Vol 39, No 3 (2020)

The article is dedicated to the 220^th anniversary of the founding of the General Surgery Department of the S. M. Kirov Military Medical Academy. During the time the department was headed by famous representatives of surgery of those times. The representatives of the General Surgery Department made a significant contribution to the development of surgery in our country, subsequently being the heads of surgical departments and medical institutions. Historically, the academic disciplines taught at the department were the primary link in the education program in surgery at the academy. Most of the heads of the department had the experience of participating in military campaigns, which is necessary for education at a military university. Traditionally, the department scientific research were devoted to the study of the wound process, wound infection, combat injuries, oncology, vascular and abdominal surgery. At present, there is currently a continuity in the formation of educational and methodological materials for various categories of students, scientific developments on topical problems of surgery have been going on (4 figs, bibliography: 4 refs).

The article is devoted to evaluating the experience of distance learning in the discipline “General surgery” during the COVID-19 pandemic. Organizational issues and some results of 6-month distance learning in General surgery have been considered.

The most significant changes occurred in the methodology of the main part of classes — in terms of teaching practical skills of medical and diagnostic orientation. Demonstration of appropriate actions in graphic and video materials did not ensure the development of practical skills, and it turned out that distance learning does not have all the properties of clinical training.

It takes much more time a teacher on preparing for classes and test activities for students, including taking the exam remotely.

Further study of distance learning opportunities is required (determining the critical duration of distance learning, the need to change the list of practical skills to be mastered, etc.) in cooperation with clinical departments of surgical and related profiles (bibliography: 8 refs).

The article is devoted to practical issues of the clinic, the diagnostic algorithm and tactics of treatment of purulent-necrotic complications of diabetic foot syndrome. Studying the wound process in patients with purulent-necrotic complications of diabetic foot syndrome using modern methods. The efficiency has been proved and an algorithm has been proposed for the use of some physical methods of sanitation in the local treatment of diabetic foot syndrome. The proposed methods of treatment make it possible to reduce the number of amputations and reduce mortality in patients with purulent-necrotic complications of diabetic foot syndrome (1 figure, 1 table, bibliography: 9 refs).

Hernias of the diaphragm are a common pathology that negatively affects the quality of life of patients and in some cases requires high-quality surgical correction. This pathology has a progressive course, which leads to an increase in the severity of clinical manifestations with the age of the patient. The article presents the experience of surgical treatment of hernias of the diaphragm on the basis of general surgery clinics of the military medical academy. The aim of the study is to determine the effectiveness of surgical treatment of hernias of the diaphragm in different categories of patients. The total number of treated patients was 216. All patients were operated on. Thirty-four patients underwent a sympultal laparoscopic cholecystectomy. The operation used laparoscopic access. The closest excellent and good results of clinical treatment occurred in 92% of cases, satisfactory and unsatisfactory results accounted for 5.4 and 2.7%, respectively. According to the results of the instrumental survey, 40.6 and 54%, respectively, achieved excellent and good results; Satisfactory and unsatisfactory — 2.7 and 2.7%. The introduction of laparoscopic techniques in surgery has reduced the number of early and late post-operative complications in the treatment of hernias of the diaphragm. The recommendations of the American Association of Endoscopic Surgeons for the operational treatment of gastroesophageal reflux disease shows the positive effect of laparoscopic fundoplications in 85–93% of patients whose medicinal therapy has proved ineffective. In general, the results of the immediate and long-term outcomes of the surgical treatment of hernias of the diaphragm at the General Surgery Clinic of Military Medical Academy showed similar results (8 figs, bibliography: 16 refs).

Minimally invasive endoscopic methods are gradually being introduced in all areas of medicine. Esophageal surgery is no exception. Recently, endoscopic clipping of the mucous membrane for fresh ruptures, stenting of the esophagus and Vacuum Assisted Closure have been used in the treatment of injuries of the esophagus when radical surgery is impossible and purulent complications develop. As the techniques were mastered, they were introduced into the clinic. This article presents a clinical observation of the treatment of a 56-year-old patient with a spontaneous rupture of the esophagus (Boerhaave΄s syndrome), who at certain stages of treatment used certain endoscopic techniques that allowed to stabilize the patient in the early stages of treatment and preserve the esophagus and its functionality in the future. The duration of the patient΄s treatment in the clinic was 45 days. Subsequent follow-up examinations did not reveal any abnormalities in the patient΄s health that required surgical correction. This observation allowed us to look at the problem of treating this group of patients from a different angle and form new algorithms for treating patients using minimally invasive methods (6 figs, bibliography: 10 refs).

The article presents an analysis of the results of treatment of a patient with purulent-necrotic complications of diabetic foot syndrome, who, in the framework of surgical treatment, used a minimally invasive method of treatment of purulent-necrotic complications of diabetic foot syndrome, developed at the departments of general surgery and normal anatomy of the S.M. Kirov Military Medical Academy. The effectiveness of the developed method has been demonstrated, which makes it possible to sanitize the purulent cavity in a short time, stop pain syndrome and restore the support ability of the foot (4 figs, 1 table, bibliography: 7 refs).

To assess the experience of stents application, formulate the main indications and contraindications for the esophageal stenting, prove that the esophageal stenting with self-expandable metal stents is considered as the treatment of choice in incurable patients. Within the period from 2007 to 2018. 78 patients have treated for the cancer of esophagus and gastric cardia, 2 patients with benign esophageal strictures were subjected to stenting at the general surgery department of the S.M. Kirov Military Medical Academy. The group of patients included 53 men and 17 women. 60 patients with dysphagia grade III–IV have been examined, 6 of them — with trachea-esophageal, 2 — esophageal-pleural fistulas formed during the tumor disintegration, 2 patients were treated for burn strictures of the esophagus. M. I. Tech's esophageal stents of Korean firm were used. Insertion was carried out by short endoscopic delivery systems of a small diameter. Satisfactory evaluation of the stent state and adequate stent expansion, absence of any misplacement were considered as an indication for starting oral food intake. Patients may be allowed to go home shortly after an esophageal stent procedure (the same day). The first day the patient could use water and foods need to be liquid, moist and soft, in the following days it was possible to increase the density of products. The study found that stenting of the esophagus is a current method of endoscopic surgery, aimed at the expanding and maintaining of the lumen of the esophagus by means of the inserted self-expandable stents. Esophageal stenting possesses by fewer complications unlike other techniques. The role of palliative treatment (for example, stenting) is considered to reduce dysphagia, improve the quality of life and increase life expectancy

Treatment and prevention of complications of portal hypertension today is a complex and unsolved problem of hepatosurgery. Mortality from esophageal-gastric bleeding (ESH) of portal genesis ranges from 22 to 100%. The aim of the study is to improve the results of the treatment and prevention of digestive haemorrhage in portal hypertension by optimize using of miniinvasive interventions. A retrospective analysis of the treatment results of 128 patients with cirrhosis of the liver, in which the predominant complication of portal hypertension resulted in bleeding from varicose veins of the esophagus and the stomach, and a high risk of its occurrence or recidivism have been carried out. Gastric laparoscopic devascularization with endoscopic ligation reduces the lethality from esophageal-gastric bleeding, compared to only ligation, for six months after the operation by 21.8% (÷² = 2.61; p = 0.106), 25.5% within a year (÷² = 2.75; p = 0.091), for two years after the 25.4% operation (÷² = 1.47; p = 0.225), for three years 25.5% (÷² = 0.43; p = 0.051). There is a statistically reliable lack of differences in the groups of patients after the traditional and endovideoxyric operations of the portocal bypass in terms of the reduction of the degree of VDEV (84.3 and 86.7%), which indicates the equivalent effect of the performed operations. A comparative study of selective portocaval anastomoses and TIPS found no reliable difference in the frequency of recurrent bleeding. Post-shunt encephalopathy, thrombosis, and stenosis of the shunt were more common in the transjugular intrahepatic portosistame shunt (p < 0.001), and survival in the group of surgical anastomosis was superior to that of TIPS. The above data indicate that the use of endoscopic, endovascular, endovision and endovision surgery, extracorporeal miniinvasive techniques is an integral part of the complex surgical treatment of patients with portal hypertension. Miniinvasive surgical treatments are required depending on the current clinical situation and the degree of liver-cell failure. Flexible and selective tactics make it possible to improve the results of treatment of patients with cirrhosis of the liver, complicated by portal hypertension (6 figs, bibliography: 14 refs).

Purpose. To evaluate the capabilities of modern minimally invasive interventions under the beam guidance in the surgical treatment of pancreatic cysts.

Materials and Methods. The results of the examination and treatment of 88 patients with pancreatic cysts. Percutaneous puncture drainage under ultrasonographic guidance holds 56 patients, endoscopic transmural drainage of cysts by ultrasonography—- in 32.

Results. After performing percutaneous drainage of cysts positive results were observed in 42 (75,0%) patients. Relapses cystic formations were observed in 14 (25.0%) patients. Endoscopic transmural drainage under ultrasonography noted one intraoperative complication — perforation of the stomach wall. 6 patients had a good result. Term follow up of patients ranged from 10 months to 3 years.

During endoscopic transmural drainage stent dislocation and relapse of cysts were not detected in all operated patients after 6 months, Long-term results were observed only in 11 patients.

Conclusions. Percutaneous external drainage of pancreatic cysts is an effective intervention in 75% of patients. A fairly high percentage (25%) of relapses is due to the fact that long-term external drainage do not allow to achieve complete obliteration of the cyst cavity in its connection with the main pancreatic duct and preservation of ductal hypertension of the pancreas. Endoscopic installation of a stent between the hand cavity and the lumen of the stomach allows you to create conditions for a constant outflow of cyst contents into the stomach and eliminate pancreatic hypertension. The effectiveness of internal drainage is determined by the duration of stent functioning, as well as the possibility of forming an internal cystogastric fistula (3 figs, bibliography: 8 refs).

In this article a case report of an effective combined treatment of a patient with locally advanced cholangiocellular cancer who underwent neoadjuvant regional chemotherapy, extended surgery, adjuvant regional chemotherapy, as well as a set of minimally invasive endoscopic and percutaneous endobiliary techniques, which allowed the progression of the disease, including to increase the patient´s survival rate is presented. (5 figs, bibliography: 5 refs).