Notes

COVID-19 crisis associated long-term persistent stress on the actual frequency involving anxiety and depression within the common populace.
Specific complications is an «Achilles heel» of pancreaticoduodenectomy. Postoperative pancreatic fistula (POPF) is the most common specific complication. POPF prediction is an actual problem in pancreatic surgery. Analysis of statistically significant scoring systems to predict POPF is a modern trend in perioperative planning. Several prognostic scales (FRS, a-FRS, ua-FRS, Modified Fistula Risk Score) are recommended for clinical practice.The issue of laparostomy treatment is still controversial, since there are insufficient evidence-based data. German military surgeons have developed and implemented the «Koblenz algorithm» of laparostomy treatment into everyday practice. The algorithm was developed at the Bundeswehr Central Hospital in Koblenz (Germany). Today, approximately 50% of German civilian hospitals use the «Koblenz algorithm». The database for laparostomy treatment was created on the basis of international platform European Registry of Abdominal wall Hernias (EuraHS) in May 2015. These data will be valuable for further multipla-center studies. This manuscript is devoted to analysis of clinical effectiveness of the «Koblenz algorithm» in the treatment of patients with laparostomy. Searching of Russian, English and German studies devoted to «Koblenz algorithm» in the treatment of patients with laparostomy was carried out in the eLIBRARY, Elektronische Zeitschriftenbibliothek, the Cochrane Library and the PubMed databases. The authors comprehensively described «Koblenz algorithm». Mortality in the group of VAC - therapy was 57% (31/54), in case of «Koblenz algorithm» - 33% (33/100). Between-group differences were significant (OR 0.36, 95% CI 0.18-0.72, p=0.003). However, an efficacy of «Koblenz algorithm» should be confirmed in further multiple-center studies including national evidence-based trials.
To study the incidence of peptic ulcers accompanied by gastrointestinal bleeding after surgery for critical lower limb ischemia and their relationship with the factors predisposing to mucous membrane damage.

The study involved 94 patients with critical lower limb ischemia who were eligible for open bypass surgery. All patients underwent preoperative gastro- and duodenoscopy. The patients were followed up for 1 year, while the relationship between the nature of the lesion of the proximal gastrointestinal tract mucosa and the duration of pain syndrome against the background of ischemia, painkiller consumption and redo surgery.

All study participants had lesions of the mucous membrane of the stomach and duodenum inflammatory changes were identified in 92.6% of patients, ulcerative defects in 7.4%. When conducting a correlation analysis, we obtained a weak and moderate strength of the relationship between the duration of rest pain and severity of mucous membrane lesion and strong correlation between painkiller consumption and endoscopic data. Postoperative gastrointestinal bleeding was more common after redo reconstructive surgery or amputation compared to one intervention (7.7% and 1.8%, respectively).

Various lesions of gastrointestinal mucous membrane are diagnosed in all patients with critical lower limb ischemia. It is associated with the underlying disease and painkiller consumption. Risk of bleeding is higher after redo surgery and amputations. selleck chemicals llc Prevention of lesions requires comprehensive examination of patients and individual approach.
Various lesions of gastrointestinal mucous membrane are diagnosed in all patients with critical lower limb ischemia. It is associated with the underlying disease and painkiller consumption. Risk of bleeding is higher after redo surgery and amputations. Prevention of lesions requires comprehensive examination of patients and individual approach.
To develop the indications and assess an effectiveness of treatment of patients with ampullary tumors followed by mechanical jaundice.

There were 26 patients with major duodenal papilla neoplasms for the period 2015-2020 at the Sklifosovsky Research Institute for Emergency Care.

Twenty patients underwent transpapillary interventions papillosphincterotomy followed by lithoextraction and bilio-duodenal stenting in 4 (15.3%) patients, bilio-duodenal stenting in 12 (46.1%) patients, nasobiliary drainage in 2 (7.6%) patients, pancreaticoduodenal stenting in 2 (7.6%) patients. Percutaneous transhepatic microcholecystostomy was performed in 6 (23.4%) patients. In all cases, laboratory values decreased in 5-7 days after drainage. Eight (30.7%) patients refused further surgical treatment and were discharged in satisfactory condition. Another 8 (44.5%) patients underwent endoscopic submucosal papillectomy. There were no postoperative complications. Patients were discharged after 5-7 days. Four (22.2%) patients unlarization of tumor justify endoscopic papillectomy. Endoscopic approach can be considered as a final minimally invasive method with minimal risk of postoperative complications in case of benign ampullary tumor.
To report our experience in surgical treatment of patients with COVID-19.

There were 7815 patients with COVID-19 for the period from April 1, 2020 to December 31, 2020. During this period, 172 operations were performed in this group.

The most common procedures were tracheostomy (
=86, 50.0%), pleural puncture and drainage (
=20, 11.6%), caesarean section (
=22, 12.7%). There were 24 (14.0%) abdominal surgeries including 11 laparoscopies, 5 appendectomies, 3 bowel resections and others. Six lower limb amputations were carried out. We should emphasize common soft tissue hematomas and effusions. This complication is associated with anticoagulation recommended for patients with COVID-19.

Surgical interventions using personal protective equipment is a significant challenge. According to our experience, round-the-clock surgical care in a specialized hospital is required.
Surgical interventions using personal protective equipment is a significant challenge. According to our experience, round-the-clock surgical care in a specialized hospital is required.
To determine the indications for combined and organ-sparing surgery depending on malignancy grade of retroperitoneal liposarcoma.

A retrospective study included 190 patients with retroperitoneal liposarcoma. Influence of malignancy grade, lesion of adjacent organs and resection/excision of adjacent organs on the overall and recurrence-free survival was studied. Moreover, we analyzed the issue of kidney-sparing surgery and nephrectomy.

Overall and recurrence-free survival were significantly worse in high grade (G2-3) compared to low-grade tumors (G1) (
=0.0001; log-rank test). Visceral invasion was revealed in 23% of patients with low-grade (G1) tumors and 53% of patients with high-grade (G2-3) neoplasms. Visceral invasion significantly impairs overall and recurrence-free survival in both low grade (G1) and high-grade (G2-3) tumors (
=0.0001; log-rank test). In case of low grade (G1) retroperitoneal liposarcoma, overall and recurrence-free survival was similar after combined surgery without histologicaned operations including nephrectomy are justified for high-grade retroperitoneal liposarcoma (G2-3).
Surgery is the only potentially radical treatment of patients with retroperitoneal liposarcoma. Organ-sparing including kidney-sparing surgery is advisable for low-grade liposarcoma (G1). On the contrary, organ-sparing surgery impairs long-term results and prognosis in patients with high-grade tumors (G2-3). Combined operations including nephrectomy are justified for high-grade retroperitoneal liposarcoma (G2-3).
To improve the short-term postoperative outcomes in patients with thymoma stage I-II by using of thoracoscopic thymectomy (VATS TE) and to compare this technique with open (OTE) thymectomy.

A retrospective analysis included 98 patients who had undergone surgery for thymoma stage I and II for the period from January 2001 to December 2019. VATS TE (main group) was performed in 53 (54.1%) cases, OTE (control group) - in 45 (45.9%) patients.

Duration of VATS TE and OTE was similar. VATS procedure was characterized by less intraoperative blood loss (50 vs 225 ml,
=0.000), lower pain scores and morphine consumption (
=0.000), shorter postoperative pleural drainage (1.5 vs 3.8 days,
=0.000), and postoperative hospital-stay (7.6 vs 12.7 days,
=0.000). Incidence of major complications was significantly less in the main group (9.4% vs. 1.9%,
=0.001).

VATS TE is effective and safe procedure for thymoma stage I-II. Postoperative period after VATS TE is characterized by less intraoperative blood loss, incidence of complications, duration of pleural drainage and hospital-stay.
VATS TE is effective and safe procedure for thymoma stage I-II. Postoperative period after VATS TE is characterized by less intraoperative blood loss, incidence of complications, duration of pleural drainage and hospital-stay.
To study the causes of resistant pleural effusions and efficiency of chemical pleurodesis with Betadin, Iodopyrone and concentrated glucose solution in these patients.

Resistant pleuritis with daily exudation over 300 ml lasting ≥6 days occurred in 206 (48%) out of 424 cases of pleural effusions. Twenty-seven patients underwent chemical pleurodesis with Betadine, 15 patients - mixture of Iodopyrone with concentrated glucose solution. Solutions were injected via pleural drainage.

In multivariate analysis, the risk factors of complicated pleuritis were air leakage, prolonged drainage period, age over 60 years, fluid output volume during thoracoscopy and higher Charlson index. Pleurodesis with a mixture of Betadine 10% 10 ml and glucose 40% 40 ml suppressed exudation in 92.6% of cases. Pleurodesis with a mixture of Iodopyron and glucose solution in the same quantities was effective in 93.4% of cases. If exudation continued, pleurodesis was repeated after 3 days. VAS score of pain syndrome following Iodopyrone injection was 3.0±1.8, in case of Betadine - 3.4±0.3. No significant hemodynamic changes were noted. In case of malignant pleural effusions and low functional parameters after fluid evacuation, favorable effect was obtained after pleurodesis with a mixture of povidone-iodine with glucose through the same catheter and subsequent removal of drainage tube.

Resistant pleural effusions with daily exudation over 300 ml for more than 6 days are characterized by advanced risk of infectious and inflammatory complications due to air leakage and duration of drainage. Pleurodesis with mixtures of Betadine or iodopyrone and 40% glucose solution is effective for resistant pleural effusions.
Resistant pleural effusions with daily exudation over 300 ml for more than 6 days are characterized by advanced risk of infectious and inflammatory complications due to air leakage and duration of drainage. Pleurodesis with mixtures of Betadine or iodopyrone and 40% glucose solution is effective for resistant pleural effusions.
To reduce the incidence of postoperative complications via reinforcement of colorectal anastomosis.

A randomized prospective study included 115 patients. In the main group (
=60), anterior resections were followed by reinforcement of colorectal anastomosis via suturing the muscular and serous layers at 2, 4, 6, 8, 10, 12 o'clock. In case of low anterior resection, all layers of intestinal wall were transanally sutured at the above-mentioned points. Reinforcement was not performed in the control group (
=55).

In the main group, overall incidence of anastomotic leakage was 8.3% (5/60), in the control group - 25.5% (14/55) (
=0.01). We also analyzed the subgroups of anastomoses with high and low risk of leakage. In case of transabdominal reinforcement, incidence of anastomotic leakage was 11% (2/18) in the main group and 0% (0/14) in the control group (
=0.6). Transanal reinforcement was followed by anastomotic leakage in 7% (3/42) of patients in the main group and 34% (14/41) of patients in the control group (
=0.
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