Background. Hepatic echinococcosis poses a great threat to human health and life. In order to minimize the risk of disability and speed up the postoperative recovery process, it is necessary to make an informed choice of the surgical treatment approach to be used. However, it is still unclear when traditional surgical methods should be applied and when less traumatic, minimally invasive, ultrasound-guided interventions can be used. This is what prompted this study. The article presents the results of using different surgical methods to treat patients with hepatic echinococcal cysts.

Aim. To improve the outcomes of treating patients with hepatic cystic echinococcosis by optimizing the surgical approach using percutaneous minimally invasive and traditional surgical interventions.

Methods. A non-randomized comparative study was conducted at the Sklifosovsky Institute for Emergency Medicine of the Moscow Department of Health. The subjects were treated in 2010–2020, with a follow-up period of four years after surgical treatment. A total of 78 patients with hepatic echinococcal cysts aged 18 to 78 years were treated. At the preoperative stage, medical history was collected from all patients, including data on migration during life. The diagnosis of all patients was confirmed through laboratory tests, instrumental methods (computed tomography and ultrasound), and a morphological examination of surgical material. All patients were divided into four groups: three groups of patients treated using different percutaneous minimally invasive methods and a comparison group of patients who underwent traditional surgery. The systematization of the material and its primary mathematical processing were performed using Excel 2016 (Microsoft, USA). The obtained numerical data were processed via methods of mathematical statistics using IBM SPSS Statistics 26 Version (IBM, USA).

Results. In the sample distribution of the studied groups by gender, age, as well as the number of cysts and concomitant diseases, no statistically significant differences were identified; however, the study yielded several results indicating the advantages of using minimally invasive treatment for hepatic echinococcal cysts. In spite of the high likelihood of biliary fistulas and a suppurative residual cavity occurring with the use of minimally invasive methods, a statistically significant reduction in the operation time, duration of anesthesia in the postoperative period, and blood loss were observed, which in turn reduced the stay in the inpatient surgical facility.

Conclusion. Minimally invasive methods can be used in all types of hepatic echinococcal cysts, as well as traditional surgery. It is reasonable to perform minimally invasive interventions if the clinic is adequately equipped and the surgeon is experienced in minimizing postoperative complications and recurrences.

Background. An introduction of minimally invasive technologies contributes to annual increase in the number of surgical interventions for hiatal hernia. However, the rate of major complications (pain syndrome, dysphagia and recurrence of gastroesophageal reflux) inevitably reaches 32%. 19% of the patients need re-surgery, 60‒70% of them fail to recover, and 45% undergo surgical interventions for the third time.

Aim. To specify the major complications of surgical treatment for hiatal hernia and to substantiate the optimal techniques of reconstructive interventions for its elimination.

Methods. An observational non-randomized study involved 78 patients diagnosed with hiatal hernia without obstruction or gangrene. Patients were categorized into three groups depending on the performed surgical intervention — primary or reconstructive. Group 1 included 31 patients who underwent surgical treatment by means of traditional tactics and techniques (Nissen, Dor procedures); Group 2 enrolled 35 patients after incomplete selective proximal vagotomy with fundoplication according to Chernousov; Group 3 consisted of 12 patients who underwent reconstructive re-surgey for complications of surgical treatment of hiatal hernia. Surgical interventions were performed in five city and district general surgical hospitals of Belgorod Oblast, Russia. The hospitals were considered equally equipped and had surgeons of similar qualification. Patients were included in the study from 2015 to 2023, the follow-up of each patient lasted from 3 months to 8 years. The results of surgical treatment were evaluated by a questionnaire survey. Presence and severity of the major complications of surgical treatment for hiatal hernia were assessed according to the Dakkak scale and Gastro Esophageal Reflux Disease (GERD) questionnaire, evaluating patient outcomes as excellent, good, satisfactory, and unsatisfactory. Statistical data processing was carried out by means of Microsoft Excel 2019 (Microsoft, USA). A statistical level with p ≤ 0.05 was considered statistically significant.

Results. The major complications of surgical interventions for hiatal hernia include recurrence of gastroesophageal reflux, pain syndrome and dysphagia, which made up 54.8, 48.4 and 61.3% in Group 1, respectively. In total, the shares of all types of complications exceed 100%, as three patients were recorded with all three complications, 12 patients — with two types of complications, and 15 patients had one complication. The results evaluating the patient’s condition were expressed as good in 19.4% of patients, satisfactory — in 22.6%, and unsatisfactory — in 58.0%. In Group 2, the results evaluating the patient’s condition appeared only good (22.9%) and excellent (77.1%). The reconstructive interventions in Group 3 included: elimination of cruroraphia; incomplete selective proximal vagotomy with modified gastroesophageal refundoplication and fundoplication according to Chernousov; formation of the esophageal hiatus in the diaphragm adequate to the parameters of the fundoplication cuff. The results evaluating the patient’s condition appeared only good (22.2%) and excellent (77.8%).

Conclusion. The major complications of surgical treatment for hiatal hernia include pain syndrome, dysphagia and recurrence of gastroesophageal reflux and can be eliminated by the reconstructive interventions composed of the following techniques: elimination of cruroraphia, removal of the cuff, incomplete selective proximal vagotomy, refundoplication by the modified method according to Chernousov, formation of the esophageal hiatus in the diaphragm with adequate parameters of the fundoplication cuff.

Background. An increased intraluminal pressure in the small intestine due to paralytic intestinal obstruction refers to one of the most important factors for development and severity of intra-abdominal hypertension in patients with diffuse peritonitis. Measurement of intraluminal pressure in the small intestine appears technically challenging, therefore, evidence on the effect of intraluminal pressure on the severity of intra-abdominal hypertension is yet to be gathered. Aim. To evaluate the influence of intraluminal pressure on the severity of intra-abdominal hypertension in patients with diffuse secondary peritonitis.

Methods. The research was performed according to the design of an observational clinical study on the basis of Regional Clinical Emergency Hospital, Krasnodar Krai, in the period of July 2022‒April 2024. The study considered dynamics of intra-abdominal pressure in 82 patients with diffuse peritonitis. Intraluminal pressure in the small intestine before and after decompression was measured in 34 patients (Group 1) when nasointestinal intubation was performed with the original tube. Group 2 included 48 patients subjected to measuring intra-abdominal pressure without nasointestinal intubation. The measurement of intra-abdominal pressure was performed through urinary catheterization using the Kron technique according to the recommendations of the World Society of the Abdominal Compartment Syndrome (WSACS). The severity of peritonitis was determined using the World Society of Emergency Surgery complication Intra-Abdominal Infections Score (WSES cIAIs Score). Statistical analysis and comparison of ordinal indices in different groups or subgroups were carried out by means of Mann-Whitney U-test; comparison of quantitative indices with normal distribution was performed using Student’s t-test.

Results. All patients in Group 1 were detected with a sharp increase in intraluminal pressure in the small intestine, which appeared 50%-responsible for intra-abdominal hypertension. However, no statistically significant dependence between the severity of peritonitis and severity of intra-abdominal hypertension was revealed due to the variety of factors behind peritonitis development and duration of the disease, which determine the severity of paralytic intestinal obstruction. Nasointestinal intubation in Group 1 patients led to a decrease in intraluminal pressure on the average by 59.4% immediately after decompression, which was accompanied by a decrease in intra-abdominal pressure indices by 49.5% from the initial ones. In group 2, intra-abdominal pressure decreased gradually; during the first 5–7 post-operative days its indices in the majority of patients corresponded to the second degree of intra-abdominal hypertension severity.

Conclusion. The level of intraluminal pressure in the small intestine determines the level of intra-abdominal hypertension in patients with diffuse secondary peritonitis. Intraluminal pressure depends on the severity of paralytic intestinal obstruction and the pathology behind peritonitis. The level of intraluminal pressure over 30 mm Hg can be considered critical for the development of severe intra-abdominal hypertension and abdominal compression syndrome. In Group 1, nasointestinal decompression of the small intestine enabled intra-abdominal pressure to be rapidly reduced to acceptable level and development of abdominal compression syndrome to be prevented.

Background. Variceal esophageal-gastric bleeding is considered to be a life-threatening complication of portal hypertension in patients with cirrhosis. In some cases, only portosystemic shunt can serve as a life-saving intervention for the patient.

Aim. To justify the forced expediency of transjugular intrahepatic portosystemic shunt (TIPS) in case of ineffective drug and endoscopic hemostasis or a high risk of early recurrence of variceal bleeding.

Methods. A single-center observational controlled study was conducted to analyze the results of shunt procedure in 62 patients during the period of 2017–2023. The patients were divided into 2 groups: the main group (n = 32) with patients who underwent “early” shunt procedure in a “salvage” variant (n = 10) with continued bleeding and in a “pre-emptive” variant (n = 22) with a high risk of early recurrence of hemorrhage, and the control group (n = 30) with patients who underwent planned shunt procedure. The value of the portosystemic pressure gradient was calculated by subtracting the value of the pressure in the inferior vena cava recorded at the initial stage of the operation from the value of the initial pressure in the portal vein, measured by direct manometry. The authors compared the dynamics of the portosystemic pressure gradient in the study groups at similar stages of the intervention — initial, after embolization of the veins of portal blood flow to the varix, after shunt stenting. The study involved the analysis of mortality rates (6-week, one-year, for the entire observation period) and complications. Statistica-for-Windows 12.0 (StatSoft®, USA) and Excel (Microsoft, USA) were used to calculate descriptive statistics.

Results. Patients of both groups achieved normalization of pressure in the portal vein system and, accordingly, the portosystemic pressure gradient as a result of shunt surgery. Effective portal decompression was confirmed by their significant reduction. In the portal vein, the pressure decreased from 33.84 ± 2.70 to 20.53 ± 1.27 mmHg (t = 4.46; p < 0.001) in the main group and from 32.80 ± 3.07 to 20.10 ± 1.60 mmHg (t = 3.67; p < 0.001) in the control group. The dynamics of the portosystemic pressure gradient showed a significant decrease from 26.16 ± 2.69 to 10.06 ± 0.88 mm Hg (t = 5.69; p < 0.001) in the main group, and from 24.83 ± 2.73 to 9.67 ± 1.21 mm Hg (t = 5.08; p < 0.001) in the control group. Together with embolization of the vessels of the hepatofugal inflow of portal blood to the varices, this led to a stable and long-term cessation of variceal bleeding. When comparing the results of shunt procedure in the study groups, no significant differences were found in terms of differentiated mortality rates and complications in both the early and long-term periods. In the main group, the 6-week and one-year mortality rates accounted for 6.3% (n = 2) and 15.6% (n = 5), in the control group — 6.7% (n = 2) and 13.3% (n = 4), respectively (p = 0.917). Mortality in the main group comprised 25.0% (n = 8) over 58 months, in the control group — 23.3% (n = 7) over 60 months (p = 0.886).

Conclusion. The transjugular shunt provides a significant reduction in the portosystemic pressure gradient. “Salvage” and “pre-emptive” shunt options can prevent death and early recurrence of bleeding. Their effectiveness increases due to endovascular blockage of vessels that ensures the overflow of esophagogastric varices with portal blood.

Background. Gastroduodenal ulcer bleeding continues to be a serious problem in modern emergency surgery. Early intensive therapy combined with endoscopic hemostasis remains crucial for successful treatment of patients with ulcerative hemorrhages. The problem of recurrent bleeding, which is recorded in 12–33% of cases, even when using combined methods of endoscopic hemostasis, is still the most difficult challenge in the treatment of patients with ulcerative bleeding. The search for new approaches in the endoscopic treatment of bleeding gastroduodenal ulcers is considered to be highly relevant.

Description of clinical cases. The present paper describes the experience of using an alginate polymer polysaccharide hemostatic hydrogel in the complex treatment of two patients with unstable bleeding from duodenal ulcers. Patient B., 70 years old, with severe somatic pathology and a history of ulcers for 20 years, was admitted to the Voronezh City Clinical Emergency Hospital No. 1 with gastroduodenal ulcer bleeding. According to urgent esophagogastroduodenoscopy, the patient was diagnosed with a bleeding ulcer of the anterior wall of the duodenum with unstable bleeding (Forrest IIA). A large thrombosed vessel 2 mm in diameter was detected in the ulcer base. Patient K., 50 years old, suffering from type II diabetes mellitus for 4 years, was admitted to an emergency hospital with Forrest IIB bleeding from an extensive ulcerative defect of the duodenum. The complex treatment of patients involved a personalized approach using an alginate polymer polysaccharide hemostatic hydrogel during therapeutic endoscopy. After applying a powdered alginate hemostatic agent, a transparent hydrogel tightly fixed to the ulcer was formed on the surface of the ulcerative defect, which remained on the surface of the defect for up to 3–4 days and provided a prolonged hemostatic effect without any damaging effect on the ulcer and the surrounding mucous membrane of the duodenum. Transendoscopic application of an alginate polymer polysaccharide hemostatic hydrogel on the surface of a bleeding ulcer in the complex treatment of unstable ulcer bleeding prevented recurrent bleeding and ensured proper healing of the ulcer defect, thereby improving treatment results for patients with complicated peptic ulcer disease.

Conclusion. Clinical observations have shown that the use of alginate polymer polysaccharide hemostatic hydrogels in combined endoscopic treatment of unstable gastroduodenal ulcer bleeding reliably prevents recurrence of hemorrhage, stabilizes the condition of patients in the early stages, improves the quality of healing of a bleeding ulcerative defect, thereby suggesting the prospects of use of this hemostatic in the treatment of gastroduodenal ulcer bleeding. However, the present paper describes only the first experience of the clinical use of hemostatic alginate polymer polysaccharide hemostatic hydrogel, which is to be analyzed in more details on a larger sample of patients.

Background. Intussusception of the small intestine loop through gastroenteroanastomosis is considered a rare but potentially dangerous complication that can occur after gastroenteroanastomosis surgery. This complication is extremely seldom associated with pancreaticoduodenectomy.

Case description. A 44-year male patient underwent pancreaticoduodenectomy for common bile duct cancer on 07.10.2019, followed by adjuvant chemotherapy. On April 14, 2021 he was admitted for the next course of chemotherapy and complained of pain in the epigastric region and nausea, that appeared a few days ago, thus, he was appointed an urgent additional examination. Gastroscopy revealed a loop of small intestine, prolapsing into the lumen of the gastric remnant through the gastroenteroanastomosis. The fixed loop of intestine precluded endoscopic disinvagination from being performed. Computed tomography confirmed intussusception of the small intestine loop through gastroenteroanastomosis. The patient underwent emergency surgery. Laparotomy revealed a 40 cm intussusception of the small intestine loop through gastroenteroanastomosis into the gastric remnant. The intestine loop was accurately disinvaginated and proved to be viable. The intestine loop was additionally fixed to prevent re-intussusception. After the complication-free postoperative period, the patient was discharged on day 6. The follow-up examination in 6 months revealed no signs of intussusception recurrence according to computed tomography. The paper reviewed the internationally published cases of jejunogastric intussusception after pancreaticoduodenectomys.

Conclusion. Jejunogastric intussusception refers to an extremely rare complication after a previously performed pancreaticoduodenectomy. A risk of the complications is to be recognized, since their timely diagnosis and surgical treatment enable successful outcome to be achieved.