a long learning curve. Therefore, an improvement of the surgical technique is very important in order to simplify training for LRP. Dorsal vein ligation and vesicourethral anastomosis (VUA) are two major problems for surgeons with insufficient experience in LRP. Previous studies have shown that between 50 and 250 procedures are required in order to get necessary skills., Aim: to compare and study the advantages of the "free-tie" technique and interrupted suture during the formation of VUA during learning curve of LRP., Materials and Methods: a single-center retrospective analysis was performed by evaluating operational reports, video recordings and histories of patients who were operated at Saint Petersburg Public Hospital of Saint Luca from 2016 to 2018. A total of 114 patients were included in the study, 56 of them were undergone to "free-tie" technique and 48 patients had interrupted suture. All procedures were performed by four surgeons with an experience of less than 100 LRP. The evaluation criteria included the time of formation of VUA, the duration of whole procedure, the duration of bladder catheterization, frequency of anastomotic leak and stress urinary incontinence., Results: For surgeons who learned the technique of LRP, the use of a continuous suture with a self-anchoring V-loc thread allowed to reduce significantly the time of formation of VUA and ligation of dorsal venous plexus. Such a suture is more convenient for the surgeon than interrupted suture and makes LRP more proficient and efficient, allowing to reduce the time of procedure, the duration of catheterization, postoperative complications rate associated with anastomotic leak, and also to lower frequency of stress urinary incontinence and obstruction of VUA. This technique may reduce the period necessary for mastering LRP., Conclusion: "Free-tie" VUA is a safer and more effective technique compared to interrupted suture technique during learning curve of LRP. According to our work, this technique allows surgeons with insufficient suturing experience to easily overcome the steep training curve.

Objective: To analyze contamination of surgical wound during tracheal resection depending on the mode of mechanical ventilation., Material and Methods: There were 976 patients. Circular tracheal resection was made in 396 of these patients., Results: Overall postoperative morbidity was 15.7%, mortality - 0.8%. Bacteriological examination of surgical wound was performed before tracheotomy and after formation of anastomosis depending on the method of mechanical ventilation. Surgical field was sterile before tracheotomy in all cases, contamination was confirmed after tracheotomy in all patients. Minimal contamination was observed in case of apneic oxygenation (100 times less than volumetric mechanical ventilation or high frequency mechanical ventilation). In all cases, several species of pathogenic microorganisms were identified. The number of species was also minimal in case of hypnotic mechanical ventilation., Conclusion: Contamination does not directly affect the development of local purulent-inflammatory process. However, this factor should not be ignored and compliance with all preventive measures is required.

Objective: To report treatment outcomes in patients with congenital aortic arch disease., Material and Methods: There were 65 patients (45 boys and 20 girls) for the period from 2005 to 2019. Mean age of patients was 53±12 days (range 1-98), weight - 3,3±1,3 kg (range 2.2-4.6). All patients were divided into 2 groups depending on the method of surgical repair. The 1 st group included 33 patients who underwent patch repair, the 2 nd group ( n =32) - anastomosis in end-to-side fashion., Results: In group I, recurrent aortic arch coarctation was observed in 16.8% of cases, in group II - only in 4% of cases ( p =0.02). Analysis of systolic pressure in both groups revealed that arterial hypertension was detected in 39% of cases in group I and only in 9,1% of cases in group II ( p =0,0025)., Conclusion: Surgical treatment of aortic arch disease using anastomosis in end-to-side fashion is associated with reduced risk of recurrent aortic arch coarctation and residual arterial hypertension in long-term postoperative period.

Objective: To describe the methodology of laparothoracoscopic Ivor Lewis esophagectomy in surgical treatment of esophageal cancer and compare early outcomes of this procedure with conventional Ivor Lewis surgery., Material and Methods: There were 30 laparothoracoscopic Ivor Lewis esophagectomies followed by non-hardware esophageal-gastric intrapleural anastomosis for esophageal cancer. All procedures have been performed for the period 2016-2019 at the Moscow Regional Research and Clinical Institute (suturing of anastomosis was based on the method of professor A.S. Allakhverdyan)., Results: Laparothoracoscopic esophagectomy is characterized by higher surgery time by 136.57 min ( p =0.012), less duration of anesthesia and mechanical ventilation by 77.5 min ( p =0.042), postoperative ICU-stay by 2.25 hours ( p =0.021), blood loss by 550 ml ( p =0,000), duration of postoperative fasting by 2 days ( p =0.034), hospital-stay by 8 days ( p =0.021) compared to open esophagectomy. There were no significant between-group differences in the number of resected lymph nodes ( p =0.142). Incidence of esophageal-gastric anastomosis failure is insignificantly higher in the OE group (χ 2 =1.89; p =0.075). Incidence of pulmonary complications (pneumonia, chylothorax, paresis of the vocal cords, pleural empyema) is less in the LTSE group ( p <0.05). Cardiovascular morbidity is significantly lower in the LTSE group ( p <0.05). A 30-day mortality rate was similar in both groups (χ 2 =2.56; p =0.0253)., Conclusion: Early results of laparothoracoscopic Ivor Lewis esophagectomy are superior to the results of conventional Ivor Lewis surgery in surgical treatment of esophageal cancer.

In the paper published in issue 2 (2020) of the Burdenko's Journal of Neurosurgery, the authors justifiably propose a technique of bilateral extraintracranial vascular microanastomosis (EICMA) in case of rapidly developing stenotic lesions of the intracranial arteries in order to compensate the marked hypoperfusion in the basins of the anterior cerebral artery and middle cerebral artery on both sides. This allows to significantly reduce the risks of possible ischemic stroke in the earliest period.

The article contains a systematic review of the literature dedicated to vascular robot-assisted operations, also discussing the use of robotic technologies in vascular surgery, their advantages and disadvantages. In so doing, we studied the experience of Russian and leading international surgical centres, comparing the reported outcomes by such parameters as the average duration of the operation, mean time of aortic cross-clamping, time spent for anastomosis formation, frequency of postoperative complications, etc. Benefits of robot-assisted operations allowed the latter to occupy the leading positions in various fields of surgery, although the use of robots in vascular surgery has only begun to gain popularity. A robotically assisted system eliminates the main shortcomings of laparoscopy and opens opportunities for expanding robot-assisted surgery in this field.

Aim: This study was undertaken to evaluate the efficacy of three-stage measurement of the transit-time flow through coronary bypass grafts with the help of flowmetry for early verification of technical errors during on-pump coronary artery bypass graft surgery., Patients and Methods: We performed an intraoperative analysis of 214 bypass grafts with the help of three-stage flowmetry. The first stage of measuring was performed on-pump with and without the proximal loop test, the second stage of measurement was performed after weaning the patient off the heart-lung machine, and the third stage of measurement was carried out after heparin inactivation prior to chest wound closure., Results: Amongst the 214 transplants regarded as functioning, intraoperative flowmetry revealed insufficient blood flow in 9 (4.2%) cases. Technical surgical errors were confirmed in these shunts during revision thereof. In 6 (2.8%) of the 9 such grafts we detected non-optimal parameters of flowmetry during the first measurement (while the heart was stopped); of these, in 5 (2.3%) cases non-optimal blood flow was verified with the use of the proximal loop test on the target coronary artery and in 1 (0.47%) case without it. In another one (0.47%) of the nine such transplants, inadequate blood flow was revealed during the second measurement, which confirmed technical errors in proximal anastomoses. In a further 2 (0.93%) of the 9 such transplants we observed low parameters of blood flow during the third measurement, which was related to kinking of the shunts due to their excessive length. All surgical errors were corrected immediately at the stage of verification thereof., Conclusion: The strategy of three-stage assessment of flowmetry makes it possible to ensure and confirm adequate functionality of coronary artery bypass grafts at all stages of the operation, thus allowing timely verification and immediate correction of any technical problems with coronary artery bypass grafts.

A 30-year-old woman with giant fusiform aneurysm of the azygos anterior cerebral artery is reported. Clipping of the aneurysm followed by modeling of pericallosal artery was performed in 2017. However, further enlargement of the aneurysm has been observed for subsequent 2 years. The patient underwent redo surgery with excision of the aneurysm followed by «hemi-bonnet bypass» procedure (anastomosis between superficial temporal artery and anterior cerebral artery with radial artery as an interposition graft). Literature data on reconstructive surgery in the treatment of complex pericallosal artery aneurysms are reviewed.

Presented in the article is a clinical case report concerning successful surgical treatment of a rare disease - a progressing congenital true brachial artery aneurysm in a newborn girl. The symptoms were first noted at the age of 7 days, later on followed by enlargement of the aneurysm, appearance of neurological symptoms, and impaired function of the extremity. The infant was subjected to clinical examination and ultrasonographic study, followed by surgical removal of the aneurysm and restoration of the brachial artery by an 'end-to-end' anastomosis. The diagnosis was finally verified only at histological examination. Also contained in the article is a review of the literature underlining that paediatric arterial aneurysms are extremely uncommon, as well as discussing the problems of diagnosis and therapeutic policy. The dilatation of the vessel turned out to be a true aneurysm with all three layers of the vessel in the wall and belonged to the class of paediatric congenital idiopathic arterial aneurysms unassociated with degeneration of the vascular wall or cardiovascular pathology.

Objective: To analyze the effectiveness of vacuum-assisted closure system for esophageal anastomotic leakage., Material and Methods: There were 10 patients with upper gastrointestinal anastomotic leakage who were treated at our institution in 2015-2018. Vacuum aspiration system was applied in all cases., Results: Esophageal wall defect was successfully closed in 9 out of 10 patients after 2-4 courses and the system was eliminated in 11 days on the average. Localized cavity with granulation tissue developed in 1 patient after 5 courses and the system was also eliminated., Conclusion: Endoscopic vacuum-assisted therapy is an innovative, minimally invasive, economically profitable and successful method for anastomotic leakage. This procedure should be taken into consideration and widely used in multi-field hospitals.

Aim: To evaluate safety of early closure of ileostomy in patients with rectal cancer after primary surgery., Material and Methods: The trial included patients from several medical centers without signs of anastomotic leakage. CT-proctography or rectoscopy were performed in 8 days after primary surgery to confirm integrity of the anastomoses. Exclusion criteria were factors affecting normal tissue regeneration (diabetes mellitus, steroid drugs prescription, etc.). Patients with intact anastomoses and no exclusion criteria were randomized into 2 groups: group 1 (n=31) with early closure of ileostomy (in 8-13 days after surgery) and group 2 (n=34) with delayed closure (after 12 weeks). All data were analyzed., Results: Postoperative morbidity was similar in both groups (6.45% vs. 5.88%, p=0.08). However, less duration of reconstructive surgery was noted in group 1 (50 (27-126) min vs. 71 min (31-134). This value was 1.42 times less in the main group (95% CI 1.30-1.52; p=0.02)., Conclusion: Early closure of ileostomy in patients after surgery for rectal cancer is feasible and does not result increased postoperative morbidity. This approach may be considered as an alternative to delayed closure. However, further researches devoted to analysis of ileostomy-associated complications and quality of life are necessary.

Aim: To evaluate the efficacy and safety of the proposed modified combined approach for laparoscopic splenic flexure mobilization (SFM)., Material and Methods: A multicenter non-randomized comparative study was conducted. The main group consisted of 12 patients who underwent laparoscopic modified combined SFM from December 2018 to May 2019, the control group consisted of 12 patients who underwent laparoscopic traditional combined SFM from 2013 to 2018. The following aspects were evaluated: total duration of the operation, duration of the SFM, blood loss, rate of conversions, intraoperative complications, postoperative complications, duration of the postoperative period., Results: Significant differences were obtained for the average duration of the SFM. The duration of the procedure was calculated during watching a video of operation. The average duration of the SFM in the main group was 37.4±12.2 min, in the control group 59.5±19.1 min (p=0.03). The average blood loss in the main group was 52.5±12.3 ml, in the control group - 115.6±20.7 ml (p=0.02). In the main group there were no intraoperative complications, while in the comparison group 1 case of the spleen damage was noted, requiring conversion, and 1 case of the pancreas damage. These differences are not significant due to the small sample., Conclusion: The use of the proposed modified combined approach for the laparoscopic SFM significantly reduces the duration of the operation and is accompanied by a decrease in the frequency of intraoperative complications. However, further randomized studies with a larger sample are needed.

Presented in the article are the results of surgical management of a patient with an extremely rare pathology - a saccular arterial aneurysm of the cavernous-ophthalmic segment of the left internal carotid artery. We performed multistage open surgical intervention in the following scope: osteoplastic pterional craniotomy on the left, creation of a wide-lumen anastomosis between the left external carotid artery and M2 segment of the left middle cerebral artery with the use of the radial artery, ligation of the cervical portion of the left internal carotid artery and clipping of its supraclinoid portion. The chosen surgical policy made it possible to create sufficient volumetric blood flow through the shunt, comparable to the blood flow through the internal carotid artery, which helped avoid ischaemic stroke after exclusion of the aneurysm from circulation. A conclusion was drawn on efficacy of this method of treatment.

Introduction: Despite the twenty-year history of laparoscopic ileal ureteral substitution, the literature is lacking studies reporting its outcomes, and those few are mainly case reports. Besides, they usually describe surgery from combined access, when the ileal segment resection and ileo-ileal anastomosis are performed from mini-laparotomy, and the remaining stages are done endoscopically., Aim: To conduct a multicenter retrospective analysis of our series of patients undergoing laparoscopic ileal ureteral substitution using only endoscopic access., Material and Methods: From 2010 to 2017, 48 ureters were replaced completely laparoscopically in 40 patients. Of them, 33 patients underwent total ureteric replacement, and the others had a subtotal ileal ureteral substitution. Video describing the operation technique is available on https://youtu.be/IeA60pSiUBE., Results: The mean operating time was 335 minutes, and the estimated blood loss was 221 ml. Intraoperative complications (7.5%) were resolved during surgery. No patients required conversion to open surgery. There was no mortality. Postoperative Clavien III complications were observed in 7.5% of patients. The mean length of hospital day was 13.5 days. Functional results were followed from 6 months to 7 years., Conclusions: The presented material is the largest available in the literature, and the results, including long-term functional outcomes, demonstrate the efficacy and safety of laparoscopic technologies in the treatment of extensive strictures and obliterations of the ureter.

The article presents the experience of successful surgical treatment of a patient with complete ureteral obliteration after transurethral endoscopic pyelolithotripsy in the left renal pelvis with lithoextraction and stenting. Two months later the patient developed stent obstruction and underwent repeat stenting and insertion of a left nephrostomy tube. After another 1.5 months, he was found to have complete obliteration of the left ureter. Ileal substitution of the left ureter was performed with the formation of a pyelo-ileal anastomosis and antireflux ileo-cysto-anastomosis. Contrast-enhanced MRI-urography performed on the 21st day ascertained the complete patency of the anastomosis. The patient was discharged in a satisfactory condition. At a follow-up examination five months after hospital discharge, the patient was in satisfactory condition with no complaints. Renal ultrasound and MRI showed no signs of obstruction of the ileal autograft.

Urine derivation after cystectomy or due to bladder functional impairment more has been a pressing problem in urology for more than a century. Various techniques of urinary derivation after cystectomy due to bladder cancer or non-cancerous diseases have been suggested. In the present day, more often, the artificial reservoirs are formed from the various intestinal segments. The article describes preoperative preparation of patients, surgical technique and efficiency of the specific method of implantation of ureters into low-pressure small intestine reservoir. Statistical data of Al. Tsulukidze National Center of Urology since 1987 and postoperative results and recommendations are presented.

The use of catheterization cerebral angiography (CCA) to assess collateral blood flow through an indirect anastomosis is traumatic for children, uses a high radiation dose, and requires anesthetic care in most cases., Aim: we aimed to compare the capabilities of triplex ultrasound (TU) of vessels, magnetic resonance angiography (MRA), computed tomography angiography (CTA), and CCA in assessing the competence of indirect cerebral revascularization (ICR) in children., Material and Methods: ICR was performed in 18 children in 24 hemispheres (24 operations). The results were evaluated by Matsushima classification-based comparison of the data of preoperative and postoperative clinical examinations, TU of the superficial temporal artery, magnetic resonance imaging (MRI) and computed tomography (CT) of vessels, and selective cerebral angiography., Results: After surgery, improvements in the neurological and neuropsychological status were assessed. Matsushima grade A collaterals were found in 12 (50%) cases, grade B collaterals were present in 3 (13%) cases, grade C collaterals were present in 7 (29%) cases, and grade D collaterals were detected in 1 (4%) case; in 1 (4%) case, the superficial temporal artery was not enhanced. MR angiography visualized 18 (75%) indirect anastomoses, CT angiography revealed 4 indirect anastomoses, and TU visualized 4 indirect anastomoses. Comparison of preoperative and postoperative TU data for the superficial temporal artery revealed significant changes in blood flow in the form of increased rate indices and a decreased resistance index; mean values of indices for each angiographic class of revascularization and significant differences in pre- and postoperative observations were calculated., Conclusion: Examination of ICR competence using CCA is necessary in the presence of persistent clinical signs of chronic cerebral circulatory insufficiency, absence of increased blood flow and decreased peripheral resistance in the superficial temporal artery, and lack of anastomosis according to MRA. The most optimal techniques for postoperative examination are MRA with perfusion and diffusion maps and TU.

Aim: To evaluate the results of selective approach for splenic flexure mobilization (SFM) after total mesorectal excision with low colorectal anastomoses., Material and Methods: Clinical data were obtained from the multicenter RCT database comparing ileostomy and colostomy in patients with rectal cancer who underwent total mesorectal excision from 2012 to 2017. Our clinic policy is performing paraaortic lymph node dissection with 'low' inferior mesenteric artery ligation, left colic artery preservation and use of sigmoid colon for colorectal anastomosis. SFM was used only in cases of inability to apply above-mentioned procedure (selective approach for SFM)., Results: SFM was performed in 15 (13%) out of 115 patients. The most frequent reasons for SFM were sigmoid colon diverticulosis, impaired blood supply or inadequate length of sigmoid colon. There were no differences in intraoperative and postoperative complications between TME without SFM and TME with SFM., Conclusion: Selective SFM in TME followed by advanced paraaortic lymph node dissection and left colic artery preservation is safe and may be considered as a viable option to routine SFM in rectal cancer surgery.

The article presents a clinical case of segmental agenesis of the cervical ICA with collateral blood supply to the ICA territory through the intercavernous anastomosis and ascending pharyngeal artery with the branching primitive stapedial artery - the aberrant ICA variant. A feature of the case is a unique combination of the intercavernous anastomosis and the aberrant ICA, which provide collateral blood flow in cervical ICA agenesis. In the world literature, there are no reports of similar combinations. The discussion provides information on the stages of circle of Willis formation and presents a literature review of cases of intercavernous anastomoses associated with ICA agenesis.

The article presents a case of laparoscopic antevasal correction of the retrocaval ureter in a 16 year old patient, who was admitted to the hospital with complaints of aching pain in the right lower back. His history was noteworthy of early age onset of intermittent fever accompanied by abdominal and lumbar pain. Blood count and urinalysis were within normal limits, and he was treated symptomatically. However, no renal ultrasound scan was done. Intravenous urography and MSCT showed a retrocaval ureter. The diagnosis was confirmed by retrograde ureteropyelography. With the patient placed in the lateral position, the right ureter was mobilized by transperitoneal access, transected and mobilized from under the inferior vena cava. Anterior uretero-ureteral anastomosis on the stent was performed, drainage was established. The operating time was 90 minutes, blood loss was 60 ml. There were no postoperative complications. Drainage was removed 2 days after surgery and the patient was discharged for outpatient treatment. The stent was removed 6 weeks postoperatively. Control urography showed normal function of both kidneys, no urodynamic abnormality of the upper urinary tract was identified.

Aim: To present the results and technical features of forming the ureterointestinal anastomoses in intestinal ureteral substitution., Material and Methods: From 1998 to December 2016, 168 patients (mean age 51 +/- 8.7 years) underwent ureteral substitution using intestinal segments at the Urology Clinic of the I.I. Mechnikov NWSMU. Of them, 76 (45.2%) were males. In 119 (70.8%) patients, intestinal segments were used to replace various parts of the ureters (iliac in 92, colonic in 4, appendix in 23), and in 49 (29.2%) patients ureteroplasty was combined with orthotopic ileocystoplasty. 96 patients underwent isolated ureteral substitution with segments of the small and large bowel., Results: Among the 96 patients, early postoperative complications occurred in 8 (8.3%) patients, whereof 5 (5.2%) required reoperations. Among them, 2 (2.1%) had a proximal anastomotic failure. Late postoperative complications occurred in 7 (7.3%) patients whereof 4 (4.2%) required surgical treatment. These patients developed strictures of the proximal ureter-intestinal anastomoses over 3 or more months after the operation. The urinary flow was restored by antegrade dilation. Vesicoureteral reflux occurred in 2 (2.1%) patients. However, it was not clinically evident and was not accompanied by hydroureteronephrosis and recurrent urinary tract infection., Conclusion: A perfect ureterointestinal anastomoses should be easy to create and have a low risk of stenosis and reflux. These requirements are met by direct anastomosis, which is associated with a minimal risk of stricture, and with isoperistaltic positioning and sufficient length (not less than 15 cm) of the graft provides antireflux protection. It should be noted that proximal (ureterointestinal) anastomoses are vulnerable in these operations and prone to the stricture formation. Unlike proximal, the distal anastomosis of the graft with the bladder is always wider, and therefore the risk of its narrowing is minimal. Isoperistaltic positioning of the graft prevents reflux formation.

Purpose: to evaluate the advantages and disadvantages of a mini-approach for performing EC-IC bypass., Material and Methods: The mini-approach was used in 35 patients (32 males and 3 females) with symptomatic occlusive lesions of the brachiocephalic arteries (BCAs) who were treated at the Department of Vascular Neurosurgery of the Federal Center of Neurosurgery in Novosibirsk in the period between January and December 2014. The mini-approach was performed through a skin incision of up to 5.5 cm in the donor artery projection. The approach was planned based on comparison of the MSCT-angiography data., Results: In all cases, the mini-approach enabled performing EC-IC bypass in the optimal location, with the minimal involvement of the donor artery and the minimal size of craniotomy. Complications (shunt thrombosis) in the early postoperative period occurred in 3 (8.5%) cases. There were no cases of marginal wound necrosis. The mean bed-day was 7 days., Discussion: We analyzed the literature regarding using the mini-approach in combination with various mapping variants based on neuroimaging data., Conclusion: The approach has a high potential for wide application in clinical practice. The disadvantage is the narrowness and depth of the surgical wound, which complicates manipulations when performing EC-IC bypass and requires special skills.

Aim: To evaluate complications and long-term results of delayed esophagoesophagostomy in children with esophageal atresia (EA)., Material and Methods: 165 EA children were operated at the Filatov Municipal Children's Hospital #13 for the period 2006-2016. Primary esophageal anastomosis was performed in 136 (82.4%) children with tracheoesophageal fistula. In 5 (3%) neonates with non-fistulous EA esophago- and gastrostomy were made for further coloesophagoplasty. Other 24 (14.5%) children underwent gastrostomy for delayed esophagoesophagostomy. 6 (25%) of them died within 12 days after admission. 18 survivors with gastrostomy subsequently underwent delayed esophagoesophagostomy., Results: Postoperative complications occurred in 16 (88.9%) children. Esophageal anastomosis failure occurred in 4 (22.2%) patients, stenosis of anastomosis in 11 (61.1%) children, gastroesophageal reflux in 14 (77.8%) children. Early postoperative mortality was 16.7% (3 children). In remote period 92.3% of children were not adapted to normal diet and only in 7.7% of patients eating behavior corresponds to the age. 11 children underwent prolonged esophageal bougienage. 9 children underwent re-operation after delayed anastomosis. Esophageal extirpation was made in 4 children., Conclusion: Esophago- and gastrostomy provides 100% survival if primary esophageal anastomosis is impossible. Herewith, in children without esophagostomy mortality rate was 25%. We still can not confirm that delayed esophageal anastomosis is a good alternative for children with esophageal atresia. In view of our results the number of candidates for delayed esophageal anastomosis should be reduced.

The article describes a case of one-stage surgical treatment of a patient with progressive chronic cerebral ischemia caused by combined steno-occlusive lesions of the carotid and vertebral arteries. The disease was complicated by intolerance to temporary occlusion of the carotid artery due to an incomplete circle of Willis. We performed extra-anatomic carotid-vertebral artery bypass with subsequent ipsilateral carotid endarterectomy. A temporary intraluminal shunt was used at the main stage of reconstructive surgery. We use this clinical case to analyze the issues of surgical treatment for combined lesions of the carotid and vertebral arteries and the techniques for prevention of associated ischemic complications.

Aim: To assess the incidence and grade of concomitant stress urinary incontinence (SUI) and the quality of life before and after endoscopic correction of vesicourethral anastomotic strictures (VAS) and the impact of the number of endoscopic interventions on these indicators., Materials and Methods: This is a retrospective study of medical records and a telephone survey of patients who underwent radical prostatectomy (RP) at our clinic from 2010 to 2015 and subsequently presented with VAS. The survey included data on the severity of SUI and quality of life using QoL questionnaire before and after endoscopic VAS correction; the factors primarily affecting the quality of life (SUI or obstructive symptoms) were identified., Results: During the above period, 1453 RP were performed. There were 60 VAS cases, of which 56 (93%) were included in the study. Stress urinary incontinence after RP occurred in 64.3% of patients, the average QoL score was 3.95 ( = 0.64; Cv = 16.2%). Before endoscopic VAS correction, 87.5% of patients reported obstructive symptoms as the main cause of dissatisfaction. After endoscopic VAS correction, SUI was observed in 82.1% of patients. De novo incontinence occurred in 15 patients, higher SUI grade was observed in 29 (51.8%) patients. The observed change in the of SUI grade was not statistically significant (paired Students t-test 1.98, p> 0.05). Mean QoL score after endoscopic correction was 2.54 ( = 0.73; Cv = 28.6%, paired Students t-test 5.08, p <0.05). After endoscopic correction of VAS, 78.6% of the patients reported that SUI was the most important factor for decreased quality of life., Conclusions: The study revealed a high incidence of VAS combined with SIU. There was a significant improvement in patients quality of life after endoscopic correction of VAS, which resulted from a change in the pattern of voiding dysfunction producing a major negative impact on the quality of life. There were no statistically significant correlations between the number of endoscopic corrections of VAS and the SUI grade and the patients quality of life.

The article presents a clinical case report of a stepwise correction of urethrovesical anastomotic stenosis and severe incontinence. At the first stage the authors performed re-urethrovesical anastomosis making the patient totally incontinent. At the second stage, an artificial sphincter was implanted.

Purpose: Presentation of the results and the technical features of the laparoscopic intestinal and appendicular ureteroplasty., Materials and Methods: From 2001 to 2015, intestinal and appendicular ureteroplasty was performed in 103 patients. ileum was used for the replacement of ureteral defects in 78 (75.7%) patients, appendix - in 21 (20.4%), and colon - in 4 (3.9%). In 10 (9.7%) cases, the surgery was performed laparoscopically. Among them, 7 patients underwent ileoureteroplasty (6 - laparoscopic ileoureterocystoanastomosis, 1 - right-sided laparoscopic ileoureterocystoanastomosis by Yang-Monti) and 3 patients underwent appendiceal ureteroplasty. In one case, ileoureteroplasy was performed in patient with complete ureter duplication., Results: The period of follow-up varied from 2 to 14 years, and the average follow-up period was 8+/-5.8 years. Complications occurred in 8 (8.1%) patients who underwent open ileo- and appendiceal ureteroplasty. Among the 10 patients who underwent laparoscopic surgery complications were not observed. The length of postoperative hospital stay was significantly shorter in patients who underwent laparoscopic surgery (median, 6 days) than in patients who underwent open surgery (median, 12 days). The results of treatment in all patients were successful. There were no fatal outcomes., Conclusion: The use of endovideosurgery for intestinal and appendicular ureteroplasty reduces surgical injury and reduces the length of hospital stay. However, there are not enough publications on this issue available in modern literature. To date, there are few number of operations performed, and it is not allow to consider the findings and conclusions as statistically significant.

Abstract The factors, determining possibility of early postoperative morbidity occurrence in patients, suffering gastro-esophageal zone cancer, were analyzed. After radical operation performance (gastrectomy, gastric and esophageal resection) 5.7% patients died. Insufficience of the anastomosis sutures with peritonitis occurrence, an acute hepato-renal insufficience, an acute coronary syndrome, pulmonary thromboembolism, pneumonia, the brain insult, pancreonecrosis and mesenterial thrombosis constituted the main morbidities. The complications occurrence depends upon the tumoral process course severity, morphological variant of cancer, presence of concomitant diaphragmatic hernia and the blood rheological properties. Initially high indices of the blood sera present a rheological properties of blood serum may serve as a prognostic criterion of the postoperative complications occurrence in the patients.

Objective: to evaluate the use of extra-intracranial microanastomosis (EICMA) in the treatment of brain ischemia in patients with nontraumatic subarachnoid hemorrhage (SAH)., Material and Methods: In the period from 01.01.14 to 01.07.15, there were 229 surgeries for ruptured intracranial aneurysms performed in the urgent surgery unit. Nine patients with marked and widespread angiospasm, subcompensated and decompensated cerebral ischemia underwent the simultaneous clipping of ruptured intracranial aneurysms and EICMA. The age of patients varied from 32 to 52 years (mean 36 years). The severity of patient's state was assessed as III-IV grades on the Hunt and Hess scale before operation. The surgery was performed 1-2 days after admission to the hospital, 1-8 days after the development of SAH., Results and Conclusion: Excellent and good outcome was recorded in 4 patients, severe disability in 3 patients, fatal outcome in 2 patients. The fatal outcome was due to decompensated cerebral ischemia and progressive angiospasm with the high linear blood flow rate and the following reduction in perfusion in the affected hemisphere. The simultaneous clipping of ruptured intracranial aneurysms and EICMA in the acute stage of SAH of patients with subcompensated cerebral ischemia allow to improve treatment, Results: This technique is most applicable for patients with proximal angiospasm of M1- and M2-segments of the middle cerebral artery in the first 24 h of the development of a focal neurological deficit supported by the reduction in perfusion in the corresponding vascular area.