Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)
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Physician's clarification on a patient's complaint as a draft of clinic's response to a complaint about the quality of medical care
Potential of artificial intelligence methods in diseases of the venous system of the lower extremities
The use of new Artificial Intelligence (AI) methods is rapidly changing the face of modern medicine, offering advanced tools for diagnosis and treatment. The aim of this review is to map key concepts and research directions in the application of AI methods in the diagnosis and treatment oflower extremity venous diseases. This review is presented in accordance with the PRISMA ScR guidelines. A search was conducted in Medline/PubMed, Web of Science, Scopus, Embase, ResearchGate, Google Scholar, and the Cochrane Database of Systematic Reviews for studies published through December 2025. Studies were included in the review if they applied AI methods in diagnostics and clinical practice. A total of 1,071 studies were analyzed. The use of AI methods inlower extremity venous pathology is rapidly evolving and demonstrates significant potential for increasing diagnostic precision, automating workflows, and improving clinical decision making. The achieved accuracy of AI algorithms exceeded 90%, significantly reducing interobserver variability and ensuring consistent interpretation, eliminating operator dependency. The implementation of AI accelerated diagnostic workflows, reducing image analysis time by more than 50%. However, most studies relied on in-house datasets withlimited model interpretability and alack of external validation. Clinical implementation and outcome evaluation remain understudied. AI methods represent a transformative innovation that, by increasing diagnostic accuracy, streamlining workflows, and enabling a personalized approach, has significant potential to improve treatment outcomes for lower extremity venous pathology. AI has a promising future in its widespread use for prognostication, developing personalized treatment strategies for patients based on individual profiles, and creatinglarge-scale multicenter datasets to improve the reliability and versatility of algorithms. Priority should be given to external validation, standardization, and the implementation of AI in real-world clinical practice.
Plantar vein thrombosis: Clinical presentation, diagnosis, treatment
Plantar vein thrombosis is an underdiagnosed and, therefore, underestimated pathology with subsequent complications of various degrees of severity. However, the close anatomical relationship between the plantar veins and the superficial and deep leg veins can lead to proximal thrombus propagation with all the consequences that come with it, including fatal pulmonary embolism. The main manifestation of plantar vein thrombosis is pain that worsens with walking, which is an obvious reason to see a surgeon or orthopedic traumatologist. As a significant number of such patients have anatomical foot deformities of varying severity, the mostlikely diagnoses are platypodia, plantar fasciitis, osteoarthritis, etc., followed by orthopedic correction and prescription of nonsteroidal anti-inflammatory drugs. It is apparent that in some cases the treatment is partially successful, which confirms the “correctness” of the diagnosis. At the same time, missed plantar vein thrombosis can reappear, and its consequences can negatively impact the calf musculovenous pump function which is the primary mechanism of centripetal blood flow from the lower extremities. This article presents a case report of a 73-old-patient D. with moderate plantar pain in his left foot in the region closer to the calcaneal tuberosity, which increases with walking. An ultrasound examination demonstrated an occlusive thrombosis of theleft foot medial andlateral plantar veins. The prescribed therapy included rivaroxaban, 15 mg twice daily with food for 3 weeks, followed by switching to a single daily dose of 20 mg for 3 months, wearing of Bauerfeind VenoTrain micro compression stockings, knee high, class 2 (Germany), and foot correction with orthopaedic appliances. After 3-month therapy, the ultrasound examination showed signs of successful recanalization of thrombotic masses in the medial andlateral plantar veins of theleft lower extremity. It should be highlighted that routine ultrasound is the best method used to diagnose plantar vein thrombosis.
Phlebitis after cyanoacrylate obliteration: Modern state of the problem
Phlebitis is a specific and widespread complication of cyanoacrylate obliteration (CAO). However, the definition, mechanisms of development, the incidence, and common treatment methods, have not been clarified. The study aimed to evaluate the incidence of phlebitis in a treated vein after CAO of varicose veins (VV) of the lower limbs and explore approaches for diagnosis and treatment of the latter complication. In March 2025, a systematic search for relevant papers was performed in PubMed, which included original studies with data about patients with VVs who underwent CAO and reported the incidence of post-procedure cyanoacrylate phlebitis (CAP). The primary endpoint was the presence of confirmed phlebitis and/or a phlebitis-like reaction in treated veins according to the original study criteria. Extracted data were summarized with a random effects model. A literature search identified 114 references, of which 24 full-text studies reporting 27,362 interventions were included in the analysis. Additionally, data from our study about the use of the original cyanoacrylate composition with “VACOV” technique in 53 patients were included. The incidence of CAP was 11% (95% CI: 7–14%; p < 0.001, I2 = 92.4%). The subgroup analysis according to methods of glue embolization revealed significant differences in CAP incidence with VariClose (Turkey), VenaBlock (Turkey) and VenaSeal (USA): 4% (95% CI: 2–6%), 3% (95% CI: 0–5%), and 16% (95% CI: 11–21%), respectively (p < 0.001). Pain along the treated vein, palpatory tenderness, hyperemia, and swelling were the most common clinical manifestations of phlebitis. The treatment of CAP was heterogeneous and included as follows: nonsteroidal anti-inflammatory drugs, antihistamines, glucocorticoids, and antibiotics. CAP is a frequent specific complication of CAO with an incidence of 11% without defined diagnostic criteria and common treatment and prophylaxis approaches.
Application of ozone-oxygen mixture for scleroobliteration of telangiectasias and reticular veins
Introduction. Telangiectasias and reticular veins (C1 by CEAP) cause aesthetic discomfort; standard sclerotherapy has side effects like pigmentation. Ozone-oxygen mixture offers an alternative via oxidative endothelial damage and tissue oxygenation. Aim. To evaluate the efficacy and safety of intravascular sclerotherapy using an ozone-oxygen gas mixture for telangiectasias and reticular varicose veins of the lower extremities. Materials and methods. The study included 30 patients (25 women and 5 men) with telangiectasias and reticular varicose veins (class C1 by CEAP). All patients underwent a course of sclerotherapy consisting of intravascular injections of an ozone-oxygen mixture into the affected superficial veins using a microneedle (ozone concentration was 70%). Procedures were performed on an outpatient basis once per week; the mean number of sessions per patient was 4.2 ± 1.1. Treatment efficacy was evaluated at 30 days after completion of therapy based on the degree of vascular network disappearance and patient satisfaction. Results. 93% of patients (28/30) achieved complete or significant (>75%) obliteration of telangiectasias and reticular veins after the treatment course. No serious complications were observed. Side effects were limited to transient erythema, mild edema and moderate pain at injection sites, which resolved spontaneously. No cases of skin hyperpigmentation, necrosis or scarring were noted. The cosmetic outcome was high: 97% of patients were satisfied with the results. Conclusion. Ozone-oxygen injection sclerotherapy is an effective and safe method for sclerobliteration of telangiectasias and reticular varicose veins, providing excellent cosmetic results with minimal invasiveness. The technique does not induce typical adverse reactions such as hyperpigmentation or scarring, and it expands options for minimally invasive treatment of early-stage varicose vein disease, thereby improving patients’ quality of life.
Potential for laser coagulation in the treatment of varicose vein disease in adolescents
Introduction. In recent years, there has been a trend toward younger patients with chronic venous disease (CVD). Only a few publications on this topic exist in the domestic and internationalliterature, which do not provide clarity on patient management strategies. Aim. To evaluate the feasibility of using modern minimally invasive techniques in the treatment of pediatric patients with varicose veins. Materials and methods. The study included 30 adolescents with clinical class C2 varicose veins; aged up to 18 years. The mean age was 15.9 ± 1.5 (12–17) years. The mean patient height was 175.9 ± 10.0 cm, body mass index was 21.5 ± 2.7 kg/m2. Venospecific symptomss were noted in 23 patients (76.7%): pain (n = 23), swelling (feeling of swelling, n = 8), excessive fatigue (n = 6). A total of 34 surgical interventions were performed: endovenous laser obliteration of the great saphenous vein (GSV) – 26 (76.5%), the small saphenous vein – 8 (23.5%), and the anterior accessory saphenous vein – 2 (5.9%). In 29 cases (85.3%),laser obliteration was supplemented by microphlebectomy of the tributaries. Results. These duplex scanning data were evaluated over a 12-month period in 28 (86.7%) patients. Target vein occlusion persisted in 96.9%. In one case, partial recanalization of the GSVlumen was observed without recurrence of clinical symptoms. Positive dynamics in subjective complaints were noted: a decrease in pain severity from 2.5 ± 0.5 to 1.2 ± 0.3 (p < 0.05), and swelling from 2.4 ± 0.5 to 0.4 ± 0.2 points (p < 0.05) on the visual analog scale. Conclusions. The obtained data allow us to consider EVLT with a wavelength of 1940 nm as the method of choice for the treatment of varicose veins in children and adolescents. There is a need for continued research in this area to more clearly substantiate the tactics of active surgical treatment for patients in this age group.
Comparative efficacy of combination drug regimens after endovenous laser coagulation and sclerotherapy in lower extremity varicose vein disease
Introduction. Endovenouslaser coagulation/obliteration (EVLC/EVLO) and microfoam sclerotherapy (MS) are highly effective treatments for chronic venous diseases, particularly varicose veins. Yet the question remains – what should be done to improve patient care after minimally invasive interventions in the postoperative period. Aim. To evaluate the efficacy of various combination drug regimens with micronized purified flavonoid fraction (MPFF) and sulodexide after EVLC and sclerotherapy inlower extremity varicose vein disease. Materials and methods. A comparative study involving 150 patients with CEAP C2–C3 varicose veins was conducted. The patients were divided into three groups of 50. Venous duplex ultrasound demonstrated the great saphenous vein (GSV) valve incompetence in 117 cases (71%) and the small saphenous vein (SSV) valve incompetence in 33 cases (29%). All patients underwent treatment with EVLC on the GSV/ SSV combined with foam sclerotherapy (FS). Three different drug regimens were used in the preand postoperative periods. Follow-up examinations of patients took place on days 1 and 10 after surgery, as well as at 3 and 6 months. Results. On day 7, the pain intensity began to regress faster in groups 2 and 3 (VAS pain score, p < 0.05). On day 90, statistically significant improvement in the quality oflife was observed in group 3 (VEINES-QOL scores, p < 0.01). On day 180, CIVIQ-20 quality-of-life scores were also higher in group 3. Treatment satisfaction and medication adherence were highest among patients in groups 2 and 3 throughout the entire course. Conclusion. The topical gel and extended 60-day MPFF-based regimen showed the best results: relief of early symptoms (pain, induration) within the first 7 days after surgery, improved quality oflife, no recurrence of varicose transformed tributaries, adequate management of chronic venous insufficiency symptoms by month 3 and 6, and patient compliance.
Modern superabsorbent wound dressing in the treatment of complicated forms of diabetic foot syndrome: Clinical research
Introduction. The number of people with diabetes mellitus (DM) in the world is increasing exponentially, most of them are of working age. Diabetic foot syndrome (DFS)leads to theloss of alimb or part of it in 60% of cases. The effective effect of modern sorbent dressings at different stages of the course of the wound process remains the subject of study, controversy and requires deeper awareness and confirmation. Aim. To detail the effect of modern superabsorbent dressings on the wound process in patients with complicated diabetic foot syndrome. Materials and methods. A clinical prospective study was conducted to study changes in: laboratory parameters (urea, creatinine, granulocytes, leukocytes, lymphocytes, MID cells); wound area; reduction of wound area as a percentage; healing rate and microbial landscape of wound defects against the background of superabsorbent wound dressing in thelocal treatment of complicated forms of diabetic foot syndrome. A total of 54 patients were selected for the analysis: the main group consisted of 24 people, aged from 49 to 79 years, the average age was 64 ± 11 years, the proportion of men was 41.6% (10/24); the comparison group consisted of 30 people aged from 54 to 75 years, the average age was 65 ± 9 years, the proportion of men was 33.3% (10/30). Results. Studies of changes inlaboratory parameters: urea, creatinine, granulocytes,leukocytes,lymphocytes, MID cells showed statistically significant differences in both groups at different stages of treatment, mainly on the 14th and 30th day of treatment (4–5 visits). The dynamics of the wound healing rate, a decrease in the wound area as a percentage, a change in the wound area as a whole, as well as a change in the bacterial contamination of the wound were significantly different already on the 7th day of treatment. Conclusions. The expediency of using Zetuvit Plus Silicone sorbent dressings was confirmed by a study of the dynamics of changes in laboratory parameters, the quantitative and qualitative microbiallandscape of trophic ulcers against the background of diabetes mellitus, and indicators of soft tissue regeneration processes.
The experience of using photodynamic therapy in the complex treatment of venous ulcers
Introduction. A promising direction in the management of venous leg ulcers is photodynamic therapy (PDT), which is based on the use of photosensitizers that selectively accumulate in pathological tissues. Upon exposure tolight of a specific wavelength, reactive oxygen species are generated,leading to the destruction of damaged cells, stimulation of tissue regeneration, and exerting an antimicrobial effect. Aim. To evaluate the treatment outcomes of patients with venous ulcers using PDT. Materials and methods. An analysis was conducted on the treatment outcomes of 49 patients, including 33 men (67.3%). The patients were aged between 51 and 76 years. All 49 individuals had a history of post-thrombotic syndrome, and the duration of the ulcerative defect exceeded six months. In 23 patients, treatment was carried out using conventional therapeutic methods. In 26 cases,locallaser exposure was added to the treatment regimen, following the application of the photosensitizing agent Photoditazine to the wound surface. Results. During treatment, the level of microbial contamination decreased in both groups. However, patients in the study group showed a more rapid decrease starting as early as the 4th day of hospitalization. By the 8th day, this indicator was significantlylower in patients in the study group. Similar trends were also recorded on the 12th day of the study. An earlier transition to the regenerative type of cytogram was observed in patients receiving PDT, along with the formation of new granulation tissue by day 12. Conclusions. The obtained results confirm the clinical feasibility of using PDT in the treatment of patients with venous ulcers.
Joint osteoarthritis: Is there something we can do without a scalpel and a pill?
Osteoarthritis oflarge joints, including knee osteoarthritis, is one of the most common diseases. Pain is one of the main symptoms of knee osteoarthritis (KOA). Itleads to a decrease in quality oflife for patients. Despite undeniable advances in both surgical and medical treatments, this problem remains far from resolved. As a result of searching the PubMed, Web of Science, Scopus, Cochrane Library and eLIBRARY.RU electroniclibrary databases, 99 publications were selected from the period from 1999 to 2025, including data from randomized controlled trials,longitudinal and cohort studies, practical and clinical guidelines. This article focuses on non-pharmacological treatments for KOA, specifically the use of specialized braces, orthoses, and insoles. Current data on these devices effectiveness in osteoarthritis treatment are presented. The use of braces and orthoses helps relieve pressure on the knee joint, reduce pain, improve quality oflife, and accelerate rehabilitation after surgery. Comparative results of orthosis and brace use are analyzed. Wedge-shaped insoles should be an important element of treatment for patients with KOA. They can serve both as a preventative measure for the osteoarthritis development and as a treatment method for slowing the progression of existing disease. Furthermore, wedge-shaped insoles help improve the musculo-venous pump function and normalize venous outflow from thelimb, which is extremely important given the currently available data on the role of chronic venous disease in the development and progression of osteoarthritis. Therefore, biomechanical devices should be a mandatory component of the treatment of patients with knee osteoarthritis.
Methods for accelerating wound healing in patients undergoing surgical interventions on the anal canal
Surgical interventions performed for hemorrhoids, anal fissures, and rectal fistulas are associated with the formation of anal canal wounds that have a number of unique characteristics. This article discusses methods for accelerating wound healing in patients undergoing anal surgery. Healing in this anatomical area is challenging due to constant bacterial contamination, mechanical stress during defecation, and the risk of tissue ischemia, which necessitates a comprehensive approach to treatment. The most significant foreign and domestic sources were analyzed through the search engines PubMed, eLIBRARY.RU and cyberleninka.ru in recent years using the following keywords and their combinations: "anal canal", "wound process", "tissue repair", "anal canal wound healing", "anal canal wound healing time". The article provides a detailed review of modern strategies for managing the postoperative period in patients who have undergone surgery on the anal canal. The analysis covers a wide range of methods: from the fundamental principles of postoperative pharmacotherapy and modern surgical techniques that improve anal canal wound repair, to the use of interactive wound dressings, physiotherapy, and promising biotechnologies. At the same time, the pathogenetic mechanisms of action of each method, their effectiveness and role in creating optimal conditions for the reparation of anal canal tissues were analyzed in detail. A comprehensive approach is key to improving reparation, reducing the healing time of anal canal wounds, and speeding up postoperative rehabilitation of patients. Prospects for further research are seen in the optimization of treatment protocols and the conduct oflarge comparative studies to determine the most effective algorithms for managing patients who have undergone intervention on the anal canal.
Simultaneous minimally invasive operations in coloproctological patients with combined surgical diseases on an outpatient basis
Introduction. Due to the active introduction of high-tech minimally invasive surgical interventions into clinical practice, there has been a noticeable increase in the interest of surgeons in simultaneous surgeries in recent years. This is particularly true for the possibilities of performing simultaneous minimally invasive surgeries on an outpatient basis. Aim. To evaluate the clinical effectiveness of simultaneous operations in coloproctological patients with various combined surgical diseases in an outpatient hospital. Materials and methods. A simple observational prospective-retrospective study design was applied (for the period from January 2021 to December 2024).The results of simultaneous surgeries performed in hospital-free conditions in 205 patients with a combination of various coloproctological diseases (chronic hemorrhoids of stages II–III – 113 (55.1%) patients, chronic anal fissure – 50 (24.4%) patients, pilonic cysts of the coccyx – 31 (15.1%) patients,low transsphincteric anorectal fistulas – 11 (5.4%) patients) with other surgical pathologies were analyzed. In 38(18.5%) patients, coloproctological diseases were combined with abdominal wall hernias, in 91(44.4%) – with urological pathology, and in 76 (37.1%) – with gynecological diseases. Results. Simultaneous surgeries in coloproctology patients with various combined surgical diseases were not accompanied by additional technical difficulties, did not significantly increase trauma of the surgery, and did not have a decisive impact on the anesthetic support. The median duration of the surgical intervention was 55 (48; 62) minutes. No serious intraor postoperative complications were observed. The average hospital stay for patients after simultaneous surgeries was 12 (8; 24) hours. Conclusion. The results we obtained indicate the effectiveness of simultaneous operations in coloproctological patients with various combined surgical pathologies, which allows us to reasonably recommend the use of minimally invasive inpatient-substituting surgical technologies in outpatient coloproctology.
Clinical experience with ligation of the intersphincteric fistula tract with internal opening distalization combined with laser fistula tract coagulation (LIFT-IOD + FiLaC) in the treatment of perianal fistulas
Introduction. Modern coloproctology demonstrates a growing trend toward the use of minimally invasive procedures, particularly in the management of complex anal fistulas. One of the most widely adopted and effective sphincter-preserving techniques for anal fistulas is the LIFT (Ligation of Intersphincteric Fistula Tract) procedure. However, according to theliterature, recurrence rates after minimally invasive fistula surgery remain relatively high. Aim. To evaluate the outcomes and analyze a seven-year clinical experience withligation of the fistula tract with internal opening distalization combined with laser fistula tract coagulation (LIFT-IOD + FiLaC – Ligation of Intersphincteric Fistula Tract and Internal Opening Distalization + Fistula Laser Closure) in the treatment of perianal fistulas. Materials and methods. This study was designed as a retrospective cohort analysis and included patients who underwent surgical treatment for complex transsphincteric and extrasphincteric fistulas of cryptoglandular origin using a modified technique at the surgical department of the Clinical Hospital “RZD-Medicine” in Rostov-on-Don between 2018 and 2025. A total of 124 patients with transsphincteric fistulas involving more than one-half of the anal sphincter circumference and extrasphincteric fistulas were included. The analysis included the incidence and nature of postoperative complications,length of hospital stay, postoperative analgesic requirements, the impact of surgery on anal continence function assessed by sphincterometry and the Wexner score, and recurrence rates. Results. Primary healing was achieved in 74.2% of cases. The mean Wexner score before surgery was 6.4 ± 2.3 points, after surgery – 6.7 ± 3.4 points (p > 0.05). According to sphincterotonometry, the mean resting pressure before surgery was 66.1 ± 15.1 mmH2O, with voluntary contraction 110.3 ± 23.5 mmH2O, after surgery – 67.4 ± 12.5 mmH2O and 108.7 ± 26.4 mmH2O, respectively (p > 0.05). Conclusions. The modified technique combining LIFT with internal opening distalization and laser fistula tract coagulation (LIFT-IOD + FiLaC) demonstrates high efficacy in the treatment of complex transsphincteric, and extrasphincteric fistulas while preserving anal continence function.
Rivaroxaban in the outpatient phlebological practice
Nowadays, ambulatory phlebology is rapidly developing. Considering this progress over a period of two to three decades, the quality of diagnosis and treatment of venous disorders has increased exponentially. In addition to the significant shift from inpatient to outpatient settings for interventions on patients with varicose veins, significant advances are being observed across all conditions and their complications where the venous component is involved. Furthermore, in addition to technical, organizational, and hemodynamic advances, more simple therapeutic strategies and minimization of side effects are seen in anticoagulation which is a key component of phlebological care. Rivaroxaban is widely adopted and, due to its convenience, actively used in clinical practice. It has now been well investigated, with numerous studies confirming its efficacy and safety. The article considers the use of rivaroxaban and highlights the importance of quality and production control in example of the Rivaxab®, which is available on the Russian market.
Effective strategies for stool regulation in surgical patients: The focus is on sodium picosulfate
According to statistics, up to 20% of the adult population in different countries suffers from constipation. In surgical practice, constipation presents two pressing challenges for surgeons: diagnostic, in terms of differential diagnosis of possible causes, and therapeutic. The first part of the review article examines possible diseases and conditions encountered in real-life surgical practice, whose clinical presentation includes constipation. The key to an accurate diagnosis and successful subsequent treatment is optimal patient preparation for colonoscopy. The use of sodium picosulfate in various bowel preparation regimens for colonoscopy promotes better tolerability and a successful colonoscopy. Sodium picosulfate is one of the most commonly used and effective medications and belongs to the group of synthetic stimulant laxatives. The second part of the review article, based on a search of Pubmed, Scopus, and eLIBRARY.RU databases, examines articles published before July 15, 2025, examining the efficacy and safety of sodium picosulfate, with a focus on surgical practice. The use of sodium picosulfate has demonstrated its effectiveness and safety in atonic constipation, for stool regulation (hemorrhoids, proctitis, anal fissures), for preparation for surgical operations, instrumental and radiological examinations, and in the postoperative period during prolonged immobilization. Sodium picosulfate is considered as the drug of choice in various categories of patients, including those with comorbidities, since it is not absorbed into the systemic circulation, so the combination with other drugs is safe and effective.
External abdominal wall hernias in rare locations
Rarely localized external abdominal wall hernias represent a poorly studied yet clinically significant group of conditions characterized by atypical anatomical locations, a wide variety of anatomical variants, and a high rate of diagnostic errors. These hernias often present with subtle or nonspecific clinical manifestations and are frequently diagnosed at the stage of complications, which is associated with an increased risk of incarceration, postoperative complications, and mortality. The review article analyzed 45 full-text articles from electronic library databases and systematized modern information on rare external hernias of the abdominal cavity, including hernias of the Spigelian line, obturator foramen, sciatic, perineal hernias, hernias of the xiphoid process of the sternum and lumbar hernias. The clinical features, anatomical and morphological prerequisites for the formation of hernia defects, as well as the main diagnostic challenges are analyzed. The role of staging is noted, which is important for determining diagnostic tactics and choosing the optimal treatment method, especially considering the patient's age and, as a consequence, the risk of complications. Particular attention is paid to the role of imaging modalities, primarily computed tomography, as well as diagnosticlaparoscopy, in the timely detection of these types of hernias. It has been shown that rare hernias of the anterior abdominal wall represent a diagnostically and tactically complex group of pathologies, often detected only at the stage of complications. It is shown that the choice of surgical strategy should be individualized and determined by thelocation of the hernia defect, the presence of complications, and the patient’s comorbid status. Analysis of the availableliterature highlights the need for the standardization of diagnostic approaches and further accumulation of clinical experience in order to improve surgical outcomes in patients with rare external abdominal wall hernias.
Modern approaches to the treatment of patients with hernias of the spigel line of the abdomen
Introduction. In recent years, various types of open, endovideosurgical surgical interventions and various options for the placement of mesh endoprostheses have been used to treat patients with spigel line hernias (GSL). Due to the rare occurrence of this pathology and the insufficient coverage of this problem in the worldliterature, it is necessary to develop optimal surgical tactics in patients with HSV. Aim. To substantiate the tactics of surgical treatment of patients with HSV based on a comparative analysis of the immediate,long-term, and cosmetic results of various types of surgical interventions. Materials and methods. A comparative study of the immediate and long-term results of surgical treatment of 69 patients with HSV was conducted. Of these, group 1 included 22 (31.9%) patients who underwent open tension hernioplasty, group 2 included 24 (34.8%) patients who underwent non-tension hernioplasty from traditional access, group 3 included 15 (21.7%) patients afterlaparoscopic intra-abdominal hernioplasty, group 4 consisted of 8 (11.6%) patients who have undergone extraperitoneal videoendoscopic hernioplasty. Results. The average duration of open surgeries in patients of groups 1 and 2 was 1.8–2.2 timesless than the duration of endovideosurgical interventions in patients of groups 3.4. The severity of postoperative pain on the VAS scale after open surgeries was 1.6–2.1 times greater than in patients who underwent endovideosurgical hernioplasty. In the early postoperative period, wound complications were noted in 1 (4.2%) patient of the first group and in 1 (4.5%) patient of the second group, no complications were observed in patients of 3.4 groups. Hernia recurrence was detected in thelong-term period in only 1 (4.8%) patient of the first group after open tension hernioplasty. Discussion. The use of endovideosurgical interventions can reduce the traumatic nature of surgery, the level of postoperative pain and postoperative complications, and improve the cosmetic result of surgery. Conclusion. The most effective operations in patients with HSV are open and endovideosurgical intraabdominal, extraperitoneal prosthetic hernioplasty.
Nimesulid: Pharmacological and Clinical Profile
The review provides information on the pharmacodynamics, pharmacokinetics, and clinical pharmacology of the nonsteroidal anti-inflammatory drug (NSAID) nimesulide. The features of the chemical structure of nimesulide and its associated mechanisms of action, as well as the clinical effects that distinguish nimesulide from its homologues, are considered. Comparative efficacy with other NSAIDs is presented. The issues of clinical pharmacokinetics (pKа index; Cmax exposure levels; biotransformation; etc.) were discussed. The clinical part of the review includes comparative studies of nimesulide and its homologues, as well as combinations of nimesulide with drugs from other groups. The specificity of nimesulid induced hepatotoxicity is also discussed. Used info resources NCBI.NLM.NIH.GOV; Micromedex Inc., Tompson Series. Drugdex, 2017. British Pharmacological Society (resources and support for educators), RxList, 40 articles containing data on the pharmacodynamics of nimesulide, of which 25 were selected, 10 articles containing information on the pharmacokinetics of NMS, of which 4, 30 articles were selected, including information on the pharmacokinetic interactions of NMS with the medications from other pharmacological groups, from which 25 articles were selected, 10 of which were based on randomized trials involving more than 2,000 subjects. Scientific search was carried out using the following keywords: “nonsteroidal anti-inflammatory drugs”, “pain syndromes and their treatment”, “nimesulide”, “cyclooxygenase”, “prostaglandins”, “arachidonic acid”, “combinations of drugs”.
Modern aspects of superior mesenteric artery morphometry: Results of computed tomographic angiography study
Introduction. In modern clinical practice, precise and detailed knowledge of the normal and variant anatomy of the superior mesenteric artery (SMA) has ceased to be the exclusive domain of fundamental science and has become a necessary condition for ensuring the safety and effectiveness of a number of surgical interventions. Aim. To perform a comprehensive morphometric analysis of the superior mesenteric artery (SMA) using multispiral computed tomographic angiography (MSCTA) and to evaluate the influence of sex and age on its anatomical parameters. Materials and мethods. A single-center retrospective study was conducted, including data from 615 patients (245 men, 370 women) aged 20–89 years who underwent MSCTA of the abdomen. The following parameters were assessed: thelevel of SMA origin relative to the vertebral bodies, the angle of origin,linear distances to adjacent arteries (the celiac trunk and the renal arteries), SMA diameter at threelevels (ostium,level of middle colic artery origin,level of ileocolic artery origin), and the number of the small intestine arteries. Statistical analysis was performed using IBM SPSS Statistics 26. Pearson's χ² test, Student's t-test (or Mann–Whitney U-test), and one-way analysis of variance (ANOVA) with Tukey's post-hoc test (or Kruskal–Wallis test) were used to compare groups. Results. Statistically significant gender differences were found: women more often had the superior mesenteric artery originating at the level of Th12 (30.3% versus 8.6% in men), a smaller origin angle (25–50° in 68.6% of cases), and a smaller orifice diameter (6.24 ± 1.25 mm versus 8.28 ± 1.36 mm in men). A strong positive correlation was found between age, the origin angle (r = 0.747), and the diameter of the superior mesenteric artery (r = 0.802–0.884). The number of small intestinal arteries did not depend on gender or age Conclusion. Sex and age significantly influence the morphometry of the superior mesenteric artery. These factors should be considered in preoperative planning, endovascular interventions, and diagnostic imaging.
Immunohistochemical clarification of the reparative process specificity after allogernioplasty using platelet-rich plasma in a chronic experiment
Introduction. Platelet-Rich Plasma (PRP) / Autologous Conditioned Plasma (АСР) therapy is currently widely used in various fields of medicine due to effects of bioactive molecules involved in healing processes. The aim of study was to evaluate the characteristics of scar formation after allografting with ACP mesh processing. Aim. To investigate the effects of ASR on scar formation after allohernioplasty. Materials and methods. The study was conducted on 5 pigs (Large White): n = 3 with ACP processing, n = 2 without ACP processing, as well as on 26 Wistar rats: n = 14 with ACP processing, n = 10 without ACP processing, and 2 rats for blood sampling and ACP production. In pig biopsies, IHC was performed on days 7, 14, and 21 of the postoperative period. The expression of TGFβ1, VEGF, Col3, fibronectin, CD45, CD68, CD3, and CD20 was studied to assess the vascular, fibrillar, and cellular components at different healing stages. In rats, the expression of matrix metalloproteinases (MMP-1, MMP-9) and their tissue inhibitors (TIMP-1) was assessed on days 7 and 21 after surgery. Results. Biopsies taken from the pigs with ACP using showed prominent VEGF expression and a more abundant vascular network in the peri-implant zone. A decrease in CD45 expression (an indicator of shortening of the active inflammation phase) was noted; more prominent expression of CD68 and CD3, TGFβ1, as well as fibronectin and collagen III was noted. In biopsies taken from the rats with ACP using, prominent MMP expression was noted at the early stages of regeneration in association with moderate TIMP expression, as well aslower MMP expression in thelater stages of healing, which predetermines mild fibrosis. Recruitment and activation of macrophages andlymphocytes, active angiogenesis, early formation of granulation tissue, marked dominance of type III collagen, protease-fibrotic balance (regulation of lysis and synthesis processes) in the scar formation zone are factors that ensure “delicate” fibrosis. Conclusion. The using of ACP increases the speed and quality of the reparative process and reduces the area of the forming scar.
Comparison of the results of treatment of acute paraproctitis in a specialized short-stay hospital and a general surgical hospital
Introduction. Acute paraproctitis (AP) is one of the most common diseases in emergency coloproctology that require emergency surgical treatment. Аim. To conduct а comparative analysis of the results of surgical treatment of patients with AP in a specialized short-stay hospital (SSSH) and a general surgical department. Materials and methods. A comparative prospective-retrospective non-randomized clinical study was conducted. The results of surgical treatment of 226 patients with AP were analyzed. In 118 patients (Group I), AP treatment was performed in the conditions of the SSSH (IMC "URO-PRO", Krasnodar), and in 108 patients (Group II) – in the conditions of a general surgical hospital in the system of municipal budgetary healthcare of the Krasnodar Territory. In patients of Group I, a transrectal ultrasound examination of the rectum and/or a magnetic resonance imaging of the pelvis were performed during the examination, and an intraoperative verification of the fistula was performed, and after the abscess was opened, an elastic theloose seton was placed through the surgical wound. In patients of Group II, only a routine clinical examination was performed, and the surgical treatment of AP waslimited to the opening and traditional drainage of the purulent cavity. Results. In Group I, the average hospital stay was 12.89 ± 5.7 hours, while in Group II, it was 4.2 ± 1.56 days. In Group I, 6 (5.08%) patients developed postoperative complications, while in Group II, 14 (12.96%) patients experienced complications. In Group II, 19 (17.59%) patients had a recurrence of the disease, while no recurrence was observed in Group I patients, which was directly related to the formation of a controlled consolidated fistula along the drainageligature. Conclusions. Surgical treatment of patients with AP in the conditions of the SSSH, in comparison with the general surgical department, allows to reduce the number of postoperative complications by 7.88% (p = 0.022), and also to exclude the risk of developing a disease relapse.
Evolution of vascular grafts: From antiquity to the contemporary era
Vascular grafts represent an integral element of reconstructive cardiovascular surgery. The search for optimal plastic materials and the development of new vascular grafts remain pressing tasks of modern medicine. The historical path of vascular surgery encompasses the transition from implanting the first experimental tubular structures made of glass, bone, and metals to the creation of high tech synthetic, biological, and tissue-engineered grafts. This review presents the key stages of introducing vascular grafts into clinical practice, summarizes the results of preclinical and clinical studies, and outlines existinglimitations and unresolved issues. Particular attention is paid to the compliance of grafts with the biomechanical properties of native vessels, their thromboand immunoresistance, as well as their durability against infectious complications. Modern vascular grafts are examined separately, with analysis of their characteristics, advantages, and disadvantages. The prospects for creating small diameter vascular grafts are associated with the development of three-dimensional bioprinting technologies and the design of individualized grafts that closely approximate the structure and functional properties of the body’s natural tissues. For the preparation of this review, a systematic search was conducted in international electronic databases, including PubMed, Web of Science, and Embase, as well as in specialized resources such as the Cochrane Library and domestic electroniclibrary systems. The search was performed using the following keywords: vascular grafts, prosthetic vascular grafts, homografts, Dacron, PTFE, tissue engineering, and small-diameter vascular grafts. In total, 604 publications were identified. After analyzing titles and abstracts, 412 sources were selected for further consideration. Of these, 338 articles were excluded due to non-compliance with the inclusion criteria (lack of relevant historical data or duplication of material). Following the final eligibility assessment, 72 articles were included in the analysis. Of these, 5 publications were used in the preparation of the Introduction section, while the remaining 67 were employed in the development of the main sections of the study.
Assessment of the level of commitment to acquiring knowledge and skills in the discipline of “Surgical Diseases”
Introduction. Currently, a combined form of education has become more widespread in the educational process of higher education and postgraduate education, which combines elements of distance and intramural/practical directions. The article examines the process and results of the combined training format in relation to practical disciplines in medicine, in particular "Surgical Diseases". Aim. To conduct a comparative characterization and analysis of the commitment to acquiring knowledge and skills of undergraduates and 2-year residents in the discipline “Surgical Diseases” of medical universities in various forms of education. Materials and methods. The paper presents the result and analysis of an anonymous sample survey of senior students (Group 1) and residents of 2 years of study (Group 2) at the clinical bases of the departments of surgical diseases in Kazan and Samara, after completing the cycle and examination control. Questionnaire questions were compiled in accordance with the tasks set in the study. The collection of survey materials from respondents was carried out using Yandex Forms, and the results were subsequently converted into Microsoft Excel tables. Results. This study demonstrated that the rate of favorable outcomes (meaning students' professional level), expressed in higher final grades, was 82% higher in the second-year resident group compared to the senior student group, compared to 59%. The relative benefit of studying in the "Surgical Diseases" course for second-year residents was 28% higher than that of senior students, indicating greater interest in the educational process and a targeted focus on their professional development. Conclusions. An analysis of the obtained results revealed that students who were more interested in the educational process and had a targeted vector of professional training demonstrated higher rates of dedication, self-control, and desire to acquire specialized knowledge and skills.
History of the creation of the first prototype of an outpatient surgery center in Russia: Celebrating the 175th anniversary of the opening of St. Lazarus Hospital (Maximilian Hospital) for visiting patients in St. Petersburg (1850–2025)
This article examines the history of the Maximilian Hospital for visiting patients founded in 1850 in St. Petersburg and provides an analysis of ifs activities – the first prototype of an outpatient surgery center in Russia. This new type of outpatient medical facility has been shown to implement the principles that are commonly found or seen today: healthcare accessibility regardless of patients’ social categories or gender; 24-hour attendance of medical staff including the ability to provide emergency surgical care; consultations of specialists in different areas of expertise; day and short-term hospital stays for patients who underwent surgery; and horse-drawn carriages to transport patients both from home and to hospitals. The presented results of the hospital's activities demonstrated its effectiveness and safety.