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Introduction. Despite the active introduction of minimally invasive techniques into modern phlebology, the problem of surgical treatment of chronic venous insufficiency (CVI) in the stage of trophic disorders is still far from being finally resolved, especially problems of horizontal reflux. Aim. Тo comparatively evaluate the results of using various tactics of minimally invasive surgical treatment in patients with lower extremitiesʹs CVI in the stage of trophic disorders.Materials and methods. A study at 139 patients with CVI at the stage of trophic disorders was carried out. Group 1 (n = 79) included patients who underwent endovasal laser coagulation of the trunks of the great and small saphenous veins (GSV and SSV) with microfoam sclerotherapy of varicose perforating veins. In group 2 (n = 60) – method of intervention was determined by the diameter of Cockettʹs perforants.Results. Indicators of the early postoperative period in the study groups were comparable. After 2 months, no cases of relapse in the GSV and SSV were registered. Recurrence of horizontal reflux was observed only in 6 (7.6%) people in group 1. In long-term postoperative follow-up, decrease in the severity of the disease according to the VCSS scale was found in both groups (p < 0.001). The persistence of pathological reflux along was observed in 16 (22.5%) patients of group 1. Moreover, in 62.5% and 68.75% cases of relapses, the perforants had, respectively, a large diameter and high blood flowʹs speed.Discussion. In general, minimally invasive techniques used demonstrated comparable clinical results and high efficiency. At the same time, the importance of preoperative assessment and taking into account the properties of perforants has been proven.Conclusion. The claimed method should be considered as an effective and safety method of obliteration of incompetent perforating veins at severe forms of CVI.

Chronic venous insufficiency, being the outcome and complication of most diseases of the veins of the lower extremities, is the fundamental cause of the formation of trophic ulcers. Over the past decade, in solving the problem of treating venous trophic ulcers, certain successes have been achieved, both in theoretical and practical terms. The modern concept of curation of patients with trophic ulcers of venous origin involves a reasonable combination of the following methods of treatment: local, including compression, as well as medical, surgical, minimally invasive and additional methods (physiotherapy, photodynamic therapy, etc.). The main goal of the treatment is to eliminate the ulcer, after which measures are taken to correct the underlying cause (chronic venous insufficiency) and prevent relapse. However, the tactics of the most successful treatment of patients with trophic ulcers of venous etiology is still not defined and requires further improvement. In particular, the method of photodynamic therapy, which includes the usage of special drugs - photosensitizers, also deserves to be studied and expanded for clinical use. The mechanism of photodynamic action is based on the ability of photosensitizers to accumulate in microbial and pathological cells. Under local light exposure, the photosensitizer enters an excited state and charges oxygen, which is associated with erythrocyte hemoglobin. Thus, in cells under the influence, a photochemical reaction is triggered, which ensures the formation of singlet oxygen and its free radicals. Reactive oxygen species, in turn, have a damaging effect on pathogenic flora and necrotic tissues. The main advantages of the method are relative simplicity, no risk of developing antibiotic resistance, acceleration of reparative and regenerative processes, and prevention of secondary infection. Thus, photodynamic therapy allows non-invasive, safe and effective optimization of local treatment and preoperative preparation of patients with venous trophic ulcers.

Introduction. Acute mesenteric ischemia is a rare, but extremely severe life-threatening condition with a mortality rate of 40 to 60%, despite the development of modern high-tech diagnostic and treatment methods. Unfortunately, acute mesenteric ischemia does not have any pathognomonic symptoms or highly specific laboratory and instrumental symptoms and manifests as abdominal pain syndrome, which makes it harder to differentiate diagnosis and results in a delay in taking appropriate therapeutic measures.Clinical case. This clinical case report describes a case of a 70-year-old patient who was admitted to the cardiology department after undergoing percutaneous coronary intervention due to acute myocardial infarction. On the third day, the patient developed severe diffuse abdominal pain and diarrhea. After the series of diagnostic measures have been performed, an acute impairment of mesenteric circulation was suspected and a decision was made to perform spiral computed tomography, which confirmed the presence of a thrombus in the superior mesenteric artery. The patient underwent X-ray endovascular thrombospiration, transluminal balloon angioplasty and stenting of the superior mesenteric artery. Due to the persistence of abdominal pain on the following day, the patient also underwent a diagnostic laparoscopy using ICG technologies to assess the presence and severity of ischemic and necrotic intestinal changes. After six months from the date of discharge, the patient continues to be followed-up by a cardiologist.Conclusions. The timely performance of spiral computed tomography in patients with suspected acute mesenteric ischemia in the vascular regimen, angiography, endovascular interventions to restore blood supply to the intestine and ICG control of perfusion is appropriate to improve the treatment outcomes of this category of patients.

Aim. To improve the results of treatment of severe chronic venous insufficiency (CEAP 4-6) using the methods of minimally invasive phlebology. Materials and methods. The study included 158 patients aged 26-72 (mean age 49,5±1,2) suffering from chronic venous insufficiency (CEAP 4-6). All patients underwent the following examination methods: assessment of subjective and objective symptoms, duplex ultrasound scan and laboratory examinations. Results. Comparative study of endovenous laser hemadostenosis of great and small saphenous veins in combination with subfascial endoscopic perforator vein surgery (SEPS) in the control group and the combined use of endovenous laser coagulation and microfoam echo-sclerotherapy in the main group showed significant benefits in the primary group in the form of a significant reduction of pain syndrome, decrease of postoperative complications, a significant reduction of terms of rehabilitation. The study demonstrated the absence of significant differences between main and control groups of respondents according to the criteria of recurrence of the disease in the late postoperative period (difference in frequency of the detected unsatisfactory effects of the studied medical interventions in the late postoperative period was not statistically significant (p=0,67). Conclusions. Positive dynamics of the combined use of endovenous laser coagulation and microfoam echosclerotherapy of the main group in the immediate postoperative period demonstrate the effectiveness of this method in patients with chronic venous insufficiency (CEAP 4-6).

Intra-abdominal hypertension during laparoscopic operations increased the risk of complications from cardiovascular and respiratory systems. An application of laparolifting systems allowed doctors to avoid changes of pneumoperitoneum, although it was associated with technical difficulties in operation performance. The authors used a test in order to determine cardiorespiratory reserve in preoperative period. The reserve was characterized by decrease of stroke volume of the heart against the background of intra-abdominal hypertension. There was noted a reliable increase of complication rate in these patients in case of application of standard laparoscopic operation compared with operation using lifting systems.

The article made a comparative assessment of traumatic injury of open hand-assisted laparoscopic anterior resection of the rectum in lateral and spinal positions. The presented technique of hand-assisted laparoscopic colon and rectal surgery is simple. There are advantages in case of obesity presence (IMT more than 30 kg/m²), in significant shortening of the mesocolon and mesentery, high fixation of splenic flexure and intimate fixation of the spleen, in case of bad preparation of the bowels in partial intestinal obstruction or in case of emergency operation, big cancer size, expressed perifocal inflammation. A comparative analysis of dynamics of hormone stress content and metabolism (cortisol, adrenaline, thyrothrophic hormone) showed their expressed increase in blood during operation after traditional surgery. Less stressed reaction was noted after hand-assisted surgery, especially in overweight patients. An application of low invasive method allowed reduction of hemorrhage, pain syndrome, terms of patient’s activation and restoration of intestinal motility after operation.