Видання англійською мовою. Кафедра хірургії № 1 з післядипломною підготовкою

The place of lymph dissection in the treatment of cancer and the choice of surgical tactics(review article)

Fri, 01 Jan 2021 00:00:00 GMT

The place of lymph dissection in the treatment of cancer and the choice of surgical tactics(review article) Nikitenko, R. P.; Vorotyntseva, K. O. Over the past years, due to increase of detection of patients with early-stage stomach cancer and colorectal cancer, and improvement of survival rate, the efforts have been made to gradually develop the concept of sentinel lymph nodes detection in order to improve postoperative quality of life. The article presents the review of the literature on the feasibility of sentinel lymph nodes intraoperative diagnosis the choice of surgical treatment of patients with tumors of the stomach and colon. Analytical work demonstrates that the real time intraoperative visualization of lymph sinesesusing fluorescent imaging of indocyanine green during laparoscopic surgery for stomach or colorectal cancer is possible and it is a useful method of the lymph nodes mapping,therefore it can lead to intraoperative changes at lymphadenectomyas well as to reduce the surgical injury. It indicates the need in further research and improvement of approach.

Effect of dietary fat on the activity of palmitic acid elongase in the blood serum and liver of rats

Sat, 01 Jan 2022 00:00:00 GMT

Effect of dietary fat on the activity of palmitic acid elongase in the blood serum and liver of rats Velichko, V. V. To determine the effect of dietary fats on the activity of palmitic acid elongase by two methods, using indicators of the fatty acid composition of lipids in the blood serum and liver of rats. Methods.Edible vegetable oils were used: high linoleic (HLSO) and high oleic (HOSO) sunflower oils, palm oil(PO). Fats were introduced into the fat-free diet (FFD) in the amount of 5% instead of the same amount of starch.The animals were fed for 30 days. A fraction of neutral lipids (triglycerides + cholesterol esters) was isolated from blood serum and liver, and the fatty acid composition was determined in it by gas chromatography.Results.HLSO consumption reduced the biosynthesis of energy fatty acids (C16:0, C16:1, C18:0 and C18:1) in the neutral fraction of serum and liver lipids. A new method for assessing the level of palmitic acid elongase, taking into account the metabolism of palmitic and stearic acids, is proposed, which gives higher values than the commonly used method for assessing elongase. With the help of the new method, elongase activation when HOSO is consumedwas determined. Conclusions.A new method is proposed for the determination of palmitic acid elongase, which takes into account the metabolism of fatty acids. It has been established that the consumption ofHLSO reduces the biosynthesis of energy fatty acids. Consumption of HOSO increases elongase activity.

The effect of dietary fat supplements on the activity of palmitic and stearic acid desaturases based on the results of a study of the fatty acid composition of neutral lipids in blood serumand liver of rats receiving a fat-free diet

Sat, 01 Jan 2022 00:00:00 GMT

The effect of dietary fat supplements on the activity of palmitic and stearic acid desaturases based on the results of a study of the fatty acid composition of neutral lipids in blood serumand liver of rats receiving a fat-free diet Levitsky, A. P.; Gozhenko, A. I.; Velichko, V. V.; Selivanskaya, I. A. Desaturase enzymes are involved in the formation of monoenoic acids from saturated fatty acids. One such enzyme is stearyl-CoA-desaturase (SCD1), which converts stearic acid to oleic acid. The aim of this work was to determine the effect of edible fats with different fatty acid compositions on SCD1 activity.Methods.High linoleic sunflower oil (HLSO), high oleic sunflower oil (HOSO) and palm oil (PO) were used. The rats were fed for 30 days with a semi-synthetic diet that did not contain any fats (FFD) and fat diets containing 5 % of each of the above oils. In animals, lipids were extracted from serum and liver and divided into3 fractions: neutral lipids (NL), phospholipids (PL), and free fatty acids (FFA).The fatty acid composition of each fraction was determined by gas chromatography. The SCD18 activity was determined by the C18:1 n-9/C18:0 ‒ratio, and the SCD16 activity was determined by the C16:1n-7/C16:0 ratio. Results.A higher activity of SCD16 and SCD18 was found in the NL fraction, and the activity of SCD18 significantly exceeds that of SCD16. A decrease in the content of C16:0, C16:1and C18:0 in the NL fraction of the liver and blood serum was shown. The activity of SCD16 in blood serum and liver decreases in rats fed fat diets, while the activity of SCD18 does not decrease, and even increases with the consumption of HOSO.Conclusions.To determine the SCD1 activity, it is advisable to use the C18:1/C18:0 ratio in terms of the level of fatty acids in the NL fraction. Fatty diet inhibits SCD16 activity, and consumption of HOSO increases SCD18 activity.

Therapeutic and preventive effectiveness of antidisbiotic agents in rats with lipid intoxication

Fri, 01 Jan 2021 00:00:00 GMT

Therapeutic and preventive effectiveness of antidisbiotic agents in rats with lipid intoxication Levitsky, A. P.; Gozhenko, A. I.; Velichko, V. V.; Selivanskaya, I. A.; Markov, A. V. Aim: to determine the effect of antidisbiotic agents on the state of the organism of rats under conditions of lipid intoxication and to propose a comprehensive method for assessing therapeutic and prophylactic efficacy. Methods: lipid intoxication was induced in rats using thermoperoxide sunflower oil. As antidisbiotic agents, drugs containing quercetin, inulin, calcium citrate (Kvertulin), lecithin, quercetin, inulin, calcium citrate (Lekvin), flavolignans, inulin, lecithin, calcium citrate (Lekasil) and lysozyme, quercetin, inulin, gelatin, calcium citrate (Lysozyme-forte). The level of markers of inflammation and dysbiosis (elastase, urease, MDA) and the level of markers of defense systems (lysozyme, catalase) were determined in the tissues of the gums, the mucous membrane of the colon, liver and blood serum. The pathogenic effect of lipid intoxication was assessed by the sum of changes in the level of markers. The therapeutic effect of antidisbiotic drugs was also assessed by the pattern of the change in the level of markers. Results: lipid intoxication increases the activity of elastase, urease and MDA content in tissues, but decreases the level of lysozyme and catalase. Antidisbiotic drugs have antiinflammatory effects. Lipid intoxication most of all affects the mucous membrane of the colon and liver. The most effective was Lysozyme-forte. Conclusions: a comprehensive method for assessing the pathogenic effect of lipid toxins and a comprehensive method for assessing the therapeutic and prophylactic efficacy of antidisbiotic drugs are proposed.

Laparoscopic appendectomy during pregnancy

Fri, 01 Jan 2021 00:00:00 GMT

Laparoscopic appendectomy during pregnancy Mishchenko, V. V.; Mishchenko, V. P.; Rudenko, I. V.; Likhachov, V. K.; Dobrovolska, L. M.; Vashchenko, V. L.; Makarov, O. G.; Міщенко, В. В.; Міщенко, В. П.; Руденко, І. В.; Ліхачов, В. К.; Добровольська, Л. М.; Ващенко, В. Л.; Макаров, О. Г. A laparoscopic appendectomy was performed in 73 pregnant women. The Alvarado scale was used for diagnostics. The average age of the examined was 25.7±0.5 years. 17.8 % of pregnant women were operated on in the first trimester of pregnancy, in the second ‒ 46.6 %, in the third ‒ 35.6 %. The time from the onset of the disease was 6 hours in 12.3 % of pregnant women, in 35.6 % ‒ 6‒12 hours, in 31.5 % ‒ 12‒24 hours, in 20.5 %‒ more than 24 hours. The postoperative period in all patients was uneventful. All patients were discharged for periods from 2 to 5 days after surgery. Acute appendicitis during pregnancy is a common surgical condition. Appendectomy in pregnant women should be performed even before complications from acute appendicitis and gestational complications develop. Diagnosis of acute appendicitis should be fast and accurate using additional imaging technologies. Laparoscopic appendectomy due to its advantages over open appendectomy, its safety for the health of the pregnant woman and the course of pregnancy should now become the gold standard of operations for acute appendicitis in pregnant women.; Лапароскопічна апендектомія виконана 73 вагітним. Для діагностики використовували шкалу Альварадо. Средній вік обстежених склав 25,7±0,5 роки. Від числа всіх прооперованих вагітні в І триместрі склали 17,8 %, у ІІ триместрі ‒ 46,6 %, в ІІІ триместрі ‒ 35,6 %. У 12,3 %вагітних час від початку захворювання до операції склав 6 годин, у 35,6 % ‒ 6‒12 годин, у 31,5 %‒ 12‒24 години, у 20,5 %‒ більше 24 годин. Післяопераційний період у всіх пацієнток протікав задовільно. Всі пацієнтки були виписані через 2‒5 діб після операції. Апендектомію у вагітних слід виконувати ще до розвитку ускладнень з боку гострого апендициту і гестаційних ускладнень. Діагностика гострого апендициту повинна бути швидкою і точною з використанням додаткових візуалізуючих технологій. Лапароскопічна апендектомія внаслідок її переваг перед відкритою апендектомією (безпека для здоров'я вагітної і перебігу вагітності) повинні стати золотим стандартом операцій при гострому апендициті у вагітних.

30 Year’s Experience of Endoskopic Operations of Trachea and Bronchi in Lung Cancer Palliative Treatment

Mon, 01 Jan 2018 00:00:00 GMT

30 Year’s Experience of Endoskopic Operations of Trachea and Bronchi in Lung Cancer Palliative Treatment Severgin, V. Endoscopic operations on trachea and bronchi are palliative method of lung cancer common forms treatment. The use of this surgical interventions type in patients with the above pathology improves quality and extends the life span. We summarized the 30-year experience of performing endobronchial operations in patients with lung cancer. In the clinic, endoscopic operations on the trachea and bronchi in lung cancer were performed in 1,720 patients, of which 1384 were men and 336 women. Total number of operations 4781. All patients had complete or partial stenosis of bronchi and trachea. Radical surgery was impossible to perform due to the prevalence of the process, either because of the comorbidity presence. Basically, we used a rigorous Friedel bronchoscope - in 1255 patients, the remaining 465 patients used an Olympus fibrobronchoscope. Rigid bronchoscopy was performed using endotracheal anesthesia, interventions with the use of a fibroblochoscope were performed under local anesthesia. We used three methods of influencing the tumor: laser radiation (1259 patients), electrosurgical method (146 patients) and radiofrequency ablation (315 patients). As a source of laser radiation, we used YAG-Nd laser, with a wavelength of 1064 nm and a power of 40 W. Both contact and non-contact methods of influencing the tumor were used. Electrosurgical operations implemented by a contact method using a conventional surgical coagulator under local anesthesia using fibrobronchoscope. The radiofrequency ablation (RFA) method implies the use of an electron wave at a frequency of 500 kHz. As a power source was used Fotec 150 generator. Operative interventions were performed under local anesthesia with the use of fibrobronchoscopy method.

Redo laparoscopic antireflux surgery in patients with hiatal hernia

Fri, 01 Jan 2021 00:00:00 GMT

Redo laparoscopic antireflux surgery in patients with hiatal hernia Bugridze, Z.; Parfentiev, R.; Chetverikov, S.; Giuashvili, S.; Kiladze, M.; Бугридзе, З. Д.; Парфентьев, Р. С.; Четвериков, С. Г.; Гиуашвили, Ш. Т.; Киладзе, М. А. The purpose was to study the features and results of redo laparoscopic antireflux surgery. For the period from 2008 to 2019, in Odessa Regional Hospital laparoscopic antireflux operations were performed in 1164 patients. 57 patients underwent laparoscopic reoperation during the study period based on the following indications: recurrence of hiatal hernia (n=37), recurrent reflux (n=4), dysphagia (n=8), severe pain (n=5), esophageal stricture (n=3). All patients underwent repeated examinations in our clinic, telephone interviews, mailing of special questionnaires. All complaints were recorded, the quality of life was determined according to the GERD-HRQL questionnaire. All redo operations were performed laparoscopically without conversion to laparotomy. Intraoperative complications were observed in 11.11% of patients. Long-term follow up from 6 months to 6 years was observed in 90.74% of patients. The quality of life of patients according to the GERD-HRQL questionnaire significantly improved in long-term follow-up (p<0.001). Good results were observed in 91.84% of patients after redo operations. The third operation was needed in 5.6% of patients. Redo laparoscopic antireflux operations are technically difficult surgical interventions and provide good long-term results in 90% of patients.; Целью исследования явилось определение особенностей и результатов повторных лапароскопических антирефлюксных вмешательств. Все повторные вмешательства выполнены лапароскопически без конверсии в лапаротомию. Интраоперационные осложнения наблюдались у 11,11 % больных. Отдаленные результаты в сроке от 6 месяцев до 6 лет прослежены у 90,74 % больных. Качество жизни больных, согласно результатам опросника GERD-HRQL, достоверно улучшилось в отдаленные сроки наблюдения (p<0,001). E 91,84 % пациентов после повторных операций отмечены хорошие результаты. Третья операция потребовалась 5,6 % больным.

Study of intraoperative indocyanine green angiography effectiveness for identification of parathyroid glands during total thyroidectomy

Fri, 01 Jan 2021 00:00:00 GMT

Study of intraoperative indocyanine green angiography effectiveness for identification of parathyroid glands during total thyroidectomy Parfentiev, R.; Grubnik, V.; Grubnik, V.; Bugridze, Z.; Giuashvili, S.; Beselia, L.; Парфентьев, Р. С.; Грубник, В. В.; Грубник, В. В.; Бугридзе, З. Д.; Гиуашвили, Ш. Т.; Беселия, Л. Ф. Postoperative hypocalcemia is a common complication of thyroidectomy. This problem is most often associated with accidental devascularisation or excision of the parathyroid glands (PG). Aim was study near-infrared fluorescent imaging with intraoperative parathyroid gland indocyanine green angiography to help identify and preserve parathyroid glands during total thyroidectomy in order to avoid postoperative hypocalcemia. For period from 2017 to 2019 years, 58 patients in Odessa regional hospital were underwent total thyroidectomy. Indications for surgery were multinodular goiter (n=42), thyroid cancer (n=11) and Graves' disease (n=5). By randomization all patients were divided into two groups: in the first group, 28 patients underwent standard total thyroidectomy, in the second group 30 patients underwent near-infrared-assisted total thyroidectomy with indocyanine green (ICG) angiography. Parathyroid autofluorescence was detected using a near infrared/indocyanine green endoscopic system (Karl Storz, Germany). Serum calcium and parathyroid hormone levels were compared between the two groups of patients in 1, 7 -15 days after surgery and then 3, 6 months later. In the first group, on based of a visual assessment of the PG, autotransplantation the PG were conduct in only 4 cases (in 3 cases - one gland, in one case - 2 glands). In the second group, autotransplantation was performed in 11 patients (in 8 cases - one gland, in 2 cases - two, in one case - 3). The transient postoperative hypocalcemia was observed in 5 patients of the first group (17,86%) and in the 2 patients of second group (6,67%) on 5-10 postoperative days. In the first group 1 patient at 3 months after surgery had permanent hypocalcemia. Near-infrared fluorescent imaging with intraoperative parathyroid gland indocyanine green angiography is a safe and an easily repeatable method. This technique provides improved detecting and assessment of the perfusion of the PG. The need for autotransplantation of the PG can be determined more objectively using ICG imaging than simple visualization.; Послеоперационная гипокальциемия – частое осложнение тиреоидэктомии. Эта проблема чаще связана со случайной деваскуляризацией или удалением паращитовидных желез (ПЖ). Целью исследования явилось определение флуоресцентной визуализации в ближнем инфракрасном диапазоне с помощью интраоперационной ангиографии паращитовидных желез с индоцианиновым зеленым для идентификации и сохранения паращитовидных желез при тотальной тиреоидэктомии и исключения послеоперационной гипокальциемии.

Comparative prospective randomized trial: laparoscopic versus open common bile duct exploration

Sat, 01 Jan 2011 00:00:00 GMT

Comparative prospective randomized trial: laparoscopic versus open common bile duct exploration Grubnik, V.; Tkachenko, A.; Vorotyntseva, K. Single-stage laparoscopic procedures for common bile duct (CBD) stones are an alternative treatment option to two-stage endo-laparoscopic treatment and to open choledocholithotomy. Several reports have demonstrated the feasibility, safety, efficiency and cost-effectiveness of laparoscopic techniques. Aim: To analyse the safety and benefits of laparoscopic compared to open common bile duct (CBD) exploration. Material and methods: The prospective randomized trial included a total of 256 patients with CBD stones operated from 2005 to 2009 in a single centre. The male/female ratio was 82/174, with a median age 62.3 ±5.8 years (range 27 to 87 years). There were two groups of patients. Group I: laparoscopic CBD exploration (138 patients). Group II: open CBD exploration (118 patients). Patient comorbidity was assessed by means of the American Society of Anesthesiologists (ASA) classification; ASA II – 109 patients, ASA III – 59 patients. Bile duct stones were visualized preoperatively by means of US examination in 129 patients, by means of ERCP in 26 patients, and by magnetic resonance cholangiopancreatography (MRCP) in 72 patients. Preoperative evaluation was done through medical history, biochemical tests and ultrasonography. Results: The mean duration of laparoscopic procedures was 82 min (range 40–160 min). The mean duration of open procedures was 90 min (range 60–150 min). Mean blood loss was much lower in the laparoscopic group than in the open group (20 ±2 v.s 285 ±27), p < 0.01. Postoperative complications were observed in 7 patients of the laparoscopic group and in 15 patients in the open group (p < 0.01). Laparoscopic common bile duct exploration was performed through a trans-cystic approach in 76 patients and via choledochotomy in 62 patients. The transcystic approach was successful in 76 patients (74.5%). External drainage was used in 25 (32.8%) patients with the transcystic approach. Conclusions: Laparoscopic CBD exploration can be performed with high efficiency, and minimal morbidity and mortality. Laparoscopic procedures have advantages over open ones in terms of postoperative morbidity and length of hospital stay.

Laparoscopic management of large hiatal hernia: mesh method with the use of ProGrip mesh versus standard crural repair

Mon, 01 Jan 2018 00:00:00 GMT

Laparoscopic management of large hiatal hernia: mesh method with the use of ProGrip mesh versus standard crural repair Ilyashenko, V. V.; Grubnyk, V. V.; Grubnik, V. V. Primary repair of large hiatal hernia is associated with a high recurrence rate. The use of mesh can lead to a reduce of recurrence rate. Despite this reduction, the type of mesh used and the placement technique are controversial. In our study, we used a new type of non-absorbable, self-fixating mesh to reinforce the cruroplasty. The aim of the present study was to compare the long-term results of laparoscopic treatment of large hiatal hernia with mesh reinforcement versus simple crura repair. Methods This study was performed on 98 gastroesophageal reflux disease patients who underwent Nissen fundoplication with mesh-augmented crura repair and fundoplication with standard crura repair. We used non-absorbable laparoscopic self-fixating mesh by ProGrip™. All patients were separated into the mesh group (n= 50) and non-mesh group (n= 48). The groups were evaluated according to the following criteria: dysphagia, patients’ symptomatic outcome judgment according to The Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) questionnaire and patients’ satisfaction, hiatal hernia recurrence according to upper endoscopy and a barium contrast swallow study. Follow-up was completed in 95 (97%) patients with a mean follow-up duration of 54 months (range 12–62 months). Results Mean operative time was not significantly different (p = 0.30302). During the 48 months of follow-up, one recurrence occurred in the mesh group and eight recurrences appeared in the non-mesh group (p=0.027). Patient satisfaction was significantly higher in the mesh group (p = 0.004). The mesh group had a more significant improvement in GERD-HRQL score (p < 0.0001) compared to the non-mesh group. Conclusion In conclusion, this study confirms that laparoscopic repair of large hiatal hernias is effective and durable over a long period of time. Reinforcement of crura repair with ProGrip™ mesh is safe and can prevent anatomical recurrences.