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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COMBINED USE OF OMENTAL FLAP AND NHS-PEG TO REDUCE THE INCIDENCE OF POSTOPERATIVE COMPLICATIONS AFTER PANCREATODUODENECTOMY
The aim of the work: to evaluate the effectiveness of using an omental flap to cover the pancreatojejunostomy during pancreatoduodenectomy and to assess the impact of combining the omentum with a biodegradable pad treated with NHS-PEG on postoperative inflammatory response and the incidence of clinically relevant postoperative pancreatic fistula (POPF). Materials and Methods. A prospective study included 97 patients who underwent pancreatoduodenectomy between 2023 and 2025. Patients were divided into three groups: the control group (n=32, standard PD without anastomotic coverage), the “Omentum without NHS-PEG” group (n=29), and the “Omentum + NHS-PEG” group (n=36). The primary endpoint was the incidence of clinically relevant POPF (Grade B/C according to ISGPS). Secondary endpoints included postoperative dynamics of inflammatory biomarkers (CRP, IL-6, PCT) measured on postoperative days 1, 3, and 7. Results. The incidence of clinically relevant POPF (Grade B/C) was 18.8 % in the control group, 10.3 % in the omental flap group, and only 5.6 % in the combined “Omentum + NHS-PEG” group. Thus, the combined method reduced the risk of POPF nearly fourfold compared with the control. Analysis of inflammatory biomarkers revealed significantly lower CRP and IL-6 levels in patients with omental coverage, especially in the “Omentum + NHS-PEG” group, starting from postoperative day 1. For PCT, statistically significant differences between groups were observed on day 7. Importantly, the use of the omental flap or NHS-PEG was not associated with additional procedure-related complications or prolonged operative time. Conclusions. Omental flap coverage of the pancreatojejunostomy reduces postoperative inflammatory response and lowers the risk of clinically relevant POPF following pancreatoduodenectomy. The highest efficacy was achieved with the combined use of omental coverage and NHS-PEG, which can be considered a safe, technically feasible, and promising method for preventing postoperative complications in pancreatic surgery.
Copyright (c) 2025 О. Ю. УСЕНКО, В. Й. СМОРЖЕВСЬКИЙ, О. М. СИМОНОВ https://creativecommons.org/licenses/by/4.0
RISK FACTORS FOR ANASTOMOTIC LEAKAGE FOLLOWING RADICAL ONE-STAGE SURGICAL INTERVENTIONS IN COLORECTAL SURGERY
The aim of the work: to identify the main factors affecting the risk of colorectal anastomotic leak following radical one-stage surgical interventions in colorectal surgery. Materials and Methods. A retrospective study was conducted of surgical treatment outcomes in 44 patients who underwent radical one-stage colonic operations with primary anastomosis. Anterior resection of the rectum was performed in 28 patients (63.5 %), left hemicolectomy in 11 (25 %), and right hemicolectomy in 5 (11.5 %). The classification of risk factors into modifiable and non-modifiable, preoperative, operative, and postoperative categories was used. Statistical analysis included calculation of odds ratios (OR) with 95 % confidence intervals (CI) and relative risk (RR) using SPSS 26.0. Results. The overall anastomotic leak rate was 13.6 %. The most significant modifiable pre-operative factors were hypoproteinemia (OR=3.74), malnutrition (OR=3.05), and obesity (OR=2.32). Among operative factors, the highest risk was associated with inadequate blood supply to the anastomosis (OR=5.21), poor blood supply to the resection site (OR=4.56), and absence of a diverting stoma (OR=3.52). Among non-modifiable factors, ASA IV (OR=3.68), Charlson Comorbidity Index ≥5 (OR=3.53), tumor location <5 cm from the anal verge (OR=4.16), and emergency surgery (OR=3.75) were prominent. Post-operative massive blood transfusion demonstrated OR=4.18. A risk stratification model was developed: high risk (≥3 factors) – 27.8 %, intermediate risk (1–2 factors) – 8.6 %, low risk (0 factors) – 3.1 %. Conclusions. Colorectal anastomotic leak is a multifactorial complication. Identification and correction of modifiable risk factors, particularly nutritional status, ensuring adequate vascularization of the anastomosis, and use of a diverting stoma in low resections, allows for individualization of the approach to anastomotic leak prevention and improvement of surgical treatment outcomes.
Copyright (c) 2025 І. Я. ДЗЮБАНОВСЬКИЙ, В. Р. БУРАТИНСЬКИЙ https://creativecommons.org/licenses/by/4.0
NUTRITIONAL SUPPORT IN THE TREATMENT OF GUNSHOT WOUNDS: THE ROLE OF COLLAGEN HYDROLYSATES
The aim of the work: to evaluate the effectiveness of collagen hydrolysates in the comprehensive treatment of gunshot limb wounds in military personnel. Materials and Methods. The study included 80 servicemen aged 20–59 years with gunshot injuries of the limbs, who were divided into two groups: control (n=42; standard treatment) and main (n=38; standard treatment plus oral collagen hydrolysate for 45–60 days). The groups did not differ in age (33.4±1.2 vs. 34.1±1.4 years), body mass index (27.7±3.2 vs. 28.3±2.7 kg/m²; p>0.05), severity of injuries, or frequency of comorbidities. The most common were shrapnel wounds (72.5%), more often affecting the lower limbs (61.3%), reflecting the conditions of combat operations. Clinical and laboratory parameters were assessed: wound cleansing dynamics, granulation tissue formation, microbial contamination level, cytological smear characteristics, inflammation intensity, and markers of intoxication. Results. In the control group, wound healing followed the typical course with marked leukocyte infiltration (130.5±7.5 cells per field of view on day 7), high levels of leukocyte destruction (96.5±2.0 %), and prolonged microbial contamination (3.5±0.8×100 microbial bodies per 100 leukocytes). In patients receiving collagen hydrolysate, the leukocyte count on day 7 was significantly lower (101.5±6.8; p<0.05), while the proportion of destroyed cells decreased nearly 1.5-fold (63.5±4.2 % vs. 92.4±3.1%; p<0.01). By day 14, microbial contamination decreased to 0.4±0.1 (vs. 1.3±0.4 in the control group; p<0.05). Cytological analysis showed a faster transition from degenerative-inflammatory to regenerative cytograms: the number of macrophages and fibroblasts in the experimental group on day 14 was nearly twice as high as in controls (18.5±1.4 % and 12.8±0.9 % vs. 8.5±0.7 % and 5.9±0.6 %; p<0.01). By day 21, the cytogram of the main group corresponded to the stage of mature granulation, while in control patients signs of delayed inflammation persisted. Conclusions. The inclusion of collagen hydrolysates in the comprehensive therapy of gunshot wounds provides a protective effect: it reduces the severity of inflammatory destruction, accelerates wound sanitation from pathogenic flora, and stimulates early formation of the macrophage–fibroblast component necessary for effective regeneration. The method has prospects for wide use in military medicine, as it shortens healing time, lowers the risk of infectious complications, and increases recovery efficiency in wounded servicemen.
Copyright (c) 2025 П. Т. МУРАВЙОВ, М. Г. БЕЗПАЛЬКO, В. В. КОЛОДІЙ, В. Г. ШЕВЧЕНКО https://creativecommons.org/licenses/by/4.0
STRESS MARKERS IN VAGOSYMPATHETIC BLOCKADE IN THORACIC SURGERY
The aim of the work: to determine the effect of vagosympathetic blockade on the dynamics of stress markers in patients before and after surgery in thoracic surgery. Materials and Methods. The article investigates the effect of vagosympathetic blockade (VSB) on the intensity of the stress response in patients who underwent resection surgery on the lungs. The dynamics of stress markers were studied: neuroendocrine markers – cortisol and adrenocorticotropic hormone (ACTH) levels; inflammatory markers – interleukin-6 (IL-6) levels; vascular and endothelial markers – endothelin-1 (ET-1) levels. Depending on the use of VSB, patients aged 30–45 years were divided into two groups. Statistical analysis of the results was performed using Statistica 13.0 software (StatSoft Inc., USA) and Microsoft Excel. Data were tested for normality of distribution using the Shapiro-Wilk test. To compare two independent samples, the Student’s t-test or the Mann – Whitney U-test was used, depending on the type of distribution. Results were considered significant at p<0.05. Results. It was found that patients who received only general anesthesia with controlled mechanical ventilation (CMV) had a significant increase in cortisol, ACTH, IL-6, and ET-1 levels on the 1st postoperative day with a slight tendency to decrease on the 3rd postoperative day. It was shown that the use of VSB in combination with total intravenous anesthesia and controlled mechanical ventilation significantly reduced cortisol, ACTH, IL-6, and ET-1 levels compared with the control group, where only general anesthesia was used. On the 7th postoperative day, the levels of these biomarkers in patients with general anesthesia remained higher than normal, which indicates a prolonged stress and inflammatory response and incomplete adaptation processes. At the same time, in the group with VSB, a more pronounced decrease in cortisol, ACTH, IL-6 and ET-1 levels was observed, with the studied indicators approaching the reference values. Conclusions. Vagusympathetic blockade is effective in the prevention of acute post-thoracotomy pain syndrome and can be used as an alternative method in the presence of contraindications for thoracic epidural anesthesia.
Copyright (c) 2025 А. І. СУХОДОЛЯ, Л. І. СУХОДОЛЯ https://creativecommons.org/licenses/by/4.0
CLINICAL AND LABORATORY CHARACTERISTICS OF THE EFFECTIVENESS OF DIFFERENT METHODS OF SURGICAL INTERVENTION IN PATIENTS WITH COMPLICATED CHOLEDOCHOLITHIASIS
The aim of the work: to evaluate clinical and laboratory parameters and the postoperative course in patients with complicated choledocholithiasis undergoing different surgical treatments in order to determine the optimal surgical strategy. Materials and Methods. The study included a clinical examination and analysis of laboratory data of 122 patients with choledocholithiasis (CHL), complicated by cholangitis (CH) and biliary pancreatitis (BP) in the presence of cholelithiasis (CHL), who were hospitalized in the Ternopil City Communal Hospital of Emergency Care. Patients were divided into 2 groups: 1st (n=59) – patients with choledocholithiasis complicated by cholangitis (CHL+CH), 2nd (n=63) – patients with choledocholithiasis complicated by biliary pancreatitis (CHL+BP). Patients in both groups were divided into subgroups depending on the treatment method. The diagnosis of choledocholithiasis complicated by cholangitis was established based on the clinical protocol “Cholelithiasis (CHL)”, Order of the Ministry of Health of Ukraine No. 271 and Tokyo Guidelines 2018. The diagnosis of biliary pancreatitis was determined according to the Japanese recommendations for the management of biliary pancreatitis. Statistical data processing was performed using the Statistica 10.0 program. Absolute indicators were presented as the mean value (Mean) ± standard deviation (SD), and for non-parametric data – as the median (Me) and quartiles. Pearson’s χ² test was used to compare percentages. Results. Surgery without contrast administration in patients with CHL+CH or CHL+BP was accompanied by a less pronounced inflammatory response, as confirmed by a significant decrease in body temperature 24 and 72 hours after surgery, as well as a decrease in the intensity of pain syndrome 72 hours after surgery (by 1.42 and 1.26 times, respectively; p<0.05–0.001). In patients with CHL+CH, 24 hours after surgery without contrast, a significantly lower level of L-FABP (by 26.09 %) was determined, and after 72 hours, lower levels of L-FABP (by 36.54 %), ALT (by 53.33 %), and total bilirubin (by 53.50 %) compared to the subgroup with contrast. Similar trends were observed in patients with CHL+BP: 24 and 72 hours after surgery without contrast, the levels of GGT, L-FABP and total bilirubin levels were significantly lower (by 58.84–131.25 %), and after 72 hours, ALT (by 32.61 %) and AST (by 21.62 %) activities decreased further compared to the subgroup with contrast. Conclusions. Refusal of contrast during surgery is clinically appropriate in patients with choledocholithiasis complicated by cholangitis or biliary pancreatitis, as it contributes to a reduction in inflammatory response, pain syndrome, and improvement in biochemical parameters in the early postoperative period.
Copyright (c) 2025 Н. М. ОСТРОВСЬКИЙ, І. М. ДЕЙКАЛО https://creativecommons.org/licenses/by/4.0
ULTRASOUND INSTRUMENTATION IN THE DIAGNOSIS OF HEMORRHAGIC COMPLICATIONS OF CHEST INJURIES
The aim of the work: to study the feasibility of using ultrasound diagnostics (US) according to the FAST protocol for chest injuries. Materials and Methods. The paper presents the results of the examination of 859 patients with isolated and combined chest injuries. Ultrasound examination has been confirmed as a highly informative and safe imaging method that does not cause additional stress on the body. The examination was performed without the need for special patient preparation. If necessary, additional ultrasound modes were used: color doppler mapping, pulsed doppler, panoramic scanning. Diagnostics was performed according to the FAST protocol for prompt detection of free fluid (blood) in the pleural cavity and signs of pneumothorax, which allowed for quick decisions on surgical intervention. Results. The method demonstrated a special diagnostic value in those 14 cases ((15.6±4.2) %) when the volume of hemothorax was relatively small (less than 450–500 ml), and with the traditional approach, surgical intervention was not considered appropriate. However, it was the ultrasound signs of ongoing bleeding that became a reasonable indication for emergency surgical care. No false-positive results were recorded when using this method, the specificity was 100 %. Conclusions. The proposed method of ultrasound imaging of ongoing bleeding in chest trauma is clinically appropriate, as it allows for prompt, non-invasive and highly specific confirmation of the presence of post-traumatic hemorrhage.
Copyright (c) 2025 В. В. БОЙКО, К. А. ВИШНЯКОВ, В. В. КРІЦАК, П. М. ЗАМЯТІН, К. Г. МИХНЕВИЧ, Л. В. ПРОВАР https://creativecommons.org/licenses/by/4.0
SURGICAL TREATMENT OF CHRONIC PANCREATITIS: A COMPARATIVE ANALYSIS OF RESULTS AND QUALITY OF LIFE
The aim of the work: to substantiate the nature and scope of surgical intervention in patients with chronic pancreatitis depending on the degree and nature of morpho-structural changes in the pancreatic tissue, and to perform a comparative assessment of the quality of life of the operated patients. Materials and Methods. The research is based on the analysis of treatment results of 147 patients with various forms of chronic pancreatitis who were treated in a general surgical hospital. Of these, 47 (31.9 %) were operated on. Males accounted for 79.8 %, and females – 20.2 %, aged 30–75 years. The diagnostic program included laboratory and instrumental data, such as ultrasound (US); computed tomography (CT); fibrogastroduodenoscopy (FGDS); and endoscopic retrograde cholangiopancreatography (ERCP). Morphological features of fibrotic forms of chronic pancreatitis were studied. To detect exocrine insufficiency, the level of fecal elastase-1 in the stool was determined, and coprological examination was performed. To detect endocrine function, fasting glucose, HbA1c, and C-peptide were measured. The results of surgical treatment were evaluated as good, satisfactory, and unsatisfactory (according to the Vizik-Komorovski method 1992). The Izbicki pain scale was used to assess pain. Functional status was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30). Preoperative management of patients was performed using the Fast Track Surgery technology. Statistical processing of the research results was carried out using biostatistical analysis methods, which were implemented in the licensed software packages Microsoft Office 2010 (Microsoft Excel 2010), and methods of variational statistics, and multivariate correlation analysis. Results. The study results showed that surgical intervention for chronic pancreatitis is recognized as the most effective option for pain control. Our study compares the short-term dynamics of the pain syndrome and quality of life after drainage, combined, and resectional types of surgical interventions. The study systematized the indications for various types of operations depending on the clinical and morphological forms of chronic pancreatitis without a negative impact on the postoperative outcome. Conclusions. A comparative evaluation of surgical interventions for clinical and morphological forms of chronic pancreatitis based on the intensity of the pain syndrome and the assessment of quality of life using the EORTC QLQ-C30 functional scale showed that resectional and combined operations had the best results. The selection of patients for surgical intervention is resolved multidisciplinarily with the involvement of a gastroenterologist, endocrinologist, and anesthesiologist.
Copyright (c) 2025 І. Я. ДЗЮБАНОВСЬКИЙ, Р. В. СВИСТУН, К. Г. ПОЛЯЦКО, О. І. ДЗЮБАНОВСЬКИЙ, М. О. ОНИСЬКІВ https://creativecommons.org/licenses/by/4.0
TREATMENT OF ISOLATED GUNSHOT SHRAPNEL WOUNDS OF SOFT TISSUES USING AUTODERMOPLASTY
The aim of the work: to evaluate the results of treatment of patients with isolated gunshot wounds of soft tissues by performing autodermoplasty. Materials and Methods. The study was conducted on the basis of the Department of Thermal Trauma and Reconstructive Surgery of the City Hospital of Emergency and Emergency Medical Care. 40 (100.0 %) patients with gunshot wounds were included in the study, who underwent primary surgical treatment of wounds in the first and second stages of evacuation and were later transferred to the third stage of evacuation. According to localization, firearm injuries were determined on the front surface of the lower leg in 8 (20.0 %) patients, in 13 (32.5 %) – on the back surface of the thigh, in 8 (20.0 %) patients - on the shoulders, in 5 (12.5 %) patients, the wound was on the back surface of the hand, in another 4 (10 %) patients – on the inner surface of the forearm. On the buttock, the injury was localized in 2 (5.0 %) patients. Dermatoplasty was performed after preparation and cleaning of the wound location. The wound was considered ready for autodermoplasty, when the predominant area of the wound surface was covered by granulation tissue - pink-red shallow-grained, bumpy tissue that bleeds easily when touched. The viability of the skin flap was assessed on the 4th day visually, based on the color of the transplanted skin, the presence of secretions from under the skin flap, the inflammatory process around the skin graft zone (hyperemia, swelling), its fixation to the wound surface. Results. The mean wound area measured by the linear method in patient data was 57.5 (16.0; 88.0) cm2. The entire area of the wound defect was covered by granulation tissue for 22.0 (14.0; 27.5) days. Dermatoplasty with a free skin flap was performed on 25.8 (16.7; 29.6) days, the duration of surgery was 55.0 (45.0; 75.0) minutes on average. Postoperative complications were found in 8 (20.0 %) patients. Repeated surgical interventions were performed in 3 (7.5%) patients. Analyzing the localization of injuries, it was determined that autodermoplasty most often requires injuries on the front surface of the lower leg, the back surface of the thigh and the outer surface of the shoulder, which is related to the anatomical and functional features of these zones. Conclusions. The granulation process is of crucial importance in the engraftment of the skin flap to the wound surface, because during the first days, the trophies of the skin flap are carried out by diffusion and osmosis. The main problem in the long-term treatment of patients who need autodermoplasty is preoperative preparation, namely the increase of granulations. The total duration of treatment in the study group was 28.9 days, of which 22 (76.1%) days were preoperative preparation. The search for methods of accelerating the growth of granulations in the preoperative period is the key to shortening the treatment period of these patients and reducing the risks of postoperative complications.
Copyright (c) 2025 С. М. ЗАВГОРОДНІЙ, П. О. БУЛЬБА https://creativecommons.org/licenses/by/4.0
FEATURES OF THE CYTOLOGICAL COMPOSITION OF PERITONEAL EXUDATE IN PATIENTS WITH ACUTE ADHESIVE SMALL BOWEL OBSTRUCTION IN THE STAGE OF DECOMPENSATION
The aim of the work: to evaluate the effect of the proposed method of postoperative treatment using nasogastric intubation with lavage, oxygen therapy and early enteral nutrition on the cellular composition of peritoneal exudate in patients with acute adhesive small bowel obstruction in the stage of decompensation, and to compare these changes with the indicators of traditional treatment. Materials and Methods. The paper analyses the results of clinical examination and surgical treatment of 52 patients with acute adhesive small bowel obstruction in the stage of decompensation. Material for cytology was obtained from drainages from the abdominal cavity. The study was conducted dynamically — on the 1st, 3rd, and 5th days after surgery. The smears were stained according to Pappenheim, and microscopic evaluation was performed at ×200 magnification. Results. In patients with acute adhesive small bowel obstruction in the stage of decompensation, cytological examination of peritoneal exudate showed a pronounced inflammatory response, manifested by massive neutrophilic infiltration already on the first day after surgery. The majority of neutrophilic granulocytes were in a state of lysis, indicating a high intensity and duration of the inflammatory process. At the same time, a significant decrease in the number of lymphocytes and macrophages was recorded, as well as pronounced dystrophic changes in mesothelial cells (vacuolisation, fragmentation, desquamation), indicating damage to the peritoneal barrier. Conclusions. The use of the proposed method of postoperative treatment in patients with acute adhesive small bowel obstruction in the stage of decompensation provides more favourable dynamics of cytological indicators of peritoneal exudate. A marked decrease in the proportion of neutrophils in a state of lysis was noted, indicating suppression of excessive acute inflammatory response. At the same time, an increase in the number of lymphocytes and macrophages was observed, as well as a decrease in signs of mesothelial cell damage, indicating restoration of the barrier function of the peritoneum. The combination of these changes demonstrates the activation of local tissue immunity, acceleration of reparative processes, and a less intense course of postoperative peritoneal inflammation compared to traditional treatment.
Copyright (c) 2025 А. Є. БУРАК, А. Д. БЕДЕНЮК, В. Б. ДОБРОРОДНІЙ, Є. Р. ЛУЦІВ https://creativecommons.org/licenses/by/4.0
MODERN MINIMALLY INVASIVE METHODS OF SURGICAL TREATMENT OF HEMORRHOIDS
The aim of the work: to compare the effectiveness of subdermal submucosal laser vaporization of hemorrhoidal nodes with transanal hemorrhoidal dearterialization (THD) supplemented with mucopexy in patients with grade II hemorrhoids. Materials and Methods. The outcomes of treatment of 50 patients with grade II hemorrhoids were analyzed. Subdermal submucosal laser vaporization was performed in 25 patients (main group). In 25 control patients, transanal hemorrhoidal dearterialization (THD) with mucopexy was carried out. The groups were comparable in age and sex. All operations were performed under general anesthesia in a day-surgery setting. Postoperative pain, complications and quality of life were compared between the groups. Results. The mean duration of laser vaporization was 25 minutes, and of THD with mucopexy 35 minutes. Patients in both groups stayed in the postoperative ward for two hours and then continued rehabilitation at home. Follow-up examinations were performed on postoperative days 10 and 30 and at 1 year. Pain was assessed using a 0–2-point scale. On the first postoperative day, the mean pain score was 1.1 points in the main group and 1.2 points in the control group; on day 10 it was 0.15 and 0.17 points, respectively. No patient in the main group developed postoperative hemorrhoidal thrombosis or rectal bleeding, whereas two patients in the control group developed thrombosis, which was managed conservatively. By day 30, all patients in both groups had complete healing of the wounds and a reduction of hemorrhoidal cushions to normal size. At the 1-year examination, anoscopy in two patients of the main group showed enlargement of one hemorrhoidal cushion, which was successfully treated by outpatient ligation; repeated examination 1 month later demonstrated recovery with normalization of hemorrhoidal vein size. In the control group, at the 1-year follow-up, hemorrhoidal cushions were of normal size, and no rectal pain or episodes of bleeding were observed after the intervention. Conclusions. The results of subdermal submucosal laser vaporization for grade II hemorrhoids are comparable to those of THD with mucopexy. Both methods rapidly restore patients’ working capacity and improve their quality of life.
Copyright (c) 2025 Є. Є. ПЕРЕШ, А. К. КУРБАНОВ https://creativecommons.org/licenses/by/4.0
IMPROVING THE RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH POSTOPERATIVE AND RECURRENT LUMBAR HERNIA
The aim of the work: to improve the results of surgical treatment of patients with postoperative and recurrent lumbar hernia by developing technical prerequisites for increasing the safety of surgical interventions, reducing the frequency of recurrences and improving the quality of life of operated patients. Materials and Methods. An in-depth comprehensive examination of 63 patients operated on for postoperative and recurrent hernia of the lumbar region of the abdomen was conducted. The main group consisted of 29 (46.03 %) patients who underwent allohernioplasty in two variants according to the proposed method with two meshes. The comparison group was represented by 34 (53.97 %) patients who underwent traditional self-tissue and allohernioplasty with different mesh placement variants. According to the types of surgical interventions performed in both groups, the number and nature of postoperative complications were studied. Results. The assessment of the results in both observation groups was carried out taking into account the frequency of local wound complications and recurrences in the early and long-term postoperative period. Of all 63 operated patients, local early postoperative complications were diagnosed in 18 (28.57 %) people. In the comparison group, local complications occurred in 11 (32.34 %) patients, and in the main group – in 7 (24.13 %) people. Hernia recurrence was observed in 14 (41.18 %) and 1 (3.45 %) cases, respectively. When analyzing the distribution of complications depending on the types of hernioplasty performed, it was found that hematoma was observed in 4 (11.76 %) of the operated patients, the formation of an infiltrate in the postoperative wound area was in 1 (2.94 %) patient, suppuration of the postoperative wound was noted in 1 (2.94 %) patient. Prolonged postoperative pain was observed in 4 (11.76 %), and such a postoperative complication as mesh torsion with cyst formation occurred only in 1 (2.94 %) of the operated patient. In the main observation group, hematoma was observed in 2 (6.89 %) patients, prolonged postoperative pain occurred in 1 (3.45 %) patient. In contrast, in the main group, seroma was observed in 4 (13.79 %) patients, which was not observed in the operated comparison group. In patients who had the first mesh placed intraperitoneally (IPOM), this complication was not observed. Conclusions. The use of developed surgical techniques aimed at preventing postoperative complications and increasing the safety of performing allohernioplasty of postoperative and recurrent hernias of the lumbar region of the abdomen allowed to reduce the frequency of early local postoperative complications from 32.34 % to 24.13 % (p<0.05). Hernia recurrence decreased from 41.18 % to 3.45 % (p˂0.05).
Copyright (c) 2025 В. І. П’ЯТНОЧКА, А. А. ЯРОШ https://creativecommons.org/licenses/by/4.0
DYNAMICS OF THE QUALITY OF LIFE OF PATIENTS WITH COMBINED PRIMARY SYMPTOMATIC VARICOSE VEINS OF THE LOWER LIMBS, AXILLARY CANAL AND PERINEAL DURING PREGNANCY DEPENDING ON TREATMENT METHODS
The aim of the work: to conduct a comparative assessment of the quality of life of patients with combined primary symptomatic varicose veins of the lower extremities, inguinal canal and perineum during pregnancy, depending on the methods of treatment. Materials and Methods. The dynamics of quality of life from the method of treatment of combined primary symptomatic varicose veins of the lower extremities, perineum, inguinal canal during the gestational period were analyzed in 85 pregnant women. To assess the quality of life before and after treatment, the CIVIQ-20 questionnaire was used. The severity of the course of chronic vein disease was studied using the VCSS scale. deep), inguinal canal and perineum before and after treatment. Results. Pregnant women were divided into 3 groups depending on the method of treatment.Patients of the first group consisting of 25 (29. %) pregnant women, 5 of whom completely refused treatment for one reason or another, 20 received treatment irregularly, not in full. Pregnant women of the second group consisting of 30 (35.29 %) patients received conservative treatment in combination with compression therapy. The third group, 30 (35.29 %) patients who agreed to open surgery, which was supplemented with compression therapy as needed. Treatment was carried out in 70.59 % of patients in the II–III th trimesters of pregnancy in the volume according to indications, depending on the trimester also at the request of patients. Analyzing the effect of treatment methods on the quality of life and severity of chronic vein disease of pregnant women suffering from combined primary symptomatic progressive varicose veins of the lower extremities, perineum and inguinal canal, external genital organs, we came to the conclusion that qualitatively performed, according to patients, open surgical treatment of this pathology is the most effective and long-lasting in terms of positive results both during pregnancy and in the postpartum period. Conclusions. Combined primary symptomatic progressive chronic varicose veins of the lower extremities, perineum, external genitalia, and inguinal canal belong to diseases with a progressive course that affect the course of pregnancy and quality of life. The use of the CIVIQ-20 questionnaire and the VCSS clinical severity scale is maximally specific for patients with chronic venous disease. The results of the QOL study provide valuable additional information about the role of treatment methods in chronic venous insufficiency.
Copyright (c) 2025 В. М. АНТОНЮК-КИСІЛЬ, І. Я. ДЗЮБАНОВСЬКИЙ, В. М. ЄНІКЄЄВА, Б. С. ЛІЧНЕР, Д. М. АФОНІН https://creativecommons.org/licenses/by/4.0
DYNAMICS OF ENDOGENOUS INTOXICATION BIOCHEMICAL MARKERS IN PATIENTS WITH ACUTE SMALL INTESTINAL OBSTRUCTION
The aim of the work: to evaluate the dynamics of biochemical markers of endogenous intoxication in patients with acute small bowel obstruction before and after surgical treatment, depending on the stage of intestinal obstruction compensation. Materials and Methods. The treatment outcomes of 221 patients with acute small intestinal obstruction. All patients underwent comprehensive clinical and laboratory examinations. The severity of endogenous intoxication was evaluated based on the dynamic changes in creatinine, urea, and middle molecular weight molecules in the preoperative and early postoperative periods. Results. It was established that the severity of endogenous intoxication increased with the progression of acute small intestinal obstruction. The most pronounced changes in biochemical indicators were observed in patients at the decompensation stage. After surgical treatment, a positive trend toward a reduction in endotoxicosis manifestations was noted in all groups; however, in patients with severe disease, complete normalization of the indicators was not achieved in the early postoperative period. Conclusions. The dynamics of endogenous intoxication indicators reflect the severity of acute small intestinal obstruction and can be used to assess the effectiveness of surgical treatment and to predict the postoperative course.
Copyright (c) 2025 В. В. БЕНЕДИКТ, В. М. БАГРІЙ https://creativecommons.org/licenses/by/4.0
THE EXPERIENCE OF THE TREATMENT OF ACUTE MESENTERIC ISCHEMIA
The aim of the work: to identify characteristic features of the clinical course of acute mesenteric ischemia (AMI) based on etiological factors, and to determine the key contributors to reducing postoperative complications and mortality, with the goal of improving treatment outcomes. Materials and Methods. The study analyzed 12 cases of AMI treated at Ternopil City Emergency Hospital between 2021 and 2024. AMI was caused by mesenteric artery thrombosis in 7 patients (58 %) and by embolism of the superior mesenteric artery in 5 patients (42 %). The overall postoperative mortality rate was 50 %. Factors associated with patient survival included etiology, diagnostic capabilities, surgical treatment strategies, and postoperative management. Results. The highest postoperative mortality (75 %) observed in patients with mesenteric thrombosis and concomitant COVID-19 or post-COVID syndrome. In contrast, the mortality rate among patients with mesenteric thrombosis without COVID-19 was 33 %. Superior mesenteric artery embolism was associated with a 40% mortality rate. Revascularization without the need for bowel resection was achieved in 16 % of cases. Explorative laparotomy due to total intestinal infarction was performed in 25 % of patients. Conclusions. Early diagnosis is critical for successful AMI treatment. The release of toxic substances resulting from intestinal ischemia and infarction contributes to multiple organ failure, which remains the leading cause of early postoperative mortality.
Copyright (c) 2025 А. Р. ВАЙДА, О. А. ЯКИМЧУК https://creativecommons.org/licenses/by/4.0
EXPERIENCE OF PERFORMING BIATRIAL AND BICAVAL ORTHOTOPIC HEART TRANSPLANTATIONS (CLINICAL OBSERVATION)
The aim of the work: to publish the results of performing biatrial and bicaval orthotopic heart transplantations, focusing on the advantages and disadvantages, possible difficulties that may arise during their performance. Materials and Methods. The article describes the experience of performing two orthotopic heart transplantations – biatrial and bicaval, two well-known and generally accepted methods. The features of the early postoperative period and the overall result of surgical radical treatment are also described. Results. It was found that the more common method of transplantation is bicaval. Biatrial orthotopic heart transplantation, described by Shumvay, is used much less frequently. Known disadvantages of the latter are conduction disturbances in the form of complete atrioventricular block due to crossing of the conduction pathways during the formation of the right atrial anastomosis or weakness of the sinus node (the recipient remains with its degeneration or ischemia). With the bicaval technique, as a rule, rhythm disturbances are less common, which is associated with a “complete” transplantation including all structures of the right atrium, the donor sinus node. In our case, there were conduction disturbances in the form of complete atrioventricular block, which, however, was transient in nature and did not require the implantation of a permanent pacemaker. In the case of bicaval transplantation, there were no persistent conduction disturbances at all, as well as other rhythm disturbances. Conclusions. In combination with a longer surgical suture line, the bicaval technique is technically more difficult, and in some cases longer than the biatrial one, which prolongs the time of ischemia of the donor organ and may worsen the overall outcome of the surgical treatment.
Copyright (c) 2025 Т. В. РОМАНЮК, В. С. МОРОЗ https://creativecommons.org/licenses/by/4.0
COMPREHENSIVE TREATMENT OF GUNSHOT INJURIES OF SOFT TISSUES OF THE LIMBS USING VACUUM THERAPY
The aim of the work: to study the feasibility and effectiveness of using VAC therapy in the complex treatment of gunshot and mine-explosive soft tissues injuries of the limbs. Materials and Methods. A retrospective analysis of the treatment of 172 patients with wound defects after gunshot/mine-explosive soft tissues injuries during 2022–2025 was conducted. The wound process was monitored using clinical, cytological, microbiological and morphological criteria according to standard methods. The microhemodynamics of the lower extremities were studied by laser Doppler fluorometry. Material for morphological research was obtained by excisional biopsy. GENADYNE XLR8 Plus device (USA) was used for VAC wound therapy. Numerical results were statistically processed using computer programs S-PLUS 2000, STATISTICA, Excell. Results. When using VAC therapy, active formation of granulation tissue began after (4.64±1.27) days, and by (9.36±1.13) days, wound defects were ready for plastic closure. Along with this, a significant reduction in the volume of wound defects was also noted (p<0.05). The use of VAC therapy until the 6th-9th day allowed to reduce the total density of microorganisms below the critical level, to (4.12±0.45) lg CFU/g. Starting from the 3rd day of VAC therapy, there was a significant improvement in local wound microcirculation. The obtained results made it possible to carry out plastic stages of wound closure 1.5–2 times faster than without using the above-mentioned method. The average term of treatment of the wounded in hospital was (33.7±4.6) bed-days. 157 (91.3 %) of the wounded were discharged for further treatment in ambulatory conditions and rehabilitation. 15 (8.7 %) of the wounded were transferred to the medical institutions of the level IV. Conclusions. Vacuum wound therapy is an effective method of local treatment of gunshot wounds of soft tissues, which provides a beneficial effect on the course of all stages of the wound process, and allows to almost halve the time it takes to prepare gunshot wounds for their closure. Therefore, it allows to reduce the duration of treatment of the wounded in hospital by an average of (14.5±3.1) bed-days, which has not only medical but also social significance.
Copyright (c) 2025 П. О. ГЕРАСИМЧУК, Д. В. ОСАДЧУК, Д. Б. ФІРА, А. В. ПАВЛИШИН https://creativecommons.org/licenses/by/4.0
ДО 100-РІЧЧЯ ВІД ДНЯ НАРОДЖЕННЯ ВИДАТНОГО ЛІКАРЯ-АНАТОМА, НАУКОВЦЯ, ПЕДАГОГА – ПРОФЕСОРА ІВАНА ІВАНОВИЧА БОБРИКА
Бобрик Іван Іванович – видатний лікар-анатом, доктор медичних наук, професор, лауреат Державної премії, заслужений діяч науки і техніки, член-кореспондент НАПН України, професор кафедри топографічної анатомії та оперативної хірургії, завідувач кафедри анатомії людини, декан медичного факультету № 1, завідувач кафедри нормальної анатомії Національного медичного університету імені О. О. Богомольця.
Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
THE INFLUENCE OF SPLENECTOMY ON THE INTENSITY OF LIPID PEROXIDATION PROCESSES AND THE ACTIVITY OF ENZYMATIC AND GLUTATHIONE LINKS OF ANTIOXIDANT PROTECTION OF THE LIVER IN THE EXPERIMENT
The aim of the study: to determine the influence of splenectomy on the intensity of lipid peroxidation processes and the activity of enzymatic and glutathione links of antioxidant protection of the liver in the experiment. Materials and Methods. The experiment was performed on 54 healthy mature male Wistar line rats weighing 200–220 g. The experiments were conducted under thiopental sodium anesthesia at a dose of 40 mg·kg-1. Rats that were only anesthetized were placed in control group 1. In control group 2, laparotomy was performed under thiopental sodium anesthesia. In the experimental group, splenectomy was performed. After 1, 7, 14, and 28 days, the content of diene and triene conjugates (DC, TC) and thiobarbituric acid reagents (TBK-active products of lipid peroxidation) as well as superoxide dismutase (SOD activity) and catalase activity were determined. The antioxidant-prooxidant index (API) was calculated based on the ratio of catalase activity to TBK-active products of lipid peroxidation. Results. It was established that modeling only laparotomy compared to control caused an increase in the content of TBK-active products of LPO during the first 7 days of the experiment, DC and TC during 1, 7, and 28 days of the experiment. After 14 days, the content of the studied LPO indicators normalized, but by the 28th day, a repeated increase in the content of primary LPO products in the liver was noted: DC and TC. After laparotomy, SOD activity in the liver did not differ significantly from the control group during the 14 days of the experiment, but increased after 28 days, indicating secondary prooxidative disorders in the liver in the late period after the inflicted injury. However, catalase activity throughout the experiment was elevated with two periods of maximum growth – 1 and 14 days after the post-laparotomy period. The API value also increased up to 14 days and reached its maximum level, which clearly indicates the dominance of antioxidant mechanisms during this period. Against the background of splenectomy, the studied LPO indicators at all studied periods of the experiment were significantly higher compared to rats that underwent only laparotomy. The maximum increase in LPO processes was observed 7 days after the surgical intervention. During this period, the greatest decrease in API and a compensatory increase in SOD activity were also observed. By the end of the experiment, the indicators had returned to the norm, but the LPO indicators remained significantly higher, and the antioxidant protection indicators lower, compared to rats that had undergone only laparotomy. Conclusions. Laparotomy and spleenectomy contribute to secondary damage to internal organs, in particular the liver, due to the intensification of LPO processes and a decrease in the activity of the enzymatic link of antioxidant protection.
Copyright (c) 2025 О. Г. ТИС, Ю. В. УГЛЯР https://creativecommons.org/licenses/by/4.0
IMMUNOHISTOCHEMICAL ASSESSMENT OF CD20 EXPRESSION IN RAT KIDNEYS 1 HOUR AFTER ADMINISTRATION OF LEIURUS MACROCTENUS SCORPION VENOM
The aim of the work: to assess the degree of CD20 expression in the kidneys of rats 1 hour after the administration of the venom of the scorpion Leiurus macroctenus. Materials and Methods. The study used 10 white male laboratory rats weighing 200 g (±10 g). The venom of scorpions from the Buthidae family, specifically the genus Leiurus and the species Leiurus macroctenus, was administered to rats intramuscularly (0.5 ml of a previously dissolved venom solution in saline; 28.8 μg/ml; LD50 = 0.08 mg/kg). To identify the subpopulation of CD20 cells in kidney tissue, rabbit recombinant primary antibody Anti-CD20 (ab64088, Abcam, USA) was used. Results. In the kidney parenchyma of control rats, the CD20 precipitate was not detected. Immunohistochemical staining is negative in all morphological structures, particularly in the renal corpuscles, nephron tubules, and interstitium. After 1 hour of the experiment, following the administration of scorpion Leiurus macroctenus venom, immunohistochemical studies of the kidney revealed single CD20 cells, which are rarely found, scattered mainly in the peritubular interstitium without a tendency to group. Conclusions. One hour after the administration of Leiurus macroctenus venom to rats, a low level of CD20 expression was observed in the kidney tissue of animals with single B lymphocytes in the peritubular interstitium, indicating an early stage of the humoral response.
Copyright (c) 2026 Р. М. МАТКІВСЬКА https://creativecommons.org/licenses/by/4.0
OSTEOBLASTOCLASTOMA OF THE ACROMIAL END OF THE CLAVICLE
The aim of the work: to familiarize surgical doctors with the atypical localization of osteoblastoclastoma (OBC) in a child who simulated an aneurysmal bone cyst for the purpose of early diagnosis and treatment of this rare disease. Materials and Methods. The survey was carried out on the basis of the municipal non-profit enterprise "Ternopil Regional Children's Clinical Hospital" of the Ternopil Regional Council. The patient's outpatient and inpatient documentation has been carefully studied. X-ray examination is standard equipment. Magnetic resonance imaging – Hitachi AIRIS Mate Open-Bore 0.2 MRI device. Histological examination – staining with hematoxylin-eosin, eyepiece x300. We did not find data on clavicle OBC in the available literature, so we consider it necessary to share our clinical observation. Results. A rare case of osteoblastoclastoma of the acromial end of the right clavicle was described in a patient aged 11 years. X-ray and clinical symptoms were more characteristic of an aneurysmal bone cyst. Histological examination of the removed tumor showed numerous foci of bone destruction with a large number of large spindle-shaped, multinucleated cells, which is characteristic of the lytic stage of osteoblastoclastoma. Five months after the operation, no functional disorders were detected in the patient, the X-ray clearly shows bone regeneration at the site of segmental resection of the clavicle. Conclusions. Osteoblastoclastoma of the clavicle in childhood is very rare. Clinical and radiological symptoms are not always reliable, the final diagnosis is possible after histological examination. A radical method of treating this disease is surgery. The high ability to regenerate bone tissue in children allows for oxidative resections over a considerable length.
Copyright (c) 2025 М. Д. ПРОЦАЙЛО, О. Є. ФЕДОРЦІВ, О. М. ШУЛЬГАЙ, І. М. ГОРІШНИЙ, О. М. ПРОЦАЙЛО https://creativecommons.org/licenses/by/4.0
3D RECONSTRUCTION OF MULTISTRUCTURAL INJURIES OF THE UPPER SHOULDER GIRDLE FOLLOWING GUNSHOT TRAUMA: A CASE REPORT
The aim of the work: to present a clinical case illustrating the use of virtual 3D modeling and an individualized locking compression plate (LCP) in the surgical management of a comminuted gunshot fracture of the clavicle with bone loss. Materials and Methods. A 42-year-old male soldier sustained a gunshot fracture of the right clavicle with associated scapular and rib injuries. Preoperative computed tomography was used to create a mirrored 3D model of the contralateral clavicle, allowing the design of a customized titanium Ti-6Al-4V ELI LCP plate. A bone defect of approximately 2 cm was reconstructed using an autologous iliac crest graft modeled on a 3D template. Results. The use of a patient-specific plate provided anatomical restoration of the clavicular contour and stable fixation without intraoperative bending. The surgical time was 85 minutes, blood loss did not exceed 200 ml, and wound healing occurred by primary intention. Radiographic evaluation at four weeks confirmed correct implant position and bone alignment. At three months, complete bone union and full functional recovery of the shoulder girdle were achieved. Conclusions. This case demonstrates that patient-specific 3D-modeled implants enable accurate anatomical reconstruction, mechanical stability, and rapid rehabilitation in complex post-traumatic clavicular injuries.
Copyright (c) 2025 А. І. ЦВЯХ, А. Я. ЧАЙКІВСЬКИЙ, А. М. ОБАРАНЧУК, А. Я. ГОСПОДАРСЬКИЙ https://creativecommons.org/licenses/by/4.0