General Surgery

Staged surgical strategy for the management of combat-related duodenal injuries according to level of care

2026-01-24T12:39:06+02:00

Objective – to assess the impact of an enhanced staged surgical management algorithm, stratified by levels of care, on postoperative complications and mortality in combat-related duodenal injuries.

Materials and methods. This prospective study included 51 military personnel with gunshot-induced duodenal injuries. Patients were assigned to an experimental group (n=28) treated according to a newly developed algorithm and to a control group (n=23) managed with a conventional approach. The groups were comparable with respect to age, injury mechanism, duodenal injury severity, overall injury severity, and peritonitis characteristics. Both parametric and nonparametric methods were used in the statistical analyses.

Results. Isolated duodenal injuries accounted for 13.7% of cases, while multiple injuries were present in 86.3%. In the experimental group, 82.1% of patients received staged care across levels II, III, and IV, with complex reconstructive and combined surgical interventions such as duodenal diverticulization with gastroenteroanastomosis, pancreaticoduodenectomy, and percutaneous transhepatic cholecystostomy (biliary decompression) primarily performed at level IV care following stabilization. In the control group, the staged model was implemented in only 26.1% of cases, while in the remaining cases, the main volume of surgical intervention was performed at level II care. A length of stay of less than 1 day at level II care was observed in 94% of the experimental group, compared with 5% of the control group (p=0.001). The experimental group demonstrated significantly lower rates of duodenal suture failure (7.1% vs. 52.2%, p=0.001), peritonitis (17.9% vs. 47.8%, p=0.022), sepsis (17.9% vs. 60.9%, p=0.002), and relaparotomies for recurrent peritonitis (14.2% vs. 60.9%, p=0.007). Mortality was 13.4% in the experimental group and 39.1% in the control group (p=0.043). The mean hospital stay was significantly shorter in the experimental group (18.2±7.1 days) compared to the control group (29.3±8.1 days; p < 0.001).

Conclusions. The enhanced staged surgical management algorithm for combat-related duodenal injuries significantly decreases the incidence of severe postoperative complications, relaparotomy rates, length of hospital stay, and mortality.

Personalized treatment algorithm for acute anal fissures: comparison with traditional symptomatic therapy

2026-01-08T14:10:39+02:00

Objective – to evaluate the clinical efficacy of a personalized treatment algorithm for acute anal fissures based on a fissure chronicity risk scale compared with standard symptomatic therapy.

Materials and methods. This prospective non-randomized comparative study included 175 patients with acute anal fissure treated at the proctology department of Kyiv City Clinical Hospital № 18 between 2021 and 2024. The mean patient age was 39.29±12.98 years. The study group received individualized treatment based on chronicity risk assessment, while the control group received standard symptomatic treatment. Efficacy was assessed by the rate of complete healing at week 4, pain dynamics on the VAS scale, and the incidence of chronicity.

Results. The personalized treatment protocol resulted in a higher rate of complete healing compared to standard therapy (81.63% versus 41.56%, p < 0.001). The incidence of chronicity of anal fissures was lower in the study group (4.08%) than in the control group (23.38%). Patients in the study group achieved pain reduction of more than 50% faster than those in the control group (6.1±2.3 versus 12.8±3.5 days). Side effects were observed in both groups, including local redness (11% and 14%), temporary incontinence (7% and 0%), and headache (0% and 3%).

Conclusions. The personalized protocol for managing acute anal fissures shows higher efficacy and significantly improved clinical outcomes compared to standard conservative therapy. Implementation of this approach in clinical practice accelerates healing, reduces chronicity rates, and lowers early recurrence. Therefore, adoption of the proposed protocol is recommended.

Short-term hemodynamic effects of splenic blood flow modulation after partial splenic artery embolization for secondary prevention of esophageal variceal bleeding

2026-01-24T13:42:47+02:00

Partial splenic artery embolization (PSE) is used in the management of portal hypertension to reduce splenic inflow. However, its hemodynamic impact in the secondary prophylaxis of esophageal variceal bleeding requires additional investigation.

Objective – to assess changes in splenic hemodynamics after PSE for secondary prevention of variceal bleeding.

Materials and methods. The study included 90 patients (mean age 49.5 years) with a history of variceal bleeding and splenomegaly (mean volume 781.6 cm³). Splenic hemodynamics were evaluated using Doppler ultrasound at baseline and 1 month after PSE. Splenic volume and complications were monitored for up to 12 months.

Results. One month after PSE, splenic artery diameter decreased from 5.77±1.20 to 4.72±1.14 mm (p<0.001). Peak systolic velocity declined (152.92±50.35 to 89.77±34.28 cm/s, p<0.001), and end-diastolic velocity decreased (56.76±21.93 to 38.18±15.59 cm/s, p<0.001). Both resistance (0.63±0.08 to 0.58±0.13, p<0.05) and pulsatility indices (1.07±0.24 to 0.95±0.27, p<0.01) reduced significantly. Splenic volume initially increased to 831.7 cm³ due to edema but significantly decreased to 504.2±209.8 cm³ by month 6 (p<0.001), with this reduction sustained through month 12. Post-embolization syndrome was managed conservatively in 99% of cases; one instance of splenic abscess occurred. Conversely, the sclerotherapy comparison group showed increased splenic volume.

Conclusions. PSE induces significant short-term attenuation of splenic arterial inflow and venous outflow, followed by a substantial reduction in splenic volume. It is an effective adjunct for secondary prophylaxis with a predictable safety profile. Future comparative studies using unified hemodynamic protocols are required.

Comparative analysis of sleeve gastrectomy with transit bipartition versus single anastomosis sleeve ileal bypass in morbidly obese patients with type 2 diabetes: a retrospective cohort study

2026-01-11T21:52:40+02:00

Objective – to compare the effectiveness of sleeve gastrectomy (SG) + transit bipartition (TB) and the novel metabolic procedure, sleeve gastrectomy with single anastomosis sleeve ileal bypass (SASI), in the treatment of morbidly obese patients with type 2 diabetes mellitus (T2DM).

Materials and methods. A retrospective cohort study was conducted among morbidly obese patients with T2DM who underwent bariatric surgical procedures, specifically SG+TB and SASI, between September 2013 and December 2024 at the study hospital. Exclusion criteria included a history of previous bariatric surgery, upper laparotomy, severe comorbidities (ASA III – IV), and psychological instability. A total of 33 patients who underwent metabolic surgery for T2DM were divided into two groups: Group I underwent SG+TB, and Group II underwent the SASI operation. The mean age of patients was 42.6 years (range: 26 to 64 years), with a mean preoperative weight of 107.5 kg (range: 92.0 – 189.5 kg), a mean preoperative body mass index of 43.2 kg/m² (range: 36.7 – 65.0 kg/m²), and a mean excess weight of 50.8 kg (range: 28 – 106 kg). The average duration of metabolic disease before surgery was 7.5 years (range: 3 – 21 years). The mean preoperative glycaemia was 11.8 mmol/L (range: 6.5 to 23 mmol/L), and the mean glycated hemoglobin (HbA1c) was 7.6% (range: 6.5 – 13.2%). The primary outcomes were the percentage of excess weight loss (%EWL), resolution of diabetes, and improvement of comorbidities. The secondary outcome was postoperative nutritional status.

Results. A cohort of 33 patients had a follow-up period of 12 to 48 months. After the Santoro operation, excess weight loss (EWL) was 72% at 6 months, 88% at 1 year, 92% at 2 years, and 86% at 4 years. After the SASI operation, EWL was 76% at 6 months, 89% at 1 year, 93% at 2 years, and 82% at 4 years. Complete resolution of diabetes occurred in all patients within the first 6 months postoperatively. Mean postoperative glycemic and HbA1c levels normalized at 1 year postoperatively. Disease control was defined as achieving normal HbA1c levels (< 6%). Among insulin-dependent patients, 76% achieved disease control during the 12- to 48-month follow-up. Patients receiving oral treatment reduced HbA1c to < 6% in 100% of cases at 1 year postoperatively and in 89% of cases over the subsequent 5 years. Two years postoperatively, the mean total protein concentration was 7.7±1.7 g/dL in Group I and 7.2±1.5 g/dL in Group II (p > 0.1). The mean albumin concentration was 4.1±0.6 g/ dL in Group I and 4.0±0.8 g/dL in Group II. The mean daily bowel movement frequency was 1.6±1.8 in both groups.

Conclusions. The novel procedure – single anastomosis sleeve ileal bypass – demonstrates effectiveness as a less invasive surgical treatment for morbid obesity and T2DM. It is expedient to conduct further investigations to evaluate the efficacy of this method and to establish clear indications and contradictions for SASI.

Organization of evacuation of the wounded in wartime: the impact of patient routing on treatment outcomes and infection risks

2025-12-22T15:59:45+02:00

Combat-related limb injuries in modern warfare are characterised by high-energy tissue destruction, extensive soft-tissue defects, and a high risk of infectious complications. Evidence from previous military conflicts in Iraq and Afghanistan, as well as civilian trauma centres, indicates that optimal management of such patients requires not only appropriate surgical tactics but also timely routing to specialised orthoplastic centres. Early radical debridement and definitive wound coverage within the orthoplastic «fix and flap» concept and BOAST standards are associated with reduced infection rates, fewer reoperations, and avoidance of delayed amputations. Despite the central role of evacuation pathways, quantitative data on how different evacuation models influence clinical outcomes in contemporary war conditions remain limited.

Objective – to assess the effectiveness of two medical evacuation models – mass (stepwise) and targeted (selective) – in patients with combat-related injuries based on the length of hospital stay and surgical burden.

Materials and methods. A retrospective cohort study was conducted among patients admitted to a specialised orthoplastic centre. Patients were stratified into two groups: targeted evacuation (direct transport to the reconstructive centre ≤ 72 hours post-injury) and mass evacuation (stepwise transfer through ≥ 2 intermediate hospitals). The primary endpoints included the length of hospital stay and the number of surgical procedures per patient. Time from injury to admission was analysed as a key factor. Statistical methods included descriptive analysis and intergroup comparison using the t-test/Mann-Whitney U test (p < 0.05).

Results. The mean time from injury to hospital admission in the targeted evacuation group was 1.77±0.32 days (range: 0 – 6), compared with 11.84±1.45 days (range: 3 – 53) in the mass evacuation group – a sevenfold increase. Mean length of hospital stay was significantly longer in the mass group: 37.03±3.68 vs. 27.27±2.47 days in the targeted group (p=0.03). The average number of surgical procedures per patient was 2.78±0.33 vs. 2.36±0.38, respectively (p=0.41), excluding prior operations performed before referral. No delayed amputations related to infectious complications or reconstruction failure were observed in either group.

Conclusions. Targeted evacuation enables a significantly shorter time to specialised surgical care, leading to reduced hospital stay and a more predictable clinical course. Although differences in surgical burden were not statistically significant, a consistent trend toward fewer interventions was observed with targeted routing. Optimising medical evacuation systems is a critical determinant in the management of limb combat injuries and may be scaled to healthcare systems operating in wartime or resource-limited environments.

First clinical application of Permacol biological mesh in Ukraine. Case report

2026-01-08T18:18:06+02:00

The article presents the first clinical experience in Ukraine of using the Permacol biological implant in the surgical treatment of a giant postoperative ventral hernia in a patient with morbid obesity and an external fistula of the anterior abdominal wall. The study is relevant due to the high incidence of postoperative ventral hernias, particularly after open surgical interventions, and the considerable risk of infectious complications in contaminated surgical fields. Additionally, the absence of standardized guidelines for the combined approach to hernioplasty and bariatric surgery in obese patients remains a significant clinical challenge. A detailed clinical case is presented involving a 63-year-old patient with сlass III obesity, a giant defect of the anterior abdominal wall aponeurosis, and a chronic external fistula, along with a complicated surgical history that included peritonitis and postoperative wound suppuration. Preoperative management involved intramuscular administration of botulinum toxin type A to relax the anterior abdominal wall muscles, reduce the risk of tissue tension, and prevent abdominal compartment syndrome. The patient underwent herniolaparotomy, viscerolysis, hernioplasty with intra-abdominal placement of the Permacol biological implant using the open intraperitoneal onlay mesh (IPOM) technique, mini-gastric bypass, excision of the anterior abdominal wall fistula, and drainage of both the abdominal cavity and postoperative wound according to Redon. The postoperative period was uneventful, with no evidence of intra-abdominal hypertension or infection. These findings support the feasibility and safety of the Permacol biological implant in patients with complex anterior abdominal wall defects and a high risk of infectious complications.

Mykola Amosov: engineer, surgeon, and world-class thinker

2026-01-08T14:01:54+02:00

Mykola Mykhailovych Amosov (1913–2002) was an outstanding Ukrainian surgeon, cardiac surgeon, world-class scientist and innovator. Born into a poor peasant family, he developed an early interest in both technology and medicine, ultimately obtaining degrees in engineering and medicine. During World War II, Amosov served as a leading surgeon in a front-line hospital, where he improved methods for treating gunshot wounds and established the basis for his PhD research. After the war, he worked in Bryansk and Kyiv, quickly becoming a leading specialist in thoracic surgery. Amosov founded the first department of thoracic surgery in Ukraine, introduced an artificial blood circulation device, performed pioneering heart operations, and developed innovative valve prostheses. As director of the Institute of Cardiovascular Surgery, he elevated the institution to a leading position in Europe. Concurrently, he headed the department of biocybernetics, contributed to the modeling of physiological and mental processes, and developed the first autonomous robots. Mykola Amosov died in 2002, leaving a substantial scientific and humanistic legacy.

Clinical characteristics of stem cell application in the surgical management of post-traumatic and trophic skin defects. Literature review

2026-01-08T19:12:11+02:00

Chronic post-traumatic and trophic skin defects present a significant clinical challenge, particularly in the context of ischemia, infection, diabetic angiopathy and neuropathy, or severe traumatic injuries. Conventional treatments such as debridement, skin grafts, and local or free flaps often fail to achieve durable healing, thereby increasing interest in regenerative technologies. Mesenchymal stem cells (MSCs), particularly those derived from bone marrow and adipose tissue (ADSCs), exert significant paracrine, angiogenic, and immunomodulatory effects. These properties enhance the wound microenvironment and augment the efficacy of standard surgical interventions. Clinical studies and meta-analyses indicate that autologous MSC therapy accelerates healing of diabetic, venous, arterial, and mixed ulcers, decreases the risk of amputation, and improves tissue perfusion. In reconstructive surgery for post-traumatic defects, ADSC/SVF-assisted lipofilling and nanofat technologies are widely utilized. These approaches promote scar tissue remodeling, improve tissue elasticity, reduce contractures, and optimize conditions for subsequent flap reconstruction. Furthermore, cellular or cell-matrix constructs (MSCs combined with scaffolds) have the potential to manage complex soft-tissue defects with bone exposure, thereby reducing the need for extensive reconstructive procedures. Despite these promising outcomes, current evidence is limited by small sample sizes, methodological heterogeneity, the absence of standardized dosing protocols, and a lack of large multicenter randomized controlled trials. Furthermore, although no significant risks have been reported in existing studies, the issue of long-term oncological safety warrants continued monitoring. Emerging strategies include cell-free approaches such as exosomes and MSC secretions. Additionally, the integration of cellular technologies with 3D-printed and bioengineered matrices, as well as the development of standardized surgical algorithms that leverage MSCs to enhance the efficacy of conventional reconstructive techniques, are being explored.

Minimally invasive percutaneous interventions in the final stage of treatment of infected necrotizing pancreatitis. Review of recent studies

2026-01-15T18:00:35+02:00

Infected necrotizing pancreatitis represents one of the most challenging conditions in abdominal surgery and requires multi-stage minimally invasive interventions as part of the widely accepted step-up approach. This strategy involves collaboration between interventional radiologists and interventional gastroenterologists. Navigation-assisted minimally invasive interventions are crucial during the initial 3 – 4 weeks of the disease, serving as the primary method for managing infected necrotic collections in the retroperitoneal tissue.

Objective – to analyze studies published between 2020 and 2025 and evaluate the effectiveness of percutaneous interventions as the definitive treatment for acute infected pancreatitis.

The analysis indicates that navigation-assisted minimally invasive interventions are effective in 35 – 55% of cases involving infected pancreatic necrosis. The increasing effectiveness of these interventions facilitates rapid reduction of systemic intoxication and stabilization of the patient’s condition. Effectiveness is evaluated by clinical and laboratory parameters, including reductions in body temperature, leukocytosis, and C-reactive protein or procalcitonin levels within 48 – 72 hours, as well as radiological assessment of the necrotic collection volume in retroperitoneal tissue. A reduction in the size of the necrotic focus by approximately 70 – 75% within 10 – 14 days reliably predicts successful isolated drainage without the need for necrosectomy (M. Wroński et al., 2014). Clinical success rates were 67.6% in the early drainage group (up to 2 weeks) and 77.0% in the late drainage group (fourth week from disease onset). These findings support the integration of percutaneous and endoscopic methods as complementary components within a step-up strategy and underscore the necessity for further development of navigation-assisted minimally invasive percutaneous techniques for the treatment of complex infected retroperitoneal masses.

Prevention and treatment of acute secondary sarcopenia in patients with infected necrotizing pancreatitis. Literature review

2026-01-24T15:25:44+02:00

This review of the current scientific literature focuses on the etiological factors, pathophysiological mechanisms, diagnostic approaches, and methods of prevention and treatment of acute secondary sarcopenia in patients with acute necrotizing pancreatitis. Acute secondary sarcopenia represents a severe complication of acute pancreatitis, resulting from a combination of systemic inflammation, physical inactivity, and nutritional deficiency. Scientific evidence indicates that sarcopenia and sarcopenic obesity are associated with higher mortality, an increased incidence of complications in acute pancreatitis, and longer hospital stays. According to the literature, the prevalence of secondary sarcopenia among patients with acute pancreatitis ranges from 18% to 70 – 80%, with variability in these indicators attributed to differences in diagnostic approaches, assessment criteria, and clinical characteristics of the patient cohorts studied. Contemporary studies have explored various approaches to diagnosing this condition, emphasizing the importance of early detection of secondary sarcopenia through functional tests, imaging, and instrumental diagnostic methods. It has been demonstrated that the prevention and treatment model for secondary sarcopenia requires a multidisciplinary team approach and includes effective anti-inflammatory therapy, optimization of nutritional support (early enteral nutrition with adequate protein and energy provision and correction of micronutrient deficiencies), the use of nutrients with anti-catabolic and anti-inflammatory properties (omega-3 polyunsaturated fatty acids, β-hydroxy-β-methylbutyrate, creatine), as well as early mobilization according to an individualized physiotherapy program. Clinical observations have confirmed that such interventions are associated with improved preservation and restoration of muscle mass and functional status, which directly influence survival rates, hospital stay duration, risk of complications, and disability. In summary, the review of international publications enabled the synthesis of current evidence on the diagnosis, prevention, and treatment of secondary sarcopenia in patients with acute necrotizing pancreatitis. The limited number of studies addressing this issue in the context of complicated acute pancreatitis underscores the relevance and necessity of further research aimed at refining and identifying optimal preventive and therapeutic strategies in this patient population.