Search

This work analyzed the results of surgical treatment of 380 patients who underwent the laparoscopic adjustable gastric banding (LAGB) at the period from 2004 to 2015. The patients were initially divided into 2 groups with metabolic syndrome (MS) and without MS according to the sex, age (up to 40 years old or older). As the result of performed analysis, there was stated that LAGB operation wasn’t effective and couldn’t be recommended for an application on the patients with MS. The patients have to follow necessary advice for life. Otherwise, the probability of complication development and recurrent operation would be really high and because of this, the more effective surgical treatment should be initially used. LAGB operation didn’t influence on pathogenetic mechanisms of main components of MS and couldn’t be regarded as effective. This LAGB operation is reasonable to apply in women without MS of young age group with initial body mass index lower than 43 kg/m². These women have to be able strictly follow doctor’s advice for life.

Laparoscopic sleeve gastrectomy (LSG) was performed in 522 patients at the period from 2007 to 2015. The operation was carried out by different methods. It was stated that «the ideal candidates» for choosing LSG operation were the patients without metabolic syndrome (MS) and body-weight index, which wasn’t higher than 48 kg/m². The operation could be performed on patients younger than 40 years old in order to correct disorders of insulinic and cholesterol metabolism. Patients with MS have limitations for LSG application, because of this reason, the operation is advisable for younger age group without severe accompanying pathology. The operation could be applied in older age group in order to stabilize general condition in case of high risks as the first (sometimes the last) stage of treatment for the patients whom more effective operation couldn’t be recommended.

Melatonin is neurohormone, which is involved in regulation of many functions of an organism, including the digestive system. Therefore the authors offered to include this hormone as a preconditioner factor in surgical treatment of colon tumors using laparotomy and laparoscopy. Preoperative application of melatonin allowed shortening the terms of postoperative period and hospital stay.

The authors developed and described an algorithm and technical aspects of lymphadenectomy performance in radical surgery based on structural variations of visceral vessels in 91 patients with stomach cancer. Preoperative helical computer tomography in regimen of angiography was carried out on 91 patients. Variant anatomy of visceral vessels was detected in 31 patients and that required change of surgical technique in order to minimize intraoperative risks of great vessel damage and allowed perforrming lymphadenectomy successfully.

It was shown by the authors that changes of the level of cytokines reflected the degree of invasiveness of operative intervention. The endovideosurgical approach was less traumatic and provided a rapid rehabilitation of the patients in postoperative period. It is possible to consider the high levels of IL-10 as a predictor of development of local inflammatory process and as an indicator of probable infectious complications in postoperative period.

Nowadays, according to data of WHO, the diabetes mellitus was diagnosed in more than 280 million people. The diabetes mellitus type II had 90% patients. The applied methods of conservative therapy seldom lead to euglycemia condition of patients. Last years the treatment of diabetes mellitus was carried out by the method of different bariatic interventions. Good results was obtained, they should be analyzed and investigate. The results of treatment of 142 patients from 628 patients (with type II) were estimated. The patients were undergone by different bariatic interventions. Modern laparoscopic operations were performed on all the patients. Controlled bandage of stomach had 81 of patients. Gastric resection was performed in 28. Gastric bypass surgery was carried out in 22 of patients and biliopancreatic diversion - in 11. The improvement of control of leukemia level was obtained. Diabetes type II could be treated by surgical methods. The best results were obtained after combined operations, which potentially could present an alternative method of treatment of type II diabetes.

On the basis of examination of 35 dialytic patients, who had clinical findings of progressed chronic cardiac insufficiency against the background of the large arteriovenous shunt through existing vascular access, the authors show the complications. The volume of blood circulation along the arteriovenous fistula, which was more than 30% of cardiac output, caused dilatation of heart cavities with cardiac decompensation. If the largest potency to volume remodeling of native proximal arteriovenous fistulas is taken into account, this kind of access could cause hemodynamic abnormalities more often than others (in 22 (62.9%) of patients). The best primary survival was demonstrated by arteriovenous shunts (87.1%) during 2 years. However, long-term survival of native arteriovenous fistulas dramatically outperformed the other kinds of accesses. The choice of constant vascular access for hemodialysis is an important and difficult task in chronic renal disease of V degree patients.

Patients with arteriovenous fistulas (648 cases) were examined for hemodialysis. The ischemic steal syndrome was detected in 47 patients and it was associated with vascular access for hemodialysis. A frequency of given complication was studied with correlation of the type of vascular access. The data of clinical and instrumental examination were described. It was revealed, that the development of steal syndrome was influenced by the blood circulation volume velocity on fistulas. Different reconstructive operations were performed on 42 patients in order to save the access for hemodialysis and eliminate the ischemia. The ligation of fistula was carried out for 5 patients. The survival of arteriovenous fistulas after reconstructive operations was till 46 months during the period of follow-up study.

An experience with using autologous bone marrow mononuclears for regeneration of the heart was analyzed in 97 patients in whom the intracoronary transplantation of autologous mononuclear bone marrow cells was performed. The results were estimated in terms up to 5 years and compared with a group of 37 patients who underwent only conservative treatment. A distinct positive dynamic of clinical and echocardiographic indices in the main group was noted in a subgroup of patients with a decreased ejection fraction (EF less than 50%) as compared with an analogous subgroup of patients in the control group. Substantial influence is exerted by regeneration therapy upon remote lethality. Thus, as a whole in the main group lethality over 5 years was 13.4% and in the group of control it was 21.6%. In the subgroup with a decreased ejection fraction and symptoms of heart failure lethality was 22.6% in the main group and 54.5%--in the control group. The intracoronary administration of the autologous bone marrow mononuclear fraction to inoperable patients with ischemic heart disease and a severe lesion of the coronary arteries and a decreased ejection fraction of the left ventricle is a safe and useful procedure resulting to substantially decreased lethality followed-up during 5 years against the background of conservative treatment.

Results of treatment of 67 patients with differentiated thyroid carcinoma were analyzed. Pathological changes in the thyroid residue structure were found in 42.3% of patients after subtotal resection of the thyroid gland (SRTG), 38.8% of the total number of patients were given inadequate suppressive therapy. Only 63.4% of women with thyroid carcinoma were found to have pathology of organs of the reproductive system. SRTG is thought to be an unreasonable volume of operative treatment. For the determination of strategy of treatment it is expedient to use the systems of risk assessment of MACIS, TNM, Clinical Class (University of Chicago).

Results of conservative treatment of 31 patients with PAD are presented. In 3 and 6 months after 10 everyday intravenous infusions of Cytoflavin (combination of succinic acid, inosine, nicitinamide and riboflavin) average increase of painfree walking distance among nonsmokers was 50.6% and 64.4% vs. 108.0% and 170.5% in subgroup of smokers respectively. Average increase of maximal walking distance in subgroup of nonsmoking and smoking patients was respectively 30.1% and 130.5% in three months and 37.6% and 144.8% in 6 months after Cytoflavin infusions.

An analysis of results of using partial ileoshunting for the treatment of dislipidemia in 159 patients with atherosclerosis has shown that operation of partial ileoshunting has an obligatory, pronounced and lifelong lipidcorrecting effect. An antiatherogenic effect of the operation of partial ileoshunting is manifested as the improvement of the clinical course of the disease caused by atherosclerosis, by less number of thrombotic complications of atherosclerosis and less lethality from cardio-vascular diseases. At a longer follow-up period, the efficiency of partial ileoshunting as a means of secondary prophylactics of atherosclerosis is confirmed but in case of liquidation after operation of dislipoproteidemia.

The authors have analyzed results of treatment of 407 patients subjected to different bariatric interventions. In 359 out of them there were different bariatric operations, in 48 patients intragastric balloons were placed. Correcting plastic operations were fulfilled in 36 patients within 1-2 years after bariatric intervention. It was found that bariatric intervention fulfilled in earlier age groups would prevent the development of metabolic syndrome (MS) in patients with obesity at later date. Combined operations are most effective bariatric intervention compared with all main elements of MS. Correcting plastic operations are expedient after bariatric interventions against the background of stabilized decrease of body mass that allows getting valuable therapeutic and esthetic effect, improvement of quality of life of patients.

The authors made a comparative assessment of carotid endarterectomy and endovascular angioplasty with stenting in patients with atherosclerotic lesions of the carotid arteries. The authors consider that indications to stenting and carotid endarterectomy are identical in patients with stenose and occlusions of the carotid arteries. Contraindications to angioplasty of carotid arteries are determined. It was shown that angioplasty and stenting in atherosclerotic lesions of the carotid arteries was an effective method with a less number of complications as compared with carotid endarterectomy and are thought to be an adequate alternative to open surgical method of treatment of patients with stenoses and occlusions of the carotid arteries.

An analysis of long-term (up to 20 years) results of performing operations of partial ileoshunting as a method of surgical correction of dislipoproteidemia in 49 patients with obliterating atherosclerosis of the lower extremity vessels has shown that operations of partial ileoshunting have a pronounced and stable lipid correcting effect. Decreased level of atherogenic lipids in blood improved the course of obliterating atherosclerosis of the lower extremity vessels. Worse long-term clinical results after partial ileoshunting were in a considerable degree due to the presence of residual dislipoproteidemia that resulted in additional medicamentous hypolipidemic therapy.

A method of intraoperative mapping of the lymph outflow tracts was used in 32 patients for a detection of the signal lymph node in gastric cancer using a lymphotropic stain BLUE PATENT V. The test-sensitivity was 78%. The intraoperative mapping of the lymph outflow tracts allows the volume and zone dissection in operations for gastric cancer to be exactly determined. The detection of the "signal" lymph node and its immunohistochemical investigation increases the accuracy of postoperative staging of gastric cancer. The absence of metastases in the signal lymph node in gastric cancer is not a determining criterion for refusal to perform lymphodissection in D2 volume.

The article analyses an experience with treatment of 96 patients with acute intestinal obstruction caused by peritoneal commissures. The technique of laparoscopic operations and principles of their realization are described. The observation of these principles is shown to give high effectiveness and safety of endovideosurgical interventions for acute intestinal obstruction. Their advantages consist in minimal invasiveness, short periods of postoperative rehabilitation and little frequency of postoperative complications.

An analysis of experiences with endovideosurgical sanation of the abdominal cavity was analyzed in 168 patients with diffuse peritonitis which complicated the course of different acute diseases. Relaparoscopy might be programmed and "on request". Programmed laparoscopy allowed adequate sanation of the abdominal cavity in most cases. It was impossible in 11.3% of cases associated with a pronounced commissural process and uncared peritonitis with formed pyogenic abscesses in the abdominal cavity. The indications and contraindications to laparoscopic sanation of the abdominal cavity are described.

Gastric ballons (GB) were introduced in 37 patients (34 women and 3 men) aged from 18 through 57 years (mean age 35.2 years) for treatment of different forms of excess body weight and obesity. Mean index of the body mass at the moment of introducing the balloon was 102.3+/-8 kg varying within the range of 80 to 178 kg. The body mass index was on the average 37.9 kg/m2 (29-63). Possible complications and clinical manifestations after introduction of GB are considered. An analysis of the results of treatment and of the nearest and long-term results shows that the body mass became on the average 78.9+/-5 kg (62-138), the body mass index decreased on the average to 29+/-1.6 kg/m2 (22-46). Maximum body weight loss was 48 kg. Using the gastric balloon is considered to be a minimally invasive technique directed to decreasing the excess body mass and its effectiveness to be higher than other methods of conservative therapy. The application of GB substantially extends the chances to help patients with obesity with the minimal risk for health and life.

Laparoscopic adjustable gastric banding (LAGB) has been fulfilled in 2958 patients in the period since 1998 through 2006 for treatment of different forms of obesity. The age of the patients was from 16 to 60 years (mean age 38 years). There were 80% of women (2366) and 20% of men (592). Mean preoperative body mass index was from 35 to 54 kg/m2, i.e 43+/-3.8 kg/m2, fluctuating from 35 kg/m2 to 54 kg/m2. The observation of 2485 (84%) patients operated in the terms in question showed the influence of LAGB on metabolic derangement, arterial pressure. Statistical data on possible early and late postoperative complications are presented. The operation of LAGB is one of minimally invasive methods for adjustable decreasing the excess body weight and its effectiveness exceeds other methods of restrictive interventions on the stomach, has a number of advantages compared with other bariatric interventions, it is relatively safe and completely reversible bariatric operation with all advantages of minimally invasive techniques.

Operations of laparoscopic adjustable gastric banding (LAGB) have been fulfilled on 2958 patients for treatment of different forms of obesity. The age of the patients was 38 +/- 7.5 years (from 16 to 60 years). There were 80% of women (2366) and 20% of men (592). Mean preoperative body mass index was from 35 to 54 kg/m2, i.e 43 +/- 3.8 kg/m2, fluctuating from 35 kg/m2 to 54 kg/m2. Bands of the following firms were used: Lap Band, Inamed, (USA), AMI Soft Band, Austria, Swedish Band J & J, USA. A description of complications in the early and late postoperative periods are given, associated with the dilatation of the formed "miniature ventricles, occlusion of intercommunication between the miniature ventricle and large ventricle with disturbed evacuation of the content, erosion of the gastric mucosa in the area of the band without its penetration, slippage of the band, complications associated with the regulation system etc. Recommendations were worked out for decreasing the number of complications. The data obtained suggest that LAGB is a highly effective method giving good results of treatment of patients with obesity and coexisting diseases. Most of the appearing complications can be eliminated laparoscopically.

The authors analyze the results of experimental and clinical investigations for comparative studying a new meshed implant of polyvinylidene fluoride as an endoprosthesis of the anterior abdominal wall with postoperative hernias. It was shown that the polyvinylidene fluoride prosthesis is a good alternative of polypropylene prosthesis. Its physico-chemical properties allow reliable prostheses of the abdominal wall, and its biological compatibility is higher as compared with polypropylene prosthesis.

The authors present first results of investigations of the connexin-26 gene in DNA obtained from peripheral blood of 55 patients operated on for gastric cancer. Gastric cancer patients were found to have carriage of the Cx 26 gene that was reliably associated with the invasive ability of the tumor. Change of the connexin-26 gene in gastric cancer is evidence of an important role of intercellular gap junctions in the arising and development of gastric cancer.

This paper analyzes the results of cell therapy carried out during multimodality treatment of 23 patients with trophic ulcers of the lower limbs because of varicosity and postthrombotic disease. Twenty-five patients were entered into the control group provided the modern wound dressings Suprasorb. It has been demonstrated that cell therapy applying fibroblasts, strain 11 00/14, noticeably upgrades the treatment efficacy. Ulcer healing was attained in all the patients of the basic group. The times of epithelialization averaged 1.5 week for varicose and 3.2 weeks for postthrombotic ulcers. In the control group, the healing of varicose trophic ulcers was recorded in 86% and of postthrombotic ulcers in 78% of patients. The times of healing averaged 3.6 and 3.9 months respectively, Cell therapy as part of multimodality treatment of trophic venous ulcers excels the modern wound dressings as regards the efficacy.

The aim of the work was to study the effectiveness of using human embryo fibroblast culture in complex treatment of trophic ulcers of venous etiology in 23 patients with trophic ulcers of lower extremities. The cause of the appearance of ulcers was postthrombophlebitic disease in 16 patients and varicose disease in 7 patients. A control group consisted of 25 patients (postthrombophlebitic disease in 18 patients and varicose disease in 7 patients). The human embryo cell culture grown on the wound cover "Foliderm" was used at the stage of epithelization in the main group, while in the control group the modern alginate, collagen, hydrogel, polyurethane and hydrocolloid covers Suprosorb--Suprosorb A, Suprosorb C, Suprosorb G, Suprosorb F and Suprosorb H were used. Healing of the varicose trophic ulcers in the control group was achieved in 86% of patients, of post-thrombophlebitic--in 78% of patients. The average period of healing was 3.6 and 3.9 months respectively. Healing of trophic ulcers in the main group took place in 100% of patients. The average period of healing was 1.5 week for varicose and 3.2 weeks for postthrombophlebitic ulcers. The cell therapy was shown to be a highly effective method in treatment of venous trophic ulcers.

The authors have analyzed their experiences with treatment of 50 patients with ischemic heart disease using transplantation of autologous mono-nuclears of the bone marrow. It was shown that this operation resulted in an improvement of indices of the heart functions and myocardium metabolism. Transplantation of stem cells as mononuclear fraction of the bone marrow is indicated in treatment of different groups of patients: in recurrent diseases after previous operations on the coronary arteries; in patients with distal lesions of the coronary bed; transplantation of autologous stem cells of the bone marrow is expedient simultaneously with coronary artery bypass grafting or coronary angioplasty (stenting).

A new method of operative treatment of postoperative ventral hernias is proposed which provides reliable fixation of the implant along the whole line of the primary scar. It excludes its migration due to profound integration into all layers of the abdominal wall and reliable fixation at different levels and with sufficient distance from the hernia hilus. The method can be used for any size of the hernia hilus. This method of plasty of the anterior abdominal wall is especially indicated for great, inreducible hernias, for great defects of the abdominal wall and incarcerated postoperative hernias when continuous preoperative preparation is impossible. Long-term results of the operative treatment were analyzed in terms from 1 year to 3 years in 16 patients aged from 40 to 73 years of age (mean age 58+/-2.6 years) with great and giant postoperative hernias. No recurrences were noted.

The authors analyze the components of the metabolic syndrome in patients with morbid obesity treated at the surgical department. The effects of a modified operation of jejunal-ileal shunt on the components of the metabolic syndrome were shown in 220 patients operated upon at the clinic of Faculty surgery of the Pavlov Medical Academy in St. Petersburg. The indications to the operative treatment of the metabolic syndrome were substantiated on the basis of etiopathogenesis. The estimation of long-term results of the operation of jejunal-ileal shunt in patients with the metabolic syndrome is given.

The investigation included 85 ischemic heart disease patients with the coexistent dyslipoproteidemia. In 39 of the patients the operation of partial shunting was performed for correction of the impaired lipid metabolism. It was found that the partial ileoshunting was an effective method of correction of dyslipoproteidemia. The effect of the operation was due to lowering the total cholesterol level in blood (at an average by 25.6%) and elevation of the HDL level (at an average by 19.6%). The results of the following angiographic examinations have shown a clear effect of the inhibition of progressing coronary atherosclerosis in patients who underwent surgical correction of dyslipoproteidemia that allows the partial ileoshunting to be considered as an effective method of the secondary prophylactics of atherosclerosis. The HDL level is the main marker of the dynamics of the atherosclerotic process in the coronary arteries.

The investigation included 120 patients who had undergone different revascularizing operations more than 10 years ago for obliterating atherosclerosis of the lower extremity vessels. Dyslipoproteidemia was diagnosed in 88 of them. It was established that in patients with dyslipoproteidemia the symptoms of ischemia of lower extremities were developed in younger age. Within 5 years after the first revascularizing operations there appear reliable differences in the course of the disease in patients with dyslipoproteidemia and normal levels of lipids in blood. More than 90% of patients with dyslipoproteidemia in the distant period of time have symptoms of generalized atherosclerosis, and the survival is mainly predetermined by cardiac and cerebral complications of atherosclerosis. The life of dyslipoproteidemia patients operated upon is 8 years shorter than of subjects with the normal-level of lipids in blood.

The possible appearance of thrombotic complications of laparoscopic cholecystectomy (LCE) is one of negative consequences of the effects of carboxyl pneumoperitoneum (CPP). Risk factors of thrombogenesis were investigated in 91 patients who had been subjected to LCE and in 50 patients after open cholecystectomy. It was established that the rate of blood flow in the femoral vein after CPP was 31% lower. The creation of CPP facilitates the development of hypercoagulation. The greatest alteration occurs in the anticoagulation system of blood: "free heparin" becomes 31.7% lower, fibrinolytic activity of blood reduces by 73.1%. Prophylactics of thrombotic complications must be complex and be started with the detection of risk factors and finished with a combination of physical and pharmacological methods.

The examination of 76 patients with chronic venous insufficiency has shown that the new method allows visualization of subcutaneous and perforant veins at a depth up to 0.5 cm. Special tests can diagnose pathological venous refluxes suggesting valvular incompetence. Telephleboscanning allows marking the perforant veins that makes the operative interventions more radical.

Presented herein is an analysis of surgical treatment of 232 patients with atherosclerotic stenoses and occlusions of the carotid arteries, including 144 persons with bilateral lesions. The patients underwent carotid endarterectomy according to the traditional and eversion techniques. Analysis of the short- and long-term results has demonstrated that they do not depend on the technique of endarterectomy. The risk of carotid endarterectomy rises in occlusions of the contralateral internal carotid artery. The measures for this risk minimization are offered. The long-term results of surgical treatment of asymptomatic stenoses are better as compared to the results of drug therapy. Surgical treatment of atherosclerotic lesions followed by the treatment of lipid metabolism disorders provides for the improvement of the quality of life due to the restoration of work fitness, physical and social activity.

The authors present herein their findings obtained in bench-test and experimental studies, which made it possible to work out an original technology of creating an endothelial covering of the inner surface of vascular grafts made of polytetrafluorethylene. The new technology includes the definite sequential processes which are as follows: 1) creation of vascular endotheliocytes; 2) stimulation of growth and reproduction of endotheliocytes; 3) preparation of the graft, including creation of stable positive potential on its inner surface in order to create optimal conditions for endothelization; 4) graft endothelization itself. In order to assess efficacy of endothelial vascular grafts, we carried out a total of 105 experiments on dogs. The experimental conditions made it possible to comparatively study the standard and endothelialized grafts using them in the position of the aortic abdominal portion, carotid and femoral arteries. The new grafts turned out to possess satisfactory performance properties, which precluded formation of thromboses and hyperplasia of the noeintima, simultaneously providing good implantability.

Dynamic lymphoscintigraphy provides adequate means for in vivo contrast-enhanced examination of functional lymph collectors in the extremeties which in turn offers best advantage in diagnosing post-mastectomy edema of the arms. A comparative study was concerned with lymph flow in healthy subjects, breast cancer patients and those with post-mastectomy edema and without it after complete course of treatment. A group of risk for edema was formed.