The aim. To evaluate the effectiveness of the diagnosis of senile asthenia using the Edmonton Frail scale in emergency abdominal surgery and to determine its impact on the severity of the perioperative period. Materials and methods. The study included 81 patients with acute cholecystitis on the background of gallstone disease, who were assessed for senile asthenia using the Edmonton Frail scale. For the reliability of the obtained results, only patients who were urgently hospitalized to the surgical department with gynecology beds of the emergency hospital with clinical symptoms of acute cholecystitis were included. All patients received treatment in only one department and according to the standards and clinical protocols of this clinic. Based on the Edmonton Frail score, all patients were divided into two groups. The comparison group included 50 (61.7 %) patients who did not have senile asthenia. The main group included 31 (38.3 %) patients diagnosed with senile asthenia. Results. Surgical treatment in both groups was carried out on an urgent basis using total intravenous anesthesia with artificial lung ventilation. According to the type of surgical intervention in both groups, preference was given to minimally invasive methods. Laparoscopic cholecystectomy in the comparison group was performed in 49 (98.0 %) patients, and only one patient (2.0 %) was converted and operation continued from the mini-access. In the main group, all surgical interventions were performed by the laparoscopic method, U = 759.50, P = 0.8841. Analyzing the results of the duration parameters and the need for prolonged mechanical ventilation, it can be seen that it progressively increases in patients with asthenia: in the comparison group 61.50 (48.00; 75.00) minutes, and in the main 93.84 (60.00; 80.00), U = 513.50, P = 0.0112. Also, we noted that in patients with senile asthenia, the number of postoperative complications increases: in the comparison group, there were only 2 (4.0 %) postoperative complications, while in the main group – 7 (22.6 %), U = 556.00, Р = 0.0337. Summarizing the results, it can be seen that due to increase of the frequency of postoperative complications and increase of the need for prolonged artificial ventilation of the lungs, the length of hospital stay of patients with senile asthenia increased: in the comparison group it was 7.9 ± 2.2 days, and in the main group 9.7 ± 3.2 days, U = 530.50, P = 0.0177. Conclusions. In our opinion, the Edmonton Frail scale is effective in diagnosing the severity of senile asthenia in elderly and senile patients in emergency abdominal surgery due to its simplicity and speed of use. The overall severity of the condition, heart failure in patients with senile asthenia lead to increase in the duration of surgery and the total duration of artificial lung ventilation: in the comparison group 39.52 (30.00; 45.00) minutes, while in the main group 49.19 (35.00; 50.00) minutes, U = 482.50, P = 0.0046. The duration of mechanical ventilation also differed significantly, in the comparison group 61.50 (48.00; 75.00) minutes, and in the main – 93.84 (60.00; 80.00), U = 513.50, P = 0.0112. The severity of senile asthenia negatively affects the course of the perioperative period, the frequency of postoperative complications increases: 2 (4.0 %) patients in the comparison group, while in the main group of 7 (22.6 %) patients, U = 556.00, P = 0.0337 and, as a consequence, the duration of inpatient treatment increases: in the comparison group it was 7.9 ± 2.2 days, in the main – 9.7 ± 3.2, U = 530.50, P = 0.0177. Modification of the approaches to preoperative preparation and postoperative management of elderly and senile patients diagnosed with senile asthenia will reduce the frequency of postoperative complications and reduce the length of hospital stay.

Objective. To estimate the structure of complicated forms of colorectal cancer and surgical tactics of treatment in patients with this pathology in conditions of general surgery stationary. Materials and methods. Into the investigation 71 patients were included, treated for complicated forms of colorectal cancer. Results. Primary radical operative interventions were performed in 48 (67.61%) patients, palliative – 18 (25.35%), and symptomatic – 5 (7.04%). Conclusion. The treatment and diagnosis tactics, formatted in the general surgery stationary conditions,leads to certainly high level of morbidity – 45.07% (the complications have occurred in 32 patients),and lethality – 11.27% (8 patients died).

The question of postoperative management for patients with nodular toxic goiter (NTG) using an infrared-wave laser remains poorly investigated and highly debatable, which creates conditions for further investigation of this issue. Aim. To evaluate the results of infrared-beam laser therapy in patients with NTG in the early and long-term postoperative periods after organ-preserving surgical interventions and thyroidectomies. Materials and methods. The main group of 35 (50.7 %) patients was examined after additional postoperative infrared-beam laser therapy (1–3 courses) while the comparison group of 34 (49.3 %) patients did not receive this treatment. Results. Thyroidectomy prevailed in the structure of surgeries in the main group (20 (57.1 %) cases). Organ-sparing surgeries were performed in 15 (42.9 %) patients. In the comparison group, 18 (52.9 %) thyroidectomies and 16 (47.1 %) thyroid resections were performed. Conclusions. Almost half of NTG cases (14 (41.2 %) in the main group and 15 (42.9 %) in the comparison group were unifocal mono- or lobar nodular affection which provided an opportunity to perform organ-sparing surgeries. No postoperative hypoparathyroidism was observed in the patients who underwent surgical resection. All the cases of this disorder were observed in patients after total thyroidectomy – 7 (35.0 %) in the main group and 8 (44.4 %) in the comparison group, P = 0.2956. The application of infrared-beam therapy to the postoperative area stimulated blood flow in the tissues and led to renewal of the parotid function: the parathormone level in the main group was restored in the average period of 3.5 (1.5; 6.0) months and in the comparison group – in 6.5 (3.5; 9.0) months, P = 0.0412. The postoperative use of infrared-beam laser therapy in patients with organ-sparing surgical interventions allowed reducing the dose of replacement therapy from 25.0 (25.0; 50.0) µg in the comparison group to 12.5 (12.5; 25.0) µg in the main group, P = 0.0341.

The aim of the study: to analyze the results of surgical treatment and pathomorphological examination of preparations of patients who were urgently operated on for complicated forms of colon cancer, and to assess their influence on the correct staging of the tumor process in the postoperative period. Materials and methods. An analysis of data from pathomorphological studies of 71 (100 %) patients who underwent treatment at the surgical department for complicated forms of colon cancer was carried out. Results. Colon adenocarcinoma was detected in all 71 (100 %) patients (mucinous adenocarcinoma in 3 (4.23 %) patients, and the rest 68 (95.77 %) – unspecified adenocarcinoma). 44 (61.97 %) patients were diagnosed with moderately differentiated adenocarcinoma of the colon, 25 (35.21 %) – with poorly differentiated, and 2 (2.82 %) – with highly differentiated tumors. Conclusions. In the case of surgical interventions for complicated forms of colon cancer, lymphatic dissection in the minimum extent (D1) was performed in 54 (76.06 %) patients, and 17 (23.94 %) patients were operated on without removal of lymph nodes. The insufficient level of performing lymphatic dissections in patients with complicated forms of malignant pathology of the large intestine does not make it possible to assess the real picture of metastatic lesions of regional lymph nodes and to assign the correct stage of pN according to TNM 8 (in 17 (23.94 %) patients, no pathomorphological assessment was performed at all, and in 40 (56.34 %) patients, the number of examined lymph nodes were not indicated in the preparation). In the structure of staging of oncopathology, in 12 (16.90 %) patients, the stage of cancer was assign only according to the criterion of the degree of invasion (T) and in 5 (7.04 %) patients – only according to the data of instrumental examination and intraoperative revision (clinically), and was overestimated. Lack of a clear consistent assessment of the macroscopic, microscopic, immunohistochemical and molecular characteristics of the tumor process in 17 (23.94 %) patients leads to inaccuracies in the assessment of the stage of the tumor process, which in turn affects the prognosis for relapse and survival of the patient, and the tactic of postoperative treatment.

Objective. To estimate the results of surgical treatment in the senile and elderly patients for an acute cholecystitis on background of biliary calculous disease in urgent abdominal surgery, depending on term of performance of operative intervention. Materials and methods. In the investigation there were included 89 patients, ageing 60-89 yrs old with diagnosis: an acute cholecystitis on background of biliary calculous disease. Median age of the patients have constituted (69.66 ± 7.30) yrs old. Results. All the patients were operated in urgent order, average duration of preoperative period was 20.00 (7.00; 27.00) h. Laparoscopic cholecystectomy with abdominal drainage was performed in 70 (78.7%) patients; laparotomy, cholecystectomy with abdominal drainage- in 14 (15.7%); laparotomy, cholecystectomy with drainage of common biliary duct - in 5 (5.6%). In 3 (4.3%) patients while performing of laparoscopic cholecystectomy the necessity have emerged for conversion due to hemorrhage from the gallbladder bed. Preoperative preparation in the senile and elderly patients during more than 24 h have led to significant improvement of their general state, comparing with those, who were operated in terms up to 24 h from the moment of admittance to hospital (U-criterion = 749.50; p = 0.0286). As well, in accordance to data, concerning postoperative period analysis, there was noted significant improvement of the patients’ state, preoperative preparation of whom lasted more than 24 h, comparing with the patients, preoperative preparation of whom lasted lesser than 24 h (U-criterion = 491.00; p < 0.0001). Average duration of stationary stay have differed in this two Groups (U-criterion = 919.00; p = 0.3984). Conclusion. The surgery deferred performance for an acute cholecystitis in the senile and elderly patients permits to improve the results of postoperative treatment and to reduce the frequency of postoperative complications significantly.