Khirurgiya最新文献

{"title":"[Trial sequential analysis in evaluation of clinical guidelines (midline incisional hernia model)].","authors":"S I Panin, T V Nechay, A V Sazhin, A Fingerhut, A N Akinchits, A A Kuznetsov, S N Kulaev, A V Puzikova, D V Perevoshchikov","doi":"10.17116/hirurgia202604191","DOIUrl":"https://doi.org/10.17116/hirurgia202604191","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the methodology of Trial Sequential Analysis as a tool for developing and critically appraising of clinical guidelines on the model of midline ventral hernias.</p><p><strong>Material and methods: </strong>Systematic searching for international guidelines on the management of ventral hernias was conducted in the PubMed, EMBASE, Scopus, Web of Science, CINAHL, and Cochrane Library databases up to May 01, 2023. Searching depth was 5 years. Quality of systematic reviews was assessed using a Critical Appraisal Sheet from the Oxford Center for Evidence-Based Medicine. TSA was performed using Copenhagen Trial Unit (Centre for Clinical Intervention Research, Denmark) software. We analyzed sensitivity of models using relative risk reduction rates.</p><p><strong>Results: </strong>We analyzed 3 international guidelines on the management of primary and incisional ventral hernias: the International Endohernia Society (IEHS, 2019), the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES, 2016), and the European Hernia Society (EHS, 2023). Systematic reviews in all guidelines had high quality. The IEHS (2019) and SAGES (2016) guidelines synthesized evidence without meta-analytical processing, whereas the EHS (2023) guideline incorporated meta-analysis. Our supplementary TSA calculations demonstrated that EHS (2023) guideline evidence base is sufficiently powered to identify diabetes mellitus and surgical site infection as key risk factors of incisional hernia following midline laparotomy. Alloplastic mesh appeared to be a preventive factor against hernia recurrence compared with suture repair. Nonetheless, optimal mesh placement technique remains inconclusive.</p><p><strong>Conclusion: </strong>To ensure necessary evidence base for updated guidelines on midline ventral hernias, further protocol studies are needed, including international collaboration. An alternative option for achieving a larger sample size, but with lower evidence base, could be research of surgical registries.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 4","pages":"91-101"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Endovascular repair for a ruptured tuberculous thoracoabdominal aortic aneurysm and secondary lumbar spondylitis].","authors":"M A Chernyavskiy, A G Vanyurkin, E V Verkhovskaya, I N Danilov, E V Shlyakhto","doi":"10.17116/hirurgia202604181","DOIUrl":"https://doi.org/10.17116/hirurgia202604181","url":null,"abstract":"<p><p>Tuberculous spondylitis and psoas abscess secondary to mycotic thoracoabdominal aortic aneurysm are extremely rare. This life-threatening condition requires surgical treatment after diagnosis. Treatment of these patients involves specific antibacterial therapy combined with total resection of infected tissues and vascular reconstruction. At the same time, the most optimal surgical tactics in these patients is unclear. We present a 65-year-old male patient with tuberculous ostitis of L2-L4 vertebrae and right-sided psoas abscess secondary to 6-month-old ruptured mycotic thoracoabdominal aortic aneurysm. The main complaint at admission was severe lumbar pain. For diagnostic purposes, the patient underwent removal of right-sided retroperitoneal lesion with subsequent histological examination of tissues. Typical signs of tuberculosis infection required anti-tuberculosis chemotherapy. A month later, the patient underwent endovascular aortic repair due to infrarenal aortic enlargement and saccular protrusion of aortic wall within its bifurcation. Pain syndrome decreased after surgery. Postoperative CT revealed shrinkage of paraaortic hematoma and reduction of infrarenal aortic diameter. After 6 months, CT angiography confirmed pulsatile blood flow through the stented visceral arteries without endoleaks. Destruction zones of L2-L4 vertebrae decreased. This case demonstrates the possibility of endovascular treatment of a patient with ruptured mycotic thoracoabdominal aortic aneurysm with secondary tuberculous spondylitis and psoas abscess. This technique seems to be an acceptable alternative to open aortic repair in elderly comorbid patients.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 4","pages":"81-90"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Modern diagnostic and treatment approach for colonic diverticulitis in the Russian Federation: survey of specialists].","authors":"T V Nechay, O A Smirnova, A E Tyagunov, L L Gusev, S N Kulaev, A G Yuldashev, A O Atroshchenko, Zh S Semenov, A V Sazhin","doi":"10.17116/hirurgia20260415","DOIUrl":"https://doi.org/10.17116/hirurgia20260415","url":null,"abstract":"<p><strong>Objective: </strong>Investigation of the causes of differences between current and recommended therapeutic and diagnostic tactics for colon diverticulitis (CD).</p><p><strong>Material and methods: </strong>An anonymous online survey was conducted from 01.2023 for 60 days. The participants received an information letter and a link to an online questionnaire. Demographic indicators, the level of self-esteem, sources of motivation in decision-making, diagnostic and therapeutic tactics were studied. The respondent's probability of choosing a specific treatment tactic was estimated in scores from 0 to 10.</p><p><strong>Results: </strong>377 respondents from the Russian Federation participated: 56 (14.9%) coloproctologists (CP), 299 (79.4%) general surgeons (GS), 22 who did not specify a specialty. The majority (46/56, 82.1%) of CP rate their knowledge of the problem as excellent and good, among GS the corresponding proportion is 199 (66.5%) (<i>p</i>=0.02). When making decisions, respondents were most often guided by professional experience (Me 8, Q₁-Q₃ 6-10), methods adopted in the clinic (Me 8, Q₁-Q₃ 5-10) and Russian guidelines (Me 9, Q₁-Q₃ 7-10). A weak relationship was found between reliance on personal experience and the level of self-esteem (<i>r</i>=0.188, <i>p</i><0.001), as well as the number of colorectal resections performed per year (<i>r</i>=0.242, <i>p</i><0.001) and between reliance on national recommendations and the level of knowledge on the diagnosis and treatment of CD (<i>r</i>=0.223, <i>p</i><0.001). Nineteen (5%) respondents for Hinchey IA and 91 (24%) respondents for Hinchey IB-II choose colon resection. In Hinchey III, non-operating specialists choose tactics that are inconsistent with the guidelines (lavage) (<i>p</i><0.001). For Hinchey IV 35 (9.3%) respondents also offered non-radical treatment options. There is no consensus on issues not covered by guidelines.</p><p><strong>Conclusion: </strong>There is low adherence to the existing recommendations that leads to significant differences in the approaches practiced by respondents from different cohorts. Further research is needed to fill in the gaps found and update the guidelines accordingly.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 4","pages":"5-15"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Evaluation of the effectiveness of perioperative nutritional metabolic support in surgical patients with burn disease].","authors":"A G Kalinin, T L Pilat, A V Alekhnovich, A L Sukhorukov, P S Markevich","doi":"10.17116/hirurgia202601164","DOIUrl":"https://doi.org/10.17116/hirurgia202601164","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy, safety, and tolerability of nutritional metabolic support (NMS) in surgical patients with burn disease (BD) and to analyze its impact on the postoperative course.</p><p><strong>Materials and methods: </strong>All patients had severe burns with thermal burns covering up to 59% of the body surface area (trunk, chest, abdomen, back, and extremities in various combinations). These patients received conventional therapy appropriate to the stage of their illness (administration of analgesics, sedatives, antibiotics, infusion and transfusion therapy, correction of fluid-electrolyte, acid-base, and blood rheology balances, and surgical treatment of burn wounds). The study group consisted of 31 (61%) burn patients. Their comprehensive treatment included enteral nutritional support using specialized dietary therapeutic and preventive nutrition products - a Detoxifying Protein Cocktail twice daily (morning and lunchtime) and a Restorative Protein Cocktail once daily (evening), manufactured by LEOVIT nutrio - for 21 days. The control group included 20 burn patients who did not receive nutritional support. Burn severity was assessed using the Frank Burn Index (FBI), taking into account the area and depth of the lesion, as well as the presence of respiratory tract burns. Patients in the groups were comparable in severity. Treatment progress was monitored using general clinical laboratory testing methods.</p><p><strong>Results: </strong>The use of therapeutic metabolic enteral nutrition has a beneficial effect on the general condition of patients; Improves healing and epithelialization, accelerates burn scab rejection, improves clinical and biochemical blood parameters, intoxication and inflammation markers, enhances antioxidant defense, reduces inflammation, and improves patients' quality of life.</p><p><strong>Conclusion: </strong>This study demonstrates the high clinical efficacy of domestically produced metabolic enteral nutrition products in surgical patients with burn disease. Effective domestic enteral nutrition ensures technological sovereignty and import substitution.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"64-74"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical experience of using modified Limberg plastic surgery using a polymer hydrogel for recurrent and complex pilonidal sinus].","authors":"G G Sahakyan, M A Danilov, S M Chudnykh","doi":"10.17116/hirurgia202601133","DOIUrl":"https://doi.org/10.17116/hirurgia202601133","url":null,"abstract":"<p><strong>Objective: </strong>Evaluation of the effectiveness of various surgical techniques, comparison of their results and study of the effect of polymer hydrogel on treatment outcomes.</p><p><strong>Methods: </strong>The study included 97 patients with a diagnosis of recurrent or complex PSD (Pilonidal sinus disease). Patients were divided into 3 groups who underwent surgery using the traditional Limberg flap, modified Limberg flap, or operated using modified Limberg flap and polymer hydrogel in the coloproctology department of the A.S. Loginov International Research Center from March 2015 to September 2023. The incidence of complications in the early postoperative period and the frequency of relapses in the late period were assessed.</p><p><strong>Results: </strong>97 patients were included in the study; long-term results were observed in 84 patients (86.6%). 88.7% of them are men, 11.3% are women. There were no statistically significant differences in the incidence of complications in the early postoperative period between the groups (<i>p</i>=0.374). The recurrence of the disease in patients who underwent traditional plastic surgery was 10.9%. In the group with modified plastic surgery, recurrence was detected in 2 patients (4.9%). In the group with the use of polymer hydrogel, 1 case of recurrence (2.5%) was recorded. There are no statistically significant differences in the following parameters: average blood loss, duration of hospitalization, indicators of postoperative control, and the level of inflammatory markers. There were no intraoperative complications in any of the groups.</p><p><strong>Conclusion: </strong>Modified plastic using a polymer hydrogel to eliminate \"dead zones\" and avoid drainage in the postoperative period has demonstrated its effectiveness, however, further studies are required to confirm the results obtained.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"33-40"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146054003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Surgical treatment of constrictive pericarditis under cardiopulmonary bypass: evaluation of short-term and long-term outcomes].","authors":"A V Lysenko, G I Salagaev, A K Uritskaya, Yu V Belov","doi":"10.17116/hirurgia2026021113","DOIUrl":"https://doi.org/10.17116/hirurgia2026021113","url":null,"abstract":"<p><p>Constrictive pericarditis is a chronic inflammatory process often characterized by pericardial fibrosis and calcification, as well as diastolic dysfunction. The authors present multidisciplinary approach to surgical treatment of these patients with favorable postoperative outcomes.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"113-117"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Optimized stratification of risk of complications in comorbid patients at the department of oncological proctology using the client-server mobile application MedDocMobile].","authors":"D A Krenev, D A Gerya, V M Kulushev, Z A Bagateliya, E L Kreneva, D N Grekov, S S Lebedev, M S Lebedko, A I Maksimkin","doi":"10.17116/hirurgia20260217","DOIUrl":"https://doi.org/10.17116/hirurgia20260217","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness and convenience of specialized mobile application for calculating postoperative risk in cancer patients compared to traditional methods.</p><p><strong>Material and methods: </strong>A comparative study involved 50 patients with solid malignant tumors scheduled for surgical treatment. Participants were divided into two equal groups. Risk assessment in the first group was manual, while the second group was evaluated using specialized mobile application. Data analysis was carried out using IBM SPSS software.</p><p><strong>Results: </strong>Mean calculation time in the control group was 14 min, in the study group - 4.3 min (<i>p</i>< 0.001). Mobile application significantly reduced calculation time and eliminated computational errors. Additionally, faster access to patient data and risks enhanced rate of clinical decision-making.</p><p><strong>Conclusion: </strong>Mobile application allows for significantly faster calculation of postoperative risks, while automation of routine processes eliminated errors inherent to manual method.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"7-13"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Non-cirrhotic portal hypertension complicated by portal biliopathy].","authors":"S V Mikhin, P V Mozgovoy, V V Mandrikov, A V Kitaeva, M Yu Lukovskov","doi":"10.17116/hirurgia2026021118","DOIUrl":"https://doi.org/10.17116/hirurgia2026021118","url":null,"abstract":"<p><p>The earliest references to association between mechanical jaundice and non-cirrhotic portal hypertension (NCPH) are by Fraser et al. (1944) and Gibson et al. (1965). The term \"portal hypertension biliopathy\" was proposed by Dhiman et al. (1999). The incidence of asymptomatic form of portal hypertension biliopathy (PHB) in patients with NCPH ranges from 81% to 100% that is significantly higher compared to patients with hepatic block (0-33%). Symptomatic form of PHB occurs only in 5-33% of patients. Any intervention on biliary tract in patients with PHB may result in significant blood loss due to coagulopathy. Currently, there is no consensus on optimal treatment algorithm for patients with symptomatic PHB. The authors present several patients with PHB complicated by mechanical jaundice and variants for correction of this complication.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"118-125"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Neoadjuvant chemotherapy for rescectable pancreatic cancer: \"fashion\" or necessity?]","authors":"V I Egorov","doi":"10.17116/hirurgia202601185","DOIUrl":"https://doi.org/10.17116/hirurgia202601185","url":null,"abstract":"<p><p>The interest in neoadjuvant chemotherapy (NACT) for resectable ductal pancreatic cancer (PC) has increased significantly in recent years, primarily due to unsatisfactory long-term outcomes in these patients. However, oncological rationale for this approach is currently interpreted controversially. Routine NACT for resectable PC remains controversial due to the lack of uniform standards for regimens and number of drug therapy courses, selection criteria, high incidence of chemotherapy-related complications, toxicity, no evidence of benefit for all patients and risks of tumor transition to inoperable category due to delayed surgery. This review is devoted to effectiveness of NACT for resectable PC. The limitations of NACT and biological factors reducing its effectiveness are identified. NACT should not be considered as a standard for resectable PC without individual approach. The main tasks for future research should be criteria for selecting patients for NACT and standardized optimal regimens and number of chemotherapy courses.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"85-90"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Intraoperative video fluorescence angiography: a method for predicting the failure of intestinal anastomoses in gunshot wounds to the small intestine].","authors":"P N Romashchenko, R K Aliev, A A Sazonov, A K Aliev, I A Makarov, A A Makarov, A I Kyrnyshev, N A Maystrenko","doi":"10.17116/hirurgia202603195","DOIUrl":"https://doi.org/10.17116/hirurgia202603195","url":null,"abstract":"<p><strong>Objective: </strong>To refine the technique of video fluorescence angiography with indocyanine green (VFA-ICG) for assessing tissue perfusion in intestinal anastomoses in patients with gunshot wounds to the small intestine and to identify a reliable criterion for predicting anastomotic suture failure.</p><p><strong>Materials and methods: </strong>A retrospective analysis was performed of treatment outcomes in 66 patients with gunshot wounds to the small intestine who, during staged surgical management, underwent creation of intestinal anastomoses and laparostomy; intraoperatively, a modified VFA-ICG protocol was used with quantitative perfusion assessment and calculation of a fluorescence index, defined as the ratio of the maximum brightness of anastomotic tissues to that of the corresponding intact small-bowel segment. A logistic regression model was constructed, followed by receiver operating characteristic (ROC) analysis, to determine the diagnostic value of the fluorescence index and threshold values associated with the risk of anastomotic leakage.</p><p><strong>Results: </strong>Logistic regression analysis demonstrated that the fluorescence index is an independent predictor of anastomotic suture failure (B=-28.1; OR 6.15·10^-13; 95% CI 2.0·10^-20-1.88·10^-5; <i>p</i>=0.001). ROC analysis identified a fluorescence index threshold of 0.69, below which the probability of anastomotic leakage increases significantly (AUC 0.975; sensitivity 91.7%; specificity 96.3%), which enabled the development of a risk stratification scale and an algorithm for selecting the extent of surgical intervention (anastomotic reinforcement, creation of a diverting enterostomy, and determining optimal timing of laparostomy closure).</p><p><strong>Conclusion: </strong>Intraoperative VFA-ICG with quantitative perfusion assessment using the fluorescence index is a reliable tool for predicting intestinal anastomotic suture failure in gunshot wounds to the small intestine and supports optimization of surgical strategy, reduction of specific intra-abdominal infectious complications and mortality, and lowering of treatment costs in this patient population.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"95-104"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}