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Year 2021 Vol. 29 No 6

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

V.V. BERESHCHENKO, A.N. LYZIKOV, E.A. NADYROV, A.N. KONDRACHUK

COMPARATIVE MORPHOLOGICAL FEATURES OF SUBCUTANEOUS TISSUE OF EXPERIMENTAL ANIMALS IN RESPONSE TO THE IMPLANTATION WITH MODIFIED POLYPROPYLENE MESH ENDOPROSTHESIS

Gomel State Medical University, Gomel
The Republic of Belarus

Objective. To study cellular and tissue reactions in experimental animals in response to the implantation of a polypropylene mesh endoprosthesis modified with a polycaprolactone solution by the different methods.
Methods. The object of the study was modified with polypropylene mesh endoprostheses implanted in experimental animals. The animals were divided into three groups: the control group – with polypropylene mesh endoprosthesis without its modification; the first experimental group – with polycaprolactone modification by its uniform distribution on the endoprosthesis surface; the second experimental group - with the samples of polypropylene mesh endoprosthesis modified by method of electrospinning. The morphological assessment of reactions to the implantation of the materials was carried out by means of the calculation of the cellular elements of inflammatory and connective tissue origin along the periphery of the implants
Results.A statistically significant increase in the number of fibroblasts was revealed on the 3rd day of observation in the animals of the second experimental group in comparison with the control one (ð=0,047). The analogous trend was noted on the 7th day of the study in comparison with the control animals (ð=0,002), as well as with the animals from the first experimental group (ð<0,001). On the 7th day of the experiment the enhancement of the fibroplastic properties of the samples modified with polycaprolactone by electrospinning was characterized by a less pronounced inflammatory reaction of the peripheral tissues and it indicates a higher rate of granulation tissue maturation.
Conclusion. Tissue and cellular reactions around the specimens modified with with polycaprolactone solution by the electrospinning method were found to be characterized by a less pronounced inflammatory reaction of the peripheral tissues and more expressed fibroplastic reaction in comparison with the control specimens. The endoprostheses obtained in this way can be used to stimulate the migration of fibroblasts and enhance local collagen synthesis, accelerate the processes of reparative regeneration in patients with undifferentiated connective tissue dysplasia. Thus it makes possible to recommend introducing this method of PSE modification in clinical practice.

Keywords: experiment, endoprosthesis, implantation, polycaprolactone, polypropylene, cellular reactions, tissue reactions
p. 645-653 of the original issue
References
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Address for correspondence:
246000, Republic of Belarus,
Gomel, Lange Str., 5, Gomel State Medical University, the Department of surgical diseases ¹3,
tel. office: 80232 50 08 14,
e-mail: val_71@inbox.ru,
Bereshchenko Valentin V.
Information about the authors:
Bereshchenko Valentin V., PhD, Associate Professor, Head of the Department of Surgical Diseases No.3, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0001-8269-8075
Lyzikov Anatoly N., MD, Professor of the Department of Surgical Diseases No.1, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0002-4668-6007
Nadyrov Eldar A., PhD, Associate Professor of the Department of Histology, Cytology and Embryology, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0002-2795-9006
Kondrachuk Alexey N., Senior Researcher of the Research Laboratory, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0003-1546-3772

GENERAL & SPECIAL SURGERY

E.A. ILYICHEVA 1, D.A. BULGATOV 1, T.A. ROY 1, D.V. LEBEDEVA 2

CHANGES OF QUALITY OF LIFE AFTER SURGICAL TREATMENT OF SECONDARY HYPERPARATHYROIDISM IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPY WITH HEMODIALYSIS

Irkutsk Scientific Center of Surgery and Traumatology 1,
Irkutsk State Medical University 2, Irkutsk,
The Russian Federation

Objective. To assess quality of life (QoL) using the Short Form Medical Outcomes Study (SF-36) questionnaire before and after surgical treatment of secondary hyperparathyroidism (SHPT) in patients undergoing renal replacement therapy.
Methods. QoL was assessed before surgery and in the period from 4 to 30 months after surgical treatment of SHPT. Twenty patients were questioned according to SF-36 questionnaire in a longitudinal study and in comparison, with the population indicators of the Irkutsk region residents. The median age before surgery was 53 years, the median level of PTH before surgery was 1715 pg/ml. After surgical treatment, the median of PTH was 12.9 pg/ml, calcium – 1.99 mmol/l; phosphorus – 1.72 mmol/l within 6-12 months.
Results. An unfavorable effect of SHPT on QoL of patients receiving hemodialysis was shown in comparison with population indicators. Evaluation of the effectiveness of surgical treatment of SHPT in relation to changes in the quality of life of patients is given. A statistically significant increase in QoL indicators after surgical treatment was proved for all the studied scales (pW<0.05). In the long term after the operation, QoL of patients receiving hemodialysis exceeds the population indicators on the scales of the psychological component of health, pain intensity, social and role functioning.
Conclusion. The SHPT in patients receiving hemodialysis is the cause of a decrease in QoL in comparison with population indicators was shown for the first time. Surgical remission of the disease leads to a statistically significant improvement in QoL, and on the scales of the psychological component of health, intensity of pain, social and role functioning, the quality of life of patients exceeds population indicators in a similar age group. The data obtained allow us to consider postoperative hypoparathyroidism as one of the favorable factors in course of postoperative period and criterion for remission of the disease.

Keywords: parathyroidectomy, secondary hyperparathyroidism, quality of life, SF-36, chronic kidney disease, postoperative hypoparathyroism, PTH
p. 654-661 of the original issue
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Address for correspondence:
664003, Russian Federation,
Irkutsk, Borcy Revoljucii Str., 1,
Irkutsk Scientific Center of Surgery
and Traumatology
tel.: 8(3952)40-78-28,
å-mail: lena_isi@mail.ru
Ilyicheva Elens A.
Information about the authors:
Ilyicheva Elena A., MD, Professor, Head of the Research Department of Clinical Surgery, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-2081-8665
Bulgatov Dmitry A., Senior Researcher of the Research Department of Clinical Surgery, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-2440-0813
Roy Tatyana A., Senior Researcher of the Research Department of Clinical Surgery, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-3273-774X
Lebedeva Darya V., Day Time Post-Graduate Student of the Hospital Surgery DEpartment, Irkutsk State Medical University, Irkutsk, Russian Federation.
https://orcid.org/0000-0001-7388-1679

A.A. HLINNIK, S.D. AULAS, S.S. STEBOUNOV, O.O. RUMMO, V.I. HERMANOVICH

BARIATRIC SURGERY FOR MORBID OBESITY

Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology,
Belarusian Medical Academy of Post-Graduate Education, Minsk,
Republic of Belarus

Objective. To improve the results of surgical treatment of patients with morbid obesity.
Methods. The database of bariatric surgery (2014–2020 yrs) was created and analyzed in the center, retrospectively and prospectively. Total 292 operations, including 150 sleeve gastrectomy, 84 mini gastric bypass procedures, 37 adjustable gastric bandings, 12 Roux-en-Y gastric bypasses, 5 gastric plications and 4 gastric plications with gastric fundus resection have been included in this database. There were 215 females and 77 males. The mean age was 41 years. All surgeries were performed laparoscopically and mean operative time was 108 minutes.
Results. As the result of performed bariatric surgeries, 36 complications were registered. Total complication rate was 11,8% without any case of mortality. Staple line and anastomotic leakage rate after surgery, related to the stomach resection or bypass, was 3,4%. Staple line and anastomotic bleeding rate after the same procedures – 3,1%. The the aforementioned complications were the most frequent and accounted up to 47% of all bariatric surgery complications. Other complications occurred much less frequently with incidence rate 0,4% – 1,2%.
Conclusion. The bariatric surgery database allows analyzing the structure of performed operations and its complications as well as identifying the regularity of their development. That would help to develop methods of the most frequent complication prevention and their early diagnostics. Compatibility of the database format with IFSO Global Registry allows providing the collected data for further analysis at the international level. Data on the spectrum and frequency of postoperative complications in the center correlate with international experience. The most significant complications in the practice of the center are incompetence, anastomotic leakage and bleeding from the lines of sutures and anastomoses after operations associated with gastric resection or bypass. Therefore, the specific measures for improvement prevention of complications permits increasing significantly bariatric surgery safety.

Keywords: morbid obesity, bariatric surgery, postoperative complications, anastomotic leakage, surgical stapling, hemorrhage
p. 662-671 of the original issue
References
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  2. Padwal R, Klarenbach S, Wiebe N, Birch D, Karmali S, Manns B, Hazel M, Sharma AM, Tonelli M. Bariatric surgery: a systematic review and network meta-analysis of randomized trials. Obes Rev. 2011 Aug;12(8):602-21. doi: 10.1111/j.1467-789X.2011.00866.x
  3. Tam CS, Berthoud HR, Bueter M, Chakravarthy MV, Geliebter A, Hajnal A, Holst J, Kaplan L, Pories W, Raybould H, Seeley R, Strader A, Ravussin E. Could the mechanisms of bariatric surgery hold the key for novel therapies? report from a Pennington Scientific Symposium. Obes Rev. 2011 Nov;12(11):984-94. doi: 10.1111/j.1467-789X.2011.00902.x
  4. Tian HL, Tian JH, Yang KH, Yi K, Li L. The effects of laparoscopic vs. open gastric bypass for morbid obesity: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2011 Apr;12(4):254-60. doi: 10.1111/j.1467-789X.2010.00757.x
  5. Himpens J, Ramos A, Welbourn R, Dixon J, Kinsman R, Walton P. IFSO Global Registry Report. 4th ed. Henley-on-Thames, United Kingdom; Dendrite Clinical Systems Ltd.; 2018. 84 p. https://www.ifso.com/pdf/4th-ifso-global-registry-report-last-2018.pdf
  6. Chang SH, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014 Mar;149(3):275-87. doi: 10.1001/jamasurg.2013.3654
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  11. Noun R, Skaff J, Riachi E, Daher R, Antoun NA, Nasr M. One thousand consecutive mini-gastric bypass: short- and long-term outcome. Obes Surg. 2012 May;22(5):697-703. doi: 10.1007/s11695-012-0618-z
  12. Talebpour M, Amoli BS. Laparoscopic total gastric vertical plication in morbid obesity. J Laparoendosc Adv Surg Tech A. 2007 Dec;17(6):793-98. doi: 10.1089/lap.2006.0128
  13. Talebpour M, Sadid D, Talebpour A, Sharifi A, Davari FV. Comparison of Short-Term Effectiveness and Postoperative Complications: Laparoscopic Gastric Plication vs Laparoscopic Sleeve Gastrectomy. Obes Surg. 2018 Apr;28(4):996-1001. doi: 10.1007/s11695-017-2951-8
  14. Yermilov I, McGory ML, Shekelle PW, Ko CY, Maggard MA. Appropriateness Criteria for Bariatric Surgery: Beyond the NIH Guidelines. Obesity. 2009 Aug;17(8):1521-27. doi: 10.1038/oby.2009.78
  15. Cummings DE, Cohen RV. Beyond BMI: the need for new guidelines governing the use of bariatric and metabolic surgery. Lancet Diabetes Endocrinol. 2014 Feb;2(2):175-81. doi: 10.1016/S2213-8587(13)70198-0
Address for correspondence:
220045, Republic of Belarus, Minsk,
Semashko Str., 8,
Minsk Scientific and Practical Center
of Surgery, Transplantology and Hematology,
the Surgical Unit.
tel. +375 29 123-86-21,
email:avlassergey@list.ru
Aulas Siarhei D.
Information about the authors:
Hlinnik Aliaksei A., PhD, Associate Professor of the Transplantology Department, Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-0530-1158
Aulas Siarhei D., Post-Graduate Student, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk ,Republic of Belarus.
http://orcid.org/0000-0003-3454-5298
Stebounov Sergei S., MD, Professor, Head of the Department of General, Plastic and Bariatric Surgery, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk , Republic of Belarus.
http://orcid.org/0000-0002-3795-6298
Rummo Oleg O., MD, Professor, Corresponding Member of National Academy of Sciences of Belarus, director, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk , Republic of Belarus.
http://orcid.org/0000-0001-7023-4767
Hermanovich Vitali I., Head of the Surgical Unit, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-9396-5407

V.P. ANDRIUSHCHENKO, D.V. ANDRIUSHCHENKO, V.V.MAHLOVAHYI

CLINICAL EVALUATION OF THE FEATURES OF CURRENT PANCREATIC INFECTION AS A COMPONENT OF THE MULTIDISCIPLINARY PRINCIPLE OF TREATMENT TACTICS IN ACUTE PANCREATITIS

Danylo Halytsky Lviv National Medical University, Lviv,
Ukraine

Objective. To study the main features of current pancreatic infection with an assessment of the clinical significance of the data obtained in the implementation of the multidisciplinary and comprehensive approaches to optimal management of patients with acute pancreatitis.
Methods. 147 bacteriological studies of liquid (peripancreatic fluid collection) and tissue (fragments of necrotized gland and retroperitoneal tissue) were carried out using the methods of aerobic (80) and anaerobic (67) cultivation and determination of the sensitivity of microflora to antibiotics. Regimes of antibiotic therapy (preventive / etiotropic) were determined during the treatment of patients (n=460).
Results. The dominance of aerobic bacteria in the form of monoculture (37%) and aerobic-anaerobic associations (39%) with gram-negative signs (56%) and the constancy of microbial associations in 54% of cases was established. It was found that the addition of an infectious factor to the primary aseptic inflammatory process occurs both in the early – up to one week (17%), and late – after three weeks (31%). The signs of pancreatic infection, which can serve as objective criteria for assessing the severity of the course of acute pancreatitis, were identified – infection of the gland tissue / retroperitoneal tissue, early attachment of a bacterial factor, dominance of aerobic-anaerobic associations and gram-negative microflora inclusion. The sensitivity of bacteria to antibiotics and the conditions for the multidrug resistance development were determined. The principles of use of antibacterial agents at various stages of treatment in the modes of preventive and etiotropic therapy have been substantiated.
Conclusion. Current pancreatic infection in acute pancreatitis is microflora in the form of monoculture (37%) and aerobic-anaerobic associations (39%) with gram-negative inclusion (56%) and a prevalence of enterobacteria and anaerobic non-clostridial flora. Infection of the gland / retroperitoneal tissues, early bacterial factor, the dominance of gram-negative aerobic-anaerobic associations, objectifies the severity of the disease. Preventive antibiotic therapy for pancreatic necrosis promotes to the preservation of the asepticity of the inflammatory process in 68% of cases. The use of etiotropic antibiotic therapy is indicated in the postoperative period due to the development of microflora resistance.

Keywords: acute pancreatitis, multidisciplinary principle of treatment, characteristics of pancreatic infection, regimens of antibiotic therapy, assessment of disease severity
p. 671-679 of the original issue
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Address for correspondence:
Ukraine, 79010,
Lviv, Pekarskaya Str., 69,
Danylo Halytsky Lviv National Medical University, General Surgery Department of Surgical Diseases No3,
tel. office +38 032 291-72-31
e-mail: avp.victor@gmail.com
Andriushchenko Victor P.
Information about the authors:
Andriushchenko Victor P., MD, Professor, Head of the General Surgery Department of surgical diseases No3, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0003-1848-7358
Andriushchenko Dmytro V., MD, Professor of the Surgery Departmentr of the Post-Graduate Training Faculty, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0003-1046-7889
Mahlovanyi Vitalii A., PhD, Associate Professor of the General Surgery Department, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0001-6872-453X

V.P. ZEMLYANOY 1, B.P. FILENKO 1, B.V. SIGUA 1, P.A. KOTKOV 2, G.Y. DZALATYAN 2

PREVENTIVE MEASURES AS AN OBLIGATORY COMPONENT IN THE TREATMENT OF PATIENTS WITH ACUTE ADHESIVE BOWEL OBSTRUCTION

North-Western State Medical University named after I.I. Mechnikov 1,
Saint-Petersburg St. Elizabeth Hospital 2, Saint-Petersburg,
The Russian Federation

Objective. Reducing the recurrence rate of adhesive disease after its surgical treatment by developing a differentiated approach to preventive measures.
Methods. A retrospective study included patients (n=260) with adhesive disease complicated by recurrent attacks of acute bowel obstruction has been performed. The main (n=105) and control (n=155) groups were formed. The patients of the main group were undergone to algorithm for prophylaxis and treatment in patients providing the implementation of planned surgical treatment and measures to prevent recurrence. The nature of preventive measures was determined by the volume of surgical trauma of the peritoneal mesothelium and the prevalence of cicatricial-adhesive changes. In the control group, patients underwent standard measures aimed at conservative resolution of acute adhesive bowel obstruction: depending on their effectiveness, patients were discharged for further outpatient treatment or for urgent surgical intervention without any preventive measures. The primary outcome was considered to be the incidence and recurrence rate of adhesive disease and the severity of clinical symptoms, which were traced to a depth from 2 to 10 years by interviewing patients. If it was impossible to assess long-term results, patients were excluded from the study.
Results. The total frequency of adhesive disease relapses requiring hospitalization was 8.6% (n=9) in the main group and 27.1% (n=42) in the comparison group, respectively. The best results were obtained in the subgroup of patients operated on for adhesive disease in a planned manner - the frequency recurrence rate was 4.6%.
Conclusion. The use of the developed therapeutic and prophylactic algorithm in the surgical treatment of adhesive disease led to decline in relapse rates from 27.1 %-8.6% cases of an improvement of life quality of patients with acute adhesive intestinal obstruction who underwent surgical treatment.

Keywords: adhesive disease, abdominal adhesions, adhesiolysis, acute adhesive intestinal obstruction, prevention of adhesions, nasointestinal intubation
p. 680-687 of the original issue
References
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Address for correspondence:
191015, Russian Federation,
Saint-Petersburg, Kirochnaya Str., 41,
North-Western State Medical University
Named after I.I. Mechnikov, the Faculty
Surgery Department Named after I.I.Grekov,
tel. +790626192131,
e-mail: kotkovdr@mail.ru
Kotkov Pavel A.
Information about the authors:
Zemlianoi Viacheslav P., MD, Professor, Head of the Faculty Surgery Department Named after I.I.Grekov, North-Western State Medical University Named after I.I. Mechnikov, Saint-Petersburg, Russian Federation.
https://orcid.org/0000-0003-2329-0023
Filenko Boris P., MD, Professor of the Faculty Surgery Department Named after I.I.Grekov, North-Western State Medical University Named after I.I. Mechnikov, Saint-Petersburg, Russian Federation.
https://orcid.org/0000-0001-7948-9862
Sigua Badri V., MD, Professor of the Faculty Surgery Department named after I.I.Grekov, North-Western State Medical University Named after I.I. Mechnikov, Saint-Petersburg, Russian Federation.
https://orcid.org/0000-0002-4556-4913
Kotkov Pavel A., PhD, Surgeon, the Surgery Unit No2, Saint-Petersburg St. Elizabeth Hospital, Saint-Petersburg, Russian Federation.
https://orcid.org/0000-0002-9762-9854
Dzhalatyan Garii Yu., Surgeon, the Surgery Unit No2, Saint-Petersburg St. Elizabeth Hospital, Saint-Petersburg, Russian Federation.
https://orcid.org/0000-0001-6075-2085

N.G. SHESTAK 1, I.P. KLIMCHUK 1, 2, V.YA. KHRYSHCHANOVICH 1, 2

COMPARATIVE ANALYSIS OF THE RESULTS OF THE MECHANOCHEMICAL ENDOVENOUS ABLATION OF GREAT SAPHENOUS VEIN USING POLYDOCANOL FOAM OF ROOM TEMPERATURE AND COOLED ONE

Minsk 4th City Clinical Hospital named after N.E. Savchenko, Minsk, Republic of Belarus
Belarusian State Medical University, Minsk, Republic of Belarus

Objective. To conduct a comparative analysis of long-term (3-yars) results of varicose veins treatment by mechanochemical endovenous ablation (MOCA) with using polidocanol foam of room temperature and a chilled one.
Methods. The study is based on the treatment results of 122 patients with great saphenous vein (GSV) incompetence. The patients were randomized into 2 groups. In the main group (n=60), mechano-chemical ablation was performed according to original technique, using a cooled sclerosant, 60ᵒ degrees leg elevation and a shin bandage; in the comparison group (n=62) standard technique was used. The median GSV diameter in the main group was Me (Q25; Q75) = 7.4 (5.8; 8.2) mm, in the comparison group - Me (Q25; Q75) = 7.3 (5.6; 8.3) mm (P=0.794).
Results. One month after the surgery, the GSV was totally occluded in 100% cases in the main and in 96.7% cases in the comparison group (P=0.496). One year after the surgery, occlusion rates were 94.6% and 80.4% respectively (P=0.042). 3 years later, GSV occlusion was diagnosed in 92.6% cases and in 76.4% cases, respectively (P=0.0033). Hyperpigmentation was reported in 21.7% legs in the main group and 22.6% legs in the comparison group (P>0,99). Transient superficial phlebitis developed in 6.7% and in 8.1% legs, respectively (P=0.744).
Conclusion. Endovenous mechanochemical cryoablation is more effective than the standard MOCA technique and can be considered as the most preferable method for eliminating reflux in the GSV.

Keywords: varicose veins, endovenous mechanochemical ablation, cryoablation, truncal reflux, Flebogrif
p. 690-698 of the original issue
References
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  3. Kalteis M, Adelsgruber P, Messie-Werndl S, Gangl O, Berger I. Five-year results of a randomized controlled trial comparing high ligation combined with endovenous laser ablation and stripping of the great saphenous vein. Dermatol Surg. 2015 May;41(5):579-86. doi: 10.1097/DSS.0000000000000369
  4. Bozoglan O, Mese B, Eroglu E, Erdogan MB, Erdem K, Ekerbicer HC, Yasim A. Comparison of endovenous laser and radiofrequency ablation in treating varicose veins in the same patient. Vasc Endovascular Surg. 2016 Jan;50(1):47-51. doi: 10.1177/1538574415625813
  5. Zubilewicz T, Terlecki P, Terlecki K, Przywara S, Rybak J, Ilzecki M. Application of endovenous mechanochemical ablation (MOCA) with FlebogrifTM to treat varicose veins of the lower extremities: a single center experience over 3 months of observation. Acta Angiologica. 2016;22(4):137-42. doi: 10.5603/AA.2016.0012
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  17. Lawaetz M, Serup J, Lawaetz B, Bjoern L, Blemings A, Eklof B, Rasmussen L. Comparison of endovenous ablation techniques, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Extended 5-year follow-up of a RCT. Int Angiol. 2017 Jun;36(3):281-88. doi: 10.23736/S0392-9590.17.03827-5
Address for correspondence:
220036, The Republic of Belarus,
Minsk, Rosa Luxemburg Str., 110,
4th City Clinical Hospital Named after N.E. Savchenko, Vascular Surgery Department,
tel.: +375 17286-19-52,
e-mail: dr.shestak@gmail.com,
Nikita G. Shestak
Information about the authors:
Shestak Nikita G., Angiosurgeon of the Department of Vascular Surgery, Minsk 4th City Clinical Hospital named after N.E. Savchenko, Minsk, Republic of Belarus. https://orcid.org/0000-0001-9556-5407
Klimchuk Ivan P., PhD, Head of the Department of Vascular Surgery, Minsk 4th City Clinical Hospital named after N.E. Savchenko, Assistant of the General Surgery Department, Belarusian State Medical University, Minsk, Republic of Belarus. http://orcid.org/0000-0001-9793-0084
Khryshchanovich Vladimir Ya., MD, Professor, Professor of the 2nd Department of Surgical Diseases, Belarusian State Medical University, Angiosurgeon, City Clinical Emergency Hospital, Minsk 4th City Clinical Hospital named after N.E. Savchenko, Minsk, Republic of Belarus. http://orcid.org/0000-0001-5353-205X

PEDIATRIC SURGERY

D.D. MOROZOV 1, S.M. SHARKOV 1, 2, D.S. TARASOVA 2, E.S. PIMENOVA 2, E.A. OKULOV 3, D.A. MOROZOV 2, 4

CORRECTION OF CLOACA: RESULTS OF TREATMENT OF 16 CHILDREN WHO UNDERWENT 83 OPERATIONS IN 17 CLINICS

Morozov Children's City Clinical Hospital, the department of Health Care of Moscow 1,
I.M. Sechenov First Moscow State Medical University (Sechenov University) 2,
National Medical Research Center for Children's Health of the Ministry of Health 3,
Yu.E.Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University 4, Moscow,
The Russian Federation

Objective. To conduct a retrospective analysis of surgical treatment and long-term outcomes of treatment of children with cloaca, admitted to clinics of Sechenov University in the period from 2015 to 2019 years.
Methods. Surgical treatment and long-term results were analyzed in 16 patients with cloaca. The age of the children at the time addressing to the clinic varied from the first day of life to 17 years. Long-term results were analyzed in children aged 2.5 to 17 years. In the late postoperative period, patients’ complaints, local status, functional state of the sphincter apparatus, and urination were analyzed.
Results. Patients with cloaca were admitted to clinics of Sechenov University from 10 regions of the Russian Federation. Three children were hospitalized in the first day of life, 13 patients were admitted at various stages of treatment. In 14 children, a stoma was formed on the first day of life, in two – later than a month. Correction of the defect by means of a posterior-sagittal perineal approach was performed in 13 patients, in 3 patients the abdominal-perineal approaches were applied. Reoperations were required in 10 patients (63%). In the long-term postoperative period, neoanus stenosis was detected in 4 (25%) patients, and neointroitus infestatio – in 3 (19%) patients. Constipation was registered in 7 children (43%), fecal incontinence in 2 (13%). 10 (62%) children had various urinary disorders.
Conclusion. We found that 16 patients with cloaca were treated in 17 clinics at different stages of treatment. At the same time, the majority of patients in the late postoperative period had problems with defecation and urination and required repeated surgical interventions. The results of the analysis indicate that treatment prospects of such patients treatment lies in the organization of interregional centers, with the possibility of concentrating material, technical and human resources, forming the flow of patients and their competent routing.

Keywords: cloaca, anorectal malformation, urogenital sinus, constipation, incontinence
p. 699-709 of the original issue
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  8. Vilanova-Sanchez A, Halleran DR, Reck-Burneo CA, Gasior AC, Weaver L, Fisher M, Wagner A, Nash O, Booth K, Peters K, Williams C, Brown SM, Lu P, Fuchs M, Diefenbach K, Leonard JR, Hewitt G, McCracken K, Di Lorenzo C, Wood RJ, Levitt MA. A descriptive model for a multidisciplinary unit for colorectal and pelvic malformations. J Pediatr Surg. 2019 Mar;54(3):479-85. doi: 10.1016/j.jpedsurg.2018.04.019
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  10. Morozov DA, Okulov EA, Pimenova ES. Russian consensus on treatment of anorectal malformation / the first steps. Ros Vestn Det Khirurgii Anesteziologii i Reanimatologii. 2013;3(4):8-13. https://cyberleninka.ru/article/n/rossiyskiy-konsensus-po-hirurgicheskomu-lecheniyu-detey-s-anorektalnymi-porokami-pervye-shagi (In Russ.)
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Address for correspondence:
19991, Russian Federation,
Moscow, Trubetskaya Str., 8-2,
I.M. Sechenov First Moscow State Medical University of the Ministry of Health,
the Department of Pediatric Surgery
and Urolory-Andrology Named after L.P.Alexandrov
tel.: 8 (916) 868-70-44,
e-mail: damorozov@list.ru,
Morozov Dmitry A.
Information about the authors:
Morozov Dmitry D., Clinical Intern, Morozov Children’s City Clinical Hospital, the Department of Health Care of Moscow, Moscow, Russian Federation.
https://orcid.org/0000-0002-9115-7008
Sharkov Sergey M., MD, Professor of the Department of Pediatric Surgery and Urolory-Andrology Named after L.P.Alexandrov, I.M. Sechenov First Moscow State Medical University of the Ministry of Health, Head of the Operative Block of Morozov Children’s City Clinical Hospital, the Department of Health Care of Moscow, Moscow, Russian Federation.
https://orcid.org/0000-0002-9563-6815
Tarasova Darya S., PhD, Assistant of the Department of Pediatric Surgery and Urolory-Andrology Named after L.P.Alexandrov, I.M. Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russian Federation.
https://orcid.org/0000-0003-2387-8740
Pimenova Evgenia S., PhD, Associate Professor of the Department of Pediatric Surgery and Urolory-Andrology Named after L.P.Alexandrov, I.M. Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russian Federation.
https://orcid.org/0000-0001-7206-5987
Okulov Evgeny A., PhD, Pediatric Surgeon, National Medical Research Center for Children’s Health of the Ministry of Health, Moscow, Russian Federation. .
https://orcid.org/0000-0002-0132-5662
Morozov Dmitry A., MD, Professor Head of the Department of Pediatric Surgery and Urolory-Andrology Named after L.P.Alexandrov, I.M. Sechenov First Moscow State Medical University of the Ministry of Health, Director of Yu.E.Veltischev Research and Clinical Institute for Pediatrics of Pirogov Russian National Research Medical University Moscow, Russian Federation.
http://orcid.org/0000-0002-1940-1395

ONCOLOGY

I.I. KOBZA, YU.S. MOTA, R.A. ZHUK, YU.G. OREL

THE RESULTS OF SURGICAL MANAGEMENT FOR CàVOàTRIàL TUMOR THROMBOSIS DUE TO RENAL CELL CARCINOMA

Danylo Halytsky Lviv National Medical University, Lviv, Ukraine

Objective. Improvement the surgical management for càvoàtrial tumor thrombosis due to renal cell carcinoma.
Methods. The results of complex clinical, laboratory, instrumental examination, intraoperative observations and morphological studies were analyzed in 62 patients with renal cell carcinoma, complicated by cavîàtriàl tumor thrombosis, hospitalized to the vascular surgery department of Lviv rågionàl clinicàl hîspital for thå påriod 1993–2019. Surgical treatment included radical nephrectomy, thrombectomy from inferior vena cava and right atrium. Kaplan-Meier method was used to evaluate the long-term survival of patients.
Results. The postoperative complications included: posthemorrhagic anemia – 22 (38,6%), acute renal failure – 15 (26,3%), pulmonary embolism – 4 (7,0%), acute liver failure – 3 (5,3%), phlebothrombosis – 3 (5,3%), pneumonia – 3 (5,3%), stroke – 2 (3,5%), wound ñomplications – 5 (8,8%) cases. Perioperative mortality was 11,3%. The causes of death included: hemorrhagic shock – 4 (6,5%), pulmonary embolism – 3 (4,8%), stroke – 1 (1,6%) cases. Long-term survival indicators were evaluated among 53 patients. The median follow-up was 36,9±13,3 months. The cumulative 2-, 5-, and 10-year survivàl ràtes wårå 53,5%; 38,2% and 17,2%, in 32 pàtiånts without metastases – 58,7%; 43,1% and 18,5% råspåctivåly. Thårå wàs nî significànt diffåråncå ³in survivàl among patients with atrial and retrohepatic venous tumor thrombosis versus infrahepatic and cavarenal venous tumor thrombosis (p>0,05).
Conclusion. The accurate preoperative assessment of the level of neoprocess involvement, improvement of surgical tactics, effective prevention of thromboembolic and hemorrhagic complications make it possible to provide acceptable survival rates for patients with renal cell carcinoma, complicated by càvoàtrial tumor thrombosis.

Keywords: tumor thrombosis, inferior vena cava, right atrium, renal cell carcinoma, surgical treatment, results
p. 710-718 of the original issue
References
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Address for correspondence:
79010, Ukraine,
Lviv, Pekarska Str., 69,
Danylo Halytsky Lviv National
Medical University, Department of Surgery No2,
Tel. +38 096 837 99 25,
e-mail: yuliamota@gmail.com,
Mota Yuliya S.
Information about the authors:
Kobza Ihor I., MD, Professor, Head of the Surgery Department No2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0001-8493-414X
Mota Yuliya S., Post-Graduate Student of the Surgery Department No2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0002-6332-8404
Zhuk Rostyslav A., PhD, Associate Professor of the Surgery Department No2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0003-3605-0862
Orel Yuriy G., MD, Professor of the Surgery Department No2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0002-2283-7843

YEV.B. RADZISHEVSKA 1, 2, A.S. SAVCHENKO 1, 4, YA.K. RADZISHEVSKA 3, O.M. BOIKO 3, L.A. VYGIVSKA 2, M. KUKSIN 5

DEVELOPMENT OF REMOTE SEQUELAE SUCH AS GASTROINTESTINAL TRACT PATHOLOGY IN PATIENTS SPECIALLY TREATED FOR DIFFERENTIATED THYROID CANCER

S.P. Grigoriev Institute of Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine 1,
Kharkiv National Medical University 2,
Kharkiv City Clinical Hospital No27 3,
Kharkiv State University named after V.N.Karazin 4, Kharkiv,
Ukraine
École Normale Supérieure 5, Lyon, France

Objective. Evaluate the potential long-term effects of differentiated thyroid cancer (DTC) treatment, on the gastro-intestinal tract (GIT) based on a retrospective study of DTC patients.
Methods. Occurrence of long-term GIT pathologies was retrospectively studied in 157 DTC patients. All patients were treated according to the standard of care, which includes radical surgery, radiation therapy and hormone therapy. The database contained digitalised medical histories of patients followed for at least 1 year after treatment. A total of 463 entries were available, representing one entry per noted consequence for each of the 157 patients. The study focused on two aspects. The frequencies of complications before and after treatment were compared, and factors impacting DTC pathology in a statistically significant manner were isolated.
Results: The total onset frequency of gallbladder, liver and pancreas disorders was increased by a factor of 1.6 in a statistically significant manner in DTC patients. Patients initially presenting gallbladder disorders received shorter cures of hormone therapy (4 versus 13 months), and lower levels of L-thyroxine in a context of uncompensated hypothyroidism (2.3 versus 3.5 mg/kg). A statistically significant relation was established between the total duration of breastfeeding in women presenting metabolic health disorders, and onset of liver pathology (essentially non-alcoholic steatohepatitis).
Conclusion. Life-long GIT pathology monitoring should be standard of care for patients after special DTC treatment.

Keywords: Differentiated thyroid cancer, long-term effects, gastro-intestinal tract disorders, hypothyroidism, L-thyroxine dose, metabolic health in women, breastfeeding duration
p. 719-727 of the original issue
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  16. Velle-Forbord V, Skr åstad RB, Salvesen Ø, Kramer MS, Morken NH, Vanky E. Breastfeeding and long-term maternal metabolic health in the HUNT Study: a longitudinal population-based cohort study. BJOG. 2019 Mar;126(4):526-34. doi: 10.1111/1471-0528.15538
Address for correspondence:
61024, Ukraine,
Kharkiv, Pushkinskaya Str., 82,
S.P. Grigoriev Institute of Medical Radiology and Oncology, Group of Medical Information Technology,
tel. office.:+380 (67) 799-36-63,
e-mail: radzishevska@ukr.net,
Radzishevska Yevgenia B.
Information about the authors:
Radzishevska Yevgenia B., PhD (Phys., Biol. Science) Head of the Group of Medical Information Technology, S.P. Grigoriev Institute of Medical Radiology and Oncology, National Academy of Medical Sciences of Ukraine, Associate Professor of the Department of Medical Biological Physics and Medical Information Technology, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0001-9149-7689
Savchenko Antonina S., PhD, Associate Professor of the Department of Oncology, Radiology and Radiation Medicine, Kharkiv State University Named after V.N.Karazin, Radiologist of the Nuclear Medicine Department, S.P. Grigoriev Institute of Medical Radiology and Oncology, National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine.
https://orcid.org/0000-0002-7055-117X
Radzishevska Yaroslava K., PhD, Therapist, US Specialist, Kharkiv City Clinical Hospital No27, Kharkiv, Ukraine.
https://orcid.org/0000-0003-0770-3852
Vygivska Ludmila A., MD, Associate Professor of the Department of Obstetrics, Gynecology and Pediatric Gynecology, Kharkov National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0002-9389-4845
Boiko Alexey N., PhD, Head of the Therapeutic Department, Kharkiv City Clinical Hospital No27, Kharkiv, Ukraine.
https://orcid.org/0000-0003-2865-2951
Kuksin M.S., Master of Biology, École Normale Supérieure. Higher School, Lyon, France.
https://orcid.org/0000-0001-8244-346X

REVIEWS

D.A. KLYUIKO

PATHOGENETIC PREREQUISITES FOR THE DEVELOPMENT OF THE ADHESION PROCESS OF THE ABDOMINAL CAVITY

Belarusian State Medical University, Minsk,
Republic of Belarus

In the literature, there is a discussion concerning the prevention, diagnosis and treatment of adhesions of the abdominal cavity and associated with intestinal obstruction, while the question of the pathogenesis of the disease and the true reasons for its development is completely overlooked. Recently, there have been no any significant achievements in solving this problem. The analysis of literature sources revealed a number of shortcomings of the scientific and practical approach associated with outdated fundamental ideas about the causes of the adhesive process, which are based on tissue oxygenation and fibrin organization. So, the healing of the peritoneum and the restoration of the native layer of mesioteliocetes without the formation of adhesions is possible only in the first 3 days from the moment of an injury. At the same time, hypoxia plays an important role in the formation of peritoneal adhesions, affecting the maturation of mesothelial cells and the differentiation of fibroblasts. The solution to the problem of adhesion is possible by influencing the key links of pathogenesis: hypoxia in the abdominal tissue, the system of fibrinolytic and extracellular matrix degradation, the formation and activation of autocoids and regulators of fibrotic tissue. Despite the traditionally established approaches, it is necessary to revise the concept of the pathogenicity theory understanding the cellular and molecular mechanisms of adhesion formation.

Keywords: abdominal cavity, complications, general surgery, intestinal obstruction, tissue adhesion, TGF-β, HIF
p. 728-735 of the original issue
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Address for correspondence:
220116, Republic of Belarus,
Minsk, Dzerzhinsky Avenue, 83,
Belarusian State Medical University,
the Department of Military Field Surgery,
+375 29 377-96-67
e-mail: mdkluiko@gmail.com
Klyuiko Dmitry A.
Information about the authors:
Klyuiko Dmitry A., PhD, Associate Professor, Medical Colonel, Head of the Department of Military Field Surgery, Belarusian State Medical University, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-4090-500X

P.N. MYSHENTSEV, S.E. KATORKIN, G.V. YAROVENKO

CURRENT ASPECTS OF SURGICAL TREATMENT OF LIMB LYMPHEDEMA

Samara State Medical University of the Ministry of Health of Russia, Samara,
Russian Federation

The article provides the literature overview on various current methods of surgical treatment of patients with limb lymphedema. Despite the fact that the basis of the treatment of this pathology is a complex antiedema therapy, the possibilities of conservative therapeutic measures for lymphedema leave much to be desired and cannot often satisfy either patients or clinicians. The use of surgical methods in the treatment of lymphedema has a long history and has gone from various types of resection to reconstructive interventions. The analysis of current literature data has shown that the choice of the volume and method of surgical correction in lymphedema requires a difficult and individual assessment of the pathological changes developing in the disease, which should be identified only with a comprehensive examination of patients. Operations of lymphovenous anastomosis, transplantation of lymph nodes are considered to be the most effective in the prevention or initial stages of lymphedema. With pronounced manifestations of the disease, optimal results are achieved with a reasonable combination of methods improving lymph drainage and operations reducing the excess volume of the affected limb, thereby provided patients with potentially improved functional outcomes and quality of life. The limitations in improvement despite multimodality treatment are consided to be at the level of satisfactory values. The experience of the most lymphedema professionals has to be suggested a reasonable balance between basic conservative therapy and surgical treatment. Undoubtedly, the results of evaluating these methods will improve the choice of the optimal method for treating patients with limb lymphedema.

Keywords: limb lymphedema, surgical treatment, lymphovenous anastomoses, liposuction, lymphatic vessel transplantation, dermalipofasciectomy
p. 736-746 of the original issue
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Address for correspondence:
443099, Russian Federation,
Samara, Chapaevskaya Str., 89,
Samara State Medical University,
Hospital Surgery Department
tel. +7 927 206-71-02,
e-mail: katorkinse@mail.ru
Katorkin Sergey E.
Information about the authors:
Myshentsev Pavel N., PhD, Associate Professor of the Hospital Surgery Department, Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation.
http://orcid.org/0000-0001-7564-8168
Katorkin Sergei E., MD, Associate Professor, Head of the Hospital Surgery Department , Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation.
http://orcid.org/0000-0001-7473-6692
Yarovenko Galina V., MD, Associate Professor of the Hospital Surgery Department, Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation.
http://orcid.org/0000-0002-5043-7193

CASE REPORTS

R.E. KALININ 1, I.A. SUCHKOV 1, V.V. KARPOV 2, A.A. EGOROV 1, 2, A.S. PSHENNIKOV 1, 2, D.V. KARPOV 1, 2, A.A. KRYLOV 1, 2

POSSIBILITIES OF VASCULAR TRANSPLANTATION IN URGENT SURGERY OF MAIN ARTERIES

I.P. Pavlov Ryazan State Medical University 1,
Regional Clinical Hospital 2, Ryazan,
Russian Federation

The article presents the experience of using allografts from a postmortem donor in emergency surgery of the main arteries of the lower extremities. Possible tactical methods of combined use of alloartery and allovein from various donors in urgent surgery have been demonstrated. High risks of interventions aimed at relieving early and late complications of vascular reconstructions remain an actual problem in angiosurgery. Very often, operations are performed in the presence of extensive necrosis and trophic ulcers (stage IV according to the Fontaine-Pokrovsky classification). Autovenous conduit from the great saphenous vein (type of arterial bed lesions C, D according to TASS II) was and remains the gold standard for choosing a shunt for reconstructive operations on infrainguinal arteries. In case of repeated reconstructions in the absence of a suitable autovein, in the presence of trophic ulcers and necrosis, an infectious process in the area of the vascular prosthesis, it is not always possible to use a synthetic prosthesis as a reliable alternative. Unsatisfactory results of using such materials dictate the need to choose a suitable graft. The problem of using allografts requires further advanced study. In this regard, the experience of using allografts in two non-standard urgent clinical situations is presented. The conclusion is made about the possibility of effective use of allografts from a postmortem donor in patients with bleeding after endovascular treatment of critical limb ischemia with trophic changes in the staged surgical treatment, as well as in patients with thrombosed anastomotic false aneurysms after previously performed surgical interventions.

Keywords: allograft, transplantation of the vessel, thrombosed false aneurysm of anastomosis, graft, autologous vein
p. 747-753 of the original issue
References
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  2. Bhardwaj B, Spertus JA, Kennedy KF, Jones WS, Safley D, Tsai TT, Aronow HD, Vora AN, Pokharel Y, Kumar A, Attaran RR, Feldman DN, Armstrong E, Prasad A, Gray B, Salisbury AC. Bleeding Complications in Lower-Extremity Peripheral Vascular Interventions: Insights From the NCDR PVI Registry. JACC Cardiovasc Interv. 2019 Jun 24;12(12):1140-49. doi: 10.1016/j.jcin.2019.03.012
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  5. Antonopoulos CN, Papakonstantinou NA, Hardy D, Lyden SP. Editor’s Choice - Cryopreserved Allografts for Arterial Reconstruction after Aorto-Iliac Infection: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg. 2019 Jul;58(1):120-28. doi: 10.1016/j.ejvs.2019.03.003
  6. Kalinin RE, Suchkov IA, Karpov VV, Pshennikov AS, Egorov AA. The first experience of using allografts in surgery of main arteries of lower limbs. Russian Sklifosovsky Journal “Emergency Medical Care”. 2020;9(3):442-448. doi: 10.23934/2223-9022-2020-9-3-442-448 (In Russ.)
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Address for correspondence:
390026, Russian Federation,
Ryazan, Vysokovoltnaya Str., 9,
I.P. Pavlov Ryazan State Medical University,
the Department of Cardiovascular,
X-ray Endovascular, Operative Surgery
and Topographic Anatomy,
e-mail: suchkov_med@mail.ru
Suchkov Igor A.
Information about the authors:
Kalinin Roman E., MD, Professor, Head of the Department of Cardiovascular, X-ray Endovascular, Operative Surgery and Topographic Anatomy, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
https://0000-0002-0817-9573
Suchkov Igor A., MD, Professor of the Department of Cardiovascular, X-ray Endovascular, Operative Surgery and Topographic Anatomy, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
https://0000-0002-1292-5452
Karpov Vyacheslav V., PhD, Physician of the Vascular Surgery Unit, Regional Clinical Hospital, Ryazan, Russian Federation.
https://0000-0001-5523-112Õ
Egorov Andrey A., PhD, Associate Professor of the Department of Cardiovascular, X-ray Endovascular, Operative Surgery and Topographic Anatomy, I.P. Pavlov Ryazan State Medical University, Head of the Vascular Surgery Unit, Regional Clinical Hospital, Ryazan, Russian Federation.
https://0000-0003-0768-7602
Pshennikov Alexander S., MD, Associate Professor of the Department of Cardiovascular, X-ray Endovascular, Operative Surgery and Topographic Anatomy, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
https://0000-0002-1687-332X
Karpov Dmitry V., PhD, Associate Professor of the Department of Surgery, Obstetrics And Gynecology, I.P. Pavlov Ryazan State Medical University, Head of Urology and Transplantation Unit, Regional Clinical Hospital, Ryazan, Russian Federation.
https://0000-0002-6097-5737
Krylov Andrew A., PhD, Assistant of the Department of Cardiovascular, X-ray Endovascular, Operative Surgery and Topographic Anatomy, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
https://0000-0002-2393-0716

T.V. ROMANIUK, R.I. LEKAN, I.I. LOYKO

INFECTIVE ENDOCARDITIS OF AORTAL AND MITRAL HEART VALVES AT CHRONIC UROSEPSIS

I.Ya.Horbachevsky Ternopil National Medical University, Ternopil,
Ukraine

Infective endocarditis (IE) is a multisystem disease that results from an infection, usually a bacterial one, on the endocardial heart surface. A clinical case of a patient admitted to the department of cardiovascular surgery with a diagnosis of active infectious endocarditis of the aortic and mitral valves with concomitant chronic urosepsis is described. According to the bacteriological study an etiological relationship between the origin of heart pathology and chronic urosepsis was established. The results of current methods of visual diagnostics on the basis of which the preoperative diagnosis was formed are also described. Prosthetics of the On-X 19 aortic valve and On-X 27/29 mitral valve was performed. The postoperative period and the features of its course were assessed, taking into account the etiological nature of infective endocarditis. This clinical case clearly shows that any chronic infectious process can cause damage to the endocardium, even with slowly developing processes of atypical origin, for example, the urinary system. Thus, this case indicates that it is necessary to examine a patient with acute and chronic infectious processes carefully and comprehensively for infective endocarditis, since in the early stages the disease manifests itself gradually; and this helps prevent serious complications in the future.

Keywords: infective endocarditis, chronic infectious process of the urinary system, chronic urosepsis, comorbid pathology, surgical treatment of acquired heart defect
p. 747-753 of the original issue
References
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Address for correspondence:
46020, Ukraine,
Ternopil, Maydan Volia Str., 1,
I.Ya. Horbachevsky Ternopil
National Medical University,
Surgery Department No2,
åë. +380637143228,
e-mail: Loikoii@tdmu.edu.ua,
Loyko Ihor I.
Information about the authors:
Romaniuk Taras V., PhD, Associate Professor, the Surgery Department No2, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine.
https://orcid.org/0000-0001-9279-3711
Lekan Roman I., MD, Professor, the Surgery Department No2, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine.
https://orcid.org/0000-0002-6385-050X
Loyko Ihar I., PhD, Associate Professor, the Surgery Department No2, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine.
https://orcid.org/0000-0003-2967-1054
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