Hospital Surgery. Journal named by L.Ya. Kovalchuk
Ukrainian Scientific and practical journal published quarterly. Journal devoted to coverage of clinical surgery, operational and experimental surgery, reconstructive and plastic surgery, transfusion and surgical hematology, urology, neurosurgery, clinical anesthesiology, and resuscitation. The publication also presents relevant materials from Ukrainian and international conferences, original works of surgeons from Ukraine and abroad. The original studies, published in the journal include high standards, the principles of evidence-based medicine, characterized by relevance, theoretical, and practical value. ISSN 2414-4533 (Online), ISSN 1681-2778 (Print)
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ANALYSIS OF THE RESULTS OF SURGICAL TREATMENT OF INFECTIVE ENDOCARDITIS IN CHILDREN WITH AN ASSESSMENT OF ITS EFFECTIVENESS
The aim of the work: to analyze the results of surgical treatment of infective endocarditis in children and to identify factors that influence its effectiveness. Materials and Мethods. The study included pediatric patients (n=71) aged 3.0 to 14.8 years (mean age (8.9±3.3) years). In all study participants, infective endocarditis was defined according to the modified Duke criteria, which developed against the background of congenital heart disease or without congenital anomaly of the cardiovascular system. All patients in the sample underwent reconstructive surgeries for infective endocarditis lesions at the Department of Surgical Treatment of Congenital Heart Defects in Newborns and Young Children of the Amosov State Research Institute of Cardiology of the National Academy of Medical Sciences of Ukraine. The material for analysis was data from the primary medical records: medical history, primary medical record, operation protocols, clinical and instrumental examination data. The parents of all study patients gave informed voluntary consent. Statistical analysis of the significance of differences was performed between the study groups at a significance level of 0.05, determined by the χ² criterion with Yates correction. Statistical processing of the study results was performed on a Macbook Pro computer (Apple, USA) using the SPSS Statistics statistical package (IBM, USA) version 26.0. Results. In this study, hospital mortality was 9.8 %, in patients of the main group it was 8.5 % and in the comparison group – 12.5 %. It was found that patients who were discharged from the hospital for rehabilitation were treated in the hospital for a significantly longer time than patients who died. This trend persisted both in patients of the main group and in patients of the comparison group. The exception was patients from the main group with congenital heart defects of the non-cyanotic type, who were in the hospital for a similar period regardless of the outcome of treatment. It was found that in pediatric patients with infective endocarditis, the following clinical factors significantly influenced hospital mortality, and therefore the effectiveness of surgical treatment: the presence of cyanotic congenital heart defects, embolic neurological complications and the development of heart failure. As a result of multivariate analysis, it was found that the following significantly influenced hospital mortality: nosocomial infection, prolonged preoperative antibiotic therapy, the presence of cyanotic congenital heart defect, embolic neurological complications and development of heart failure. Conclusions. As a result of studying the results of surgical treatment of infective endocarditis in pediatric patients, factors influencing its effectiveness were identified, in particular, the presence of nosocomial infection, prolonged preoperative antibiotic therapy, the presence of congenital heart defects of the cyanotic type, embolic neurological complications, the development of heart failure or causing hospital mortality.
Copyright (c) 2025 О. Г. СЕНЬКО, В. В. ЛАЗОРИШИНЕЦЬ https://creativecommons.org/licenses/by/4.0
RESULTS AND COMPLICATIONS AFTER TAPP-PLASTY OF INGUINAL HERNIAS IN ELDERLY AND SENILE PATIENTS
The aim of the work: to assess the course and frequency of complications during and after laparoscopic transabdominal preperitoneal plasty of inguinal hernias in elderly and senile patients. Materials and Methods. A retrospective comparative study of prospectively collected data was conducted on the basis of the Volochysk Multi-Profile Hospital and the Lutsk City Clinical Hospital, which included 56 male patients diagnosed with inguinal hernia (K40 according to ICD-10). The average age of the patients was (69.8±5.8) years, which corresponded to the age categories of elderly and senile age. The patients were divided into two groups depending on the method of mesh implantation: group A (with mesh fixation, n=28) and group B (without fixation, n=28). All patients underwent laparoscopic transabdominal preperitoneal plasty (TAPP). Pneumoperitoneum was created up to 12 mm Hg. 3 trocars were used: one 10-mm (umbilical) and two 5-mm (right and left iliac). All patients were operated on under inhalation anesthesia with artificial ventilation. Pain was assessed using a visual analog scale (VAS) after 2–6 h, the next day, on the day of discharge, after 1 week and 1 month. Chronic pain and paresthesias were assessed using the CPSP (Chronic Post-Surgical Pain) scale in the long term. All patients signed an informed consent to participate in the study and to process personal data for scientific purposes. Results. The average duration of operations in patients from group A (with mesh fixation) was (64.3±12.5) min, while in group B (without fixation) – (51.4±10.8) min, which is approximately 20 % less than in group A, and is consistent with the data of world researchers, who indicate a reduction in operating time with a fixation-free technique due to the lack of need for additional manipulations with mesh fixation. There were no intraoperative complications during laparoscopic interventions. The total frequency of early and late postoperative complications was recorded in 9 patients: in group A (with mesh fixation) – in 7, in group B (without mesh fixation) – in 2. Pulmonary artery thromboembolism and postoperative pneumonia were not observed in any case. After complete desufflation and control of the correct location of the mesh, the procedure was completed. The ports were sutured with appropriate sutures. Conclusions. The results of the study showed that TAPP-plasty of inguinal hernias in elderly and senile patients is effective in both fixation and non-fixation methods of mesh implantation. The use of the non-fixation method allowed to significantly reduce the level of postoperative pain and contributed to a faster restoration of functional activity without recurrence.
Copyright (c) 2025 І. Ю. ЛАВРЕНЮК, А. М. ПРОДАН, Ю. В. ЛАВРЕНЮК https://creativecommons.org/licenses/by/4.0
EFFECTIVENESS OF STATIC RECONSTRUCTIVE METHODS IN THE TREATMENT OF LONG-TERM PARALYSIS OF THE FACIAL NERVE
The aim of the work: to evaluate the effectiveness of static reconstructive interventions, in particular using a fascial flap of the broad fascia of the thigh, in patients with long-term facial nerve palsy (FNP). Materials and Methods. The purpose of the study was to comprehensively evaluate the effectiveness of static reconstructive methods in patients with long-term PLN. To achieve the goal, a flap of wide fascia of the thigh was applied, which was fixed to the commissure of the mouth and to the temporal fascia with tunneling through the musculo-aponeurotic system of the face. In addition to the basic interventions, adjuvant procedures – unilateral facelift and correction of the lower eyelid ectropion by lateral tarsal suture were used, which provided an improvement not only in cosmetic but also in functional characteristics. Statistical analysis was performed using Microsoft Excel (Microsoft 365), the significance level was considered at p<0.05. All stages of the study complied with current international ethical standards. Patients signed informed consent, and the study protocol was approved by the Ethics Committee of the Valikhnovski Surgery Institute (LLC "Clinic 311"). Results. The study presents clinical cases of three patients with long-term PLN who underwent reconstructive surgery describing technique, rehabilitation period and outcomes. The obtained data indicate a high level of correction of facial asymmetry –the success rate of interventions reached 97–98 %, which significantly exceeds the indicators of classical dynamic methods (about 50–52 %). Operations were marked by relatively short duration (60–75 minutes), minimal blood loss, and postoperative results remained stable throughout the year of follow-up. The comprehensive approach promoted the activation of the temporalis muscle as the main driver of the mouth angle movement in the absence of facial nerve function. Conclusions. The findings confirm the high efficacy of static reconstructive techniques in the treatment of long-term iatrogenic PLN, especially in paralysis over 24 months, when dynamic techniques are ineffective due to muscle atrophy. The use of a flap of the wide fascia of the thigh provides a stable correction of the asymmetry of the oral slit and improves the functional and aesthetic condition of patients with minimal complications.
Copyright (c) 2025 Р. Л. ВАЛІХНОВСЬКИЙ https://creativecommons.org/licenses/by/4.0
INTRA-ABDOMINAL PRESSURE AS A PREDICTOR OF MICROCIRCULATORY DISORDER SEVERITY IN PATIENTS WITH ACUTE ADHESIVE SMALL BOWEL OBSTRUCTION
The aim of the work: to establish the correlation between the level of intra-abdominal pressure and the parameters of systemic microcirculation in patients with acute adhesive small bowel obstruction at different stages of the disease. Materials and Methods. A total of 86 patients with acute adhesive small bowel obstruction (AASBO) were examined and divided into 3 groups: compensated stage (n=31), subcompensated stage (n=41), and decompensated stage (n=14). Intra-abdominal pressure (IAP) was measured using the transvesical method. The state of systemic microcirculation was assessed by Laser Doppler Flowmetry (LDF) with wavelet analysis of regulatory mechanisms. For comparison, analysis of variance (ANOVA) or its nonparametric analogue – the Kruskal – Wallis test, depending on the nature of the data distribution, was used. To establish the relationship between the level of ICP and microcirculation parameters, correlation analysis was used with the calculation of the Pearson correlation coefficient (r). Differences were considered statistically significant at the level of p<0.05. Results. A strong direct correlation was established between the increase in IAP and the progressive suppression of active vasomotor regulation mechanisms (myogenic: r = -0.78; neurogenic: r = -0.71) and increased venous congestion (respiratory: r = 0.82; p<0.001). The progression of AASBO stages from compensation to decompensation was accompanied by an increase in mean IAP from (13.8±1.1) to (24.1±1.5) mmHg and a sequential depletion of microcirculatory regulatory reserves. Such a change in the state of microcirculation at different stages of GSKN, which we have studied, is fully consistent with modern ideas about the pathophysiology of ICH and abdominal compartment syndrome (ACS). The initial decrease in perfusion and activation of neurogenic tone in the compensation stage is a classic stress reaction of “centralization of blood circulation”, aimed at supporting vital organs. The body tries to adapt to the increasing pressure, mobilizing its regulatory reserves. Conclusions. The level of IAP is a reliable and objective predictor of the severity of systemic microcirculatory disorders in AASBO. IAP monitoring should be included in the patient management protocol for early risk stratification and optimization of treatment tactics.
Copyright (c) 2025 І. М. ДЕЙКАЛО, В. В. БУКАТА, А. В. ЧОРНОМИДЗ https://creativecommons.org/licenses/by/4.0
MODIFIED METHOD OF ACCELERATING ARTERIOVENOUS FISTULA MATURATION USING VENOUS COMPRESSION TECHNIQUE
The aim of the work: to investigate the clinical efficacy of a modified method of controlled venous compression in patients with terminal stage of chronic kidney disease, determination of its effect on the haemodynamics of arteriovenous fistulas, and comparison with standard methods of accelerating vascular access “maturation”. Materials and Methods. A single-centred prospective study was conducted, which included observation of 128 patients with the 5th stage of chronic kidney disease whom primary radiocephalic arteriovenous fistulas (AVF) were formed on the upper limb in the lower third of the forearm. The examined were divided into three groups: group I, control (n=39) – patients who did not perform auxiliary exercises to accelerate the maturation of vascular access; group II experimental (n=43) – performed standard exercises with an expander for 5 minutes 3 times a day; group III experimental (n=46) – used a modified method of controlled venous compression (20 s of compression / 55 s of relaxation 2–3 times а day). The exercises were performed from the 10th day after the formation of vascular access. Results. It was found that in patients of group II, increased blood flow velocity exceeded the control values after 1, 3 and 6 months by 10.19, 12.40 and by 11.95 % p<0.05), respectively, and the growth of the AVF diameter on the main vein was the greatest (20.83 %, p<0.05) 3 months after the vascular access formation. In group III, the highest growth of blood flow velocity (by 29.79 %, p<0.05) and diameter (by 37.21 %, p<0.05) compared to the control was registered one month after the beginning of the exercises, which characterises early fistula maturation. It is important that in patients of group III the lowest number of complications (26.08 %) was observed, while in group II and the control, this number was 30.20 % and 35.90 %, respectively. Conclusions. The use of controlled venous compression is advisable in the postoperative stage of vascular access creation and can increase the functional effectiveness and duration of AVF use.
Copyright (c) 2025 В. О. ВОРОНИЧ, О. Я. ПОПАДЮК https://creativecommons.org/licenses/by/4.0
COMPARATIVE CHARACTERISTICS OF THE STATE OF MICROCIRCULATION WHEN USING ELECTROCOAGULATION AND MEDICAL LASER IN THE SURGICAL TREATMENT OF ACUTE CONDYLOMAS OF THE ANOGENITAL REGION UNDER THE CONDITIONS OF USING NITROGEN DONORS
The aim of the work: comparative characteristics of the effect of surgical treatment methods for acute condylomas of the anogenital region (ACAR) on microcirculation in complex therapy using nitrogen donors. Materials and Methods. 146 patients with ACAR were examined and treated, divided into 3 groups. Group 1 (n=70): patients with multiple ACAR – 47 (67.14 %); isolated – 21 (30.0 %); Buschke – Levenstein condylomas – 2 (2.86 %); Group 2 (n=35): multiple – 19 (54.29 %); single – 15 (42.86 %); Buschke – Levenstein condylomas – 1 (2.86 %); Group 3 (n=41): multiple – 21 (51.22 %); solitary – 20 (48.78 %). Microcirculation was studied during the initial examination, after preoperative preparation, and in the postoperative period on days 3 and 10 using laser Doppler flowmetry: M – arithmetic mean value of microcirculation index (MCI); σ (“flax”) – standard deviation (SD) of blood flow amplitude fluctuations from the mean value M; Kv – coefficient of variation – the ratio between the perfusion index and its variability: Kv = σ/M×100%. The nature of microcirculation and its changes depending on the surgical method and the use of arginine aspartate were determined. Patients in groups 1 and 3 underwent Arginine aspartate therapy before surgery and in the postoperative period. Surgical treatment in groups 1 and 2 was performed using electrocoagulation, while in group 3, it was performed by using surgical laser. Results. In all groups, the initial MCI data were representative, with mean values in patients with multiple ACAR`s: M – (12.29±0.32) pf. units (p<0.05), flax – (0.66±0.03) pf. units (p<0.05), Kv – (5.52±0.22) % (p<0.05) (hyperemic type); in isolated cases: M – (4.60±0.06) pf. units (p<0.05), flax – (0.56±0.03) pf. units (p<0.05) and Kv – (12.23±0.58) % (p>0.05) (spastic type); for giant condylomas of Buschke – Levenshtein: M – (18.92±0.55) pf. units (p<0.05), flax – (0.55±0.21) pf. units (p<0.05), Kv – (2.95±1.17) % (p<0.05) (hyperemic, congestive-stasis). After preoperative preparation, patients with multiple ACAR in groups 1 and 3 undergoing arginine aspartate therapy showed a change in microcirculation toward normalization, indicating the elimination of the venous component in the form of slowed blood outflow. In group 2, these changes were less pronounced, which can be explained by the absence of the effect of the NO donor on the vascular endothelium. In the postoperative period, patients in groups 1 and 2 showed persistence of the inflammatory phase of the wound healing process, which was offset in group 1 by arginine aspartate therapy. In the group of patients treated with a surgical laser, microcirculation parameters did not change significantly and did not differ from the control group by day 10. In groups 1 and 3 of patients with isolated ACAR, after preoperative preparation, there were significant shifts toward the normotonic variant of microcirculation. In group 2, the positive dynamics were insignificant in the form of a tendency toward normalization. On the third day of the postoperative period after electrodestruction, a slowdown in microcirculation was observed as a reaction to trauma, more significant in group 2, with gradual normalization in group 1 on the tenth day. In group 3, the indicators did not differ significantly from those in healthy individuals. The condition of the MCI in patients with Buschke-Levenstein condylomas in group 1 tended to improve in one case but did not change significantly, depending on the nature of the spread and complications. Conclusions. The use of a surgical laser promotes earlier restoration of microcirculation than the use of electrocoagulation, due to early normalization of microcirculation and reduction of the inflammatory phase. When using the electrocoagulation method, the use of arginine aspartate promotes the optimization of microcirculation and neutralizes the effects of post-traumatic tissue reactions.
Copyright (c) 2025 А. М. СЛЄПІЧКО, І. М. ДЕЙКАЛО https://creativecommons.org/licenses/by/4.0
MAIN ASPECTS OF MANAGEMENT OF HAEMODYNAMIC DISORDERS OF ARTERIOVENOUS FISTULAS IN PATIENTS ON HAEMODIALYSIS
The aim of the work: to study the feasibility of antiplatelet therapy administration to prevent the occurrence of thrombotic, occlusive, and stenotic lesions of arteriovenous anastomoses site. Materials and Methods. Patients underwent radiocephalic arteriovenous fistula (AVF) formation on the forearm, with a follow-up control examination 10 days, 3, 6, and 12 months after surgery. Patients of the 1st (control) group did not receive any antiplatelet agents in the postoperative period, 2nd (main) – received antiplatelet therapy daily for 12 months of observation. Depending on the type of pharmacological agent, the following research subgroups were identified: 2.1 – in the postoperative period the patients took acetylsalicylic acid (ASA, 100 mg daily, per os), 2.2 – platelet P2Y12 receptor inhibitor clopidogrel (75 mg daily, per os). Results. A reliable increasing of primary patency index of AVF was observed in patients of the 2nd group 6 and 12 months after surgery, by 13.4 and 25.4 %, respectively regarding to control. A detailed analysis of the type of antiplatelet therapy showed that clopidogrel administration is the most effective, that is confirmed by an increase the indexes of primary patency of vascular access by 14.1 and 29.0 % compared to the indicators in patients of the 1st group. During 12 months of observation, thrombotic lesions of AVF were detected in 33.8 % of examined without antiplatelet therapy, 24.3 % – against the background of ASA, 17.8 % – of clopidogrel. Ultrasound examination revealed a positive effect of clopidogrel administration, reflecting a reliable increase the diameter of the efferent vein 12 months after surgery by 22.5 % compared to the data in patients without antiplatelet therapy. Conclusions. The obtained results indicate the advisability of long-term use of antiplatelet agents (especially clopidogrel) for the purpose to improve the rate of AVF maturation and prevention of complications occurrence to improve the quality and duration of patients’ life on renal replacement therapy.
Copyright (c) 2025 В. А. СЕМЧЕНКО, О. Я. ПОПАДЮК https://creativecommons.org/licenses/by/4.0
REGIONAL ANESTHESIA AS PART OF THE RECOVERY STRATEGY IN PATIENTS WITH CHEST TRAUMA
The aim of the work: analysis of modern methods of regional anesthesia, their use and effectiveness in pain relief of patients with chest injuries, as well as assessment of their role in the recovery strategy after traumatic and surgical interventions. Materials and Methods. Scientific information databases, including PubMed, Web of Science, Embase and Cochrane Library, were used to collect relevant information. Search queries included combinations of keywords relating to regional anesthetic techniques such as «thoracic epidural blocks», «thoracic paravertebral blocks», «intercostal blocks», «fascial plane blocks», as well as terms related to chest injuries, postoperative pain and pain relief strategies («regional anesthesia», «thoracic surgery», «chest injuries», «patient treatment», «stress marks»). Only prospective randomized controlled trials were selected for analysis. The search was carried out according to the inclusion criteria. The synthesis of the results was carried out according to thematic sections revealing the main aspects of the application of regional anesthesia in the strategy of analgesia and restoration of functions after chest injuries. Results. Despite the high effectiveness of epidural anesthesia for pain relief in various surgical interventions, this method has a number of difficulties. Thus, the technical performance of epidural anesthetics is quite difficult and can cause significant discomfort in sleepless patients. The most frequent adverse event of this method is considered to be a non-functioning block, which occurs in approximately 30% of cases. Migration or misposition of the catheter may result in unilateral or spotty blockages. Among the serious complications of the procedure, vascular injuries, paresthesias and nerve damage, which occur especially often in patients with complex anatomy, should be noted. In this regard, as an alternative to epidural anesthesia, the European Society of Thoracic Surgeons (ESTS) recommends the use of thoracic-paravertebral block (TPB) or intercostal nerve block for analgesia in thoracic surgery. Conclusions. Among the anesthetic techniques used in chest injuries, regional techniques, in particular intercostal, paravertebral, epidural and plane block, are of important clinical importance, provide a high level of analgesia with minimal systemic impact, improve patient compliance with respiratory therapy, contribute to reducing the frequency of pneumonia and shorten the duration of hospitalization. In particular, intercostal block, as one of the most direct and targeted techniques, is effective in isolated rib fractures, allowing for rapid pain relief. Regional anesthesia is recognized as the optimal tool for effective pain relief for chest injuries, especially in conditions of polytrauma, intensive care units and thoracic surgery.
Copyright (c) 2025 А. І. СУХОДОЛЯ, Л. І. СУХОДОЛЯ https://creativecommons.org/licenses/by/4.0
CLINICAL VALUE OF VOLUMETRY COMPARED TO RECIST CRITERIA 1. 1 IN EVALUATING RESPONSE TO TREATMENT OF LIVER METASTASES IN PATIENTS WITH COLORECTAL CANCER
The aim of the work: to compare the informative value and diagnostic sensitivity of RECIST 1.1 and volumetry methods in assessing the dynamics of metastatic liver lesions in patients with colorectal cancer, to determine the correlation between linear and volumetric indicators of the tumour process and to justify the feasibility of their combined use to improve the accuracy of monitoring the effectiveness of systemic therapy. Materials and Methods. The study included 14 patients (8 men and 6 women, aged 47–73 years) with metastatic liver lesions against the background of colorectal cancer, who were under dynamic observation in 2020–2025. Treatment efficacy was assessed using RECIST 1.1 criteria (sum of the largest diameters of target lesions) and volumetry (calculation of the total volume of metastases using semi-automatic segmentation of CT images). Comparisons were made using Pearson's correlation analysis between linear and volumetric parameters, with determination of the consistency of results in subgroups by age and gender. Results. Among 14 patients, partial response (PR) was recorded in 5 cases, stable disease (SD) in 3, and progression (PD) in 6. The correlation coefficient between RECIST and volumetry was r = 0.48, indicating a moderate positive relationship between the methods. In a number of cases (patients No. 2, 8, 12), discrepancies were observed when minimal linear changes were accompanied by significant volume fluctuations. Volumetry was found to be more sensitive to early structural transformations, such as necrosis or decreased density of metastases, while RECIST may underestimate the therapeutic response. Conclusions. RECIST 1.1 remains the standardised criterion for response assessment, but does not take into account the three-dimensional structure of lesions. Volumetry provides an objective quantitative characterisation of tumour burden and detects early morphological changes. The combined use of RECIST and volumetry improves the accuracy of treatment monitoring and the soundness of clinical decisions.
Copyright (c) 2025 М. М. ДРОСИК https://creativecommons.org/licenses/by/4.0
To the 60th anniversary of the birth of Professor Oleg Bogdanovich Slaby
Oleg Bogdanovich Slaby
Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
CHARACTERISTICS OF THE FUNCTIONAL STATE OF SMALL-CALIBER ARTERIES UNDER THE INFLUENCE OF PNEUMOPERITONEUM OF VARIOUS DURATION AND SIMULATED MECHANICAL JAUNDICE IN THE EXPERIMENT
The aim of the work: to conduct a morphometric analysis of the features of changes in the indicators of small-caliber arteries of the diaphragm under conditions of pneumoperitoneum with intra-abdominal pressure of 10 mmHg of different duration during simulated mechanical jaundice. Materials and Methods. For the experimental study, sexually mature white rats of the reproductive period (6–7 months), weighing (225.0±15.0) grams, in a total of 55 individuals, were selected. The animals were divided into 4 groups: control – individuals with mechanical jaundice; and three experimental groups where jaundice and pneumoperitoneum were simulated for 1, 2 and 3 hours according to the group number. At the end of the experiment, the diaphragm was isolated and morphometric indicators were determined. Results. As a result of the action of the simulated pathological processes, an increase in the indicators of the external diameter of the artery from 5.9 to 6.7 %, a decrease in the internal diameter of the vessel from 24.6 to 25.4 % was observed. The Wogenvoord index increased by 2.1 times, while the thickness of the media naturally increased from 17.1 to 18.7 %. Changes in these indicators indicated a violation of the blood supply to the organ, a sharp decrease in the throughput of vessels of this type. The indicators of the height of endothelial cells and the diameter of their nuclei decreased, but no statistically significant difference was found. The relative volume of damaged endothelial cells increased significantly from (3.32±0.24) % to (29.50±0.21) % in the costal part of the diaphragm and from (4.03±0.11) % to (30.70±0.14) % in the lumbar part, which indicated signs of endothelial dysfunction. These changes should be taken into account in the clinical practice of doctors in surgical departments, where laparoscopic surgical interventions are common, for a better understanding of the impact of pneumoperitoneum on the human body and the diaphragm in particular, which plays an important role in the act of breathing and pulmonary excursion. Conclusions. The results obtained indicate that pneumoperitoneum created by carbon dioxide leads to changes in the morphometric parameters of small-caliber arteries, which are directly proportional to the duration of the latter.
Copyright (c) 2025 І. Я. ДЗЮБАНОВСЬКИЙ, М. Ю. КРІЦАК https://creativecommons.org/licenses/by/4.0
COMPARATIVE ASSESSMENT OF THE INFLUENCE OF ACUTE BLOOD LOSS ON THE ANTIOXIDANT-PROOXIDANT BALANCE IN THE LUNGS OF RATS WITH MECHANICAL TRAUMA OF VARIOUS LOCALIZATION
The aim of the work: to determine the influence of acute blood loss on the antioxidant-prooxidant balance in the lungs of rats with traumatic brain injury, blunt abdominal trauma, and skeletal trauma. Materials and Methods. In mature male Wistar line rats under conditions of thiopental sodium anesthesia, traumatic brain injury (TBI), blunt abdominal trauma (BAT), and skeletal trauma (ST) were modeled. The rats were taken out of the experiment with anesthesia after 3, 7, 14, 21, and 28 days of the post-traumatic period. Catalase activity and the content of thiobarbituric acid reagents were determined in the lung homogenate extract, and the antioxidant-prooxidant index (API) was calculated based on their ratio. Results. It was determined that on the background of isolated trauma of various origins, a shift in the antioxidant-prooxidant ratio toward a predominance of prooxidant mechanisms was observed in the lungs. Moreover, the result was statistically significant after 14–28 days of the experiment in the context of isolated TBI, and at all stages of the post-traumatic period in the context of isolated BAT and ST. After 7, 14, 21, and 28 days of the post-traumatic period, the API value of the lungs was the lowest in the group of rats with BAT, and after the 7 and 21 days – in rats with ST. Additional acute blood loss in the volume of 1.5 % of body weight on the background of TBI, BAT, and ST significantly aggravates the intensity of disturbances in the antioxidant-prooxidant system in the lungs. A significant decrease in the value of API of the lungs occurred after the application of BAT compared to TBI and ST, the intensity of disorders in which was practically the same. Conclusions. More severe API value disturbances on the background of BAT compared to other experimental groups occurred during the period of late manifestations of traumatic disease – from 14 days of the experiment.
Copyright (c) 2025 Р. Д. ЛЕВЧУК https://creativecommons.org/licenses/by/4.0
SIMULTANEOUS TAPP AND CYSTECTOMY IN WOMEN WITH INGUINAL HERNIA AND OVARIAN CYST
The aim of the work: to increase the effectiveness of surgical treatment of combined inguinal hernias with ovarian cysts in patients by simultaneous transabdominal preperitoneal plasty (TAPP) and cystectomy. Materials and Methods. An analysis was conducted of surgical treatment in 67 women with primary inguinal hernias combined with ovarian cysts, using simultaneous transabdominal preperitoneal repair (TAPP) with ovarian cystectomy. The patients’ ages ranged from 25 to 45 years (mean age – 35±1). All patients had a primary inguinal hernia combined with ovarian cysts of varying sizes. They were divided into two groups: the main group (n=33), who underwent simultaneous TAPP and cystectomy, and the comparison group (n=34), who underwent only TAPP without cyst removal. Before surgery, all patients underwent laboratory and instrumental examinations according to clinical protocols, including ultrasound and, if necessary, MRI of the pelvis and anterior abdominal wall. Additionally, the effectiveness of surgical treatment was assessed using the Euro-Qol-5D questionnaire, based on which the QALY (quality-adjusted life years) indicator was calculated, the number of quality years of life gained as a result of surgical intervention, the QALY indicator for 12 months was taken into account with the dynamics of its change in patients in the main and comparison groups and compared. Results. In both groups, postoperative complications were rare and comparable: seromas – 6 %, hematomas – 2–6 %, with no infections or intraoperative complications. Long-term outcomes showed no hernia recurrence in the main group and a 2.9 % recurrence rate in the comparison group. Chronic groin pain was noted in 6 % of cases in both groups. According to the EQ-5D-5L questionnaire administered 12 months postoperatively, 54.5 % of patients in the main group reported no health complaints, whereas there were none in the comparison group. The mean health index (QALY) was 0.97 in the main group versus 0.79 in the comparison group. Statistically significant differences were observed in “self-care,” “usual activities,” and “anxiety/depression,” in favor of the simultaneous surgery group (p<0.05). Technically, simultaneous TAPP did not require additional trocar placement, and the increase in operative time was minimal. Simultaneous TAPP makes it possible to avoid repeated anesthesia, reduce surgical stress, accelerate recovery, and lower treatment costs. Conclusions. Simultaneous TAPP with cystectomy is safe, effective, and advisable in cases of combined inguinal hernia and ovarian cyst, providing a better quality of life compared to separate operations.
Copyright (c) 2025 Я. П. ФЕЛЕШТИНСЬКИЙ, А. А. ШТАЄР https://creativecommons.org/licenses/by/4.0
EVALUATION OF THE RESULTS OF THE USE OF LAPAROSCOPIC TECHNOLOGIES IN THE COMPLEX TREATMENT OF PATIENTS WITH COMPLICATED FORMS OF COLON CANCER
The aim of the work: to analyze the results of the use of laparoscopic methods in the complex treatment of patients with complicated forms of malignant diseases of the colon. Materials and Methods. A prospective cohort study was conducted in the surgical departments of the City Hospital of Emergent and Rapid Medical Care and the City Hospital No. 7 of the ZMR from 2020 to 2023. The study group included 109 (100 %) patients with complicated forms of colon cancer. The gender structure of the group showed a slight predominance of female patients – 57 (52.29 %) over male patients – 52 (47.71 %). The average age of the patients was (69.78±16.37) years. Statistical analysis was performed using STATISTICA 13.0 (TIBCO Software Inc.) and MICROSOFT EXCEL 2013. The data were presented as mean ± standard deviation (M±m) for normally distributed data and median Me (Q1; Q3) for data whose distribution differs from normal. Statistical differences between groups were assessed using the Mann–Whitney U test. A result was considered statistically significant at p<0.05. Results. Laparoscopic methods were used in 31 (28.44 %) cases. In 7 (6.42 %) patients, laparoscopic surgery ended with conversion by laparotomy. In 71 (65.13 %) patients, primary open surgery was performed by laparotomy. Postoperative complications occurred in 6 (19.35 %) patients after laparoscopic operations and in 32 (41.03 %) after laparotomy, p=0.0286. Wound complications occurred more often in the laparotomy subgroup – 17 (21.79 %) versus 1 (3.23 %) in the laparoscopic subgroup, p=0.0083. The structure of general surgical complications was similar between the subgroups. Mortality was 5 (16.13 %) in the laparoscopic subgroup and 18 (23.08 %) in the laparotomy subgroup, p=0.3781. The mean length of hospital stay was 10.00 (8.00; 13.00) days for laparoscopic operations and 19.00 (13.00; 27.00) days for laparotomies, p=0.0011. The results confirm the advantages of laparoscopic surgery over open oncosurgery for complicated forms of colon cancer and indicate the possibility of using these methods provided that patients are properly selected and adequately preoperatively prepared. Conclusions. Laparoscopic surgical techniques can be safely used in the treatment of patients with complicated forms of malignant colon pathology, reducing the level of complications, mortality and length of stay of patients in the hospital.
Copyright (c) 2025 М. А. КУБРАК, С. М. ЗАВГОРОДНІЙ, М. Б. ДАНИЛЮК https://creativecommons.org/licenses/by/4.0
DETERMINATION OF CLINICAL EFFECTIVENESS OF INNOVATIVE DRUGS IN PATIENTS WITH WOUND DEFECTS
The aim of the work: determine the clinical efficacy of the proposed treatment regimen in patients with complicated wounds, using granulation rate, epithelialization speed, and functional activity of innate immune cells as endpoints, compared with standard therapy. Materials and Methods. A prospective cohort study included 11 patients with chronic complicated wounds. Patients from the main group received a two-component wound treatment regimen using two drugs: spray (decamethoxin, hydrolyzed collagen, glycine, arginine, aspartic acid) and gel (collagen, sodium hyaluronate, silver sulfadiazine, decamethoxin, silicon dioxide). Patients from the comparison group received a standard treatment regimen, which included surgical wound debridement, antiseptic treatment, systemic antibiotic therapy (penicillins, cephalosporins, fluoroquinolones, metronidazole, lincosamides, carbapenems, monobactams) and local antiseptics with propylene glycol. The dynamics of regenerative processes was assessed by cytological analysis of the wound surface. The quantitative ratio of cellular elements was determined, which allowed assessing the degree of inflammatory reaction and the level of tissue regeneration. Statistical data processing was performed using licensed software IBM SPSS Statistics, version 26.0 (license No. ABCD-123456; IBM Corp., Armonk, NY, USA). Results. Patient selection was carried out in accordance with the specified inclusion and exclusion criteria. The study involved people aged 18–80 years who had unhealed complicated wounds lasting more than 3 months. At the initial stage (5th day), the area of ​​granulations in the main group reached 45 %, which is 20 % more than in the comparative group (p<0.05). By the 20th day, complete epithelialization was observed in 81.8 % of patients in the main group versus 40 % in the comparative group (p<0.05). The results of cellular analysis showed a decrease in degenerative neutrophils by 1.77 times (p<0.05) and an increase in monocytes with lymphocytes. Phagocytosis activity increased: HCT-positive neutrophils increased by 2.18 times, myeloperoxidase – by 1.38 times (both p<0.05). Conclusions. The proposed regimen accelerates granulation tissue formation and epithelialization, optimizes the inflammatory response, and sustains immune activation, thereby shortening healing times compared with standard therapy.
Copyright (c) 2025 Г. П. КОЗИНЕЦЬ, Г. П. ГОМОЛА https://creativecommons.org/licenses/by/4.0
DYNAMICS OF CHANGES IN BLOOD COAGULATION AND ANTICOAGULATION SYSTEMS IN THE SURGICAL TREATMENT OF DISEASES AND WAR INJURIES OF THE PLEURAL CAVITY
The aim of the work: to study the dynamics of changes in the coagulation and anticoagulation systems of blood in patients of the surgical department during hospitalization, as well as after pleural surgeries for relatively limited inflammatory diseases and war injuries. Materials and Methods. The medical records of 109 patients who were hospitalized for pleural surgeries in 2018–2024 were analyzed. The study used generally accepted examination methods, radiological methods, clinical and biochemical blood tests, and studies of coagulation indicators. One-way ANOVA with multiple comparisons was used to assess the difference between groups using GraphPad Prism 8.0 software. Results. Activation of the blood coagulation system is observed in the first days after surgical interventions in patients with injuries and inflammatory processes of the pleural cavity, which was confirmed by a decrease in plasma recalcification time to (56.1±1.3) s (sick) and (55.2±1.3) s (wounded), an increase in fibrinogen levels to (6.2±0.08) g/l and (6.6±0.07) g/l, respectively, and an increase in plasma tolerance to heparin. By day 7, hemostasis was stabilized: plasma recalcification time approached control values ((59.1±1.3) s in sick and (58.9±1.3) s in the wounded), fibrinogen levels decreased to (3.8±0.08) g/l and (4.0±0.07) g/l, respectively, and fibrinolytic activity increased to (210.1±3.5) in sick and (220.7±3.9) in the wounded, respectively. The preservation of an elevated platelet level (366.4±33.1×109/l in sick and 392.1±31.9×109/l in the wounded) by day 7 indicated prolonged activation of hemostasis. Conclusions. Activation of the blood coagulation system was noted during hospitalization in patients with injuries and inflammatory processes, which is an adaptive response of the body to injury and the inflammatory process. By day 7, most coagulation parameters tended to normalize, and increased fibrinolytic system activity was a manifestation of the body's remedial response to coagulation. Increased platelet activity requires further monitoring to prevent complications.
Copyright (c) 2025 І. Д. ДУЖИЙ, П. Ф. МИРОНОВ, В. В. БРЯНИК https://creativecommons.org/licenses/by/4.0
COMPREHENSIVE ASSESSMENT OF RISK FACTORS FOR COLORECTAL ANASTOMOTIC LEAKAGE IN RECTAL CANCER SURGERY
The aim of the work: to improve treatment outcomes in patients with rectal cancer by analyzing key risk factors for anastomotic leakage (AL) at the preoperative, intraoperative, and postoperative stages. Materials and Methods. This retrospective single-center study included 92 patients with stage I–III rectal adenocarcinoma (TNM: cT1–4, N0–2, M0), located within 15 cm from the anal verge and without involvement of the anal sphincter. All patients underwent laparoscopic anterior or low anterior resection with colorectal anastomosis. Based on the presence of clinically significant leakage, patients were divided into two groups: AL (+) – 17 patients (18.5 %) and AL (-) – 75 patients (81.5 %). A range of clinical, morphological, and surgical variables were analyzed and categorized according to treatment stages. Results. The rate of clinically significant AL was 18.5 %. Statistically significant risk factors included: distal tumor location (5–10 cm from the anal verge) (p=0.001), prolonged operative time (p=0.024), D3 lymph node dissection (p=0.009), use of ≥2 linear stapler firings (p=0.020), absence of splenic flexure mobilization (p=0.012), and ligation of the left colic artery (p=0.001). Elevated C-reactive protein level on postoperative day 3, fever, and tachycardia may serve as early clinical-laboratory markers of AL and indicate the need for prompt diagnostic and therapeutic interventions. Conclusions. Identifying key risk factors for colorectal anastomotic leakage – particularly those related to tumor location, surgical technique, and early signs of inflammation – enables timely detection of high-risk patients and prevention of postoperative complications.
Copyright (c) 2025 В. В. ВАСИЛІВ, В. Д. СКРИПКО https://creativecommons.org/licenses/by/4.0
ANALYSIS OF LONG-TERM RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH MITRAL HEART DEFECTS AND ATRIOMEGALIA
The aim of the work: to study the risks of fatal cases in the long term after surgical treatment of patients with mitral heart defects and atriomegaly. Materials and Methods. The study included 671 patients with mitral heart disease and left atriummegaly. Atriomegaly was considered as an increase in the linear size of the left atrium by more than 6.0 cm and its volume by more than 59.8 cm3/m2 according to echocardiography. All patients in the sample underwent surgical treatment of mitral valve disease at the Department of Surgical Treatment of Acquired Heart Defects of the State Institution "Amosov National Institute of Cardio-Vascular Surgery affiliated to National Academy of Medical Sciences of Ukraine". The study design was built depending on the surgical technique used and the volume of surgical intervention, according to which the patients in the sample were divided into two groups: the main and comparison groups. The main group (n=271) included patients who underwent mitral valve prosthesis and left atrial appendage resection. In patients in the comparison group (n=400), only surgical correction of mitral valve disease was performed. The material for analysis was data from primary medical records: medical history, operation protocols, and clinical and instrumental examination data. All patients of the study gave informed voluntary consent. Results. In this study, hospital mortality was 2.2 % among all cases, in patients of the main group it was 1.8 %, and in the comparison group – 2.5 % (p>0.05). It was established that the frequency of fatal cases in patients of the sample in the long term was 5.8 %, in patients of the main group – 4.5 %, and in the comparison group – 6.7 % (p=0.015; χ2=5.93). It was found that patients who underwent left atrial plasty for atrial atrium megaly with resection of its appendage, in addition to surgical correction of mitral valve disease, had a reduced risk of mortality both in the hospital period (OR=1.35; 95 % CI: 0.45–4.0, RR=1.34; 95 % CI: 0.46–3.89, p>0.05) and in the period of observation of long-term results (OR=1.50; 95 % CI: 0.74–3.02, RR=1.46; 95 % CI: 0.75–2.85, p>0.05). Conclusions. As a result of studying the long-term results of surgical treatment of the mitral valve in patients with atriomegaly, it was found that patients who underwent its correction and left atrial appendage resection with resection of its appendage have a lower frequency of hospital mortality and a 1.35-fold lower risk of its occurrence (OR=1.35; RR=1.34; p>0.05). Patients who underwent correction of mitral heart defect and left atrial appendage resection have a significantly lower frequency of fatal events in the long term after surgery (p=0.015; χ2=5.93) and a 1.5-fold lower risk of their occurrence, compared with patients who underwent only surgical correction of mitral heart defect (OR=1.50; RR=1.46; p>0.05).
Copyright (c) 2025 В. Ж. БУКАРІМ, В. В. ПОПОВ https://creativecommons.org/licenses/by/4.0
HYSTERORESECTOSCOPY AS A STRATEGY FOR INCREASING THE CHANCES OF EMBRYO IMPLANTATION IN WOMEN WITH POLYCYSTIC OVARY SYNDROME AND METABOLIC SYNDROME
The aim of the work: the aim of the study was to evaluate the effect of pre-pregnancy metabolic optimization and operative hysteroresectoscopy before embryo transfer on the condition of the endometrium and in vitro fertilization (IVF) results in patients with polycystic ovary syndrome (PCOS) and metabolic syndrome (MS), in particular on the frequency of implantation and clinical pregnancies. Materials and Methods. The study included 128 women of reproductive age with PCOS, divided into three groups: 1st – PCOS+MS, routine pre-protocol preparation; 2nd – PCOS+MS, metabolic optimization 8–12 weeks before the IVF program; 3rd – control, PCOS without MS. The indications for hysteroscopy were ultrasound and clinical signs of intrauterine pathology, thin or heterogeneous endometrium, repeated failed implantations, suspicion of chronic endometritis. The procedure was performed in the early proliferative phase with removal of detected formations, targeted biopsy, and subsequent morphological/immunohistochemical examination. Results. Hysteroscopy was indicated in 42.2 % of patients, mainly in the PCOS+MS group without metabolic optimization. Hysteroscopy most often revealed endometrial polyps (up to 37.5 % in group 1) and simple hyperplasia without atypia (up to 25 %), less often proliferation disorders, signs of endometritis, and micropolyposis. In the group with pre-pregnancy optimization, the frequency of clinical pregnancies was 8.0% higher than in the routine preparation group and 5.7 % higher than in the control group; the live birth rate exceeded these figures by 10.5 % and 6.2 %, respectively. Although no statistically significant differences were found, there is a clinically significant trend toward improved IVF outcomes. Conclusions. Women with PCOS, especially when combined with metabolic syndrome, often experience endometrial changes that reduce the effectiveness of IVF programs. The combination of pre-pregnancy metabolic optimization with operative hysteroscopy before embryo transfer improves the condition of the endometrium and has shown a tendency to increase the frequency of clinical pregnancies and live births.
Copyright (c) 2025 С. В. ХМІЛЬ, Ю. Б. ПРАВАК https://creativecommons.org/licenses/by/4.0