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Year 2023 Vol. 31 No 6

SCIENTIFIC PUBLICATIONS

A.L. LIPNITSKI 1, 2, À.V. MAROCHKOV 1, 2, I.Y. SAVOSTENKO 1, A.V. VYUKHINA 1, E.L. STAVCHIKOV 1, 2, I.G. TISHKEVICH 1

ASSESSMENT OF SURGICAL INVASIVENESS BY THE DYNAMICS OF SERUM IRON AND C-REACTIVE PROTEIN LEVELS

Mogilev Regional Clinical Hospital 1, Mogilev,
Vitebsk State Order of Peoples’ Friendship Medical University 2, Mogilev, Republic of Belarus

Objective. The aim of the study was to examine the possibility of using C-reactive protein and serum iron levels in patients in the perioperative period as a quantitative criterion of surgical invasiveness.
Methods. A retrospective non-randomized observational study was conducted and was approved by the ethics committee. The study involved 125 patients who underwent the following surgical interventions: total knee replacement (n=44), radical phlebectomy (n=34), otolaryngological surgery (n=12), open heart cardiac surgery (n= 33). All patients underwent blood sampling to determine the content of CRP and serum iron at the following stages: stage 1 – before surgery; stage 2 – 20-24 hours after surgery; stage 3 – 48-72 hours after surgery.
Results. At stage 1 of the study (before surgery), the content of CRP in the blood serum in all patients was 1.73 (0.54; 4.09) mg/l; at stage 2 (20-24 hours after surgery), a significant increase in CRP was observed to 29.92 (14.02; 68.3) mg/l (p<0.05). At stage 3 (48-72 hours after surgery), the content of CRP also significantly increased compared to stage 1 and stage 2 – 65.77 (29.03; 124) mg/l (p<0.05). The serum iron at stage 1 of the study in all patients was 18.41 (13.23; 23.05) mmol/l. 20-24 hours after surgery, the iron level decreased statistically significantly to 5.36 (3.87; 8.48) mmol/l (p<0.001). At stage 3, the iron level did not change significantly compared to stage 2 – 6.09 (4.05; 9.1) mmol/l (p>0.05).
The correlation analysis showed the presence of a statistically significant negative correlation between the level of C-reactive protein and serum iron in the postoperative period: at stage 2 – R=-0.37, p=0.0017; at stage 3 – R=-0.68, p<0.0001.
Conclusion. Analysis of the dynamics of the level of C-reactive protein and serum iron can be an independent criterion for surgical traumatism and can be used for quantitative comparison of operations in different anatomical areas.

Keywords: C-reactive protein, serum iron, traumatism of surgical interventions, surgical traumatism criteria, surgical invasiveness
p. 431-438 of the original issue
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Address for correspondence:
212016, Republic of Belarus,
Mogilev, Belynitsky-Biruli st. 12,
Mogilev Regional Clinical Hospital,
Department for Coordinating the Collection
of Organs and Tissues for Transplantation,
tel.: +375 222 62-75-95,
e-mail: Lipnitski.al@gmail.com,
Lipnitsky Artur L.
Information about the authors:
Lipnitsky Artur Leonidovich, PhD, Anesthesiologist-Resuscitator, Head of the Department for Coordinating the Collection of Organs and Tissues for Transplantation, Mogilev Regional Clinical Hospital, Associate Professor of the Branch of the Departments of Anesthesiology and Resuscitation with a Course of FPK and PC and Hospital Surgery with a Course of FPK and PC EE «Vitebsk State Medical University», Mogilev, Republic of Belarus.
https://orcid.org/0000-0002-2556-4801
Marochkov Alexey Viktorovich, MD, professor, Anesthesiologist-Resuscitator of the Department of Anesthesiology and Resuscitation, Mogilev Regional Clinical Hospital, Professor of the Branch of the Departments of Anesthesiology and Resuscitation with a Course of FPK and PK and Hospital Surgery with a Course of FPK and PK. Vitebsk Institution State Medical University», Mogilev, Republic of Belarus.
https://orcid.org/0000-0001-5092-8315
Savostenko Igor Yakovlevich, Surgeon, Department Of Surgery, Mogilev Regional Clinical Hospital, Mogilev, Republic of Belarus.
https://orcid.org/0009-0004-4751-5551
Vyukhina Elena Vladimirovna, Otorhinolaryngologist, Head of the Otorhinolaryngology Department of the Mogilev Regional Clinical Hospital, Mogilev, Republic of Belarus.
https://orcid.org/0009-0004-9029-9962
Stavchikov Evgeny Leonidovich, Surgeon of the Department of Purulent Surgery of the Mogilev Regional Clinical Hospital, Senior Lecturer of the Branch of the Departments of Anesthesiology and Resuscitation with a Course of FPK and PC and Hospital Surgery with a Course of FPK and PC of the Vitebsk State Medical University, Mogilev, Republic of Belarus.
https://orcid.org/0000-0001-5147-5274
Tishkevich Igor Gennadievich, Cardiac Surgeon, Department of Cardiac Surgery, Mogilev Regional Clinical Hospital, Mogilev, Republic of Belarus.
https://orcid.org/0000-0003-3616-1933

Z.M. SIGAL, O.V. SURNINA, O.A. SIGAL, S.Z. SIGAL, R.K. AUBOV

NEW METHOD OF TREATMENT AND DIAGNOSTIC TACTICS FOR THYROID NEOPLASMS

Izhevsk State Medical Academy, Izhevsk,
The Russian Federation

Objective. To optimize the surgical tactics of treating patients with focal diseases of the thyroid gland based on the use of a developed highly informative program for monitoring the structural and functional state of the tissue structures of the lesion and adjacent tissues, based on the developed original optosonographic technology.
Methods. The comparison group of patients (n=1406) underwent a puncture biopsy using the traditional method without ultrasound visualization; and the observation group (n= 1870), biopsy material was taken using an innovative method of puncture biopsy of neoplasms of the thyroid and mammary glands by a device for puncture of space-occupying formations of the thyroid and mammary glands.
Results. For the first time, normal indicators of pulse and non-pulse optical density in the thyroid gland in healthy people have been identified, which are used as a conditional physiological norm. When studying thyroid diseases, in 85.0-98.0% of cases, deviations were identified both before and after the studies, which indicates the high sensitivity of these methods in diagnosing thyroid diseases. Consequently, these studies can be one of the main ways to detect thyroid diseases. Also, the proposed treatment and diagnostic tactics made it possible to develop additional indications for surgical treatment of thyroid tumors based on optosonographic monitoring data.
Conclusion. It has been shown that the method of puncture biopsy, based on determining the amplitude of pulse oscillations and the optical density of the tissue under study, allows one to detect a space-occupying formation earlier than it appears with visual methods of examination, and the presence of an additional channel allows one to simultaneously perform a puncture of tissues bordering the pathological focus and evaluate the effectiveness of the treatment and predict the further development of the disease. Creative surgical methods for puncture biopsy and a device for its implementation have been developed, based on pulse optometry using an emitter and a photodetector. The method increases the efficiency and accuracy of differential diagnosis of space- occupying neoplasms, provides control over the effectiveness of treatment and the prevention of false-positive and false-negative results.

Keywords: puncture, puncture biopsy, image-guided biopsy, ultrasonography, computed tomography, thyroid neoplasms, breast neoplasms, pulse optometry, thyroid neoplasm, optosonographic device, optosonographic monitoring, puncture biopsy, puncture
p. 439-448 of the original issue
References
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Address for correspondence:
426056, Russian Federation,
Izhevsk, Kommunarov st., 281,
Izhevsk State Medical Academy, Department
of Operative Surgery and Topographic Anatomy,
tel.: +7 912 751-24-12,
e-mail: uzd-ur@mail.ru,
Surnina Olga Vladimirovna
Information about the authors:
Sigal Zoltan Moishevich, MD, Professor, Head of the Department of Topographic Anatomy and Operative Surgery, Izhevsk State Medical Academy, Udmurt Republic, Izhevsk, Russian Federation
https://orcid.org/0000-0001-9823-868Xorcid.org/0000-0001-9823-868X
Surnina Olga Vladimirovna, MD, Associate Professor, Associate Professor of the Department of Topographic Anatomy and Operative Surgery, Head of the Ultrasound Diagnostics Department, Republican Clinical Diagnostic Center, Izhevsk State Medical Academy, Izhevsk, Russian Federation,
https://orcid.org/0000-0002-9538-1808.
Sigal Olga Aleksandrovna, Graduate Student of the Department of Topographic Anatomy and Operative Surgery, Izhevsk State Medical Academy, Russia, Udmurt Republic, Izhevsk, Russian Federation:
https://orcid.org/0000-0002-0556-8522.
Sigal Sofya Zoltanovna, Dermatovenerologist, Cosmetologist, Head Physician of SIGAL Aesthetic club, Izhevsk, Russian Federation
https://orcid.org/0000-0002-0973-8971.
Ayubov Roman Kemranovich, Laboratory Assistant at the Department of Topographic Anatomy and Operative Surgery, Izhevsk State Medical Academy, Udmurt Republic, Izhevsk, Russian Federation.
https://orcid.org/0009-0000-1993-1324

I.V. MIKHAILOV 1, V.A. KUDRYASHOV 2, S.L. ACHINOVICH 2, N.N. PODGORNY 2, A.P. DYATLOV 1, CH.A.A.D. WEERAKOON 1

RESULTS OF PANCREATODUODENECTOMY IN PERIAMPULAR TUMORS AND TUMORS OF ADJACENT ORGANS

EE Gomel State Medical University 1,
Gomel Regional Clinical Oncology Center 2, Gomel,
Republic of Belarus

Objective. To analyze the immediate and long-term results of pancreatoduodenectomy in periampular tumors and tumors of adjacent organs.
Material and Methods. A retrospective (case-control) study included 325 patients who underwent pancreatoduodenectomy (PD) or total pancreatoduodenectomy (TPD) for periampular tumors (PT) and tumors of adjacent organs. The analysis of the immediate and long-term results was carried out depending on the main clinical and morphological factors.
Results. Length of postoperative hospital stay of patients was 15 (13; 23) days, the frequency of postoperative complications was 41.8%. 90-day mortality was 7.7%, hospital mortality 5.5%, and in the age group over 70 years – 17.7%. The most common complication and the main cause of death was surgical infection, the main manifestation of which after PD was pancreatic fistula (25.5%), after TPD – intra-abdominal abscesses (27.3%). The incidence of delayed gastric emptying after gastric resection and pylori-preserving operations was 10.8 and 9.1%, respectively (P=0.5). After operations R0 and R2, the overall 5-year survival was 28.2±3.0 and 0%, the median survival was 20.0 (10.0; 81.0) and 8.0 (5.5; 13.0) months (P=0.0008). The overall 5-year survival rate of patients with pancreatic head cancer was 19.8±3.5%, cancer of the ampulla of Vater – 35.0±6.2%, common bile duct cancer – 59.3±12.9%, duodenal cancer - 33.6±15.7%, gastric cancer – 19.3±8.5% and colon cancer – 40.0±15.5% (P=0.02). In all nosological types, survival decreased with an increase in the stage of the disease. The overall 5-year survival rate of patients with pancreatic head cancer with ductal adenocarcinoma and neuroendocrine tumors was 14.7±3.5% and 77.8±13.9%, respectively (P<0.001). The 5-year survival rate of patients with PT, receiving preoperative biliary drainage compared to operative intervention first was 13.0±3.4 and 40.4±4.6%, respectively (P = 0.0003).
Conclusion. The immediate results of PD are characterized by a high frequency of postoperative complications. Surgical infection prevails among them. It was diagnosed in most cases as pancreatic fistula and was the main cause of deaths. The most difficult problem is the surgical treatment of patients over the age of 70. Factors of low survival in all nosological types were residual tumors, high-stage cancer and PBD. The lowest survival rate was in patients with ductal adenocarcinoma of the pancreas.

Keywords: pancreatoduodenectomy, pancreatic cancer, periampular tumors, complications, pancreatic fistula, survival, biliary drainage
p. 449-457 of the original issue
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Address for correspondence:
246041, Republic of Belarus,
Gomel Meditsinskaya st., 2,
Department Oncology Gomel State
Medical University,
tel.: +375 29 734-68-60,
e-mail: igor-mikhailov-2014@yandex.ru,
Mikhailov Igor V.
Information about the authors:
Mikhailov Igor Viktorovich, PhD, Associate Professor, Head of the Department Oncology, Gomel State Medical University, Gomel, the Republic of Belarus.
https://orcid.org/0000-0002-3796-0342
Kudryashov Vadim Andreevich, Head of the Abdominal Oncology Department, Gomel Regional Clinical Oncology Dispensary, Gomel, Republic of Belarus.
https://orcid.org/0000-0002-1512-8539
Achinovich Sergey Leonidovich, PhD, Head of the Hathology Department, Gomel Regional Clinical Oncology Dispensary, Gomel, Republic of Belarus
https://orcid.org/0000-0002-0977-5581
Podgorny Nikolay Nikolaevich, Oncologist-Surgeon of the Abdominal Oncology Department, Gomel Regional Clinical Oncology Dispensary, Gomel, Republic of Belarus.
https://orcid.org/0009-0007-9083-1877
Dyatlov Alexander Petrovich, Assistant, Department of Oncology, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0003-4682-2045
Virakoon Chintana Agbo Abesundara Dissanayaka, Assistant Department Oncology, Gomel State Medical University Gomel, Republic of Belarus.
https://orcid.org/0000-0002-0939-1138

I.V. MAKAROV, A.G. SONIS, B.D. GRACHEV, V.V. TIMOSCHUK

COMPARATIVE ANALYSIS OF COMNONENTS SEPARATION TECHNIQUES IN THE TREATMENT OF MEDIAN VENTRAL HERNIAS

Samara State Medical University, Samara,
Russian Federation

Objective. To compare the immediate and long-results of the technique of anterior and posterior components separation of abdominal wall.
Methods. 237 cases of treatment of patients with median ventral hernias W3 and W4 in one surgical department were analyzed. The technique of front separation (group 1, n=62) was implemented by the methods of V.I. Belokonev. Rear separation (group 2, n=175) were produced by A. M. Carbonell, Y. W. Novitsky, and V. N. Yegiiev. Long-term results were studied in terms of more than one year in 70.1% of patients.
Results. There were no deaths. The frequency of early complications in group 1 was 38.7%, in group 2 – 9.7%.The average bed day in group 1 was 16.8, in group 2 – 10.2. Chronic paraprosthetic infection in group 1 developed in 4 (6.5%), in group No. 2 – in 4 (2.3%).Recurrence of hernia in group ¹1 was revealed in 4 (6,5%), in group 2 – in 5 (2,9%) patients. Functional recovery of the abdominal wall in both groups was achieved in more than 90% of patients.
Conclusion. Technology as a front separation of the first and second method V. I. Belokonev and rear separation technique in options M. A. Carbonell, Y.W. Novitsky and V.N. Yegiiev give good results in the treatment of median postoperative ventral hernia large sizes. In the absence of recurrence of hernia, they provide functional recovery of the anterior abdominal wall, significantly improving the quality of life. With the complete destruction of one of the straight muscles or subtotal destruction of both straight muscles, the use of anterior separation technique is not rational. It is preferable to use the rear separation technique. It was found that both options give good results, however, the use of posterior separation plastic surgery reduced the number of postoperative complications by 4 times (from 38.7 to 9.7%), reduced the time of drainage of subcutaneous tissue and wounds from 10.3 to 5.8 days and reduced the length of hospital stay from 16.8 to 10,2 days. At the same time, the number of relapses in the long-term period decreased from 6.5% to 2.9%. Anterior separation is easier and can be recommended to surgeons who do not know the technique of posterior separation. This technique requires careful postoperative management with daily monitoring of drainage patency and drainage period of at least 7-10 days. Rear separation can be recommended for implementation only to surgeons of high qualification, and while technically correct performance provides faster postoperative rehabilitation.

Keywords: incisional hernia; repair of hernia; anterior components separation technique, posterior anterior components separation technique, polypropylene mesh implant, post-operative rehabilitation
p. 458-467 of the original issue
References
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  5. Belokonev VI, Ponomareva JuV, Pushkin SJu, Kovaleva ZV, Melent’eva ON. Otkrytye protezirujushhie sposoby gernioplastiki pri lechenii pacientov s ventral’nymi gryzhami. V sb: Materialy 2-go Vserossijskogo súezda gerniologov. Moscow, RF; 2017. p.14-17.(In Russ.)
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Address for correspondence:
443079, Russian Federation,
Samara, Karl Marx Ave., 165, B;
Clinics of Samara State Medical University,
Clinic of Propaedeutic Surgery,
tel.: +7 927 000 41 50,
e-mail: v.v.timoschuk@samsmu.ru,
Timoshchuk Vladislav V.
Information about the authors:
Makarov Igor Valerievich, MD, Professor, Head of the Department of General Surgery and Surgical Diseases, Samara State Medical University, Samara, Russian Federation.
http://orcid.org/ 0000-0002-1068-3330
Sonis Alexander Grigorievich, MD, Professor, Professor of the Department of General Surgery and Surgical Diseases of Samara State Medical University? Samara, Russian Federation.
https://orcid.org/0000-0002-2148-6754
Grachev Boris Dmitrievich, PhD, Associate Professor of the Department of General Surgery and Surgical Diseases of Samara State Medical Samara University, Samara, Russian Federation.
http://orcid.org/ 0000-0002-4778-9518
Timoshchuk Vladislav Vladimirovich, Full-time Graduate Student (2 years), Department of General Surgery and Surgical Diseases, Samara State Medical University Samara, Russian Federation.
http://orcid.org/ 0000-0002-6733-8327

M.D. LEVIN 1, 2, V.I. AVERIN 1, 3, YU.G. DEGTYAREV 1, 3

DIAGNOSIS AND TREATMENT OF RECTAL ATRESIA

State Institution "Republican Scientific and Practical Center of Pediatric Surgery" ¹, Minsk, Republic of Belarus,
Dorot-Netanya Geriatric Medical Center, Israel ²,
Belarusian State Medical University ³, Minsk, Republic of Belarus

Objective. It is known that patients with rectal atresia (RA) or stenosis (RS) have a normal anal canal. The narrowing or complete atresia is located a few centimeters proximal to the dentate line. The ARM-Net Consortium authors analyzed 36 (1.3%) of 2619 patients with anorectal malformations: RA (n = 18) and RS (n = 18). They emphasize that due to the low level of evidence, it is impossible to judge the benefits of a particular treatment method.
Methods. The purpose of this study is to review the diagnostic methods used to evaluate RA/RS. A total of 18 radiological studies of RA/RS were identified, but 4 were excluded because the diagnosis was not consistent with the clinical and/or radiological findings. We used a previously developed x-ray method, as well as studies on the anatomy and physiology of the anorectal zone.
Results. In 8 cases, radiological data indicated the presence of a septum not in the rectum, but in the anal canal approximately 1 cm from the anus. In 6 cases, on radiographs, the distal contour of the intestine was located at the level of the pubococcygeus line, as is normal. Consequently, the obstruction was in the anal canal, but since conditions were not created to open the upper part of the anal canal, it was impossible to judge the level of obstruction.
Conclusion. The study showed that RA/RS is not located in the rectum, but in the anal canal approximately 1 cm from the anus and is represented by the septum. This makes it possible to excise the septum through anal access without damaging the anal canal. Methods of diagnosis and treatment are described.

Keywords: anorectal malformations; anorectal physiology; rectal atresia; rectal stenosis; x-ray study; anorectal embryology
p. 468-477 of the original issue
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Address for correspondence:
220116, Republic of Belarus,
Minsk, Dzerzhinsky Ave., 83,
Belarusian State Medical University,
Department of Pediatric Surgery,
tel. office: +375 017 290-49-23,
e-mail: averinvi@mail.ru,
Averin Vasily Ivanovich
Information about the authors:
Levin Mikhail Davidovich, MD, Radiologist at the State Geriatric Center Dorot, Netanya, Israel.
https://orcid.org/0000-0001-7830-1944
Averin Vasily Ivanovich, MD, Professor, Head of the Department of Pediatric Surgery, Belarusian State Medical University, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-3343-8810
Degtyarev Yuri Grigorievich, MD , Professor, Head of the Department of Pediatric Surgery, Institute of Advanced Training and Retraining of Healthcare Personnel, Belarusian State Medical University, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-2696-4989

REVIEWS

N.M. GREKOVA, Y.V. NAIMUSHINA, O.S. SLEPYKH, S.S. ANUFRIEVA, V.V. BELOV, D.N. SADARDINOV, S.F. KUBASOV

GASTROINTESTINAL STRICTURES IN CROHN’S DISEASE: SURGICAL TECHNIQUE

South Ural State Medical University, Chelyabinsk
Russian Federation

The prevalence of Crohn’s disease (CD) in the European population is high – 322 per 100,000 people. Primary or recurrent fibrous stricture in one or more parts of the gastrointestinal (GI) tract is the most frequent complication of CD (21-29.4%), which requires surgical treatment performed as emergency or planned. Stricture recurrences after resection intervention during 10 years of follow-up occur in 35% of cases and require repeated operations. Repeated resections worsen the quality of life, often require preventive stomas, lead to the development of short bowel syndrome, malabsorption, maldigestion. Recurrence rate after stricturoplasty is 28.9%. Nowadays alternative antistricture and antirecurrence resection and anastomotic techniques for surgery for CD strictures, as well as organ-preserving minimally invasive endoscopic interventions are offered along with traditional ones. This review focuses on modern methods of surgical treatment of CD strictures. The justified choice of surgical treatment of strictures of esophagus, stomach and duodenum, small and large intestine allows to improve the quality of life of operated patients with CD complicated by primary and recurrent strictures of these GI parts.

Keywords: Crohn’s disease/surgery, constriction, fibrosis, recurrence, endoscopy
p. 478-490 of the original issue
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Address for correspondence:
454092, Russian Federation,
Chelyabinsk Region, Chelyabinsk, Vorovskij st., 64,
South Ural State Medical University,
Department of Faculty Surgery,
tel. +7-922-231-89-11,
e-mail: lebedevareg@mail.ru,
Naimushina Yuliana V.
Information about the authors:
Grekova Natalia M., PhD, Associate Professor, Associate Professor of the Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk, Russian Federation.
http://orcid.org/0000-0002-3364-7201
Naimushina Yuliana V., PhD, Associate Professor, Associate Professor of the Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk, Russian Federation.
http://orcid.org/0000-0002-6032-3501
Slepykh Oksana S., PhD, Associate Professor of the Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk, Russian Federation.
http://orcid.org/0009-0006-3291-0756
Anufrieva Svetlana S., MD, Associate Professor, Head of the Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk, Russian Federation.
http://orcid.org/0000-0002-3921-5266
Belov Vadim V., PhD, Associate Professor of the Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk, Russian Federation.
http://orcid.org/0009-0009-2501-0532
Sadardinov David N., 6th year student, South Ural State Medical University, Chelyabinsk, Russian Federation.
http://orcid.org/0000-0002-7820-6493
Saveliy Fedorovich K., 6th year student, South Ural State Medical University, Chelyabinsk, Russian Federation.
http://orcid.org/0000-0001-8636-4590
Kubasov Savely F., 6th year student, South Ural State Medical University, Chelyabinsk, Russian Federation.
http://orcid.org/0000-0001-8636-4590

LEMEKHOVA N.M. PETRUSHIN A L.

TRIANGULAR BONE (OS TRIGONUM) AND ITS CLINICAL SIGNIFICANCE. LITERATURE REVIEW

State budgetary institution of the Arkhangelsk region
“Karpogorskaya Central District Hospital”, Karpogory settlement, Arkhangelsk region,
Russian Federation

To summarize and systematize the available literature data and current views on the prevalence, anatomical features of the os trigonum and associated pathology. The triangular bone refers to the accessory bone formations of the foot; the cause for its formation is the lack of unification of individual ossification centers of the talus and the lateral tubercle of its posterior process; rarer the cause is a fracture of the hypertrophied lateral process. In most cases, it does not cause symptoms, but under certain circumstances it can cause pain in the posterior parts of the ankle joint. The prevalence of os trigonum in the general population ranges from 1.7 to 45%. Symptoms associated with the triangular bone develop in 14-25% of cases, the main associated pathology is posterior impingement syndrome of the ankle joint (os trigonum syndrome). The development of the syndrome associated with entrapment of the triangular bone along with the surrounding fibrous tissues between the posterior surface of the tibia and calcaneus during plantar flexion of the foot. This syndrome is typical for individuals whose activities involve repeated and frequent plantar flexion of the foot with a load on it and performing kicking movements: ballet dancers, football players, swimmers and athletes involved in cross-country running. Diagnosis of os trigonum syndrome based on clinical and radiographic data; CT and MRI are used in inexplicable cases. Treatment begins with conservative measures; if they are ineffective, resection of the os trigonum performed, which can be carried out using both open and minimally invasive methods. Minimally invasive (endoscopic and arthroscopic) resection characterized by earlier functional recovery.

Keywords: ankle anatomy, os trigonum, posterior ankle joint impingement, os trigonum syndrome, accessory bones
p. 491-501 of the original issue
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Address for correspondence:
164600, Russian Federation,
Arkhangelsk Region, Karpogory Settlement,
Lenin st, 47,
State Budgetary Institution of the Arkhangelsk
Region “Karpogory Central District Hospital”,
tel.: 818-56-2-11-03,
e-mail: petrushin.59@mail.ru,
Petrushin Alexander L.
Information about the authors:
Lemekhova Natalya M., Radiologist State Budgetary Institution of the Arkhangelsk Region “Karpogorsk Central District Hospital”
https://orcid.org/0009-0004-3209-3093
Petrushin Alexander L., Surgeon, PhD, State Budgetary Institution of the Arkhangelsk Region “Karpogorsk Central District Hospital”.
https://orcid.org/0000-0002-3246-7452

CASE REPORTS

E.A. TONEEV 1, 2, A.A. FIRSTOV 2, E.A. KESHYAN 4, O.V. PIKIN 3, L.A. DANILOVA 1, A.A. MARTYNOV 1, A.V. GINOV 1

IMMEDIATE SURGICAL RESULTS OF GASTRECTOMIES FOR GASTRIC CANCER. EXPERIENCE OF THE REGIONAL ONCOLOGY CENTER

Municipal Healthcare Institution "Regional Clinical Oncology
Dispensary of Ulyanovsk City" 1,
Ulyanovsk State University 2,
P.A. Herzen Moscow Scientific Research Oncology Institute – Branch of the Federal State Budgetary Institution "National Medical Research Center of Radiology" of the Ministry of Health of Russia 3, Ulyanovsk,
Russian Federation
State Budgetary Institution "City Clinical Hospital ¹15 named after O.M. Filatova Moscow health department" 4, Moscow,
Russian Federation

Objective. Comparative assessment of two options for the formation of esophago-enteric anastomosis (EEA) after gastrectomy – hand-sewn and stapled. Assessment of the impact of an increased risk of nutritional deficiency in the development of postoperative complications.
Material and Methods. 173 patients with stages I-III of gastric cancer were divided into 2 groups depending on the type of anastomosis formed – hand-sewn (n=106) or stapled (n=67). All the studied patients were analyzed for the presence of an increased risk of nutritional insufficiency on the MUST scale (Malnutrition Universal Screening Tool).
Results. In the group analysis, the statistically significant parameters based on the main clinical and anamnestic data was not identified. In the group of patients with hand-sewn anastomosis tumors localized in the cardiac part of the stomach were more common, whereas with stapled anastomosis the tumor was more often localized in the body of the stomach (p< 0.001). Perioperative parameters such as blood loss were higher in the stapled anastomosis group (ð=0,037). The formation time for the hand-sewn anastomosis was longer than for stapled anastomosis (p <0.001). Other parameters did not differ between groups, including the volume of lymph node dissection, the number of removed lymph nodes. Serious complications (Calvien-Dindo IIIA-V scale) were more common in the stapled anastomosis group (p=0.036). Among 55 patients with postoperative surgical complications, 27 (49%) patients with an increased risk of nutritional insufficiency were identified: 17 (63%) of them with a high nutritional risk and 10 (37%) – with an average.
Conclusion. The frequency of EEA failure after stapled anastomosis was 1.15% in our retrospective study, and 0% after hand-sewn anastomosis, but a statistically significant difference was not achieved (p = 0.073). There were no significant differences in the time of surgical intervention, despite the presence of a statistically significant difference in the time of anastomosis formation. The increased risk of nutritional insufficiency plays an important role during the postoperative period. In 49% of cases, postoperative surgical complications occur in patients with an increased risk of nutritional insufficiency.

Keywords: gastric cancer, gastrectomy, hand-sewn esophagojejunostomy, stapled esophagojejunostomy, nutritional insufficiency
p. 502-512 of the original issue
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Address for correspondence:
432017, Russian Federation,
Ulyanovsk, 12 September St, Building 90,
State Healthcare Institution «Regional Clinical Oncology Dispensary»,
tel.: +79084731198,
e-mail: e.toneev@inbox.ru,
Toneev Evgeny A.
Information about the authors:
Toneev Evgeny A., PhD, Thoracic Surgeon of the Surgical Department of Thoracic Oncology at the State Clinical Oncology Dispensary of Ulyanovsk, Associate Professor of the Faculty Surgery Department, T.Z. Biktimirov Medical Faculty, Institute of Medicine, Ecology, and Physical Education, Ulyanovsk State University, Ulyanovsk, Russian Federation.
http://orcid.org/0000-0001-8590-2350
Firstov Artemii A., Resident of the Department of Hospital Surgery, Anesthesiology, Intensive Care, Urology, Traumatology, and Orthopedics, Faculty of Dentistry, Pharmacy, and Postgraduate Medical Education, Institute of Medicine, Ecology, and Physical Education, Ulyanovsk State University, Ulyanovsk, Russian Federation.
http://orcid.org/0000-0002-2551-9795
Keshyan Eric A., PhD, physician of the surgical department of the State Budgetary Institution «City Clinical Hospital No. 15 named after. O.M. Filatov DZM”, Assistant of the Department of Hospital Surgery, Russian National Research Medical University named after. N.I. Pirogov, Moscow, Russian Federation.
http://orcid.org/0000-0001-5557-1925
Pikin Oleg V., MD, Professor, Head of the Thoracic Surgery Department, P.A. Herzen Moscow Oncology Institute – Branch of the Federal State Budgetary Institution «National Medical Research Center of Radiology» of the Ministry of Health of Russia, Moscow, The Russian Federation.
http://orcid.org/0000-0001-6871-6804
Danilova Lyudmila A. PhD, First Deputy Chief Physician of the State Healthcare Institution OKOD Ulyanovsk, Associate Professor of the Department of Oncology and Radiation Diagnostics, Faculty of Medicine named after T.Z. Biktimirova, Institute of Medicine, Ecology and Physical Culture, Ulyanovsk State University, Ulyanovsk, Russian Federation
http://orcid.org/0000-0002-0060-4061
Martynov Alexander A., Thoracic Surgeon, Head of the Surgical Thoracic Department, State Clinical Oncology Dispensary of Ulyanovsk, Ulyanovsk, Russian Federation.
http://orcid.org/0000-0003-4662-9886
Zhinov Anatoly V., PhD, Surgeon, Head of the 1st Surgical Department of the State Healthcare Institution OKOD, Ulyanovsk, Russian Federation
http://orcid.org/0009-0009-1738-100X
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