The paper presents a clinical case of one of the rare pathologies of the small intestine – a carcinoid tumor complicated by acute intestinal obstruction and covered perforation. The clinical picture of small intestinal carcinoid tumor is very poor, and paraclinical diagnostic methods of this disease are not very informative, which our observation confirms. As a rule, patients receive surgical treatment only after the development of complications.

The aim of the study was to perform clinical and economic analysis of the results of stapleless band-separated gastric pouch surgery and standard one-anastomosis bariatric gastric bypass surgery using endoscopic staplers. Material and methods. The study included 80 patients with morbid obesity randomized into two groups. Method of laparoscopic one-anastomosis gastric bypass with band-separated gastric pouch (OAGB-BSGP) was used for the treatment of patients in the first group (n = 40). Standard method of laparoscopic one-anastomotic gastric bypass with a staple-separated gastric pouch (OAGB-SSGP) was used in the second group (n = 40). Method of “cost – expenses reduction” was used for clinical and economic analysis. Results. The difference in bariatric effectiveness in the compared groups was not significant. The total weight loss (TWL) after two years was 34.06 ± 9.03% in the first group and 29.27 ± 10.6% in the second group (p = 0.03). Significant differences between the groups were revealed when calculating the cost of surgical treatment. Cost of OAGB-BSGP amounted to US $1404.12 versus $3916.76 for OAGB-SSGP (P <0.0001). When adding direct expenses, cost of preoperative examination and postoperative observation to the cost of surgical treatment, the total cost for OAGB-BSGP amounted to $1,488.81 versus $4,000.72 for OAGB-SSGP (P <0.001). Conclusion. As a result of the analysis using the “cost reduction” method, it was found that with the same clinical effectiveness of the two compared methods the staple-free method is much cheaper and, therefore, it is economically more favorable for practical use.

The aim of the study is to evaluate the results of cyanoacrylate embolization (CAE) of the great (GSV) and small (SSV) saphenous veins in patients with varicose veins (VVs) of the lower limbs. Material and methods. This is a prospective observational study that started in 2017 at the «Neftyanik» Medical unit, including patients with VVs (C2 and higher according to the CEAP) who underwent CAE of the GSV and/or SSV using VenaSeal system. Patients underwent clinical and ultrasound evaluation 1 week, 3, 6, 12 months after the surgery and then every year. Efficiency criteria are: technical success of treatment; absence of recanalization; length of the GSV stump; vein involution; absence of reflux in the trunk; absence of reflux at the SFJ (saphenofemoral junction); no need to remove tributaries; no need for re-intervention in the trunk; CEAP classification of chronic venous disease; severity of disease according to the VCSS. Safety criteria are the absence of adverse reactions (ARs). Results. In the period of 2017–2019 cyanoacrylate embolization (CAE) have been performed on 122 limbs in 92 patients with VVs: 46 women and 46 men aged from 28 to 69 years (mean age 45.3±10.3 years) with the CEAP class of C2 (47.6 %), C3 (35.2 %), C4 (16.4 %), and C5 (0.8 %). The GSV trunk (diameter of 4.5–18.0 mm; mean 9.0±2.5) was treated in 82 % and the SSV (3.7–13.0 mm; mean — 7.0±2.3) in 18 %. Technical success was achieved in all cases. The length of the GSV stump varied from 0 to 48 mm (mean — 19.0±9.7). Sclerotherapy for varicose tributaries during the first 3 months was performed in 55 legs (45.1 %). Patients were followed up for 1 week — 18 months (3 months on average). Additional sclerotherapy for varicose tributaries was required for 35 (28.7 %) limbs. Trunk recanalization >5 cm was found in 8 limbs (6.6 %) 3–12 months after intervention and required second CAE (n=1), laser ablation (n=1) or sclerotherapy (n=4). Other ARs that did not require re-intervention were represented with GSV trunk (n=8; 6.6 %) or tributary (n=5; 4.1 %) phlebitis, allergic reaction (n=4; 3.3 %), tension sensation (n=5; 4.1 %), glue propagation towards the SFJ (n=2; 1,6 %), glue propagation from the junction to femoral vein (n=2; 1,6 %), sensitivity disturbance (n=4; 3,3 %), puncture site hematoma (n=1; 0,8 %). Conclusion. CAE of saphenous veins is effective and associated with an acceptable incidence of non-severe AEs with low re-intervention rate.

Aim of the study is to evaluate the results of treatment of patients with ventral hernias who underwent intraperitoneal surgery and traditional separation repair using Sublay method. Material and methods. The study included 108 patients with ventral hernias who underwent a surgical treatment with mesh implants from 2013 to 2018. Intraperitoneal mesh repair was performed in 51 patients; in 57 patients the implant was placed using the Sublay technique. Results. It has been shown that there are not so many convincing advantages of intraperitoneal hernioplasty over traditional TAR (transversus abdominis release) repair. Only the duration of the operation was significantly different. Intraperitoneal repair was faster. The average time was 54 (49; 86) minutes versus 94 (56; 114) minutes. Conclusion. Despite the apparently greater traumatic nature of operations and the apparent high incidence of chronic pain syndrome and long-term physical limitations when using the Sublay method, there were no statistically significant differences from the technique of intraperitoneal surgery. The frequency of relapses and wound complications was almost identical. All this indicates the feasibility of further widespread use of the Sublay technique.

Staphylococcus epidermidis is considered clinically less significant among all types of staphylococci, but its effect on the wound process is not well understood. The objective of the study is to provide an analysis of local and systemic manifestations of wound process in case of staphylococcal soft tissue infections. Materials and methods. 232 cases of purulent diseases of soft tissues were analized, they were divided into three groups by etiology: 1) Staphylococcus aureus (St.a) monoinfection (n=120), 2) Staphylococcus epidermidis (St.e) monoinfection (n=54), 3) combination of St.a-St.e (n=58). The results of bacteriological and cytological studies of wounds were analyzed and the level of markers of inflammation (C-reactive protein, lactoferrin) and endotoxemia (oligopeptides) was assessed. Results. St.e was the causative agent of infection in 16% of cases of purulent diseases of soft tissues. 52-54% of St.e monoinfection and association of St.a-St.e were characterized by the development of a local form of limited purulent processes with moderate growth and rapid normalization of C-reactive protein, lactoferrin and oligopeptides. St.e superinfection was observed in 24-29% of cases on day 15-25, its presence in the purulent focus accelerated the elimination of St.a by a factor of 4, reduced the transition time from inflammation phase to regeneration by a factor of 1.8-3.4. Conclusion. The revealed positive effects of St.e on the inflammatory response indicate the need for early diagnosis of St.e and appropriate correction of antibiotic therapy that is aimed at elimination of other types of pathogenic microorganisms.

The aim of the study is to evaluate the effectiveness of laser removal of interstitial hemorrhoids in the short-stay surgical unit. Material and methods. The technique of laser removal of interstitial hemorrhoids (LHP – laser hemorrhoidoplasty) was chosen for surgical treatment of 76 patients with hemorrhoids. Patients with 1-3 degree of chronic hemorrhoids (the leading symptoms were bleeding, prolapse and frequent inflammation of hemorrhoids) underwent such method of treatment. For patients with the 4th degree hemorrhoids, as well as with a pronounced external component, this technique was not applied. Results. All the patients were treated in the short-stay surgical unit of the Municipal clinical hospital (period of hospitalization was less than 24 hours). The duration of surgery was between 11 and 23 minutes (average - 15.2 ± 4.7 minutes). Final satisfactory treatment result was noted in 98.7% of cases. Conclusion. Laser hemorrhoidoplasty (LHP ™) is a minimally invasive, low-traumatic and almost painless, technically simple procedure that allows to effectively and reliably eliminate the symptoms of the disease for a long period of time. Patients maintain a high level of quality of life and socialization in the postoperative period, since there is practically no need for rehabilitation.

The aim of the study was to improve the surgical treatment of Peyronie’s disease. 24 patients with this disease underwent surgery, in 21 patients replacement surgery was performed using a transplant of the buccal mucosa (incision and grafting), 3 men underwent additional plication of the tunica albuginea of the penis. Three patients underwent Nesbit surgery in various modifications. Aneurysmal deformity of the graft was revealed in 2 (8.4%) patients in the distant postoperative period. Surgical technique that was developed by our team allowed to reduce the risk of this complication when using large buccal mucosal graft.