Novosti
Khirurgii

DOI: https://dx.doi.org/10.18484/2305-0047.2019.2.131   |  

V.N. NIKITIN ¹, V.L. POLUEKTOV ¹, T.P. KHRAMYKH ¹, L.O. BARSKAYA ¹, E.A. ZABLOTSKAIA ², V.A. PUTINTSEV ¹, V.P. EFANOV ¹

FIRST RESULTS OF AN ORIGINAL METHOD APPLICATION OF EXPERIMENTAL STOMACH ULCER MODELING

Omsk State Medical University ¹,
Omsk Regional Clinical Medical Sanitary Unit № 9 ², Omsk,
The Russian Federation

Objective. To work out and to test experimentally the method for modeling gastric ulcer in small laboratory animals.
Methods. The experiment included 38 white mongrel rats. Mini-laparotomy was performed, stomach was taken out into the operating field. 70% solution of the acetic acid was introduced into the submucosal layer from the side of the stomach lumen using the device for intra-organ intraluminal injections. The animals were excluded from the experiment on the 3rd, 5th, 7th day after the operation, the area of ulcerative defect with microscopic assessment of tissue and cellular composition in the area of ulcerative defect was determined.
Results. In two animals, when injected into the submucosal layer of the stomach wall 0.06 ml of 70% acetic acid, there was a total necrosis of all layers with concurrent phlegmon of the stomach; they died on the 2nd day because of the generalized peritonitis on the background of perforation of the stomach necrotic wall. The median area of gastric ulcer was: with the introduction of 0.04 ml after 3 days – 1.88 cm², after 7 days – 0.34 cm²; with the introduction of 0.03 ml – 0.94 cm² and 0.19 cm², respectively; with the introduction of 0.02 ml – 0.63 cm² and 0.16 cm², respectively; with the introduction of 0.01 ml – 0.31 cm² and 0.02 cm², respectively. It is morphologically confirmed that the bottom of the ulcer is the muscle layer of the stomach. Thus, the threshold dose of the injected 70% acid solution (0.06 ml) was revealed, the excess of which results in total necrosis of the stomach wall, as well as the prospects for a possible relationship between the volume of the damaging factor, the size of the emerging ulcer defect and the healing time of the latter.
Conclusions. The proposed method of modeling gastric ulcers is reproducible and can be recommended for use in experimental surgery.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2019.2.138   |  

I.D. DUZHYI, O.V. KRAVETS, S.V. POPOV, I.A. HNATENKO

OPTIMIZATION OF SURGICAL TREATMENT OF MULTI-DRUG-RESISTANT TUBERCULOSIS OF THE LUNGS

Sumy State University, Medical institute, Sumy,
Ukraine

Objective. To improve treatment effectiveness in patients with multi-drug-resistant pulmonary tuberculosis, the spread of the lesion in which exceeds 5 segments, by introducing an improved combined method of treatment into practice.
Methods. The proposed method of surgical treatment was used in 17 patients with the extensive multi-drug-resistant pulmonary tuberculosis. Extended resistance was found in 6 (35.3%) people, multi-drug resistance  in 11 (64.7%). The first stage of the proposed technique was the application of the pneumoperitoneum 2 months before the operation. A modified thoracoplasty was used during the surgical intervention. The operation implied a complete removal of the I rib, the partial cutting of the paravertebral segments II and IV (46 cm), V and VII (68 cm) ribs and fragmentation of the III and VI ribs by snacking them in the vertebral and axillary divisions, after which the vertebral portions II and IV, V and VII ribs «were taken together» over the fragmented sections of III and VI ribs, which significantly reduced the volume of the pleural cavity and decreased the collapse of the affected lung.
Results. The postoperative bed-day was 75.838.3. Closure of the decay cavities in the lung of the operated hemithorax had occurred in 15 (88.2%) patients by the time of discharge from the hospital. Bacterial excretion finished in 15 (88.2%) operated in the hospital. In 2 (11.8%) of the operated, bacterial excretion decreased, but the decay cavity continued to be determined. The closure of the decay cavity in one of them was recorded in 3 months after the operation at the outpatient stage of treatment.
Conclusions. The proposed method of treatment allows achieving the closure of destructive cavities, resorption of infiltrative changes in the operated lung and abacillation of patients. The method is recommended for use in the treatment of various forms of multi-drug-resistant tuberculosis, which affects more than 5 segments of the lung when contraindications to resection methods of treatment are present.

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DOI: https://dx.doi.org/10.18484/2305-0047.2019.2.146   |  

V.I. BELOKONEV¹, A.V. ZHAROV^{1, 2}

FEATURES OF SURGICAL TREATMENT OF PATIENTS WITH UNCOMPLICATED FEMORAL HERNIA

Samara State Medical University¹,
Samara City Hospital №10 ², Samara,
The Russian Federation

Objective. To improve the treatment results of patients with uncomplicated femoral hernia by identifying the features of clinical course and reasonable application of the operation methods taking into account a possible destruction of the Cooper ligament.
Methods. The treatment analysis of 46 patients with uncomplicated femoral hernia was performed. There were 12 males (26%) and 34 females (74%). The control group included 24 patients with the repair of hernial orifice with local tissues. The main group included 22 patients in whom prosthetic repair has been used, including using the proposed method of operation. The results evaluation of the femoral canal repair in groups was performed according to the incidence of complications.
Results. In the control group, early complications occurred in 11 patients: hematoma – in 3; inflammatory wound infiltration – in 4; suppuration of the wound – in 4. Late complications were found in 12 patients: pain in the surgical area – in 4; parasthesia – in 5; groin discomfort – in 3, recurrence of the disease was revealed in 4. In the main group, early complications occurred in 4 patients: hematoma – in 1, inflammatory wound infiltration – in 1, wound suppuration – in 1, seroma – in 1. Late complications revealed in 3 patients: pain in the area of operation – in 1, numbness – in 1, discomfort in the inguinal region – in 1, disease recurrence was found in 2. The use of prosthetic repair methods of the femoral canal reduced the incidence of early complications by 2.5 times, late complications – by 3.7 times the number of the disease recurrence – by 2 times.
Conclusions. Plastic surgery of the femoral canal with local tissues and with the use of prosthesis is limited when the ligament of Cooper is destroyed. The proposed method of operation with prosthesis with protrusion along the lower medial edge allows performing the operation when the tissue in the area of the femoral canal is destroyed.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2019.2.153   |  

M.F. CHERKASOV, K.M. GALASHOKYAN, YA.M. STARTSEV, D.M. CHERKASOV, A.A. POMAZKOV, S.G. MELIKOVA

EFFECTS OF VACUUM THERAPY ON WOUND HEALING IN SACROCOCCYGEAL AREA

Rostov State Medical University, Rostov-on-Don,
The Russian Federation

Objective. To assess the wound repair in patients with pilonidal disease with open wound management and stimulation of healing by vacuum therapy.
Methods. The clinical study includes 73 patients who underwent open surgical treatment. There were 58 males (79.5%) and 15 females (20.5%). Patients were divided into the main group (n=39), where the original vacuum therapy after excision was carried out and the control group (n=34), where the excision of the pilonidal sinus was conducted with the open wound treatment by ointment bandage dressings. Clinical characteristics, cytological and planimetric parameters of healing were evaluated.
Results. In the main group, during the first week of treatment, a decrease in inflammation was observed, and by the second week – granulation tissue formation resulted in purification and epithelization of the wound, and by the third week the optimum conditions for wound contraction and scar tissue formation were observed. At cytological examination, from the 8th day after the VAC-therapy, inflammatory response decreased in 32 (82.1%) patients, from the 12th days regenerative cytological patterns were determined in 12 (30.8%) patients. By the 16th day in 23 (59%) observations of the main group the wound regenerative processes were noted, and in the control group, inflammatory-regenerative cytograms prevailed – 20 (58.8%). In the compared groups, it was found out that average healing and wound area reduction rate during the first 16 days of treatment was 2.6 times higher in main group.
Conclusions. Using VAC-therapy in postoperative wounds with open treatment of pilonidal disease promotes acceleration of healing and improves results of treatment in comparison with using standard bandage dressings.

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DOI: https://dx.doi.org/10.18484/2305-0047.2019.2.161   |  

I.N. KLIMOVICH, S.S. MASKIN, P.V. ABRAMOV, A.V. PAVLOV

CLINICAL IMPORTANCE OF INTESTINAL INSUFFICIENCY SYNDROME IN ULCEROUS GASTRODUODENAL BLEEDINGS

Volgograd State Medical University, Volgograd,
The Russian Federation

Objective. To establish the frequency and predictors of intestinal insufficiency syndrome in patients with bleeding from gastroduodenal ulcers, to clarify its role in the pathogenesis of systemic dysfunctions.
Methods. The study involved 149 patients with bleeding from gastroduodenal ulcers. The severity of endotoxicosis in the intestinal insufficiency syndrome and without was investigated, the relationship of the syndrome with the formation of other systemic dysfunctions (for example, hepatic and renal failure) was traced.
Results. In the dynamics from the 1st to the 5th day of hospital stay, intestinal insufficiency syndrome was found in 72 (65%) patients out of 110 (110/149 – 74%) patients with only severe degrees of blood loss. In 90% of cases, the development of intestinal insufficiency syndrome was preceded by hypotension (systolic pressure <70 mmHg) of over 80 minutes duration. Ischemic-reperfusion injury of the small intestine wall led to the violation of its “barrier” function and a flood of blood with intraintestinal toxins, increasing systemic endotoxicosis reliably more significantly than in patients without the syndrome of intestinal insufficiency. In patients with the syndrome of intestinal insufficiency, systemic dysfunctions developed in 90% (65/72) of cases, and without it, only in 11% (4/38) of cases (p<0.05). This is explained by the fact that in the syndrome of intestinal insufficiency, an additional long-term toxic effect on the liver and kidneys leads to a breakdown in the adaptive capacities of their main functions, the violation of which extremely negatively affects homeostasis indicators. Mortality in the group with the intestinal insufficiency syndrome was 15% (11/72), and mortality in the group without the intestinal insufficiency syndrome was 5% (2/38).
Conclusions. 65% of patients with severe bleeding from gastroduodenal ulcers develop the intestinal insufficiency syndrome, which plays a significant negative role in the potentiation of systemic endotoxicosis, as a consequence in the formation of systemic dysfunctions and the outcome of the disease as a whole.

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DOI: https://dx.doi.org/10.18484/2305-0047.2019.2.168   |  

V. ALEKSEEVA, A. LUPYR, N. UREVICH, R. NAZARYAN, V. GARGIN

SIGNIFICANCE OF ANATOMICAL VARIATIONS OF MAXILLARY SINUS AND OSTIOMEATAL COMPONENTS COMPLEX IN SURGICAL TREATMENT OF SINUSITIS

Kharkiv National Medical University, Kharkiv,
Ukraine

Objective. Determining the anatomical variability of the upper maxillary sinus and ostiomeatal complex components as well as on the basis of the obtained data the selection of the optimal access to the zones of the maxillary sinus to choose sinusitis treatment method, which allows minimizing intra- and postoperative complications.
Methods. The results of studies of the paranasal sinuses of 30 patients conducted on the spiral computed tomography were studied: 10 with the subtotal reduction of pneumatization of the maxillary sinus and 10 patients with hyperplasia of the mucous membrane. The control group included 10 SCTs of healthy individuals. The average volume, bone density of the maxillary sinus, the average size of the inferior nasal turbinate, the size, density of processus uncinatus under physiological and pathological conditions, the correlation between these parameters were determined.
Results. A significant correlation (r=0.96, 0.96, 0.95, and 0.9 in the physiological state and r=0.95, 0.94, 0.97, and 0.91 in sinusitis) was noted between the volume, thickness and the density of the walls of the maxillary sinus. A moderate correlation was between the volume of the sinus, the thickness and density of the processus uncinatus, the volume of the sinus and the longitudinal size of the inferior turbinate in the unchanged sinus (r=0.65, 0.68 and 0.66). A very strong correlation was between the thickness of the upper wall and the volume of the sinus (r=0.96). A strong positive linear relationship (r=0.72) is noted between the volume and thickness of the medial wall (p<0.05). The reliable (p<0.01) strong (r=0.75) interconnection was between the thickness of the processus uncinatus and the average sinus volume. Very strong linear correlation was between the density of the middle and upper walls of the maxillary sinus in physiological and pathological conditions (r=0.9 and 0.84)
Conclusions. Spiral computed tomography is a diagnostically significant method for the study of the maxillary sinuses. Parameters of the paranasal sinuses necessary for successful endoscopic rhinosurgery were determined. The obtained data helps to choose access during endoscopic operations, to prevent intra-, postoperative complications, to predict the likelihood of intracranial or intraocular spread of the pathological process.

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DOI: https://dx.doi.org/10.18484/2305-0047.2019.2.177   |  

I.A. ILYIN

RESULTS OF REPEATED COLON INTERPOSITION FOR ESOPHAGEAL REPLACEMENT IN ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION IN CARCINOMA SURGICAL TREATMENT

N.N. Alexandrov National Cancer Centre of Belarus, Minsk,
The Republic of Belarus

Objective. To evaluate the results of the repeated colon interposition for esophageal replacement in the esophageal and gastroesophageal junction carcinomas surgical treatment.
Methods. Repeated colon interposition after discontinuity resections for ischemic complications of primary gastric or jejunal pull up procedures during the esophageal and gastroesophageal junction carcinomas surgical treatment was implemented in 40 patients. Squamous cell esophageal carcinoma was represented in 52.5% (21/40) observations and gastroesophageal junction adenocarcinoma — in 47.5% (19/40). Patients’ mean age was 56.0 (52.0, 63.0) years, body mass index — 21.4 (18.9, 24.5) units. Male patients predominated over females — 90% (36/40) and 10% (4/40) respectively. Repeated reconstructions were preceded by previously performed discontinuity procedures. Esophago-gastric anastomosis resection was performed in 57.5% (23/40) patients, gastric conduit removal ― in 7.5% (3/40), esophageal demucosation with complicated anastomosis resection ― in 35% (14/40).
Results. Time of procedures was 345.0 (310.0, 407.5) minutes, blood loss — 400.0 (300.0, 500.0) ml, in-hospital stay — 27.5 (21.0, 40.5) days. Esophago-colonic anastomosis leakage and/or an oral end graft necrosis were detected clinically and radiologically on the 8th day after surgery. Anastomotic leakage developed in 12.5% (5/40) observations, graft loss — in 5% (2/40). Late esophageal anastomotic strictures, determined by means of esophagocolonoscopy 3 months after the repeated esophagoplasty, were formed in 7.5% (3/40) patients. 30- and 60-day mortality rate made up 7.5% (3/40) and 10% (4/40) cases respectively. Overall 5-year survival was 26.9%.
Conclusions. Repeated colon interposition for esophageal replacement in esophageal and gastroesophageal junction carcinomas surgical treatment is a «salvage» procedure for patients who undergo discontinuity surgical interventions which allows achieving satisfactory long-term treatment outcomes.

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DOI: https://dx.doi.org/10.18484/2305-0047.2019.2.188   |  

V.YU. ZIAMKO ¹, V.K. OKULICH ¹, A.M. DZYADZKO ²

FACTORS OF PHENOTYPIC AND GENOTYPIC RESISTANCE OF THE MOST PROBLEMATIC INFECTIOUS AGENTS IN INTENSIVE CARE UNIT

Vitebsk State Medical University ¹, Vitebsk,
Minsk Scientific and Practical Center of Surgery, Transplantation and Hematology ², Minsk,
The Republic of Belarus

Objective. To establish factors of phenotypic and genotypic resistance of the most problematic infectious agents in the intensive care unit.
Methods. A comprehensive examination of 224 clinical isolates from the sputum of 99 patients in the intensive care unit was performed. Carbapenemase genes in Klebsiella pneumonia isolates were detected by real-time polymerase chain reaction and minimum inhibitory concentrations of antibiotics for microorganisms were determined in planktonic form and biofilm form by the method of double serial dilutions.
Results. In the structure of the studied isolates the most common were Acinetobacter spp. (32.6%), Klebsiella pneumonia (33.5%), Pseudomonas aeruginosa (14.7%). 91.4% of Klebsiella pneumoniae isolates possessed genes of resistance and in most cases – OXA-48 (80%). All the studied isolates moderately or well formed the biofilm, among the studied microorganisms Proteus mirabilis demonstrated this ability best of all. All isolates both in plankton form and in the form of biofilm were sensitive to tigecycline (100%) and resistant to carbapenems in 94.7%, to cephalosporins – in 100% of cases. For 90% of the studied isolates the minimum inhibitory concentration for tigecycline and ciprofloxacin in the biofilm does not change and increases for moxifloxacin in 1.3 times, for meropenem – 1.2 times.
Conclusions. The factors of phenotypic and genotypic resistance of the most problematic infectious agents in the intensive care unit have been established. Most of the carbapenemresistant Klebsiella pneumoniae isolates (88.5%) had gene associations: OXA-48 and CTX-M (37.1%), NDM and CTX-M (2.9%), NDM and OXA-48 (37.1%), CTX-M and OXA-48 (11.4%). The identification of resistance genes that determine the synthesis of carbapenemazes and cefalosporinazes eliminates the antibiotics that are destroyed by these enzymes from the algorithms of antibacterial therapy.

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DOI: https://dx.doi.org/10.18484/2305-0047.2019.2.196   |  

I.V. MAIBORODIN ¹, A.I. SHEVELA ¹, V.V. MOROZOV ¹, T.V. MIKHEEVA ¹, N.F. FIGURENKO ¹, R.V. MASLOV ¹, V.I. MAIBORODINA ²

THE INFLUENCE OF EXTRACELLULAR VESICLES (EXOSOMES) OF MESENCHYMAL STROMAL CELLS ON BONE TISSUE REGENERATION

Institute of Chemical Biology and Fundamental Medicine, Russian Academy of Sciences, Siberian Branch ¹,
Institute of Molecular Pathology and Pathomorphology, Federal Research Center for Fundamental and Translational Medicine ²,
Novosibirsk,
The Russian Federation

Mesenchymal stem/stromal cells (MSC) have been widely used for tissue regeneration including the repair of bone defects. However, shortcomings of MSC application, including the limited term of existence in tissues, have become an obstacle for further direct transplantation of MSC.
There is a necessary to create new methods of cell therapy that do not have the disadvantages of the direct MSC application, but which influence the bone tissue regeneration with the same effectiveness.
Cells influence each other and exchange the functional proteins and genetic material through the secretion of exosomes which can be also applied for the impact on tissue regeneration. Exosomes strengthen proliferation, migration and act as the inductors of differentiation of MSC in the determined direction including osteogenic one that leads to the considerable acceleration of bone defect reparation. The delivery of microRNA and various regulating cytokines is a possible mechanism of optimization of tissue reparation by exosomes. The action of exosomes to a large extent is similar to effects of MSC. The creation of animals with preset properties has good prospects. However, the assessment of therapeutic potential and use in future clinical tests of the extracellular vesicles secreted by various cells, demands their total characteristic, standardization of strictly particular conditions of storage and receiving, removal xenogenic and others substances, bound to the source.
The application of exosomes has high potential for reparative medicine, in particular, for acceleration of bone tissue regeneration, and opens new paths of medical research.

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DOI: https://dx.doi.org/10.18484/2305-0047.2019.2.204   |  

V.S. KOZOPAS

TREATMENT OF MULTI-FRAGMENT DIAPHYSEAL BONE FRACTURES BY BLOCKING INTRAMEDULLARY OSTEOSYNTHESIS TECHNIQUE (ANALYSIS OF ERRORS AND COMPLICATIONS)

Danylo Halytsky Lviv National Medical University, Lviv,
Ukraine

The growth of the level of traumatism and the prevalence of orthopedic pathology determine the necessity to advance diagnostics and treatment of injuries and diseases of the musculoskeletal system as a priority trend in the development of health care. Improvement of diagnostic capabilities of modern methods of visualizing conditions of bones, joints and soft tissues, expansion of the scope of high-tech minimally invasive osteosynthesis techniques will change the concept for implementation of orthopedic trauma care.
The proposed literature review is dedicated to the urgency of the problem and analysis of the structure of traumatic injuries, as well as the fundamental advantages of their treatment by the method of intraosseous osteosynthesis, which, due to the closed reposition of fragments and low surgical access outside the damage zone, doesn’t cause any additional injury to the tissues in the fracture zone.
The main errors of surgeons when performing intramedullary blocking osteosynthesis have been studied and analyzed. It has been shown that treatment of patients with diaphyseal multi-fragment fractures of the long tubular bones should include measures to restore the anatomical structures of the injured segment and the function of the injured limb. The determination of clear indications and consistent preoperative planning of surgical intervention with careful selection of parameters of fixing structures are the main factors affecting the quality of fixation of fragments and they ensure the final result.

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DOI: https://dx.doi.org/10.18484/2305-0047.2019.2.212   |  

S.A. SUSHKOU, E.I. LEBEDEVA, O.D. MYADELETS

PERICYTES AS A POTENTIAL SOURCE OF NEOANGIOGENESIS

Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

The scientific literature analysis has shown that researchers in the field of regenerative medicine consider pericytes to be a promising therapeutic target. However, there are still too many problems that require thorough investigations. One of the main tasks is the identification of pericytes. Despite numerous attempts, the molecular marker panel remains undeveloped. All markers which are used to identify pericytes are dynamic in their expression. This may be related to the stages of pericyte differentiation, peculiarities of the tissue structure, the pathological state, the hierarchy of the vessels and the stage of their development. The identification of the source of pericyte development and understanding of the processes governing their differentiation remain the problem of current interest. The mechanism of pericyte differentiation into myofibroblasts, osteoblasts, adipocytes, chondrocytes, smooth myocytes and macrophages remains insufficiently studied and debatable. There is no consensus about pericyte heterogeneity. This is the subject of further research aimed at proving pericyte heterogeneity in terms of morphology and function along the blood vessels; quantitative determination of differences in the expression of markers in different pericyte subtypes and the development of the nomenclature. The determination of phenotypic differences between pericytes during angiogenesis and in mature vessels is of particular interest. This is necessary to understand the functions of pericytes in the microvasculature. An important direction is the detailed study of signaling pathways involved in the regulation of complex interactions between pericytes and endothelial cells. This will not only expand the understanding of the pathogenesis, but also will allow introducing new methods of treatment into practical medicine.

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DOI: https://dx.doi.org/10.18484/2305-0047.2019.2.222   |  

A.V. MIKHEEV, S.N. TRUSHIN

ANEURYSMAL BONE CYST OF THE RIB

I.P. Pavlov Ryazan State Medical University, Ryazan,
The Russian Federation

Aneurysmal bone cyst is a rare benign tumor-like disease, which typically affects metaphyses of long tubular bones. Most often this osteolytic bone neoplasm occurs and is diagnosed in childhood or adolescence with a slight predominance of female subjects. There is no specific clinical manifestation of an aneurysmal bone cyst; its development is characterized by pain syndrome, swelling of soft tissues, restriction of limb function, less frequently - by pathological fractures. Aneurysmal bone cyst as a primary benign rib tumor is extremely rare, especially in the elderly. The article presents a clinical observation of a 69-year-old male patient with an aneurysmal bone cyst of the second left rib. The reason for seeking medical help was the increasing pain in the chest on the side of the lesion. X-ray computed tomography made it possible to determine the exact localization of the neoplasm, its relationship with the ribs and structures of the mediastinum. The cyst was radically removed through left thoracotomy, by excision of the tumor with the cortical layer of the rib. The subsequent morphological study confirmed the diagnosis of the aneurysmal bone cyst. The patient was being observed for 6 months and had no signs of the disease recurrence.

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DOI: https://dx.doi.org/10.18484/2305-0047.2019.2.227   |  

S.N. LEONOVA, I.V. USOLTSEV

SURGICAL TREATMENT OF OVERLAPPING TOES

Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk,
The Russian Federation

The article presents a clinical case of successful surgical treatment of the female patient with the combination of two types of toe deformities – hallux valgus and 2^nd varus hammer toe (overlapping toes). At the examination of the patient we assessed the character and the degree of severity of toe deformity, made necessary calculations and chose optimal surgical methods of treatment. Using original method of surgical treatment allowed us correcting hallux valgus and using Helal method contributed to the correction of 2^nd varus hammer toe. This clinical case shows the importance of preoperative planning including precise preliminary calculations and determination of some parameters which are necessary for the correction of toe deformities. Preoperative calculation of such parameters as length of necessary shortening and value of necessary lateral shift of the instep bone fragment makes it possible to perform precise marking of the lines on the instep bone fragment which helps restoring its anatomy and statodynamic function without any recurrence in the postoperative period.

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RESOLUTION OF THE XVI CONGRESS OF SURGEONS OF THE REPUBLIC OF BELARUS (NOVEMBER 1-2, 2018, GRODNO)

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