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In recent studies, it has been established that extralevator abdominoperineal extirpation (ELAPE) of the rectum can improve the oncological results of treatment of distal rectal cancer compared to standard abdominoperineal extirpation. As a result of extralevator dissection, a large defect of the perineum is formed, which requires plastic closure. While performing ELAPE, the structures that form the pelvic diaphragm are affected. This increases the risk of pelvic organ prolapse in women and significantly affects the quality of life of these patients, which requires subsequent surgical treatment. Despite the fact that pelvic organ prolapse develops as a consequence of previous surgical treatment by an oncologist, they do not consider it as a complication in the long-term postoperative period. Such patients are not referred to the operating gynecologist. Currently, this problem is poorly understood and there are no standardized approaches to the surgical treatment of pelvic prolapse in this category of patients.

Aim. To compare the results of surgical treatment using bipolar hemostasis and traditional ligation of ligaments and blood vessels in vaginal hysterectomy.Material and methods. Fifty patients with benign uterine disease underwent vaginal hysterectomy using electrosurgery (n = 29) or conventional suture ligation (n = 21 controls).Results. Postoperative pain (especially on the fi rst day) was decreased in the electrosurgery group (5.50 ± 1.43 VAS points) as compared to the control group (7.64 ± 0.58 points), p < 0.001. Intraoperative blood loss was signifi cantly lower in electrosurgery group (82.86 ± 22.58 ml) than in the control group (226.36 ± 129.12 ml), p < 0.001. Operating time was signifi cantly shorter in the main group than in the controls (65.36 ± 20.9 min vs. 86.59 ± 40.19 min, p < 0.05). On average, 2.75 ± 1.11 suture packages were used with bipolar coagulation, 6.00 ± 1.93 in the controls (p < 0.001). Hospital stay was similar for both groups. Adverse event rates did not differ signifi cantly.Conclusions. Bipolar coagulation with the TissueSeal Plus proved to be more effi cient or identical to traditional suture ligation. Intraoperative blood loss, postoperative pain and the duration of the operation were less, while the complications were identical for both groups. In addition, bipolar coagulation was easier to use and cost effective. These fi ndings prove the feasibility and effectiveness of the use of electrosurgical techniques to perform hysterectomy and its further study

This article presents a comparative analysis of the effectiveness of endoscopic transpapillary management in patients with choledocholithiasis. The minimal complications are achieved using classical endoscopic papillosphincterotomy. However, in some cases, cannulation can be extremely difficult (stenosis, tumor of the major duodenal papilla, the anatomical features of the major duodenal papilla) or even impossible (wedged stone), and the introduction of a guidewire into the pancreatic duct significantly increases the risk of developing postoperative pancreatitis. The desire to increase the success when performing endoscopic papillosphincterotomy with diagnostic purpose (to perform endoscopic retrograde cholangiopancreatography after failure of traditional cannulation) and for the purpose of performing transpapillary operations has naturally led to the development of new non-standard methods of endoscopic papillotomy, the introduction of new instruments – wire guides and guided cannulas. Further increase in the frequency of successful endoscopic papillotomy can be facilitated by using atypical methods of surgery. Some authors show that classical papillosphincterotomy is comparable to the method of endoscopic papillosphincterotomy with balloon dilatation in effectiveness of extracting stones from the common bile duct. However, balloon dilatation in the extraction of choledocholithiasis is preferable due to fewer postoperative complications.The authors of this article note that endoscopic management do not always solve the problem of choledocholithiasis, but still have undeniable advantages compared with the laparotomy, in which choledocholithotomy sometimes has to be expanded, and duodenotomy with transduodenal papillosphincterotomy is conducted. Literature shows that main mortality causes after endoscopic interventions in patients with choledocholithiasis were progression of purulent cholangitis, biliary sepsis, acute postoperative pancreatitis, “discharge” syndrome.

The authors described the case of replantation of the right hand in the men of 28 years after a traumatic amputation. This injury was accompanied by damage to the main vessels, which could lead to acute blood loss, hemorrhagic shock and death. The complication after surgery in the form of suppuration of the wound and its effective treatment was shown. This clinical example demonstrated the possibility of limb replantation in traumatic amputations not only in specialized clinics, but also in General surgical hospitals. The basis of the success of the results of the operation was the phasing in the treatment, active monitoring of the replanted limb in order to early identifying possible complications in the postoperative period.

This paper contained data from different literature about problem of minimally invasive treatment of patients with choledocholithiasis. The clinical example justified the use of partial papillosphincterotomy with balloon dilatation in the case of large choledocholithiasis. It was shown that the use of this operation did not increase the risk of intra and postoperative complications during the lithoextraction of large stones from the biliary tract.

Background. In recent years, various methods of combined anesthesia during abdominal surgery have been introduced into clinical practice.Aim. To demonstrate the possibilities of a combination of high prolonged spinal anesthesia and endotracheal anesthesia during abdominal surgery.Materials and methods. A clinical case of combined use of high prolonged spinal anesthesia and endotracheal anesthesia in a 48-year-old patient with a tumor in the right half of the ascending part of the right half of the colon is presented.Results. The patient received a puncture of the spinal space at a standard point and was installed a spinal catheter in the cranial direction for 3 cm. An isobaric solution of marcaine in the initial dose of 20 mg was injected into the catheter. The regulation of the development of the block was regulated by the inclination of the head end of the table by 60°. After that endotracheal anesthesia was performed on the basis of fentanyl and propofol. This combination allowed to expand the scope of surgical intervention, provided adequate pain relief intraoperatively and in the postoperative period, without the use of narcotic analgesics. With the appearance of signs of recovery of pain sensitivity, intraoperatively or in the postoperative period, re-introduction of the anesthetic into the spinal catheter was performed in half of the initial dose with liquor barbotage. In the early postoperative period, the patient was on strict bed rest with a head end of the bed raised at 30–45°. The method provides complete segmental blockade and muscle relaxation in the area of operation, stability of central hemodynamics during surgery and in the postoperative period.Conclusion. This type of anesthesia is more easily tolerated by patients, accompanied by early awakening and extubation, characterized by stability of central hemodynamics, reduced risk of complications, the possibility of prolonging anesthesia with lower doses of narcotic analgesics in the intraoperative period, providing high-quality anesthesia in the postoperative period without resorting to the use of narcotic analgesics.

To evaluate the efficacy of the most common endoscopic transpapillary interventions for choledocholithiasis in randomized controlled trial.There were 90 patients with choledocholithiasis who were randomized into 3 groups: main, clinical comparison 1, clinical comparison 2. In the main group A (n=30), patients underwent endoscopic partial papillosphincterotomy combined with balloon dilatation, in the group of clinical comparison 1 (n=30) - endoscopic papillosphincterotomy, in the group of clinical comparison 2 (n=30) - endoscopic papillosphincterotomy with mechanical lithotripsy.The greatest number of complications (38%) was observed in the group of clinical comparison 2. Less morbidity was noted in the group of clinical comparison 1 (19%). Minimum number of complications was observed in the main group (6%). Acute pancreatitis was diagnosed in groups of clinical comparison 1 and 2 as a rule, whereas only 3% of patients had this complication in the main group. Cholangitis was predominantly observed in the group of clinical comparison 2, in other groups this complication occurred in 3% of patients. Bleeding was observed only in the groups of clinical comparison 1 and 2 (10 and 13%, respectively). Loss of the lithotripter rope (3%) was detected only in the group of clinical comparison 2.Endoscopic partial papillosphincterotomy with balloon dilatation is advisable for choledocholithiasis due to minimal risk of intra- and postoperative complications.Цель исследования - оценить эффективность наиболее часто используемых эндоскопических транспапиллярных вмешательств по поводу крупного холедохолитиаза. Материал и методы. Исследование выполнено среди 90 больных с крупным холедохолитиазом, случайным образом рандомизированных на три группы по 30 человек: основная, клинического сравнения 1 и клинического сравнения 2. В основной группе пациентам проводили эндоскопическую парциальную папиллосфинктеротомию в сочетании с баллонной дилатацией, в группе клинического сравнения 1 - эндоскопическую папиллосфинктеротомию, в группе клинического сравнения 2 - эндоскопическую папиллосфинктеротомию с механической литотрипсией. Результаты. Наибольшее количество осложнений - 38% отмечено в группе клинического сравнения 2. Несколько реже осложнения наблюдали в группе клинического сравнения 1 - 24%. Минимальное количество осложнений было в основной группе - 6%. Острый панкреатит чаще всего регистрировали в группах клинического сравнения 1 и 2, тогда как в основной группе - лишь в 3% случаев. Холангит чаще всего отмечали в группе клинического сравнения 2, кровотечение - только в группах клинического сравнения 1 и 2 - соответственно 12 и 14%. Повреждение корзины Дормиа наблюдали только в группе клинического сравнения 2 -7%. Выводы. При выборе лечебной тактики по поводу крупного холедохолитиаза целесообразно использовать эндоскопическую парциальную папиллосфинктеротомию, при которой риск интра- и послеоперационных осложнений минимальный.

Authors of the given work develop a technique of high spinal anaesthesia in the operations on the upper part of abdominal cavity, and also conduct the assessment of its efficiency and safety at the operations. Experience of performance of 112 operations is presented. The given way of one-stage high spinal anaesthesia allows to achieve the high neuromuscular block to level of the 1-2nd thoracic vertebras. Time introductions anaesthetics in volume to 5 -10 ml. makes (on the average) 1 - 2 minutes that allows to create high degree of turbulence of an entered solution and as promotes distribution of vortical streams in cranial a direction liqour spaces for the purpose of distribution anaesthetics further from an injection place. In the early postoperative period anaesthesia was not required from patients narcotic analgetics. Complications in a kind: headaches, a nausea, vomiting, temperature it has not been noted. Complications from operative intervention it was not marked. In article it is shown that high spinal anaesthesia has considerable advantages before other kinds of anaesthesia, in particular before endotrachea a narcosis. It is easier transferred by the patient, does not cause terrible complications.

The study was carried out in the patients with bulky masses in the liver. Acute hepatic failure was initiated by resection of the liver. In the patients with bulky masses in the liver, increased serum levels of the common cytokines were detected during postoperative period. The blood contents of IL-1β and IL-6 are directly dependent on the surgery-related factors (extent of resection, duration of hepatoduodenal ligation, blood loss volume), that may be employed for prediction of disease course and planning surgical treatment. Determination of a level IL-1β and IL-6 levels is a diagnostic index of liver damage, and it may be used for evaluation of the postresection hepatic failure.

Subject matter. Subject matter was the comparative study of complications of laparoscopic-assisted vaginal hysterectomy (LAVH) and abdominal hysterectomy (AH).