Surgery

Современные взгляды на патогенез дегенерации межпозвонковых дисков / Н. А. Шнайдер [и др.] // Клиницист. – 2024. – Т. 18, № 1. – С. 37–48.

(Modern views on the pathogenesis of intervertebral disc degeneration)

  Intervertebral disc (IVD) degeneration is defined as a multifactorial degenerative disease of the spine,
starting from the structures of the nucleus pulposus of the IVD, spreading to the fibrous ring and other elements of the spinal motion segment. Unlike natural aging, a pathological degenerative process that occurs in IVDs as a result of the additive effect of genetic predisposition and external environmental factors leads to the formation of chronic back pain and reduces the patient’s quality of life. Despite many years of studying the problem of the pathogenesis of IVD degeneration, it is far from being resolved, which encourages us to further study the pathogenetic mechanisms of the development
of this pathology. Aim. To update the knowledge of practicing neurologists about the results of modern studies of the leading mechanisms of development of IVD degeneration in humans and their role in the development of promising biomarkers of this pathology and new strategies for pathogenetic therapy. Materials and methods. A search and analysis of publications was carried out in Russian-language (e-Library) and Englishlanguage databases (PubMed, Oxford Press, Clinical Keys, Springer, Elsevier, Google Scholar). Search depth – 5 years (2018–2023). Results. The analyzed and generalized results of studies of the molecular mechanisms influencing the development and progression of this pathology are presented. The leading pathogenetic mechanisms for the development of IVD degeneration, such as oxidative stress and the NO system, cytokine imbalance, increased activity of matrix metalloproteinases, dysfunction of fibrillar collagens and proteoglycan, as well as their relationship with each other, were considered. Conclusion. The review provides a broader look at the pathogenetic mechanisms of IVD degeneration, which makes it possible to set new goals for future development of promising therapeutic strategies.
Магнитотерапия как эффективная технология медицинской реабилитации / Н. В. Котенко [и др.] // Врач. – 2024. – Т. 35, № 9. – С. 16–21.

(Magnetic therapy as an effective technology for medical rehabilitation)

 Objective. Provide a scientific overview of world research works on the study of the influence of magnetic fields on the human body under various pathological conditions. Materials and methods. The literature review was conducted using the PubMed, Medline, Google Scholar, and Elsevier databases over the past 14 years (2010–2024); only full-text articles were included in the review. Key words used to conduct the search: “Magnetic therapy”, “Magnetic therapy pain”, “Magnetic stimulation”, “Pulsed magnetic therapy”. The criteria for inclusion of articles in the review were: year of publication of the scientific work from 2010 to 2024, full-text articles, papers, systematic reviews, meta-analyses and experimental studies. Exclusion criteria: coincidence of identical works in different databases. Results. This review combines data from 9 modern systematic reviews and meta-analyses for 2010-2024, which consider the use of magnetic fields in clinical practice and 4 experimental studies studying the mechanisms of action of magnetic fields on tissues and metabolic regulatory systems. Conclusion. Based on the results of the analysis of the data obtained, the role of the most significant techniques that are appropriate for use in medical rehabilitation and have a wide range of prescriptions was determined.
Минимально инвазивная хирургия спондилолистезов пояснично-крестцового отдела позвоночника: систематический обзор / Н. А. Коновалов [и др.] // Вестник неврологии, психиатрии и нейрохирургии. – 2024. – Т. 17, № 7. – С. 854–860.

(Minimally invasive surgery with lumbosacral spine spondylolisthesis: systematic review)

 The article discusses spondylolisthesis, the characterization of this disease and its specific development. Studies indicating the cause of the occurrence of lumbosacral spine spondylolisthesis are presented. Conservative, epidural and surgical treatment is considered. The essence of the expediency of surgical intervention in progressive spondylolisthesis of the lumbosacral spine is revealed. The results of studies within the framework of this problem, which have been conducted in recent years in relation to adult patients and children, are presented. The effectiveness of minimally invasive types of surgical intervention is indicated. The importance of individual components of clinical practice in the implementation of approaches in the process of minimally invasive surgery of lumbosacral spine spondylolisthesis is determined. The importance of conducting separate studies related to minimally invasive surgery is revealed due to two problems existing in the scientific community related to insufficient evidence of the effectiveness of a conservative course of treatment and the specifics of implementing minimally invasive surgical intervention on a planned basis.
Лемехова, Н. М. Треугольная кость (Os trigonum) и ее клиническое значение. Обзор литературы / Н. М. Лемехова, А. Л. Петрушин // Новости хирургии. – 2023. – Т. 31, № 6. – С. 491–501.

(Triangular Bone (Os trigonum) and its Clinical Significance. Literature Review)

 To summarize and systematize the available literature data and current views on the prevalence, anatomical features of the os trigonum and associated pathology. The triangular bone refers to the accessory bone formations of the foot; the cause for its formation is the lack of unification of individual ossification centers of the talus and the lateral tubercle of its posterior process; rarer the cause is a fracture of the hypertrophied lateral process. In most cases, it does not cause symptoms, but under certain circumstances it can cause pain in the posterior parts of the ankle joint. The prevalence of os trigonum in the general population ranges from 1.7 to 45%. Symptoms associated with the triangular bone develop in 14-25% of cases, the main associated pathology is posterior impingement syndrome of the ankle joint (os trigonum syndrome). The development of the syndrome associated with entrapment of the triangular bone along with the surrounding fibrous tissues between the posterior surface of the tibia and calcaneus during plantar flexion of the foot. This syndrome is typical for individuals whose activities involve repeated and frequent plantar flexion of the foot with a load on it and performing kicking movements: ballet dancers, football players, swimmers and athletes involved in cross-country running. Diagnosis of os trigonum syndrome based on clinical and radiographic data; CT and MRI are used in inexplicable cases. Treatment begins with conservative measures; if they are ineffective, resection of the os trigonum performed, which can be carried out using both open
and minimally invasive methods. Minimally invasive (endoscopic and arthroscopic) resection characterized by earlier functional recovery.
Методика локального отрицательного давления в абдоминальной хирургии: преимущества, недостатки, спорные вопросы / А. А. Сазонов [и др.] // Вестник хирургии им. И.И. Грекова. – 2023. – Т. 182, № 4. – С. 77–84.

(Local negative pressure technique in abdominal surgery: advantages, disadvantages, controversial issues)

 A literature review of studies on the use of local negative pressure technique (vacuum therapy) in abdominal surgery is presented. The article highlights modern approaches to its use in emergency pathology of the abdominal cavity and retroperitoneal space. The mechanisms of action, advantages and disadvantages of the local negative pressure technique, as well as the main morphofunctional aspects of its application are discussed in detail. Data from recent clinical studies and meta-analyses are summarized, and the effectiveness of using vacuum-assisted laparostomy within the framework of the «damage control» concept in multi-stage surgical treatment of injuries and urgent abdominal diseases accompanied by abdominal sepsis is demonstrated. The use of local negative pressure techniques can reduce postoperative mortality, as well as shorten the length of hospital treatment of patients. However, despite the obvious positive effect on the course of the wound process, vacuum therapy carries the risk of developing serious complications, the most dangerous of which are bleeding and perforation of hollow organs. In addition, it requires very expensive equipment and consumables, as well as training of medical personnel. Thus, the use of vacuum therapy requires a sound approach and a clear understanding of the technical features of its implementation. However, the indications for the use of local negative pressure in abdominal surgery have not yet been clarified, which undoubtedly hinders the wider introduction of this promising technique into clinical practice.
Пути улучшения результатов хирургического лечения неосложненных паховых грыж и восстановления после оперативного вмешательства (обзор литературы) / Д. М. Яковлева [и др.] // Вестник новых медицинских технологий. – 2024. – Т. 31, № 3. – С. 47–54.

(Ways to Improve Surgical Outcomes for Uncomplicated Inguinal Hernias and Recovery after Surgery (Literature Review))

 Anterior abdominal wall hernias are one of the most common surgical conditions in the world. Among anterior abdominal wall hernias, inguinal ones are the most common and most often occur in males. The working age of patients determines the importance of the social aspect of this disease and the need for their early social and labor rehabilitation. Purpose of the study is to determine the ways to improve the results of treatment of patients with inguinal hernias, using the basis of national and foreign literature analysis. Materials and methods of research. A retrospective analysis of scientific works devoted to the treatment of inguinal hernias was carried out. The articles published in the period from 1980 to 2023 were selected for the analysis. More than 50% of the analyzed works are not older than 10 years. Results and their discussion. Based on the analysis of literature data, it was revealed that modification of surgical techniques and application of multimodal anesthesia can contribute to further development of inguinal hernia surgery, including in the conditions of short-term unit. Conclusion. The application of new techniques in the treatment of inguinal and the protocol of early patients’ rehabilitation are not systemized, which makes further research in this direction relevant.
Гипоальбуминемия как независимый предиктор риска развития осложнений, критических состояний и преждевременной смерти (обзор литературы) / Н. П. Шень [и др.] // Анестезиология и реаниматология. – 2024. – № 4. – С. 83–89.

(Hypoalbuminemia as an independent predictor of complications, critical illness and premature death)

 Currently, there is no reduced serum albumin in prognostic scales devoted to clinical assessment and risk of possible negative events. The purpose of this review was to summarize national and foreign data on the role of hypoalbuminemia in predicting the risk of critical conditions. We analyzed 37 national and foreign available full-text studies. The relationship between low serum albumin and various adverse events (premature mortality, complications of the underlying disease, risk of various pathological processes) was considered. Hypoalbuminemia is an important indicator in predicting the adverse outcomes in intensive care. At the same time, the issue of direct causal relationship between hypoalbuminemia and negative events is still important and requires further study.
Майоров, М. О. Обеспечение проходимости дыхательных путей у пациентов с ожирением: обзор литературы / М. О. Майоров, Д. В. Федерякин, Е. В. Белевский // Анестезиология и реаниматология. – 2024. – № 3. – С. 67–73.

(Airway management in obese patients: a review)

 Obesity is a chronic disease and one of the main risk factors of cardiovascular diseases and type 2 diabetes mellitus. Obesity has now reached pandemic proportions. If conservative therapy is ineffective in obese patients, bariatric surgery is recommended. The number of bariatric procedures increases every year. However, the problem of airway management and predicting difficult intubation in obese patients is still unresolved. Thus, the purpose of this review was to highlight the current state of the problem of airway management in obese patients.
Особенности периоперационного ведения пациентов с опухолью хиазмально-селлярной области: обзор литературы / Л. М. Ценципер [и др.] // Вестник интенсивной терапии имени А. И. Салтанова. – 2024. – № 2. – С. 137–149.

(Some features of the perioperative management of patients with a tumor of the chiasmal cellaric region: a review)

 Tumors of the chiasmal-sellar region (CSR) account for more than 20 % of all primary intracranial neoplasms, of which pituitary adenomas account for up to 20 % of the world population. Currently, removal of these neoplasms is performed using endoscopic transsphenoidal surgical accesses. OBJECTIVE: analysis of the results of publications concerning perioperative management of patients with CSO tumors. MATERIAL AND METHODS: publications were searched and selected in bibliographic databases PubMed, Web of Science, Scopus. To study the approach to perioperative management of patients with CSF tumors, the works published from 2013 to 2023 were analyzed. Search keywords: pituitary surgery, anesthesia. Based on the analysis of current problems in anesthesia planning for patients with CSF tumors, the search was expanded with additional keywords: “pituitary tumor”, “perioperative complications”, “endocrine disorders”, “difficult airway”, “acromegaly”, “cardiologic complications, acromegaly”, “peripheral neuropathy, acromegaly”, “trigemino-cardiac reflex”, 206 publications were additionally analyzed and the main key points in anesthesia planning were summarized. A total of 230 publications were included but 161 were excluded. A total of 69 studies were selected. RESULTS: The main features of patients with CSF tumors are: water-electrolyte disorders, cardiovascular pathology, difficult airway. This determines a multidisciplinary approach in preparation for surgery. It is necessary to take into account these features when planning anesthetic support and management of the early postoperative period. In addition, endoscopic transnasal-transsphenoidal access may cause a number of complications: damage to the hypothalamic region and large vessels, and in the postoperative period: respiratory disorders, hormonal insufficiency, Water and Sodium Disturbances. CONCLUSIONS: Additional vigilance is required when preparing a patient with CSF formation for surgery. Perioperative management of a patient with CSO tumor requires a team approach with participation of neurosurgeons, neurologists, ophthalmologists, endocrinologists, cardiologists, anesthesiologists-resuscitators.
Внутрипротоковая радиочастотная абляция под контролем эндосонографии и холангиоскопии при резидуальной аденоме большого сосочка двенадцатиперстной кишки с внутрипротоковым компонентом. Обзор литературы / Ю. Г. Старков [и др.] // Хирургия. Журнал имени Н. И. Пирогова. – 2024. – № 5. – С. 138–145.

(Intraductal radiofrequency ablation under endosonography and cholangioscopy for residual adenoma of the major duodenal papilla with intraductal component)

 All adenomas of the major duodenal papilla (MDP) require resection regardless of morphological structure due to high risk of malignancy. Currently, intraluminal endoscopic interventions are preferable for these adenomas. MDP neoplasms with intraductal spread (type III and IV) are of particular difficulty for endoscopic techniques. Intraductal radiofrequency ablation provides new opportunities for minimally invasive treatment of patients with MDP adenomas and intraductal component. A 72-year-old patient after previous endoscopic papillectomy for MDP adenoma admitted to the Vishnevsky National Research Medical Center of Surgery due to residual adenomatous growths within the papillectomy zone extending to the common bile duct throughout 13 mm. The patient underwent intraductal RFA under endosonography and cholangioscopy. Despite difficult localization of residual growths extending to the common bile duct, endosonography-guided intraductal RFA provided total destruction of residual tumor that was confirmed by cholangioscopy. Length of treatment was 4 months, relapse-free period — 10 months. Minimally invasive endoscopic technology for residual MDP adenoma provided good clinical results.
Важность динамической функциональной оценки патологической извитости внутренних сонных артерий у больных с мультифокальным атеросклерозом / О. И. Загорулько [и др.] // Хирургия. Журнал имени Н. И. Пирогова. – 2024. – № 5. – С. 146–151.

(Functional assessment of internal carotid artery tortuosity in patients with multifocal atherosclerosis)

 The review is devoted to diagnosis and treatment of internal carotid artery tortuosity. The authors consider modern classification, epidemiology and diagnostic options using neuroimaging or ultrasound-assisted functional stress tests depending on medical history and complaints. In addition to standard Doppler ultrasound, rotational and orthostatic tests are advisable due to possible changes of local shape and hemodynamic parameters following body position changes, especially in patients with concomitant atherosclerotic stenosis. Thus, a personalized approach is especially important for treatment and diagnostics of internal carotid artery tortuosity.
Хирургия нейробластомы абдоминальной локализации у детей / А. А. Кривоносов [и др.] // Хирургия. Журнал имени Н. И. Пирогова. – 2024. – № 5. – С. 152–160.

(Surgery for abdominal neuroblastoma in children)

 This review is devoted to surgical approach for neurogenic tumors in children. The authors discuss epidemiological data, history of surgical approaches, preoperative imaging and risk factors. A special attention is paid to the influence of surgical interventions for various neuroblastomas on overall and event-free survival in pediatric population, as well as the most common surgical complications and modern approaches to their treatment.
Сравнительная характеристика методов лечения метастатического плеврита (обзор литературы) / Л. А. Ефтеев [и др.] // Хирургия. Журнал имени Н. И. Пирогова. – 2024. – № 7. – С. 141–147.

(Treatment of malignant effusion)

 Malignant effusion complicates more than 15% of all cancers in delayed stages of progression. The most common causes of metastatic pleuritis are lung cancer, breast cancer, ovarian cancer, lymphoproliferative diseases or dissemination of gastrointestinal tumors. Malignant effusion is associated with negative prognosis for overall survival regardless of etiology of tumor, significantly complicates the course of the underlying disease, impairs life quality and complicates treatment. Despite various methods for pleural cavity obliteration in recurrent metastatic pleuritis, there is still no a uniform approach to choosing the optimal treatment strategy. We analyzed the main methods of conservative and surgical treatment of recurrent metastatic pleuritic regarding efficacy, risk of recurrence and reproducibility.
Никитин, А. С. Межостистая фиксация в хирургии дегенеративной болезни позвоночника. Обзор литературы / А. С. Никитин, Ф. А. Ларкин // Вестник неврологии, психиатрии и нейрохирургии. – 2024. – Т. 17, № 6. – С. 755–768.

(Interspinous fixation in surgery for degenerative spine disease. Literature review)

 The article presents the biomechanical concept of using interspinous fixation in surgery for degenerative spine disease. Clinical and statistical data on the results of its use in various clinical situations are also provided.
Технологии дополненной реальности в нейрохирургии: применение и ограничения. Обзор литературы / А. Н. Коновалов [и др.] // Вестник неврологии, психиатрии и нейрохирургии. – 2024. – Т. 17, № 6. – С. 784–795.

(Augmented reality in neurosurgery: application and limitations. A literature review)

 Detection of surgical pathology is one of the primary tasks of a neurosurgeon, forming the basis of a topical diagnosis. In addition to the generally accepted neuronavigation using special navigation systems, establishing the localization of lesions in the brain and spinal cord can be achieved by integrating virtual information into the physically surrounding space of the operator, which is implemented in augmented reality (AR). This article reviews the history of the development of this technology and its application in neurosurgery and analyzes the results of using AR not only in the context of clinical neurosurgical practice, but also during the educational process, improving manipulation skills and studying neuroanatomy. The review analyzes the experience of researchers who have applied the AR method in various branches of neurosurgery, such as vascular, functional, and spinal neurosurgery and neuro-oncology, characterizes the accuracy of this method compared with frameless neuronavigation systems, and considers current prospects for future development in this area. Despite the increasing interest of the neurosurgical community in this technology and all the benefits it can potentially bring to the surgical process, its use in routine practice, both clinical and educational, is still associated with certain limitations and difficulties, and this article presents possible ways to solve this problem.
Оценка эффективности локальной криотерапии после эндопротезирования коленного сустава в раннем послеоперационном периоде. Систематический обзор литературы / Д. И. Казанцев [и др.] // Вестник травматологии и ортопедии имени Н. Н. Приорова. – 2024. – Т. 31, № 1. – C. 109–126.

(The evaluation of the effectiveness of cryotherapy after a knee replacement in the early postoperative period. Systematic review)

 A literature review of the clinical efficacy of various methods of local cryotherapy after knee endoprosthesis in the early postoperative period is presented. A literature search using the keywords “cryotherapy” and “knee arthroplasty” was conducted in the databases Medline.Ru, CyberLeninka, E-Library, PubMed, and Cochrane. The search date was January 7, 2023. The review included studies that assessed the effectiveness of cryotherapy after knee replacement in the early postoperative period. After electronic search, 562 abstracts were found, and 16 studies were included in the review. Although the patients had similar characteristics, significant heterogeneity was noted in the studies according to cryotherapy modality, duration, and frequency of cold exposure. This may have been the reason for the contradictory results of the review. It is challenging to draw a clear conclusion on the advantages and disadvantages of using cryotherapy after knee replacement. Thus, high-quality studies should examine the effectiveness of cryotherapy.
Белобородов, В. А. Вариантная анатомия полового нерва и ее клиническое значение: обзор литературы / В. А. Белобородов, И. А. Степанов // Оперативная хирургия и клиническая анатомия (Пироговский научный журнал). – 2023. – Т. 7, № 4. – С. 40–45.

(Variant anatomy of the pudendal nerve and its clinical significance: a literature review)

 The course of the pudendal nerve through the gluteal region is of clinical importance. At this point, the nerve passes behind the sacrospinous ligament. Detailed knowledge of the variant anatomy of the pudendal nerve and the location of the latter relative to the sacrospinous ligament is important in many cases of appearance. The anatomy of the pudendal nerve is also important when performing a pudendal nerve block, which requires insertion of a needle into its sensitivity. Variant anatomy of the pudendal nerve is important when performing surgical interventions on the nerve itself. Thus, the formation of anastomoses of the pudendal nerve is expedient for the purpose of innervation of the newly formed sphincter in patients undergoing rectal excision. Often, for the treatment of insufficiency of the anal or urethral sphincters, electrical stimulation of the pudendal nerve is performed. In the case of nerve compression, decompression and neurolysis of the latter occur. A search of literature sources in the PubMed, Medline, EMBASE, Cochrane Library and eLibrary databases demonstrated the presence of separate studies devoted to the English version of the anatomy of the pudendal nerve. At the same time, in the case of detection, the features of the anatomy of the pudendal nerve in the gap from various detected phenomena are reported, which was the motivation for this study.
Синхронные миксома левого предсердия и рак желудка. Клинический случай / В. Ю. Стручков [и др.] // Хирургия. Журнал имени Н. И. Пирогова. – 2023. – № 11. – С. 99–103.

(Synchronous left atrial myxoma and gastric cancer: a case report)

 The authors present a 57-year-old patient with synchronous left atrial myxoma and gastric cancer undergoing staged treatment. Distal gastrectomy with gastroduodenostomy at the first stage was followed by resection of the left atrial myxoma after 22 days. Postoperative period was uneventful after both interventions. The follow-up examination revealed favorable clinical status and no cancer progression.
Кутовая, А. С. Эверсионная эндартерстентэктомия при критическом рестенозе внутренней сонной артерии после Wallstent стентирования / А. С. Кутовая, А. Л. Головюк, А. В. Чупин // Ангиология и сосудистая хирургия. – 2023. – Т. 29, № 3. – С. 119–128. Острое нарушение мозгового кровообращения является второй причиной смертности в России. В настоящий момент каротидная эндартерэктомия остается «золотым стандартом» профилактики инсультов у пациентов со стенозом внутренних сонных артерий, в особенности при симптомном течении заболевания. Эндоваскулярное лечение атеросклеротического поражения каротидной бифуркации претендует на роль альтернативы открытым реконструкциям. Проблема рестенозов после обоих видов вмешательства остается значимой. По данным литературы, массивный кальциноз атеросклеротической бляшки становится предиктором большего количества осложнений при выполнении стентирования и невозможности достижения технического успеха в связи с резидуальным стенозом и деформацией стента в отдаленном периоде. Нами обобщены данные мировой и отечественной литературы о результатах стентирований у пациентов с кальцинированными бляшками, факторах риска рестеноза, а также проанализированы опубликованные результаты открытых хирургических вмешательств по поводу рестеноза после эндоваскулярных процедур. Также в работе представлено собственное клиническое наблюдение выполнения последовательной билатеральной эверсионной каротидной эндартерстентэктомии у пациентки с критическим рестенозом внутренних сонных артерий после имплантации стента Wallstent.
Селяев, В. С. Современные подходы к уровню формирования дистального анастомоза при остром расслоении аорты I типа по DeBakey (обзор литературы и собственный взгляд на проблему) / В. С. Селяев, А. В. Редкобородый // Ангиология и сосудистая хирургия. – 2023. – Т. 29, № 3. – С. 140–147.

(Contemporary strategies to the level of distal anastomosis formation for patients with acute DeBakey type I aortic dissection (literature review and own view on the problem))

 The article presents the data of domestic and foreign literature on the surgical treatment of DeBakey type I acute aortic dissection, as one of the most challenging pathologies in the practice of a cardiac surgeon. Unfavorable nature of the disease, a variation in presentation and clinical course along with an urgent treatment require significant attentiveness. A unified concept of treatment is practically excluded due to the variety of surgical approaches, clinical experience and interventions. There have been demonstrated approaches to surgical treatment and level of a distal anastomosis formation including simple clamp on operations only on the ascending aorta to total arch replacement with hybrid-techniques and their combination in the form of proximalization of the distal anastomosis zone. The clinic’s own vision of this problem is also presented.
Русскова, К. С. Роль ангиогенеза и коагулопатии в патогенезе портальной гипертензии у больных циррозом печени / К. С. Русскова, К. Ф. Черноусов, Р. В. Карпова // Новости хирургии. – 2023. – Т. 31, № 2. – С. 146–156.

(The Role of Angiogenesis and Coagulopathy in Pathogenesis
of Portal Hypertension in Liver Cirrhosis)

 Portal hypertension is the most dangerous complication of chronic liver diseases. There are three closely related processes leading to this: inflammation, fibrosis and pathological angiogenesis. A number of studies showed that antiangiogenic therapy prevents the progression of cirrhosis and portal hypertension. Recent studies suggest that the role of angiogenesis in the progression of fibrotic changes and their reorganization is complex and ambiguous. Such processes as sinusoidal angiogenesis and perisinusoidal fibrolysis, their contribution to the reduction of intrahepatic resistance and compensation of portal hypertension are discussing. Historically, hemorrhagic complications have been considered the main manifestation of coagulation disorders in patients with liver cirrhosis, however, portal vein thrombosis occurs in 16-23% of cirrhosis patients. Currently, liver cirrhosis is considered as a prothrombotic condition that requires careful diagnosis and the corrective drug therapy. It was that patients with cirrhosis taking anticoagulants have a lower risk of bleeding from varicose veins of esophagus and are less likely to become decompensated. However, there are not enough results of clinical studies to form clear indications for
drug and surgical treatment of thrombotic complications in liver cirrhosis, therefore this question requires further investigation.
Плаксин, С. А. Диагностика и лечение гемоторакса при закрытой травме груди (обзор литературы) / С. А. Плаксин // Новости хирургии. – 2023. – Т. 31, № 2. – С. 157–165.

(Diagnosis and Treatment of Hemothorax in Blunt Chest Trauma. A Review of the Literature)

 Hemothorax occurs in 15-58% of cases of blunt chest trauma. Computed tomography and echosonography
data improved the diagnosis and changed the tactics of treating hemothorax. The presented literature review is devoted to topical issues of comparative assessment of routine x-ray examination and new methods for recognition of hemothorax and changes of surgical tactics according to the obtained results. Criteria of hemothorax classification i.e. acute, retained, late and latent are described. Up to 28-80% of hemothoraxes not found during radiography turn out to be revealed on computer tomography. Conservative treatment and dynamic monitoring is possible in the cases of a small hemothorax, based on the quantitative results of the separation of the pleura sheets according to ultrasound and computed tomography. Videothoracoscopy has been reported as a useful approach in the management of patients with stable hemodynamic conditions for persistent, residual, late, clotted hemothorax or in the cases of other interventions in the pleural cavity. The best results of thoracoscopy are noted in the first 48-72 hours after an injury. If a patient is actively bleeding
and remains hemodynamically unstable, thoracotomy is the procedure of choice. The frequency of drainage complications of the pleural cavity is 19% and remains at the same level. They are divided into complications of insertion, malposition, removal, infectious-immunological and functioning of the drainage. Multiple reports have suggested that smaller bore tubes may be just as effective as larger bore tubes. Video-assisted thoracoscopy is used to treat clotted hemothorax; the possibility to evacuate a retained hemothorax successfully by administration of intrapleural fibrinolytic agents and fresh frozen plasma has resulted in resolution of clotted hemothoraxi has been demonstrated.
Лапароскопические операции при распространенном вторичном перитоните / Н. В. Лебедев [и др.] // Новости хирургии. – 2023. – Т. 31, № 3. – С. 240–249.

(Laparoscopic Operations of Generalized Secondary Peritonitis)

 Currently, mortality in generalized peritonitis remains high, reaching 20-30%, and with the development of septic shock it increases to 70-90%. Surgeons actively discuss the choice of approach for generalized peritonitis based on intraoperative findings and the severity of the patient’s condition. The paper presents the results of studies and opinions of domestic and foreign surgeons on the possibility of performance laparoscopic operations in patients with generalized peritonitis. Despite the fact that world surgery has accumulated extensive experience in performance laparoscopic operations in patients with generalized peritonitis, the inconsistency of literature data, and that is the most important, the lack of a generally accepted approach in determining the criteria for choosing surgical access and reasonable indications and contraindications for performing laparoscopic surgery let talking about the relevance of this problems. A possible solution of this problem can be the creation of a scale, the combined criteria of which
(local and general) will allow, at leastapproximately, to select the surgical approach in patients with generalized peritonitis.
Черепенин, М. Ю. Анализ современных малоинвазивных методик хирургического лечения геморроидальной болезни: обзор литературы / М. Ю. Черепенин, И. В. Лутков, В. А. Горский // Хирургия. Восточная Европа. – 2023. – Т. 12, № 4. – С. 471–482.

(Analysis of Modern Minimally Invasive Techniques of Surgical Treatment of Hemorrhoidal Disease: A Literature Review)

 The literature review presents the historical development of surgical methods for the treatment of hemorrhoids. Examples of the most effective modern minimally invasive techniques are given, the experience of their application, the results of various
combinations of these techniques are analyzed. The effectiveness of the proposed methods is evaluated depending on the technical complexity of the application, clinical limitations, the presence of complications, relapses of the disease and the impact on the quality of life of patients. Special attention is paid to minimally invasive techniques with the residence of the vascular pedicle of the hemorrhoid node, mucopexy and the use of laser techniques for the treatment of hemorrhoidal disease at stages 3 and 4 of the disease. The printed works devoted to the physical processes that occur during laser exposure to tissues, depending on the wavelength of the laser installations used, are analyzed. There is also a tendency to combine various isolated methods of treatment of hemorrhoidal disease in order to improve the outcome of treatment of patients with
chronic hemorrhoids
Повторная дискэктомия и спондилодез при лечении рецидивирующих грыж поясничного отдела позвоночника: систематический обзор литературы / С. К. Макиров [и др.] // Хирургия позвоночника. – 2023. – Т. 20, № 3. – С. 43–49.

(Repeat discectomy and spinal fusion in the treatment of recurrent lumbar disc herniation: systematic review of the literature)

 Objective. To conduct a literature review of studies comparing the treatment of recurrent lumbar disc herniation using discectomy and spinal fusion.

Material and Methods. A comprehensive search across four electronic databases (PubMed, Google Scholar, Science Direct, and Cochrane) was conducted. Studies comparing the outcomes of discectomy and spinal fusion for recurrent lumbar disc herniation were analyzed. Postoperative complications, cost and duration of surgery, length of hospital stay, pain score, and recurrence rate were compared. Results. Ten studies comprising data of 1066 patients met the inclusion criteria. Discectomy was performed in 620 of them, while 446 patients underwent spinal fusion surgery. Discectomy yielded good results in VAS scores for leg and back pain, but after 3–6 months, there was no significant difference compared to spinal fusion. The recurrence rate for discectomy varied from 7.27 % to 22.91 %, while fusion had 0 % same-level recurrence. Fusion surgery had fewer complications: 1.72–28.00 % (average 11.6 %) vs 5.25–32.73 % (average 15.7 %) for discectomy. However, spinal fusion had longer operation time, greater blood loss and longer hospital stay compared to discectomy. Conclusion. Discectomy and spinal fusion are effective treatment options for recurrent lumbar disc herniation. At the same time, discectomy demonstrates a high level of initial relief of symptoms and is more cost-effective. However, the risk of recurrence is significant, and the progression of degeneration and instability may result in pain recurrence within a year. Fusion surgery provides stability and eliminates the risk of recurrence, but the main challenge is the cost of surgery. The choice of technique should be based on individual patient factors, and the advantages and disadvantages of each approach should be carefully considered.
Ларькин, И. И. Травма спинного мозга без рентгенологических изменений у детей (синдром Sciwora). Обзор литературы / И. И. Ларькин, В. И. Ларькин // Вятский медицинский вестник. – 2023. – № 4. – С. 101–105.

(Spinal Cord Injury without Radiological Changes
in Children (Sciwora Syndrom). Literature Review)

 This literature review is devoted to the analysis of publications that describe a special, peculiar phenomenon of traumatic spinal cord injuries in children – SCIWORA syndrome. The injuries do not display any traumatic changes on radiography and computer tomography as to the manifestations from the spinal cord disorders. This feature is associated with a pronounced extensibility of the spine and the spinal cord. In preschool children, injuries are more severe and, in some cases, surgical treatment is required. The lack of a universal approach to diagnosis and choice of treatment method makes the publication relevant.
Царукаев, Б. А. Тактика хирургического лечения пациентов с дефектами черепа после декомпрессивной краниоэктомии и с ликвородинамическими нарушениями / Б. А. Царукаев, А. Д. Кравчук, Я. А. Латышев // Вопросы нейрохирургии им. Н. Н. Бурденко. – 2023. – Т. 87, № 6. – С. 114–119.

(Surgical treatment of patients with skull defects and cerebrospinal fluid flow disorders after previous decompressive craniectomy)

 Decompressive craniectomy (DC) is performed for refractory intracranial hypertension following severe traumatic brain injury, vascular and oncological diseases. This fact increases the number of patients with extensive and giant skull defects. Cerebrospinal fluid (CSF) flow disorders after DC are often accompanied by ventriculomegaly. However, only some patients with ventriculomegaly have hydrocephalus and require CSF bypass procedures. Differentiation of post-traumatic hydrocephalus requiring surgical treatment and atrophic dilation of ventricular system «ex vacuo» caused by brain injury is still an important issue. Skull sealing as a way to normalize CSF circulation and eliminate hydrocephalus is also an open question. Currently, there is no unified approach to patients with extensive and giant cranial defects combined with post-traumatic hydrocephalus. There is no unified algorithm for sequence of reconstructive and CSF bypass operations in these patients. Literature data on risks of infectious complications for different surgical strategies are controversial.
Применение робототехники в сосудистой хирургии (обзор литературы) / Т. Э. Бахишев [и др.] // Ангиология и сосудистая хирургия. – 2023. – Т. 29, № 4. – С. 130–136.

(Application of robotics in vascular surgery (literature review))

 One of innovative trends in modern medicine is robot-assisted technologies that allow performing the most complex surgical interventions with high accuracy and effi ciency. The active use of such technologies in vascular surgery can be characterized as a new stage of minimally invasive interventions, the world experience of which is not yet suffi ciently
vast. This literature review analyzes the data on surgical interventions, anastomoses formation methods, length of hospital stay, and the number of complications occurring during the use of robotic surgical systems in vascular surgery.
Применение лазерной флюоресцентной спектроскопии и навигации при хирургическом лечении опухолей спинного мозга и позвоночника: систематический обзор литературы / Н. А. Коновалов [и др.] // Журнал Вопросы нейрохирургии им. Н. Н. Бурденко. – 2024. – Т. 88, № 1. – С. 109–114.

(Laser fluorescence spectroscopy and navigation in surgical treatment of spinal tumors: a systematic review)

 The main problem in microsurgical resection of spinal cord tumors is excessive surgical aggression. The last one often leads to unsatisfactory clinical and neurological outcomes. Laser fluorescence spectroscopy is a modern neurosurgical approach to distinguish tumor boundaries even if standard visible fluorescence techniques are ineffective. OBJECTIVE. To evaluate the effectiveness of laser fluorescence spectroscopy alone or in combination with visual 5-ALA fluorescence for improvement of safety and quality of resection, as well as intraoperative diagnosis. MATERIAL AND METHODS. Searching for literature data was carried out in accordance with the PRISMA recommendations. The authors reviewed articles independently of each other. These data were systematized. RESULTS. Laser fluorescence spectroscopy is valuable to identify fragments of intramedullary ependyomas in 86% of cases, while visual fluorescence only in 81% of cases. Advisability of this technique for low-grade astrocytomas is still unclear and requires further study. Its effectiveness is 87.5% for extramedullary meningiomas. Neuromas do not accumulate 5-ALA. In addition, this method can be used to determine the boundaries of intradural metastatic lesions. CONCLUSION. 5-ALA fluorescence is a safe and useful intraoperative method for identifying tumor tissue and resection margins in patients with intramedullary or infiltrative extramedullary spinal cord tumors. Visual fluorescence combined with laser spectroscopy is a perspective method for intraoperative visualization of tumor remnants. This approach can improve safety and postoperative outcomes while maintaining resection quality.
Нерешенные вопросы лечения ишемий головного мозга при окклюзионно-стенотическом поражении позвоночных артерий / Н. Н. Иоскевич [и др.] // Журнал Гродненского государственного медицинского университета. – 2024. – Т. 22, № 1. – С. 5–12.

(Unresolved Issues in the Treatment of Cerebral Ischemia in Occlusive-Stenotic Lesion of the Vertebral Arteries)

 Background. The relevance of the review is determined by the fairly high incidence of strokes in the vertebrobasilar region. Aim. To analyze the literature on occlusive-stenotic lesions of the vertebral arteries as the causes of ischemic strokes and methods of their treatment. Results. It has been established that the problem of ischemic strokes due to occlusive-stenotic lesions of the vertebral arteries is a poorly covered topic. Existing options for eliminating stenosis of the vertebral artery mouth have advantages and disadvantages, and vary depending on many factors. Conclusions. The most effective method of treating occlusive-stenotic lesions of the vertebral arteries, which cause the development of vertebrobasilar insufficiency, has not yet been finally determined. This emphasizes the need for further research to develop a pathogenetically based treatment algorithm for such patients.
Тенденции в рентгенэндоваскулярном лечении и профилактике портальных кровотечений (обзор литературы) / С. В. Михин [и др.] // Хирургия. Журнал имени Н. И. Пирогова. – 2024. – № 3. – С. 38–44.

(Trends in endovascular treatment and prevention of portal bleeding)

 Bleeding from esophageal and gastric varices is a major factor of mortality in patients with portal hypertension. The gold standard for diagnosis of portal hypertension is hepatic venous pressure gradient determining the treatment algorithms and risk of recurrent bleeding. Combination of endoscopic methods and therapy is limited by varix localization and not always effective. In these cases, endovascular bypass and decoupling techniques are preferred. Early endovascular treatment of portal bleeding is effective for hemostasis and higher transplantation-free survival of patients. Early transjugular intrahepatic portosystemic bypass should be associated with 8-mm covered stents of controlled dilation. Combination of endovascular techniques reduces the complications of each technique and potentiates their positive effect. Endovascular treatment and prevention of portal bleeding should be determined by anatomical features of portal venous system.
Коршунов, Д. А. Целесообразность каротидной эндартерэктомии у асимптомных больных. Аналитический обзор / Д. А. Коршунов, В. А. Кульбак, А. В. Чупин // Хирургия. Журнал имени Н. И. Пирогова. – 2024. – № 3. – С. 45–53.

(Advisability of carotid endarterectomy in asymptomatic patients)

 OBJECTIVE. To determine the optimal treatment strategy for patients with asymptomatic carotid stenosis. MATERIAL AND METHODS. The authors reviewed clinical guidelines for the management of patients with asymptomatic carotid stenosis 60—99%, as well as medical studies and meta-analyses comparing carotid endarterectomy and optimal drug therapy in asymptomatic patients between 1993 and 2023. RESULTS. The choice of treatment strategy for patients with asymptomatic carotid artery stenosis is still a controversial issue. There were several large randomized clinical trials comparing carotid endarterectomy with optimal medical therapy in asymptomatic patients at the end of the 20th century. However, drug therapy has undergone significant changes calling into question the relevance of previous results. This review highlights the evolution of management of patients with asymptomatic carotid stenosis and also presents modern approaches to the treatment of these patients. CONCLUSION. Patients younger 75 years old gain an advantage from carotid endarterectomy with small perioperative risk compared to optimal drug therapy and yearly risk of cerebral embolism. Patients with asymptomatic carotid stenosis 80—99% are candidates for carotid endarterectomy due to higher risk of acute cerebrovascular accident at least until more data are available. The choice of the best tactics for a particular patient should be made individually depending on own experience and patient’s adherence to therapy and lifestyle correction. The results of the ACTRIS (2025) and CREST-2 (2026) studies are expected to clarify this issue.
Отсроченные реконструктивно-пластические операции у больных с опухолями челюстно-лицевой области: обзор литературы / Д. Ю. Азовская [и др.] // Опухоли головы и шеи. – 2023. – Т. 13, № 3. – С. 72–81.

(Delayed reconstructive plastic surgery in patients with tumors of the maxillofacial region: literature review)

 Introduction. The main treatment option for malignant neoplasms of the head and neck is combined. However, survival rates are still relatively unchanged. The surgical stage of treatment leads to extensive defects that are eliminated through reconstructive technologies. Despite the priority of performing reconstruction at the same time, delayed reconstructions are still being discussed 6–12 months after surgical treatment; therefore, it is necessary to develop new methodological and practical approaches. Aim. To determine the features of the delayed reconstructive-plastic stage in patients with malignant tumors maxillofacial region, evaluation of possible solutions for optimizing the stage. Material and methods. The analysis of available literature sources was taken in the database Medline, Pubmed, eLibrary, etc. The 101 studies were found, 60 were used to write a systematic review. Results. Delayed reconstructive plastic surgery should take into the possibility more complex and larger defects of soft and bone tissues during the reconstructive stage, previous surgery and/or radiation therapy create significant difficulties for the identification of recipient vessels. Computer-aided design (CAD)/computer-aided manufacturing (CAM) technologies allow projecting the design and positioning of reconstructive material at the preoperative stage. Mandibular reconstruction is the most difficult, that isn’t achieve only an aesthetic result, but also to restore the biomechanics of the temporomandibular joint. The development of specific complications hinders the improvement of the patient’s quality of life. In the early postoperative period is may develop necrosis of the flap, thrombosis of vascular pedicle, hematoma; in the late postoperative period plate extrusion is still one of the common complications, planning delayed reconstruction an important aspect is prevention or treatment of osteoradionecrosis. The combination of precarbohydrate loading and dalargin will allow to reduce the frequency of perioperative complications and improve the long-term results of surgical treatment. Conclusion. Reconstructive treatment in patients with defects requiring postponed reconstructive surgeries is a complex problem which requires development of an integrated approach with detailed analysis of the existing defect and previous antitumor therapy.
Оперативные доступы к брюшному отделу аорты с позиции профилактики послеоперационных вентральных грыж (обзор литературы) / Д. В. Фролов [и др.] // Ангиология и сосудистая хирургия. Журнал имени академика А. В. Покровского. – 2024. – Т. 30, № 1. – С. 131–137.

(Operative accesses to the abdominal aorta from the perspective of prevention of postoperative ventral hernias (literature review))

 Cardiovascular diseases rank first in the annual structure of mortality, with the number of reconstructive operations for these diseases growing steadily. Thus, according to the data of A.V. Pokrovsky, approximately 70 thousand arterial reconstructions were performed over 2018 alone. The traditional open surgery by the number of arterial reconstructions continues to hold a leading position. One of the possible remote complications after laparotomy, a frequently performed access to the abdominal aorta, is the development of postoperative ventral hernias. Reducing the incidence of this complication remains a challenging task for several decades. Objective. The purpose of this study was to assess the possibility of primary prevention of postoperative ventral hernias after various accesses to the abdominal aorta. Material and methods. We analyzed the data published in the Russian and English languages – PubMed, Scopius, Web of Science, eLibrary. Results and discussion. The article describes all possible types of accesses to the abdominal aorta, of laparotomic ones – the transverse and midline approaches. Based on Russian and international sources, discussed are advantages and disadvantages of each of them from the point of view of the biomechanics of the anterior abdominal wall, organization of the access, anesthesia, suture materials, postoperative wound suturing technique, use of meshes, and prevention of postoperative complications. Conclusion. Continuous suture with a monofilament long-term absorbable thread used in the small-bite stitching technique with a suture length to wound length ratio of not less than 4:1 is currently a highly recommended method for closing the abdominal cavity. Among the transperitoneal accesses, the transverse one is less often complicated by hernia formation. In patients at high risk for developing postoperative ventral hernias, especially in a longitudinal access, a polypropylene mesh may be used.
Денисенко, Э. В. Свищи прямой кишки: современное состояние проблемы, направления хирургического лечения (обзор литературы) / Э. В. Денисенко // Новости хирургии. – 2023. – Т. 31, № 5. – С. 383–396.

(Rectal Fistulas: Current State of the Problem, Directions of Surgical Treatment (Literature Review))

 Based on the literature data, an analysis of the current state of the problem of rectal fistulas is carried out in a comparative aspect: the causes of their occurrence, classification, and effectiveness of existing surgical treatment methods. The text database of medical and biological publications PubMed (based on the section “biotechnology” of the National Library of Medicine of the USA) was used through NCBI-Entrez access. The analysis of more than 450 sources of special medical literature was performed. Despite the presence of a huge number of techniques, both invasive, characterized by a high incidence of incontinence, and minimally invasive, the use of which is associated with a high risk of recurrence, diverse indicators of their effectiveness indicate that still the problem of rectal fistula and requires further search for more effective treatment methods.
Склерозирующий мезентерит как хирургическая проблема: обзор литературы и собственное клиническое наблюдение / Б. В. Болдин [и др.] // Амбулаторная хирургия. – 2024. – Т. 21, № 1. – С. 136–156. Проблеме изучения патологии брыжеечного жира тонкой кишки в практике хирурга до настоящего времени уделяется недостаточно внимания. Остается нерешенным ряд вопросов, касающихся этиологии и патогенеза заболеваний брыжейки, их возможной связи с доброкачественными и злокачественными заболеваниями, методов их лабораторной и инструментальной диагностики, возможных вариантов консервативного и хирургического лечения, а также систематизации и структурирования классификации. Одним из малоизученных представителей заболеваний брыжейки тонкой кишки продолжает оставаться склерозирующий мезентерит, характеризующийся различными гистологическими вариантами поражения брыжеечного жира и разнообразной неспецифической клинической картиной. В совокупности это приводит к определенным трудностям диагностики, обращаемости пациентов к врачам различного профиля, что в конечном итоге отрицательным образом отражается на результатах лечения и может приводить к социальной дезадаптации и возможной инвалидизации. Сообщения о встречаемости данной патологии в медицинской литературе немногочисленны и, как правило, описывают исключительно редкие клинические случаи. Однако в последние годы частота выявления этой патологии продолжает неуклонно расти, что связано с прогрессирующим старением населения, высокой степенью хирургической активности в отношении ургентных заболеваний органов брюшной полости, совершенствованием методов инструментальной диагностики. Вопросы этиологии, патогенеза, дифференциальной диагностики данного заболевания и его возможной связи с паранеопластическим процессом в настоящее время продолжают вызывать дискуссии. Дальнейшее накопление клинического опыта, лучшее понимание патогенеза заболевания, совершенствование визуализационных методик позволит разработать более четкие диагностические и клинические критерии, сузить диагностический поиск и в конечном итоге улучшить и стандартизировать лечение. В статье приведен обзор литературы, посвященный этой редкой хирургической патологии, представлено собственное клиническое наблюдение, рассмотрены вопросы диагностики и варианты лечения данного заболевания.
Роль экстракорпоральной перфузии легких при трансплантации / А. П. Фабрика [и др.] // Трансплантология. – 2024. – Т. 16, № 1. – С. 99–115. Во всем мире выполняется недостаточно операций по трансплантации легких. Это происходит вследствие малого количества подходящих (идеальных) доноров, отсутствия возможности использовать легкие от доноров, умерших от остановки сердца, невозможносности выполнения данной технически сложной операции в бедных, развивающихся странах и ряда других причин. В различных зарубежных источниках имеются сведения о повышении числа операций по трансплантации легких за счет использования органов от неидеальных (субоптимальных) доноров. Это стало возможным благодаря применению экстракорпоральной нормотермической перфузии донорских легких. Цель. Демонстрация возможностей в оценке, терапии и восстановлении функции неидеальных (субоптимальных) донорских легких благодаря применению методики экстракорпоральной перфузии донорских легких. Материал и методы. При написании статьи был произведен анализ научных статей, опубликованных в период с 2003 по 2023 г., на основе баз данных PubMed и Google Scholar по ключевому запросу “ex vivo lung perfusion”. Выводы. Методика перфузии легких ex vivo является перспективной и эффективной процедурой для их оценки, восстановления и терапии во время трансплантации. Стремительное развитие технологий, применяемых в данной методике, позволяет увеличить количество легких, пригодных для трансплантации, снизить количество посттрансплантационных осложнений и показатели смертности в листе ожидания.
Малоизученные мишени патогенеза ишемически-реперфузионного повреждения при трансплантации печени / П. О. Свищева [и др.] // Трансплантология. – 2024. – Т. 16, № 2. – С. 244–259. Трансплантация печени в настоящее время является самым эффективным методом лечения заболеваний с терминальной стадией печеночной недостаточности. Осложнения связаны чаще всего с исходно тяжелым состоянием пациента, несовершенством методов консервации органов, с самим оперативным пособием и иммунологическими осложнениями. К числу наиболее распространенных осложнений трансплантации относится ишемически-реперфузионное повреждение, которое, в той или иной степени, возникает в каждом трансплантированном органе и ухудшает течение послеоперационного периода. В основе данного процесса лежат сложные патофизиологические механизмы повреждения клеток, возникшие вследствие ишемии и воспаления, вызванного реперфузией. Цель. Обобщить современные данные о механизмах развития ишемического реперфузионнного повреждения при трансплантации печени и способах уменьшения неблагоприятных последствий. Материал и методы. Проведен анализ данных зарубежных и отечественных экспериментальных и клинических исследований, посвященных вопросам патогенеза ишемического реперфузионного повреждения при трансплантации печени. Поиск литературных данных проводился в международных базах данных (PubMed/MedLine, ResearchGate), а также в научной электронной библиотеке России (eLIBRARY.RU) за период 2020–2024 гг. Заключение. В проанализированных публикациях приводятся различные алгоритмы консервации донорских органов, в том числе с использованием аппаратной перфузии. Заслуживают внимания различные алгоритмы консервации донорских органов, в том числе с использованием аппаратной перфузии.