Aim. To present the experience in performing posterior separation plasty according to Yu. Novitskiy, to evaluate the efficacy and safety of the technique. Methods. The results of treatment of 22 patients with giant middle postoperative ventral hernias, treated in the surgical department №1 of Kazan City clinical hospital №7 in 2013-2016, were analyzed. 9 patients had open posterior separation plasty of the abdominal wall in Yu. Novitskiy’s modification performed (study group). Comparison group included 13 patients who had standard tension-free inlay-plasty. Results. The average duration of surgery in the study group was 143.9±10.7 min, in comparison group - 136.6±12.1 min. In the study group there were no serious complications in the immediate postoperative period. In 3 cases at control ultrasound examination clinically insignificant seromas were found which did not require additional treatment and self-resolved within the period of 3 weeks. In one case there was lymphorrhea from the wound for 9 days. Healing of a surgical wound in all cases was by primary intention. Average hospital stay was 10.2±0.6 days. There were no lethal outcomes. Recurrence of the disease in the observed period was not registered. Conclusion. Posterior separation plasty of the abdominal wall in Yu. Novitskiy’s modification is a safe and effective technique that allows recommending this surgery to the surgeons operating patients with giant postoperative ventral hernias.

Aim. To study diagnostic value of various diagnostic methods for patients with closed abdominal injury, to develop a diagnostic algorithm to make a reasonable conclusion about the amount and severity of injuries of the abdomen.Methods. Various diagnostic methods used in closed abdominal injuries from 120 patients admitted to Surgical Department №2 of Kazan city clinical hospital №7 from 2007 to 2015 were analyzed. Majority of victims (65%) with closed abdominal trauma were males aged 20 to 50 years.Results. Efficiency of diagnostic program for patients with closed abdominal injury used in clinical practice was studied. In a closed abdominal trauma, injury of abdominal organs was detected in 52.5% of patients. 71.4% of those injuries were isolated and 28.6% were concomitant. According to frequency of injuries liver took the first place 15 (23.8%), followed by spleen on the second place (14; 22.2%) and kidneys (12; 19.1%) and intestine (12; 19.1%) on the third, bladder on the fourth (7; 11.1%), and pancreas on the fifth place (3; 4.8%). Importance of radiological methods and laparoscopy was demonstrated. Clinical examination and laboratory diagnostic techniques allow making a timely diagnosis in only 40% of victims. Informativity of radiologic study was 64%. The accuracy of ultrasound in damaged kidneys was 100%, that in rupture of liver was 72%, of spleen, 69%, and of the intestine (0%). Diagnostic accuracy of laparoscopy was 98.9%.Conclusion. Experience and extensive acquaintance with modern literature allowed the authors to present the algorithm of examination of patients with suspected closed abdominal trauma.

Introduction. Diagnosis of Mortoan neuroma in some cases does not cause much difficulty and is based on typical signs, but in some cases it presents certain difficulties. Therapeutic tactics for this disease involves the use of conservative or surgical treatment.Aim. Study of the results of differential diagnosis of Morton’s neuroma in the practice of an outpatient surgeon.Material and methods. A study of the results of diagnostics and differential diagnostics in 15 patients with chronic foot pain at the age of 28 to 46 years was conducted. Among them, there were 14 women and 1 man. Differential diagnostics for foot pain syndromes allowed us to distinguish three groups of patients. The first group included 7 patients with Morton’s neuroma. The second group included 4 patients with plantar fasciitis and the third group-4 patients with arthritis, synoviitis of the metatarsophalangeal joints. To conduct differential diagnostics, we used anamnesis, physical examination, and data from instrumental diagnostic methods.Results. Diagnosis of Morton’s neuroma was based on the use of standard research methods (anamnesis, data from a physical instrumental examination of the foot). It should be noted the importance of ultrasound examination of the soft tissues of the foot on the plantar surface for the diagnosis of Morton’s neuroma. This allows for differential diagnosis with foot diseases such as plantar fasciitis and metatarsophalangeal joint synovitis, which may show similar symptoms.Conclusion. Morton’s neuroma is not a rare disease of the foot, which in the initial stages of the disease has a blurred clinical picture, similar to other diseases of the foot. This can lead to diagnostic errors, but the use of modern diagnostic methods, including sonographic methods, allows in most cases to establish an accurate diagnosis and choose an appropriate treatment strategy.

Aim. To evaluate the results of treatment of patients with varicose disease of the lower extremities using endovenous laser obliteration. Methods. Endovenous laser obliteration of the saphenous and perforating veins was used in the treatment of 72 patients with varicose disease of the lower extremities by applying a laser with a wavelength of 1.56 µm. The intervention technique included puncturing and catheterizing of the great saphenous vein or small saphenous vein under ultrasound angioscanning control followed by an introduction of the laser fiber-optic light guide and advancing it to the level of the saphenofemoral or saphenopopliteal junction. After paravasal introduction of the anesthetic solution the laser obliteration was performed under ultrasound control. Results. Postoperatively noted was the low intensity of pain, low severity of ecchymosis and no tenderness along the obliterated veins. No complications were recorded. 40 patients were examined in follow-up during the period from 2 to 4 months after the endovenous laser obliteration. The degree of obliteration of 39 great saphenous veins, 2 small saphenous veins and 8 perforating veins was evaluated. In all cases complete obliteration of veins subjected to laser exposure was noted, no abnormal refluxes or areas of preserved blood flow were revealed. Conclusion. The endovenous laser obliteration is a mini-invasive effective method of providing a complete occlusion of the blood vessel, which eliminates the vertical and horizontal pathological reflux in varicose disease of the lower extremities; this technique can be used in an outpatient setting.

No abstract