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Objective: To analyze the complications following endoscopic hemithyroidectomy and to develop the principles of tissue dissection for safe surgical intervention., Material and Methods: The results of surgical treatment of 136 patients were studied. The main group consisted of 44 patients who underwent endoscopic hemithyroidectomy through a «gasless» axillary approach (EH group). The first control group consisted of 45 patients who underwent minimally invasive video-assisted hemithyroidectomy (MIVAH group). The second control group consisted of 47 patients who underwent open hemithyroidectomy (OH group)., Results. O: Verall complication rate was significantly higher in the EH group (20.5% vs. 6.4% in the OH group and 4.4% in the MIVAH group; p <0.05). In the EH group, Clavien-Dindo grade I complications occurred in 11.4% of cases. There were no similar complications in the control groups ( p <0.05). Clavien-Dindo grade II complications occurred in 9.1% of patients in the EH group, 4.3% in the OH group and no similar events were identified in the MIVAH group ( p >0.05). Clavien-Dindo grade III complications occurred in 1 (2.1%) case in the OH group and 2 (4.4%) cases in the MIVAH group. There were no Clavien-Dindo grade III complications in the EH group. Thus, minor complications prevailed in the EH group. Their incidence decreased along with accumulation of experience. Moreover, endoscopic procedure is safer regarding the risk of severe complications., Conclusion: Endoscopic hemithyroidectomy is safe, and the proposed principles of tissue dissection can further increase surgical safety.

Background: Endoscopic submucosal dissection (ESD) is a perspective method of organ-sparing treatment of benign colon tumors., Material and Methods: The study included 1.000 patients with colon neoplasms who underwent ESD between October 2016 and October 2021. All surgeries were performed under intravenous sedation., Results: Mean dimension of tumors was 3.4 cm, median of surgery time - 51 (31; 101) minutes. Conversion of endoscopic approach occurred in 7.6% of cases. The main cause of conversion was unsatisfactory lifting in submucosal injection process. Incidence of en bloc and R0 resections was 84.1% and 68.3%, respectively. Postoperative morbidity was 2.9% that correlates with the world literature data., Conclusion: Endoscopic submucosal dissection is an effective and safe method for benign colon neoplasms. Considering high incidence of en bloc resection and low rate of local recurrence in benign neoplasms, further research of efficacy and safety of ESD in early colon cancer is needed.

Aim: To improve the results of treatment of patients with focal liver formations by preventing the development of postoperative complications after liver resections., Methods: The study included 304 patients with benign and malignant liver lesions. In 196 (64.4%) patients, resections were performed for malignant liver damage, in 108 (35.6%) - for a benign process. To assess the impact of ongoing measures to prevent the development of postoperative complications, patients were divided into two time periods: from 2007 to 2012 and from 2013 to 2018., Results: The introduction of a protocol of preoperative examination of patients for whom resection of 3 or more liver segments is planned, with the inclusion of SPECT/CT, which allows determining the volume of the remaining functioning liver parenchyma, allowed to reduce the percentage of development of acute post-resection liver failure from 11.6% to 3.6% during the second time period (p=0.0064). The use of modern suture material, surgical binocular loops, as well as the use of the concept of predominantly performing parenchyma-saving resections, reduced the number of biliary complications from 8.1% to 5.7% (p=0.1). The use of a proprietary dissection algorithm for the liver parenchyma significantly reduced hemorrhagic complications from 5.3% to 1.04% (p=0.0074)., Conclusion: The use of modern pre- and intraoperative technologies has reduced the number of postoperative complications after liver resections from 38.3% to 20.9% (p=0.018) and mortality from 2.6% to 0.5% (p=0.004), thereby improving the results of liver resections.

Aim: To define the the role of small bowel length in development of SBS., Material and Methods: Seventeen patients with SBS after small bowel resection in neonatal period were included into the study. Total small bowel length ranged from 5 to 55 cm (11.8±5.59% from normal length for certain age)., Results: Described small bowel length has high risk of SBS/IF development irrespective to other factors (specific segment of small bowel that was resected, preserved intestinal segment state, absence of colon and/or ileocecal valve)., Conclusion: It is required to perform further studies with greater amount of patients to discover exact small bowel length which is associated with SBS and other factors affecting small bowel state.

Aim: To develop and investigate in the experiment the method of endoscopic parathyroidectomy in order to prevent intraoperative 'conflict of the instruments' and to reduce surgical trauma via extracervical approach., Material and Methods: The results of 10 experimental endoscopic parathyroidectomies with original pectoral-retroauricular approach were analyzed., Results: Mean time of surgery was 77.8±10.2 minutes (65-97), mean time of surgical exposure - 50.3±6.7 minutes (41-59). Visualization and identification of parathyroid glands were achieved in 100% of cases. Recurrent laryngeal nerve was preserved in 100% of cases., Conclusion: Original endoscopic pectoral-retroauricular approach for parathyroidectomy is methodologically and technically justified and can be recommended for clinical application.

Aim: To analyze the outcomes in patients with epithelial coccygeal course (ECC) after original vacuum-therapy., Material and Methods: The study included 61 patients with ECC. Patients were divided into 3 groups: 22 patients underwent ECC excision followed by wound closure by Donati, ECC excision with following wound management with ointment swathes was used in 19 cases, vacuum-therapy of open wound was conducted in 20 patients., Results: In group 1 hospital-stay was 11±1.9 days (ranged 3-20, Me=11), time of complete wound healing - 14.9±4.9 days (ranged 8-49, Me=12.5), early postoperative complications were observed in 5 (22.7%) patients, recurrence - in 3 (13.6%) cases. In group 2 hospital-stay was 13.7±2.6 days (ranged 3-25, Me=15), time of complete wound healing - 74±5,7 days (ranged 35-112, Me=57,0), early postoperative complications were observed in 2 (10.5%) patients, recurrence - in 1 (5.3%) case. In group 3 hospital-stay was 13.9±2.3 days (ranged 5-24, Me=15), time of complete wound healing - 31.1±2.7 days (ranged 15-39, Me=31.0), complications and recurrences were absent., Conclusion: Vacuum therapy improves surgical results compared with conventional treatment.

Aim: To analyze the results of diagnosis and treatment of combined echinococcosis., Material and Methods: The study included 51 children. 40 (78.4%) of them had combined lesion of liver and other organs, 29 - combined echinococcosis of liver and lungs. Echinococcosis of both lungs was observed in 14 children including lesion of liver in 6 cases. Combined echinococcosis of three organs was observed in 5 patients., Results and Discussion: Combined echinococcosis in children was associated with uneven growth of parasitic cysts in various tissues. Small cysts were revealed in 15 (37.5%) out of 40 observations of combined lesion of liver and other organs. 7 patients underwent medical therapy for small cysts after previous surgery for medium and large cysts. Rapid growth of remained cysts occurred within 1-3 months between surgical stages. It may be often associated with complications related to remained cyst especially in case of both lungs echinococcosis. There were 6 (11.8%) postoperative complications in 51 patients with combined echinococcosis. Recurrence occurred in 2 (3.9%) children. Deaths were absent., Conclusion: Conservative therapy for small cysts provides 2-fold decrease of operations number and prevents recurrence of the disease. Reduced period between surgical stages up to 11±2 days prevents complications in case of both lungs echinococcosis.

Aim: To present the results of treatment of long bones chronic osteomyelitis using local cement reinforcing antibacterial implant., Material and Methods: The implant is made intraoperatively using polymethylmethacrylate. It was used in main group (n=30), while conventional treatment was applied in comparison group (n=30)., Results: Better early and remote outcomes were shown in main group including more effective and earlier suppression of infectious process, more than 2-fold decrease of recurrent infection incidence, minimization of risk of pathological fracture due to internal reinforcement, early recovery of extremity's function, creation of favorable conditions for bone structures restoration, substitution of post-resection bone defect and following organotypic reorganization of bone tissue.

Unlabelled: The aim was analysis of results of Limberg skin-plastic closure of wound defect after excision of extensive fistulous forms of coccygeal passage with some modifications., Materials and Methods: 41 patients with fistulous form of epithelial coccygeal passage degree III were enrolled into investigation. Mean age was 35.6±6.4 years. The modification consisted of asymmetric displacement of the lowermost part of excised diamond-shaped defect laterally from the median line and fixation of flap to inter-gluteal fold bottom especially its caudal part., Results: Noncomplicated course of early postoperative period with wound healing by first intention was observed in 38 (92.7%) patients. Recurrent coccygeal passage developed in 1 (2.4%) patient and it was limited (fistulous passage in one of the wound edges).

It was operated 24 patients with gastrointestinal stromal tumor (GIST). Robot-assisted method was applied in 15 observations, laparoscopy - in 9 patients. Laparoscopic operations were preferable for GIST localized in anterior wall or greater curvature of stomach, in small intestine and caecum. Robot-assisted GIST removal was performed in case its location in posterior wall of stomach, on lesser curvature of stomach, in duodenum, what required organ's dissection or had a risk of great vessel injury.

It is presented the treatment results of abdominal and intraabdominal desmoid fibromas. Group of abdominal localization included 19 patients. 15 of them had primary tumors, 4 - recurrent tumors after surgical treatment. Radical (R0) operations were performed in all cases. Tumor removal was associated with plastic of abdominal wall by synthetic implant in 17 patients. Wide excision of surrounding tissues and musculo-aponeurotic layer of anterior abdominal wall allows to achieve long-term disease-free period. There weren't recurrent symptoms in terms from 4 to 60 months of observation. The second group included 28 patients with intraabdominal desmoid fibromas. Operations were performed in 11 (35.2%) patients including 3 cases of reoperations. There were 14 operations. Radical (R0) volume was applied in 11 (78.6%) operations, cytoreductive (R2) volume - in 1 (7%) operation. Explorative laparotomy was used in 3 (21.4%) cases because of involvement of mesenteric vessels. Combined treatment was performed in 4 (14.3%) patients. 14 (50%) patients received conservative therapy because of unresectable tumor including chemo-, hormone- and radiotherapy. Operated patients were under observation in terms from 11 to 156 months, median was 63.2 months. Recurrence developed in 4 of 10 (40%) patients after R0-surgery. Cytoreductive (R1/R2) volume is admitted for intraabdominal desmoid fibromas. But even in case of unresectable process and explorative intervention stabilization and regression of tumor is possible by means of chemo-, hormone- and radiotherapy in different combination. It allows to preserve a good life quality.

The author considers results of inestigation for studying an efficiency of permanent intramesenteric (retroperitoneal) blockade and applying lymphotropic therapy for prevention of incompetence of sutures of intestinal anastomosis against the background of diffuse peritonitis and acute intestinal obstruction. An infusion was carried out 4-6 times a day with a special solution (novocain 0.5% (7 ml/kg/day); heparin (150 units/kg/days); proserin (0.03 mg/kg/day) and seftriakson (15 mg/kg/days)) in order to obtain the effect of permanent intramesenteric blockade and lymphotropic therapy. The solution is administered by droplet injection with the rate 100-120 drops a minute (80-120 ml per each infusion). Due to the application of the given method the frequency of cases of the incompetent sutures of intestinal anastomoses in patients of the main group decreased from 15.5% to 3.4% (X2 = 16.2; p < 0.001) as compared with the other patients.

The progress in colorectal cancer treatment of IV stage that was shown in last decades was mainly due to modern chemotherapy schemes and aggressive surgical approach towards distant metastatic lesions. Meanwhile less attention is paid to primary tumour treatment - the questions of necessity and volume of its resection are still open. The AIM of this study was to evaluate safety and oncologic effectiveness of primary tumour resection with D3 lymph node dissection in synchronous metastatic colorectal cancer. Patients with colorectal cancer and synchronous metastatic lesion of distant organs who underwent surgical resection of primary tumour were chosen from prospectively collected department database. The analysis of short-term and long-term results of resections with and without extended D3 lymph node dissection and prognostic factors affecting overall survival was carried out. From 2006 to 2011 total of 190 patients underwent primary tumour resection, 157 (82.6%) among them - with extended D3 lymph node dissection. Twenty one patient (11%) developed postoperative complications that required reintervention, 30-days mortality rate was 2.6%. Three-year cumulative overall survival was 37%, median survival - 22 months (25 months with extended lymph node dissection and 4 months without, p<0.001). Univariate analysis revealed following statistically significant prognostic factors improving overall survival: metastatic lesions in one distant organ, solitary haematogenous nodes, extended D3 lymph node dissection, postoperative chemotherapy, resection of metastatic lesions. Removal of primary tumour with extended lymph node dissection in metastatic colorectal cancer doesn't increase the number of postoperative complications and mortality. Performing D3 lymph node dissection favours increase of median survival and is a significant prognostic factor influencing outcomes.

Complex clinical and ultrasound examination of 81 women with chronic venous insufficiency (CVI) of the pelvis was analyzed. All the patients had left-side regional renal venous hypertension which caused valvular insufficiency of the left ovarian vein with spread of the reno-ovarian blood reflux onto the pampiniform, uterovaginal, presacral, vesical and rectal plexuses. Right-side cavaovarial reflux of blood was found but in 29.6% of the patients and in combination with reno-ovarial reflux caused complete decompression of the venous outflow from the pelvis. The treatment was performed depending on the stage of CVI of the pelvis. At the stage of compensation (59.3% of patients) complex conservative treatment was used, at the stage of subcompensation (17.3%)--sclerotherapy, at the stage of decompensation (23.4%)--operative dissection of gonad veins. Excellent results were registered in 34.5%, good--in 43.2%, satisfactory--in 21%, unsatisfactory in 1.2% of the patients. On the basis of self-assessment of quality of life 77.8% of the patients thought to be completely restored, 16%--improved, 6.2% of women had no changes.

The experience of treatment of a rare form of pathology of the lymphatic system was analyzed. The surgical tactics, depending on both the dimentions and the form of lymphangiodysplasia, were described. The absence of the pain sensitivity and large tumor size were the main reason of medical help seeking for the patients on the late stages of the disease. To minimize the volume of the intraoperative bleeding, the authors recommend skeletization of the magistral arteries or their embolisation as a preliminary step before the lesion's surgical excision. The method proved to be extremely effective in two patients with giant lymphagioma.

The experience of 329 gastropancreatoduodenal resections for malignant tumors of the periampullary zone has been reviewed. The obstructive jaundice complicated the disease in 237 (70%) patients. The fact required various modalities of the preoperative artificial bile drainage. To evaluate the jaundice influence on the perioperative period, patients were divided in 4 groups, considering the bile drainage modality and bilirubin blood levels. The early postoperative period was respectively analyzed, which led to the conclusion that bilirubin blood level has no influence on either intraoperative characteristics or postoperative morbidity and mortality. For the reason of that, radical treatment of the periampullary cancer, complicated by the obstructive jaundice, does not require preoperative bile drainage.

Objective: To investigate the immediate outcomes of surgical treatment of patients presenting with pathological deformity of the internal carotid artery., Methods: The study was based on retrospective analysis of the outcomes of surgical management of 142 patients with isolated pathological deformity of the internal carotid artery who underwent a total of 166 reconstructive procedures., Results: Resection with redressing of the internal carotid artery and reimplantation into the old bed was a method of choice of repairing the deformed artery (74%). More often it was possible to have performed it in kinking, C- and S-shape tortuosity of the internal carotid artery, whereas prosthetic repair was more often in coiling (P < 0.05). A positive clinical effect of the operation was achieved in 97% of the patients. Neurological efficacy of the performed interventions depended upon the baseline degree of cerebrovascular insufficiency and the duration of clamping of carotid arteries (P < 0.05). The incidence of the development of thrombosis of the reconstructed internal carotid artery (1.2%) did not depend on either the form of pathological deformity or the method of reconstruction thereof. Cerebral circulation impairments in two (1.2%) cases were transitory and in three (1.8%) resulted in ischaemic stroke, one of which having become the cause of the patient's death. The index "stroke + lethality from stroke" amounted to 2.4%. Neurological complications had been caused by rheological impairments, instability of haemodynamics and inadequate redressing of the internal carotid artery., Conclusion: Analysing the immediate outcomes confirmed that surgical treatment of pathological deformity of the internal carotid artery is an effective method aimed at preventing cerebral circulation impairments and removal of cerebrovascular insufficiency in patients with the disease concerned.