Surgical treatment of peripheral hepatic cholangiocarcinoma with a visceral vein invasion

Objective. To estimate the immediate and late results of surgical treatment in patients, suffering peripheral cholangiocarcinoma with invasion of visceral vein. Маterials and methods. Retrospective analysis was accomplished for surgical treatment of 84 patients, suffering peripheral cholangiocarcinoma, in whom radical operations were performed in Department of Transplantation and Hepatic Surgery of Shalimov National Istitute of Surgery and Transplantology in a period from Jan. 2004 tо Dec. 2018 yrs. The investigated group consisted of 28 patients, to whom hepatic resection with simultant resection and plasty of visceral veins for tumoral vascular invasion was performed. Into comparison group 56 patients were included, in whom hepatic resection was not accompanied with vascular resection. Results. Trustworthy differences were absent between groups in accordance to following indices: the patients’ age (p=0.16-0.7), gender (p=0.3), physical status (p=0.36), pre- and postoperative stationary stay (p=0.4). In the investigated group there were performed 14.3% hemihepatectomies, 32.1% extended hemihepatectomies and 53.6% threesectioectomies, and in a comparative one - 57.2% (р ≤ 0.001), 14.3% (р = 0.054) and 21.4% (р = 0.002), accordingly. Simultant intervention on biliary ducts was done in 37.5% patients from investigated group and in 25% patients from comparative group (р = 0.305), the adjacent organs resection - in 14.3 and 12.5% (р = 0.819) patients, accordingly. Clinically significant postoperative complications were observed in 25 and 30.4% (р = 0.262) patients, accordingly. In the investigated group postoperative mortality was absent, while in a comparative one it constituted 3.5%. In the investigated group a 3-years and a 5-years total survival was noted in 47 and 35% patients, accordingly, while in a comparison group - in 49% (р = 0.317) and 38% (р = 0.003) patients, accordingly. In investigated group a 3-years and a 5-years survival without a recurrence was noted in 39 and 28% patients, accordingly, and in a comparative group - in 44% (р = 0.04) and 31% (р=0.002) patients, accordingly. Conclusion. Іnvasion of peripheral cholangiocarcinoma into visceral veins does not constitute a contraindication for operative treatment, if it is conducted in a highly specialized multidisciplinary centre.

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Analysis of surgical treatment of duodenal ulcers with multiple combined complications

Technology transfer innovative solutions in medicine ◽

10.21303/2585-6634.2021.002151 ◽

2021 ◽

pp. 10-12

Author(s):

Pavlo Ivanchev ◽

Maxim Bilyachenko ◽

Anton Kurbanov ◽

Oleksii Lissov

Keyword(s):

Surgical Treatment ◽

Postoperative Mortality ◽

Bleeding Complications ◽

Duodenal Ulcers ◽

The Third ◽

Number Of Patients ◽

Group A ◽

Analysis Of Results ◽

Surgical Tactics ◽

Group B

The aim of the research. Analysis of results and development of surgical tactics for the treatment of DU with multiple combined complications. Materials and methods. The results of the analysis of surgical treatment of duodenal ulcers with multiple combined complications (3 and 4 combined complications) for 3 periods are presented: 1st (1983–1995) (group A) – 77 patients, 2nd (2000–2007) years (group B) – 30 patients and 3rd (2008–2020) (group C) – 46 patients. Results. 153 patients (100 %) underwent surgery for complicated duodenal ulcer (DU), of which 130 patients (84.9 %) had a combination of three complications and 23 (15.1 %) had four complications. Bleeding complications were noted in 139 of 153 patients, accounting for 90.8 %, and ulcer perforation in 69 patients, accounting for 45.1 % of all other complications. Based on the obtained data of the analysis, there is a steady tendency to increase the proportion of organ-preserving operations (OPO) by 1.5 times (from 50.7 % to 76.2 %), reducing the number of gastrectomy (GR) by 3 times (from 14.5 % to 4.8 %) and palliative operations (PAL) 3.3 times (from 15.8 % to 4.8 %) with a relatively stable number of performed organ-saving operations (OSO): in group A – 17 (24.6 %) interventions, in group B – 4 (21.1 %), group C – 6 (14.3 %). Conclusions. The use of modern measures of endoscopic hemostasis allowed to operate on patients in the delayed period, and their share from the second period to the third increased 2.8 times. The number of patients who underwent emergency surgery with perforation of the ulcer as one of the complications decreased in the third period compared to the second by 2.6 times, due to the widespread use of PPIs in the conservative treatment of DU. According to the results of the analysis it became known that the chosen active-individualized tactics and developed algorithms for choosing the type of surgery allowed to achieve a stable level of postoperative mortality at 8.3 %.

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Decompressive craniectomy in the treatment of supratentorial hypertensive intracerebral hematomas

Russian journal of neurosurgery ◽

10.17650/1683-3295-2021-23-2-66-76 ◽

2021 ◽

Vol 23 (2) ◽

pp. 66-76

Author(s):

V. G. Dashyan ◽

V. A. Khamurzov ◽

E. A. Sosnovskiy ◽

A. V. Sytnik ◽

D. V. Khovrin ◽

...

Keyword(s):

Surgical Treatment ◽

Mortality Rate ◽

Decompressive Craniectomy ◽

Comparison Group ◽

Postoperative Mortality ◽

Study Objective ◽

Recurrent Hemorrhage ◽

Brain Substance ◽

The Brain

The study objective is to evaluate feasibility and effectiveness of decompressive craniectomy (DC) for treatment оf supratentorial hypertensive intracerebral hematomas (ICH).Materials and methods. Between 1996 to 2019, 97 patients with supratentorial hypertensive ICHs underwent surgical treatment. DC was performed in 50 patients (primary - in 41, secondary - in 9). Putaminal hematomas were diagnosed in 30 patients, subcortical - in 20. The comparison group consisted of 47 patients, of which 20 had osteoplastic craniotomy (OPC) with microsurgical removal of ICH, and 27 had endoscopic aspiration (EA). The performed DCa were treated as unjustified (decreased brain dislocation without prolapse of the brain substance into the trepanation defect), ineffective (preservation of brain dislocation and absence of prolapse of the brain substance into the trepanation defect, as well as small size of the trepanation hole) and effective (prolapse of the brain substance into the trepanation defect and regression of transverse brain dislocation).Results. DC was effective only in 22 (44 %) patients (13 - primary, 9 - secondary). Among patients with subcortical ICH, mortality rate after DC was equal to that after OPC and EA. Among patients with putaminal ICH, the mortality rate after DC was significantly higher than after OPC and EA. Among the patients who underwent primary EA and delayed DC (due to recurrent ICH), postoperative mortality rate was significantly higher than among the patients who underwent repeated EA of recurrent ICH. However, there were no fatal outcomes among patients who underwent delayed DC due to increased edema and transverse dislocation of the brain without recurrent ICH.Conclusion. In the surgical treatment of supratentorial hypertensive ICH, decompressive effect of DC was achieved only in 44 % of patients. Open removal of putaminal hematomas in combination with DC was unjustified, mortality rate was 66 %. Primary DC with removal of ICH is indicated in patients with subcortical hematomas with a volume >50 cm3 , with transverse dislocation >7 mm, deep deafness or sopor. Delayed DC, regardless of the location of ICH, is recommended in case of increased edema and transverse dislocation of the brain in patients without recurrent hemorrhage.

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Surgical treatment of patients with descending purulent mediastinitis

Medicni perspektivi (Medical perspectives) ◽

10.26641/2307-0404.2021.4.248192 ◽

2021 ◽

Vol 26 (4) ◽

pp. 118-123

Author(s):

I.M. Shevchuk ◽

S.S. Snizhko

Keyword(s):

Surgical Treatment ◽

Pleural Cavity ◽

Comparison Group ◽

Postoperative Mortality ◽

Complete Removal ◽

Main Group ◽

Surgical Interventions ◽

Results Of Treatment ◽

Minimally Invasive Surgical ◽

Surgical Tactics

The aim of the study was to improve the results of treatment of patients with descending purulent mediastinitis by means of individualized surgical tactics with the priority use of minimally invasive surgical interventions and developed methods of drainage of the mediastinum and pleural cavity. Examination and treatment of 73 patients with descending purulent mediastinitis receiving treatment in the department of thoracic surgery of Ivano-Frankivsk regional clinical hospital was carried out. Treatment of patients in the main group included intramediastinal administration of antibiotics, the use of the developed method of cascade drainage of the mediastinum and pleural cavity, the priority use of video-assisted thoracoscopy and surgical tactics aimed at anticipating the spread of the purulent process in the mediastinum. The rapid and reliable decrease in the indices of endogenous intoxication in the main group confirms the effectiveness of the developed tactics of surgical treatment of patients with mediastinitis, adequate sanation of purulent mediastinatis, complete removal of the purulent substrate from the mediastinum and pleural cavity. The developed tactics of surgical treatment of purulent mediastinitis allowed reducing the overall postoperative mortality from 26.3% in the comparison group to 11.4% in the main group of patients.

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EVALUTION OF MAMMARY GLAND PROSTHESIS ROTATION PROPHILAXIS EFFECIENCY IN A THREE YEARS POSTOPERATIVE PERIOD

Clinical anatomy and operative surgery ◽

10.24061/1727-0847.18.4.2019.5 ◽

2019 ◽

Vol 18 (4) ◽

pp. 29-36

Author(s):

O. I. Zakhartseva ◽

Ya. M. Susak ◽

L. Yu. Markulan

Keyword(s):

Mammary Gland ◽

Postoperative Period ◽

Comparison Group ◽

Main Group ◽

Augmentation Mammoplasty ◽

Lactation Period ◽

Significant Difference ◽

Group A ◽

Clinically Significant ◽

One Year

Mammary gland prosthesis rotation (MGPR) after augmentation mammoplasty is a poorly studied complication of plastic surgery. The frequency of MGPR is not well known. There are indications that MGPR of 90○ , which is considered clinically significant, ranges from 0.9 % to 14 %. Preventing methods of MGPR are not developed enough. Aim: determination of the effectiveness of the upper pole reinforcement of «neo pocket» with prolen thread for the prevention of MGPR after primary augmentative mammoplasty (PAMP) in three years of postoperative period. Material and methods. The invectigation is performed on the basis of the Surgery Department No. 4 of Bogomolets NMU in the period from 2013 to 2018. A prospective, independent comparison of the primary augmentative mammaplasty results between three independent groups of patients was performed: two groups of comparison and one main groups. The first group of comparison (Group P1) included 94 patients who evaluated the results of augmentative mammaplasty one year after the operation, the second comparison group (Group P3) – 63 patients three years after this operation. The main group (group O) included 76 patients who had a prospective study after one (group O1) and then three years later (group O3) – 62 patients. In the comparison groups, the standard MGPR was performed, in the main group – according to the developed method. The patients did not differ statistically by age, body mass index (BMI), weight of prostheses, percentage of pregnant women and patients with lactation period. In all the cases, textured prostheses with high and medium profile were implanted. The majority of patients were operated with prostheses from 325-335 ml and 375 ml. The MGPR evaluation was carried out in accordance with the developed method using the ultrasound of the ESAOTE firmware model Technos Partner with a linear sensor with frequency of 12.5 MHz. Data analysis was performed using the IBM SPSS Statistics 22 statistical analysis packets. Results. One year after the operation in the P1 group, a slightly lower, but not reliable percentage of prosthesis rotation – 143 (76.1 %) against 103 (81.7 %) in the group P3, p=0.231, was diagnosed. At the same time, in the P1 group only 4 (4.3 %) women did not have the rotation of the prosthetics of both mammary gland (MG) and in the P3 group 2 women (3.2 %), p=0.001. Significant difference of the frequency of patients with clinically significant MGPR: 11 (11.7 %) patients in the P1 group versus 12 (19.0 %) in the P3 group (p = 0.202) and 13 (6.9 %) in the P1 group against 13 (10.3 %) of the prostheses in the group P3 (p=0.284). In patients in the main group, a small (30.9%) frequency of clinically insignificant MGPR was noticed after PAMP and it did not increase after the three years period (32.1%). In the P1 group, 143 (76.1 %) prostheses were diagnosed with rotation, in the group O1 – 46 (30.3 %), p = 0.001. At the same time, in the P1 group, only 4 (1.6 %) women didn`t have the rotation of the of both MG prostheses and in the group – 39 (51.3 %), p = 0.001, which indicates the effectiveness of the developed methodology. A similar trend was observed in the case of comparison of the three years results between the group P3 and the group O3. The absence of rotation of prostheses was diagnosed in 83 (66.9 %) O3 group and 26 (20.6 %) in the P group, and there was no clinically significant rotation of O3 patients versus group P where these patients were observed: 12 (19.0% ), p=0.001. Conclusion: the method of fixation of the submuscular «neo pocket» upper pole with prolen thread, provides stable protective effect of MGPR and gives a possibility to avoid a clinically significant rotation(more than 900) throughout three years after augmentative mammoplasty comparing with a traditional method – 11.7 %, patients in a year – 19 %, in three years after PAMP, р<0,01.

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Immediate results of surgical treatment of peripheral hepatic cholangiocarcinoma in elderly and senile patients

Klinicheskaia khirurgiia ◽

10.26779/2522-1396.2020.9-10.48 ◽

2020 ◽

Vol 87 (9-10) ◽

pp. 48-53

Author(s):

O. Yu. Usenko ◽

O. V. Hrynenko ◽

A. І. Zhylenko ◽

O. O. Popov ◽

A. V. Husiev

Keyword(s):

Surgical Treatment ◽

International Study ◽

Main Group ◽

Control Group ◽

Results Of Treatment ◽

Peripheral Cholangiocarcinoma ◽

Acute Pulmonary Thromboembolism ◽

Clinically Significant ◽

Selection Of

Objective. To estimate immediate results of surgical treatment of peripheral cholangiocarcinoma in elderly and senile patients. Materials and methods. In 2004-2018 yrs period in the Department of Transplantation and Surgery of the Liver of the Shalimov National Institute of Surgery and Transplantology 84 patients, suffering peripheral cholangiocarcinoma, were radically operated: 31 (36.9%) patients older than 60 yrs (the main Group), and 53 (63.1%) patients, younger than 60 yrs (control Group). Results. Postoperative clinically significant (IIIa-IV degree in accordance to classification of Clavien-Dindo) complications during 90-days of postoperative period were noted in 29.1% patients of the main Group and in 32.1% patients of a control Group (p=0.262), postoperative hepatic insufficiency, in accordance to The International Study Group of Liver Surgery criteria, - in 16.1 and 22.6% accordingly (p=0.473); reoperation was performed in 9.6 and 9.4% patients, accordingly (p=0.973). The causes of postoperative lethality in 2 patients of the main Group were an acute myocardial infarction (1) and an acute pulmonary thromboembolism (1). Conclusion. Hepatic resection is characterized by satisfactory immediate results of treatment of peripheral cholangiocarcinoma in elderly and senile patients, if performed in highly-specialized multidisciplinary centre and thorough selection of patients.

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The methods of prophylaxis of the morbidity occurrence after pancreatico-duodenal resection

Klinicheskaia khirurgiia ◽

10.26779/2522-1396.2019.05.03 ◽

2019 ◽

Vol 86 (5) ◽

pp. 3-7

Author(s):

V. М. Коpchak ◽

L. О. Pererva ◽

О. V. Duvalko ◽

V. V. Khanenko ◽

S. V. Аndronik ◽

...

Keyword(s):

Postoperative Complications ◽

Pancreatic Fistula ◽

Comparison Group ◽

Main Group ◽

Postoperative Pancreatic Fistula ◽

Occurrence Rate ◽

Results Of Treatment ◽

Comparative Group ◽

Clinically Significant ◽

Duodenal Resection

Objective. To elaborate the system of measures with objective of lowering of the occurrence rate for pancreatic fistula and severe complications after pancreaticoduodenal resection (PDR). Маterials and methods. Results of treatment was analyzed for 143 patients, to whom pancreaticoduodenal resection performed. In accordance to the scheme proposed, using elaborated scale of the risk for occurrence of postoperative pancreatic fistula, were operated 56 patients in 2017 - 2018 yrs (the main group). Comparative group consisted of 87 patients, operated in the clinic in 2015 - 2016 yrs without estimation of the risk for postoperative pancreatic fistula occurrence and sarcopenia presence, and formation of pancreaticojejunoanastomosis have depended upon decision of a surgeon-operator. Results. The rate of occurrence of the postoperative complications was trustworthily higher in the comparison group (c2 = 5.8, p=0.01). In the main group a clinically significant pancreatic fistula of Grade В was observed in 1 of 7 patients with postoperative complications. In the comparison group pancreatic fistulas of Grades В or С were diagnosed in 15 of 26 patients with postoperative complications, which are trustworthily higher, than in the main group (c2 = 4.16, p=0.04). Conclusion. The system of measures elaborated gave the possibility to reduce the occurrence rate for pancreatic fistula significantly - from 17.2 tо 1.8% and severe postoperative morbidity - from 29.9 tо 12.5%.

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Surgical approaches for definitive treatment of hepatic alveolar echinococcosis: results of a survey in 178 patients

Parasitology ◽

10.1017/s0031182019000891 ◽

2019 ◽

Vol 146 (11) ◽

pp. 1414-1420 ◽

Cited By ~ 4

Author(s):

Chuang Yang ◽

Jingyu He ◽

Xianwei Yang ◽

Wentao Wang

Keyword(s):

Liver Resection ◽

Hepatic Resection ◽

Alveolar Echinococcosis ◽

Larval Growth ◽

Postoperative Mortality ◽

Definitive Treatment ◽

Surgical Approaches ◽

Hepatic Alveolar Echinococcosis ◽

Group A ◽

Group D

AbstractHepatic alveolar echinococcosis (HAE) is a potentially fatal disease caused by the larval growth of Echinococcus multilocularis. We analysed the clinical data of 178 consecutive HAE patients treated with definitive radical surgery at our institution. According to the surgical approach: group A patients underwent direct radical hepatic resection; group B patients first underwent percutaneous puncture external drainage, followed by radical hepatic resection 2 months later; group C patients underwent a two-step hepatic resection; and group D patients underwent liver transplantation. The baseline characteristics, mortality, postoperative complications and recurrence rates were evaluated. Symptoms were present in 79.8% (142/178) patients. Bi-lobar lesion was found in 34 (19.1%, 34/178) patients, 47.2% (84/178) of whom had ⩾2 lesions each. There were no intraoperative deaths. The postoperative mortality was 2.29% in group A, 8.62% in group D and 0% in groups B and C. The main cause of death was a serious postoperative complication (Clavien–Dindo grades III–V). Patients were followed-up systematically for a median of 35.8 months (8–72) without recurrence. Active HAE should be treated by radical liver resection, and the complicated alveolar echinococcosis of the liver has been managed whenever possible using principles of radical liver resection by experienced hepatic surgeons.

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Selflessness in Anorexia Nervosa as Reflected in the Rorschach Comprehensive System

Rorschachiana Journal of the International Society for the Rorschach ◽

10.1027/1192-5604/a000028 ◽

2012 ◽

Vol 33 (1) ◽

pp. 78-93 ◽

Cited By ~ 1

Author(s):

Gili Curiel-Levy ◽

Laura Canetti ◽

Esti Galili-Weisstub ◽

Myrna Milun ◽

Eitan Gur ◽

...

Keyword(s):

Multivariate Analysis ◽

Anorexia Nervosa ◽

Analysis Of Variance ◽

Clinical Observation ◽

Comparison Group ◽

Comprehensive System ◽

Multivariate Analysis Of Variance ◽

Rorschach Comprehensive System ◽

Group A

This study examines the expression of selflessness – the tendency to ignore one’s own needs and serve others’ needs – in Rorschach protocols of women suffering from anorexia nervosa. The protocols of 35 women suffering from anorexia nervosa were compared to 30 protocols of a psychiatric comparison group. A multivariate analysis of variance over five variables (AG, PER, PHR, COP, and GHR) was significant: Anorexic patients showed higher characteristics of selflessness compared to the psychiatric comparison group. These findings contribute to the validation of the Rorschach technique and to the clinical observation of selflessness in anorexic patients, and they emphasize specific characteristics in the treatment of anorexia nervosa patients.

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Re-operation rate after surgical treatment of osteochondral lesions of the talus in paediatric and adolescent patients

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02282-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Daniel Körner ◽

Christoph E. Gonser ◽

Stefan Döbele ◽

Christian Konrads ◽

Fabian Springer ◽

...

Keyword(s):

Surgical Treatment ◽

Bone Grafting ◽

Cartilage Damage ◽

Osteochondral Lesions ◽

Retrograde Drilling ◽

Autologous Bone Grafting ◽

Operation Rate ◽

Group A ◽

Autologous Bone ◽

Group B

Abstract Background The aim of this study is to analyse the re-operation rate after surgical treatment of osteochondral lesions of the talus (OCLTs) in children and adolescents. Methods Between 2009 and 2019, 27 consecutive patients with a solitary OCLT (10 male, 17 female; mean age 16.9 ± 2.2 years; 8 idiopathic vs. 19 traumatic) received primary operative treatment (arthroscopy + bone marrow stimulation [BMS], n = 8; arthroscopy + retrograde drilling, n = 8; autologous chondrocyte implantation [ACI]/autologous bone grafting, n = 9; arthroscopy + BMS + retrograde drilling; n = 1; flake fixation, n = 1). Seventeen OCLTs were located at the medial and ten at the lateral talus. ‘Re-operation’ as the outcome measure was evaluated after a median follow-up of 42 months (range 6–117 months). Patients were further subdivided into groups A (re-operation, n = 7) and B (no re-operation, n = 20). Groups A and B were compared with respect to epidemiological, lesion- and therapy-related variables. Results Seven of 27 patients needed a re-operation (re-operation rate 25.9% after a median interval of 31 months [range 13–61 months]). The following operative techniques were initially used in these seven patients: arthroscopy + BMS n = 2, arthroscopy + retrograde drilling n = 4, ACI + autologous bone grafting n = 1. A comparison of group A with group B revealed different OCLT characteristics between both groups. The intraoperative findings according to the International Cartilage Repair Society (ICRS) classification revealed significantly more advanced cartilage damage in group B than in group A (p = 0.001). Conclusions We detected a re-operation rate of 25.9% after primary surgical OCLT treatment. Patients with re-operation had significantly lower ICRS classification stages compared to patients without re-operation.

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Outcomes of Surgical and Nonsurgical Treatment for Colorectal Cancer in Nonagenarian Patients

The American Surgeon ◽

10.1177/0003134821995060 ◽

2021 ◽

pp. 000313482199506

Author(s):

Youngbae Jeon ◽

Kyoung-Won Han ◽

Won-Suk Lee ◽

Jeong-Heum Baek

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Surgical Treatment ◽

Postoperative Complications ◽

Postoperative Mortality ◽

Nonsurgical Treatment ◽

Perioperative Outcomes ◽

Rank Test ◽

Kaplan Meier ◽

Number Of Patients

Purpose This study is aimed to evaluate the clinical outcomes of surgical treatment for nonagenarian patients with colorectal cancer. Methods This retrospective single-center study included patients diagnosed with colorectal cancer at the age of ≥90 years between 2004 and 2018. Patient demographics were compared between the operation and nonoperation groups (NOG). Perioperative outcomes, histopathological outcomes, and postoperative complications were evaluated. Overall survival was analyzed using Kaplan-Meier methods and log-rank test. Results A total of 31 patients were included (16 men and 15 women), and the median age was 91 (range: 90‐96) years. The number of patients who underwent surgery and who received nonoperative management was 20 and 11, respectively. No statistical differences in baseline demographics were observed between both groups. None of these patients were treated with perioperative chemotherapy or radiotherapy. Surgery comprised 18 (90.0%) colectomies and 2 (10.0%) transanal excisions. Short-term (≤30 days) and long-term (31‐90 days) postoperative complications occurred in 7 (35.0%) and 4 (20.0%) patients, respectively. No complications needed reoperation, such as anastomosis leakage or bleeding. No postoperative mortality occurred within 30 days: 90-day postoperative mortality occurred in two patients (10.0%), respectively. The median overall survival of the operation group was 31.6 (95% confidence interval: 26.7‐36.5) and that of NOG was 12.5 months (95% CI: 2.4‐22.6) ( P = 0.012). Conclusion Surgical treatment can be considered in carefully selected nonagenarian patients with colorectal cancer in terms of acceptable postoperative morbidity, with better overall survival than the nonsurgical treatment.

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