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Aim. To study the possibilities of using video endoscopic technologies in the surgical treatment of hiatal hernia and evaluate long-term results.Materials and methods: 52 patients who underwent laparoscopic correction of hiatal hernia were examined.Results. Excellent and good results were obtained in 31 patients (73,8%), a group with satisfactory treatment results were 2 (4,8%) patients, and an unsatisfactory result was observed in 9 (21,4%) patients.

Aim was to study the prevalence of gastrointestinal tract pathology and the state of intestinal biocenosis among bronchial asthma patients.Materials and methods: 93 patients with asthma in the exacerbation stage who had diseases of the gastrointestinal tract were examined. Instrumental, immunological, bacterial studies of the respiratory and digestive organs were carried out.The results of our study indicate a relationship between the development of bronchial asthma and gastrointestinal pathology due to negative environmental effects, stress, glucocorticosteroid therapy, changes in general and local protective reactions against a background of a chronic disease involving organ barriers with an autoimmune pathogenesis mechanism in the pathological process.

Aim was to study the prevalence of gastrointestinal tract pathology and the state of intestinal biocenosis among bronchial asthma patients. Materials and methods: 93 patients with asthma in the exacerbation stage who had diseases of the gastrointestinal tract were examined. Instrumental, immunological, bacterial studies of the respiratory and digestive organs were carried out. The results of our study indicate a relationship between the development of bronchial asthma and gastrointestinal pathology due to negative environmental effects, stress, glucocorticosteroid therapy, changes in general and local protective reactions against a background of a chronic disease involving organ barriers with an autoimmune pathogenesis mechanism in the pathological process.

Aim. To study the possibilities of using video endoscopic technologies in the surgical treatment of hiatal hernia and evaluate long-term results. Materials and methods. 52 patients who underwent laparoscopic correction of hiatal hernia were examined. Results. Excellent and good results were obtained in 31 patients (73,8%), a group with satisfactory treatment results were 2 (4,8%) patients, and an unsatisfactory result was observed in 9 (21,4%) patients.

Aim of the study is to present a clinical case of abdominal morcellomas.Methods: The technique of morcellation involves not only incisions, but also a significant crushing of tumor cells, which can eventually lead to the spread of the disease. Fibroids left in the abdominal cavity during morcellation continue their development and can reach tumors of considerable size. An observation of the detected parasitic uterine fibroids several years after laparoscopic myomectomy is presented.Result: Histological examination of the removed preparation shows a microscopic picture of the uterine leiomyoma node of a typical structure in a thin fibrous capsule. It was received a normal postoperative course and a patient was discharged from hospital on the 4th day.Conclusion: Abdominal morcellomas after laparoscopic interventions on the uterus is a rare complication associated with the parasitic persistence of myomatous tissue on the abdominal organs. The risks of such complications of endosurgery indicate the need for strict compliance with all technical aspects of using a devices for the evacuation of removed tissues, careful intraoperative monitoring and sanitation of the abdominal cavity.

Aim of the study is to present a clinical case of epiploic appendagitis as a rare acute abdominal pathology.Methods. This case demonstrates the prevalence of acute appendicitis symptoms in the clinical picture of the disease. During the operation was identified a necrotic changes in epiploic appendage of the ileocecal region with presence of secondary appendicitis.Result. The histological examination of the removed epiploic appendagitis gives a picture of tissues infarct with adipose necrosis and the presence of simple catarrhal appendicitis. It was received a normal postoperative course and a patient was discharged from hospital on the 8th day.Conclusion Epiploic appendagitis, due to the absence of pathognomonic symptoms, is an extremely difficult pathology for diagnosis. To establish the correct diagnosis, it is necessary to take into account a complex of data, including clinical and anamnestic, laboratory and instrumental diagnostic methods.

More than a thousand laparoscopic fundoplication operations for hiatal hernia (HH) have been performed at the Clinic of the Bashkir State Medical University over the period between 2000 and 2019 and the results of surgical treatment of 502 patients were analyzed. Our research results indicate that routine instrumental methods used in hiatal hernia diagnosis provide valuable information, however only their combined application allows us to establish the correct diagnosis in all patients. Authors propose a new original X-ray balloon method that allows to improve the quality of diagnosis of hiatal hernia significantly. Balloon X-ray allows us to establish the true dimensions of the hiatus and select the most appropriate treatment accordingly. Isolated fundoplication without plastic of esophageal opening was performed in 180 patients. Surgical correction of the hiatus was performed on 322 patients. Diaphragmcrouroraphy was carried out in 199 cases, in 123 cases mesh implants were used to support the crus of the diaphragm. In 215 cases, simultaneous surgical procedures were performed to treat multiple abdominal pathology. We studied the changes in quality of life of 100 patients with hiatal hernia before and after laparoscopic esophagofundoplication by comparing the results of the survey (questionnaires) and medical examination of the cardiac sphincter of the esophagus function. The vast majority of patients demonstrated a significant improvement in the cardiac closure function, a decrease in the frequency and severity of gastroesophageal reflux, and reduced signs of reflux esophagitis.

Background. Gallstone ileus is a rare complication of cholelithiasis accounting for 0.3–2.1% total acute intestinal obstructions. The recent years are witnessing a sharply elevated incidence of cholelithiasis and its entailed complications. The major diagnostic biases are the atypical clinical presentation, instrumental and laboratory evidence, and a relative paucity of surgical cases.Aim. Highlighting to surgeons the feasibility of this rare reluctantly diagnosed form of acute small bowel obstruction.Materials and methods. The article presents the clinical observations of gallstone-induced small intestinal obstruction collected at a surgery unit of the Bashkir State Medical University Clinic. Patients had surgeries for cholecystoduodenal fistula embolisation, gastro/enterotomy and lithoextraction followed by gastro/enterotomy wound suturing.Results and discussion. Patients had a benign postoperative period are were discharged in a satisfactory condition on day 7–10 after surgery for outpatient surveillance.Conclusion. Surgeons need to contemplate this pathology to ensure timely diagnosis and treatment, as well as avoid possible complications. Mostly important still is a timely gallbladder resection upon diagnosing cholelithiasis via laparoscopic cholecystectomy as a “gold standard” in treatment for this disease.

Aim. To identify a perspectives for using a single incision laparoscopic technologies in surgery.Materials and methods: Today we have a several questions relating to a single incision laparoscopic surgery such as the possible spectrum of their application, safety and economic efficiency. The main is: does this technologies have a perspectives in future.In paper was performed a retro and prospective analysis of the data of modern literature and authors own experience in surgical treatment using a single incision laparoscopic technologies.Results: The study included 74 patients who underwent: cholecystectomy – 64 (86,5%), nephrectomy – 4 (5,4%), ovarian cyst removal – 4 (5,4%), kidney resection – 2 (2,7 %), using various kind of ports: “X-Cone Karl Storz” (28), “Covidien” (18), “PPP” (7), and 21 cases of multi-trocar access.Conclusions: Our opinion that the perspectives for the development of single incision laparoscopy, is the further development of endoscopic devices, including robotic ones, and we believe that it will be a real future and endoscopic surgeons should be ready for this.

Morbid obesity is a distinct disorder which leads to metabolic disorders and to the development of many severe chronic diseases, therefore, the effective treatment of the disorder is an urgent problem of modern medicine. Currently, morbid obesity and the corresponding disorders are a growing problem associated with a significant risk of morbidity and mortality. The study was aimed to assess the morphological and functional changes in the stomach wall after gastroplication performed by the new method worked out in the Clinic of the Department of Surgical Diseases and New Technologies of the Bashkir State Medical University. Gastroplication was performed in 15 male rabbits of the Gray Giant breed aged 12–16 months weighting 3050–5380 g. The animals were withdrawn from the experiment 3, 6 and 12 months after surgery, followed by histological examination of the stomach wall plicated section. Changes in the mucous membrane and the muscle layer of the stomach wall after gastroplication were adaptive and associated with no severe morphological impairment. That made it possible to use the method in clinical practice in 15 patients with morbid obesity, 9 women and 6 men aged 42 ± 2.1. In most patients (13 people, 86.7%), a steady decrease in the body weight was achieved during the first 2–12 months. Long-term treatment results had been tracked during two years. It has been confirmed, that the new laparoscopic gastroplication technique does not lead to pathological changes in the stomach wall plicated section, therefore, the simple and cost-effective method may be used in clinical practice for treatment of patients with morbid obesity.

Aim. To improve the reparative tissue regeneration, applying oxymethyluracil in surgical patients. Materials and methods. The impact of 5-oxymethyluracil-2,4-dioxo-5-hydroxy-6-methyl-1,2,3,4-tetrahydropirimidine (5-OMU) on the processes of regeneration stimulation in the tissues was studied in 4 groups, including different organs and systems of the body. The analysis of the results of using 5-OMU for torpid wounds in general surgery included 145 patients, erosive-ulcerous lesion of the upper parts of gastrointestinal tract – 126, reparative surgeries on GIT – 105 and revasculizing interventions on the heart – 63. To develop experimental models, mature rats, aged 11–12 months, with the body mass 2.9 ± 1.7 kg were used. Two sets of experiments with cut and burn wounds were implemented. Results. The experimental studies, aimed at investigation of histological and histochemical preparations, demonstrated positive influence of oxymethyluracil on the healing of skin wounds. Conclusions. On the basis of the studies carried out, the preparation is also recommended for use in other fields of surgery for the treatment of erosive-ulcerous lesions of the upper part of gastrointestinal tract, for intestinal anastomoses and when performing revasculizing surgeries on the heart. Different drug forms of this preparation were developed to reach its maximum concentration in the tissues, clinical trials were conducted and its efficient use in clinical practice was confirmed.

Aim. To improve the immediate and long-term results of diabetic foot syndrome treatment, using modern surgical techniques. Materials and methods. The results of treatment of 264 patients were analyzed. For these patients with purulo-necrotic affection of extremities against the background of diabetes mellitus, complex treatment, including the techniques of extremity revascularization as well as modern hydrocolloid bandage materials, depending on the stage of wound process, was used; different variants of foot unloading at the clinical and ambulatory stages were offered. The method of treatment of purulo-necrotic wounds against the background of diabetes mellitus, based on differentiated use of ozonotherapy combined with application of biomaterials for closing ulcerous defects, was developed and introduced by the authors. Results. The systemic approach and criteria for choosing surgical strategy of diabetic foot syndrome treatment were worked out and presented. The immediate and long-term results of using the introduced scheme of the management of patients were studied. Conclusions. The developed complex approach is aimed at preservation of the foot and supporting function of the lower extremity; its clinical use permits to decrease the percent of amputations and lethality, improving patients’ quality of life indices.

Background: AB0 blood type antigens are unequally expressed in different portions of the colon resulting in so-called proximal-distal gradient. In most research studies considering the link between blood types and colorectal cancer, this gradient has not been taken into account. In the present context the findings of such studies are not convincing, no evidence-based results are reflected in literature. Valid studies of this association require antigenic distribution of the colon and malignant tumor location to be taken into account. Aim : To assess the possible relation between AB0 blood type antigens and malignant tumors located in different parts of the large intestine. Materials and methods: We performed a case-control study with retrospective analysis of medical records on patients with the presented disease (cases) and patients who did not suffer from it (controls). Required data was obtained from regional oncological centers of South Kazakhstan, Karaganda, East Kazakhstan, and Mangystau regions. Every third case of colorectal cancer registered in 2011−2016 years was included in the survey. The studied association was estimated by means of a chi-square test. A multinomial logistic regression was used to calculate the odds ratio (OR) with confounding risk factors to be taken into account. Shares of the samples were compared by means of Student’s t-test. A critical level of statistical significance (p-value) was considered to be 0.05. Results: Each group included 1570 patients. Gender, age, and ethnic distribution did not differ statistically in cases and controls (p>0.4 for all comparisons). When blood type distributions were compared between groups regardless of tumor locations, any significant difference was not revealed (p=0.141). When similar calculations were applied to specific parts of the large intestine, the association between 0 blood type and malignancies of distal portions of the colon was demonstrated (p=0.0002). When we calculate the odds ratio for the disease development in the colon parts (using a multinomial logistic regression), the following results were obtained: 1.518 (p=0.004) for 0, 0.781 (p=0.099) for A, 0.785 (p=0.143) for B, and 0.965 (p=0.884) for AB blood types. Conclusions: The results of the present study revealed a statistical correlation between the 0 blood type and malignant tumors located in the distal portions of the colon.

The article presents the results of treatment of 201 patients with neuroischemic form of diabetic foot syndrome. The research included 158 women and 43 men of the middle age of 62,5±11,2 years. The complex approach was applied in treatment includ ing medicamentous treatment, revasculization of extremity, an application of modern combined collagenous coating and foot relieving using silicone insoles and orthopedic footwear. The endovascular and open reconstructive operations were performed in order to obtain the revasculization of extremity. Given complex approach allowed reducing the terms of hospital stay, the rate of ulcerous defects recurrences and relapses of ischemia of lower extremities during one year after endovascular interventions.

Aim. To study the effects of combined dressings on the processes of free radical oxidation in patients with purulent wounds.Methods. The performance of luminol-dependent chemiluminescence of whole blood from 30 healthy donors and 122 patients with purulent wounds, as well as tissue chemiluminescence of festering wounds tissue homogenates were examined before and after the treatment. To assess the free radical oxidation in vitro, spontaneous and zymosan-induced whole blood chemiluminescence measurement, iron-induced chemiluminescence assessment of festering wounds tissue homogenates were performed. The distribution of chemiluminescence parameters compared to normal expected distribution was analyzed to group homogeneity on these criteria.Results. Group of donors was homogeneous in composition that allowed the calculation of mean values. By changing in whole blood chemiluminescence of patients with soft tissue festering wounds, they were allocated to two groups, in which a marked increase or decline of the investigated parameters was seen. Increased luminol-dependent blood chemiluminescence indicates excessive free radicals generation by phagocytes and is characteristic of acute inflammation. Decreased intensity of chemiluminescence was observed in the blood of patients who showed reduced functional activity of phagocytes, which, together with the clinical features indicate a long-term smoldering inflammation. The comparative assessment of «Poliderm», «Voskopran», «Polysorb», «Levomekol» medications, used for local treatment of suppurative wounds, influence on free radical oxidation in model systems in vitro, was performed.Conclusion. There is a triple increase in chemiluminescence intensity in the acute phase of the inflammatory process, marking increased production of reactive oxygen radicals with microbicide activity); in long-term smoldering processes, chemiluminescence decreases by half, indicating reduced efficiency of protective mechanisms

To present the new method of gastric plication in treatment of patients with overweight and obesity.There were 132 different bariatric interventions in patients with overweight and obesity.It is described an original technique of laparoscopic gastric placation characterized by reduced postoperative morbidity, simplicity, low traumatism, and economic efficiency. The method was applied in 12 patients with morbid obesity. The majority of patients (83.3%) achieved a persistent decrease in body weight.The prospects of the method are seen in determining surgical indications and selection of patients for the operation. Further assessment of laparoscopic gastric plication will make it possible to determine its place among restrictive methods for weight loss.В Клинике БГМУ накоплен опыт 132 различных бариатрических вмешательств у больных с избыточной массой тела и ожирением. Описана оригинальная методика лапароскопической гастропликации, простая, малотравматичная, экономически эффективная, позволяющая снизить риски развития послеоперационных осложнений. Способ применен в клинической практике у 12 больных морбидным ожирением. У 83,3% пациентов достигнуто стойкое снижение массы тела. Перспективы развития метода видятся в детализации показаний и отборе больных для операции. Дальнейшее изучение результатов применения лапароскопической гастропликации позволит определить ее место среди рестриктивных методов по снижению массы тела.

The article presents the results of treatment of 201 patients with neuroischemic form of diabetic foot syndrome. The research included 158 women and 43 men of the middle age of 62.5 ± 11.2 years. The complex approach was applied in treatment including medicamentous treatment, revasculization of extremity, an application of modern combined collagenous coating and foot relieving using silicone insoles and orthopedic footwear. The endovascular and open reconstructive operations were performed in order to obtain the revasculization of extremity. Given complex approach allowed reducing the terms of hospital stay, the rate of ulcerous defects recurrences and relapses of ischemia of lower extremities during one year after endovascular interventions.

To present an experience of surgical treatment of hiatal hernia.An experience of more than thousand laparoscopic fundoplications in various modifications has been accumulated in the Clinic of Bashkir State Medical University for the period 2001-2016.An original device for intraoperative measurement of hiatal orifice is described. Hiatal orifice repair was indicated in case of its dimension over 3.5 cm. 310 patients underwent hiatal orifice repair including diaphragmocrurorrhaphy in 189 cases, hiatal orifice replacement by using of mesh implant in 121 cases. Simultaneous interventions were performed in 211 cases due to hiatal hernia combined with other abdominal diseases.Thus, selection of hiatal hernia patients for antireflux surgery should be clearly indicated according to clinical and instrumental data in the context of health care system reforming and widespread use of minimally invasive technologies. Laparoscopic operations for hiatal hernia are preferable and contribute to decrease of morbidity and improvement of outcomes.В клинике Башкирского государственного медицинского университета за 2001-2016 гг. накоплен опыт более тысячи лапароскопических фундопликаций в различных модификациях. Описано оригинальное устройство, позволяющее интраоперационно измерять диаметр пищеводного отверстия. Пластику пищеводного отверстия диафрагмы считали показанной при его расширении более 3,5 см. Диафрагмокрурорафия осуществлена в 189 наблюдениях, в 121 наблюдении выполнено протезирование пищеводного отверстия диафрагмы сетчатым имплантом, всего коррекция пищеводного отверстия произведена в 310 наблюдениях. При сочетании ГПОД с другими заболеваниями органов брюшной полости, требующими хирургической коррекции, в 211 наблюдениях выполнены симультанные вмешательства. Таким образом, в условиях реформирования системы здравоохранения, повсеместного внедрения и совершенствования минимально инвазивных технологий отбор больных на антирефлюксную операцию при ГПОД следует проводить по строгим показаниям, основанным на данных комплексного клинико-инструментального обследования. Лапароскопические операции при лечении больных ГПОД являются операциями выбора, способствуют уменьшению частоты осложнений, улучшению результатов лечения.