Introduction. There is a perception that the use of a mesh for surgical treatment of paraesophageal hernias significantly reduces the number of recurrences. But considering the numerous complications associated with mesh reinforcement, there is a need of strong indication for it. It is not still clear what is the best shape of a mesh, the best material and the appropriate way of fixation. Thus, in last years with the accumulation of surgical experience there are a growing number of patients which are not satisfied with the results of operative approach. In this regard, it is important to study the long-term results of treatment and determine causes of failures.

Materials and methods. In the clinic of faculty surgery department based in Hospital № 21, Ufa, 22 laparoscopic operations for patients with parasophageal hernia were performed in 2012-2017 (main group). The comparison group consisted of 87 patients operated for sliding hiatal hernia without using a mesh. Long-term results were studied in terms of 6 to 60 months after the operation. 

Results. 9 (53%) of the patients in the main group and 54 (62%) of the control group had problems with swallowing in the early postoperative period. There was no difference in the incidence of early postoperative dysphagia between the groups (p = 0.1345). In the period from 6 months to 5 years after the operation, 13 (12%) patients complained of dysphagia of varying severity. Comparing the incidence of dysphagia in the main and control groups, a statistically significant difference was found in favor of the control group: 6 patients (27%) versus 6 patients (7%), p = 0.027. Comparing radiological recurrences of the hiatal hernia revealed a significant advantage in favor of the main group: no radiologic relapse versus 5 (6%) in the control group.

Conclusion. Laparoscopic surgical treatment of paraesophageal hernias types III and IV with the use of a mesh is an effective and safe method for up to 5 years after surgery, but the technical details of the operation still remain the subject of discussion. 

Introduction. Study of different treatments effectiveness of these injuries allows to distinguish the rational side of medical factors, which directly reflect the key pathogenetic mechanisms. A substantial portion of the currently used methods of clavicle fractures surgical treatment allow one to achieve rapid recovery of structural and functional patterns of the patient in most cases.The purpose of the study is to improve the results of surgical treatment of patients with fractures of the clavicle in the middle third.

Material and methods. The study included 104 patients with fractures of the clavicle in the middle third.In the main group (48 patients) the clavicle lockable rod of the original design was used for osteosynthesis, in the comparison group (56 patients) plate osteosynthesis was performed.

Results and discussion. The proposed technology of operative treatment of clavicle fractures in the middle third using the original hip compression-locking rod must improve the results of treatment in this group of patients. The developed algorithm of diagnostics, treatment and rehabilitation of patients with clavicle fractures allows to improve the results of treatment, provides domestic and social reintegratie patients.

Conclusion. Analysis of the clinical studies results have revealed a reliable advantage of the results on a scale DASH and a lower frequency of complications in the main group (p<0.05).

Introduction. Cancer metastasis consists of several steps including detachment from the primary tumor, migration, invasion, transport in the blood or lymphatic vessels, attachment at the secondary site, and growth of secondary tumor. Migration and invasion areinvolved in the mechanism of all types of cancer metastasis. We previously isolated novel cellular migration inhibitor migracin A and B from a culture filtrate of Streptomyces sp. Migracin A was shown to inhibit IGF-1-mediated cellular migration and invasion in ovarian carcinoma cells. However, it is difficult to prepare large amount of migracin A. Migracin A consists of substituted benzene and an alkylated sugar moiety. In the present research, we have designed and synthesized a simplified dialdehydederivative of migracin called migracinal having no sugar moiety.

Material and methods. Migracinal was purchased from Techno Chem Co., Ltd., Tokyo, Japan. Migracinal was prepared from 2,4-dihydroxybenzaldehyde (2,4-DHBA). The structure was confirmed by proton and carbon NMR spectra and ESI mass spectroscopy. The antitumor activity of the new derivative was studied by standard tests under conditions in vitro.

Results. Migracinal inhibited cellular migration and invasion in ovarian clear cell carcinoma ES-2 cells. It also inhibited IGF-1 expression as migracin A. Moreover, it induced anoikis rather than apoptosis in ES-2 cells.

Conclusions. Migracinal is easier to prepare than migracins, and it may be useful for the mechanistic study and suppression of metastasis. 

Introduction. Despite the fact that the existence of varicocele in puberty men, may be one of the risk factors of male infertility the mechanism of spermatogenesis breach remains unclear and should be proved further.

Materials and methods. This study conducted a systematic review of randomized researches that are available on PubMed, with the purpose to analyze the optimum choice of surgical techniques to perform varicocelectomy on the basis of the presented results in men suffering from infertility.

Results and discussion. According to the literature data the surgical treatment of varicocele in the presence of clinically significant forms leads to a significant improvement of spermatogenesis after 3-6 months surgical treatment. It is worth noting that the effectiveness of varicocelectomy significantly surpasses the results of drug stimulation of spermatogenesis and dynamic monitoring. At present, therefore it is significant to evaluate efficiency and the choice of the optimal method to surgically treat varicocele. According to the results of meta-analysis, it was concluded that the implementation of microsurgical subinguinal varicocelectomy has a number of advantages compared with such methods as Palomo surgery, laparoscopic varicocelectomy, Ivanissevich surgery and selective embolization of sperm veins.

Conclusion. Application of microsurgical subinguinal varicocelectomy significantly improves quality and quantity parameters of sperm analysis and, consequently, increases probability of spontaneous pregnancy in partners with minimum percentage of complications, as well as of occurrence of relapse in postoperative period. 

Introduction. Intestinal fistulas to date remain one of the unresolved surgical problems. If patients with low intestinal fistulas are treated roughly the same way by the majority of authors, then the most effective treatment of intestinal fistula of high localization remains controversial. In this context, the objective of the work was to improve the treatment of patients with unformed duodenal and high enteric fistulas by local administration of collagen coating with selective angiotropic effect.

Materials and methods. The work involved open prospective randomized study including 109 patients admitted in purulent surgery Department of the Republican State Clinical Hospital named after G.G. Kuvatov (city of Ufa) for surgical treatment in the period 2000-2016. The main criterion to include patients in the study was the presence of duodenal and/or other enteric fistulas. All patients were randomly divided into two main groups: group of traditional therapy (68 patients), where, sealing of intestinal fistula was followed by standard pharmacological therapy; the study group (41 patients), where the sutures on intestine were strengthened with collagen with subsequent selective administration of angioprotectors and laser antibiotic therapy.

Results. The findings show that the use of originally developed regimen leads to decreased suture failure from 39.5 to 17.0% and lethality from 37.5 to 19.5%.

Conclusion. Local application of collagen in combination with selective lengthy administration of angioprotectors allows reducing the frequency of early postoperative complications and thereby improve patients’ health outcomes with unformed duodenal and high enteric fistulas. 

Introduction. Several studies showed a correlation between blood groups and cancer of the stomach and the pancreas. However, the obvious links between colorectal cancer and blood groups have been found. In this context, the main objective of this work is to analyze the association between colorectal cancer and blood groups among the population of Southern Kazakhstan.

Materials and methods. The study was conducted in two phases. The first phase calculated the share of each blood group (according to ABO and Rh systems) among 87329 donors of Blood Transfusion Centre (city of Shymkent). The second phase of the retrospective analysis of disease history in patients with colorectal cancer, according to the Regional Oncology Center (city of Shymkent). Each story is reviewed, based on such factors as patient’s age, gender, blood group (according to ABO and Rh systems), localization of colorectal cancer, stage of the disease.

Results. The research defined the following distribution of blood groups for the population of South-Kazakhstan region:  0 - 31.76%, A - 31.3%, B - 27.18%, AB - 9.76%, Rh (+/-)-95.09%, Rh (-)-4.91%. The level of interconnection between blood groups and disease was assessed as insignificant (V = 0.081 and V = 0.073 for ABO and Rh, respectively). Analysis of the relation of blood group and the left colon cancer demonstrates week correlation (χ2 (3) = 8.233, p = 0.041). The strength of the relation between ABO blood group and the tumor of this localization was assessed as average (V = 0.265).

Conclusion. The received results do not imply a correlation between blood groups and colorectal cancer. However, there is weak correlation regarding the intercorrelation of cancer lesions of the left colon and I(0) blood group in the study population. 

Introduction. According to WHO up to 50-60% of women in postmenopause suffer from prolapse of genitalia. Wherein as a rule this state is accompanied with a number of anatomic and functional disorders: primarily obstructive uresis or enuresis, overactive bladder, defecatory disorder, gamic disorder, and also permanent sense of discomfort and heaviness in perineal region. In connection therewith, the main objective of the research was to evaluate the results of surgical correction of genital prolapse using differentiated approaches to the management through up-to-date methods to morphologically assess the device that immobilize the uterus.

Materials and methods. The article presents the results of a study of 203 patients with genital prolapse II-IY stages, which were divided into 2 groups: the first group included 45 patients of reproductive age from 35 to 45 years, and the second group consisted of 158 patients, aged 45 to 60 years, who underwent pelvic floor reconstruction, vaginal hysterectomy with the use of endoscopic techniques in combination with urethropexies mesh material, salvageable, including using titanium metallicity. As to justify surgical correction, patients in the second group were conducted histological analysis of the round uterine ligaments, the cardinal ligaments of the uterus and the Sacro-uterine ligaments. Patients were examined after 6, 12, 24, 36 months after the complex treatment.

Results. It was found that in patients of reproductive age with unfulfilled reproductive function of type of surgical treatment is considered only in combination with urethropexies mesh or collagen material.

Conclusion. To reduce the risk posthysterectomy prolapse requires a comprehensive diagnostic anatomical and functional disorders of pelvic organs and pelvic diaphragm in the preoperative period, which determines the access, the scope of surgical intervention and allows to minimize both operational and postoperative complications. 

Introduction. Laboratory indicators of endotoxinemia in conjunction with the clinical picture have been used as the criteria to diagnosticate sepsis for quite a long time. The objective of the study is to analyze the prognostic significance of endotoxin activity indicator in patients with sepsis that undergo treatment in conditions of surgical resuscitation and intensive care at multidisciplinary hospital.

Materials and methods. One-center prospective study on the basis of ICU department of the Republic Clinical Hospital (Ufa, Russia) during the period of 2015- 2016. We have performed screening of 60 patients with sepsis and 15 healthy volunteers.

Results. The median of the value of endotoxin activity in group of patients with sepsis amounted to 0.42 vs. 0.1 of group of healthy volunteers. It was found that the level of endotoxin activity correlates with the severity of the disease: low scores on the scale of the APACHE II severity are consistent with low endotoxin activity (r=0.985, r2=0.971, p=0.0001). Findings show that the median of sensitivity of the medical test corresponds to 87.5% and that of specificity - to 32.6%. The prognostic value of a positive result amounted to 27.5%, and the prognostic value of a negative result - 97.8%. The area under the ROC-curve for the level of endotoxin activity is equal to 0.749±0.084, 95% confidence interval (CI) 0.620-0.852. Sensitivity-61.5% (54.8-86.0), specificity is 93.6% (82.4-98.6). The optimum point of separation was 0.88. Positive predictive level amounted to 72.7%, negative one - 89.8%.

Conclusions. The test to determine the level of endotoxin activity of blood has high sensitivity and negative prognostic value, allowing you to use it as an effective screening method to assess the probable invasion of gram-negative flora, days before the results of bacteriological research are available. 

Purpose of the study. Study of the nearest results of laparoscopic operations in patients with localized renal cell carcinoma.

Materials and methods. The results of treatment of 92 patients who underwent operative treatment in the period from 2015 to 2017 with the help of laparoscopic technique for kidney carcinoma were analyzed and evaluated. Of these, 57 men (62%) and 35 women (38%), the average age is 50.5 ± 2.25 years (min. 26 and not more than 75 years).

Results. The duration of the operation was influenced by various factors, such as the features of the vascular anatomy of the kidneys, the presence of the adhesive process of the abdominal cavity, the state of paranephalic fat. When improving the technique of performing laparoscopic interventions, the operation time was reduced. In the period of mastering the technique of laparoscopic interventions on the kidney, the operation time averaged 210.0 ± 20.2 min (min 120 and max 300 min); subsequently it decreased on average to 130.00 ± 10.5 min (min 70 and max 190 min). After accumulation of experience, the technique of laparoscopic resection of the kidney without total ischemia with selective clamping of segmental arteries, or without compression of the renal artery was mastered.

The conclusion. An analysis of the immediate results of laparoscopic interventions in patients with renal cell carcinoma showed their high efficacy and safety. The results of laparoscopic nephrectomies and kidney resections significantly improve with the improvement of technology and the accumulation of surgical experience. 

Introduction: Modern interventional surgery is one of the most dynamically developing areas of modern medicine. Evidence of this is the bioresorbable stent appearance in its stockpile – intravascular frames, which provide temporary mechanical support and the delivery of cytotoxic substances in the vascular wall during its regeneration. The emergence of this technology in English literature is often called the fourth revolution in x-ray surgery. In this literature review, the authors tried to reflect modern ideas about safety, indications and disadvantages of bioresorbable scaffolds.

Methods: This review presents data of 65 articles on bioresorbable intravascular frames in pubmed. The preference was given to the data of multicenter studies and international registries and records of clinical cases of complications associated with implantation of bioresorbable intravascular scaffolds.

Results: This literature review presents the latest English-language publications on the use of bioresorbable intravascular scaffolds in the treatment of ischemic heart disease, and it lists the main stages of their development too. 

Introduction. Aneurysm of renal artery is a rare and complex pathology of renal bloodstream. Large percentage of observations show that renal artery aneurysms are iatrogenic and happen due to urological interventions. Traumatic aneurysms are much less frequent. By the nature of the blood supply arterial aneurysms are subdiveded into those, which occur when the injured organ is only artery and arteriovenous aneurysms that occur while an artery is damaged along with the accompanying veins. Aneurysms may be treated only surgically, and the only exception is pregnancy. It is possible to use the open treatment option such as aneurysm resection with prosthetics, reanastomosing or its collateral plastics of the renal artery; exclusion of aneurysm with shunting of renal artery or its branches; resection of aneurysm with anastomosing of artery with azygos splanchnic arteries; complex reconstruction using autovein or internal iliac artery segment; including kidney resection at local infarction or nephrectomy in the case of evident nephrosclerosis.

Materials and methods. This paper presents a clinical case of successful minimally invasive surgical treatment of traumatic aneurysm of renal artery. It was carried out through stenting of the right lowpolar renal artery: a coronary sheath was used to transfuse and implant the Explorer-Itgimedical Aneugraft 3.0 * 18.0 mm graft-system; the stent-graft was implanted into the right lowpolar renal artery so that it covers the aneurysm ostium.

Results. The above case shows the possibility to successfully apply the endovascular method to treat posttraumatic aneurysms of renal arteries with derivative circulation.

Conclusion. This technique can be safely and successfully used as an alternative to the traditional «open» surgery, as it is minimally invasive, and allows performing a complete blockade of the pathological blood flow and to avoid an additional operating trauma and compromenation of distal branches. 

Introduction. Deep wound surgical infection that occurs after installing mesh implants, with ventral hernia, is a serious problem that does not have a definite approach to its solution.

Materials and methods. The work clinically demonstrated effectiveness of originally developed method to surgically remove the infected mesh implants after hernioplasty. The developed method of surgical intervention when deleting infected mesh implants is to excise the post operational scar together with adipose tissue within healthy tissues, to detach and  subsequently separate the previously installed implant from the abdominal wall by the destruction of connective-tissue adhesions using ultrasound. The surgery technique provides for the devastating effect of ultrasonic waves on the connective tissue through a liquid antiseptic - 0.2% solution of water chlorhexidine of bi-gluconate.

Results. The findings show that the use of a new original method facilitates the effective removal of the mesh implant using ultrasonic cavitation from adhesions with tissues of the organism in the field of surgery without excision, traumatizing and bleeding, and also promotes wound sterilization.

Conclusion. Thus, the developed method allows eliminating infected implants using ultrasound, minimizing trauma of the underlying soft tissues, which means that it preserves the possibility to keep hernial defect sutured with first row of sutures, which helps to prevent relapse of herniation.