Year 2018 Vol. 26 No 6




Belarusian State Medical University 1,
City Clinical Pathoanatomical Bureau 2, Minsk,
The Republic of Belarus

Objective. To assess the osseointegration process in reconstructive surgeries of traumatic defects of the facial skull and cerebral cranium bones with the help of pure titanium implants in experiment.
Methods. Experimental researches were conducted on same-sex rabbits (males) of Chinchilla breed (n=40). Three series were created: the first main (surgeries on lower jawbone), the second main (surgeries on frontal bone), the third comparative (without implanting). In two main series the defects of mandibular ramus bone and frontal bone were modeled. We implanted perforated plates of pure titanium into defected areas. Total time of experiment amounted to 3, 7, 14, 30, 90, 180 days and 24 months. The following aspects were studied: safety, biological inertness, local and general reaction of the body tissue to titanium implant, morphological characteristics of osteogenesis in bone-implant system, factor of implant fixation in the reparative osteogenesis.
Results. Trombogenic safety of pure titanium for myocardium and kidneys was demonstrated; parts of corroded titanium were not found in bone tissue of lower jaw and frontal bone and in a new bone graft. Pure titanium does not cause any immune reaction. In reparative osteogenesis one proved the absence of joint capsule, new bone implant fibrosis and important role of biological fixation of the implant; and also a possibility to predict the complication development in the bone-implant system was established. The perforated pure titanium implant used in the process of reparative osteogenesis activates the formation of new bone graft, facilitates all stages of bone tissue transformation: inflammation, osteoblast proliferation, collagenogenesis and ossification.
Conclusions. Research results of general reaction of the organism to pure titanium in bone-implant system prove its bio-inertness, ensuring biological fixation during implantation into the body due to the ingrowth of the bone regenerate into the perforation holes of the titanium plates without connective tissue fibrous layer.

Keywords: defect of facial skull and cerebral cranium bone, reconstructive surgery, titanium implant, osseointegration, "bone-implant" system, reparative osteogenesis process
p. 645-654 of the original issue
  1. Stupak VV, Mishinov SV, Sadovoy MA, Koporushko NA, Mamonova EV, Panchenko AA, Krasovsky IB. Modern materials used to close defects of the bones of the skull. Sovr Problemy Nauki i Obrazovaniia. 2017;(4). [Electronic resource]. [cited 2018 Nov 23]. Available from: (in Russ.)
  2. Kubrakov KM, Karpuk IIu, Fedukovich AIu. Rekonstruktivnaia alloplastika defektov kostei cherepa titanovymi implantatami. Novosti Khirurgii. 2011;19(1):72-76. ttp:// (in Russ.)
  3. Cabraja M, Klein M, Lehmann TN. Long-term results following titanium cranioplasty of large skull defects. Neurosurg Focus. 2009 Jun;26(6):E10. doi: 10.3171/2009.3.FOCUS091
  4. Iriyanov YM, Chernov VF, Radchenko SA, Chernov AV. Plastic efficiency of different implants used for repair of soft and bone tissue defects. Bull Exp Biol Med. 2013 Aug;155(4):518-21.
  5. Shah AM, Jung H, Skirboll S. Materials used in cranioplasty: a history and analysis. Neurosurg Focus. 2014 Apr;36(4):E19. doi: 10.3171/2014.2.FOCUS13561
  6. Levchenko V. Modern methods of cranioplasty. Part 1. Neirokhirurgiia. 2010;2:5-13. (in Russ.)
  7. Leventhal GS. Titanium, a metal for surgery. J Bone Joint Surg. 1951;33(2):473-74.
  8. Kihara A, Morimoto K, Suetsugu T. Improved method using a bubble-free adhesion technique for the preparation of semi-serial undecalcified histologic sect ions containing dental implants. J Oral Implantol. 1989;15(2):87-94.
  9. Depprich R, Zipprich H, Ommerborn M, Naujoks C, Wiesmann HP, Kiattavorncharoen S, Lauer HC, Meyer U, R Kübler N, Handschel J. Osseointegration of zirconia implants compared with titanium: an in vivo study. Head Face Med. 2008 Dec 11;4:30. doi: 10.1186/1746-160X-4-30
  10. Kozakiewicz M, Szymor P. Comparison of pre-bent titanium mesh versus polyethylene implants in patient specific orbital reconstructions. Head Face Med. 2013 Oct 29;9:32. doi: 10.1186/1746-160X-9-32
  11. Mishchenko ON, Kopchak AV, Krishchuk NG, Skiba IA, Chernogorsky DM. Computer simulation of the stress-strain state of the bone - implant system when the implants made from zirconium alloys. Sovrem Stomatologija. 2017;(2):62-68. (in Russ.)
  12. Sheng HS, Shen F, Wang MD, Lin J, Lin FC, Yin B, Zhang N. Titanium mesh implants exposure after cranioplasty in two children: involvement of osteogenesis? Chinese Neurosurgical Journal. 2017;3(8). doi: 10.1186/s41016-017-0072-9
Address for correspondence:
220116, The Republic of Belarus,
Minsk, Dzerzhinsky Ave.,83,
Belarusian State Medical University,
Department of Surgical Dentistry.
Tel. +375172052173,
Oleg P. Chudakov
Information about the authors:
Chudakov Oleg P., MD, Professor, Professor of the Department of Surgical Dentistry, Belarusian State Medical University, Minsk, Republic of Belarus.
Xie Xukai, Post-Graduate Student of the Department of Surgical Dentistry, Belarusian State Medical University, Minsk, Republic of Belarus.
Yudzina Olha A., PhD, Associate Professor, Head of the Pathoanatomical Department, City Clinical Pathoanatomical Bureau, Minsk, Republic of Belarus.
Butsko Liudmila V., PhD, Leading Veterinarian of the Experimental Biological Clinic (Vivarium), Belarusian State Medical University, Minsk, Republic of Belarus.




Road Clinical Hospital at the Station of Irkutsk-Passenger 1,
Irkutsk State Medical Academy of Postgraduate Education 2, Irkutsk,
The Russian Federation

Objective. To investigate the treatment results of patients with the postoperative medial ventral hernias in the submuscular location of the mesh and TC-repair(two-cordlike).
Methods. The prospective study was carried out including 136 patients with postoperative mid-ventral hernias. Repair with submuscular mesh location was performed in 69 patients who made up the clinical comparison group (CCG). TC-repair surgery was applied in 67 cases. These are the patients of the main group (MG). In terms of 1 year and 2 years, the results of surgical treatment were evaluated in 62 patients from MG and 64 from CCG. Evaluation criteria were the duration of the operation and the number of postoperative complications, the timing of evaluation one and two years.
Results. It was registered that the duration of the operation decreased significantly. During the operation in the CCG, the time of the operation made up 90.215.2 min (p <0.05). When using TC-repair surgery the duration was 40.312.1 min. In the CCG, the complications occurred in 8 (11.6%) patients. In MG, in 3 cases (4.5%), seromas were formed, which were eliminated by a puncture method. One case of suppuration occurred in the CCG. It can be concluded that with the use of less traumatic TC repair, there is a decrease in the number of postoperative complications. Lethal outcomes are not registered. One recurrence was detected in the CCG, no late complications were noted. Relapse and complications in the later periods after surgery in the MG were not observed.
Conclusions. C-repair, being an effective treatment method of patients with medial postoperative ventral hernias, has a number of serious advantages in comparison to submuscular techniques in patients with submuscular location of the mesh. TC-repair demands less time, it has less traumatism, which leads to the reduction of the postoperative complications number.

Keywords: postoperative midline ventral hernia, hernia repair, synthetic mesh, retromuscular repair, C-repair
p. 655-662 of the original issue
  1. Charyshkin AL, Frolov AA. Gernioplasty problems at patients with postoperative ventral hernias Ul'jan Med-Biol Zhurn. 2015;(2):39-46. (in Russ.)
  2. Lembas AN, Tampej II, Ivanchenko VV, Baulin AV, Zjul'kin GA. O lechenii posleoperacionnyh ventral'nyh gryzh. Klin Medicina. 2010;(1):56-57. (in Russ.)
  3. Rastegarpour A, Cheung M, Vardhan M, Ibrahim MM, Butler CE, Levinson H. Surgical mesh for ventral incisional hernia repairs: Understanding mesh design. Plast Surg (Oakv). 2016 Spring;24(1):41-50.
  4. Bringman S, Conze J, Cuccurullo D, Deprest J, Junge K, Klosterhalfen B, Parra-Davila E, Ramshaw B, Schumpelick V. Hernia repair: the search for ideal meshes. Hernia. 2010 Feb;14(1):81-87. Published online 2009 Dec 11. doi: 10.1007/s10029-009-0587-x
  5. Ilker Murat Arer, Hakan Yabanoglu, Huseyin Ozgur Aytac, Ali Ezer, Kenan Caliskan. Long-term results of retromuscular hernia repair: a single center experience. Pan African Medical Journal. 2017;27:132. doi: 10.11604/pamj.2017.27.132.9367
  6. Parshikov VV, Petrov VV, Romanov RV, Samsonov AA, Samsonov AV, Gradusov VP, Baburin AB. Kachestvo zhizni pacientov posle gernioplastiki. Med Al'm. 2009;1(6):100-103 (in Russ)
  7. Bogdan VG, Varikash DV. Posleoperacionnye ventral'nye gryzhi: sovremennye aspekty patogeneza. Voen Medicina. 2017;(4):78-82. (in Russ.)
  8. Vichová B, Oravský M, Schnorrer M. Scar hernia repairs using a mesh--the sublay technique. Rozhl Chir. 2008 Mar;87(3):138-40. [Article in Slovak]
  9. Schumpelick V, Junge K, Rosch R, Klinge U, Stumpf M. Retromuscular mesh repair for ventral incision hernia in Germany. Chirurg. 2002 Sep;73(9):888-94. doi: 10.1007/s00104-002-0535-0 [Article in German]
  10. Schumpelick V, Klinge U, Rosch R, Junge K. Light weight meshes in incisional hernia repair. J Minim Access Surg. 2006 Sep;2(3):117-23.
  11. Schumpelick V, Klinge U, Junge K, Stumpf M. Incisional abdominal hernia: the open mesh repair. Langenbecks Arch Surg. 2004 Feb;389(1):1-5. doi: 10.1007/s00423-003-0352-z
  12. Kurzer M, Kark A, Selouk S, Belsham P. Open mesh repair of incisional hernia using a sublay technique: long-term follow-up. World J Surg. 2008 Jan;32(1):31-6; discussion 37. doi: 10.1007/s00268-007-9118-z
  13. Egiev VV, Ljadov KV, Voskresenskij SN, Rudakova MN, Chizhov DV, Shurygin SN. Atlas operativnoj khirurgii gryzh. Moscow, RF: ID Medpraktika-M; 2003. 228 p. (in Russ.)
  14. Parshikov VV, Fedaev AA. Abdominal wall prosthetic repair in ventral and incisional hernia treatment: classification, terminology and technical aspects (Review) STM. 2015;7(2):138-52. doi: 10.17691/Stm2015.7.2.19. (in Russ.)
  15. Petri A, Sjebin K. Nagljadnaja statistika v medicine. Leonov VP, per. s angl. Moscow, RF: GJeOTAR-MED; 2003. 144 p. (in Russ.)
  16. Korenkov M, Paul A, Sauerland S, Neugebauer E, Arndt M, Chevrel JP, Corcione F, Fingerhut A, Flament JB, Kux M, Matzinger A, Myrvold HE, Rath AM, Simmermacher RK. Classification and surgical treatment of incisional hernia. Results of an experts' meeting. Langenbecks Arch Surg. 2001 Feb;386(1):65-73. doi: 10.1007/s004230000182
Address for correspondence:
664013, The Russian Federation,
Irkutsk, Obraztsov Str., 27,
Road Clinical Hospital
At the Station of Irkutsk-Passenger,
Surgical Unit,
tel. mob: +7(950)069 35 67,
Sergey V. Shalashov
Information about the authors:
Shalashov Sergey V., PhD, Surgeon of the Surgical Unit, Road Clinical Hospital at the Station of Irkutsk-Passenger, Irkutsk, Russian Federation.
Kulikov Leonid K, MD, Professor of the Surgery Department, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russian Federation.
Mikhailov Alexander L., Surgeon of the Surgical Unit, Road Clinical Hospital at the Station of Irkutsk-Passenger, Irkutsk, Russian Federation.
Buslaev Oleg A., PhD, Deputy Chief Physician for Surgery, Road Clinical Hospital at the Station of Irkutsk-Passenger, Irkutsk, Russian Federation.
Egorov Ivan A., Head of the Surgical Unit, Road Clinical Hospital at the Station of Irkutsk-Passenger, Irkutsk, Russian Federation.
Yurkin Evgeniy M., Surgeon of the Surgical Unit, Road Clinical Hospital at the Station of Irkutsk-Passenger, Irkutsk, Russian Federation.
Eremenko Oleg B., Head of the Resuscitation Unit, Road Clinical Hospital at the Station of Irkutsk-Passenger, Irkutsk, Russian Federation.
Sekretarev Vadim E., Clinical Intern, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russian Federation.



V.T. Zaytsev Institute of General and Urgent Surgery 1,
V.N. Karazin Kharkiv National University 2, Kharkiv,

Objective. To determine the lung destructive indices in patients with a local, diffused and generalized forms of bullous emphysema complicated by spontaneous pneumothorax to predict a risk of the spontaneous pneumothorax recurrence and to choose the most effective tactics of surgical treatment.
Methods. The morphometric investigation includes 253 lung tissue biopsies of patients with a generalized, diffused, and local form of bullous emphysema complicated by spontaneous pneumothorax. The destructive index (DI) was measured using an overlay on a micrograph (10×10 cm in size; a microscope magnification when shooting × 200) of the Avtandilov morphometric grid of 10×10 cm in size, consisting of 100 equidistant points. Micrographs with large bronchi and bronchioles, vessels, collapsed tissue and fibrosis were excluded from the study. The number of points trapped on the damaged (rupture) and intact alveolar wall was counted, and then the destructive index was calculated: DI=D/[D+N]×100%; where, D damaged alveolar wall; N intact alveolar wall. DI 0-25% a low risk of the spontaneous pneumothorax recurrence; 26-50% a moderate risk; 51-75% a high risk; 76% or more a very high risk.
Results. In the control group, DI is 12.5%. The patients with a generalized form of emphysema have a very high risk of the spontaneous pneumothorax recurrence in the all of three zones of the lung (the damage zone [DI=97.2%], the risk zone [DI=89.7%] and the intact zone [DI=77, 4%]); the patients with a diffused form of emphysema a very high risk in the damage zone [DI=95,7%] and a high risk in the risk zone [DI=66,2%]; the patients with a local form of emphysema a very high risk in the damage zone only [DI=91,3%].
Conclusions. The lung destructive index is a reliable diagnostic and prognostic morphological criterion, which allows choosing the most effective tactics of surgical treatment of the bullous pulmonary emphysema.

Keywords: destructive index, bullous pulmonary emphysema, forms of pulmonary emphysema, spontaneous pneumothorax, videothoracoscopy
p. 663-668 of the original issue
  1. Toktokhoev VA, Budaev AE, Badmaev DD, Chepurnykh EE. Modern features of vats treatment of spontaneous pneumothorax as a complication of bullous lung emphysema: a systematic literature review. Biul VSNTs SO RAMN. 2016;1(4):162-67. (in Russ.)
  2. Pogodina AN, Voskresenskii OV, Nikolaeva EB, Barmina TG, Parshin VV. Sovremennye podkhody k lecheniiu spontannogo pnevmotoraksa i spontannoi emfizemy sredosteniia. Atmosfera. Pul'monologiia Allergologiia. 2011;(1):45-51. (in Russ.)
  3. Zhestkov KG, Barskii BG, Atiukov MA, Pichurov AA. Natsional'nye klinicheskie rekomendatsii po lecheniiu spontannogo pnevmotoraksa. S-Petersburg, RF; 2014. 24 p. /thoracic-surgeon-kr003.pdf (in Russ.)
  4. Vanderschueren RG. The role of thoracoscopy in the evaluation and management of pneumothorax. Lung. 1990;168(Suppl):1122-25. doi: 10.1007/BF02718252
  5. MacDuff A, Arnold A, Harvey J. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010 Aug;65 Suppl 2:ii18-31. doi: 10.1136/thx.2010.136986
  6. Ezhemenskii M, Desiaterik VI, Mikhno SP, Miroshnichenko VM. The medical videothoracoscopy for treatment of spontaneous pneumothorax. Vestn Neotlozh i Vosstanov Meditsiny. 2013;14(3):336-38. (in Russ.)
  7. Iablonskii PK, Atiukov MA, Pishik VE, Bulianitsa AL. Choice of treatment for the first episode of primary spontaneous pneumothorax. Vestn SPbU. Ser 11: Meditsina. 2010;(1):118-29. (in Russ.)
  8. Saito K, Cagle P, Berend N, Thurlbeck WM. The destructive index in nonemphysematous and emphysematous lungs. Morphologic observations and correlation with function. Am Rev Respir Dis. 1989 Feb;139(2):308-12. doi: 10.1164/ajrccm/139.2.308
Address for correspondence:
61018, Ukraine,
Kharkiv, Balakirev Drive, 1,
V.T. Zaytsev Institute of General
and Urgent Surgery,
Department of Urgent Surgery,
Tel.: +38 066 776-58-50,
Konstantyn L. Gaft
Information about the authors:
Boiko Valery V., MD, Corresponding Member, Professor, Director of V.T. Zaytsev Institute of General and Urgent Surgery, Kharkiv, Ukraine.
Gaft Konstantyn L., PhD, Surgeon, V.T. Zaytsev Institute of General and Urgent Surgery, Kharkiv, Ukraine.
Protsenko Elena S., MD, Professor, Head of the Department of General and Clinical Pathology of the Medical Faculty, V.N. Karazin Kharkov National University, Kharkiv, Ukraine.
Remnyova Natalia A., PhD, Associate Professor of the Department of General and Clinical Pathology of the Medical Faculty, V.N. Karazin Kharkov National University, Kharkiv, Ukraine.



Scientific and Practical Center for Preventive and Clinical Medicine, Kiev,

Objective. To evaluate the effectiveness of endovascular interventions in the treatment of non-saphenous varicose veins of lower limbs in women with pelvic congestion syndrome.
Methods. The treatment analysis of non-saphenous varicose veins of the lower limbs combined with the pelvic congestion syndrome was conducted in 25 women. The main group consisted of 10 patients with non-saphenous varicose veins, pelvic varices and clinically expressed pelvic congestion syndrome. In this group, patients underwent pelvic phlebography with embolization of the left ovarian vein and miniphlebectomy of non-saphenous varicose veins. Control group included 15 patients with non-saphenous varicose veins, pelvic varices and with poorly expressed or absent clinic of pelvic congestion syndrome. In this group only miniphlebectomy of non-saphenous varicose veins was performed. The results of treatment were evaluated within 2 years. The incidence of varicose vein recurrence and pelvic pains was evaluated.
Results. During the a 2-year observation in 8 patients (80% (95%CI=46%-99%)) of the main group, the clinical symptoms of pelvic congestion syndrome regressed or significantly decreased. In 2 patients a chronic pelvic pain recurred to the intensity of the pre-hospital period. Relapses of varicose veins of the lower limbs were not observed. During a 2-year follow-up period, 1 (6.7%) patient of the control group had a recurrence of non-saphenous varicose in the lower limbs and 1 (6.7%) patient had relapse in the system of the great saphenous vein. In 2 (13%) patients, the intensity of pelvic pain increased.
Conclusions. The embolization of the left ovarian vein in patients with pelvic congestion syndrome, according to the study data, is effective in 80% of cases. Conducting the hybrid interference in case of varicose veins of the lower limbs and pelvic congestion syndrome is effective method for correction of pathological phlebohemodynamics in patients with chronic diseases of the lower limb and pelvic veins.

Keywords: non-saphenous superficial varicose veins of the lower limbs, pelvic congestion syndrome, pelvic phlebography, embolization, miniphlebectomy
p. 669-676 of the original issue
  1. Creton D, Hennequin L, Kohler F, Allaert FA. Embolisation of symptomatic pelvic veins in women presenting with non-saphenous varicose veins of pelvic origin - three-year follow-up. Eur J Vasc Endovasc Surg. 2007 Jul;34(1):112-17. doi: 10.1016/j.ejvs.2007.01.005
  2. Giannoukas AD, Dacie JE, Lumley JS. Recurrent varicose veins of both lower limbs due to bilateral ovarian vein incompetence. Ann Vasc Surg. 2000 Jul;14(4):397-400. doi: 10.1007/s100169910075
  3. Labropoulos N, Tiongson J, Pryor L, Tassiopoulos AK, Kang SS, Mansour MA, Baker WH. Nonsaphenous superficial vein reflux. J Vasc Surg. 2001 Nov;34(5):872-77. doi: 10.1067/mva.2001.118813
  4. Meissner MH, Moneta G, Burnand K, Gloviczki P, Lohr JM, Lurie F, Mattos MA, McLafferty RB, Mozes G, Rutherford RB, Padberg F, Sumner DS. The hemodynamics and diagnosis of venous disease. J Vasc Surg. 2007 Dec;46(Suppl S):4S-24S. doi: 10.1016/j.jvs.2007.09.043
  5. Steenbeek MP, van der Vleuten CJM, Schultze Kool LJ, Nieboer TE. Noninvasive diagnostic tools for pelvic congestion syndrome: a systematic review. Acta Obstet Gynecol Scand. 2018 Jan 30. doi: 10.1111/aogs.13311.
  6. Meneses L, Fava M, Diaz P, Andía M, Tejos C, Irarrazaval P, Uribe S. Embolization of incompetent pelvic veins for the treatment of recurrent varicose veins in lower limbs and pelvic congestion syndrome. Cardiovasc Intervent Radiol. 2013 Feb;36(1):128-32. doi: 10.1007/s00270-012-0389-x
  7. Perrin MR, Labropoulos N, Leon LR Jr. Presentation of the patient with recurrent varices after surgery (REVAS). J Vasc Surg. 2006 Feb;43(2):327-34; discussion 334. doi: 10.1016/j.jvs.2005.10.05
  8. Gibson K, Minjarez R, Ferris B, Neradilek M, Wise M, Stoughton J, Meissner M. Clinical presentation of women with pelvic source varicose veins in the perineum as a first step in the development of a disease-specific patient assessment tool. J Vasc Surg Venous Lymphat Disord. 2017 Jul;5(4):493-99. doi: 10.1016/j.jvsv.2017.03.012
  9. Dabbs E, Nemchand JL, Whiteley MS. Suprapubic varicose vein formation during pregnancy following pre-pregnancy pelvic vein embolisation with coils, without any residual pelvic venous reflux or obstruction. SAGE Open Med Case Rep. 2017 Aug 8;5:2050313X17724712. doi: 10.1177/2050313X17724712. eCollection 2017.
  10. Beckett D, Dos Santos SJ, Dabbs EB, Shiangoli I, Price BA, Whiteley MS. Anatomical abnormalities of the pelvic venous system and their implications for endovascular management of pelvic venous reflux. Phlebology. 2017 Jan 1:268355517735727. doi: 10.1177/0268355517735727
  11. Kachlik D, Pechacek V, Musil V, Baca V. The venous system of the pelvis: new nomenclature. Phlebology. 2010 Aug;25(4):162-73. doi: 10.1258/phleb.2010.010006
  12. Geier B, Barbera L, Mumme A, Köster O, Marpea B, Kaminsky C, Asciutto G. Reflux patterns in the ovarian and hypogastric veins in patients with varicose veins and signs of pelvic venous incompetence. Chir Ital. 2007 Jul-Aug;59(4):481-88.
Address for correspondence:
01014, Ukraine,
Kiev, Verkhnaya Str., 5,
Scientific and Practical Center
For Preventive and Clinical Medicine,
Scientific Department of Minimally Invasive Surgery,
Tel.: +380978430155,
Oleh I. Nabolotnyi
Information about the authors:
Nabolotnyi Oleh I., Junior Researcher of the Scientific Department of Minimally Invasive Surgery, Scientific and Practical Center for Preventive and Clinical Medicine, Kiev, Ukraine.
Hupalo Yrii M., PhD, Leading Researcher of the Scientific Department of Minimally Invasive Surgery, Scientific and Practical Center for Preventive and Clinical Medicine, Kiev, Ukraine.
Shved Olena E., PhD, Senior Researcher of the Scientific Department of Minimally Invasive Surgery, Scientific and Practical Center for Preventive and Clinical Medicine, Kiev, Ukraine.
Gurianov Vitaly G., PhD, Associate Professor, Senior Researcher of the Scientific Departments of Medical Care Organization, Scientific and Practical Center for Preventive and Clinical Medicine, Kiev, Ukraine.



Samara State Medical University, Samara,
The Russian Federation

Objective. To advance treatment effectiveness of patients with chronic venous insufficiency of the lower extremities through the introduction of the clinical and pathogenetic concept of diagnosis and treatment based on the correction of the functional state of the muscular-venous pump.
Methods. A prospective, controlled clinical trial of patients (n=452) with clinical classes C3-C6 was conducted. The analysis in the comparison group (n=224) made it possible to identify the causes of unsatisfactory results, to develop the concept of diagnosis and treatment of chronic venous insufficiency, which was prospectively applied in the main group (n=228).
In the postoperative period, biomechanical stimulation of the lower limb muscular-venous pump was used in the main group patients(n=186) to correct the spring, balancing, and jog functions of the feet under static and dynamic load, as well as locomotor reconstruction of the walking pathology. Stimulation was performed in the vertical position of the patient in the frequency range from 2 to 30 Hz with fifteen-minute duration of the stimulation session.
Treatment efficacy was assessed by the VCSS scale, indices of volumetric blood flow in the deep vein system, and malleolar extremity volume after surgical treatment and after 12 months.
Results. A combined lesion of the venous and musculoskeletal systems was revealed in 402 (88.9%) cases. The combination of surgical treatment and biomechanical stimulation resulted in the improvement in the evacuation function of the muscular-venous pump. In the course of treatment, the bioelectrical activity of the gastrocnemius muscle increased, the volume outflow of blood in the muscular system decreased, the gait parameters and kinematics of the joints approached the values of healthy individuals. After 12 months, with a total assessment of the treatment effectiveness, a statistically significant predominance of good (74.1%) and a decrease in unsatisfactory results from 19.2% (comparison group) to 3.1% in the main group were obtained.
Conclusions. Surgical treatment of chronic venous insufficiency should be complemented by a complex of surgical and rehabilitation measures aimed at stimulating the muscular-venous pump and correcting the pathology of the musculoskeletal system.

Keywords: chronic venous diseases, chronic venous insufficiency, musculoskeletal system, functional diagnostics, clinical analysis of movements, muscle-venous pump
p. 677-688 of the original issue
  1. Rabe E, Berboth G, Pannier F. Epidemiology of chronic venous diseases. Wien Med Wochenschr. 2016 Jun;166(9-10):260-63. doi: 10.1007/s10354-016-0465-y [Article in German]
  2. Zolotukhin IA, Seliverstov EI, Shevtsov YN, Avakiants IP, Nikishkov AS, Tatarintsev AM, Kirienko AI. Prevalence and risk factors for chronic venous disease in the general russian population. Eur J Vasc Endovasc Surg. 2017 Dec;54(6):752-58. doi: 10.1016/j.ejvs.2017.08.033
  3. Serra R, Butrico L, Ruggiero M, Rossi A, Buffone G, Fugetto F, De Caridi G, Massara M, Falasconi C, Rizzuto A, Settimio UF, Perri P, Dardano G, Grande R, De Franciscis S. Epidemiology, diagnosis and treatment of chronic leg ulcers: a systematic review. Acta Phlebologica. 2015 April;16(1):9-18.
  4. Galanaud JP, Monreal M, Kahn SR. Epidemiology of the post-thrombotic syndrome. Thromb Res. 2018 Apr;164:100-109. doi: 10.1016/j.thromres.2017.07.026
  5. Osęka M, Tworus R, Kabala P, Skórski M. Severity of chronic venous disease and anatomic distribution of valvular incompetence. Int Angiol. 2014 Jun;33(3):282-91.
  6. Lee BB, Nicolaides AN, Myers K, Meissner M, Kalodiki E, Allegra C, Antignani PL, Bækgaard N, Beach K, Belcaro G, Black S, Blomgren L, Bouskela E, Cappelli M, Caprini J, Carpentier P, Cavezzi A, Chastanet S, Christenson JT, Christopoulos D, Clarke H, Davies A, Demaeseneer M, Eklöf B, Ermini S, Fernández F, Franceschi C, Gasparis A, Geroulakos G, Gianesini S, Giannoukas A, Gloviczki P, Huang Y, Ibegbuna V, Kakkos SK, Kistner R, Kölbel T, Kurstjens RL, Labropoulos N, Laredo J, Lattimer CR, Lugli M, Lurie F, Maleti O, Markovic J, Mendoza E, Monedero JL, Moneta G, Moore H, Morrison N, Mosti G, Nelzén O, Obermayer A, Ogawa T, Parsi K, Partsch H, Passariello F, Perrin ML, Pittaluga P, Raju S, Ricci S, Rosales A, Scuderi A, Slagsvold CE, Thurin A, Urbanek T, van Rij AM, Vasquez M, Wittens CH, Zamboni P, Zimmet S, Ezpeleta SZ. Venous hemodynamic changes in lower limb venous disease: the UIP consensus according to scientific evidence. Int Angiol. 2016 Jun;35(3):236-52.
  7. Sushkou SA, Samsonova IV, Galishevic MM. CD34 expression patogenetic value in lower limb varicose veins. Novosti Khirurgii. 2015 May-Jun; 23 (3): 302-308. doi: 10.18484/2305-0047.2015.3.302. (in Russ)
  8. Ercan S, Çetin C, Yavuz T, Demir HM, Atalay YB. Effects of isokinetic calf muscle exercise program on muscle strength and venous function in patients with chronic venous insufficiency. Phlebology. 2018 May;33(4):261-66. doi: 10.1177/0268355517695401
  9. Partsch H. Ankle range of motion vs. venous ulcer healing rate: a complex relationship. Wound Repair Regen. 2014 Jul-Aug;22(4):435. doi: 10.1111/wrr.12210
  10. Huang Y, Gloviczki P. Relationships between duplex findings and quality of life in long-term follow-up of patients treated for chronic venous disease. Phlebology. 2016 Mar;31(1 Suppl):88-98. doi: 10.1177/0268355516630868
  11. Ebner JA, Ebner A, Taurino M, Morandell S, Falk M, Stringari C, Dellis C, Ebner H. Recurrent residual or progressive varicose veins: postoperative long term follow-up of 353 patients. Ann Ital Chir. 2017;88:526-33.
  12. Behrendt CA, Heidemann F, Rieß HC, Kleinspehn E, Kühme T, Atlihan G, Gebhardt C, Debus E. Open surgical treatment for postthrombotic syndrome. Phlebology. 2016 Mar;31(1 Suppl):48-55. doi: 10.1177/0268355516633016
  13. Morrison N. Venous intervention in chronic venous ulcer treatment and recurrence avoidance. Phlebologie. 2016;45(3):135-39. doi: 10.12687/phleb2310-3-2016
  14. Kotelnikov GP, Losev II, Sizonenko YV, Katorkin SE. Peculiarities of diagnostics and treatment tactics of patients with combined lesion of the musculoskeletal and venous systems of the lower limb. Novosti Khirurgii. 2013 May-Jun; 21 (3): 42-53. doi: 10.18484/2305-0047.2013.3.42. (in Russ.)
  15. Engelbert TL, Turnipseed WD. Chronic compartment syndrome secondary to venous hypertension: fasciectomy for symptom relief. Ann Vasc Surg. 2014 Oct;28(7):1798.e11-4. doi: 10.1016/j.avsg.2014.05.011
Address for correspondence:
443079, The Russian Federation,
Samara, Karl Marx Ave., 165 b,
Clinics of Samara State Medical University,
Department and Clinic of Hospital Surgery,
tel.: +7 927 206 71 02,
Sergey E. Katorkin
Information about the authors:
Kotelnikov Gennady P., Academician of RAS, MD, Professor, Head of the Department of Traumatology, Orthopedics and Extreme Surgery named after Acad. of RAS A.F. Krasnov, Samara State Medical University, Samara, Russian Federation.
Katorkin Sergey E., PhD, Associate Professor, Head of the Department and Clinic of Hospital Surgery, Samara State Medical University, Samara, Russian Federation.
Korymasov Evgenii A., MD, Professor, Head of the Department of Surgery of the Institute of Vocational Education, Samara State Medical University, Samara, Russian Federation.



Krasnoyarsk State Medical University named after Prof. V.F.Voino-Yasenetsky, Krasnoyarsk,
The Russian Federation

Objective. To reveal the features of the immune status and blebbing of lymphocytes connected with the course of peripancreatic infiltrates in severe acute pancreatitis.
Methods. 86 patients with severe acute pancreatitis and peripancreatic infiltrates who came to Ia disease phase were studied. In 42 patients complete clearance of infiltrate was observed (the 1st group). 44 patients, in whom pseudocysts and purulent complications developed, made up the 2nd group.
On hospitalization, a cellular link of immunity (CD3+, CD4+, CD8+, CD16+, CD19+, CD25+, CD95+, CD72+, HLA-DR+) was estimated using the method of indirect immunofluorescence, phagocytes activity with flowing cytometry, interleukin-4, interleukin-6, interleukin-10 and tumor necrosis factor alpha with the immunofermental analysis, the membrane state of lymphocytes with phase and contrast microscopy. Presence of infiltrate was defined on the 14th day from the beginning of the disease.
Results. T-lymphocytes, NK-cells and CD25+ had a strong inverse correlation with unfavorable course. There is a strong direct correlation of CD95+ with unfavorable course. The immune regulatory index had a strong inverse correlation with unfavorable course of rS=-0.76, (p<0.001). Interleukin-6 was increased in both groups. There was the correlation of the tumor necrosis factor alpha with unfavorable course of rS=0.69, (p<0.001). Interleukin-10 was increased in the 1st group. In the 1st group the cells in the condition of the initial blebbing exceeded the norm in 2 times, in the 2nd group in 3 times. The terminal blebbing in the 1st group was 4 times higher, in the 2ndgroup in 8 times. Increase in the total blebbing happened due to a terminal blebbing in both groups.
Conclusions. The unfavorable course of peripancreatic infiltrates is followed by lymphopenia, decrease in relative population of T-helpers, NK-cells, CD25+, the increase in CD95+, expressed decrease in the immunoregulatory index, increase in interleukin-6, tumor necrosis factor alpha, increase in indicators of terminal and total blebbing of lymphocytes.

Keywords: pancreatitis, peripancreatic infiltrates, immunity, blebbing, lymphocyte, interleukin
p. 689-696 of the original issue
  1. Ermolov AS, Ivanov PA, Blagovestnov DA, Grishin AV, Andreev VG. Diagnostika i lechenie ostrogo pankreatita. Moscow, RF: Vidar. 2013. 384 p. (in Russ.)
  2. Shorokh GP, Shorokh SG. Ostryi destruktivnyi pankreatit. Minsk, RB: Paradoks; 2013. 208 p. (in Russ.)
  3. Belorusets VN, Karpitskii AS, Golubeva NN. Morphological changes in the retroperitoneal fat tissue in the early phase of acute necrotizing pancreatitis. Novosti Khirurgii. 2018 Jan-Feb; 26 (1):34-41. doi: 10.18484/2305-0047.2018.1.34 (in Russ.)
  4. Vinnik YS, Dunaevskaya SS, Antufrieva DA. Possibility of the current methods of visualization at severe acute pancreatitis. Novosti Khirurgii. 2014 Jan-Feb; 22 (1): 58-62. doi: 10.18484/2305-0047.2014.1.58 (in Russ.)
  5. Anishchenko VV, Kim DA, Baram GI, Morosov VV, Kovgan YuM, Kan BV, Korkotyan AG. The substantiation of necessity the early surgical treatment of patients with heavy acute pancreatitis by the features complex. Sib Med Obozrenie. 2017;105(3):43-49. doi: 10.20333/2500136-2017-3-43-49. (in Russ.)
  6. Rosenberg A, Steensma EA, Napolitano LM. Necrotizing pancreatitis: new definitions and a new era in surgical management. Surg Infect (Larchmt). 2015 Feb;16(1):1-13. doi: 10.1089/sur.2014.123
  7. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS. Classification of acute pancreatitis 2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11. 10.1136/gutjnl-2012-302779
  8. Pietruczuk M, Dabrowska MI, Wereszczynska-Siemiatkowska U, Dabrowski A. Alteration of peripheral blood lymphocyte subsets in acute pancreatitis. World J Gastroenterol. 2006;12(33):5344-51. doi: 10.3748/wjg.v12.i33.5344
  9. Dabrowski A, Osada J, Dabrowska MI, Wereszczynska-Siemiatkowska U. Monocyte subsets and natural killer cells in acute pancreatitis. Pancreatology. 2008;8(2):126-34. doi: 10.1159/000123605
  10. Hoque R. Update on innate immunity and perspectives on metabolite regulation in acute pancreatitis. Curr Opin Gastroenterol. 2016;32(6):507-12. doi: 10.1097/MOG.0000000000000311
  11. Zhylai GA, Oleinik EK, Ostrovskii KA, Oleinik VM, Kravchenko PN. Alterations of lymphocyte subsets and indicators of immune suppression in patients with acute pancreatitis. Eksperim i Klin Gastroenterologiia. 2014;(9):21-25. (in Russ.)
  12. Mylona V, Koussoulas V, Tzivras D, Makrygiannis E, Georgopoulou P, Koratzanis G, Giamarellos-Bourboulis EJ, Tzivras MD. Changes in adaptive and innate immunity in patients with acute pancreatitis and systemic inflammatory response syndrome. Pancreatology.2011;11(5):475-81. doi: 10.1159/000329460
  13. Pinhu L, Qin Y, Xiong B, You Y, Li J, Sooranna SR. Overexpression of Fas and FasL is associated with infectious complications and severity of experimental severe acute pancreatitis by promoting apoptosis of lymphocytes. Inflammation.2014;37(4):1202-12. doi: 10.1007/s10753-014-9847-8
  14. Takeyama Y, Takas K, Ueda T, Hori Y, Goshima M, Kuroda Y. Peripheral lymphocyte reduction in severe acute pancreatitis is caused by apoptotic cell death. J Gastrointest Surg. 2000;4(4):379-87. doi: 10.1016/S1091-255X(00)80016-5
  15. Shen Y, Cui N, Miao B, Zhao E. Immune dysregulation in patients with severe acute pancreatitis. Inflammation. 2011 Feb;34(1):36-42. doi: 10.1007/s10753-010-9205-4
  16. Shen Y, Deng X, Xu N, Li Y, Miao B, Cui N. Relationship between the degree of severe acute pancreatitis and patient immunity. Surg Today. 2015;45(8):1009-17. doi: 10.1007/s00595-014-1083-1
Address for correspondence:
660077, The Russian Federation,
Krasnoyarsk, Partizan Zheleznyak Str., 1,
Krasnoyarsk State Medical University
Named after Prof. V.F.Voino-Yasenetsky,
General Surgery Department
Named after Prof. M.I. Gulman,
Tel. office: +963-191-29-70,
Svetlana S. Dunaevskaya
Information about the authors:
Vinnik Yurii S., MD, Professor, Head of the General Surgery Department named after Prof. M.I. Gulman, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Russian Federation.
Dunaevskaya Svetlana S., MD, Associate Professor of the General Surgery Department named after Prof. M.I. Gulman, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Russian Federation.
Antufrieva Daria A., PhD, Assistant of the General Surgery Department named after Prof. M.I. Gulman, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Russian Federation.
Deulina Vera V., Full-Time Post-Graduate Student of the General Surgery Department named after Prof. M.I. Gulman, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Russian Federation.




North-West State Medical University named after I.I. Mechnikov1,
Military Medical Academy named after S.M. Kirov 2, Saint Petersburg,
The Russian Federation

Objective. To improve the results of osteosynthesis of long tubular bones on the basis of working out and application of the mathematical forecast model to prevent the surgical site infection (SSI).
Methods. A retrospective analysis of data of 179 patients who underwent osteosynthesis of long tubular bones after the diaphyseal fractures was performed. The data were compared on patients who underwent osteosynthesis without SSI (the 1st group 144 observations) with the data of the operated ones, where SSI was observed (the 2nd group 35 cases). A prospective analysis included 117 cases of diaphyseal fractures of long tubular bones.
Results. 18 prognostic criteria for the development of SSI have been identified and evaluated in quantitative terms (gender, age, information about comorbidities, the type and location of a fracture, the type of metal construction, the operation theatre list, etc.). The developed method of SSI prognosis made it possible, on the basis of the total prognosis index, to single out among the patients with fractures of long tubular bones the risk group in respect of whom individual preventive measures were taken. In the study of immunological parameters, it is advisable to consider T/NK cells as a prognostic criterion for the development of SSI, the preoperative indicators of which in patients with SSI exceeded those in the group without SSI and amounted to 2.213×109/l and 1.397×109/l, respectively (p<0.01).
Conclusions. The developed method of SSI prediction and the use of individual preventive measures can significantly reduce the incidence of SSI compared with the group of retrospective studies.

Keywords: long tubular bones, diaphyseal fracture, osteosynthesis, surgical site infection, prognosis, risk factors
p. 697-706 of the original issue
  1. Belen'ki IG, Kutianov DI, Spesivtsev AIu. Long-bone fractures in patients who need surgical treatment in municipal multi-field emergency hospital. Vestn S-Peterb Un-ta. Ser. 11. 2013;(1):134-39. (in Russ.)
  2. Van den Berg J, Osei D, Boyer MI, Gardner MJ, Ricci WM, Spraggs-Hughes A, McAndrew CM. Open tibia shaft fractures and soft-tissue coverage: the effects of management by an orthopaedic microsurgical team. J Orthop Trauma. 2017 Jun;31(6):339-344. doi: 10.1097/BOT.0000000000000815
  3. Popov VP, Zdrel'ko VP, Trukhachev IG, Popov AV. Complications of extramedullary osteosynthesis in patients with long bone fractures. Genii Ortopedii. 2014;(2):5-9. (in Russ.)
  4. Scharfenberger AV, Alabassi K, Smith S, Weber D, Dulai SK, Bergman JW, Beaupre LA. Primary wound closure after open fracture: a prospective cohort study examining nonunion and deep infection. J Orthop Trauma. 2017 Mar;31(3):121-26. doi: 10.1097/BOT.0000000000000751
  5. Dvornik S, Kezlya O, Rustamov Kh. Surgical complications of long bones fractures of the lower extremities in patients with combined injuries. Ekstr Meditsina. 2014;(1):53-61. (in Russ.)
  6. Westgeest J, Weber D, Dulai SK, Bergman JW, Buckley R, Beaupre LA. Factors associated with development of nonunion or delayed healing after an open long bone fracture: a prospective cohort study of 736 subjects. J Orthop Trauma. 2016 Mar;30(3):149-55. doi: 10.1097/BOT.0000000000000488
  7. Dorofeev YuL, Ptashnikov DA, Tkachenko AN, Bakhtin MYu, Kalimullina AF. Prognosis of deep infectious complications in hip arthroplasty. Vestn Khirurgii im II Grekova. 2015;174(5):40-44. (in Russ.)
  8. Derkachev VS, Aleksejev SA, Ibragimova ZA, Potapnev MP, Bordakov VN, Honcharick AV, Semerichina SE, Kartun LV. Immunological predictors of early postoperative pyo-inflammatory complications in patients with long bone fractures. Novosti Khirurgii. 2016 Nov-Dec; 24 (6): 561-67. doi: 10.18484/2305-0047.2016.6.561 (in Russ.)
  9. Miromanov AM, Trubitsin MV, Mironova OB., Miromanova NA. The personalised aspects of development of inflammatory complications in fractures of bones of extremities. Politravma. 2017;(2):37-41. (in Russ.)
  10. Hernigou J, Schuind F. Smoking as a predictor of negative outcome in diaphyseal fracture healing. Int Orthop. 013 May;37(5): 883-87. Published online 2013 Feb 8. doi: 10.1007/s00264-013-1809-5
  11. Wald A. Sequential tests of statistical hypotheses. Ann Math Statist. 1945;16(2):117-86. doi: 10.1214/aoms/1177731118
  12. Gubler EV, Genkin AA. Primenenie neparametricheskikh kriteriev statistiki v mediko-biologicheskikh issledovaniiakh. Leningrad, SSSR: Meditsina; 1973. 142 p. (in Russ.)
  13. Kempegowda H, Richard R, Borade A, Tawari A, Graham J, Suk M, Howenstein A, Kubiak EN, Sotomayor VR, Koval K, Liporace FA, Tejwani N, Horwitz DS. Obesity is associated with high perioperative complications among surgically treated intertrochanteric fracture of the femur. J Orthop Trauma. 2017 Jul;31(7):352-57. doi: 10.1097/BOT.0000000000000825
  14. Nahm NJ, Moore TA, Vallier HA. Use of two grading systems in determining risks associated with timing of fracture fixation. J Trauma Acute Care Surg. 2014 Aug;77(2):268-79. doi: 10.1097/TA.0000000000000283
  15. Qu C, Pu C, Shang K, Dong N, Xing Y, Li X, Wang J. Reference intervals and its verification for leukocyte differential count in peripheral blood by CytoDiff flow cytometry. Zhonghua Yi Xue ZaZhi. 2015 Jul 14;95(26):2079-83. [ArticleinChinese]
Address for correspondence:
195067, The Russian Federation,
Saint-Petersburg, Piskarevsky Ave., 47,
North-West State Medical University
Named after I.I. Mechnikov,
Department of Traumatology,
Orthopedics and Military Field Surgery,
el.: +7-911-215-19-72,
Aleksandr N. Tkachenko
Information about the authors:
Tkachenko Aleksandr N., MD, Professor of the Department of Traumatology, Orthopedics and Military Field Surgery, North-West State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russian Federation.
Gaikovaya Larisa B., MD, Professor of the Department of Biological and General Chemistry, North-West State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russian Federation.
Ehsan Ulhaq, Post-Graduate Student of the Department of Traumatology, Orthopedics and Military Field Surgery, North-West State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russian Federation.
Korneenkov Aleksei A., MD, Professor of the Department of Medical Service Management Automation with Military Medical Statistics, Military Medical Academy named after S.M. Kirov, Saint Petersburg, Russian Federation
Kushnirchuk Igor O., PhD, Associate Professor of the Department of Medical Service Management Automation with Military Medical Statistics, Military Medical Academy named after S.M. Kirov, Saint Petersburg, Russian Federation
Mansurov Djalolidin Sh., Post-Graduate Student of the Department of Traumatology, Orthopedics and Military Field Surgery, North-West State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russian Federation.
Ermakov Aleksei I., Physician of the Central Clinical and Diagnostic Laboratory, North-West State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russian Federation.




Kazan State Medical University 1,
Tatarstan Regional Clinical Cancer Center2, Kazan
I. N. Ulianov Chuvash State University3, Cheboksary,
The Russian Federation

Objective. To work out a multifactorial prognostic model for the development of inconsistency of colorectal anastomosis sutures after sphincter-saving operations on the rectum for cancer.
Methods. The work is based on the study of 145 patients who were subject to low and ultra-low intra-abdominal resections of the rectum for cancer; there were 65 males, 80 females. The average age of patients was 66.110.81 years, there were 95 patients (76.6%) over the age of 60 and 54 (37.3%) over 70. The following parameters were analyzed: gender, age, body mass index, anesthesia assessment according to ASA, concomitant diseases, tumor stage, tumor level from the anus, volume of operation, anastomosis level from the anus, postoperative complications. The multifactorial prognostic model of the development of the anastomosis sutures failure is based on the binary logistic regression method.
Results. The colorectal anastomoses sutures failure has developed in 23 patients (15.9%). No patient was reoperated because of the formation of an intestinal stoma. The following statistically significant factors of the inconsistency of the colorectal anastomosis sutures were obtained: the anastomosis level from the anus, the level of the tumor to the anus, the body mass index, the presence of coronary heart disease, the status of anesthesia in ASA (p <0.001, p=0.002, p=0.035, p<0.001, p=0.037, respectively). Based on the information about the influence of various factors on the incidence of the sutures failure of colorectal cancer, a prognostic model was designed that was transformed into a computer program to simplify the use in the practice of a doctor.
Conclusions. The developed multifactorial prognostic model and its implementation in the form of a simple computer program enables physicians to assess the risk of development of the colorectal sutures failure on the basis of several statistically significant factors and apply appropriate measures to prevent postoperative complications after low and ultra-low rectal resections for cancer.

Keywords: colorectal cancer, colorectal anastomosis, anastomosis leakage, prognosis, software
p. 707-714 of the original issue
  1. Siegel RL, Miller KD, Fedewa SA, Ahnen DJ, Meester RGS, Barzi A, Jemal A. Colorectal cancer statistics, 2017. CA Cancer J Clin. 2017 May 6;67(3):177-93. doi: 10.3322/caac.21395
  2. Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, Stein KD, Alteri R, Jemal A. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016 Jul;66(4):271-89. doi: 10.3322/caac.21349
  3. Stevenson ARL. The future for laparoscopic rectal cancer surgery. Br J Surg. 2017;104(6):643-45. doi: 10.1002/bjs.10503
  4. Kang CY, Halabi WJ, Chaudhry OO, Nguyen V, Pigazzi A, Carmichael JC, Mills S, Stamos MJ. Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg. 2013 Jan;148(1):65-71. doi: 10.1001/2013.jamasurg.2
  5. Alves A, Panis Y, Pocard M, Regimbeau JM, Valleur P. Management of anastomotic leakage after nondiverted large bowel resection. J Am Coll Surg. 1999 Dec;189(6):554-59. doi: 10.1016/S1072-7515(99)00207-0
  6. Fouda E, El Nakeeb A, Magdy A, Hammad EA, Othman G, Farid M. Early detection of anastomotic leakage after elective low anterior resection. J Gastrointest Surg. 2011 Jan;15(1):137-44. doi: 10.1007/s11605-010-1364-y
  7. Caulfield H, Hyman NH. Anastomotic leak after low anterior resection: a spectrum of clinical entities. JAMA Surg. 2013 Feb;148(2):177-82. doi: 10.1001/jamasurgery.2013.413
  8. Wu Z, van de Haar RC, Sparreboom CL, Boersema GS, Li Z, Ji J, Jeekel J, Lange JF. Is the intraoperative air leak test effective in the prevention of colorectal anastomotic leakage? A systematic review and meta-analysis. Int J Colorectal Dis. 2016 Aug;31(8):1409-17. doi: 10.1007/s00384-016-2616-4
  9. Cauchy F, Abdalla S, Penna C, Angliviel B, Lambert B, Costaglioli B, Brouquet A, Benoist S. The small height of an anastomotic colonic doughnut is an independent risk factor of anastomotic leakage following colorectal resection: results of a prospective study on 154 consecutive cases. Int J Colorectal Dis. 2017 May;32(5):699-707. doi: 10.1007/s00384-017-2769-9
  10. Jatal S, Pai VD, Demenezes J, Desouza A, Saklani AP. Analysis of risk factors and management of anastomotic leakage after rectal cancer surgery: an Indian Series. Indian J Surg Oncol. 2016 Mar;7(1):37-43. doi: 10.1007/s13193-015-0457-1
  11. Parthasarathy M, Greensmith M, Bowers D, Groot-Wassink T. Risk factors for anastomotic leakage after colorectal resection: a retrospective analysis of 17 518 patients. Colorectal Dis. 2017 Mar;19(3):288-98. doi: 10.1111/codi.13476
  12. Akhmetzyanov FSh, Shaykhutdinov NT, Valiev NA, Shemeunova ZN, Egorov VI. Aspiration drainage in the prevention of postoperative septic complications in rectum sphincter-sparing abdominoperitoneal resection. Kazan Med Zhurn. 2015;96(6):935-39. doi: 10.17750/KMJ2015-935 (in Russ.)
  13. Hong J, Han YD, Zhu XC, Li XN, Li C, Yang J, Shi LS. Indications of preventive ileostomy in sphincter-preserving surgery for patients with rectal cancer. Int J Clin Exp Med. 2016;9(5):8506-13.
  14. Man VC, Choi HK, Law WL, Foo DC. Morbidities after closure of ileostomy: analysis of risk factors. Int J Colorectal Dis. 2016 Jan;31(1):51-57. doi: 10.1007/s00384-015-2327-2
  15. Kornmann VN, Walma MS, de Roos MA, Boerma D, van Westreenen HL. Quality of life after a low anterior resection for rectal cancer in elderly patients. Ann Coloproctol. 2016 Feb;32(1):27-32. doi: 10.3393/ac.2016.32.1.27
Address for correspondence:
420012, The Russian Federation,
Kazan, Baturin Str., 49,
Kazan State Medical University,
Department of Oncology,
X-ray Diagnostics and Radiotherapy,
Tel. office: +7 927 429 96 71,
Vasiliy I. Egorov
Information about the authors:
Akhmetzyanov Foat Sh., MD, Professor, Head of the Department of Oncology, X-ray Diagnostics and Radiotherapy, Kazan State Medical University, Head of the Tatarstan Regional Clinical Cancer Center, Kazan, Russian Federation.
Egorov Vasiliy I., PhD, Assistant of the Department of Oncology, X-ray Diagnostics and Radiotherapy, Kazan State Medical University, Oncologist of the General Oncology Unit of Tatarstan Regional Clinical Cancer Center, Kazan, Russian Federation.
Fomin Aleksey I., Applicant for Masters Degree of the Faculty of Informatics and Computer Science, I. N. Ulianov Chuvash State University, Cheboksary, Russian Federation.
Kokshin Alexander V., Post-Graduate Student of the Department of Neurosurgery, Kazan State Medical University, Kazan, Russian Federation.




Gomel State Medical University 1,
Gomel Regional Clinical Hospital 2, Gomel,
The Republic of Belarus

Objective. To assess the x-ray anatomic parameters of the spinal canal at the lumbosacral level and to suggest the method for their application in the diagnosis and surgical treatment of central dystrophic stenosis.
Methods. 64 patients operated on because of the degenerative-dystrophic pathology of the lumbosacral spine were included in the study. The main group consisted of patients with the combination of herniated intervertebral disc and central dystrophic stenosis of the spinal canal. The control group included patients with herniated discs without stenosis. The anteroposterior, interarticular ligamentous parameters, the area of the dural sac, and thickness of the ligamentum flavum were investigated. The method of determining of the surgical decompression dimension for cases of central stenosis of the spinal canal has been developed.
Results. The study revealed a statistically significant difference between the groups in the anteroposterior, interarticular ligamentous distance and dural sac area. Isolated hypertrophy of the ligamentum flavum with anteroposterior size value of 12 mm and more was the most common cause of dystrophic stenosis (38.2%). There was a strong correlation between interarticular ligamentous distance and area of the dural sac (in the main group rs=0.72 at p<0.00001; in the group of control rs=0.70 at p<0.00001). Cases of thickening of the ligamentum flavum more than 4 mm are noted both in the stenotic segments, and in the segments with herniated discs without stenosis.
Conclusions. Interarticular ligamentous distance has confirmed its diagnostic significance and the possibility of using as a criterion for a deficiency of free space in the spinal canal in cases of hypertrophy of the ligamentum flavum and/or articular processes. The fact of thickening of the ligamentum flavum does not in all cases indicate the presence of its compressive effect on the dural sac and is not sufficient to establish the diagnosis of dystrophic stenosis. The developed measurement procedure according to the 7 specified plans allows performing a reasonable, selective resection of the elements of the posterior support complex in cases of combination of herniated disc and central dystrophic stenosis.

Keywords: central dystrophic stenosis, interarticular ligamentous distance, ligamentum flavum, articular processes, area of dural sac, intervertebral fissure
p. 715-725 of the original issue
  1. Chung S, Kang M, Shin Y, Baek O, Lee S. Postoperative expansion of dural sac cross-sectional area after unilateral laminotomy for bilateral decompression: correlation with clinical symptoms. Korean J Spine. 2014 Dec; 11(4):227-31. Published online 2014 Dec 31. doi: 10.14245/kjs.2014.11.4.227
  2. Morgalla MH, Noak N, Merkle M, Tatagiba MS. Lumbar spinal stenosis in elderly patients: is a unilateral microsurgical approach sufficient for decompression? J Neurosurg Spine. 2011 Mar;14(3):305-12. doi: 10.3171/2010.10.SPINE09708
  3. Pedachenko YuE. Lumbar spinal stenosis. Ukrain Neirokhirurg Zhurn. 2009;(4):9-14. (in Russ.)
  4. Ul'rikh EV, Mushkin AIu. Vertebrologiia v terminakh, tsifrakh, risunkakh. Saint-Petersburg, RF: ELBI-SPb; 2004. 179 p. (in Russ.)
  5. Cehla AI. gnetic-resonant visualization of neurologic displays of an osteochondrosis of lumbo-sacral department of a backbone. Tavr Med-Biol Vestn. 2012;15(1):287-90. (in Russ.)
  6. Sobottke R, Schlüter-Brust K, Kaulhausen T, Röllinghoff M, Joswig B, Stützer H, Eysel P, Simons P, Kuchta J. Interspinous implants (X Stop, Wallis, Diam) for the treatment of LSS: is there a correlation between radiological parameters and clinical outcome? Eur Spine J. 2009 Oct;18(10):1494-503. Published online 2009 Jun 27. doi: 10.1007/s00586-009-1081-y
  7. Shmirjev VI, Morozov SP, Voinov DA. Clinical and radial correlations in stenoses of the spinal canal. Kremlev Meditsina. 2009;(4):76-79. (in Russ)
  8. Sorokovikov VA, Gorbunov AV, Koshkareva ZV, Briukhanov VG, Pozdeeva NA. Klassifikatsii stenozov pozvonochnogo kanala v poiasnichnom otdele pozvonochnika. Biul VSNTs RAMN. 2010;2(72):243-47. (in Russ)
  9. Shevelev IN, Kornienko VN, Konovalov NA, Cherkashov AM, Nazarenko AG, Asiutin DS. Analysis of correlation of radiological criteria and clinical manifestation of central lumbosacral spinal stenosis. Vopr Neirokhirurgii. 2012; (3): 61-68. (in Russ.)
  10. Karabekir HS, Yildizhan A, Atar EK, Yaycioglu S, Gocmen-Mas N, Yazici C. Effect of ligamenta flava hypertrophy on lumbar disc herniation with contralateral symptoms and signs: a clinical and morphometric study. Arch Med Sci. 2010 Aug 30;6(4):617-22. doi: 10.5114/aoms.2010.14477.
  11. Olizarovich MV, Remov PS. Microsurgical intervention on the spine using computer calculation and graphic visualization. Novosti Khirurgii. 2016;(6):592-600. doi: 10.18484/2305-0047.2016.6.592. (in Russ.)
  12. Hermansen E, Moen G, Barstad J, Birketvedt R, Indrekvam K. Laminarthrectomy as a surgical approach for decompressing the spinal canal: assessment of preoperative versus postoperative dural sac cross-sectional areal (DSCSA). Eur Spine J. 2013 Aug;22(8):1913-19. doi: 10.1007/s00586-013-2737-1
  13. Abbas J, Hamoud K, May H, Hay O, Medlej B, Masharawi Y, Peled N, Hershkovitz I. Degenerative lumbar spinal stenosis and lumbar spine configuration. Eur Spine J. 2010 Nov;19(11):1865-73. doi: 10.1007/s00586-010-1516-5
  14. Haig AJ, Adewole A, Yamakawa KS, Kelemen B, Aagesen AL. The ligamentum flavum at L4-5: relationship with anthropomorphic factors and clinical findings in older persons with and without spinal disorders. PMR. 2012 Jan;4(1):23-29. doi: 10.1016/j.pmrj.2011.07.023
Address for correspondence:
246000, The Republic of Belarus,
Gomel, Lange Str., 5,
Gomel State Medical University,
Department of Neurology and Neurosurgery
With the Course of Medical Rehabilitation,
Mob. tel. :+375 44 597 04 76,
Pavel S. Remov
Information about the authors:
Remov Pavel S., Assistant of the Department of Neurology and Neurosurgery with the Course of Medical Rehabilitation, Gomel State Medical University, Gomel, Republic of Belarus.
Alizarovich Mikhail V., PhD, Associate Professor of the Department of Neurology and Neurosurgery with the Course of Medical Rehabilitation, Gomel State Medical University, Gomel, Republic of Belarus.




Belgorod Regional Clinical Hospital of Saint Joasaph 1,
Belgorod National Research University 2,
The Russian Federation

Objective. To estimate the possibilities of transureteroureterostomy in the surgical treatment of the invasive bladder cancer.
The article analyzes the publications dealing with transureteroureterostomy in various pathologies. Positive results of using this approach in pediatric urology are shown. 94 observations of augmentation plasty of the bladder in children with unilateral ureterohydronephrosis and subsequent transureteroureterostomy were analyzed. Long-term effectiveness (for terms from 6 to 13 years) on 134 repeated plastics of the extended strictures of the ureter was proved. The incidence of anastomotic failure was 9.5%, and relapse of obstruction developed in 10% of patients. The elimination of the need for the intestinal reconstruction after radical cystectomy reduces the number of perioperative complications. It is shown that transureteroureterostomy does not have high morbidity and does not increase the number of urobiobstructive complications in comparison with Bricker ileal conduit. The authors highlight the most important technical aspects of performing this type of urine derivation after cystectomy for the muscular-invasive bladder cancer.
Conclusions. Carrying out transureteroureterostomy and the formation of cutaneous ureterostomy after radical cystectomy does not increase the frequency of early postoperative complications and saves patients from bilateral urostomy.

Keywords: transureteroureterostomy, radical cystectomy, urine diversion, bladder cancer, ureterocutaneosostomy
p. 726-734 of the original issue
  1. Kolontarev KB, Rapoport LM, Carichenko DG. Rak mochevogo puzyrja. V kn: Aljaev JuG, Glybochko PV, Pushkar' DJu, red. Rossijskie klinicheskie rekomendacii po urologii. Ministerstvo zdravoohranenija Respubliki Burjatija [Jelektronnyj resurs]. 2013. [Data dostupa: 26.01.2018]. Rezhim dostupa: (in Russ.)
  2. Prodolzhitel'nost' zhizni pri rozhdenii po regionam Rossii (ozhidaemaja) za 2015 god (Obn. 12.04.2018) [Jelektronnyj resurs] [Data dostupa: 26.01.2018]. Rezhim dostupa: (in Russ.)
  3. Nizamova RS, Zimichev AA, Klymentyeva MS, Korabelnikov AS. Aetiopathogenesis of bladder cancer and forecasting the probability of disease. Aspirant Vestn Povolzh'ja. 2015;( 5-6):102-107. (in Russ.)
  4. Yafi FA, Cury FL, Kassouf W. Organ-sparing strategies in the management of invasive bladder cancer. Expert Rev Anticancer Ther. 2009 Dec;9(12):1765-75. doi: 10.1586/era.09.151
  5. Kitamura H, Masumori N, Tsukamoto T. Role of lymph node dissection in management of bladder cancer. Int J Clin Oncol. 2011 Jun;16(3):179-85. doi: 10.1007/s10147-011-0235-1
  6. Chou R, Selph SS, Buckley DI, Gustafson KS, Griffin JC, Grusing SE, Gore Jl. Treatment of muscle-invasive bladder cancer: A systematic review. Cancer. 2016 Mar 15;122(6):842-51. doi: 10.1002/cncr.29843
  7. van Rhijn BW, Burger M, Lotan Y, Solsona E, Stief CG, Sylvester RJ, Witjes JB, Zlotta AR. Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy. Eur Urol. 2009 Sep;56(3):430-42. doi: 10.1016/j.eururo.2009.06.028
  8. Petrov SB, Levkovskij NS, Korol" VD, Parshin AG. Radikal'naja cistjektomija kak metod hirurgicheskogo lechenija myshechno-invazivnogo raka mochevogo puzyrja. Prakt Onkologija. 2003;4(4):225-30. (in Russ.)
  9. Safiullin KN, Karyakin OB. Radical cystectomy in the treatment of non-muscle-invasive bladder cancer. Oncourologija. 2012;(2):40-44. doi: 10.17650/1726-9776-2012-8-2-40-43 (in Russ.)
  10. Scarpato KR, Morgans AK, Moses KA. Optimal management of muscle-invasive bladder cancer - a review. Res Rep Urol. 2015 Sep 4;7:143-51. doi: 10.2147/RRU.S73566. eCollection 2015.
  11. Veskimäe E, Neuzillet Y, Rouanne M, MacLennan S, Lam TBL, Yuan Y, Compérat E, Cowan NC, Gakis G, van der Heijden AG, Ribal MJ, Witjes JA, Lebrét T. Systematic review of the oncological and functional outcomes of pelvic organ-preserving radical cystectomy (RC) compared with standard RC in women who undergo curative surgery and orthotopic neobladder substitution for bladder cancer. BJU Int. 2017 Jul;120(1):12-24. doi: 10.1111/bju.13819
  12. Chang SS, Hassan JM, Cookson MS, Wells N, Smith JA. Delaying radical cystectomy for muscle invasive bladder cancer results in worse pathological stage. J Urol. 2003;170(4Pt1):1085-87. doi: 10.1097/
  13. Sánchez-Ortiz RF, Huang WC, Mick R, Van Arsdalen KN, Wein AJ, Malkowicz SB. An interval longer than 12 weeks between the diagnosis of muscle invasion and cystectomy is associated with worse outcome in bladder carcinoma. J Urol. 2003 Jan;169(1):110-15; discussion 115. doi: 10.1097/01.ju.0000039620.76907.0d
  14. Kogan MI, Vasil'ev ON. Outcomes of radical cystectomy in urinary bladder cancer in elderly patients. Vopr Urologii i Andrologii. 2016;4(1):28-33. (in Russ.)
  15. Arcangeli G, Arcangeli S, Strigari L. A systematic review and meta-analysis of clinical trials of bladder-sparing trimodality treatment for muscle-invasive bladder cancer (MIBC). Crit Rev Oncol Hematol. 2015 Apr;94(1):105-15. doi: 10.1016/j.critrevonc.2014.11.007
  16. Aboumarzouk OM, Hughes O, Narahari K, Drewa T, Chlosta PL, Kynaston H. Safety and feasibility of laparoscopic radical cystectomy for the treatment of bladder cancer. J Endourol. 2013 Sep;27(9):1083-95. doi: 10.1089/end.2013.0084
  17. Novara G, Catto JW, Wilson T, Annerstedt M, Chan K, Murphy DG, Motttrie A, Peabody JO, Skinner EC, Wiklund PN, Guru KA, Yuh B. Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy. Eur Urol. 2015 Mar;67(3):376-401. doi: 10.1016/j.eururo.2014.12.007
  18. Hautmann RE, Abol-Enein H, Hafez K, Haro I, Mansson W, Mills RD, Montie JD, Sagalowsky AI, Stein JP, Stenzl A, Studer UE, Volkmer BG. Urinary diversion: how experts divert. Urology. 2015 Jan;85(1):233-38. doi: 10.1016/j.urology.2014.06.075
  19. Krajewski W, Zdrojowy R, Tupikowski K, Małkiewicz B, Kołodziej A. How to lower postoperative complications after radical cystectomy - a review. Cent European J Urol. 2016;69(4): 370-76. Published online 2016 Nov 30. doi: 10.5173/ceju.2016.880
  20. Patidar N, Yadav P, Sureka SK, Mittal V, Kapoor R, Mandhani A. An audit of early complications of radical cystectomy using Clavien-Dindo classification. Indian J Urol. 2016 Oct-Dec;32(4):282-87. doi: 10.4103/0970-1591.191244
  21. Zuk K, Jensen D, Gills J, Wyre H, Holzbeierlein JM, Lopez-Corona E, Lee EK. The July effect in radical cystectomy: mortality, morbidity, and efficiency. Bladder Cancer. 2016 Oct 27;2(4):433-439. doi: 10.3233/BLC-160059
  22. Amini E, Djaladat H. Long-term complications of urinary diversion. Curr Opin Urol. 2015 Nov;25(6):570-7. doi: 10.1097/MOU.0000000000000222
  23. Tomaszewski JJ, Smaldone MC. Perioperative strategies to reduce postoperative complications after radical cystectomy. Curr Urol Rep. 2015 May;16(5):26. doi: 10.1007/s11934-015-0503-0
  24. DiBianco JM, George AK, Su D, Agarwal PK. Managing noninvasive recurrences after definitive treatment for muscle-invasive bladder cancer or high-grade upper tract urothelial carcinoma. Curr Opin Urol. 2015 Sep;25(5):468-75. doi: 10.1097/MOU.0000000000000201
  25. Maffezzini M, Campodonico F, Canepa G, Gerbi G, Parodi D. Current perioperative management of radical cystectomy with intestinal urinary reconstruction for muscle-invasive bladder cancer and reduction of the incidence of postoperative ileus. Surg Oncol. 2008 Jul;17(1):41-48. doi: 10.1016/j.suronc.2007.09.003
  26. Hugen CM, Daneshmand S. Orthotopic urinary diversion in the elderly. World J Urol. 2016 Jan;34(1):13-18. doi: 10.1007/s00345-015-1696-z
  27. Kozacıoğlu Z, Değirmenci T, Günlüsoy B, Yasin Ceylan, and Süleyman Minareci. Ureterocutaneostomy: for whom and when? Turk J Urol. 2013 Sep;39(3):143-46. doi: 10.5152/tud.2013.030
  28. Higgins C. Transuretero-ureteral anastomosis. Report of a clinical case. J Urol. 1935Nov;3(Is 5):349-55. doi: 10.1016/S0022-5347(17)72288-4
  29. Youssif M, Badawy H, Saad A, Hanno A, Mokhless I. Augmentation ureterocystoplasty in boys with valve bladder syndrome. J Pediatr Urol. 2007 Dec;3(6):433-37. doi: 10.1016/j.jpurol.2007.06.005
  30. Mure PY, Mollard P, Mouriquand P. Transureteroureterostomy in childhood and adolescence: long-term results in 69 cases. J Urol. 2000 Mar;163(3):946-48. doi: 10.1097/00005392-200010000-00050
  31. Lee NG, Corbett ST, Cobb K, Bailey GC, Burns AS, Peters CA. Bi-institutional comparison of robot-assisted laparoscopic versus open ureteroureterostomy in the pediatric population. J Endourol. 2015 Nov;29(11):1237-41. doi: 10.1089/end.2015.0223
  32. Kaiho Y, Ito A, Numahata K, Ishidoya S, Arai Y. Retroperitoneoscopic transureteroureterostomy with cutaneous ureterostomy to salvage failed ileal conduit urinary diversion. Eur Urol. 2011 May;59(5):875-78. doi: 10.1016/j.eururo.2009.06.003
  33. Piaggio LA, González R. Laparoscopic transureteroureterostomy: a novel approach. J Urol. 2007 Jun;177(6):2311-14. doi: 10.1016/j.juro.2007.02.004
  34. Pesce C, Costa L, Campobasso P, Fabbro MA, Musi L. Successful use of transureteroureterostomy in children: a clinical study. Eur J Pediatr Surg. 2001 Dec;11(6):395-98. doi: 10.1055/s-2001-19730
  35. Knight RB, Hudak SJ, Morey AF. Strategies for open reconstruction of upper ureteral strictures. Urol Clin North Am. 2013 Aug;40(3):351-61. doi: 10.1016/j.ucl.2013.04.005
  36. Lo TS, Wijaya T, Lo LM, Kao CC, Wu PY, Cortes EF, et al. Clinical relevance and treatment selection of ureteral injury after cesarean section. Female Pelvic Med Reconstr Surg. 2016 Sep-Oct;22(5):303-6. doi: 10.1097/SPV.0000000000000275
  37. Burks FN, Santucci RA. Management of iatrogenic ureteral injury. Ther Adv Urol. 2014 Jun;6(3):115-24. doi: 10.1177/1756287214526767
  38. Elliott SP, McAninch JW. Ureteral injuries from external violence: the 25-year experience at San Francisco General Hospital. J Urol. 2003 Oct;170(4Pt1):1213-16. doi: 10.1097/01.ju.0000087841.98141.85
  39. Goel A, Dalela D. Options in the management of tuberculous ureteric stricture. Indian J Urol. 2008 Jul-Sep; 24(3): 376-81. doi: 10.4103/0970-1591.42621
  40. Kawamura J, Tani M, Sumida K, Yazawa T, Kawasoe J, Yamamoto M, Harada H, Yamamoto H, Zaima M. The use of transureteroureterostomy during ureteral reconstruction for advanced primary or recurrent pelvic malignancy in the era of multimodal therapy. Int J Colorectal Dis. 2017 Jan;32(1):135-38. doi: 10.1007/s00384-016-2672-9
  41. Göktaş C, Horuz R, Yıldırım M, Faydacı G, Sahin C, Albayrak S. Major urologic surgical procedures in locally advanced colorectal cancers. Actas Urol Esp. 2012 Jun;36(6):361-66. doi: 10.1016/j.acuro.2011.09.007 [Article in Spanish]
  42. Richter S, Kollmar O, Lindemann W, Schilling MK. Transureteroureterostomy allows renal sparing radical resection of advanced malignancies with rectosigmoid invasion. Int J Colorectal Dis. 2007 Aug;22(Is 8):949-53. doi: 10.1007/s00384-006-0235-1
  43. Sugarbaker PH, Gutman M, Verghese M. Transureteroureterostomy: an adjunct to the management of advanced primary and recurrent pelvic malignancy. Int J Colorectal Dis. 2003 Jan;18(1):40-44. doi: 10.1007/s00384-002-0399-2
  44. Iwaszko MR, Krambeck AE, Chow GK, Gettman MT. Transureteroureterostomy revisited: long-term surgical outcomes. J Urol. 2010 Mar;183(3):1055-59. doi: 10.1016/j.juro.2009.11.031
  45. Joung JY, Jeong IG, Seo HK, Kim TS, Han KS, Chung J, Lee KH. The efficacy of transureteroureterostomy for ureteral reconstruction during surgery for a non-urologic pelvic malignancy. J Surg Oncol. 2008 Jul 1;98(1):49-53. doi: 10.1002/jso.21086
  46. Kilciler M, Bedir S, Erdemir F, Zeybek N, Erten K, Ozgok Y. Comparison of ileal conduit and transureteroureterostomy with ureterocutaneostomy urinary diversion. Urol Int. 2006;77(3):245-50. doi: 10.1159/000094817
  47. Rainwater LM, Leary FJ, Rife CC. Transureteroureterostomy with cutaneous ureterostomy: a 25-year experience. J Urol. 1991 Jul;146(1):13-15. doi: 10.1016/S0022-5347(17)37702-9
  48. Chen CL, Tang SH, Cha TL, Meng E, Tsao CW, Sun GH, Yu DS, Chang SY, Wu ST. Combined Y-shaped common channel transureteroureterostomy with Boari flap to treat bilateral long-segment ureteral strictures. BMC Res Notes. 2014 Aug 20;7:550. doi: 10.1186/1756-0500-7-550
  49. Png JC, Chapple CR. Principles of ureteric reconstruction. Curr Opin Urol. 2000 May;10(3):207-12. doi: 10.1097/00042307-200005000-00004
Address for correspondence:
308007, The Russian Federation,
Belgorod, Nekrasov Str., 8/9, b. 8,
Belgorod Regional Clinical Hospital
Of Saint Joasaph,
Urology Unit,
Tel.: +79103207071,
Sergey V. Shkodkin
Information about the authors:
Shkodkin Sergey V., MD, Associate Professor, Urologist of the Urology Unit, Belgorod Regional Clinical Hospital of Saint Joasaph, Professor of the Hospital Surgery Department, Belgorod National Research University, Belgorod, Russian Federation.
Idashkin Yury B., Urologist of the Out-Patient Department, Belgorod Regional Clinical Hospital of Saint Joasaph, Belgorod, Russian Federation.
Bocharova Ksenia A., PhD, Associate Professor of the Department of Faculty Therapy, Belgorod National Research University, Belgorod, Russian Federation.
Dmitriev Vadim N., PhD, Associate Professor of the Department of Faculty Surgery, Belgorod National Research University, Belgorod, Russian Federation.
Lyubushkin Aleksey V., PhD, Clinical Intern of the Department of Faculty Surgery, Belgorod National Research University, Belgorod, Russian Federation.
Nevskyi Aleksandr A., Clinical Intern of the Department of Faculty Surgery, Belgorod National Research University, Belgorod, Russian Federation.



National Research Ogarev Mordovia State University, Medical Institute1,
Mordovia Republican Center for Advanced
Training of Health Professionals 2, Saransk,
The Russian Federation

The review presents the data on the etiology and pathogenesis of intra-abdominal adhesions after abdominal surgical interventions. It has been shown that the main etiological preconditions for formation of adhesions and the development of adhesive intestinal obstruction are a peritoneal injury, intraabdominal bleeding, presence of infection and foreign bodies in the abdominal cavity, influence of various aggressive substances, local antibiotic therapy, and regional tissue ischemia. This leads to an increase in the amount of peritoneal fluid, the penetration of microorganisms into the abdominal cavity with disturbance of the metabolism of the peritoneum mesothelium and damage to the cellular membranes, tissue organization of fibrinous matrix, degranulation of lysosomal enzymes, the pituitary-adrenal insufficiency, and the development of hypercoagulation and postoperative paresis of the intestine. The situation is aggravated by the addition of an autoimmune or allergic component to the inflammatory process.
The main modern methods of adhesion prevention are described, taking into account the latest achievements in abdominal surgery, including the use of D-penicillamine, the drugs blocking the activity of collagen synthesis enzymes, anticoagulants of various actions, gels Polymers, proteolytic enzymes, antioxidants, hemostatics, hyperbaric oxygenation, as well as insufflation of carbon dioxide into the abdominal cavity. A special place is given to the use of synthetic absorbable suture materials, dynamic laparoscopy and laparoscopic adhesion.

Keywords: adhesions, abdominal cavity, intestinal obstruction, abdominal surgery
p. 735-744 of the original issue
  1. Chekmazov IA. Spaechnaia bolezn' briushiny. Moscow, RF; 2008. 160 p. (in Russ.)
  2. Markos'ian SA, Lysiakov NM. Experimental evaluation of changes in some indicators coagulation-lytic system of the blood in ischemic part of the small intestine with anastomosis after intraoperative paravasal routes of administration of heparin. Vestn Eksperim i Klin Khirurgii. 2012;(4):690-693.
  3. Whang SH, Astudillo JA, Sporn E, Bachman ShL, Miedema BW, Davis W, Thaler K. In search of the best peritoneal adhesion model: comparison of different techniques in a rat model. J Surg Res. 2011 May 15;167(2):245-50. doi: 10.1016/j.jss.2009.06.020
  4. Lutsevich OE, Akimov VP, Shirinskiy VG, Bichev AA. Formation and modern approaches to its prevention. a systematic review. Moskov Khirurg Zhurn. 2017;(3):11-26. (in Russ.)
  5. Gainsbury ML, Chu DI, D'Addese L, Reed KL, Stucchi AF, Becker JM. Key regulators of adhesiogenesis, including vascular endothelial growth factor (VEGF) and transforming growth factor-β1 (TGF-β1), are reduced by the antioxidant N-acetyl-L-cysteine (NAC) in a rat model of intraabdominal adhesions. J Surg Res. 2010 Febr;158(2):255. doi: 10.1016/j.jss.2009.11.234
  6. Alonso Jde M, Alves AL, Watanabe MJ, Rodrigues CA, Hussni CA. Peritoneal response to abdominal surgery: the role of equine abdominal adhesions and current prophylactic strategies. Vet Med Int. 2014;2014:279730. doi: 10.1155/2014/279730
  7. Rodgers KE, diZerega GS. Function of peritoneal exudate cells after abdominal surgery. J Invest Surg. 1993 Jan-Feb;6(1):9-23. doi: 10.3109/08941939309141188
  8. Mailova KS, Osipova AA, Corona R, Binda M, Koninckx F, Adamian LV. Intraoperative bleeding: adhesions formation and methods of their prevention in mice. Problemy Reproduktsii. 2012;(2):18-22. (in Russ.)
  9. Koninckx PR, Gomel V, Ussia A, Adamyan L. Role of the peritoneal cavity in the prevention of postoperative adhesions, pain, and fatigue. Fertil Steril. 2016;106(5):998-10. doi: 10.1016/j.fertnstert.2016.08.012
  10. Andreev AA, Ostroushko AP, Kir'ianova DV, Sotnikova ES, Britikov VN. Adhesive disease of the abdominal cavity. Vest Eksperim i Klin Khirurgii. 2017;X(4):320-26. (in Russ.)
  11. Gomon MS, Konoplya AI, Lipatov VA, Bezhin AI, Loktionov AL, Sukovatykh BS, Kas'yanova MA, Besedin AV. The dynamic changes of immunologic reactivity at stimulation of adhesive process in abdomen cavity. Vestn Novykh Med Tekhnologii. 2008;15(1):35-37. (in Russ.)
  12. Petlakh VI, Lipatov VA, Eletskaya ES, Sergeev AV. Morphology of postoperative abdominal adhesions. Detskaia Khirurgiia. 2014;(1):42-46. (in Russ.)
  13. Skipetrov VP, Vlasov AP, Golyshenkov SP. Koaguliatsionno-liticheskaia sistema tkanei i trombogemorragicheskii sindrom v khirurgii: monografiia. Saransk, RF: Izd-vo Mordov un-ta; 2011. 192 (in Russ.)
  14. Sapin MR, Miliukov VE, Dolgov EN, Bogdanov AV, Murshudova KhM, Nguen KK, Polunin SV. Acute adrenal insufficiency in the acute intestinal obstruction Vestn Eksperim i Klin khirurgii. 2013; VI(1):90-99. (in Russ.)
  15. Vlasov AP, Rubtsov OIu, Trofimov VA. Lipidnyi distress-sindrom pri spaechnoi bolezni. Saransk, RF: Krasnyi Oktiabr'; 2006. 280 p. (in Russ.)
  16. Habriyev RU, Kamayev NO, Danilova TI, Kakhoyan EG. Peculliarities of the action of Osobennosti deistviia hyaluronidase of different origin to the connective tissue. Biomed Khimiia. 2016;62(1):82-88.) (in Russ.)
  17. Nazarenko AA, Akimov VP, Malyshkin PO. Epidemiologiia, patogenez i profilaktika posleoperatsionnogo spaechnogo protsessa v briushnoi polosti. Vestn Khirurgii im II Grekova. 2016;175(5):114-18. doi: 10.24884/0042-4625-2016-175-5-114-118. (in Russ.)
  18. Shapoval'iants SG, Larichev SE, Babkova IV, Timofeev ME, Safarov AN. Differentsial'naia diagnostika form ostroi spaechnoi tonkokishechnoi neprokhodimosti. Moskovskii Khirurgicheskii Zhurnal. 2013;3(31):29-33. (in Russ.)
  19. Malkov IS, Bagautdinov EB, Sharafislamov IF, Zogot SR, Misiev DKh. Acute adhesive small-bowel obstruction: laparotomy or laparoscopy. Kaz Med Zhurn. 2018;99(3):508-14. doi: 10.17816/KMJ2018-508. (in Russ.)
  20. Tarasenko SV, Zaitsev OV, Sokolov PV, . Natalsky AA, Prus SIu, Rakhmaev TS, Bogomolov AIu, Kulikova IV. Laparoscopic access in the treatment of adhesive intestinal obstruction. Vestn Khirurgii im II Grekova. 2018;177(2):30-33. doi: 10.24884/0042-4625-2018-177-2-30-33. (in Russ.)
  21. Filenko BP, Lazarev SM, Efremova SV. Surgeon's strategy in recurrent adhesive intestinal obstruction. Vestn Khirurgii im II Grekova. 2010;169(6):75-79. (in Russ.)
  22. Shapoval'iants SG, Larichev SE, Timofeev ME, Soldatova NA. Otsenka riska retsidiva ostroi spaechnoi tonkokishechnoi neprokhodimosti, razreshennoi konservativnym putem. Ros Zhurn Gastrenterol Gepatol Koloproktologii. 2009;19(6):34-38. (in Russ.)
  23. Izbasarov RZh. Laparoscopic adhesiolysis in the management of acute adhesive intestinal obstruction. Endoskop Khirurgiia. 2013;19(2):28-30. (in Russ.)
  24. Stepanian SA, Apoian VT, Mesropian RN, Eiramdzhian KhT, Zanadvorov LV, Petrosian AA, Egiazarian GG. Primenenie protivospaechnykh sredstv v profilaktike spaechnoi bolezni zhivota. Vestn Khirurgii im II Grekova. 2012;171(1):45-49. (in Russ.)
  25. Strizheletskii VV, Ryvkin AIu, Makarov SA, Suvorov II, Li MV. New possibilities in diagnosis and treatment of patients with acute adhesive bowel obstruction with the use of endovideosurgery. Endoskop Khirurgiia. 2011;17(3):7-10. (in Russ.)
  26. Plechev VV, Latypov RZ, Timerbulatov VM, Pashkov SA, Sufiiarov IF, Gumerov AA, Izosimov AN. Khirurgiia spaechnoi bolezni briushiny: ruk. Ufa, RF: Bashkortostan; 2015. 748 p. (in Russ.)
  27. Magomedov MA, Abdulgadiev VS. Result treatment of of acute intestinal obstruction. Moskov Khirurg Zhurn. 2017;(4):5-7. (in Russ.)
  28. Svinoboi IN, Lazareva LP. Operativnaia laparoskopiia v lechenii spaechnoi bolezni u detei mladshego vozrasta. Med sestra. 2004; (2): 9-10. (in Russ.)
  29. Sukovatykh BS, Zhukovskii VA, Lipatov VA, Blinkov IuIu. Sovremennye tekhnologii profilaktiki posleoperatsionnogo spaikoobrazovaniia. Vestn Khirurgii im II Grekova. 2014;173(5):98-104. doi: 10.24884/0042-4625-2014-173-5-98-104. (in Russ.)
  30. Markos`yan SA, Lysyakov NM, Ismail Alawal MA, Irkova KI, Martyanov IV. Effect of intraoperative heparin administration on some indices of the blood coagulatory-lytic system in the ischemic region of the small intestine with anastomosis. Bull Exp Biol Med. 2014; 156 (6): 753-755. doi: 10.1007/s10517-014-2441-0. (in Russ.)
  31. Klimovich IN, Maskin SS, Dubrovin IA, Karsanov AM, Derbentseva TV. Endovideokhirurgiia v diagnostike i lechenii posleoperatsionnogo peritonita. Vestn Khirurgii im II Grekova. 2015;174 (4):113-16. doi: 10.24884/0042-4625-2015-174-4-113-116 (in Russ.)
  32. Ten Broek RP, Stommel MW, Strik C, van Laarhoven CJ, Keus F, van Goor H. Benefits and harms of adhesion barriers for abdominal surgery: a systematic review and meta-analysis. Lancet. 2014;383(9911):48-59. doi: 10.1016/s0140-6736(13)61687-6
  33. Falabella CA, Melendez MM, Weng L, Chen W. Novel macromolecular crosslinking hydrogel to reduce intra-abdominal adhesions. J Surg Res. 2010 Apr; 159(2):772-78. doi: 10.1016/j.jss.2008.09.035
  34. Lang R, Baumann P, Schmoor C, Odermatt EK, Wente MN, Jauch KW. A-Part Gel, an adhesion prophylaxis for abdominal surgery: a randomized controlled phase I-II safety study. Ann Surg Innov Res. 2015;9:5. doi: 10.1186/s13022-015-0014-1
  35. Lavreshin PM, Gobejishvili VK,.Gobejishvili VV, Kelasov IG. The predictions and prophylaxis of intraabdominal adhesion in patients with acute intesninal non-tumor obstruction. Vestn Eksperim i Klin Khirurgii. 2012;(1):65-70 (in Russ.)
  36. Cherdantsev DV, Vinnik IuS, Kasparov EV, Titova RM, Pervova OV. Diagnostika i lechenie okislitel'nogo stressa pri ostrom pankreatite. Krasnoiarsk, RF: Bona Company; 2002. 146 p. (in Russ.)
  37. De Lano FA, Schmit PJ, Schmid-Schnbein GW, Saltzman DJ. Enteral and peritoneal blockade of serine proteolytic enzymes decreases post-operative adhesions. J Surg Res. 2012 Feb;172(2):340. doi: 10.1016/j.jss.2011.11.694
  38. Esposito AJ, Heydrick SJ, Cassidy MR, Gallant J, Stucchi AF, Becker JM. Substance P is an early mediator of peritoneal fibrinolytic pathway genes and promotes intra-abdominal adhesion formation. J Surg Res. 2013 May 1;181(1): 25-31. doi: 10.1016/j.jss.2012.05.056
  39. Ward BC, Kavalukas S, Brugnano J, Barbul A, Panitch A. Peptide inhibitors of MK2 show promise for inhibition of abdominal adhesions. J Surg Res. 2011 Jul;169(1):e27-e36. doi: 10.1016/j.jss.2011.01.043
  40. Yuzbasioglu MF, Ezberci F, Imrek E, Bulbuloglu E, Kurutas EB, Imrek S. The effect of intraperitoneal catalase on prevention of peritoneal adhesion formation in rats. J Invest Surg. 2008;21(2):65-69. doi: 10.1080/08941930701883616
  41. Hoffmann NE, Siddiqui SA, Agarwal S, McKellar SH, Kurtz HJ, Gettman MT, Ereth MH. Choice of hemostatic agent influences adhesion formation in a rat cecal adhesion model. J Surg Res. 2009 Jul;155(1):77-81. doi: 10.1016/j.jss.2008.08.008
  42. Peng Y, Zheng M, Ye Q, Chen X, Yu B, Liu B. Heated and humidified CO2 prevents hypothermia, peritoneal injury, and intraabdominal adhesions during prolonged laparoscopic insufflations. J Surg Res. 2009 Jan;151(1):40-47. doi: 10.1016/j.jss.2008.03.039.
  43. Raptis DA, Vichova B, Breza J, Skipworth J, Barker S. A comparison of woven versus nonwoven polypropylene (PP) and expanded versus condensed polytetrafluoroethylene (PTFE) on their intraperitoneal incorporation and adhesion formation. J Surg Res. 2011 Jul;169(1):1-6. doi: 10.1016/j.jss.2009.12.014
  44. Baranov GA, Karbovskii MIu. Otdalennye rezul'taty operativnogo ustraneniia spaechnoi kishechnoi neprokhodimosti. Khirurgiia Zhurn im NI Pirogova. 2006;(7):56-60. (in Russ.)
  45. Dudanov IP, Sobolev BE. Laparoskopiia pri ostroi spaechnoi kishechnoi neprokhodimosti. Endoskop Khirurgiia. 2005;11(1):46-47. (in Russ.)
  46. Khasanov AG, Sufiyarov IF, Kayumov FA. Method of peritonization of the small intestine for prophylaxis of the development of peritoneal adhesions. Vestn Khirurgii im II Grekova. 2008;167(5):34-36. (in Russ.)
  47. Gungor B, Malazgirt Z, Topgül K, Gök A, Bilgin M, Yürüker S. Comparative evaluation of adhesions to intraperitoneally placed fixation materials: a laparoscopic study in rats. Indian J Surg. 2010 Dec;72(6):475-80. doi: 10.1007/s12262-010-0168-3
  48. Gasparov AS, Dubinskaia ED. Tazovye peritoneal'nye spaiki. Etiologiia, patogenez, diagnostika, profilaktika. Moscow, RF: Med inform agentstvo; 2013. 168 p. (in Russ.)
  49. Beburishvili AG, Mikhin IV, Vorob'eva AA, Kalmykova OP, Gal'chuk GG. Laparoskopicheskie operatsii pri spaechnoi bolezni. Khirurgiia Zhurn im NI Pirogova. 2004;(6):27-30. (in Russ.)
  50. Shavaleev RR, Plechev VV, Kornilaev PG, Garipov RM, Duniushkin SE, Pashkov SA. Laparoskopicheskoe lechenie spaechnoi bolezni briushnoi polosti. Khirurgiia. Zhurn im NI Pirogova. 2005;(4):31-32. (in Russ.)
Address for correspondence:
430032, The Russian Federation,
Saransk, Ulyanov Str., 26 a,
Medical Institute, National Research Ogarev
Mordova State University,
Department of the Faculty Surgery with the
Courses of Topographic Anatomy and
Operative Surgery, Urology and Pediatric Surgery, +79176990604,
Sergey A. Markosyan
Information about the authors:
Markosyan Sergey, MD, Associate Professor, Department of the Faculty Surgery with the Courses of Topographic Anatomy and Operative Surgery, Urology and Pediatric Surgery, National Research Ogarev Mordova State University, Medical Institute, Saransk, Russian Federation.
Lysyakov Nikita, PhD, Lecturer, Mordovia Republican Center for Advanced Training of Health Professionals, Saransk, Russian Federation.



Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

This review presents modern data about the pros and cons of femtosecond lasers usage in cataract surgery. International scientific and medical databases PubMed and Cochrane library were used. The study showed that femtolaser assistance provides a new level of accuracy in different stages of the operation, which guaranties their standardization, unification and predictability. Using laser assistance in all patients, it is possible to get anterior-capsular holes of a given diameter within 0.25 mm; if capsulorhexis is performed manually, such level of accuracy will be obtained only in 10% of the operated eyes. At the same time, it was found that despite the increase in the accuracy of the stages performed by femtosecond lasers, the differences in postoperative refractive indicators and visual acuity in patients who underwent phacoemulsification of cataracts with laser assistance are not higher than in the application of the standard technique. In addition, due to high cost of the equipment and lack of a significant effect in post-operative visual acuity, the widespread introduction of femtosecond lasers in cataract surgery is still doubtful. Despite the absent of consensus of experts about the clear advantages of laser assistance, this technique should be developed, for so that it provides opportunity to determine the influence of different stages on the final result of the operation and determine the direction of their further improvement and standardization of the stages creates the prerequisites for the use of ophthalmic robots.

Keywords: femtosecond laser, cataract surgery, phacoemulsification, lens nucleus, capsulorhexis, QALY
p. 745-757 of the original issue
  1. Bourne RRA, Flaxman SR, Braithwaite T, Cicinelli MV, Das A, Jonas JB, Keeffe J, Kempen JH, Leasher J, Limburg H, Naidoo K, Pesudovs K, Resnikoff S, Silvester A, Stevens GA, Tahhan N, Wong TY, Taylor HR. Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis. Lancet Glob Health. 2017 Sep;5(9):e888-e897. doi: 10.1016/S2214-109X(17)30293-0
  2. Lee CM, Afshari NA. The global state of cataract blindness. Curr Opin Ophthalmol. 2017 Jan;28(1):98-103. doi: 10.1097/ICU.0000000000000340
  3. Blindness: Vision 2020 - control of major blinding diseases and disorders. The global initiative for the elimination of avoidable blindness [Electronic resource]. Fact Sheet. 214. [cited 2018 20]. Available from:
  4. Kessel L, Andresen J, Erngaard D, Flesner P, Tendal B, Hjortdal J. Indication for cataract surgery. Do we have evidence of who will benefit from surgery? A systematic review and meta-analysis. Acta Ophthalmol. 2016 Feb; 94(1):10-20. doi: 10.1111/aos.12758
  5. Nagy Z, McAlinden C. Femtosecond laser cataract surgery. Eye Vis.(London). 2015;2:11. doi: 10.1186/s40662-015-0021-7
  6. Hatch KM, Talamo JH. Laser-assisted cataract surgery: benefits and barriers. Curr Opin Ophthalmol. 2014 Jan;25(1):54-61. doi: 10.1097/ICU.0000000000000013
  7. Abell RG, Darian-Smith E, Kan JB, Allen PL, Ewe SY, Vote BJ. Femtosecond laser-assisted cataract surgery versus standard phacoemulsification cataract surgery: outcomes and safety in more than 4000 cases at a single center. J Cataract Refract Surg. 2015 Jan;41(1):47-52. doi: 10.1016/j.jcrs.2014.06.025
  8. Nagy Z. New technology update: femtosecond laser in cataract surgery. Clin Ophthalmol. 2014 Jun;8:1157-67. doi: 10.2147/OPTH.S36040
  9. Kelman CD. Phaco-emulsification and aspiration. A report of 500 consecutive cases. Am J Ophthalmol. 1973 May;75(5):764-68. doi: 10.1016/0002-9394(73)90878-7
  10. Callou TP, Garcia R, Mukai A, Giacomin NT, de Souza RG, Bechara SJ. Advances in femtosecond laser technology. Clin Ophthalmol. 2016 Apr;19;10:697-703. doi: 10.2147/OPTH.S99741
  11. Miháltz K, Knorz MC, Alió JL, Takács AI, Kránitz K, Kovács I, Nagy ZZ. Internal aberrations and optical quality after femtosecond laser anterior capsulotomy in cataract surgery. J Refract Surg. 2011 Oct;27(10):711-16. doi: 10.3928/1081597X-20110913-01
  12. Vasquez-Perez A, Simpson A, Nanavaty M. Femtosecond laser-assisted cataract surgery in a public teaching hospital setting. BMC Ophthalmol. 2018;18:26. Published online 2018 Feb 2. doi: 10.1186/s12886-018-0693-6
  13. Wolffsohn J., Buckhurst P. Objective analysis of toric intraocular lens rotation and centration. J Cataract Refract Surg. 2010 May;36(5):778-82. doi: 10.1016/j.jcrs.2009.12.027
  14. Krasnov MM. Laser-phakopuncture in the treatment of soft cataracts. Br J Ophthalmol. 1975 Feb;59(2):96-98.
  15. Nagy Z, Takács A, Filkorn T, Sarayba M. Initial clinical evaluation of an intraocular femtosecond laser in cataract surgery. J Refract Surg. 2009 Dec;25(12):1053-60. doi: 10.3928/1081597X-20091117-04
  16. McAlinden C, Moore JE. Retreatment of residual refractive errors with flap lift laser in situ keratomileusis. Eur J Ophthalmol. 2011 Jan-Feb;21(1):5-11. doi: 10.5301/EJO.2010.391
  17. Bartlett JD, Miller KM. The economics of femtosecond laser-assisted cataract surgery. Curr Opin Ophthalmol. 2016 Jan;27(1):76-81. doi: 10.1097/ICU.0000000000000219.
  18. Chung SH, Mazur E. Surgical applications of femtosecond lasers. J Biophotonics. 2009 Oct;2(10):557-72. doi: 10.1002/jbio.200910053.
  19. Binder PS. Femtosecond applications for anterior segment surgery. Eye Contact Lens. 2010 Sep;36(5):282-85. doi: 10.1097/ICL.0b013e3181ee2d11
  20. Hjortdal J, Nielsen E, Vestergaard A, Søndergaard A. Inverse cutting of posterior lamellar corneal grafts by a femtosecond laser. Open Ophthalmol J. 2012;6:19-22. doi: 10.2174/1874364101206010019
  21. Levitz L, Reich J, Roberts TV, Lawless M. Incidence of cystoid macular edema: femtosecond laser-assisted cataract surgery versus manual cataract surgery. J Cataract Refract Surg. 2015 Mar;41(3):683-86. doi: 10.1016/j.jcrs.2014.11.039
  22. Nagy ZZ, Takacs AI, Filkorn T, Kránitz K, Gyenes A, Juhász é, Sándor GL, Kovacs I, Juhász T, Slade S. Complications of femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2014 Jan;40(1):20-28. doi: 10.1016/j.jcrs.2013.08.046
  23. Kulikov AN, Kokareva EV, Dzilikhov AA. Effective lens position. A review. Oftal'mokhirurgiia. 2018;(1):92-97. doi: 10.25276/0235-4160-2018-1-92-97 (in Russ.)
  24. Kránitz K, Takács A, Miháltz K, Kovács I, Knorz MC, Nagy ZZ. Femtosecond laser capsulotomy and manual continuous curvilinear capsulorrhexis parameters and their effects on intraocular lens centration. J Refract Surg. 2011 Aug;27(8):558-63. doi: 10.3928/1081597X-20110623-03
  25. Mayer WJ, Klaproth OK, Hengerer FH, Kohnen T. Impact of crystalline lens opacification on effective phacoemulsification time in femtosecond laser-assisted cataract surgery. Am J Ophthalmol. 2014 Feb;157(2):426-32.e1. doi: 10.1016/j.ajo.2013.09.017
  26. Cao H, Zhang L, Li L, Lo S. Risk factors for acute endophthalmitis following cataract surgery: a systematic review and meta-analysis. PLoS One. 2013 Aug 26;8(8):e71731. doi: 10.1371/journal.pone.0071731. eCollection 2013.
  27. Bang JW, Lee JH, Kim JH, Lee DH. Structural analysis of different incision sizes and stromal hydration in cataract surgery using anterior segment optical coherence tomography. Korean J Ophthalmol. 2015 Feb;29(1):23-30. doi: 10.3341/kjo.2015.29.1.23
  28. Kankariya VP, Diakonis VF, Goldberg JL, Kymionis GD, Yoo SH. Femtosecond laser-assisted astigmatic keratotomy for postoperative trabeculectomy-induced corneal astigmatism. J Refract Surg. 2014 Jul;30(7):502-4. doi: 10.3928/1081597X-20140527-01
  29. Abell RG, Kerr NM, Howie AR, Mustaffa Kamal MA, Allen PL, Vote BJ. Effect of femtosecond laser-assisted cataract surgery on the corneal endothelium. J Cataract Refract Surg. 2014 Nov;40(11):1777-83. doi: 10.1016/j.jcrs.2014.05.031
  30. Lawless M, Levitz L, Hodge C. Reviewing the visual benefits of femtosecond laser-assisted cataract surgery: Can we improve our outcomes? Indian J Ophthalmol. 2017 Dec;65(12):1314-22. doi: 10.4103/ijo.IJO_736_17
  31. Popovic M, Campos-Möller X, Schlenker MB, Ahmed IIK. Efficacy and safety of femtosecond laser-assisted cataract surgery compared with manual cataract surgery: a meta-analysis of 14567 eyes. Ophthalmology. 2016 Oct;123(10):2113-26. doi: 10.1016/j.ophtha.2016.07.005
  32. Chang DF. Does femtosecond laser-assisted cataract surgery improve corneal endothelial safety? The debate and conundrum. J Cataract Refract Surg. 2017 Apr;43(4):440-442. doi: 10.1016/j.jcrs.2017.04.019
  33. Day AC, Burr JM, Bunce C, Doré CJ, Sylvestre Y, Wormald RP, Round J, McCudden V, Rubin G, Wilkins MR. Randomised, single-masked non-inferiority trial of femtosecond laser-assisted versus manual phacoemulsification cataract surgery for adults with visually significant cataract: the FACT trial protocol. BMJ Open. 2015 Nov 27;5(11):e010381. doi: 10.1136/bmjopen-2015-010381
  34. Abell RG, Vote BJ. Cost-effectiveness of femtosecond laser-assisted cataract surgery versus phacoemulsification cataract surgery. Ophthalmology. 2014 Jan;121(1):10-16. doi: 10.1016/j.ophtha.2013.07.056
  35. Onukwugha E, McRae J, Kravetz A, Varga S, Khairnar R, Mullins CD. Cost-of-Illness Studies: An Updated Review of Current Methods. Pharmacoeconomics. 2016 Jan;34(1):43-58. doi: 10.1007/s40273-015-0325-4
  36. Ewe SY, Abell RG, Oakley CL, Lim CH, Allen PL, McPherson ZE, Rao A, Davies PE, Vote BJ. A comparative cohort study of visual outcomes in femtosecond laser-assisted versus phacoemulsification cataract surgery. Ophthalmology. 2016 Jan;123(1):178-82. doi: 10.1016/j.ophtha.2015.09.026
  37. Conrad-Hengerer I, Al Sheikh M, Hengerer FH, Schultz T, Dick HB. Comparison of visual recovery and refractive stability between femtosecond laser-assisted cataract surgery and standard phacoemulsification: six-month follow-up. J Cataract Refract Surg. 2015 Jul;41(7):1356-64. doi: 10.1016/j.jcrs.2014.10.044
  38. Day AC, Gore DM, Bunce C, Evans JR. Laser-assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery (Review) [Electronic resource]. Cochrane Database of Systematic Reviews. 2016;7. [cited 2018 Sept 4]. Available from:
  39. Ye Z, Li Z, He S. A Meta-analysis comparing postoperative complications and outcomes of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract [Electronic resource]. J Ophthalmol. 2017;2017:3849152 [cited 2018 Nov 233]. Available from:
  40. Packer M, Teuma EV, Glasser A, Bott S. Defining the ideal femtosecond laser capsulotomy. Br J Ophthalmol. 2015 Aug;99(8):1137-42. doi: 10.1136/bjophthalmol-2014-306065
  41. Toto L, Mastropasqua R, Mattei PA, Agnifili L, Mastropasqua A, Falconio G, Di Nicola M, Mastropasqua L. Postoperative IOL axial movements and refractive changes after femtosecond laser-assisted cataract surgery versus conventional phacoemulsification. J Refract Surg. 2015 Aug;31(8):524-30. doi: 10.3928/1081597X-20150727-02
  42. Panthier C, Costantini F, Rigal-Sastourné JC, Brézin A, Mehanna C, Guedj M, Monnet D. Change of capsulotomy over 1 year in femtosecond laser-assisted cataract surgery and its impact on visual quality. J Refract Surg. 2017 Jan;33(1):44-49. doi: 10.3928/1081597X-20161028-01
  43. Mursch-Edlmayr AS, Bolz M, Luft N, Ring M, Kreutzer T, Ortner C, Rohleder M, Priglinger SG. Intraindividual comparison between femtosecond laser-assisted and conventional cataract surgery. J Cataract Refract Surg. 2017 Feb;43(2):215-22. doi: 10.1016/j.jcrs.2016.11.046
  44. Oltulu R, Erşan I, Şatırtav G, Donbaloglu M, Kerımoğlu H, özkağnıcı A. Intraocular lens explantation or exchange: indications, postoperative interventions, and outcomes. Arq Bras Oftalmol. 2015 May-Jun;78(3):154-57. doi: 10.5935/0004-2749.20150040
  45. Nagy ZZ, Kiss HJ, Takács ÁI, Kránitz K, Czakó C, Filkorn T, Dunai Á, Sándor GL, Kovács I. Results of femtosecond laser-assisted cataract surgery using the new 2.16 software and the SoftFit Patient Interface. Orv Hetil. 2015 Feb8;156(6):221-25. doi: 10.1556/OH.2015.30089
  46. Takács AI, Kovács I, Miháltz K, Filkorn T, Knorz MC, Nagy ZZ. Central corneal volume and endothelial cell count following femtosecond laser-assisted refractive cataract surgery compared to conventional phacoemulsification. J Refract Surg. 2012 Jun;28(6):387-91. doi: 10.3928/1081597X-20120508-02
  47. Mastropasqua L, Toto L, Mastropasqua A, Vecchiarino L, Mastropasqua R, Pedrotti E, Di Nicola M. Femtosecond laser versus manual clear corneal incision in cataract surgery. J Refract Surg. 2014 Jan;30(1):27-33. doi: 10.3928/1081597X-20131217-03
  48. Conrad-Hengerer I, Hengerer FH, Al Juburi M, Schultz T, Dick HB. Femtosecond laser-induced macular changes and anterior segment inflammation in cataract surgery. J Refract Surg. 2014 Apr;30(4):222-26. doi: 10.3928/1081597X-20140321-01
  49. Ecsedy M, Miháltz K, Kovács I, Takács A, Filkorn T, Nagy ZZ. Effect of femtosecond laser cataract surgery on the macula. J Refract Surg. 2011 Oct;27(10):717-22. doi: 10.3928/1081597X-20110825-01.
Address for correspondence:
210009, The Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Ophthalmology,
Tel. +375 33 647-65-95,
Eugene A. Khadasevich
Information about the authors:
Pristupa Vadim V., PhD, Associate Professor of the Department of Ophthalmology, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
Karalkova Natallia K., PhD, Associate Professor, Acting Head of the Department of Ophthalmology, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
Khadasevich Eugene A., 5-Year Medical Student, Vitebsk State Medical University, Vitebsk, Republic of Belarus.




Grodno State Medical University, Grodno,
The Republic of Belarus

The article presents a clinical case of the combined pathology of neurogenic mediastinal benign tumor and pericardial cyst. The study provides a summary of the etiology and pathogenesis of these diseases. As an example, the statistical data of clinics on the frequency of neurogenic mediastinal tumors and pericardial cysts among different age groups are used. The peculiarities of a clinical and x-ray picture and the stages of diagnosis are described. Thoracoscopic resection of the lung with a tumor and a pericardial cyst is found out to be effective as a surgical treatment.
The literature data as well as our own practical observation showed that the combination of benign neurogenic mediastinal tumor and pericardial cyst is a rare disorder with non-specific symptomatology, which is characterized by difficulties in diagnostics. High accuracy of the differential diagnosis with oncological pathology can be achieved by means of punch biopsy.
As the result of our own observations and literature review it has been established that thoracoscopic cyst and tumor removal with or without a resection of the lung is priority as less invasive and effective surgical treatment of this pathology.

Keywords: mediastinal neurofibroma, pericardial cyst, punch biopsy, thoracoscopy, lung resection, cyst removal
p. 758-764 of the original issue
  1. Shepetko MN, Prokhorov AV, Letkovskaya TA, Labunets IN, Solovey SV. Diagnostics and surgical treatment of neurogenic mediastinum tumors. Med Novosti. 2013;(9)35-37. (in Russ.)
  2. Weiss SW, Nickoloff BJ. CD-34 is expressed by a distinctive cell population in peripheral nerve, nerve sheath tumors, and related lesions. Am J Surg Pathol. 1993 Oct;17(10):1039-45. doi: 10.1097/00000478-199310000-00009
  3. Maurea S, Cuocolo A, Reynolds JC, Neumann RD, Salvatore M. Diagnostic imaging in patients with paragangliomas. Computed tomography, magnetic resonance and MIBG scintigraphy comparison. Q J Nucl Med. 1996 Dec;40(4):365-71.
  4. Megahed M. Histopathological variants of neurofibroma. A study of 114 lesions. Am J Dermatopathol. 1994 Oct;16(5):486-95.
  5. Laurent F, Latrabe V, Lecesne R, Zennaro H, Airaud JY, Rauturier JF, Drouillard J. Mediastinal masses: diagnostic approach. Eur Radiol. 1998;8(7):1148-59. doi: 10.1007/s003300050525
  6. Zubritskiy V, Tokin S, Ageyev A, Kiprenskiy A, Kiprenskiy Yu, Kolesnikova A, Arefyev M. Diagnosis and surgical treatment of cysts and primary tumors of pericardium and mediastinum. Med Vestn MVD. 2014; (1):8-13. (in Russ.)
  7. Bousamra M, Wrightson W. Neurogenic mediastinal tumors. In: Deslauriers J, Shari Lynn Meyerson, Patterson A, ed, Cooper JD, ed. Pearson's Thoracic and Esophageal Surgery. 3rd ed. Philadelphia: Churchill Livingstone; 2008. p. 1634-40.
  8. Herlitzka A, Gale JW. Tumors and cysts of mediastinum. AMA Arch Surg. 1958;76(5):697-706. doi: 10.1001/archsurg.1958.01280230037006
  9. Patel J, Park C, Michaels J, Rosen S, Kort S. Pericardial cyst: case reports and a literature review. Echocardiography. 2004 Apr;21(3):269-72. doi: 10.1111/j.0742-2822.2004.03097.x
Address for correspondence:
230009, The Republic of Belarus,
Grodno, Gorky Str., 80,
Grodno State Medical University,
1st Department of Surgical Diseases,
Tel. mob.: +375 29 202 61 18,
Aliautsina G. Kalach
Information about the authors:
Sushko Aleksandr A., PhD, Associate Professor of the 1st Department of Surgical Diseases, Grodno State Medical University, Grodno, Republic of Belarus.
Mahilevets Eduard V., PhD, Associate Professor, Head of the 1st Department of Surgical Diseases, Grodno State Medical University, Grodno, Republic of Belarus.
Salmin Roman M., PhD, Assistant of the 1st Department of Surgical Diseases, Grodno State Medical University, Grodno, Republic of Belarus.
Kalach Aliautsina G., 6-Year Student of the Medical Faculty, Grodno State Medical University, Grodno, Republic of Belarus.



Kursk Regional Clinical Hospital 1,
Kursk State Medical University 2, ursk,
The Russian Federation

The article presents the clinical observation of the diagnosis and treatment of the patient with iatrogenic damage of the common hepatic duct during the performance of video laparoscopic cholecystectomy without traditional clinical and laboratory signs of biliary iatrogenia using methods of minimally invasive x-ray surgery.
The results of the successive application of diagnostic puncture and drainage under the US-control of separated bile accumulations of the right retroperitoneal space and the pelvic cavity, antegrade cholangiography on the unexpanded ducts, revealed the intersection of the common hepatic duct with its partial clipping and transformed into percutaneous transhepatic cholangiostomy are shown. Subsequently, cholangiostomy drainage was intraoperatively transformed into external-internal biliary drainage, performed for biliodigestive anastomosis when hepaticoenterostomy was performed on the R-loop of the small intestine.
Iatrogenic damage of the bile ducts, not accompanied by concomitant disturbance of the bile outflow, can be difficult for timely diagnosis if the formation of the bile accumulation is retroperitoneal. Thus, ultrasound monitoring of patients undergoing video-laparoscopic cholecystectomy should be considered as a necessary routine instrumental examination, which allows detecting possible iatrogenic complications in time, including those not accompanied by traditional clinical and laboratory manifestations. Antegrade X-ray external surgical drainage of the biliary tree is an effective primary minimally invasive adjuvant intervention in relation to reconstructive surgery - gepaticojejunostomy.

Keywords: laparoscopic cholecystectomy, iatrogenic damage of bile ducts, ultrasound examination, biloma of retroperitoneal space, antegrade transhepatic cholangiostomy
p. 765-771 of the original issue
  1. Gould L, Patel A. Ultrasound detection of extrahepatic encapsulated bile: biloma. AJR Am J Roentgenol. 1979 Jun;132(6):1014-15. doi: 10.2214/ajr.132.6.1014
  2. Tani C, Nosaka S, Masaki H, Kuroda T, Honna T. Spontaneous perforation of choledochal cyst: a case with unusual distribution of fluid in the retroperitoneal space. Pediatr Radiol. 2009 Jun;39(6):629-31. doi: 10.1007/s00247-009-1189-6
  3. Yaşar NF, Yaşar B, Kebapç? M. Spontaneous common bile duct perforation due to chronic pancreatitis, presenting as a huge cystic retroperitoneal mass: a case report. Cases J. 2009 Sep 8;2:6273. doi: 10.4076/1757-1626-2-6273
  4. čólović R, Perisić-Savić M. Retroperitoneal biloma secondary to operative common bile duct injury. HPB Surg. 1991;3(3):193-97. doi: 10.1155/1991/39181
  5. Lim DZ, Wong E, Hassen S, Al-Habbal Y. Retroperitoneal bile leak after laparoscopic cholecystectomy. BMJ Case Rep. 2018 Jan 18;2018. pii: bcr-2017-222750. doi: 10.1136/bcr-2017-222750
  6. Lee Y, Roh Y, Kim M, Kim Y, Kim K, Kang S, Jang E. Analysis of post-operative complication in single-port laparoscopic cholecystectomy: A retrospective analysis in 817 cases from a surgeon. J Minim Access Surg. 2018 Jan 10. doi: 10.4103/jmas.JMAS_168_17.
  7. Conrad C, Wakabayashi G, Asbun HJ, Dallemagne B, Demartines N, Diana M, Fuks D, Giménez ME, Goumard C, Kaneko H, Memeo R, Resende A, Scatton O, Schneck AS, Soubrane O, Tanabe M, van den Bos J, Weiss H, Yamamoto M, Marescaux J, Pessaux P. IRCAD recommendation on safe laparoscopic cholecystectomy. J Hepatobiliary Pancreat Sci. 2017 Nov;24(11):603-615. doi: 10.1002/jhbp.491
  8. Chun K. Recent classifications of the common bile duct injury. Korean J Hepatobiliary Pancreat Surg. 2014 Aug;18(3):69-72. doi: 10.14701/kjhbps.2014.18.3.69
  9. Iwashita Y, Hibi T, Ohyama T, Umezawa A, Takada T, Strasberg SM, Asbun HJ, Pitt HA, Han HS, Hwang TL, Suzuki K, Yoon YS, Choi IS, Yoon DS, Huang WS, Yoshida M, Wakabayashi G, Miura F, Okamoto K, Endo I, de Santibañes E, Giménez ME, Windsor JA, Garden OJ, Gouma DJ, Cherqui D, Belli G, Dervenis C, Deziel DJ, Jonas E, Jagannath P, Supe AN, Singh H, Liau KH, Chen XP, Chan ACW, Lau WY, Fan ST, Chen MF, Kim MH, Honda G, Sugioka A, Asai K, Wada K, Mori Y, Higuchi R, Misawa T, Watanabe M, Matsumura N, Rikiyama T, Sata N, Kano N, Tokumura H, Kimura T, Kitano S, Inomata M, Hirata K, Sumiyama Y, Inui K, Yamamoto M. Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: an evolutionary cul-de-sac or the birth pangs of a new technical framework? J Hepatobiliary Pancreat Sci. 2017 Nov;24(11):591-602. doi: 10.1002/jhbp.503
  10. Kapoor VK. Bile duct injury repair: when? what? who? J Hepatobiliary Pancreat Surg. 2007;14(5):476-79. doi: 10.1007/s00534-007-1220-y
  11. Fong ZV, Pitt HA, Strasberg SM, Loehrer AP, Sicklick JK, Talamini MA, Lillemoe KD, Chang DC. Diminished survival in patients with bile leak and ductal injury: management strategy and outcomes. J Am Coll Surg. 2018 Jan 4. pii: S1072-7515(17)32186-5. doi: 10.1016/j.jamcollsurg.2017.12.023.
  12. Panchenkov DN. Mamalygina LA. Iatrogennye povrezhdeniia vnepechenochnykh zhelchnykh protokov: diagnostika i khirurgicheskaia taktika na sovremennom etape. Annaly Khirurg Gepatologii. 2004;9(1):156-63. (in Russ)
  13. Okhotnikov OI, Yakovleva MV, Gorbacheva OS, Pakhomov VI. Using of a coated self-expanding endobiliary stent for temporary restoration of biliary tract after iatrogenic injury. Annaly Khirurg Gepatologii. 2017;22(3):87-93. doi: 10.16931/1995-5464.2017387-92 (in Russ.)
  14. Korobkin M, Silverman PM, Quint LE, Francis IR. CT of the Extraperitoneal Spase: normal anatomy and fluid collections. AJR Am J Roentgenol. 1992 Nov; 159(5): 933-42. doi: 10.2214/ajr.159.5.1414803
  15. Mindell HJ, Mastromatteo JF, Dickey KW, Sturtevant NV, Shuman WP, Oliver CL, Leister KL, Barth RA. Anatomic communications between the three retroperitoneal spaces: determination by CT-guided injections of contrast material in cadavers. AJR Am J Roentgenol. 1995 May;164(5):1173-78. doi: 10.2214/ajr.164.5.7717227
Address for correspondence:
305047, The Russian Federation,
Kursk, Sumskaya Str., 45,
Kursk Regional Clinical Hospital,
Department of X-ray Surgical
Diagnostic and Treatment Methods 2,
Tel.: +7 910 740 20 92,
Oleg I. Okhotnikov
Information about the authors:
Okhotnikov Oleg, MD, Professor, Head of the Department of X-ray Surgical Diagnostic and Treatment Methods 2, Kursk Regional Clinical Hospital, Professor of the Department of Radiation Diagnostics and Therapy, Kursk State Medical University, Kursk, Russian Federation.
Yakovleva Marina, PhD, Associate Professor of the Department of Surgical Diseases of the Faculty of Post-Graduate Education, Kursk State Medical University, Physician of the Department of X-ray Surgical Diagnostic and Treatment Methods 2, Kursk Regional Clinical Hospital, Kursk, Russian Federation.
Gorbacheva Olga, PhD, Head of the Department of General Surgery, Kursk Regional Clinical Hospital, Assistant of the Department of Surgical Diseases of the Faculty of Post-Graduate Education, Kursk State Medical University, Kursk, Russian Federation.
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